A phenomenologically grounded empirical approach to experiences of adolescent depression

Abstract

Extant literature suggests a correlation between the thematic core of an adolescent’s personal account of depression and the trajectory of her personality development. This possible correlation has not been explored in a way that includes detailed qualitative analyses of reported experiences of adolescent depression. By discussing a single case design, this contribution illustrates and justifies an interpretative procedure that has been implemented to assist such an exploration. The paper focuses on the suitability of this approach for the investigation of all-encompassing alterations of the experiential field in psychopathological conditions. I argue that this suitability is grounded in a phenomenological understanding of the explicative task in terms of a disclosure of the intentional constitution of the life-world of adolescent depression. The discussion begins with a contextualization of the single case design within a multilayered and methodologically mixed study. Against this background, I illustrate the steps of a ‘systematic of interpretation’ aimed at exposing meaning horizons. Touching on issues concerning the empirical validity of the approach, these meaning horizons are construed as objectively plausible frames of intelligibility of a subjectively particular form of experience. Drawing on a characterization of transcendental arguments, I discuss the relationship between the illustrated procedure and the investigational attitude that, according to Husserl, defines phenomenology as a properly philosophical endeavor. In this context, I eventually characterize the illustrated procedure as a crossover approach to human experiential life aligned with the tradition of phenomenological psychopathology.

1 Introduction

Asked to describe her feelings when she is going through a condition that she labels the misunderstandingness, an adolescent female I shall call Anna employs the following images¹:

Well, I would say, one actually feels captured in a sort of hole, so that one just cannot come out, and for this reason, no one takes one seriously; not that one is being jeered at, but one has the feeling that one is simply not being perceived in the world, kind of as if one were invisible.

Seeking to convey how the world appears to her in this state, Anna elaborates:

Yes, I more or less feel I am running around at the lowest layer, and that the world is then very chaotic, that there is no order.

Requested to describe this experience of a chaotic world in more detail, she explicates:

Well, I would compare it with a kind of completely messy ball of yarn; that there is no starting point and no end, so that one practically has to fight one’s way through it until one can climb up and get out again.

[…]

Yes, like in a labyrinth, one just needs a long time until one comes out again, there just are so many ways. Some ways, however, do simply not end where one would like to go to, but somewhere else; one has to go back repeatedly.

Compare these descriptions with the following pictures that arose in the context of similarly structured conversations with two further adolescents.

Here is Ben’s description of a condition he calls the sad phase:

One somehow feels bad in a particular way, not necessarily worse than when one is just sad, but … it is weird somehow, one feels like one is not really within the world, and one can only think about one thing.

[…]

As if one had put all negative feelings in a mixer, mixed them with one another, and then swallowed them down, something like that.

Claudia captures an aspect of a predicament she calls the lasting burden as follows:

I then simply have the impression that time runs as though it had been bent, and that … don’t know … that the time somehow lags behind a little, but I somehow have to think about things constantly.

These are all examples of the sorts of descriptions that can emerge in the course of a semi-structured interview aimed at bringing adolescents diagnosed with depression to articulate in words how their experiences of themselves and their world become transformed when they are going through a depressive episode. The participants are invited to develop their own images to characterize what is special about a series of all-encompassing experiences they have when they are suffering a depressive episode. The schedule that orients the conversation focuses the participants’ attention on transformations of specific experiential domains.

On the basis of the small sample of descriptions quoted, an intuition one might have when starting to study the experiential life of depressed adolescents could appear questionable: that there is a specific form of intentional self- and world-relatedness that characterizes adolescent depression.² But it is not only this presupposition that seems to be challenged by the quoted fragments. Observe, furthermore, that some of the topics articulated do not correspond to the symptoms a psychiatrist would likely explore in order to diagnose a ‘typical’ depressive episode. However, being able to make sense of some of these descriptive motifs may seem crucial to a proper understanding of an adolescent’s personal account of depression.

Interestingly, some of these motifs appear to be recurrent in the sense of being identifiable across different individuals’ personal accounts. The study in the frame of which the cited excerpts emerged was motivated by the idea that some of these motifs could be, furthermore, differentially recurrent. That is to say, that a comparison of results of the interpretation of these accounts may offer the basis for a clinically relevant classification of kinds of adolescent depression.

Whether it is justified to assert the existence of a motivic recurrence apt to ground an experience-based categorization of varieties of adolescent depression is an empirical question. However, given this garden of pictures, we are required to decide, in advance, how to select those motifs that could guide the development of such a typology. Moreover, if this endeavor is to claim some scientific rigor, it has to describe a principled way to decide which of the recognized motifs capture experiences that are at the heart of adolescent depression.

By discussing a single case design, this contribution illustrates a procedure that permits interpreting personal accounts in order to expose connotations that play a central role in the frame of the relevant narrative. Being part of a multilayered and methodologically mixed research project, this single case study cannot aspire to answer the questions the larger study described below seeks to answer. Aiming exclusively at a methodological discussion of a particular approach to experiences of adolescent depression, this paper does not present the results of a completed research endeavor.³

2 Clinical and theoretical considerations

There are reasons to presume that the thematic core of an adolescent’s personal account of depression mirrors the developmental stage of what psychodynamic theory calls the individual’s mental structure (Rudolf, 2004). This possible correlation has not been studied in an empirical way that includes detailed qualitative analyses of reported experiences of depression. To contextualize the single case design in focus in this paper, in this section I shall describe a study designed to close this gap.

Two independent topics inform this study. A discussion of the first of them indicates the reasons we have to suppose that the mentioned correlation exists and clarifies why some findings that point to this association have not been replicated in pediatric populations (subsection 2.1). The discussion of the second topic specifies what is special about the view of experiential field transformations in psychopathology that guides this study (subsection 2.2).

