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Intersubjectivity and Neuroscience in the Diagnostic Process

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The Clinician in the Psychiatric Diagnostic Process
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Abstract

Advancements in neuroscience have fostered substantial research in psychopathology, opening many new questions. Classically, psychiatric diagnosis was considered a descriptive activity based on the detection of “objective” symptoms. Based on this model, researchers have tried unsuccessfully to find the neurobiological dysfunctions responsible for mental disorders. Here, the characteristics and limitations of reductionist and translational research programs are described.

As an alternative to the reductionist approach, it is here emphasized that, in diagnosing a mental disorder, the interviewer must grasp what the patient is experiencing and acknowledge how it resonates with his or her own experience of similar phenomena. This must be done while being aware of the clinician’s own emotional reactions to the patient’s interpersonal communication, and conversely of the reactions of the patient to the interpersonal encounter with the clinician. Provided that intersubjective dynamics have diagnostic relevance, the question explored here was whether neuroscience can help in the development of a better conceptual understanding of these (largely implicit) processes.

Empathy for pain is used as a concrete example of how neuroscience has explored an intersubjective phenomenon. This area of research shows how early models of automatic bottom-up activity can be replaced by more complex accounts, with, in the case of empathy, several areas involved in the network, a top-down modulation, and a temporal dynamic of activation. This example suggests the fruitfulness of interdisciplinary research in which phenomenological analyses offer to researchers well-determined phenomena to be investigated, and conversely, experimental findings solicit possible revision of early phenomenological distinctions.

I argue here that a similar approach can be used in research exploring intersubjective phenomena occurring in psychiatric interviews, such as the clinician’s emotional resonance, including praecox feeling. It is acknowledged that by conceiving new instruments to assess the clinician’s subjective experience with the patient, European psychopathology has made a significant step forward in this direction.

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Aragona, M. (2022). Intersubjectivity and Neuroscience in the Diagnostic Process. 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_6

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  • DOI: https://doi.org/10.1007/978-3-030-90431-9_6

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  • Online ISBN: 978-3-030-90431-9

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