Thursday 23 April 2015

The Phenomenological Bases of the Therapy of Severe Mental Disorders

Giovanni Stanghellini
A course entitled The Phenomenological Bases of the Therapy of Severe Mental Disorders took place on April 9-11 in Florence. Organized by the EPA (European Psychiatric Association) Section of Philosophy and Psychiatry, the course accommodated 30 practitioners and philosophers from all over Europe to offer an advanced practical workshop on Phenomenological Psychotherapy.

The participants learned therapeutic skills from such professionals as Giovanni Stanghellini, Thomas Fuchs, Andrea Fiorillo, Andrea Raballo and Borut Skodlar.

The first day started with an intensive but fascinating introduction by the course’s director Giovanni Stanghellini, who took his audience through the theoretical underpinnings of the phenomenological model, with philosophical references to Husserl, Heidegger and Levinas. Stanghellini argued that a human being ought to be seen and understood as a dialogue with Alterity. It is exactly in a dialogue, where the true essence of language lies and where subjectivity is displaced. Mental illness, argued Stanghellini, ought to be understood as the crisis of this dialogue.

Psychopathology happens when a human being becomes unable to maintain his/her dialogue with Alterity. The dialogue, in turn, was defined as driven by the subject’s will to reveal something new about the subject to the interlocutor. It functions like Husserl’s phenomenological reduction: it is the means by which it becomes possible for things to show themselves to a subject. In this light, a phenomenon which is regarded as a symptom, has a very special meaning: it is the Truth in a person that manifests itself.

In his seminar entitled Jaspers’ Concept of Limit Situation and Its Importance in Phenomenological Psychotherapy, Thomas Fuchs presented two ways in which Jaspers’ well-know ideas could be introduced into psychopathology. Firstly, Fuchs explained, trauma ought to be understood as a limit situation which can affect everybody. Secondly, certain people carry particular sensitivity for limit situations – the sensitivity, which he called existential. Limit situations uncover the basic conditions of existence. It is in mental illness when the shelter (Gehause) breaks and one’s basic assumptions about the world are fundamentally shattered. The limit situation of trauma remains an alien element in one’s life and cannot be integrated unless through psychotherapeutic treatment.

In his second talk, entitled Phenomenology and Psychotherapy of Depression in the Light of
Thomas Fuchs
, Thomas Fuchs shared his thorough analysis of the way that time is experienced in depression. Life, he argued, is a process of synchronisation, that is a balanced relation of one’s own time to the world time.

The basic structure of temporal experience consists of implicit (lived) time and explicit (or experienced) time. In depression this basic relation is a subject of disruption (desynchronisation). Explicit temporal experience becomes interrupted by the sudden event of internal character (shock, surprise, amazement, disappointment, loss). This, in turn, leads to further separation of “now” and “no more” experience.

Andrea Fiorillo, in his inspiring talk on Why We (still) Have to Study Psychopathology, presented results of the study conducted among young career psychiatrists in Europe, which exposed the lack of basic phenomenological training. He argued that there is a rising need for this type of knowledge, in order to give a meaningful and coherent form of life to clinical symptoms.

The course was enriched by the real life case studies, presented by Andrea Rabelli and Borut Skodlar. The participants had a chance to learn how the phenomenological theory of illness and care might be successfully applied to psychotherapeutic practice.

The talks and seminars presented were followed by long and fruitful discussions. The unique value of the course was that it offered a dynamic platform of a dialogue between psychiatrists, psychologists and philosophers in order to construct a better understanding of human experience in the face of suffering.

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