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

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)

In _The Analyst’s Experience of the Depressive Position: The Melancholic Errand of Psychoanalysis_, Steven Cooper explores a subject matter previously applied more exclusively to patients, but rarely to psychoanalysts. Cooper probes the analyst’s experience of the depressive position in the analytic situation. These experiences include the pleasures and warmth of helping patients to bear what appears unbearable as well as the poignant experiences of, limitation, incompleteness, repetition and disappointment as a vital part of clinical work. He describes a seam (...) in clinical work in which the analyst is always trying to find and refind a position from which he can help patients to work with these experiences. The Analyst’s Experience of the Depressive Position includes: An exploration of the analyst’s participation and resistance to helping patients hold some of the most unsettling parts of their experience. Cooper draws some analogies between elements of theory about aesthetic experience in terms of how we bear new and old experience. An examination of the patient as an artist of sorts and the analyst as a form of psychic boundary artist: just as the creative act of art involves the capacity to transform pain and ruin into the depressive position, so does the co-creation of how we understand the patient’s mind through the mind of the analyst. Clinical chapters which focus on helping patients move from paranoid to depressive positions, with an emphasis on the analyst’s personal participation in that process. The Analyst’s Experience of the Depressive Position explores a rich, provocative and long overdue topic relevant to psychoanalysts, psychodynamically oriented psychotherapists, as well as students and teachers of both psychoanalysis and psychodynamic psychotherapy. (shrink)

Too little attention has been paid by philosophers to the cognitive and epistemic dimensions of emotional disturbances such as depression, grief, and anxiety and to the possibility of justification or warrant for such conditions. The chief aim of the present paper is to help to remedy that deficiency with respect to depression. Taxonomy of depression reveals two distinct forms: depression (1) with intentionality and (2) without intentionality. Depression with intentionality can be justified or unjustified, warranted (...) or unwarranted. I argue that the effort of Aaron Beck to show that depressive reasoning is necessarily illogical and distorted is flawed. I identify an essential characteristic of that depression which is a mental illness. Finally, I describe the potential of depression to provide credal contact with important truths. (shrink)

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

Although the Historical concept of melancholia has undergone numerous metamorphoses, it has maintained a place in psychiatric classification and currently refers to a specific melancholic subtype of major depression (American Psychiatric Association 2000, 419). Although melancholia—as a description of pathological states—constitutes the focus of this paper, it must be pointed out that the range of states encompassed by melancholia cover a far wider spectrum than that covered by the term ‘disease.’ As Jennifer Radden notes, melancholia (and melancholy) referred (...) to “both a normal disposition and a sign of mental disturbance” (Radden 2000, ix), thus covering a wide range of emotional variations that cannot be reduced .. (shrink)

The theoretical implications of equating the melancholic states of past eras with today's depression are explored. These include the presuppositions of the descriptive psychiatry so influential in twentieth century classification, which attempts to identify and describe mental disorders without reference to underlying causes. It also includes claims made about different forms of masked, and non-Western depression, and the new "drug cartography" assigning psychiatric categories based on psychopharmacological effect. An evaluation of the relative merits of descriptivist and causal (...) ontologies, together with an assessment of the similarities and differences between melancholia and depression, suggest the conclusion that these two conditions are misleadingly equated. (shrink)

