What I offer here is a moral philosophical sketch of depression. Or rather three kinds of depression, distinguished according to three moral emotions: remorse, guilt, and shame. Contrary to a popular myth, the majority of depression arises from problems of being in being in the world rather than from biological causes. At the heart of such difficulties lie problems of connection, loss, selfhood, meaning and value. Hence moral philosophy - reflection on meaning and value - is vital for understanding depression and orienting our way through it. Inventing names, I will speak first about remorse-based depression. I will write more about that another time, so I move quickly to its much more widespread cousin, which I call guilt-based depression. Following that I offer a sketch of a third sort, shame-based depression.
Before starting I would like to anticipate and address a concern of some readers. It may strike some as odd that I explore depression from a moral philosophical perspective, given that many depressed people moralistically condemn themselves or are so condemned by others. Surely we ought to banish all talk of morality? My answer is that value-neutrality is impossible in life, including in therapy. Indeed a core problem of depression regards the ways value and meaning is lost or goes awry. Furthermore I would say that the problem just mentioned is not one of morality, but of a moralistic attitude. Just as making judgements, something that we do by necessity on a constant basis, is different to being judgemental. Indeed, wisdom and compassion are forms of moral judgement! Some people have a deep difficulty distinguishing moralism from morality, often for emotional, defensive reasons which they do not clearly see. This is especially so with people suffering depression, for in many cases their problem includes the internalisation of a moralistic, judgemental voice, such that their criticism of the concept of morality is actually a confused attempt to attack on their inner-moralist. As Nietzsche said, so much philosophy - and certainly so much bad philosophy - is autobiographical, an expression of one's psychological life. Morality at its best is about goodness and truth. It is about value. We cannot do away with these and neither should we. The most important things in life are all given to distortion and corruption. To run from the danger of such corruption requires running from everything that really matters. In the case of depression what people need is not a shift from distorted values to no values - that would be nihilism (see below!) - but rather an orientation toward clear-sighted and nourishing values, or rather, a reshaping of their emotional life around those values.
When a decent person wrongs another they tend afterwards to feel remorse. Remorse is a moral emotion: it is a pained recognition of the wrong one has done another. Hence remorse is a form of lucidity, a recognition of reality through opening one's eyes to other people and the meaning of one's deeds toward them.
Sometimes depression arises from remorse as a catastrophic experience of a pained recognition of the terrible thing one has done. Imagine a person who regularly risks the safety of others while driving and who finally causes an accident which kills another; or a young bully who flippantly taunts another to kill herself and she does so; or a friend of a couple who manipulates and seduces so as to break up a marriage for the sake of a fling. Such people might later find themselves claimed - as they ought to - by a devastating or at least powerful realisation of what they have done. In response they may fall into a depression. In essence they have brought bleakness in the world, and if they are lucid that bleakness will return to them. (This is a case of where striving to be a good person means suffering more - the callous merely turn their back on reality.) Friends may try to talk such people out of their remorse, as though to feel so bad must be irrational. In effect these others are inviting the person to betray their call to moral lucidity.
Of course this lucidly remorseful depression may be mixed with unreasonable guilt, misapprehension, unjust self-condemnation, maudlin self-indulgence et cetera, but the pain of lucid remorse needs to be distinguished and answered to truthfully.
There are many moral emotions. Remorse is one. Guilt is another. We often use the concepts of 'guilt' and 'remorse' interchangeably, however guilt is unstable from a moral point of view. For while remorse is a reality principle, opening one's eyes, guilt can blind a person. It can become uncoupled from reality, becoming maudlin, misplaced, unjust or disproportionate. When guilt is not determined by truth then nothing limits it, and one easily descends in a downward cycle. Such guilt-based depression is traditionally the most common form of depression.
As I said initially, morality is about meaning and value. It is not moralism, judgementalism, nor is it merely about praise and blame. In guilt-based melancholia however, morality becomes just that: a pattern of neurotic self-blame and self-loathing. A condition for suffering guilt-based melancholia is therefore the possession of a moral sense of reality, however this fact can be obscured, because the sufferer might endorse moral relativism, such as I pointed to above. This is what is known in philosophy as a "lived contradiction": the possession of an explicit philosophical stance which is implicitly contradicted by one's way of being. The moral sense of reality is however a distorted one.
There are many reasons why the possession of guilt might turn into an entrenched depression. A critical parent during one's childhood - a parent who induces unreasonable guilt in a child - is a major cause. The child swallows the parent's voice, takes on a ghost of the critical parent within themselves. Therapy for depression often involves an exorcism so to speak, a driving out or killing of this critical inner voice.
Guilt may also become depression when a person finds themselves in a culture, whether at a micro or macro level, which fails to appreciate or even to recognise the value in their particular way of being, seeing in them only flaws or vices, and expressing that judgement to them. In his memoir Romulus, My Father the philosopher Raimond Gaita looks back at the social context for the suicide of his mother in 1958:
But for someone like my mother, highly intelligent, deeply sensuous, anarchic and unstable, this emphasis on [moral] character, given an Australian accent, provided the wrong conceptual environment for her to find herself and for others to understand her. Tom Lillie's contempt for her was common. It was also emblematic of a culture whose limitations were partly the reason she could not overcome hers.
The most common conditions for guilt-based depression appear at first to need a more psychological than moral description. Attachment theorists, who claim that personality structure is rooted in early childhood experiences of care, have shown that early loss or abuse can lead to depression in adulthood. But even such psychological-deterministic theories contain moral elements at their very core. The philosopher Simone Weil wrote: “At the bottom of the heart of every human being, from earliest infancy until the tomb, there is something that goes on indomitably expecting, in the teeth of all experience of all crimes committed, suffered, and witnessed, that good and not evil will be done to him.” It is this human need and desire which is at the core of all emotional problems. Typically a child (and later adult) will have responded to the loss of, or abuse by, a parent, by holding themselves responsible. They will instinctively blame themselves, often without recognising it. This feels much better than the feeling that the world really is this uncaring or cruel, or that the object of their love and the source of their value - their parent - really does not love them. Hence the child grows up feeling flawed and contemptible because it is the lesser evil among bad a set of options. Guilty depression is self-loathing. I hate myself because I have lost, in some deep and complex way, that which I loved and the love from them which I needed. Notice how the distinction between morality and psychology becomes blurred, as a moral language of desire for goodness, and the need to love and to be loved, is required to describe the heart of a supposedly psychological problem. The need to find oneself valuable, worthy of love, is at the heart of the childhood psychological processes described by attachment theory, including attachment theory's explanations of depression.
Guilt-based depression is the most well-known form at both a professional and popular level, as it is perhaps the most common form traditionally brought to therapy. It arises in a culture which is concerned with moral character. But as culture changes, so too does depression. We like to imagine in the first world that we are liberated beings regarding old moralities, so it may surprise people to realise that this older form of depression is being superseded by a new form, rooted in shame. This is the consequence of a materialistic age.
To be continued, April 2017
Author: Matthew Bishop
Image: Kole Berishaj, Agony