Patronising Attitudes Towards Depression - A Conversation with Jake Jackson

In this episode, George talks to the philosopher Jake Jackson about patronising attitudes towards depression, how they stigmitise the illness, and how to combat this stigma using empathy (what Jake calls 'the empathetic attitude').

Disclaimer: this episode contains brief references to suicide and suicidal ideation.

If you would like support with your mental health, you can:

Contact your GP

Call Nightline, a student run listening service:

https://www.nightline.ac.uk/want-to-talk/

Check out the resources on the Student Minds website:

https://www.studentminds.org.uk/supportforme.html

If you would like help to effectively support a friend or family member, check out:

https://www.studentminds.org.uk/startingaconversation.html

If you would like to hear Jake Jackson speak about similiar issues on another podcast, you can find him on the Good is in the Details Podcast:

https://podcasts.apple.com/us/podcast/moody-responsibility/id1466729675?i=1000457202578

Jake can be contacted on Twitter at:

http://twitter.com/mood_adrift

And his personal website is:

http://jakejackson.net/

Hope you enjoy the episode!

Transcript

George S: 0:00

Hello and welcome to the changing mentality podcast. This is George. This is a podcast created by a group of male students from across the UK to create a place where we can discuss issues related to men's mental health. In this episode, I talk to the philosopher Jake Jackson, who is an adjunct professor at the University of temple Philadelphia, and we discussed paper he's written about patronising attitudes towards people experiencing depression. These are attitudes which even well meaning friends and family who wants to support someone with depression can end up exhibiting too we talk about the harms involved in those attitudes. And we also discuss a more positive attitude which Jake calls the empathetic attitude a couple of disclaimers. Neither Jake nor I are mental health professionals. And the episode does contain some references to suicide and suicidal ideation. Although we don't go into any detail. If you're looking for support with your mental health, you can get in contact with your GP, look at the Student Minds website. And you can call nightline, which is a student run content, you're listening service. There's links to all of those support services in the description. Also, if you're looking to support someone else experiencing depression or anxiety, Student Minds the charity runs a really good series of workshops called look after your mates. I actually went to one of these when I was studying at Southampton. They're really good. I really recommend them. They give you a lot of resources, a lot of helpful advice and skills you can use to really approach the issue sensitively. I should say I was a bit depressed when I recorded this episode. It's just one of those days where I didn't wake up feeling all that good. So I had some reservations about recording it. But I went ahead and did it anyway. And I'm really glad I did because it went well. I know Jake's really enjoyed it. So hopefully you'll get something out of it too. Thanks for listening. Hi Jake, welcome. Thanks for having me. Yeah, so we're gonna talk about your paper patronising depression, epistemic injustice, stigmatising attitudes and the need for empathy. But before we get into that, why don't you say a little bit about your background and how you came to do this kind of research?

Jake Jackson: 2:27

Yeah. So I'm a recent PhD in philosophy from temple. Here in Philadelphia, it's in philosophy with a focus on philosophy of psychiatry, existentialism, and ethics, originally from the Boston area spent a lot of time then in New York before coming to Philadelphia a few years ago. In terms of personal connection with this work, I've got a lifelong history of anxiety and depression, with some periods of suicidal ideation, also, probably PTSD from so from my handful of traumatic things, it's really hard, especially the United States to get like a real diagnosis for things, which is something I work on in general is is this sort of limitations that prevent people from being able to access diagnostic care or, or therapeutic care. I initially meant to study comparative religion in undergrad, but took an existentialism course, in my first semester, and then really like ....., ruined my life. Really, in the sense that, like, I realised that I had to do choices and make choices every day, more specific to philosophy of psychiatry, I spent, like the period of my masters at the new school, trying to figure out like, some sort of, like ethics of empathy or ethics of emotion. But really, what I kept finding was the, when it comes to talking about mental health, philosophy just doesn't talk about mental disorder much, especially at least within like, General grand sweeping theories. So, so ethical theories will often ignore the fact that people have mental disorder, or we'll say something to the effect of Well, that's not that's not what people do. So like, I had this sort of side project of trying to use philosophy to figure out what the best thing to do was, I didn't really sort of have a sense of where that was going. But that was more of a personal project. And then just before I started my PhD, Robin Williams died by suicide and it just brought in that influx of really bad hot takes about, like, What? What happened, right? Because everyone felt like they owned some sort of stake in Robin Williams his life as people who have grown up with with his work or have just enjoyed his work over the years. But what was especially bad was Russell Brand said something to the effect, like Robin Williams, his struggles were a divine gift or like a divine spark, and really was a gift to us as viewers. And at that point, I realised that that really, that's the sort of work that I need to combat against is a sort of sense that of what stigma and ignorance and sort of the general confusion about what mental illness is or isn't and how to treat it to a necessity to talk about it within philosophical circles.

George S: 5:59

Okay, great. That sounds really interesting. I think later in the episode, we'll get into the specifics about the kinds of attitudes that you're interested in combating. I suppose one place to start is this paper we're going to talk about the paper is patronising depression, epistemic injustice, stigmatising attitudes, and the need for empathy. big focus of this is on depression. I just wondered if you could outline what depression is, and especially you make this point that it's a heterogeneous condition. What do you mean by that?

