On the epistemology of psychopathology: Critical insights and methodological concerns
- Autores: Jaime Adán Manes
- Directores de la Tesis: Pablo Ramos Gorostiza (dir. tes.)
- Lectura: En la Universidad Autónoma de Madrid ( España ) en 2016
- Idioma: español
- Tribunal Calificador de la Tesis: José Luis Ayuso Mateos (presid.), Carlos Rejón Altable (secret.), Ignacio Boné Pina (voc.), Enric Novella (voc.), Antonio Pacheco Palha (voc.)
- Programa de doctorado: Programa de Doctorado en Medicina y Cirugía por la Universidad Autónoma de Madrid
- Materias:
- Enlaces
- Tesis en acceso abierto en: Biblos-e Archivo Biblos-e Archivo Biblos-e Archivo
- Resumen
This doctoral thesis represents the collection of three papers published between 2011 and 2016. Overall, these papers focus on epistemological and semantic issues pertaining to the area of psychopathology. The unifying line of argument can be described as consisting of two parts. In the first place, a pars destruens will focus on a critique against the aspirations of a positivistic psychiatry, which takes the psychopathological phenomenon as a definite object that is reducible to spatio-temporal variables and can be subsumed under deterministic and apodictic laws. Secondly, a pars construens will focus on the argument in favour of the hermeneutical nature of the psychopathological endeavour.
The main motivation underlying this doctoral thesis is based on the uncomfortable, although undeniable, instability that characterises psychiatric theory and practice. It is the author's view that this instability represents the insufficiency of all objectifying, reifying and deterministic approaches towards mental illness. Hence, against the accommodating view that represents psychiatry as a young science that walks firmly through the path of science and that only needs more sophisticated scientific devices in order to achieve similar results to those obtained by other medical disciplines, these papers pertain to a critical tradition that strives in order to respect the peculiar nature of subjective experience and the epistemic demands it imposes upon psychiatric theory and practice.
The first paper ('Misunderstanding Psychopathology as Medical Semiology') focuses on the clear delimitation between psychopathology and medical semiology. This analysis is based on the identification of ontological differences found between the object of study of bodily medicine and psychopathological phenomena, highlighting the radical dependence of the meaning of mental symptoms (as opposed to physical symptoms) with regards to the horizon that the individual represents (i.e. the meaning attributed to a psychopathological phenomenon might differ depending on who the individual is, on his biography, his personality traits, his fears and hopes for the future, his social and family relations, etc.).These specific features pertaining to psychopathological phenomena (and subjective experience in general) will impose certain epistemic demands upon psychopathology, highlighting the need for a hermeneutic-interpretative procedure that will lead us to understanding psychopathology not as a mere semiological device, but as an activity aimed at rendering our patients' utterances and behaviour intelligible.
The second paper ('Should Definitions for Mental Disorders Include Explicit Theoretical Elements?') represents an analysis of the semantic structure of terms applied to psychopathological phenomena. Revisiting the ideas regarding the interpretative nature of the psychopathological task exposed in the first paper, we criticise the idea that psychopathological phenomena might be defined in terms of superficial descriptive criteria, as if they were mere objects that could be immediately and directly apprehended. The idea that mental symptoms can be defined in atheoretical terms, borrowed from Logical Positivism and found in the latest editions of the DSM and ICD, is critically assessed and the inherent limitations of a Descriptive Theory of Meaning are highlighted. We further argue for the need to explicitly state those theoretical assumptions that characterise our perspective on subjective experience, for they determine both the way we understand what mental illness is and the meaning that each one of us attaches to different psychopathological terms. Eventually, we will reach an understanding of the role that these theoretical assumptions play as a guiding framework for the interpretative process implied in psychiatric judgement.
The third and last article ('On the notion of Psychosis: Semantic and Epistemic Concerns') represents an attempt aimed at understanding the reasons underlying the arbitrariness with which the term 'psychosis' is deployed in clinical practice. Following the ideas developed in the previous articles, we analyse the reasons underlying the practical, semantic and theoretical instability that characterises this term, which represents in our view a perfect example of the failure of psychiatry's naturalistic and positivistic aspirations. Revisiting the idea that theoretical assumptions regarding the nature of subjective experience should be made explicit, we will focus on the need to develop the notion of subjectivity as the realm where mental illness takes place. Following this line of argument, we will see how the meaning of the term 'psychosis' (or any other psychopathological term) is susceptible to variation depending on how subjective experience is conceptualised. Similarly, the possibility of applying the term 'psychosis' to a particular case will differ depending of how we understand what subjective experience actually is and therefore how it might become distorted. Finally, this paper examines the pretension of truth that psychiatric judgement aims for (i.e. how is it that, as psychiatrists, we can be certain that an individual is experiencing a psychosis). Since psychopathological phenomena do not stand in causal or fixed relations with other objects and cannot be subsumed under deterministic or apodictic laws, psychopathology should aim for an alternative pretension of truth (not for the one aimed at by the natural sciences) that respects its interpretative and theory-dependent character.
This doctoral thesis could be criticised for the width of its scope (after all, the issues discussed include areas related to epistemology, ontology, the philosophy of language, semiology, hermeneutics and the philosophy of science). However, the papers here compiled represent different intellectual efforts aimed at soothing the estrangement I experience when facing the inconsistencies and arbitrariness that can be found scattered all over the realm of psychiatry. In this sense, these papers aim at shedding some light on an area of knowledge so complex and confusing that has led in the last couple of decades to the development of a new specific discipline: the philosophy of psychiatry. Finally, the conclusions reached should not be taken as my final word on the subject, but rather as a platform from which the peculiarities of psychopathological phenomena might be further explored, leading to a more solid understanding of the epistemic demands imposed by subjective experience and hopefully to an improvement in psychiatric practice.
