Depression

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 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)

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)

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)

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)

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)

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)

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)

The neuropsychopharmacological methods and theories used to investigate the nature of depression have been viewed as suspect for a variety of philosophical and scientific reasons. Much of this criticism aims to demonstrate that biochemical- and neurological-based theories of this mental illness are defective, due in part because the methods used in their service are consistently invalidated, failing to induce depression in pre-clinical animal models. Neuropsychopharmacologists have been able to stave off such criticism by showing that their methods are context and (...) domain-sensitive, and that the worth of an animal model is relative to its purpose – thereby creating logical space for the question of whether there could ever be a “good” animal model of depression. I contend that this sort of response implicitly leans on Feyerabendian principles in the philosophy of science, and exemplify this connection using a standard taxonomy of behavioral models of depression. I then take one central Feyerabendian principle – methodological and theoretical pluralism – and show how it maps onto the neuropsychopharmacological research tradition as it is currently practiced. (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.

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)

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)

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)

In this paper, we draw on developmental findings to provide a nuanced understanding of background emotions, particularly those in depression. We demonstrate how they reflect our basic proximity (feeling of interpersonal connectedness) to others and defend both a phenomenological and a functional claim. First, we substantiate a conjecture by Fonagy & Target (International Journal of Psychoanalysis 88(4):917–937, 2007) that an important phenomenological aspect of depression is the experiential recreation of the infantile loss of proximity to significant others. Second, we argue (...) that proximity has a particular cognitive function that allows individuals to morph into a cohesive dyadic system able to carry out distributed emotion regulation. We show that elevated levels of psychological suffering connected to depressive background emotions may be explained not only in terms of a psychological loss, but also as the felt inability to enter into dyadic regulatory relations with others—an experiential constraint that decreases the individual’s ability to adapt to demanding situations. (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)

Values-based practice (VBP), developed as a partner theory to evidence-based medicine (EBM), takes into explicit consideration patients’ and clinicians’ values, preferences, concerns and expectations during the clinical encounter in order to make decisions about proper interventions. VBP takes seriously the importance of life narratives, as well as how such narratives fundamentally shape patients’ and clinicians’ values. It also helps to explain difficulties in the clinical encounter as conflicts of values. While we believe that VBP adds an important dimension to the (...) clinician’s reasoning and decision-making procedures, we argue that it ignores the degree to which values can shift and change, especially in the case of psychiatric disorders. VBP does this in three respects. First, it does not appropriately engage with the fact that a person’s values can change dramatically in light of major life events. Second, it does not acknowledge certain changes in the way people value, or in their modes of valuing, that occur in cases of severe psychiatric disorder. And third, it does not acknowledge the fact that certain disorders can even alter the degree to which one is capable of valuing anything at all. We believe that ignoring such changes limits the degree to which VBP can be effectively applied to clinical treatment and care. We conclude by considering a number of possible remedies to this issue, including the use of proxies and written statements of value generated through interviews and discussions between patient and clinician. (shrink)

Several prominent philosophers have argued that the fact that depressed agents sometimes make moral judgments without being appropriately motivated supports Humean externalism – the view that moral motivation must be explained in terms of desires that are distinct from or “external” to an agent’s motivationally inert moral judgments. This essay argues that such motivational failures do not, in fact, provide evidence for this view. I argue that, if the externalist argument from depression is to undermine a philo-sophically important version of (...) internalism, it must make use of a general assumption about motivational states. However, at a reasonable level of abstraction, the needed assumption also implies that even desires could not be effective sources of motivation. For, just as depressed agents might sometimes lack motivation to act consistently with their moral judgments, they also sometimes lack motivation to pursue their desires. Moreover, the most plausible responses that Humeans can give to this general argument undermine the externalist case against internalism. Thus, there is a deep tension between the argument from depression for externalism and a fundamental Humean commitment. (shrink)

