Revealing the Disturbed Consciousness and Reforming the Sense of Self: Phenomenological Psychiatry and Its Empirical Application in Schizophrenia

Introduction

Phenomenology, a philosophical tradition initiated by Edmund Husserl in the early 20th century, accounts for the awareness of phenomena in our conscious experience. Consciousness, which is the main subject of phenomenology, is treated as our only contact with the external world that allows us to intend a life-world relationship with the objects as they appear to subjects as the content of a given experience. According to Husserl (1913/1982), this act of consciousness, or noesis, is always intentionally directed at a correlative object of consciousness, or noema, to form the noematic field of our awareness. Intuitively, this phenomenological understanding of the subjective self could be constructive in the field of psychology that studies human minds and behaviors. However, the naturalistic tendency in science separates the person from their empirical senses or functionalities. Instead of viewing the person as a whole, naturalistic psychology is reductionistic and fragments the person into separate psychological processes. Thus, by introducing phenomenology as a frame of reference to psychological research, a wholistic and non-reductionistic research method can emerge to qualitatively assess the difficult phenomena in human consciousness.

This paper overviews the phenomenological method as a rigorous procedure applied in the field of empirical psychology and developed by Amedeo Giorgio (1985). By exercising phenomenological reduction and temporarily suspending the natural attitude, the psychologist collects descriptive data and analyzes it in search of the psychological meaning in the context experienced by the participant. I argue that the phenomenological method is empirically feasible in the qualitative research of human consciousness, with a demonstrable emphasis on its applicability in the psychiatric diagnosis and treatment of mental illnesses such as schizophrenia.

Defined by the American Psychiatric Association (APA 1994), mental disorders are psychological syndromes with clinically significant phenomena of behaviors that impact someone’s ability, health, and freedom of activity, with distress, pain, and a higher risk of disability and suffering. This modern classification of mental illnesses overlooks the subjective experience that is fundamental to patients and their relationships with the illnesses. This paper uses schizophrenia, increasingly characterized as a “clinical-phenomenal disorder of self-experience” (Sass et al., 2011), as the paradigmatic case to demonstrate the empirical feasibility of the phenomenological method that addresses the etiological gap in its classification and offers new treatment directions with a focal point on intentionality in mental causation.

In short, with the phenomenological perspective in psychiatry, schizophrenia is more thoroughly understood with the presence of perplexity that accords with descriptive accounts of diminished self-affection as a conscious subject accompanied by hyperreflexivity in normally tacit phenomena (Sass & Parnas, 2001). And in the cases of treatment-resistant schizophrenia, the recovery process can also be modeled after Giorgio’s phenomenological method to restore their sense of self and a certain “I-You” connection to common sense. Instead of pathologizing patients with symptomatic preconceptions that render patients fragile, the phenomenological method employs the intentionality inferred from the phenomenal essence in description that propels agency to re-orient the disordered self by committing to patterned habits and intersubjective perspectives with shared social meanings. However, the phenomenological process of analysis is at risk of being interpretively relativistic and unrealistic to implement. My paper also responds to this objection by underscoring the importance of epoché in deriving an invariant meaning in phenomenological descriptions and the training of such professionals across psychological and phenomenological understanding of mental illnesses.

Descriptive Phenomenology and its Explanatory Role

Phenomenology places consciousness or the noesis in the central role, through which experiences of real objects are made aware to us. It stresses a certain “givenness” (Giorgi, 1997, p.237) that describes the presence of the noema exactly as they are given in experiences. Instead of seeking to analyze the noema in their objective sense, the phenomenal meaning of the encountered appearances as given is revealed in precise descriptions of the noesis of the experiencer. These meanings are the essence of the intentional correlates of acts. During these acts, the noesis directs itself toward objects, mental and material, in the noematic field of awareness through the conscious function of intentionality, which then forms a subject-object or self-world relationship (Husserl, 1913/1982; Giorgi, 1985). This section overviews the philosophical method of phenomenology and how its descriptive intention can have explanatory significance for the motivation or intentionality behind mental causation.

