Depression: The Purview of Psychologists or Exorcists? Melinda Selmys Originally published in Issue XI of Vulgata, August 2003.

Over the last century, as psychology has gained greater authority, there has been a certain amount of controversy regarding the causes and nature of mental illness. Theories range from entirely biophysical explanations of human behaviour, to those which incorporate both mental and physical factors, to those which explain problems in entirely spiritual terms. For obvious reasons, the former must be rejected by any Christian – it necessarily proceeds from a view of human nature that excludes the spiritual and denies human free will. But what of the other theories? Are we to look at mental illnesses as a spiritual problem, demonic attacks and the like, or are we to view it primarily as a physiological illness that effects the mind?

I am going to deal here only with one of the most common mental illnesses: depression. Psychologists estimate that nearly one in ten North Americans suffer from this condition. It is generally believed that women are at a higher risk than men, but there is some concern that the diagnostic manuals identify depression in women more accurately than in men (tearfulness, for example, is a major symptom which is likely to be suppressed by men more than by women,) and that women are more likely to feel that it is acceptable to discuss their symptoms with health care workers. We do know that incidence of depression has been increasing steadily since the end of World War II, though there is little agreement as to why this might be the case. We also know that depression is accompanied by certain chemical imbalances in the brain, and that it can be treated with drugs, though there is some controversy over whether this is an acceptable way of dealing with the problem.
 

What is depression?

Unfortunately, its symptoms are fairly wide ranging – in fact, psychologists usually break it down into a number of disorders – but it all essentially amounts to a feeling of emptiness, purposelessness, hopelessness, and lack of interest in life. This is often accompanied by the desire to be dead, by withdrawal from the people and things that one loves, and by an inability to cope with the stresses of daily life. For those who are practicing religion it can include an inability to feel God’s presence, and a lack of joy or comfort in religious practice.
 

What are its causes?

There is a great deal of controversy surrounding this question, with religious fundamentalists usually claiming that it is entirely spiritual – either the result of interior sin or of external demonic attack – and psychologists usually claiming that it is the result of biochemical processes which affect the mind. At the root of this controversy is one of the greatest metaphysical errors of modern thought: Cartesian dualism. Essentially, this is the widely held understanding that the soul and the body are two separate entities which interact in some sort of mysterious and ill defined way. The effect of this assumption is the idea that a thing must be caused either physically or spiritually – that if its effects can be seen in the chemistry of the brain, then it must be a biological problem, and that if it is spiritual it doesn’t have physical causes. In order to understand what is really happening in a mental disorder like depression, it would seem necessary to first understand what the relationship between soul and body really is.

For this we turn to the medieval scholastics, who did a wonderful job of defining this relationship (though what they defined was essentially the common understanding of their time and of most preceding generations.) The soul is neither a separate being effecting the body through some undiscoverable medium, nor is it a thing that somehow resides in some area of the body. Rather, it informs and contains the body. This is why we believe that abortion is murder right from the moment of conception: because a human soul is a creature which, by nature, is joined to a body. The body cannot live without the soul to order it and give it life, and the soul is not some external thing that can be placed in the body at some point during gestation. They are a unity, and what effects one effects the other. This is why St. Paul says that people are becoming sick and dying because they have partaken of the Eucharist unworthily – not because God is intervening in a miraculous way in order to bring about sickness and death as punishment, but rather because the sickness that is imparted to the soul through sacrilege naturally effects the body which is joined to the soul.

What this means, is that our understanding of depression can’t really be one in which soul and body are divided. Obviously, we cannot deny the fact that there is a biophysical component to depression. Indeed, there are certain cases where we can be fairly certain that it is primarily a matter of something which effects the body also effecting the soul – as is the case with the hormonal changes that cause periodic depression for some women over the course of their menstrual cycle. On the other hand, we also know that it is sometimes a matter, primarily, of the soul effected the body, as is the case in Post-Abortion Syndrome, where guilt for the sin of abortion causes a depressive state that effects the body. We must also keep in mind that, in many cases, it is precipitated by some sort of spiritual suffering, such as the loss of a loved one, which in turn produces a physical response.
 

