From “Things” to Structures
A Dialectical Phenomenological Perspective to Mental Health
DOI:
https://doi.org/10.37067/rpfc.v15i1.1254Palavras-chave:
Psychiatric epistemology, Phenomenology, Phenomenological psychopathology, Ecology, SchizophreniaResumo
The general aim of this contribution is to discuss a dilemma which lies in the conception and exercise of psychiatry. This dilemma lies in the recognition that, on one hand the reified model for describing and understanding mental health is not sufficient for overcoming a Kraepelinian paradigm still influent in psychiatry; on the other hand, that despite this recognition we are still stuck with this theoretical model. To overcome this aporia, we propose a theoretical hypothesis which may contribute to abandon the reified paradigm in favor of a different approach for which what is at the stake in mental health conditions are not “things” happening in the brain, rather variations of subjective and intersubjective structures. Put it differently, “mental diseases” may not be seen as brain disorders, as the naturalist reductionism proposes, and as consequence, localized in the brain. Drawing on resources from classical phenomenological literature and its recent dialogue with enactivism, we propose a dialectic model of phenomenology, the use of which may contribute to the understanding of these variations and pave the route to a different consideration of mental health conditions. To explain our proposal, this paper is divided into three sections: in the first section, we appraise critically the epistemological model in psychiatry starting from the legacy of the Kraepelinian heritage still influent in this specialty and moving toward a more fine-grained model for describing and understanding mental health conditions. In the second section, we provide a theoretical hypothesis, namely the dialectic model of phenomenology, able to elicit the variations of the subjective and intersubjective structures that are at the core of mental health condition. In doing so, we examine four cardinal elements: ambiguity, reciprocity, negativity and betweenness, which dialectically shape the fundamental structures of subjectivity and intersubjectivity. In the last section, we present some of the characteristics that phenomenological psychopathology assumes from a dialectical perspective in the paradigmatic case of schizophrenia.
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Alonso-Fernández, F. (1976). Fundamentos de la psiquiatría actual. Tomo I Psiquiatría General. Madrid: Editorial Paz Montalvo, 191-216.
American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders. 3. ed.
Binswanger, L. (1957). Schizophrenie. Pfullinger: Günther Neske Verlag
Binswanger, L. (1992). Drei formen missglückten Daseins: Verstiegenheit, Verschrobenheit, Manieriertheit. In: Herzog, M. (Ed.). Ausgewählte werke. Band 1. Heidelberg, Germany: Roland Asanger
Bizzari, V., & Brencio, F. (2024). Psychiatric Diagnosis as a Political and Social Device: Epistemological and Historical Insights on the Role of Collective Emotions. The Humanistic Psychologist, 52(1), 70–82. https://doi.org/10.1037/hum0000307
Blankenburg, W. (1982). A dialectical conception of anthropological proportions. In de Koning, A.J.J., Jenner, F.A. (Eds.), Phenomenology and Psychiatry. Grune & Stratton. pp. 35–50.
Blankenburg, W. (2012). Der Verlust der natürlichen Selbstverständlichkeit. Ein Beitrag zur psychopathologie symptomarmen Schizophrenen. Berlin: Parodos Verlag
Bleuler, E. (1950). Dementia Praecox or the Group of Schizophrenias. New York: International Universities Press
Brencio, F. (2021). The algebra of negativity. Hegel, Heidegger and their legacy in the contemporary scenario. In Lucci, A., Knobloch, J. (Eds.), Gegen das Leben, gegen die Welt, gegen mich selbst: Figuren der Negativität. 117-132. Universitätsverlag Winter Heidelberg.
