Existential Depression: A Nonpathological and Philosophical-Existential Approach

Introduction

Depression is one of the most widespread mental disorders, with more than 300 million people affected across the globe according to the World Health Organization (www.who.int/mental_health/management/depression/en), and can present itself in many forms. Often when we talk about depression, we talk about it generically, not considering that there are many clinical pictures, sometimes very different from each other. It is indeed appropriate to think of depression as dimensional, with different states that vary in intensity and severity, each sharing depressed mood as a common element. This continuum includes “normal” states, such as sadness, “common unhappiness” (Freud, 1892-1895/1967), and the depressive character, up to profoundly pathological states such as major depression, psychotic depression, postpartum depression, or bipolar disorder. On this broad depressive spectrum, there is also a particular condition with primarily philosophical implications, defined here as existential depression.

The current classifications used in psychiatry and psychology tend to ignore, and therefore exclude, this specific condition, including it in the usual diagnostic categories, with the clinical consequence of not properly understanding the philosophical and existential essence of this depressive state and, thus, treating it in an inappropriate way. Depression generally originates from different causes, psychological or biological, or can be the expression of an innate, characteristic individual predisposition. In this article, I want to propose the possibility of a nonpathological depressive state, without any neurobiological causes and independent of typical psychological dynamics, one that derives entirely from an acute and disturbing awareness of our stark existential reality.

The term existential depression defines a condition in which the mood is oriented in a depressive sense, and stems from particular reflections and considerations on the nature of existence (Berra, 2018). In existential depression, the mood is depressive in a similar way to other forms of clinical depression, but there are not known biological causes (as in endogenous depression) nor specific psychopathological dynamics (such as the reactive or neurotic type) as seen in psychogenic depression. Therefore, we must consider existential depression a non-pathological mental state, one which does not necessarily benefit from the usual pharmacological or psychotherapeutic interventions. Typically, this type of depression is pathologized by most clinicians, and considered to be a mental disorder. Not understanding its diversity and true existential meaning results in incorrectly categorizing it within conventional psychopathological frameworks, but above all, to its inappropriate treatment. It is therefore important to be able to define precisely the characteristics and phenomenology of this not uncommon clinical entity, so that it can be recognized, differentiated, and diagnosed correctly by clinicians.

This term existential depression was used the first time by Haefner (1954) to describe a condition that has no clear relationship to previous psychological traumas, but with the whole meaning of life, and which appears when the subject feels a significant absence of goals and aspirations. The same term was used some years later by W. T. Winkler (1957), considering the possibilities of psychotherapeutic treatment of depression. Existential analyst Ludwig Binswanger (1960) recognizes the difficulty of distinguishing sadness as an “existential form” (Daseinsgestalt) from endogenous depression, especially in particularly severe cases. We can consider this kind of existential depression to be the direct consequence of questioning the fundamental meanings of life, and its subsequent emptying and nullification. It is frequently connected to a general feeling of anguish, a troubling sense of malaise from the loss of existential reference points (Berra, 2017). There is a close link between existential depression and anguish because, in both cases, there is a modification of the view and perception of existence, of oneself, and the world. Indeed, a deep sense of anguish is often associated with depressed mood. Anguish and depression have a close interrelationship, overlapping and reinforcing each other.

The Genesis of Existential Depression

In life, there can be moments when deep reflections on existence and its meaning, or lack thereof, lead to a crisis. Questions about the ultimate meaning of life, about what we do, about why we do it, about what we are, about our goals, about our duties, arise at least once in everyone’s existence. The answers to these questions are never reliable and sure, but always insecure and precarious, and only faith or trust in some theory or system can reassure us. Often the solution taken to this dilemma is the assiduous avoidance or denial of the questions themselves. But sometimes, there is no way to avoid the unrelenting anxiety of doubt, and the issue painfully imposes itself without choice.

The search for a definitive meaning in life, one which can express the ultimate truth, is a basically hopeless enterprise. When a person suddenly discovers that life has no intrinsic significance, the only possibility left to him or her is some irrational act, such as religious faith or suicide. If reason wants to impose itself, we have to face the inherent laws and limits of our human mind. This existential crisis of the senses involves an excruciating state of suspension in the void, in the total absence of any certainty. When every formerly held meaning comes to lose its strength or credibility, there is a painful and perilous state of emptiness and suffering, not easily tolerable.

Facing Death

Often the thought of death can induce such a depressive existential crisis. The appearance of the possibility of dying, or instead the awareness of the inevitability of this event, can catalyze the painful loss of meaning of existence. What sense does it make to live if we must die? Why struggle vainly in a life that then ultimately dissolves into nothingness? In the devastating perspective of death, every event loses its significance, and the person may find him or herself empty, discouraged, and defeated, with no more motivation to live.