Husserl’s philosophical method of phenomenology begins with a methodology of reduction. We usually take on a natural attitude towards the existence of objects around us where we naively take their objectivity for granted without questioning how they come to be. Phenomenological reduction requires one to suspend the immediate intuition of the obvious existence of objects external to us and recede to descriptions of them as phenomenal presences perceptually presented to our consciousness. In terms of psychological reduction, the prior knowledge of all phenomena, except for the empirical subject, is bracketed. In this way, the subjective consciousness can exercise linguistic expressions to describe any phenomenon in its awareness directly as given. When practiced in empirical psychology, the researcher must adopt the phenomenological attitude of epoché on the everyday positions of belief towards the descriptions given by the participants, which distinguishes the phenomenological method from other qualitative approaches. By allowing the “givenness” to come in as presented, the psychologist holds back any theoretical presuppositions, stereotypical prejudices, or hypothetical rationalizations and embraces the personally lived experience of participants with a non-dogmatic openness (Englander & Morley, 2021, p.32). Nevertheless, the researcher is aware of the common-sense beliefs in the naïve descriptions, and psychological reduction is only a temporary suspension of the mundane, which will need to be invoked in the restructuring of the descriptions in the later search for qualitative meanings that elucidate the natural attitude.

Very importantly, phenomenal description differentiates itself from causal explanation or interpretation. An explanation usually entails a departure from what is given and searches for historical factors behind these presences to account for it. An interpretation relies on a theoretical ground to make sense of any phenomenon. The primary task of description is to account for the intentional objects in rich details that are limited only to what is precisely given in experience without addition or subtraction (Giorgi, 1997, pp.241-242). Therefore, the data collection through phenomenological reduction of narrative descriptions given by research participants is a descriptive act on the nature of experience rather than an endeavor to explicate the causal mechanisms behind psychological abnormalities. It is not aimed to shed light on the etiological cause when employed in psychiatry but to capture the phenomenal essence of consciousness.

Nevertheless, phenomenology retains an explanatory function when it comes to motivation or intentionality. The descriptive boundary is meant for the reduction to have a purified focus on subjective consciousness without any preconceptions to intercept the narrative phenomena to be given as they are. Husserl advocated for the supplement of explanation to the descriptive aspect in his later work (Sass, 2009, p.636). Particularly, phenomenology can take on an explanatory role in elucidating motivational causality that orients the “fundamental lawfulness of spiritual life” (Husserl, 1989, p. 231). It is different from the natural causality that connects empirical events and seeks to explain the physical causes of psychological phenomena. Instead, it is a form of mental causation that concerns the subject’s attitude in their experience or interpretation of the world that explains the interdependent arising of mental phenomena that make up the coherent consciousness through time (Sass, 2009, p.637). This explanatory role of the phenomenological method that elucidates a subject’s essential intentionality is the key to treating persons with schizophrenia through rebuilding their sense of self and repairing their intersubjectivities with others, which will be discussed in the last section.

Ultimately, the descriptive task within phenomenological reduction aims for the end goal of locating the most durable, intrinsic, and invariant essence behind the noema through reflections. According to Husserl, this meaning-seeking step is conducted with the natural method of free imaginative variation, which spontaneously modifies components of a phenomenon to seek the possibilities of maintaining its core identity while removing the excess properties (Giorgi, 1997, pp.242-243). To convert the essence-producing phenomenological reduction and imaginative variation into an applicable tool in psychology, concrete steps of data analysis on narrative interviews must be taken, which will be explained in the next section.

The Procedural Phenomenological Method Applied in Psychiatry

In empirical psychological or psychiatric research, the scientific essence would have to adhere to a disciplinary perspective of a person directly experiencing a concrete situation. To derive the psychological essence, the phenomenological method, which emanated from Grigio (1985;1997; 2012), goes through the process of data analysis that follows the general structure of “whole-part-whole” (Englander & Morley, 2021, pp. 31-36). This section illustrates these steps with a phenomenological study on mentally ill patients recovering from psychosis.

