Schizophrenia Bulletin vol. 33 no. 1 pp. 113–121, 2007
doi:10.1093/schbul/sbl043
Advance Access publication on October 5, 2006
A Modest Proposal for Another Phenomenological Approach to Psychopathology
Paul E. Mullen1
and reliable clinical assessment. This has bred an approach among clinicians, as well as researchers, which
privileges the specific question and the proper categorization of the patient’s response.
The carefully articulated diagnostic classifications of
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV)1 and International Statistical Classification
of Diseases, 10th Revision (ICD 10) are generally accepted
to relate meaningfully to the world of mental disorders.
Nevertheless, the increasingly obvious gaps between research findings and the definitions of mental disorders
in today’s diagnostic manuals is beginning to raise questions about whether validity has been sacrificed on the
altar of reliability. Even the diagnostic centerpiece,
schizophrenia, is starting to fragment under the impact
of genetic, neuroimaging, neuropsychological, social,
and other research methodologies whose findings are difficult to make sense of within anything approaching the
manual’s models of schizophrenia. Bleuler’s plurality of
the schizophrenias has returned, and schizophrenia is
now for some once more a syndrome not a disorder.
All of which reopens the question of what abnormalities
of mental state and behavior best map onto the developing research database. A question which todays selfconfirming and fixed diagnostic categories with their
simple symptom signposts are helpless to answer. In addition, mental health clinicians with any critical faculties
cannot but notice that the better you know a patient and the
more information that is available, often the more problematic becomes fitting them into any specific diagnostic
category. This is the reverse of the situation in wellestablished medical specialities. This difficulty persists
despite the rather forgiving polythetic basis of modern diagnostic classification. These research and clinical problems
might be alleviated through a return to a descriptive psychopathology based on the phenomenological method.
2
Victorian Institute of Forensic Mental Health, Monash University,
Locked Bag 10, Fairfield, Melbourne, Victoria 3078, Australia
In 1912, Karl Jaspers published an article entitled ‘‘The
Phenomenological Approach to Psychopathology.’’ This
and his subsequent text, General Psychopathology, was
to exert a profound influence on the development of psychiatry in general and psychiatric nosology in particular. The
current Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases both
reflect, at least in part, that legacy. This article will argue
that the descriptive psychopathology of Jaspers has been
gradually transformed into a caricature which has
substituted authority for enquiry and simplification for subtlety. We have been left with classificatory systems which
impose reified categories increasingly at variance with clinical reality and increasingly divorced from the data generated by scientific enquiry. Returning to the phenomenological
method, despite its contradictions, may open the way to clinical and research approaches which free us from the current
straightjacket of orthodoxy which is impending our progress.
Key words: psychopathology/nosology/phenomenology
Introduction
The interest in phenomenology among mental health
professionals may be undergoing one of its periodic revivals. This article contains a modest proposal to harness
such interest to a critical reexamination of approaches
to the descriptive psychopathology which sustains current classifications and clinical practice.
The phenomenological approach to descriptive psychopathology has in recent decades taken a back seat
to the perceived need for explicit definitions of symptoms
and disorders to promote reliable clinical diagnosis.
Diagnostic ‘‘instruments’’ and the use of structured
and semistructured interviews have come to be seen as
the royal road to both defining research populations
A Problem with Contemporary Psychopathology and
Nosology
Psychiatry has been preoccupied in recent decades with
the Kraepelinian project of defining mental disorders
in terms of symptoms and signs with the hope that
a knowledge of course, prognosis, and ultimately cause
would follow. The great monument to this project are
today’s 2 manuals, the ICD and the DSM. The hope
1
To whom correspondence should be addressed; tel: 61-3-94959136, fax: 61-3-9495-9195, e-mail: [email protected].
gov.au.
Ó The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.
For permissions, please email: [email protected].
