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 the University of Toronto 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.

Epistemic injustice in the therapeutic relationship in psychiatry

Today’s post is by Eisuke Sakakibara, who is currently a lecturer at the University of Tokyo Hospital. He is a clinical psychiatrist as well as a researcher in the field of philosophy of psychiatry. Since 2013, he has been leading a study group in Tokyo, aptly named Philosophy of Psychiatry and Psychology. 

His recent publication, “Epistemic injustice in the therapeutic relationship in psychiatry,” published in Theoretical Medicine and Bioethics, discusses the effects of epistemic injustice on the interactions between psychiatrists and their patients. Originally, this post appeared on the EPIC blog on 6 June 2023.

Eisuke Sakakibara

I first heard of the concept of epistemic injustice in 2019 in San Francisco. From that moment on, I intuitively knew that it is a concept suitable to highlight practical and ethical issues of communication that arise between psychiatrists and psychiatric patients. I have decided to further my research.

The psychiatrist-psychiatric patient relationship is a type of doctor-patient relationship, and furthermore, the doctor-patient relationship is a type of professional-client relationship. I have made a distinction between problems that arise specifically between psychiatrists and psychiatric patients, problems that arise within the broader doctor-patient relationship, and problems that can arise generally in the professional-client relationship. Although there are no clear boundaries to what is called professional work, in addition to the classic three professions of physician, lawyer, and clergy, one could add psychologist, pharmacist, accountant, etc. to the list of professionals.

Professionals’ work involves helping clients solve problems through paid consultation. This problem-solving process requires an “epistemic collaboration,” a shared understanding and exploration of the problem, between the professional and the client. However, a professional’s high level of expertise and their close-knit relationships with peers can sometimes hinder this collaborative process. They might unintentionally dismiss certain issues important to the client as irrelevant from a professional perspective.

The doctor-patient relationship is unique among professional-client relationships in that it seeks to solve the client's bodily problems. Thus, the client experiences the duality of being both the problem solver and the problem itself—both informant and source of information. This is where the epistemic injustice inherent in medicine can arise, since in today’s medicine, objective findings from the patient's body, such as CT scans and blood tests, tend to be more prioritized than the patient’s verbal complaints.

Finally, psychiatry deals with illnesses that may impair the patient’s rational capacities, which further creates additional difficulties in epistemic collaboration. If a patient is delusional, the psychiatrist may have to accept the patient’s utterances not as testimonials, but as sources of information that reflect the patient’s illness.

The paper identifies a variety of epistemic injustice that occurs between psychiatrist-psychiatric patients from these three perspectives and proposes possible remedies.

Information Deprivation and Democratic Engagement

Today's post is by Adrian K. Yee. Adrian is finishing his PhD at the University of Toronto focusing on the intersection of philosophy of science, politics, and economics (PPE) and will begin a position as Research Assistant Professor at Lingnan University starting August 2023. 

Adrian has previously published on ‘econophysics’ (applications of physics to economic & financial phenomena) and misinformation studies, and has a forthcoming paper improving the methodology of Universal Basic Income studies. His upcoming research projects focus on philosophy of AI, attention economics, and epistemological & ethical issues in military intelligence analysis.

Adrian K. Yee

In the paper ‘Information Deprivation and Democratic Engagement’, I argue that there remains no consensus among social scientists as to how to measure and understand forms of information deprivation such as misinformation. Machine learning and statistical analyses of information deprivation typically contain problematic operationalizations which are too often biased towards epistemic elites’ conceptions that can undermine their empirical adequacy. A mature science of information deprivation should include considerable citizen involvement that is sensitive to the value-ladenness of information quality and that doing so may improve the predictive and explanatory power of extant models.

There are three central problems extant models face. Firstly, operationalizations of misinformation are too focused on problematic alethic accounts (i.e. misinformation defined as simply false information) considering there is false information that is extremely useful and explanatorily powerful (e.g. any regression method in applied statistics) and there is true information that is misinformation (e.g. spin, malinformation, misleadingness etc.). 

