2.1 Evaluative judgments

According to Goldman (Reference Goldman2009), deep desires are reflected in the evaluative judgments one makes. The person who believes he is unworthy of being loved may still claim that a life filled with love would be better for him than a life without it – he merely believes it is unattainable. Such evaluative judgments indicate, according to Goldman, that deep concerns like the desire to have a life filled with love still exist. Judgments about what is good, worthwhile or important tend to be an indication of what a person cares deeply about. The desire for friendship, for example, is characterized by a disposition to spend time with friends and to get pleasure from thoughts of having friends, but it is also accompanied by the judgment that it would be good to have friends. Perhaps depressed people express judgments like that having friendship is valuable, that not being loved is a bad thing, or that having success in their career is a good thing. If so, we would have some evidence for thinking they also have desires for these things.Footnote ¹¹

Goldman argues that depressed people do continue to make such judgments. As he points out, having negative evaluations of oneself is a common symptom of depression.

According to Goldman, the negative self-evaluations made by depressed people, such as that they are incapable of being loved or too incompetent to succeed in their chosen field, provide evidence that they take certain states of affairs to be good. And the fact that they take these states of affairs to be good is evidence that they have desires for them.Footnote ¹²

However, while it may be true that all depressed people continue to make evaluative judgments, there is evidence that, in some cases of depression, these judgments do not reflect the kind of deep desires which would give rise to reasons to go to work or seek treatment. Some depressed people say that nothing is worth doing, that there is no purpose or point in life, or that they feel empty (Watson and others Reference Watson, Harvey, McCabe and Reynolds2020). In an autobiographical account of his depression, author Andrew Solomon says that, in his depression, “the meaninglessness of every enterprise and every emotion, the meaninglessness of life itself, becomes self-evident. The only feeling left in this loveless state is insignificance” (Solomon Reference Solomon2002: 15). The evaluative judgments expressed in these claims appear to reflect either an absence of concerns altogether, or concerns of the wrong kind to generate reasons to go to work.Footnote ¹³

On one interpretation of the quoted passages, these claims might appear consistent with the picture suggested by Goldman according to which some valued and desired ends are simply out of reach. On one interpretation of a claim like “every enterprise is meaningless,” what is meant is that nothing they do will get them what they really want. In other words, they have deep desires for some things, but believe no amount of effort will bring these things about. However, other claims made by depressed people about meaninglessness appear to be incompatible with this interpretation. In describing his own battle with depression and suicide, Tolstoy writes:

What is noteworthy in this passage is that Tolstoy claims that he would not wish for anything. Similarly, Maria von Herbert, in a correspondence with Kant in which she describes her depression, writes:

These claims appear incompatible with an interpretation according to which “everything is pointless” means “nothing I do will get me what I truly want” because both Tolstoy and von Herbert maintain that there is nothing that they would wish for. One would think that, if their lack of motivation to do anything were due to a belief that a roadblock prevented them from achieving their goals, they would at least wish for that roadblock to be removed.Footnote ¹⁴

2.2 Moral desires

Despite the evidence just presented, it might be argued that depressed people – even those who judge life to be meaningless – still have moral concerns which give them reasons to go to work or get treatment. They surely continue to care about their families, for example, and they surely would choose to save a dog from cruel neglect if they could so with minimal effort. Empirical evidence appears to support this hypothesis. Those with depression experience empathy just as often and to the same degree as non-depressed people, and they tend to be even more concerned than non-depressed people with how well they are meeting the requirements of morality (O'Conner and others Reference O'Connor, Berry, Lewis, Mulherin, Crisostomo, Farrow and Woodruff2007: 54). This evidence conflicts with the evidence considered in the last section. Perhaps when Tolstoy and von Herbert claim they could not wish for anything, they mean that they could not wish for anything for themselves, but could wish and desire things for others.