The human being is thrown into the possibility of dying from the first moment of birth, as a constitutive fact of being in the world. However, the awareness of death, which generates the existential crisis, must be in the authentic mode, that is to say, the direct and real awareness of one’s own inevitable death, of the actual and concrete possibility of no longer being. Usually, in the inauthentic mode of existence, we escape this dreadful thought, or consider it as something that does not belong directly to us. It is not our own personal and real death, the effective and definitive termination of one’s life, but something more vague, less relevant, that does not belong to us. It is always the death of the Other, as some abstract entity, as a theoretical possibility, which we can speak of and discuss, but always with a certain intellectual detachment and distance. But, in the authentic mode, the understanding of death, of the impossibility of existence, of nothingness, the pure and simple nullity of Being, is commonly accompanied by an intense affective state, that for Heidegger (1927), is anguish.

Symptoms of Existential Depression

Existential depression has a series of characteristic symptoms. However, I do not seek to determine specific criteria for a formal diagnosis here but try rather to describe phenomenologically an existential mental condition that should not be considered pathological.

The existential depressive is, above all, hopeless, that is to say, without hope, deprived of the possibility of denying the absolute evidence of the tragic existential facts of life. This hopelessness can be connected to the concept of “depressive realism,” a condition characterized by studies suggesting that mildly depressed or dysthymic people may have a clearer view of some aspects of reality than normal or nondepressed people (Alloy & Abramson, 1979; Feltham, 2017). Once one has become acutely aware of the nothingness that envelops us, when the vertiginous lucidity has reached one, there is no more possibility of going back. The process is irreversible. The lie to oneself, the “bad faith” (mauvaise foi) described in detail by Sartre (1938), is only another ephemeral attempt at salvation, a futile effort destined for failure.

The loss of meaning of existence is then the consequence of the perception of the relativity of everything, of the precariousness of every value, of the awareness of the subtle and deceptive games of our human mind. When we disclose the last enigmatic mystery of life, everything appears empty and insignificant, having lost every sure reference. There is a crucial moment in which every motivation to exist, to plan, to do, to create, can be lost. The prospect of an inevitable, unpredictable, and looming death destroys all vitality. The depressed person’s elàn vital crashes painfully against the overwhelming wall of death, apparently closing off every future possibility forever. It is at this critical and dangerous moment that the idea of suicide may arise, a seemingly thoughtful, rational suicide, subjectively seen as a reasonable solution to life’s absurdity and suffering.

The Nihilistic Attitude

Life’s unfairness, the constant struggle, loss, the pain, the infinite, the doubt, the temporariness of everything, death, the evil that surrounds us. These are real, indisputable, and undeniable existential truths, unlike the psychotic distortion of reality characteristic of pathological conditions. Nevertheless, this nihilistic attitude can become, in some ways, excessively pessimistic, never balanced by a positive view of existence. For this reason, we consider existential depression a phase, a pivotal point in the life of the individual, which must be somehow overcome in existential psychotherapy. Remaining in this painful condition with no psychological, philosophical, or spiritual evolution, eventuates in a perilously pathological and profound form of depression.

Despite experiencing such existential anguish, the depressed person can maintain a good, gratifying, even satisfying social and work life, without pathological symptoms such as severe abulia and apathy, psychosomatic disorders, or delusional ideas. Insomnia may appear in the initial phase, representing a sort of potentially positive existential catalyst, one in which recurring and persistent thoughts about the nature of existence can eventually lead to increasing awareness. The last typical symptom to consider here is the frequent presence of a vague and heterogeneous feeling similar to that of boredom. Boredom is a sense of malaise, ennui, and inertia, with an oppressive monotony of deeds and thoughts. It is the expression of a subjective state of suspension of time, of stopping the natural flow of life, of emptying existence. Boredom, says Kierkegaard (1844/2014), rests on nothingness, meanders through existence, and its vertigo is similar to what one feels when staring into the infinite abyss. For philosopher Martin Heidegger (1927), boredom is a potentially revealing feeling that allows us to better grasp the totality of our being, thus becoming authentic boredom. He writes in Was ist Metaphisik (Heidegger, 1929): “The deep boredom that, like a silent fog, collects itself in the abyss of our being, unites us men and things, ourselves with all that is around us, in a singular indifference” (p. 66).

