The loss of nosological validity: why and how should we consider disturbances of subjective world experience?

Abstract

Contemporary psychiatric nosology has evolved with a primary goal of reducing the presence and influence of subjectivity by valuing objective symptoms and explanations (e.g. neurobiological models of psychopathology). However, improvements in the reliability and validity of these endeavours have fallen short of expectations, and it has been argued that one reason for these failures is the very omission or neglect of subjectivity in understanding and explaining mental illness. This paper supports the need for a paradigm shift, from researching the “what” of mental symptoms to a focus on “how” patients experience themselves and the world when undergoing a mental disorder. We review past contributions to disturbances of subjectivity, particularly in schizophrenia, which have contributed to the creation of a new bio-pheno-social model. We also discuss available tools for the systematic assessment of subjective anomalies. We pay special attention to the Examination of Anomalous World Experience (EAWE), which considers disturbances in world engagement, including the experience of atmosphere, space and objects, lived time and temporality, interpersonal relations, language, and existential concerns. Ultimately, we stress that the exploration of subjective experiences is essential, promising, and achievable in research on mental disorders.