Depression

There has been recent work on acedia and its relationship to depression, but the results are a mixed bag. In this essay, I engage some recent scholarship comparing acedia with depression, endeavouring to clarify the concept of acedia using literature from theology, philosophy, psychiatry, and even a 16th-century treatise on witchcraft. Along the way, I will show the following key theses. First, the concept of acedia is not identical to the concept of depression. Acedia is not merely a primitive psychological (...) predecessor to depression, but it marks off significantly different ways of being, not least because of one’s spiritual relation to God. As Lucrèce Luciani-Zidane (2009: 13) has said, “acedia is entangled in the heart (or life) of Christian dogma.” Second, however, it is still possible that an instance of acedia can coincide with an instance of depression, if one’s condition, or state, is such that each term can be correctly and truthfully applied. By the conclusion of this piece, I begin to explore what practical implications this view has for practitioners and laypersons. (shrink)

This work analyzes the conceptual metaphors of depression in a corpus of 23 blogs written in Catalan by people suffering major depressive disorder. Its main aim was comparative, in order to check w...

Depression has been widely studied by researchers from different fields, but its causes, and mechanism of action are still not clear. A difficulty emerges from the shifting from objective diagnosis or analysis to exploration of subjective feelings and experiences that influence the individuals' expression, communication and coping in facing depression. The integration of the experiential dimension of the first-person in studies on depression–and related methodological recommendations–are needed to improve the validity and generalizability of research findings. It will allow the development (...) of timely and effective actions of care. Starting from providing a summary of the literature on theoretical assumptions and considerations for the study of the mind, with particular attention to the experiential dimension of patients with depression, this contribution is aimed to provide practical suggestions for the design of research able to incorporate first- and third-person accounts. It is also aimed to review qualified phenomenological methods for the acquisition and interpretation of experiential data in patients with depression. Recognizing the first-person perspective in the study of depression is a major step toward a better understanding and treatment of this disorder. Theoretical constructs and technique suggestions that result from this review offer a valid starting point for the inclusion of the experiential dimension to common third-person research in the study of the mind. (shrink)

Much of the literature on impairment to self-governance focuses on cases in which a person either lacks the ability to protect herself from errant urges or cases in which a person lacks the capacity to initiate self-reflective agential processes. This has led to frameworks for thinking about self-governance designed with only the possibility of these sorts of impairments in mind. I challenge this orthodoxy using the case of melancholic depression to show that there is a third way that self-governance can (...) be undermined: an agent may fail to form the desire she most wants to act on. (shrink)

Immediately before the release of DSM-5, a group of psychiatric thought leaders published the results of field tests of DSM-5 diagnostic criteria. They characterized the interrater reliability for diagnosing major depressive disorder by two trained mental health practitioners as of “questionable agreement.” These field tests confirmed an open secret among psychiatrists that our current diagnostic criteria for diagnosing major depressive disorder are unreliable and neglect essential experiences of persons in depressive episodes. Alternative diagnostic criteria exist, but psychiatrists rarely encounter them, (...) forestalling the discipline’s epistemological crisis. In Alsadair MacIntyre’s classic essay, such crises occur in science when a person encounters a rival schemata that is incompatible with their current schemata and subsequently constructs a narrative that allows them to reconstruct their own tradition. In search of rival schemata that are in conversation with their own tradition, psychiatric practitioners can utilize alternative diagnostic criteria like the Cultural Formulation Interview, embrace an epistemologically humble psychiatry, and attend to the narrative experience of a person experiencing a depressive episode. (shrink)

The pathologization of women’s depression covers over the social and institutional causes of that symptomology. Insofar as patriarchal values continue to devalue and debase women and mothers in ways that colonize psychic space, and depression becomes a cover for what I call ‘social melancholy.’ This is not the melancholy of traditional psychoanalysis, but a form of melancholy that results from oppression, domination, and the colonization of psychic space. Social melancholy differs from both Freud’s notion of melancholy in that it is (...) the result of social factors that constitute the depressed subject as ashamed and lacking agency. Crucial to my analysis is a distinction between shame and guilt missing from traditional psychoanalytic accounts of melancholy and depression. (shrink)

