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In The Dark

Aaron Kheriaty


Depression, Dark Nights, and the Virtue of Hope

Associate Professor of Psychiatry / Director of the Program in Medical Ethics, University of California Irvine School of Medicine
March 9, 2014

Depression is often misunderstood. Many people mistakenly think it nothing more than intense or prolonged sadness, when in fact it’s a complex illness that can profoundly impair a person’s mental and physical functioning.

Those who are afflicted with this disorder often suffer in silence, unrecognized by others. If someone is diagnosed with cancer, this person is typically flooded with sympathy from family and friends, with an outpouring of support from their local church community. Rightly so. But if someone suffers from depression, this person probably receives, at best, a few well-meaning but ineffective attempts at sympathy from family or close friends, but often without real understanding. There’s rarely public mention of the problem due to the broader cultural stigma against mental illness.

I am convinced that our Christian tradition has something important—indeed, indispensible—to offer those suffering from depression. The medical and psychological sciences have taught us much about depression, but the full story of this affliction is more complicated. Depression is a multifaceted problem that cannot be fully accounted for by a disease-based model alone. In addition to biological and psychological factors, depression is often caused and influenced by various social, cultural, and, yes, spiritual factors. Because it is multifaceted, depression requires several complementary perspectives to adequately understand, address, and cure it.

My approach to depression begins with the premise that the human sciences (neuroscience, medicine, psychology) are in harmony with the theological sciences (philosophy and theology, sacred scripture, and the tradition of the Church, the writings of the Church Fathers and Saints). Our task is to integrate insights from all these sources in order to understand depression. Our understanding of something like depression can be much more complete if we draw upon insights from medicine and psychology on the one hand, and from our Christian tradition on the other.

In a 1993 address to a group of psychiatrists, Pope John Paul II said:

“By its very nature your work often brings you to the threshold of human mystery. It involves sensitivity to the tangled workings of the human mind and heart, and openness to the ultimate concerns that give meaning to people’s lives. These areas are of the utmost importance to the Church, and they call to mind the urgent need for a constructive dialogue between science and religion for the sake of shedding greater light on the mystery of man in his fullness.”

In a 2003 address on the theme of depression, John Paul II said that depression is always a spiritual trial:

“This disease is often accompanied by an existential and spiritual crisis that leads to an inability to perceive the meaning of life.”

He goes on to stress how both professionals and non-professionals, motivated by Christian charity and compassion, can help those with depression:

“The role of those who care for depressed persons and who do not have a specifically therapeutic task consists above all in helping them to rediscover their self-esteem, confidence in their own abilities, interest in the future, the desire to live. It is therefore important to stretch out a hand to the sick, to make them perceive the tenderness of God, to integrate them into a community of faith and life in which they can feel accepted, understood, supported, respected; in a word, in which they can love and be loved.”

Depression, Soul, and Body

Depression is a complex condition that affects more than just a person’s emotions; it impairs one’s cognition, one’s perceptions of the world, one’s physical health and bodily functioning.

The medical model that characterizes depression as simply a “chemical imbalance in the brain” is true but also incomplete. Neurobiological and genetic factors do play a causative role; but psychological, interpersonal, behavioral, cultural, social, moral, and indeed, spiritual factors also play a role.

Medications and other biological treatments have an important therapeutic role in many cases. And of course, so does psychotherapy when it is provided by competent, sensitive, and skilled professionals. These therapeutic interventions should be integrated with spiritual support and spiritual direction, with a life of prayer and the sacraments.

My approach to healing is grounded in the conviction that to fully know ourselves as human beings, we must know Jesus Christ. In my own Catholic tradition, the Second Vatican Council taught that the truth is that only in the mystery of the incarnate Word does the mystery of man take on light. Our Christian faith shed’s light on this deeply human problem of depression, which seems to afflict one’s soul as well as one’s body.

In the Apostles’ Creed, Christians profess faith in the “resurrection of the body.” We are neither disembodied souls nor simply material bodies. Rather, in each human person there is a substantial unity between soul and body, between spirit and matter. This Christian perspective is consistent with experimental findings from modern science. Modern medicine has shown that there is a profound connection between the mind and the body: what affects the one has profound effects on the other.