While philosophy and psychoanalysis privilege language and conceptual distinctions and mistrust the image, the philosopher and psychoanalyst Julia Kristeva recognizes the power of art and the imagination to unblock important sources of meaning. She also appreciates the process through which creative acts counteract and transform feelings of violence and depression. Reviewing Kristeva's corpus, Elaine P. Miller considers the intellectual's "aesthetic idea" and "thought specular" in their capacity to reshape depressive thought on both the individual and cultural level. She revisits (...) Kristeva's reading of Walter Benjamin with reference to melancholic art and the imagination's allegorical structure; her analysis of Byzantine iconoclasm in relation to Freud's psychoanalytic theory of negation and Hegel's dialectical negativity; her understanding of Proust as an exemplary practitioner of sublimation; her rereading of Kant and Arendt in terms of art as an intentional lingering with foreignness; and her argument that forgiveness is both a philosophical and psychoanalytic method of transcending a "stuck" existence. Focusing on specific artworks that illustrate Kristeva's ideas, from ancient Greek tragedy to early photography, contemporary installation art, and film, Miller positions creative acts as a form of "spiritual inoculation" against the violence of our society and its discouragement of thought and reflection. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 53-55 [Access article in PDF] A Pragmatic Consideration of the Relation between Depression and Melancholia David H. Brendel THE MELANCHOLIA OF THE PAST and the major depression of the present are extraordinarily complex notions that represent different things to different people. With her compelling article "Is This Dame Melancholy? Equating Today's Depression and Past Melancholia," Jennifer Radden makes an important (...) contribution to the debate on whether these concepts are identical, overlapping, or distinct. Exploring both conditions from descriptive and causal points of view, Radden appropriately concludes that fully equating the two of them would constitute a "troubling oversimplification." Her line of reasoning runs as follows. Because past descriptions of melancholia and current descriptions of major depression are marked by dissimilarities (such as the genius and creativity associated with the former and the self-loathing and emphasis on loss associated with the latter), only an underlying causal base common to both conditions would justify our equating them. But the cause (or causes) of melancholia and depression remain mysterious. Thus, although Radden acknowledges that a causal explanation might yield substantial benefits ("research possibilities, further hypotheses, and even hope of prevention, or cure"), she suggests that we remain in a descriptive mode when comparing the two conditions and conclude that they are not one and the same.Radden's argument that past melancholia and contemporary depression are descriptively distinct is convincing and, I think, indisputable. But I would like to challenge and expand upon some of her ideas about considerations of causality and about the role of pragmatic reasoning in working out the relation between melancholia and depression. First of all, although Radden is correct that the cause of many (or perhaps most) depressive states is unknown, she underrates the extent of the empirical knowledge that we have acquired about the causation of depression and, in so doing, undervalues the relevance of causal reasoning to making the melancholia/depression distinction. Recent empirical research has revealed that major depressive episodes can result from brain lesions such as left-sided strokes or metabolic disorders such as hypothyroidism (Yudofsky and Hales 2002). Psychosocial research, moreover, has suggested that stressful life events also can be understood as causes of depression (Kendler, [End Page 53] Karkowski, and Prescott 1999). These findings provide some hope that the identification of causes of various clinical states is a real possibility. Identification of such causes, I believe, could empower us to make some plausible claims about the similarities or differences between past melancholia and current depression. A melancholic individual like van Gogh, for example, had a different illness than a contemporary stroke patient with major depression in a present-day hospital, not only on the basis of descriptive distinctions between their conditions, but also on the basis of the causes of their respective states. Although of course we cannot know the cause of van Gogh's melancholia, we can reasonably assume that it was not the result of a left-sided stroke due to the absence in his case of other clinical deficits that usually result from such a stroke (such as language and motor deficits). Plausible assertions about the causes of melancholic and depressive states would add to the robustness of any claims regarding the distinctness of the conditions.Conversely, careful consideration of the etiology of various clinical presentations might prompt us to hypothesize a shared pathophysiology and thereby lead us to believe that they are essentially identical conditions. It is difficult or impossible to discover a cause of melancholia in individuals who lived in past eras. But we might achieve our goal by comparing well-defined major depression to various forms of what Radden calls "masked depression," such as those seen in cross-cultural settings, where the subjective symptoms of sad mood are absent but numerous somatic signs of depression are observed. If it turned out that major depression and masked depression had the same cause, then differences in their clinical phenomenology would become merely surface differences that belie a shared etiological process. How might one discover the existence of such a process... (shrink)

Guided by a phenomenological perspective, this paper aims to account for the existence of a corporeal consciousness—something that clinicians should take into account, not merely in the case of physical pathologies but especially in the case of mental disorders. Firstly, I will highlight three cases: schizophrenia, depression, and autism spectrum disorder. Then, I will show how these cases correspond to three different kinds of bodily existence: disembodiment (in the case of schizophrenia), chrematization (in melancholic depression), and dyssynchrony (...) (in the autism spectrum disorder). Finally, I will argue for the importance of an “expressive common environment” between the patient and the clinician, who are two distinct, embodied conscious subjects resonating with one another. In this view, the primary goal of the therapeutic process seems to develop a shared understanding of the patient’s life-world, which finds its main expression through the disrupted body. (shrink)

The paper first introduces the concept of implicit and explicit temporality, referring to time as pre-reflectively lived vs. consciously experienced. Implicit time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative–affective dynamics of life on the other hand. Explicit time results from an interruption or negation of implicit time and unfolds itself in the dimensions of present, past and future. It is further shown that temporality, embodiment and intersubjectivity are closely connected: (...) While implicit temporality is characterised by tacit bodily functioning and by synchronisation with others, explicit temporality arises with states of desynchronisation, that is, of a retardation or acceleration of inner time in relation to external or social processes. These states often bring the body to awareness as an obstacle as well. On this basis, schizophrenia and melancholic depression are investigated as paradigm cases for a psychopathology of temporality. Major symptoms of schizophrenia such as thought disorder, thought insertion, hallucinations or passivity experiences may be regarded as manifesting a disturbance of the constitutive synthesis of time consciousness, closely connected with a weakening of the underlying pre-reflective self-awareness or ipseity. This results in a fragmentation of the intentional arc, a loss of self-coherence and the appearance of major self-disturbances. Depression, on the other hand, is mostly triggered by a desynchronisation from the social environment and further develops into an inhibition of the conative–affective dynamics of life. As will be shown, both mental illnesses bear witness of the close connection of temporality, embodiment and intersubjectivity. (shrink)

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

SummaryStarting with an analysis of the respiratory function and of the way it automatically connects the living organism with the physical milieu without any conscious or voluntary effort, Dr De Greeff then asserts that, on the Psychological level, similar basic mechanisms connect the individual with the social environment, and more generally with the Cosmos.Typical disorders of these mechanisms are to be seen in melancholic depressions and in the feelings of strangeness and loneliness they bring about. These mechanisms have à (...) neural basis in the diencephalic region and may be influenced by shock therapies. On the other hand, cerebral surgery shows that the frontal lobe intervenes to adjust these connecting mechanisms to the external world in its concrete structure, present and future.The author then criticizes the freudian conception, as he understands it, and proposes to substitute to the Instinct‐Reality dichotomy the antagonism of two internal attitudes, which are basic, automatic, and nearly organic, in the sense defined above: the sympathy‐attitude, which results in valorisation of and subordination to the object, and the defence‐attitude, which manifests itself in aggression and aims at annihilating the object. These attitudes are complementary and any awakening of one of them supposes the inhibition of the other one. But such an inhibition never reaches the stage of an absolute suppression.So much for the instinctive, unconscious and diencephalic basis of action. What kind of new developments do the cerebral cortex and the higher mental functions bring about? They make the individual aware of his basic attitudes, or, more exactly, of the way the object is affected by them so as to appear pleasant or unpleasant, lovable or threatening. They give him the possibility of accepting or refusing the first movements of instinct, and of stabilizing, delaying or inhibiting the corresponding reactions. They are the basis of temporal dimension and integration, of choice, liberty and morality. (shrink)

