An Empirical-Phenomenological Exploration of Anderssein (Feeling Different) in Schizophrenia: Being in-between Particular and Universal.

INTRODUCTION: In this paper, we wish to elucidate alterations of basic existential and intersubjective configurations in schizophrenia spectrum disorders (SSD) through the phenomenon of Anderssein ("feeling different"). Anderssein is an important yet neglected notion from German psychiatry, referring to a specific sense of feeling profoundly different from others occurring in SSD. Although phenomenological-psychopathological research mentions it as an aspect of the core disturbance of SSD (namely, "self-disorders"), the phenomenon has not yet been explored in empirical or theoretical detail. METHOD: We present material from a phenomenological-empirical study on the mode and onset of psychosis based on qualitative interviews with 25 patients with SSD. RESULTS: Most of the participants in our study report having felt fundamentally and often ineffably different since childhood and articulate it as a sense of existing "outside" of the shared reality. Intersubjective reality appears progressively unreal or inauthentic, and simultaneously, the patient's intimate, subjective sphere is permeated by an alien otherness. Importantly, this outside position should be understood carefully as it is often accompanied by the sense of being invaded by social rules, other people's thoughts, or emotions. Incipient psychosis is described as a gradual extension of precedent alterations of the structures of (inter)subjectivity. CONCLUSION: We conceptualize the ontological feature of Anderssein as an altered "being in-between" - that is, some sort of halting of the dynamic movement between particularity and intersubjectivity. Finally, we discuss the critical implications of these results for research into the "onset" of schizophrenia.

Facing the Unknown: An Inductive Analysis of the Lived Experience of Medical Residents during the COVID-19 Pandemic.

INTRODUCTION: The COVID-19 pandemic had significant repercussions for the everyday life and public health of society. Healthcare professionals were particularly vulnerable. Here, we interviewed medical residents about their lived experiences during the pandemic to offer a phenomenological analysis. To this end, we discuss their pandemic experiences considering Jaspers' "limit situation" concept - that is, a radical shift from their everyday experiences, to one causing them to question the basis of their very existence. METHODS: We interviewed 33 medical residents from psychiatry and other specialties from the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) who either (a) worked directly with COVID-19 patients or (b) provided psychiatric care to other healthcare professionals. Semi-structured interviews were developed using the Inductive Process to Analyze the Structure of lived Experience (IPSE). RESULTS: The descriptions of the lived experiences of medical residents during the pandemic were organized into four content themes: (a) existential defense, (b) limit situations during the COVID-19 pandemic, (c) changes in lived experience, and (d) new world meanings through lived experience. CONCLUSION: During the COVID-19 pandemic, medical residents experienced what can be thought of as a "limit situation," as they encountered the healthcare delivery challenges coupled with the social isolation imposed by the COVID-19 pandemic. These challenges included fear of infection and potential death, uncertainty about the future, and the emotional overload caused by the sharp increase in patient deaths. That said, after facing such a limit situation, residents reported feeling strengthened by this experience. This is consistent with the notion that when confronted with limit situations, we draw on our resources to overcome adversity and, in turn, reap existential gains. Health care providers might use these experiences to energize their own professional approach.

Fostering dialogue: a phenomenological approach to bridging the gap between the "voice of medicine" and the "voice of the lifeworld".

This article adopts Husserl's transcendental phenomenology to explore the complex relationship between patients and physicians. It delves into the coexistence of two distinct voices in the realm of medicine and health: the "voice of medicine" and the "voice of life-world." Divided into three sections, the article emphasizes the importance of shifting from a scientific-medical attitude to a more personalistic approach in physician-patient interactions. This shift aims to prevent depersonalization and desubjectification. Additionally, it highlights the equal and irreducible nature of patients while acknowledging the vital role physicians hold in the realm of illness. The article stresses the need for a balanced and equitable relationship between both parties, rooted in the shared life-world. Moreover, empathy is underscored as a crucial element in fostering meaningful dialogue, wherein understanding diverse perspectives and attitudes towards illness is paramount. The article argues that differences between patients and physicians are necessary for empathy, while shared similarities form its foundation. Ultimately, a harmonious relationship facilitates empathy and enables the constitution of a new sense of life for both patients and physicians.

First-Episode Psychosis and Centrality in the Work of Psychiatrist Henri Grivois: A Dialog with Phenomenological Psychopathology.