2.1 Varieties of depressive experience: a presumed dependency on the trajectory of personality development

Over the last 30 years, findings have accumulated suggesting that the depressive experiences of individuals who have also received the diagnosis of a borderline personality disorder (BPD) differ from the experiences of depressed individuals lacking this comorbidity (Blatt, 2004; Levy et al., 2007; Silk, 2010; Westen et al., 1992; Wixom et al., 1993). This difference does not primarily concern the intensity of the depressive feelings. Rather the particular quality and, more specifically, the core thematic of the experiences that characterize the depressive suffering have been claimed to vary depending on the presence of this comorbidity.

Studies involving mainly adults support a distinction between interpersonally directed depressive experiences, which include, among others, feelings of dependency, feelings of loneliness, and fear of being abandoned, and self-critical depressive experiences, such as feelings of inferiority, feelings of unworthiness, fear of failure, and feelings of guilt (Blatt, 2004). Based on relatively contradictory empirical evidence, a correlation between the interpersonally directed sort of depressive experiences and the comorbid presence of a BPD has been proposed (cf. Köhling et al., 2015). Although few studies have included pediatric populations (Levy et al., 2007; Westen et al., 1992; Wixom et al., 1993), taken together, the evidence is indicative of a possible relationship between variants of depressive experiences in adolescence and what I shall call the individual’s trajectory of personality development. In order to explain the rationale for coining the latter term and its relationship to the notion of mental structure, I shall delineate the main positions of a psychiatric debate.

For decades, the pertinence of diagnosing personality disorders in adolescence has been discussed controversially. On the one hand, it has been maintained that some of the signs and symptoms that are central to the diagnosis of a personality disorder—particularly those pointing to an unsteady identity and affective instability—may be regarded as typical of adolescence itself. Advocates of this line of argument have warned about the risk of psychiatrically stigmatizing (Catthoor et al., 2015) individuals who are going through a ‘stormy adolescence’. Opposing this view, some authors have pointed out that an individual who has not begun to develop a personality disorder during the period in which mature personality comes to be developed, namely during adolescence, will improbably develop a personality disorder. Defenders of this line of thought warn of the risk of missing the opportunity to intervene therapeutically in early stages of the development of a personality disorder (Fonagy et al., 2015).

In the meantime, it is taken to be well established that some relatively stable indicators of a personality disorder can be recognized during adolescence (Goth et al., 2012; Miller et al., 2008; Sharp & Romero, 2007). Early clinical markers of a beginning personality disorder can be documented in the course of a standard assessment of an adolescent’s mental structure (OPD-CA-2 Task Force, 2017, 60ff.). Such an assessment evaluates the ‘level of integration’ of a functional organization of mental operations assumed to develop as a function of interpersonal experiences during the first years of life. This organization is taken to explain an individual’s distinctive disposition to behave in singular ways in the face of certain kinds of circumstances. Personality disorders are associated with lower levels of mental structural integration.

A clinical assessment of the mental structure occurs punctually in the temporal dimension. However, the concept of mental structure involves the idea of a personality development path. Therefore, the assessment instrument (OPD-CA-2 Task Force, 2017, 157ff.) considers normative differences based on the individual’s age.

In the context of the debate mentioned, this idea of a personality development trajectory facilitates the exploration of the presumed correlation between phenomenological varieties of adolescent depression and the developmental psychopathology of personality disorders. Given the reluctance to diagnose adolescents with a personality disorder that is still patent in clinical practice, by avoiding the categorical distinction BPD/No-BPD that normally frames this line of investigation, this study opens the summarized avenue of research to child and adolescent psychiatric theorizing about depression.

2.2 ‘Existential changes’: what a phenomenological account of depression is about

Karl Jaspers ([1913] 1963) captures the idea of a ‘break with reality’ that is at the core of the concept of psychosis in terms of the fundamentally un-understandable character of psychotic mental life. This limited intelligibility of ‘psychotic ideation’ is usually taken to be grounded in radical experiential field transformations. It might, thus, be assumed that non-psychotic psychopathological states—like most forms of depression—do not involve structural experiential changes.⁴ From the very beginning, though, phenomenological-psychopathological work on melancholia/depression has challenged this assumption (cf. Binswanger, 1960; Minkowski, [1933] 2019; Tellenbach, [1961] 1980). Drawing on this tradition, Matthew Ratcliffe (2015) has recently offered a thorough philosophical analysis of dimensions in relation to which the experiential field of depressed patients suffers fundamental transformations. In order to specify what is central to a properly phenomenological approach to depression, in what follows I shall discuss Ratcliffe’s work on existential changes in depression.

Ratcliffe’s (2015) account of depression compellingly shows that the so-called depressive mood is vastly undercharacterized by a description in terms of persistent feelings of sadness, hopelessness, and loss of interest in activities previously enjoyed, as articulated in the psychodiagnostic manuals currently in force. This certainly is merit enough. However, from a phenomenological point of view, the virtue of Ratcliffe’s account consists in its specification of the role different aspects of the ‘depressive mood’ play in constituting the ‘world of depression’. To explain this, let me characterize the main thrust of Ratcliffe’s theory.

Elaborating on Martin Heidegger’s ([1927] 1962) observation that experience always occurs against the background of an affective attunement to the world [Befindlichkeit], Ratcliffe (2008) points to a distinctive group of feelings which he calls existential feelings. He characterizes existential feelings as ‘ways of finding oneself in a world’ which amount to ‘a changeable feeling of relatedness between body and world’ (2008, 2).

Ratcliffe unfolds this idea by proposing that existential feelings situate us in specific worlds by serving as meaning-conferring ‘background orientations’. He writes: ‘The possibilities of purposively engaging with anything, of striving towards a goal, of valuing something, of registering something as practically salient and of pursuing a project all presuppose a sense of things “mattering” to us’ (47). The suggestion is that the ‘Befindlichkeit’ one finds oneself in allows things to always already have certain sorts of significance when one comes to encounter them.

