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📙 Experiences of Depression

Author: Matthew Ratcliffe

Full Title: Experiences of Depression

Highlights from January 11th, 2021.

At a very general level of description, the phenomenology of (existential) depression can be characterized as follows:
The practical significance of things is somehow diminished; they no longer offer up the usual possibilities for activity.
The resultant estrangement from the world amounts to a change in the sense of reality and belonging—things no longer appear available; they are strangely distant, not quite ‘there’ anymore.
I conclude that the epistemic allure of existential despair is symptomatic of a contingent loneliness, rather than an inevitable human condition.
It is clear that ‘depression’ and ‘major depression’ accommodate a range of different kinds of experience. There are currently no additional non-phenomenological criteria that we might appeal to in order to unite them. Furthermore, it is unlikely that any such criteria are forthcoming.
I suggest instead that we construe ‘depression’ in terms of what Jaspers (1963), drawing on the work of Max Weber, calls an ‘ideal type’. In a more recent discussion, from which I take my lead, Schwartz and Wiggins (1987a, b) construe ideal types in psychiatry in a way that involves no metaphysical commitment and credits them only with a methodological role. They are starting points from which to navigate, and the types one works with are partly a reflection of one’s values and goals. In the context of mental health, the values are those of ‘promoting health and ameliorating mental illness’, and the goals are to facilitate informative generalizations and engage with individual patients.

Highlights from January 18th, 2021.

There is either a loss of fundamental projects or a more profound loss of certain kinds of significance, but there remains a positive enticement to act. So there is a feeling of being ‘busy’, ‘productive’, or doing something ‘important’, but one that has been decoupled—to varying degrees—from an enduring network of cares, concerns, commitments, and projects. Binswanger (1964, p.) describes more extreme forms of the ‘manic mode of being-in-the-world’ as active but unfocused in exactly this way:     His so-called hyperactivity which, in the onset of illness, is often still a stimulus for outstanding achievement, projects, scientific or artistic works of every kind, gradually turns into an aimless, meaningless, empty busy-ness. What we call the seriousness of living turns into a game. […] Everything is ‘handy’ for the patient, is at once ‘handled’ and ‘played away’. So he is continually on the move.
A self that does not live into the future, that moves around in a merely playful way in the here and now, and, at best, still lives only from the past, is but momentarily ‘attuned’, not steadily advancing, developing or maturing, is not to borrow a word, an existential self.
She is ‘active’ in the sense that her environment constantly calls for action, but there is another sense in which she is ‘passive’. What solicits her to act is not shaped by projects of her own; she is pulled in by her surroundings like a puppet on strings. This is not to suggest that these enticements need be inconsistent with each other or random; much the same things could draw the person in at different times. The point is that any consistency is not attributable to enticements being embedded in longer-term and wider-ranging systems of significant possibility.
You are sitting in front of your computer with the aim of writing something. You need to get it done soon, and you also want to get it done. So you prepare to start writing, but it doesn’t happen. Instead, you check your email, attend to other less pressing tasks, or resort to distracting yourself with the Internet. On one account, you lack motivation; loss of enticing possibilities in relation to task x is loss of the motivation to perform task x. Nevertheless, you really do want to complete the paper, you envisage a future state of affairs where it is complete as better than one where it is not, and you experience an increasingly pronounced sense of bodily agitation as you waste hour after hour. Sometimes, it just does not happen—the situation does not draw you in. Without any enticement, what remains of motivation is insufficient to spur you into action. Now, think of a world that offers only this kind of experience—an appreciation that things need to be done, a sense of being unable to act, and an unpleasant, bodily feeling of tension and urgency. It would amount to a kind of ‘agitated’ Depression.
There is a felt need to act upon one’s situation in some way. In a world from which the possibility of meaningful change is absent, this involves ‘urgent’, unstructured, racing thoughts, as well as a more general feeling of agitation. One cannot rest, even though there is nothing to be done.

