Depression is More than Low Mood – it’s a Change of Consciousness

November 12, 2021

ou’ve lost a habitable Earth. You’ve lost the invitation to live that the Universe extends to us at every moment. You’ve lost something that people don’t even know is. That’s why it’s so hard to explain.

This is one person’s experience of living with depression, as recounted in the psychologist Gail Hornstein’s book Agnes’s Jacket (2009). If you ask someone to describe what depression is like, they will often struggle to put it into words. We know a lot of the symptoms, but we still don’t understand the nature of the illness.

We are like someone who knows that a fever, a cough, and loss of smell are all symptoms of something, but has no idea about the virus that causes them.

People who’ve never been through depression might assume it’s just an extreme form of feeling low. Don’t we all find that our daily activities can sometimes lose their sparkle?

Yet, accounts of people with depression point in a different direction. As another person said to the psychologist Dorothy Rowe, recorded in her book The Experience of Depression (1978): ‘I awoke into a different world. It was as though all had changed while I slept: that I awoke not into normal consciousness but into a nightmare.’

Such reports support the idea that depression stands apart from other forms of everyday experience, as the philosopher Matthew Ratcliffe has emphasised in his book Experiences of Depression (2015).

Depressed people often say it involves a fundamental shift, like entering a different ‘world’ – a world detached from ordinary reality and other people. Depression seems to be a more totalising kind of experience than some others. Perhaps it is even a distinct state of consciousness, and can, in turn, reveal something about the nature of consciousness itself.

The self-reports of people with depression point to a deep and interesting connection with consciousness. To make sense of this idea, think about the effect of sleeping and dreaming on your mental life, or the experience of emerging from dreamless sleep into wakeful consciousness. In these transitions, our consciousness undergoes a profound structural shift.

Consider, for example, how your experience of the passage of time when dreaming diverges from your experience of time when awake: we frequently experience days and weeks passing in a dream in the space of a few waking hours. Similarly, our sense of self and identity is highly malleable in the dream: we sometimes perceive ourselves from the ‘outside’ looking down at our bodies, dream of being someone other than ourselves, or dream of being detached from a body altogether.

While depressed people are not literally in a different world, they are in a different state of consciousness

Similar sorts of structural changes to conscious experience occur after taking psychedelics. Examples include the well-documented phenomenon known as ‘ego dissolution’ – the breakdown and loss of self in its entirety – or the dramatic warping of space in the psychedelic state. In both dreams and psychedelic states, people report robust, wide-ranging alterations that disturb and alter not only their sensory experiences but their conception of themselves and their connection to reality and other people.

Neuroscientists and philosophers of consciousness have recently coined a new term – the global state of consciousness – to describe the structural properties of experience that varies between ordinary wakefulness, dreaming, the psychedelic state and the minimally conscious state. These states are called ‘global’ because the whole of conscious experience is altered, not just a particular element.

The fine detail of what we experience in everyday waking life changes all the time (sounds, colours, odours all come and go), but the structure stays largely fixed: I feel myself to be present in the world, at the centre of an integrated, coherent point of view; time carries on flowing at the same rate; space has the same geometric structure.

The global state is this overarching structure and ordinarily stays constant as particular experiences pass us by. When we dream, take psychedelics or suffer a brain injury, this structure can be altered, and we enter a different global state.

Could depression belong in this family too? What people with depression describe as their ‘world’ or their ‘nightmare’ might be a distinctive global state, in which some of the structural pillars of ordinary experience (such as the sense of self, space and time) are distorted. Not a ‘dream’ or a ‘trip’, but a state that belongs in the same group.

One clear and telling theme in reports of depression is the idea of inhabiting or falling into another ‘world’ or ‘place’. ‘For me, depression was a place,’ wrote the late journalist Sally Brampton in a 2003 article in The Telegraph. ‘The landscape is cold and black and empty. It is more terrifying and more horrible than anywhere I have ever been, even in my nightmares.’

We’d suggest this talk isn’t merely metaphorical. While depressed people are not literally in a different world, they are in a different state of consciousness – one they can become awake to and, hopefully, awake from.

Seeing depression along with other altered global states of consciousness is a theoretical rather than a clinical shift – but it could make a difference to how we treat depression further along the line. In particular, the idea can shed light on the success of psychedelic psychiatry, a recent and growing research field, which looks to treat various mental disorders with psychedelics such as ketamine, mescaline and psilocybin (the active ingredient in magic mushrooms).

While psychedelic psychiatry is still in its early days, initial results for depression have been promising, and major research centres have now been set up at Imperial College London and Johns Hopkins University.

Many of us have dreamt or been drunk or high. We know about other alterations to the structure of experience

But why might psychedelic therapy work as a treatment for depression? One common suggestion is that psychedelics provide individuals with an uninhibited space or window for insight and emotional release. Yet the idea that depression is an altered state of consciousness suggests a different explanation: it could be that psychedelics work by forcing a transition between global states of consciousness.

First, they propel a depressed patient into a new state of consciousness, the psychedelic state. At the end of the episode, the patient must transition out of it – but into what? Perhaps, after a psychedelic trip, the patient can emerge into a state of ordinary consciousness, rather than the ‘nightmare’ of the depressed state.

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