From “Things” to Structures

Abstract

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.