Husserlian Phenomenology and the Treatment of Depression

Commentary and Critique

Marilyn Nissim-Sabat
Philosophy, Psychiatry, & Psychology, Volume 17, Number 1,
March 2010, pp. 53-56 (Article)
Published by The Johns Hopkins University Press
DOI: 10.1353/ppp.0.0270

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Husserlian
Phenomenology and
the Treatment of
Depression:
Commentary and
Critique
Marilyn Nissim-Sabat

Keywords: Husserl, phenomenology, psychotherapy,

drug therapy

rofessor hadreas begins his interesting

and challenging essay by saying that, This
paper is concerned with a model of selfawareness which fits the testimony of subjects
reactions to selective serotonin reuptake inhibitors (SSRIs), of which fluoxetine (Prozac, Lilly,
Indianapolis, IN) is probably the best known
(2010, 43). Several important features of Dr.
Hadreas approach can be inferred from this statement. Most important, the verbatim testimony of
subjects regarding their states of self-awareness
is analyzed and interpreted for its compatibility
with three philosophical models of self-awareness:
Empiricism, rationalism, and Husserlian phenomenology. This is the methodology through
which the author aims to show that one of the
three models is more adequate than the others as
a model of the self-awareness of the subjects, and
that model is that of Husserlian phenomenology

2010 by The Johns Hopkins University Press

(hereinafter, phenomenology, with the understanding that only phenomenology according to Husserl
is intended by both Dr. Hadreas and myself). In
formulating this as the aim of his paper and his
research, Dr. Hadreas has taken on an extremely
difficult task.
In general, attempts to show that any philosophical stance bears directly and immediately
on the understanding of patients symptoms, as
well as on both theoretical and therapeutic work
with people with mental disorders, is, owing to the
ostensible gap in levels of conceptualization and
systematicity, that is, the theory/praxis divide ostensibly separating the two realms, extraordinarily
difficult. The task is rendered even more difficult
in work like that of Prof. Hadreas, in which, I
believe, the researcher does not want to apply
philosophy parasitically, as if research into psychiatric phenomena in relation to philosophy is
just a matter of cannibalizing philosophy for selfjustification, or vice versa; rather, Hadreas wants
to preserve the integrity of both research into the
phenomenology of psychiatric disorders and of

54 PPP / Vol. 17, No. 1 / March 2010

the philosophical perspective that may improve

understanding of those disorders. In undertaking
an effort along these lines, Hadreas breaks new
ground.
In particular, for this commentator, bringing
Husserlian phenomenology to bear on these issues is particularly gratifying. Moreover, and
most important, Hadreas bases his critique of
classical empiricist and rationalist models of selfawareness on bringing to the fore Husserls views
on pre-reflective consciousness. This is extremely
important for, as Dan Zahavi, noted Husserlian
phenomenologist and philosopher of the phenomenologypsychiatry interface, points out, not only
in the book cited by Hadreas but in a more recent
article (Zahavi 2003), Husserls notion of selfawareness has been critiqued by many who claim
that he lacked a notion of pre-reflective consciousness. Indeed, Zahavis (2003) work in this area
quite effectively refutes these claims, and he does
so by drawing on a large body of evidence from
Husserls posthumous writings. Thus, Hadreas
is to be congratulated for using Husserls longneglected notion of pre-reflective consciousness
as a means of approaching phenomenologically
the testimony of patients who discussed changes
in their self-awareness owing to their experiences
with SSRI medications, chiefly fluoxetine. However, it is just because I share with Hadreas the
conviction that Husserlian phenomenology is the
best philosophical approach to understanding,
and indeed, possibly improving the treatment of
mental disorders, that I think it is vital to raise
some questions regarding Hadreas approach.
My first critical comment is this: Hadreas aim
in writing his paper is unclear in a way that calls
his project into question. In the conclusion of his
paper, he indicates that his findings can enable
psychiatrists to determine which patients are more
likely to experience SSRI cures. Given this, it
would seem that his purpose in introducing Husserlian phenomenology is to facilitate this goal.
Those subjects, he finds (based on his phenomenological analysis of the subjects own testimony),
who have lived enough of life to have formed,
for better or worse, an abiding empirical ego are
more likely to be good responders to SSRIs.
It would seem, then, that this finding would aid

psychiatrists in evaluating patients who have been

treated, or who might be treated, with SSRIs. This,
then, if correct, would be a considerable validation
of the practice of treating depression with such
medications. In this sense, we can view the paper
in question as a report to psychiatrists of some
research data, with a philosophical framework
for understanding the data. This bears directly
on one of the marked, and I think problematic,
characteristics of Hadreas paper that leads to the
unclarity of purpose in the paper.
When Hadreas describes the subjects whose
testimony he uses (not his own patients, but
gleaned by him from several books), the paucity
of information he provides about these people
is quite striking. Of course, because none of the
respondents were his patients (as far as I am
aware, Hadreas is not a psychiatric practitioner),
additional information might not be available.
Not having read the books in question, I do not
know. But, Hadreas does not expect his readers
to have read the books in question. Nevertheless,
these are the patients, or subjects, whom he chose.
What is problematic is that in no case are we
informed whether or not the subjects, any or all,
were receiving any other modalities of treatment,
for example, psychotherapy, before, after, or in
conjunction with their drug therapy. Are we to assume that they were not? This is not a satisfactory
basis on which to evaluate the research. Why is the
question of psychotherapy important?
In the first place, consideration of the question of what modality of treatment is best for a
given patient or patients is both a clinical and an
ethical imperative. As noted, Hadreas determined
that patients with an abiding empirical ego are
more likely to experience SSRI cures of their
depression. However, an abiding empirical ego
is also a good indicator for the outcome of psychotherapeutic treatment of depression and other
problems that bring people to psychotherapy,
and many people are treated for depression by
psychotherapy alone or, as recommended by the
American Psychiatric Association, by combined
psycho- and drug therapy.
It is important to bring Husserlian phenomenology to bear on the discussion of this point,
the question of treatment modalities, in a manner

