Phenomenology, epistemic practices, and patients’ experience of the psychiatric diagnostic interview

Abstract

The psychiatric diagnostic encounter has recently been subjected to renewed philosophical scrutiny, particularly through the lens of epistemic injustice. Within this literature, the diagnostic interview is often conceived as a testimonial encounter in which patients present self-reports that clinicians judge. This paper examines whether such a “testimonial model” adequately captures the epistemic dynamics of psychiatric diagnostic interviews, with particular attention to the semi-structured, phenomenological interview. Conceptually, we argue that prevailing accounts overstate both patient passivity and the transparency of their lived experience. Psychiatric symptoms are rarely available as simple, namable objects, readily available in self-reports; rather, the symptoms’ clinical significance typically emerges through dialogical exploration. We propose that the semi-structured, phenomenological interview can be understood as a co-constructed epistemic space in which the clinical significance of patient experience, interpretation, and behavior are jointly explored within a trustful patient–clinician relationship. Empirically, we draw on data from a study in which patients underwent both a fully structured interview and a semi-structured, phenomenological interview, supplemented with written evaluations of their experience of the interviews. Despite relying on the same diagnostic manual, the two interview formats yielded different diagnostic outcomes, with the phenomenological interview systematically eliciting psychopathological phenomena not captured by the structured interview. Thematic analysis of patient evaluations indicated that most patients experienced the phenomenological interview as more dialogical, meaningful, and better able to capture their difficulties. Collectively, these findings suggest that epistemic richness and diagnostic accuracy are closely intertwined, supporting a conceptualization of the psychiatric diagnostic interview beyond the testimonial model.