| Summary: | Psychiatry relies upon semantic and epistemological concepts in characterising psychopathology as meaningful or meaningless, rational or irrational. These in turn are used to distinguish between the normal and the abnormal as definitions of mental disorder often invoke meaninglessness as a hallmark of dysfunction or neurological damage. Despite this reliance the analysis of such concepts within psychiatry is minimal; clinicians and carers instead relying on common sense intuitions. Detailed study of semantic and epistemological concepts belongs primarily to philosophy with Karl Jaspers descriptive psychopathology the major psychiatric contribution to the topic. Over the course of the Twentieth Century theories of meaning have been developed within philosophy oftentimes utilising the psychopathological as boundary cases. Neuropsychiatric phenomena, alleged to straddle the neurology/psychiatry divide, may represent boundary cases between the meaningful and meaningless. The aim of the current study is to therefore to investigate whether the meaningfulness of neuropsychiatric phenomena does falter or even fail and, if so, to explore some of the implications for psychiatry. How to conduct such an investigation, however, is unclear. Interpretative Phenomenological Analysis (IPA) was chosen as a robust qualitative methodology to conduct and analyse interviews exploring what patients and their carers understood of neuropsychiatric symptoms (the primary analysis). An additional attraction of IPA is the ability to apply hypotheses formalised from other theoretical domains, such as philosophy, to the interview material (secondary analysis). Patients with classical neuropsychiatric (confabulation, visual hallucinations, misidentification syndrome) symptoms were recruited from two London teaching hospitals. The interviews underwent primary analysis to discover relevant themes and issues with regards meaning of the symptoms. There was then a secondary analysis utilising the theories of meaning developed by Daniel Dennett, Donald Davidson, and Ludwig Wittgenstein. The outcomes of the analyses are presented separately as results parts A & B. The patient and carer interviews demonstrated that the meaning of symptoms becomes increasingly contested but is not revoked. For carers, neuropsychiatric symptoms simultaneously signify disease and symbolise distress. While Dennett’s intentional stance does indeed falter when interpreting the symptoms his reductive consequences fail to follow. Davidson’s and Wittgenstein’s approaches are more preserving of meaning and enable us to see that a scientific neuropsychiatry cannot abandon meaning.
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