Subjective experience and its categorization

Within certain limits subjective experience is both predictive and quantifiable. When an individual loses a close relative it can be predicted that he or she will experience misery and loss. It is possible to quantify depressive symptoms and compare the degree of depression at different times in the same individual or differences between individuals at the same time. An important distinction for psychopathology is that between form and content. The form of psychological experience is the description of its structure in phenomenological terms (e.g. a delusion). Its content is the psychosocial environmental context within which the patient describes this abnormal form: 'Nurses are coming into the house and stealing my money'. The form is dependent upon the nature of the mental illness, and ultimately upon whatever are the aetiological factors of that condition. Content is dependent upon the life situation, culture, and society within which the patient exists. The distinction is important for diagnosis and treatment; determining the psychopathological form is necessary for accurate diagnosis, whereas demonstrating the patient's current significant concerns from the content of symptoms will be helpful in constructing a well-directed treatment regime.

Whereas most science is concerned with objectivity and with trying to eliminate the observer as far as possible from being a variable within the experiment, descriptive phenomenology tries to make evaluation of the subjective both quantifiable and scientific. It is a mistake to discredit subjectivity in our clinical practice. Inevitably we use it all the time and we should learn to use it skilfully and reliably. When I make an assessment, within the Mental State Examination, that my patient is depressed, I am, at least to some extent, making a subjective judgement based upon the experienced and disciplined use of empathy: 'If I felt as my patient looks and describes himself to be, I would be feeling sad'. In psychopathology the distinction is also made between development, where a change of thinking or behaviour can be seen as emerging from previous patterns by understanding what the individual's subjective experience is, and process, where an event is imposed from outside and this cannot be understood in terms of a natural progression from the previous state. Anxiety symptoms could be seen as a development in a person with anankastic personality confronted with entirely new external circumstances; epilepsy and its psychiatric symptoms would be a process imposed upon the individual and not understandable in terms of previous life history.

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