Wednesday, 27 September 2023

Losing the light at the end of the tunnel: Depression, future thinking, and hope

Today's post is by Juliette Vazard on her recent paper "Losing the light at the end of the tunnel: Depression, future thinking, and hope" (Mind & Language 2023). Juliette Vazard is a postdoctoral researcher at City University of New York, Graduate Center and she works at the intersection of philosophy of mind (particularly emotion), epistemology, and cognitive science.

Juliette Vazard

Patients with clinical depression show a significant decrease in their ability to entertain thoughts of future positive events that could happen as part of their lives (MacLeod et al., 1996; Bjärehed et al., 2010; Thimm et al., 2013; Anderson & Evans, 2015; Szőllősi et al., 2015). Understanding the mechanisms which sustain this change in prospective cognition is of major clinical import, since developing a perspective on the future is key in the recovery of these patients (Cooper, Darmody, & Dolan, 2003). 

Although the connection between lack of hope and depression is well established in the literature (Cheavens, 2000; Beck et al., 1979; Lazarus, 1980), much empirical research is focused on the idea that pessimism and hopelessness are the result of an inability to imagine desirable possible futures. Instead, in this article I take seriously the hypothesis that a loss of the affective capacity to experience hope is causally responsible for the change in the prospective cognition of patients. This hypothesis rests on the more general idea that our ability to engage with desirable hypothetical futures might depend in large part on our affective disposition to experience the anticipatory emotion of hope.

I thus propose, using a viable concept of “hope” as developed by philosophers of emotion, that a reduction in the affective disposition towards hope might be a direct cause of the reduced ability of depressive patients to generate rich mental representations of desirable futures. In the philosophy of emotion, hope is viewed as an evaluative state which immediately apprehends a given possibility p as a genuinely possible and desirable state of affairs. As a positively valenced emotion, hope takes the phenomenological shape of a longing towards its target state of affairs, and involves a motivation to pursue and promote it. Because hope is an “anticipatory emotion”, this motivated pursuit includes attempts to practically promote p, but also the recruiting of imagination and counterfactual reasoning to create a rich (conceptual and sensory) mental representation of p that one can entertain and manipulate in thought. 

In short, feeling hope towards p acts as a motivating reason to deploy certain possible futures (the ones that we view as both desirable and genuinely attainable) in thought, enrich and refine our mental presentations of them, so as to explore them, learn about them, and promote them. According to this conception of hope, hope is an evaluative and motivational mental state which functions to direct our attention and our motivation to identify and pursue hypothetical futures that we desire for ourselves. Accordingly, subjects who lose the disposition to experience hope lose this important source of motivation to generate positive episodic future thinking. An affective dysfunction could thus be directly responsible for the decrease in positive prospective cognition in depression individuals.

This idea implies a reversion of the assumptions and methods of future‐directed therapies (FDT) for major depressive disorder (MDD). Rather than focusing on developing goal-setting and planning skills in patients, eliciting genuine hope could be a useful, primary goal of future-directed therapy.