Abstract
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.
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Notes
The DSM-5 currently lists nine relevant symptoms for the diagnosis of MDD. In order to qualify for a diagnosis of MDD, a patient must have at least five of the symptoms, with one of the five being either depressed mood or loss of interest or pleasure (APA 2013). Taking into account that five symptoms must be met, and that there are nine total symptoms to select from, it would seem that any two people diagnosed with depression must share at least one symptom. However, many of the symptoms are actually clusters of possible symptoms, in many cases including polar opposites. For example, item three can be met by having either significant weight loss or significant weight gain; item four can be met by having either insomnia or hypersomnia; and item five can be met by having psychomotor agitation or retardation. Taking into account the divergence of symptoms such as weight gain versus weight loss, or insomnia versus hypersomnia, it is in fact possible for two people to be diagnosed with MDD without sharing a single symptom.
Throughout the paper I will use “structure” and “form” interchangeably. “Structure,” as used in the English translations of the work of Husserl and Heidegger, is a concept that is roughly parallel to “form” as found in the English translations of Merleau-Ponty’s works.
The term “ground mood” [Grundstimmung] is typically associated with Fundamental Concepts of Metaphysics, rather than Being and Time. However, Heidegger does discuss such moods (specifically anxiety) in Being and Time, but refers to them by a different term. In this work, he refers to them as Grundbefindlichkeit, which was originally translated as “basic state-of-mind” (Heidegger 1927/1962, 233).
Throughout this paper, “intentional” will be used as a technical, phenomenological term. In this sense, it refers to the fact that consciousness is always consciousness of something or other. Consciousness is always about, or directed at, something within the world (or in some cases, the world itself). Certain kinds of emotions are also intentional, which is to say, they are felt as being toward or about something.
In Being and Time, Heidegger explicitly differentiates his notion of existential structures from Aristotelian categories. However, this distinction is stressed precisely because the two notions share important similarities. As he explains, existentials pertain only to the entity whose being is being-in-the-world. Categories, on the other hand, pertain only to beings that do not have a world (e.g. present-at-hand or ready-to-hand entities). In some of Heidegger’s early lecture courses, he even refers to existentials as “categories of Dasein” (Heidegger 1920-21/2010; 1923/2008).
One might wish to argue this point by appealing to Heidegger’s discussion of anxiety as “ontological.” It must be understood that anxiety itself is not ontological (although it is certainly deep, in the sense of being pre-intentional). One might be led to believe that anxiety is itself ontological because it has the power of disclosing the ontological structure of Dasein as Care. For Heidegger, anxiety is ontologically instructive, but only in a methodological sense. In other words, Heidegger finds that the mood of anxiety discloses Being-in-the-world in such a distinctive way that it reveals a previously hidden structure of human existence. However, in spite of this disclosive power, anxiety is still only a mode of human existence, and is therefore ontic, rather than ontological. This follows for the deep existential feelings of guilt and hopelessness as discussed by Ratcliffe.
In his essay, “The Varieties of Temporal Experience in Depression,” (2012) Ratcliffe may offer phenomenological accounts of existential changes in temporality; that is to say, changes in the structure of temporality. However, more work would have to be done before changes in the structure and mode of temporality can be adequately differentiated.
This project is given a cursory discussion in Cartesian Meditations (1931/1960), but is developed in more detail in Analyses Concerning Passive and Active Synthesis (1918-26/2001) and On the Phenomenology of the Consciousness of Internal Time (1928/1991), reaching a climax (at least in the published works) in The Crisis of European Sciences and Transcendental Phenomenology (1936/1970). In these works, Husserl developed a phenomenology in which personal-biographical (genetic) and social-historical (generative) circumstances play a role in shaping the structures of the life-world.
Another excellent example of changes in the structure of existence is the case of Ian Waterman, especially as interpreted by Shaun Gallagher in How the Body Shapes the Mind (2005). I have chosen to focus on Merleau-Ponty’s investigation of Schneider’s case, rather than Gallagher’s investigation of Waterman’s, because Merleau-Ponty remains more closely aligned to philosophical, or transcendental phenomenology, which is the primary framework within which this paper is written.
The kind of phenomenological account of depression I am developing here is not without precedent. The double aspect of depression as a degradation of feeling, coupled with feelings of guilt, was explored by some of the phenomenological psychiatrists of the 20th century, such as Ludwig Binswanger, Hubertus Tellenbach, and Erwin Straus. They considered this double aspect to be central to the diagnostic category of melancholia. I am grateful to Giovanni Stanghellini for bringing this historical link to my attention.
I do not mean to suggest that phenomenological accounts of persons diagnosed with depression are necessarily illegitimate if they appeal only to changes in the mode of existence. Due to the heterogeneity and ambiguity of the diagnostic criteria for MDD, it is likely that many people with this diagnosis have not suffered any change in their basic existential structure, and for them, Ratcliffe’s account is likely to be accurate.
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Acknowledgments
I would like to thank James Goetsch and Nathan Andersen for their support of the original project that led to the writing of this paper. I would also like to thank Charles Guignon, Alex Levine, Giovanni Stanghellini, Steven Crowell, Christine Wieseler, Sarah Wieten, Brad Warfield, and Zac Purdue for their support of this project and comments on earlier drafts of this paper. Finally, I would like to thank the three anonymous reviewers for their extensive and helpful comments.
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Fernandez, A.V. Depression as existential feeling or de-situatedness? Distinguishing structure from mode in psychopathology. Phenom Cogn Sci 13, 595–612 (2014). https://doi.org/10.1007/s11097-014-9374-y
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DOI: https://doi.org/10.1007/s11097-014-9374-y