113
P. E. Mullen
was that clearly and operationally defined disorders
would facilitate research, improve communication, and
provide a structure to clinical practice which would improve diagnosis and treatment. This ongoing labor has
reordered, solidified, and occasionally renamed the conditions inherited from past generations. More dramatically, it has generated a plethora of new disorders like
posttraumatic stress disorder and panic disorder to say
nothing of annexing problem behaviors like child molestation and shoplifting to their own specific mental disorders. The escalating size of the diagnostic manuals
conveys an impression of progress and accumulating
knowledge. But what lies behind this inflation of disorder?
The DSMs and ICDs undoubtedly began in an attempt
to build diagnostic criteria out of clinical descriptions often influenced by phenomenological approaches. Today,
however, they confront us not as sets of tentative hypothesis about preliminary but potentially useful ways of conceptualizing disordered states of mind and behavior.
Quite the reverse, they claim to ground the subject offering the touchstone of certainty from which research and
clinical practice starts and from which it derives its legitimacy. Those who create these manuals are neither fools
nor rogues. They know that classificatory systems grow
and develop. They welcome research, debate, and change.
They are often painfully aware of the compromises and
hopeful approximations which go to create the final
authoritative text. But this intellectual honesty does not
translate into the practices and ideologies which DSM
and ICD sustain in the cities of psychiatry and psychology. In today’s field of mental health if you seek research
funding or publication, you are forced into the languages
of DSM or ICD. To claim rebates for clinical work or to
present expert testimony to courts and tribunals, increasingly, the language of these diagnostic manuals is imposed upon you. To even contribute to the professional
debates on nosology you are constrained within the premises which sustain the manuals. To be a researcher or even
a mainstream clinician plunges you into the very core of
the self-justifying and self-sustaining hermeneutic world
of today’s manuals of mental disorders.
Heidegger2 writes of just this process whereby phenomena once revealed can with time be covered over
and become a ‘‘dangerous’’ source of misleading systems.
Systems can be developed from phenomenological enquiries in which the original revealed structures have
been obscured by selecting some aspects and forgetting
others. These ghosts of obscured phenomena can then
be bound together into an authoritative structure. These
systems ‘‘then present themselves as something ‘clear’ requiring no further justification and thus can serve as the
point of departure for a process of deduction’’.(p60) But
these degenerate systems become not a source of new
knowledge but a source of error. They have become
the expression of reified concepts based not on the original phenomenological explorations but on subsequent
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deforming simplifications. They are transformed into entities which claim to be the appearances which announce
some other supposedly hidden reality, in short, they
metamorphose from phenomena to symptoms. In this
process, the phenomena derived as an attempt to begin
the exploration of disorders of mind become the appearances of the disorders themselves. The disorder’s existence is guaranteed by these symptomatic appearances
which in reality are no more than the reifications of simplified accounts of phenomena, phenomena which were,
at best, intended as the starting point of an exploration of
the possibility of the existence of such disorders. Such
bowdlerization and concretization ends the possibility
of the scientific enquiry they were intended to usher in.
This process in practice is illustrated by Ungvari and
Tang3 who note Bleuler required 95 separate psychopathological phenomena to characterize the schizophrenias,
Kraepelin in his final formulation used 75, but DSMIV employs only 30.4,5 It is this truncated psychopathology which forms the basis of virtually all characterizations of schizophrenia in today’s scholarly literature.
In defence of the manuals, those of us whose research
and clinical practice involves reviewing the case notes
of colleagues would be delighted to encounter the full
panoply of DSM’s phenomena noted as present or absent. At best, we tend to find 4 or 5 symptoms identified
by name as present, usually without quotes or characterizations, and the absence of a phenomenon is rarely if
ever recorded.
A central issue is whether the diagnostic manuals have
become self-sustaining impediments to scientific progress
or whether they truly remain open to refutation and productive of good practice and research. The question for
this article is how a phenomenological perspective on descriptive psychopathology might progress, or confound,
today’s diagnostic systems. Such a process of phenomenological enquiry might end up strengthening the rocks
on which we have built the psychiatric enterprise. Conversely, it could fragment those foundations bringing
down authority and reinstating science.
