A main task of psychopathology is to gain a profound understanding of the basic starting points for the work of psychiatrists. Such a psychopathology of understanding depends to a great extent on where the “understanding” psychopathologist is coming from and on what his or her perspectives and concepts are. An understanding of the valency of psychopathological phenomena in the structure of an illness, as an indispensable basis for effective treatment of mental disorders, is impossible without knowledge and understanding of the philosophical roots in the theory of psychopathological research and psychiatric practice. The scientific work on that has found its way into psychiatric literature under headings like theoretical psychopathology, meta-psychiatry or philosophy of psychiatry. What theoretical psychopathology seeks to do is not to address issues of clinical practice per se, but rather using meta-analyses, analyses of the fundaments of psychopathological thinking and practice to contribute to a clarification of seminal and relevant problems of clinical practice and of empirical science. Since self-reflection always entails self-creation within an autopoietic system, theoretical psychopathology as a the self-reflecting sub-discipline of psychopathology plays a central role as a driving force in the development and creation of future psychiatry.