An analysis of the use of medication in depression through Kierkegaard
Besides my other numerous circle of acquaintances I have one more intimate confidant – my melancholy. In the midst of my joy, in the midst of my work, he waves to me, calls me to one side, even though physically I stay put. My melancholy is the most faithful mistress I have known; what wonder, then, that I love her in return. 
In the Diapsalmata there are a couple of small entries, musings if you will, which vary in subject matter. One of these talks about melancholy and the familiarity with it, the way in which you can feel so at home with something that is destructive. It is something that I recognize, painfully so, and it struck a chord with me. There is something soothing in giving yourself over to this melancholy because it knows you so well and you it. However, there is also a part that wishes to break free of this relationship, but that part needs some help which can be found in the use of medication.
In this essay I would like to look at the use of medication in depression and the way this could be interpreted by Kierkegaard. I am well aware that this would have been a non-issue in his day and age but to me it is an interesting subject nonetheless. I knew quite early on in the process that this would by no means be an easy subject for me to write about. There is a lot of personal hurt and ache that goes into the subject but that did make me more determined to write about it. In a way it is exactly what Kierkegaard would have wanted, because finding your goal in life is not always a happy thing and the road towards your weirdness can be paved with difficulties.
“finding your goal in life is not always a happy thing and the road towards your weirdness can be paved with difficulties.”
I felt compelled to write this essay ever since reading The Sickness unto Death (SuD). There was something about the first part that hurt me, and I wanted to delve deeper into that hurt to find out what it was that made me find it extremely difficult to read. The first part of this essay will consist of my own thoughts on the subject and a first-person account of depression and the use of medication. In the second part I will give an analysis of Kierkegaard. More specifically, I will discuss two particular pieces from SuD that struck a nerve with me and—I feel—give quite a striking view of how we can interpret Kierkegaard in regards to the subject matter. In the third part of this essay I will refer more and more to Either/Or (E/O) for reasons that will become clear along the way but have mostly to do with an interpretation of the way masks play a part in the way people shield themselves from the world. In the fourth and final part of this essay I will summarise the previous parts and address my thesis again.
Throughout the essay I will refer to Kierkegaard as the main author of all the used works. It is, however, important to keep in mind that he wrote both SuD and E/O under pseudonyms. For SuD this is the so-called Anti-Climacus, and for E/O there are two main authors, Johannes (also known throughout the book as A) and Wilhelm (known as B). I will address these as A and B respectively when and if needed but for general points I shall refer to Kierkegaard as the author of these works.
Preliminary thoughts on depression and the use of medication
Our goal in life, according to Kierkegaard, should be to find our weirdness. We should find out what this entails and then put all our effort in making that weirdness (or; that which makes you different from everybody else) stand out. Our assignment in life is not always something that makes you feel good. Maybe your assignment is to care for someone in your family and this does not necessarily mean you will be happy doing so. It could take a lot of time and effort without actually seeing what the use of this is other than helping this person.
“Our goal in life, according to Kierkegaard, should be to find our weirdness.”
What Kierkegaard would see, however, is that you are fulfilling your gift or assignment. There is something intrinsically odd about this, both the way that he describes it and the way you should deal with it as a person. For Kierkegaard, there is no way you should be happy enough with your life when you are doing mediocre. Being mediocre is living in despair, even if you are not entirely aware of it. Even worse is denying you are in despair because everyone is always in despair. Some of us more than others, but we all know what it feels like and we all know what can do to overcome this despair and make it lighter. The difference, however, is how we actually deal with this despair.
Kierkegaard argues that to deal with this despair is to see that it comes from the inside. You can be unhappy about, for example, your spouse breaking up with you. You will be sad that they left you or maybe even angry at them for doing this to you. But at the end of the day this anger or sadness is coming from inside you, you are not angry because of what they have done but by the way it has left you in the world. Your world has changed because of their actions but this despair comes from inside. It might be a fear of being alone, or perhaps you are angry more because you placed your trust in them than them actually leaving you. Because these feelings start inside you it seems only logical that the way to deal with these problems is also from the inside out. You could talk to a therapist or do something else that gives you an insight into your own psyche and a way to change the way you feel and behave. There is an emphasis on God in Kierkegaard’s work, but even that God is not going to be able to help you with these issues because they are not his work. God is not like some policeman trying to tell you when you are doing something wrong, so this work needs to come from yourself. What then, would be Kierkegaard’s opinion on the use of medication when your despair is so overwhelming that you cannot function?