Jake Jackson: 6:30

Yeah, so the fact that it's like heterogeneous in the sense just means that you can have like a whole bunch of different system symptoms from someone else who has died, diagnosis for depression. And you can both have major depression. As, as I noticed, really, the the DSM five, so the Diagnostic Statistical Manual of Mental Disorders, which is in its fifth edition now, which is the psychiatric diagnostic text, the DSM five, overall, the point is to create a sort of laundry list of these are symptoms that that manifests, right like these are, these are a cluster of symptoms that manifest in different ways. So you have this this list, that includes that depression has to include this two week period of either this sort of stereotypical likes, like sad mood or depressed mood, along with or, alternatively, a lack of pleasure in activities, which is called anhedonia. And so already into that a lot of people don't recognise that they have depression, because they just feel numb, right, they don't feel sad, they just feel numb, or that they the things that they used to enjoy just don't end up being enjoyable. But then it comes with with a list of other symptoms that it could have, right or that depression needs to include. And you have to have at least four of the following to have a diagnosis within this two week period. Also, the two week period thing seems relatively arbitrary, just more to show that you're not having a one bad day or like a string of bad days, that it's something that that is continual, but it includes other, other symptoms, oftentimes, like they're, they're kind of contradictory, right. So like, you have weight and diet changes, changes in sleep patterns, either insomnia or hypersomnia, psychomotor problems, fatigue, feelings of guilt, or worthlessness, concentration problems, or obsessive thoughts of death and suicide. So within a depressive episode, you can have someone who gains weight, another person could lose weight. You can have people who sleep too much you can have people who just can't sleep at all. And it's all depression. It's all under this large like umbrella, which means that it's something where it's really hard to unless if you're looking for signs of it, it's really hard to say okay, so this is depression at but there's all of these other people who also have depression that have very different symptom. ologies.

George S: 9:22

Yeah. Oh, that's great. Yeah, thanks for summarising that. So I think that's an important point that depression can manifest in all these different ways. And it might be entirely different in one person, to another person. Now I know, in terms of my own experience of depression, like I, I fail to recognise it as such for quite a while because I The main thing for me was like my sleep had become really bad. And I was getting what's good sleep, maintenance insomnia, where you go sleep fine, and you wake up and it's hard to get back to sleep for a couple of hours for me and then go back to sleep, but it just disrupts everything. And I just thought Oh, This is just insomnia. Like, I know what insomnia is, and this is what it is. And it was only later that I realised that I was having these other symptoms which I was attributing to the insomnia, like physical pain and stuff like that. Which I then realised, oh no, this is all part of this one thing called depression. And insomnia is part of the depression. It's not the insomnia is causing these other symptoms. But until you realise something like that, and you realise all these different ways depression can manifest, it's very hard to see that in yourself, or even in other people.