David Shoemaker presents a new pluralistic theory of responsibility, based on the idea of quality of will. His approach is motivated by our ambivalence to real-life cases of marginal agency, such as those caused by clinical depression, dementia, scrupulosity, psychopathy, autism, intellectual disability, and poor formative circumstances. Our ambivalent responses suggest that such agents are responsible in some ways but not others. Shoemaker develops a theory to account for our ambivalence, via close examination of several categories of pancultural emotional responsibility (...) responses and their appropriateness conditions. The result is three distinct types of responsibility, each with its own set of required capacities: attributability, answerability, and accountability. Attributability is about the having and expressing of various traits of character, and it is the target of a range of aretaic sentiments and emotional practices organized around disdain and admiration. Answerability is about one’s capacity to govern one’s actions and attitudes by one’s evaluative judgments about the worth of various practical reasons, and it is the target of a range of sentiments and emotional practices organized around regret and pride. Accountability is about one’s ability to regard others, both evaluatively and emotionally, and it is the target of a range of sentiments and emotional practices organized around anger and gratitude. In Part One of the book, this tripartite theory is developed and defended. In Part Two of the book, the tripartite theory’s predictions about specific marginal cases are tested, once certain empirical details about the nature of those agents have been filled in and discussed. (shrink)

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)

Purpose of review: What is the relationship between rationality and mental health? By considering the psychological literature on depressive realism and unrealistic optimism it was hypothesized that, in the context of judgments about the self, accurate cognitions are psychologically maladaptive and inaccurate cognitions are psychologically adaptive. Recent studies recommend being cautious in drawing any general conclusion about style of thinking and mental health. Recent findings: Recent investigations suggest that people with depressive symptoms are more accurate than controls in tasks involving (...) time perception and estimates of personal circumstances, but not in other tasks. Unrealistic optimism remains a robust phenomenon across a variety of tasks and domains, and researchers are starting to explore its neural bases. However, the challenge is to determine to what extent and in what way unrealistic optimism is beneficial. Summary: We should revisit the hypothesis that optimistic cognitions are psychologically adaptive, whereas realistic thinking is not. Realistic beliefs and expectations can be conducive to wellbeing and good functioning, and wildly optimistic cognitions have considerable psychological costs. (shrink)

In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative justification. However, this (...) approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis. (shrink)

Working toward a phenomenological account of depression, this article suggests that the relevant level of analysis is that of experiential immediacy based on intersubjectivity. The argument focuses on the experience of one boy and one girl who participated in the study Southwest Youth and the Experience of Psychiatric Treatment (SWYEPT), in which we followed the experience of adolescent psychiatric inpatients and their families over the course of a year. I emphasize the role of language as a form of disclosure and (...) empathy in the interview setting in elaborating a set of criteria for inferring immediacy from interview data, and point to how illness experience is bound up with domains of the life-world such as relationships, religion, morality, reflexivity, identity, and treatment. (shrink)

Arguments in favor of legalized assisted suicide often center on issues of personal privacy and freedom of choice over one's body. Many disability advocates assert, however, that autonomy arguments neglect the complex sociopolitical determinants of despair for people with disabilities. Specifically, they argue that social approval of suicide for individuals with irreversible conditions is discriminatory and that relaxing restrictions on assisted suicide would jeopardize, not advance, the freedom of persons with disabilities to direct the lives they choose. This paper examines (...) the idea promoted by some proponents of assisted suicide that it is reasonable to be depressed about one's diminished quality of life in cases of irreversible illness or disability and, therefore, such depression should not call into question the individual's competence to request assistance in dying. The concept of rational depression is defined and examined in the context of: four real-life cases involving individuals with disabilities who requested assistance in dying; a set of criteria commonly applied to decision-making to determine rationality; and research bearing on the emotional status of people with disabilities. It is concluded that although disability is associated with particular socially mediated stressors, there is no theoretical or empirical evidence to indicate that depression and its role in the right to die is dynamically different, more natural, or more reasonable for disabled people than for non-disabled people. (shrink)

Depression is often diagnosed in patients nearing the end of their lives and medication or psychotherapy is prescribed. In many cases this is appropriate. However, it is widely agreed that a health care professional should treat sick persons so as to improve their condition as they define improvement. This raises questions about the contexts in which treatment of depression in late life is appropriate. This article reviews a problematic case concerning the appropriateness of treatment in light of the literature in (...) bioethics. Specific attention is paid to the concept of authenticity and the role of suffering. Suffering is often the result of a situation in which one's self is damaged. In some circumstances, this suffering should not be seen as a symptom of illness but as a reflection, in a difficult life context, of the individual's authentic nature. Assessment of depression in the elderly must go beyond a symptom list and must consider both the context of the individual's situation and his or her authentic self. When the symptoms reflect the individual's assessment of the situation in the context of the authentic self, they may be "appropriate." However, even when the symptoms are appropriate, if they interfere with life assessment and adjustment, treatment should be considered. (shrink)

