Lars von Trier's film Melancholia offers a powerful portrayal of the affliction traditionally known as melancholia, which is today called depression. The opening sequence involves a set of slow-moving ‘stills’, of deadened scenes where lethargy infects the body like heavy vines clinging to a walker's legs, and life is without purpose - for the future is annihilated. Today I will reflect on this malady from the perspective of various existential philosophers and therapists, including Martin Heidegger, Jean-Paul Sartre, Ludwig Biswanger, and Viktor Frankl.
Many existential therapists eschew the medical model, and any associated notion that melancholia or depression is one thing. Freud saw it this way too: "Melancholia, the definition of which fluctuates even in descriptive psychiatry, appears in various different clinical forms; these do not seem amenable to being grouped together into a single entity." To put the point in terms inspired by the philosopher Ludwig Wittgenstein, we are easily deceived by language: because "depression" is one word, we imagine that it refers to one thing, describes one problem with one nature, which reveals one cause and solution. Or perhaps one set of problems with one set of causes and solutions. This is what Wittgenstein referred to as "the bewitchment of our intelligence by means of language." Instead, when we look at actual experiences, we see that the single word refers to a multitude of phenomena which hang together in related but differing ways. Existential therapy takes a descriptive approach which assumes differences, but also that there are universal human concerns present in this malady. What follows is a discussion of some such universal themes which inform existential therapeutic theory and practice.
Time shows itself as a major, if implicit, theme in depression, just as it does in von Trier's film. The character Justine is a prophet and she sees the future destroyed, which equates to the annihilation of hope. Hence she lives in a state of anticipatory mourning as well as anger and even hate. Depression is often described as a mourning for I-know-not-what. A loss of the future, of hope. The melancholic person appears like one in grief, but without a lost object.
Probably the most important philosopher for thinking about time in human experience, including in depression, is Martin Heidegger. His existential-phenomenology helps us in many ways to think about this malady. For example melancholia can be described as a mood, and as Heidegger's analysis of our human way of being suggests, we all stand, always, in a certain mood. Our particular mood expresses our relation to the world, to life. It discloses that relation. The mood we are in shows how we are with the world. (See Heidegger's essay, What is Metaphysics?)
It is important to understand that a mood, for Heidegger, is not located inside person, but rather it expresses their interaction with the world. It is the relation, the in-between. This is what it discloses. This is why approaches such as cognitive-behavioral therapy (CBT) which view depression as a consequence of faulty thinking - as an intra-psychic disorder, as per the medical model in general - is sometimes be too limited. CBT can be very effective in individual cases, but it often fails to see how deeply depression is a problem of relationship with: others, the world, time, with the meaning of things.
Moving from Heidegger to the second greatest phenomenological-existentialist, Jean-Paul Sartre wrote in his novel Nausea, “Nothing happens while you live. The scenery changes, people come in and go out, that's all. There are no beginnings. Days are tacked on to days without rhyme or reason, an interminable, monotonous addition.” This captures an essential experience of many cases of depression. In my early 20s I suffered this malady, and I remember shaving one morning, and being overcome by a sense of the many, many days stretching out ahead, when I would repeat this activity. It was a feeling of overwhelmed exhaustion at the pointlessness of the exercise, of everything I did, a sense of life stripped of quality and reduced to quantity. That is not a neutral experience, rather it is painful when it is an expression of depression or despair.
Sartres' long essay which is often published as a book - Sketch for a Theory of the Emotions - is highly worth reading. It contains, on my reading, the seeds of a therapeutically powerful theory of melancholia: depression as a defense against loss and the associated pain. I mentioned loss and mourning a moment ago. Ludwig Biswanger notes this connection of depression with time and loss too. He writes of depression that “Everything that is possible has already happened. Life is ruled by the shadow of loss – a loss which is not just anticipated but is already fact.” Again consider Justine. Biswanger says of depression that it is “the break-up of the experience of time’s continuous flow.”
How does a person move out of depression, from an existential viewpoint? Biswanger writes that “the goal of psychotherapy [for depression] is to bring the patient safely back ‘down to earth’ [...]. Only from this point is any new departure and ascent possible.” I sometimes put this by saying that a person has been drawn out of the stream of life and needs to re-enter it. In their dislocation they cannot see how the world is from within the stream - a Heideggerian point referencing moods - and their melancholic perception obstructs any re-entry. They believe in what they see from their stand-point, from their disconnected attunement to the world, and their current experience becomes an obstruction to seeing another possibility and entering it. As one therapist put it, "Depression is a prison where you are both the suffering prisoner and the cruel jailer." There is an implicit appeal in many melancholic clients: "Remind me that I am wrong, that this perception is not the truth." But there is also the pull and push, a desperate desire to escape depression, and a deep resistance to doing so.
Viktor Frankl, the existential therapist, may be our best guide here. ( I recommend his book, Man's Search for Meaning.) Note that his thoughts were tested in the laboratory of the Holocaust. He survived three years in Nazi concentration camps and his whole family, including his pregnant wife, was murdered in those same camps. He agrees that depression is an effect of a loss of meaning especially with regard to the future, and claims that meaning must be found if change is to occur. Frankl's solution seems brilliant in its theoretical simplicity and common sense. In fact he is simply repeating an age-old philosophical insight which connects existential philosophy and therapy with classical philosophical traditions like Stoicism. His solution is that the meaning currently available to the depressed resides in the attitude they take to the depression. By gradations one can eventually find themselves outside their depression through constant re-interpretation, or to put it another way, by repeated habituation of a new interpretation. Philosophical reflection within therapy serves as both a search for this better and truer perspective and also, importantly, as the practice of habituating through repetition of the new perspective, applying it to the variations of one's experiences and responses, and repeating that application until it sets down strong roots within oneself. These two aspects are the core of a therapeutic response as I practice it. Counselling is not a mere consultation, thought sometimes it is that, but rather it is a practice of inhabiting the something better. It is a return to the connected, meaningful world by inhabiting a perspective which opens our being to the (ongoing) event of this connection.
The themes of loss of the future which renders the present meaningless, and depression as a mourning of that loss, are certainly common among people who come to me with depression, although most do not at first realise this. I analyse depression as expressing varying levels of affliction in life. For example I speak here of its moral variations. At one deeper level depression reflects the challenge we each face, of coming to terms with life - to terms with the human condition as one of vulnerability. We are vulnerable to loss and violation, and so to profound suffering. There is a potential bleakness just beyond the everyday veil, and it haunts some people. The person whose depression is rooted in this, feels this potential bleakness in their bones. They are disturbed, even shattered. They feel it within them as an anxiety - which is an often unremarked but very common feature of depression - and as anticipatory mourning. Their challenge, as with everybody, but in their case through the challenge of melancholia, is to come to terms with life, to find life meaningful and good in a way that can absorb the suffering, absorb the risk. So there is a task of understanding, a task of interpreting, a task of finding deeper meaning, a task of courage in the face of our vulnerability, a task of coming to love life in a way that can absorb its darker realities too. There is the possibility here to return to life wiser than before the depression.
My name is Matthew Bishop. I am a counsellor, with a background in philosophy. I have spent years exploring how philosophy enters into therapy, both theoretically and practically. One of my big influences is existential therapy. Although uploaded here recently, these are reflections written at different times over the last ten years.