Jake Jackson: 10:28

Yeah. and it's this hard to see in other people part as well that one usually only speaks from tehir own experience of depression, they end up projecting onto others, saying 'you're not derpressed, you don't have this particular niche symptom set that I had'. So overall, this is this is more sort of the sense of, of what you were just talking about, where it's, oh, well, I'd never knew that I was depressed, right? That sort of mentality, right. So So mass depression, to a large extent is this is the sense that you don't necessarily recognise what it is, but you have this, this condition going on, right? Or you something's wrong, what ends up happening, and what a lot of people have told me, as a, as I've been working on this, is that they sort of didn't realise that they were depressed, they didn't realise that they had depression, they didn't realise that they had any sort of mental disorder, depending on what it is. But really, just because they they only sort of noticed one symptom, right? Or they only noticed one symptomology at one time. And that means that the really, it's masked, because it's something where they aren't necessarily taking care of themselves in the way that they, they could or or, or anything like that, but rather, they're they're focusing on one particular issue, right? So if it's, if it's bad sleep, right, like you said, like, bad sleep, seems like it's its own thing. And, and, of course, you know, it becomes this sort of feedback loop as well, where you end up having worse sleep or end up having fatigue issues, because of course, if you're not sleeping, then there's fatigue issues, but that all makes you more depressed, etc. So mass depression is really just this idea that you don't necessarily recognise it when it when it appears. Yeah. And I think often, as you say, people have, say, one or two symptoms that they think are emblematic of depression. And they think they will I don't have those for I don't have it. So like, for me, I remember that was, well, I can still get out of bed in the morning, you know, I can still I'm still doing all the things I need to be doing in my life. So how can I be depressed? Like, if I was depressed, I wouldn't have that. And I know that's not the case. But until you know that it's very hard to recognise, like, Oh, no, this is just depression showing up in a different way from how it might show up in someone else. Yeah, and, and it's something where there are certain narratives that we have or like, that are sort of like canonical ideas of what depression is, including, like Sylvia Plath's Bell Jar, it was willing to siren's darkness visible. And, and these are, these are great in terms of like explaining what, what their own particular experiences are. But when you focus only on particular experiences, then it sort of just edges out anything else, or edges out, like the sort of wider array of disordered experiences that one can have. Yeah. And kind of as an offshoot of this idea of masked depression, you talk about how one way depression can be masked in American men is that it comes out as anti social behaviour. And in the UK, we have an organisation called the men and boys coalition, which looks into these kinds of issues of mental health. And one thing they found is that a lot of boys end up getting excluded or expelled from school for bad behaviour, when what's actually going on is they're depressed. And I think the explanation is, well, they don't really know how to express this, but it's it has to come out some way. And so it's coming out in this way that we wouldn't usually recognise as depression. I wondered, why do you think it shows up in that kind of demographic in that way? Yeah, so I think this is a good question. The way in which depression manifests for different people as well has a lot to do with with social expectations. Particularly in this case, it's it's all derivative, sort of gender roles and gender explicit expectations. It all boils down to just just toxic masculinity and or just masculinity in general because I I find a hard time parsing those two down to a large extent but, but really the idea is that, yeah, you have a lot of young men acting out young men and boys that act out in certain ways out of aggression because they internalise their feelings of depression, don't know how to talk about it, etc. Additionally, it's something where we can look at sort of, like the statistics that that go about in terms of prevalence, cis women and trans individuals have higher incidences of of depression, then cis males do, right. But that's only in terms of, like, who seeks a diagnosis or who goes out and gets a diagnosis as well, talking about feelings is is very, not masculine. In terms of the way that we talk about it, in terms of the way that we understand it, really the, you know, we have this this large belief in stoicism and aggression as being the sort of more masculine traits, which means that the, you don't have people talking about their feelings when they are expressing their feelings in certain ways. And it also means that they're not seeking diagnoses, it's not, they also don't necessarily see this as a problem in themselves, they don't recognise that, that the amount of anger or aggression that they're exhibiting is a is a problem, right? Because we we throw a lot of boys will be boys will be boys type rhetoric around and that has all to do with with the way in which we talk about gender and talk about emotions, right? Women are imagined to be more, more emotional, right, we talk about women being more emotional, having more emotional intuition and things like that. And so they're the ones that are more likely to even try to seek a diagnosis or seek to understand their feelings, when men just sort of bottle it all up. And then and then the worst thing sort of, sort of just erupt. And this also includes, or like, it's really important to point out that I think the end result of this oftentimes sort of shows up in in suicide rates. Right? So So cis, cis, women, again, have higher diagnosis rates of depression, yet cis men are more likely to die by suicide. And this has a lot to do, not just with the sort of masked depression type thing. But it also has to do with the way in which like men act, in general, is that is that if they're going to attempt suicide, they're going to be more violent in their means. Right? So so the it's it's more often this question of, like using using firearms using violent physical ways of dying, when it's actually pretty levelled out? In terms of, like, attempts, right? It's just that we also don't, we don't also recognise all the, like suicide attempts as suicide attempts in a lot of cases. So I think it's I think a lot of it is is more or the way in which like, the way in which diagnoses or or depression diagnoses exist, has more to do with this question of like, the way in which we envision gender, the way in which we envision social stigma in general, that it sort of just loops, right, very similar to the work of Ian Hacking, talking about the sort of feedback loops where, of course, if you give, if you present a pattern that someone is supposed to conform to, then they'll try to conform to it as much as possible. Or they'll resist these in in really troubling ways. Really, it's why the I think that it gets sort of diagnosed as anti social behaviour as opposed to depression is that it is, instead of allowing for someone to manifest their depression in a more healthy way, or more like, talk about your feelings way, it just bottles up, and the only means that they understand is aggression, and anti social behaviour.

George S: 19:36

Yeah, yeah, I think that makes a lot of sense. And there's a lot there in terms of, you've got this one point about why statistically, does it look like sis women and trans women like why are they more highly diagnosed with depression? And you might think, well, maybe they just get depressed more. But I think what you're saying is. No, it's more that what you're actually measuring is who seeks help. When you look at who gets diagnosed the most not, it's not representative of who's actually got the most problems.

Jake Jackson: 20:11

Yes and no. So I think there is more of a diagnostic prevalence as well, because there is a little bit more prevalence when it comes to the way in which we treat women and especially the way in which we treat trans individuals. The Of course, depression and trauma is is at a severe uptick. But that's not it. But I think I think it's more just the the there's a lot of a lot of cases of masked depression and assessment that we don't that that we don't necessarily notice or, or pay attention to. Because we just have this compulsory stoicism.

George S: 20:57

Yeah. Yeah, I think that's an important point. There's a lot feeding into those statistics. Perhaps at this point, I should move on to kind of a central concept in the paper is this idea of epistemic injustice and how this is something that depressed people experienced an awful lot of people struggling with depression experienced an awful lot. Maybe just say a bit about what this concept is.

