Taking subjectivity seriously: towards a unification of phenomenology, psychiatry, and neuroscience

An Overview of Neurophenomenological Approaches to Meditation and Their Relevance to Clinical Research

There is a renewed interest in taking phenomenology seriously in consciousness research, contemporary psychiatry, and neurocomputation. The neurophenomenology research program, pioneered by Varela, rigorously examines subjective experience using first-person methodologies, inspired by phenomenology and contemplative practices. This review explores recent advancements in neurophenomenological approaches, particularly their application to meditation practices and potential clinical research translations. First, we examine innovative multidimensional phenomenological assessment tools designed to capture subtle, dynamic shifts in experiential content and structures of consciousness during meditation. These experience sampling approaches enable shedding new light on the mechanisms and dynamic trajectories of meditation practice and retreat. Second, we highlight how empirical studies in neurophenomenology leverage the expertise of experienced meditators to deconstruct aversive and self-related processes, providing detailed first-person reports that guide researchers in identifying novel behavioral and neurodynamic markers associated with pain regulation, self-dissolution, and acceptance of mortality. Finally, we discuss a recent framework, deep computational neurophenomenology, that updates the theoretical ambitions of neurophenomenology to naturalize phenomenology. This framework uses the formalism of deep parametric active inference, where parametric depth refers to a property of generative models that can form beliefs about the parameters of their own modeling process. Collectively, these methodological innovations, centered around rigorous first-person investigation, highlight the potential of epistemologically beneficial mutual constraints among phenomenological, computational, and neurophysiological domains. This could contribute to an integrated understanding of the biological basis of mental illness, its treatment, and its tight connections to the lived experience of the patient.

Let's fail better: Using philosophical tools to improve neuroscientific research in psychiatry

Despite predictions that neuroscientific discoveries would revolutionize psychiatry, decades of research have not yet led to clinically significant advances in psychiatric care. For this reason, an increasing number of researchers are recognizing the limitations of a purely biomedical approach in psychiatric research. These researchers call for reevaluating the conceptualization of mental disorders and argue for a non-reductionist approach to mental health. The aim of this paper is to discuss philosophical assumptions that underly neuroscientific research in psychiatry and offer practical tools to researchers for overcoming potential conceptual problems that are derived from those assumptions. Specifically, we will discuss: the analogy problem, questioning whether mental health problems are equivalent to brain disorders, the normativity problem, addressing the value-laden nature of psychiatric categories and the priority problem, which describes the level of analysis (e.g., biological, psychological, social, etc.) that should be prioritized when studying psychiatric conditions. In addition, we will explore potential strategies to mitigate practical problems that might arise due to these implicit assumptions. Overall, the aim of this paper is to suggest philosophical tools of practical use for neuroscientists, demonstrating the benefits of a closer collaboration between neuroscience and philosophy.

Meeting the multidimensional self: fostering selfhood at the interface of Creative Arts Therapies and neuroscience

Intriguing explorations at the intersection of the fields of neuroscience and psychology are driven by the quest to understand the neural underpinnings of "the self" and their psychotherapeutic implications. These translational efforts pertain to the unique Creative Arts Therapies (CATs) and the attributes and value of the self-related processes they offer. The self is considered as a multi-layered complex construct, comprising bodily and mental constituents, subjective-objective perspectives, spatial and temporal dimensions. Neuroscience research, mostly functional brain imaging, has proposed cogent models of the constitution, development and experience of the self, elucidating how the multiple dimensions of the self are supported by integrated hierarchical brain processes. The psychotherapeutic use of the art-forms, generating aesthetic experiences and creative processes, touch upon and connect the various layers of self-experience, nurturing the sense of self. The present conceptual analysis will describe and interweave the neural mechanisms and neural network configuration suggested to lie at the core of the ongoing self-experience, its deviations in psychopathology, and implications regarding the psychotherapeutic use of the arts. The well-established, parsimonious and neurobiologically plausible predictive processing account of brain-function will be discussed with regard to selfhood and consciousness. The epistemic affordance of the experiential CATs will further be portrayed, enabling and facilitating the creation of updated self-models of the body in the world. The neuropsychological impact of the relational therapeutic encounter will be delineated, acknowledging the intersubjective brain synchronization through communicative verbal and non-verbal means and aesthetic experiences. The recognition and assimilation of neuroscientific, phenomenological and clinical perspectives concerning the nested dimensionality of the self, ground the relational therapeutic process and the neuroplastic modulations that CATs have to offer on the premise of fostering, shaping and integrating selfhood.

