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.

Why do I follow Jesus?

“Truly, truly, I say to you, unless you eat the flesh of the Son of Man and drink his blood, you have no life in you. Whoever feeds on my flesh and drinks my blood has eternal life, and I will raise him up on the last day. For my flesh is true food, and my blood is true drink.” When I think about why I follow Jesus, I think of Peter’s response to Jesus after many had deserted him because of what he said. Jesus looked at his disciples and asked, ‘you don’t want to leave too do you?’ But Peter replied, ‘Lord, to where else will we go? You have the words of life.’

Just as he fed 5000 with only 2 loaves of bread and 5 baskets of fish, so Jesus offers himself as true bread and drink. For him, to eat and drink of him is to believe him and so believe in his words. I think it follows that our beliefs therefore shape reality. Will I believe Jesus and have eternal life? Or will I try to obtain it another way? Pascal acknowledges that in everything people do, they seek their own happiness and joy (though that doesn’t exclude others). I follow Jesus because I believe him and when you meet him you realize that there is nowhere else and no one else to go to, like an immigrant who finally finds that piece of land called home. For me this home is the home of my affections, the resting place of all my restless searching for joy. In all my years before meeting Jesus, I had thought that what I was looking for all these years were found in myself and my activities but I never suspected that I was made for another.

I follow Jesus because I believe that every desire we have finds their fulfillment in him. It’s not that we’re too eager for happiness and God wants to ruin the fun, it’s that we’re far too easily satisfied. I was like a child content with playing in mud when sand castles, not knowing that beaches were offered to me. But when I took and read his words I realized that these beaches were here all along. This restless heart had found its true and eternal home.

When Good Ends and Evil Begins

What makes evil, evil? Is it evil to hate a person in my mind? Or if I pretend to love them while secretly hating them? What if I openly hate them? What if I pretend to love them and then hate them by working against them without their knowledge? What if I murder them? You might say, ‘that’s enough. Of course you shouldn’t murder them!’ So abstractly labeling the latter as evil is easy. But if you’re required to retrace your steps backwards then it’s not so clear when good ends and evil begins. I think the default is to pass over every stage until the last one. In the age of the trite and trivial, it’s easy to pass over the early behaviors because they have less obvious consequences.

In truth, they’re all evil though varying in degrees. That seems overblown until you realize these behaviors or thoughts aren’t isolated incidences but states of being lived in the presence of an infinite person. Like my mother used to say, ‘it’s your attitude.’ When we pass over these small ‘bad’ actions without recognizing its evil, it’s akin to severing our vessels from our heart. These little behaviors are symptoms of our inner condition and who we are. Imagine the physician who points out to the patient that he has peripheral vascular disease. The patient retorts, ‘nice try doctor but these aren’t my vessels.’ Yet the madness of severing our behaviors from our self is seen everywhere. The malady becomes terminal when blinded by our spiritual sickness we can no longer recognize the good and evil we attempt to define. The fruit of the tree of the knowledge of good and evil is not to know good and evil. No, the food poisoning sets in before that.

In The Sickness Unto Death, Kierkegaard described the severity of sin (the Christian conception of evil) as terrible precisely because it occurred before God –

”…there was much truth in the idea, even though it has occasionally been misused, that what made sin so terrible was its being before God. From this people proved the eternity of hell’s punishment and then later became cleverer and said: ‘sin is sin; it is none the worse for being against or before God.’ Strange! Even lawyers talk of aggravated crimes; even lawyers distinguish between crimes committed against public officials and private citizens, prescribe different punishments for patricide and ordinary murder.

Wronging God infinitely heightens the severity of sin because God is not someone external, who exists outside ourselves like a police constable. Instead, he is a constant relation relating to our self. And the magnitude of our crime is judged based on the self’s standard and the person its been committed against. And it has always been this way. What would one think if a child murdered his father? Would such a child have committed the same crime by murdering his dog?

Kierkegaard wrote that the self has a conception of God yet does not do what God wants and is disobedient. Thus God is never sinned against occasionally but always as long as one was in such a state. Now the higher the consciousness of one’s self, the more intensely the awareness of the self’s standard of measurement – God. The more conception of self, the more God and the more conception of God, the more self.

Calvin, the Swiss theologian recognized the link between the knowledge of one’s self and of God:

“For, in the first place, no man can survey himself without forthwith turning his thoughts towards the God in whom he lives and moves; because it is perfectly obvious, that the endowments which we possess cannot possibly be from ourselves; nay, that our very being is nothing else than subsistence in God alone. In the second place, those blessings which unceasingly distil to us from heaven, are like streams conducting us to the fountain. Here, again, the infinitude of good which resides in God becomes more apparent from our poverty”

The state of evil therefore lies in the will. And its severity lies in its relating of the self to its foundation, God. Evil is evil because it says “this is good for me!” and defies God for good is not ‘for you’ but rather ‘for God’. He is the person of infinite goodness. After all, Nietzsche remarked that good and evil were simply expressions of the will to power. A person who sins is a daughter who slaps her father whilst sitting on his lap. “I would rather sit on my own lap than yours, thank you very much!” Her crime lay in slapping not an inconsequential person but her father who gave her life and of using the elevation of his lap to do the very deed. Little girl, don’t you realize that you can’t slap your father without sitting on his lap?

Complement this article with:

  1. The Sickness Unto Death, Soren Kierkegaard.
  2. Beyond Good and Evil, Friedrich Nietzsche
  3. Institutes of the Christian Religion, John Calvin.