The paper presents the phenomenological conception of bodily perception as a possible therapeutic model for treating melancholic depression. At the beginning, it discusses some key concepts of Freud’s psychoanalysis: instinct, memory, perception, narcissism and melancholia. Next, the Freudian theory of melancholia is compared with studies of phenomenological psychopathology. It is investigated how melancholia is based on the division of temporal relations. Finally, the main problem of the paper is investigated: can the structure of perception and its constitutive openness (...) toward the future represent a theoretical model for therapeutic practices designed to treat melancholic depression? (shrink)

In this article the author seeks to highlight a specific disorder related to bodily experience in melancholia conceived as a severe form of clinical depression. The article is divided into three parts. In the first section, the author investigates the intersubjective dimension of bodily experience in light of the categories of Außen- and Innenleiblichkeit. In the second section, I explore a specific disturbance of the dimension of intercorporeality. The excessive feeling of the bodily (außenleibliche) visibility of his/her own sufferance (...) is a fundamental aspect of depression. At a pre-reflexive level, we constantly assume the noncoincidence between one's own bodily expression and the Other's experience/reading of these expressions. An alteration of this (pre-reflexive) awareness occurs in melancholia. The patient feels as if the melancholic condition would be transparent to the other. In the third section, the author intends to show the alteration of the embodied communication between the melancholic person and the other investigating two particular phenomena: the exchange of gaze in a face to face encounter, and the disturbance of the oral sense, revealing a specific form of irresponsiveness and the experience of void. (shrink)

‘Cosmetic psychopharmacology’ is a term coined by Peter Kramer in his 1993 best‐seller, Listening to Prozac. It has come to refer to the use of psychoactive substances to effect changes in function for conditions that are either normal or subclinical variants. In this paper, I ask: What distinguishes an existential ailment from clinical depression, or either of those from normal depressed mood, melancholic temperament, dysthymia or other depressive disorders? Can we reliably distinguish one from the other? Are the (...) boundaries of illness and disorder really so distinct? If not, how can we know that treatment of ‘depression’ with Prozac in any given instance constitutes a cosmetic as opposed to, say, a medical or clinical use of psychopharmacology – a distinction that seems to turn on our ability to clearly differentiate the clinical from the cosmetic. If we cannot reliably distinguish between such conditions, can we even have a cosmetic psychopharmacology that is not a form of malpractice, broadly speaking? What if we unplugged Prozac from all the amplitude and hype that resulted in Listening to Prozac becoming an instant best‐seller and simply asked whether or not we can clearly distinguish an appropriate cosmetic use of Prozac for ‘depression’ from an inappropriate cosmetic use of Prozac, and both of those from Prozac's appropriate clinical, that is, non‐cosmetic uses? If we cannot make these distinctions, perhaps it is too early to say there can be such a thing as a cosmetic psychopharmacology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic WannabesJennifer Radden, PhD (bio)Saunders explores challenges for the clinician faced with self-styled sufferers from attention deficit hyperactivity disorder, post-traumatic stress disorder, bipolar disorder, autism spectrum disorder (ASD), and fibromyalgia. The diagnostic system was not meant to be used as “a scaffold for identity,” she points out. Yet wannabe patients now step into the clinic wielding self-proclaimed diagnoses as social identities. Saunders explains the context where such phenomena arise, (...) and offers guidelines for clinicians addressing this new reality. To do so, she enlists Rashed’s innovative normative approach to the so-called boundary problem of assigning, and providing justification for, the contested line between normal and disordered. The boundary problem itself seems to rise to prominence during our current era of increasingly dimensional thinking, it is worth noting, with psychiatric diagnoses taken to refer to points on a continuum, rather than to discrete categorical disease entities.On the likely sources of these ‘diagnostic’ social identities, as well as reasons why certain diagnoses attach to them more commonly than others, Saunders points to social trends (including what she asserts to be a “post-stigma” cultural environment), the failure of efforts to identify neurobiological markers for psychiatric disorder, the ubiquity of social media, the algorithms themselves, and the hyperconnected existence of contemporary times. Such narratives also offer the comforts of a sense of belonging and explanations for perceived inadequacies, she rightly observes.Despite today’s virtual and other inducements, the problem introduced here is not an entirely new one. The first part of the seventeenth century in Europe saw an apparent “epidemic” of what was known as “melancholy,” a condition associated with the spleen, whose symptoms loosely resembled those of today’s depression and anxiety. Much of this suffering was undeniably real, but much was a fashionable, identity-conferring pose. “Every distemper of the body now is complicated with spleen,” the poet John Donne ironically observes in a letter dated 1622, “and when we were young men we scarce ever heard of the spleen. In our declinations now, every accident is accompanied with heavy clouds of melancholy”1 (Gosse, 2019). By then, the Melancholic Man (or homo melancholicus), with his surfeit of spleen, was an unmistakable character type—or social identity, as we would now say. Recognized and saluted in centuries-long literary and illustrative traditions, the type was an anchoring element of the humoral medicine which, despite the gradual emergence of more empirical science, had endured since Galenic times.Melancholy’s closest descendants, affective depressive and anxiety disorders, are today less evident among the troubling identities Saunders discusses—somewhat preempted, she points out, by more cognitively-based diagnoses such as ASD. [End Page 279] This is itself an ironic reminder of the vagaries of cultural attitudes, cautioning us to remember the broader context where these particular social identities are selected for emulation and adoption.The lure of the melancholy man’s2 social identity is well understood: already normalized, within the humoral system in which excess black bile afflicted roughly one in four people, it had been valorized for centuries—arguably by Aristotelian writing (in the dubious ‘Problems’), during the Renaissance by Ficino, and Shakespeare—even by Freud in his 1916 ‘Mourning and Melancholia.’ Through most of Western history, the positive attributes and benefits of the dark moods of melancholy have needed no further explaining or justifying. They glow with glamorous associations.Applying Rashed’s conditions for appropriately acknowledging and recognizing the fit of a person’s chosen social identity, Saunders‘ guidance for clinicians clarifies boundary matters. And it illustrates how to understand, regulate and communicate the appropriate norms in ways that can dissuade those whose personal growth and mental health are not served by claiming such identities.With at least some of the popular social identities Saunders describes, I think we can helpfully continue the comparison with the homo melancholicus. For the ‘neurodiversity’ rhetoric of our own times contains forces promoting both the normalization and the valorization of syndromes such as ASD. Pointing to analogies with differences of gender, ethnicity and culture, neurodiversity theorizing argues for a respect for, and appreciation of, difference. Mental or cognitive variations are equally natural and valuable, it is... (shrink)