Is it an illness, or a sin?

It is probably best to look at it as something similar to same sex attraction – an objective disorder which is usually involuntary but which may be brought about or exacerbated by voluntary actions. In cases where it is entirely involuntary, it is not sinful in itself, though it remains dangerous because it constitutes a disordered inclination to despair. In cases where voluntary factors have brought it on, it may be sinful in so far as the person is aware of the relationship between their moral choices and their depression, and in so far as they choose to continue in behaviours that they know contribute to their depression.

This spiritual and moral dimension of depression is extremely important, though it is often overlooked, because it can provide us with valuable information in how to overcome depression. In the first place, it would seem that, because depression is usually involuntary, and because it does include biophysical factors, it is permissible to seek medical treatment, either through the use of drugs, through counseling, and through other forms of therapy which have their basis in medicine and psychology. This cannot be undertaken, however, without a recognition of any spiritual factors that incline a person towards depression, or else the underlying problems will simply be glossed over and ignored. For example, exaggerated guilt is one of the common symptoms of depression, and while this can be the result of intense scruples, it may also be caused by a displacement of guilt over some act that a person is not willing to accept responsibility for. This is the case, especially, in situations where a person may be involved in some sort of activity, such as abortion or homosexual sex, which their conscience knows to be wrong, but which they choose to believe is morally acceptable. In this case, the causes of depression are essentially spiritual, and treatment with drugs should only serve as a stop-gap measure to allow the person to function while they are undergoing some form of spiritual healing.
 

What is the difference between depression and despair?

The former is to the latter essentially what same sex attraction is to sodomy – depression, while often not sinful in and of itself, constitutes a condition in which a person is strongly tempted to commit the sin of despair. Depression is an emotional state which, because of our concupiscence, may exist independently of any movement of the will. Despair, on the other hand, demands the will’s consent. Strictly defined, it is the belief that one’s salvation is impossible – either because God does not exist, or because He does not will to save us, or because one’s sins are too great to be forgiven, or because the grace will not be given in order to repent. There are, however, lesser forms of despair, as when we still hope for our eternal salvation, but believe that God will not provide us with all that we need, or that He will not provide the strength to perform some task. Thus, for example, when a person suffering depression refuses to attempt some activity because they do not believe that they will have the strength, and do not trust that God will provide it, they are committing the sin of despair with regards to that particular action. (Note that, depending on the severity of the depression, and the degree to which its genesis is biological, the degree of culpability for such a sin may be drastically reduced.) The most severe form of this is obviously suicide, the state in which the person believes that God will not provide them with the strength, healing and purpose necessary to continue living.
 

What voluntary actions can lead to or exacerbate depression?

It must be understood that for some people depression constitutes a life-long cross – just as some may struggle with same sex attraction, or alcoholism throughout their entire life, no matter how long they practice the virtues of chastity or sobriety. These people need to see their depression in the context of Christ’s cross. In moments when we feel that we cannot bear the burdens of life, we must recognize our unity with Him as He fell under the weight of His cross on the way to Calvary. When we are unable to derive any consolation from prayer, and we feel that God has abandoned us, we must meditate on that moment when Christ called out “My God, my God, why have you forsaken me?” We must accept it, as St. Paul accepted the thorn in his flesh, understanding that God’s grace will be sufficient. In this way, an ongoing temptation can be transformed into an occasion for habitual virtue, and for drawing nearer to God.

When a depressed person is tempted to feel that they are worthless, they can choose to dwell upon this thought, to explore and justify it, and when they do so they commit a venial sin because they apply their will towards a self-destructive course that recommends despair. On the other hand, they can actively seek to engage themselves in purposeful activities, or to meditate on God’s love for them, or any other activity which contradicts the matter of the temptation. While this will not necessarily eliminate the original feelings of depression, or the temptations to despair, it will provide the person suffering from this condition with the good habits necessary to survive it and to persevere in living out a meaningful life.