Once self-reports on the narrative descriptions of lived experience are received from research participants, the data analysis begins with an initial reading of the whole description that provides a preliminary and tentative background for the researcher. The researcher would adopt the epoché in phenomenological reduction that allows her to study the natural attitude of her participants while her own natural attitude is suspended. Then, the process is followed by a division of the descriptive accounts into “meaning units” that are manageable in size for further analysis. It is crucial that no description is lost during the dissection, which requires the researcher to stay within the epoché and forgo the natural attitude that may deem some units as redundant. Nevertheless, variable degrees of discrimination are allowed to focus on the meaning units with the relevant phenomena that fit the research purpose. The next step is for these meaning units to be transformed from descriptions in everyday language into phenomenological descriptions with psychological relevance. During this step, the researcher would need to focus on the central phenomenon of the unit and elucidate the psychological implications associated with the intentionality given in the descriptions. Finally, the last step would be to synthesize the essential and invariant parts to form a new structural whole that is simple, reasonable, and relevant to the context. The last two steps are where the imaginative variation takes place, and the psychological aspects of descriptions are resembled into a new structure with phenomenological essence, such that the meaning will distort with the removal of any parts of it.

In a psychiatric nursing research that focused on patients’ recovery experience from psychosis, the above steps of an empirical phenomenological method were applied and concluded to be insightful in understanding patients’ demands and guiding changes in future psychiatric help (Koivisto et al., 2001). I’ll use this study as an example to illustrate the procedural applications of the phenomenological method outlined above.

The researchers interviewed nine voluntary patients recovering from mental illnesses with psychotic episodes in a psychiatric hospital in Northern Finland. The interviews were open-ended questions about their experience with psychiatric care, where they were asked to describe their admissions and the following events at the facility. The researchers were restricted to only asking for further elaborations from the participants’ narrative descriptions without comments or interjections. The analysis of the 330 pages of transcribed interviews began with a free and open reading of the whole to shift into the interviewees’ natural perspectives without the researchers’ own projections. Then, they delineated each subject’s description into meaning units and carefully transformed the natural language into psychological language without committing to theoretical assumptions. These units of an individual subject were later synthesized imaginatively to uncover the psychological essence with mental contents. Here is an example of transformation with the transcribed texts in brackets (Koivisto et al., 2002, p.262):

“After the operation I felt quite depleted and didn’t have any thoughts anymore. (She experienced herself as empty and did not have any thoughts). So, I felt that I wasn’t myself. (She experienced that she was not herself anymore). I couldn’t control myself and quarreled with the others at home because I tried to protect my significant others against the evil I felt by crossing and blessing them in inadequate situations. (She experienced an inability to control herself. She quarreled with family members because she tried to protect them in inadequate ways.)”

Notice how the transformation step contained little manipulations of the descriptions given, only a change of the first-person perspective into a third-person perspective with psychological revelations behind the natural language, omitting the spiritual particularity when necessary but retaining its relevance and implication for the experiencer. Epoché is being practiced here by the researchers to not intervene in the narrations and alter their psychological meaning. Then, these transformed meaning units were synthesized into a specific description of a situated structure with the essential elements (Koivisto et al., 2002, p.262):

“After the operation she had found herself unable to control her mind and body and had felt that someone from space took control over her. She experienced that these outside forces shattered and re-created her. She had fears that she could harm others, which made her very frightened. She could not think about anything else except her feelings, which depleted all her energy and power. She related these feelings to real incidents at home, which, in turn, caused quarrels between the family members.”

This synthesizing step of imaginative variation enriched the meaning units and elucidated the psychological essence in more explicit languages that reoriented the descriptions in order and in-depth. For example, the spiritual transcendence to an alien force is made connected to the feeling of being out of control by the researcher. Here, that intentionality to care for others and recuperate self-control is revealed with hints on potential aspects in need of psychiatric help.

