Dr. Anna Bergqvist

Narrative Particularism and the Self: On Seeing the Person in Recovery

Abstract. This paper develops a novel transcendental claim about the role of lived experience in personalised mental health care. Building on my earlier work on narrative particularism in clinical decision-making (Bergqvist, 2020; 2022; 2023), I argue that the patient’s first-personal perspective is not one input to clinical judgment among others — to be added, weighted, or balanced against expert opinion — but the structural condition under which any clinical judgment about that patient is possible at all. Lived experience, on this account, is best understood as a pre-reflective structural perspective: a transcendental condition for self-awareness rather than a further viewpoint to be integrated into shared decision-making.

My particularist re-framing departs from dominant ways “lived experience” has been theorised in the philosophy of psychiatry. On the one hand, it resists the atomistic reading worried about by Thornton (2010), on which idiographic judgment of particulars threatens to insulate clinical understanding from shared rational scrutiny. On the other, it resists the constructivist temptation in recent intersubjectivist work (Ben-Moshe, 2017; Orange, 2002; Jaenicke, 2008), on which patient values are taken to constitute rather than condition clinical meaning. Drawing on phenomenology (Schutz, 1967; Fuchs, 2018), moral perception (Bergqvist, 2018; 2022), and a Wittgensteinian conception of forms of life as the ground rather than the object of sense (Moore, 1997), I argue that lived experience structurally precedes the distinction between first-personal content and shared concept application. It is the condition under which testimony, recognition, and the practical wisdom (phronesis) of clinical attunement become possible.

Three consequences follow. First, the longstanding worry that taking lived experience seriously undermines clinical objectivity rests on a confusion between perspectival realism and stance-independence. If lived experience is the transcendental condition for clinical judgment, there is no “outside” from which a perspective-neutral judgment could be made; objectivity in psychiatry is necessarily perspectival without being relativist. Second, the distinction between co-production and co-creation in service-user involvement gains philosophical depth: co-creation is not the inclusion of an additional voice but the structural acknowledgement that there was never a clinical encounter without lived perspective. Third, “shared decision-making” cannot be modelled as a search for consensus. Because every party’s contribution is structurally conditioned, the appropriate model is one of dissensus — open-ended dialogical engagement in which meaning is co-constituted within the treatment context rather than ratified from a perspective-neutral standpoint.

I illustrate the framework by comparison with Richard Moran’s (2001) account of first-person authority: the authority of the first-personal stance is not the authority of privileged access to inner content but the structural authority of the position from which lived experience is given. The same logic, I argue, governs the clinical encounter. Recovery, on the resulting view, is not the restoration of a pre-clinical self but the cultivation of a relational, embodied, and historically situated self-understanding sustained through dialogue. The paper concludes by drawing out implications for recovery-oriented practice, person-centred care, and the organisational conditions — trust, belonging, governance — that make such recovery institutionally possible.

Keywords: narrative particularism; lived experience; transcendental phenomenology; first-person authority; recovery; shared decision-making; moral perception; person-centred care.