Brencio, F. (2023). From words to worlds. How metaphors and language shape mental health, In Wuppuluri, S., Grayling, A.C. (eds.), Metaphors and Analogies in Sciences and Humanities: Words and Worlds. Springer, 233-250. https://doi.org/10.1007/978-3-030-90688-7
Brencio, F. (2024). (Dis)Embodied Encounters: Deciphering Intersubjectivity in the Context of the Prescription of Drugs. In Gargiulo, P.Á., Mesones-Arroyo, H.L. (eds) Psychiatry and Neuroscience Update – Vol. V. Springer, Cham. https://doi.org/10.1007/978-3-031-72219-6_1
Brown, P. (1995). Naming and framing: The social construction of diagnosis and illness. Journal of Health and Social Behavior 35, 34–52 https://doi.org/10.2307/2626956
Cohen, B. M., Öngür, D., & Harris, P. Q. (2022). Past due: improving the naming of psychiatric disorders. Lancet Psychiatry. v.9(1):264-266. https://doi.org/10.1016/S2215-0366(21)00478-8
Dörr-Zegers, O. (1990). Hacia una concepción dialéctica en psiquiatría [Toward a dialectic concept in psychiatry]. Actas luso-espanolas de neurologia, psiquiatria y ciencias afines, 18 (4):244–57.
Englander, M. (2018). Phenomenology and the Social Context of Psychiatry. Social Relations, Psychopathology, and Husserl’s Philosophy. London: Bloomsbury.
Ferrarello, S., & Brencio, F. (2025). Husserl, Heidegger, and Jaspers. Emergent Perspectives and Advancements. In Hoffmann, L., Hocoy, D., De Robertis, E. (eds.). APA Handbook of Humanistic and Existential Psychology, vol. I, American Philosophical Association Press (in press)
Foucault, M. (1988). Politics, philosophy, culture: Interview and other writings 1977–1984. London: Routledge.
Fuchs, T. (2018). Ecology of the brain. Oxford: Oxford University Press.
Fuchs, T., Breyer, T., & Mundt, C. (2014). Karl Jaspers’ Philosophy and Psychopathology (eds.), Springer: London
Gallagher, S., & Zahavi, D. (2012). The Phenomenological Mind (2nd. ed.). Routledge.
Ghaemi, S. N. (2009). Nosologomania: DSM & Karl Jaspers' Critique of Kraepelin. Philosophy, Ethics, and Humanities in Medicine v. 4, 10. https://doi.org/10.1186/1747-5341-4-10
Hoff, P. (2015). The Kraepelinian tradition. Dialogues in Clinical Neuroscience 17(1):31-41. https://doi.org/10.31887/DCNS.2015.17.1/phoff
Hoff, P. (2024). What kind of «thing» is mental illness? Listening to Kraepelin, Jaspers and Kronfeld. International Review of Psychiatry, 36(6):557–567. https://doi.org/10.1080/09540261.2024.2356690
Jaspers, K. (1910). Eifersuchtswahn: Ein Beitrag zur Frage: “Entwicklung einer Persönlichkeit oder” Prozeß„? Zeitschrift für die gesamte Neurologie und Psychiatrie, 1, pp.567–637 https://doi.org/10.1007/BF02895947
Jaspers, K. (1968). The Phenomenological Approach in Psychopathology. The British Journal of Psychiatry, 114(516):1313-1323 https://doi.org/10.1192/bjp.114.516.1313
Jaspers, K. (1997). General psychopathology. Baltimore: Johns Hopkins University Press.
Kendler, K., & Parnas, J. (2012). Philosophical Issues in Psychiatry II. Nosology. Oxford: Oxford University Press.
Lantéri-Laura, G. (1962). La notion de processus dans la penseé psychopathologique de K. Jaspers. L'Evolution psychiatrique, xxvii, 459-499.
Larsen, R. R., Maschião, L. F., Piedade, V. L., Messas, G., & Hastings, J. (2022). More phenomenology in psychiatry? Applied ontology as a method towards integration. Lancet Psychiatry 9 (9):751-758. https://doi.org/10.1016/S2215-0366(22)00156-0
Lopes, M.V., & Messas, G. (2023). Towards a phenomenological approach to psychopharmacology: drug-centered model and epistemic empowerment. Phenomenology and the Cognitive Sciences 24, 1061–1078. https://doi.org/10.1007/s11097-023-09921-2
Merleau-Ponty, M. (1968). The Visible and the Invisible. Evanston: Northwestern University Press.
