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The Table Video

Aaron Kheriaty

In the dark

Associate Professor of Psychiatry / Director of the Program in Medical Ethics, University of California Irvine School of Medicine
January 31, 2014

Psychiatrist Aaron Kheriaty (UC Irvine School of Medicine) comments on the nature of depression, how to understand it in light of Christian formation, and how to deal with it in our own lives and the lives of those around us.


Thanks for checking out this video from the table conference entitled Mind Your Heart. This next video will be Dr. Aaron Kheriaty from University of California Irvine School of Medicine. He’s gonna be talking about the topic of depression and the dark night of the soul, how we understand this time in our spiritual lives and how we can deal with them as we grow in Christ. We hope you enjoy the video.

I wanna thank you for that generous introduction and thank my friends at Biola’s Center for Christian Thought for the invitation to speak with you on this theme of depression. And I’m convinced that our Christian tradition has something important, indeed something indispensable to offer to those who are suffering from depression.

The medical and psychological sciences, my own discipline, have taught us a lot about depression but I think the full story of this affliction is more complicated, because depression is really a multi-faceted problem. And so trying to account for it by reductionistic sort of disease-based model alone is insufficient. I think in addition to the biological and even psychological factors that mental health professionals tend to explore, depression is often caused and influenced by various social, cultural and, I would argue, even spiritual factors. Depression is often misunderstood.

Those who have not personally experienced it may not fully realize the intense suffering which it can involve. And those who suffer from depression often do so in silence, unrecognized by others or misunderstood by others. If somebody is diagnosed with cancer, they are typically flooded with sympathy from family and friends, with an outpouring of support from their local church community.

But if somebody suffers from depression, this person probably receives at best a few well-meaning but often ineffective attempts at sympathy from family or close friends, but often times without real understanding of the nature of this affliction. And I think there’s rarely public mention of the problem due to the unfortunate and continuing stigma against mental illness. I recall one patient of mine, Mary, a Christian woman in her seventies with several children and grandchildren, who had suffered from both life threatening breast cancer and from severe depression. And she once told me that if she was given the choice, she would take the cancer over the depression any day of the week, because the depression caused far more intense suffering.

A few years after she stopped seeing me for psychotherapy I heard from a colleague that she had tragically committed suicide. Likewise, just a month or two ago, a radio host who was interviewing me on this topic of depression mentioned during the show that the episode of depression that he suffered after the loss of his leg was far worse than the actual physical ordeal of losing the limb itself. So the first thing that I want to say is that those who are afflicted with depression should not have to bear this cross alone. As Christians we need to learn how to better support them.

My own approach to depression, and to mental health in general, begins with the premise that the human sciences, neuroscience, medicine, psychology, are in harmony with the theological sciences, with sacred scripture and the tradition of the church. And I think that our understanding of something like depression can be much more complete and effective if we draw upon insights from medicine and psychology on the one hand, and from our Christian tradition on the other hand. In a 1993 address to a group of psychiatrists, Pope John Paul II said the following, “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”, he says, “are of 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.”

Well it seems to me that this conference can make a very important contribution to precisely this kind of dialogue between science and religion. Pastors, psychologists, medical professionals, all of us should be working together here. We should encourage I think a both-and rather than an either-or approach to psychological healing. When a patient who is a religious believer asks me whether I should pray more or see a psychotherapist or take a medication to deal with an episode of depression, my answer is likely going to be yes to all three.

In another address specifically on the theme of depression, John Paul II claimed that depression is always a spiritual trial. “This disease”, he said, “is often accompanied by an existential and spiritual crisis that leads to an inability to perceive meaning in life”. And he went on to stress how both professionals like me and nonprofessionals motivated by Christian charity and compassion can help those who are afflicted with depression and related disorders.

“The role of those who care for depressed persons”, he said, “and who do not have a specifically therapeutic, or professional, task, consists above all in helping them to rediscover their self-esteem, confidence in their 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 the 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.”

