08 - Mental health in a pandemic: why social distancing must only bring us closer - Jamie Bobowicz
The Office for National Statistics published data showing that as of June 2020 19.2% of people reported moderate to severe depressive symptoms, in comparison with 9.7% as of March 2020. In many ways, this makes sense; the pandemic has and is inflicting immense amounts of stress, whether it’s bereavement, social isolation, financial hardship, and so on. 2020 was not an easy year by any stretch of the imagination and we all hope things get better, fast. But, in the case that we’ve still got some time to go, how do we go about mitigating these detrimental effects on our mental health and the prevalence of depression? For me, a crucial starting point is to readdress our understanding of depression, to hopefully better equip ourselves in trying to deal with it.
There seems to be a strong disconnect between our scientific understanding of depression and our understanding of the experience itself. Whilst we can assert that it manifests as some sort of chemical imbalance in the brain, depression isn’t experienced in the brain. But, how then, do we explain the experience? The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, uses ‘depressed mood’ to explain a key feature of major depressive experiences. It strikes me as problematic that our latest and greatest attempt to describe and explain the depressive experience culminates as such. In many ways, it seems to fall short; at the very minimum, the proposed explanation ought not to be some rehashing of the thing itself. Whilst it is perfectly natural to struggle in such turbulent times, we don’t exactly tilt the odds in our favour wielding this insufficient understanding of the depressive experience. In what follows, I seek to address this problem using phenomenology, offering an explanation that helps us better understand the experience, especially in our current context.
Phenomenology is best understood relative to Cartesianism. Roughly characterised, Cartesianism seeks to extract the human experience from our explanation of the world and the things within it. The thought is that we should quarantine things like sense perception and emotions as they are distortive relative to an accurate understanding of reality. Comparatively, phenomenology emphasises the very structure of human experience by and through which we come to form an understanding of the world. The idea is that our understanding of reality cannot be extracted from the structure of the human experience, nor does it make sense to try to. At its core then, phenomenology seeks to explain how it is that the world shows up as meaningful, not merely as something of theoretical apprehension. It is this focus on the lived experience that renders phenomenology so useful to the current task.
A distinctive structure of experience to have been highlighted in the phenomenological tradition is to always already find oneself embedded in a meaningful world. When I believe X, imagine Y, remember Z, and so on, I always already find myself immersed in a world in which such intentional states are possible. To give a more explicit example, to sense danger, I must already find myself in a world that incorporates the possibility of threat. The underlying point is that our experience of the world or how it shows up as meaningful is structured by the spaces of possibility incorporated within it.
This can be developed further. Not only is it that this space of possibility in which we find ourselves shapes how the world shows up as meaningful in the present, but it also shapes how we anticipate the world showing up as meaningful in the future. This is quite an intuitive addition. Experience does seem to unfold against a backdrop of that which we anticipate as possible. Consider a surprise: an experience is only surprising insofar as it contradicts that which we anticipated. The overarching point is that our experience of the world (both current and that which we anticipate) occurs against and according to an all-enveloping backdrop of the spaces of possibility offered within it.
It is relative to this understanding of experience that we can better explain depression, as a drastic shift in the all-enveloping structure of experience. Before going further, it is useful to first ground how any such shift in the structure of experience can occur. Consider the evening in which your friend blows you out. You feel pretty bored and lonely. There is a sense in which your mild sadness influences how the rest of your evening is experienced: the recipe you planned on making doesn’t seem that enticing anymore, the film you picked out probably won’t be that funny and the idea of work tomorrow seems to linger. It is not that you are refusing to see things otherwise, your experience just unfolds as such.
Depression is then more adequately explained as a far more powerful shift in the governing structure of experience, drastically changing the types of possibility offered by the experienced world. Hope and happiness, for example, no longer feature as incorporated within one’s space of possibility. In the same way one cannot sense danger in a world that doesn’t incorporate threat, the depressive cannot be optimistic in a world that doesn’t incorporate hope. The depressive finds themself in a completely different space of possibility, in which, hope and happiness are no longer entertainable states.
In drastically changing the space of possibility in which one finds oneself, depression not only alters one’s experience of the present but also that which one anticipates as possible in the future. It is in this sense that depression seems eternal. In finding oneself in a space of possibility bereft of happiness and hope, it is impossible to anticipate a future in which things are different. It is not that one no longer understands the concept of happiness, but that no future presents itself in which one is happy. Unlike when my friend bails on me, the depressive fails to retain a sense in which their experience is temporary. Their experience of the world is bereft of an important sense of contingency, which can otherwise ground the anticipation of things being different.
So, how does this understanding of depression change anything?
First and foremost, it helps us better conceptualise the importance of interpersonal relations as a component of strong mental health; instead of functioning merely as a means to take our mind off things, social interactions help us retain the vital sense in which our experience is contingent, the loss of which is central to depression. That is, interpersonal relations are capable of imbuing the world with a distinctive kind of openness and uncertainty. It is a kind of uncertainty that is in normal times taken for granted, but that means the night your friend bails on you, your sadness is experienced as passing. It grounds the sense in which things can be different; the sense in which that which is possible is not exhausted by what I can currently conjure up. Whilst interpersonal relations influence our experience of the present, it is crucially our anticipation of future interactions that imbues experience with an important unknown, which precludes one’s current predicament from being experienced as inescapable. It is because of this openness that where interpersonal relations persist, we enable ourselves to entertain future possibilities for ourselves and our realities which we do not yet know. As such, we actively reduce the extent to which one’s situation is experienced as incapable of being otherwise and help retain the anticipation of a different state of affairs in the future.
And so, it is no surprise that during a time in which our social lives have been so disrupted and restricted that it has become harder than ever to entertain a future in which things are different. COVID-19 has undeniably presented a uniquely distressing situation, frustrating one of the strongest resources in our repertoire to help negotiate depressive experiences. However, I do not see this as a cause to lose hope, but as a reason to collectively prioritise the ways in which we can still socially engage and interact. Primarily, we’ve got to do more than just check in with people, we must make concerted efforts to nurture and sustain meaningful connections. This is not achieved through explicitly imposing one’s positivity on each other every now and then. Rather, the capacity to entertain a future possibility of happiness and hope is symptomatic of sustained and meaningful interpersonal connections, which require due care and attention.
So, ultimately, this means that it is a matter of quality, rather than quantity. For myself, I much prefer face-to-face interaction in the form of socially distanced walks. The face-to-face component more naturally retains the sense of a formalised social event, creating something to look forward to and making it easier to give time to each other. However, where this isn’t possible, we need to be more explicit in our efforts to make an occasion out of social interactions. This can be something as simple as instead of giving someone a quick ring, suggest a time to sit down and have a coffee together over a video call, thereby preparing yourself to fully engage with and dedicate time to each other, no differently than you would in normal times. It seems strange to think of it in this way because our social lives normally take care of themselves, but in a time of such social frustration, our efforts to preclude social estrangement must appropriately adapt. Above all else, revisiting our understanding of depression in this way emphasises the collective importance we all bear to each other and that, fundamentally, addressing it is partly a collaborative project.
A collection of useful resources to help us through this difficult time:
· Young Minds advice page: Coronavirus and mental health
· Work from home: a wellness action plan
· NHS Psychological Therapies Service