Phenomenology and making sense of the DSM: situatedness in melancholic and atypical depression

Abstract

In light of the recent calls for integrating phenomenology and psychiatry, I will address the problem of heterogeneity in major depressive disorder (MDD) using the phenomenological account of depression put forth by Fernandez (Fernandez, 2014). I will first go over the distinction between two of the major specifiers of major depressive disorder, namely melancholic and atypical depression. Then, I review the account of depression developed by Fernandez, which considers some of the people diagnosed with MDD to have an erosion of the capacity for the category of moods as opposed to a particular kind of mood. I will apply this conception to the diagnostic and statistical manual criteria for melancholic and atypical depression, and consider how reactive and unreactive depressed moods can be clarified using this conception. I argue that we can help our understanding of MDD by viewing melancholic depression as primarily characterized by structural erosion of the person's situatedness (observed as a lack of mood reactivity) and atypical depression as a state in which the capacity for moods in general has not been eroded (hence, the retention of mood reactivity), with the psychopathology rooted only in the content of experience (the moods themselves). I discuss how this conception related to other phenomenological accounts of depression and why it can be useful in making sense of some clinical observations between the two specifiers, namely the differences in illness severity and symptoms of depersonalization and derealization, before concluding the work by considering its relationship with the operationalized approach of the DSM.