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Psychiatry is a hermeneutical and descriptive discipline. It describes and interprets unconventional mental health experiences and responds in ways that bring hope, healing, and relief. We will focus on the issue of interpretation later. Here we concentrate on the descriptive dimensions of psychiatry. Historically via psychiatrists such as Karl Jaspers,11 and in contemporary times through the detailed work of Andrew Sims,12 an approach to description has emerged known as descriptive psychopathology. This phenomenological tradition provides rich and deep descriptions of psychopathology so that psychiatrists can gain insight and create rich and thick descriptions that help them develop deep and therapeutic understandings that lead to effective clinical intervention. Andrew Sims lays out this approach as follows:

The study of individual personal experience is fundamental to psychiatry. Descriptive psychopathology is the precise description and categorization of abnormal experiences as recounted by the patient and observed in his behavior. There are two components to this: careful and informed observation of the patient, and phenomenology, which implies, according to Karl Jaspers, the study of subjective experience. The descriptive psychopathologist is trying to hear what the patient is saying without any theoretical, literary or artistic gloss of interpretation, and without the mechanistic explanations of science used inappropriately. In order to achieve understanding, phenomenology uses empathy as a precise clinical tool.13

The purpose of such a phenomenological approach is not to explain what is going on but to try to understand it: “In Jaspers’ usage, understanding is contrasted with explanation. Understanding, in this sense, involves the use of empathy, subjective evaluation of experience by the ‘understander’ using his or her own qualities of observation as a human being: feeling inside. Explanation is the normal work of natural science involving the observation of phenomena from outside, and objective assessment. Both are required of the practicing doctor but whereas the method of observation in science is carefully and comprehensively taught, teaching the method of empathy to give subjective understanding is frequently neglected.”14 Sims draws attention to this phenomenological tradition but acknowledges that it does not get the recognition it deserves either in medical education or in practice.

One of the reasons this phenomenological tradition has been “lost” relates to the systems currently in place through which we make diagnoses and describe mental health challenges. These systems prefer thin descriptions to the richness and thickness of the phenomenological look. Part of the issue, as we have seen, relates to time. If you have only fifteen minutes with a patient, gathering rich phenomenological detail is not going to be high on your list of priorities. But lack of time is not the only reason for the thinness of psychiatric descriptions.