The medical model approach in Psychiatry brought up pressure for clear descriptors in diagnostic procedures. This presentation will address two particular psychopathological phenomena, described from the viewpoint of the observer and considered to be key psychotic features: patients’ “loss of contact with reality” and “bizarre” attribute of the content of the delusional phenomena. Challenges seem to occur from present hermeneutical, epistemological and conceptual limitations. Relevant to this is the practical impossibility to fully access a patient frame of reference and our (psychiatrists) subjective knowledge of the world, leading to a value-laden analysis of patients. We’ll be analyzing the historical, cultural and linguistic background and stressing the relevant links to the current psychiatric phenomenology.

The validity of both descriptors, used in classification systems, seems questionable as we find a practical impossible to represent those ways of experiencing, and something remaining unsurpassable, not understandable and inapprehensible. But if we find no consistent judgment in these psychopathological signs and remain confortable with frequent biases in clinical findings that do occur, then the weakness of both descriptors raises ethical problems. This presentation aims to suggest clues to an unbiased use and conceptualization of both. But a vital conclusion is that the gap between inner/subjective reality and objectively valuable and classifiable experience is perhaps beyond epistemic and constituent of personhood.