Highlights from January 19th, 2021.

Husserl describes the ‘allure given to consciousness, the peculiar pull that an object given to consciousness exercises on the ego’ (2001, p.). There is, he suggests, a kind of ‘striving’ that belongs to ‘normal perception’, and a ‘feeling’ that ‘goes hand in hand with this striving’ (1973, p.). What we actually perceive invites us to actualize further perceptual possibilities, those that enhance our perceptual grasp on the object by reducing open uncertainty.
I will offer a tentative account of another kind of Narrative disturbance, one that I think occurs in at least some cases of Depression. Here, the person needs a Narrative, principally one about where she is going and how she is going to tackle various tasks, but she cannot formulate one because there is no sense that the future could be any different. However, what results is not an absence of Narrative thought. Instead, there is a cacophony of disordered thoughts as she struggles to form a coherent Story that cannot take shape. Thoughts go round and round without any efficacy, like a car engine that is out of gear.

Highlights from January 21st, 2021.

However, we can also draw on neurobiology to support a distinction between motivation and anticipated reward. According to Berridge (2007), current evidence suggests that the neurotransmitter dopamine plays an important role in motivation or ‘incentive salience’, but is neither necessary nor sufficient for ‘hedonic “liking”’ or learning to anticipate outcomes. Motivation and reward are thus dissociable.
We might gain satisfaction from something and also anticipate doing so, but remain unmotivated. Conversely, we might feel motivated to do something without anticipating or achieving any satisfaction.
Our sense of acting freely is not primarily something we experience as internal to ourselves, an episodic feeling associated with the initiation or performance of certain actions. Instead, all actions (along with any feelings or ‘qualia’ that might be associated with acting or being about to act) presuppose an experience of freedom. This experience consists simply of ‘the world’—the sense that we are free is integral to how we experience our surroundings.
When we perform goal-directed actions, such as reaching for a pen, crossing the road, or drinking from a glass of water, every movement of a finger, hand, arm, or leg does not comprise a discrete free action.
Flicking a wrist is not a typical free action but a movement that would ordinarily contribute to such an action, one that has been extricated from its usual context.
I will draw on Sartre’s discussion of freedom in Being and Nothingness in order to argue that the experience of freedom is neither an inchoate internal feeling nor an episode that accompanies some instances of action. Rather, it is an ordinarily constant background to all our activities.
Freedom, I will argue, is a way of experiencing the world.
Our being presented with the ‘I can’, along with other kinds of possibility that it is distinct from, is what constitutes our experience of freedom.
Take his well-known example of walking along the edge of a precipice and feeling afraid. Sartre stresses that my fear is a way of experiencing my surroundings; they appear as offering the ‘possibility of my life being changed from without’.
Sartre maintains that the experience of worldly possibility is essentially bodily in character. He also offers a transcendental argument to the effect that having a body is a necessary condition for thought, action, and choice:
If our capacities were unlimited, to wish would be to be to get, and the distinction between Desire, Choice, and action would break down.
Sartre suggests that all of our activities and projects, all of the ways in which we find things significant, can be traced back to an original project that is chosen: ‘all these trivial passive expectations of the real, all these commonplace, everyday values, derive their meaning from an original projection of myself which stands as my Choice of myself in the world’ (1989, p.). I reject this last claim on phenomenological grounds.
The phenomenology of freedom does not originate in an ungrounded Choice but in a pre-given space of possibility, a space that is susceptible to various kinds of change.
Depression involves a change in the kinds of possibility that are integral to experience, amounting to a diminishment of freedom.
Openness to certain kinds of possibility is inseparable from a ‘core’ sense of self, of being a cohesive locus of experience and agency. Contraction of the possibility space therefore amounts to an experienced erosion of self (at least in those cases where there is an experience of loss, lack or absence).
When you’re depressed, it feels as though there is a huge distance between you and things, which are inert, unresponsive to your wishes. Now that I was feeling better, a pen would leap into my hand, soap seemed to cover me of its own accord, the towel would be in exactly the right place for me to pick it up. Instead of being the slave of the objects around me, I was part again of an active world in which I could participate. (Lewis, 2006, p.)