This does not mean, of course, that we should not seek to overcome these feelings, especially since in some cases they constitute a grave threat to those around us (if we should break down), and even to our own lives. We are always called to avoid occasions of sin, and so those who suffer from depression should seek means by which to address the underlying causes. In cases where those causes are biological, it is up to the person to decide whether or not they feel that the use of antidepressant drugs would be prudent. In cases where depression is having a severe impact on one’s family relationships or ability to work, or where suicidal thoughts are constant and difficult to fight, consultation with a competent spiritual director would certainly be highly advisable.
 

What are some ways in which a depressed person might actively fight depression?

It is interesting that many of the recommendations made by psychologists in order to promote healing from depression essentially involve overcoming certain sinful habits. The most striking is the connection between sloth, gluttony and depression (and this may explain why the problem has become so prevalent since World War II.) Healthy eating, regular exercise, and consistent involvement in some sort of meaningful activity are amongst the most common recommendations. While, obviously, there are cases where poor eating habits and lack of activity arise as consequences of depression, they can also serve as causes, and they certainly exacerbate the problem once it exists.

Someone suffering from this condition needs to be aware of this, especially since depression creates the illusion that any further activity or responsibility will be crushing and unbearable. In fact, while work and relationships may continue to feel impossible when they are first undertaken, a consistent commitment to any sort of meaningful activity will, for obvious reasons, slowly build up within the soul the tenacity necessary to cope with depression, and will provide a purpose for living when depression becomes most difficult to deal with.
 

What are the social factors that have contributed to the rise of depression?

We live in a culture which is largely out of touch with spirituality, and even those who have a strong personal investment in their spiritual life are affected by that culture. One of the major problems with a materialist outlook on life is that suffering cannot be reconciled with meaningfulness (thus the push for such evils as euthanasia), and therefore comfort and ease are pursued with great energy. This leads to the assumption that hard work and discomfort are evils that we should seek to avoid, and, especially, from which we should protect our children. We arrive, then, at a society in which children are provided with every luxury and convenience under the assumption that once they cease to be children they will have to endure all sorts of misery, and that, therefore, we should put off the start of real responsibility as long as possible. Is it any wonder, then, that when adolescents first begin to experience any sort of hardship that they break down? Having come to view leisure as a right and meaningful work as misery, they are unequipped to deal with the pressures and stresses of normal life and thus come to view every responsibility as a crushing, unbearable weight, and death, which appears as the ultimate escape from responsibility, becomes appealing.

It is not, however, merely a matter of providing a context for the meaningfulness of suffering– children raised with religious values remain susceptible to this sort of depression. It is a matter, rather, of presenting and entirely different vision of work, so that it is not perceived as a form of suffering that must be endured, but rather as a type of highly meaningful activity. Unfortunately, as the Popes have pointed out in their letters and encyclicals on labour, this can be very difficult in a society in which workers are seen as human resources instead of human beings, and where there is often little effort made to preserve their dignity in the workplace. It is not, however, impossible to imbue factory labour with a sense of purpose – the World War II economies of the Western world were highly industrialized, and yet almost every worker had a strong sense of being part of the war effort (and hence a part of something meaningful), even if they were only sliding pieces of sheet metal into a machine. The process of valuing people’s work grants them a greater sense that there is dignity in what they are doing, and helps to counteract the feelings of meaninglessness and unjust hardship that promote depression. Unfortunately, far from seeking to imbue work with meaning, our society is obsessed with retirement, consistently belittles all sorts of meaningful work (most notably motherhood) by labeling it “menial,” and consistently promotes an individualist agenda in which even the dignity of providing for a family is no longer recognized.

