Looking for the Self in Psychiatry: Perils and Promises of Phenomenology-Neuroscience Partnership in Schizophrenia Research

Schizophrenia is a mental disorder with high rates of prevalence in the United States and elsewhere (Jablensky 1999). It is listed as the ninth leading cause of disability worldwide (Thaker and Carpenter 2001). Yet, precisely what schizophrenia is, how its etiology unfolds, and which treatments are most effective in treating it remain largely controversial. It is diagnosed primarily according to the criteria provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, these particular criteria have been the target of a number of criticisms, resulting in a Kuhnian crisis in the DSM-led schizophrenia research. There are a number of anomalous research findings inconsistent with the dominant DSM paradigm. Consider a few. First, DSM’s phenomenology-oriented critics suggest that the symptoms and signs listed in the DSM’s schizophrenia category do not match the clinical realities of the patients (e.g., Parnas 2000; Parnas and Handest 2003). There are also environmental, cultural, and gender-related variations in the expression of the symptoms (American Psychiatric Association 2013, 103). Second, there are concerns about the DSM’s reliability; there is no uniformity between the DSM and the International Classification of Diseases (ICD) with respect to schizophrenia diagnostic criteria (Jansson et al. 2002). In fact, based on such findings, some philosophers and psychologists including Richard P. Bentall (1993; see also this volume), Mary Boyle (1990), and Jeffrey Poland (2007) have argued against considering schizophrenia as a discrete illness. For instance, Bentall challenges the view that what are considered the symptoms of this condition fall neatly under the label “schizophrenia,” and that hallucinations and delusions associated with the condition are meaningless. In this regard, the concept of “schizophrenia” is similar to a number of other concepts; for example, “phlogiston” and “the luminiferous ether” were widely employed by scientists for a time but turned out to be scientifically misleading (Bentall 1993, 227). These concerns are mirrored also in the psychiatric community, especially in the United Kingdom and continental Europe, where there is an international debate on what to replace the concept of schizophrenia with. Third, there are cultural variations in recovery rates; for example, third-world countries have higher recovery rates than first-world countries (Warner 2009). Finally, there is skepticism raised by the National Institute of Mental Health (NIMH) about the DSM-led research program’s efficacy in encouraging research into the genetic and neural etiology of mental disorders; these concerns are applicable to schizophrenia (Insel 2013). It remains to be seen how schizophrenia will be targeted by the NIMH’s Research Domain Criteria project—the proposed research alternative to the DSM-5. Psychiatric research on schizophrenia is currently undergoing a period of extraordinary science, to apply Kuhn’s terminology to the current situation in psychiatry, with many alternative research programs investigating the illness using different assumptions and methodologies. As the struggles the DSM-led research faces are now “more generally recognized as such by the profession,” trust in the dominant DSM-led research paradigm is shaken, and “numerous partial solutions to the problem” are made available (Kuhn 1962, 82–83). I use philosophical tools in this chapter to evaluate one of these alternative research approaches that I call “phenomenology– neuroscience partnership” (PNP). First, in the “Phenomenological Approach to Schizophrenia” section, I lay out the phenomenological approach to schizophrenia that is critical of the DSM-led research. Next, in the “Phenomenology–Neuroscience Partnership in Schizophrenia Research” section, I focus on the PNP that takes this phenomenological approach as a starting point to investigate schizophrenia, and I ad