Saturday, 19 September 2015

Let’s not kill Phenomenology

Phenomenology is defined as first person subjective descriptions of what it means to live in a subjective world. That is, it is more concerned with lived experience rather than objective truths. In Psychotherapy this has traditionally been a powerful tool for helping people understand and come to terms with how they perceive the world and what it means to live in their subjective world.

With the surge in neuroscience and the heavy weight of authority given to DSM V (Diagnostic and Statistical Manual of the American Psychiatric Association), the phenomenology of psychiatric and psychological clients seems to have become less important. Both Neuroscience and the DSM have revolutionised the way we think about mental health, but we run the risk of converting clients into “objects of research”.

Objective classifications as laid out by the DSM and developments in Neuroscience research enable to emphasise the external, observable, measurable and recordable features and characteristics of a mental disorder. Undoubtedly this gives clinicians a huge advantage in helping sufferers and advances in Neuroscience help understand the how and the why.

However, it is also of upmost importance, in my opinion, not to lose sight of the clients lived experience of such phenomena.

Below I’d like to present two different perspectives for the same phenomena, the first is a description of Agoraphobia reproduced from A different existence by Van de Berg. J 1972

“The houses…gave the impression of being closed up, as if all the windows were shuttered, although he could see this was not so. He had an impression of “closed citadel”. And looking up, he saw the houses leaning over towards the street, so that the strip of sky between the roofs was narrower than the street on which he walked. On the square, he was struck by the expanse that far exceeded the width of the square. He knew he would not be able to cross it. An attempt to do so would, he felt, end in so extensive realisation of emptiness, width, rareness and abandonment that his legs would fail him. He would collapse…It was the expanse, above all that frightened him.”

Secondly, I have my copy of DSM V open at page 217 and it states:

Agoraphobia

      A.      Marked fear or anxiety about two (or more) of the following five situations

·         Using Public Transport
·         Being in open spaces
·         Being in enclosed spaces
·         Standing in line or being in a crowd
·         Being outside of the home alone

      B.      The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms.”

The second enables me to coordinate well with my support psychiatrist and helps me to plan strategies and interventions, but the first powerful description helps me to understand what it means to clients to live in “their world”. Both perspectives are of equal importance.