Body-Subject or Neo-Liberal Subject? Phenomenology, Depression, and CBT

Depression is notable for high rates of disability. The medical model typically characterizes depression as a physiological dysfunction or psychological disorder. However, both views fail to appreciate the phenomenology of depressed experience. Drawing on the existential phenomenology of Merleau-Ponty, this article contends that the lived experience of chronic depression is marked by a disturbance between the body-subject and the world. More specifically, the experience of depression is characterized by alienation from the world, self and others. While anti-depressants have long been the first line of treatment of depression, many governments subsidize cognitive behavioral therapy (CBT) as an adjunct treatment. CBT is said to be the gold standard psychotherapeutic treatment given that it is evidence-based, cost-effective, and short in duration. However, not only are these justifications questionable, but the theoretical underpinnings of CBT have ideological significance. Rather than approaching depressed persons as body-subjects, CBT casts service users as neo-liberal subjects, insofar as depression is characterized as disordered thinking that is independent of a person’s situated life. The emphasis on quickly returning people to work to reduce strain on welfare systems, while a valid economic concern, is not a valid therapeutic concern. The limited choice of subsidized psychotherapeutic options fails to recognize that depression is a heterogenous phenomenon, meaning that the CBT model of disordered thinking is not necessarily representative of the way in which depression manifests.