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)

According to current opinion in western psychopathology, depression is regarded as a disorder of mood and affect on the one hand, and as a distortion of cognition on the other. Disturbances of bodily experience and of social relations are regarded as secondary to the primarily 'inner'and individual disorder. However, quite different concepts can be found in cultures whose members do not experience themselves as much as separate individuals but rather as parts of social communities. Disorders of mood or well-being (...) are then conceived less as intra-psychic, but rather as bodily, interpersonal, or atmospheric processes. On this background, the paper describes depression as a disorder of intercorporeality and interaffectivity. After developing these phenomenological concepts, it analyses depression as a 'detunement' of the resonant body that mediates our participation in a shared affective space. Instead of expressing the self, the body is turned into a barrier to all impulses directed to the environment. This impairs particularly the patient's interaction with others, resulting in a general sense of detachment, separation, or even segregation. Moreover, the restriction of the lived body also corresponds to the triggering situations of depression, namely experiences of a disruption of social bonds. Thus, intercorporeality and interaffectivity are presented as crucial dimensions for an ecological and non-reductionist view of depression. (shrink)

In _Black Sun_, Julia Kristeva addresses the subject of melancholia, examining this phenomenon in the context of art, literature, philosophy, the history of religion and culture, as well as psychoanalysis. She describes the depressive as one who perceives the sense of self as a crucial pursuit and a nearly unattainable goal and explains how the love of a lost identity of attachment lies at the very core of depression's dark heart. In her discussion she analyzes Holbein's controversial 1522 painting (...) "The Body of the Dead Christ in the Tomb," and has revealing comments on the works of Marguerite Duras, Dostoyevsky and Nerval. _Black Sun_ takes the view that depression is a discourse with a language to be learned, rather than strictly a pathology to be treated. (shrink)

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)

In _Black Sun_, Julia Kristeva addresses the subject of melancholia, examining this phenomenon in the context of art, literature, philosophy, the history of religion and culture, as well as psychoanalysis. She describes the depressive as one who perceives the sense of self as a crucial pursuit and a nearly unattainable goal and explains how the love of a lost identity of attachment lies at the very core of depression's dark heart. In her discussion she analyzes Holbein's controversial 1522 painting (...) "The Body of the Dead Christ in the Tomb," and has revealing comments on the works of Marguerite Duras, Dostoyevsky and Nerval. _Black Sun_ takes the view that depression is a discourse with a language to be learned, rather than strictly a pathology to be treated. (shrink)

Smartphone apps might offer a low-threshold approach to the detection of mental health conditions, such as depression. Based on the gathering of ‘passive data,’ some apps generate a user’s ‘digital phenotype,’ compare it to those of users with clinically confirmed depression and issue a warning if a depressive episode is likely. These apps can, thus, serve as epistemic tools for affected users. From an ethical perspective, it is crucial to consider epistemic injustice to promote socially responsible innovations within (...) digital mental healthcare. In cases of epistemic injustice, people are wronged specifically as epistemic agents, i.e., agents of the production and distribution of knowledge. We suggest that epistemic agency relies on different resource- and uptake-related preconditions which can be impacted by the functionality of passive self-tracking apps. We consider how this can lead to different forms of epistemic injustice (testimonial, hermeneutical, and contributory injustice) and analyze the influence of the apps’ use on epistemic practices on an individual level, in mental healthcare settings, and on the structural level. (shrink)

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

What if depression, in the Americas at least, could be traced to histories of colonialism, genocide, slavery, exclusion, and everyday segregation and isolation that haunt all of our lives, rather than to biochemical imbalances? This article seeks alternatives to the medical model found in most depression memoirs by considering how the epistemological and methodological struggles faced by a scholar of the African diaspora confronted by the absent archive of slavery are relevant to discussions of political depression. Combining (...) scholarly investigation and personal memoir, Saidiya Hartman’s Lose Your Mother exemplifies feminism’s affective turn not only by bringing personal narrative into scholarship, but by seeking reparation for the past in the affective dynamics of cultural memory rather than in legal reform or state recognition. Stubbornly refusing to find solace in an African past before slavery, though, Hartman provides a model of emotional reparation in which feelings of loss and alienation persist. Her work suggests the relevance of political depression to both the ordinary life of racism and to what gets called clinical depression. (shrink)

