Abstract
Although the importance of the psychiatric diagnostic interview is undeniable in the actual clinical practice, its peculiarities as a specific kind of interpersonal phenomenon have not attracted much attention in the literature. This chapter approaches the diagnostic interview from the perspective of research on social cognition, by drawing on discussions about the difference between second-person and third-person relations. We start by motivating a picture of the diagnostic interview according to which the clinician has to draw on multiple sources of diagnostically relevant information. This picture leads to the question of how to approach the complexity of the interview, and the role that the distinction between second-person and third-person relations might play for a better understanding of it. By elaborating on a conceptualization of second-person relations which foregrounds the roles of reciprocity and communication, we propose that second- and third-person relations are complementary methodological tools by means of which the clinician seeks to gain a better understanding of the patient.
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Notes
- 1.
Thought processes are obviously hard to detect if the patient does not communicate linguistically, and one may argue that they do not belong to the expressive features. This issue involves a long debate about the relation between thinking and speech that we will leave out here. Formal thought disorders are here included as an expressive feature showing itself in the speech of the patient, but often without semantic disturbances, e.g., by responding with an answer that is only slightly related to the main topic of the question being asked (tangentiality).
- 2.
See [6] for a critical review.
- 3.
A phenomenological characterization of the clinical encounter along these lines can be found in the work of Gurwitsch. Although Gurwitsch’s work didn’t focus on psychiatry, his view captures a traditional picture: “when the doctor confronts a mental patient whose condition he wishes to diagnose. […] there is no common situation at all obtaining between doctor and patient, in the sense that with respect to this situation they would do something with one another. We only say, however, that a common situation obtains where people do something with one another and, accordingly, live as situational partners. The doctor, however, has before him an object that he investigates—everything that he does and says to and with the patient is guided by this intention. For his part, the patient lives in his world, which we call a pathological world; from and on the basis of this world the patient speaks to the doctor. For the doctor, the patient is not a situational partner together with whom he does something in and according to the sense of a common situation—as his colleague would be when he gives advice about the case. The patient is, instead, an object which the doctor will know and define. To the same extent as the patient, the doctor also has his own situation, the sense of which is to penetrate into the world of the patient but which is not shared as something in common with the patient. As a consequence, the language of the doctor also does not possess the structure of ‘speaking together’ [...], because doctor and patient are by no means ‘together with each other’ in the genuine sense.” ([29], p. 17).
- 4.
“At its heart, a second-person relation involves the experience of being addressed by another, of being seen as a You by another person, and of the mutuality that is generated in seeing the other as a You in turn.” ([41], p. 437).
- 5.
This goes against Brinck and Reddy’s more radical rendering of the second-person perspective as one that may be applicable to the inanimate world. One central example in their discussion is the engagement between potter and clay ([45], p. 25).
References
Millon T. Classification in psychopathology: rationale, alternatives, and standards. J Abnorm Psychol. 1991;100(3):245–61.
Sánchez O, Brownlee-Duffeck M. Medical model. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of clinical neuropsychology. Cham: Springer International Publishing; 2018. p. 2107.
Parnas J, Sass LA, Zahavi D. Rediscovering psychopathology: the epistemology and phenomenology of the psychiatric object. Schizophr Bull. 2013;39(2):270–7.
Parnas J. Differential diagnosis and current polythetic classification. World Psychiatry. 2015;14(3):284–7.
Stanghellini G. The grammar of the psychiatric interview. Psychopathology. 2007;40(2):69–74.
Galbusera L, Fellin L. The intersubjective endeavor of psychopathology research: methodological reflections on a second-person perspective approach. Front Psychol. 2014;5:1150.
Gupta M, Potter N, Goyer S. Diagnostic reasoning in psychiatry: acknowledging an explicit role for intersubjective knowing. Philos Psychiatr Psychol. 2019;26(1):49–64.
Nordgaard J, Revsbech R, Saebye D, Parnas J. Assessing the diagnostic validity of a structured psychiatric interview in a first-admission hospital sample. World Psychiatry. 2012;11(3):181–5.
Spitzer RL, Williams JB, Gibbon M, First MB. The structured clinical interview for DSM-III-R (SCID): I: history, rationale, and description. Arch Gen Psychiatry. 1992;49(8):624–9.