An equally important issue is the unforeseen effect on
the practice of clinical assessment that propagating the
diagnostic manuals and developing standardized instruments to identify the disorders they contain has produced. Lists of criteria and instruments made up of
specific probes to elicit whether or not the criteria are
met breeds an examination style based on specific questions and specific answers. The enquiry is about the presence or absence of the indicators of disorder not about an
exploration of the patient’s life and state of mind.6 We
now have generations of mental health professionals,
many of whom have learned all the right questions.
They may in the process, however, have lost the capacity
to listen or to see what may challenge or otherwise discomfort the established diagnostic process. This would
be of less importance if the disorders they seek, and
Phenomenological Approach to Psychopathology
find, were firmly established clinicopathological entities
with established management protocols, but they most
definitely are not. The clinical bankruptcy of much of
modern mental health is in part a child of that admirable
project for explicit, reproducible, and shared definitions
of disorders.
In the clinical situation, the ‘‘multiaxial nature’’ of the
classificatory systems of DSM and now ICD can offer
layers of complexity to the formulation of the patient’s
problems. The multiaxial approach was intended to guide
clinicians into taking account of the dynamic interactions
in the mentally disordered between social context, personality, substance abuse, disability, and abnormalities
of mental function. Though in the right hands, the multiaxial approach functions as intended, all too often, the
axis are reconstructed as independent variables creating
further fragmentation and simplification. This is painfully obvious in my area of forensic psychiatry where
the mentally disordered offender’s personality vulnerabilities, substance abuse, and social dysfunction are
often approached not just as autonomous factors but
as competing explanations for the offending behavior.
Particularly in those with a schizophrenic syndrome,
this not only confuses evaluations for courts but leads
to a failure to act effectively to recognize and reduce
the risk of violence.7
What Is the Phenomenological Approach and Where Did
It Come From?
Phenomenological approaches share a project to systematically consider and study human experience and behavior in a manner which does not start from prior theories
and assumptions. The slogan of ‘‘to the things themselves’’ evokes the active attempt to set aside the prejudices about what should be and start trying to grasp
how something actually is. In psychopathology, it is
about the struggle to grasp the nature of experiences prior
to their being lost in futile debates about the meanings
and definitions of the words used by others to describe
those experiences. One of the few things, however, modern philosophers of science seem agreed upon is the impossibility of simply gathering the type of facts which
form the scientific discourse without prior assumptions
and theories expressed within an agreed language.
Whether the phenomenological enterprise can in fact provide a method for a direct confrontation with the objects
of the world in general, and human experience in particular, must remain questionable.8 What is, however,
important and potentially liberating for the psychopathologist is that this approach leaves a place for subjective experience and attempts to circumvent, if not
overcome, the imposed technologies of examination
and classification which weigh down our subject. As
a minimum, the phenomenological approach allows
a place for genuine curiosity and wonder when confronting the mental experience of our patients.
The term phenomenology is used frequently enough in
the current psychiatric literature, but the meanings attached to the term are many and various, including in
the area of psychopathology.
1. Phenomenology as the precise definition of psychiatric
symptoms. This merges into an operational technology, which lies at the heart of such classifications as
the DSM, in which authority constructs and imposes
definitions in the name of consistency, reproducibility,
and ease of communication. Though, currently, this
is probably the commonest usage of the term phenomenology, it is really phenomenalism with no connection to phenomenology as a methodology or system
of ideas.
2. Phenomenology as a way of describing the experiences
and actions of patients. A description in which an attempt is made to approach the accounts given by
others, and the observations of them, without imposing preexisting assumptions about significance. The
intention is to describe both the subjective world
and behavior of the patient in and for themselves.
The method is linked to Husserl’s transcendental reduction which in simplistic terms means assuming,
for the moment, what is to be described exists in isolation from the rest of the world freed of questions of
context, significance, and type. This can then be used
in exercises of classification or understanding. It is first
and foremost a methodology.
3. Phenomenology which attempts not just to grasp
descriptively and empathically the experience of the
other but to derive their essential meaning in a process
Husserl called eidetic analysis. An analysis that aims
to be always rooted in the actual experience of the
concrete lived world.9 This phenomenology is linked
to Minkowski’s10 structural analysis. Here an attempt
is made to delineate a generating or basic disturbance
of consciousness from which the rest of the abnormalities in the patient’s state derive. A recent
example is provided by Stanghellini’s11 analysis of
the lack of commonsense as a basic relational deficit
in the schizophrenias.