Because the study interviewed multiple participants, the next step was to overview the individual structures and compare them to locate generalized truths. In this step of generalization, first, the individual phenomenological structures were refreshed again to remove the individual particularities, such that “she had found herself unable to control her mind and body” is replaced by “psychological feelings of a lack of control over self and body” (Koivisto et al., 2001, p.263). Second, these anonymous structures were classified into relevant categories to formalize a general structure, where the feeling of a loss of control is grouped into an experience of self. At last, the researchers were able to conclude on common phenomenal essence of psychotic experience where psychological contents such as the change and loss of self, being controlled by an alien force, and feelings of shame in losing control are pronounced, invariant, and representative across the recovery experience from psychosis. Accordingly, the phenomenological study concluded that future psychiatric care should emphasize regaining that sense of self and easing the associated fears and guilt (Koivisto et al., 2001, p.264). As to how, the explanatory role of the phenomenological method reveals potentialities to effect on patients’ existing intentionality to reform a stable subjectivity and intersubjectivity through creating reliable habits in life that reinvigorate one’s agency and accumulate one’s confidence to care for oneself and others around. Detailed strategies of treatment are elaborated in the last section using the case of recovery from schizophrenia.

In summary, the phenomenological method, when applied empirically in psychiatry, requires simultaneously an explicit rejection and an implicit awareness of the natural attitude of the researcher to capture the participants’ lived experience as given in its immediate presence. With a rigorous methodology of data analysis in the sequential steps of “whole-parts-whole,” common sensical descriptions of conscious experience can be translated into phenomenological descriptions with intrinsic psychological meanings that transcend the intentionality between the noesis and the noema. With a descriptive psychological analysis, the life-world events in human consciousness are elucidated to reveal the intentional meaning. Consequently, these meanings can be used to investigate and rehabilitate the disturbed consciousness experienced in mental illnesses of a disordered self. In short, phenomenology is not only a philosophical perspective of the transcendental consciousness but also a qualitative method that untangles consciousness and can be yielded to further psychiatric research and treatment potential of self-disorders.

Schizophrenia: Disturbance in the Subjective and Intersubjective Self

In the psychiatric diagnosis of schizophrenia, simple quantitative distinctions of positive and negative symptoms that characterize the illness with either excessive mental phenomena such as hallucinations or deficits in normal cognitive or motoric abilities are typical methods of classifications. However, a set of qualitative concepts provided by phenomenological analysis is much richer in capturing the spectrum of abnormalities in patients’ experience of the self. Under the phenomenological method, the essence of an ipseity-disturbance with perplexity is revealed in three experiential facets of schizophrenia: a noetic abnormality with hyperreflexive consciousness in normally operative processes; a noetic abnormality with diminished sensitivity to existing in a unified awareness; and a noematic abnormality that disturbs the normal grip on the world of objects in noematic relationships (Sass, 2009). This ipseity disorder is also referred to as “a crisis of common sense” (Stanghellini, 2001) that regards the core feature of disturbance to be in intersubjectivity, which I argue also stems from the same noematic disturbance in the subject-world relationship in Sass’s phenomenological analysis.

The phenomenological method provides a holistic conception of conscious experience rather than individual symptoms. Phenomenological psychiatry would then have a particular focus on the subjective dimension, which is critical in diagnosing the subtle disturbances of the self in schizophrenia. However, the most prominent method of subtyping schizophrenic disorders is based on a distinction between positive and negative symptoms that are defined quantitatively on the absences or exaggerations of certain psychological processes or phenomena, with the negative symptoms receiving a pathogenic priority (Sass & Parnas, 2001, p.349). These negative symptoms could include poverty of speech, diminished affective responses, apathy, avolition, inattentiveness, and an apparent diminution in other activities that would normally be present, while the positive symptoms indicate the excess presence of phenomena such as hallucinations and delusions (Marneros et al., 1991). Nevertheless, more and more empirical research conducted phenomenologically that forgo these stereotypical and quantitative diagnostic criteria has challenged this dualistic classification and discovered that the seemingly evident “negative” symptoms are often accompanied by “positive” disturbances in cognition. The decline of vitality and the motoric or emotional blockages displayed as deficiencies in the capabilities of normal functions are often accompanied by a hyperreflexive awareness of bodily sensations or the act of noesis as if the consciousness itself becomes a separate noema being watched (Sass, 2000).