Nordgaard J, Sass LA, Parnas J. The psychiatric interview: validity, structure, and subjectivity. Eur Arch Psychiatry Clin Neurosci. 2013;263(4):353–64.
Laing RD. The politics of experience and the bird of paradise. Harmondsworth: Penguin; 1967.
Laing RD. The divided self. Harmondsworth: Penguin; 1990.
Urfer-Parnas A. Eugène Minkowski. In: Stanghellini G, Broome M, Raballo A, Fernandez AV, Fusar-Poli P, Rosfort R, editors. The Oxford handbook of phenomenological psychopathology. Oxford University Press; 2019. p. 104–110.
Binswanger L. On the manic mode of being-in-the-world. In: Broome MR, Harland R, Owen GS, Stringaris A, editors. The Maudsley reader in phenomenological psychiatry. Cambridge and New York: Cambridge University Press; 2012. p. 197–203.
Parnas J, Urfer-Parnas A. The ontology and epistemology of symptoms: the case of auditory verbal hallucinations in schizophrenia. In: Kendler KS, Parnas J, editors. Philosophical issues in psychiatry IV: classification of psychiatric illness. Oxford: Oxford University Press; 2017. p. 201–16.
Parnas J. A disappearing heritage: the clinical core of schizophrenia. Schizophr Bull. 2011;37(6):1121–30.
Trzepacz PT, Baker RW. The psychiatric mental status examination. New York: Oxford University Press; 1993.
Bleuler E. Dementia praecox oder Gruppe der Schizophrenien. Psychosozial-Verl: Gießen; 1911/2014.
Minkowski E. La schizophrénie. Psychopathologie des schizoides et des schizophrènes. Paris: Petite Bibliothèque Payot; 1927.
Blankenburg W. Der Verlust der natürlichen Selbstverständlichkeit. Ein Beitrag zur Psychopathologie symptomarmer Schizophrenien. 1971.
Sass LA, Parnas J. Schizophrenia, consciousness, and the Self. Schizophr Bull. 2003;29(3):427–44.
Kraepelin E. Lehrbuch der Psychiatrie. 6. Auflage. Johann Ambrosius Barth; 1899.
Rümke H. The nuclear symptom of schizophrenia and the praecox feeling (1948). In: Broome MR, Harland R, Owen GS, Stringaris A, editors. The Maudsley reader in phenomenological psychiatry. Cambridge and New York: Cambridge University Press; 2012. p. 193–6.
Schwartz MA, Wiggins OP. Typifications: the first step for clinical diagnosis in psychiatry. J Nerv Ment Dis. 1987;175(2):65–77.
Goldman AI. Theory of mind. In: Margoilis E, Samuels R, Stich S, editors. The Oxford handbook of philosophy and the cognitive sciences. Oxford: Oxford University Press; 2012. p. 402–24.
Michael J, De Bruin L. How direct is social perception? Conscious Cogn. 2015;36:373–5.
Buber M. I and Thou. Mansfield Centre, CT: Martino Publishing; 2010.
Meindl P, León F, Zahavi D. Buber, Levinas, and the I-Thou relation. In: Fagenblat M, Erdur M, editors. Levinas and analytic philosophy: second-person normativity and the moral life. New York: Routledge; 2020. p. 80–100.
Gurwitsch A. Human encounters in the social world. Pittsburgh: Duquesne University Press; 1979.
Lavin D. Other wills: the second-person in ethics. Philos Explor. 2014;17(3):279–88.
Baron-Cohen S. Mind blindness. An essay on autism and theory of mind. Cambridge, MA: MIT Press; 1995.
Scholl BJ, Leslie. Modularity, development and ‘Theory of Mind’. Mind Lang. 1999;14(1):131–53.
Carruthers P. Simulation and self-knowledge: a defense of theory-theory. In: Carruthers P, Smith K, editors. Theories of theories of mind. Cambridge University Press; 1996. p. 22-38.
Gopnik A, Wellman HM. Why the child’s theory of mind really is a theory. In: Davies M, Stone T, editors. Folk psychology: the theory of mind debate. Oxford: Blackwell; 1995. p. 232–58.
Gallese V. The roots of empathy: the shared manifold hypothesis and the neural basis of intersubjectivity. Psychopathology. 2003;36(4):171–80.
Goldman AI. Interpretation psychologized. In: Davies M, Stone T, editors. Folk psychology: the theory of mind debate. Oxford: Blackwell; 1995. p. 74–99.
