The phenomenological model of depression: from methodological challenges to clinical advancements

Abstract

In this article our overall aim is to illustrate how phenomenological psychopathology can advance the clinical work on depression. To do so, we start by unfolding the current phenomenological model of depression. We argue that this model faces a methodological challenge, which we define as ‘the challenge of patho-description’. Mental disorders, such as depression, influence how people are able to access and describe their own experiences. This becomes a challenge for phenomenological psychopathology since its methodology is based on people’s ability to describe their own experiences. To deal with this challenge, in the case of depression, we turn to the framework of phenomenological interview. We interview 12 participants (7 women, 5 men, age-range from 29 to 57 years) with moderate and severe depression. From the interview results, we show how phenomenological interview deals with the challenge of patho-description and how patho-description in depression conceals experiential nuances. We unfold these nuances and describe how people with depression pre-reflectively experience a variety of feelings, a type of agency, overly positive self-image, and relations in a hyper-social way. These descriptive nuances not only strengthen the phenomenological model of depression, but they also help advance the clinical work on depression. We firstly illustrate how the descriptive nuances can be added to current manuals and rating scales to advance diagnostic work. Secondly, we illustrate how phenomenological, ‘bottom-up’, and embodied approaches function at the pre-reflective level of experience, and that further effort at this level can help advance therapy for depression.

Examination of self patterns: framing an alternative phenomenological interview for use in mental health research and clinical practice

“…The ESP shares a key theoretical commitment of phenomenological interview methodologies widely discussed in the literature ( Parnas et al, 2005 ; Petitmengin, 2006 ; Høffding and Martiny, 2016 ; Sass et al, 2017 ; Rasmussen et al, 2018 ; Køster and Fernandez, 2021 ; Stanghellini et al, 2022a ; Frohn and Martiny, 2023 ) in eschewing physicalist reductionism, exemplified by both the medicalized disease model and the more recent neurocentric view. The ESP distinctively provides a rethinking of the “psychiatric object,” in favor of an understanding of the multi-dimensionality of the individual dynamically immersed in a meaningful shared world that can be captured in the 10 elements/ processes of the self-pattern.…”

“…The phenomenological interview is a method generally used in qualitative research. It functions as a set of second-person interview questions and techniques, generating a narrative that in the psychiatric context can then be analyzed and interpreted for purposes of research ( Høffding and Martiny, 2016 ; Køster and Fernandez, 2019 , 2021 ; Gallagher and Zahavi, 2021 ; Frohn and Martiny, 2023 ). As mentioned above, variations of it can be found in the ‘Examination of Anomalous Self Experience’ ( EASE ) protocol ( Parnas et al, 2005 ) and the more recent ‘Examination of Anomalous World Experience’ ( EAWE ) ( Sass et al, 2017 ) and ‘Examination of Anomalous Fantasy and Imagination’ (EAFI) ( Rasmussen et al, 2018 ).…”

“… Køster and Fernandez (2021) , for example, suggest that interviews may frontload “what phenomenologists call ‘invariant existentials’ or ‘existential’ structures to provide a framework allowing the qualitative researcher to focus on a specific feature of human existence and investigate its particular modes.” In a similar fashion, Frohn and Martiny (2023) frontload the interview process with a framework defined by four enactive-phenomenological dimensions: the existential, biological, social, and psychological (following De Haan, 2020 ). Frontloading phenomenological existential or enactive dimensions means simply that the interview is guided by these elements.…”

“…15 By emphasizing the dynamical relations among the processes of the self-pattern, for example, we can specify how affective processes in a particular patient directly relate to how they perceive the world and other people. Thus, if a patient is asked to explore the affective dimension of the self-pattern with questions from the interview —for example: “Can you describe how your mood has been recently?” — a patient may report “I experienced that I became more and more apathetic toward my own life… Even the things that I thought were fun normally, and which gave me something normally - it was all devoid of meaning” (cited in Frohn and Martiny, 2023 , cf. Table 1 ).…”

“…This analytic move is central to exploring self-patterns insofar as this process may unveil the key relationships that tie the elements together into a dynamical gestalt, and give rise to specific experiential, psychological, behavioral, intersubjective manifestations. Consider, for example, the patient’s response cited earlier: “I experienced that I became more and more apathetic toward my own life… Even the things that I thought were fun normally, and which gave me something normally - it was all devoid of meaning” (cited in Frohn and Martiny, 2023 , cf. Table 1 ).…”