4. Phenomenology in which the inner world of the other
is grasped through an analysis of categories of experience such as of time, space, the materiality of the
world, and causality. This Ellenberger12 termed categorical phenomenology. It is an approach permeated
with the arcane language, concepts, and occasional
brilliant insights of Heidegger. It does not usually confine itself to descriptions on the way to scientific or
clinical understanding but metamorphoses into a joint
project between patient and clinician to make meaningful, and transcend, the distress and disorder of
their existence.
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P. E. Mullen
Thus, phenomenology covers a spectrum from technology, via a methodology, to systems of understanding
which merge into psychotherapeutic practices. Phenomenology has even been invoked in the journey to the
infernal region of antipsychiatry with its rejection of
all categories of madness and notions of diseases of
mind.13 All except the phenomenalist technology make
some appeal to the ideas developed within the phenomenological movement in philosophy. The manner in
which the ideas and practices of philosophers and psychiatrists interact in the field of phenomenology is, however, far from clear, even in the case of Karl Jaspers who
had a foot in both camps.
The Phenomenological Movement
Edmund Husserl (1859–1938) stands at the base of the
phenomenological movement which arguably begins
with the publication of Logical Investigations.14 Husserl’s
phenomenology is indebted to Brentano (1838–1917), but
like most continental philosophers of the period, there
are obvious influences from Descartes, Kant, and
Hegel.15 Husserl’s most famous pupil, and his eventual
personal nemesis, was Martin Heidegger (1889–1976).
Heidegger remains contentious and contaminated because of his active involvement in National Socialism.
Whether his Nazi enthusiasm stemmed from the temptations of power, anti-Semitism, or from his philosophical
position does not effect this judgement.16–18 Through
Husserl’s teachings, books, and the editorship of the
Jahrbuch für Philosophie und phänomenologische
Forschung from 1913, he influenced a whole generation
of philosophers. These included Max Scheler (1880–1937),
Jean-Paul Sartre (1905–1980), Maurice Merleau Ponty
(1908–1961), as well as psychiatrists including Erwin
Straus (1891–1954), Kurt Schneider (1887–1967),
Ludwig Binswanger (1881–1966), and even Jacques
Lacan (1901–1981). An excellent introduction to contemporary thought on Husserl is presented by Smith and
Smith19 though sadly psychiatry and psychology attract
scant attention. In the English-speaking world, the influence of Husserl’s work on psychiatry often came either
via Karl Jaspers or in a combination with Heidegger’s
ideas, a dichotomy which produced a curious and starkly
contrasting array of descendants. Via Jaspers, we have
bastions of transatlantic psychiatric orthodoxy like Willy
Mayer-Gross,20,21 Michael Shepherd,22 Paul McHugh
and Phillip Slavney,23 and Frank Fish.24 The amalgam
with Heidegger provided one of the ideological foundations for both existential and antipsychiatrists like
Medard Boss, Ronnie Laing,25,26 and David Cooper,27 as
well as influencing both Rollo May28 and Karl Rogers.29
Reading Husserl, let alone Heidegger, is a formidable
task for anyone but particularly for those of us whose
background is in medicine and psychology. Many phenomenologists seem to delight in arcane language filled
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with neologisms and sentence constructions of awesome
complexity (eg, ‘‘State of mind and understanding are
characterized equiprimordially by discourse. Under the
existential constitution of ‘‘there’’ we shall accordingly
treat: Being—there as state-of-mind’’ [format as original]).2 Ricoeur’s30 account of Husserl is approachable
without being simplistic, and Merleau Ponty’s31 Phenomenology of Perception and Max Scheler’s32 Ressentiment
are among the more gentle introductions to this approach. Spiegelberg33 provides a magisterial overview
of phenomenology’s influence on psychology and psychiatry. Collections like Existence28 and Phenomenology and
Psychiatry9 provide interesting samplers. For me, Jaspers’
General Psychopathology remains the most relevant starting point for mental health professionals.
