British Journal of Psychiatry (1992), 161, 195-200 Abnormal Subjective Time Experience in Depression A. E. BLEWETT Abnormality of subjective time experienceis well recognisedin psychiatric illness. Earlierauthors suggested thatslowedtimeexperience indepression isanaspectofpsychomotoretardation, whilemorerecently ithasbeenarguedthatthisdisturbance isnon-specifically linked tothe globalseverityof the depressivesyndrome.This study offers evidencethat both views can bejustified:slowedtime awarenessisa commonsymptomof depression,relatedparticularly toretardation, andtotheseverity ofthemood disturbance. Some oftheexperimental difficulties inthiskindofresearch areillustrated. Disturbed time perception is well recognised in mental disorder, and varies in normal emotional states. It is said that time drags when one is bored or sad. This study examines that aspect of time perception known as time awareness and its relationship to depressive illness. In early literature, experience of time in psycho pathology is divided into outer ‘¿world time' and inner ‘¿ego time' (Straus, 1928). Jaspers (1959) divided the knowledge of time, i.e. judgement about objective time, from the experience of time. Experience of time involves an awareness of the constancy and continuity, as well as of the direction, of time. Lehmann (1967) called this ‘¿time awareness', the term used here, from which he further distinguished ‘¿time perspective', meaning the subject's attitudes towards past, present, and future. Historically, time awareness has been most amenable to phenomenological examination, and its inaccessibility to objective measurement has made comparative studies difficult. The early theories of Janet and of the phenomenologists who followed developed the idea of the ‘¿central now' in normal experience. The normal subject is firmly rooted in a concrete present thawing on the past (memories) and the future (anticipation) to act. In melancholia the present loses its clarity, the future is diminished as change seems less and less possible, and the past looms into the present in the form of guilt and regret (Minkowski, 1988; Straus, 1947; Fouks eta!, 1988). There is a considerable amount of experimental knowledge about objective time judgement in depression. Some studies have found time judgement to be preserved (Mezey & Cohen, 1961; Melges & Fourgerousse, 1966; Lehmann, 1967; Bech, 1975; Kitamura & Kumar, 1983). This agrees with early impressions (Lewis, 1932). Others have found time judgement to be disturbed, although differences in method and terminology make their studies difficult to compare (Dilling & Rabin, 1967; Wyrick & Wyrick, 1977; Tysk, 1984; Kuhs et a!, 1989). Unlike time judgement, there is agreement from early work onwards that time awareness is altered in depressiveillness, andthat it characteristicallyfeels slower (Lewis, 1932;Mezey & Cohen, 1961;Lehmann, 1967; Bech, 1975; Wyrick & Wyrick, 1977; Kitamura & Kumar, 1982). There is disagreement as to its specificity to subgroups of depressed patients: no definite experimental evidence has linked it with retardation, as suggested by earlier authors (Lewis, 1932; Mezey & Cohen, 1961). Kitamura & Kumar (1982) found evidence that it might be more prominent in association with endogenous symptoms irrespective of depth of depression, but this did not reach significance. Bech (1975) stated that there was no relationship between slowed time awareness and subsyndromes, including psychomotor retardation. These findings leave the status of slowed time awareness uncertain. It seems important to re examine the relationship between time awareness, retardation, and the global depressive syndrome. It may be that earlier reviews were correct, but this has been obscured by limitations in the methods used to test the hypothesis. These have always relied on questionnaires to quantify the degree of change from normal. In this study, an alternative technique, the visual analogue (VA) scale, of time awareness, as well as a time questionnaire, was used to compare patients' subjective time experience. Depressive symptoms were quantified by the HARD scale (Rufin & Ferreri, 1984; Ferreri et a!, 1986), an acronym for the French terms humeur, anxiété, ralentissement, anddanger(‘mood', ‘¿anxiety', ‘¿slowing', and ‘¿danger'), the headings given to its four subscales. HARD is an observer-rated scale which can be used with a routine clinical interview and is well adapted to the limited time available to the examiner. It was developed at St Antoine 195