The Nested States Model: A Phenomenologically-Grounded Model of the Mind

BACKGROUND

Subjective experience is central to the nature of mental illness, yet it has not played a central role in most empirical approaches to psychopathology. While phenomenological perspectives in psychiatry have seen a recent resurgence, there remains a need for more detailed models of psychopathological processes based on explicit phenomenological and enactive foundations.

SUMMARY

We present a framework derived from the Nested States Model (NSM) through which such phenomenologically-grounded models might be constructed. The NSM describes the dynamic structure of subjective experience as a system of nested states that reciprocally influence one another across hierarchical layers. Here, we show how the NSM provides a scheme for characterizing patterns of experience that comprise various psychopathological processes. We demonstrate the utility of this scheme both for clinical practice and for building our knowledge of psychopathological processes more broadly.

KEY MESSAGES

The NSM can advance three aims that we see as critical for the lasting integration of phenomenological approaches to psychopathology within psychiatry. First, we show that the NSM provides a means for constructing clinical formulations and treatment considerations that center squarely on an individual's subjective experiences. Second, the NSM supplies a framework for organizing findings from clinical-phenomenological research that can guide the construction of broader phenomenologically-grounded models of psychopathological processes. Lastly, the NSM aligns our perspective on subjective experience with emerging perspectives on brain dynamics, helping to bridge phenomenological work with ongoing neurophysiological research.

A neurofunctional signature of subjective disgust generalizes to oral distaste and socio-moral contexts

While disgust originates in the hard-wired mammalian distaste response, the conscious experience of disgust in humans strongly depends on subjective appraisal and may even extend to socio-moral contexts. Here, in a series of studies, we combined functional magnetic resonance imaging with machine-learning-based predictive modelling to establish a comprehensive neurobiological model of subjective disgust. The developed neurofunctional signature accurately predicted momentary self-reported subjective disgust across discovery (n = 78) and pre-registered validation (n = 30) cohorts and generalized across core disgust (n = 34 and n = 26), gustatory distaste (n = 30) and socio-moral (unfair offers; n = 43) contexts. Disgust experience was encoded in distributed cortical and subcortical systems, and exhibited distinct and shared neural representations with subjective fear or negative affect in interoceptive-emotional awareness and conscious appraisal systems, while the signatures most accurately predicted the respective target experience. We provide an accurate functional magnetic resonance imaging signature for disgust with a high potential to resolve ongoing evolutionary debates.

Arthur Schopenhauer: An underappreciated philosopher in psychiatry and his applied epistemology of body and self- experience

BACKGROUND

Arthur Schopenhauer (1788-1860) was one of the most important thinkers of the 19th century. Although his writings have exerted great influence in many different disciplines, his epistemological concepts and analysis of the body and self-experience were rarely considered in the context of psychiatric research of schizophrenia spectrum disorders (SSD) and depression (MDD).

METHODS

The method applied for the study of anomalous self and body-experience first consists in the close reading and analysis of Schopenhauer's most influential writings, namely his opus magnus "The World as Will and Representation" and his dissertation "On the Fourfold Root of the Principle of Sufficient Reason". Second, psychopathological and phenomenological aspects of the anomalous body and self, as well as altered space and time experience, are discussed by means of Schopenhauer's philosophy and four patient cases.

RESULTS

Schopenhauer's insights contribute to contemporary psychiatry by (1) unifying materialistic (neurobiological) and idealistic (subjective) conceptions of psychiatric disorders and improving the awareness of methods in psychiatric research; (2) emphasizing the integral significance of the body as a gateway to the surrounding world and basal self-experience; (3) delineating subjective space and time-experience as crucial dimensions of the conditio humana in SSD and MDD; and (4) demonstrating the feasibility of transferring his theories directly to clinical case vignettes stemming from the daily clinical routine.

CONCLUSION

Close reading of Schopenhauer's texts might help bridge the gap between different scientific methods in psychiatry and overcome the translational crisis of contemporary psychiatry by unifying neurobiological and subjective approaches to SSD and MDD.

The Nested States Model: An Empirical Framework for Integrating Brain and Mind

Philosophy of mind has made substantial progress on biologically-rooted approaches to understanding the mind and subjectivity through the enactivist perspective, but research on subjectivity within neuroscience has not kept apace. Indeed, we possess no principled means of relating experiential phenomena to neurophysiological processes. Here, we present the Nested States Model as a framework to guide empirical investigation into the relationship between subjectivity and neurobiology. Building on recent work in phenomenology and philosophy of mind, we develop an account of experiential states as layered, or nested. We argue that this nested structure is also apparent in brain activity. The recognition of this structural homology - that both experiential and brain states can be characterized as systems of nested states - brings our views of subjective mental states into broad alignment with our understanding of general principles and properties of brain activity. This alignment enables a more systematic approach to formulating specific hypotheses and predictions about how the two domains relate to one another.