Against this background, Ratcliffe (2015) proposes understanding the experiences of depression in terms of aspects of an erosion of an all-enveloping ‘sense of belonging’ which we normally (i.e., under non-psychopathological conditions) take for granted. Specifically, he proposes conceiving of experiences of depression in terms of a morbidly altered sense of the space of possibilities. Such a ‘space’ is thought to be determined by those categories of significance in relation to which something can come to be experienced in a particular situation.

Concerning the main feature of the account provided by Ratcliffe, it is crucial to understand that his appeal to ‘background orientations’ is completely different from the tenet of cognitive-behavioral therapy (CBT) that certain cognitions determine the depressive mood. The point is not merely that the dispositional states invoked by Ratcliffe are affective in nature, as opposed to being cognitive. Rather, the point is that the CBT view has to be regarded as typical of psychological theorizing in that it offers an account in causal-functional terms. Ratcliffe’s account, on the contrary, discloses that which intentionally constitutes the sort of meaning that is proper to the ‘world of depression’. This leads to an account in terms of implications that render the relevant lived experiences intelligible. Similarly, Ludwig Binswanger’s (1960) treatment of the ‘world of melancholia’ is part of a project that discloses the ‘constitutive moments’ of experiences characteristic of different forms of psychopathology. Eugène Minkowski ([1933] 2019), too, touches on melancholic experience in the context of an attempt to elucidate how psychopathological conditions transform fields of significance—and ultimately the patient’s very mode of existence.

Something that is special about Ratcliffe’s account is that he partially abandons the ‘classical’ phenomenological-psychopathological project of understanding melancholia/depression mainly in terms of an altered sense of temporality. However, the mentioned interest in the constitution of the life-world [Lebenswelt] of depression defines Ratcliffe’s account as a phenomenological one.

3 Overall methodological setup

The study participants are adolescents aged 14 to 17 years who, in the course of a standard diagnostic procedure completed at the Department of Child and Adolescent Psychiatry of the University Hospital Münster, fulfilled the criteria required by the ICD-10 classification of mental and behavioral disorders to diagnose a depressive episode. Additionally, they reached a score of 14 points or more during a self-assessment using the second version of the instrument Beck Depression Inventory. Some of them received additional psychiatric diagnoses.

The study gathers data on two fronts. On the one hand, by means of two validated clinical instruments, the study collects data related to the participants’ personality development trajectory: (1) a semi-structured interview guided by the interview-schedule ‘Axis Structure’ of the second version of the instrument Operationalized Psychodynamic Diagnosis in Childhood and Adolescence (OPD-CA-2) and (2) the self-assessment instrument Assessment of Identity Development in Adolescence (AIDA). On the other hand, a semi-structured interview (in the remainder Depression Experiences Interview [DEI]) is employed to generate the descriptive material subjected to the interpretative procedure illustrated below (section 4). The self-developed schedule that orients this interview focusses the conversation on specific aspects of the participants’ experiences of depression. Until the last stage, the investigator—who personally analyzes the DEI transcripts—remains blind to the assessment of the OPD-CA-2 interview—which is rated by a person blind to the results of the DEI transcripts analyses. Given the focus of this contribution on the generation and interpretation of a personal account of adolescent depression, I shall exclusively characterize the study’s main instrument.

The Depression Experiences Interview Schedule (DEIS) consists of 16 questions organized in three sections. Section A focusses the participant’s attention on depressive episodes and registers conceptualizations strongly influenced by current discourses on depression. It also brings the participant to concretize first idiosyncratic pictures of the described predicament. The participant is required to propose a label to refer to the initially characterized condition. In the remaining conversation, the interviewer systematically uses the label proposed by the participant, avoiding the term ‘depression’.⁵ The second section’s questions lead the participant to describe specific aspects of her experiences of depression. Drawing on the mentioned phenomenological literature on ‘existential changes’ in depression, the DEIS predefines certain broad thematic domains (e.g., alterations in the affective relation to the world, transformations in the experienced social relatedness, modifications in the sense of embodiment).⁶ Section B constitutes the main section of the interview schedule. Each of the questions in section B serves as an entry into a certain realm of topics, allowing the interviewer to get a first impression of the relevance this specific aspect has to the participant when struggling to make sense of her experiences of depression. The interviewer is expected to react to spontaneous responses and elaborate on them with follow-up questions. This leads to an open-ended thematically centered conversation guided by the manifest interest of the interviewer to understand in detail some of the participant’s initial answers. Section C consists of questions that aim at bringing to light aspects of the participant’s experiences that have not been touched upon during the second part. It also explores difficulties the participant experienced while trying to articulate in words her experiences of depression.

The interview transcript constitutes the raw material subjected to the interpretative analysis described in the following section.

4 Single case study: exemplification of the approach

4.1 The research question in context

In order to specify the question this single case study aspires to answer, it is important to differentiate three levels of inquiry and their respective relationship to a hypothesis-based mode of questioning.

At the ultimate level of investigation, the study aims at answering the question concerning the plausibility of the above-mentioned presumed correlation. Such an inquiry is motivated by the hypothesis that a correlational analysis based on the results of a qualitative examination of personal accounts of depression could render claims concerning the existence of this association entirely reasonable.

In order to generate a basis for such an investigation, at an intermediate level, the project explores the possibility of developing a typology of adolescent depression rooted in phenomenology. The question at this level is whether a comparison of the results of the idiographic qualitative analyses conducted at the most basic level of inquiry permits differentiating varieties of depressive experience in adolescence.