Boredom is then an opportunity to deeply perceive the essence of our existence. “Boredom,” writes Cioran (1949), “is the echo that is in us of time that tears, . . . the revelation of emptiness, the depletion of that delirium that sustains—or invents—life” (p. 26). Somewhat differently, Schopenhauer, in the World as Will and Representation (1819/2014), affirms that, “Life is a perpetual oscillation, where as soon as misery and pain grant man a truce, boredom is immediately present” (p. 412). Only humans, so far as we surmise, can feel boredom. Boredom, when courageously and consciously related to, can be a way to discover our authenticity, forcing us to face the nothingness of existence, and this expresses an important aspect of the psychological state of existential depression. As Sartre (1943) succinctly states, “Consciousness is being, the nature of which is to be conscious of the nothingness of its being” (p. 86).

Treating Existential Depression

Once the big question about the meaning of life has come up, it is challenging to give a firm answer authentically, while at the same time, not abandoning or evading the issue. In fact, being in an authentic mode does not allow for escaping the subject of the meaning of life. Returning to a dimension of ordinary existence, or we could say inauthenticity, where the question does not arise, is a difficult and often impossible undertaking (Berra, 2015). At the same time, no proposed truth regarding the meaning of life has ever been without a doubt. In this sense, as Sartre (1938) suggests, meaning is not so much found or discovered, but must be constantly created anew by each of us.

The human mind has the peculiarity of asking questions as the outcome of an intrinsic way of functioning. The awareness of the fact that often issues, such as the one about meaning, are the result of specific mental mechanisms, like the law of causality (Berra, 2006), and tend to diminish the value of the question. “He who knows no longer believes in all the stories generated by desire and thought, comes out of the current, no longer consenting to deception,” says the philosopher Emil Cioran (1969, p. 99). “Knowing” is here tantamount to having revealed the self-deception that produces our thought. Questions such as, “What is the meaning of life?” can never receive answers free of uncertainty. There will always remain an unsurpassable quota of doubt, because the question itself is a consequence and artifact of our human psychology, which compels us to search for a purpose, a motive, a cause, a meaning, without necessary correspondence in reality.

Albert Camus writes in the Myth of Sisyphus (1942), “the reflection on the ‘why’ brings the spirit to fall back on itself, and the understanding of the world depends solely on the form given to it by the man himself” (pp. 19-20). Therefore, principles, which are inherent to the structure of human thinking, impose “whys,” or force us to postulate the existence of abstract and unreal concepts, such as that of nothingness, the possible, and the absurd. Resolving existential depression requires helping patients become more aware of the relativity of their reflections, and the arbitrary consequences of our mental functioning. The resulting “emptying” of truth leads us to the need to choose to reformulate a path away from the comforting yet artificial claims of our own elaborate theories. This painful yet insightful and potentially liberating moment is indeed fundamental, and essential for patients to experience in the effective treatment and evolution of an existential depression, which, if it remains stuck and blocked in a darkly nihilistic vision, can lead only to an increasingly pathological and disturbed state of mind, and possibly suicide in some tragic cases.

Psychiatrist and philosopher Karl Jaspers, in the Psychology of the Worldview (1919), identifies behind single existence a transcendental structure, defined as a “blank and naked reticulate” (pp. 38-39) that the individual fills with meaning, thus determining their existence and vision of the world. The human mind is originally an empty, vacuous container, a tabula rasa, that can be filled with the most heterogeneous ingredients: values from family or social culture, experiences, memories, beliefs, and myriad ideas. Thus, progressively, the individual structures and gives meaning to their life and Weltanschauung.

This is not a static and unchangeable way of relating to existence, but rather a fluid and pliable condition concerning events and the will of the individual (Berra, 2013a). The “emptying” of the value content, the nullification of the essence of things in the world, does not imply the permanent irreversibility of this phenomenon. The “empty and naked reticulated” can be filled up again, but now chosen with a full and conscious will, and this can be a vital task in psychotherapy with these existentially depressed patients.

Conclusion

Existential psychotherapy (Berra, 2013b, 2014) emphasizes the philosophical, humanistic value of individual existence and its relations with the world, trying to avoid conditioning arising from preconceived interpretative theories, models, diagnostic categories, or standardized intervention methods, and operating without the presupposition that every sort of mental suffering must be classified as pathological and cured. Existential therapy and philosophical counseling represent an ideal approach for an inner rebuilding of meaning and identity, wherein a philosophical attitude becomes a central tool (Berra, 2016). In fact, for me, the problem of existential depression is primarily philosophical, and philosophy, more than any other discipline, properly poses the question regarding the meaning of life. It is, therefore, necessary to embark on a path of philosophical re-elaboration and re-clarification, through which the worldview of the individual’s sets of ideas, values, and meanings are existentially analyzed, discussed in depth, and finally, freely and consciously chosen, giving a new shape and vitality to life.