In this article, I examine stigmatizing and especially patronizing attitudes towards others’ depression that people who are well-intentioned produce. The strategy of the article is to consider the social experience of depression through two separate subfields of philosophy: epistemic injustice and phenomenology. The solution that I propose is a phenomenological account of empathy. The empathetic attitude that I argue for involves actively listening to the depressed individual and taking their depression testimony as direct evidence. The article has (...) been written both for those who seek to better support neurodiverse people in their lives and for depressives (and other neurodivergents) themselves in order to provide them with a better account for advocating for themselves against social stigma. (shrink)

Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities (understanding, appreciating, reasoning and ability to express a choice) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions.

In this paper I offer an alternative phenomenological account of depression as consisting of a degradation of the degree to which one is situated in and attuned to the world. This account contrasts with recent accounts of depression offered by Matthew Ratcliffe and others. Ratcliffe develops an account in which depression is understood in terms of deep moods, or existential feelings, such as guilt or hopelessness. Such moods are capable of limiting the kinds of significance and meaning (...) that one can come across in the world. I argue that Ratcliffe’s account is unnecessarily constrained, making sense of the experience of depression by appealing only to changes in the mode of human existence. Drawing on Merleau-Ponty’s critique of traditional transcendental phenomenology, I show that many cases of severe psychiatric disorders are best understood as changes in the very structure of human existence, rather than changes in the mode of human existence. Working in this vein, I argue that we can make better sense of many first-person reports of the experience of depression by appealing to a loss or degradation of the degree to which one is situated in and attuned to the world, rather than attempting to make sense of depression as a particular mode of being situated and attuned. Finally, I argue that drawing distinctions between disorders of structure and mode will allow us to improve upon the currently heterogeneous categories of disorder offered in the DSM-5. (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)

If a human subject knows they are being measured, this knowledge may affect their attitudes and behaviour to such an extent that it affects the measurement results as well. This broad range of effects is shared under the term ‘reactivity’. Although reactivity is often seen by methodologists as a problem to overcome, in this paper I argue that some quite extreme reactive changes may be legitimate, as long as we are measuring phenomena that are not simple biological regularities. Legitimate reactivity (...) is reactivity which does not undermine the accuracy of a measure; I show that if such reactivity were corrected for, this would unjustifiably ignore the authority of the research subject. Applying this argument to the measurement of depression, I show that under the most commonly accepted models of depression there is room for legitimate reactivity. In the first part of the paper, I provide an inventory of the different types of reactivity that exist in the literature, as well as the different types of phenomena that one could measure. In the second part, I apply my argument to the measurement of depression with the PHQ-9 survey. I argue that depending on what kind of phenomenon we consider depression to be, we will accept different kinds of reactivity. I show that both under the harmful dysfunction model and the practical kinds model, certain reactive changes in measuring depression are best seen as legitimate recharacterizations of the underlying phenomenon, and define what legitimate means in this context. I conclude that in both models, biological aspects constrain characterization, but the models are not so strict that only one concept is acceptable, leaving room for reactivity. (shrink)

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

Despite the relevance of silence in several psychopathologies, first-person perspectives on silence have been largely neglected in the phenomenological scholarship on those conditions. This paper proposes a phenomenological framework for addressing this neglect and demonstrates its usefulness through a case study of empty silence, an experience which can be found in many first-person accounts of depression. The paper begins by surveying research on silence in depression in mental health research and phenomenological psychopathology. Drawing on the thought of Merleau-Ponty, (...) it then outlines a phenomenological framework for explicating the structure of silence experiences in psychopathology. Finally, it applies this framework to articulate the experiential structure and implications of empty silence, with a particular emphasis on the bodily doubt that can flow from repeated experiences of empty silence. (shrink)

