This dissertation in Theory of Practical Knowledge contends that depression is a disorder of the self. Using the existential-phenomenology of Maurice Merleau-Ponty, I argue that if we want to disclose the basic structure of depressed experience, then we must likewise disclose how selfexperience is inseparable from depressed experience. However, even though depression is a contemporary psychiatric category of illness, it is nevertheless a historically and heterogenous concept.

To make sense of depression in the context of contemporary psychiatric practice, I show that depression has historically been characterized by two broad models of causation; that is, a phenomenon that is causally explained by either a biological dysfunction or a psychological conflict. But this stark characterization is not limited just to history; by conducting qualitative interviews with psychiatric professionals, I illustrate how this causal dichotomy remains prevalent in contemporary psychiatric practice. On one hand, the clinicians report dissatisfaction with the depression diagnostic criteria (i.e. it is impersonal or vague), while on the other hand, the clinicians also recognize that a depression diagnosis is useful insofar as a diagnosis facilitates access to various resources associated with psychiatric care. Consequently, clinicians have developed a coping strategy that is witnessed in their empathetic desire to distance patients from their depression diagnosis, which led to statements such as, “you are not the problem, the problem is depression.” One consequence of this approach is that depression is artificially cleaved from the person who experiences depression, which subsequently means that depression is viewed to be something independent of oneself.

Because I argue that depression and the self are mutually implicated, it is crucial to disseminate some of the most influential contemporary models of selfhood. I show that the brainbound, situated, psychological, and narrative model of self, all have respective strengths and weaknesses. But I also go beyond these models and characterize selfhood as a developmental phenomenon that is expressed as an embodied-style. This style reflects the way in which we establish perceptual contact with the otherness, without which there could be no self-experience.

Denna avhandling i ämnet den praktiska kunskapens teori undersöker hur depressionen griper in i och förändrar vår erfarenhet av oss själva. Genom att använda mig av Maurice Merleau-Ponty’s existentiella fenomenologi, argumenterar jag för att vi måste beskriva och analysera erfarenheten av självet och hur den är relaterad till den depressiva erfarenheten om vi vill blottlägga depressionens grundläggande struktur.

Depression har historiskt sett förklarats med hjälp av två olika orsaksmodeller: antingen har den betraktats som en biologisk dysfunktion eller som ett resultat av en psykologisk konflikt. Gränsdragningen återfinns emellertid inte bara i historien; genom att genomföra djupintervjuer visar jag hur denna kausala dikotomi fortfarande är verksam i den samtida psykiatriska praktiken. Å ena sidan redogjorde mina informanter för sitt missnöje med kriterierna för diagnosen depression (exempelvis att de är opersonliga eller otydliga), medan de, å andra sidan, vidkände att diagnosen är användbar såtillvida som den gör det möjligt att få tillgång till den psykiatriska vårdens olika resurser. Personer som är verksamma inom den psykiatriska professionen har därför utvecklat olika strategier för att hantera detta dilemma, något som exempelvis visar sig i deras vilja att distansera patienter från deras depressionsdiagnoser, vilket ledde till uttalanden som ”du är inte problemet, det är depressionen som är problemet”. En av följderna med denna strategi är att depressionen separeras på ett artificiellt sätt från personen som lider av den, vilket också innebär att depressionen betraktas som något som är oberoende av det egna självet.

Eftersom jag argumenterar för att depression och själv påverkar varandra ömsesidigt är det viktigt att analysera några av de mest inflytelserika modellerna för att förstå självets struktur inom samtida forskning. Jag visar att den hjärnbaserade modellen, den situerade modellen, den psykologiska modellen och den narrativa modellen av självet har sina respektive styrkor och svagheter. Men jag går också bortom dessa modeller och karakteriserar självet som ett utvecklingsfenomen som ger sig till känna som en förkroppsligad stil. Denna stil reflekterar det sätt på vilket vi etablerar en perceptuell kontakt med annanheten, förutan vilken det inte skulle finnas någon erfarenhet av det egna självet.