Jake Jackson: 21:22

Yeah, um, so epistemic injustice is a concept in epistemology. So epistemology is the branch of philosophy about how do we know things? Do we know things? Let's find out. And this initially comes from a book by the same title epistemic injustice by philosopher Miranda fricker. She's arguing particularly that there are there are forms of injustice, right, so that there is an ethics about the way in which we know things, the way in which we trust other people, and we believe other people, but also a way in which we don't know things, right. There's particular things that are missing our notions of like our scientific notions and our concepts that are missing, because of the way in which society is is laid out. hierarchically, in terms of identity prejudice, so she identifies two major forms of epistemic injustice, right. So one is testimonial, injustice, and the other is hermeneutical. injustice, testimonial injustice is really when someone is actively doubted and disbelieved, despite telling truthful testimony to others, because and the reason that they're doubted is because of their identity. More specifically, it occurs when the hearer or recipient of the testimony casts doubt on the testifier based on the latter's social identity, rather than the merits of the testimony itself. And so the prominent example of this is not believing women, because for whatever sexist reason that you might have as to why you don't believe women in particular things, not not believing people of colour, because you're you have certain racist biases, whether explicit or implicit, etc. The example that Fricker uses in this, more specifically is is in To Kill a Mockingbird, but no one believes Tom Robinson, on the stand, even though all of the evidence conforms to his his testimony, the jurors in that in that court case, do not believe him, because of because of him being a black man. And then hermeneutical, injustice has to do with a lack of knowledge. So, so that there are sort of resources that are missing their hermeneutical of resources, so like, ways in which we could know things are missing from the, from the way in which we we talk about it or discuss it. And one of the main and really, this is more sort of, to the effect of they're missing concepts that, that that should exist, or there's missing avenues of research that should exist. But unfortunately, because of the way that that society is laid out, we don't know these things, and it particularly affects the people in marginalised position more often than not one example that that fricker uses in this book is postpartum depression. So for a long, long time, you know, there was this sense of alienation, or or sense of, or there, that period of depression was exacerbated by this alienation of no one knowing what it was. Right? And no one really looking into it either by doctors not necessarily leaving it, etc, women feeling that, that after they've given birth, they they have this, like disconnect from from their child or disconnect from the world, etc. And it wasn't until people got together and said, Okay, so this, this is the thing that we keep experiencing, that doctors went and came through and coined the concept postpartum depression. And so hermeneutical injustice has to do with a missing concept or missing things that that could help a person succeed in life, or could help a person like overcome issues in life. But we deliberately don't know it because we don't listen to these particular or pay attention to these particular people. The paper that I'm that we're discussing today, primarily just is focused on testimonial injustice. But my work since then, is sort of interrelated, although not quite the same as as hermeneutical. injustice. Okay, yeah.

George S: 26:15

That's a good summary. So when we're thinking about this more injustice, when it comes to the experiences of depressed people, how does that manifest

