Matthew Ratcliffe's <i>Experiences of Depression</i>: A Review

Matthew Ratcliffe's Experiences of Depression applies the methods and insights of phenomenology to the experiences of depression. This study complements the existing literature on the phenomenology and hermeneutics of illness by figures such as Kevin Aho, Havi Carel, Drew Leder, and Arthur Frank, and specifically advances the existing phenomenological literature on depression by figures such as Fredrik Svenaeus and Thomas Fuchs.1-7 As Ratcliffe writes, one of the main aspirations of this volume is to “emphasize the often-profound difference between the ‘world’ of the depressed and the non-depressed, and to provide a detailed account of what this difference consists of” (8(p2)). The ultimate aim of this project is to provide phenomenological insights into the understanding and treatment of depression that cannot be arrived at through objective and impersonal approaches. The key concept used in this exploration is “existential feeling,” ie, an affect that orients our interaction with the world and delimits what is experienced as possible for the subject within the world. The world, treated as a possibility space toward which a subject is oriented, is shaped by existential feelings. Some forms of depression, Ratcliffe contends, can be understood through an analysis of existential feelings. What is crucial for existential feelings, and which Ratcliffe endeavours to make clear throughout the collection, is their status as pre-intentional states: “they determine the kinds of intentional states we are capable of having, amounting to a ‘shape’ that all experience takes on” (8(p35)). In other words, rather than being intentional in character (eg, “neither x nor y activity make S happy anymore”), existential feelings determine the possibility of certain experiences within the subject's world (eg, “S sees their world as bereft of any possibility for happiness”). Depression, then, constitutes a shift, or an existential change, for the subject. The first 2 chapters in this collection develop this idea and explain the phenomenological framework from which it is drawn. Borrowing from Edmund Husserl, Ratcliffe argues for conceptualizing depression as a fundamental shift or change of a person's world and looks to interpretations of first-person narratives and questionnaire responses on depression to support his claim. Ratcliffe refers to these narratives and responses throughout the book but is careful to note potential methodological issues in his approach; he makes clear that his use of these resources is not as data to be analysed, but as testimonies to interpret (8(p31)). The aim is to arrive at an understanding of what it is like to live with depression, and not to determine the objective, neurobiological causes of depression. Ratcliffe also makes use of Martin Heidegger's analysis of “mood” and argues that one can arrive at a notion of existential feeling through a Heideggerian lens. Near the end of the second chapter, however, Ratcliffe moves from establishing and justifying his project to contrasting the phenomenological approach to depression with what he identifies as the cognitive approach. The cognitive approach consists of treating depression as either a system of beliefs that an agent reasons from, a set of particular reasoning biases held by an agent, or both. Against this approach, Ratcliffe argues that the cognitive view of depression presupposes existential feeling and misses the real nature of depression: “It is not just that one's belief contents change; the way in which one believes changes too” (8(p72)). The third chapter serves a similar role to the first 2 in establishing Ratcliffe's project but emphasizes a key component of phenomenological analysis: embodiment. Depression is often conceived as a psychological condition, and not a somatic condition. Even though effects of depression may manifest themselves in the body, depression is considered primarily mental. Against this view, Ratcliffe refers to questionnaire respondents' descriptions of their bodily experience during episodes of depression, in which they describe themselves as heavy, lethargic, and weak. He incorporates this into his phenomenological exploration of depression through what he calls “noematic feelings” and “noetic feelings” (8(p83)). The first refers to having one's body as an object of experience; the second refers to the body serving as the vehicle or medium through which one has experiences. Both, along with existential feeling, are used to elaborate on how shifts in any of these feelings can affect the bodily experience of a person and how one's body can become conspicuous or inconspicuous in experience. Interestingly, Ratcliffe then discusses scientific research and uses it to compare experiences of depression with experiences of bodily illness, with a focus on experiences of inflammation. The aim here is to argue that some experiences of depression are indistinguishable from some experiences of bodily illness, which points to the seeming heterogeneity of depression and the difficulty in determining what exactly constitutes depression. This is reinforced by Ratcliffe's discussion of the unsatisfactory attempts in the Diagnostic and Statistical Manual of Mental Disorders to provide criteria for depression. This ultimately leads Ratcliffe to claim that “in the absence of phenomenological