Genom att använda mig av begreppet självet-som-stil, visar min fenomenologiska analys hur depressionens erfarenhetsstruktur är oskiljaktig från den levda rumsligheten. Jag visar hur den deprimerade erfarenheten är en affektiv förändring av det sätt på vilket rumsligt djup upplevs; ting i världen upplevs som frånvarande, utom räckvidd, eller så upplever den deprimerade personen helt enkelt sig vara oförmögen att utan stor ansträngning etablera kontakt med omvärlden. Därför argumenterar jag också för att förhållandet mellan depression och självet kan karakteriseras på två huvudsakliga sätt, antingen som en depressiv stil eller som ett avbrott av självets stil.

Denna distinktion mellan depressiv stil och en avbruten självstil får konsekvenser för diagnosticeringen och behandlingen av depression. Jag visar att en långvarig depressiv sjukdom – dystymi – fenomenologiskt sett vittnar om en depressiv självstil medan en kortare depressiv sjukdom motsvarar en avbruten självstil. När det kommer till frågan om behandling av depression utgår jag från filosofen John Russons verk för att visa hur samtalsterapi också kan förstås som ett existentiellt projekt som syftar till att medvetandegöra våra oreflekterade och förkroppsligade vanor i ett försök att omstilisera det sätt på vilket självet förmår handskas med de förändringar som uppstår i vardagliga situationer.

In standard philosophical classifications of feelings, bodily pain is not considered an emotion, since it does not contain any beliefs or judgments about the world in the way that emotions do (Goldie 2000). I am mad, sad, afraid, or happy about something (not) being the case, but when I find myself in pain this intentional structure is not present. Pain is therefore classified as a pre-intentional feeling, which makes (a part of) the body appear in a specific (painful) way, which does not, however, have a proper meaning content. Bodily sensations can be of the negative sort—pains, itches, feelings of being too hot or cold—or of the positive sort—tickles, feelings of bodily comfort or orgasms—but they do not carry any cognitive content beyond this perceived painfulness or pleasantness of the body (parts).

Phenomenology has the potential of improving upon such narrow conceptions of pain by showing how it is a peculiar and many-faced form of embodied experience. To be in pain is not only to perceive parts of one’s body in a certain way but also to feel how the perceived world changes in structure and content. Accordingly, pain can be explored and understood as an embodied mood; a way of finding oneself in the world that typically leads to certain emotions of the negative type: frustration, irritation, anger, fear, sadness, self-pity or even loss of hope and trust in others (Kusch and Ratcliffe forthcoming; Svenaeus 2015, 2017, chapter 2). Such emotions, that typically occur if pain is intense and long lasting, display beliefs about the situation of the pain sufferer that are nurtured by the bodily affliction. 

In his recently published study The Phenomenology of Pain Saulius Geniusas sets himself the task of developing precisely that – a phenomenology of pain – on the basis of Edmund Husserl’s philosophy. According to Geniusas, in Husserl’s work (including the posthumously published manuscripts) we find all the resources needed to develop such a phenomenology. Husserl took the first steps himself in developing a phenomenology of pain and by following in his footsteps, proceeding by way of the phenomenological method and concepts he developed, we can achieve this important goal. Why is it important to develop a phenomenology of pain? Apart from the general impetus of exploring all phenomena relevant to human life, we may in this case also point towards the mission of helping those who suffer from severe and chronic forms of bodily pain. Pain is from the experiential point of view generally something bad to have, even though it may guide our actions and call for changes of life style that are in some cases beneficial for us in the long run.

The paper presents an account of suffering as a multi-level phenomenon based on concepts such as mood, being-in-the-world and core life value. This phenomenological account will better allow us to evaluate the hardships associated with dying and thereby assist health care professionals in helping persons to die in the best possible manner. Suffering consists not only in physical pain but in being unable to do basic things that are considered to bestow meaning on one's life. The suffering can also be related to no longer being able to be the person one wants to be in the eyes of others, to losing one's dignity and identity. These three types of suffering become articulated by a narrative that holds together and bestows meaning on the whole life and identity of the dying person. In the encounter with the patient, the health-care professional attempts to understand the suffering-experience of the patient in an empathic and dialogic manner, in addition to exploring what has gone wrong in the patient's body. Matters of physician assisted suicide and/or euthanasia-if it should be legalized and if so under which conditions-need to be addressed by understanding the different levels of human suffering and its positive counterpart, human flourishing, rather than stressing the respect for patient autonomy and no-harm principles, only. In this phenomenological analysis the notions of vulnerability and togetherness, ultimately connecting to the political-philosophical issues of how we live together and take care of each other in a community, need to be scrutinized.

