This paper integrates personal narratives with the methods of phenomenology in order to draw some general conclusions about ‘what it means’ and ‘what it feels like’ to be depressed. The analysis has three parts. First, it explores the ways in which depression disrupts everyday experiences of spatial orientation and motility. This disruption makes it difficult for the person to move and perform basic functional tasks, resulting in a collapse or contraction of the life-world. Second, it illustrates how (...) class='Hi'>depression creates a situational atmosphere of emotional indifference that reduces the person’s ability to qualitatively distinguish what matters in his or her life because nothing stands out as significant or important anymore. In this regard, depression is distinct from other feelings because it is not directed towards particular objects or situations but to the world as a whole. Finally, the paper examines how depression diminishes the possibility for ‘self-creation’ or ‘self-making’. Restricted by the illness, depression becomes something of a destiny, preventing the person from being open and free to access a range of alternative self-interpretations, identities, and possible ways of being-in-the-world. (shrink)

In this study I explore from a phenomenological perspective the relationship between affectivity and narrative self-understanding in depression. Phenomenological accounts often conceive of the disorder as involving disturbances of the narrative self and suggest that these disturbances are related to the alterations of emotions and moods typical of the illness. In this paper I expand these accounts by advancing two sets of claims. In the first place, I suggest that, due to the loss of feeling characteristic of the illness, (...) the narratives with which the patients identified prior to the onset of depression are altered in various ways, thus leading to the weakening or abandonment of the narratives themselves. I then move to show that these autobiographical narratives are replaced by new stories which possess a distinctive structure and I argue that this is dependent upon specific configurations of affective experience, such as existential feelings of guilt, hopelessness, and isolation, and particular forms of temporal and spatial experience. (shrink)

Competent decision-making is required for informed consent. In this paper, I aim, from a phenomenological perspective, to identify the specific facets of competent decision-making that may form a challenge to depressed patients. On a phenomenological account, mood and emotions are crucial to the way in which human beings encounter the world. More precisely, mood is intimately related to the options and future possibilities we perceive in the world around us. I examine how possibilities should be understood in this context, and (...) how, in depression, decision-making might be compromised. I suggest that, based on this analysis, a specific emphasis and alertness in assessments of competence in depressed patients is called for. In fact, close attention should be paid to the range of future possibilities depressed patients are able to perceive. In addition, providing environmental cues to these patients might be one way of enhancing their decision-making capacity. The practical suggestions arrived at are open to empirical research. (shrink)

_Abstract_: The overarching aim of this paper is to provide a comprehensive account of melancholic depression from the perspective of hermeneutic phenomenology. More specifically, we propose that this condition should be interpreted as an alteration in the intentional arc that affects corporeality, temporality, and spatiality, rather than as a mood disorder. In fact, classifying melancholic depression as a mood disorder seems a particularly poor choice; the mood disorder is not a cause but a consequence of a primary (...) disturbance in operative intentionality. Our paper comprises four sections: (1) We provide a methodological and conceptual framework for our theoretical work, adopting a hermeneutic phenomenological perspective on melancholic depression, and underlining the main differences between melancholia and depression. (2) We offer a detailed reconstruction of the different interpretations of melancholic depression and their relationships to the issue of temporality. (3) We analyze the disruption of intentionality in melancholic depression and how it affects corporeality and directionality. (4) We focus on the disruption of moods and affects in melancholic depression, observing how they shape subjective experience. The goal of this theoretical contribution is to underscore the role of operative intentionality and its disruptions in melancholic depression. We argue that taking elements such as intentionality, embodiment, and spatiality into consideration could help to direct therapies along more promising paths. _Keywords_: Melancholic Depression; Operative Intentionality; Corporeality; Directionality; Temporality; Mood Disorders _La depressione melancolica. Un’interpretazione fenomenologico-ermeneutica_ _Riassunto_: L’intento generale di questo contributo è di fornire un’interpretazione della depressione melancolica attraverso la fenomenologia ermeneutica. Più specificatamente, la nostra ipotesi è che questa condizione potrebbe essere interpretata come un’alterazione dell’arco intenzionale la quale impatta la corporeità, la temporalità e la spazialità, e non come un disordine dell’umore. Infatti, classificare la depressione melancolica come un disordine dell’umore ci sembra una scelta particolarmente limitata; il disordine dell’umore non è la causa ma la conseguenza di un disturbo a livello primario dell’intenzionalità operativa. Il nostro contributo si articola in quattro sezioni: nella prima, forniamo una cornice metodologica e concettuale finalizzata a chiarificare le fondamenta teoretiche del nostro lavoro, ad illustrare l’utilizzo della fenomenologia ermeneutica in riferimento alla depressione melancolica, e a sottolineare le differenze principali tra melancolia e depressione. Nella seconda sezione, ricostruiamo in modo dettagliato le diverse interpretazioni della depressione melancolica e la loro relazione con la temporalità. Nella terza sezione, analizziamo l’alterazione dell’intenzionalità nella depressione melancolica e come essa impatti sia la corporeità che la direzionalità. Infine, nell’ultima sezione ci concentriamo sull’alterazione degli stati umorali e della componente affettiva, osservando come questi elementi vadano a caratterizzare l’esperienza soggettiva. Il fine di questo contributo teoretico è di evidenziare il ruolo dell’intenzionalità operativa e delle sue alterazioni nella depressione melancolica. La nostra tesi è che prendere in considerazione alcuni elementi, come l’intenzionalità, l’embodiment e la spazialità, possa contribuire a delineare interventi terapeutici in modo più promettente. _Parole chiave_: Depressione melancolica; Intenzionalità operativa; Corporeità; Direzionalità; Temporalità; Disturbi dell’umore. (shrink)