Gordon R. Radical simulation. In: Carruthers P, Smith PK, editors. Theories of theories of mind. Cambridge: Cambridge University Press; 1996.
Schilbach L, Timmermans B, Reddy V, Costall A, Bente G, Schlicht T, et al. Toward a second-person neuroscience. Behav Brain Sci. 2013;36(04):393–414.
de Bruin L, van Elk M, Newen A. Reconceptualizing second-person interaction. Front Hum Neurosci. 2012;6:1–14.
Dimberg U, Thunberg M, Elmehed K. Unconscious facial reactions to emotional facial expressions. Psychol Sci. 2000;11(1):86–9.
Reddy V. Why engagement? A second-person take on social cognition. In: Newen A, De Bruin L, Gallagher S, editors. Oxford handbook of 4E cognition. New York, NY: Oxford University Press; 2018. p. 433–52.
Zahavi D. Self and other: exploring subjectivity, empathy, and shame. New York: Oxford University Press; 2014.
Herschbach M. Critical note. How revisionary are 4E accounts of social cognition? In: Newen A, De Bruin L, Gallagher S, editors. Oxford handbook of 4E cognition. 1st ed. New York, NY: Oxford University Press; 2018. p. 513–25.
Taipale J. From types to tokens. Empathy and typification. In: Szanto T, Moran D, editors. Phenomenology of sociality: discovering the we. New York: Routledge, Taylor & Francis Group; 2016. p. 143–58.
Brinck I, Reddy V. Dialogue in the making: emotional engagement with materials. Phenom Cogn Sci. 2020;19(1):23–45.
Overgaard S, Michael J. The interactive turn in social cognition research: a critique. Philos Psychol. 2015;28(2):160–83.
Eilan N. Other I’s, communication, and the second person. Inquiry. 2020:1–23.
Eilan N. Knowing and understanding other minds: on the role of communication. https://warwick.ac.uk/fac/soc/philosophy/news/seminars/consciousness/wmagrads_.pdf. Accessed 18 Jan 2022.
Husserl E. Zur Phänomenologie der Intersubjektivität III. Texte aus dem Nachlass. Dritter Teil. 1929-35. Kern I, editor. Den Haag: Martinus Nijhoff; 1973.
Zahavi D. Second-person engagement, self-alienation, and group-identification. Topoi. 2019;38(1):251–60.
Husserl E. Ideas pertaining to a pure phenomenology and to a phenomenological philosophy.Second book: studies in the phenomenology of constitution. Dordrecht: Kluwer Academic Publishers; 1989.
Caminada E. Vom Gemeingeist zum Habitus: Husserls Ideen II. Sozialphilosophische Implikationen der Phänomenologie. Cham: Springer International Publishing; 2019.
Zahavi D. Intersubjectivity, sociality, community. In: Zahavi D, editor. The Oxford handbook of the history of phenomenology. Oxford University Press; 2018. p. 734–752.
Stanghellini G, Lysaker PH. The psychotherapy of schizophrenia through the lens of phenomenology: intersubjectivity and the search for the recovery of first- and second-person awareness. APT. 2007;61(2):163–79.
Stanghellini G. The puzzle of the psychiatric interview. J Phenomenol Psychol. 2004;35(2):173–95.
Davidson L. Living outside mental illness: qualitative studies of recovery in schizophrenia. New York: New York University Press; 2003.
Craig E. Knowledge and the state of nature: an essay in conceptual synthesis. Oxford: New York: Clarendon Press; Oxford University Press; 1990.
Moran R. The exchange of words: speech, testimony, and intersubjectivity. New York: Oxford University Press; 2018.
Acknowledgments
Felipe León and Dan Zahavi received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 832940). Maja Zandersen and Dan Zahavi acknowledge funding from the Carlsberg Foundation (grant ID: CF18-1107), and Patricia Meindl from the Independent Research Fund Denmark (grant ID: DFF-7013- 00032).
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León, F., Zandersen, M., Meindl, P., Zahavi, D. (2022). The Distinction Between Second-Person and Third-Person Relations and Its Relevance for the Psychiatric Diagnostic Interview. In: Biondi, M., Picardi, A., Pallagrosi, M., Fonzi, L. (eds) The Clinician in the Psychiatric Diagnostic Process . Springer, Cham. https://doi.org/10.1007/978-3-030-90431-9_4
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