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Whatsapp Our understanding of depression as ‘perilously thin’, according to philosopher Matthew Ratcliffe

The experience of depression has been known since classical times. Yet a deeper understanding still eludes us. Neuroscience might be leading the charge now, but philosophy is still in the race. Joe Gelonesi talks to two philosophers on the trail of an existential beast.

To describe the indescribable: that’s how philosopher Matthew Ratcliffe of Durhum University sees his task. He’s made it a career goal to shine light into bleak corners, and perhaps gift some valuable insights into the treatment of depression.

It began with Ratcliffe’s sense that the medical model falters with the enormity of the experience.

The gray drizzle of horror induced by depression takes on the quality of physical pain.

‘I had been working on philosophy of psychiatry for some time and in this context I started reading first person memoirs of depression,’ he says. ‘Some things struck me: one was that people weren’t just describing feeling less happy than usual, more miserable and more tired, but were relating a radical transformation between themselves and other people. In addition, in almost every memoir you find the complaint that depression is utterly indescribable.’

It’s not as if psychiatry has not given its best efforts to come to terms with the symptoms of depression. The latest iteration of controversial guidebook The Diagnostic and Statistical Manual of Mental Disorders does its best to survey the known boundaries of the experience. For Ratcliffe, however, something of elemental importance is missing: meaningful description of the symptoms.

It’s this lacuna of qualitative data that motivates him to look for clues beyond the clinical setting. Art is fertile terrain; Ratcliffe is ever attentive to the observations of established writers and artists who have fallen into the pit, as often they can describe the experience with excoriating accuracy.

American novelist William Styron is one such craftsman and excerpts of his work crop up in Ratcliffe’s professional papers. In Darkness Visible the renowned American author has penned an unflinching exploration of his despair.

‘The gray drizzle of horror induced by depression takes on the quality of physical pain,’ he writes.

‘My brain had begun to endure its familiar siege: panic and dislocation, and a sense that my thought processes were being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world.

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For Ratcliffe, Styron represents the literary tip of a deeply submerged iceberg. His concern is that when you look closely at the detail of the depressed experience, a remarkable range of subtle differences come into view, and they just aren’t captured in the traditional, medical model.

As it stands, he sees our understanding of depression as ‘perilously thin’. Moreover, if depression cannot be identified without appealing to its symptoms, then a diabolical regress is complete: a serious malady remains darkly visible.

‘The inability for others to understand makes it all the more painful,’ laments Ratcliffe. ‘This lack of understanding isn’t really separable from the painfulness of depression and from a sense of isolation already so central to this condition.’

Here, Ratcliffe’s speciality comes into focus: a branch of contemporary philosophy known as phenomenology. In phenomenology, experience matters: the real life human experience of being in the world. Founder Edmund Husserl pioneered an analysis which takes emotions, perceptions and judgements seriously.

Husserl’s hunch was that attending to consciousness and its immersion in the world could unveil some truth or truths about the human condition, and possibly something more precise about the very nature of reality. It’s big stuff, and for Ratcliffe it’s extraordinarily important work when applied to maladaptive conditions such as depression.

Ratcliffe’s interests in philosophy bear the deep influences of this contemporary European movement, as demonstrated by his award winning writing on the importance of touch, in which he follows Aristotle’s lead on a vital but poorly understood human sense. For Ratcliffe, how we inhabit the world is central to philosophical enquiry.

Husserl, Merleau Ponty and Heidegger are three stellar names of the field. They had their disagreements, but they all homed in on this act of being in the world. Ratcliffe recognises this as thoroughly germane to the task of lassoing the ogre.

‘When we reflect on experience there is an important aspect that’s overlooked ... the sense of belonging to the world, already finding oneself in the world; the pervasive experiential background that frames all of our experiences and thought. It’s so basic it’s overlooked. You don’t really glimpse it unless it wobbles.'

It’s when the world gives way under your feet that valuable insights might be released.

‘The world in phenomenology coincides remarkably well with what you might call the world of depression,’ says Ratcliffe. ‘So many people who suffer depression describe living in an utterly alone world divorced from consensus reality.’