The article aims at expanding the horizon of phenomenological psychopathology of depression from a social theoretical perspective. Based on Merleau-Ponty’s phenomenological ontology, in the first section, depression is reinterpreted as a disruption of chiasm: it is not merely the illness of the body, the disorder of the mind, or a specific form of social suffering, but the interrelated distortion of time consciousness, agency, and interaffectivity. The phenomenological clarification of these components provides opportunity for connecting sociological and psychopathological insight. (...) In the second part, contemporary critical theories of acceleration, globalization, biopolitics, and system colonization are reinterpreted to highlight the structural and cultural context of late modern time consciousness, agency, and interaffectivity. In the third section, it is analyzed, how these social constituents shape the space of contemporary socialization processes, including the emergence of those intersubjective distortions, which potentially affect the entirety of chiasm in a depressive way. In the final section, the conclusions for therapy are explored, including the potentials for expanding the epistemological, substantive, and emancipatory horizon of phenomenological psychopathology. (shrink)

In this paper I offer an alternative phenomenological account of depression as consisting of a degradation of the degree to which one is situated in and attuned to the world. This account contrasts with recent accounts of depression offered by Matthew Ratcliffe and others. Ratcliffe develops an account in which depression is understood in terms of deep moods, or existential feelings, such as guilt or hopelessness. Such moods are capable of limiting the kinds of significance and meaning (...) that one can come across in the world. I argue that Ratcliffe’s account is unnecessarily constrained, making sense of the experience of depression by appealing only to changes in the mode of human existence. Drawing on Merleau-Ponty’s critique of traditional transcendental phenomenology, I show that many cases of severe psychiatric disorders are best understood as changes in the very structure of human existence, rather than changes in the mode of human existence. Working in this vein, I argue that we can make better sense of many first-person reports of the experience of depression by appealing to a loss or degradation of the degree to which one is situated in and attuned to the world, rather than attempting to make sense of depression as a particular mode of being situated and attuned. Finally, I argue that drawing distinctions between disorders of structure and mode will allow us to improve upon the currently heterogeneous categories of disorder offered in the DSM-5. (shrink)

In this article, I examine stigmatizing and especially patronizing attitudes towards others’ depression that people who are well-intentioned produce. The strategy of the article is to consider the social experience of depression through two separate subfields of philosophy: epistemic injustice and phenomenology. The solution that I propose is a phenomenological account of empathy. The empathetic attitude that I argue for involves actively listening to the depressed individual and taking their depression testimony as direct evidence. The article (...) has been written both for those who seek to better support neurodiverse people in their lives and for depressives (and other neurodivergents) themselves in order to provide them with a better account for advocating for themselves against social stigma. (shrink)

Describing, understanding, and explaining subjective experience in depression is a great challenge for psychopathology. Attempts to uncover neurobiological mechanisms of those experiences are in need of theoretical concepts that are able to bridge phenomenological descriptions and neurocognitive approaches, which allow us to measure indicators of those experiences in quantitative terms. Based on our own on going work with patients who suffer from depersonalization disorder and describe their experience as flat and detached from self, body, and world, we introduce the (...) idea of phenomenal depth as such a concept. Phenomenal depth is conceptualized as a dimension inherent to all experiences, describing the relatedness of one's self with one's mental processes, body, and the world. More precisely, it captures the experience of this relatedness and embeddedness of one's experiences, and it is thus a meta- or secondorder experience. The psychopathology of DPD patients can be understood very generally as an instance of reduced phenomenal depth. We will argue that similar experiences in depression can also be understood as a reduction in phenomenal depth. We relate those ideas to neurocognitive studies of perception, emotion regulation, and the idea of predictive coding. Finally, we will speculate about possible neurobiological underpinnings of the dimension of phenomenal depth. (shrink)

For phenomenological psychopathologists an important methodological question is which philosopher, or philosophical corpus, one is going to draw on to help organize and illuminate raw psychopathological data. For the main phenomenological psychopathologists of the past this involved selecting from among phenomenological philosophers and keeping close to them to varying degrees. For Minkowski it was Bergson, for von Gebsattel it was Scheler, and for Binswanger it was Heidegger and then Husserl. A question that arises is what makes the choice of philosopher (...) non-arbitrary?A pragmatist, or pluralist, answer to this question which I tend to favor is that psychopathologists... (shrink)

According to current opinion in western psychopathology, depression is regarded as a disorder of mood and affect on the one hand, and as a distortion of cognition on the other. Disturbances of bodily experience and of social relations are regarded as secondary to the primarily 'inner'and individual disorder. However, quite different concepts can be found in cultures whose members do not experience themselves as much as separate individuals but rather as parts of social communities. Disorders of mood or well-being (...) are then conceived less as intra-psychic, but rather as bodily, interpersonal, or atmospheric processes. On this background, the paper describes depression as a disorder of intercorporeality and interaffectivity. After developing these phenomenological concepts, it analyses depression as a 'detunement' of the resonant body that mediates our participation in a shared affective space. Instead of expressing the self, the body is turned into a barrier to all impulses directed to the environment. This impairs particularly the patient's interaction with others, resulting in a general sense of detachment, separation, or even segregation. Moreover, the restriction of the lived body also corresponds to the triggering situations of depression, namely experiences of a disruption of social bonds. Thus, intercorporeality and interaffectivity are presented as crucial dimensions for an ecological and non-reductionist view of depression. (shrink)

