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AN EXPERIENTIAL APPROACH TO PSYCHOPATHOLOGY What is it like to suffer from mental disorders?
... Perhaps one of the most common experiences reported by people with BPD is a sense of emptiness. This emptiness, which has nothing to do with a form of freedom or casualness, is experienced as a weight that pulls the self down [44] and takes on several determinations [45]: the sense of emptiness is lived as a feeling of internal absence [4], an impression of deadness, nothingness, a void feeling swallowed [46], a sense of vagueness [47], an internal hole or vacuum, aloneness [48], an impression of woodenness [49], and numbness and alienation [10]. In the narrative interpretation of TPL, this feeling has been related to the absence of a stable and coherent history of self and thus to a breakdown in what we have termed the selfinstitution. ...
... Sometimes, this identification with others metamorphoses into dilution or diffusion of the self. Then the person adopts the form and characteristics of their casual partner and loses themselves in it [44]. These experiences are accentuated during periods of stress in which individuals with BPD can experience dissociative symptoms, such as losing a sense of themselves (depersonalization) or their environment (derealization). ...
Borderline personality disorder (BPD) is a complex condition marked by heterogeneity. People with BPD have a profusion of symptoms spread across various levels of lived experience, such as identity, affectivity, and interpersonal relationships. Researchers and clinicians have often resorted to the structuring concept of Self to organize the fragmentation of their experience at the identity level. Notably, using the concept of the narrative self, Fuchs proposed to interpret BPD as a fragmentation of narrative identity. This interpretation of BPD, widely shared, has been challenged by Gold and Kyratsous, who have proposed a complementary understanding of the self through the idea of agency, and to which Schmidt and Fuchs in turn have countered. This article proposes to contribute to this discussion from a phenomenological perspective. First, we will briefly review the discussions around narrative interpretation of BPD. From the problems left unresolved by the discussion, we will then justify the necessity to proceed with a stratification of the self from a phenomenology method. Third, from the thought of the Hungarian phenomenologist László Tengelyi, we will continue with an archaeology of the self, in three layers - self-institution, self-formation, and minimal self - integrating Schmidt and Fuchs' concepts of self, in addition to those of Gold and Kyratsous, but also, to a lesser extent, those of Dan Zahavi. Finally, we will proceed with a phenomenological reconfiguration of the experiences and manifestations associated with the identity axis of BPD.
... However, in this paper, we position the embodiment of cognition that views the brain-mind in our shared cognitive-affective map where the brain-mind is entangled. This entanglement allows the I-experiential to express their experiences with disorders within the accepted cognitive-affective map (Stanghellini & Aragona, 2016). ...
Background: Mental health studies indicate that digital mental health care can alleviate the symptoms of those struggling with mental disorders. We have seen Extended Reality (XR) systems, mental health apps, and other digital tool applications employed in mental healthcare settings to help service users cope with their emotions. Nonetheless, research has questioned the effectiveness of those findings and non-usage by immigrant groups. The calls to tackle this issue, chiefly the effectiveness of digital tools, prompted us to take an interdisciplinary approach. Methods: In this research, we use the theoretical concept of mental disorders beyond classical and critical approaches as a theoretical conduit to demonstrate how this issue of effectiveness is linked with the concept of mental disorders. Also, we process interviews with digital mental healthcare service users in three European countries, namely, the United Kingdom, Spain and Ireland, to gauge the effectiveness of digital tools in mental healthcare to improve the quality of care provided in the sector. Results: Answering this question from the position we put forward leads to an integrative approach where digital mental health care can be applied to reduce the symptoms of mental conditions along with other mental healthcare approaches. Conclusions: Our findings support mental disorders as a multidimensional concept, consistent with non-reductionistic approaches, and provide a foundation for further studies in the emerging field.
... In research toward an integrative and genetic theory of affects, Simondon's (1958Simondon's ( /2020) philosophy of individuation is particularly useful 16 . It provides an (see Bürgy, 2016 for a threefold analysis of obsessive-compulsive disorders). However, the definition of genetic phenomenology I am adopting here, which draws on Husserl's definition, differs from Jasper's. ...