But Tolstoy, elaborating on the extent of meaninglessness he found in the world, claimed that he wondered why he should take care of his children:

The “terrible truth” to which Tolstoy refers is that life is meaningless. This passage suggests that he judged, not merely that his own life was meaningless and not worth living, but that no life was worth living. Therefore, though he might have been preoccupied with morality, it was out of skepticism about why he should care for others.Footnote ¹⁵

2.3 Desires for meaning

Perhaps instead we should interpret Tolstoy and others as expressing a deep desire for meaning in life – some purpose that would provide a justification for their doing something rather than nothing. Both Solomon and Tolstoy appear to attribute their inactivity to an absence of meaning in life. When they say that life is meaningless, this could be evidence that they desire meaning in life but believe that bringing it about is impossible. Rather than showing that they have no deep concerns, these statements could be taken as expressions of one of the deepest desires people can have. If meaning in life is possible for them, then their desire for it could be satisfied, and they would thereby have reasons to do what is necessary to satisfy it.

The problem with this interpretation is that it is not clear that these statements about meaninglessness point to a desire for meaning. An inference to the existence of such a desire requires more than a claim about meaninglessness. My claim that water is flavorless does not, by itself, imply that I desire water to have flavor. Andrew Solomon mentions the way that life appears meaningless in his depression apparently only to describe what it is like to be depressed, and not to lament a lack of meaning. If this is right, then a claim that life appears meaningless when depressed does not give us reason to think the depressed person desires meaning in life.

4.1 Rationality

Consider, first, whether making the depressed person more rational can be expected to have the necessary effect on her motivations. Idealization could involve an improvement in either epistemic rationality or practical rationality (or both). My focus will be on improvement in epistemic rationality, as I am skeptical that any kind of improvement in practical rationality will generate the necessary motivations. This is because requirements of practical reason usually have to do with what one is required to do, or be motivated to do, given one's other beliefs and desires. For example, instrumental rationality requires that one take the necessary means to one's ends. But in the sort of cases we have been describing, the depressed person desires almost nothing, and the desires that remain are for the most part being satisfied. Other requirements of practical reason, such as the requirements of consistency and coherence, would seem unlikely to make a difference for similar reasons. The coherence requirement, for example, requires that one's desires be organized in such a way as to promote maximal overall desire satisfaction. This can require that one not have certain ends. To have drinking alcohol as one's end could be irrational if it were incompatible with other ends to which one has assigned a higher priority. But, again, in the cases we have been considering, the depressed person desires almost nothing, but is getting the few things they do want, such as to lie in bed. So there appears to be no failure of coherence or consistency.Footnote ¹⁸

The most promising way to argue that the depressed person would have desires if they were rational is to argue that depression is caused by epistemic irrationality. The basic thought is that depression is caused by irrational beliefs, and so removing that irrationality would allow a normal range of desires to return. The view that irrational beliefs are responsible for depression has been influential in clinical psychology and psychiatry. Cognitive Behavioral Therapy (CBT) is a scientifically supported and widely used type of psychotherapy which treats depression (among other conditions) by attempting to eliminate irrational beliefs and thought patterns. The thought patterns addressed by this therapy include things like over-generalization, the tendency to focus on negative rather than positive aspects of one's life, and self-defeating thoughts such as the thought that one will never succeed (National Alliance on Mental Illness Reference Alliance and Illness2020). Given that this therapy treats depression by aiming to reduce epistemic irrationality, the effectiveness of such a therapy may be taken as evidence that if the depressed person were ideally epistemically rational, he would have a normal range of desires.

However, some empirical research also suggests that depressed people tend to be in some ways more “realistic” than non-depressed people – a phenomenon known as “depressive realism” (Alloy and Abramson Reference Alloy and Abramson1979). This research indicates that people with depression tend to be less susceptible than people without depression to certain biases in reasoning, such as overestimating one's own reputation, importance, abilities, and one's control over events.Footnote ¹⁹

Moreover, empirical research on the factors responsible for the treatment effect in psychotherapy indicates that the improvement in mood and motivation attributed to therapies like CBT is due to factors which are common to all effective psychotherapies, many of which do not focus on challenging irrational beliefs. Common factors theory suggests that factors like having a supporting and trusting patient/therapist relationship are doing most of the work in psychotherapeutic change, whereas the “specific ingredients” of particular psychotherapeutic approaches, like CBT and its focus on irrational beliefs, are doing comparatively little work (Messer and Wampold Reference Messer and Wampold2002).