This paper seeks to illuminate the nature of empathy by reflecting upon the phenomenology of depression. I propose that depression involves alteration of an aspect of experience that is seldom reflected upon or discussed, thus making it hard to understand. This alteration involves impairment or loss of a capacity for interpersonal relatedness that mutual empathy depends upon. The sufferer thus feels cut off from other people, and may remark on their indifference, hostility or inability to understand. Drawing (...) upon the example of depression, I argue that empathy is not principally a matter of ‘simulating’ another person’s experience. It is better conceived of as a perception-like exploration of others’ experiences that develops progressively through certain styles of interpersonal interaction. (shrink)

This volume addresses the question of what it is like to be depressed. Despite the vast amount of research that has been conducted into the causes and treatment of depression, the experience of depression remains poorly understood. Indeed, many depression memoirs state that the experience is impossible for others to understand. However, it is at least clear that changes in emotion, mood, and bodily feeling are central to all forms of depression, and these are the book's (...) principal focus. In recent years, there has been a great deal of valuable philosophical and interdisciplinary research on the emotions, complemented by new developments in philosophy of psychiatry and scientifically-informed phenomenology. The book draws on all these areas, in order to offer a range of novel insights into the nature of depression experiences. To do so, it brings together a distinguished group of philosophers, psychiatrists, anthropologists, clinical psychologists and neuroscientists, all of whom have made important contributions to current research on emotion and/or psychiatric illness. (shrink)

It is generally maintained that emotions consist of intentional states and /or bodily feelings. This paper offers a phenomenological analysis of guilt in severe depression, in order to illustrate how such conceptions fail to adequately accommodate a way in which some emotional experiences are said to be deeper than others. Many emotions are intentional states. However, I propose that the deepest emotions are not intentional but pre-intentional, meaning that they determine which kinds of intentional state are possible. I go (...) on to suggest that pre-intentional emotions are at the same time feelings. In so doing, I reject the distinction that is often made between bodily feelings and the world-oriented aspects of emotion. (shrink)

I examine several aspects of the experience of time in depression and in the experience of different emotions. Both phenomenological and experimental studies show that depressed subjects have a slowed experience of time flow and tend to overestimate time spans. In comparison to patients in control conditions, depressed patients tend to be preoccupied with past events, and less focused on present and future events. Recent empirical findings in studies of emotion perception show different degrees of over- or underestimation of (...) time in perception of faces showing different emotions compared with neutral faces. Clinical phenomenology predicts that the effects on time estimation would not be additive if these tests were conducted with depressed subjects. (shrink)

In this paper, I offer an argument for cultivating cheerfulness as a remedy to sadness and other emotions, which, in turn, can provide some relief to certain cases of depression. My thesis has two tasks: first, to establish the link between cheerfulness and sadness, and second, to establish the link between sadness and depression. In the course of accomplishing the first task, I show that a remedy of cultivating cheerfulness to counter sadness is supported by philosophers as diverse (...) as Thomas Aquinas, Baruch Spinoza, and David Hume in their writings on the passions. I also show that my argument can generalize to promote the cultivation of other emotions. In the course of accomplishing the second task, I consider different models of depression and how the emotions are related to depression. The purpose of this paper is to offer conceptual, philosophical support that is consistent with the most current empirical data on depression. (shrink)

This paper will explore the relationship between selfhood and depression, by focusing upon the lived body's capacity to 'resonate'with the world and thus open up an 'attuned' space of meaning. Persons will become differently tuned in different situations because they embody different patterns of resonance -- what is most often referred to as different temperaments -- but the self may also suffer from idiosyncrasies in mood profile that develop into deficiencies of resonance, making the person in question ill. In (...) many cases of depression one might describe this as a being out of tune in the sense of being oversensitive to the sad, anxious, and boring tune qualities of the world. This phenomenological model allows us to describe a spectrum of various normal sensitivities which might favour certain moods over others, but also to identify pathologies, like depression, in which the body is out of tune and makes the being-in-the-world overwhelmingly unhomelike. (shrink)

The differential activation hypothesis (DAH; Teasdale, 1988) proposes that individuals who are vulnerable to depression can be distinguished from non-vulnerable individuals by the degree to which negative thoughts and maladaptive cognitive processes are activated during sad mood. While retrieval of negative autobiographical memories is noted as one such process, the model does not articulate a role for deficits in recalling positive memories. Two studies were conducted to compare the autobiographical memory characteristics of never-depressed and formerly depressed individuals following a (...) sad mood induction. In Study 1, features of negative memories of never-depressed and formerly depressed individuals did not differ, either in neutral or sad mood. For positive memories, groups did not differ in neutral mood, but following a sad mood induction, formerly depressed individuals rated their positive memories as less vivid than their never-depressed counterparts. Study 2 examined positive autobiographical memory features more comprehensively and replicated the finding that in a sad mood formerly depressed individuals recalled less vivid positive memories than never-depressed controls. These findings suggest that the phenomenological features of positive memories could represent an important factor in depressive vulnerability, and, more broadly, that depression may be associated with a deficit in the processing of positive material. (shrink)