This dissertation in Theory of Practical Knowledge contends that depression is a disorder of the self. Using the existential-phenomenology of Maurice Merleau-Ponty, I argue that if we want to disclose the basic structure of depressed experience, then we must likewise disclose how selfexperience is inseparable from depressed experience. However, even though depression is a contemporary psychiatric category of illness, it is nevertheless a historically and heterogenous concept. To make sense of depression in the context of contemporary psychiatric practice, I show (...) that depression has historically been characterized by two broad models of causation; that is, a phenomenon that is causally explained by either a biological dysfunction or a psychological conflict. But this stark characterization is not limited just to history; by conducting qualitative interviews with psychiatric professionals, I illustrate how this causal dichotomy remains prevalent in contemporary psychiatric practice. On one hand, the clinicians report dissatisfaction with the depression diagnostic criteria, while on the other hand, the clinicians also recognize that a depression diagnosis is useful insofar as a diagnosis facilitates access to various resources associated with psychiatric care. Consequently, clinicians have developed a coping strategy that is witnessed in their empathetic desire to distance patients from their depression diagnosis, which led to statements such as, “you are not the problem, the problem is depression.” One consequence of this approach is that depression is artificially cleaved from the person who experiences depression, which subsequently means that depression is viewed to be something independent of oneself. Because I argue that depression and the self are mutually implicated, it is crucial to disseminate some of the most influential contemporary models of selfhood. I show that the brainbound, situated, psychological, and narrative model of self, all have respective strengths and weaknesses. But I also go beyond these models and characterize selfhood as a developmental phenomenon that is expressed as an embodied-style. This style reflects the way in which we establish perceptual contact with the otherness, without which there could be no self-experience. (shrink)

In the current study it was investigated whether a maternal depressive disorder influences the mother-infant-interaction in infancy and the later ToM-understanding. Therefore, it was examined if there is a relationship between early mother-infant-interaction and later ToM-understanding. To our knowledge this is the first study that investigated gender as moderator for this relationship and that investigated if the infant’s ability of self-regulation is a predictor for ToM-understanding. It was examined if boys and girls of depressed mothers differ concerning their ability of (...) self-regulation. 53 mother-child dyads were studied over the period of 4 years, 20 mothers had a postpartum or lifetime depression, 33 mothers didn’t have any mental disorder. The mother-child-interaction was studied using the Face-to-Face-Still-Face-Paradigm. In preschool age ToM understanding was measured by using content-false-belief- and location-false-belief tasks. There was no difference between the mother-infant-interaction and ToM understanding between the experimental group and the control group. Furthermore, neither a relationship between early mother-infant-interaction and later ToM understanding nor a moderating influence of gender were found. Only the behavior of self-regulation during an interactive stress situation in FFSF was a marginal significant predictor for later ToM understanding for all participants. Furthermore, a significant difference between boys and girls was found within the experimental group. Girls of depressive mothers showed more behavior of self-regulation during an interactive stress situation than boys. Further research about the relationship between self-regulation in infancy and ToM understanding is needed. (shrink)

Adherence to certain religious beliefs is often cited as both an efficient deterrent to immoral behavior and as an effective trigger of morally praiseworthy actions. I assume the truth of the externalist theory of motivation, emphasizing emotions as the most important non-cognitive elements that causally contribute to behavioral choices. While religious convictions may foster an array of complex emotions in a believer, three emotive states are singled out for a closer analysis: fear, guilt and gratitude. The results of recent empirical (...) studies are examined to evaluate the relative motivational efficiency of all three emotions, as well as the likely negative psychological side-effects of these affective states, such as aggres­sion and depression. While an action motivated by fear of punishment can be seen as a merely prudential strategy, the reparatory incentive of a guilty subject and a desire to reciprocate of the one blessed by undeserved favors are more plausible candidates for the class of genuine moral reactions. The available evidence, how­ever, does not warrant a conclusion that a sense of guilt before God or as a sense of gratefulness to wards God, may produce a statistically significant increase in the frequency of prosocial actions aimed at other humans. (shrink)

