Theology or Therapy? Does Depression Even Exist? A Fresh Perspective

Whose reality counts?

Last week I was finishing a pastoral care plan for Captivate Presbyterian, the church I’m currently interning at. The pastoral care plan was aimed at addressing the holistic needs of those suffering from depression in the congregation. What I repeatedly encountered during my research was a tension between the natural and the supernatural that approached the level of paradox (just like most of reality). Modern society sees depression as a distinct clinical entity like having the flu (although I’d much rather have the flu) without any spiritual element to it. But Christians recognize that every person is an embodied spirit and that the Christian Scriptures cover every aspect of human experience. All personal experience is therefore a spiritual one too and depression likewise. But people struggle to balance different perspectives. Christians tend to either treat depression as any other physical illness or to blame it on some spiritual cause. My friend shared this paper with me that gave us a fresh perspective on theology, philosophy and psychiatry through its examination of depression and I want to explore this a bit further.

Does depression even exist?

Natural brokenness

There’s no denying that depression exists. But no one can seem to agree on what it is or who has it across any culture. These days in the West, it can be a matter of ticking a few boxes on a DASH questionnaire. Which raises the question — in what sense does depression actually exist? This is the issue that Swinton’s paper recognizes.

Worse, there isn’t a consistent understanding of depression across time or cultures. We’ve struggled to determine whether one even has it. This is tied to the problem of whether depression actually exists as a disease in itself. Even the symptoms and the way people with deep sadness or apathy describe depression differ from what mental health ‘experts’ offer. So am I depressed because I say I am? Whose reality ultimately counts?

When a diagnosis is reified (that is the idea that the person has depression is made real), the psychiatrist pronounces that the patient has a certain disease. But when we understand it in this way, it focuses on the individual and the problem he has. It numbs us to the possibility that perhaps depression is not a disease in itself, but a signal of the emotionally toxic society we live in. Instead of better understanding our time and place, the emphasis is often on numbing and medicating and treating the ‘sick’ person.

Spiritually transformative

Swinton’s paper reviews one approach to spiritually understand depression. Rather than something innately bad, the potentially transformative model frames depression as a natural experience that can be interpreted differently and used to grow and transform the individual. The problem of modern society is that it treats health and wholeness as the absence of any disease and tries to avoid any suffering. Because it views it as the greatest evil any God and spirituality have to answer to it (this might account for the problem of theodicy). Yet even Nietzsche the true postmodern saw suffering and depression not as an evil but as a necessity for transformation and true life. Just like the movies, it is better to have loved and lost than never to have loved at all.

Theology over self actualization

But without a transcendent dimension, the potentially transformative model only becomes a “spiritually” oriented self actualization. It’s just another tool for your psychological wellbeing. The focus is still too therapeutic. It is as spiritually bankrupt as mindfulness and meditation without any reference to anything else but yourself. Theologically, Judaism and Christianity has always viewed health not as self-actualization, or the absence of disease or sadness. Rather it’s the presence of God (the divine) in the midst of suffering (cf. The story of Job). You don’t have to be happy or guilt free or physically whole to be healthy! It’s about one’s relationship to God and their assurance of his love and presence.

If this is true, then suffering doesn’t have to be inevitably bad. Yes, it still sucks. The feeling of suffering especially depression can feel like an eternal longing that never ends. It can be paralyzing guilt over who we are. It can feel the alienation of being and the shame of being unlike others. After all, it is the regret between the ideal of what life could be and what it really is: a sad abyss, full of sound and fury, signifying nothing. Lemony Snickett puts it like this, “the sad truth is that the truth is sad.”

Where to go?

I’m not saying that understanding depression as a transformative opportunity denies how awful it is to experience it. I don’t think we have to mutually exclude paradoxical ideas. Instead, if we realize that there is more than one way to understand depression and suffering in general, we can understand ourselves and the world better. We can understand what depression ultimately points to. And we don’t have to simply treat a person with depression like some sick individual who just needs panadol. They have to change. But maybe we do too.

For Christians it is only the evil and suffering that separates us from God that is truly evil. Only when one recognizes that, can one transcend suffering. As Dostoevsky would say, “How can one be well when one suffers morally?” So suffering can be transformative. It can lead us to know God and through knowing him, to become better than who we are. And it highlights the need to reform society before the face of God and the need for him to manifest his transcendence in the immanent. Depression becomes not a final destination but a pothole along a journey. There is a time for weeping and lamenting and healing. But there is also a time for learning and growth and overcoming. As it is written, weeping may tarry for the night but joy comes in the morning.

2 thoughts on “Theology or Therapy? Does Depression Even Exist? A Fresh Perspective”

  1. This is a great approach between medicalising normal brokenness and spiritualising disease! I’ve been reading a book lately- grace for the afflicted, by Matthew Stanford, which addresses similar issues from a Christian psychiatrist’s point of view. I think he veers too much towards the former though.
    The most important concept to hold onto as we walk with and counsel those with mental illness is the concept of Shalom that you were referencing. Too often we are trying to solve the problem of the sadness rather than walking with the tension of unperfected redemption.

    1. Ooh wait till you see the other stuff I have. I’m working a pastoral care project and exploring the intersection of psychology, theology and social science. Thanks for the recommendation. Even in psychiatry many, even wackos like Robert Laing, have recognized that the mad have much to teach us and are not people to shy away from and shut out. After all, insanity is the only sane response to an insane world.

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