Schuklenk and van de Vathorst's paper is a very welcome addition to the literature on the assisted dying debate and will be of great interest to clinicians working in the field of mental health.1 Many psychiatrists will have had patients who have asked them to allow them to die, to desist in their efforts to prevent their suicide, and one of us has had personal experience, outside of professional life, of being asked to aid in someone's attempt to end their (...) life in the context of an episode of mood disorder. The person with depression asking professionals, friends and family members to aid them in ending their life is a very real phenomenon. In their discussion, Schuklenk and van de Vathorst's paper uses two principles that we endorse and add weight to their argument: namely, the reality of suffering in depression and the parity of mental and physical illness. Indeed, the case Schuklenk and van de Vathorst make is a strong one and our commentary will focus on the premise of the argument around choosing death and some empirical clarification about competence in depression and the nature of treatment-resistant depression (TRD) and its prognosis. The conceptual concern we wish to discuss in relation to assisted dying, endorsed by the state and legislature, is not linked to any moral or religious concern, or even on grounds related to ‘slippery slope’ or ‘abuse’ arguments. Rather the worry is how one could operationalise decisions around assisted dying as based on competence and capacity and view such decisions as rational. I think this concern is not limited to depressive illness, but to all decisions regarding choosing non-existence. Schuklenk and van de Vathorst offer the following useful criteria to regulate assisted suicide:1. (shrink)

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

Autobiographical memory and the self are closely linked. AM retrieval in depression is characterized by a lack of specificity, suggesting an impairment of episodic AM. Autonoetic consciousness and self-perspective, which are critical to episodic AM, have never been addressed in depression. Twenty-one depressed inpatients and 21 matched controls were given an episodic AM task designed to assess positive and negative memories regarding specificity, autonoetic consciousness, and self-perspective. For specificity, “remember”, and “field” responses, ANOVAs revealed a main group effect (...) and a group × valence interaction. Between groups, patients showed lower scores than controls for positive memories. Within groups, patients showed greater scores for negative memories, and controls showed greater scores for positive memories. There is a global episodic AM impairment of positive memories in depression regarding specificity, autonoetic consciousness, and self-perspective. Our results suggest new cognitive interventions to improve the self-relevance of positive memories in depression. (shrink)

In this paper, I address the question of whether it is ever permissible to grant a request for physician-aid-in-dying (PAD) from an individual suffering from treatment-resistant depression. I assume for the sake of argument that PAD is sometimes permissible. There are three requirements for PAD: suffering, prognosis, and competence. First, an individual must be suffering from an illness or injury which is sufficient to cause serious, ongoing hardship. Second, one must have exhausted effective treatment options, and one’s prospects for (...) recovery must be poor. Third, the individual must be judged competent to request PAD. I argue that many cases of treatment-resistant depression meet the first two requirements. Thus, the key question concerns the third. I consider four features of depression that might compromise a person’s decision-making capacity. Ultimately, I conclude that PAD requests from depressed patients can be permissibly granted in some circumstances. (shrink)

The present study examined relationships among counterfactual thinking, perceived control, and depressive symptoms. Undergraduate participants, grouped according to nondepressed, mild–to–moderately depressed, and severely depressed symptom categories, described potentially repeatable negative academic events and then made upward counterfactuals about those events. Whereas participants endorsing mild–to–moderate depressive symptom levels generated more counterfactuals about controllable than uncontrollable aspects of the events they described, participants endorsing severe levels of depressive symptoms generated counterfactuals that were less controllable, less reasonable, and more characterological in nature. Furthermore, (...) controllable (relative to uncontrollable) counterfactual thinking enhanced retrospective control perceptions for less depressed participants, but depleted control perceptions for more depressed participants. Discussion focuses on the possibility that whereas controllable counterfactual thinking may be functional for nondepressed individuals, it may be less functional, if not dysfunctional, with increasingly depressed symptoms. (shrink)

