The meanings of psychopathology

Giovanni Stanghellini
Department of Biomedical Sciences, University ‘G.
d’Annunzio’, Chieti Scalo, Italy
Correspondence to Giovanni Stanghellini, Department
of Biomedical Sciences, University ‘G. d’Annunzio’,
Via dei Vestini, 31–66100 Chieti Scalo, Italy
Tel: +39 3473790707; fax: +39 872355892;
e-mail: giostan@libero.it
Current Opinion in Psychiatry 2009, 22:559–564
Purpose of review
The scope of the present review is to criticize the trivial meanings of ‘psychopathology’
and re-examine its technical meanings and the role that psychopathology as the
discipline that studies abnormal mental phenomena can play in today’s clinical practice
and research, and in the conceptualization of mental disorders.
Recent findings
I will first describe and discuss the way the term ‘psychopathology’ is mainly used in
current psychiatric literature. This meaning, I will argue, is trivial. Then, I will move on to
its technical meanings, including three classic sub-areas: descriptive, clinical and
structural psychopathology, stemming from the studies of Karl Jaspers, Kurt Schneider
and the phenomenological movement in psychiatry.
Summary
I will address the meanings of the term ‘psychopathology’ in current literature and
contrast it with its meanings in continental 20th century tradition. The relevance of the
discipline of psychopathology for psychiatry is three-fold: it is the common language that
allows psychiatrists to understand each other; it is the basis for diagnosis and
classification; it makes an indispensable contribution to understanding the patients’
personal experiences.

Keywords
interview, phenomenology, philosophy, psychopathology, understanding

Curr Opin Psychiatry 22:559–564

ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
0951-7367

kind of intelligibility based on the meanings of personal

Introduction
How is the word ‘psychopathology’ mainly used in cur-
rent literature and what is its original meaning in the 20th
century psychiatric tradition? In current literature, the
word ‘psychopathology’ is used to refer to the subject
matter of psychiatry, that is, pathologies of the psyche.
This use, I will argue, is trivial. I will contrast this with the
proper meaning of the term ‘psychopathology’, that is,
the discipline that studies the phenomena of mental
disorders [1,2,3,4,5,6]. I will distinguish three types
of psychopathologies: descriptive, clinical and structural
psychopathology.
I will not confine myself to a review of available literature,
but unfold my own views on the importance of psycho-
pathology for psychiatry, mainly focusing on its aims,
values and methods. The importance of the discipline of
psychopathology for psychiatry is three-fold: it is the
common language (koiné) that allows specialists, belong-
ing to different schools each one speaking its own dialect
or jargon, to understand each other; it is the basis for
diagnosis and classification in a field where all major
conditions are not etiologically defined disease entities,
but exclusively clinically defined syndromes; it makes an
indispensable contribution to understanding, a special
0951-7367 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
experiences rather than on causes to be found in
neurobiological abnormalities.
The trivial meanings of ‘psychopathology’
A SCOPUS search reveals that 23 711 studies have
been published since the year 1895 including the word
‘psychopathology’ in the title, abstract or keywords. The
majority of these are journal articles (17 682) and reviews
(3366). The most represented subject areas are medi-
cine, psychology and neuroscience. Four hundred and
ninety-eight of these studies were published by the
American Journal of Psychiatry. There has been a constant
increase in publications on this topic; for example, in
1977, 289 papers, in 1987, 341, in 1997, 819 and in
2007, 1424.
What is the meaning of ‘psychopathology’ in these stu-
dies? A first answer can be found in the way ‘psycho-
pathology’ is explicitly defined in MeSH (Service of the
National Library of Medicine and the National Institutes
of Health) and PsycINFO Thesaurus.
In MeSH we can find the following definition of
‘psychopathology’: ‘the study of significant causes and
DOI:10.1097/YCO.0b013e3283318e36