The article traces the hypotheses of the contemporary French psychiatrist Henri Grivois, concerning what he calls nascent psychosis. In a perspective close to descriptive phenomenology, Grivois tries to identify the alteration of subjective experience specific to the first moments of a psychosis. He thus describes the experiences of concernment and centrality as consisting in a disruption of the tacit mechanisms of mimesis and interindividual attunement. Using the common points between Grivois's aim and that of the phenomenological approach, the article puts these two conceptions of first-episode psychosis into dialog, questioning in particular the prereflexive register of experience. The notion of centrality questions the conditions of the constitution of intersubjectivity: it places the question of the bodily and gestural incarnation that founds the relationship to the other at the center of our understanding of psychosis. Grivois's hypotheses and the phenomenology of psychoses together contribute to the questioning of the therapeutic methods employed in the early stages of treatment. Centrality, in particular, questions the limits of verbal descriptions of psychotic experiences and invites us to think about methods that are based more on the anchoring and bodily attunement of the patient and the therapist.

Reframing Anorexia Nervosa: A Phenomenological Exploration of the Self-Other Relationship with Husserl's Intersubjective Theory.

This paper explores the overlooked contributions of Husserl's Phenomenology of intersubjectivity in understanding anorexia nervosa. It highlights the intricate relationship between the self and others, emphasizing their mutual constitution while acknowledging inherent differences. The distorted body image approach often overlooks this perspective, leading to psychopathological issues in individuals with anorexia nervosa. By integrating subjective experience and external observation, a more balanced and equal intersubjective relationship can be established. Utilizing this philosophical framework allows for a deeper understanding of the disorder's dynamics and sheds new light on the subjective experiences of individuals with anorexia nervosa in relation to others.

The Human Spectrum: A Phenomenological Enquiry within Neurodiversity.

INTRODUCTION: Autism has typically been characterized by its external manifestations rather than experienced phenomenology, with consequent impacts on both research and practice. There have recently been increasing calls for more phenomenological enquiry in autism, but little actual work reported. METHOD: A shared participatory phenomenological self-investigation was conducted, by the four authors, of lived experience across the autistic/non-autistic divide. The sample size was chosen as necessary for the feasibility and acceptability to participants of such work in this context. Roles of "researcher" and "interviewee" were purposefully alternated between participants to establish trust and reciprocity. Initial phenomenological reduction or bracketing was applied to the description and recording of each participant's intimate lived experience in a number of key domains across social relationships, the physical environment, development, and in adult life. These experiences were shared within dialogue to open them to investigation and questioning from the others, with alternating interviewer and respondent roles. A third step synthesized these shared observations across individuals into themes of continuity and difference. RESULTS: A number of emergent themes, such as the need for trust and reliability, and the impact of context on regulation of emotion, sociability, and empathy, showed striking commonalities between all participants. Other themes, such as primary sensory experience and social joining, pointed up more clear differences between autism and non-autism in development and the adult world. Themes of interest-focus and attention were marked by both commonalities and difference. CONCLUSIONS: This shared phenomenological method was taken as a first step within a new area of active investigation in autistic phenomenology. It proved successful in eliciting detailed information on self-experience. The results suggested hypotheses for a new understanding of autism within the wider "human" spectrum of experience; for instance, the common basic need for trust and social connection but striking differences in sensory experience. It suggested that some characteristics long thought intrinsic to autism, such as social mis-perception and reduced empathy, may be alternatively understood as state-dependent outcomes contingent on specific contexts and interactions. Implications are suggested for testing in further research, developmental theory, and intervention practice.

"You would think she would hug me": Micropractices of Care Between First-Generation College Students and Their Parents During Covid-19.

The Covid-19 pandemic has greatly disrupted the education of first-generation college students (first-gens)-those whose parents did not complete a college degree. With campuses closed, activities canceled, and support services curtailed, many first-gens have increasingly relied on their parents for mental, emotional, and logistical support. At the same time, their parents face compounding stresses and challenges stemming from the prolonged effects of the Covid pandemic. We examined the role that relational dynamics between first-gens and their parents played in how they weathered the first 2 years of the Covid pandemic together. We draw upon journals submitted by self-identified first-gens and parents of first-gens to the Pandemic Journaling Project between October 2021 and May 2022 as part of a pilot study of first-gen family experiences of Covid-19, along with a series of interviews conducted with three student-parent dyads. We argue that what we term the micropractices of care-the "little things," like a kind word, small gift, or car ride, that were regularly exchanged between parents and students-played a key role in mental wellness and educational persistence. We find that when there is synchrony between practices offered by one dyad member and their reception by the other, mental wellbeing is preserved. When there is asynchrony, mental health is destabilized. These findings reflect the strategies on which first-gen families have creatively relied to maintain shared mental wellness and student success during a time of crisis. We show how everyday mental wellness is forged in the intersubjective space between two people engaged in achieving shared life goals.

