Depression has been widely studied by researchers from different fields, but its causes, and mechanism of action are still not clear. A difficulty emerges from the shifting from objective diagnosis or analysis to exploration of subjective feelings and experiences that influence the individuals' expression, communication and coping in facing depression. The integration of the experiential dimension of the first-person in studies on depression–and related methodological recommendations–are needed to improve the validity and generalizability of research findings. It will allow the development (...) of timely and effective actions of care. Starting from providing a summary of the literature on theoretical assumptions and considerations for the study of the mind, with particular attention to the experiential dimension of patients with depression, this contribution is aimed to provide practical suggestions for the design of research able to incorporate first- and third-person accounts. It is also aimed to review qualified phenomenological methods for the acquisition and interpretation of experiential data in patients with depression. Recognizing the first-person perspective in the study of depression is a major step toward a better understanding and treatment of this disorder. Theoretical constructs and technique suggestions that result from this review offer a valid starting point for the inclusion of the experiential dimension to common third-person research in the study of the mind. (shrink)

Affordances are action-possibilities, ways of relating to and acting on things in our world. They help us understand how these things mean what they do and how we have bodily access to our world more generally. But what happens when this access is ruptured or impeded? I consider this question in the context of psychopathology and reports that describe this experience. I argue that thinking about the bodily consequences of losing access to everyday affordances can help us better understand these (...) reports. An affordance-based approach to psychopathology can illuminate some of the causes, as well as the experiential character and consequences, of affective disorders and diminished spatial agency in self-world disturbances. It also highlights some under-explored ethical and political dimensions of these issues that need further attention. (shrink)

One popular description of current society is that it is a depressed society and medical evidence about depression’s prevalence may well make such an estimation plausible. However, such normative-critical assessments surrounding depression have to date usually operated with a one-sided understanding of depression. This understanding widely neglects the various ways depression manifests as well as its comorbidities. This becomes evident at the latest when considering one of depression’s most prominent and well-known comorbidities: chronic pain. Against this background, we aim in (...) this article to substantiate our leading claim that the phenomenal interconnection between depression and chronic pain must be acknowledged in the global diagnosis of a depressive society. Thus, we argue here for a complementation of the dominant interpretation of a depressed society. This would support the overcoming of oversimplified images and estimations about depression in current society and further, help to recognize chronic pain properly on the larger scale of assessments that address society as a whole. (shrink)

In this paper, I propose an existentialist-phenomenological model that conceives of mental illness through the terminology of Heidegger’s Being and Time. In particular, the concepts of existentiality, disturbance and the relation between ‘being-with’ and ‘the one’, will be implemented in order to reconstruct the experience of mental illness. The proposed model understands mental illness as a disturbance of a person’s existentiality. More precisely, mental illness is conceptualized as the disturbance of a person’s existential structure, the process of which leads to (...) a becoming explicit of the otherwise implicit dynamical structure that constitutes a person’s experience. In particular, the existential component of ‘being-with’ comes to play a central role in the disturbance of existentiality, thus, I will claim, that it enables a person’s structure of experience to be ‘open for normativity’. By adopting a pragmatist stance on Heideggerian phenomenology, the suggested model proves compatible with naturalist and normativist theories of mental illness while still offering a phenomenological description of the phenomenon. (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)

According to pluralistic intuitionist theories, some of our moral beliefs are non-inferentially justified, and these beliefs come in both an a priori and an a posteriori variety. In this paper I present new support for this pluralistic form of intuitionism by examining the deeply social nature of moral inquiry. This is something that intuitionists have tended to neglect. It does play an important role in an intuitionist theory offered by Bengson, Cuneo, and Shafer-Landau (forth), but whilst they invoke the social (...) nature of moral inquiry in order to argue that ordinary moral intuitions are trustworthy, my argument focuses on what I will call the ‘frontiers’ of moral inquiry. I will show that inclusive and cooperative dialogue is necessary at moral inquiry’s frontiers, and that intuitionists can expect such dialogue to result in both a priori and a posteriori moral beliefs. (shrink)