Another important contributing factor is the creation of a celebrity culture in which virtuosity is more valued that virtue. I am currently corresponding with a young man who obviously suffers from depression, and whose depression is clearly associated with a lack of any meaningful activity in his life, and it is quite telling that he cites, amongst the reasons for his inactivity, a feeling of frustration with the idea that, no matter what he does someone else will be better at it than he is. This sort of thinking is obviously the result of an excessive focus on celebrity and recognition – we feel that success is really only achieved by the best, and that, therefore, if our life’s work is to be really meaningful, we must be the best. We are bombarded with the notion that people who are thinner and more beautiful, or who are fitter and more athletic than other people are therefore objectively better. Our role-models not only lack virtue, they actively engage in every sort of vice – and yet remain as popular (if not more popular) than if they had not. Attempts to counter this take the form of absurd programs that try to make all children feel valued by praising mediocrity as if it were excellence – a solution that really only exacerbates the problem because it provides young people with an unrealistic expectation that they will be rewarded as if they had excelled when in fact they have not. This may hold up well enough in kindergarten, but, again, is it any wonder that despair is so prevalent amongst adolescents when they have to finally realize that, not only will they fail to make the top of their field without actually excelling, but that they don’t even have the right to attend university unless they earn the appropriate marks?
 

How can we counteract these problems?

What is necessary, as a first step in countering depression, is a culture which promotes a realistic love of self. This can be neither a disordered love, based upon pride, nor a sense of self-esteem based on a fantasy in which everyone is equally talented. Unfortunately, this sort of love cannot be effectively promoted by an educational system (though some exceptionally dedicated teachers may be able to encourage it.) It is a love that is primarily learned in the home environment – though a child’s experience of being loved, supported and forgiven by their parents. This relationship, when properly constituted, is one in which the child is encouraged to improve, in which they are criticized and disciplined realistically and constructively, and in which they learn both that they are valued regardless of their failures, and that their successes are valued independently of their dignity as a person. It is tremendously difficult to provide this sort of support without the full-time attention of one parent, however, in a society where full-time mothers are few, and where we have been consistently taught that our work is unfulfilling and menial, there is a high risk that those who do stay at home with their children will lack the sense of purpose and perseverance necessary to completely invest themselves in this essential work.
 

What should we do if we know someone who is depressed?

Unfortunately, many people who are suffering with depression will not seek help, either because they are embarrassed by their condition, or because they have despaired of any possible help being effective. It is important, therefore, for those in regular contact with someone who experiencing these feelings to be compassionate, supportive and concerned. It is especially important for parents to be vigilant, since the rate of depression is higher amongst adolescents than amongst adults. We need to be especially conscious of the fact that people experiencing depression are often inclined to withdraw, and that they may not wish to talk, and may even become belligerent if addressed about it directly. Our responsibility is always to provide help – but in order to do so there are a couple of things that we need to keep in mind. The first is that the most important thing we can do is often simply to communicate with and persevere in relating to a person suffering despair. This can be difficult because the relationship will be emotionally draining, and there is usually a strong temptation to blame the other person, especially when our own resources are dwindling. It is absolutely essential to avoid this – we must truly put the other person first if we are to help, if our love is contingent on convenience, or we expect to be repaid for our efforts, they will fail. This being said, we need to understand that what happens is not necessarily our fault. There are cases where even the most dedicated, compassionate, selfless outreach will end in suicide – this is a necessary consequence of human free will (even Christ’s crucifixion, which was certainly the most powerful and the most perfect outreach in the world, cannot undo the power of free will to reject help and love.) We are still, however, called as Christians to reach out to those most in need of healing and mercy, and to do so regardless of the pain that it may bring us. One of the greatest factors which can cause depression to lead to despair and suicide is lack of a support network. Talking, even with someone who has no training whatever, is highly beneficial, because the person who is depressed feels, when they have someone to talk to, that they are not suffering alone, and this is grounds for hope. This means that when someone we know becomes a burden, when our friendship or marriage descends into a long and apparently fruitless exercise in bolstering self-esteem, we are obligated to stick with it. Whether we ultimately succeed or fail in this world, our effort and compassion will be amply rewarded in the next.