Jake Jackson: 26:26

for the most part, it has everything to do with just not being believed or that one has to suck it up, or one has to just or that one is being lazy when it's being being too selfish, or things like that. Within this paper, I sort of undercut the the sort of general stigma that exists or the stigma that people usually talk about. And I, I am more focused on what happens when people are well meaning. So what is it that when someone says to you, I have I have depression, and you want to help them? What are some attitudes that sort of come out? where the person is it where, you know, someone is trying to help another person with depression, but can easily fail through just not paying attention or not listening fully? Yeah, yeah. Okay. So. And you in the paper, you carve up the kinds of responses that people with depression experience that are forms of testimony and justice into these three attitudes. So you call them the naive attitude, the romantic attitude and interventionist attitude. I wonder if you could just go through what those are? Sure. So yeah, each of these attitudes are our testimonial injustices, as I argue within this paper, and it's, and it's about that moment, we're about that sort of interaction where someone says to another person, I have depression, and that other person tries to help in some way. And then sort of, like more, for whatever reason, will just not be actively listening or actively engaged. So I'm concerned really, with with what's what I think is well meaning or well intentioned reactions to another person's suppression. And it's something where they can be held by someone who has depression themselves or it can be held by just anyone, I outline it as three different attitudes, I also think that they probably overlap a lot in practice, I talk about these as attitudes mainly in the sort of phenomenological literature of talking about taking an attitude towards the world or taking that attitude towards another person, etc. to really sort of like taking up a particular stance or or like belief or set of actions. So, the naive attitude, the romantic attitude, and the interventionist attitude. The naive attitude is is a denialist approach, or is is sort of this this way in which you you sort of just deny the effect of depression or you deny that the person who has depression and and so it's a sense in which the person downplays depression or downplays the depression the other person, either in denying that the person is depressed or focusing on the good things in the person's life. This is, in itself an attempt to make the individual feel better by focusing on you know, good vibes, right that sort of like good vibes only type, type shtick Or downplaying their lived experience. This, oftentimes I think, exacerbates the person's sense of alienation. Or like their, because it's something where the naive attitude tells someone, you Well, you should be happy, you, you're blessed, right? You have all these blessings, you have all these people who love you, you have, like, whatever stage of your career it is, etc, this sort of reaction to saying, Well, I have depression is not helpful, right? It doesn't, it doesn't do anything. It just, it just sort of shows or like, it accentuates like, Oh, well, you should be happy, but you're not happy. So something's wrong with you. And it's very close to identifying that that's what depression is, in and of itself, is that it doesn't matter what someone's mere material conditions are, if they like, if they have benefited like good, good relationships or something like that the person with chronic depression, like even if they like have like, a happy home, and like, like, great relationships, and like good career and all these other things, they don't see it that way. So like, this is just immediately sort of saying, well, you don't have to worry about it, like you, you really have are living a good life. And it's harmful, right? It's harmful in the sense because in the sense that it leads to a person feeling that they can't speak about one's feelings, honestly, it means that they sort of imagined that this is something that just get shut down a lot. That naive attitude also is one of the one of the major things is like when someone is like, well, you just need to change your diet, or do yoga about it or whatever, like that, that sort of notion of trying to, like, sidestep it, right? Just say, Oh, well, you know, this isn't the thing that you're experiencing, or like, it's really just like your fault, right? You're not eating enough. Insert here, or like you're not doing enough insert here. And that, of course, that's something that that exacerbates the feelings of worthlessness and guilt. It's almost like a flinch reaction, I think, as well, the naive attitude is something and maybe they all are like sort of like flinch reactions of trying to immediately console the person, even if that's not what they're asking for, when they're just really just asking to be heard. The romantic attitude is also a form of denialism. But it focuses on on creativity and productivity. Right? So this, this really is an attitude of comparisons where it's sort of just downplays the experience of the persons having so long as they do. creative things are like, really, it's like comparing, it's oftentimes like comparing the person to, like famous, famous historical individuals or famous of other individuals, right? Like one of the more famous sort of things are like what I think is a trope, to a large extent, is pointing to like Lincoln, right? So Abe Lincoln, famous for being troubled by by some sort of disorder, troubled by grief and troubled by the fact that there was a civil war going on at the time. And and using Lincoln as some sort of like, example of like, good, good melancholy or good depression or good, whatever. That's a bad case. Right? Because he was he was in a important position. Right? And, and if you're trying to tell someone who's depressed, well, Lincoln had depression, and look at all the things that he could do. That really undercuts the way in which like, someone feels like good and like they've done things. It also works a lot in terms of creativity circles, so like, whether it's comedy or art or writing cetera, you end up doing these things where you say, like, Oh, well, you know, like Robin Williams, had lifelong struggles. And like, he made everyone laugh. So like, look at what you could do. Right? When a lot of times depression is fixated on Look at all these things that I could do, but I haven't done because I have depression. It's not really helpful to when someone is dealing with this, this sense of of overwhelming worthlessness or guilt about not doing enough for something like that, to then immediately say to them, well look at how all these people that have this as well. Must have overcome it right. And that sort of like really insidious inspiration porn notion of of Well look, they overcame this is something that that, like, immediately undercuts the person trying to feel as though they they can connect with another person. So trying to tie it to creativity ends up being something that doesn't like it makes someone feel worse, if they don't feel secure in what they do. The interventionists attitude, in contrast, is not one that is denialist physician, but rather, it's so that it takes depression seriously, to the point of being too serious. Right, this is this is the reaction in which one assumes that if, if this person is going to tell me that they're depressed, they must be in crisis, or, or be hyper vigilant and assume that any time that this person drops off, or like is is not responsive, or something like that, then the worst has happened. Right? It's this sort of alarmism as well, right. It's thinking that one should intervene in this person's life at any point, right? Because this person is admitted to having depression depression comes with bouts of suicidality, which means this person can't be trusted with with their choices, right? So it's patronising as well, right or rather, all of these are are patronising. Like, the whole paper is called that patronising compression, but like this is the most patronising because it assumes that the person who who has depression is is always a risk, or is always a suicide risk is always a risk in general, you then get hyper vigilant and you get too worried about that about the things that they're into. And that means that, you know, they feel like they can't trust you, because because they're paying too much attention or like, like, the helicopter parent thing. They're like, just like two years, invested or two into one person's personal life. And the thing is, there are points where we're intervention is necessary, right? This is, this is probably the hardest one to really tell or figure out in the sense that that someone explaining that they're that they have depression is, is really just being vulnerable with the person with the other person. But But not every moment of vulnerability or, or like, like putting trust into someone requires some sort of intervention, it doesn't mean that someone's in the crisis things, necessarily. But it requires like listening, actively listening and actively engaging in things not like jumping to the conclusion that this person cannot take care of themselves, or that they cannot be full human being.

George S: 38:09

Yeah, so that thank you for going through all of that. I think that's there's a lot there. I mean, I suppose in response to the last thing you said, I think that's a really important point that through talking to the person experiencing depression, you might discover that there are certain interventions that are appropriate, or you might discover that they're at risk in certain ways. But as you say, merely someone telling you that they're experiencing depression doesn't tell you that that's the case, it doesn't tell you how severe it is, didn't tell you what kind of risks they might be subject to doesn't tell you what your response should be. And I think the point that you make, really, at this point in the paper and in the kind of empathic attitude that you recommend that we'll come to is, it's really a matter of listening to the depressed person's experience, and like treating that as kind of bedrock and learning from that as much as possible. Because as you say, like all of these attitudes undermine the person experiencing depression, they undermine their testimony. So the naive attitude undermines it because it says, it tells us more you think you're experiencing depression, but you're actually not, you're experiencing something much more familiar, which is like unhappiness. And we all know what unhappiness is like. And we all know what the kind of remedy is for us to just do those things. And they kind of offer these quick fixes. And then with the romantic attitude, it's very much like imposing a kind of meaning on the road, the the person suffering depressions, like on their experience of depression, when it's not been asked for, and it's, as you say, it's putting onto this pressure to perform. As you were talking, I was thinking about what, when I think of what's been helpful for me, I've experienced depression. It's not been thinking of all the really momentous things that I could do but haven't done. It's been thinking of all the small things that I actually have done. Even if it's just things I've done that day, you know, like, I've got off, I've got dressed, I've done, how much work I've done, I've maybe done some like, cleaning or all the little things I might have done that day. That's the thing that can actually, to some extent, mitigate a certain feeling of depression. But if you encourage to dwell on Well, there are these examples of these people who have achieved so much. And they had depression it then as you say, it puts it back on them as well, why aren't you one of them. And as you say, it's like a person experiencing depression already feels bad about all the things that they could do and haven't done and they don't think much of the things that they could do and have done and that are worth celebrating or feeling proud of. Perhaps now we should move to what you talk about is the empathic attitude.

