Lived autonomy and chronic mental illness: a phenomenological approach

• Published in: Theoretical medicine and bioethics Vol. 33; no. 6; pp. 387 - 404
• Main Author: Schlimme, Jann E.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.12.2012; Springer Nature B.V
• Subjects: Attitude; Autonomy; Chronic Disease; Depression - psychology; Depressive Disorder, Major - psychology; Dysthymic Disorder - psychology; Education; Ethics; Freedom; General Surgery; Goals; History of Medicine; Humans; Mental disorders; Mental Disorders - psychology; Personal Autonomy; Philosophy; Philosophy of Medicine; Qualitative research; Theory of Medicine/Bioethics; Thinking; Volition; Phenomenological psychopathology; Depression; Autonomy; Goods of agency; Habituality
• ISSN: 1386-7415; 1573-1200; 1573-0980
• DOI: 10.1007/s11017-012-9235-z

In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of the will. I will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions (‘depressive habituality’). These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her ‘depressive disabilities’ (i.e., her levelled amount of daily activities, her social retreat in certain periods). Lastly, I will compare this manner of life-conduct with the constellation of includence ( Inkludenz ), as described by Tellenbach, and discuss the limitations of this study.