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Encountering Depression In-Depth An existential-phenomenological approach to selfhood, depression, and psychiatric practice Patrick Seniuk SÖDERTÖRN DOCTORAL DISSERTATIONS DOCTORAL DISSERTATIONS SÖDERTÖRN Encountering Depression In-Depth An existential-phenomenological approach to selfhood, depression, and psychiatric practice Patrick Seniuk Södertörns högskola Subject: Theory of Practical Knowledge Research Area: Critical and Cultural Theory School: Culture and Education Södertörns högskola (Södertörn University) Biblioteket SE-141 89 Huddinge www.sh.se/publications © Patrick Seniuk Cover illustration: “Depths”, Thomas Hawk, CC BY-NC 2.0 (a re-working of the original work) Cover layout: Jonathan Robson Graphic form: Per Lindblom & Jonathan Robson Printed by Elanders, Stockholm 2020 Södertörn Doctoral Dissertations 176 ISSN 1652–7399 ISBN 978-91-89109-22-3 (print) ISBN 978-91-89109-23-0 (digital) Abstract This dissertation in Theory of Practical Knowledge contends that depres- sion is a disorder of the self. Using the existential-phenomenology of Maurice Merleau-Ponty, I argue that if we want to disclose the basic struc- ture of depressed experience, then we must likewise disclose how self- experience is inseparable from depressed experience. However, even though depression is a contemporary psychiatric category of illness, it is neverthe- less a historically and heterogenous concept. To make sense of depression in the context of contemporary psychiatric practice, I show that depression has historically been characterized by two broad models of causation; that is, a phenomenon that is causally explained by either a biological dysfunction or a psychological conflict. But this stark characterization is not limited just to history; by conducting qualitative interviews with psychiatric professionals, I illustrate how this causal dicho- tomy remains prevalent in contemporary psychiatric practice. On one hand, the clinicians report dissatisfaction with the depression diagnostic criteria (i.e. it is impersonal or vague), while on the other hand, the clinicians also recognize that a depression diagnosis is useful insofar as a diagnosis facili- tates access to various resources associated with psychiatric care. Conse- quently, clinicians have developed a coping strategy that is witnessed in their empathetic desire to distance patients from their depression diagnosis, which led to statements such as, “you are not the problem, the problem is depression.” One consequence of this approach is that depression is artificially cleaved from the person who experiences depression, which subsequently means that depression is viewed to be something independent of oneself. Because I argue that depression and the self are mutually implicated, it is crucial to disseminate some of the most influential contemporary models of selfhood. I show that the brainbound, situated, psychological, and narrative model of self, all have respective strengths and weaknesses. But I also go beyond these models and characterize selfhood as a developmental pheno- menon that is expressed as an embodied-style. This style reflects the way in which we establish perceptual contact with the otherness, without which there could be no self-experience. By adopting the notion of self-as-a-style, my phenomenological analysis of depression discloses the way in which an experiential structure of depres- sion is inextricable from lived-space. More specifically, I show that de- pressed experience is an affective modification to the way spatial depth is experienced; things in the world are experienced as being distant, out of touch, or simply that one feels incapable of effortlessly engaging the sur- rounding world. Accordingly, I argue that the relationship between depres- sion and selfhood may be characterized in two broad ways, as either a de- pressive-style, or as an interruption of self-style. The distinction between depressive-style and interrupted self-style has implications for depression diagnosis and treatment. I show that persistent- depressive disorder is phenomenologically indicative of a depressive-style, whereas major-depressive disorder corresponds with interrupted self-style. In the context of depression treatment, I draw on the work of philosopher John Russon to offer an account of psychotherapy that is rooted in pheno- menological sensibilities. Most notably, I show how “talk” therapy is also an existential project, one that attempts to raise our unreflective and embodied habits to the level of explicit awareness in an attempt to re-style the way in which the self is able to cope with the vicissitudes that arise from our everyday situations. Keywords: Phenomenology, existential philosophy, psychiatric practice, Merleau-Ponty, selfhood, depression. Abstract Denna avhandling i