Melancholia is an attunement of despair and despondency that can involve radical disruptions to temporal experience. In this article, I extrapolate from the existing analyses of melancholic time to examine some of the important existential implications of these temporal disruptions. In particular, I focus on the way in which the desynchronization of melancholic time can complicate the melancholic’s relation to death and, consequently, to the meaning and significance of their life. Drawing on Heidegger’s distinction between death and demise, I argue (...) that melancholic time leaves the melancholic in an impossible state of existing, where they are both unable to live and unable to die. Turning to the role of the physician, I consider the significant role that clinical interventions might have in resynchronizing the melancholic with time and examine these ideas further through a case study on physician-assisted suicide. In so doing, I demonstrate that the desynchronization of melancholic time should indeed be understood as a matter of life and death. (shrink)

Post-Traumatic Stress Disorder is a mental health condition in which the experience of a traumatic event causes a series of psychiatric and behavioral symptoms such as hypervigilance, insomnia, irritability, aggression, constricted affect, and self-destructive behavior. This paper investigates two case studies to argue that the experience of PTSD is not restricted to humans alone; we have good epistemic reason to hold that some animals can experience genuine PTSD, given our current and best clinical understanding of the disorder in humans. I (...) will use this evidence to argue for two claims. First, because the causal structure of PTSD plausibly requires reference to a traumatic conscious experience in order to explain subsequent behaviors, the fact that animals can have PTSD provides new evidence for animal consciousness. Second, the discovery of PTSD in animals puts pressure on accounts which hold that animal behavior can be fully explained without reference to subjective experience. (shrink)

In a recent paper, Kyselo argues that an enactive approach to selfhood can overcome ‘the body-social problem’: “the question for philosophy of cognitive science about how bodily and social aspects figure in the individuation of the human individual self” ). Kyselo’s claim is that we should conceive of the human self as a socially enacted phenomenon that is bodily mediated. Whilst there is much to be praised about this claim, I will demonstrate in this paper that such a conception of (...) self ultimately leads to a strained interpretation of how bodily and social processes are related. To this end, I will begin the paper by elucidating the body-social problem as it appears in modern cognitive science and then expounding Kyselo’s solution, which relies on a novel interpretation of Jonas’s concept of needful freedom. In response to this solution, I will highlight two problems which Kyselo’s account cannot overcome in its current state. I will argue that a more satisfactory solution to the body-social problem involves a re-conception of the human body as irrevocably socially constituted and the human social world as irrevocably bodily constituted. On this view, even the most minimal sense of selfhood cannot privilege either bodily or social processes; instead, the two are ontologically entwined such that humans are biosocial selves. (shrink)

Being in a mood—such as an anxious, irritable, depressed, tranquil, or cheerful mood—tends to alter the way we react emotionally to the particular objects we encounter. But how, exactly, do moods alter the way we experience particular objects? Perceptualism, a popular approach to understanding affective experiences, holds that moods function like "colored lenses," altering the way we perceive the evaluative properties of the objects we encounter. In this essay, I offer a phenomenological analysis of the experience of being in a (...) mood that illustrates the limitations of the colored lens metaphor and demonstrates the basic inadequacy of the perceptualist account of moods. I argue that when we are in a mood, it is common to experience a kind of "emotional disconnection" in which we perceive evaluative properties that would normally elicit strong emotional reactions from us, but nonetheless we find that, in our present mood, we remain emotionally numb to these perceptions. Such experiences of "seeing but not feeling" are difficult to understand from within the perceptualist paradigm. Building on the work of Martin Heidegger, I sketch an alternative, phenomenological analysis of moods that can better account for experiences of emotional disconnection. On this alternative account, being in a mood does not merely alter the content of our perceptions but, rather, alters the way we interpret the overall significance of what we perceive, relative to a certain situational context. (shrink)