The phenomenological method, characterized by the suspension of judgment (epoché), has helped analyzing the subjective experience of patients affected by mental disorders. Psychiatry, dealing with the human being itself in its complexity and unicity, is placed between the biological positivistic attempt, for which the symptoms of mental illness are a mere consequence of brain dysfunctions and the phenomenological-existential approach, inclined to consider the symptoms as meaningful phenomena of the person’s subjective experience. Eugène Minkowski, Ludwig Binswanger, Arthur Tatossian, Kimura Bin, Henri (...) Maldiney and Hubertus Tellenbach are fundamental authors in the phenomenological psychopathology of depression; they described the alterations of the lived time, space, body and others experienced by the depressed. Starting from the main theoretical contributions of the authors, we will focus on the psychopathology and discuss the key themes of clinical depression: guilt, poverty and hypochondriasis. Finally we will focus on the typus melancholicus construct. (shrink)

Individuals suffering from depression consistently report experiencing a lack of connectedness with others. David Karp (2017, 73), in his memoir and study of depression, has gone so far to describe depression as “an illness of isolation, a disease of disconnectedness”. It has become common, in phenomenological circles, to attribute this social impairment to the depressed individual experiencing their body as corporealized, acting as a barrier between them and the world around them (Fuchs 2005, 2016). In this paper, (...) I offer an alternative view of the experience of social disconnectedness in depression, suggesting that rather than necessarily experiencing their body as object-like, the depressed individual’s bodily is saturated with experiences of lethargy, tiredness, heaviness, sadness, hopelessness and so on, to the exclusion of being able to bodily connect to others. I suggest that depression does not involve a complete social impairment but a specific impairment of affective forms of interpersonal experience. (shrink)

This commentary examines the implications of the Depue & Collins model for the etiology and treatment of depression, specifically, whether it can account for findings concerning neurobiological, behavioral, and phenomenological facets of depression. Drawing upon the construct of self-regulation, I explore the fit of the model to current knowledge about depression, conceptualized as a dysfunction within a hypothetical brain/behavior system for maximizing positive outcomes.

We develop a philosophical interpretation of altered experience in conditions of severe unipolar depression. Drawing on phenomenological analysis, on published depression memoires and on a recent questionnaire study with patients in Britain, we hold that depression is a profound impairment of agency. Its experiential core consists in a paralyzing loss of drive and energy, a suspension of initiative, an inability to adopt a stance and act in accordance with it. Moreover, we show that experiences such as a (...) loss of self and world, altered interpersonal relatedness, modified corporeal experience as well as marked changes in the experience of time go along with the loss of agency. In order to assess their broader philosophical significance, we relate our analyses to an almost forgotten philosophical discussion: that of the term Selbstgefühl in 19th century German philosophy and early psychiatry. We also briefly discuss recent debates about the alleged historical and cultural specificity of depression. (shrink)

In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that (...) severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attune to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state. (shrink)

This chapter will introduce everyday aesthetics and conceptions of happiness, explore their interconnections, and indicate some ways they might relate to depression. I introduce the main claims and concerns of everyday aesthetics and illustrate these with examples from the Indian, Chinese, and Japanese philosophical traditions. I then consider two popular accounts of happiness – ‘hedonic’ and ‘life-satisfaction’ theories – and offer an alternative phenomenological account of happiness. Aesthetic appreciation and agency and happiness, it is argued, depend on a phenomenologically (...) fundamental capacity to experience different kinds of significant possibility. It is the loss or disruption of that capacity which characterises experiences of depression. (shrink)

Major depressive disorder is a complex and challenging condition that significantly impacts an individual’s motivation. The purpose of this paper is to shed new light on the motivational psychology of people with this condition. To achieve this purpose, first, I will critically analyze two possible accounts of motivation in depression, namely, the Humean and the phenomenological accounts. Subsequently, I will propose an account of why people with depression appear to be demotivated, drawing insights from a prevalent treatment of (...) this condition, known as Mindfulness-based therapy. I propose that what might look like a lack of motivation is a misdirected form of motivation, where the individual is stuck in a cycle of trying to solve perceived problems that exist primarily within their own mind. This internal focus leaves little room for responding to or engaging with other aspects of their environment, such as positive stimuli, which leads to the outward appearance of demotivation. (shrink)

This paper argues that the DSM diagnostic category 'major depression' is so permissive that it fails to distinguish the phenomenology of depression from a general 'feeling of being ill' that is associated with a range of somatic illnesses. We start by emphasizing that altered bodily experience is a conspicuous and commonplace symptom of depression. We add that the experience of somatic illness is not exclusively bodily; it can involve more pervasive experiential changes that are not dissimilar (...) to those associated with depression. Then we consider some recent work on inflammation and depression, which suggests that the experience of depression and the 'feeling of being ill' are, in some cases at least, much the same . However, we add that the phenomenology of depression is heterogeneous and that many cases involve additional or different symptoms. We conclude that 'major depression' is a placeholder for a range of different experiences, which are almost certainly aetiologically diverse too. (shrink)

Among the characteristic features of depression is a diminishment in or lack of action and motivation. In this paper, I consider a dominant philosophical account which purports to explain this lack of action or motivation. This approach comes in different versions but a common theme is, I argue, an over reliance on psychologistic assumptions about action–explanation and the nature of motivation. As a corrective I consider an alternative view that gives a prominent place to the body in motivation. Central (...) to the experience of depression are changes to how a person is motivated to act and, also as central, are changes to bodily feelings and capacities. I argue that broadly characterizing motivation in terms of bodily capacities can, in particular, provide a more compelling account of depressive motivational pathology. (shrink)