Background: Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home. Depression affects an estimated one in 15 adults (6.7%) in any given (...) year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Psychologist in diagnosing depression disease through its symptoms such as: a loss of energy, a change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt or hopelessness and thoughts of self-harm or suicide. The proposed expert system presents an overview about depression disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed depression disease diagnosis expert system was evaluated by psychologist students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for psychologist, patients with depression and newly graduated psychologist. (shrink)

The aim of my paper is to review the discussion concerning various difficulties which surround the definition of depression and the methods of diagnosing and treating the disease against the background of the now dominant reductionist paradigm in psychiatry, as well as to answer the question whether a new approach to psychiatric disorders proposed by philosophers of psychiatry working within the phenomenologically inspired embodied and enactive paradigm indeed offers a solution to these difficulties. I present the issues specific to the (...) subject of depression in light of the more general problems related to biological psychiatry that have recently caused much debate. In the second part of the paper, I consider enactive, phenomenological and embodied theories of depression and the possibilities of new methods of treatment. My goal is to assess whether these theories indeed add anything important to the conceptions that are already present in psychiatry. I conclude that even if the embodied philosophy of psychiatry does not solve many of the problems faced by modern psychiatry, it can, nevertheless, provide a useful theoretical basis for future changes. (shrink)

Although scholars have read “The Depressed Person” in relation to questions of the self and problems of communication and self-expression, this paper reads the story as an entry point for examining the religious dimensions of Wallace’s work. Comparing Wallace with G.K. Chesterton, the paper argues that if we can accept that the depressed person’s condition is not a biologically grounded clinical depression but an exaggerated personification of a common ailment—a particular brand of loneliness—then we can see that we each have (...) a stake in the search for a way to break the dehumanizing pull of our own egos. Wallace and Chesterton point to submission and attention as potential means of escape, even if they disagree about how to do this. When confronted with the challenge of finding happiness, joy, and connection in a world that encourages introspection, explanatory mastery, and mechanistic views of the self—of finding meaning in the face of forces of meaninglessness, nihilism, and self-centeredness—both draw on imaginative literature as a source of knowledge. Wallace stops just short of orthodoxy, but his works stand as courageous defenses of the human person against the strange but dangerous foes of modern American life. (shrink)

This article examines the role of time as a methodological tool and pathological focus of clinical psychiatry and psychology in the first half of the 20th century. Contextualizing ‘psychopathologies of time’ developed by practitioners in Europe and North America with reference to the temporal theories implicit in Freudian psychoanalysis and Henri Bergson’s philosophy of durée, it illuminates how depression, schizophrenia, and other mental disorders such as obsessive-compulsive behaviours and aphasia were understood to be symptomatic of an altered or disturbed ‘time-sense’. (...) Drawing upon a model of temporal synthesis whereby in healthy individuals, a subjective temporal sense was perceived and understood in relation to objective time frameworks, clinicians argued that mentally ill patients were unable to synthesize Ichzeit and Weltzeit, using variations in this disturbance to define specific pathological conditions. (shrink)

How to draw the line between depression-as-disorder and non-pathological depressive symptoms continues to be a contested issue in psychiatry. Relatively few philosophers have waded into this debate, but the tools of philosophical analysis are quite relevant to it. In this paper, I defend a particular answer to this question, the Contextual approach.On this view, depression is a disorder if and only if it is a disproportionate response to a justifying cause or else is unconnected to any justifying cause. I present (...) four objections to this approach and then defend it from them. Along the way, I explain why it matters whether we get this question right. (shrink)

This paper is a response to Justin Bell's “Depression Applied to Moral Imagination: Deweyan Tools for Moral Inquiry." The author first contextualizes Bell’s use of evolutionary psychology in the context of two influential philosophical engagements with medicine: Alasdair MacIntyre’s concept of the therapeutic and the recent turn towards person-centered medicine over disease-centered medicine. He then raises two concerns about the accounts of depression used in the sources Bell draws on: the way they identify depression as oriented towards social problems and (...) the way they view depression as intentional. (shrink)

