The psychiatrist as a ragpicker. Introduction to Walter Benjamin for psychiatrists (II): the dialectics between the fragment and the whole

Abstract

In this paper, taking a cue from the image provided by Walter Benjamin, I argue that the work of the psychiatrist can be compared to that of the ragpicker who collects what others consider to be ‘waste’, rescuing it from oblivion and transforming it into a key resource for treatment. I review two ‘logics of discovery’- phenomenologically inspired structural psychopathology and that of narrative psychopathology - whose purpose is to complement mainstream diagnostic approach based on ‘ticking boxes’. I try to identify the shortcomings of these two methodologies, in particular the confirmation bias that can cause selective inattention to anything that does not fit into the expected structure or narrative. I highlight the heuristic importance of these ‘fragments’ that are in danger of remaining on the fringes of the clinician’s attention who is too focused on ‘making ends meet,’ showing how in certain psychopathological conditions - e.g. early schizophrenia and borderline personality disorder, marked by fragmentation - inattention to fragments can impede understanding and treatment. I argue for the importance in psychiatry of an ‘emergentist’ logic of discovery, of a kind of psychopathological knowledge ‘co-produced’ with patients, and of fragment-oriented listening in order not to lose the richness of patients’ own accounts.