This article aims at a philosophical reflection on depression, from a melancholic standpoint; in order to do this, it explores the etymological, paremiological, historical and conceptual references of such term, having as a result a thesis: Before melancholy, an affirmation of life is likely from Spinoza’s conatus and Seneca’s tranquillity of mind.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 337-338 [Access article in PDF] On Kimura's Écrits de psychopathologie phénomenologique John Cutting This book is a French translation of six articles that the Japanese psychiatrist, Kimura Bin, wrote in the 1970s and 1980s. There is the usual long introduction in such books by the translator. There is also the mandatory explanation of the whole matter as a postface by philosopher Henry Maldiney (...) as if the meaning of anything these days has to be in the form of a sandwich.The first article by Kimura Bin deals with the meaning of certain Japanese words pertaining to self and inter-subjectivity. The critical Japanese word is aida, which means something like interpersonal bonding and is that primordial state of the human being that founds both everyday sociality and the individual self, the latter both in its external and internal composition and orientation: "From time immemorial, the Japanese understood interpersonal social existence, the being between, life in the aida of itself and of others, as the essential trait of an individual human. The interpersonal aida is in some sense the quintessence of known individuality." Schizophrenia, for Kimura, stems from a disturbance in this aida at the most fundamental level, and all its manifestations follow from this.The second article is entitled "Time and Anxiety (Angoisse)." This sets out his major psychopathological thesis—judging from these six articles—which is that schizophrenia and depressive illness differ fundamentally in their temporality. In schizophrenia the subject is geared toward the future: "Subjects with a schizophrenic tendency give sufficient proof in their daily life of a marked inclination to imagine future possibilities or ideas whose feasibility is impossible or implausible." In depressive illness there is a preoccupation with the past: "The lived time of the melancholic type of person has a preponderance towards the past, or, more precisely, towards lived being up to the present."The third article, entitled "Schizophrenic Temporality," amplifies this thesis and introduces his terminology for these, respectively, as the Latin terms, ante festum and post festum. The French translation gives the meaning of the latter as "apres la fête" and "trop tard"—after the holiday, too late. (I shall deal with the potpourri of languages involved below.) This article is the most elaborate, and in it Kimura attempts to derive the core characteristics of the two nosological entities from these two underlying anomalous temporalities.The fourth article is about borderline states, a nosological entity that I have no sympathy for, and I shall not discuss it.The fifth article is entitled "Reflection and Self in Schizophrenia." Again, it concerns a fundamental difference between the mode of reflection in schizophrenia and that in depressive illness, but I cannot say, despite numerous readings, [End Page 337] that I understand it. The reason for this may be my poor French, an inadequate translation, or a confused formulation in the first place, or all three. The gist of it seems to be that in schizophrenia the "other" is a "stranger" projected by the thinking self, whereas in depressive illness the "other" is a "familiar" inhabitant of the sociality adherent to this condition.The sixth article, "Pathology of Immediateness," is an attempt to seek philosophical, theoretical, psychopathological, and even nosological and biological backing for what Kimura has set out earlier, particularly in the third article. Hegel, Lacan, Bergson, Heidegger, Derrida, and Husserl are brought in as philosophical support. Blankenburg and Binswanger provide psychopathological backing. A third prong is the nosological tradition, prevalent in Germany and Japan in the twentieth century, of promoting the concept of an atypical or third type of psychosis with a biological resemblance to epileptic psychosis. All this is then brought together and complicated by a discussion of language and 'mediation' to support the notion that there is a third psychopathological principle—in addition to the ante festum pertaining to schizophrenia and the post festum pertaining to depressive illness—which is that of an intra festum: a preoccupation with the now, characteristic of atypical psychoses with an epileptic basis.These articles tax one's linguistic and conceptual repertoire to the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 63-66 [Access article in PDF] The Pragmatics of Psychiatry and the Psychiatry of Cross-Cultural Suffering Jennifer Radden I AM IN SUBSTANTIAL AGREEMENT with many of the conclusions David Brendel draws in his thoughtful discussion. Misleading language aside, I particularly applaud his use of my plea for ontological descriptivism to support clinical practice, which respects, as he puts it, the subjectively "melancholic" person (...) living behind the objectively "depressed" clinical presentation.Brendel offers two main critiques of my discussion about the relationship between today's depression and melancholia of past eras. First, he asserts that I neglect the relevance of causal reasoning in my preference for a descriptivist over a causal ontology. Second, arguing that pragmatic considerations ought to be, as he says, front and center when philosophers and psychiatrists "grapple with the complexities of psychiatric explanation," (Brendel 2003, 54) he questions what he sees as my too ready dismissal of pragmatism in this discussion. Allegiance to pragmatism seems to me to sit strangely with support for a causal ontology, as I shall try to demonstrate. But first let me comment on these two sides of Brendel's commentary.The case of Van Gogh's alleged melancholia is particularly well chosen because there has been continuing debate about Van Gogh's condition, including scholarly work attributing it to an inherited metabolic disorder (Arnold 1992). Brendel's suggestion that a causal ontology might allow us to use historical evidence to throw light on the relation between depression and melancholia is an interesting and fruitful one that I had overlooked. Brendel also holds hope for drug cartography as a means of determining the causes of mental disorders. I admit to the initial plausibility of the approach to classification employed by drug cartography, of course. Diagnostic maps must be evaluated according to their effectiveness for the purposes they serve, and cannot—or should not—be seen as mere descriptions of natural phenomena. And maps based on psychopharmacological effects will serve one of the most important purposes we can have in relation to mental disorders: their successful treatment. Nonetheless, as I indicated in my essay, there are conceptual limitations to drug cartography. That several different syndromes respond to the same drug is suggestive, but it does not tell us anything definitive about structural similarities or differences between those different disorders. Nor, from the fact that a condition is alleviated by drugs, does it follow that a particular brain state was the initiating cause of that condition.My dismissal of a pragmatic approach in the foregoing discussion may have been overly hasty. [End Page 63] But in trying to make good this omission, I find myself struck by the complexity of the task. There appear to be at least five different places where a pragmatic response might be called for: (1) in deciding what to say about the relationship between depression and melancholia; (2) in determining the structure of any given psychiatric classification; (3) in choosing between what I have called descriptivist and causal ontologies; (4) in electing a course or method of treatment in the clinical context; and (5) in evaluating psychiatric explanations.With regard to (1), I have sketched in a note one pragmatic consideration in favor of equating melancholia and depression: by so doing, we might reinvest depressive states with some of the glamorous associations from the past and so diminish the stigma and provide some compensation and consolation for the suffering attaching to depression. Pragmatic reasoning may be perfectly appropriate here. I beg to point out that pragmatic considerations let me neglect it.With regard to (2), I recognize that psychiatric classifications are not so much identifications of natural kinds as responses to our various purposes; indeed, this point is offered as one drawback of adopting a causal analysis, because there is little reason to expect our purposes, which are a product of culture, to correspond to natural arrangements, which are not.With regard to (3), if there were overriding pragmatic considerations that favored accepting one or the other of these ontologies, then perhaps this would be... (shrink)