Karl Jaspers
Arguably, it was Karl Jaspers of all those influenced by
the phenomenological movement who had the greatest
influence on psychiatry or at least mainstream psychiatry
in the English-speaking world. Jaspers as a philosopher sits
more comfortably within the existential tradition than the
strictly phenomenological. Nietzsche and Kierkegaard
are his most obvious influences, and it is in his exegesis
of Nietzsche that one of his most impressive essays in psychopathology is to be found as he struggles to relate the
philosopher’s genius to his neurotic and eventually psychotic
states.34
Jaspers, who began as a law student before qualifying
in medicine, presented his dissertation on crime and nostalgia in 1908. This owes its most obvious debt to Max
Weber. In 1910, Jaspers’ classic study of morbid jealousy
appeared.35 This illustrates his approach based upon extremely detailed case histories which focus on both the
patient’s actions and their inner experiences, drawing together the commonalities between the cases to provide
a vivid picture of the phenomena which make up morbid
jealousy. The next year saw an article on the psychopathology of schizophrenia. Jaspers36 then published what
amounts to a manifesto for a phenomenological psychopathology, rapidly followed by the first edition of the
General Psychopathology.37,38
Jaspers39 in later life acknowledged the influence of
Husserl writing ‘‘as a method I adopted Husserl’s phenomenology.although I rejected its further development to insight into essences. [This made it possible] to
describe the inner experiences of patients as phenomena
of consciousness.so clearly that they became recognizable with certainty in other cases.’’[p18] Despite such clear
acknowledgments of his debt to phenomenological
thought, others have found fit to question Husserl’s influence on Jaspers.40–42 The General Psychopathology is
clearly not simply an exposition of Husserlian ideas
and, for better or for worse, Jaspers dissociated himself
from the directions phenomenology took in the later
Phenomenological Approach to Psychopathology
work of Husserl and from most of Heidegger’s ideas.39,43
The General Psychopathology remains, however, indebted to the phenomenological approach, and parts
can only adequately be understood within that philosophical context.44,45 Jaspers39 linked the phenomenological method to eclecticism in theory and research with an
open-minded attempt to ‘‘survey all possible pictures
without lapsing into any.’’ (p19) Jaspers invokes a caution
verging on scepticism to any systems based on psychopathology alone ‘‘as all concepts of this kind are always
merely provisional, always ‘‘wrong’’ [but] if they stimulate analysis and lead to finer distinctions they served
their purpose’’ (Quoted in Kolle46).
Jaspers seems to envisage a psychopathology and a nosology which is open ended, ever changing, never authoritative, always conscious of its limitations, provisional,
and refutable. A psychopathology and a nosology which
if it ever is to rest and become a fixed point of reference
can only do so when externally validated clinicopathological entities set its boundaries. Even then because these
clinicopathological entities manifest through the consciousness of a living person, the complexity of the experience of mental disorder will always escape, to some
extent, the psychopathologists attempts to describe and
define.38 No wonder some of Jaspers colleagues accused
him of being a nihilist.39
Phenomenological Psychopathology
Phenomenological psychopathology as a method can be
regarded as having 4 distinct, albeit overlapping, stages:
1. Engaging repeatedly with others who share some assumed psychological or behavioral dysfunction (eg,
extraordinary beliefs, hearing voices, stalking others,
intense jealousy, profound unremitting hopelessness,
the label of schizophrenia, etc). Exploring using spontaneous accounts and responses to direct enquiries,
their experiences and actions which could be related
to their dysfunction either directly, indirectly, or even
conceivably. Some favor a structured enquiry as part
of the engagement which explores areas of experience
which might otherwise pass unregarded or shamefully
hidden (eg, related experience of time, distance and direction, reality (materiality), ideas about what causes
what, sense of control and agency, evoked fantasy
and images, etc).
