Experiences of Depression is a philosophical exploration of what it is like to be depressed. In this important new book, Matthew Ratcliffe develops a detailed account of depression experiences by drawing on work in phenomenology, philosophy of mind and psychology, and several other disciplines.

The paper first introduces the concept of implicit and explicit temporality, referring to time as pre-reflectively lived vs. consciously experienced. Implicit time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative–affective dynamics of life on the other hand. Explicit time results from an interruption or negation of implicit time and unfolds itself in the dimensions of present, past and future. It is further shown that temporality, embodiment and intersubjectivity are closely connected: (...) While implicit temporality is characterised by tacit bodily functioning and by synchronisation with others, explicit temporality arises with states of desynchronisation, that is, of a retardation or acceleration of inner time in relation to external or social processes. These states often bring the body to awareness as an obstacle as well. On this basis, schizophrenia and melancholic depression are investigated as paradigm cases for a psychopathology of temporality. Major symptoms of schizophrenia such as thought disorder, thought insertion, hallucinations or passivity experiences may be regarded as manifesting a disturbance of the constitutive synthesis of time consciousness, closely connected with a weakening of the underlying pre-reflective self-awareness or ipseity. This results in a fragmentation of the intentional arc, a loss of self-coherence and the appearance of major self-disturbances. Depression, on the other hand, is mostly triggered by a desynchronisation from the social environment and further develops into an inhibition of the conative–affective dynamics of life. As will be shown, both mental illnesses bear witness of the close connection of temporality, embodiment and intersubjectivity. (shrink)

People with depression often report alterations in their experience of time, a common complaint being that time has slowed down or stopped. In this paper, I argue that depression can involve a range of qualitatively different changes in the structure of temporal experience, some of which I proceed to describe. In addition, I suggest that current diagnostic categories such as "major depression" are insensitive to the differences between these changes. I conclude by briefly considering whether the kinds of temporal experience (...) associated with depression are specific to depression. (shrink)

Recently, several authors have argued that assisted dying may be ethically appropriate when requested by a person who suffers from serious depression unresponsive to treatment. We here present four arguments to the contrary. First, the arguments made by proponents of assisted dying rely on notions of “treatment-resistant depression” that are problematic. Second, an individual patient suffering from depression may not be justified in believing that chances of recovery are minimal. Third, the therapeutic significance of hope must be acknowledged; when mental (...) healthcare opens up the door to admitting hopelessness, there is a danger of a self-fulfilling prophecy. Finally, proponents of assisted dying in mental healthcare overlook the dangers posed to mental-health services by the institutionalization of assisted dying. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.3 (2005) 195-198 [Access article in PDF] Implicit and Explicit Temporality Thomas Fuchs Keywords implicit/explicit temporality, embodiment, intersubjectivity, desynchronization, melancholia, schizophrenia Since Minkowski (1970), Strauss (1966), v. Gebsattel (1954), and Tellenbach (1980), temporality has been a main subject of phenomenological psychiatry. Drawing on philosophical concepts of Bergson, Husserl, and Heidegger, these authors have analyzed psychopathologic deviations of time experience, mainly from an individual point of (...) view, for example, as a slowing down or inhibition of lived time in depression or obsessive–compulsive disorder. Their analyses are still most valuable today, but may be carried further by introducing concepts such as embodied and intersubjective temporality into psychopathology. Martin Wyllie (2005), by opening up a wide scope of temporal phenomena and related concepts, makes a laudable effort to contribute to such a progress.In my commentary, I would like to propose a distinction that is suggested by much of Wyllie's analysis and may shed further light on psychopathology, namely between implicit and explicit temporality. If we look at a child while obliviously playing with his toys, lost to the world, we may assume that there is no sense of the time passing. Lived time runs with the movement of life, implicit in the child's experience of being engaged in his play and directed toward his goals. It "unfolds through the processes of bodily activity" (Wyllie 2005). Future and past do not stand out against the pure presence of "becoming." This implicit mode of temporality is retrieved every time that we are absorbed in what we are doing, and may even reach the climax of "flow experiences" (Csikszentmihalyi 1988) where the sense of time is lost in unimpeded, fluent performance.However, this changes when a gap arises between need and satisfaction, desire and fulfillment, or plan and execution. Now the future appears as a "not yet" or "yet to come," experienced as the temporality of awaiting, striving, or longing for. Time is felt as passing by and refusing the desired fulfillment; it becomes conscious or explicit. A similar gap arises between the present and something irretrievably lost, bringing the past to consciousness as a "no more." Again time is experienced explicitly, but now as moving on relentlessly and separating us from the lost object. The gap to the past may not be bridged any more: this is the temporality of missing or mourning. In both cases, explicit time arises as a negation of implicit or lived time (here my use of the term is a bit divergent from Wyllie's); it is experienced as a "not yet" or "no more," often with a component of displeasure or suffering (Fuchs 2001a, 2003)."Implicit" versus "explicit time" thus come near to another distinction well known in phenomenology, namely between the "lived" and [End Page 195] the "corporal body" (Leib versus Koerper). The first term refers to the body functioning in the tacit mode, as the medium of everyday performance. The second term points to the body as turning into the object of attention, for example, when it puts up resistance to our purposes, or is used as an instrument deliberately (Fuchs 2001b). In fact, implicit temporality and tacit performance of the body are nearly synonymous: Lived time may be regarded as a function of the lived body, opened up by its potentiality and capability. The more we are engaged in our tasks, the more we forget time as well as the body; we are, as it were, "inside time." On the other hand, in explicit temporality the body often appears in the corporal or explicit mode as well. For example, when falling ill, we experience our body no more as a tacit medium but rather as an object or obstacle, while we notice the slowing down of time and may even feel excluded from the movement of life. Thus, embodiment and temporality have a parallel background–foreground structure.I now try to carry these considerations further by including the intersubjective dimension of time. In an earlier paper, I describe the attunement of the living being to its environment as a continuous synchronization on the biological as... (shrink)

