Feeling and time: the phenomenology of mood disorders, depressive realism, and existential psychotherapy.
S Nassir Ghaemi
Schizophrenia Bulletin November 22, 2006 DOI: 10.1093/schbul/sbl061 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | Depression Philosophy of mind |
| Keywords | Humans Diagnostic errors Emotions Reality testing Self concept Internal-external control Awareness Perceptual distortion Time perception Existentialism Cognition disorders Bipolar disorder Neuropsychological tests Psychotherapy Circadian rhythm Cognitive behavioral therapy |
| Key points | Argues that pure manic and depressive states are less common than mixed states, that time is experienced as sped up in mania and slowed in depression, and that differences in insight contribute to overdiagnosis of unipolar depression and misdiagnosis of bipolar disorder. Proposes that the "depressive realism" model better fits many mild to moderate depressions than the cognitive distortion model, making existential psychotherapy its corollary, and that some chronic sub-syndromal depression after treated bipolar disorder may be existential despair rather than depression proper. |
Abstract
Phenomenological research suggests that pure manic and depressive states are less common than mixtures of the two and that the two poles of mood are characterized by opposite ways of experiencing time. In mania, the subjective experience of time is sped up and in depression it is slowed down, perhaps reflecting differences in circadian pathophysiology. The two classic mood states are also quite different in their effect on subjective awareness: manic patients lack insight into their excitation, while depressed patients are quite insightful into their unhappiness. Consequently, insight plays a major role in overdiagnosis of unipolar depression and misdiagnosis of bipolar disorder. The phenomenology of depression also is relevant to types of psychotherapies used to treat it. The depressive realism (DR) model, in contrast to the cognitive distortion model, appears to better apply to many persons with mild to moderate depressive syndromes. I suggest that existential psychotherapy is the necessary corollary of the DR model in those cases. Further, some depressive morbidities may in fact prove, after phenomenological study, to involve other mental states instead of depression. The chronic sub-syndromal depression that is often the long-term consequence of treated bipolar disorder may in fact represent existential despair, rather than depression proper, again suggesting intervention with existential psychotherapeutic methods.
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