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 560 History and philosophy
processes in the development of mental illness’. A list of
subheadings for ‘psychopathology’ (including those items
paired at least once with this heading in MEDLINE)
includes: classification, diagnosis, economics, education,
ethics, etiology, history, instrumentation, legislation and
jurisprudence, methods, standards, statistics and numeri-
cal data, trends
PsycINFO Thesaurus defines ‘psychopathology’ as the
‘study of mental disorders, emotional problems, or mal-
adaptive behaviors. Used for the scientific discipline or
for unspecified dysfunctions’. According to PsychINFO,
a broader term for ‘psychopathology’ is ‘pathology’, and
narrower terms are adolescent psychopathology and child
psychopathology. Also, related terms are: abnormal psy-
chology, antisocial behavior, comorbidity, defense mech-
anisms, emotional adjustment, homeless, mentally ill,
mental disorders, psychiatric patients, psychiatric symp-
toms, psychological assessment.
More information about the meaning of ‘psychopathol-
ogy’ in the current literature can be found in the way this
term is implicitly used.
In the majority of studies (taken from MEDLINE or
SCOPUS) ‘psychopathology’ is used as a synonym for
‘symptoms’. The following is an example: ‘eating dis-
order psychopathology does not predict the overweight
severity in subjects seeking weight loss treatment’ [7].
In this example, the word ‘psychopathology’ can be
substituted by ‘symptom(s)’ without any change in
the overall meaning of the sentence. In another set of
studies, psychopathology is synonymous with mental
disorder or ‘madness’, as in the following example,
‘The link between artistic creativity and psychopathol-
ogy: Salvador Dalı̀’ [8]. In other articles, ‘psychopathol-
ogy’ is used to address symptoms and mental disorder
interchangeably, ‘to assess psychopathology in transsex-
uals at different phases of sex reassignment, we admi-
nistered the Spanish adaptation of the MMPI-2. The
results show that the majority of patients were free of
psychopathology’ [9].
In these studies, ‘psychopathology’ is used to talk about
the subject matter of psychiatry, that is, pathologies of
the psyche, not to define the study of the phenomena
of mental disorders, a subdiscipline of psychiatry to be
listed next to nosography, epidemiology, genetics, neu-
roimaging, psychopharmacology, etc. This use of the
term ‘psychopathology’ is trivial for the following main
reasons: it ignores the origin and history of the disci-
pline named ‘psychopathology’, it is ill-defined and
confusingly overlaps with other concepts, it overlooks
basic epistemological distinctions and evades the pro-
blem of defining the nature of the entities that are
being diagnosed and classified. ‘Psychopathology’ is
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
blurring when used as an umbrella term to refer to
isolated ‘psychiatric symptoms’ as well as to ‘psychiatric
syndromes’ (constellations of symptoms); this is like
confounding the bricks of a building with the building
itself. Also, this use of ‘psychopathology’ conflates
different concepts like ‘illness’ and ‘disease’, to be kept
rigorously distinct [10].
The technical meanings of ‘psychopathology’
In this section, I will distinguish and illustrate three
sub-areas of psychopathology: descriptive, clinical and
structural psychopathology.
Descriptive psychopathology
In 1976, Franz Fish stigmatized the fact that descriptive
psychopathology was, in English, ‘conspicuous by its
absence’ ([11], p. 1). In the last 2 years, three psycho-
pathology handbooks have been published [12] or re-
edited [13,14]. In these books, descriptive psycho-
pathology is considered the ‘fundamental professional
skill of the psychiatrist; possibly, the only diagnostic skill
unique to the psychiatrist’ ([13], p. 3). Descriptive
psychopathology is generally defined as ‘the precise
description and categorization of abnormal experiences
as recounted by the patient and observed in his behavior’
([13], p. 4). It is a gigantic dissection and explication of
the patient’s field of consciousness whose aim is bringing
into view his subjectivity.
The ‘breeding ground’ of descriptive psychopathology
is the study of Karl Jaspers [15] and the Heidelberg
School ([16], p. 189). Jaspers delimited the field of
descriptive psychopathology, which he called ‘phenom-
enology’, as follows: ‘It gives a concrete description of
the psychic states that the patients actually experience.
It reviews the interrelations of these, delineates them as
sharply as possible and creates a suitable terminology.
Since we never can perceive the psychic experience of
the other in any direct fashion. There has to be an act of
empathy. Our chief help in all this comes from the
patients’ own self-descriptions. We confine ourselves
solely to the things that are present to the patients’
consciousness. Conventional theories, psychological
constructions, interpretations and evaluations must be
left aside’ ([15], pp. 55–56).
Thus, the main purpose of descriptive psychopathology is
the systematic study of conscious experiences, ordering
and classifying them, and creating valid and reliable
terminology. To obtain this, it focuses on the patients’
states of mind as they are experienced and narrated by
them; expressions and behaviors are considered import-
ant, but less specific than personal experiences. The form
in which a content is given to consciousness is considered
more important than the content itself.