Secondly, the intrinsic value-ladenness of judgments of misinformation entails that determining information quality is not something intersubjectively verifiable in the way natural scientific phenomena are; hence, information quality is intrinsically socially constructed and negotiable by relevant stakeholders. 

Thirdly, it follows that if we wish to avoid epistocracies, or harmful misinformation laws like Singapore’s since 2019, which fail to provide an adequate definition of misinformation (i.e. it simply allows the state to fine or imprison those it considers engaged in seditious informational practices), then we require further democratic engagement in the adjudication of information quality. As it stands, epistemic elites (e.g. journalists, university researchers, government policymakers, etc.) are almost entirely the ones who are solicited for adjudicating information quality, especially in supervised learning contexts in algorithmic content curation. 

And yet, given that information quality is manifestly not merely a matter of truth, but can involve considerations of explanatory power, relevance, aesthetic quality, moral consequences, parsimony, and other epistemic and non-epistemic values, it follows that such values will require input from average citizens much more so than is currently the case in extant models.

Is it good to conceive of one's life narratively?

This post is by Sally Latham. Sally is a PhD candidate with the Open University Philosophy Department, researching non-narrative approaches to treating mental illness. She also teaches Philosophy A Level at Birmingham Metropolitan College. 

Sally Latham

Stories are undoubtedly amazing things. Telling and listening to them improves our lives in many ways. However, in my view, this is not true of the stories we tell about our own lives.

In my PhD thesis I reject the widely-held view that telling our life-narrative is a good thing. I focus particularly on why illness narratives and narrative-inspired therapies are not always the ideal form of treatment for mental illness (and in fact can do more harm than good). This sits within a far broader social paradigm in which ‘telling your story’ has become almost a cultural imperative, especially when recovering from mental illness.

One of the many reasons I believe the dominance of life-narratives to be so worrying is that – contrary to the prevailing view – they are likely to hinder self-understanding, misrepresenting our lives.

In this blog, Grace Hibshman discussed her paper "Narrative, Second-person Experience, and Self-perception: A Reason it is Good to Conceive of One's Life Narratively" (2022). In it, she argues that life-narratives can yield a rare second-person insight into oneself, which you can obtain by imagining an audience immersed in your life-narrative. This insight can enhance self-understanding, which contributes to flourishing.

In our short paper "Is it Good to Conceive of One’s Life Narratively?" (2023), Mark Pinder and I argue that, pace Hibshman, life-narratives are likely to misrepresent our lives and therefore hinder self-understanding and flourishing.

One way in which this can happen is because we confabulate. We give earnest, coherent reasons for our choices, but these are not backed up by relevant evidence and do not correspond to our actual decision-making process (Nisbett and Wilson 1977). These will sometimes conform to already existent biases (Bortolotti 2018). This will naturally translate into the decisions we include in our life-stories, meaning that despite our best intentions, the explanations given in our narratives will be confabulated.

Additionally, we seek the gratification of the emotional closure that a good story brings, and mistake emotional closure for truth. A ‘good’ story provides an emotionally satisfying resolution, often conforming to familiar tropes, such as rags-to-riches, sinner-to-saint or triumph over adversity. A story that provides such emotional closure is more likely to seem true, regardless of its actual truth, even when that story is about ourselves.

Moreover, even if individual events within a narrative are accurately represented, a life-narrative can still misrepresent due to the way those events are selected. In putting together our life-narratives, we disproportionately favour events that support our self-conception: if I believe I am courageous, I will discount the times I shrank from danger. The resulting life-narratives misrepresent us.

We tell our stories to ourselves and others, in good faith. In so doing we may well gain a new perspective on ourselves. But that new perspective is likely to be of a misrepresentation. In telling our life narrative, we mislead ourselves about who we are.