What is the relationship between negative experience, artistic production, and prudential value? If it were true that (for some people) artistic creativity must be purchased at the price of negative experience (to be clear: currently no one knows whether this is true), what should we conclude about the value of such experiences? Are they worth it for the sake of art? The first part of this essay considers general questions about how to establish the positive extrinsic value of something intrinsically (...) negative. The second part emphasizes the importance of various distinctions within the realm of the negative. We must distinguish between adversity (which is non-mental) and negative mental states, and between negative thoughts (or attitudes) and negative affect. Within the realm of negative affect, we must distinguish between negative emotions and moods, on the one hand, and negative affective perspectives on the other, and then between mildly negative affective perspectives and severely negative ones (for which I reserve the term ‘suffering’). These distinctions matter greatly, since different types of negative experience have very different degrees of prudential disvalue. Although many types of negative experience may be “worth it”—because their positive extrinsic value outweighs their negative value—this is rarely true of severe suffering. (shrink)

In his "Let the drugs lead the way! On the unfolding of a research program in psychiatry," Shai Mulinari nicely lays out the evolution of theories of depression since the late 1950s; that is, understanding depression as ultimately a brain disorder centering on the functioning of monoamine neurotransmitters. Moreover, the emergence of various psychotropic drug treatments have provided researchers with a "pharmacological bridge" to gain a more precise understanding of depression by observing the effects of these drugs on patients' monoamines (...) and mood. This evolution, Mulinari argues, fits Imre Lakatos's concept of a research program. Mulinari's narrative is clear, compelling, and informative and it generates some... (shrink)

In current mental health care psychiatric conditions are defined as compilations of symptoms. These symptom-based disease categories have been severely criticised as contingent and boundless, facilitating the rise to epidemic proportions of such conditions as depression. In this article we look beyond symptoms and stress the role of epidemiology in explaining the current situation. By analysing the parallel development of cardiovascular disease and depression management in Finland, we argue, firstly, that current mental health care shares with the medicine of chronic (...) somatic conditions an attachment to risk factor epidemiology, which accentuates risk and prevention in disease management. However, secondly, due to the symptom-based definitions of psychiatric conditions, depression management cannot differentiate properly between symptoms, signs and risk factors such as, for example, cardiovascular medicine, but treats symptoms as signs or risk factors in contexts of treatment and prevention. Consequently, minor at-risk conditions have become difficult to separate from proper cases of depression. (shrink)

Anastasia Philippa Scrutton renders helpful service to philosophers and mental health clinicians by highlighting strongly voluntarist approaches to depression within some present-day Christian writers and communities, particularly Pentecostal and Evangelical Christian communities in the United States and the United Kingdom. Drawing on a number of evangelical Christian books and online resources, she argues that these resources are "voluntaristic because they emphasize the role of libertarian free will and choice in the attitudes and behaviors of people with depression, such that depression (...) is seen to be a sin, or the result of sin, because depression sufferers are able to do otherwise." She counters these... (shrink)

Technical Delusions in Schizophrenia: productivity and Limits of an AnalogyIn the debates on psychosis, the cases of "technical delusions" or "influencing machines" are regularly coming back, both in phenomenological and psychoanalytical psychiatry. As Alfred Kraus points out in the 1990s, "Even if such delusions do not represent the most frequent content in schizophrenia, they receive relatively high consideration for the diagnosis of schizophrenia". And more recently, he notes that, "It is not by chance that people with schizophrenia so often use (...) technical metaphors to explain their schizophrenic experiences", but he then concludes that they are not in fact metaphors, at least... (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)

I am grateful to Dien Ho and James Phillips for their comments on my article. Although they approach the topic from different perspectives, they both seem to find my account of the evolution of monoamine theories into neuroplasticity theories to be compelling. They especially seem to find my principal argument to be persuasive: Until quite recently, the use of drugs to generate and test pathophysiological hypotheses—the pharmacological bridge—has been a paramount driving force in psychiatric research.In his thoughtful commentary, Phillips is (...) right to draw attention to the role of "nonbiological" factors, which tend to be overlooked by biological psychiatry, in the etiology of depression. He... (shrink)

Recent years have witnessed an intensification of historical and philosophical research on the link between psychotropic drugs and psychiatric theories. For example, Kendler and Schaffner detailed how the dopamine hypothesis of schizophrenia was intimately linked to the dopamine theory of antipsychotic drug action. Here, a related case is explored: the use of antidepressants' neurochemical effects to speculate about the pathophysiology of depression.This rationale was central to American psychiatrist Schildkraut's landmark article on the catecholamine hypothesis of affective disorders. Accordingly, the paper's (...) hypothesis—that depressions may relate to decreased... (shrink)

