Presents various reactions to the crisis in the DSM-5 project and how they coalesce around the idea that dimensionality is the way to classify mental disorder. This idea is then subject to some historical analysis, and recommendations are made about how to balance future debate on classification drawing upon both the classic and romantic perspectives.

Elaborates the meaning of descriptive psychopathology given by the psychiatrist/philosopher Karl Jaspers. Presents phenomena of ‘bizarreness’ often taken to indicate the puzzling condition of schizophrenia. Applies philosophical thought experiments to this phenomena drawing on the work of Louis Sass and John Cutting which press beyond Jaspers’ understanding of schizophrenia. Gives recommendations on the future of psychiatric phenomenology.

Starts with phenomena patients report and discusses the interpretative challenge. Addresses two meanings of phenomenology: one from philosophy and one from descriptive psychopathology in medicine. Discusses the use some romantic psychiatrists have made of philosophical phenomenology to understand ‘the worlds’ of patients.

Urges psychiatry to get back to human nature because the concept, together with the idea of human freedom and classic and romantic perspectives, is required to calibrate the normal and the pathological in psychiatry. Highlights balance by showing how ‘sickly’ (Goethe) pictures of human nature and human freedom have adverse effects on psychiatry, including its interface with political life. Revisits the classicl and romantic perspectives, considering them in and out of balance in different ways. Distils a tripartite picture of the relationship between human nature, human freedom and mental disorder relevant to future research and teaching on psychiatric formulation and psychiatric ethics.

Presents classification debates in psychiatry historically as a struggle between the classic perspective, which seeks to classify, and the romantic perspective, which rebels against classification. Presents the DSM-III project as an achievement of the classic perspective, which resolved one crisis only to bring forth another.

Introduces and elaborates a distinction between the ‘classic’ and ‘romantic’ perspectives. Contextualises the terms using Goethe’s idea of ‘world literature’. Draws out qualities such as the ‘Olympian detachment’ of the classic perspective and the temporality, self-awareness and will to action of the romantic perspective with right and left political hues. Explores prototypes both in and out of psychiatry and outlines how the perspectives will be used in the book.

Traces the history of the biopsychosocial model, the concept of diagnostic hierarchy and the role of ‘Verstehen’ (or intersubjective meaning grasping) in the psychiatric assessment. All three of these holistic concepts are considered relevant to the practice of case formulation. Responding to challenges aimed at these concepts, it is argued that they can be re-thought and defended and some recommendations are given for a renewed practice of formulation which balances classic and the romantic perspectives.

Considers suicide (or intentional self-killing) both from the perspective of psychiatry, where it affords risk formulation, and from the perspective of self-determination, where, increasingly, it is viewed in terms of a human right. Maps the imbalances in both mental disorder-only and autonomy-only views of suicide and the deep complexities of policy-making in this area as society thinks anew. Some recommendations are made about calibrating suicide risk formulation and deliberating assisted suicide.

Continues the discussion of mental capacity with expansion of the debates brought by the romantic perspective. Presents the political demand for radical equality coming from left romanticism with its wild ‘abolitionist’ agenda on the one hand, and a seeding of some new social approaches to capacity assessment on the other. A deeper inquiry into mental capacity and mood disorder using romantic ideas of temporality is presented as additional stimulus for the evolution of mental capacity. Some characteristics of mental capacity fitting it to a ‘superconcept’ are explained, which may guide future interdisciplinary research and teaching.

A distinction between types of methods (understanding and explanation) that generate different kinds of evidence relevant to the psychiatric assessment is characterised. The distinction is animated with both non-clinical and clinical examples and exercises. Scepticism about the distinction is addressed, and three influential systems of psychiatric knowledge which collapse understanding and explanation in different ways are discussed. The argument is made that the distinction (analogous to the romantic/classic distinction) resurfaces and is compelling. However, another challenge becomes important – holism in psychiatric assessment – which the understanding/explanation distinction leaves in an unsatisfactory state.