In the works of Blankenburg (1971/1991) on schizophrenia, a characteristically “negative” symptom described as the “loss of natural self-evidence” that refers to the loss of the usually unquestioned familiarity of the social world is accompanied by a heightened awareness of structures or processes that normally goes un-noticed (Sass, 2001, p.258). Anne, one of Blankenburg’s central cases, described her phenomenological awareness as constantly doubting how the trivial choices usually made unconsciously, such as putting on clothes or bathing oneself, are done in one way and not another (Sass & Parnas, 2001, p.350). This exaggerated sensitivity on the simplest operational tasks experienced by Anne is on a fundamentally bodily level, with an “operative hyperreflexivity” that constantly interrupts a normally pre-reflective awareness with intrusive feelings or thoughts (Sass, 2009, p.648). Other self-reports that would normally be regarded as attentional deficiencies in the naturalistic attitude also display this excessive self-awareness of their noetic acts. I have two meaning units of descriptions below with my attempts of phenomenologically transforming and synthesizing them in square brackets:

“I have to do everything step by step; nothing is automatic now. Everything must be considered.” (McGhie and Chapman 1961, 108) [She has to attentively perform mundane tasks in rigid routines. A background operation that is normally automatic becomes static in the need of extra attention on every detail of its function.]

“It’s trying to think what they are talking about when they are speaking because I’m concentrating so much and trying to listen to what they are saying, and I lose track of the conversation.” (Chapman,1966, 237) [He excessively ponders on every bit of a conversation as it happens and this rigid concentration on the listening act itself prevents him to comprehend the overall conversation.]

A naturalistic reading of the above narrations or empirical observation of the above acts would immediately point to the incapability to perform basic tasks with motoric blockages and attention deficits, which are stereotypically understood as negative symptoms of schizophrenia. However, when analyzed phenomenologically, there is an invariant theme of being overly attentive to the most basic human functioning, echoing a heightened self-awareness operating statically or rigidly to disrupt a normally coherent consciousness. At the same time, there is an absence of a basic reactivity or intentionality that organizes and unites the spontaneous arising of mental phenomena to give vitality to existence, which is also described eloquently by the writer and schizophrenic Antonin Artaud (1976, p.293) as follows:

“in every [normal] state of consciousness there is always a dominant theme, and if the mind has not ‘automatically’ decided on a dominant theme it is through weakness and because at that moment nothing dominated, nothing presented itself with enough force or continuity in the field of consciousness to be recorded. The truth is, therefore, that rather than an overflow or an excess there was a deficiency; in the absence of some precise thought that was able to develop, there was slackening, confusion, fragility”

Analyzing Artaud’s description phenomenologically, his consciousness experiences an abnormality of a lack of domination by any precise thought that is assertive or definite enough to occupy the mind at a given moment, leaving the mind in a vulnerable and confused state. This essence of deficiency echoes the diminished sense of self where one simply feels to be there but without being present with existential certainty. A loss of intentional directedness occupies a mind that is normally organized with myriad motivations to act and react. Concurrently, to notice and even articulate such a lack of vital existence, one must be hyper-conscious of the level of reality that usually hides at the back of our minds.

Here, a perplexity of abnormalities reduced as the phenomenological essence where an overflown self-awareness accompanies a diminishing evidential grasp of existence better captures the subtleties of schizophrenia than a quantitative approach that separates the negative deficiencies of psychological processes from the positive influx of mental phenomena. The phenomenological analysis of schizophrenia reveals that negative and positive symptoms occur simultaneously, which distort the noesis to be hyperreflexive in the pre-reflective senses with a diminished sense of the normal self. It creates a disturbance in noetic awareness of the subjective self where it is disrupted by a more pronounced reflexivity in the inhabited or taken-for-granted phenomena, and a diminished self-affection demonstrated through the loss of intentionality or vital existence (Sass, 2003, pp.155-156). It also generates a disturbed noematic field where normal directedness from noesis to noema becomes disordered, with ambiguous connections to noema that fractures the usual perceptual grip of the world (Sass, 2009, p.639).