clarification, the category ‘depression’ risks being a ‘catch-all’ term” (8(p97)). Chapters Four and Five move toward discussions of hopelessness and guilt, respectively. In both chapters, Ratcliffe distinguishes between intentional and pre-intentional forms of hopelessness and guilt. Intentional hopelessness and guilt are thought of as loss of hope in x or y, and guilt about p or q. Pre-intentional forms, however, constitute a pervasive diminishment or complete inability to feel hope at all in the case of hopelessness, or, as Ratcliffe writes: “one not only loses however many actual hopes but also an orientation that is presupposed by the possibility of hoping for anything” (8(p109)). For pre-intentional guilt, there is a sense of oneself being inherently flawed or bad. Recalling the heterogeneity of depression referred to in Chapter Three, Ratcliffe notes that experiences of depression can have intentional or pre-intentional forms of hopelessness and guilt, or both, but claims that pre-intentional forms of hopelessness are more common in depression, while pre-intentional forms of guilt are less common. Chapters Six through Eight continue this phenomenological analysis by addressing a person's sense of agency during depression, their experiences of time, and their altered (in)ability to encounter and interact with other persons in the world. In Chapter Nine, Ratcliffe turns to the possibility of empathizing with someone who experiences depression. Ratcliffe argues against what he refers to as the simulationist view of empathy, which involves simulating in one's mind the experiences of another. If Ratcliffe's view is that many experiences of depression involve changes in existential feeling, then the key failure of the simulationist view consists in its inability to account for these shifts in existential feeling, as it assumes that the depressed person and the non-depressed person share the same possibility space: “to the extent that we are psychologically unable to take on board various moods and habitual dispositions, we are unable to transcend a first-person perspective and appreciate how it is for him” (8(p238)). Instead, Ratcliffe puts forth a view of empathy that approaches the depressed person through a phenomenological lens. While some simulation may still be involved, what is key to this view is that the empathizer is involved in “suspending the usual assumption that both parties share the same space of possibilities” (8(p242)). In the 10th and closing chapter, Ratcliffe returns to the heterogeneity of depression. Despite the problems present in determining what depression is, he maintains that the categories of “depression” and “major depression” should be held to be abstract concepts for methodological purposes. Ratcliffe then moves to a discussion of the differentiation of mental illness, particularly the differentiation of depression from schizophrenia. Finally, Ratcliffe considers the claim that depression is epistemically beneficial in that it may allow a person to give a more accurate assessment of human life and the world. Against this view, Ratcliffe argues that depression constitutes a privation of human life, because it effects a reduction of a person's world as a possibility space. The mere fact that human life is contingent does not entail that a person's projects are futile or meaningless. The depressed person is deprived to the extent that she is unable to access possibility spaces that allow her to imbue meaning on her world and her projects. Ratcliffe's efforts in this work present a strong case for incorporating a phenomenological understanding of depression into medicine and psychiatry, but there are some aspects of the collection that can be seen in a negative light, depending on one's background and perspective. Due to the work being a collection of previously published articles, he often repeats his major claims, such as the distinction between intentional states and pre-intentional states. While Ratcliffe is a very careful and clear writer, his attention to detail in combination with the repetitions that appear throughout the collection can make certain sections tedious. Additionally, due to the repetition of particular points and claims throughout the collection, Ratcliffe's attempts to connect certain lines of thought that arise in one chapter to the primary content of another chapter often come off as unnecessary deferrals. However, as mentioned, whether this constitutes a problem depends on one's background and perspective; on one hand, a philosopher who is somewhat familiar with phenomenology may find this to be a shortcoming of the editing process involved in this collection. On the other hand, a medical practitioner, a philosopher with a different specialization, or any reader who is otherwise a neophyte to phenomenology will likely find the reinforcement of particular claims throughout the chapters to be a boon to their understanding of the phenomenological approach to experiences of depression. With this in mind, this volume is likely to be a strong resource for practicing psychologists who are interested in what phenomenology can contribute to their field, as well as the philosopher who is looking for an introduction to phenomenological approaches to psychopathology and a sophisticated view of the phenomenology of depression.

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