…it was as if the whatness of each thing—I’m no good at philosophical vocabulary—but the essence of each thing in the sense of the tableness of the table or the chairness of the chair or the floorness of the floor was gone. There was a mute and indifferent object in that place. Its availability to human living, to human Dwelling in the world was drained out of it. Its identity as a familiar object that we live with each day was gone. […] the world had lost its welcoming quality. It wasn’t a habitable earth any longer. […] It became impossible to reach anything. Like, how do I get up and walk to that chair if the essential thing that we mean by chair, something that lets us sit down and rest or upholds us as we read a book, something that shares our life in that way, has lost the quality of being able to do that? (Quoted by Hornstein, 2009, pp.–3)
a world where dread is all-pervasive is a world where things cannot entice one to act in a confident, habitual, effortless way.
we can employ a broadly Sartrean interpretative framework in order to illuminate alterations in the experience of freedom and agency that occur in depression.
Sartre insists that even the most exceptional circumstances leave our freedom intact. For example, he writes that ‘the red hot pincers of the torturer do not exempt us from being free’ (Sartre, 1989, p.). However, reflection on experiences of depression indicates that matters are more complicated.
A category need not have ‘natural kind’ status in order for its retention to be defensible. In other words, it does not have to be an accurate or uniquely accurate reflection of how the world really divides up. For certain purposes, its utility may be justification enough. Historical entrenchment is also a consideration.
Here is one of many scenarios we might explore: The person first feels exhausted and increasingly unable to do things. She feels unsupported by others, gradually loses trust in the world and then experiences a growing sense of non-localized dread. This exacerbates the feeling of inability so that everything now appears utterly impossible, after which feelings of irrevocable worthlessness and guilt take hold.
Consider Jaspers’ well known description:     Patients feel uncanny and that there is something suspicious afoot. Everything gets a new meaning. The environment is somehow different—not to a gross degree—perception is unaltered in itself but there is some change which envelops everything with a subtle, pervasive and strangely uncertain light. A living-room which formerly was felt as neutral or friendly now becomes dominated by some indefinable atmosphere. Something seems in the air which the patient cannot account for, a distrustful, uncomfortable, uncanny tension invades him. (Jaspers, 1963, p.) This differs from the static world of depression, in that everything appears somehow novel, surprising.
Superficially this state of mood is similar to anxiety, but its internal structure is different. In a state of anxiety anything can happen, whereas in delusional moods something strange, enigmatic and incomprehensible is already happening. (Lopez-Ibor, 1982, p.)
Delusional atmosphere involves experiencing possibilities in a less structured way. A comfortable sofa may look somehow menacing, thus conflicting with the prior expectation that it will appear as something ‘for sitting on’ and perhaps also ‘entice’ one to sit. So it looks somehow wrong, strange and unfamiliar.
Schizophrenia can therefore involve an erosion of practical significance that differs from what I have described in relation to depression. The world lacks a coherence that is required for the Intelligibility of sustained purposive activity.
In summary, then, I think that a very general (and admittedly rough) distinction can be drawn between different disturbances of the anticipation-fulfilment structure. Existential depression experiences involve privation, whereas schizophrenia is often associated with disruption.
Simeon and Abugel (2006, p,72) observe that depersonalization is not always an unpleasant experience; sometimes ‘the dissociation is a safe, comforting place for them to retreat, which shields them from being overwhelmed and envelops them in a state of nothingness’. However, the possibility of retreating to a ‘safe, comforting place’, whatever that might amount to, is absent from the world of depression.
What, if anything, makes a depression experience ‘pathological’? In addressing this question, I will use the term ‘pathological’ in a loose way, to mean simply that depression involves something going ‘wrong’ according to one or another criterion.
As we saw in Chapter 2, many depression experiences are much like illness experiences. Indeed, some (but certainly not all) are likely to be wholly or partly attributable to the same inflammatory processes.
If a person won’t get out of bed, won’t eat, can’t face other people, can’t perform mundane tasks, aches all over, experiences all-pervasive dread, and wants to die, there is clearly something ‘wrong’. She is unable to do what she ordinarily does, and she is suffering.
One might object that there are also benefits to having depression. People can and often do gain something from it.
But this observation is consistent with the view that, overall, depression is a bad thing to have.
The potential benefits of having experienced depression certainly include that of learning something from it. For instance, I have suggested that having undergone a profound existential change can serve to culture recognition of the fact that finding oneself in the world is a phenomenological achievement, one that is fragile and changeable.