Another essential feature shared among the above phenomenological descriptions is a tolerance of the ambiguity that emerged in every psychological process that used to be as simple and straightforward as listening. This aspect is also referred to as “a disorder of common sense” (Stanghellini, 2001), which constitutes our relationship with the world of noema through the noesis. Nevertheless, this common sense that we use to typify and interact with mundane tasks and daily encounters is bracketed in schizophrenia. Lacking this critical and reflective ability that allows humans to behave instinctively on a social database of tacit knowledge, schizophrenia impedes and disrupts one’s intersubjective relationship with others, which in turn intensifies the vulnerabilities and fragilities experienced by persons with schizophrenia, resulting in a defective attunement to social settings. Nevertheless, this difficulty in engaging in socially shared rules originates from the disturbed grip of the world represented in the noematic field of awareness. This perceptual ground is the basis of any subjective experience, it is “a general setting in which my body can co-exist with the world” (Merleau-Ponty, 1962, p.250). The gradually diminishing self-evidence that takes stock of social knowledge in relationship building comes from a constantly weakened noesis, absent of common-sensical thoughts, vacant yet intensively occupied by an introspective hyper-awareness of the noesis itself as another noema, which is articulated by Artaud in his conscious experience earlier. Living long enough with such an ipseity disorder that impairs the fundamental common sense of social life inevitably ruptures the intersubjectivity between a person with schizophrenia and the external social world.

Overall, a phenomenological method that demanded epoché from the researchers to abandon the quantitative subtyping of the symptoms and focus on the nuanced conscious experience of patients led to insightful knowledge of the subjective and intersubjective experience of schizophrenics. It is proof of the empirical significance of phenomenology in psychiatric research that corrects the fundamental classification of schizophrenia.

Phenomenological Treatment of Schizophrenia: From Intentionality to Shared Meaning

Given the phenomenological discoveries of the disordered subjectivity and intersubjectivity with a lack of intentionality in the noetic act, treatment of schizophrenia can be modeled accordingly in these areas. By focusing on the role of the person and the person’s activity behind the disorder, with a phenomenological emphasis on intentionality, temporality, and psychological meaning of self, significant progress in recovery can be made in treatment-resistant schizophrenic cases (Davidson, 1992). Meanwhile, intersubjective relationships or an “I-You” perspective of social attunement is also a key aspect in re-establishing that missing existential grasp of the social world, where a phenomenologically oriented method of psychotherapy becomes valuable (Stanghellini, 2007). Whether it is by focusing on the subjective or the intersubjective self, a phenomenological treatment of schizophrenia seeks to utilize any intentionality revealed in the first-person description of experience, where that intentional essence offers possibilities to motivate actions and instill enduring meaning in one’s life that restores their distorted perceptions of themselves and with the world.

Before all else, a phenomenological approach shifts the psychiatric focus away from being solely on the mental illness itself but toward the conscious experience of the person as a whole. Instead of considering the person as entirely overpowered by the illness under the implicit assumption that “once a schizophrenic, always a schizophrenic,” the improvement process addresses the person’s agency to overcome the disorder (Davidson, 1992, p.4). It differs from a cognitive approach that understands schizophrenia in terms of dysfunctional cognitions through positive and negative symptoms to revise their beliefs and behaviors. Instead, it focuses on the disturbed self and its vulnerable link to the social environment where it is hard to establish a shared second-person view of oneself (Stanghellini, 2007, p.170). Therefore, the phenomenological method begins with epoché of the assumption of patients as helplessly consumed by mental illnesses and proceeds with an openness to the patients’ phenomenal experience as described so that their existing agencies in areas outside the illness can be apprehended to facilitate meaning-producing activities for treatment purposes.

In a proper phenomenological treatment that reignites personal agencies, three elements must be present in any conscious experience: intentionality, temporality, and meaning (Davidson, 1992, pp.5-7). The primary aspect of agency would be intentionality in the noetic act when the noesis is directed to a particular noema in the noematic field. Even though a schizophrenic person experiences a sense of confinement in terms of the range of activities to take on, he or she would still retain this ability to intend as a very basic aspect of consciousness. In addition, to discover the intentionality unrelated to schizophrenia, a perspective of temporality must be considered to examine life experiences that existed before and will extend beyond the illness in the future. It is critical to understand that the schizophrenic person exists outside the cross-section of his or her illness at different times of life. Lastly and importantly, meaning must persist in phenomenal experiences to effect a change in a person’s attitude or actions toward schizophrenia. With these three elements of intentionality, temporality, and meaning, a phenomenological framework can be structured to treat persons with schizophrenia as capable agents instead of lost causes of mental illness.

