Reconceptualizing the \u27schizophrenia\u27 diagnosis: A transcultural, phenomenological investigation

In recent decades, psychopathologists have increasingly voiced discontent with the official diagnostic paradigm for defining and classifying their subject matter, mental illness. One primary concern has been wide empirical variation within and between the symptom profiles of putatively discrete disorder categories. This \u27heterogeneity problem\u27 has been highlighted by international research, where robust evidence has suggested that disorder constructs may vary as a function of cultural context. The present project utilized phenomenological methods to investigate the heterogeneity problem in a multicultural sample of persons diagnosed with psychotic disorders. In-depth interviews were collected from four pilot-comparison participants and 21 culturally diverse psychiatric patients living in Jerusalem and New York City, 18 of whom carried an accurate psychotic-disorder diagnosis. Interviews comprised a life-historical narratives, select items from extant anomalous-experience interviews, and a gold-standard measure for assessing psychotic symptom profiles. Data were analyzed using systematic phenomenological methods for the description of lived experience. Findings revealed a general psychological structure (i.e., meaningful experiential constellation) that was shared by all 18 primary hospital participants. This psychological structure, tentatively named \u27urhomelessness,\u27 was characterized by the experience of feeling (1) profoundly vulnerable and unsafe in an inhospitable world and (2) alienated, invalidated, and unacknowledged, such that the experience of basic belonging to a human community was eclipsed or foreclosed. This general structure was comprised of three interrelated horizons of experience: (1) the nomadic manifestation, characterized by psychological wandering and the attempt to secure existential shelter; (2) the settled manifestation, characterized by the rigid adoption of an imaginal home, and (3) the destitute manifestation, characterized by relinquishment of the attempt to obtain basic psychological safety and social belonging. Results also indicated substantial experiential variation within and between the three manifestations, as well as distinct patterns of cultural experience that were characteristic of each manifestation. These findings diverge from classic and contemporary diagnostic definitions of the schizophrenia-spectrum disorders, supporting recent calls to rename and reconceptualize the diagnostic class. Moreover, according to the present findings, experiential heterogeneity is not a taxonomic artifact but rather an essential constituent of a heterogeneous and transcultural general structure. These results demonstrate how \u27phenomenological kinds,\u27 as a potential alternative to categorical diagnosis, may contribute to broader taxonomic reform efforts aimed at enhancing the ecological validity and empirical grounding of psychiatric constructs and nomenclatures