Phenomenological and Biological Psychiatry: Complementary or

Mutual?

James Morley

Philosophy, Psychiatry, & Psychology, Volume 9, Number 1, March 2002,

pp. 87-90 (Article)

Published by Johns Hopkins University Press

DOI: https://doi.org/10.1353/ppp.2003.0012

For additional information about this article

https://muse.jhu.edu/article/42133

Access provided by University of South Dakota (5 Sep 2018 14:39 GMT)

 MORLEY / PHENOMENOLOGICAL AND BIOLOGICAL PSYCHIATRY
Phenomenological
and Biological
Psychiatry:
Complementary or
Mutual?
KEYWORDS: phenomenology, psychiatry, psychoanaly-
sis, ontology.
We feel that even if all possible scientific questions
be answered the problems of life have still not been
touched at all. (Witgenstein, Tractatus, 6.52)
I
F ONE WAS TO PERFORM a thought experiment
by imagining a scientifically explained uni-
verse, how would this explained universe re-
solve my issues of value and meaning? Would it
help me to live a better life? In one sentence,
Witgenstein expressed exactly the issues divid-
ing, and defining, the phenomenological and bio-
physical approaches to psychiatry. (Natural) sci-
entific questions are concerned with relations of
physical causality while phenomenology is aimed
at the problems of life, i.e., the elucidation of
lived personal meanings.
Clarifying the relation between phenomenol-
ogy and the general psychiatric literature is clear-
ly a significant undertaking. At this juncture in
the history of psychiatry where the biophysical
model is so dominant, the authors’ efforts are
especially welcome, as I wholeheartedly appreci-
ate, and thank the authors for this endeavor. I
only wish to explicate a few issues latent within
© 2003 by The Johns Hopkins University Press
9.1morley 87
■ 87
James Morley
the article and perhaps add a few supportive points.
Explicitly or implicitly, the need for phenomenolo-
gy in psychiatry is long enduring and will always
persist (Ellenberger 1981, 1993). The integration
of phenomenology with general psychiatric prac-
tice would certainly serve the needs of patients
and society generally. But, in the present state of
affairs where the biological model is so preemi-
nent, a full accounting of the dramatic diver-
gences between the two approaches is necessary
if there is to be authentic dialogue between them.
Essentially, I want to stress that phenomenol-
ogy and natural science medicine are genuinely
distinct paradigms for construing reality and or-
ganizing knowledge. As distinct scientific para-
digms, each one is holistically self-contained. Like
soap bubbles, if pushed together too forcefully
one or the other may burst. In this case, it is more
likely that the smaller, less prevalent paradigm
would burst by becoming absorbed into the more
dominant paradigm. I believe that this is precise-
ly the risk when phenomenology is introduced to
conventional psychiatry as “complementary.”
Whereas one could hardly object to any applica-
tion of empathy and understanding toward the
experiences of patients, it would be tragic if the
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 88 ■ PPP / VOL. 9, NO. 1 / MARCH 2002
full philosophical power of phenomenology were
to be overlooked in favor of its mere utility as a
preliminary stage of diagnosis and assessment, a
framework for bedside manners, or worst of all,
an appendage to neuroscience or pharmacology.
This would not be phenomenology but the very
symptomatology that the authors have has so
clearly distinguished from true phenomenology.
This equation of phenomenology with symp-
tomatology is exactly the misunderstanding that
the authors so effectively address. However, I
would hesitate to join the authors’ optimism in
regard to phenomenology’s potential complemen-
tary role to conventional psychiatric practice.
Furthermore, in the process of paradigm mix,
certain constituents of each paradigm may be
taken out of context and the strength of each
paradigm thus diluted. For example, the very
power of the experimental method is its reduc-
tion of phenomena to measurable variables that
can be altered in order to discern causality. Un-
measurable variables detract form the rigor of
this entire approach. Then on the other hand,
phenomenological empathy is only possible within
a standpoint that is severed from the causal think-
ing of experimental science. This is the holistic
perceptual shift that cannot be accomplished
when one only appends phenomenological in-
sights to an otherwise materialist approach to
psychiatry. Thus, it is not at all clear how one
can be both phenomenological and nonphenom-
enologically natural scientific. Instead of posi-
tioning phenomenology as a potential compli-
mentary component of natural-science psychiatry,
both world views need to be examined, on their
own terms, in a framework of mutuality.
Empathy or the understanding of other peo-
ples subjective experience is indeed an essential
component of the application of phenomenology
to clinical assessment and especially therapeutic
treatment. But, to limit phenomenology to this
theme alone may not honor the profoundly radi-
cal character of this paradigm. As the authors
point out, phenomenology asks the practitioner
to engage in what Husserl called the phenome-
nological epoché, which is a skeptical suspension
of doubt and belief in all of one’s ontological
assumptions about reality. In Western culture the
9.1morley 88
natural attitude or prevailing ontological assump-
tions are those of physical science itself. Hence,
Husserl asks us to put even time, space, and
causality under the neutralizing suspension of
the epoché Certainly, this is a radical undertak-
ing that goes beyond “empathy for other points
of view.” It asks for an entirely precategorical
position toward the reality of the world, not just
psychiatric syndromes. In other words, phenom-
enology demands that we enter an alternative
world view, that we alter our own perspective
and enter into a new relation to the world. The
epoché is analogous to a conversion experience.
This is not a matter of assimilating a new experi-
ence into a preexisting framework (as in
pseudophenomenological symptomatology) but
one of accommodation, where the psychiatrist
recasts his or her own mind to adapt to the new
experienceCi.e., to the thing itself.