This enquiry and witnessing attempts to progress
without assumptions about whether the accounts reflect
pathology, are reasonable, are symptomatic, are accurate or even plausible, reflect unconscious mechanisms,
or are useful and relevant. Jaspers attempts a distinction between the form of a psychopathological phenomena which is shared by all like experiences and
therefore generalizable and the content which is individual, specific, and productive of theories of meaning
but not categories. This distinction is a helpful fiction
directing attention to the form of experiences which
are indeed critical to any process of recognition and
categorization. It remains a fiction, however, given
that firstly experience is always about something
and their form is only manifest in their content, and
secondly, some experiences are pathological because
of their content not just their form (eg, Jaspers criteria
for the ununderstandability of delusions).
2. Augmenting what emerges from the self-accounts of
those with the supposed dysfunction with potentially
relevant material from artistic, philosophical, and
other cultural sources in an attempt to provide as
‘‘rounded’’ a description as possible. The material
‘‘borrowed’’ in this manner is strictly about the nature
of the experiences not their understanding in some
intellectual or cultural context. For example, in
attempting to grasp the nature of vexatious and querulous litigation, it is revealing and relevant to use
Dickens’ descriptions in Bleak House of the experience of being caught up in an unremitting and futile
pursuit of justice through the endless Courts of Chancery. What would not be relevant is Dickens’ understanding that what drives the plaintives to madness is
a complex legal system designed to enrich lawyers and
entrap suitors. This latter theory of causation, however, attractive and personally satisfying, remains
strictly outside of phenomenology’s world. Phenomenologists may use not only descriptions of potentially
similar phenomena from artistic and biographic material but also conceptual structures deriving from
philosophical speculations, psychological studies,
and even neurobiological observations.47–49
3. Bringing to the material a degree of imaginative empathy sufficient to grasp potential connections and articulate partially inchoate experience. Empathy is, as
Jaspers35 warned, only of use if it remains modest
and constrained to the task of clarifying. Empathy easily becomes a serious danger to the task of descriptive
psychopathology when it moves to understand and
make meaningful, thus potentially slipping through
the backdoor all the preconceptions, dynamic assumptions, essentialism, and models that were so carefully
excluded at the outset.
4. Deriving from the totality of the material a provisional
description of all those aspects of experience and behavior which make up a description of the phenomenon. That is, a description of those elements necessary
to make this phenomenon what it is and all those elements whose absence is critical to it remaining what it
is and not becoming some other.
This stage may not emerge obviously from the material but may require the use of imaginative variation.
This involves varying the elements in the description
taking them away one by one until the description
collapses as an account of the phenomenon or
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P. E. Mullen
alternatively adding elements until it metamorphoses
into what you believe to be another phenomenon.
Clearly, this organization of the data cannot remain
entirely innocent. This all too easily becomes an exercise of imposing preexisting assumptions. Thus, bringing the whole exercise down at the final hurdle.
Without such a process of ordering the experiences
and behaviour, however, any particular psychopathological phenomenon in a particular person must remain forever unique and incomparable. We as
clinicians would be reduced to speaking only of this
patient, paralyzed and incapable of generalization or
applying external knowledge. The project to describe,
classify, and to systematically investigate mental disorder would collapse. Not a few phenomenologically
influenced psychiatrists have progressed down exactly
this path, declaring madness dead, and psychopathology to exist only in the eye of the beholder.50
5. The final stage is to employ the phenomenological
descriptions to inform and direct subsequent examinations and to lay the basis for a provisional classification which then seeks its refutation in the science of
systematic enquiry.
It might be objected that when this account is stripped
of good intentions and caveats, all that remains is exactly
the approaches to clinical examination and psychiatric
nosology that this phenomenological method was supposed to counter and improve. Is it differentiated only by
the dubious claim to be constantly and self-consciously
provisional and tentative? Or worse still, is it only distinguished by the politically correct embracing of refutability? The answer to such objections lies perhaps in the
modesty of the phenomenological method which strives
to clarify and explore not to create authoritative systems.
Unlike today’s operational definitions, phenomenology
as a method does not attempt to short cut and substitute
for the fruits of genuine scientific enquiry.