The album Echo was produced in a depressed, drug-riddled phase when Tom Petty’s first marriage was ending and his physical condition so degraded that he took to using a cane. Petty filmed no videos, avoided playing the album’s songs on the follow-up tour and reported little memory of its making. The thoughtfulness and self-reflection that traumatic circumstances spur distinguish the album. So too does the tendency to look backwards in times of crisis, whether in hopes of finding solidity in the (...) past or just out of exhausted inability to cope with the present. -/- While melancholically creative, the album might be regarded as an echoing of past musical fragments. The sprightly mix of acoustic and electric guitars, the backing vocal harmonies and the stories of loss in songs such as “Won’t Last Long” and “This One’s for Me” harken to Petty’s albums from the late 80s to mid-90s. “Accused of Love” similarly contains echoes of Petty’s more upbeat work, but with depressing lyrical undertones. The production qualities and lyrics of “Rhino Skin” recollect “Asshole,” a Beck cover from Petty’s previous album. “I Don’t Wanna Fight”—a Heartbreakers performance composed and sung by Mike Campbell—returns to the hard driving rock of Damn the Torpedoes. The lyrics, straight-laced drums and layered drones of electric guitars of “Free Girl Now” go back further to “American Girl,” which itself was influenced by psychedelic music. At the same time, all of this typifies Petty’s oeuvre. Throughout his career, he made music steeped in past rock traditions. He was also a seminal figure in Southern rock, with its emphatically nostalgic character. -/- The crisis that Petty was experiencing echoes throughout the album in more specific ways, with many songs repeating the theme of being up or down, high or low. The theme of fighting or not wanting to has an especially strong echo, showing up in “Swingin’,” “Billy the Kid” and “I Don’t Wanna Fight.” These songs, in turn, exhibit nostalgia for past icons, with protagonists going down hard like Billy the Kid; or going down swinging like Sonny Liston; or again like Benny Goodman, Glenn Miller and Sammy Davis in a punny reference to the swing era. -/- The retrospective feel of the album is one of looking to the past for the sake of self-preservation in the present, along lines discussed by Nietzsche. While symptomatic of illness, Nietzsche maintains this movement “springs from the protective instinct of a degenerating life which tries by all means to sustain itself and to fight for existence.” This seeming denial of growth can, as Nietzsche continues, be “among the greatest conserving and yes-creating forces of life.” Petty clearly associated Echo with personal grief, refusing to listen to it for years. As with many other examples of art, however, the album was also a way of surviving and growing beyond a present trauma, and one more specifically that compelled him to overcome an important part of his past, namely, his wife of 20-plus years. One can speculate that clinging to fragments of the past—musical and otherwise—was a way of coping with a difficult present and a fading past. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mourning or MelancholiaJ. Melvin Woody (bio)Keywords“objective correlative”, depression, grief, cognitive-affective dissonanceIn a celebrated and controversial critical essay, T.S. Eliot faults Shakespeare's Hamlet on the grounds that the playwright has not provided sufficient “objective correlative” for the moods of his melancholy Dane. For lack of the “complete adequacy of the external to the emotion” that he finds in Shakespeare's other tragedies, Eliot judges that “the play is almost certainly (...) an artistic failure” (Eliot 1921, 101, 98). Dr. Bailey's explanation of Colin's melancholy provokes parallel critical reflections. When his initial expectation that he will discover the cause of depression in traumatic battle experiences in Iraq proves groundless, he finds that cause, instead, in the very absence of traumatic experiences. I cannot but wonder whether the lack of opportunity to prove heroic provides an adequate objective correlative for Colin's mood.To be sure, persistent sadness cannot be regarded as pathological if adequate reasons for sadness also persist. There lies the difference between mourning and melancholia. As Freud remarks at the outset of his comparison of the two, “although grief involves grave departures from the normal attitudes to life, it never occurs to us to regard it as a morbid condition and hand the mourner over to medical treatment.” Even though the mourner displays almost all the same symptoms as melancholia, where there is a recognizable objective correlative, we look upon any interference “as inadvisable or even harmful... because we know so well how to explain it... this attitude does not seem to us pathological” (Freud 1963, 165). Neither the absence of battlefield trauma nor the lack of heroic opportunities seems sufficient occasion for Colin's sadness. But (perhaps) that very explanatory insufficiency justifies regarding his plight as pathological, as a case of melancholia rather than mourning and therefore as warranting psychiatric interference. Insofar as that is true, the self-criticisms engendered by his trauma-free stint in Iraq might best be regarded as an effect rather than cause of his depression. Freud found this sort of “fall in self esteem” that “finds utterance in self reproaches and self revilings” to be the singular feature that distinguishes melancholia from mourning.” In the clinical picture of melancholia, dissatisfaction with the self on moral grounds is far the most outstanding feature” (Freud 1963, 167, 169).Anyone who has dealt with depression will recognize such feelings as standard symptoms. The DSM- IV cites “feelings of worthlessness or excessive or inappropriate guilt” as one of the defining criteria of a major depressive episode and “low self esteem” as a diagnostic criterion of dysthymic disorder.Freud speculated that the