Psychology and Philosophy of Depression
Depression is more than just fleeting sadness. It's a deep, pervasive mental state that affects not only the content of our thoughts and emotions but also directly affects our body's physiology. However, our exploration of depression within this article will be confined to the perspectives of psychology (including psychotherapy) and philosophy.
The first-line therapies for depression in clinical settings are usually either CBT (Cognitive Behavioural Therapy) or IPT (Interpersonal Therapy). However, the evidence is clear that there is little to no difference in efficacy when comparing all major psychotherapeutic interventions. CBT and IPT are not first line due to them being more effective than the others. There is a misconception that because something has the most evidence, that it’s the most efficient. This is not the case. CBT is a great therapy, and one that has a growing body of literature that points to its efficacy, but the large evidence base is purely a consequence of the money and attention put towards the research of it. The efficacy of one thing does not prove the inefficacy of another. And so when looking at the large studies that have compared the main psychotherapeutic modalities, there is little to no difference in therapeutic effects between them.
The main factors to take into account when considering which treatment modality is optimal, is instead the skillset of the therapist and the corresponding preferences of the client. So with that in mind I'll now spend a bit of time outlining the major therapeutic modalities, which I hope will facilitate a more informed decision on what kind of approaches may suit you.
By explaining how depression is viewed from each modality, we can lead on to the justification of how they then go on to treating it. I will also do the difficult task of introducing the philosophical schools I believe each of them have been most influenced by. The reason I think this is so important is because, especially with the newer forms of psychotherapies, they sometimes fall short in their ability to transcend academic boundaries. They can therefore appear formulaic without a deeper perspective on their delivery. Merging philosophy with psychotherapy addresses this limitation, as philosophy, much like art in a way, by making some necessary assumptions, has a way of touching the very essence of an individual. By talking through all of the most influential perspectives the differing schools of philosophy and psychology have on causes and cures for depression, it’ll give you a complete understanding. As they rarely contradict each other, so if you're a therapist they can often be integrated, or if you are an individual who is either prone to depression or even just interested in it, you will have clarity on the landscape, enabling you to better decide the approaches that interest or even appeal to you.
Depth Psychology: Analytical Psychology and Psychodynamic
Psychodynamic and analytical models bring into focus the unconscious undercurrents that shape our emotional lives—hence the term depth. Here, the answers are seen as from within. Specifically in the realm of analytical psychology, the founder of this school, Carl Jung, posited that depression often stems from a lack of unity between the conscious and unconscious processes, rather than merely being a signal from the unconscious. This disunity leads to unresolved conflicts that Jung believed could be addressed through an exploration of the unconscious, utilising methods like dream interpretation and engaging with archetypes. In relation to the philosophical schools that are closely paralleled to this approach, Jung was definitely heavily influenced by the Gnostics and the Taoists. Within Taoism, the emphasis on balance and unity which is referred to as simply the Tao, closely resembles this kind of unity Jung spoke of between unconscious and conscious processes. As well as this, a theme that runs through analytical psychology is this interplay of opposites. The Taoist concept of Yin and Yang represents the dynamic interplay of opposites and closely mirrors Jung's idea of the anima and animus, the feminine and masculine aspects within each individual, and his broader theme of integrating opposites within the self to reach psychological wholeness.
Behavioural Therapy
The behavioural model reminds us of the role of action and reinforcement in our mood states. This perspective suggests that depression can be maintained by a cycle of inactivity and avoidance, which in turn prevents positive reinforcement from natural sources of pleasure and accomplishment. By altering our behaviours—engaging in activities that provide direct or indirect rewards—we can disrupt this cycle. Behaviourists approach depression from the perspective of learned behaviours and maladaptive responses to the environment. They utilise techniques like behavioural activation and exposure therapy to encourage patients to engage in activities that are likely to be rewarding, thereby disrupting the cycle of avoidance and inactivity that perpetuates depression. This method resonates with the Stoic emphasis on focusing on what is within our control, advocating for a pragmatic approach to change through action. They taught that our reactions to external events, more than the events themselves, determine our well-being.
Cognitive Therapy
The cognitive model underscores the power of thought patterns in shaping our emotional world. Cognitive therapy, particularly focused on the treatment of depression, scrutinises the role of cognitive distortions and biases—systematic ways of thinking that are not based on reality. Examples include 'all-or-nothing' thinking, where individuals see situations in black or white terms; or even 'overgeneralisation', where a single negative event is seen as a never-ending pattern of defeat. There are actually many more of these distortions which we all fall prey too on a daily basis- a topic I will expand on in another segment. But by identifying and challenging these distortions, cognitive therapy works to replace them with more accurate and beneficial thoughts. Again, turning to ancient Greece, this approach largely echoes the Socratic method of questioning assumptions and beliefs, encouraging a philosophical dialogue with oneself to uncover and challenge the veracity of negative thoughts.
