In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may represent the joints of a phenomenologically oriented diagnosis. The “tightrope walking” attitude refers to the psychiatrist’s ability to swing between 2 different and sometimes contrasting tendencies (e.g., engagement and disengagement). The “holistic experience” includes all those intuitive, nonverbal, and pre-thematic elements that emerge in the early stages of the clinical encounter as an emanation of the atmospheric quality of the intersubjective space. The “co-construction of symptoms” regards the hermeneutic process behind psychiatric symptoms, involving both the patient as a self-interpreting agent and the clinician as a translator of his/her experience. Finally, by the “evolving typification” we mean that the closer the relationship becomes with the patient, the more specific and nuanced becomes the typification behind psychiatric diagnosis. Each of these concepts will be accompanied by an extract from a clinical case deriving from one of the authors’ most recent clinical experiences.

1.
Gupta
M
,
Potter
N
,
Goyer
S
.
Diagnostic reasoning in psychiatry: acknowledging an explicit role for intersubjective knowing
.
Philos Psychiatry Psychol
.
2019
;
26
(
1
):
49
64
. .
2.
Nordgaard
J
,
Sass
LA
,
Parnas
J
.
The psychiatric interview: validity, structure, and subjectivity
.
Eur Arch Psychiatry Clin Neurosci
.
2013
;
263
(
4
):
353
64
. .
3.
Srivastava
A
,
Grube
M
.
Does intuition have a role in psychiatric diagnosis?
Psychiatr Q
.
2009
;
80
(
2
):
99
106
. .
4.
Fuchs
T
.
Subjectivity and intersubjectivity in psychiatric diagnosis
.
Psychopathology
.
2010
;
43
(
4
):
268
74
. .
5.
Fernando
I
,
Cohen
M
,
Henskens
F
.
A systematic approach to clinical reasoning in psychiatry
.
Australas Psychiatry
.
2013
;
21
(
3
):
224
30
. .
6.
Morrison
J
.
Diagnosis made easier: principles and techniques for mental health clinicians
. 2nd ed.
New York
:
Guilford Press
;
2014
.
7.
Cargnello
D
.
Ambiguità della Psichiatria
.
Comprendre
.
1999
;
9
:
7
48
.
8.
Markovà
IS
,
Chen
E
.
The hybrid structure of psychiatry
.
Dial Phil Ment Neuro Sci
.
2020
;
13
(
2
):
36
42
.
9.
Giorgi
A
.
Phenomenology and psychological research
.
Pittsburgh, PA
:
Duquesne University Press
;
1985
.
10.
Kraus
A
.
Phenomenological and criteriological diagnosis: different or complementary?
In:
Sadler
J
,
Wiggins
O
,
Schwartz
M
, editors.
Philosophical perspectives on psychiatric diagnostic classification
.
Baltimore
:
The John Hopkins University Press
;
1994
. p.
148
60
.
11.
Stanghellini
G
.
The meanings of psychopathology
.
Curr Opin Psychiatry
.
2009
;
22
(
6
):
559
64
. .
12.
Jaspers
K
.
Allgemeine Psychopatologie
. 1st ed.
Berlin
:
Springer-Verlag
;
1913
.
13.
Jaspers
K
.
Allgemeine Psychopathologie
. 7th ed.
Berlin
:
Springer-Verlag
;
1959
.
14.
Varese
F
,
Smeets
F
,
Drukker
M
,
Lieverse
R
,
Lataster
T
,
Viechtbauer
W
,
Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies
.
Schizophr Bull
.
2012
;
38
(
4
):
661
71
.
15.
Van Snellenberg
JX
,
de Candia
T
.
Meta-analytic evidence for familial coaggregation of schizophrenia and bipolar disorder
.
Arch Gen Psychiatry
.
2009
;
66
(
7
):
748
55
. .
16.
Jaspers
K
.
Die phänomenologische Forschungsrichtung in der Psychopathologie
.