Trusting Automation: Designing for Responsivity and Resilience.

OBJECTIVE: This paper reviews recent articles related to human trust in automation to guide research and design for increasingly capable automation in complex work environments. BACKGROUND: Two recent trends-the development of increasingly capable automation and the flattening of organizational hierarchies-suggest a reframing of trust in automation is needed. METHOD: Many publications related to human trust and human-automation interaction were integrated in this narrative literature review. RESULTS: Much research has focused on calibrating human trust to promote appropriate reliance on automation. This approach neglects relational aspects of increasingly capable automation and system-level outcomes, such as cooperation and resilience. To address these limitations, we adopt a relational framing of trust based on the decision situation, semiotics, interaction sequence, and strategy. This relational framework stresses that the goal is not to maximize trust, or to even calibrate trust, but to support a process of trusting through automation responsivity. CONCLUSION: This framing clarifies why future work on trust in automation should consider not just individual characteristics and how automation influences people, but also how people can influence automation and how interdependent interactions affect trusting automation. In these new technological and organizational contexts that shift human operators to co-operators of automation, automation responsivity and the ability to resolve conflicting goals may be more relevant than reliability and reliance for advancing system design. APPLICATION: A conceptual model comprising four concepts-situation, semiotics, strategy, and sequence-can guide future trust research and design for automation responsivity and more resilient human-automation systems.

Pain cannot (just) be whatever the person says: A critique of a dogma.

McCaffery's definition of pain has proven to be one of the most consequential in nursing and healthcare more generally. She put forward this definition in response to the persistent undertreatment of pain. However, despite raising her definition to the status of a dogma, the undertreatment remains a real problem. This essay explores the contention that McCaffery's definition of pain elides critical aspects of it, aspects that demand consideration when treating pain. In section I, I set the stage. I discuss how McCaffery's definition and her understanding of pain science interrelate. In section II, I raise three problems for this understanding. In section III, I argue that these problems stem from an incoherency in her definition. Finally, in section IV, I draw from hospice nursing as well as philosophy and the social sciences to redefine 'pain' so that an intersubjective feature of it is foregrounded. I also briefly discuss one implication this redefinition has for pain management.

Philosophical underpinnings of intersubjectivity and its significance to phenomenological research: A discussion paper.

Intersubjectivity is the proposition that human experience occurs in a world of shared and embodied understandings, mediated by culture and language. Nursing is fundamentally relational, and nursing research stems from an exchange between participants and researchers and indeed around the transaction of the patient and the nurse in the intersubjective space of clinical settings. Through the philosophical standpoints of Husserl, Merleau-Ponty, Heidegger, and Gadamer we examine these differing philosophical constructs of intersubjectivity and the contribution of these positions to phenomenological nursing inquiry. Particular framings of intersubjectivity should influence the way researchers interact with their participants and data so that the chosen philosophy sits coherently within a research plan and methodology. This exploration of philosophical standpoints is extended through examples of, and reflections upon, the authors' experiences of intersubjectivity in our published phenomenological nursing studies and through dynamic interactions that characterise interpretive activities within a research team.

Focusing the Clinical Supervision on the Therapist's Developmental Trauma: A Single Case Study.

The term developmental trauma (DT) refers to the impact of stressful events which occur cumulatively within the child's relevant relationships and contexts, and usually early in life. According to several authors, DT depends on the caregiver's inadequate intersubjective recognition of one or more aspects of the evolving individual's identity. In the clinical and empirical literature, the study of therapists' developmental trauma, and how it might constitute a relevant variable in the clinical exchange, seem to be underrepresented. In this paper, through the analysis of the supervision process of a clinical case, we show how the therapeutic relationship may implicitly take the form of a "dance" between the patient's and therapist's DT, that prevents the therapist from intersubjectively attuning with the patient; and how a supervision process peculiarly focused on the therapist's DT can effectively promote this attunement and a good clinical outcome.