Finally, and perhaps most importantly, CBT and related therapies are far from universally effective in treating depression. In some cases, anti-depressant medication or electroshock therapy is the only effective treatment. This fact points to the conclusion that irrational belief is not responsible for the existence of depression in all cases. In research on the etiology of depression, the consensus seems to be that there are many causes of depression (Kaltenboeck and Harmer Reference Kaltenboeck and Harmer2018). In one form of depression, known as Seasonal Affective Disorder (SAD), depression appears to be caused by reduced exposure to sunlight during winter months, which in turn causes a change in neurochemistry (Melrose Reference Melrose2015). The difference between a non-depressed person and someone with SAD does not seem to be a difference in rationality. All of this suggests that even significant improvements in epistemic rationality will not remove depression in all cases, and so also gives us reason to doubt that full epistemic rationality would generate the necessary motivations in all depressed people.

Before moving on, it is worth looking at a different sort of response based on the irrationality of the depressed person. In the “the Moral Problem,” Michael Smith defends the view that a fully rational agent is one who is not emotionally disturbed:

Smith is here claiming that desires which are entirely the product of a disorder or a disease are not relevant to one's normative reasons. This may seem to offer a reply to the problem of depression. The desires of the depressed person may be wholly and solely the product of a disorder, disease or emotional disturbance, and would therefore count as irrational on Smith's view, making them irrelevant to the depressed person's reasons.Footnote ²¹

It is important to ask why such desires ought to be considered irrelevant. It is not enough to say that it is because diseases such as depression and obsessive-compulsive disorder cause one's thinking to be irrational, as this is precisely what needs to be explained. Without justifying such an addition, the distinction between internalism and externalism is threatened. The internalist cannot add just any kind of counterfactual requirements to their view, since otherwise requirements could be added that gerrymander counterfactual desires to fit a preconceived set of what reasons there are. For example, one could add that, in addition to being emotionally undisturbed, one must also be moral. These sorts of “substantive” additions to an internalist view must be ruled out to avoid this threat. It is for this reason that the view Smith proposes which says that says one's reasons depend on what one would desire if not emotionally disturbed, etc. be justified on internalist grounds.Footnote ²²

The most plausible justification is that if a desire is wholly dependent on the existence of a disease, then the existence of that desire is not subject to rational rejection. The disease has complete control over whether one has that desire. The desires of a fully rational agent, by contrast, may be eliminated if, upon reflection, they are found to conflict with the satisfaction of other, more important desires. The same could be said for the absence of desire: a fully rational agent is one who can come to form a desire to take necessary means to a given end, and so is able to form new desires, but depression can make the formation of new desires impossible. This response dovetails nicely with the internalist argument considered above that says cognitive therapy can eliminate depression by making the depressed person more rational. My response was in part to say that cognitive therapy does not work for everyone, and so we should be skeptical of the claim that a more rational version of all depressed people will have reason-grounding desires. But now the internalist can say that, in exactly those cases, the inability on the part of the depressed person to form new desires in the face of rational therapy is proof that their desires, or lack of them, are irrational.

However, while the inability to form or reject a desire can lead to irrationality, it does not itself constitute irrationality. That a desire cannot be eliminated is a problem only if the existence of this desire conflicts with other requirements of rationality, such as the requirements of consistency and coherence. Similarly, the absence of a particular desire is not irrational if requirements like consistency and coherence do not call for one to have that desire. If the immutability of desire were enough to make a desire irrational, it seems that many desires which appear perfectly rational would turn out to be irrational. A non-depressed person's most basic desires, such as the desire that one's children be happy, may be quite steadfast – as steadfast as a depressed person's absence of desire. But these desires do not seem irrational. There are also many desires non-depressed people lack, such as a desire to end the world, which they may be unable to come to have through reflection – at least, as unable as some depressed people are to form new desires. But those absences of desire do not seem irrational. So, desires or their absence which are wholly the product of an emotional disturbance or addiction may be irrational, but only if this leads to a conflict with standard requirements of rationality. The depressed person may be unable to form the desire to go to work or accept treatment for her depression, but for reasons discussed earlier in this section, it is not clear that standard requirements of rationality, like coherence and consistency, require them to form these desires.

