ABSTRACT
This chapter argues that psychiatry needs a clinical concept of psychiatric illness alongside other scientific concepts of disease. The clinical concept of psychopathology considers that psychiatric symptoms and syndromes are intrinsically self-related and context bound. This clinical conception recognizes that psychiatric illness results from patterns of ingrained interaction between the patient as a person, the patient’s dysfunctions and vulnerabilities, and all conceivable sorts of contextual factor.
This chapter develops a clinical perspective in the form of a model of the web of relationships in which psychopathology evolves, and, more particularly, of the interactions between the person, his or her psychopathology, and the context. Distinctions will be made among self-relatedness, self-referentiality, self-awareness, and self-interpretation; and among different types of self-referentiality. The counterpart of these distinctions is a set of contextual distinctions, which are only briefly introduced here and more extensively discussed in later chapters. The web of relationships evolves in time and contributes to a layered ingraining of patterns of self- and context-dependent relating to the early illness manifestation. In clinical practice, it is often not so much the condition itself (which, in fact, is an abstraction) that is the target of intervention but rather one or more aspects of this layered this network of relationships.
