Top

Published in:

01-11-2013 | Scientific Contribution

Depression and embodiment: phenomenological reflections on motility, affectivity, and transcendence

Author: Kevin A. Aho

Published in: Medicine, Health Care and Philosophy | Issue 4/2013

Abstract

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.

To make her case, Angell points to a 35 fold increase in mental disorders among children from 1987 to 2007 and the fact that nearly half of all Americans met the criteria for a psychiatric disorder as established by the American Psychiatric Association (APA) (Angell 2011a). Contributing to this epidemic is the ever-increasing number of diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the current edition of which contains 365 different psychiatric diagnoses. Angell also cites the fact that of the 170 contributors to the current DSM, over half had financial ties to drug companies, “including all of the contributors to the sections on mood disorders and schizophrenia” (Angell 2011b; Cosgrove 2006).

The result, according to Angell, is that since the introduction of Prozac in 1987, “the number of people treated for depression [has] tripled… and about 10 percent of Americans over age six now take antidepressants” (2011a). Angell goes on to point out that despite its cultural pervasiveness as a causal explanation, the chemical imbalance theory has never been empirically demonstrated. Moreover, studies have repeatedly shown that the medications used to treat depression are only marginally better than placebos in double blind clinical trials and that drug companies tend to only publish positive results in medical journals, while the negative results usually remain unpublished (2011a). Angell goes on to suggest that long-term use of the most popular antidepressants (selective serotonin reuptake inhibitors or SSRIs such as Prozac, Zoloft, and Celexa) may even cause a type of iatrogenic or medically induced brain damage by fundamentally altering neural functioning, making it exceedingly difficult to get off the medications (2011a).

Kramer, Oldham, and Carlat agreed with a number of Angell’s points, for instance, that psychiatrists are often too quick to medicalize ordinary feelings of grief, sadness, and anxiety with little or no biological evidence for these diagnoses; that psychiatric medications are overprescribed as the first line of treatment; and that clinicians and research psychiatrists are too ready to accept money from the drug industry resulting in increasing conflicts of interest. Kramer (2011), however, criticized Angell’s reticence in accepting the medical legitimacy of depression and highlighted the long-term efficacy and health promoting benefits of antidepressants. Oldman (2011)argued that whether or not “chemical imbalances are causes of mental disorders or symptoms of them” is not the point. “The bottom line is that medications often relieve the patient’s suffering, and this is why doctors prescribe them.” And Carlat (2011) claimed that regardless of the evidence provided by Angell regarding the scientific validity of the chemical imbalance theory, the “unequivocal if perplexing truth about psychiatric drugs—on the whole, [is that] they work.”

Shenk (2001) describes the difficulty of capturing in words the experience of depersonalization. “Words—unhappy, anxious, lonely—seemed plainly inadequate, as did modifiers: all the time, without relief. Ordinary phrases such as I feel bad or I am unhappy seemed pallid. Evocative metaphors—My soul is burned skin, aching at any touch. I have the emotional equivalent of a dislocated limb—were garish. Though this language hinted at how bad I felt, it could not express what it felt like to be me” (pp. 248–49).

But regardless of the identity I happen to choose, I am also not that person because I can always question myself and choose to assign different meanings and values to my experiences in the future. In short, there is no pre-given nature or essence that ultimately determines or defines me as a human being because my identity is always penetrated by a ‘not’ (Sartre 1946/2000, 293).

Aho, J., and K. Aho. 2008. Body matters: a phenomenology of sickness, illness, and disease. Lanham, MD: Lexington Books.

Alvarez, A. 1990. The savage god: a study of suicide. New York: W. W. Norton.

American Psychiatric Association. 1994. Diagnostic and statistical manual of mental disorders (DSM-IV). Washington, DC: American Psychiatric Association.

Angell, M. 2011a. The epidemic of mental illness: Why? The New York Review of Books. July 23.

Angell, M. 2011b. The illusions of psychiatry. The New York Review of Books. July 1.

Blackman, L. 2001. Hearing voices: embodiment and experience. London: Free Association Books.

Breggin, P.R., and G.R. Breggin. 1995. Talking back to Prozac: what doctors won’t tell you about today’s most controversial drug. New York: St. Martin’s Paperbacks.

Carlat, D. 2011. The illusions of psychiatry: An exchange. The New York Review of Books. August 18.

Cosgrove, L. et al. 2006. Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychotherapy and Psychosomatics 75.

Dorman, L. 2001. Planet No. In Unholy ghost: writers on depression, ed. N. Casey, 229–241. New York: Harper Perennial.

Fraser, M. 2001. The nature of Prozac. History of the Human Sciences 14(3): 56–84.

Fuchs, T. 2005a. Delusional mood and delusional perception—A phenomenological analysis. Psychopathology 38: 133–139.PubMedCrossRef

Fuchs, T. 2005b. Corporealized and disembodied minds: a phenomenological view of the body in melancholia and schizophrenia. Philosophy, psychiatry, and psychology 12(2): 95–107.

Fuchs, T. 2005c. The phenomenology of the body, space and time in depression. Comprendre 15: 108–121.