At the most basic level, the study explores in a detailed and open-ended manner, i.e., in a manner that does not aim at verifying or rejecting any specific presupposition, the particular way in which an adolescent’s experiences become transformed when she is going through a depressive episode. In what follows, I shall illustrate the method that guides this basic level of inquiry by describing, in a step-by-step mode, how the transcript of the interview conducted with the participant I call Anna was generated and subsequently interpreted.

4.2 Generating Anna’s personal account

At the time the interview (DEI) with Anna took place, the diagnosis of a depressive episode had already been established and communicated to her. It was completely transparent to her that the interviewer (and researcher) was interested in understanding for scientific purposes the ways in which her world- and self-experiences are transformed when she is going through a depressive episode.

Since the account that arose in the course of the conversation may be regarded as a narrative which, referring to Anna’s subjective world, is inevitably co-determined by the specific context of the interview and its interpersonal dynamics, I would like to clarify four points.

First, there was no therapeutic relationship between Anna and the interviewer. However, the interviewer (a child and adolescent psychiatrist) had, in the course of two clinical encounters, personally completed the clinical assessment that led to the diagnosis of a depressive condition. Therefore, the possibility that Anna could be inclined to ‘please’ the interviewer with certain answers cannot be ruled out entirely.

Second, by means of follow-up questions, which intended to be non-prescriptive, the interviewer made an effort to ‘go deeper’ into Anna’s experiential world, requesting her to elaborate on specific points. These were points he took to be (1) particularly important to her, (2) conspicuously idiosyncratic, and/or (3) interesting in the light of prior conceptualizations and notions taken from phenomenological accounts of depression.

Third, as a clinician the interviewer was familiar with the features that characterize depressive episodes. This minimized the risk that other (psychopathological) conditions had been ‘snuck’ into the description by Anna. Having during the first part of the interview focused Anna’s attention on the relevant phases, the interviewer was alert to identifying sequences in which it seemed required to ‘bring her back’ to a description of depressive episodes, in order to ensure the validity of the data.

Finally, the conversation drawing on Section B of the DEIS was guided by theoretical considerations which challenge certain medical assumptions concerning depressive experience. Based on his clinical expertise, the interviewer constantly compared the emerging picture with ‘traditional’ views of depression. On the other hand, to ensure the integrity of the data, he consistently employed the label proposed by Anna, thereby allowing the initial pictures—obtained before theoretically motivated questions had been posed—to guide the conversation. To control the impact of what Ian Hacking (1995) calls the ‘looping effect’, in the first part of the interview Anna was, furthermore, required to explain what she thought (1) depression is and (2) what caused her to develop a depression. All these steps followed a methodological principle Lucy Yardley articulates in terms of ‘ensuring that unexpected findings or observations which conflict with the investigator’s understandings of the topic are not merely noted, but actively sought’ (2000, 220). This was reinforced by the questions of Section C, in which a theoretically guided form of exploration was abandoned.

So, although the ‘phase of data collection’ was clearly separated from the ‘phase of analysis’, acts of interpretation permeated the whole process. This is the reason why I prefer to talk of a personal account that was generated, and not merely collected, during the interview.⁷

The conversation with Anna was tape-recorded and transcribed verbatim (including the interviewer’s questions and all the words spoken, regardless of whether or not they constituted well-formed sentences). Prosodic features were ignored.

4.3 Disclosing frames of intelligibility

The procedure employed to interpret the transcript of Anna’s account elaborates on principles of the qualitative research method Interpretative Phenomenological Analysis (IPA), as described by Smith and Osborn (2015). In this section, I shall use Anna’s account to illustrate the steps of my interpretative procedure. A justification of the approach, in the context of a discussion concerning its alignment with phenomenology, is provided below (section 5).

The interview invites the participants to articulate in words what is special about a particular predicament they are first-personally acquainted with: a condition diagnosed as a depressive episode. This predicament is such that the participants cannot assume the interviewer’s first-personal familiarity with it. During the conversation, thus, the participants see themselves engaged in an explicative quest defined by a complex hermeneutic situation: they are struggling to convey how they understand a peculiar condition they are facing, and they are doing so in response to certain requests of an interviewer who is struggling to understand these explicative efforts. This typically leads to the articulation of a complex web of more or less tightly interconnected meanings. Although these meanings are supposed to capture the participant’s subjective world, in the context of the dialogue, the participant necessarily has to understand them as connotations that are fundamentally conveyable—as descriptions that make sense within an intersubjectively shared space of intelligibility. I would like to call the web of meanings emerging under such conditions the context of explication.

The main methodological idea of this approach is that the complexity of the particular context of explication articulated in a participant’s personal account can be reduced by means of an interpretative-analytic procedure that identifies and hierarchically interrelates thematic motifs. This hierarchy permits determining themes that, in a sense to be explained, may be argued to be constitutively central to this personal account. I shall claim that this procedure permits the disclosure of frames of intelligibility.

What the procedure reveals are meaning horizons of a set of expressions assumed to be interconnected. The term ‘frames of intelligibility’ is coined here—and treated as a central notion—in an attempt to exploit a picture that has proven helpful in therapeutic work with families. In the context of a conversation with different members of a family, various expressions contributing to a shareable view of a problem may be understood as ‘diagnostic windows’ (Cierpka, 2008, 5ff.). These windows give access to an aspect of an underlying web of references which is normally not immediately recognizable in the singular points of view articulated by the participants. In analogy, frames of intelligibility offer more or less illuminating perspectives on an underlying meaning-complex that finds (singular) expression in the diverse (but presumably interrelated) images that constitute the personal account subjected to analysis.