The phenomenological philosophical move-
ment has developed considerably over the past
century. The recent publication and translation
of Husserl’s later writings (1989) have modified
our understanding of his thought in a way that is
at variance with most conventional commentar-
ies and much updating is in order. It appears to
many scholars that he was moving in a direction
congruent with Heidegger’s (1927) and Merleau-
Pony’s (1945, 1964) existential versions of phe-
nomenology. It is also essential to consider the
later psychologically oriented phenomenologists
such as Alfred Schutz (1973), Aaron Gurwitch
(1966), and especially Merleau-Ponty, who were
all influenced by Husserl’s later unpublished writ-
ings that stressed the lifeworld, holism, embodi-
ment, and intersubjectivity concepts that must be
included in any discussion of contemporary phe-
nomenology.
Despite its many developments, certain themes
that distinguish phenomenology from the project
of natural science remain constant: phenomenol-
ogy is an intuitive science that elucidates mean-
ing whereas natural science is an analytic science
that explains physical events through causality.
Phenomenology seeks an ontological foundation
in precategorically lived experience that precludes
dualisms such as subjectivity and objectivity; in
contrast, natural science is metaphysically found-
4/10/03, 10:51 AM
 MORLEY / PHENOMENOLOGICAL AND BIOLOGICAL PSYCHIATRY
ed on the materialism of modern physics. Phe-
nomenology affirms cultural-historical situated-
ness; natural science affirms the goal of objective
universal knowledge that is beyond the sphere of
cultural and personal situatedness.
Phenomenological psychiatry has already been
instituted by figures such as Kurt Goldstein
(1934), Erwin Straus (1966), Ludwig Binswanger
(1963), and the Duquesne Group (Giorgi 1970)
(to only name a few) who all understood the
physiologic as a stratum within the wider phe-
nomenological paradigm. In other words, these
clinicians used phenomenology as a framework
for understanding the biological dimension, not
as a complimentary appendage to it. Unfortu-
nately, their work seems to have been obscured
by the partial-phenomenology of both Jaspers
and psychoanalysis generally. Kohut’s denial-cum-
acknowledgment of phenomenology is exempla-
ry of the psychoanalytic practice of employing
the insights of phenomenology while feigning the
authority of natural science. Again, an unfortu-
nate confusion caused by paradigm mix, as Ricou-
er showed in his well-known (1970) elucidation
of Freud’s “dual narrative” of science. This issue
aside, Kohut’s approach is one of many examples
of the “common latency” shared by both phe-
nomenology and psychoanalysis. Freud himself
attended five lecture courses with Franz Bren-
tano (Husserl’s own teacher) and was influenced,
albeit indirectly, by some phenomenological ideas
prevalent in the intellectual climate of turn of the
century, German-speaking academic culture.
(McGrath 1987). Points of philosophical conver-
gence with phenomenology can be discerned in
most depth, dynamic, or “humanistic” approach-
es to psychiatry. There exists a literature on the
interface between the phenomenological and psy-
choanalytic psychiatric traditions (for some re-
cent studies, see Morley 1999, 2000; Phillips
1996, 1999; Phillips and Morley 2003; Richard-
son 1964; Wertz 1993). Continued work in this
area could do psychiatry a considerable service.
Can one practice a phenomenological psychi-
atry independent of the prevailing medical mod-
el? In the present state of affairs, I would think
this highly unlikely. Potentially, however, this
could be possible. Far from a absurdly Luddite
9.1morley 89
■ 89
rejection of the technological benefits of natural
science, phenomenological psychiatry would in-
tegrate our knowledge of biological systems into
a wider, encompassing, more (dare I use the word)
holistic or integrative framework. The difference
would be a matter of emphasis. Phenomenology
privileges lived meaning over material causality;
biological psychiatry privileges biological cau-
sality over lived meaning. Apart from extremists,
I believe we all wish to resolve this chasm in the
very heart of our profession. But, as with so
many human affairs, true consensus can only be
achieved through a relation founded on mutual
respect for difference.
Having said all of this, I must add that such
exchanges, as exemplified by this article, be-
tween phenomenology and mainstream psychia-
try could be of great service to clinicians who
may yet be unaware of this rich tradition. Prac-
ticing health care professionals may be relieved
to learn that there is a systematic psychiatric
paradigm that validates so much of their own
hard-earned concrete experience as therapists,
diagnosticians, and supervisors. Clinicians are
often dispirited by explanatory models that can
seem so remote from the raw personal relation-
ships that take place in the in the consulting
room. Articles that elucidate psychiatric phenom-
enology, such as this one, answer a real need in
the profession. On the other hand, traditional
phenomenologists have been rightly accused of
turgid and inaccessible writing styles and cryptic
terminologies. It would behoove phenomenolo-
gists to follow the example of the present au-
thors by abandoning unnecessary jargon, affirm-
ing clarity, and reaching out to a wider audience.
Recent authors such as Francisco Varela (1999),
Shaun Gallagher (1997) and Natalie Depraz
(2002) have also made efforts to naturalize phe-
nomenology, that is, to translate these concepts
in terms comprehensible, even experimentally op-
erational, to physical scientists. Along with the
present article, I cannot more strongly recom-
mend these works to the readers of this journal.
Phenomenology and natural science psychia-
try are radically divergent ontologies, each as
“scientifically” valid as the other. True dialogue
across the paradigms toward integration cannot
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 90 ■ PPP / VOL. 9, NO. 1 / MARCH 2002
be achieved without both sides granting this point.
The authors have successfully inaugurated a long-
overdue reassessment of a psychiatry that would
forgo biologism for “the problems of life itself.”
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