ämnet den praktiska kunskapens teori undersöker hur depressionen griper in i och förändrar vår erfarenhet av oss själva. Genom att använda mig av Maurice Merleau-Ponty’s existentiella fenomenologi, argumenterar jag för att vi måste beskriva och analysera erfarenheten av självet och hur den är relaterad till den depressiva erfarenheten om vi vill blottlägga depressionens grundläggande struktur. Depression har historiskt sett förklarats med hjälp av två olika orsaks- modeller: antingen har den betraktats som en biologisk dysfunktion eller som ett resultat av en psykologisk konflikt. Gränsdragningen återfinns emellertid inte bara i historien; genom att genomföra djupintervjuer visar jag hur denna kausala dikotomi fortfarande är verksam i den samtida psykiatriska praktiken. Å ena sidan redogjorde mina informanter för sitt missnöje med kriterierna för diagnosen depression (exempelvis att de är opersonliga eller otydliga), medan de, å andra sidan, vidkände att diagnosen är användbar såtillvida som den gör det möjligt att få tillgång till den psykiatriska vårdens olika resurser. Personer som är verksamma inom den psykiatriska professionen har därför utvecklat olika strategier för att hantera detta dilemma, något som exempelvis visar sig i deras vilja att distansera patienter från deras depressionsdiagnoser, vilket ledde till uttalanden som ”du är inte problemet, det är depressionen som är problemet”. En av följ- derna med denna strategi är att depressionen separeras på ett artificiellt sätt från personen som lider av den, vilket också innebär att depressionen betraktas som något som är oberoende av det egna självet. Eftersom jag argumenterar för att depression och själv påverkar varan- dra ömsesidigt är det viktigt att analysera några av de mest inflytelserika modellerna för att förstå självets struktur inom samtida forskning. Jag visar att den hjärnbaserade modellen, den situerade modellen, den psykologiska modellen och den narrativa modellen av självet har sina respektive styrkor och svagheter. Men jag går också bortom dessa modeller och karakteriserar självet som ett utvecklingsfenomen som ger sig till känna som en förkropps- ligad stil. Denna stil reflekterar det sätt på vilket vi etablerar en perceptuell kontakt med annanheten, förutan vilken det inte skulle finnas någon er- farenhet av det egna självet. Genom att använda mig av begreppet självet-som-stil, visar min feno- menologiska analys hur depressionens erfarenhetsstruktur är oskiljaktig från den levda rumsligheten. Jag visar hur den deprimerade erfarenheten är en affektiv förändring av det sätt på vilket rumsligt djup upplevs; ting i världen upplevs som frånvarande, utom räckvidd, eller så upplever den deprimerade personen helt enkelt sig vara oförmögen att utan stor an- strängning etablera kontakt med omvärlden. Därför argumenterar jag också för att förhållandet mellan depression och självet kan karakteriseras på två huvudsakliga sätt, antingen som en depressiv stil eller som ett avbrott av självets stil. Denna distinktion mellan depressiv stil och en avbruten självstil får kon- sekvenser för diagnosticeringen och behandlingen av depression. Jag visar att en långvarig depressiv sjukdom – dystymi – fenomenologiskt sett vittnar om en depressiv självstil medan en kortare depressiv sjukdom motsvarar en avbruten självstil. När det kommer till frågan om behandling av depression utgår jag från filosofen John Russons verk för att visa hur samtalsterapi också kan förstås som ett existentiellt projekt som syftar till att medvetande- göra våra oreflekterade och förkroppsligade vanor i ett försök att omstilisera det sätt på vilket självet förmår handskas med de förändringar som uppstår i vardagliga situationer. Nyckelord: Fenomenologi, existentiell filosofi, psykiatrisk praktik, Merleau- Ponty, självet, depression. Table of Contents Acknowledgments ...................................................................................................... 13 INTRODUCION ........................................................................................................ 17 x. Research aim ..................................................................................................... 17 x.i Investigative approach ................................................................................ 18 x.ii Philosophical framework: The field of depression studies ................... 21 x.iii Investigation structure .............................................................................. 25 x.iv Outline of research contribution ............................................................. 28 CHAPTER 1 Looking behind and ahead: A historical discussion of depression and psychiatry ...................................................................................................................
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