Importantly, the method that establishes the hierarchical relevance of the different motifs does not rely on any measurement of their frequency of appearance. Rather, the hierarchy is determined by the differential capacity the identified motifs have to amplify the comprehensibility of other motifs and, ultimately, the complete personal account. In a way that parallels the above-described participant’s complex hermeneutic situation during the interview, in the course of the analysis, the interpreter struggles to increase this understandability for an envisaged ‘critical other’ with whom he assumes to be sharing (implicit) standards of rationality and broader frames of intelligibility.⁸

The procedure begins with a segmentation of the transcript. For this purpose, the whole transcript is read a number of times, in order to mark thematic breaks in the text. Broad thematic nuclei, which are not entirely determined by the interviewer’s questions, are expected to arise as a result of a process that compresses and synthetizes a number of associative notes the interpreter makes during the initial reading of the transcript. Once the text has been segmented, formulations are sought that are apt to paraphrasing in a maximally compact but sufficiently detailed way the meaning of the relevant fragments. I shall call these formulations condensation-statements.

The challenge—not only here, but at every single stage of this interpretative analysis—consists in achieving an increasingly higher degree of abstraction, without losing touch with the raw material. This requires a recurrent examination of the emerging formulations’ power to capture at higher interpretative levels meanings identifiable in statements that compose the raw material. This general requirement offers an empirically rigorous foundation for the procedure.

Since the described segmentation permits a number of associative ideas of the interpreter to merge with the original text, the last cycle of this first step of analysis attempts to disentangle the data from these associations. Observations that oriented the segmentation are extracted (as well as possible) from the emerging condensation-statements and placed in parallel statements which I shall call associative remarks.⁹ These associative remarks may include links to connotations found in other segments and terminology suggested by theoretical conceptualizations. This establishment of ‘thematic bridges’, which could precede generalization efforts, proves extremely helpful during the second step of analysis. To begin illustrating the procedure, Table 1 offers an example of how the meaning of a short fragment of Anna’s transcript has been captured in a condensation-statement ‘purged’ of the interpreter’s associations that permitted the transcript’s segmentation.

Table 1 An emerging condensation-statement

The first analytic step is concluded by listing all the condensation-statements in a manner that respects the sequential appearance of the paraphrased descriptions during the interview. This list serves as the ‘main input’ to the procedures of the second analytic step. Here are the first 10 condensation-statements of the list resulting from the analysis of Anna’s transcript.

Box 1: Sequential list of themes (fragment)

When depressed, … one finds oneself in a very negative situation characterized by loneliness, helplessness, and perplexity … one finds oneself in a state that endures and makes it difficult to accept support … due to a hard-to-overcome restricted openness to other people, it is difficult to get a hold on others … the fear that other people could condemn one’s frequent dysphoric mood as a sort of attention-seeking behavior reinforces social withdrawal … one’s being negatively minded when feeling, perceiving, and thinking does NOT result in a misperception of how things really are … one fears that, in adopting an appreciative state of mind, one makes oneself vulnerable to something that could make one’s predicament worse … one has the impression that something external and negative has brought one to this condition10 … one feels like having resisted too long, to the point of having lost all force … one feels unable to come out from a situation which makes it impossible to be regarded as a part of THE world … one feels detached from THE world and only able to encounter other people who are in a similar condition

In a second move, the emerging condensation-statements are grouped with regard to thematic convergences and divergences. This step, which includes slight reformulations and the fusion of certain condensation-statements, leads to the emergence of thematic bundles. This formation of bundles is achieved by repeatedly reordering the obtained condensation-statements.

There is no operationalization for ‘thematic closeness’. Grouping together expressions with similar connotations just is a matter of intuitively proposing a regularity to cut across different motifs. So, it is basically the requirement that the emerging thematic bundles ought to appear plausible to a ‘critical other’ that here (again) limits ‘associative speculations’.¹¹ However, two principles common to various qualitative methods orient this analytic step: the principle of mutual exclusivity, according to which ‘no data should fall between two categories or be placed in more than one category’ (Cho & Lee, 2014, 10), and the principle of exhaustiveness, which specifies that ‘enough categories to accommodate important contents must be created’ (ibid.).¹² The employment of these principles secures the taking into account of the whole material with its inconsistencies, avoiding non-principled raw material selections in which biases should be presumed to be operative (cf. Giorgi, 2010, 9–10; Yardley, 2000, 220).¹³

Once thematically close condensation-statements have been located in proximity to one another, the condensation-statements’ position within the relevant bundle is determined by reordering the statements until a short coherent text emerges. Here, those condensation-statements that capture something in a more abstract or general way (relative to the other condensation-statements that constitute the relevant bundle) are located at the first and last position. This leads to the emergence of a paragraph in which the first sentence states an issue which the following statements seem to concretize and the last statement (ideally in a summarizing manner) rounds off. In an attempt to condense further, a short title is sought for the emerging bundle.

Following a similar logic, a ranking of bundles is obtained by reordering the arising thematic bundles until an arrangement is found in which, ideally, each of the bundles offers a horizon of comprehensibility to those bundles located at lower positions. The logic that leads to the emergence of such an order follows an idea I shall explicate below: in relation to a particular account—understood holistically—some statements play a structuring role in relation to certain other statements. To exemplify, here are the first three bundles that emerged in the course of the analysis of Anna’s interview transcript.