Zeitschr ges Neurol Psychiat
.
1912
;
9
(
1
):
391
408
. .
17.
Fuchs
T
.
Phenomenology and psychopathology
. In:
Gallagher
S
, editor.
Handbook of phenomenology and cognitive science
.
Dordrecht
:
Springer
;
2010
. p.
546
73
. .
18.
Ballerini
A
.
La diagnosi in Psichiatria
.
Roma
:
Carocci Editore
;
1997
.
19.
Lanteri-Laura
G
.
Psychiatrie et connaissances
.
Paris
:
Sciences en situation
;
1991
.
20.
Parnas
J
.
A disappearing heritage: the clinical core of schizophrenia
.
Schizophr Bull
.
2011
;
37
(
6
):
1121
30
. .
21.
Pallagrosi
M
,
Picardi
A
,
Fonzi
L
,
Biondi
M
.
Psychopathological dimensions and the clinician’s subjective experience
. In:
Biondi
M
,
Pasquini
M
,
Picardi
A
, editors.
Dimensional sychopathology
.
Berlin
:
Springer
;
2018
. p.
267
86
. .
22.
Rümke
HC
.
Das Kernsymptom der Schizophrenie und das “Praecoxgefuhl”
.
Zentralb Gesamte Neurol Psychiatrie
.
1941
;
102
:
168
9
.
23.
Rümke
HC
,
Neeleman
J
.
The nuclear symptom of schizophrenia and the praecoxfeeling
.
Hist Psychiatry
.
1990
;
1
(
3 Pt 3
):
331
41
.
24.
Moskalewicz
M
,
Schwartz
MA
,
Gozé
T
.
Phenomenology of intuitive judgment: praecox-feeling in the diagnosis of schizophrenia
.
AVANT
.
2018
;
9
(
2
):
63
74
. .
25.
Stanghellini
G
,
Rossi
R
.
Pheno-phenotypes: a holistic approach to the psychopathology of schizophrenia
.
Curr Opin Psychiatry
.
2014
;
27
(
3
):
236
41
. .
26.
Gozé
T
,
Naudin
J
.
Discussing Rümke’s “praecox feeling” from the clinician’s experience of schizophrenic contact
.
Psicopatologia Fenomenológica Contemporânea
.
2017
;
6
(
2
):
112
23
.
27.
Griffero
T
.
The Invasion of felt-bodily atmospheres: between pathic aesthetics and psychopathology
. In:
Francesetti
TG
, editor.
Psychopathology and atmospheres neither inside nor outside
.
Newcastle upon Tyne
:
Cambridge Scholar
;
2019
. p.
6
34
.
28.
Tellenbach
H
.
Geschmack und Atmosphäre. Medien menschlichen Elementarkontaktes
.
Salzburg
:
O. Müller
;
1968
.
29.
Minkowski
E
.
La schizophrénie
.
Paris
:
Editions Payot & Rivages
;
1927
.
30.
Binswanger
L
.
Welche Aufgaben ergeben sick für die Psychiatrie aus den Fortschritten der neueren Psychologie?
Zeitschr ges Neurol Psychiat
.
1924
;
91
(
1
):
402
36
. .
31.
Wyrsch
J
.
Über die Intuition bei der Erkennung des Schizophrenen
.
Schweizerische Medizinische Wochenschrift
.
1946
;
46
:
1173
6
.
32.
Schneider
K
.
Wesen und Erfassung des Schizophrenen
.
Zeitschr ges Neurol Psychiat
.
1925
;
99
(
1
):
542
7
. .
33.
Costa
C
,
Carmenates
S
,
Madeira
L
,
Stanghellini
G
.
Phenomenology of atmospheres. The felt meanings of clinical encounters
.
Psychopathology
.
2014
;
20
(
4
):
351
7
.
34.
Gibson
JJ
.
The ecological approach to visual perception
.