The paper aims to single out and clarify some causal connections between theconcomitant growth of depressive phenomena, not only in the strict clinicalsense, and the establishment of the new capitalist model, which has taken place in Western countries from the early seventies until today. As well as onthe mechanism of labour market flexibility, the essay dwells in particular onthe paradoxical dynamics of the ethical and moral ideals of the newideological configuration. Finally, the paper will also use the category of hegemony (...) to offer some theoretical instruments directed at reactivating theemancipatory potentials frustrated by social suffering of a depressive and regressive nature. Il saggio mira a individuare e delucidare alcuni nessi causali tra il concomitante incremento dei fenomeni depressivi, non solo in senso strettamente clinico, e l’affermazione del nuovo modello capitalistico avvenuto nei paesi occidentali dai primi anni settanta ad oggi. Oltre che sul meccanismo della flessibilità del mercato del lavoro, si insiste in particolare sulle dinamiche paradossali delle istanze etiche e morali della nuova configurazione ideologica. Ricorrendo anche alla categoria di egemonia, vengono da ultimo approntati degli strumenti teorici finalizzati a riattivare i potenziali emancipativi frustrati nella sofferenza sociale di natura depressiva e regressiva. (shrink)

The essay aims to analyse the gradual historical process of the partial overlap, replacement and expansion of the theoretical paradigm of depression with respect to that of melancholy. The first part is devoted to analysing some of the central features of the multivalent thematizations of melancholy drawn up during modernity, also with relation to the spirit of capitalism (in its Weberian acceptation). This is followed by an overview of the birth of the modern category of depression, and the process that (...) during the twentieth century led to its transformation into a theoretical and nosological paradigm which in the end replaced that of melancholy. The second part is the attempt to draw up a Zeitdiagnose: the aim is to assess the ‘depressive’ psychosocial impact exercised by particular socio-economic mechanisms and cultural trends, with particular reference to what has been defined as the ‘new spirit of capitalism’, as well as the new forms of individualism and their paradoxical dynamics. In conclusion, I will form a bridge between the history of the two aforesaid paradigms and the contemporary psychosocial dynamics correlated to the phenomenon today interpreted as a ‘depression epidemic’. Il saggio mira ad analizzare il graduale processo storico di parziale sovrapposizione, sostituzione ed ampliamento del paradigma teoretico della depressione rispetto a quello della melanconia. La prima parte è dedicata ad analizzare alcuni dei tratti nevralgici delle polivalenti tematizzazioni della malinconia avvenuti nel corso della modernità, anche in relazione allo spirito del capitalismo (nella sua accezione weberiana). Segue una panoramica sulla nascita della categoria moderna di depressione, e del processo che nel corso del XX secolo l’ha condotta alla sua trasformazione in un paradigma teoretico e nosologico che ha infine sostituito quello della melanconia. La seconda parte rappresenta il tentativo di elaborare una Zeitdiagnose: l’obiettivo è valutare l’impatto psicosociale di natura ‘depressiva’ esercitato da particolari meccanismi socioeconomici e tendenze culturali, con particolare riferimento a ciò che è stato definito il «nuovo spirito del capitalismo», nonché alle nuove forme dell’individualismo e alle loro dinamiche paradossali. In conclusione viene gettato un ponte tra la storia dei due suddetti paradigmi e le dinamiche psicosociali contemporanee correlate al fenomeno oggi interpretato quale «epidemia depressiva». (shrink)

Philosophy says that life must be understood backwards. But . . . it must be lived forward. . , , It is more and more evident that life can never be really understood in Time. It was a pleasure to read Jason Thompson’s serious and thought-provoking piece, and I am grateful to the editors for giving me a chance to comment. The idea that the self is revealed in narrative is a popular one among different schools of psychotherapy, both in (...) terms of technique and theory; and my response addresses both these issues in turn. As a clinician, I have always liked people’s stories. As a junior psychiatrist, I used to love the moment when I first met someone and could say to them, ‘You were born; and then what .. (shrink)