Existential Therapy: Focusing on Logotherapy and Humanistic Therapy
The Humanist approach to depression is deeply rooted in the concept of self-actualisation, which refers to the realisation and attainment of an individual's potential. Humanists often posit that when individuals are unable to fulfil their potential and live in accordance with their values- for instance as a result of societal pressures, unfulfilling relationships, or work environments - the stifling of creativity and personal expression is instrumental in the cause of depression. This lack of authenticity humanists would argue can often lead to depression. This not only provokes ongoing internal conflicts within the individual, because they are forever aware, at some level, they’re living a lie. But its also obvious too see how living a life of perceived monotone, whereby the majority of our time is taken up by experiences that are not perceived to be of value- well for an extended period of time, this is likely going to have a detrimental effect on our well being.
In the case of depression, this is very similar to Viktor Frankl's logotherapy which would focus on the existential vacuum that arises when an individual's life lacks purpose or meaning, or when there's a stark misalignment between one's values and their current situation. I would argue the existentialists take it one step further in that they address both this, alongside the individual's attitude to the circumstance which is also largely perpetuating the depressed state. And this too is important. As in the current state of society, there is a large amount of bureaucracy that floods into a lot of what we do- whether it's our jobs, daily transactions, the list goes on. As well as the fact that many of us may have responsibilities- people relying on us, say for instance income from a job that doesn’t fulfil us. So in most circumstances our choices affect those around us, and so a radical reorientation towards a path of authenticity, when identified, is realistically not going to be straight away. It’ll be done incrementally over a period of time. So importantly addressing the attitude taken to an individual's current circumstances that may be temporarily out of their control, and the framing needed in order to extract meaning regardless of their external environment, is also a crucial step. This, alongside the practical implication of aligning oneself with their individual purpose, is where existential psychotherapy flourishes.
In sum, each of these important schools of thought (logotherapy and humanistic therapy)- well their methods both lie in specific ways designed to help individuals discover their unique purpose and meaning in life, and then ensuring they pursue this, allowing for this necessary realignment. This is obviously closely paralleled, and influenced by existentialist philosophy, particularly the works of philosophers who grapple with the concepts of freedom, choice, and the inherent search for meaning in the human condition. Take Nietzsche- he viewed suffering, including the depths of depression, as integral to personal growth and the development of strength. 'What does not kill me, makes me stronger,' he famously stated, suggesting that the struggle with depression can lead to a revaluation of values, fostering resilience and a deeper appreciation of life's complexities. Similarly, Kierkegaard, often considered the father of existentialism, delved into the nature of despair, which he saw as the sickness unto death. For Kierkegaard, despair arises from not fully becoming oneself, from an imbalance within the self that is aware of its potential but unable to actualise it. And lastly, Albert Camus, in confronting the absurdity of life, argued that recognition of life's inherent meaninglessness should not lead to despair but rather to a rebellion through embracing life passionately. It’s almost empathising courage, turning into pain with a smile on our face.
Conclusion and Key Takeaways
So that’s a comprehensive overview of depression from the fields that I guess have the most to say about it. And by speaking about it from these perspectives, I don’t want to detract from the fundamental factors we all need to ensure maintenance of generally good health- factors that will no doubt also be addressed during any therapeutic session. Examples include: Exercise (movement is medicine), a job, relationships, sleep/wake cycle, nutrition, and lastly the deliberate practice of remaining present in our day-to-day experiences.
The last thing that I would like to add as a reminder for all of us— it’s the importance of showing a genuine concern for others, especially if they may be experiencing depression. When someone is at their lowest, the accompanying hopelessness and the lack of faith in existence can be overwhelming. Ironically the most potent of all forms of kindness at this point, is often that received by a stranger with no incentive besides unconditional care. To demonstrate a genuine concern for the well-being of someone else, whether you know them or not, is to be a figure of hope capable of restoring some faith that they have lost sight of.
Now with all of the approaches I’ve touched on, unfortunately there are cases where someone’s pessimistic outlook, or general lack of motivation, can be so significant that they do not want to agree to doing anything. The belief here, is that nothing will help them. The emphasis at this point, whether it be yourself, or someone you know, is really to emphasise that sometimes it is necessary to act out something before you can believe it to be true. And to start small. Small gains accumulate over time, we gain momentum, and factoring in the ‘Law of Accelerating Returns’- aggregates exponentially expand. This momentum is vital for one reason, which is that the most significant component to determining our sense of worth (i.e what we tell ourselves about ourselves), is not the place in which we currently reside, but instead the direction in which we are currently heading.
Anyway—I hope this overview has provided some clarity, or even sparked interest into what I see as a fascinating topic. For any further questions, please do not hesitate to contact myself- I’m always more than willing to help.