Gadamer, H.G. 1993. The enigma of health. (trans: Gaiger, J. and Walker, N.).Palo Alto: Stanford University Press.

Hall, D. 2001. Ghost in the house. In Unholy ghost. (pp. 162–172).

Heidegger, M. 1927/1962. Being and time. (trans: Macquarrie, J. and Robinson, E.). New York: Harper and Row.

Heidegger, M. 1929–30/1995. The fundamental concepts of metaphysics. (Trans: McNeil, W.). Bloomington, IN: Indiana University Press.

Heidegger, M. 1961/1973. Messkirch’s seventh centennial. Listening Vol. 8 (1–3): 40–57.

Husserl, E. 1912/1989. Ideas pertaining to a pure phenomenology and to a phenomenological philosophy, second book. (trans: Rojcewicsz, R. and Schuwer, A.). The Hague: Martinus Nijhoff.

Karp, D. 1996. Speaking of sadness: depression, disconnection, and the meanings of illness. Oxford: Oxford University Press.

Kaysen, S. 2001. One cheer for melancholy. In Unholy ghost. (pp. 38–43).

Kleinman, A., and B. Good. 1985. Culture and depression: studies in the anthropology and the cross-cultural psychiatry of affect and disorder. Berkeley: University of California Press.

Kramer, P. 2011. In defense of antidepressants. The New York Times, July 11. http://www.nytimes.com/2011/07/10/opinion/Sunday/10antidepressants.html?_r=1&scp=1&sq=peter%20kramer&st=cse. Accessed on 12 July.

Leder, D. 1990. The absent body. Chicago: University of Chicago Press.

Merleau-Ponty, M. 1958/1964. The primacy of perception. (trans: Dallery, A.). Evanston, IL: Northwestern University Press.

Merleau-Ponty, M. 1945/1962. The phenomenology of perception. (Trans: Smith, C.). Evanston, IL: Northwestern University Press.

Oldman, J. 2011. The illusions of psychiatry: an exchange. The New York Review of Books. August 18.

Ratcliffe, M. 2009. Understanding existential changes in psychiatric illness: the indispensability of phenomenology. In Psychiatry as cognitive neuroscience: philosophical perspectives, ed. M.B. Broom, and L. Bortolotti, 223–244. Oxford: Oxford University Press.

Ratcliffe, M., and M. Broome. 2012. Existential phenomenology and psychiatric illness. In The Cambridge companion to existentialism, ed. S. Crowell, 361–382. Cambridge: Cambridge University Press.CrossRef

Rose, N. 2003. Neurochemical Selves. Society, November/December, 46–59.

Rose, N. 2007. The politics of life itself: biomedicine, power, and subjectivity in the twenty-first century. Princeton: Princeton University Press.

Sartre, J.P. 1945/2001. The humanism of existentialism. In C. Guignon and D. Pereboom (eds.) Existentialism: basic writings (pp. 290–308). Indianapolis: Hackett.

Shenk, J.W. 2001. A melancholy of mine own. In Unholy ghost. (pp. 242–255).

Stenke, D. 2001. Poodle bed. In Unholy ghost. (pp. 60–74).

Solomon, A. 2001. The noonday demon: an atlas of depression. New York: Simon and Schuster.

Stanghellini, G. 2004. Disembodied spirits and deanimated bodies: the psychopathology of common sense. Oxford: Oxford University Press.CrossRef

Styron, W. 1990. Darkness visible: a memoir of madness. New York: Modern Library.

Svenaeus, F. 2000. The hermeneutic of medicine and the phenomenology of health: steps towards a philosophy of medical practice. Dordrecht, The Netherlands: Kluwer.CrossRef

Svenaeus, F. 2007. Do antidepressants affect the self? A phenomenological approach. Medicine, Health Care and Philosophy 10: 153–166.CrossRef

Tellenbach, H. 1980. Melancholy: history of the problem, endogeneity, typology, pathogenesis, clinical consideration. Pittsburgh: Duquesne University Press.

Wurtzel, E. 1995. Prozac nation: young and depressed in America. New York: Riverhead Books.

Young, I.M. 1990. Throwing like a girl and other essays in feminist philosophy and social theory. Bloomington: Indiana University Press.

Title: Depression and embodiment: phenomenological reflections on motility, affectivity, and transcendence
Author: Kevin A. Aho
Publication date: 01-11-2013
Publisher: Springer Netherlands
Published in: Medicine, Health Care and Philosophy / Issue 4/2013
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-013-9470-8

At a glance: The STEP trials

Springer Medicine

Depression and embodiment: phenomenological reflections on motility, affectivity, and transcendence

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2013

Through the looking glass: good looks and dignity in care

The varieties of human dignity: a logical and conceptual analysis

Quality in ethics consultations

Transparency and accountability in mass media campaigns about organ donation: a response to Morgan and Feeley

Does proficiency creativity solve legal dilemmas? Experimental study of medical students’ ideas about death-causes

Conflicts and conflict regulation in hospices: nurses’ perspectives