Aversive experiences have been thought to provoke or exacerbate clinical depression. The present review provides a brief survey of the stress-depression literature and suggests that the effects of stressful experiences on affective state may be related to depletion of several neurotransmitters, including norepinephrine, dopamine, and serotonin. A major element in determining the neurochemical changes is the organism's ability to cope with the aversive stimuli through behavioral means. Aversive experiences give rise to behavioral attempts to cope with the stressor, (...) coupled with increased utilization and synthesis of brain amines to contend with environmental demands. When behavioral coping is possible, neurochemical systems are not overly taxed, and behavioral pathology will not ensue. However, when there can be no behavioral control over the stressful stimuli, or when the aversive experience is perceived as uncontrollable, increased emphasis is placed on coping through endogenous neurochemical mechanisms. Amine utilization increases appreciably and may exceed synthesis, resulting in a net reduction of amine stores, which in turn promotes or exacerbates affective disorder. The processes governing the depletions may be subject to sensitization or conditioning, such that exposure to traumatic experiences may have long-term repercussions when the organism subsequently encounters related stressful stimuli. With continued uncontrollable stimulation, adaptation occurs in the form of increased activity of synthetic enzymes, and levels of amines approach basal values. It is suggested that either the initial amine depletion provoked by aversive experiences or a dysfunction of the adaptive processes, resulting in persistent amine depletion, contributes to behavioral depression. Aside from the contribution of behavioral coping, several organismic, experiential, and environmental variables will influence the effects of aversive experiences on neurochemical activity, and may thus influence vulnerability to depression. (shrink)

Franklin Miller's thoughtful reply to our paper asks pointed questions about the role of the physician qua physician in physician-assisted death. Would making assisted dying available to treatment-resistant depressed people necessarily affect the professional integrity of healthcare professionals, as Dr Miller asserts? Dr Miller agrees with us on a number of crucial points: It is possible that some patients with treatment-resistant major depression are competent to make the decision to ask for assisted dying; it is possible that some such (...) patients could make a rational choice if they requested such assistance. He also is generally supportive of physician-assisted death, at least for ‘terminally ill’ patients. He defines a terminally ill patient as someone who has a ‘predictable short life span and will die soon regardless of medical intervention’. We disagree with his conceptualisation of ‘terminal illness’ as requiring that death occurs within 6–12 months, given the existence of illnesses like Amyotrophic lateral sclerosis (ALS) or certain prostate cancers that are commonly considered to be terminal illnesses and that are taking their predictable course sometimes over years. If, all other things being equal, an illness is going to kill a patient at some point down the track, it surely should qualify for the label ‘terminal illness’. However, we will accept his definition for the sake of the argument. Dr Miller supports the availability of assisted dying for patients likely to die from that illness within 6 months from the day their request for assisted dying has been made. He broadly holds the kind of view we aimed to sway with our analysis. Apparently, we failed. Dr Miller thinks that physician-assisted death must be consistent with professional integrity, requiring that it is consistent with ‘the proper goals of medicine and the specific duties incumbent on clinicians in acting to realize …. (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)

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

We describe the design and evaluation of a sub-clinical digital assessment tool that integrates digital biomarkers of depression. Based on three standard cognitive tasks on which people with depression have been known to perform differently than a control group, we iteratively designed a digital assessment tool that could be deployed outside of laboratory contexts, in uncontrolled home environments on computer systems with widely varying system characteristics. We conducted two online studies, in which participants used the assessment tool in (...) their own homes, and completed subjective questionnaires including the Patient Health Questionnaire —a standard self-report tool for assessing depression in clinical contexts. In a first study, we demonstrate that each task can be used in isolation to significantly predict PHQ-9 scores. In a second study, we replicate these results and further demonstrate that when used in combination, behavioral metrics from the three tasks significantly predicted PHQ-9 scores, even when taking into account demographic factors known to influence depression such as age and gender. A multiple regression model explained 34.4% of variance in PHQ-9 scores with behavioral metrics from each task providing unique and significant contributions to the prediction. (shrink)