The Mediating Role of Anxiety/Depression Between Auditory Verbal Hallucinations and the Level of Insight in Schizophrenia

OBJECTIVE

Auditory verbal hallucination (AVH) is a prominent symptom of schizophrenia causing profound distress. The influence of AVHs on insight appears to be intricate and contingent on other accompanying symptoms. This study investigated the relationship and possible mediators between AVHs and the degree of insight.

METHODS

One hundred patients with schizophrenia participated in the study. Scales were used to evaluate the hallucinatory experience, the level of insight and other psychopathology. Complex relationships between variables were envisaged as a path model, whose initial structure was constructed via Gaussian Graphical Model. The validity of the final model was verified by Structural Equation Modeling. Separate analyses were performed for self-reported and clinician-rated data to enhance the model's robustness.

RESULTS

The greater the severity of the physical aspects of AVHs, the lower the level of insight observed. Conversely, higher emotional distress was associated with increased insight. These relationships were only evident in the self-reported results and were not reflected in the clinician-rated results. The path model suggested that the Positive and Negative Syndrome Scale (PANSS) anxiety/depression factor was an important mediator that linked the found association. Notably, the PANSS negative symptom had the opposite effect on the PANSS anxiety/depression factor and insight, making it difficult to define its overall effect.

CONCLUSION

The findings of this study provided one possible route for the positive influence of AVH experience in gaining insight. The mediating role of anxiety/depression modified by negative symptoms emerged as a valuable concept for clarifying this intricate relationship.

A Tale of Three Spectra: Basic Symptoms in Clinical-High-Risk of Psychosis Vary Across Autism Spectrum Disorder, Schizotypal Personality Disorder, and Borderline Personality Disorder

Background and Hypothesis

The clinical-high-risk (CHR) approach was developed to prevent psychosis through the detection of psychosis risk. CHR services are transdiagnostic in nature, therefore the appropriate management of comorbidity is a central part of care. Differential diagnosis is particularly challenging across 3 common comorbidities, schizotypal personality disorder (SPD), autism spectrum disorder (ASD), and borderline personality disorder (BPD). Phenomenological research indicates a disturbance of "basic self" may differentiate between these commonly comorbid disorders and can be captured by Huber's basic symptoms (BS) concept. We investigated whether BS vary across these disorders and may inform differential diagnosis in young person's meeting CHR criteria.

Study Design

A total of 685 participants meeting CHR criteria from the NAPLS-3 cohort completed the COGDIS items of the schizophrenia proneness instrument, a measure of BS, as well as the structured interview for DSM-5 (SCID-5). A logistic regression model was used to investigate the variation of COGDIS across SPD, ASD, and BPD, while controlling for age and SIPs positive severity.

Study Results

Meeting COGDIS criteria was positively associated with SPD (OR = 1.72, CI = [1.31-2.28], P = .001) but not ASD nor BPD.

Conclusions

Our results indicate that "basic self-disturbance" as indicated by COGDIS differs across SPD, ASD, and BPD. COGDIS may be useful to inform the management of comorbidities in CHR services, by providing insight into subtle subjective experiences that may benefit from disorder-specific interventions.

Autistic phenomenology: past, present, and potential future

We are now at a transition point in autism conceptualisation, science, and clinical practise, where phenomenology could play a key role. This paper takes a broad view of the history of phenomenological perspectives on the autism concept and how this has evolved over time, including contemporaneous theory and methods. Early inquiry from a clinical perspective within the tradition of classical continental phenomenology, linked closely to the consideration of schizophrenia, is contrasted with emerging observations of child development and a period in the second half of the twentieth century of scientific inquiry into a behavioural autistic phenotype where there was little or no phenomenological aspect; a phenotype that has determined the recent scientific and clinical conceptualisation of autism within current nosology. We then mark a more recent reawakening of interdisciplinary interest in subjective experience and phenomenological inquiry, which itself coincides with the increasing prominence and salience of the neurodiversity movement, autistic advocacy, and critical autism studies. We review this emerging phenomenological work alongside a contemporaneous clinical phenomenology perspective and representations of autistic experience from within the extensive literature (including life writing) from autistic people themselves; all perspectives that we argue need now be brought into juxtaposition and dialogue as the field moves forward. We argue from this for a future which could build on such accounts at a greater scale, working toward a more co-constructed, systematic, representative, and empirical autistic phenomenology, which would include citizen and participatory science approaches. Success in this would not only mean that autistic experience and subjectivity would be re-integrated back into a shared understanding of the autism concept, but we also argue that there could be the eventual goal of an enhanced descriptive nosology, in which key subjective and phenomenological experiences, discriminating for autism, could be identified alongside current behavioural and developmental descriptors. Such progress could have major benefits, including increased mutual empathy and common language between professionals and the autistic community, the provision of crucial new foci for research through aspects of autistic experience previously neglected, and potential new supportive innovations for healthcare and education. We outline a programme and methodological considerations to this end.

