Anthony Fernandez answers some questions on an exciting new project, Understanding Experiences of Mood Disturbances in Depression.
Could you give us the background to the project?
Understanding Experiences of Mood Disturbances in Depression is a new project combining qualitative and philosophical methods to establish a preliminary taxonomy of mood disturbances experienced by people diagnosed with depression. It will be carried out in the Department of Psychology, University of Southern Denmark.
A one-year pilot is currently running, funded by EPICUR, The European University Alliance, and co-funded by the European Union. The pilot is carried out in collaboration with Julian Kiverstein at the Lemon Tree Center for Psychiatry, Psychotherapy and Philosophy, Department of Psychiatry, Amsterdam University Medical Center. The full four-year project is funded by Independent Research Fund Denmark. Parts of the project will be carried out in collaboration with Evan Kyzar and George Denfield at the Department of Psychiatry, Columbia University.
What do you want to investigate?
The project investigates how people diagnosed with depression experience mood disturbances during their depressive episodes. However, the aim isn’t to generate general descriptions of what it’s like to live with depression or how depression affects one’s day-to-day life. Rather, the project aims to critically interrogate common psychiatric concepts and develop more nuanced or refined concepts that better capture the variety of mood disturbances experienced by this population.
The concept of “depressed mood”, for example, is poorly defined or not defined at all in psychiatric textbooks and diagnostic manuals. Instead, these texts tend to list a variety of affective states that are merely indicative of depressed mood, such as feeling sad, blue, despondent, empty, hopeless, or cheerless. It’s therefore unclear what a depressed mood even is, or what we mean when we say that someone has a depressed mood. By generating detailed descriptions using in-depth interviews and analyzing the transcripts with philosophical methods, we aim to revise and develop new mood-related concepts, producing a preliminary taxonomy of mood disturbance that can inform psychiatric research and clinical practice.
Why is this important?
Despite depression being one of the most common psychiatric disorders, treatments remain ineffective for many patients. One possible reason for the low response rates is that the diagnostic category of depression doesn’t capture a single disease entity. Rather, it likely captures a variety of heterogeneous conditions that, due to superficial similarities in experience and behavior, we’ve lumped under a common label. This heterogeneity is also reproduced at the level of symptoms, where a single symptom construct, such as depressed mood, may lump together states that should be disambiguated.
We aim to develop more precise concepts that capture specific mood disturbances experienced by people diagnosed with depression. These more specific concepts can then be used by researchers in other disciplines, such as clinical psychology, psychiatry, and neuroscience to determine, for instance, the prevalence of these mood disturbances, whether they correlate with treatment effects and course of illness, or even whether they correlate with biological markers. This is all work for after the project, though. Our immediate aim is to develop a preliminary taxonomy of mood disturbances.
Will the research programme be interdisciplinary?
The project is interdisciplinary through and through. My own background is in philosophy, although I’ve worked collaboratively with clinical psychologists and psychiatrists since my Ph.D. Julian Kiverstein, who’s collaborating on the pilot, has a similar background. The project also includes Martin Vestergaard Kristian, a postdoctoral researcher and clinical psychologist. He will conduct interviews using Phenomenologically Grounded Qualitative Research, an approach to qualitative study design and interviewing I co-developed with Allan Køster, also a philosopher and psychologist. Then we’ll hire on a PhD. student with a background in phenomenology and philosophy of psychiatry to help analyze the data and work on concept development. That’s the core team. But we also have two neuropsychiatrists, Evan Kyzar and George Denfield, who will help not only to develop our new mood disturbance concepts, but also make them accessible to an audience of psychiatrists and neuroscientists so we can disseminate our results in major journals in these fields.
What do you expect the impact to be?
I think the immediate impact will be more evidence that what we call major depressive disorder actually captures a diverse array of experiences and behaviors, which may be best to distinguish, both for research and clinical practice. In the longer term, I hope we’re able to identify and conceptualize mood disturbances that will eventually be shown to correlate with different course of illness or treatment outcomes, since that will have the most impact on clinical practice.
Anthony Vincent Fernandez is Associate Professor of Applied Philosophy and Theoretical Psychology at the Department of Psychology and the Department of Sports Science and Clinical Biomechanics, and a Senior Fellow of the Danish Institute for Advanced Study at University of Southern Denmark. His work focuses on the use of phenomenology in disciplines outside of philosophy, including psychiatry, nursing, anthropology, and sociology. He is co-editor of The Oxford Handbook of Phenomenological Psychopathology and co-editor-in-chief of Phenomenology and the Cognitive Sciences. He is currently writing new introduction to phenomenology, which details how researchers in the psychological, social, and health sciences, as well as in art and design, understand and use phenomenology.