The essay aims to analyse the gradual historical process of the partial overlap, replacement and expansion of the theoretical paradigm of depression with respect to that of melancholy. The first part is devoted to analysing some of the central features of the multivalent thematizations of melancholy drawn up during modernity, also with relation to the spirit of capitalism (in its Weberian acceptation). This is followed by an overview of the birth of the modern category of depression, and the process that (...) during the twentieth century led to its transformation into a theoretical and nosological paradigm which in the end replaced that of melancholy. The second part is the attempt to draw up a Zeitdiagnose: the aim is to assess the ‘depressive’ psychosocial impact exercised by particular socio-economic mechanisms and cultural trends, with particular reference to what has been defined as the ‘new spirit of capitalism’, as well as the new forms of individualism and their paradoxical dynamics. In conclusion, I will form a bridge between the history of the two aforesaid paradigms and the contemporary psychosocial dynamics correlated to the phenomenon today interpreted as a ‘depression epidemic’. Der Aufsatz zielt darauf, der Prozess der historischen Überlagerung, Substitution und Verbreitung des theoretischen Paradigmas der Depression gegenüber jenem der Melancholie darzustellen. Im ersten Teil wird versucht, einige der einschneidenden Eigenschaften der Thematisierungen der Melancholie in der Frühen Neuzeit anzugeben, auch im Verhältnis zum Geist des Kapitalismus. Nachdem eine Skizze der Entstehung der moderne Kategorie der Depression, geht es darum, den Verlauf nachzuzeichnen, der im 20. Jahrhundert zu ihrer Transformation in ein weitläufiges theoretisches Paradigma geführt hat, das schließlich jenes der Melancholie ersetzt hat. Der zweite Teil stellt den Versuch dar, eine Zeitdiagnose umzureißen: An dieser Stelle ist die psychosoziale Bedeutung bestimmter sozioökonomischer und kultureller Mechanismen zu untersuchen, unter besonderem Hinweis auf das, was als »der neue Geist des Kapitalismus« bezeichnet worden ist, sowie auf neue Formen des Individualismus und ihre paradoxen Dynamiken. Abschließend wird eine Brücke geschlagen, zwischen der Geschichte der beiden bezeichneten Paradigmen und der zeitgenössischen psychosozialen Dynamiken, die mit dem als »depressive Epidemie« interpretierten Phänomen verbunden sind. (shrink)

Few subjects have provoked more speculation or scholarly inquiry than the relationship between creativity and madness—or, in the case of Jason Thompson, the link between memoir writing and depression. Plato theorized that the poet’s madness is divinely inspired, and two thousand years later Sigmund Freud (1928/1961) admitted that “Before the problem of the creative artist analysis must, alas lay down its arms” (p. 177)—a cautionary injunction he then disregards. Should authors heed Thompson’s prudent advice not to write about present traumas, (...) or should they accept D. H. Lawrence’s (1981) statement that “One sheds one’s sicknesses in books, repeats and presents again one’s emotions, to be master of them” (p. .. (shrink)

The answer, if you look at this paper, is that writing is not good for your mental health, but I think that anything done excessively is not good for your mental health. This paper is about excessive reactions, which given the childhood he gives us a glimpse of he has a tendency toward. I, like him, am a mental health service user. However, all experiences of mental ill health are unique to the person concerned. We all have a tendency to (...) blame others for what has happened to us, for what has triggered our mental distress. For Jason, it is his mother who was triggered in to mental illness. For me it was an alcoholic husband, who was triggered in to alcoholism/mental illness by childhood events. This is a .. (shrink)

We reply to the Ioannidis's paper "Effectiveness of antidepressants; an evidence based myth constructed from a thousand controlled trials." We disagree that antidepressants have no greater efficacy than placebo. We present the efficacy from hundreds of trials in terms of the percentage of patients with a substantial clinical response (a 50% improvement or more symptomatic reduction). This meta-analysis finds that 42-70% of depressed patients improve with drug and 21%-39% improve with placebo. The response benefit of antidepressant treatment is 33%-11% greater (...) than placebo. Ioannidis argues that it would be vanishingly smaller because systematic biasing in these clinical trials would reduce the drug-placebo difference to zero. Ioannidis' argument that antidepressants have no benefit is eroded by his failures of logic because he does not present any evidence that there are a large number of studies where placebo is substantially more effective than drug. (To reduce to zero, one would also have to show that some of the unpublished studies find placebo better than drug and have substantial systematic or methodological bias). We also present the empirical evidence showing that these methodological concerns generally have the opposite effect of what Ioannidis argues, supporting our contention that the measured efficacy of antidepressants likely underestimates true efficacy.Our most important criticism is Ioannidis’ basic underlying argument about antidepressants that if the existing evidence is imperfect and methods can be criticized, then this proves that antidepressant are not efficacious. He presents no credible evidence that antidepressants have zero effect size. Valid arguments can point out difficulties with the data but do not prove that a given drug had no efficacy. Indeed better evidence might prove it was more efficacious that originally found.We find no empirical or ethical reason why psychiatrists should not try to help depressed patients with drugs and/or with psychotherapeutic/behavioral treatments given evidence of efficacy even though our treatment knowledge has limitations. The immense suffering of patients with major depression leads to ethical, moral, professional and legal obligations to treat patients with the best available tools at our disposal, while diligently and actively monitoring for adverse effects and actively revising treatment components as necessary. (shrink)