Descriptive psychopathology relies on two main meth-
odological assumptions, avoiding theoretical explanations
and the centrality of empathic understanding.
Avoiding theoretical explanations, as well as presupposi-
tions and prejudices, is the quintessential methodological
prerequisite of descriptive psychopathology. How suc-
cessful a genuinely theory-free approach can be in the
face of arguments as to essential theory-ladenness of data
is a matter of debate [17]. However, descriptive psycho-
pathology must be clearly demarcated from explanatory
psychopathologies, for example psychodynamic psycho-
pathology. The latter aims to explain how a symptom
occurred and why it should be that particular symptom,
mainly on the evidence of that person’s experience in
early life. This is stigmatized as ‘prescient understand-
ing’, indicating presumed foreknowledge of how events
of mental life must unfold because they will necessarily
conform with theoretical postulates ([13], p. 21). Inter-
pretative constructs represent a paradigm different from
that of descriptive psychopathology that stand in the
way of true description. These constructs are supposed
to be ‘overly interpretive and lack objective definition’
([12], p. 10).
Empathy is usually defined as the means to understand
another person’s experience by putting oneself in his
position. Descriptive psychopathology attempts to use
empathy as a clinical instrument to recreate in the
psychopathologist the subjective experience of a patient
to obtain a valid and reliable description of his experi-
ence. ‘It is empathy that makes it possible for us to know
what it is like for another person, another subject of
experience, to be in a particular mental state’ ([13],
p. 5). Empathy is a special kind of intentional experience
in which my perception of the other leads me to grasp
(or to feel that I grasp) his personal experience. It
implies a special kind of feel of immediate resonance
between myself and the other person. Empathy also
puts into play my personal past experiences and my
personal knowledge about commonly shared experi-
ences (common sense). Two main epistemological con-
cerns arise in this study [2]. The first is about reliability,
since empathy implies a kind of grasping by analogy, in
which I actively look inside myself for stored experi-
ences to make them resonate with those of the other, how
do I know that I am not projecting my own experiences
onto the other? The second is about validity, since
empathic grasping implies transposing another person’s
experience into my own consciousness, how can I grasp
the experiences of a person, say a person with schizo-
phrenia, that are rooted in an overall (prereflectively
given) disturbed mode of consciousness [18], or in a
radically alien constitutive structure of the life-world
[19]?
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The meanings of psychopathology Stanghellini 561
Clinical psychopathology
Clinical psychopathology is essentially aimed at the
identification of symptoms that are significant in view
of nosographical distinctions. K. Schneider, in the preface
to the fourth edition of his Clinical Psychopathology, affirms
that clinical psychopathology aims at becoming the ‘psy-
chopathological doctrine of symptoms and diagnosis’.
Clinical psychopathology aims at becoming the link
between descriptive psychopathology and nosography
[6]. The assessment made following the principles of
clinical psychopathology is chiefly of pragmatic diagnos-
tic use [20]. Lanteri-Laura pointedly stated that, in the
Schneiderian view, ‘psychopathology tends, contrarily to
symptomatology [séméiotique], to select pathognomonic
signs’ ([21], p. 606). It restricts the task of the psycho-
pathological inquiry to the search for pathognomonic, or
at least diagnostically relevant, symptoms. This means
that clinical psychopathology is interested in eliciting,
during the psychopathological interview, those abnormal
psychic phenomena that help the clinician to establish a
reliable diagnosis.
Blankenburg [22] pointed out that such a tight association
between psychopathology and nosography, character-
izing psychiatric tradition, did not constantly operate in
favor of these two directions of research. Schneider
admits to the serious difficulties that we must occasion-
ally overcome in order to build, from a psychopathological
finding, a psychiatric diagnosis, and recommends the use
of psychopathological concepts as floating buoys useful as
marks of reference for clinical navigation.
Notwithstanding Schneider’s advice, the result is that in
the majority of psychiatric handbooks only those symp-
toms which are supposed to have diagnostic importance
are researched, in a sort of nosography-focused crepus-
cular state. At issue, here, is the problem of clinical utility.
Which bits of information are relevant? And for what?
Jaspers was very clear in stating that ‘in phenomenology
we expect to account for every psychic phenomenon. In
no circumstances should we rest satisfied with a general
impression or a set of details collected ad hoc’ ([15],
p. 56). Clinical psychopathology goes in the opposite
direction.
As Broome [23] puts it, there are two kinds of science of
the psychopathological interview, one is concerned with
generalizing the individual case and subsuming it into a
general rule or category, this is the case with the interview
oriented by clinical psychopathology. The other is con-
cerned with understanding the irreducible concrete indi-
viduality of a single case. For the first kind of science,
the patient is nothing but an ‘instantiation of a general
category, rather than a primordially real individual’
([23], p. 114). For nomothetic science the ‘perfection
 562 History and philosophy
of a concept depends on the degree to which empirical
concreteness has disappeared from its content’ ([23], p.