Abstract: The notion of a self-pattern, as developed in the pattern theory of self, which holds that the self is best explained in terms of the kind of reality that pertains to a dynamical pattern, acknowledges the importance of neural dynamics, but also expands the account of self to extra-neural (embodied and enactive) dynamics. The pattern theory of self, however, has been criticized for failing to explicate the dynamical relations among elements of the self-pattern; as such, it seems to be (...) nothing more than a mere list of elements. We’ll argue that the dynamics of a self-pattern are reflected in three significant and interrelated ways that allow for investigation. First, a self-pattern is reflectively reiterated in its narrative component. Second, studies of psychiatric or neurological disorders can help us understand the precise nature of the dynamical relations in a self-pattern, and how they can fail. Third, referencing predictive processing accounts, neuroscience can also help to explicate the dynamical relations that constitute the self-pattern. (shrink)

In this essay I address the question, “What is the subject matter of phenomenological research?” I argue that in spite of the increasing popularity of phenomenology, the answers to this question have been brief and cursory. As a result, contemporary phenomenologists lack a clear framework within which to articulate the aims and results of their research, and cannot easily engage each other in constructive and critical discourse. Examining the literature on phenomenology’s identity, I show how the question of phenomenology’s subject (...) matter has been systematically neglected. It has been overshadowed by an unending concern with phenomenology’s methodological identity. However, an examination of recent contributions to this literature reveals that a concern with articulating phenomenology’s subject matter has gradually increased, although such articulations remain preliminary. In light of this, I delineate, define, and illustrate three layers of phenomenological research, which I term “existentials,” “modes,” and “prejudices.” While the delineation of these layers is drawn primarily from classical phenomenological texts, they are defined and illustrated through the use of more contemporary literature. Following the articulation of this subject matter, I briefly consider some of the debates—both foundational and applied—that can be facilitated by the adoption of this framework. (shrink)

According to Thomas Metzinger, many human cognitive processes in the waking state are spontaneous and are deprived of the experience of epistemic agency. He considers mind wandering as a paradigm example of our recurring loss of epistemic agency. I will enrich this view by extending the scope of the concept of epistemic agency to include cases of depressive rumination and creative cognition, which are additional types of spontaneous cognition. Like mind wandering, they are characterized by unique phenomenal and functional properties (...) that give rise to varying degrees of epistemic agency. The main claim of this paper will be that the experience of being an epistemic agent within a certain time frame is a relational phenomenon that emerges from the organism’s capacity to interact with its cognitive niche. To explore this relation, I develop a new framework that integrates phenomenological considerations on epistemic agency with a functional account of the reciprocal coupling of the embodied organism with its cognitive niche. This account rests upon dynamical accounts of strong embodied and embedded cognition and recent work on cognitive niche construction. Importantly, epistemic agency and organism-niche coupling are gradual phenomena ranging from weak to strong realizations. The emerging framework will be employed to analyze mind wandering, depressive rumination, and creative cognition as well as their commonalities and differences. Mind wandering and depressive rumination are cases of weak epistemic agency and organism-niche coupling. However, there are also important phenomenological, functional, and neuronal differences. In contrast, creative cognition is a case of strong epistemic agency and organism-niche coupling. By providing a phenomenological and functional analysis of these distinct types of spontaneous cognition, we can gain a better understanding of the importance of organism-niche interaction for the realization of epistemic agency. (shrink)

Major depression is a prevalent mental disorder that leads to persistent negative mood and tremendous suffering in affected individuals. However, the biological realization of this disorder and associated symptom clusters remain poorly understood. Recently, phenomenological accounts of major depressive disorder and contributions to the emerging predictive processing account have provided valuable insights into the phenomenological and neuro-functional components that lead to manifestations of major depressive episodes. The purpose of this paper is to weave together these different strands of research to (...) develop a predictive processing account of major depressive disorder. In doing so, I will relate personal-level descriptions of associated phenomenal experiences to a sub-personal-level predictive processing account of the functional realization of major depression. I will argue that pervasive symptoms of the disorder, which include a diminished sense of agency, fatigue, social withdrawal, and rumination, are integrated by existential feelings of loss and impossibility. These phenomenal experiences, I will argue, are associated with dysfunctional processes of prediction error minimization, which are characterized by an overall decrease of the causal contributions of active inference and by distorted precision estimates. The emerging account promises to contribute to a better understanding of the complex processes that give rise to depressive experiences. (shrink)

Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in (...) diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits. (shrink)

It has been argued that affordances are not meaningful and are thus not useful to be applied in contexts where specifically meaningfulness of experience is at stake (e.g. clinical contexts or discussions of autonomous agency). This paper aims to reconceptualize affordances such as to make them relevant and applicable in such contexts. It starts by investigating the ‘ambiguity’ of (possibilities for) action. In both philosophy of action and affordance research, this ambiguity is typically resolved by adhering to the agents intentions (...) and concerns. I discuss some recent accounts of affordances that highlight these concerns but argue that they tend to adopt an ‘atomistic’ approach where there is no acknowledgement of how these concerns are embedded in the agents wider concerns, values, projects and commitments. An holistic approach that does acknowledge this can be found in psychological research on agents having a sense of what they’re doing. I will discuss this research in the second part of the paper and argue that agents can analogously have a sense of what is afforded. This is deemed the entry point for understanding the meaningfulness of affordances. In the final part of the paper I apply this analysis to recent attempts which seek to make sense of authentic and autonomous agency in terms of affordances. (shrink)

This is a thesis in three parts. It concerns the normative capacity of attributive goodness. Specifically, it critically evaluates Attributivism, the theory that attributive goodness is fundamentally normative, or that the distribution of that property determines when, whether, and in what way agents ought to act. The first third develops, refines and defends Attributivism. Doing so is, in part, a ground-clearing exercise. I distil that theory from the arguments of many other philosophers. In doing so I isolate and precisify its (...) core commitments. I defend it from a number of objections. The second third analyses fundamental normativity. I stipulate that a standard or property is fundamentally normative if its distribution alone can ground normativity. I argue that for anything to be so fundamentally normative, it must minimally meet two criteria. It must be both authoritative and regulatory. The final third evaluates whether or not attributive goodness satisfies the established criteria, and so whether or not Attributivism is correct. I argue that in its canonical form it isn’t. I then develop a revised view of Attributivism that can satisfy the criteria. I argue, however, that the revised view is unsatisfying in almost every respect. Attributivism, revised or otherwise, should be rejected. (shrink)

This article is an introduction to the special issue on philosophy of medicine. Philosophy of medicine is a field that has flourished in the last couple of decades and has become increasingly institutionalized. The introduction begins with a brief overview of some of the most central recent developments in the field. It then describes the six articles that comprise this issue.

Most mental health research largely ignores or minimises gender and age differences in depression. In ‘Don't mind the gap: Why do we not care about the gender gap in mental health?’, Patalay and Demkowicz identify a dearth of research on the causal factors of depression in young women. They attribute this to an over-reliance on biological accounts of gender differences in depression. Patalay and Demkowicz conclude that a person-centred approach that meaningfully engages with the reports of young women with depression (...) is more likely to expose the social drivers of depression that impact this group. This commentary focuses on Patalay and Demkowicz's call to examine the patient's lived experience. We argue that there is an urgent need to reflect upon the methodologies involved in examining lived experience and how they can be best utilised. Ultimately, we advocate for an approach known as ‘phenomenological psychopathology’, through a phenomenological investigation of depression in young women, we can go some way towards closing the gender gap. (shrink)

Self-disorders in depression and schizophrenia have been the focus of much recent work in phenomenological psychopathology. But little has been said about the role the material environment plays in shaping the affective character of these disorders. In this paper, we argue that enjoying reliable (i.e., trustworthy) access to the things and spaces around us — the constituents of our material environment — is crucial for our ability to stabilize and regulate our affective life on a day-today basis. These things and (...) spaces often play an ineliminable role in shaping what we feel and how we feel it; when we interact with them, they contribute ongoing feedback that " scaffolds " the character and temporal development of our affective experiences. However, in some psychopathological conditions, the ability to access to these things and spaces becomes disturbed. Individuals not only lose certain forms of access to the practical significance of the built environment but also to its ​ regulative​ significance, too — and the stability and organization of their affective life is compromised. In developing this view, we discuss core concepts like " affordance spaces " , " scaffolding " , and " incorporation ". We apply these concepts to two case studies, severe depression and schizophrenia, and we show why these cases support our main claim. We conclude by briefly considering implications of this view for developing intervention and treatment strategies. (shrink)

