["Understanding" in psychiatry -Part 2 : From incomprehensibility to an attitude of participative communication].

BACKGROUND: Starting from a systematic research of "incomprehensibility" we propose a turn from an epistemological analysis of "to understand" to an anthropological perspective relying on participative communication in a shared space of resonance.

METHOD: We propose a systematization of the modes of understanding and of incomprehensibility based on a two-dimensional model combining epistemological and ontological perspectives. Finally, we outline "understanding" as a medical stance related to the healing relationship, which implies a disposition to get involved in a participative communication. We put forward the hypothesis that acceptance of the otherness of the patient, without the intention of a complete appropriation of meaning, could be noted as crucial feature of the anthropological approach.

RESULTS: In clinical medicine, especially in psychiatry, "not understood" is threefold: as "misunderstanding", as "not-understanding" (as a temporary lack of understanding), and as incomprehensibility (to understand, that there is nothing to be understood). Incomprehensibility may only allow for interpretative operations up to a certain limit. This unidirectional understanding as a diagnosing subsumption or as a psychological explanation in order to grasp meanings has to be completed by a bi-directional personal approach based on an engaging attitude (dialogical as well as quiescent) while acknowledging the incomprehensible.

DISCUSSION: A second-person-perspective emphasizes the healing relationship as an existential encounter, especially in personal liminal situations for the patient. From an anthropological perspective "to understand" has not only to be grasped as a semantic agreement, but also as an attitude towards participative communication. That means a disposition to get involved in the encounter with the mentally ill without aiming for grasping rationally significances or even to attribute meanings. The stance therefore should be based on an awareness for the patient's idiosyncrasy as well as on the empathetic production of a shared space of resonance within the healing relationship.