melancholic's attacks upon himself actually aim at an abandoned but internalized love object. But he acknowledged [End Page 245] that his speculation was based on “a small number of cases the psychogenic nature of which was indisputable,” and that some cases of melancholia suggest more somatic causes. Recent psychiatry has veered sharply toward somatic causes and cures, although the psychogenic nature of depression associated with traumatic stress is generally acknowledged. But in the absence of trauma and stress, as in Colin's case, a somatic account seems more plausible than supposing that the depression is triggered by that very absence.The contrast between somatic and psychological sources of depression threatens to prove distracting, however. We are not faced with a simple either/or here, and however we sort out the genetic, environmental, somatic, and psychological sources of depression in any given case, the depression itself is always a profoundly incarnate experience. Moreover, what seems of especial pertinence to this case, the loss of self-esteem and feelings of worthlessness and guilt seem to prevail regardless of the particular balance of causes of the depression and can, therefore, be regarded as characteristic symptoms rather than explanatory causes of the mood. And the blackness of melancholy typically extends well beyond such negative self-judgments to cast a shadow on the depressive's whole world and future.Epistemology and pathology converge in the clinical diagnosis of depression. Depression seems pathological insofar as it seems unreasonable in light of the circumstances as we apprehend them. Of course, the person who is depressed... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Creativity Belongs to the Person, not to DiseaseJuan J. López-Ibor Jr. (bio) and María-Inés López-Ibor (bio)Keywordscreativity, patho-biography, Saint Teresa, visionsIn the paper, “From the Visions of Saint Teresa of Jesus to the Voices of Schizophrenia,” Cangas, Sass, and Pérez-Álvarez (2008) take an original approach to patho-biography that is very welcome.The temptation to designate historical individuals or characters of fiction as suffering from mental disease has always produced disagreeable feelings (...) in me. This sort of abuse of psychiatry and of the people in question is parallel to the abuse by the media or lay citizens when they describe, say, an especially violent murderer as a schizophrenic—forgetting that the vast majority of people with schizophrenia are not in the least violent. Having read Santa Teresa’s writings during my adolescence, well before I even considered entering medicine, I reacted to comments about her alleged psychiatric illnesses with uneasiness, to put it mildly. The Santa Teresa of La Vida de la Santa Madre Teresa de Jesús (her autobiography), of the Camino de Perfección, and of the El Castillo Interior was surely not a mental patient, it seemed to me. The same would apply to San Juan de La Cruz, Jean D’Arc, Don Quijote, Sancho Panza, Edipus, and Clitemnestra, to mention a few. Even van Gogh’s paintings did not seem to me the productions of a patient with schizophrenia or epilepsy. Of course all of them may have suffered, at certain periods of life, symptoms attributable to a mental disorder, but their creativity rested elsewhere, and was often manifest during healthy periods of their lives. After years spent fighting the stigma of mental diseases, and after organizing several exhibitions of works of art of people with mental diseases, we came to the conclusion that creativity and singularity belong to the person, not to the illness. Some of the diseases of these individuals may have being accidents (van Gogh’s hallucinations and psychotic symptoms, for example, were most probably due to intoxications with absinthe, then rich in hallucinogenic alkaloids such as tujone), or, together with other life circumstances, may have had unspecific influences on the person’s condition. In contrast with many other psychiatric disorders that are represented in ancient Greek and Roman literature, there are no descriptions of individuals with schizophrenia in the Greek and Roman literature dating from the fifth century bc to the beginning of the second century Ad (Evans et al. 2003), and several authors have speculated that schizophrenia did not exist before the eighteenth century (Ellard 1987).Caution is important when dealing with mental health and religious issues in contrast with creativity. The creativity of people suffering from bipolar disorders is well recognized (Jamison 1993) and [End Page 277] the same applies to alcohol and drug intoxication. Tellenbach (1986) has also written on the creativity of depressed persons, although he refers more to the disposition of mood (Schwermut) than to clinical depression as such. The link between melancholia and genius put forward by Aristotle has often been misinterpreted. The philosopher was considering the melancholic temperament and not the melancholic illness as we would understand it today. Of the four temperaments, it is in his view only the melancholic that is gifted with creativity. The sanguine person seeks the immediate pleasures of life, the choleric one considers himself powerful and dedicates himself to manifesting this power, and the phlegmatic individual is disconnected from life and seeks to live without effort or pleasure. The melancholic temperament leads to creativity because of the predominance of doubt, reflection, and dissatisfaction with the miseries of life.Freud’s notion of religiosity as a collective obsessive neurosis is totally mistaken, in my view. The three main themes of obsessions are cleanliness, order, and guilt. In none of these cases is the theme the goal of the action; rather, it is a strategy to contain anxiety. As a consequence, patients with obsessions and compulsions about dirt and cleanliness tend to be dirty themselves, because the real purpose of their compulsions is not in fact to be clean but rather to satisfy a ritual. When order... (shrink)