On the face of it, suffering from the loss of a loved one and suffering from intense pain are very different things. What makes them both experiences of suffering? I argue it’s neither their unpleasantness nor the fact that we desire not to have such experiences. Rather, what we suffer from negatively transforms the way our situation as a whole appears to us. To cash this out, I introduce the notion of negative affective construal, which involves practically perceiving our situation (...) as calling for change, registering this perception with a felt desire for change, and believing that the change is not within our power. We (attitudinally) suffer when negative affective construal is pervasive, either because it colours a large swath of possibilities, as in the case of anxiety, or because it narrows our attention to what hurts, as in the case of grief. On this view, sensory or bodily suffering is a special case of attitudinal suffering: the unpleasantness of pain causes pervasive negative affective construal. Pain that doesn’t negatively transform our world doesn’t make for suffering. (shrink)

Recently, psychologists have started to distinguish between three kinds of experience of meaning. Drawing on philosophical as well as empirical literature, I argue that the experience of one’s own life making sense involves a sense of narrative justification, so that not just any kind of intelligibility suffices; the experience of purpose includes enthusiastic future-directed motivation against the background of a global sort of hopefulness, or the resonance of what one does right now with one’s values; and finally, the experience of (...) significance consists primarily of feelings of pride and fulfilment, which construe our actions as making a positive difference to the world or as mattering to someone who matters to us. Mutually exclusive philosophical views of what makes our lives meaningful could all be simultaneously correct about the fittingness of these different kinds of experience. (shrink)

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)

In this thesis I propose a new way of understanding depressive illness as not exclusively harmful, but as related to particular, empirically evidenced, epistemic and pragmatic benefits for the subject, alongside the associated costs. For each of the benefits considered, I provide and concisely analyse the empirical evidence both in its favour and against it, suggest ways in which these benefits could apply in the circumstances presented, discuss some outstanding problems for that application as stated, and describe potential implications. The (...) issues discussed involve topics in cognitive psychology as well as in ethics, which I regard as complementary to the debate. I take the view that depression related phenomena such as low mood, low self-esteem, and mood-congruent delusions offer potential benefits to a subject under certain circumstances, but not under others. In discussing the hypotheses presented, I argue for a more complex view of depression, which includes its potential epistemic and pragmatic benefits as well as its costs and I propose possible directions for future research. (shrink)

In this article, I argue that phenomenological psychopathologists, despite their critical attitude toward mainstream psychiatry, still hold problematic prejudices about the nature of psychiatric conditions as illness or disorder. I suggest that phenomenological psychopathologists turn to resources in the neurodiversity and mad pride movements to critically reflect upon these prejudices and appreciate the methodological problems that they pose.

I discuss Young’s “asymmetrical reciprocity” and apply it to an ethics of mental health care. Due to its emphasis on engaging with others through respectful dialogue in an inclusive manner, asymmetrical reciprocity serves as an appropriate framework for guiding caregivers to interact with their patients and to understand them in a morally responsible and appropriate manner. In Section 1, I define empathy and explain its benefits in the context of mental health care. In Section 2, I discuss two potential problems (...) surrounding empathy: the difficulty of perspectivetaking and “compassion fatigue.” In Section 3, I argue that these issues can be resolved if examined through the lens of an ethics of care. Reciprocal relationships between patients and caregivers are an important element in the development of an ethics of care. In Section 4, I introduce two models of reciprocity that can be applied to a health care context: Benhabib’s symmetrical reciprocity and Young’s asymmetrical reciprocity. In Section 5, I demonstrate how asymmetrical reciprocity cultivates empathy and, in Section 6 and Section 7, I show how it overcomes the objections of empathy and improves therapeutic relationships. (shrink)