This volume fits into a wider dialogue between philosophy and modern mechanistic medicine. While the title takes itself as philosophy, one finds on reading the book that it is more specifically phenomenology. This is an approach that brings to the fore the person and his subjective experiences in understanding and analysing disease. Phenomenology certainly has a lot to offer on the subject of depression and readers, from whatever background, will find many fruitful studies in this volume. It is much needed since depression has always been a difficult subject to examine and explain comprehensively; it is one that refuses to have limits drawn around it due to the scope of its effects, varying shades of severity, and causes. The qualitative methodology of phenomenology necessitates the inclusion of the self and emotion, and the chapters here give us accounts of depression that are more humane and attentive to the subject, beyond its immediate effects, than one finds in the standard research. Each chapter provides a different perspective on the subject, with the collection being divided into four sections: Self and Agency; Comparative Phenomenology; Body and Culture; Phenomenological and Neurobiological Perspectives. Collectively the essays allow us to identify factors underlying the experience of depression, but unfortunately the editors leave that effort to the reader. The lack of an introduction that draws together the common threads of argument obscures those factors and could present a difficulty for the reader unfamiliar with phenomenology or philosophy in general. This may also cause the volume to lose some of the impact it could have on the treatment of depression in the clinical workplace. It leaves the editors' hopes of achieving this (vi) weaker than if they had.
The division into sections should not be taken as designating disparate approaches to the subject matter, something I'm sure the editors wished to avoid. There is much conceptual overlap across all chapters and many accounts compliment each other well. The sections appear to have been arranged in such a way, even though there are minimal references between chapters, to gradually build for the reader a view of depression that increases in component factors and in reference to particulars. The progression of the book, then, is one in which a wider and fuller grasp of depression is gained with little contradiction between chapters. It is fitting that the first section deals specifically with a thread that runs through the entirety of the book, that of the self. This is seen as the experiencing entity through which the phenomenon of depression shows itself (1). By taking the self as the facet on which depression hinges, some scholars are brought into conflict with the clinical definitions of the DSM (Diagnostic and Statistical Manual of Mental Disorders). This is most apparent in the first section, where Svenaeus directly challenges the idea of depression 'being a biological dysfunction of the brain' (4) with the idea that it alters selfhood (10). Benson et al. dispute the more thought-driven clinical research on suicide with the argument that feelings, themselves of the self's experiential realm, illustrate a true explanation of that mental state (38). Such conflict emerges throughout the book, Ratcliffe et al. suggesting that the DSM definition of major depression is too broad on the phenomenological level to identify a unitary form of illness (164), which Stanghellini & Rosfort agree with in saying that there is a need for 'a phenomenological discrimination between different forms of “depressed” mood' (125). All of these observations are owed to the self being affected by the experience of depression. This brings Svenaeus to state that 'Depression is suffered and identified at the phenomenological level of experience' (16). Some authors do take the DSM definitions as their point of reference and one wonders whether that is the right approach to take if those patients have already been labelled and the basis of the authors' research comes not from phenomenology but from a more quantitative methodology. That is for the reader to decide, but the criticisms of authors on the DSM definitions leads one to agree with Svenaeus in the primacy of phenomenology and the central role the self has in understanding depression. The volume, as a whole, argues convincingly for the notion that the self acts as the locus of depression.