Jake Jackson: 40:52

Yeah. So, so, so I talked about it as as an empathetic. And I, I don't know whether this is like a distinction in British or American English. But I mean, I mean, empathetic, as opposed to empathic. Like, there's this sort of insidious trope, or like, there's a trope in in at least in the United States, where, where people call themselves empaths. And really what they do is they they do all the things that are that are the patronising aspects, right. So like, like, there's a whole bunch of jokes and memes about about this, where it's like, oh, you're an empath, like tell me all the things that you've projected onto me. Right? So so I'm talking about about empathetic as opposed to empathic. So empathetic, I take this to a large extent, from the phenomenological tradition, particularly from from Edmund Husserl, early 20th century philosopher, who, who created the phenomenological method, what he does is he he talks about empathy and something where it's like, you have to habituate yourself to others, other people, you have to, like pay attention to what other people say, and do. And you have to, and and that can't just be that you project into the other person, you can't like some projection is helpful, right? So that sort of projected Oh, well, you know, you can see the way that like, you can't necessarily see the way that that I see myself or something like that, although now mediated through zoom, I constantly see how other people see me, which is horrifying, itself. But empathy for for who Sorrell is, is this notion of trying to like habituate and understand the other person through just sort of interacting and through experiencing and through listening, I call it the empathetic attitude, I think, I think really, it's it's probably just like, like active listening or something like that. It's not that you speak for the person or that you you. This is something that I think that the the patronising attitudes that I that I outlined in the paper, I think that they're motivated by this, this notion of discomfort, right? when someone tells you that they're depressed, that's, that creates a discomfort for for the person hearing it. Right, either because it's something where, like, they, they might not care about you, I don't know. And like you're telling them this vulnerable thing, but in the case that they do care, right, which is what the paper is more about, it's this problem of like wanting that discomfort, wanting this person's pain to just end, right? If this person pain could just end, then then this would be better, right? Then then they would be happy. And I if I love them that I want them to not suffer anymore, or something like that. And so so each of the patronising attitudes are the sort of flinching moves right to sort of like take that that vulnerability and trust but but also just like, kind of be disgusted or like panicked about it and say, Well, no, no, you're not depressed, you're just are having a bad day or like you have so much to live for. Think of all the things that you can do creatively like this is actually gift, etc. Or, oh, no, I have to fix this right now and send you the hospital or something, or put you on medication or put you on whatever, like all of these are, are just speaking for the individual who just said, like I'm depressed, I'm trying to work this out. And I think the empathetic attitude in in contrast is more like allowing oneself to sit with that discomfort. For a little bit, right now, granted, there's also the risk of someone with depression just sort of like overburdening someone else. Right? And, and that is in and of itself sort of this this, like, major issue, in terms of talking about mental health is, is whether or not you at a given point just like word vomit onto someone who's not ready or not in the headspace or not, you know, emotionally connected, or is able to really, like do anything about it. But that's not it either. Right? Like, like, the empathetic attitude really is something that needs to be from both both sides of both positions. And it has to do with with, like, reaching out to someone and, and, and listening and engaging. But also, if it's something where someone does feel discomfort, like uncomfortable about talking about depression, they also need to be honest about that as well, I think so the the empathetic attitude is really this attempt at like directly engaging, like actively engaging with the with the other person. And it's rare, right? Or like, it's, it's rare to have, like that sort of amount of emotional connection. And this, that's really what why I wrote this papers is to try and carve out what the best reaction to someone admitting that they have depression is.

George S: 46:31

Yeah, yeah, I think there's a few good points. I mean, what one thing that came to my mind, so this podcast is produced in association with student minds, and actually do these workshops where they teach active listening to people who are trying to support who are friends of people experiencing things like depression, anxiety, and a course, it's called help your mate. And yeah, involves, I think they're kind of things that you're talking about, where you're not trying to speak for the person, you're not trying to make it all go away. I think one thing that stuck out for me is he was talking about when we have good intentions towards these people, when we kind of care about them and love them. And it's, in a way, it's kind of ironic, sometimes, that can actually make us bad at taking out this attitude. Because when you care about someone you really hate to see them depressed, that doesn't justify taking out these attitudes and try and silence the person experiencing depression or undermine a testimony. But it's something to be aware of that actually. Sometimes, what you're feeling of care or love for a person, you're those immediate impulses, when it gets you to do, those aren't necessarily the best thing for the person experiencing depression. And it can take a little bit of holding back and being patient, and really letting the person experiencing depression, just say what that experience is like. And I think patience is really important just because it is it can be really difficult to describe what that experience of depression is like. And you talk about how they often people experiencing depression often use metaphors and stuff, but it's hard to get out directly. So the empath gatien is really important. And as you say, it's rare, I think, partly because it can be challenging, and it's also not something we're taught to do.