The standard view in medical practice is that patients have to be in an appropriate state of mind to count as autonomous. For example, according to the Macarthur Competency Assessment Tool for Treatment patients need to be able to: (1) communicate a choice; (2) factually understand the issues; (3) appreciate their situation; and (4) rationally manipulate information. These capacities are normally taken to be compromised by factors that may diminish one’s capacity to properly assess one’s situation. One of these diminishing (...) factors is depression, which is especially relevant to decisions about assisted suicide or termination of treatment, since depression might contribute to the patient’s leaning towards an action resulting in her death. I argue, however, that in certain circumstances, depression and the accompanying desires can be appropriate. Specifically, I demonstrate that even when depression is a factor in the patient’s decision, it does not automatically undermine autonomy. (shrink)

This chapter argues that despite the recent, welcome interest in autobiographical writing about depression, its use for research purposes presents an epistemological challenge because the extent to which these descriptions illuminate the true nature of depressive experience cannot be discerned. Contextualized within the genre of autobiography as well as the subgenre of illness memoir, the depression memoir exhibits ambiguities, it is shown, imposed by the constraints of its genre, and by the nature of autobiographical memory. Sources of ambiguity (...) distinctive to depression memoirs are next introduced, some tied to cultural meanings, others to the status of depressive states as constituted by moods. Finally, some empirical corroboration for these claims is cited, in findings indicating that depression affects autobiographical memory and writing style. The indeterminacy identified here is not a reason to dismiss depression memoirs, it is concluded, so much as to employ caution in drawing inferences from them. (shrink)

What produces emotions? Why do we have emotions? How do we have emotions? Why do emotional states feel like something? The Brain, Emotion, and Depression addresses these issues and more, providing a unified approach to emotion, reward value, economic value, decision-making, and their brain mechanisms.

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

Next SectionBackground There is an established link between depression and interest in hastened death in patients who are seriously ill. Concern exists over the extent of depression in patients who actively request euthanasia/physician-assisted suicide (PAS) and those who have their requests granted. Objectives To estimate the prevalence of depression in refused and granted requests for euthanasia/PAS and discuss these findings. Methods A systematic review was performed in MEDLINE and PsycINFO in July 2010, identifying studies reporting rates of (...) depression in requests for and cases of euthanasia/PAS. One author critically appraised the strength of the data using published criteria. Results 21 studies were included covering four countries. There was considerable heterogeneity in methods of assessing depression and selecting patients. In the highest quality studies, in the Netherlands and Oregon, 8–47% of patients requesting euthanasia/PAS had depressive symptoms and 2–17% of completed euthanasia/PAS cases had depressive symptoms. In the Netherlands, depression was significantly higher in refused than granted requests, and there was no significant difference in the rate of depression between euthanasia cases and similar patients who had not made a request for euthanasia. Conclusion It is unclear whether depression increases the probability of making a request for euthanasia/PAS, but in the Netherlands most requests in depressed patients are rejected, leaving a depression rate in cases that is similar to the surrounding population. Less evidence is available elsewhere, but some level of depression has been identified in patients undergoing euthanasia/PAS in all the countries studied. Whether the presence of depression is ever compatible with an ethical decision on euthanasia/PAS is discussed. (shrink)

The received view about depression in the philosophical literature is that it is defined, in part, by epistemic irrationality. This status is undeserved. The received view does not fully reflect current clinical thinking and is motivated by an overly simplistic, if not false, account of depression’s phenomenal character. Equally attractive, if not more so, is a view that says depression can be instantiated either rationally or irrationally. This rival view faces challenges of its own: it appears to (...) entail that there are situations when not being depressed is rationally sub-optimal and that resilience to, and healthy coping strategies for avoiding, depression can be rationally remiss. I criticise an existing reply to these challenges before motivating a better one from the perspective of epistemic consequentialism. (shrink)

