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Phenomenological Dimensional Approach in Psychiatry

Interview with Anthony Vincent Fernandez

Anthony Vincent Fernandez is Assistant Professor of Applied Philosophy at the Danish Institute for Advanced Study (DIAS) and the Department of Sports Science and Clinical Biomechanics at the University of Southern Denmark. His academic pursuits focus on classical and contemporary phenomenology, with a specific emphasis on its applications in psychiatry, psychology, nursing, and qualitative research.

Within the realm of psychiatry, there is an ongoing debate surrounding the efficacy of current classification systems, notably the Diagnostic and Statistical Manual (DSM), leading to what is termed a crisis in classification. Fernandez has directed his attention towards proposing an alternative approach known as the “phenomenological dimensional approach,” aimed at addressing these concerns. This approach diverges from others, such as the Research Domain Criteria (RDoC)[1] or the spectral approach.

Fernandez’s exploration stemmed from his observation of how phenomenological psychopathologists, while critical of mainstream psychiatry and its symptom framing, largely accepted existing diagnostic categories, such as major depressive disorder or schizophrenia, as legitimate. In contrast, he noted a growing skepticism within psychiatry itself towards these categories, prompting him to devise a dimensional approach inspired by developments outside phenomenology, particularly the RDoC.

While the RDoC incorporates various matrices covering genetics, neurobiology, behavior, and subjective experience, Fernandez found its treatment of subjective experience lacking, merely considering self-reports as an extra part without clear guidelines. His proposed phenomenological dimensional approach seeks to complement frameworks like the RDoC by integrating phenomenological “existentials”[2], such as selfhood, embodiment, affectivity, temporality, spatiality, relation to others, into broad domains with multiple dimensions.

Distinct from the spectral approach increasingly prevalent in psychiatry, which merely substitutes the term “syndrome” with “spectrum,” Fernandez’s approach aims for a more nuanced understanding. Rather than assuming the legitimacy of categories, it encourages research along dimensions without preconceived notions of disorder categories.

In terms of integrating scientific and philosophical approaches, Fernandez highlights the importance of qualitative research in refining conceptual distinctions, which can then inform quantitative research methodologies. This iterative process ensures that quantitative investigations align with the complexity of subjective experience, thus yielding more meaningful data.

Regarding the Renewing Phenomenological Psychopathology Project [3], Fernandez observes a common thread among participants: a heightened sensitivity to cultural contexts and a willingness to engage with political dimensions, such as incorporating elements from the Mad Pride movement or the neurodiversity movement. These endeavors aim to critique and develop phenomenological psychopathology in innovative ways, emphasizing the integration of diverse perspectives and standpoints.

[1]The Research Domain Criteria (RDoC) is a theoretical framework developed by the National Institute of Mental Health (NIMH) in the United States. It aims to redefine mental disorders by integrating research findings from various disciplines, including genetics, neuroscience, psychology, and behavior. Unlike traditional diagnostic approaches, which rely on symptom-based classification systems like the DSM, the RDoC initiative seeks to understand mental health conditions based on underlying neurobiological and behavioral dimensions.

[2] Existentials, in philosophy, refer to fundamental aspects or structures of human existence. These are the basic conditions or features that characterize human experience. The concept of “existentials” was particularly developed within the framework of existentialist philosophy. The existentialists, notably philosophers such as Martin Heidegger and Jean-Paul Sartre, emphasized the importance of understanding human existence in terms of its fundamental structures or “existentials”.

[3] The Renewing Phenomenological Psychopathology (RPP) Project is an initiative aimed at revitalizing and advancing the field of phenomenological psychopathology. This project brings together scholars, researchers, and practitioners who are interested in exploring innovative approaches to understanding mental illness through the lens of phenomenology. The closing event of this project was held in Florence on the 1st of March 2024.

Emiliana Mancuso

Laureata in medicina e chirurgia presso l’Università Vita-Salute San Raffaele di Milano. Specializzanda in psichiatria presso l’Università degli Studi della Campania “Luigi Vanvitelli”. Allieva della Scuola di Specializzazione in Psicoterapia Fenomenologico-Dinamica di Firenze. Si interessa della riflessione filosofica intorno alla psichiatria. Editor presso

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