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In-Depth Information
Phenomenology listens to Prozac
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9 This chapter is inspired by an ongoing empirical research project based on
interviews with doctors and patients prescribing and consuming SSRIs. Since I
am in the middle of collecting and analyzing the empirical material, it will not
be presented in the text. Rather I will aim at analyzing conceptual issues, but
the models of understanding I propose have certainly been infl uenced by the
conversations I have enjoyed so far in the project. The literature on depression
is certainly vast; for a good introduction with many references see Solomon
(2001). See also Elliott and Chambers (2004) for an interesting collection of
papers on the SSRI development containing further references.
10 Even if such laboratory tests were developed, the question would of course
remain whether they really measured depression, or rather something else.
11 DSM-IV and ICD-10 are to a very large extent compatible, even though the
ICD manual lacks the multi-axial assessment, and generally deploys somewhat
less fi ne-tuned diagnostic criteria. Both manuals are diagnostic tools; they do
not make any recommendations about treatment. The reason for concentrating
on depressive disorders and anxiety disorders below is that the SSRIs have been
approved for treatment of these kinds of disorders - as they are specifi ed in
DSM and ICD - by regulatory authorities. In Sweden this regulatory authority
is “Läkemedelsverket”, in the USA it is the “FDA”, in Great Britain it is the
“MHRA”.
12 It should be mentioned at this point that I am certainly not the fi rst one to
try to utilize Heidegger's insights in the philosophy of psychiatry. Well-known
psychiatrists and psychoanalysts, such as Ludwig Binswanger, Medard Boss,
Wolfgang Blankenburg and Jacques Lacan, have developed theories inspired by
Heidegger's phenomenology, since the 1930s (Spiegelberg 1972).
13 Heidegger himself, in
The Fundamental Concepts of Metaphysics
, refers
to the
famous comment by Aristotle, made in the
Problemata
, that all great and creative
men have been melancholics (1983: 271). Heidegger writes on the same page
that philosophical thinking comes out of basic moods that are characterized by
“
Schwermut
” (sadness, melancholy). Anxiety and boredom would thus bear this
relationship to sadness and melancholy for Heidegger, a kinship we will return
to later in this chapter.
14 Melancholia is the pre-modern expression for depression and depressive
personality traits, which disappears around 1900 in the vocabulary of psychiatry.
Melancholia, however, has ironically found its way back into contemporary
psychiatry. It is found in DSM-IV as a specifi ed type of depression with deep,
persistent boredom (2000: 419). In twentieth-century psychiatry, this type of
depression has carried many different names - endogenous, vital, biological
- all contaminated, however, by etiological hypotheses, which made them
unsuitable for the DSM classifi cation. Even more important in this context is
the reoccurrence of the old notion of “dysthymia” in DSM, which is similar to
the pre-modern notion of melancholia in indicating a certain temperament, or
personality type (2000: 376). See Healy (1997) and Kramer (1994).
15 This question is certainly related to the whole fi eld of developmental child
psychology and the issue of when the child becomes a subject (ego) in its own
right. The reason why very early experiences (being abandoned by the mother,
or even being born) are claimed by some researchers to be qualitatively different
from later losses in life would be that the child, indeed, at these early stages, was
not yet an ego. See Freud (1957b). For more recent theories of child development
see Stern (1985).
16 In psychiatry one has tried to get around this (and other) dilemmas, by talking
about mental “disorder”, instead of disease or illness. But, as should be clear
from my paragraph on diagnosis above, what is specifi ed is rather illness- than
disease-issues.