Depression vs. The Dark Night

We need to understand depression in relation to the spiritual life. It is important to distinguish depression from moral or spiritual disorders like sloth, or what the early Church Fathers called the deadly sin of acedia.

We should also distinguish it from the dark nights of the senses and spirit that John of the Cross and other Christian mystics have written about. I think most Christian therapists have had the experience of patients who prematurely “spiritualized” what were actually more psychologically or biologically rooted problems.

Speaking somewhat loosely and without awareness of the more technical meanings of the term, Christians will sometimes refer to any spiritual trial—dryness in prayer, doubts or difficulties with faith, or strong temptations—as “dark nights of the soul.” I have evaluated some devout Christian patients who interpret their depressive symptoms as a “dark night.” An exclusively spiritual interpretation of their problem may lead them away from seeking medical or psychological help. When they fail to find relief from their suffering from spiritual direction or prayer or Bible reading, they can be tempted to despair, or may feel as though God has abandoned them.

John of the Cross teaches that both dark nights (the dark night of the senses and the dark night of the spirit) are the result of God’s increasing self-communication to the person, which purifies the soul first of sensory and then of spiritual attachments. Such a state may feel like darkness to the person, but objectively it is an intensification of divine light in the soul.

Although a sense of loss is common to both depression and the dark nights, the sense of loss is manifested differently. Depression involves the loss of ordinary abilities to function mentally and physically, and it can also be triggered by interpersonal loss, loss of a job, etc. The interior dryness of the dark night of the senses involves a loss of pleasure in the things of God and in some created things. However, it does not involve disturbed mood, loss of energy (with cognitive or motor slowing), or diminished sexual appetite—all of which are seen commonly in depression. Persons in the dark night of the senses have trouble applying their mental faculties to the practice of prayer and meditation, but do not typically have difficulty concentrating or making decisions in other areas of life. Think of Mother Theresa, who was extraordinarily effective exteriorly even while enduring dark nights interiorly.

With the dark night of the spirit there is an acute awareness of one’s own unworthiness before God, of one’s personal defects and moral imperfections, and of the great abyss between oneself and God. However, a person in this state does not experience morbid thoughts of excessive guilt, self-loathing, feelings of utter worthlessness, or suicidal thoughts—all of which are commonly experienced during a depressive episode. Furthermore, neither of the two darks nights involve changes in appetite, sleep disturbances, weight changes, or other physical symptoms (like gastrointestinal problems or chronic pain) that often accompany depression.

The Effects of Religion on Depression

There now exists a considerable body of scientific research that suggests that prayer, religious faith, participation in a religious community, and other spiritual practices like cultivating gratitude and other virtues can reduce the risk of depression and help in recovery. This does not mean that religious faith inoculates a person against depression, nor does it mean that depression is due to a lack of faith. But it does suggest that faith may have an important role in a person’s healing.

Healing may involve restoring the depressed person’s sense of his or her divine filiation—this most beautiful and consoling truth of our existence: the truth that God is my loving Father. God the Father created me; God the Son redeemed me; God the Holy Spirit is present within me, to sanctify and heal me.

Hope

The psychiatrist Aaron Beck, famous for developing cognitive therapy for depression, did a long-term prospective study of 1,400 suicidal patients to determine which risk factors were most closely linked to suicide. Beck managed to follow these patients for the next ten years to see who survived and who eventually completed suicide. In trying to find the key differences between the survivors and those who died by suicide, Beck examined the patients’ diagnosis, the number and type of mental and medical symptoms, the degree of physical pain a person was in, social and economic factors, and so on.

The results of his study surprised some behavioral scientists. The one factor most predictive of suicide was not how sick the person was, nor how many symptoms he exhibited, nor how much pain he was in. The most dangerous factor was a person’s sense of hopelessness. The patients who believed their situation was utterly without hope were the most likely candidates for completing suicide.

There is no prescription or medical procedure for instilling hope. Hope is ultimately found in the revelation of God’s love and his promises. We can have a natural sort of hope when things in our life clearly appear hopeful. But when our situation appears or feels hopeless, the only hope that can sustain us is supernatural—the theological virtue of hope, which can only be infused by God’s grace.

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