The British Journal of Psychiatry (2005) 186: 547-548
© 2005 The Royal College of Psychiatrists
Disembodied Spirits and Deanimated Bodies: The Psychopathology of Common Sense
Matthew R. Broome, Lecturer
Section of Neuroimaging, Division of Psychological Medicine, Institute of
Psychiatry, De Crespigny Park, London SE5 8AF and Honorary Specialist
Registrar, Brixton Community Mental Health Team, Maudsley Hospital, London SE5
8AZ, UK
By Giovanni Stanghellini. Oxford: Oxford University Press. 2004. 225 pp.
£29.95 (pb); £65.00 (hb). ISBN 0 19 852089 1; 0 19 852088 3
This is the most recent of the successful and influential Oxford University
Press series ‘International Perspectives in Philosophy and
Psychiatry’ and, in common with the others, it is well-written and a joy
to read. In this marvellous book, Stanghellini considers both schizophrenia
and bipolar affective disorder and in doing so reinvigorates and resurrects
psychopathology as more than just the listing of symptoms: he proposes it as
the ‘science of the meanings of abnormal human phenomena’
(p. 33). This process, through the
particular analysis of these disorders as disorders of common sense, returns
psychopathology to its rightful place as the science concerned with
understanding our patients and their symptoms, rather than eliciting and
charting them. He argues that phenomenology is the method clinicians and
researchers can use to provide an in-depth understanding of the experiences of
those with paranoid and affective psychoses. Therapeutic and theoretical
advances are likely to depend on more structured and detailed approaches to
mental states. Certainly, in psychiatry, there is a growing concern that the
validity of our diagnostic categories has been at least partially sacrificed
to improving the reliability of clinicians in detecting mental disorders. This
improvement has been facilitated by operationalised diagnostic criteria and
standardised interviews. This has occasionally led to the unintended but
nevertheless unfortunate consequence that the symptoms that make up a given
disorder can be viewed as discrete and atomistic, rather than as interrelated
holistically within the patient and their social and physical environment.
Phenomenology may help psychiatry to look beyond this current conception of
symptoms as non-specific and isolated to more subtle and specific disorders of
subjective experience. A delusion, for example, is not an abstract proposition
but a world the patient inhabits.
Clinicians and biological psychiatrists should not be put off by the
mention of philosophy or phenomenology. The book is not an esoteric, arcane or
otherwise impractical read: rather, through the vignettes and the insights
Stanghellini provides, it serves as a guide and a way for psychiatry to
remember itself through a return to listening, and trying to understand, what
our patients tell us. The data provided from such in-depth analysis of
subjective experience, Stanghellini argues, can be of enormous benefit for
both diagnosis and classification, as well as scientific psychopathology where
neuroscientists need to clarify the object under investigation.
It is hard to think of any psychiatrist who would not gain from reading
this book, and it has much in it to be recommended to carers and patients
confronting the sometimes frightening and disorienting reality of psychosis.
As Jaspers reminds us, ‘It is impossible to explain something without
previously understanding it’.