The author has reviewed the history of biological theories of depression with a fascinating account of how researchers have argued backward, starting with the neurochemical effects of antidepressants on the monoamine system in the brain, and ending with etiological theories that place the biological cause of depression in disturbances of the monoamine system. He explains how further work in biological etiology has followed the same backward path. In carrying out this task, he has done such an excellent job that I (...) have little to offer as a critique of his work. The author uses a research model developed by Lakatos, and he points out that Lakatos's approach... (shrink)

Psychiatry has a habit of ignoring its past, which is understandable but, in some instances, a mistake. It is my contention that some of the lacunae about mood disorder in today's psychiatric understanding and treatment may be illuminated by the medical lore captured in Burton's Anatomy of Melancholy (1621). The implications of the present analysis for network based accounts of depression seem to encourage a reconsideration of therapeutic and remedial principles based on those found in Burton's work.

My thanks go to Marcia Webb and Warren Kinghorn for their thoughtful and stimulating commentaries, one drawing attention to clinical studies of religion and depression and neuroscientific studies of determinism and free will, and the other making a case for a theological rather than philosophical argument against Christian voluntarism. In combination, the commentaries raise an important question about what a philosophical approach might valuably bring to the topics surrounding this paper, Kinghorn's by raising an explicit challenge to this end and (...) Webb's by pointing to the achievements of empirical studies in this field without the aid of philosophical engagement. Unfortunately, there is not space in this response... (shrink)

Christian interpretations of what psychiatry terms "depression" vary widely. Although liberal forms of Christianity regard depression as both a form of mental illness and a catalyst for moral and spiritual transformation, some Catholic theology regards some forms depression not as pathological but as a Dark Night of the Soul. Nonliberal Protestant forms of Christianity tend to view depression more as a sign of spiritual illness than spiritual health: an indication of demonic possession in some Charismatic and syncretistic/indigenous forms of Christianity, (...) and a sin or a result of sin, primarily in conservative Evangelical thought.This paper is about the... (shrink)

In her article, "Is Depression Sin? A Philosophical Examination of Christian Voluntarism," Anastasia Phillippa Scrutton has offered a thoughtful contribution to the philosophical literature regarding depression and freedom of the will. Her analysis provides a careful and well-organized review of the position, prevalent in some Christian literature, that depression is within the individual's control and is thus a sin. She describes various components of this view, which she labels Christian voluntarism, and distinguishes it from more moderate versions of free will, (...) in its assumptions that nearly all persons in all situations possess total freedom, and thus the inherent ability to prevent or to overcome depression.... (shrink)

In “Prozac or Prosaic Diaries?”, Ginger Hoffman and Jennifer Hansen examine gendered messages in popular depression memoirs, using narrative self-constitution theory to emphasize the damaging effects such messages can have on women readers. In doing so, they bring a welcome feminist perspective to matters of mental health, as well as raising thought-provoking questions about depression memoirs, a genre that can have a far-reaching impact on public opinions about mental illness. Overall, Hoffman and Hansen do an excellent job of explaining the (...) philosophical concepts that form a basis for their arguments. This work allows even relative newcomers to philosophy to follow along, co-inspecting the... (shrink)

Based on previous studies implicating increased functional connectivity within the self-referential brain network in major depressive disorder (MDD), and considering the functional roles of three distinct modules of such brain net (responsible for three-dimensional components of Selfhood) together with the documented abnormalities of self-related processing in MDD, we tested the hypothesis that patients with depression would exhibit increased connectivity within each module of the self-referential brain network and that the strength of these connections would correlate positively with depression severity. Applying (...) the electroencephalogram (EEG) operational synchrony analysis to extract three modules of the self-referential brain network in 12 medication-free depressive outpatients and 10 control subjects we have found an increase in the strength of EEG synchrony within all three modules in depressive patients (though non-significant for the right module). Furthermore, multiple regression analysis that used 3 factors (values of synchrony strength for all three modules) as input indicated that combined increase in the strength of synchrony in all three modules was positively associated with severity of depression. Taken together the findings of this study suggest that depression is primarily associated with hypersynchrony in all three modules of the brain self-referential network (the anterior module been responsible for “witnessing observation and first–person perspective”, the left posterior module been responsible for “reflective agency and narration” and the right posterior module been responsible for “bodily representational-emotional agency”), thus contributing to excessive self-focus, rumination, and body tension. (shrink)

