The heterogeneity of depressions: A phenomenological viewpoint

The term 'depression', used in the singular, is clinically misleading as it suggests a unitary and well-defined nosographic category. Instead, what is commonly referred to as 'depression' indicates a heterogenous complex disorder which includes distinct psychopathological forms. More accurate classifications, as for instance phenomenological ones, recognize discrete subtypes that can be identified on the basis of individual experiences of depression. Indeed, several (although not infinite) forms of depressive experiences exist. Some are characterized by guilt, others by anger, dysphoria, spleen, shame, emptiness, frustration, demoralizations, exhaustion, etc. The mainstream approach to the diagnosis of depression mainly relies on ‘ticking boxes’, whose aim is neither an in-depth understanding of the patient’s personal experiences, nor to reveal previously unknown features of the patient’s condition. Rather, the aim of this approach is to assess those phenomena that are a priori deemed important as diagnostic indexes leading to the classification of the patient’s complaints and dysfunctions according to pre-defined – and, in the case of major depression, overinclusive - diagnostic categories. In this paper, I outline a method for a more precise and detailed characterization of depressions based on what I will call ‘drafting arrows’ and ‘linking dots’. In a nutshell, ‘drafting arrows’ is constructing motivational diagrams connecting a given pre-morbid personality make-up with a given form of acute depressive decomposition via the corresponding pathogenic (traumatic) pre-depressive limit-situation. If we want to understand the forms taken by depression, we must trace back each of these forms to its specific anthropological matrix, that is, to the vulnerable structure from which they emerge. These structures – I assume - are axiotypes, that is forms of existence characterized by a given moral value (what is important or ‘matters to’ a given individual pre-structuring a world-view that establishes what is relevant and meaningful).