At first glance, it seems he would be against it simply because it means someone is trying to adhere to the norm that is being set by society. There is nothing worse, according to Kierkegaard, than trying to fit in with what other people say is the norm. Why would you want to forsake your weirdness just to fit in? Medication seems to do just that. It makes sure that people with depression manage to function within the norms of society and behave just as people are ‘supposed’ to behave. It gives these people the chance to function on a day-to-day basis that previously was not possible. But what happens when these people fit the norm? Do they go on to reach for the metaphorical stars and find their assignment in life and fulfil it? If they do not do exactly that, they are committing a sin. For being mediocre, as previously mentioned, is a terrible thing.
If we use our medication for other reasons it might be okay though. Because living your best life, a slogan often used nowadays, is quite impossible if you are suffering with mental health problems. It is possible to take the view that the use of medication is a sign of weakness, a betrayal of your unique self, but the flipside is an inability to function in a way you might want to function without this help. I myself have found life much easier when I started taking medication. Sure, there is no wonder pill that will instantly make me feel amazing about myself and makes the voices in my head shut up about my insecurities.
It does, however, give me an opportunity to talk to a psychologist and psychiatrist because I do not spend my days crying or sleeping. It makes the voices that called me out earlier in my life just a little bit more quiet, so sometimes I can actually hear another kind of voice in my head, one that is being trained by years of therapy to tell me that maybe things are not as bad as they seem. Maybe people do actually like me for who I am. Now that is a tricky thing, people liking you for who you are. Because some people may view this way of being who I am in-authentic.
“My authentic self would probably, in all honesty, not be alive right now.”
My authentic self would probably, in all honesty, not be alive right now. This is due to the simple fact that I was fed up with this authentic self that kept me from doing things. This old self, for I believe there is no such thing as a static authentic self, made me not want to see people, not shower for days on end, and cry whenever something did not go the way I wanted it to. I had panic attacks before going to work because I was afraid I would do something wrong and my boss would be angry at me and yell (in my defence, the man was prone to yelling and had it out for me, as colleagues would often affirm) even if this had not happened the last couple of times I went to work. I became suspicious, thinking everyone who was saying they felt bad for me and wanted me to get better was lying because it was the social norm. I thought I had no real friends and the ones I had were just pretending whilst talking among themselves about how much they loathed me.
Now, two years on, I am still not a great person. I am still prone to crying when things happen that I did not expect, but at least I am finding my way around the world with slightly more ease. When something does not go the way I planned, I have learned to stop and breathe and think about what I can do to make things better. I have learned that it is okay to be upset and it is okay to take a mental health day. Things I definitely could not do before I started taking medication to help me in my battle with depression. Again, these antidepressants are no miracle cure, they simply help me make some room for other things in my life (and mind) other than the negativity that my depression caused. There is now room to talk to people, to explore things I would like to do with my life, there is even room to explore things like my sexuality. Something which I was afraid to do because it required opening yourself up both physically and mentally to someone else and I could not even do it alone so let alone with a partner.
Medication has not instantaneously caused an epiphany about what my assignment in life is, but it has made room for me to think about it. I became a teaching assistant, started working for a new company which I enjoy tremendously, and am more able to be open with other people. Something I previously did not do out of fear they would use the information against me. My personal experience with antidepressants is a good one, but there are people that do not feel this way, which is understandable. It is interesting, however, to look at what Kierkegaard wrote about despair and the way in which people deal with it.
The Sickness unto Death
In all honesty, I have felt slightly attacked by the way Kierkegaard talks about despair in The Sickness unto Death. To me it felt like he was judging me for the way I was handling, or betterput not handling, my despair. I recognised myself profusely in an example that is used in SuD:
But while one kind of despair steers blindly in the infinite and loses itself, another kind of despair allows itself to be, so to speak, cheated of its self by ‘the others’. By seeing the multitude of people around it, by being busied with all sorts of worldly affairs, by being wise to the ways of the world, such a person forgets himself, in a divine sense forgets his own name, dares not believe in himself, finds being himself too risky, finds it much easier and safer to be like the others, to become a copy, a number, along with the crowd. […] Precisely by losing himself in this way, such a person gains all that is required for a flawless performance in everyday life, yes, for making a great success out of life.
There is an irony in the way that someone is losing him or herself just to be able to make a success out of life. You could very well argue that there is no such thing as success when you have no idea who you are anymore, and Kierkegaard would argue exactly that. By pretending to be someone else and trying to fit in with what is considered the norm.
“This attempt to fit in with everyone else is a small step away from actually pretending to be someone else, someone you wish you could be. This, Kierkegaard writes, is the worst kind of despair.”
The greatest crime is to forget that life is a miracle and then just roll through it, casually, like you know what life is about without actually knowing because you have forgotten what it is like to be yourself. This attempt to fit in with everyone else is a small step away from actually pretending to be someone else, someone you wish you could be. This, Kierkegaard writes, is the worst kind of despair.