In an empirical study that interviewed 74 subjects with psychiatric disorders over a three-year period, gradual recoveries were found to be strongly associated with the phenomenological approach that centers around the discovery of an enduring and revitalized sense of self (Strauss et al., 1985). The treatment process begins with a phenomenological understanding of the person as a separate entity from the illness, where possibilities of a positive and active self are disclosed. Betty, one of the participants of the study, described how her nurse encouraged her sense of agency, “And she knew I had potential and talent and all this and that I could get better, and I knew it too. And I just woke up. I wasn’t hallucinating as much, and I was active and eager, and I was also more social” (Davidson, 1992, p.8). Through a phenomenological transformation and synthesizing, we see Betty as displaying a will to manage her condition and become more active and attuned to the social world, encouraged by the acknowledgment she reciprocally received from others. What must follow from this will to separate oneself from the illness must be further interviews where specific areas of interest can be utilized to strengthen this faith of the capable self through repetition of activities that take stock of existential evidence. In Betty’s case, she enjoyed jazz. And the act of allocating time to listen to jazz every day enforced a persisting sense of productiveness and responsibility in her. It is a trivial activity, but that organization of the pre-reflective sense in performing simple tasks is exactly what tunes down the hyperreflexivity seen in an earlier description where even the act of listening itself is challenging.

The discovery of a certain motivation for a new self is also intricately tied to one’s shared sense of intersubjectivity. Listening to jazz on the radio can find its social following where one shares a common interest with others—this achievement of being attuned and accepted nourishes that renewed self to be more stable. One re-establishes a second-person view through an activity with shared social meaning, and that view starts in a psychotherapy session with the therapist. Grieg, a person with schizophrenia who had seen a therapist for more than four years, started his session with a phenomenological psychologist, Paul Lysaker, by describing the “bad things” in his life (Stanghellini, 2007, p.167). The therapist did not make assumptions about why Grieg was experiencing distress but constantly reiterated his descriptions in a second-person view, expressing and confirming Greig’s feelings by saying, “You are feeling bad” and “Something has happened to you” without interceptive guesses. When Greig described that people are not his friends, the therapist simply acknowledged this with epoché by saying, “You have no friends.” These constant affirmations eventually helped him open up about how he felt humiliated and hopeless when he failed to help his adult children and ended up destroying a valuable item (Stanghellini, 2007, p.168). By constantly offering a “you” perspective from the therapist, the person being treated can re-experience the same description with a re-asserted second-person perspective. This is a tactic developed from the phenomenological lens where schizophrenics experience a loss of touch with common-sensical social agreements through their disordered noematic field. The therapist’s aim would be to highlight how a subjective experience is viewed intersubjectively to firstly offer empathy and encourage that agency beyond illness and secondly foster a reciprocal affirmation of other people’s views that reinitiate a grasp of social reality. Betty evidently also benefitted from a similar acknowledgment of agency from her nurse, where such an affirming act with an “I-You” relationship saw the person behind the illness in the smallest unit of social relationships between two people. It builds a partnership in the treatment process that eventually would lead to shared meanings at the intersection of two subjectivities in the therapeutic processes and offers a scaffold for a renewed sense of self to reconnect with the societal horizon (Stanghellini, 2007, p.175).

Gradually, the efficacious sense of self replaces the helpless sense of self by providing a refuge immune to the illness that, in turn, generates vital meanings of existence to combat the destabilizing aspects of the illness. Betty regains control in one aspect of her life through jazz to battle with the schizophrenic side of her. In Greig’s case, where he discovered a strong motivation to be an active agent who is capable of maintaining intersubjective relationships, small acts of relationship-building may be worked through in future sessions to help him gain that intuitive social knowledge in interpersonal networks. In general, by uncovering the person’s intentionality independent of the illness, which one can act on and build meaningful and enduring life projects with, this qualitative understanding of schizophrenia leads to encouraging progress that rehabilitates the subjective sense of self through personal agency and revitalizes the intersubjective sense of self through second-person acknowledgments in psychotherapy.