Nissim-Sabat / Husserlian Phenomenology 55

that Hadreas does not. From the Husserlian point

of view, an SSRI cure for depression is necessarily experientially different, for the patient, than
a cure via psychotherapy. The reason for this is
that different intentional acts are the basis for the
phenomena, the changes that take place in the
patients experience. This can be illustrated in this
way: The Husserlian notion of the intentionality of
consciousness views consciousness as noetic, that
is, as act consciousness, the locus of acts of intending objects of either inner or outer experience.
Thus, the act of intending a fantasied object is a
different act than the act of intending a perceptual
object, and, different acts are experienced differently by the subject intending those acts.
Thus, when patients take medications, they
have a set of beliefs and attitudes regarding
what will or will not happen to them as a result,
and these factors are variables that should be
incorporated in any study. People who undergo
psychotherapy have a different set of such beliefs
and attitudes that are also relevant variables.
Moreover, outcomes and goals of drug treatment
versus psychotherapy, or conjoint with psychotherapy, are very different, and these differences
are also relevant to any phenomenological assessment. For example, there is no indication in
Hadreas paper whether or not any of the patients
improvements were understood to have endured
after drug therapy was (if it was) discontinued.
Yet, the goal of psychotherapy is for patients
to experience continued improvement after the
therapy is completed. In his paper, Hadreas does
not mention psychotherapy at all.
What is at issue here is the qualitative character
of the patients experiences, with the supposition
that such qualitative differences are experienced
and can be expressed by patients. The absence of
consideration of qualitative differences, the type
of differences that can be phenomenologically
conceptualized and explored, indicates the severely
limited scope of the paper as a whole, and this narrowness of approach leads to further problems.
In the first place, because we learn so little about
the subjects, the suspicion arises that, primarily,
rather than providing a means of improving the
outcome of drug therapy for certain patients, Hadreas chief interest or aim in the paper is to validate

Husserlian phenomenology. Hadreas analysis incorporating phenomenological concepts (most importantly, pre-reflective consciousness) that set
phenomenology apart from classical philosophical
empiricism and rationalism, receives a validating
boost when we learn that the patients post-SSRI
descriptions of their experiences coincide with
the phenomenological notion of consciousness,
or, rather, the phenomenological notion of prereflective consciousness, as over and against the
other two philosophical stances. So, again, the
aim of Hadreas project in his paper is marked by
unclarity, and this unclarity obscures crucial issues
and can generate misleading inferences.
Furthermore, a very important caveat must
be issued here. Because Hadreas neither discusses
any other modality of treatment nor gives us any
significant details of the subjects ongoing lives, he
generates the sense that SSRI cure is the way to
go for these patients. And, as noted, he in no way
addresses possible qualitative experiential differences for different modalities of treatment. Thus,
although Hadreas does not at all declare himself
regarding the best modality of treatment for the
subjects he discusses, it is difficult to escape the
conclusion that for him drug therapy is the therapy
of choice, whether or not this is what he actually
believes, or whether or not he has any opinion
on this matter.
The further problem here is that focusing very
narrowly, as Hadreas does, on drug therapy without any discussion of the naturalistic implications
of such therapy is profoundly incongruent with
Husserlian phenomenology, and Hadreas failure
to even mention this issue severely compromises
the value of his paper. It is simply not credible to
present a phenomenological analysis of outcomes
of drug therapy without raising the question of
how these results are to be understood in terms
of implications for a perspective, phenomenology,
that holds the person to be a psychophysical unity
that is incompatible with any physicalist reduction.
My point is not at all that a more comprehensive
phenomenological approach to these issues necessarily would lead to rejection of drug therapy! This
is not at all my view. However, without reference
to Husserls views on naturalism, that is, Husserls
view that the raison detre of phenomenology is

56 PPP / Vol. 17, No. 1 / March 2010

to develop an attitude that overcomes naturalism once and for all, (Husserl 1970, 299) phenomenology is just simply misrepresented. What
would inhibit someone from saying, after reading
Hadreas paper: Phenomenology is superior to
classical empiricism and rationalism as a philosophical framework for understanding patients
self reports regarding their experiences of drug
therapy. Drug therapy alone is phenomenologically explained as beneficial to certain patients.
Ergo, drug therapy alone is the therapy of choice
for those patients. Nothing in Hadreas paper
precludes such a response that, while not in itself necessarily reductive, in no way precludes,
nor militates on the basis of phenomenological
evidence, against physicalist reduction. In other
words, Hadreas essay, whether deliberately or
not, abstracts from some of the most crucial and
far-reaching issues confronting psychiatry today

in understanding both its scientific and ethical

foundations. And, these are issues that a more
comprehensive phenomenological perspective, or
at least some suggestions regarding a more comprehensive phenomenological perspective, would
go a long way toward resolving.

References
Hadreas, P. 2010. Husserlian self-awareness and SSRIs. Philosophy, Psychiatry, & Psychology 17, no.
1:4351.
Husserl, E. 1970. The Vienna lecture. In The Crisis of
European Sciences and Transcendental Phenomenology, trans. with an introduction by D. Carr.
Evanston, IL: Northwestern University Press.
Zahavi, D. 2003. Inner time-consciousness and prereflective self-awareness. In The new Husserl: A
critical reader, ed. D. Welton. Bloomington: Indiana
University Press.