112); signs and symptoms are used to subsume an indi-
vidual to a general category. The second kind of science
keeps the individual in focus. Nihil est praeter individuum,
nothing exists but concrete individuals; generalizations or
categories, for example mental disorders (like ‘schizo-
phrenia’ or ‘obsessive–compulsive neuroses’), do not
exist per se. They are mere abstractions, concepts devised
to guide our categorizations. ‘Symptom counting and
checklist’, Broome writes, ‘have altered how clinicians
view mental illness and patients. What began as a well
intentioned guide to classification, and a spur to research
and communication, has become a hegemonic metaphy-
sics’ ([23], p. 114). The dominance focus on classifi-
cations encourages a focus on psychiatric concepts, rather
than on real people’s experiences [5,24]. As a con-
sequence, clinical utility is confined to ad hoc bits of
information useful for clinical decision making. This
excludes the scrutiny of the manifold manifestations of
what is really there in the patients’ experience, the
essential prerequisite to understand the worlds they
live in.
Beyond description and diagnosis: structural
psychopathology
Structural psychopathology, which builds on and extends
the study of Minkowski [25], Straus [26], Binswanger
[27], Ey [28], Tellenbach [29] and Blankenburg [22]
among many others, assumes that the manifold of
phenomena of a given mental disorder is a meaningful
whole, that is, a structure. The symptoms of a syndrome
have a meaningful coherence. One can find, and should
look for, internal links between the various aspects of
a person’s experience. To display a structure means
that the parts stand ‘in a relationship to each other of
reciprocal expression’ ([30], p. 157; quoted in [19]).
Structural thinking belongs to the mature phase of the
evolution of psychiatry as a science [31]. What is a
structure? Danish linguist Hjelmslev [32] succinctly
defines a structure as ‘an autonomous entity of internal
dependences’ ([32], p. 28). ‘Autonomous entity’ refers to
the assumption that meaningfulness can be found in the
structure itself, without involving external elements (the
opposite of this is, this bit of the structure has this
meaning since it is the effect of that event that is external
to the structure, as it is the case with traumatic expla-
nation; for example, dissociation of consciousness is
better understood as a consequence of an early experi-
ence of abandonment). ‘Internal dependences’ refers to
the assumption that meaningfulness emerges from the
internal links between the elements of the structure (the
opposite is, the meaning of this bit of the structure is this
since it can be substituted by that other bit that is more
intelligible, as it is the case with paradigmatic interpret-
ation, e.g. an imagined tower is/means a phallus).
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Meaningfulness emerges from a structure via a process of
unfolding. With ‘unfolding’ we mean the explication of
a ‘text’ or ‘discourse’ which ‘does not transform it into
something else, but makes it become itself’ ([33], §148).
To unfold or explicate means to grasp the fleeting entan-
glement of interlaced parts of a given structure, for
example interrelated actions in a narrative or intercon-
nected symptoms in a syndrome. To explicate or unfold a
text is to bring out or lay bare its structure, that is, the
internal relations of dependence which constitute the
static of the text, or its immanent pattern.
A philosophical definition of this process can be found in
the works of Heidegger [33] and Wittgenstein [34]. In
§7 of Being and Time, entitled ‘The Concept of Logos’,
Heidegger clarifies that the grasping of meaningfulness
happens through a process of ‘synthesis’. He explains
that ‘[s]ynthesis does not mean a binding and linking
together of representations, a manipulation of psychical
occurrences’. ‘Here the syn has a pure apophantical
signification and means letting something be seen in
its togetherness with something’. This means that, in a
structure, meaningfulness is not the outcome of the
action of an external subject who artificially cuts-and-
pastes separate elements. Rather, meaningfulness comes
into sight and emerges via a kind of epiphany or mani-
festation. The role of the knowing subject is that of
letting this manifestation happen. Meaningfulness is
not the product of an active construction; rather, it
emerges from an act of receptiveness or voluntary inac-
tion (a ‘wise passiveness’ in the words of the poet Words-
worth) that lets the links between the parts of the
structure become manifest.
Wittgenstein [34] suggested that, in order to obtain a
coherent view of a given set of phenomena, one just
needs to ‘see from above’ what is there, without inter-
polating hypothetical facts or superimposing general
theories. In this way, we will obtain a view of the whole,
a Uebersichtliche Darstellung, that is a panoramic view, or a
perspicuous (i.e. intelligible) representation. Meaning-
fulness is the product of this holistic view, rather than
the product of an active construction, that is, of some
kind of genetic (e.g. traumatic) explanation, or symbolic
(paradigmatic) interpretation. This attitude is remark-
ably in agreement with the concept of structure and with
the phenomenologist’s agenda. All aspire to collecting a
range of phenomena that point to multiple facets of
a potentially significant concept [35], forcing tacit,
implicit and opaque phenomena and their meanings
to the surface of awareness [36]. The final aim of this
meaning-oriented and contextually sensitive approach
is sometimes referred to as ‘thick description’ [37,38].
The limitations and possible implementations of this
approach cannot be discussed in the present study and
will be the topic of a further study.