Over the last years, self-management has become a central value in the practice of mental health care. Patients are positioned as expertclients who are actively involved in the management of their disease. Some of the ideas that are implied in the concept of self-management may raise important and intriguing questions. For instance, in the context of psychiatry impaired agency and altered self-experience are often part of the psychopathological process itself. The capacity to manage oneself may be impeded by the very (...) problem that needs to be managed. Therefore, how should self-management be conceived in... (shrink)

The stories we tell of psychiatric disability1 and gender play a crucial role not only in the experience of psychiatric disorders, but in who disordered individuals are in the most literal sense. Recent theories of the self—so-called narrative self-constitution views, or “narrative theories”—contend that the self is, fundamentally, constituted by a narrative one tells about oneself. Furthermore, this narrative almost certainly absorbs elements from surrounding cultural scripts. Thus, narrative self-constitution views can shed light on some of the ways in which (...) cultural... (shrink)

A primary intention of our original manuscript was to provide examples of both harmful and helpful influences of one cultural artifact—depression memoirs—on who female readers take their selves to be, and who they may actually end up being. Bradley Lewis beautifully articulated our strategy as “chart[ing] out … conflicting vectors” : that is, delineating select examples of how certain outer narratives conveyed in depression memoirs may kindle sexist and sanist modes of being. Our hope was that making these vectors explicit (...) could ultimately be liberating for some individuals by “opening up... (shrink)

This chapter relates the problem of demarcating the pathological from the non-pathological in psychiatry to the general problem of defining ‘disease’ in the philosophy of medicine. Section 2 revisits three prominent debates in medical nosology: naturalism versus normativism, the three dimensions of illness, sickness, and disease, and the demarcation problem. Sections 3–5 reformulate the demarcation problem in terms of semantic vagueness. ‘Disease’ exhibits vagueness of degree by drawing no sharp line in a continuum and is combinatorially vague because there are (...) several criteria for the term’s use that might fall apart. Combinatorial vagueness explains why the other two debates appear hopeless: Should we construe ‘disease’ in a naturalistic or in a normative way? Neither answer is satisfactory. How should we balance the three dimensions of pathology? We do not have to, because illness, sickness and disease (narrowly conceived) are non-competing criteria for the application of the cluster term ‘disease’. (shrink)

After the publication of third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1980, psychiatry no longer characterized psychological problems as 'reactions,' which seemed to assume unproven psychoanalytically derived explanations, and referred to them instead as 'disorders,' which, it was thought, could be identified phenomenologically and without theoretical 'presuppositions.' Since then, psychiatrists have typically made diagnoses without reflecting on the fact that any categorization, including psychiatric diagnosis, exists within a framework of beliefs and practices and will, therefore, (...) have implications and consequences. The fact of making a diagnosis, the act of doing so... (shrink)

I argue that consideration of certain cases of severe depression reveals a problem for desire-based theories of welfare. I first show that depression can result in a person losing her desires and then identify a case wherein it seems right to think that, as a result of very severe depression, the individuals described no longer have any desires whatsoever. I argue that the state these people are in is a state of profound ill-being: their lives are going very poorly for (...) them. Yet desire theories get this case wrong. Because no desires are being frustrated, the desire theorist has no grounds for ascribing ill-being; indeed, because the individuals described seem utterly without desire, the desire theorist has no grounds for treating these people as subjects of welfare ascription at all. I argue that these results are unacceptable; therefore, we should reject desire-based theories of well-being and ill-being. (shrink)