Box 2: Emerging hierarchy of thematic bundles (fragment)

(Self-)exclusion from the world When depressed, one feels unable to come out from a situation which makes it impossible to be regarded as a part of THE world. One feels detached from THE world, misunderstood in a non-selective but fundamental way (IC),14 and only able to encounter other people who are in a similar condition. The confrontation, in group-contexts, with a cheerfulness one feels no longer able to achieve reinforces the tendency toward social isolation. One is basically in a different world which is, however, grounded in a radically transformed orientation towards THE world. Captive in a chaotic underworld When depressed, one feels like wandering around a chaotic underworld, from which one cannot escape. One has to carry on doing things to abandon one’s situation, although one cannot recognize any orientation, start, or end. One navigates confusing roads. The world’s sad character is accompanied by a persisting sense of quiet chaos. Loneliness and the evasion of negative sides of existence When depressed, due to a hard-to-overcome restricted openness to other people, it is difficult to get a hold on others. It is particularly difficult to explain to another person what and how one is feeling, since one has the impression that people do not want to touch on certain negative sides of human existence they are actually aware of. One finds oneself in a very negative situation characterized by loneliness, helplessness, and perplexity (DC).15

The claim is that these thematic bundles located at higher positions within the emerging ranking of motifs are better suited to offering a broad picture of what it is to suffer the condition Anna calls the misunderstandingness (compared to other thematic bundles that emerged during the analysis and were, in its course, located at lower positions).

The results of this empirical procedure may serve as a basis for philosophical arguments based on the phenomenologically cardinal idea of an intentional constitution of meaning in lived experience. Here, given the methodological focus of the discussion, I can offer only a sample of the possibilities.

Arthur Tatossian (1983) suggests that the depressive sense of restricted ‘vital communication’ is rooted in a sort of experienced paradox. In non-psychotic forms of depression, he argues, the other does not completely disappear as a possibility of communication, despite the fact that relationships are experienced as profoundly altered and distant (cf. Bloc et al., 2016, 114). This claim may be understood as a specification of Ratcliffe’s idea of a transformed sense of the space of possibilities which connects to the results presented in Box 2. A sense of (self-)exclusion from the world, that is specified by the impression of being fundamentally misunderstood, and which reinforces anhedonic tendencies toward social isolation, could be regarded as a ‘structural moment’ of the form of morbid experience captured by Anna’s personal account. Including results of analyses of other personal accounts, in an attempt to address the intentional performance that leads to the constitution of the life-world of adolescent depression, it may be argued that a self-contradictory depressive feeling of being a-part (Sánchez Guerrero, in preparation) enables and constrains a series of lived-experiences that centrally define a certain form of depressive suffering in adolescence.¹⁶

However, abandoning at this point the constitutive analysis, one could also treat these results as the outcome of a qualitative endeavor that straightforwardly connects to mundane scientific examinations which, operating from the ‘natural attitude’, interpret the results from a more objectivist-positivist perspective.¹⁷ To this extent, this approach may be understood as a crossover method.

4.4 Comparative extension of the procedure

At the intermediate level, the study compares across accounts looking for convergences and divergences in the distinct thematic bundle rankings. This analytic step goes beyond the single case design illustrated here. I shall, however, broadly describe the procedure.

Themes proposed by the relevant literature are employed to orient the formation of groups of accounts. Particularly, common denominators that could organize the material in terms of interpersonally directed vs. self-critical forms of adolescent depression are sought. However, given the ideal of exhaustiveness, further groups are anticipated to arise.¹⁸ This is expected to challenge the first categorization, urging an ‘optimization’ of the distinctions made (requiring a search for better categories that cut across a greater number of personal accounts).¹⁹

Once personal accounts that centrally touch on similar issues have been grouped together, an intra-group comparative analysis, which follows the same interpretative logic, identifies thematic bundles that may be claimed to be more typical of the relevant group.

On this basis, in a last step, an inter-group comparative procedure is conducted to determine whether certain thematic bundles may be claimed to be, not merely typical of, but also specific to a particular group. The result of this step constitutes the basis for a discussion of the plausibility of the explored correlation, at the ultimate level. At this last stage, the results of the analyses of data collected by means of the AIDA and during the OPD-CA-2 interview become relevant.

5 Justification of the approach

This section discusses the extent to which the illustrated approach can methodologically ground an attempt to close the research gap mentioned above (section 2). The frame of the discussion is a specification of the alignment of this empirical inquiry with philosophical phenomenology. Particularly, given that diverse qualitative approaches claim allegiance to phenomenology, I shall explicate in how far this study offers more than a sheer upheaval of ‘lived experience’ as a point of departure for an understanding of adolescent depression. Six interrelated remarks should permit me to set up the discussion.

First, in attempts to support the claim that a qualitative exploration amounts to a phenomenological inquiry, pointing to the employment of methodological principles of IPA could be regarded as a non-starter.²⁰ So, it is important to clarify that IPA is treated here primarily as a systematic for the interpretation of personal accounts that is sufficiently detailed at the level of implementation and—supplemented in the way described above—permits responding to issues of empirical validity.²¹ However, I shall argue that the illustrated approach allows maintaining a properly phenomenological investigational attitude for as long as required.

Second, my goal is not to develop a novel method. I believe that at the level of procedural implementation the illustrated approach does not significantly diverge from IPA. The point of the discussion is to highlight a possibility offered by a particular understanding of this systematic: the possibility to either remain faithful to a transcendental attitude—as the explorative attitude that is proper to phenomenology (Husserl, [1977] 1983)—or ‘jump’ at some point to a more realist and positivist stance in order to connect to a scientific mode of thinking.