Okay, but what exactly is depression, how should we understand it? Depression is a complex condition. It affects more than just a person’s emotions. It can impair their ability to think, their cognition. Their perceptions of the world are colored by depression. Their physical health and bodily functioning, sleep-wake cycle, appetite, all of these things are involved. And as I said earlier the causes of depression can likewise be just as complex.

So the typical medical model that characterizes depression simply as a chemical imbalance in the brain is true, certainly to an extent there are important brain changes and biological factors at work here, but it’s also incomplete, it needs to be complemented by other perspectives. Christianity makes the claim that to fully know and understand ourselves as human beings, we must know Jesus Christ. In my own Catholic tradition, the second Vatican Counsel put it this way, “The truth is that only in the mystery of the incarnate word of Jesus Christ, does the mystery of man take on life”.

In other words, Jesus reveals not only God to man, he reveals man to himself. Our Christian faith I think sheds light on this deeply human problem of depression, which seems to afflict a person’s soul as well as their body. Course, in the Apostle’s creed, Christians profess faith in the resurrection of the body, not just the resurrection of some disembodied mind or soul. So we’re neither disembodied minds, nor are we simply reducible to material bodies.

In each human person there is a substantial unity between mind and matter, between body and soul. The Christian perspective, here, on the nature of the human person, is it turns out consistent with experimental findings from modern science. Modern medicine, as you may be aware, is now discovering this profound connection between the mind and the body, what impacts one is going to have profound impacts and redound to the other.

Now practically speaking, of course, we would like whenever possible to provide healing and comfort to those individuals who suffer from depression, anxiety, and other psychological afflictions. But in addition to the standard recommendations of a medical consult, perhaps medication, perhaps psychotherapy, what more can be done?

Well there’s now a considerable body of scientific research that suggests that prayer, religious faith, participation in a religious community, and other spiritual practices like cultivating virtues, the virtue of gratitude, I saw that Robert Emmons will be speaking here in a month or two, these things can help reduce the risk of depression and aid in a person’s recovery from depression.

Now I want to emphasize, this does not mean that religious faith or Christian faith somehow inoculates a person against depression or against any other mental disorder. It doesn’t mean that if I’m suffering from depression it’s because of a lack of faith, or if only I prayed more or read the Bible more then I wouldn’t be suffering in that way.

But it does suggest that faith may have, and in many case does have, an important role in a person’s healing. I’ve certainly seen this in my own clinical practice. For example, part of a person’s healing may involve restoring the depressed person’s sense of their own divine affiliation, this most beautiful and consoling truth of our existence, that God is my loving father, that I am a child of God who created me, who redeemed me, who loves me and is very close to me, very intimate to me. Saint Augustine put it in his mysterious formulation, “The God who is more inward to me than I am to myself”.

What issues forth from this kind of conviction, or an awareness of our divine affiliation, is the indispensable Christian virtue of hope, which is so important for the depressed person’s healing. Christianity can offer hope in the midst of difficulties, in the midst of psychological and physical pain, in the midst of situations that otherwise might feel intolerable. With Christian hope, a person can find redemptive value, not despite their suffering but even in and through the suffering that they may be enduring. The psychiatrist Aaron Beck, who’s very well known in my field for developing cognitive therapy for depression, did a long term prospective 10 year study of 1400 suicidal individuals to determine which risk factors were most closely linked to suicide. He managed to follow these folks out 10 years, to see which ones ended up unfortunately dying by suicide and which ones ended up surviving.

And he looked at all the types of factors that are usually done in these sorts of studies, the number and type and intensity of mental symptoms, of physical symptoms, the degree of physical pain that the person was in, their medical problems, socioeconomic factors, age, income, all these sorts of things. The results of his study surprised many behavioral scientists because the one factor that stood out, the one factor that was most predictive of suicide, turned out not to be how sick the person was, or how many symptoms he or she exhibited, nor how much pain the individual was in.

The most dangerous factor was a person’s sense of hopelessness. The individual who believed that his or her situation was intolerable, and that the future held out no hope for them, this was the most likely candidate for suicide. Now of course there’s no simple medical procedure or prescription for instilling hope. Hope is ultimately grounded in the revelation of God’s love and his promises to us. We can have a natural, human sort of hope, if we look around at our life and see that things appear to be going pretty well for me.