Highlights from January 30th, 2021.

The manic person thus lives in an enticing present. It draws her in, but in a way that is unconstrained by longer-term projects and associated systems of significant possibilities that would otherwise inhibit her from acting in response to the immediate allure of things.

Highlights from February 1st, 2021.

Husserl maintains that, when we experience or think about another human being in a personal or an impersonal way, we do so in the context of a world that is shared by interpreter and interpreted. A background sense of residing in the same world as one’s object of study is itself part of one’s experience.
Waking life is always a directedness toward this or that, being directed toward it as an end or as means, as relevant or irrelevant, toward the interesting or the indifferent, toward the private or public, toward what is daily required or intrusively new. All this lies within the world-horizon; but special motives are required when one who is gripped in this world-life reorients himself and somehow comes to make the world itself thematic, to take up a lasting interest in it.
There are two inextricable aspects to this background acceptance of the world: (i) an experience of being ‘there’, part of some situation, and (ii) what I call a ‘sense of reality’.
Having a sense of reality is not a matter of experiencing however many entities as ‘here, now’ or of making however many non-perceptual judgments to the effect that some state of affairs is or is not the case. Rather, it is what enables us to distinguish ‘here, now’ from other possibilities, and to distinguish what is the case from what is not the case.
The sense of reality is itself a phenomenological achievement, one that is inseparable from the experience of belonging to a shared world.
Although this ‘world’ or ‘sense of reality and belonging’ is not completely lost in Depression, I will argue in the following chapters that it is profoundly altered—the person does not feel fully ‘part of the world’ and everything seems somehow different.
According to Husserl, a perspectival shift is needed in order to recognize ‘world’ as a phenomenological achievement. To accomplish this, he instructs us to perform the ‘epoché’, a suspension or bracketing of the ‘natural attitude’ of believing in the existence of the world. This involves, he says, a ‘universal depriving of acceptance, [an] “inhibiting” or “putting out of play” of all positions taken towards the already-given Objective world and, in the first place, all existential positions’ (Husserl, 1960, p.).
What is interrogated through the phenomenological reduction is not just everything we take to be the case but also the sense of reality and belonging that is presupposed by our taking anything to be the case or otherwise, something that personal and psychological understandings continue to take for granted. As we will see, disturbances in this sense of ‘world’ are central to experiences of depression.
He adds that, despite disagreements between Husserl and Heidegger, what Heidegger in Being and Time calls ‘Being-in-the-world’ is exactly what we gain reflective access to by performing the phenomenological reduction. This sounds right to me. For example, Heidegger (1927/1962, p.) writes that ‘the world itself is not an entity within-the-world; and yet it is so determinative for such entities that only in so far as “there is” a world can they be encountered and show themselves, in their Being, as entities which have been discovered’.

Highlights from February 2nd, 2021.