‘It’s so utterly unfamiliar that it’s an aspect of experience they wouldn’t have been aware of even unless it had happened to them. It is part of our experience that we do not have an awareness of, and that awareness can be brought about by engaging in phenomenology.’

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So how can Heidegger, that other giant of the field, help? Well, as Ratcliffe wryly quips, the controversial German thinker can’t help directly as his work can be bedevilling; it‘s no self-help manual. Nevertheless, his classic tome Being and Time does offer a way of unfurling the fabric of despair. Through attempting a comprehensive portrait of existence through time, Heidegger displays a bigger cosmic backdrop against which the shreds of individual despair can be read.

Matthew Ratcliffe’s pioneering work has been picked up by Australia doctoral candidate Emily Hughes. She too became concerned with a medical model seemingly closed off to the full extent of the experience.

‘[Depression] is thought of as a dark and harmful sort of suffering, one that happens on the interior psyche of the subject, and I think that it’s restrictive to confine it to that. I started to become concerned that the focus has come down to a disorder of the brain.’

Hughes treads on that ever-so-contested ground of the physical basis of mental disturbance. She knows that the intellectual stakes are high, but feels strongly that it’s worth the fight.

‘How do you answer the question when someone says, “I feel empty inside, I feel lost, I feel like nothing means anything, that nothing matters.” Thinking in terms of the medical model with disease and illness and treatment is not actually answering people’s suffering and engaging with what their suffering actually means to them. I think that’s a real problem that needs to be addressed and I think philosophy is one way we can do that.’

Back to Heidegger: Hughes’ dissertation is steeped in Heidegerrian notions of mood. She follows a similar route to Ratcliffe in attempting to widen the lens on the experience of despair.

‘For Heidegger, moods reflect the fact that we are always in the world, immersed—always thrown into the world. What things show up as meaningful and meaningless, what possibilities and projects seem enticing or frightening, that is all determined by how we are disposed through moods. For Heidegger, moods reflect our thrownness; they come before any conceptual reflection or thinking. They are our fundamental way of being.’

It’s a known, everyday kind of word, but in Heidegger’s hands ‘mood’ becomes a specific tool to prise open this ‘thrown’ existence.

‘Heidegger has a stratified view of moods,’ says Hughes. ‘His classic distinction in Being and Time is between fear and anxiety. Fear is a fallen mood. It’s a mood that is entangled with the world. It’s a response to a specific threat. The example that is often used is of a frightening dog encountered on a walk. The cause is something in the world. For Heidegger, anxiety, in contrast to fear, is a ground mood.’

Unlike the snarling dog’s obvious intentions, ground moods don’t announce themselves. They just are, like anxiety, or boredom. According to Hughes, they are essential to a fuller understanding of the human experience, especially when it appears to malfunction.

‘What happens with a ground mood like anxiety is that it turns us away from the world... we’re withdrawn from the world into what Heidegger calls the nothing. It’s in that groundlessness that Heidegger says we are confronted by the issue of our existence. We are forced to confront what it means to be human.'

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Hughes’ intricate analysis weaves in Heidegger’s other main preoccupation: time and its place in existence. She sees it as one of the most important ideas to arise from phenomenological work. More importantly, she sees it as a crucial opportunity to put what appears to be inaccessible deep theory into tangible everyday practice.

‘You can open up a dialogue between philosophy and psychiatry through looking at the ways melancholic depression radically modifies time. ‘

Time is often reported to be warped in the experience of depression. As Hughes observes, often temporal displacement can be exacerbated by medical interventions such as drugs and electroconvulsive therapies. It is here that the cross-disciplinary conversation can get going.

‘We could look at questions around feeling numb, being spaced out, detached or very fatigued, which are all very common experiences of people on psychoactive medicines,’ says Hughes. ‘If we can start reengaging with these questions we can start to think about what depression means and about how we experience our existence, and the breakdown of our situatedness in the world, which is what happens in anxiety, and in profound boredom, and I want to argue also happens in melancholia and despair. ‘

There is no doubt that neuroscience is adding valuable knowledge to our understanding of depression, but philosophy, in the hands of practitioners like Ratcliffe and Hughes, could expand our thinking on a malady so far refusing to reveal its darker secrets.

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