This leads on to another commonality the chapters share in identifying factors of depression, that of the self-world relation. By focusing on the self's experience of depression, all chapters come to deal with issues of meaning and goal-laden activity. These aspects involve the world, from which meaning is drawn and through which goals are orientated, and depression is seen as an impediment on the self's engagement with the world. It is understood variously as causing a loss of identity (14), lack of agency (24), loss of meaningful activity (50), deficiency in self-integration towards goal-orientated actions (70; 111), alienation from everyday experience (151), and detachment from the world at large (227). This list is not exhaustive, all authors come to have depression violate in one way or another the everyday mode of engaging with the world. These examples stand to show the centrality of the self in analyses, but are also suggestive of depression acting as an attack on the self. Indeed, Sass & Pienkos almost say as much (88), but as with other authors this step is never taken. One feels that had an author's study moved in that direction, particularly when considering a deficiency of agency, we would have come to consider a person's own relationship to depression per se, something the book does not address. But nonetheless, the attention paid to a dysfunction in the self-world relation proves to be fertile ground in addressing the scope of depression's effects and what exactly it entails. It is on formulating how depression impedes this relation that differing interpretations between chapters are opened up. These differences seem to rest largely on what authors take as their starting point of analysis and through this subtle distinctions between sections emerge. The first section on selfhood has depression act as something that isolates the self from a world of meaning (10), or else by making the person a passive entity through depriving them of agency (24), or through separating them from their own identity within the narrative of their life and so how the past constructs goal-laden activity in the now (50). For these authors, depression is an impediment that acts directly on the self and the self's sense of identity and ability to act. This in turn cuts one off from the world and the meaning it offers.
The following section, Comparative Phenomenology, could be construed as supporting and expanding on the first. It compares depression to other states, such as mania and schizophrenia, in order to inform and distinguish the experience of depression. Sass & Pienkos tie in well with the previous discussion on selfhood by understanding how mania and schizophrenia differ in their affect by centring it on the unity of the self. Radden does the same, but considers moods as the basis of these affective disorders and turns to focus on how moods relate to the self and infringe on everyday experience. Stanghellini & Rosfort continue with the notion of mood, but see it as an oppressor (135) that breaks down the relationship to the body, thereby separating one from the world. This analysis concerning the body provides a gateway for the theme of the third section that addresses depression in relation to the body and somatic illness. Carel's account of bodily doubt, whereby one's experience of the body is altered, tries to explain the altered relationship to the world through this and her discussion can be applied not only to depression. One feels, however, that had these valuable discussions of the body also incorporated notions of agency already discussed by others, these chapters would have been all the more compelling. Ratcliffe et al. argue that somatic illness and depression share characteristics and this chapter compliments well the inclusion of the body by others for explaining the experience of depression. Their ideas also bleed into Fuch's study of depression between cultures and of how it is psychosomatic in nature, which leads to a changed relationship to the body (190). The Body and Culture section is valuable in breaching the mind-body dualism that still pervades the health sciences, but is not so closely related to the earlier sections through distancing itself from issues of self-narrative and agency. Yet it brings in to our understanding of depression the relationship one has to their body and somatic factors that can show themselves in depression and similar illnesses. The self-world relation for them has depression centre not intrinsically on the self, but rather on the relationship that the self has with the body and depression is not reducible to either.
The last section, dealing largely with the neurosciences, is the most complex and its bearing on other sections is not as great as what one finds elsewhere in the volume. That said, here we see attempts made to marry the qualitative methodology of phenomenology with the quantitative neurosciences (227). They do not seem to make for easy bedfellows, given that key aspects such as agency, the self-body dichotomy, and self-identity are not fully dealt with, at least to the same extent as earlier chapters, but the self-world relation continues. Gaebler et al.'s discussion on depersonalisation disorder and depression specifically calls for the self to be considered in depression (243) lending weight to depression being a phenomenological issue. The account of mood and emotion provides an excellent exploration of the relationship to each other and to the world, which does accord well with earlier examinations of mood and depression. Finally, the chapter on narrative attachment looks for a neural basis of one's association with meaning in the world. All of these, to some extent, try to bring in empirical evidence for phenomenological findings and it helps to qualify the value phenomenology can offer to the subject of depression and affective disorders.
The volume provides us with excellent discussions on depression and how it relates to emotion and the self. One can see that depression deprives one of meaning through acting as an impediment on the self-world relation and this it is not strictly a psychological issue, but incorporates somatic factors as well. There is much to recommend it beyond what I have space to say here. Ultimately one feels on finishing the volume that the argument made in the first chapter, that depression is identified at the phenomenological level, carries through to the end.
© 2015 Joseph Walsh
Joseph Walsh is a doctoral candidate in the School of Philosophy at University College Dublin. His thesis is concerned with establishing an existential conception of suffering.