Consider the following passage from Autobiography of a Schizophrenic Girl, where the author, ‘Renee’, describes a short-lived return to reality:     …when we were outside I realized that my perception of things had completely changed. Instead of infinite space, unreal, where everything was cut off, naked and isolated, I saw Reality, marvelous Reality, for the first time. The people whom we encountered were no longer automatons, phantoms, revolving around, gesticulating without meaning; they were men and women with their own individual characteristics, their own individuality. It was the same with things. They were useful things, having sense, capable of giving pleasure. Here was an automobile to take me to the hospital, cushions I could rest on. […] for the first time I dared to handle the chairs, to change the arrangement of the furniture. What an unknown joy, to have an influence on things; to do with them what I liked and especially to have the pleasure of wanting the change.
A sense of the possibilities offered by our surroundings is inseparable from a sense of what we could do, where the latter is comprised of various bodily dispositions.
Hence our experience of the possible is at least partly constituted by kinaesthetic dispositions; we experience the world through them, and the body operates more as a ‘medium’ or ‘organ’ of perception than as an object of perception
Existential feelings, I suggest, consist in a diffuse, background sense of bodily dispositions. I use the term ‘background’ to emphasize that they are presupposed by our experiences of situations within a world.

Highlights from February 3rd, 2021.

A phenomenological stance, as I understand it here, is not a radical transformation of all experience, where the phenomenologist becomes, as Husserl puts it, ‘the “non-participant onlooker” at himself’ (1960, p.). Rather, it is a methodological shift, through which one comes to appreciate that certain questions cannot be satisfactorily addressed from the standpoint(s) of empirical science or from any other perspective that takes a sense of reality and belonging as given.
A phenomenological stance, however refined, includes (i) attentiveness to an aspect of experience that is more usually presupposed and overlooked; (ii) a commitment to reflect upon it; and (iii) at least some appreciation of what the relevant aspect of experience consists of.

Highlights from February 22nd, 2021.

Reflecting on being in bed with influenza, Woolf notes how ‘the world has changed its shape’; ‘the whole landscape of life lies remote and fair, like the shore seen from a ship far out at sea’ (2002, p.). This is not unlike the feeling of detachment that many depressed people describe.
To illustrate the relational phenomenology of bodily feeling, we can appeal to experiences of touch. When I run my hand along the surface of a desk, what I perceive is not a feeling in my hand but the texture of the desk.
If you write on a rough surface with a pencil, you perceive the surface through the pencil, rather than the boundary between pencil and hand. And when you cut through a steak with a knife, it seems that you perceive the texture of the steak through touch, regardless of whether or not you also perceive the steak knife. Indeed, distance touch is ubiquitous in the context of tool use.
When we experience intense and enduring pain, the world can cease to be a realm of significant possibilities that draws us in and become something before which we are passive, vulnerable and threatened.
Scarry (1985, p.) goes so far as to say that pain can be ‘world-destroying’; it ‘destroys a person’s self and world, a destruction that is experienced spatially as either the contraction of the universe down to the immediate vicinity of the body or as the body swelling to fill the entire universe’.
A world that fails to entice, to draw one in, corresponds to a sluggish body, one that is not primed for action. A heavy, aching body is a world full of difficulties, where tasks appear daunting, insurmountable. And a world that threatens, overwhelms or suffocates in some inchoate way is at the same time an experience of bodily tension, tightness and pressure.
The most radical conclusion to draw would be that depression and a feeling of being ill are one and the same: depression is a form of experience associated with chronic inflammation.
Indeed, van den Berg (1966, p.) points out that an experience of illness can give things a new significance; the sick person can make ‘his room, his window sill, his window and his view a world full of significant and breathtaking events’. He goes so far as to say that bodily illness gives one a ‘soundness of mind’ that is often lacking in health.

Highlights from March 12th, 2021.

It is interesting to note that people who have suffered from depression sometimes report confusing its return with the onset of an infection.
Depression is often associated with high levels of inflammatory cytokines.
Hence it has been proposed that depression is wholly or partly attributable to over-activation of the immune system: ‘depressive disorders might be best characterized as conditions of immune activation, especially hyperactivity of innate immune inflammatory responses’ (Raison et al. 2006, p.).

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