Jake Jackson: 48:24

Yeah, I mean, I think I think this is something that that needs to framed or to actively sort of figure out how to how to be better. The other thing that I stress that it is fallible, right, it is something that that it's not, it's not about getting it right, or or getting it perfectly. And the thing about empathy is that it's a process, like getting to know someone is the process, right. And it requires a large amount of processing to deal with someone that you've known for years to then tell you or for however long to then tell you I have depression this is this is an issue that I'm going through, it's about it's about give and take, in order to avoid stigma or to mitigate that stigma. It is something that that is like it is a process that requires practice. It can't just be done immediately. It's not that you figure out this one size fits all like all my all my friends who have depression, I talk to them like this. It has to do like, you're different, like different friendships have different demands. Different friendships have different things that are going on. Like you have different relationships with different people in different ways. And it's never something where it's it's all together like this is the only way that I react. Everything needs to be sort of like fit To the to the existential needs of, of each friendship or each encounter. And it's difficult, right? it's notoriously difficult. It's also something more like, more often than not, even though or like, pretty often, even if even if someone like unburdens themselves and says, I have depression, I hope that this isn't too much of a burden to you or something like that. Sometimes it is for the person. I've definitely had a history of unburdening myself to the wrong people, and too much or too much to the right people. And it's something that requires a sense of fallibility of a sense of, of trust, and a sense of of, like taking boundaries or or like claiming and staking boundaries for the other person, which is probably something I didn't really adequately talk about in this one particular paper. But it's something that I think about a lot since. But no papers is full. or complete. Yeah. Oh, yeah.

George S: 51:12

Yeah, I think the point about boundaries is really important. I think it matters to emphasise that the empathetic attitude you're talking about, not only is it not incompatible with having boundaries, it's actually boundaries, I think, are a big part of being able to take on this attitude effectively. Because as you're saying, there can be these cases where someone experiencing depression will unburden themselves with by confiding in someone, and that can be sometimes too much for that other person to handle. If you put yourself in the position of always being on the recipient of being on the receiving end of that, even actually, when it starts to become a burden on you, and starts to be too much for you to handle, then you're actually less able to take up the empathic attitude overall, like over the one we're on because you get burnt out. And there's a certain point, you know, that can breed like feelings of resentment or frustration that actually, this person is putting so much onto you. But I think it's important to emphasise that we have agency in those situations, and we can set our own boundaries. And it's often best for both people involved if they know mutually what the expectations are. Because then even if someone you're confiding in seems like they're okay with what you're saying, or that they're okay with you unloading that even if the boundaries haven't been clear, the person with depression might secretly think like, Is this too much? I've known people with depression where they constantly fear that they're overburdening everyone. And I think one thing that can exacerbate that is it's not been made clear to them what the boundaries are. And it can be hard to see those boundaries when you're experiencing depression, because it's, it's quite overwhelming in and of itself. Yeah, yeah. Yeah, I think that a large part of the social aspects of depression, a lot of it has to do with the sort of boundary problems. So it's like feeling as though one that no one wants to hear it. Right. That one is automatically vowed like a burden. But then, you know, I've, in my own personal life, I've been told by a lot of people, oh, well, you can tell me anything that I did. And then I turned, it turned out that that was not true.

Jake Jackson: 53:34

And it's difficult. It's it's extremely difficult to navigate, to figure out, like how relationships work, like friendships, in intimate relationships, family dynamics, things like that. And so I think, I think really, gamut that I put down within this paper is that if if someone trusts you, to tell you about, about their mental health struggles, like try to figure out a way to engage with it actively, but then also, like, figure out a way in which he doesn't deplete your own resources as well. That's a difficult one to figure out. Always.

George S: 54:23

Yeah, I think is when you said, you know, you've heard people say, you can tell me anything. I mean, I feel like whenever I've said that to people or not, if like I've probably been that person in certain situations, especially when I've like when I was younger. It's easy to go in with a lot of naivety. If you try and do that for long enough, eventually someone's gonna say something which does shock you and which is to something you're unprepared for. It can be a little bit of arrogance or a bit of naivety perhaps in there where it kind of like similar as perhaps what you're saying about being an empath you know, like, you have this concept that are on the kind of person who really helps people. But then you discover that actually, I'm like, not qualified to help this person. I'm out of my depth. And I think having some humility with that may important. Yeah, yeah, I think there's there is an important sense, especially like, this is something that has become sort of its own trope is that

Jake Jackson: 55:20

a lot of cis men, if they tap into this a notion of Well, I have feelings, right? Oftentimes, what they'll end up doing is is seeking out friendships or like, like relationships with, especially women, or, or people who are more in tune with their feelings, and then treat them as if they're a therapist, which is not not good at all. It's not it's not helpful. It's not. It's an instrumental way, even though it's emotional and intimate. It is an instrumental way of complicating your friendships.

