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Authenticity & Treatment For Depression

Alisa Anokhina on how the quest for authenticity can help in treating depression.

Colloquially, the word ‘depression’ is often used for listlessness, extreme sadness, or a profound sense of loss. It’s no wonder that so many people with a diagnosis of depression struggle to be taken seriously: to the unaffected, the problem sounds akin to a diagnosis of ‘sadness’. But sadness, in fact, is not the only or even the main complaint: a clinical diagnosis of Major Depressive Disorder requires at least five symptoms, and only one of those refers to a ‘depressed mood’. Depression is exhausting. Feelings of listlessness and fatigue saturate life, and everyday tasks become laborious, as though wading through tar. Things which previously gave joy or rest become encumbering; socializing is a chore. Shadows creep across the walls of the mind. Depression is not the same as sadness. Sadness is transient – depression is pervasive.

Depression is like schizophrenia in the sense that both are disorders of perception. It is difficult to accept the extent to which our emotions warp our reality. Writer Andrew Solomon has said that, in a depressed state, “you think that the veil has been taken away, the veil of happiness, and that now you are seeing truly” (see Depression, the secret we share in TED Talks). The depressive comes to believe the worthlessness – either their own or the world’s – and this belief appears infallible, despite evidence to the contrary.

The nature of the link between perception and reality is perhaps one of the oldest philosophical debates. The debate is also one without a resolution. Even if what we perceive as reality might not be reality, we have no choice but to continue behaving as if it were. Yet from a neuropsychological perspective, the possibility that our grasp of reality is limited, or even corrupted, is almost a certainty. Our brains provide our only window to the world, and, like any other organ, they’re fallible and prone to malfunction. Our brains are capable of creating false memories; we mistake dreams for reality; and we fall for optical illusions. Hallucinogenic drugs systematically distort perception.

Existentialist philosophers discuss the nature of experience from the perspective of meaning and morality, arguing that the world is intrinsically meaningless. This realisation can be the source of anguish and anxiety: if life is intrinsically meaningless, then why live? The existentialist solution to this nihilistic dread is autonomy. Within existentialist philosophy, the onus is on us to define our values, and to act in a way that is consistent with them, so shaping our selves. We are thus to reject the social roles and assumptions thrust upon us by others, and discover our authentic selves. The self only becomes authentic when it is consciously constructed; until we do that we are merely a patchwork of our genes, culture, upbringing, and experiences. Discovering the authentic self also means making decisions about the version of reality we choose to accept. By definition, this process is subjective. And it can be applied to help treat clinical depression.

People who have overcome depression talk about it as a restorative process: a disintegration and subsequent rebuilding of the self. Severe depression can be crippling, but these phases will often naturally give way to periods of remission. In these states a beneficial reevaluation of perception can be sought. This can involve questioning deeply ingrained thought patterns, (re)assessing personal values, and evaluating one’s personal development. Because the immediate causes of depression will be different for every person afflicted with it, overcoming it also requires introspection.

The issue of agency comes into play here. Often, depression can arise seemingly out of nowhere, causing significant confusion and distress to a person. Other times, depression follows a catalyst: the loss of a loved one, or a significant personal failure. The negative aspects of life which can serve to exacerbate depression can sometimes be removed; for example, a toxic relationship, or an unfulfilling job. However, we must accept that our agency is limited. We will always be tethered to our basic biological needs, and constricted by social rules. The only way in which we are infinitely flexible is in the construction of our values. This is, perhaps, the only sphere in which our own agency is absolute. The pursuit of authenticity allows us to set our own parameters here. Ultimately, depression is the consequence of genetic predisposition, chemical dysfunction, and, in many cases, a catalyst. We cannot undo the loss of a loved one, or escape the confines of social norms. However, fallacies in perception and interpretation perpetuate depression, and we have the agency to alter these.

People with depression are often reluctant to try drug therapies because they worry about warping their reality and sacrificing their authenticity: Is the medicated mind artificial, or does medication restore normality to a mind which is deficient? Am I still myself if every day I swallow a powder which changes how I think and feel? Seeking treatment can also feel like lying to yourself: if one is unworthy of life, then one is certainly unworthy of treatment. In a state of depression, worthlessness appears to be a fact, a complete certainty. Viewing the world through depression can give the impression of finally seeing things for what they are. Through existentialist thinking, however, it is possible to break down these sorts of assumptions: if no values are objectively true, then the depressed mind can be reevaluated. Here medication is nothing more than a repair mechanism for a malfunctioning organ. Of course, not all medications work equally for everyone, and side effects are a valid concern. However, through existentialist eyes, we can see that refusing treatment on the basis of its effects on one’s ‘objective’ reality or on the ‘authentic unmedicated self’ is invalid.

Depression can often be devastating – but in cases where subjective reevaluation can lead to the creation of an authentic self, the person can be transformed.

© Dr Alisa Anokhina 2016

Alisa Anokhina obtained her PhD in Psychology at University College London. She works in London as a research psychologist.

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