Boston
:
Houghton Mifflin
;
1979
.
35.
Jensen
TW
,
Pedersen
SB
.
Affect and affordances: the role of action and emotion in social interaction
.
Cogn Semiot
.
2016
;
9
(
1
):
79
103
. .
36.
Churchill
SD
.
On the empathic mode of intuition. A Phenomenological Foundation for Social Psychiatry
. In:
Englander
M
, editor.
Phenomenology and the social context of psychiatry social relations, psychopathology, and Husserl’s philosophy
.
London
:
Bloomsbury Academic
;
2017
. p.
64
93
.
37.
Scheler
M
.
The nature of sympathy
.
London
:
Routledge & Kegan Paul
;
1954
.
38.
Schloßberger
M
.
Max Scheler
. In:
Szanto
T
,
Landweer
H
, editors.
The Routledge handbook of phenomenology of emotions
.
Abingdon
:
Routledge
;
2020
. p.
72
85
.
39.
Gallagher
S
.
Direct perception in the intersubjective context
.
Conscious Cogn
.
2008
;
17
(
2
):
535
43
. .
40.
Thompson
E
.
Mind in life: biology, phenomenology, and the sciences of mind
.
Cambridge, MA
:
Harvard University Press
;
2007
.
41.
Gallagher
S
.
The practice of mind: theory, simulation or interaction?
J Conscious Stud
.
2001
;
8
:
83
107
.
42.
Zahavi
D
.
Self and other: exploring subjectivity, empathy, and sharing
.
Oxford
:
Oxford University Press
;
2014
.
43.
Fernandez
AV
,
Zahavi
D
.
Basic empathy: developing the concept of empathy from the ground up
.
Int J Nurs Stud
.
2020
;
110
:
103695
.
44.
Husserl
E
.
Cartesianische Meditationen und Pariser Vorträge, Husserliana, Bd. I
.
Den Haag
:
Martinus Nijhoff
;
1950
.
45.
Stein
E
.
On the problem of empathy
.
Washington, DC
:
ICS Publications
;
1989
.
46.
Merleau-Ponty
M
.
Phenomenology of perception
.
Abingdon
:
Routledge & Kegan Paul
;
1962
.
47.
Straus
E
.
Von Sinn der Sinne
.
Berlin, Gottingen, Heidelberg
:
Springer
;
1935
.
48.
Weizsäcker
V
.
Der Gestaltkreis. Theorie der Einheit von Wahrnnehmen und Bewegen 4. Aufl
.
Stuttgart
:
Georg Thieme Verlag
;
1950
.
49.
Zahavi
D
,
Michael
J
.
Beyond mirroring: 4E perspectives on empathy
. In:
Newen
A
,
De Bruin
L
,
Gallagher
S
, editors.
The Oxford handbook of 4E cognition
.
Oxford
:
Oxford University Press
;
2018
. p.
589
606
.
50.
Krueger
J
.
Direct social perception
. In:
Newen
A
,
De Bruin
L
,
Gallagher
S
, editors.
The Oxford handbook of 4E cognition
.
New York
:
Oxford University Press
;
2018
. p.
301
20
.
51.
Bizzari
V
,
Dambha-Miller
H
,
Laughaey
WF
,
Carvalho
C
,
Programme
OE
.
Defining therapeutic empathy: the philosopher’s view
.
J R Soc Med
.
2019
;
112
(
3
):
91
5
. .
52.
Svanaeus
F
.
Edith Stein’s phenomenology of empathy and medical ethics
. In:
Magrì
E
,
Moran
D
, editors.
Empathy, sociality, and personhood: essays on Edith Stein’s phenomenological investigations
.
Berlin
:
Springer
;
2017
. p.
171
8
.
53.
Preston
SD
,
de Waal
FB
.
Empathy: its ultimate and proximate bases
.
Behav Brain Sci
.
2002
;
25
(
1
):
1
71
; discussion 20–71. .