George S: 56:00

Yeah. You know, one thing I want to pick up on, you said a little earlier with regard to the empathic attitude is that that is fallible. Anyone taking this off is going to get it wrong at some point. And I think it's important to emphasise that because someone who thinks, you know, I don't want to take on the stigmatising attitudes, I want to understand this other person, I want to make as much effort as possible. I think sometimes there's a sense of, if you do get it wrong, you know, the first time you're trying this or how many times you've been attempting it, that a sense of like, Oh, my God, you know, I, I've really felt this person, I've let them down. This is terrible. I can't do this. I think it's like that's, that is, so long as it's done skillfully and sensitively like that is part of the process, and that what can be really helpful, is acknowledging that in practice, I remember I did a counselling skills course, and this is something that it came up there, and it's something I've noticed in my own counsellor is when you are taking up that position, not necessarily of a counsellor, but the position of trauma, take the empathic attitude towards someone when you get it wrong. And when someone says no, you know, it's not really that or it's not, that's not how I feel, you acknowledge that. And I've, I've had my counsellor say, Oh, you know, maybe I got that wrong, then or maybe say a bit more about that. And so there's this recognition of, I am fallible. But I'm that big. I'm aware of that. And I'm constantly working to correct course, and just feel out what's going on here. So because otherwise, if someone kind of gets it wrong, so to speak, or they mis-judge it, and they say the wrong thing, if that's if they don't themselves acknowledge it, it might be that the person on the receiving end also doesn't feel able to acknowledge it. But at the same time, it's created some sort of riff, like somehow, just in the saying the one insensitive thing. There's a distance between the two people. And I think sometimes just naming that can close the gap a little bit and reassure the other person that the person they're talking to they're confidant is trying their best trying to get that what this experience is like through the other person's testimony directly. Yeah, yeah, it requires a certain amount of recognition of

Jake Jackson: 58:21

imperfection of our ability. And I think really, what's what's important is, especially given, especially given the depression is something that that engages fully with this with this notion of guilt. A lot of times for a lot of people, there's this feeling of almost delusional or excessive guilt leads to the sense that that one has to unburden from from that guilt and realise that Yeah, one is going to screw up at times. And that doesn't destroy someone's credibility as a person doesn't destroy their ability to do other things. And it is difficult. A lot of times for people who, like if they're, if they've done something that they're not proud of, during the depressive or mental or psychiatric episode of some sort, it's hard to then sort of like pick up the pieces later, right and fix themselves or like, figure out how to, like improve their behaviour or be a better person after when it sort of turns into this, this guilt spiral. So I think I think a large part of of, like, moving forward with depression, with with engaging with people who have depression, living with depression for oneself, is to is to recognise that the times that one has has done something wrong in discussing with someone or or trying to figure out like how to how to live and not dwelling on it. Which That's impossible. But sometimes because depression is, is a disease of rumination and self flagellation, but like figure out ways in which one can move forward and do better, even if that means that one does has has sort of overburdened people and has a can't necessarily reforge trust or reforge relationship with people that to take those lessons and move on, and figure out how to how to do better. Right? The empathetic attitude, and this sort of sense is something where like, you do recognise that that someone is complicated, like we're all Walt Whitman's, we all contain multitudes. And it's all this question of trying to figure out how, how best to continue?

George S: 1:01:03

Yeah, yeah, I think that's an important point, and can also be a matter of having, you know, having on the part of the confidant and having boundaries, and you know, there being certain things you won't tolerate, but also having a certain amount of patience and knowing that you are going to potentially, depending on the severity of depression, you might be dealing with someone who is going to be quite inconsistent, or quite unpredictable in some ways. And that, that can be confusing, that doesn't necessarily mean that the relationship isn't workable, it just might mean that it's going to have to work a different way to relationships, you have other people who don't have those kinds of mental health problems.

Jake Jackson: 1:01:46

Yeah. Yeah, I think it is something that unpredictable or or, like, depression is also very predictable, sometimes. like to know ahead of time, like, okay, so like, when I get depression, I have these things, that the other things that I engage with or, when this person has depression, they get these things, and these are the things to look out for. Yeah. And I think that's also a good thing to realise. It's like, sometimes people have this idea of, you know, I never give up on anyone I never, you know, like, you can always trust me, I'll always be there for you. But sometimes, you do have to realise that there are gonna be times where you can't help someone, and when your presence in their life isn't making it better, necessarily, it's not making your life better. And it's not, that there might not be a functional way forward for the relationship, and they can be hard. And then in those cases, the best thing for both people might be leave the relationship. And that can be very difficult. And you might the confidant might experience a whole load of guilt and various feelings about it. But that thing emphasising that sometimes that's necessary. Yeah, there's there's plenty of places where one should quit. also say that as someone who is divorced.

George S: 1:03:18

So, do you want to just say, what you're working on now? Yeah. Um, so. So currently, I'm teaching courses in bioethics. I'm also working on adapting parts of my dissertation as articles, and then also

Jake Jackson: 1:03:38

spinning off part of what I did with my dissertation into a book project with the working title, please, anguish responsibly, which I love that title. Next, I can't tell whether it's too kitschy or not. But is it's trying to present an ethics specific for people living with depression and trying to figure out what exactly they they should be doing. That's outside of the role of like, therapy. Given that ethical theories in and of themselves don't necessarily usually make eggs, exclusions when it comes to mental disorder.

George S: 1:04:24

Okay, well, people can look out for that.

Jake Jackson: 1:04:27

Yeah, do you want to just let people know how they can contact you? So I tweet way too much as as mood adrift. Oh, D underscore address and then I have a personal website. That is Jake Jackson. dotnet. Okay. Great. Yeah. Thanks for being on the podcast. This conversation was really cool. Thanks for having me. This was this is great. This was a great conversation.

George S: 1:04:57

Links to the support ages sugges The start this episode can b found in the description as ca links to contact details fo jack Jackson. I hope you enjoye the episode and thank you fo listenin