Clarifying a Dimensional Approach to Phenomenological Psychopathology

Abstract

Clarifying a Dimensional Approach to Phenomenological Psychopathology Anthony Vincent Fernandez (bio) Somogy Varga's criticisms and questions provide me with a welcome opportunity to clarify some key elements of my proposal. First, I briefly summarize my motivation and original proposal for a phenomenological–dimensional research program. Second, I address Varga's two challenges. Each challenge highlights an element of my proposal that was underdeveloped in the original article (Fernandez, 2019). I therefore provide a brief clarification of my proposal before responding directly to Varga's two challenges. Proposal Summary My proposal is to shift phenomenological psychopathology toward a broadly dimensional, rather than categorial, research program. This approach will allow phenomenologists to operate outside the constraints of current diagnostic categories, including those in the DSM and the ICD. Why should we want to operate outside of these constraints? The diagnostic categories now enshrined in these manuals were never intended to guide psychiatric research. They were intended as preliminary categories to guide clinical practice and be revised in light of future research. However, over time, these preliminary diagnostic categories became de facto research categories, hindering psychiatry's ability to revise its categories and, thus, undermining its ability to enhance the validity and clinical utility of its classifications. In light of this critical shortcoming, psychiatry is moving away from categorial classifications (at least in the context of research) and toward dimensional approaches—the most well-known being the Research Domain Criteria initiative (Cuthbert & Insel, 2013). My proposal, in brief, is that phenomenological psychopathology should develop its own dimensional approach—not as a component of the Research Domain Criteria, but as a research program in its own right. Because we have good reason to believe that current diagnostic categories are poorly delineated—with individual categories likely encompassing a range of heterogeneous conditions—they simply do not provide a viable framework for conducting phenomenological research. How can phenomenologists clarify the core experiential features of, for example, major depressive disorder (MDD) or schizophrenia spectrum disorder if these categories do not refer to a homogenous phenomenon in the first place? [End Page 81] If phenomenologists wrongly assume that current diagnostic categories encompass discrete disease entities, each with its unique experiential profile, then they will simply perpetuate the same circular process at the heart of contemporary psychiatric research. But what is the phenomenological alternative? I propose that phenomenologists orient their research through the basic structural features of human experience and existence—what Heidegger calls "existentials," but are also referred to as "essential" or "ontological" structures. These existentials include, but are not limited to, intentionality, temporality, spatiality, situatedness, and selfhood. If we orient our studies through basic structural features of human existence, then we need not presume the legitimacy of current diagnostic categories. Rather than studying, for instance, the experience of MDD, we might study disturbances of affectivity, including those disturbances that fall within the boundaries of MDD. Such a study might reveal that there are a variety of affective disturbances that occur within the boundaries of MDD, thus motivating a revision of the diagnostic category. In this way, we can use dimensional approaches to critically assess the legitimacy of current diagnostic categories. In sum, a dimensional outlook allows phenomenologists to step outside the constraints of current diagnostic categories, taking a new perspective upon psychopathological experiences—a perspective that, I hope, will allow phenomenologists to more effectively contribute to our understanding and classification of psychopathological conditions. Varga's Challenges Varga articulates two challenges for this dimensional research program. Each challenge highlights an underdeveloped aspect of my initial proposal, requiring that I further clarify and articulate the dimensional framework that I envision for phenomenological psychopathology. In this section, I summarize Varga's two challenges, briefly clarify how the dimensional framework is meant to operate, and then respond directly to both challenges. Challenge One Varga's first challenge arises from psychiatry's concern with particular, concrete ways of being in the world. As he points out, psychiatrists do not simply require an account of the structures of human existence in general—that is, the set of existentials. Rather, they require accounts of the concrete modal variations of human existence that are characteristic of...