[O]r lowest of all: wanting in despair to be someone else, wanting a new self. Immediacy really has no self; it doesn’t know itself and so cannot recognize itself either, and therefore usually it ends in fantasy. When immediacy despairs, it has not even enough self to wish or dream that it had become what it has not become. The immediate person helps himself in another way: he wishes he were someone else. 
The immediacy Kierkegaard is referring to here, is a way of going through life without critical reflection. There is no sense of thought and yet again you are just making do with what the norm is and adapting yourself to it. By always living in this immediacy you are committing a sin most foul: you are not taking control of your own life and trying to live it as best you can. To wish you were someone else is something that relates back quite well to taking antidepressants when you are depressed. By taking medications you are essentially becoming someone else, you are stepping away from the person you were in despair. But this despair, and the wish to become better, is actually not what Kierkegaard is referring to here. For immediacy, as seen in the quote above, does not have enough self or wish to dream of a better life, of becoming a better person.
That is exactly where the difference lies between someone who is so low in despair that they cannot see a way out other than wishing they were someone else, and someone who wishes that but actually does something about it. This last person will try to make something of their life, albeit with the help of medication. You need to understand yourself before you can actually start living like yourself. It takes work and courage to live in alignment with yourself and to stop being an immediate person. This step is a conscious decision to want to do something about the despair you are living in and changing your life for the better.
Every actual moment of despair is to be referred back to its possibility; every moment he despairs he brings it upon himself; the time is constantly the present; nothing actual, past and done with, comes about; at every moment of actual despair the despairer bears with him all that has gone before as something present in the form of possibility. This is because despair is an aspect of spirit, it has to do with the eternal in a person. […] since the self is indeed the relation to oneself. 
Once again, we see here that there is a conscious decision to be made. When you become aware of the fact that you are in despair, you will carry that knowledge with you at all times. You bring your despair upon yourself every time you choose not to do something about it. It is this relation, of the self to oneself, that Kierkegaard deems so important. You depend on the power that establishes you but at the same time your mind and the reality of what is happening around you are of influence when it comes to the self.
“When you become aware of the fact that you are in despair, you will carry that knowledge with you at all times.”
You should always be aware of this interplay and especially between the mind and reality. Too much dependence on either one is no good, you need to be able to take charge of your own life. The fact that there is something that establishes you does not mean that you should just let everything happen to you in your life. As we shall see in Either/Or, there is a possibility of maybe not changing your life entirely but at least editing it. You cannot choose where you are born, geographically but also culturally speaking, but you can choose how to handle these given things.
In Either/Or we see, as mentioned in the introduction, two different people. A and B have, according to the editor, written letters to one another regarding their lives. Where A lives his life without seemingly making choices, B has his life together and thinks A should change his way of life. There are quite a few references to wearing masks in B’s Equilibrium between the aesthetic and the ethical in the development of personality, a letter which he writes to A. In this letter he tries to convince A that he should change his mask because he is afraid A will no longer know who he really is after wearing it for too long. In this part I will draw upon the idea of masks as it is used by people with depression quite often; the idea that you wear a mask throughout your life for fear of showing your true (depressed) self and the judgement of others. B writes to A:
Don’t you know that a midnight hour comes when everyone has to take off his mask? Do you think life always lets itself be trifled with? Do you think you can sneak off a little before midnight to escape this? And does it not dismay you? I have seen people in real life who deceived others for so long that in the end their true nature could not reveal itself; I have seen people play hide-and-seek for so long that finally, through them, madness forced their secret thoughts upon others as distastefully as hitherto they had proudly kept them to themselves. Or can you imagine anything more frightful than that it might end with your nature dissolving into a multitude, with your really becoming many, becoming, like that unhappy demoniac, a legion, and in that way losing the innermost, the most holy thing in a man, the unifying power of personality? Truly, you should not trifle with what is not only serious but terrifying.
This passage is reminiscent of a passage in SuD mentioned before. B fears that A will lose himself and will not be able to tell his imagination from reality. We also see this in the use of medication concerning depression. On the one hand a patient will want to become a better version of themselves but to do so they must take medication. Medications, in this case, can be viewed as a temporary mask. One the patient needs in order to be able to show their real face in the long run. What is problematic, however, are those situations where a patient would have to take medication for the rest of their lives. It is a game of hide-and-seek with their personality because they are essentially denying what lies underneath at that given moment.
“It is therefore of utmost importance that someone who takes medication does not rely on it too much but also strives to change things intrinsically.”
