is the discipline that provides psychiatrists with basic knowledge about
the abnormal phenomena that affect the human mind and with a valid, reliable
method to appraise them. In contemporary usage, the term ‘psychopathology’ is
employed in a number of different ways. A common way to use it is to conflate
psychopathology with symptomatology - the study of isolated symptoms in view of
their diagnostic and aetiological significance. Assessing symptoms allows the
identification of specific diagnostic entities that, in turn, enable prediction of
natural history and response to treatment. Psychopathology is about that, but not
just about that. Whereas symptomatology is strictly illness oriented,
psychopathology is also person oriented, since it attempts to describe the
patient’s experience and her relationship to herself and to the world.
Biomedical science was in part built upon the transformation of a complaint into a
symptom. This allowed medical science to see in a complaint (e.g. exhaustion) the
effect of a pathological cause active in the human body (e.g. an endocrine
dysfunction). This move from complaint to symptom to pathophysiology may
overshadow the fact that a complaint has a meaning for the individual sufferer: it
expresses a question or desire. A person may not necessarily seek elimination of
his complaint, but rather fulfilment of his desire (e.g. to see the doctor fail
and himself triumphantly to become an incurable patient). Biomedical science’s
success can be viewed as due to its focus on how symptoms relate to causes and
treatment; this success is due to partial exclusion of the subjectivity of the
patient and the meaning their symptoms hold for them. A psychopathological
approach, by contrast, does not exclude seeing abnormal phenomena as symptoms
caused by a dysfunction to be cured, but additionally includes the exploration of
personal meanings. Psychopathology focuses on the experiencing subject and can
operate in parallel with a traditional biomedical approach. The patient is an
active partner in the diagnostic process, capable of interpreting her own
complaints. Symptoms are conceptualised as the outcome of a mediation between a
vulnerable self and the sick person trying to cope with and make sense of her complaints.
A second use of the term psychopathology is as a synonym to nosography. The latter
term outlines conventional characteristics of a syndrome (i.e. a combination of
symptoms empirically aggregated) and thereby serves the goal of a clinical
diagnosis. Psychopathology is not merely about diagnosis. In psychopathology, what
matters most is that the ‘chaos of phenomena’ should stand out in an evident way
and in multiple connections. Psychopathology promotes attention to the person’s
whole field of experience, rather than a restricted focus on symptoms selected
according to their putative diagnostic relevance. The existing classifications of
mental illnesses are merely provisional diagnostic conventions. Since no
extraclinical (e.g. biological) indexes of putative nosological discontinuities
our taxonomy is necessarily based on psychopathologically defined
syndromes. Hence, psychopathology has become the main method of linking symptoms
and diagnosis, but if psychopathology is conflated with nosography, only those
symptoms that are supposed to have diagnostic value will be investigated, in a
sort of nosography-focused twilight state where we wear clinical blinkers
structured by contemporary classification systems. The focus on diagnosis
discourages attention to real people’s experiences. As a consequence, clinical
utility is confined to ad hoc bits of information useful for
Why is psychopathology useful for psychiatry
There are at least six reasons for psychopathology to be at the heart of
(a) Psychiatry is a heterogeneous discipline. Its practitioners approach
the ‘object’ of their discipline from many different angles, for
instance neuroscience, dynamic psychology, and sociology, each of
which has its own language, methodology, and practice. Psychiatrists
therefore need a common ground and a joint language. Psychopathology
does not aim to conceptualise mental disorders - as is the case with
psychoanalysis or the cognitive sciences. Psychopathology aspires to
respect the phenomenon rather than to market a specific, inflexible
theory. Psychopathology, in its Jasperian foundation, is at the end of
a continuum where theoretical assumptions are minimised and the forms
and contents of the patient’s experience are prioritised. Thus,
psychopathology can be understood as a shared language that allows
clinicians with different theoretical backgrounds to understand each
other when dealing with mental disorders.
(b) Psychiatry aims to establish rigorous diagnoses. Psychopathology is
still highly useful in fields where the major disorders cannot be
neuroscientifically defined as disease entities, but are exclusively
syndromes defined according to characterising symptoms, such as
abnormal subjective experiences.
(c) Psychiatry is about understanding disturbed human experience, in
addition to diagnosing and classifying that experience.
Psychopathology functions as a bridge between the human and clinical
sciences, providing the basic tools to make sense of mental suffering.
Today, there is a risk that clinical blinkering results in clinicians
being only able to view the phenomena relevant to diagnosis and
classification and excludes the scrutiny of the diverse and varied
nature of what is really there in the patient’s experience - the
essential prerequisite to understanding his or her illness - and
closes us off to the discovery of new psychopathological
(d) Psychiatry addresses abnormal human subjectivity. Psychopathology
attempts to define what is abnormal (rather than taking for granted
common-sense views) and to grasp which elements of mental life remain
normal in the context of illness.
(e) Psychiatry is about caring for troubled human existence, rather than
judging, marginalising, punishing or stigmatising it. Psychopathology
connects understanding with caring, and endeavours to establish a
methodological as well as ethical framework for this.
(f) Psychiatry looks for a way to connect first-person subjective
experience with brain functioning. Psychopathology is about bridging
understanding (meaningfulness) and explanation (causality) in research
and clinical settings. Phenomenological psychopathology in itself is
prior (i.e. antecedent) to any causal accounts addressing sub-personal
mechanisms. At least part of the difficulties in establishing a
neuroscientific psychiatry may be insufficient knowledge of
psychopathology. Basic psychopathological knowledge is a prerequisite
for research in explanatory psychopathologies and it can give new
impulse to epistemologically sound biological psychiatry.
Phenomenology and psychopathology
The basic purpose of psychopathology is to empower psychiatrists with a
systematic knowledge of the patients’ experiences. This issue is primarily
addressed by phenomenology, whose main object is human subjectivity.
Phenomenology is the method that stands at the basis of psychopathology.
Phenomenological psychopathology is ‘open’ to an unusual extent, in that it
reveals aspects of experience that other approaches tend to overwrite or
eclipse with their strong theoretical claims. In this sense, phenomenological
psychopathology can be conceived of as psychopathologia prima.
It assumes that the primary object of psychiatry is the patient’s subjectivity,
thus putting all its efforts into focusing on the patient’s state of mind as it
is experienced and narrated by them. Expressions and behaviours are considered
important, but less specific than personal experiences. The form - that is, the
mode in which content is given to consciousness (e.g. verbal-acoustic
hallucination) - is considered more important than the content itself (the
precise theme, e.g. the verbal hallucination being persecuting). In
phenomenological psychopathology, a symptom is the expression of a profound
modification of the human subjectivity and its form (more than its content)
reveals its underlying characteristic.
The form of a symptom, as it emerges from careful psychopathological
analysis, is potentially more informative than surface clinical features
in describing a given phenotype, establishing a reliable diagnosis and
understanding the ‘world’ a patient lives in.
Psychopathology is not one of numerous approaches aiming at conceptualising
mental disorders or illuminating their pathogenesis. It is prior to any causal
accounts addressing sub-personal mechanisms. Core psychopathological knowledge
is presupposed in order to achieve explanatory ambitions. Psychopathology is
‘phenomenological’ not in the sense that it embraces a given philosophical
approach: rather, it is methodologically so.
Although the emphasis on subjectivity and form may look like a
theoretical commitment, that commitment is the product of a stance that seeks
to respect the phenomenon rather than impose upon it.
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