54.
Szanto
T
,
Moran
D
.
Empathy and collective intentionality: the social philosophy of Edith Stein
.
Hum Stud
.
2015
;
38
(
4
):
445
61
.
55.
Magrì
E
.
Subjectivity and empathy. A Steinian approach
. In:
Mariani
E
, editor.
Discipline filosofiche: figures, functions and critique of subjectivity beginning from Husserlian phenomenology
;
2015
.
Vol. 25
; p.
129
48
.
56.
Fernandez
AV
,
Zahavi
D
.
Can we train basic empathy? A phenomenological proposal
.
Nurse Educ Today
.
2020
;
98
:
21
2
.
57.
Svanaeus
F
.
The relationship between empathy and sympathy in good health care
.
Med Health Care Philos
.
2015
;
18
:
267
77
.
58.
Koehler
K
.
First rank symptoms of schizophrenia: questions concerning clinical boundaries
.
Br J Psychiatry
.
1979
;
134
:
236
48
. .
59.
Klosterkötter
J
,
Gross
G
,
Huber
G
,
Gnad
M
.
Bassissymptomorientierte Diagnostik schizophrener Vulnerabilität
. In:
Huber
G
, editor.
Idiopathische Psychosen: Psychopathologie: Neurobiologie–Therapie
.
Stuttgart
:
Schattauer
;
1990
. p.
137
48
.
60.
Sass
LA
,
Parnas
J
.
Schizophrenia, consciousness, and the self
.
Schizophr Bull
.
2003
;
29
(
3
):
427
44
. .
61.
Parnas
J
,
Henriksen
MG
.
Disordered self in the schizophrenia spectrum: a clinical and research perspective
.
Harv Rev Psychiatry
.
2014
;
22
(
5
):
251
65
. .
62.
Ruhrmann
S
,
Schultze-Lutter
F
,
Salokangas
RK
,
Heinimaa
M
,
Linszen
D
,
Dingemans
P
,
Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study
.
Arch Gen Psychiatry
.
2010
;
67
(
3
):
241
51
.
63.
Schultze-Lutter
F
,
Ruhrmann
S
,
Fusar-Poli
P
,
Bechdolf
A
,
Schimmelmann
BG
,
Klosterkötter
J
.
Basic symptoms and the prediction of first-episode psychosis
.
Curr Pharm Des
.
2012
;
18
(
4
):
351
7
. .
64.
Parnas
J
,
Handest
P
,
Saebye
D
,
Jansson
L
.
Anomalies of subjective experience in schizophrenia and psychotic bipolar illness
.
Acta Psychiatr Scand
.
2003
;
108
(
2
):
126
33
. .
65.
Parnas
J
,
Handest
P
,
Jansson
L
,
Saebye
D
.
Anomalous subjective experience among first-admitted schizophrenia spectrum patients: empirical investigation
.
Psychopathology
.
2005
;
38
(
5
):
259
67
. .
66.
Nordgaard
J
,
Parnas
J
.
Self-disorders and the schizophrenia spectrum: a study of 100 first hospital admissions
.
Schizophr Bull
.
2014
;
40
(
6
):
1300
7
. .
67.
Ballerini
A
.
Gerd Huber: i Sintomi Base e la riaffermazione della psicopatologia jaspersiana
. In:
Ballerini
A
, editor.
Psicopatologia Fenomenologica: Percorsi di Lettura
.
Roma
:
CIC Edizioni Internazionali
;
2002
. p.
348
51
.
68.
Stanghellini
G
,
Bolton
D
,
Fulford
WK
.
Person-centered psychopathology of schizophrenia: building on Karl Jaspers’ understanding of patient's attitude toward his illness
.
Schizophr Bull
.
2013
;
39
(
2
):
287
94
. .
69.
Ballerini
A
,
Rossi Monti
M
.
La vergogna e il delirio
.
Torino
:
Bollati-Boringhieri
;
1990
.