In this paper we have two main aims. First, we present an account of mood-congruent delusions in depression (hereafter, depressive delusions). We propose that depressive delusions constitute acknowledgements of self-related beliefs acquired as a result of a negatively biased learning process. Second, we argue that depressive delusions have the potential for psychological and epistemic benefits despite their obvious epistemic and psychological costs. We suggest that depressive delusions play an important role in preserving a person’s overall coherence and narrative identity at (...) a critical time, and thus can be regarded as epistemically innocent. (shrink)

It is common today to think about depression as an illness best understood and thus best managed by medical specialists. Indeed, the medical language of depression increasingly provides people with a way of signaling to others that what they suffer from needs no further elaboration. It is what it is: hormonal, genetic, a disease, words whose authority is all the more accepted the more they’re left up to specialists to interpret. Such an approach to managing sadness has its appeals. Insofar (...) as such diagnoses can help people manage symptoms that make their lives unlivable, there is great value in them. And insofar as people suffering from depression feel overwhelmed and out of control of their symptoms, it is.. (shrink)

Psychiatry widely assumes an internalist biomedical model of mental illness. I argue that many of psychiatry’s diagnostic categories involve an implicit commitment to constitutive externalism about mental illness. Some of these categories are socially externalist in nature.

In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in (...) our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research. (shrink)

For half a century the idea of rational thought has been challenged by discoveries that call into question some of its foundations. How we actually think seems to be at odds with descriptive and prescriptive models that once held sway in the development of modern science and scholarship. One response to these challenges has been a loss of nerve. Another—the one on display in Rationality: Contexts and Constraints—is an active attempt to revise those models, so as to enhance their compatibility (...) with new discoveries, in a maximally coherent and inclusive way. Rationality: Contexts and Constraints is an inter-disciplinary reappraisal of the nature of rationality. In method it is pluralistic, drawing upon the analytic approaches of philosophy, linguistics, neuroscience, and more. These methods guide exploration of the intersection between hoary scholarship and cutting-edge philosophical or scientific research. In this way, Rationality: Contexts and Constraints contributes to development of a suitably revised, comprehensive understanding of rationality, one that befits the 21st century, one that is adequately informed by recent investigations of science, pathology, non-human thought, emotion, and even enigmatic Chinese texts that might previously have seemed to be expressions of irrationalism. • Addresses recent challenges and Identifies a direction for future research on rationality • Investigates the relationship between rationality and mental disorders such as delusion and depression • Assesses reasoning in artificial intelligence and nonhuman animals • Reflects on ancient Chinese Philosophy and possible cultural differences in human psychology • Employs philosophical reflection along with linguistic, probabilistic, and logical techniques -/- . (shrink)

Most research on mind-wandering has characterized it as a mental state with contents that are task unrelated or stimulus independent. However, the dynamics of mind-wandering—how mental states change over time—have remained largely neglected. Here, we introduce a dynamic framework for understanding mind-wandering and its relationship to the recruitment of large-scale brain networks. We propose that mind-wandering is best understood as a member of a family of spontaneous-thought phenomena that also includes creative thought and dreaming. This dynamic framework can shed new (...) light on mental disorders that are marked by alterations in spontaneous thought, including depression, anxiety and attention deficit hyperactivity disorder. (shrink)

