This book follows a series of efforts done by various researchers and practitioners in recent decades to revive interest in phenomenological philosophy and the application of the phenomenological method in the understanding and treatment of mental distress. What is distinct about this book, is that it is one of the few in recent literature that does not attempt to present phenomenological method as in opposition to current practices, but conceives it as a necessary methodological complement to them, fundamental in creating the foundations for a modern mental healthcare. The patients in receipt of mental health services are the ones who are going to benefit from such an effort by seeing aspects of their experience to be accounted in the formulation of the intentional horizon within which their life and vicissitudes unfold.
The author suggests that the aim of pure psychology, as a version of phenomenology, is to integrate the three registers of the biological, the psychological and the intersubjective around an understanding of meaning for consciousness. For this kind of biopsychosocial holism, the author offers a structured approach where, in the first two parts, they develop the epistemic foundations for a practical approach to mental disorders present in part III. The author draws inspiration mainly by Edmund Husserl and we find numerous references to his philosophical works. Readers that have not been previously exposed to Edmund Husserl's phenomenology may find it difficult initially to engage with the dense meanings and philosophical idiom that populate the first two parts. If that is the case, then a suggestion would be probably to follow an unorthodox approach and read part III first. Part III can probably be intuitively accessible to mental health practitioners without the underlying conceptual structure that has been developed in the first two parts. Subsequent readings of the first two parts will elucidate further the foundations upon which part III has been articulated. Methodologically, this is appropriate in phenomenological terms because the aim, as we will see, is to enable us to understand the constitutive elements of any explicitly given phenomenon. For the purposes of this review, we are going to follow the structure by the author and will attempt to clarify briefly certain key concepts that will make intelligible the project on which the author invites us to embark.
In the first part, titled ‘Defining phenomenology and pure psychology’, the author gives us an introduction on phenomenological philosophy and its object of enquiry, namely consciousness. One of the foundational principles of philosophical phenomenology is that consciousness is not epiphenomenal, a mere illusion caused by the brain. Furthermore, per the philosopher Franz Brentano, consciousness is never empty; it is always about something, always in relation to an object, and this essential property is called intentionality. The author invites us on a methodological journey that will help us clarify the intentional contents of an individual consciousness as it is presented to us, and reach a formulation that will serve as a meaningful account of the encountered phenomena. The author calls this process formulation and presents it as a means of representing distressed consciousness in the world. Phenomenology, per its founder Edmund Husserl, attempts to provide a boundary to the knowledge that can be attained through varieties of metaphysical realism that claim that facts and truth stand completely outside of anyone's perspective, as some fixed totality of mind-independent objects. In a way, our initial observations and assessments are always contaminated by pre-existing notions and theoretical assumptions that obfuscate the complex reality of the patient and undermine any therapeutic efforts as aspects of their experience will be neglected. Time and again the author uses the metaphor that ‘the map isn't the territory’, pointing to a fundamental distinction between understanding from theory and what is understood. Quoting Husserl, the ability to map dynamic processes for an individual or larger cultural group has the limit that no theory could meet all the actual possibilities: a way of stating that all maps are limited representations with respect to their territories. For that reason, the author invites us to adopt the phenomenological attitude and specifically aim towards a pure psychology that can reinterpret the findings of research into the substrate of neuroscience, behavioural genetics of the research on identical twins, biochemistry, psychophysics and interpersonal neurobiology, to name but a few possible sources for consideration. Pure psychology follows a reflective method that initially performs a reduction by suspending the natural attitude towards a given phenomenon. As the author says, the natural attitude is common sense realism that understands consciousness as a thing within the human body-thing, as just one more thing in the world. This effort to suspend ready-made causal inferences is followed by an eidetic reduction that may reveal universal aspects of conscious experience that can become intersubjectively intelligible.