In Being and Time, Martin Heidegger introduces a unique interpretation of death as a kind of world-collapse or breakdown of meaning that strips away our ability to understand and make sense of who we are. This is an ‘ontological death’ in the sense that we cannot be anything because the intelligible world that we draw on to fashion our identities and sustain our sense of self has lost all significance. On this account, death is not only an event that we (...) can physiologically live through; it can happen numerous times throughout the finite span of our lives. This paper draws on Arthur Frank’s (At the will of the body: reflections on illness. Houghton, Boston, 1991) narrative of critical illness to concretize the experience of ‘ontological death’ and illuminate the unique challenges it poses for health care professionals. I turn to Heidegger’s conception of ‘resoluteness’ (Entschlossenheit) to address these challenges, arguing for the need of health care professionals to help establish a discursive context whereby the critically ill can begin to meaningfully express and interpret their experience of self-loss in a way that acknowledges the structural vulnerability of their own identities and is flexible enough to let go of those that have lost their significance or viability. (shrink)

Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death? This is possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. Those opposed to all instances of PAD point to Belgium and the Netherlands as a dark warning that once PAD is legalized, restricting it will prove impossible because safeguards, such as the requirement that a patient be terminally ill, will inevitably be (...) eroded or discarded. However, some supporters respond that limiting PAD to those suffering from terminal illness, or physical illnesses generally, is arbitrary and illogical. In addition, precisely because such patients are not terminally ill, their suffering may last for years, even the rest of their lives. Finally, severe depression may not be treatable. If PAD is justifiable under some conditions—as I shall assume in this article—then why wouldn't it be justifiable for these patients? Why shouldn't psychiatrists who have nothing else to offer their suffering patients be able to help them to die, if that is what they want? (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)

Some psychopathologic experiences have as one of their structural aspects the experience of restructured temporality. The general argument is that one of the universal microstructures of experience, namely, lived time offers a particular perspective relevant to certain psychopathologic experiences. Lived time is connected with the experience of the embodied human subject as being driven and directed towards the world in terms of bodily potentiality and capability. The dialectical relationship between the embodied human subject and the world results in a sense (...) of lived time (personal time), a lived time that is intimately synchronized with the time of others (intersubjective time). Some experiences of acute suffering, and in particular acute melancholic suffering, can dramatically alter the temporal microstructure of experience to the extent that personal lived time becomes disordered. Normally, past and future withdraw on their own according with their nature of "not being." The future is characterized as openness to change and movement. The absence of this openness is the closing of the future; without this openness, the future appears static and deterministic. When the future is experienced as static, then one longer has the possibility of "things getting better," nor does one have any possibility of relinquishing or escaping from the past because a static future does not allow openness to change and movement. In short, both past and future become static. With the presence of melancholic suffering and the absence of temporal movement, a sense of hopelessness may arise in the individual because suffering without temporal movement becomes, from the sufferer's perspective, eternal suffering. (shrink)

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. -/- Popular and academic discourse about assisted suicide paradigmatically focuses on individuals (...) with ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions. (shrink)