Les sentiments existentiels et les expériences subjectives de la psychose : une description phénoménologique du sens de la réalité

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ObjectivesThe concept of “existential feeling” has been recently suggested by M. Ratcliffe to encompass a specific range of bodily feelings, which constitute a basic sense of reality. Existential feelings play a phenomenological role in all experience, as a background structure prior to definite perceptions, emotions and judgement. Rooted in a phenomenological psychiatry perspective inspired by Husserl and Heidegger's works, this concept attempts to grasp both variations in feelings of familiarity in everyday life, and their alterations in psychopathology, through the experiences of derealization, strangeness, doubt or reference. This paper aims to explore the phenomenological definition of existential feeling, and to discuss its application to the field of psychiatry and especially to psychosis. MethodA review of the conceptual background framing the notion of “existential feeling” sheds light on its anchoring in the phenomenological tradition, linking philosophy and psychopathology. Clinical descriptions allow for the exploration of the pertinence of this concept in understanding subjective experiences and delusional phenomena in psychopathology. ResultsThe hypothesis of a pre-reflective sense of reality and presence in the world makes it possible to describe distinct levels within the broad category of “loss of reality”. The dimension of a “sense of reality”, which gives to the experience its presence and consistency, has to be carefully distinguished from the dimension of the judgement of reality, pertaining to the doxastic level of belief. DiscussionFrom a multidisciplinary perspective of philosophy and psychopathology, these distinctions invite discussion of the relevance of the concepts of “existential feeling”, “horizon” or “natural self-evidence” to shedding light on the loss of reality phenomena. In relation to psychosis, these notions can contribute to understanding the formation process of delusion and lead to criticizing its definition as a false belief. Stressing the experiential dimension and the alteration of background frameworks invites an exploration of the specificity of pre-delusional phenomena, and of delusions as attempts to restore some of these background frameworks. Regarding differential diagnosis, one key point is the possibility to point out some phenomenological criteria, relying on different kinds of existential feelings and structures of experience. This could allow clinical distinctions within the range of feelings such as depersonalization or derealization, which can occur in various clinical contexts. ConclusionsThe notion of existential feeling and the phenomenological perspective can be highly relevant, both conceptually and clinically, to studying the various phenomena of loss of a common reality. In the context of the contemporary definition of delusion as a false belief and the dimensional approach of a psychosis continuum, there is a call for the description of the specific and singular tonality of psychotic subjective experiences.