Psychedelics have shown promise as a treatment for depression. Although there is some debate, a popular view is that psychedelics produce their benefits in an experience-dependent manner. This is the view that a depressed person gets better, inter alia, because of the experience she has had on psychedelics. Among the various questions that treatment for depression with psychedelics raise, one of the most important is: By what mechanism do these drugs reduce symptoms? If the experience-dependent view is correct, (...) the answer, at least on the personal level of explanation, lies in the phenomenology. In this paper, borrowing mainly from Ratcliffe’s account of depression, I offer such an answer. I argue that psychedelic experiences involve a surge of existential feelings, which can revise the depressed person’s diminished sense of possibility and restore their ability to be affected by the world. I explain how this occurs via a change in the sense of reality linked to the subjective effects of psychedelics. This, I suggest, is the personal level mechanism or process behind psychedelic-assisted psychotherapy for depression. (shrink)

Phenomenologists define social impairments as key aspects of depression and argue that depression is irreducible to the individual. In this article I aim to further elaborate this non-reductionist notion of depression by claiming that depression not only corresponds to an impaired experience of social relations, but also arises from a socially impaired world. To pursue this goal, I will challenge the understanding of depression as an affective disorder blocking the affective communication between individual and environment. (...) I will redefine feelings of depression as situated affections, and hence suggest that (1) they are products of the individual's situatedness in a depressogenic environment and (2) they function in initiating an active withdrawal from such environment. (shrink)

We report on an interview-based study of decision-making capacity in two classes of patients suffering from depression. Developing a method of second-person hermeneutic phenomenology, we articulate the distinctive combination of temporal agility and temporal inability characteristic of the experience of severely depressed patients. We argue that a cluster of decision-specific temporal abilities is a critical element of decision-making capacity, and we show that loss of these abilities is a risk factor distinguishing severely depressed patients from mildly/moderately depressed patients. (...) We explore the legal and clinical consequences of this result. (shrink)

Memoirs and autobiographical accounts of mental illness have been widely utilized in phenomenological psychopathology and, in particular, in the investigation of depression (Fuchs 2013; Ratcliffe 2010; Ratcliffe 2015), mania (Binswanger 1960; Bowden 2013), schizophrenia (Binswanger 1957; Parnas and Henriksen 2016; Sass 1994), anorexia nervosa (Bowden 2012; Legrand 2010), and borderline personality disorder (Stanghellini and Rosfort 2013). In this article I will provide a critical illustration of the different ways in which self- narratives have been employed in this context and (...) I will advance some suggestions as to how the use of life stories could further enhance the phenomenological understanding of mental illness and the therapeutic process. (shrink)

I reflect on an argument with a friend, “S,” who also struggles with depression. In examining my formalization of S’s argument, I claim, we may discern the structure of depressive thought. In observing what is missing from this structure, we may identify what depression tends to hide from depressed persons and what, more broadly, it tends to compel from them. I argue for a redescription of depressive thinking in terms of two compulsions: 1) to perceive an absolute and (...) vague threat that causes disruption to action and 2) to take this disruption as also being a reason for inaction. To do ethics for the depressed, I conclude, is to ask what philosophical argument can do for those who seek justification for action but struggle with these specific limits on their responsiveness to reasons. (shrink)

Extant literature suggests a correlation between the thematic core of an adolescent’s personal account of depression and the trajectory of her personality development. This possible correlation has not been explored in a way that includes detailed qualitative analyses of reported experiences of adolescent depression. By discussing a single case design, this contribution illustrates and justifies an interpretative procedure that has been implemented to assist such an exploration. The paper focuses on the suitability of this approach for the investigation (...) of all-encompassing alterations of the experiential field in psychopathological conditions. I argue that this suitability is grounded in a phenomenological understanding of the explicative task in terms of a disclosure of the intentional constitution of the life-world of adolescent depression. The discussion begins with a contextualization of the single case design within a multilayered and methodologically mixed study. Against this background, I illustrate the steps of a ‘systematic of interpretation’ aimed at exposing meaning horizons. Touching on issues concerning the empirical validity of the approach, these meaning horizons are construed as objectively plausible frames of intelligibility of a subjectively particular form of experience. Drawing on a characterization of transcendental arguments, I discuss the relationship between the illustrated procedure and the investigational attitude that, according to Husserl, defines phenomenology as a properly philosophical endeavor. In this context, I eventually characterize the illustrated procedure as a crossover approach to human experiential life aligned with the tradition of phenomenological psychopathology. (shrink)

Experiences of Depression is a philosophical exploration of what it is like to be depressed. In this important new book, Matthew Ratcliffe develops a detailed account of depression experiences by drawing on work in phenomenology, philosophy of mind and psychology, and several other disciplines.