Overall, the phenomenological approach to psychiatric research is not only empirically valuable to the classification of schizophrenic disorders but also to the treatment process. By letting go of the quantitative, clear-cut, and non-interactive distinctions of positive and negative symptoms, as well as the presupposition of mental disorders as a biological illness detached from the person, a well-rounded understanding of schizophrenia as a person-related illness emerges and reveals its symptomatic perplexity with a personal narrative of hope and action that inculcates shared meaning of social attunement inside and outside the therapeutic process.

Conclusion

The phenomenological method of approaching consciousness as undetachable from the person and detachable from the illness provides a holistic and non-reductionistic view of human psychology that is empirically applicable in the research of psychiatric disorders such as schizophrenia. However, objections may be raised in terms of how this method could be converted into precise, repeatable, and manualized techniques in psychotherapy so that it could be massively delivered in mental health care with efficiency. Even with the 5-step data analysis that grounds the method procedurally, one can argue that the process of translation for phenomenological meaning is largely interpretive and varies qualitatively with different researchers, which makes the method unreliable and relativistic.

To this objection, I first want to clarify the differences between interpretation and description. The former has a strong connotation that something unclear is in need of a theoretical explanation external to what is given and renders the givenness apparent (Giorgi, 2014, p.544). The phenomenological method begins with pure description, where the givenness is grasped as is in linguistic communications without external references. The transformations of first-hand lived experience into phenomenological meaning are looking for expressions of the noema in intentionality that best satisfies the participant’s life-world description (Giorgi, 2012, p.8). These descriptions are bestowed with meaning within them, which are transformed and synthesized to reveal their essence, where any researcher who receives the description can derive the true and invariant theme with phenomenological reduction and imaginative variation. As seen in the different descriptions of schizophrenia quoted in earlier sections, an interpretive framework would be judging based on the acts described to infer cognitive-motor dissonance in the example of Anne’s inability to put on clothes or florid auditory signals and attention deficits in the case of having trouble to listen to conversations. However, a phenomenological method is aimed at the substructures or categorical features of conscious experiences without any pre-supposed external theories rooted in particularities or instantiations. Therefore, with the same pool of descriptive data, any phenomenological psychiatrist should be able to deduce the same transcendental essence that describes unchanging characteristics of the studied experience.

In other words, the phenomenological method is not interpretively relativistic, but it can be inferred to be so due to the real difficulty in the method, which is to have the researchers consummate in applying the phenomenological method. For researchers, the epoché of the natural attitude is the real challenge. An informed interviewer needs to be sufficiently trained in the phenomenological theory and the psychiatric practice so that this rare “dual citizenship” (Englander & Morley, 2021, p.50) in both phenomenological philosophy and empirical psychology can guide the interviewees to give descriptions of their immediate awareness and make clinical judgments with a flexible distance to the naturalistic assumptions. A philosopher versed in textual phenomenology would be inexperienced in communicating with patients describing life-world phenomena, and a psychologist alone may have a difficult time overcoming the naturalistic attitude to apply phenomenological reduction. Therefore, I argue that the method itself is empirically reliable but requires sufficient interdisciplinary training of such researchers, from where the method is standardized with these medically capable professionals. Promisingly, there are schools of psychotherapy that offer institutionalized training that supplements the naturalistic psychological tradition with an applied phenomenological perspective. Though a cross-disciplinary requirement on psychiatric training erodes the method’s appeal by being labour-intensive and procedurally complex, its empirical significance in psychiatry argued in the paper is worthy of making a call for collaborations between phenomenology and psychology.

In the end, the empirical application of the phenomenological method is feasible but relies critically on the researcher’s attitude of epoché during the phenomenological reduction. The key is to generate invariant meanings of descriptions that are essential and reliable. These meanings can then lead to a better understanding of psychiatric disorders with intricate dimensions of human consciousness and significant progress in the subsequent treatment where the person of intentionality takes precedence over the naturally assumed overpowering illness.

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