There is, then, no way of curing this by medication alone. It is therefore of utmost importance that someone who takes medication does not rely on it too much but also strives to change things intrinsically. There is a need to talk to a psychologist or psychiatrist, to be able to take off this mask of medication in the long run. On the other hand, we see that this mask is a pretending of patients towards other people, not so much the medication in itself. It is not showing the world what is going on inside of you but pretending you are fine. It is a way of fitting in with the crowd and doing what is deemed the norm. This pretending would not do according to Kierkegaard. By pretending to be someone you are not being truthful to yourself but even worse you are not being truthful to God:
For the eternal dignity of man lies in the fact that he can acquire a history, and the divine element in him lies in the fact that he himself can impart to this history a continuity if he will; for it acquires that not by being the sum of all that has happened to or befallen me, but by being my own work, so that even what has befallen me is transformed in me and translated from necessity to freedom. The enviable thing with a human life is that one can come to the aid of the Deity, and understand Him, and again the only way of understanding Him worthy of a man is freely to appropriate all that has fallen to one, both the joyful and the sorrowful. Or does it not seem so to you? That is how it strikes me, yes, I think one would only have to say it aloud to a man to make him envious of himself. 
The holiest thing you can do as a human is to give yourself continuity. There is a need to make what has happened your own, do not just acknowledge it and go with it but to make it an active part of your life. There is a sin in being passive about what has happened to you and giving yourself over to this despair that might follow from the negative things that have happened in your life. You need to note that the things that have happened are a part of you. God may have given you negative things but he has also given you positive things. In making both these things your own, you create your relationship with God.
This is a form of positive freedom, you are free to realize your goals and duties whereas a negative freedom means you are just free from duty, but in that sense you will not be able to realize your goals and will therefore always be in despair and living in sin. In this sense, as long as you are dealing with what is befalling you we can say that medication is a way to get closer to God and realizing your full potential. This potential, the assignment in life that you are burdened with at times, can only be fulfilled in this way; to take both the good and the bad and make the most of it. There is a sense of editorship, not so much authorship for you are still dependent on your circumstances.
For although the ethical individual might refer to himself as his own editor, he is at the same time fully aware of his editorial responsibility to himself, in so far as what he chooses has a decisive influence on him personally, to the scheme of thing in which he lives, and to God. 
You are the editor of your life, there are certain things given to you and you cannot change it entirely, but you can change certain things and the way they influence you. You are free within the context to make the text, that is your life, beautiful. It is impossible to do so while only using limited amounts of what is happening in your life because you need to look at it as a whole. Using medication is, in that sense, a way to view the whole instead of being so absorbed in the despair that you cannot even sense the positive things in your life.
So what should we do according to Kierkegaard? We should strive to be our best and weirdest self. Mediocrity should be avoided at all costs because it is a sin to live that way and we will just be denying our despair. It will still be there, looming over you in the background. But when we read Either/Or we also see that B tells A that he thinks it is unwise to pretend for too long. Once you get used to wearing different masks all the time you will have no idea who you are underneath anymore.
This leaves us in a difficult position because sometimes it seems quite necessary to wear a mask, especially when you are struggling with your mental health. It is no use going outside when you know you are just going to be crying all the time so you wear a mask for a while and take it off when you are alone. I think therein lies the difference, the fact that there are times at which you take the mask off. The mask Kierkegaard is referring to is one that is on permanently, A is never true to himself because he refuses to make actual decisions and just does everything on a whim. He does things because he can, but has no purpose in life and does not strive to be a higher being. He is perpetually wearing masks.
“The mask Kierkegaard is referring to is one that is on permanently.”
There is a fear for who you are beneath the mask but wearing one for too long you tend to forget what is underneath and do not know who you really are. The medication, or mask, will give you some room to breathe, knowing that it is quite safe for a while to go about daily life without having to worry about what other people see or think about you or even you yourself doing exactly that. It is a mask that is not a wish to be someone else, but to be a better version of yourself, knowing full well that even when you become this better version of yourself you are formed by the positive and the negative things that have happened in your life.
At the start of this essay I said I wanted to look into Kierkegaard’s interpretation of the use of medication in depression and research what his opinion of it would be. The main idea flowing from my research is that Kierkegaard would not be entirely opposed to the idea of using medication to better yourself when you are dealing with mental health problems. There is a catch however; the medication should not become a new mask for the user to wear just so they can go through life without acknowledging their despair and just so they can fit in with what is considered the norm of the current society. Medication is a way to find out what your assignment in life is and to work towards that, but if it leads to mediocrity it should be avoided at all costs.
 Søren Kierkegaard, Either/Or, trans: Alastair Hannay (London: Penguin Books, 1992) 44.
 Søren Kierkegaard, The Sickness unto Death, trans: Alastair Hannay (London: Penguin Books, 1989), 63-64.
 Kierkegaard, The Sickness unto Death, 83.
 Kierkegaard, The Sickness unto Death, 47
 Kierkegaard, Either/Or, 479.
 Kierkegaard, The Sickness unto Death, 63-64.
 Kierkegaard, Either/Or, 542.
 Kierkegaard, Either/Or, 551.