Messas, G. (2021). The existential structure of substance disorders. A psychopathological study. Springer. https://doi.org/10.1007/978-3-030-62724-9
Messas, G. (2023). How and why psychiatry still needs Karl Jaspers: a dialectical account. Revista Latinoamericana De Psicopatologia Fundamental, 26, e230312. https://doi.org/10.1590/1415-4714.e230312
Messas, G., & Brencio, F. (2024). Topography of depressive experiences. A dialectic approach. Journal of affective disorders, 369, 986-994 https://doi.org/10.1016/j.jad.2024.10.064
Messas, G., & Fulford, B. K. W. M. (2021). Three dialectics of disorder: refocusing phenomenology for 21st century psychiatry. Lancet Psychiatry. 8(10):855-857. https://doi.org/10.1016/S2215-0366(21)00357-6
Messas, G., Stanghellini, G., & Fulford, B. K. W. M. (2023). Phenomenology yesterday, today, and tomorrow: a proposed phenomenological response to the double challenges of contemporary recovery-oriented person-centered mental health care. Frontiers in Psychology 14:1240095. https://doi.org/10.3389/fpsyg.2023.1240095
Messas, G., & Tamelini, M. (2018). The pragmatic value of notions of dialectics and essence in phenomenological psychiatry and psychopathology. Thaumazein. Rivista di filosofia. v. 6. 93-115. https://doi.org/10.13136/thau.v6i0.94
Messas, G., Tamelini, M., & Cutting, J. (2017). A meta-analysis of the core essence of psychopathological entities: an historical exercise in phenomenological psychiatry. History of psychiatry, 28(4), 473–481. https://doi.org/10.1177/0957154X17715414
Morley, J. (2002). Phenomenological and biological psychiatry: Complementary or mutual? Philosophy, Psychiatry, & Psychology 9 (1):87–90 https://doi.org/10.1353/ppp.2003.0012
Nielsen, K. M. (2022). Own-world and Common World in Schizophrenia: Towards a Theory of Anthropological Proportions. Phenomenology and the Cognitive Sciences 23, 903–923. https://doi.org/10.1007/s11097-022-09852-4
Putnam, H. (1987). The Many Faces of Realism. LaSalle, IL: Open Court.
Ricoeur, P. (1970). Freud and Philosophy: An Essay on Interpretation. New Haven: Yale University Press.
Ritunnano, R. et al. (2022). Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis. Lancet Psychiatry 9(6):458-476. https://doi.org/10.1016/S2215-0366(22)00104-3
Stanghellini, G., & Ballerini, M. (2007). Values in persons with schizophrenia. Schizophrenia Bulletin 33 (1): 131–41. https://doi.org/10.1093/schbul/sbl036
Stanghellini, G., & Fuchs, T. (2013). One century of Karl Jaspers' general psychopathology. Oxford University Press.
Stanghellini, G., Broome, M., Fernandez, A. V., Fusar-Poli, P., Raballo, A., & Rosfort, R. (2019). Oxford Handbook of Phenomenological Psychopathology. Oxford, Oxford University Press
Tamelini, M., & Messas, G. (2016). On the phenomenology of delusion: the revelation of its aprioristic structures and the consequences for clinical practice. Psicopatologia Fenomenológica Contemporânea 5(1):1-21 https://doi.org/10.37067/rpfc.v5i1.985
Volkow, N. D., Gordon, J. A., & Koob, G. F. (2021). Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Neuropsychopharmacology 46, 2230–2232. https://doi.org/10.1038/s41386-021-01069-4
World Health Organization. (2022). World mental health report: transforming mental health for all. Geneva: World Health Organization
Wyrsch, J. (1949). Die Person des Schizophrenen: Studien zur Klinik, Psychologie, Daseinsweise. Berna: Paul Haupt.
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Copyright (c) 2026 Guilherme Messas, Francesca Brencio

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