On Bion's Concept of Truth in an Extra-Moral Sense.

The paper explores the concept of truth in Bion's theory and in the post-Bionian context of the analytic field. Truth is addressed on three levels: epistemological, metapsychological, and clinical. Bion criticizes positivism in psychoanalysis, and the same vertex when it appears in psychoanalysis itself, stating that the search for truth at all costs is similar to the arrogance and stupidity of the psychotic part of the personality. He revolutionizes the analytic concept of truth by orienting it to the function of the emotional linking between analyst and patient rather than to content. Post-Bionian analytic theory further develops these concepts. In a field or radically intersubjective perspective, the author emphasizes the shift from an "I/you" perspective to a "we" perspective. The treatment is less about the abstract search for supposed truths and more about the truth being expressed in the process of emotional and affective attunement.

CULTURAL HISTORY OF PSYCHOANALYSIS IN THE AGE OF NEUROSCIENCE.

In this paper I have chosen the topic of psychoanalysis in the age of neuroscience, with the aim of showing why the cultural history of psychoanalysis still matters. To make myself better understood I shall refrain from evaluating the current findings in neuroscience and limit myself to reporting briefly on them. Although I do not regard myself by any means as an expert in that field, I may be permitted to offer a few ideas about it. In this regard, there is presently a significant predominance of biological ideologies and practices regarding the treatment of mental illness, which implies an increase in the interest in etiology, nosology, definitions, and the effectivity of treatments. Even so, those psychoanalytic historians and/or analysts among us who are committed to psychoanalysis and its therapeutic implications, irrespective of what drugs might be prescribed and what the research findings might conclude, believe that patients still want to be listened to in depth and always will. For that reason, it is justified to ask why the cultural history of psychoanalysis still matters in a contemporary mental health environment that is ever more oriented towards the neurosciences.

[The therapeutic mediation device in the clinic of adolescent action]. / Le dispositif à médiations thérapeutiques dans la clinique de l'agir adolescent.

The pathologies of the adolescent act illustrate the overflow so characteristic of the "modernity" of a world in perpetual evolution. Through compulsive bodily symptoms that are as noisy as they are enigmatic (self-mutilation, suicide attempts, addictions, fast sex, eating disorders), adolescents are always in search of transitional and containing spaces, which are indispensable for symbolizing and calming destructuring intrapsychic conflicts. Therapeutic mediations, adapted to the different singularities, offer a space through which integration and subjectivation processes are possible.

[Meeting your baby and becoming a father]. / Rencontrer son bébé et devenir père.

The birth, the moment when the father physically discovers his baby, is essential in the development of fatherhood. Accompanying this encounter during the stay in the postnatal unit leads to a greater commitment to care on the part of the father over the following three months. It therefore seems essential to support him during these first moments, by offering him skin-to-skin contact, for example, or by showing him in practical terms how to provide nursing care for his newborn. Encouraging the development of the father-baby relationship is beneficial for the family alliance that is being built around the cradle.

"We know what they're struggling with": student peer mentors' embodied perceptions of teaching in a health professional education mentorship program.

This paper reports on a study of student peer mentorship in the context of nursing education in a higher education program in Canada. The study used an embodied hermeneutic phenomenological methodology to investigate student peer mentors' perceptions of teaching during peer mentorship. The data were collected over one calendar year (2019) and involved analysis of 10 participants' interview data and their 'body maps,' produced in response to guided questions. Through the data analysis a core theme of 'commitment to mentee growth' was identified, along with seven interrelated themes: sharing responsibility for learning, moderating stress, mediating power relations, navigating unknown processes, valuing creative approaches, offering generous acceptance, and facilitating confidence. Student peer mentorship has the potential to contribute to health professions education in a number of unique ways including through embodied attunement, trusting intersubjective relations, and dialogic education. This study is innovative in its purposeful design and aim to investigate both cognitive and embodied perceptions of student peer mentors. The findings point to the promise of student peer mentorship for advancing health sciences education. Implications for peer mentorship program development in health professions education are discussed.

Person-Centered Psychiatry as Dialogical Psychiatry: The Significance of the Therapeutic Stance.