Phenomenological descriptions of depressed mental life offer a profound understanding of depression from the first-person perspective. In this paper, such descriptions are developed by drawing on the work by Ludwig Binswanger and on the autobiographical report of depression by Piet C. Kuiper . I will argue that Binswanger’s central claim in his phenomenological description of the depressed state of mind fails due to crucial misunderstandings of Edmund Husserl’s phenomenology. Nonetheless, by drawing on Kuiper’s first-hand account, I will (...) develop a phenomenological description of depressed mental life, highlighting the altered manner of pre-reflective valuing in depression and introducing the concept of a ‘depressive habituality.’ This term refers to the acquisition of a new set of habitualisations, especially on the foundational levels of automatic mental life. It offers explanations for the fact that it is not easy to recover from depression and that people may more easily become depressed again. (shrink)

In Moody Minds Distempered philosopher Jennifer Radden assembles several decades of her research on melancholy and depression. The chapters are ordered into three categories: those about intellectual and medical history of melancholy and depression; those that emphasize aspects of the moral, psychological and medical features of these concepts; and finally, those that explore the sad and apprehensive mood states long associated with melancholy and depressive subjectivity. A newly written introduction maps the conceptual landscape, and draws out the analytic (...) and thematic interconnections between the chapters. Radden emphasizes and develops several new themes: the implications, theoretical phenomenological and moral, of recognizing melancholy and depressive states as mood states; questions of method, as they affect how we understand and characterize claims about melancholy and depression; and the persistence and force of cultural tropes linking such states to brilliance, creativity, and sagacity. Insights from literature and the history of medicine, psychology, and psychiatry are woven together with those from the more recent disciplines of feminist theory and cultural studies. This is interdisciplinary writing at its best-part analytic philosophy, and part history of ideas. (shrink)

The aim of this study is to explore the relationship between affectivity and moral experience from a phenomenological perspective. I will start by showing how in a phenomenologically oriented account emotions can be conceived as intentional evaluative feelings which play a role in both moral epistemology and the motivation of moral behaviour. I will then move to discuss a particular kind of affect, "existential feelings" (Ratcliffe in Journal of Consciousness Studies 12(8–10), 43–60, 2005, 2008), which has not been considered so (...) far in the discourse on moral and affective experience. Relying on the notion of pre-intentionality through which Ratcliffe characterizes existential feelings (Inquiry: An Interdisciplinary Journal of Philosophy 53(6), 602–626, 2010) and on some insights into the relationship between affectivity and ethics developed by De Monticelli (2003, 2006), I suggest that key to the role played by existential feelings in moral experience is that they determine the kinds of evaluations that it is possible for us to make and the range of our possibilities of action. I then illustrate and further develop this idea through a phenomenological analysis of some forms of psychopathological experience. More specifically, by considering some experiential features of depression and borderline personality disorder, I claim that, by acquiring an existential character, emotions such as guilt, feelings of isolation, anger and shame can radically alter the structure of the individual evaluative perspective, having a deep impact on both moral judgements and behaviours. (shrink)

In this paper, I explore the questions of how and to what extent new antidepressants (selective serotonin-reuptake inhibitors, or SSRIs) could possibly affect the self. I do this by way of a phenomenological approach, using the works of Martin Heidegger and Thomas Fuchs to analyze the roles of attunement and embodiment in normal and abnormal ways of being-in-the-world. The nature of depression and anxiety disorders — the diagnoses for which treatment with antidepressants is most commonly indicated — is also (...) explored by way of this phenomenological approach, as are the basic structures of self-being. Special attention is paid in the analysis to the moods of boredom, anxiety and grief, since they play fundamental roles in depression and anxiety disorders and since their intensity and frequency appear to be modulated by antidepressants. My conclusion is that the effect of these drugs on the self can be thought of in terms of changes in self-feeling, or, more precisely, self-vibration of embodiment. I present the idea of a spectrum of bodily resonance, which extends from the normal resonance of the lived body, in which the body is able to pick up a wide range of different moods; continuing over various kinds of sensitivities, preferences and idiosyncrasies, in which certain moods are favored over others; to cases that we unreservedly label pathologies, in which the body is severely out of tune, or even devoid of tune and thus useless as a tool of resonance. Different cultures and societies favor slightly differently attuned self-styles as paradigmatic of the normal and good life, and the popularity of the SSRIs can therefore be explained, not only by defects of embodiment, but also by the presence of certain cultural norms in our contemporary society. (shrink)

The DSM characterizes major depressive disorder partly in temporal terms: the depressive mood must last for at least two weeks, and also must impact the subject "most of the day, nearly every day." However, from the standpoint of phenomenological psychopathology, the long-lasting quality of the condition hardly captures the distinctiveness of depression. While the DSM refers to objective time as measured by clocks and calendars, what is especially striking about depression is the distortions to lived time that it (...) involves. But is there any relation between a) these disruptions to temporal experience and b) the tendency for depressive symptoms to persist and endure? To explore the connection between lived time and objective time, I investigate the embodied and enactive nature of intentionality among subjects suffering from depression. What I call 'affective framing' is a spontaneous, pre-reflective way of filtering information that involves bodily attunement and allows subjects to focus their attention on what they feel is important. I will argue that affective framing ordinarily has a forward-looking temporal structure and a "teleological direction" that is rooted in our embodiment. However, depression involves a distortion in future-directed intentionality, so that a subject becomes temporally desituated and cut off from the future. This contributes to many of the characteristic features of depression, including apparent lack of motivation, inability to imagine future possibilities, alterations in lived time, and a sense that one is "stuck." To gain a better understanding of this disruption to the futuredirected structure of affective framing in cases of depression, I look to concepts from complex dynamic systems theory and the notion of 'habit.' My proposed account aims to shed light on how a disruption to future-directedness impacts bodily attunement and reinforces depression as a long-term condition. (shrink)