But when our situation appears or feels hopeless or intolerable, I think the only real hope that can sustain us at that point is supernatural. The theological virtue of hope, which ultimately can only be infused by God’s grace. One of my patients, who had suffered from sexual and physical abuse at the hands of both of her parents once told me, “If it were not for my relationship with Jesus, I would’ve killed myself a long time ago”.

I have absolutely no doubt that this statement was true, in a very literal sense. In spite of her sufferings, her life remained then, and still remains, grounded in a sure Christian hope. I’d like to conclude my remarks with just a brief excerpt from the concluding chapter of my book on depression which discusses this theme of hope. “The virtue of hope can be cultivated in the context of our work, our family life, our leisure, really in any honest human activity. And even, mysteriously, in our brokenness.

We may sometimes wonder whether our efforts to be a better employee, a better husband or wife, father or mother, friend or colleague, are doing any good. Are these efforts worthwhile, am I contributing anything meaningful to the church, or to the world? Saint Josemaría Escrivá used the analogy of comparing us to donkeys that used to be harnessed to turn water wheels. Round and round the donkey would go, churning a pump that watered a distant field.

This humble beast of burden, with its head down and its blinders on, would labor in this routine work day after day. He never saw the flowers of the field that bloomed as a result of his efforts, but these flowers were no less real for being hidden from his sight. Saint Paul put it this way, “For you have died” in baptism, with Christ, “and your life is hidden with Christ in God”. Our life, our work, the fruits of our labors, our sufferings and our pain, all these things, are hidden with Christ in God.

And so we persevere whatever the apparent results, whatever the outward successes or failures, because living and working for God is always fruitful. Christian hope is never individualistic. The Anglican clergyman John Donne wrote the famous lines, “No man is an island sufficient unto himself.” Donne, who in his own bouts of serious depression, was often tempted to despair and at times contemplated suicide, understood that to resist despair, we cannot struggle alone.

Because our life is hidden with Christ in God we don’t know the effects of even our smallest acts of kindness. A few years ago, a man in his thirties committed suicide by jumping off the Golden Gate Bridge in San Francisco.

Afterwards, his psychiatrists went with the medical examiner to the man’s apartment where they found his diary. The last entry that was written just a couple of hours before his death said, “I’m going to walk to the bridge. If one person smiles at me along the way, I will not jump”. We do not know all that we can be to another person, that smile, that small act of kindness is hidden with Christ in God. Now sometimes hope may seem like an unrealistic attitude, a luxury of those who don’t realize how bad things are.

That cheerful or optimistic outlook may appear ludicrous to the person suffering from depression. But such a person can in fact live in the objective joy, though perhaps at times it will be unfelt, the objective joy of a life of theological hope. Because the cheerfulness, the joy of a Christian is not a sort of naive and easygoing optimism. It doesn’t involve putting on blinders or ignoring the evil in the world.

Our joy and our peace are rooted in this virtue of hope, and our hope is grounded in the conviction that the ultimate victory belongs to Christ. This is a victory that he’s already won for us, on the cross. And he says to us now, he says to all those who are suffering and afflicted, what he said to his apostles at the last supper, “Truly, truly I say to you, you will weep and lament but the world will rejoice. You will be sorrowful, but your sorrow will turn into joy”.

And he assures us, “In the world you will have tribulation, but take courage for I have overcome the world”.” Thank you all for your attention. I want to invite you, if you’re interested, to take a look at the forum on mental illness in the church that will be held March 28th at Saddleback Church, if I could put a brief plug in this I hope the CCT folks don’t mind.

This will be cosponsored by Saddleback and by the Catholic Diocese of Orange, Bishop Kevin Vann and Pastor Rick Warren will be among our fine speakers there. So take a look at the Saddleback website if you’re interested for more information on that conference, which I think dovetails nicely with the themes of this conference.

Thanks for watching everyone. If you want to watch other videos from the same session, check ’em out right here. And if you really want to follow all of the videos that are coming out of the Center for Christian thought, make sure you subscribe to our channel.