The quality of patient and therapist relationship has been identified as the main
common factor for the success of a therapeutic process. However, the research on
the therapeutic relationship has been overly influenced by cognitivist approaches
in cognitive science and mindreading and simulationist theories of empathy. These
approaches to intersubjectivity, however, do not do justice to the complexity of the
therapist-patient interactions and the transformative potential of therapeutic
encounters. In this regard, two outstanding problems can be identified in
psychology and cognitive sciences: methodological individualism and the mindbody divide. As an alternative, the present thesis proposes an enactive approach to
psychiatry and psychotherapy that goes beyond a purely “mentalistic” conception
of the therapeutic alliance and empathy towards a second-person and embodied
perspective, highlighting the constitutive role of pre-reflective engagements of
therapists and patients in the therapeutic process. It builds on the enactive theory
of intersubjectivity as participatory sense-making, which describes the
coordination of intentional and non-intentional activities as preconditions from
which shared meanings emerge in interpersonal interactions. On this basis, clinical
empathy is defined as a participatory and pre-reflective process of knowing-how
to respond to the solicitations of patients. Along with the relational turn in
psychotherapy, the thesis adopts a second-person perspective by placing
participatory sense-making processes at the center of the investigation.
Accordingly, it presents three pieces of work applying the enactive framework to
research in psychotherapy: (1) a comment on correlational studies on non-verbal
coordination and psychotherapeutic outcome, where new working hypothesis and
interpretation of empirical data are suggested; (2) an interpretativephenomenological-analysis of the pre-reflective intercorporeal mechanisms
involved in the transition from face-to-face to online therapeutic settings, and (3)
a phenomenological-enactive analysis and classification of therapeutic
interventions on the body in dialogic therapies. These works illustrate that the
enactive framework can potentially promote a particular way of doing science in
psychotherapy research. In addition to that, the thesis suggests a theoretical
deepening of the theory of participatory sense-making under the lens of two
related perspectives – phenomenology of atmospheres and Gilbert Simondon’s
philosophy of individuation. This analysis highlights the pathic character of the
lived body and the pre-individual dimension of experience. The discourse on
atmospheres is contrasted with enactive-ecological theories of affordances and a
possible definition of mental disorders as disorders of affectivity is suggested. The
thesis concludes that the theory of participatory sense-making should be
understood in terms of transindividuality, that is, as holding the tension between
the sense of belonging to a “primordial we” and the objectification of the other, a
tension that allows for differential degrees of pre-individual affective participation.
This perspective is particularly relevant to understand the complexity of modes of
participation in the therapist-patient dyad.
... Each patient, urged by the drive for the intelligible unity of her life-construction, with her unique strengths and resources, plays an active role in interacting with these experiences. The product of this yearning for meaning can be establishing a new identity, or producing psychopathological symptoms (Stanghellini & Aragona, 2016). In this way, dialectical psychopathology subsumes the three meanings that "dialectics" has assumed in the Western philosophical tradition, from its inception as etymologically derived from the Ancient Greek verb dialégesthai ("to talk with," "to reason with"): ...
The main aim of our article is to discuss the importance of recognition in the psychotherapeutic process. To achieve recognition, patient and clinician should be able to build a space where the patient can find an “ecological niche” in which he can find an “adaptive equilibrium” between the burdensome demands of his psychopathological condition and the external, imposing demands of society. The clinician’s recognition is to a patient the condition of possibility to survive the “oceanic” social currents without integrating too much into them, and in so doing losing all his “non-adaptive” traits, his “pathological” freedom and unique and valuable way to interpret and henceforth live in the world. A schizophrenic person and his psychiatrist discuss the patient’s condition and his way of dealing with it. A dialogue between a “view-from-within” and a sympathetic “view-from-without” whose purpose is to build a circle of reciprocal recognition that allows the patient to come out of isolation and try to construct a fulfilling, even though schizophrenic, life. The concluding remarks will not be a definitive and “closed” examination of the material brought forth by the dialogue, but the opening of a series of questions for further research on this very important and promising theme in the psychotherapy of schizophrenia.
Deep Brain Stimulation (DBS) represents a key area of neuromodulation that has gained wide adoption for the treatment of neurological and experimental testing for psychiatric disorders. It is associated with specific therapeutic effects based on the precision of an evolving mechanistic neuroscientific understanding. At the same time, there are obstacles to achieving symptom relief because of the incompleteness of such an understanding. These obstacles are at least in part based on the complexity of neuropsychiatric disorders and the incompleteness of DBS devices to represent prosthetics that modulate the breadth of pathological processes implicated in these disorders. Neuroprostheses, such as an implanted DBS system, can have vast effects on subjects in addition to the specific neuropsychiatric changes they are intended to produce. These effects largely represent blind spots in the current debate on neuromodulation. Anthropological accounts can illustrate the broad existential dimensions of patients' illness and responses to neural implants. In combination with current neuroscientific understanding, neuropsychiatric anthropology may illuminate the possibilities and limits of neurodevices as technical "world enablers".
Psychosis is the most ineffable experience of mental disorder. We provide here the first co‐written bottom‐up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically‐informed perspectives. First‐person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud‐based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self‐referentiality and permeated self‐world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re‐establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.
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