In this article, we present holistic and person-centered perspectives in psychiatry, with the aim of better understanding what a focus on personhood might really mean and what clinical implications it might have. We first introduce classical and philosophical concepts of personhood, in order to then outline person-centered approaches in psychiatry, which mainly focus on the person of the patient. We then argue that, for it to really be person-centered, psychiatry must necessarily also focus on the person of professionals. We thus explore the notion of stance, as the expression of the therapist's personhood. By unpacking the effects that a professional's stance can have on patients, we finally turn to a consideration of the interpersonal sphere. More specifically, we propose clinical considerations on a therapeutic stance that strives to support and to help the person of the patient unfold. Such a stance must - we argue - necessarily be a dialogical one. Drawing on these considerations, we thus claim that a truly person-centered approach in psychiatry must necessarily and automatically be interperson-centered and dialogical. In the concluding remarks, we finally discuss broader societal implications and outline future research perspectives.

Interpersonal and Intersubjective Alienation in Social Stigmatization and Depression.

The subjective experience of social stigma has been widely researched in terms of discrimination, rejection, isolation, etc. These are commonly understood within the traditional individualistic framework of affective experience and sociality, which fails to address the transformative effects of social stigma on how one experiences the social realm and the own self in general. Phenomenology and recent work on the relationality of affective experience acknowledge the central role interpersonal interactions play in subjectivity and offer a suitable approach towards addressing the complexity of the subjective experience of social stigma. Focussing on autobiographical accounts, I propose that the experience of social stigmatization is characterized by an affective atmosphere of interpersonal alienation. Its counterpart, an atmosphere of belonging, is closely related to social empathy, which is eroded by prejudicial attitudes and stereotypes. The breakdown of social empathy establishes a peculiar form of relationless relationality that radically transforms one's subjectivity. The transformation of subjectivity is structurally similar to disturbances of intersubjectivity in psychopathological conditions such as depression and feelings of disconnectedness, loneliness, and even shame are common in both cases.

Right brain-to-right brain psychotherapy: recent scientific and clinical advances.

This article overviews my recent acceptance of a Lifetime Achievement Award from Sapienza University of Rome, in which I discussed three decades of my work on the right brain in development, psychopathogenesis, and psychotherapy. In the following, I offer current brain laterality and hemispheric asymmetry research indicating that right brain emotional and relational processes operate beneath conscious awareness not only in early human development, but over the lifespan. I discuss recent interdisciplinary studies on the central role of ultrarapid right brain-to-right brain intersubjective communications of face, voice, and gesture and the implicit regulation of emotion in nonverbal attachment dynamics. Special emphasis is on the fundamental psychobiological process of interpersonal synchrony, and on the evolutionary mechanism of attachment, the interactive regulation of biological synchrony within and between organisms. I then present some clinical applications, suggesting that effective therapeutic work with "primitive" nonverbal emotional attachment dynamics focuses not on conscious verbal insight but on the formation of an unconscious emotion-communicating and regulating bond within the therapeutic relationship. Lastly, I review recent hyperscanning research of the patient's and therapist's brains during a face-to-face, emotionally focused psychotherapy session that supports the right brain-to-right brain communication model. I end suggesting that the right brain is dominant in both short-term symptom-reducing and long-term growth-promoting deep psychotherapy.

Maternal perception of infant's intersubjectivity: a questionnaire.

INTRODUCTION: Intersubjectivity is a fundamental dimension of the mother-infant relationship. OBJECTIVE: Design of a questionnaire to assess maternal perception of the infant's intersubjectivity. DESIGN: After running a focus group with mothers of infants within their first year of life, items related to maternal perception of the infant's intersubjectivity were generated. These items were applied to a sample of 125 mothers and the results were submitted to principal components analysis. RESULTS: Principal components analysis (forced extraction to 3 factors, KMO = .752, Bartlett = 976.202, p = .000; explained variance = 42.12%) identified 22 items grouped in three factors: a) F1, 'Interactive Competence' (α = .817); b) F2, 'Emotional States' (α = .749), and c) F3, 'Initiative' (α = .647). Positive and significant correlations were observed among all MPIIQ factors (p ≤ .01). Maternal perception of infant's intersubjectivity varied according to the number of gestational weeks at birth (T = -1.15, p ≤ .05) and according to the infant´s age (F = 7.834, p ≤ .001). Mothers of preterm infants reported lower perception of infant's intersubjectivity whereas mothers of older infants reported higher perception of infant's intersubjectivity. CONCLUSION: The Maternal Perception of Infant's Intersubjectivity Questionnaire (MPIIQ) seems to be a sensitive instrument, able to discriminate different levels of maternal perception about the infant's intersubjective competences.