Despite the relevance of silence in several psychopathologies, first-person perspectives on silence have been largely neglected in the phenomenological scholarship on those conditions. This paper proposes a phenomenological framework for addressing this neglect and demonstrates its usefulness through a case study of empty silence, an experience which can be found in many first-person accounts of depression. The paper begins by surveying research on silence in depression in mental health research and phenomenological psychopathology. Drawing on the thought of Merleau-Ponty, (...) it then outlines a phenomenological framework for explicating the structure of silence experiences in psychopathology. Finally, it applies this framework to articulate the experiential structure and implications of empty silence, with a particular emphasis on the bodily doubt that can flow from repeated experiences of empty silence. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Why the Phenomenology Remains FoundationalRobert Harland (bio)Keywordspsychology, cognitive-behavioral therapy (CBT), phenomenology, psychiatry, depressionDemian Whiting in his paper criticizes an exclusively cognitive approach to the treatment of emotional problems. There is no doubt that the cognitive model of the mind has been recently in the ascendancy and therapies based on it are to be found in almost every subspecialty of psychiatry. Cognitive-behavioral therapy (CBT) in particular is "discovered" (...) as being effective in everything from posttraumatic stress disorder to psychosis. The heartland of the approach is and remains anxiety and depression, the two most common emotional states that psychiatrists and psychologists are asked to deal with. As Dr. Whiting describes, leaving aside the behavioral aspects, the basic principle is about eliciting and challenging distorted cognitions. Cognitive theory suggests that distorted cognitions are the cause of, the substance of, and the maintaining factors in most if not all depression and anxiety.The author accepts that in certain cases distorted cognitions lead to an experience that is represented contra to reality. He suggests that in certain circumstances a cognitive therapist could help a patient to reappraise the world they find themselves in and by gathering evidence with the therapist, to challenge these distortions. So in depression, a patient sees themselves as worthless and their therapist suggests they gather evidence that helps them form a more balanced perspective. The cognition "I am worthless" is shown empirically to be a distortion. Whiting argues, correctly in my opinion, for the limitation of this approach. In doing so he argues against a growing psychological hegemony, one that sees itself as developing evidence-based practice that should be applied (on the back of national guidelines) to many presentations before or exclusively of others such as medication or alternative psychotherapeutic approaches.Whatever the outcome in the clinic, as opposed to the randomized controlled trials, many clinicians and health care managers are attracted to CBT because of its pragmatic, short-term, problem- and consumer-orientated nature. It has an approach tailored for most disorders and therefore fits very well within the organization of modern mental health services. With this background, nonclinical readers may more readily appreciate the potential target of Dr. Whiting's critique.Whiting suggests three examples where eliciting cognitions can at best be seen as secondary [End Page 247] to the problem in hand: First, where a drug (e.g., alcohol) or state (e.g., tiredness) directly causes an emotion; second, where an emotion causes a mistaken understanding of a situation; and third, where the representation is accurate but the response defective (e.g., the pedophile in his article, or more routinely a person particularly sensitive to anxiety). The phenomenology, before the prism of analysis, is that in all three cases the patients find themselves in an emotional state where any putative cognitive etiology is at best post hoc and at worst tautological. Furthermore, as the author states, in the cases where accurate representations elicit the wrong kinds of emotions, the question why cannot be answered by referring back to the person's representations.To answer the question of why someone is particularly sensitive to anxiety or gets aroused by children, Dr. Whiting points to several possibilities that all impact on treatment: First, the influence of noncognitive desires and emotions; second, physical contamination; third, an idiosyncratic or abnormal constitution; and fourth, a defective emotional acculturation. In all these cases, suggesting that the patient's problems will be resolved through altering eliciting cognitions seems illogical.The paper then preempts two criticisms from the cognitive approach. The first again rightly expands that, if a higher order evaluative level is proposed, this in no way answers a noncognitive critique. Either the higher level of evaluation is simply an unnecessary (or unpredictable) cognitive confirmation of a negative (or positive) representation, or the evaluation is a cognitive foil for an emotional reaction that is simply not cognitive; when someone says they are worthless they are merely giving voice to their depressed emotional state. Second, that retreating to a position where the cognitive approach is used to challenge distorted representations that are secondary to, and yet maintain, an inappropriate emotion may have a role, but does not mean that... (shrink)

Although depression is characterized as a mood disorder it turns out that, like moods in general, it cannot be explained independently of a theory of emotion. In this paper I outline one promising theory of emotion and show how it deals with the phenomenon of depressive mood. An important aspect of MAT is the role it assigns to peripheral information processing systems in setting up emotional responses. The operations of these systems are automatic and opaque to consciousness, but they (...) represent information about the significance of the environment for the subject, bias cognition and behaviour, and have a characteristic phenomenology. I show how understanding the nature of peripheral appraisal provides a principled way to link neurochemistry and mood via an information processing theory of the circuitry targeted by antidepressant treatment. The discussion is organized around Matthew Ratcliffe's distinction between pre-intentional and intentional feelings and suggests that the MAT might provide a way to link phenomenological and mechanistic accounts of feeling states characteristic of depression. (shrink)