70.
Ballerini
A
.
La psicopatologia tra “comprendere” e “spiegare”
. In:
Garofalo
A
,
Del Pistoia
L
, editors.
Sul comprendere psicopatologico
.
Pisa
:
Edizioni ETS
;
2003
. p.
31
48
.
71.
Aragona
M
.
The roots of psychopathological understanding: Karl Jaspers’ Verstehen and the influence of Moritz Geiger’s empathy
.
Dialogues Philos Ment Neuro Sci
.
2016
;
9
(
2
):
36
42
.
72.
Stanghellini
G
,
Aragona
M
.
Phenomenological psychopathology: toward a person-centered hermeneutic approach in the clnical encounter
. In:
Stanghellini
G
,
Aragona
M
, editors.
An experiential approach to psychopathology
.
Berlin
:
Springer
;
2016
. p.
1
44
.
73.
Weber
M
.
The methodology of the social sciences
.
New York
:
Free Press
;
1949
.
74.
Schwartz
MA
,
Wiggins
OP
.
Diagnosis and ideal types: a contribution to psychiatric classification
.
Compr Psychiatry
.
1987
;
28
(
4
):
277
91
. .
75.
Husserl
E
.
Ideen zu einer reinen Phänomenologie und phänomenologischen Philosophie II, Husserliana IV
.
Den Haag
:
M. Nijhoff
;
1952
.
76.
Schwartz
MA
,
Wiggins
OP
,
Norko
MA
.
Prototypes, ideal types, and personality disorders: the return to classical psychiatry
.
J Pers Disord
.
1989
;
3
(
1
):
1
9
. .
77.
Schwartz
MA
,
Wiggins
OP
.
Typifications. The first step for clinical diagnosis in psychiatry
.
J Nerv Ment Dis
.
1987
;
175
(
2
):
65
77
. .
78.
Schwartz
MA
,
Wiggins
O
.
Science, humanism, and the nature of medical practice: a phenomenological view
.
Perspect Biol Med
.
1985
;
28
:
331
66
. .
79.
Bormuth
M
.
Karl Jaspers
. In:
Stanghellini
G
,
Broome
M
,
Raballo
A
,
Fernandez
AV
,
Fusar-Poli
P
,
Rosfort
R
, editors.
The Oxford handbook of phenomenological psychopathology
.
New York
:
Oxford University Press
;
2019
. p.
97
104
.
80.
Feinstein
AR
.
An analysis of diagnostic reasoning. I. The domains and disorders of clinical macrobiology
.
Yale J Biol Med
.
1973
;
46
(
3
):
212
32
.
81.
Croskerry
P
.
Clinical cognition and diagnostic error: applications of a dual process model of reasoning
.
Adv Health Sci Educ Theory Pract
.
2009
;
14 Suppl 1
(
1
):
27
35
. .
82.
Marcum
JA
.
An integrated model of clinical reasoning: dual‐process theory of cognition and metacognition
.
J Eval Clin Pract
.
2012
;
18
(
5
):
954
61
.
83.
Monteiro
SM
,
Norman
G
.
Diagnostic reasoning: where we’ve been, where we’re going
.
Teach Learn Med
.
2013
;
25
:
S26
S32
.
84.
Husserl
E
.
Logische Untersuchungen
. 2nd ed.
Tübingen
:
Niemeyer
;
1913
.
85.
Richir
M
.
De l’analyse phénoménologique comme démarche en zig-zag. Actes du colloque franco-peruvien “La notion d’analyse”
.
Toulouse
:
Presses Universitaires du Mirail
;
1991
. p.
141
60
.
86.
Sholokhova
S
.
Benefits and challenges of the phenomenological approach to the psychiatrist’s subjective experience: impassivity, neutrality, and embodied awareness in the clinical encounter
.
Philos Psychiatr Psychol
.
2019
;
26
(
4
):
E83
96
. .
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