ABSTRACT This paper argues for the contemporary relevance of melancholy as something different than depression or a state of mental illness. Instead, through examples of a literary, philosophical, and artistic nature, it is shown that melancholy functions as a force-field – a topos where the finite and the infinite, the earthly and the heavenly, the physical and the spiritual come together and meet in huge tension. By means of an exploration of the historical notion of melancholy and a revisit (...) of Dürer’s Melencolia I (1514), coupled to a much more recent example, Lars von Trier’s film melancholia (DK/se/fr/de 2011), this paper shows how the melancholic motif continues to play an essential role in our contemporary society. The melancholic is described as a person who lives a life on the border: who intuits the point where two worlds meet and who longs for a revelation of the beyond – an apocalypse (literally: ‘an uncovering’). It is this longing – a nostalgia for being – that increasingly pervades our contemporary world, a world that represses the heterogeneous through numerous social and political conditions. The study of melancholy here undertaken therefore provides a valuable contribution to the understanding of melancholy in our (post-) modern time. (shrink)

First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that this (...) experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development. (shrink)

The phrase ‘Never Again,’ ‘plus jamais, ‘nie wieder,’ ‘nunc más’ and ‘nunca mais’ promises to end the atrocities of the 20th century and warns of their return if individuals and governments remain indifferent to injustices in the world. Never Again is based on the moral claim that active remembrance is central to learning from the past and to preventing violence in the future. Indeed, as President Volodymyr Zelensky argued in his speech on May 8th commemorating the end of World War (...) II, ‘Never Again’ is ‘the anthem of the civilized world.’ While the promise of Never Again was undermined by genocide in Yugoslavia and Rwanda, and the bombing of civilians in Syria and war in Afghanistan, Russia’s full-scale invasion of Ukraine tests the ethics of Never Again on a larger scale with its looming specter of nuclear war and growing list of war crimes. In an effort to understand how the very institutions that were created in the aftermath of World War II could not prevent war from returning to Europe, my argument proceeds in three parts: (1) Never Again is based on a paradox between the universal and the particular, as well as between the historical experience of individuals in the past and the universal promise to avert its reoccurrence. (2) Never Again refers to a break in historical time that links the living with memories of the dead and promises not to repeat the violence of the past in the future. At issue is the kind of intergenerational responsibility implied in the ethics of Never Again. (3) The imperative of Never Again is weakened when memory is reduced to a melancholic gaze of catastrophe that privileges a tragic understanding of history. (shrink)

Since late antiquity, a connection was made between Jews and the psychological state of despondency based, in part, on the link between melancholy and Saturn, and the further association of the Hebrew name of that planet, Shabbetai, and the Sabbath. The melancholic predisposition has had important anthropological, cosmological, and theological repercussions. In this essay, I focus on various perspectives on melancholia in thinkers as diverse as Kafka, Levinas, Blanchot, Rosenzweig, Benjamin, Bloch, Scholem, and Derrida. A common thread that links (...) these thinkers is the hopelessness of hope imparted by the messianic belief in a future that must be perpetually deferred. (shrink)

