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.

He Is Not Silent

He is here. He hears every word. The words poured over me as water over a rock. I was hearing but not listening. I saw but didn’t perceive. And I was reminded once again that God promises to never leave or forsake his children. They are not orphans. But he has come to them and made his home in them. Yet what do you do when he seems so far away?

Your subjective mind and your perception is all you have. And it’s all you know. Isn’t it? After all, if a tree falls in the woods and no one is around to hear it, does it make a noise? And if God is there but no one is around to listen, does he really speak? I pondered these thoughts in my mind as I spoke with my teachers and afterwards as I sat eating, chewing each thought with every bite.

And then I remembered the stars. I’ve always loved stargazing. But growing up in Malaysia and China doesn’t give you much of an opportunity to see them. So when I moved to Sydney I was floored. There were stars everywhere and every night. And yet people walked about each day with their eyes on the ground. But I couldn’t stop staring at the sky. It was a battle between me, time and my spinal stability. Usually I lost.

Every time I see the stars I’m reminded of how little we know of what’s outside us. And yet it isn’t because little exists beyond us. Vast stars, constellations, planets, and galaxies are all formed beyond my knowledge and control, playing a harmony to their creator. And yet to my eyes they are but little specks of white light, light that has travelled for so long and so far that by the time they reach me their very bodies have died and exploded on the black canvas of space.

Why do the stars exist? It would be absurd to think they were for us when we can’t even see them. No, the stars exist for their creator who calls each one out by their name. Not one of them is forgotten or lost to him. Though they seem little more than white dusty specks to us. Often God seems so small and so far off he might very well cease to exist. In times like that you can believe that he doesn’t exist. But then neither do you, a random incoherent bundle of thoughts. But God is able to exist just fine without our perception. And just like the stars, he shines brightest only in the darkest night.

It is just a matter of seeing. So I’m going to keep waiting until I can say, “Then will the eyes of the blind be opened and the ears of the deaf unstopped. Then will the lame leap like a deer, and the mute tongue shout for joy. Water will gush forth in the wilderness and streams in the desert. The burning sand will become a pool, the thirsty ground bubbling springs. In the haunts where jackals once lay, grass and reeds and papyrus will grow.

Sometimes it’s hard to tell

Has it been so long

Since I met the morning

Instead of it meeting me

Sometimes it’s hard to tell

Has it been so long

That clouds were white dreams

Instead of leering faces pressing

On the earth’s window pane

Sometimes it’s hard to tell

Has it been so long

That the Word kindled flames

Instead of a gray wilted ashtray

Sometimes it’s hard to tell

Sometimes I think the trees

Have an answer for me

As leaves rustle and whisper

‘Sometimes it’s hard to tell’.