This process will give rise to a king of meta-cognition, or meta-representation that will elucidate the conditions of possibility for a given experience. For instance, the author highlights how Husserl came to the realisation that it is the form of time across the lifespan that is an a priori universal that enables the meaningfulness of the current moment. In the second part, titled ‘The findings on meaning for consciousness’, the author proceeds further on the essential characteristics of consciousness and how these contribute to making experiences intelligible. By contextualising consciousness, it becomes central in his enquiry the concept of world horizon, a spatiotemporal whole within which phenomena are given. Here essential dimensions of consciousness, such as embodiment and temporality, are analysed. Consciousness is always embodied and temporal in ways where the different instances of it, such as retention and protention, always operate in the here and now. With the analysis given, the author will lead us gradually in the art of how to constitute meaningful objects from our enquiry. In this enterprise, empathy occupies a central position as the medium of connection in the intersubjective whole. Intersubjectivity is used both as a noun and an adjective, indicating a huge range of experiences that include manifolds of possible senses that could be given to cultural objects. Even with that, the extent of what is constructed socially extends to further contexts of sense and further timeframes. In a way, even before we meet a patient, we have already encountered him through our common prereflective embedment in language, shared meaning and culture; something that must be taken in account in our practice.
The third part is titled ‘Applying pure psychology to psychotherapy and mental health care’. From the title, it becomes evident that the author does not want to limit the methodological approach offered only to psychotherapy, but rather sees it as a fulcrum, a method and a language for collaborative working within the mental healthcare system. Reading the following chapters, practitioners of different theoretical backgrounds, such as those coming from the cognitive–behavioural therapy tradition or from the psychoanalytic one, especially object-relations, will find many similarities to their practice that will further be enriched and sharpened by the phenomenological method outlined thus far. In this last part, the author discusses the way a self-reflexive relationship to the self is constituted in the cases of social anxiety and paranoia, providing an idea as to how formulation can be achieved with clinical phenomena. Furthermore, the author responds to criticisms to pure psychology coming from the field of evidence-based practice and its implementation of randomised controlled trials as the methodological foundation for approaching clinical phenomena. The author rightly points out the limitations of the randomised controlled trial research model when it is confronted with the multitude of variables that take place in the intersubjective encounter. The author quotes extensively the research done by Stiles and Shapiro, supporting the view on how misleading can be the aim of randomized control trials in identifying in therapeutic modalities the ‘single ingredient’ that proves their superiority in effectiveness, granting them the much desired evidence based status. The author addresses methodological limitations, such as the implementation of numerous exclusion criteria, that affect considerably the applicability of their outcomes as the sole guidance for everyday intersubjective encounters with patients. The author ends in pointing out once again the central role that the articulation of meaning plays in every form of psychology, psychotherapy and mental healthcare. A theory of meaning constitution in his view is necessary because science, being always subject to falsificationism, cannot provide absolute certainties. The biopsychosocial whole is meaningfully integrated in consciousness, and the method offered by pure psychology is the way to understand the territory where it unfolds.
This is not a book for those that deny the existence of consciousness and see it only as epiphenomenal, a mere illusion caused by the brain. Advocates that the whole (consciousness) is only a sum of its parts (brain mechanisms) will not find this book appealing. Moving along the lines of eliminative materialism and its teleological claims that sooner or later scientific breakthroughs of neuroscience or genetics will unveil all secrets of the mind, they will stay faithful to a sweeping biological reductionism and its promise land for a God's Eye point of view. At the same time, also other kinds of reductionism, such as those of antipsychiatry that sees mental distress as a medicalization of mere problems of living, will not find an alliance here. The author is not promoting a theory or an ideology, but methodological principles that will help the practitioner overcome the inherent limitations of the scientific method and make his approach truly person centred. This is a book for all those that accept consciousness and articulation of meaning as central in being human and want to achieve within the biopsychosocial register a formulation that will recognize constitutive elements of psychopathological phenomena and at the same time will enable pathways to recovery. I have thoroughly enjoyed it and it is my firm belief that research, clinical practice and especially medical education would benefit from the direction offered by the author.
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