Understanding Psychosis: Integrating Phenomenology and Descriptive Psychopathology

Psychosis involves a profound disruption in how a person experiences themselves and the world, marked by symptoms such as loss of reality testing. Standard psychiatric approaches often rely on descriptive psychopathology, which can miss the rich subjective experiences of those affected. This paper proposes an integrative framework that combines phenomenology—the study of first-person conscious experience—with descriptive clinical categorization. By examining disturbances in basic selfhood and perception of the outer world, the authors aim to bridge standardized evaluation with personal narrative. They describe psychotic features transdiagnostically, viewing psychosis as a dynamic disruption in experiential frameworks from early stages. Incorporating empathic, intersubjective communication into psychiatric interviews supports person-centered care and may improve early intervention, therapeutic alliances, and treatment strategies.

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Abstract

Psychosis constitutes a profound alteration in the individual's relationship with the self and the world, expressed through symptoms signalized by loss of reality testing. Mainstream psychiatric approaches often rely heavily on descriptive psychopathology, which may overlook the multifaceted subjective experiences of affected individuals. This paper outlines an integrative framework to enhance the understanding of psychosis, bringing together phenomenology – the study of structures of consciousness as lived from the first-person perspective - with descriptive psychopathology, which represents the clinical categorization of symptoms. Drawing on phenomenological philosophy, we examine disturbances in the basic structures of selfhood and the perception of the outer world that underpin the observable features of psychotic symptoms along with their clinical course. Through the transdiagnostic description of psychotic features in both primary and secondary psychosis, we aim at bridging the inconsistencies between standartized evaluation and the personal narrative of the individual affected. By focusing on the interplay between symptoms and experiences, we examine the psychopathology of psychosis as a dynamic phenomenon of fundamental disruption in the individual's experiential framework, which is reflected in the clinical manifestations already present from the initial stages of the disorder. The alignment of phenomenological insights with structured clinical observations, enriches the conceptualization and assessment of psychotic phenomena. Moreover, on the basis of an established scientific knowledge regarding recognition and treatment of psychotic disorders, the incorporation of an intersubjective empathic communication in the psychiatric interview further supports a person-centered therapeutic orientation. Integrating phenomenological insights and descriptive psychopathology into assessment and care may advance early intervention, therapeutic alliances and effective treatment strategies in psychosis.