Depression as a Disorder of Consciousness

People with major depression often describe a profound shift in their conscious experience, feeling as if they have entered a 'different world' detached from reality and others. This paper proposes that depression involves a departure from ordinary wakeful consciousness into a distinctive global state of consciousness similar to dreaming or the psychedelic state. The hypothesis is developed using research in consciousness science and has implications for understanding the neurobiology of depression and for psychedelic psychiatry. The account offers a conceptually well-motivated framework that can guide empirical investigation.

Study at a glance

Abstract

First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that this experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development.