Wednesday, 11 March 2020

depressive theories of depression?

In a recent talk on the phenomenology of depressed mood the following thought occurred to me... But to first set the scene, the talk was on the difference between such phenomenological understandings of depression as stress a mis-attunement, and those which instead understand depression as a dis-attunement, between patient and world. In the former category we had the approaches of Aho, Ratcliffe and Svenaeus; in the latter we have the approaches of Fuchs, Stanghellini and Fernandez. The former see depressed mood as itself a way of being affectively attuned to the world - where the mood of attunement is one of boredom, radical hopelessness, deep guilt etc. And the latter focus on the absence of affective attunement - as found, for example, in an inability to grieve.... Anyway, the thought I had was born of the experience of going straight from the therapy clinic into the lecture. It took the form of a question: might not all such theories of depression themselves rather be partaking of their objects? Might phenomenological theorisations of depression not themselves be depressive?

So the thing is that in the clinic I tend, as I believe many other clinicians do, to work in a zone between the intentional (qua intended) and the non-intentional (the mere happening). The zone is structured not by intention but by motivation; we often refer to it loosely as 'the unconscious'. Take for example Minkowski's schizophrenic patient (cited in Laing's review of La Schizophrénie) who said 'I suppressed all feeling as I suppressed all reality. I dug a moat around myself.' Who knows what actually he meant, but I think it not unlikely that this retrospective report took the form of an acknowledgement, a confession if you like, of agency that was in play yet which at the time of the suppressing and digging would've found no registration in avowal. Agency, that is, in the generation of his anhedonia. Or take pretty much any of the classic psychoanalytic case studies: here we meet again and again not with full-blown intended acts - not the sort of acts the aim of which could be ascertained by asking questions about intention - but nevertheless motivated acts, acts which subserve an affective goal, acts which aim to reduce anxiety, prevent psychic pain, and achieve the ersatz satisfaction of wishes.

In the clinic I often find myself using the language of motivation to describe depressed mood. A patient is facing certain anxious stresses in life; they don't yet have the habits of self-acceptance and self-care necessary to suffer their concerns; their mood consequently drops. Or, well...: drops or is dropped? This is the question I'm here trying to convince my reader to leave open. It's certainly part of the patient's experience of mood - and in truth it's part of our very understanding of mood (we take ourselves to find ourselves in moods; contrast our relation to our feelings into which we are not similarly sunk) - that moods happen to her. But in the clinic, in the greater balm of my solicitude, where the patient's self-understanding - facilitated by an ambiance of acceptance rather than shame - is enhanced, a certain kind of acknowledgement becomes possible. Latent bad faith may now be undone. I might for example gently say 'So when you couldn't face the overwhelm of your difficulties, you dealt with it by flattening yourself, taking the wind out of your own sails?' Or: 'fearful of the possible disappointments that lay ahead, you lowered your own hopes?' And the patient may now say 'Yes, you know I believe I did' - not simply by way of agreement but by way of acknowledging something both to me and to himself. In the process he owns the motivation for the mood.

When I've my clinical hat on, this just is how I (and I suspect many other therapists of a psychodynamic bent) see it: depressed mood presents itself as unmotivated, but this covers over the latent agency at play within it. Mood, if you like, is the collapse of emotion - where by emotion I mean something discrete, something that understands itself, something which has a clear intentional object. And one of the things that makes it depressive is that it takes it that here there's nothing to be understood. 'This is simply something that is happening to me; it's not something done by me'. But when we're doing the phenomenology of mood we needn't speak the language of mood itself. What we might be struck by is precisely what's not being said, what is unusually absent. We might also want to think genetically about it - i.e. to comprehend it in terms of its unfolding, which needn't exclude later avowals which acknowledge such motives as were not apparent at the time. In taking a passive description of mood as the proper description of it, phenomenological psychopathology implicitly invokes a passive understanding of mood itself - one which exscribes agency from the psyche, one which invites us to understand depression as illness rather than dynamism. And that, it seems to me, is to risk colluding in a depressive understanding of depression itself.