Understanding Experiences of Mood Disturbances in Depression

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. 

Silence

This post is by Dan Degerman, Leverhulme Early Career Research Fellow at the University of Bristol. Dan is soon to join project EPIC. 

Some members of team EPIC: Matthew Broome, Ian Kidd, 
Dan Degerman, Havi Carel, Kathleen Murphy-Hollies, and Fred Cooper.

Silence is an important phenomenon in mental health. But while philosophers have had much to say about the social silencing of people with psychiatric diagnoses, other ways in which silence can feature in psychopathology have been underexplored. In a recent workshop at the University of Bristol, generously funded by the Leverhulme Trust, we sought to begin to address this neglect by exploring the different faces of silence in psychopathology.

Ian Kidd opened the workshop with a talk that explored painful silences common in bereavement grief. In particular, he focused on four silences, each characterised by a loss of communicative possibilities that follows the death of a loved one. This included, for example, silence as the loss of the distinctive communicative style of the deceased and silence as the permanent absence of narrative closure. For the person subject to these silences, they are painful for three reasons, Ian explained. Firstly, these silences cannot be filled. Secondly, they involve the awareness that the ways of being in the world the relationship with the deceased made possible are now impossible. Thirdly, they involve the awareness that one can no longer be the same person that one was with the deceased.

Ian Kidd

The second speaker, Richard Stupart, drew on accounts of investigative journalists working in South Sudan to shed light on some of the mental dangers of being silent. He argued that journalists are at a heightened risk of moral injury, referring to the negative psychological impact a person experiences when they are unable to respond to a situation in what they consider a morally appropriate way. Journalists in conflict and crisis situations are particularly vulnerable to such injury because they often find themselves subject to structural pressures that may prevent them from communicating their knowledge about morally charged stories.

Richard Stupart

Inner speech in mental disorders was the subject of the next talk by Sam Wilkinson. He defended what he called a strong dialogical account of inner speech, which entails that all inner speech is directed at a recipient, namely, ourselves. This account also suggests, among other things, that inner speech plays a central role in shaping our identity. Sam then outlined some ways this account can help clarify the implications of inner speech and its absence in different mental disorders. For example, the strong dialogical account indicates that negative inner speech in anxiety and depression is not just an epiphenomenon of pre-existing a person’s feelings but that it can create a downward spiral of those feelings.

 

Sam Wilkinson

The fourth talk by Anna Bortolan examined experiences of silence in social anxiety. Drawing on some distinctions proposed in a recent paper on silence in mood disorders, Anna showed that these capture experiences described by people with social anxiety as well. She then went beyond that account to argue that a further two experiences of silence can be discerned in accounts of social anxiety. The first is characterised by a perceived inability to fill certain silences when one wants to do so, and the second is accompanied by a diminished sense of agency over how silences are filled.

Anna Bortolan

Finally, in my talk, I argued for the importance of attending to first-person experiences of silence in psychopathology through a case study drawn from accounts of depression. Using a phenomenological framework inspired by the work of Merleau-Ponty, I described an experience common in first-person accounts of depression that I termed empty silence. This is an unpleasant experience that involves a solicitation to speak and a breakdown in a person’s habitual relationship with words, which confronts them with their own outward and inner silence. I proceeded to argue that if lived repeatedly, it may give rise to bodily doubt in one’s ability to speak.

Dan Degerman

If you are interested in learning more about the talks, presentation materials from most of them can be found here. The talks were followed by wonderful discussions with the interdisciplinary audience that was in attendance in the room and online, and I want to extend heartfelt thanks to all those who participated.

The workshop was the capstone event for my Leverhulme Early Career Fellowship. However, it also served as an informal launch event for the EPIC project, with many of its team members in attendance, including Ian Kidd, Havi Carel, Matthew Broome, Fred Cooper, Kathleen Murphy-Hollies, and myself. The conversations and explorations that began during this workshop on silence and psychopathology will continue as part of the project, and if you are interested in contributing or participating in some way, please do get in touch.