Suffering and Eternal Recurrence of the Same: The Neuroscience, Psychopathology, and Philosophy of Time

Keywords
time, depression, phenomenology, neurophenomenology, cognitive neuroscience, psychopathology

It is not easy to persuade him who suffers in one or other of these ways that he is not doomed to madness, or that he has not the mortal disease of brain which he fears he has. Notwithstanding that he has had previous attacks of the same kind from which he has recovered, he always declares the present attack to be different from and much worse than any former one and is sure he cannot possibly get well again. There is a feeling of eternity, no feeling of time, in relation to it. Of the worst grief at its worst there is always, when in health, a tacit or subconscious instinct of ending; but here an all-absorbing feeling of misery so usurps the being that there is no real succession of feelings and thoughts, no sense of time therefore, a sense only of an everlasting is and is to be [. . .]. To inspire a gleam of real hope in the gloom of melancholy is to initiate recovery; it is to plant a morrow in the midnight of its sorrow: to infix a distinct belief of recovery is almost to guarantee it.

(Maudsley 1895/1979, 171–172).

Wyllie's paper is a very welcome addi-tion to the phenomenological litera-ture on depression. Or rather it is more than that—Wyllie demonstrates in his analysis of temporality how phenomenology has genuine value in terms of both clinical understanding and providing hypotheses for testing in empirical research. The therapeutic and research benefits that can potentially be garnered from Wyllie's paper demonstrate how much philosophy, and phenomenology more narrowly, can do for psychiatry.

In this gloss on Wyllie's paper, I briefly review the available information on the psychopathology of time in a variety of mental disorders, including depression. Second, I attempt to place Wyllie's hypotheses about lived experience and melancholia in the context of recent work from cognitive science on the perception of time. Last, I discuss how the philosophy of time in the twentieth century may be of utility to psychiatrists both in understanding their patients and in researching the disorders.

Psychopathology and Time

Although one often is struck by how a sense of time is distorted in patients with a variety of different mental illnesses, there has been little or no recent empirical work on these symptoms. There is a literature that relies on clinical anecdotes or case reports, but no clear data that either measure the frequency and prevalence of such symptoms in a given population, or any psychological data that seek to measure such distortions and relate them other elements of psychopathology. Wyllie offers a way of understanding melancholia holistically, rather than as a collection of atomistic symptoms and signs. That is, as a clinical entity cohered by the centrality of a disorder of the experience of lived time. Through an existence dominated by the present and past, the sufferer is experiencing a determinate future with a lack of hope of change, a disproportionate dwelling on the past and guilty recollections; thoughts of suicide may seem the only way to end such eternal anguish. From Wyllie's analysis, one could construct the hypothesis that factors such as hopelessness and suicidal ideation may correlate with, and be at least partially caused by, a change in lived time. Such a hypothesis is eminently testable and further, if found to be the case, could provide evidence that may be of great use to cognitive-behavioral therapists in designing and refining psychological interventions that may be efficacious in depression. That such data do not exist may indicate that with operationalized criteria there comes a risk that clinicians may forget to listen to how their patients describe how their symptoms "hang together" in a rational and understandable manner.

Cutting (1997) helpfully reviews the psychopathologic disorders of time. In...