From a phenomenological viewpoint, shame and guilt may be regarded as emotions which have incorporated the gaze and the voice of the other, respectively. The spontaneous and unreflected performance of the primordial bodily self has suffered a rupture: In shame or guilt we are rejected, separated from the others, and thrown back on ourselves. This reflective turn of spontaneous experience is connected with an alienation of primordial bodiliness that may be described as a "corporealization": The lived-body is changed into the (...) objective, corporeal body or "body-for-others." The polarity of "bodiliness" and "corporeality" may further a phenomenological understanding of several mental disorders connected with shame and guilt. This is shown by the examples of body dysmorphic disorder and melancholic depression. (shrink)

Interdisciplinary in approach, this book combines philosophy, sociology, history and psychology in the analysis of contemporary forms of suffering. With attention to depression, anxiety, chronic pain and addiction, it examines both particular forms of suffering and takes a broad view of their common features, so as to offer a comprehensive and parallel view both of the various forms of suffering and the treatments commonly applied to them. Highlighting the challenges and distortions of the available treatments and identifying these as (...) contributory factors to the overall problem of contemporary suffering, Empty Suffering promises to widen the horizon of therapeutic interventions and social policies. As such, it will appeal to scholars across the social sciences and humanities with interests in mental health and disorder, social theory and social pathologies. (shrink)

본 논문은 현상학적 방법에 따라 정신의학에 관한 현상학적 연구를 우울증을 사례로 개괄한다. 논문은 정신의학에서 현상학의 역할이 무엇이며, 현상학적 탐구 방법의 의의가 어떤 것인지를 우울증과 함께 살펴본다. 현상학은 정신의학에서 체험의 중요성을 상기시킨다. 현상학은 매뉴얼 중심으로 손쉽게 진단되는 정신 질병에 대해 판단중지를 요청하며 체험 기술로부터 본질 통찰할 것을 요구한다. 우울증의 사례로 확인되듯, 정신질환에 대한 이해는 총체적인 탐구가 필요하다. 현상학은 체험 기술에서부터 초월론적 환원에 이르기까지 정신질환의 양상과 원인을 다양한 관점에서 총체적으로 살피도록 돕는다. 이는 인간과 정신질환에 대한 개방적, 포용적 이해로 이어진다.

In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of the will. (...) I will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions. These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her ‘depressive disabilities’. Lastly, I will compare this manner of life-conduct with the constellation of includence, as described by Tellenbach, and discuss the limitations of this study. (shrink)

This chapter offers a phenomenological account of impaired agency in depression. It begins by briefly considering some first-person descriptions of how depression affects the ability to act, which point to an altered "experience of free will." Although it is often assumed that we have such an experience, it is far from clear what it consists of. The chapter argues that this lack of clarity is symptomatic of looking in the wrong place. Drawing on themes in Sartre's Being and (...) Nothingness, it is suggested that the sense of freedom associated with action is not-first and foremost-an episodic "quale" or "feeling" that is experienced as internal to the agent. Rather, it is embedded in the experienced world; my freedom appears in the guise of my surroundings. This makes better sense of what people with depression consistently describe-a diminished ability to act that is inextricable from a transformation of the experienced world. In addition to illuminating an aspect of the experience of depression, the chapter aims to illustrate something more general: how phenomenology and psychiatry can interact in a fruitful way. (shrink)

This book is an investigation into cultural variations in experiences of depression. With the aid of empirical data, and with a phenomenological outlook, the analyses presented aim to give a comparative account of the significance of culture in shaping cross-cultural variations, as seen in Iran and the UK. Through analysis of elements of Iranian culture such as literature and folk theories, and important pillars of current social make-up of the country like experience of Iran-Iraq war, the Islamic revolution and (...) its dominant religious discourse, variations in conceptions, experiences and narratives of depression are accounted for. Some of the themes explored include discussions of particular symptoms of depression such as guilt, hopelessness, loss of meaning and somatic symptoms; social stigmas and help-seeking behaviours; changes in relations with others; and metaphors used to convey experiences of depression. The findings of the empirical data examined challenge the universalist approach to psychiatry as science and practice, as well as theoretical notions like idioms of distress that aim to account for cross-cultural variations of mental illness. Instead, it is claimed that a better understanding of the workings of mental illness is achieved by situating individuals and their experience in a meaning-making sociocultural context. (shrink)

This paper utilizes the enactivist notion of ‘sense-making’ to discuss the nature of depression and examine some implications for treatment. As I understand it, sensemaking is fully embodied, fundamentally affective, and thoroughly embedded in a social environment. I begin by presenting an enactivist conceptualization of affective intentionality and describing how this general mode of intentional directedness to the world is disrupted in cases of major depressive disorder. Next, I utilize this enactivist framework to unpack the notion of ‘temporal desituatedness,’ (...) and maintain that the characteristic symptoms of depression result from a disruption to the future-directed structure of affective intentionality. This can be conceptualized as a loss of “online intelligence” and a shrinking of the field of affordances. Then, I argue that two of the standard modes of treatments for depression, medication and cognitive behavioral therapy, are not fully sufficient means of restoring online intelligence, and that these limitations stem partly from the approaches’ implicit commitment to a brain-bound, overly cognitivist view of the mind. I recommend expressive arts interventions such as dance-movement therapy and music therapy as important supplementary treatment methods that deserve further consideration. Insofar as they revitalize subjects’ bodies and emotions, cultivate an openness to the future, and promote self-insight and social synchrony, these treatment modes not only reflect key insights of enactivism, but also offer great potential for lasting healing. (shrink)