Depression is vastly heterogeneous in its symptoms, neuroimaging data, and treatment responses. As such, describing how it develops at the network level has been notoriously difficult. In an attempt to overcome this issue, a theoretical “negative prediction mechanism” is proposed. Here, eight key brain regions are connected in a transient, state-dependent, core network of pathological communication that could facilitate the development of depressive cognition. In the context of predictive processing, it is suggested that this mechanism is activated as a (...) response to negative/adverse stimuli in the external and/or internal environment that exceed a vulnerable individual’s capacity for cognitive appraisal. Specifically, repeated activation across this network is proposed to update an individual’s brain so that it increasingly predicts and reinforces negative experiences over time—pushing an individual at-risk for or suffering from depression deeper into mental illness. Within this, the negative prediction mechanism is poised to explain various aspects of prognostic outcome, describing how depression might ebb and flow over multiple timescales in a dynamically changing, complex environment. (shrink)

Recent findings indicate that frontal brain asymmetry may be a marker of for depression. However, the psychological predispositions that account linkage between frontal brain asymmetry and depression are unclear. approach-withdrawal hypothesis is the primary framework that has been to account for the linkages between frontal brain asymmetry and or emotional disorders. We review evidence consistent with this and suggest several directions for its extension. One such direction is to constrain the approach-withdrawal hypothesis by linking frontal asymmetry to the (...) known functions of the prefrontal cortex. On this we propose that frontal brain asymmetry may be preferentially linked processes that promote the temporal continuity and shifting of or emotional priorities and the suppression of interference by sources of motivation or emotion. We review evidence from and neurobiological studies of depression that is broadly consistent with these predictions. We emphasise the need for future studies testing our hypotheses. (shrink)

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

The World Health Organization states that depression is the leading cause of disability worldwide, and predicts that by 2030 the epidemic of depression raging across the world will be the single biggest contributor to the overall burden of disease of all health conditions. Yet this gloomy picture masks a number of paradoxes concerning the diagnosis and cultural interpretation of depression that appear to challenge the claimed prevalence rates on which it is based. This book's essays by some (...) of the world's leading researchers and scholars on depression explores these anomalies in detail from multidisciplinary and multicultural perspectives, and in doing so reshapes the debate on the nature of depression that is currently under way in the US and abroad. At the book's core is the exploration from the multiple perspectives of a key dilemma: is the epidemic of depression real or is it just apparent? In particular, could it be the result of criteria laid down in the official American classification system of mental disorders, the DSM, interacting with cultural changes to reshape our view of melancholy, pathologizing what were formerly normal symptoms of grief or intense sadness? The debate over the DSM's conception of depression has an international relevance, with the WHO's upcoming revisions to its International Classification of Diseases requiring coordination with the DSM. This collection of perspectives has an unprecedented international dimension, as scholars from Europe and around the world join US academics to explore a central and controversial element of contemporary psychiatric diagnosis - and one that has enormous practical implications for the future of mental health care and how we view our emotions. The book's accessible essays will make it useful to scholars, practitioners, and students across a wide range of disciplines. (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at (...) the first, fourth and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)

The differentiation of trait anxiety and depression in nonclinical and clinical populations is addressed. Following the tripartite model, it is assumed that anxiety and depression share a large portion of negative affectivity, but differ with respect to bodily hyperarousal and anhedonia. In contrast to the tripartite model, NA is subdivided into worry and dysthymia, which leads to a four-variable model of anxiety and depression encompassing emotionality, worry, dysthymia, and anhedonia. Item-level confirmatory factor analyses and latent class cluster (...) analysis based on a large nation-wide representative German sample substantiate the construct validity of the model. Further evidence concerning convergent and discriminant validity with respect to related constructs is obtained in two smaller nonclinical and clinical samples. Factors influencing the association between components of anxiety and depression are discussed. (shrink)

Critical theorists, especially in the Frankfurt School tradition, claim that normative thought and critique arise from experiences of suffering and oppression. It seems intuitive that oppression sometimes makes people sad and angry in ways that motivate critique and resistance; yet, other times, it leads to debilitating experiences of depression, resignation, and self-blame. Especially, in the context of our contemporary “mental health epidemic,” it is worth asking whether and how critique and resistance could possibly spring from such experiences. This paper (...) therefore investigates the potential for experiences of depression to disclose social injustice. Drawing on phenomenological accounts of depression, I argue that it is best understood as consciousness of one's alienation from the social world—and under the right conditions, this consciousness can become politicized and lead to critique. Critical theory, here, can play a crucial role as a form of “political therapy” that supplies the hermeneutical tools for this politicization. (shrink)