Bernard Williams famously argued that eternal life is undesirable for a human because it would inevitably grow intolerably boring. I will argue against Williams and those who share his view. To make my case, I will provide an account of what staves off boredom in our current, earthly-mortal lives, and then I will draw on this account while advancing reasons for thinking that eternal life is desirable, given certain conditions. Though my response to Williams will partly overlap with some prior (...) responses to Williams, especially the one offered by J. M. Fischer, my response will also be distinctive in some important ways. For instance, it will be distinctive in that it will discuss the role that one’s part-whole-reality conception plays in fending off boredom, where by ‘one’s part-whole-reality conception’ I mean ‘one’s conception of his or her place (or purpose) in the whole of reality’. (shrink)

In this article, I argue that depression and suicide are natural kinds insofar as they are classes of abnormal behavior underwritten by sets of stable biological mechanisms. In particular, depression and suicide are neurobiological kinds characterized by disturbances in serotonin functioning that affect various brain areas (i.e., the amygdala, anterior cingulate, prefrontal cortex, and hippocampus). The significance of this argument is that the natural (biological) basis of depression and suicide allows for reliable projectable inferences (i.e., predictions) to be made about (...) individual members of a kind. In the context of assisted suicide, inferences about the decision-making capacity of depressed individuals seeking physician-assisted suicide are of special interest. I examine evidence that depression can hamper the decision-making capacity of individuals seeking assisted suicide and discuss some implications. (shrink)

This chapter examines the core explanatory strategies of cognitive science and their application to the study of psychopathology. In addition to providing a taxonomy of different strategies, we illustrate their application, with special attention to Autism Spectrum Disorder and Major Depressive Disorder. We conclude by considering two challenges to the prospects of a developed cognitive science of psychopathology.

In this paper, I address two related challenges the phenomenon of depression raises for conceptions according to which autonomy is an agency concept and an independent source of justification. The first challenge is directed at the claim that autonomous agency involves intending under the guise of the good: the robust though not always direct link between evaluation and motivation implied here seems to be severed in some instances of depression; yet, this does not seem to affect the possibility of autonomous (...) action. The second challenge targets the feasibility of a reliable distinction between autonomous and non-autonomous choices in the context of depression: value-neutral and value-laden ways of drawing the distinction seem both open to decisive objections. I develop an account of paradoxical identification which supports a revised value-neutral distinction between autonomous and non-autonomous choices in the context of depression (my response to challenge 2), and shows that depression is inconsistent with autonomy to the extent that it involves an agent’s (paradoxical) identification with projects she implicitly loathes, that is, to the extent that depression thwarts intending under the guise of the good (my response to challenge 1). (shrink)

Motivational internalism (MI) holds that, necessarily, if an agent judges that she is morally obligated to ø, then, that agent is, to at least some minimal extent, motivated to ø. Opponents of MI sometimes invoke depression as a counterexample on the grounds that depressed individuals appear to sincerely affirm moral judgments but are ‘listless’ and unmotivated by such judgments. Such listlessness is a credible counterexample to MI, I argue, only if the actual clinical disorder of depression, rather than a merely (...) hypothetical example of such listlessness, is the source of this listlessness. However, empirical evidence concerning depression shows that, to the extent that the depressed are motivationally listless at all, they are abnormally listless only with respect to an important class of non-moral judgments, namely, their prudential normative judgments (i.e., those concerning their own happiness and well-being), not their moral judgments. Hence, depressed individuals do not constitute a counterexample to MI. This conclusion has important methodological implications concerning how supporters and opponents of MI can best defend their respective theses. (shrink)

Research on the neurobiology and psychosocial features of Major Depressive Disorder has the ability to extend our understanding of affiliative behavior. In depression, decreased hedonic capacity and hypoactivity in dopaminergic and prefrontal circuitries may decrease the ability to experience affiliative relationships as rewarding. We suggest that neurobiological research on depression can provide a test case for theoretical models of affiliation.