The Ethical Treatment of Depression
Autonomy through Psychotherapy
Publication Year: 2011
Published by: The MIT Press
Series: Philosophical Psychopathology
Title Page, Series Page, Copyright, Dedication
The Philosophical Psychopathology series publishes interdisciplinary work that is broadly concerned with psychopathology and that has significance for conceptual, methodological, scientific, ethical, and social issues related to contemporary mental health practices, as well as for more traditional philosophical issues such as the...
This book stems from my doctoral thesis, completed at the Centre for Human Bioethics at Monash University, Melbourne, Australia. I am indebted to my supervisors, Justin Oakley, Helga Kuhse, Nicholas Allen, and Ian Gold, for their invaluable assistance in the preparation of the thesis. I learned a great deal, both...
If you are not already sure that depression is a major global health issue, consider the following statistics. One in six people will experience depression over the course of a lifetime.1 The incidence of depression is estimated to have increased from 50 cases per million people in the 1950s to 100,000 cases per million in the late...
2. Autonomy: The Importance of Justified Beliefs about Material Facts
In this chapter, I provide the account of autonomy that will inform claims that doctors are morally required to promote this trait in their depressed patients. I set out agency and liberty as foundational elements of autonomy and then elaborate four contemporary theories that stipulate the kinds of desires compatible with...
3. Autonomy: The Importance of Justified Beliefs about Affect
In the preceding chapter, I argued that autonomous action requires the agent to hold justified beliefs about material facts, where materiality describes those contingencies likely to have an impact on the agent’s important interests. The beliefs examined thus far have pertained to facts about objects that are mostly...
4. Depression: Disorder of Affect, Disorder of Autonomy
My task now is to show that depression undermines personal autonomy. Such a claim is hardly controversial, as most accept that the depressed worldview frequently misrepresents reality and, on just about any account, sets back autonomy. However, I want to be quite specific about the nature and mechanism of skewed perception...
5. Understanding Negative Biases Promotes Autonomy in Depression
In the previous chapter, I argued that a number of factors conspire against the exercise of autonomy by people with depression. I showed that negative biases breed a pessimism, with doubtful warrant, that pervades judgments about important life events. I also argued biological beliefs about depression causation to be prominent...
6. Understanding Causal Stressors Promotes Autonomy in Depression
I will now argue that psychotherapy promotes autonomy in depression by creating awareness of the causal role of psychosocial stressors and of effective means of dealing with them. I will further argue that the autonomy-promoting effects of CBT are superior to those of ADM. The argument hinges on the claim, defended...
7. A Special Duty to Promote Autonomy in Depression: The Moral Case for Psychotherapy
I'm now going to argue that physicians have a moral obligation to provide CBT to their depressed patients, based on its superior capacity to promote autonomy in this disorder. To make my case, two primary claims must be substantiated. First, it is necessary to show that autonomy promotion is a legitimate and indeed a principal...
Appendix: The Hamilton Rating Scale for Depression