Among the characteristic features of depression is a diminishment in or lack of action and motivation. In this paper, I consider a dominant philosophical account which purports to explain this lack of action or motivation. This approach comes in different versions but a common theme is, I argue, an over reliance on psychologistic assumptions about action–explanation and the nature of motivation. As a corrective I consider an alternative view that gives a prominent place to the body in motivation. Central (...) to the experience of depression are changes to how a person is motivated to act and, also as central, are changes to bodily feelings and capacities. I argue that broadly characterizing motivation in terms of bodily capacities can, in particular, provide a more compelling account of depressive motivational pathology. (shrink)

Some recent considerations of religion and psychiatry have drawn a distinction between pathological and spiritual/mystical experiences of mental phenomena typically regarded as within the realm of psychiatry (e.g. depression, hearing voices, seeing visions/hallucinations). Such a distinction has clinical implications, particularly in relation to whether some religious people who suffer from depression, hear voices, or see visions should be biomedically treated. Approaching this question from a theological and philosophical perspective, I draw a distinction between (what I call) ‘spiritual health’ (...) (SH) and ‘potentially transformative’ (PT) theologies, arguing that a PT model is therapeutically and philosophically more sound than a SH one. I then apply this to the clinical debate in critical dialogue with Dein and Durà-Vilà’s 2009 article, ‘The Dark Night of the Soul: spiritual distress and psychiatric implications’. My primary focus is on depression, though the discussion is also relevant to debates about psychosis and schizophrenia. (shrink)

There are many Christian theologies of depression. Depression is spoken of variously as the result of personal or original sin, as a kind of sin, as a sign of demonic possession or as involving demons, as a test of faith, as a sign of holiness, or as an occasion for spiritual transformation. Although it is difficult to draw any absolute distinctions, we might helpfully split them into the following three categories for the sake of discussion:Spiritual illness SI), in (...) which depression and other forms of mental illness are believed to be a kind of SI. This includes the ideas that depression is caused by sin or demons or both);Spiritual health SH), where depression is viewed as an indication of and... (shrink)

In this review I describe research conducted in my laboratory concerning implicit mood-congruent memory (MCM) bias in clinical depression. MCM is the tendency for depressed individuals to retrieve more unpleasant information from memory than nondepressed controls, and may be an important maintenance mechanism in depression. MCM has been studied frequently with explicit memory tests, but relatively few studies have investigated MCM using implicit memory tests. I describe several implicit memory studies which show that: (a) an implicit MCM bias (...) does not appear to exist when perceptually driven tests are used; (b) implicit memory bias can be found when conceptually driven tests are used, but (c) not all conceptually driven tests show implicit MCM bias. I conclude that conceptual processing is necessary, but is not sufficient for demonstrating implicit memory bias in depression. Future studies should investigate specific components of conceptual elaboration that support implicit memory bias in 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)

Phenomenological descriptions of depressed mental life offer a profound understanding of depression from the first-person perspective. In this paper, such descriptions are developed by drawing on the work by Ludwig Binswanger and on the autobiographical report of depression by Piet C. Kuiper . I will argue that Binswanger’s central claim in his phenomenological description of the depressed state of mind fails due to crucial misunderstandings of Edmund Husserl’s phenomenology. Nonetheless, by drawing on Kuiper’s first-hand account, I will develop (...) a phenomenological description of depressed mental life, highlighting the altered manner of pre-reflective valuing in depression and introducing the concept of a ‘depressive habituality.’ This term refers to the acquisition of a new set of habitualisations, especially on the foundational levels of automatic mental life. It offers explanations for the fact that it is not easy to recover from depression and that people may more easily become depressed again. (shrink)

