Epistemically Adrift: Mood Disorders and Navigating Responsibility

Abstract

This is a dissertation in philosophy of psychiatry and ethics focused on the question of how does one live and react responsibly to the experience of mood disorders such as depression and anxiety. In looking to the current state of psychiatry and cultural understandings of mental disorder, I identify what I call being “epistemically adrift” – the sense that individuals face too many conflicting opinions and a constant debate of how to live with depression that they are unable to process for themselves what their best options for living are. This feeling of being epistemically adrift is all the more complicated by the experience of mood disorder itself, which often makes individuals feel morally inadequate and pressured to do the right thing without clear direction. In the absence of a clear path regarding depression and anxiety, this dissertation proposes an ethics for depression and anxiety disorders – drawing a virtue theory from the existentialist tradition that focuses on the outskirts of mental disorder in order to create an inclusive ethical system for those generally excluded in moral philosophy. The first chapter outlines the general theory of being epistemically adrift in relation to depression and anxiety and how the themes of uncertainty in these conditions inherently lead to different epistemic insights. This chapter establishes the dissertation’s roots in existential phenomenology and epistemic injustice literature in order to sketch out how the combined uncertainty in interdisciplinary understanding of mental illness with the uncertainty experienced within mood disorders lead individuals to feeling adrift and unable to determine what they should do for themselves in living good lives. Meanwhile I argue that the insights of depression and anxiety attune individuals to the world in different ways than their non-depressed peers, which imports interesting questions regarding our responsibility toward one another. The second chapter explores a case study of this sort of insight, arguing that the experience of excessive or “delusional” guilt within depressive disorders can provide a deeper insight into our general moral responsibility towards one another. I compare this feeling of guilt to Karl Jaspers’ conception of “metaphysical” or collective guilt in his analysis of the German people after the Second World War and Holocaust. These sorts of guilt feelings within depression is often incapacitating and hard to make sense of for individuals, but it additionally has a transformative ability to reevaluate moral life. I argue that parallel to the concept of “depressive realism” where individuals with depression have different and sometimes better insights than others, depressive guilt differently attunes individuals to how they relate to others and the world at large. From there, the third chapter engages with how psychiatric diagnosis shapes and limits one’s perceptions of their freedom and agency. More specifically, this chapter employs an existentialist analysis of how one can react to their diagnosis in bad faith – deflecting their own responsibility either by indulging into diagnostic patterns as inherent destiny or denying the condition’s effect on their motivations. I argue that there must be a middle path where one takes responsibility for one’s situation as being depressed or anxious, which both acknowledges the condition but also sees it as a personal challenge to improve on one’s life. The final chapter of the dissertation culminates in the development of an ethical theory that directly centers itself within the experience of mood disorders. This theory stems from both existentialism for its commitment to projecting meaning on uncertainty and absurdity along with virtue theory which allows for a sense of imperfection and improvement over time. I have been developing a set of virtues for how to be responsible for one’s depression or anxiety. “Responsibility” in this sense is the question of how one responds to their moods and other symptoms related to mood disorders, that is, an account of responsibility that resists narratives of fault or blame. These virtues are meant to be a set of therapy-informed guidelines to help those with depression and anxiety counteract the worst feelings of being adrift and foster autonomy and dignity for themselves.