Most mental disorders affect only a small segment of the population. On the reasonable assumption that minds or brains are prone to occasional malfunction, these disorders do not seem to pose distinctive explanatory problems. Depression, however, because it is so prevalent and costly, poses a conundrum that some try to explain by characterizing it as an adaptation—a trait that exists because it performed fitness-enhancing functions in ancestral populations. Heretofore, proposed evolutionary explanations of depression did not focus on thought processes; instead, (...) they emphasized that it facilitates navigation of adverse social circumstances or promotes immune response to infectious agents. According to a new hypothesis, the “analytical rumination hypothesis” (ARH), however, depression’s crucial adaptive trait is rumination—negative, intrusive thought. ARH holds that, (i) social dilemmas trigger depressed mood; (ii) depressed mood induces changes in body systems that facilitate ruminative analysis aimed at solving dilemmas; and, (iii) depressive rumination is a fitness-enhancing trait that was selected for in evolutionary time. Jointly, (i)~(iii) imply that we should not think of rumination as a disorder; instead, it is a trade-off, an eminently rational one. In the same way that fever solves a problem—coordination of the immune system in response to infection—so too does depressive rumination solve a problem, a social dilemma, albeit at the cost of inducing anhedonia and other maladies. But they argue that the cost is worthwhile, something that should be endured “until the problem is solved.” First, we argue that there are two distinct types of rumination, brooding and pondering; the former is associated with a disposition for depression, not the latter. But only the latter has the problem-solving capabilities that ARH requires. Second, recent brain imaging studies of depression reveal resting state hypoactivity in lateral regions and hyperactivity in paralimbic regions; this asymmetric pattern correlates with heightened levels of brooding, self-focused rumination. In other words, on the personal level, patients are trapped within self, isolated from the external world and suffused with negative affect; on the subpersonal level, this pattern is reflected by an asymmetric pattern of lateral vs. paralimbic resting state activity. Third, we proceed to conjecture that rational responses (e.g., pondering) to social dilemmas are those that strike a balance between internal and external considerations in the process of belief formation. Fourth, because the asymmetric resting state activity blocks those who suffer with depression from accessing and processing potentially positive stimuli from the external world, the capacity for rational, analytic response—hence, problem-solving—is constrained. Fifth, it follows that, although there might be conditions for which suffering should be endured rather than pharmacologically alleviated, depression is not one of those. Indeed, in view of the effects of the asymmetric resting state pattern, it is unlikely that depressive rumination would have been useful even for ancestral populations. (shrink)

This groundbreaking volume of original essays presents fresh avenues of inquiry at the intersection of philosophy and psychiatry. Contributors draw from a variety of fields, including evolutionary psychiatry, phenomenology, biopsychosocial models, psychoanalysis, neuroscience, neuroethics, behavioral economics, and virtue theory. Philosophy and Psychiatry’s unique structure consists of two parts: in the first, philosophers write five lead essays with replies from psychiatrists. In the second part, this arrangement is reversed. The result is an interdisciplinary exchange that allows for direct discourse, and a (...) volume at the forefront of defining an emerging discipline. Philosophy and Psychiatry will be of interest to professionals in philosophy and psychiatry, as well as mental health researchers and clinicians. (shrink)

Many contemporary accounts of moral status consider an individual's status to be grounded in some cognitive capacity, e.g. the capacity to experience certain states, to reason morally, etc. One proposed cognitive capacity significant particularly to killing, i.e. having a status that precludes being killed absent cause, is the capacity to value one's own life. I argue that considering this a condition for moral status is a mistake, as it would lead to the exclusion of some individuals with mental health problems (...) who are generally considered clear cases. -/- While a cognitive capacities approach may turn out to be generally feasible, that particular cognitive capacity is not. In the course of this discussion I address two conceptual issues, the first regarding what it means to 'value ones life' and the second regarding what conditions must obtain for something to count as a capacity. These conceptual issues, when resolved pursuant to this account of moral status, lead the account to exclude individuals with major depressive disorder, i.e. deny that it is morally wrong to kill such individuals based on their moral status. I then argue that this is a decisive reason to reject this particular cognitive capacity as implicated in moral status. (shrink)

This chapter has two aims. The first aim is to compare and contrast three different conceptual-explanatory models for thinking about mental illness with an eye towards identifying the assumptions upon which each model is based, and exploring the model’s advantages and limitations in clinical contexts. Major Depressive Disorder is used as an example to illustrate these points. The second aim is to address the question of what conceptual-theoretical framework for thinking about mental illness is most likely to facilitate the discovery (...) of causes and treatments of mental illness in research contexts. To this end, the National Institute of Mental Health’s Research Domain Criteria (RDoC) Project is briefly considered. (shrink)

Several authors have recently suggested that the suffering caused by mental illness could provide moral grounds for physician-assisted dying. Yet they typically require that psychiatric-assisted dying could come to question in the cases of autonomous, or rational, psychiatric patients only. Given that also non-autonomous psychiatric patients can sometimes suffer unbearably, this limitation appears questionable. In this article, I maintain that restricting psychiatric-assisted dying to autonomous, or rational, psychiatric patients would not be compatible with endorsing certain end-of-life practices commonly accepted in (...) current medical ethics and law, practices often referred to as ‘passive euthanasia’. (shrink)