The promises and pitfalls of seizure phenomenology

The typical adult patient presenting with a first seizure has a normal clinical examination, uninformative investigations, and often has no witness to their episode. The assessing clinician, therefore, has one primary source of information to guide their assessment; the patient's experience. However, seizure phenomenology - the subjective seizure experience - has received relatively less attention by researchers than objective semiology or investigations. This essay reviews the clinical importance of seizure phenomenology, and the challenges clinicians face in eliciting accurate and clinically relevant descriptions of ictal experience. I conclude by discussing tools that clinicians may use to support the clinical application of seizure phenomenology, and exploring the subjectivity of epilepsy more broadly.

Overcoming the translational crisis of contemporary psychiatry - converging phenomenological and spatiotemporal psychopathology

Despite all neurobiological/neurocomputational progress in psychiatric research, recent authors speak about a 'crisis of contemporary psychiatry'. Some argue that we do not yet know the computational mechanisms underlying the psychopathological symptoms ('crisis of mechanism') while others diagnose a neglect of subjectivity, namely first-person experience ('crisis of subjectivity'). In this perspective, we propose that Phenomenological Psychopathology, due to its focus on first-person experience of space and time, is in an ideal position to address the crisis of subjectivity and, if extended to the brain's spatiotemporal topographic-dynamic structure as key focus of Spatiotemporal Psychopathology, the crisis of mechanism. We demonstrate how the first-person experiences of space and time differ between schizophrenia, mood disorders and anxiety disorders allowing for their differential-diagnosis - this addresses the crisis of subjectivity. Presupposing space and time as shared features of brain, experience, and symptoms as their "common currency", the structure of abnormal space and time experience may also serve as template for the structure of the brain's spatiotemporal neuro-computational mechanisms - this may address the crisis of mechanism. Preliminary scientific evidence in our examples of schizophrenia, bipolar disorder, anxiety disorder, and depression support such clinically relevant spatiotemporal determination of both first-person experience (crisis of subjectivity) and the brain's neuro-computational structure (crisis of mechanism). In conclusion, converging Phenomenological Psychopathology with Spatiotemporal Psychopathology might help to overcome the translational crisis in psychiatry by delineating more fine-grained neuro computational and -phenomenal mechanisms; this offers novel candidate biomarkers for diagnosis and therapy including both pharmacological and non-pharmacological treatment.

The embodied mind in motion: a neuroscientific and philosophical perspective on prevention and therapy of dementia

The embodied mind in motion is a concept in which health and well-being, prevention and therapy, as well as lifestyle and habits meet. The mind changes profoundly in the course of dementias, affecting daily living and resulting in reduced quality of life. Interdisciplinary approaches are required for a holistic understanding of how the mind is affected by dementia. We here explore what such a holistic theory of dementia might look like and propose the idea of "embodied mind in motion". The paradigm is biopsychosocial or biocultural, the theoretical anchor point is the lifeworld, and the guiding concept is "embodiment," as body and mind are constantly in motion. Physical activity is, hence, central for the experience of health and well-being, beyond being "exercise" and "health behavior". We discuss the embodied mind in motion referring to phenomenology, enactivism and (philosophical) anthropology. In our view, habits are embodied long-term memories and a philosophical equivalent to lifestyle. They unfold the meaningfulness of moving the body, complementing the objectifiable benefits of physical exercise. Empirical studies on "holistic activities" like hiking, yoga, music and dance illustrate improved integration into everyday life. Their meaningfulness enhances compliance and increases the preventive and even therapeutic potential. A crucial factor for this is the emotional dimension of lifestyle, exemplified by the virally popularized performance of "Swan Lake" by wheel-chair bound ex-ballerina Marta Cinta González Saldaña, suffering from Alzheimer's disease. A number of epistemological and ontological consequences anchor "embodied movement" as a valuable principle for dementia research.