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

We examined amygdala subregion volumes in patients with a first episode of major depression and in healthy subjects. Covariate-adjusted linear regression was performed to compare the MD and healthy groups, and adjustments for age, gender, and total estimated intracranial volume showed no differences in amygdala subregion volumes between the healthy and MD groups. Within the MD group, we examined the association between amygdala subregion volume and the 17-item Hamilton Rating Scale for Depression score and the HAMD subscale score, (...) and found no association in the left amygdala. In the right amygdala, however, there was an inverse linear association between the HAMD total and the HAMD core and lateral nucleus and anterior-amygdaloid-regions. Furthermore, an inverse linear association was seen between the HAMD psychic and the lateral nucleus, anterior-amygdaloid-regions, transition, and whole amygdala. The findings of this study suggest that the severity of MD and some symptoms of MD are associated with right amygdala volume. There have been few reports on the relationship between MD and amygdala subregional volume, and further research is needed to accumulate more data for further validation. (shrink)

Background: Recent research has demonstrated that depressed individuals show impairments in inhibiting irrelevant emotional material, and that these impairments are linked to rumination. Cognitive inhibition, however, is not a unitary construct but consists of several components which operate at different stages of information processing. The present study was designed to assess two components of inhibition and examine their relation to depression and rumination in a sample of clinically depressed and healthy control participants. Methods: Twenty-two individuals diagnosed with a current (...) depressive episode and 27 never-disordered control participants completed an Emotional Flanker Task to assess individual differences in interference control and a modification of the Working Memory Selection Task to assess individual differences in the ability to discard no longer relevant emotional material from working memory. Participants completed self-report measures to assess depressive symptoms and rumination. Results: Clinically depressed compared to control participants showed significantly reduced interference control of irrelevant negative information. The groups, however, did not differ in their ability to discard no longer relevant negative information from working memory. In contrast, rumination was associated with difficulty removing no longer relevant negative material from working memory but not with deficits in interference control. Conclusions: Results highlight the importance of differentiating among components of inhibition to gain a better understanding of cognitive mechanisms underlying depression and rumination. (shrink)

See the external link on this entry for a "widget" supplied by Bloomsbury, which will give you access to the first chapter. -/- Today, we find ourselves surrounded by numerous reasons to despair, from loneliness, suffering and death at an individual level to societal alienation, oppression, sectarian conflict and war. No honest assessment of life can take place without facing up to these facts and it is not surprising that more and more people are beginning to suspect that the human (...) story will end in tragedy. However, this focus on despair does not paint a complete and accurate picture of reality, which is also inflected with beauty and goodness. Working with examples from poetry and literature, including Virginia Woolf and Jack Gilbert and the films of Terrence Malick, Melancholic Joy offers an honest assessment of the human condition. It unflinchingly acknowledges the everyday frustrations and extraordinary horrors that generate despair and argues that the appropriate response is to take up joy again, not in an attempt to ignore or dismiss evil, but rather as part of a “melancholic joy” that accepts the mystery of a world both beautiful and brutal. (shrink)

Trauma informed care (TIC) “realizes the widespread impact of trauma… recognizes the signs and symptoms of trauma in clients, families and staff; responds by fully integrating knowledge of trauma i...

Depression is a widespread and debilitating disorder, but developing effective treatments has proven challenging. Despite success in animal models, many treatments fail in human trials. While various factors contribute to this translational failure, standardization practices in animal research are often overlooked. This paper argues that certain standardization choices in behavioral neuroscience research on depression can limit the generalizability of results from rodents to humans. This raises ethical and scientific concerns, including animal waste and a lack of progress in (...) treating human patients. To address these issues, animal ethics committees can establish reasonable expectations for preclinical research and highlight the impact of standardization on generalizability. Such efforts can help improve translation from animal models to human patients and ultimately benefit those suffering from depression. (shrink)

Studies on mental health and academic performance have been conducted throughout the world. Thus, this study aims to assess the students' mental health amidst the new normal of education employing 21-item Depression, Anxiety, and Stress Scale or DASS-21, concerning their academic performance. The study's findings showed that almost more than half of the respondents suffered from moderate to extremely severe levels of depression, stress, and anxiety. Thus, there was no significant relationship between high negative mental health symptoms and (...) academic performance. In conclusion, students that encounter extreme levels of adverse mental health can still maintain high academic achievement. However, the students' mental health should always be managed and helped to cope with their life problems, especially during this pandemic crisis. (shrink)

There is growing interest in nature-based interventions to improve human health and wellbeing. An important nascent area is exploring the potential of outdoor therapies to treat and prevent common mental health problems like depression. In this conceptual analysis on the nature–depression nexus, we distil some of the main issues for consideration when NBIs for depression are being developed. We argue that understanding the mechanisms, or ‘active ingredients’ in NBIs is crucial to understand what works and for whom. (...) Successfully identifying modifiable mediating intervention targets will pave the way for interventions with increased efficacy. We highlight a non-exhaustive list of five clinically relevant putative, candidate mechanisms which may underly the beneficial effects of NBIs on depression: stress, rumination, mindfulness, sleep and exercise. We also make the case that when developing NBIs it is important to not neglect young people, explore personalised approaches and focus on both treatment and prevention approaches. To achieve these aims methodologically rigorous programmes of clinical research are needed that include well-powered and controlled experimental designs including randomised controlled trials, qualitative research, longitudinal studies and large prospective cohorts. (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)