The Ethics of (Dis)connection: Understanding 'Care' Through Phenomena of Despair

This dissertation examines the outbreak of depression in the United States through an ethical lens of care and disconnection. Discussions in bioethics and collaborating fields largely speak of mental health as a series of phenomena attributable to individuals, subsequently using terms like 'disease' and 'disorder' to denote abnormality in those persons affected by distress. Alternatively, I respond to the ongoing "crisis of care" through a critique of neoliberalism and biomedicalization. I argue that widespread despair is the result of a collective way of life wherein persons are detached from fundamental physical and psychosocial needs by nature of fallacious cultural commitments and techniques. I implement constructivism to empirically ground a new application of care ethics to be considered by normative ethicists. In addition to merging several established traditions such as feminist philosophy and the capabilities approach, I also contribute a comprehensive model for understanding basic needs and the distribution of caring responsibilities/roles. Further, the project enhances the field of applied bioethics by featuring a practically-specific relational approach that is built from the experiences of those embedded in daily decision-making. The dissertation critiques the theoretical soundness of psychiatric and psychological classifications and the practical efficacy of prominent solutions such as antidepressant medications and various psychotherapies. I further assert that these depictions of mental health misrepresent the experiences of those affected by depression, and thus share their stories of derealization, isolation, frustration, resentment, and hopelessness through a lens of disconnection. These feelings apply to caregivers as well: the commodification of care alongside of the constraints attached to "professionalism" are used to inhibit their autonomy, exploit their labor, and detach them from relationships with charges and other carers. This leads to issues such as moral distress, burnout, and vicarious traumatization, all of which foster despair. Finally, I respond to these collective concerns with a new framework consisting of an expanded account of fundamental needs and an analysis of "care-abilities": the capabilities one has to meet their needs and to fulfill the needs of others who depend on them. I then supplement this account with a detailed distribution of skills and responsibilities attached to the particular caring roles that one might occupy. This ethical framework is intended to be advisory and malleable to contextual practice rather than prescriptive. Doctor of Philosophy This dissertation outlines the techniques and conditions which, through persuasion or coercion, direct us towards a particular way of living marked by isolation, alienation, and precarity. This life, I argue, has facilitated an epidemic of depression and related conditions of distress in the United States. We largely consider mental health to be a series of phenomena attributable to individuals, and subsequently use terms like 'disease' and 'disorder' to denote abnormality in those persons affected by distress. Alternatively, I follow a question proposed by Johann Hari, who asks "What if depression is, in fact, a form of grief – for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need?" The dissertation critiques the paradigms of neoliberalism, which refers to the ideology of elevating market theories to state-sponsored and enforced norms, and biomedicalization, an affiliated logic which individualizes and medicalizes all human problems. In response, I develop an ethics of care framework that prioritizes relationships, acknowledges our shared dependencies, and fosters skills for quality care and advocacy. By viewing depression as an affective reaction to social dysfunction, my analysis also challenges conventional interpretations regarding mental health and illness. This project critiques the theoretical and empirical efficacy of modern mental health solutions, details the various challenges and harms experienced by both depressed persons and particular caregivers, and outlines an alternative ethical approach to be used for evaluation and subsequent care.