Third, Amedeo Giorgi’s Descriptive Phenomenological Psychological Method (DPPM) would probably offer a more straightforward connection to phenomenology than IPA (cf. Morley, 2019, 165). However, Giorgi’s method is less appropriate to the holistic hermeneutic impetus of this study. Despite the explicit mention of an interdependence of so-called ‘meaning units’ (Giorgi et al., 2017, 186), DPPM strikes me as profoundly atomistic. For, its goal consists in exposing—ultimately by means of eidetic variation—the ‘essential’ character of underlying content-elements distilled in the course of an analysis which does not take seriously the mentioned interdependence. On the contrary, IPA permits elucidating the structural character of the meaning of certain fragments in terms of a constitutive relationship of this meaning to the meaning of other fragments of the very same account.²²

Fourth, there is a belief that the scientific rigor of a phenomenological-psychological inquiry is grounded in some ‘technique’ that permits describing in detail ‘normally unnoticed aspects’ of a ‘private reality’ in a manner that imitates the procedures of the natural sciences. This has been suggested to be possible by, for instance, employing some device that brings the instructed participant to focus on what at a given moment is occurring in her experiential field (Hurlburt, 2011) or by means of a sort of training that refines the participant’s ability to apprehend inconspicuous aspects of experience (Petitmengin et al., 2019). In putting the emphasis on the apprehension of subtle qualities of an inner reality, these approaches, willingly or not, distance themselves from phenomenological philosophy. They do so in that they (1) suggest that phenomenology is primarily a study of phenomenality, (2) insinuate that phenomenology is a sort of introspective science, and (3) confound the crucial issue that phenomenology is about the constitution of meaning in experience with the idea that the goal of phenomenology is to capture unnoticed components of experiences (cf. Zahavi, 2019). The particular adaption of IPA that methodologically informs this study heavily draws on an understanding of phenomenology as a transcendental philosophical endeavor.

Fifth, James Morley suggests that the epoché, which he characterizes as ‘the intrinsic core of [the phenomenological] method’ (2019, 164), amounts to ‘the especially crucial first step in doing phenomenology’ (ibid.). In a similar vein, Giorgi and coauthors argue that, to warrant a phenomenological perspective in the context of psychological research, a methodical step they call the ‘scientific reduction’ (2017, 181) has to be conducted early on in the course of the analysis. It is true that something that unifies the tradition of phenomenology is a shared preoccupation with the method. However, I believe that, in the course of the debate on the possibility of a phenomenological-empirical psychology, an emphasis on what is construed as phenomenological methodology has distracted us from what is crucial, namely maintaining the phenomenological investigational attitude.²³ Maintaining a phenomenological perspective is not a matter of conducting some initial technical move, but of remaining, in ultimate instance, faithful to the transcendental attitude I shall characterize below.²⁴

Finally, discussions concerning the value, empirical validity, and intellectual integrity of phenomenological-psychological inquiries are extremely important to an adequate development of the field. However, it is essential to understand that the validity of a qualitative psychological exploration does not reflect the capacity of the method to secure a correspondence between a series of experiences and the personal account that refers to them. Touching on this issue, Høffding and Martiny warn against the misleading idea that ‘descriptions of experience can be final or complete [… and] treated as static “data” subject to “reliability” or “reproducibility”’ (2016, 544). As for the present study, it is crucial to block a possible confusion based on the double genitive of the expression ‘experiences of adolescent depression’. This study does not aim at a narratively mediated epistemic restoration of some entity called ‘adolescent depression’. Rather, the efforts to get a ‘saturation’ of the empirical material during the interview aim at a sufficiently consistent and, at the same time, multifaceted personal account concerning how the participants experience the world—and themselves in this world—in phases in which they fulfill the criteria for diagnosing a depressive episode. Correspondingly, and as explained previously, the analysis exclusively aims at disclosing the specific field of significance that makes the account comprehensible as a characterization of the life-world of adolescent depression.²⁵ The standards of validity that are relevant to such an inquiry are more akin to the standards of textual analyses, where coherence, plausibility, and adherence to the source play the crucial role. According to these standards, the best interpretation of a personal account is the one which can make better sense of the account as a unity and, particularly, of the apparent contradictions that constitute this unity.²⁶ As I hope to have shown above (section 4), a supplementation of IPA with the principles of mutual exclusivity and exhaustiveness can lead to such a result.

This having been said, let me explain in how far the connection of this study to phenomenology is grounded in a commitment to a mode of thinking about the relationship between subjectivity and objectivity that is central to phenomenology. According to this conceptualization, it is possible to account for the constitution of objectivity in experience by specifying conditions of possibility/intelligibility. Drawing on Charles Taylor’s characterization of what he calls transcendental arguments, I shall elucidate how the analytic procedure illustrated above is connected to this way of approaching ‘reality’ which defines phenomenology.²⁷

Taylor describes the general structure of this mode of argumentation as follows:

The arguments I want to call ‘transcendental’ start from some feature of our experience which they claim to be indubitable and beyond cavil. They then move to a stronger conclusion […] by a regressive argument, to the effect that this stronger conclusion must be so if the indubitable fact about experience is to be possible (and being so, it must be possible). (1978–1979, 151)

The idea is that, in the course of a broadly deductive procedure, it is possible to arrive at a series of conclusions concerning necessary meaning-bestowing structures of experience. This can be done by showing that we could not understand a certain phenomenon as being the way it appears to be in experience were we not to take for granted the structural condition articulated in the argument’s conclusion. This procedure leads to what Taylor calls a string of ‘indispensability claims’ (159). The starting point of such a string is an intelligible characterization of the phenomenon investigated. In other words, ‘indubitable and beyond cavil’ is the premise that opens up such an argumentative procedure to the extent to which the way the phenomenon is argued to appear in experience rings comprehensible and plausible. What such an argument aims at elucidating are the grounds of the understandability of the phenomenon as it has been characterized.

It is important to emphasize the broadly deductive nature of this mode of reasoning. Taylor stresses the point by writing: ‘[T]hese indispensability claims are not meant to be empirically grounded, but a priori. […] I would suggest further that they are supposed to be self-evident’ (159). The idea is that we can elucidate the nature of a phenomenon by articulating in words something that we, in a sense, already understand—something we have to already have intuitively grasped (in an at least non-thematic way) if we can argue to have found the phenomenon intelligible. Take as an example Heidegger’s famous analysis of fear [Furcht] in Being and Time ([1927] 1962, §30). Oversimplifying massively for purposes of illustration, we may take Heidegger to be arguing that we can understand a human person as a being capable of fear, a form of Befindlichkeit Heidegger—aiming at a characterization that is ‘indubitable and beyond cavil’—construes as a response to something detrimental which comes close, just in case we have always already understood a human being as a being for whom its own existence is an issue (cf. Heidegger, [1927] 1962, 179ff.).