Major Depressive Disorder (MDD) is a serious condition with a large disease burden. It is often claimed that MDD is a “brain disease.” What would it mean for MDD to be a brain disease? I argue that the best interpretation of this claim is as offering a substantive empirical hypothesis about the causes of the syndrome of depression. This syndrome-causal conception of disease, combined with the idea that MDD is a disease of the brain, commits the brain disease conception (...) of MDD to the claim that brain dysfunction causes the symptoms of MDD. I argue that this consequence of the brain disease conception of MDD is false. It incorrectly rules out genuine instances of content-sensitive causation between adverse conditions in the world and the characteristic symptoms of MDD. Empirical evidence shows that the major causes of depression are genuinely psychological causes of the symptoms of MDD. This rules out, in many cases, the “brute” causation required by the brain disease conception. The existence of cases of MDD with non-brute causes supports the reinstatement of the old nosological distinction between endogenous and exogenous 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)

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)

Adequate measurement is an essential component of the assessment of mental health disorders and symptoms such as depression and anxiety. The present study investigated sex-specific differences in the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. This comprehensive cross-sectional design study pursued four objectives: measurement invariance of PHQ-9 and GAD-7 between male and female; depression and anxiety prevalence differences; cross-sex differences in the relationship between depression and anxiety; and a comparison of symptom heterogeneity. A sample of 1966 students (...) from South Africa completed the PHQ-9 and the GAD-7. Data analyses for measurement invariance, latent class analysis, inter-variable correlations and group comparisons were conducted in Mplus. The two-dimensional PHQ-9 achieved scalar invariance, while the GAD-7 yielded metric invariance. The somatic and non-somatic latent dimensions of depression were compared and showed no significant difference between male and female groups. The positive relationship between depression and anxiety was also not significantly different between the two groups. While the PHQ-9 symptoms formed three classes in the male group, and four classes in the female group, the GAD-7 had the same number of classes and a similar pattern between the two groups. These findings hold implications for the measurement, assessment and understanding of symptom manifestation and distribution, as well as the treatment of depression and anxiety in South Africa. (shrink)

Depressive symptoms are characterised by reduced cognitive control. However, whether depressive symptoms are linked to difficulty in exerting cognitive control in general or over emotional content specifically remains unclear. To better differentiate between affective interference or general cognitive control difficulties in people with depressive symptoms, we employed a non emotional (cold) and an emotional (hot) version of a task-switching paradigm in a nonclinical sample of young adults (N = 82) with varying levels of depressive symptoms. Depressive symptoms were linked to (...) greater difficulties in exerting cognitive control in complex situations (mixed-task blocks) compared to simple and semiautomatic situations (single-task blocks) in both task versions. Moreover, greater depressive symptoms were associated with longer latencies in the emotional version of the task across all trial types. Thus, the emotion-specific effect was not modulated by the degree of cognitive control required to perform the task. In sum, depressive symptoms were characterised by a general difficulty to exert cognitive control in both emotional and non emotional contexts and by greater difficulty in even simple attentional processing of emotional material. This study granted novel insights on the extent of cognitive control difficulties in emotional and non emotional contexts for people with depressive symptoms. (shrink)

Distressing emotions and emotions that impede social functioning are standard components of psychiatric disorders, but the presence of a pathology requires underlying psychological dysfunction in addition. This article argues that, given a commitment to a popular philosophical picture of emotions (and moods), affective dysfunction should be understood in terms of the normative concept of fittingness. Therefore, an individual should be understood to be affectively disordered only if their emotional responses are systematically unfitting. This view gains support from some quarters; notably, (...) the DSM-V-TR diagnostic criteria for Major Depressive Disorder exhibits an inchoate appreciation of the importance of (un)fittingness to psychiatric disorder, and debates about the pathological status of prolonged grief are naturally interpreted as debates about the fittingness of that attitude. Taking a synoptic perspective, accounting for fittingness can help to establish the limits of psychiatric practice and avoid potential disciplinary injustices. (shrink)