title: The epistemological role of empathy in psychopathological diagnosis: a contemporary reassessment of Karl Jaspers' account.
abstract: BACKGROUND
  In his classic essay "The phenomenological approach to psychopathology", Karl Jaspers defended the irreducible reality of the "subjective" mental symptoms and stressed the pivotal role of empathy in their diagnostic assessment. However, Jaspers' account of the epistemological role of empathy in psychopathological diagnosis was far from clear: whereas at several places Jaspers claimed that empathy provides a direct access to patients' abnormal mental experiences, at other places he stressed that it did so only indirectly, through a whole battery of their observable clinical indicators. The aim of this paper is to reassess Jaspers' account of the epistemological role of empathy in psychopathological diagnosis.
  
  
  METHODS
  I examine thoroughly Jaspers' assertions on in the role of empathy in the diagnosis of "subjective" symptoms. Moreover, I explicate briefly the epistemological status of psychopathological diagnostic examination with the aid of the distinction between direct and indirect observation.
  
  
  RESULTS
  Diagnostic assessment of "subjective" mental symptoms involves necessarily indirect psychopathological observation. Jaspers' ambiguity is traced to his failure to distinguish clearly between direct and indirect psychopathological observation along with his excessive reliance on empathy. Relatedly, Jaspers' ambiguity is also traced to his conflation of the semantics with the epistemology of psychopathological concepts representing patients' "subjective" mental symptoms. These results apply also to contemporary phenomenological approaches to psychopathological diagnostic examination which maintain that patients' abnormal mental experiences are invariably expressed in their overt behavior.
  
  
  CONCLUSIONS
  Jaspers was right in stressing that psychopathological concepts of subjective mental symptoms represent patients' genuine abnormal experiences irreducible to concepts representing their associated behavioral manifestations. Moreover, he was right in stressing the importance of the empathic 'second person' approach to patients' mental experiences. However, he failed to recognize unambiguously that the epistemological access to patients' mental symptoms, though enormously aided by empathy, remains mainly indirect and thus requires also a 'third person' approach to them. Overall then, clinical psychopathological examination requires both a 'second' and a 'third' person approach, as well as their judicious alternation during the diagnostic interview. Although focused on Jaspers' essay, my critical analysis is also highly relevant to contemporary psychopathological approaches aiming to overcome the serious limitations of currently prevailing systems of diagnostic criteria of mental disorders.
authors.affiliation: First Department of Psychiatry, University of Athens, Eginition Hospital, 72-74 Vas, Sophias Avenue, Athens 11528, Greece. oulisp@med.uoa.gr.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Oulis
mesh_terms: D004645:Empathy; D049673:History, 20th Century; D006801:Humans; D019359:Knowledge; D001523:Mental Disorders / Q000175:diagnosis*; D010686:Philosophy, Medical / Q000266:history; D010817:Physician-Patient Relations