Descriptive psychopathology, whether it uses a phenomenological method or not, inevitably involves the imposition of artificial divisions onto what is continuous
lived experience. We do not perceive, evaluate, intend,
and act, we simply pick out our favorite chocolate
from the box. The separations inflicted on experiential
reality reflect our prior assumptions about the nature
and basis of mental function, eg, that perception, preference, and movement are mediated by distinct, albeitinked, neural process.
To take an example, in exploring and describing an experience, such as the passion of jealousy, it is inadequate
to remain at the sufferer’s account of imposed ungovernable reactions, however evocative it may be of that nasty
state of mind. Bringing to the descriptive process, the
fruits of prior phenomenological explorations may allow
a finer elucidation of this individual’s concrete experience. One hypothesis about jealousy suggests that it
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involves an intentional attitude to another person believed to owe the jealous fealty, who is judged to be,
or about to be, unfaithful. The reaction to that apprehended loss involves desires, painful feelings, fantasies,
and predispositions to behave. The drama is played
out within a cultural and interpersonal context which
sets the parameters of all of the separate elements.51,52
Using this model allows an exploration which is finer
grained, more likely to evoke a sense in the sufferer of
being understood, and potentially links to later therapeutic intervention. It remains, however, just a hypothesis,
useful or otherwise. The correspondence of the model
to the reported experiences of patient groups and community samples can be systematically evaluated and
the model reviewed in the light of such studies.53 What
cannot happen as long as one remains true to the phenomenological method is the creation of a category which
then defines for all time the experience of jealousy.
A Practical Example
An example of this phenomenological approach enabling
our contemporary science to progress where conventional diagnostics had failed would be ideal. In the continuing absence of such an exemplar, an account is
provided from our current work with unreasonably
persistent complainants.
Our clinic receives referrals from the courts of persistent complainers who, in pursuit of their notions
of justice, resorted to threats, stalking, or other forms
of violence. The traditional approach centers on evaluating whether or not they have a major mental disorder such as delusional disorder. The difficulties fitting
such people into existing definitions of mental disorders
are one of the reasons for the clinical disinterest and
almost total disappearance of any systematic studies
in this area.54 The phenomenological approach ignores
diagnostics and focuses on attempting to grasp and describe in each individual what initiated and sustained
the problem behavior. The days when journal editors
and readers would tolerate detailed clinical case histories are gone, so in its stead a schema of a suitable anonamized case analysis is presented in figures 1 and 2.
This man believed the health professionals had abrogated their obligations to him. Obligations constructed
from a traditional view of doctors as dedicated agents
of the patients interests combined with an exaggerated
view of their therapeutic powers. There is in such querulous complainants a remarkable overlap in terms of
personality, worldview, self-image, and even personal
histories. Most share a zealous commitment to their
quest which endows them with an enviable energy
marked by elation, enthusiasm, and loquaciousness.
The pursuit of justice becomes the core of their being.
All combine the expected desire for reparation and/or
compensation, with a desire for personal vindication
Phenomenological Approach to Psychopathology
Complaint to Hospital
Complaint about medical
treatment of deceased mother
Commenced litigation against
doctors and hospital
Rejected
Complaints to Medical Board and
Nursing Council
Failed
Complaint to Health Commissioner
All Rejected
Appealed
Appealed to Review Board
Rejected
Rejected
Appealed to Higher Court
Picketed and leafleted hospital and
doctors offices
Rejected
Began stalking one doctor
Began picketing court
Arrested and Convicted
Going to Court to establish
right to further Appeal
Conciliation Fails
Case Closed Against his Protests
Appealed to Ombudsman and
Commission on Human Rights
Appealed
Fig. 1. The Problem Behavior. This unfolded over 5 years. At the time of referral, he was involved in 5 separate legal actions
(all self-represented), was picketing 3 establishments, wrote almost daily to newspapers, his M.P. and the Queen, and was
attempting to set up a Web site.
and retribution, often of an extreme nature.54 Testing
some of the emergent hypothesis through a study of
a large cohort of unreasonably persistent complainants
supported some, but by no means all, phenomenological hypothesis.55 Currently, the use of a combination
of the systematic and phenomenological data is being
used to develop testable interventions, including for
early recognition and optimal management of this
vulnerable group. The hope is to reduce both the terrible damage they do themselves and the enormous
costs in stress and dollars they impose on complaints
organizations.
