A personal viewpoint piece published in The Lancet Psychiatry advocated for the integration of a phenomenological dimension to psychiatric research. Phenomenology centers around the subjective experience of the patient. A phenomenological approach to psychiatry aims to improve treatment outcomes by prioritizing patient accounts over a standardized “checklist” of symptoms.
While phenomenological psychopathology is currently peripheral to mainstream psychiatry, prior editorials in the Lancet Psychiatry have called for renewed focus on phenomenology in treatment. One review from 2021 found that a phenomenological approach affords a richer definition of clinical delusions than that provided by the current psychiatric paradigm.
Standard psychiatry defines delusions as “strongly-held false beliefs” and describes false beliefs as the result of faulty reasoning. Phenomenologists, by contrast, argue that delusions are not a result of errors in reasoning. Instead, most patients have difficulty integrating delusions with existing beliefs and are aware that these thoughts may “[belong] to a different realm of reality.”
Delusions are also accompanied by disruptions in self-awareness and selfhood, which are not characteristic of false beliefs. “It is perhaps tempting to conclude that there is nothing unique about the phenomenological analyses,” the authors wrote. However, the analyses “meaningfully inform phenotypic studies of mental health conditions, as they enhance the granular resolution for particular clinical cases on which universal phenotype definitions are usually based.”
As a method of integrating phenomenology with mainstream psychiatry, authors of the piece described applied ontology. Ontology broadly refers to a set of structured definitions that describe entities in a domain and the relationship between entities. Ontologies contain unique identifiers, definitions, names, synonyms, and other pertinent metadata. In the field of biology, a prominent example is the Gene Ontology, which “provides…terminology for the functions of genes across species,” using a controlled vocabulary that is interpretable across specialties.
The authors proposed the development of the Ontology of Phenomenological Psychopathology (OPheP), an ontology connected to the larger existing Mental Functional Ontology. OPheP is comprised of entities related to disruptions of the basic conscious experience. Entities of interest include disruptions of the conscious experience that have been identified in schizophrenia, hyper-reflexivity, alienation, and delusions of control. Future development of the OPhep will require “community-wide participation to enhance…[the] definition of entities in phenomenological psychopathology.”
According to the authors, further integration of phenomenology in psychiatry is anticipated to improve the understanding of mental health symptoms, center patient experiences, and encourage treatment innovation. However, achieving these benefits is “contingent on our practical ability to integrate entities…from this domain with mainstream psychiatry,” the authors wrote. “As such, the development of the OPheP resource can be understood as an effort to mitigate this fundamental challenge related to the capture and integration of data, information, and knowledge.”
Larsen RR, Maschião LF, Piedade VL, Messas G, Hastings J. More phenomenology in psychiatry? Applied ontology as a method towards integration. Lancet Psychiatry. Published online July 8, 2022. doi:10.1016/S2215-0366(22)00156-0