In a manner that resembles the way in which transcendental arguments disclose strings of conditions of intelligibility, the exemplified empirical approach reveals a series of interconnected connotations that are central to the comprehensibility of the analyzed account. The goal is not to recognize basic elements of experience, but to expose a complex of meaning horizons that ground the fundamental understandability of certain lived experiences, as they have been described.²⁸

There are two fundamental differences, however, between transcendental arguments and the illustrated interpretative procedure. First, a transcendental argument is completely aprioristic. On the contrary, the frames of intelligibility revealed by the illustrated approach emerge as progressively abstract condensations of descriptions that constitute the raw material. Second, the connections sought are in both cases rational in the sense that one is investigating a series of distinctive relationships at the level of understandability. However, as emphasized, a transcendental argument of the sort described by Taylor is broadly deductive in nature. In contrast, my approach is grounded in a broadly abductive form of reasoning: it is based on inferences to the most plausible account-immanent explications.²⁹ The latter difference permits me specifying the extent to which the proposed approach is related to a form of exploration that is not merely transcendental, but, furthermore, phenomenologically transcendental.

To amount to a phenomenological inquiry, besides aiming at elucidating conditions of intelligibility of the life-world, an exploration has to regard experiential evidence as the only source apt to validating cognition. This is something the presented approach does insofar as it elucidates the intelligibility of an account’s fragment f1 in terms of the sense of other fragments that are argued to provide ‘structural moments’ to the meaning of f1 and the whole account. Here, aspects of an experiential field are exclusively validated by other aspects of the same experiential field.³⁰ To this extent, the study’s theoretical assumptions concerning the nature of the object of inquiry—the life-world of adolescent depression understood phenomenologically as a multilayered and sedimented field of significance—and the methodological premises concerning the empirical accessibility of this object fit one another in virtue of a mirroring relationship.³¹

But even finding such an approach appropriate for a disclosure of the structure of certain personal experiences, one could be skeptical about drawing conclusions concerning the claim that a certain kind of experiences are typical of adolescent depression. It is important to understand, however, that, in disclosing objectively plausible frames of intelligibility of a subjectively particular form of experience, this method opens the door to a comparative-interpretative endeavor that makes possible generalizations of a theoretical kind. These generalizations are based on plausibility and not, as in the case of inductive empirical generalizations, on measures of probability or, as in the case of strictly deductive generalizations, on logical necessity.³² So, the results of the intermediate level analysis provide a basis for generalizations insofar as they actually prove illuminating in relation to a particular group of experiences which, according to the elucidation, could not be what they are were the revealed structures not to predefine them. However, they hardly support generalizing claims in relation to experience tout court (cf. Westerlund, 2014).

In closing, let me come back to the claim that the discussed procedure amounts to a crossover approach to human experiential life. On the one hand, this exploration is unquestionably empirical in that it (1) in a methodically disciplined way ‘asks the world a question’ and (2) exclusively and exhaustively treats ‘that which comes in return’ as data. On the other, the discussed interpretative procedure is phenomenologically oriented in that it accounts for the intelligible character of certain appearances exclusively in terms of a series of ‘constitutive moments’ that determine boundaries of significance of a certain sort of experiences. The results of the analysis have a ‘bridging’ character insofar as they can feed either into an account that maintains the transcendental stance or into one that, assuming an objectivist perspective, postulates, for instances, a series of (operationalizable) psychological functions. So, the method is such that it permits the researcher to decide which of two possible—but mutually exclusive—explorative attitudes to ultimately adopt.³³

Such an ‘amphibious’ character appears to me fundamental if one is to develop ‘meaningful phenomenological methods that [match] the interests of health professionals, as healers’ (Morley, 2019, 163; my emphasis). It does not amount to a mark of uniqueness of the proposed approach, but to a feature that characterizes phenomenological psychopathology as a discursive field in the intersection between clinical preoccupations, on the one hand, and theoretical/methodological commitments, on the other, with radically different attitudes towards the objectivity of appearances. However, it is something that distinguishes this approach from current proposals concerning the ‘mutual illumination’ of phenomenological and scientific endeavors (cf. Zahavi, 2013). Particularly, this approach should be differentiated from merely phenomenologically ‘front-loaded’ naturalistic inquiries, on the one hand, and from mere phenomenological interpretations of scientific literature, on the other.

6 Outlook

Simon Glendinning (2008) argues that something that characterizes phenomenology as a particular force within the contemporary philosophical culture is a concern with what it means to inherit the tradition called ‘philosophy’ in times dominated by naturalism. Drawing on this characterization of ‘the distinctive outlook of phenomenological philosophy’, the ultimate ambition of the presented study may be specified as follows. We live in times in which mainstream academic psychiatry increasingly disdains the role philosophical inquiries can play in attempts to comprehend the relevant subject matter. Correspondingly, the direct connection of the relatively young discipline of child and adolescent psychiatry to phenomenological psychopathology is null. Given that the ‘neuroscientistic’ orientation of the dominant research culture makes great portions of the science that ‘grounds’ psychiatry to appear unconnected to clinical practice (cf. Kleinmann, 2012), efforts are due to show that alternative forms of investigation can also guide child and adolescent psychiatric theorizing. In this order of ideas, this study begins to fulfill an ambition to position phenomenological developmental psychopathology as a form of basic research [Grundlagenforschung] in child and adolescent psychiatry. I believe that this aspiration ‘twins’ my approach with all the above-mentioned attempts to provide a phenomenologically informed systematic for the qualitative exploration of human experiential life, despite the alleged differences.