4.2 Information

Internalists who accept a rationality constraint on reasons often also accept an information requirement. An information requirement is motivated by thought experiments like Williams's example of the gin drinker who desires to drink a glass of what he believes to be gin but which is in fact gasoline (Williams Reference Williams and Harrison1979). The gin drinker may be fully practically rational and may have a rationally formed belief that the glass contains gin. But though the gin drinker desires to drink the contents of the glass, intuitively, he has no reason to do so. This example suggests that one's reasons are determined by the desires one would have if sufficiently informed – if one had an accurate picture of what the world is like. The internalist who accepts such a view may claim that absence of desires in the severely depressed person would not persist were they more informed.

In thinking about which kind of information idealization should require, David Sobel suggests that there are two models to choose from (Sobel Reference Sobel1994: 796). One, which he calls the “report model,” has idealization involve gaining merely propositional information about the ways one's life could go. Receiving information, on this model, is akin to hearing an “expert lawyer” argue for each option. For example, being informed about my ice-cream flavor decision would require having each flavor option be argued for as fully as possible. The second model, which Sobel calls the “experiential model,” has being fully informed require knowing “from the inside” what the experience of each option would be like (in addition to having propositional information). My ice-cream decision would only be fully informed on this model if I had actually had the experience of tasting each flavor.

Consider first whether giving the depressed person full propositional information would have the necessary effect on her motivations. One reason for thinking it would is that a natural reaction to encountering someone who is depressed, and especially someone who is considering suicide, is to remind them of all of the things they have to live for. These would be the sorts of things that we think make it desirable for most people to continue living: being able to smell flowers, listen to the rain, and watch your children grow up. The assumption behind this reaction seems to be that the depressed person has forgotten some of the information they used to have. Full information, on the report model, would remind them of all of the things they have forgotten. The hope is that after being apprised of all of this information about what makes life so great, some of their former, non-depressed desires would return to them.

But efforts to remind depressed people of the things they have to live for often fail to motivate them. This is because they usually have not forgotten about the existence of these things, but, like Tolstoy, simply are not moved by the thought of them anymore. An attempt to help a depressed or suicidal person in this way sometimes backfires by making that person feel misunderstood. For this reason, this method of trying to help is discouraged by mental health professionals (National Suicide Prevention Lifeline 2020).

What other reason is there for thinking that full propositional information would have an anti-depressant effect? I can see no other reason for thinking that it would. In fact, I think the phenomenon of depressive realism discussed in the previous section should make us at least wonder whether full propositional information would increase motivation in depressed people rather than decrease motivation in non-depressed people. Depressed people may be more informed than non-depressed people about things which generally affect motivation. For example, they may have more information about their own limitations or may be more cognizant of the amount of suffering in the world and of their own mortality.

If full information can be expected to have the right kind of effect on motivation, I think it is must be experiential information. A reason for thinking so is that depression makes a person unable to have certain kinds of experiences. Importantly, depression appears to make it difficult or impossible for depressed people to experience taking pleasure in the things they used to take pleasure in. Anhedonia, or the inability to feel pleasure, is a common symptom among people with depression. Even colors can appear duller and less vibrant (Bubl et al. Reference Bubl, Kern, Ebert, Bach and van Elst2010). This inability may mean they have lost crucial information about what the experience feels like, even if they remember having had pleasure experiences in the past. If they were to have a vivid enough awareness of what pleasure feels like, only then could they fully appreciate what life would be like if they were to get treatment. Under these conditions, perhaps they would desire treatment.Footnote ²³

The problem is that changing the depressed person in this way may make them unable to have the experience of not taking pleasure in anything, and so not able to fully appreciate what life would be like as a depressed person. This is an instance of a more general problem for the experiential model of full information theories: being able to have certain kinds of experiences sometimes precludes being able to have other kinds of experiences, and so no single, fully informed perspective may be possible. To illustrate the problem, Connie Rosati (Reference Rosati1995: 318) gives us the example of an obtuse person. An obtuse person is unable to appreciate what it would be like to experience life as a compassionate person. To make them able to have that experience “from the inside” would require that they take on the ideals, traits, and motivations which characterize the compassionate person. But if this is done, it creates someone who no longer has the ideals, traits and motivations necessary for appreciating a life as the obtuse person would experience it. Similarly, if we change the depressed person so that they are able to appreciate pleasure, and in effect allow them to appreciate a non-depressed life, we make them unable to know how it feels to be depressed. Even a person who has experienced depression in the past may no longer have a sufficiently vivid awareness of what the emptiness of depression feels like.