Conclusion
The phenomenological approach to psychopathology is
riddled with contradictions. To stand in wonder before
the world does not obviously relate to programes of establishing generalizable descriptions. Attempting to
grasp in a totalizing movement fits ill with projects of separation and organization which in effect produce the
reified mental disorders of today’s diagnostic manuals.
Husserl’s grandiose project to ground all human sciences
in Jaspers’ hands becomes a method to serve the needs of
a developing scientific psychiatry. Yesterday’s phenomenological psychopathology is in no small part responsible
for the phenomenalism of today’s diagnostic practices.
Establishing a basis for generalization and a common
language to progress research and clinical practice inevitably struggles to remain self-consciously tentative and
provisional in the face of a human need for authority.
In practice, there is always a dialectic between the observational/experiential data and the search for, and imposition of, structure and order on that data.
The resolution of the tensions inherent in today’s
phenomenological psychopathology in its application
to classification can only be resolved externally by establishing clinicopathological entities which will allow transformations of phenomena into simplified symptom
signposts. The current dialectic will then be replaced
by a new set of contradictions between the presence of
the clinicopathological entity and the experience of
that disorder in the sufferer. For example the fully characterized variants of today’s major depressions, will continue to manifest through the depressed person who will
never be reducible to the disorder which influences and
perverts their experience of the world. But this would
have become a problem for philosophers, not health professionals. For medicine, it is sufficient to know enough
to treat pathology for the benefit of the patient. Reduction is the essence of all science. Defining and classifying
allows generalization and systematic study which produces knowledge, which in turn leads to the reductions
which allow diagnosis, prognosis, and treatment. For
the health professional, phenomenology is a methodological stepping-stone. The problem is that most of today’s
psychopathological stepping-stones seem to lead nowhere particularly useful for either medical science or
clinical practice. It is psychopathology’s task to seek
new paths in the hope not of establishing a new orthodoxy but of making itself irrelevant.
119
P. E. Mullen
Escalation of Claimed Injuries
Recruitment of Agents
Changing Social Situation
Poor communication
A Doctor
Married, financially secure.
Limited social networks
Callous Behaviour
Doctors and Nurses
Increasing time off work to
pursue campaign
Hiding Facts of Case
plus Hospital
Negligence
Alienates friends and family
by constant fixation on ‘the
case’
plus professional boards and
health commissioner
Loses Job
Cover up of Malpractice
plus courts
Pattern of Criminal
Negligence of which mothers
death just one example
Rigid Perfectionist.
Pedantic. Ambitious. Proud.
Discontented. Distrustful
Increasingly fixated on minute
details of mothers treatment
and death.
Totally preoccupied with
exposing the wrongdoing and
obtaining justice.
Wife leaves him
plus police
Bankruptcy
plus wife and neighbours
Spied upon, slandered, and
persecuted
Developing Psychological
State
plus government and federal
agencies
Increasingly convinced he is
victim of active persecution
because he is about to expose
a massive conspiracy.
Living alone in hostel
Destitute
Relevant Beliefs about World and Himself
What he Seeks
That chaos is kept in check by rules and
agreements.
Compensation for his injuries (Increasing
constantly).
Things go wrong because others either fail
in their responsibilities or deliberately
cause damage.
Reparation (for things to be as theywere).
Retribution against those who failed in
their responsibilities.
Others have not recognised his abilities.
He is destined to some form of greatness.
Vindication in the form of public
recognition that through his struggle he is
making the world a safer place.
That he is more honourable intelligent,
honest, and persevering than others.
Fig. 2. The Unfolding of Querulousness.
Acknowledgments
Many thanks for the helpful comments of Gabor Ungvari
and Tim Lambert on the earlier drafts of this article
and for the constructive and relevant criticisms of the
journals reviewers.
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