The Phenomenology of Mental Disorder

This article attempts to introduce a specialty of the philosophy department in Durham: the phenomenology of mental disorder. Those working within this field seek to use the philosophical movement known as phenomenology to obtain in-depth understandings of specific mental disorders. Hopefully I’ll be able to give a flavour of what such an approach is about, and the uses it can serve.

Phenomenology in general takes as its starting point experience in its attempt to get a grip on the world. Shunning dogmatic preconceptions of what we think our experiences are like, it urges actual close scrutiny of them, their structure, and the conditions which must be in place for them to be intelligible. As a result, it frequently focuses on detailed descriptions of kinds of experience, but this does not mean it rejects explanation. It does however distrust what it sees as pseudo-explanation, that might for instance attempt to “explain away” experience as some unimportant epiphenomenon of the brain, rather than taking it as our only means of understanding the world.

This might seem pretty abstract. But let’s see how this might apply to the area of mental disorder. A phenomenological approach to studying mental disorder is then, going to involve close scrutiny of suffers’ experiences in mental disorder. This might seem like an obvious point, but this approach sets phenomenology at odds with trends in some kinds of psychiatry and psychology. Here, the focus for identifying mental disorder is on “exterior” symptoms, definite changes that can be noted of the sufferer’s behaviour by an observer, like disordered speech or poor social interaction. This is combined with a belief that the “bottom-line” in explaining the disorder is the state of the brain.

To say that phenomenologists would disagree with these points is not to say phenomenologists deny the causal dependence of states of mind on states of the brain; nor is it to say that they’d affirm it. Rather, they’d seek to “bracket” any explanation of experience outside of the field of experience, such as an appeal to the states of the brain, as beyond their concerns. But this focus on experience would lead them to question the relevance of brain states in order to understand mental disorder, as we’ll see in more detail later.

Against a focus on these “exterior” symptoms, the phenomenologist would argue that such symptoms must not be confusedly thought to be the most central symptoms of the disease, purely because they are the easiest to observe. Instead they’d urge us to consider for instance the viscous, burdening nature of depression, that makes even the smallest task a great effort, and is felt almost as a physical weight on the body. Or the icy distancing from the world a schizophrenic might experience, along with a loss of an ability to be fluidly, happily immersed in activity. Or the agonised, repetitious though of the compulsive, which constantly loops back to one central anxiety, that can never be put aside, never ameliorated.

To clarify: the phenomenologist aims to express a sufferer’s experience from their particular own point of view (“from the inside” so to speak) and the ways this point of view is differs from others. This is accomplished through studying the testimony of suffers, often using case histories and autobiographies. Phenomenology has long sought to investigate the background sense of reality in which ordinary life is immersed, a kind of tacit, subtle orientation in our environment; in Heidegger’s terminology, our “being-in-the-world”. So it often articulates the way a sufferer’s experience is altered in terms of a change in this background, a change in the whole way someone relates to the world, which must be understood, if we are to realise how this change influences subsidiary symptoms and the behaviour of the sufferer

Now, I can sense objections brewing along the lines that such an approach to mental disorder is a vague, unproductive form of inquiry, and hence a waste of time, when compared with what is our best medical science on the subject. Our best medical science here is probably thought to be similar to the trends mentioned above; some kind of neuropsychology, whereby mental disorders are studied through correlation of mental symptoms with certain kinds of brain malfunction.

In order to see why this criticism is misguided, we must tease apart the two the notions of productivity it alludes to. If by productivity is meant productive of explanations, then what is central here is the issue of causal relevance. For even if some mental disorder is entirely dependent on the malfunction of the brain of the suffer, it is often irrelevant, or at least incomplete, to argue that the explanation of the disorder – the combination of the sufferer’s experience, their behaviour and perhaps other elements – is only the state of their brain. If you were trying to understand the nature of verbs in language, or why a piece of algebra followed from another, would you consult a neurologist as to what was going on in a person’s brain when they spoke a verb, or did that piece of algebra? Probably not, because, due to various socio-linguistic or mathematico-logical factors, neurological information is for a large part irrelevant to explaining these phenomena. And yet we see this kind of reasoning all the time: newspaper articles will herald the discovery of the part of the brain that lights up when people pray, or feel anger, as though that is the explanatory “bottom-line”; the ultimate in comprehending the phenomena in question.

If however, by productivity is meant productive of medical treatments, here phenomenology can also claim important roles. Firstly, within a psychiatric project of attempting to located bodily causes for mental disorders, there is a need in the first place to have a clear idea of what manner of disorder is hopefully being alleviated. How many symptoms? What kind of symptoms? Which faculties of the sufferer are disturbed? Which are not? Questions like these are ones that phenomenology can provide answers to, which will enable informed biological investigation of the disorder. In some cases, in the absence of such descriptions, bodily investigation has proceeded on crude assumptions about mental disorders, like assuming that depression is simply unhappiness without interruption, or that schizophrenia simply involves a loss of capacity for emotion.

Secondly, we must remember that successful psychiatry generally proceeds by a combination of bodily and psychotherapeutic treatments. And in the area of the latter, phenomenological scrutiny of the disorders they are treating can help psychotherapists be more aware of how their methods aim to help that disorder and so better apply them, as well as making them more competent to develop new therapies.

Let me then finish by summing up the various reasons for phenomenological study of mental disorders. We have seen how phenomenology might be able to explain states of mind in mental disorder; in this sense it is worthwhile simply as an intellectual exercise, an attempt to understand altered states of consciousness. This kind of reflection on the nature of consciousness can importantly lead us to reassess our ideas about the mind in more ordinary states. We have also seen how phenomenology might have a role clarifying the nature of consciousness for medical science and for psychotherapy. However, it is important to realise that rather than blindly accepting the categories offered for investigation, phenomenology can also criticise these categories based on phenomenological evidence, helping to test for instance, whether or not such categories denote true pathological processes that ought to be treated medically. Lastly, phenomenology’s earnest attempt to understand the state of mind of someone suffering from a mental disorder can help facilitate empathy for them, in members of professional bodies or the public at large, which can be a great comfort to the sufferer, who may feel alienated and stigmatised. This is often achieved through showing that, despite initial appearances to the contrary, many elements of the experience of mental disorder are in fact similar to elements of healthier experience.

Epigram is from Autobiography of a Schizophrenic Girl by Marguerite Sechehaye, p1

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