As an example of the structural view, I will briefly out-
line Sass and Parnas’ [19,39] phenomenological under-
standing of schizophrenia. ‘To have a phenomenological
grasp of the mind of another person is to grasp the
motivational relationships that lend coherence and con-
tinuity to that person’s consciousness’ ([19], p. 264).
Phenomenological relationship focuses on formal (rather
than content) aspects of experience, like space, time and
qualities of the object-world and self-experience. The
implications between the manifold phenomena are not
logical, but phenomenological, since each phenomenon
in schizophrenia ‘carr[ies] the traces of the under-
lying formal alterations of subjectivity’ ([19], p. 267).
Looking for structural relationships consists in the
unfolding of the basic structure(s) of subjectivity, that
is, the way consciousness appropriates phenomena. Sass
and Parnas list three types of ‘synchronic relationships’
between schizophrenic abnormal phenomena: equipri-
mordial, something is another facet of something else
(e.g. hyper-reflexivity and diminished self-affection are
two facets of noetic disturbance in schizophrenia); con-
stitutive, something is the condition of possibility of
something else (e.g. hyper-reflexivity/diminished self-
affection are the basis of perplexity; the noetic disturb-
ance is the condition of possibility of the noematic
disorder; the noetic does not exist independently or prior
to the noematic); expressive, something is emblematic of
something else (e.g. the noematic content expresses the
noetic or more general form of mental life; bizarre delu-
sions express/are emblematic of disorders of self/world
articulation).
Conclusion
In the present study, I have sorted out three types of
psychopathologies. Descriptive psychopathology, whose
main aim is ‘to account for every psychic phenomenon,
every experience met with in our investigation of the
patient’ ([15], p. 56). Clinical psychopathology, which is a
descriptive tool for ‘pragmatic diagnostic use’ [20],
restricting the scope of the clinical interview to those
symptoms that are useful to establish a reliable diagnosis.
Structural psychopathology, which ‘instead of the trivi-
alities of semiotics, looks for a global level of intellig-
ibility at a stage of synthetic knowledge’ ([21], p. 604).
References and recommended reading
Papers of particular interest, published within the annual period of review, have
been highlighted as:
 of special interest
 of outstanding interest
Additional references related to this topic can also be found in the Current
World Literature section in this issue (pp. 651–653).
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