Swiss Arch. Neurol. Psychiatry Psychother. 2026, 176(1), 5; https://doi.org/10.3390/sanpp176010005 (registering DOI) - 18 Jun 2026
Abstract
Standard diagnostic categories (International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM)) were developed as a pragmatic compromise between competing theoretical schools in psychiatry and psychotherapy. Focused on recognizable patterns of symptoms, they produce reliable descriptions and facilitate
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Standard diagnostic categories (International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM)) were developed as a pragmatic compromise between competing theoretical schools in psychiatry and psychotherapy. Focused on recognizable patterns of symptoms, they produce reliable descriptions and facilitate clinical communication, research, and reimbursement. Such a focus, however, necessarily falls short of the etiological complexity of bodily, personal, interpersonal, and cultural processes that shape human suffering. This article argues that beneath the diversity of approaches seeking to address this gap, a fundamental complementarity emerges—one constitutive of human existence itself: the complementarity between two irreducible ways of being in the world. The first is the organismic–biological dimension, elaborated in Jakob von Uexküll’s biosemiotics: sign-governed, evolutionarily pre-formed processes of meaning-attribution that operate prior to and independent of language. The second is the symbolic–cultural dimension, developed in Ernst Cassirer’s philosophy of symbolic forms: the embedding of human beings in socially created, intersubjectively shared symbol systems through which the world is seen and understood. Although both approaches were published nearly a century ago, this article is not primarily a historical contribution. Rather, it argues that psychopathology and therapy can be understood more fully—and clinical practice enriched—when both dimensions are taken into account as genuinely complementary perspectives.
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