A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that proceeds from the first-person perspective when attempting to understand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenomenological account of health and illness, represented by philosophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increasingly influential in philosophy of medicine and medical ethics is the criticism of it that has been voiced in some recent studies. In this article, two such critical contributions, proceeding from radically different premises and backgrounds, are discussed: Jonathan Sholl's naturalistic critique and Talia Welsh's Nietzschean critique. The aim is to defend the phenomenological account and clear up misunderstandings about what it amounts to and what we should be able to expect from it.

In “Dying Bodies and Dead Bodies: A Phenomenological Analysis of Dementia, Coma, and Brain Death,” Fredrik Svenaeus investigates how we should look upon the death of persons and their bodies, especially in cases in which they appear to split ways. The chapter makes use of the work of Martin Heidegger, Hans Jonas and other phenomenologists to argue that although life and death are to be understood on a bodily level, the ontological and ethical analyses of dying need to be complemented by a phenomenology of how persons may gradually disappear in power of being constituted by bodily processes that are breaking down. In this analysis, a continuous scale of different levels of personhood is introduced and compared to some influential views on the essence of human being and death in contemporary medicine and bioethics.

Utgångspunkten för det treåriga projektet The Phenomenology of Suffering in Medicine: Explorations in the Baltic Sea Region är den centrala roll lidan­de intar i medicinsk praxis, och därmed också i den medicinska etiken. Den teoretiska grunden för projektet är den breda tradition inom huma­nistisk reflektion och forskning under 1900-talet som innefattar fenome­no­logi, hermeneutik och narrativitet.

I projektets empiriska del har fem medicinska fakulteter runt Östersjön valts ut, delvis beroende på etablerade kontakter, delvis för att på dessa orter pågår intressant undervisning och forskning inom ovan beskrivna fält. Med hjälp av kontaktpersoner på respektive orter har sedan studiebesök genomförts, med informella samtal och formella inter­vjuer. Intervjuerna har analyserats för teman som belyser forsknings­projektets grundläggande fråga om hur fenomenet lidande upp­märk­sam­mas, tolkas och hanteras inom dels medicinsk undervisning och i någon mån även i forskning inom medicinsk humaniora på respektive orter.

In On the Problem of Empathy Edith Stein claims empathy to be a three-step process in which the experiences of the other person (1.) emerge to me as meaningful in my perception of her, I then (2.) fulfil an explication of these experiences by following them through in an imaginative account guided by her, in order to (3.) return to a more comprehensive understanding of the experiences of the other person. Stein obviously intends the phenomenon of empathy to be importantly related to (A.) the project of getting to know more about the experiential world of the other person, as well as (B.) the project of developing an ethics centred around the notion of spirit (Geist) and personhood. Although it is debatable whether Stein actually succeeds in fully realizing either of these aims in her book, in this chapterI intend to explore how the Steinian theory of empathy could serve both as an experientially based anchoring point of medical epistemology and as a founding ground for medical ethics. Empathy is an apt starting point for medical ethics in that it acknowledges that moral reflection begins in experiencing the suffering of a person, who is in need of help, a starting point that also connects to the question of which capabilities (virtues) a good doctor (health care professional) needs to embody. 

This paper presents and explicates the theory of empathy found in Edith Stein’s early philosophy, notably in the book On the Problem of Empathy, published in 1917, but also by proceeding from complementary thoughts on bodily intentionality and intersubjectivity found in Philosophy of Psychology and the Humanities published in 1922. In these works Stein puts forward an innovative and detailed theory of empathy, which is developed in the framework of a philosophical anthropology involving questions of psychophysical causality, social ontology and moral philosophy. Empathy, according to Stein, is a feeling-based experience of another person’s feeling that develops throughout three successive steps on two interrelated levels. The key to understanding the empathy process á la Stein is to explicate how the steps of empathy are attuned in nature, since the affective qualities provide the energy and logic by way of which the empathy process is not only inaugurated but also proceeds through the three steps and carries meaning on two different levels corresponding to two different types of empathy: sensual and emotional empathy. Stein’s theory has great potential for better understanding and moving beyond some major disagreements found in the contemporary empathy debate regarding, for instance, the relation between perception and simulation, the distinction between what is called low-level and high-level empathy, and the issue of how and in what sense it may be possible to share feelings in the empathy process. © 2017 The Author(s)