An American psychiatrist explains what inspired him to write a guide to the condition specifically for members of the Church
I was motivated to write the book A Catholic Guide to Depression because I believe that our Catholic tradition – including the writings of the Church Fathers and saints – has something important to say to those suffering from this terrible affliction. Depression is often misunderstood; most people mistakenly believe it’s 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. Because of mistaken assumptions, those who are afflicted with clinical depression often suffer in silence, unrecognised by others. I wrote the book first to speak to those who suffer from depression. I hope it will also be helpful for family, friends, clergy, and spiritual directors to gain a better understanding of depression, so that they can more effectively support their loved ones.
If someone is afflicted with cancer, this person is flooded with sympathy from family and friends, and support from the local parish, perhaps with special mention in the general intercessions at Mass, and so on. 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 true understanding. There is rarely public mention of the problem due to the stigma of mental illness.
I recall one patient, a married Catholic woman with several children and grandchildren, who had suffered from both life-threatening breast cancer and severe depression. She once told me she would choose the cancer over the depression, as the latter caused far more intense suffering. She tragically committed suicide a few years after she stopped seeing me for treatment.
In a 2003 address on the theme of depression (included in an appendix of the book), Blessed 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 went on to stress how 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 is a complex condition that affects more than just a person’s emotions; it impairs one’s cognition, perceptions of the world, physical health and bodily functioning. The causes of depression are likewise complex. The medical model that characterises depression as simply a “chemical imbalance in the brain” is true but also incomplete. Neurobiological and genetic factors do play a causative role; but so do psychological, interpersonal, behavioural, cultural, social, moral, and indeed, spiritual factors. Depression should be understood and treated from all of these complementary perspectives. Medications and other biological treatments have an important therapeutic role in many cases, as does psychotherapy provided by competent, sensitive, and skilled professionals. These should be integrated with spiritual support and spiritual direction, a life of prayer and the sacraments.
All truth is symphonic: there is a harmony between faith and reason, theology and science, if only we discover it. Our understanding of depression can be more complete if we draw upon insights from medicine and psychology on the one hand, and from our Catholic tradition on the other. There is a need for a constructive dialogue here, as John Paul II pointed out to a group of psychiatrists in 1993: “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.”
According to its original Greek root, the word “psychiatrist” literally means “doctor of the soul”. But in modern psychiatry, this original meaning has largely been abandoned: psychiatrists today tend to focus on the body, especially the brain, to the exclusion of the soul. Other critics have levelled the opposite complaint against psychiatry and psychology, claiming that we overstep our limitations and often tread on territory that was once occupied by religion. For example, Archbishop Fulton Sheen wondered whether the psychoanalyst’s couch has replaced the priest’s confessional in the modern world.
Despite the legitimate concerns raised by these critics, John Paul II reaffirmed that a genuine dialogue presupposes that both parties involved have something worthwhile to say to the other. The confessional was never meant to cure neurosis or other mental disturbances, and the couch was never meant to absolve sin. John Paul II continues in the same address: “The confessional is not, and cannot be, an alternative to the psychoanalyst or psychotherapist’s office, nor can one expect the Sacrament of Penance to heal truly pathological conditions. The confessor is not a physician or a healer in the technical sense of the term; in fact, if the condition of the penitent seems to require medical care, the confessor should not deal with the matter himself, but should send the penitent to competent and honest professionals.”
While the sacraments alone were never meant to cure mental afflictions like depression, they can and do play a healing role in a plan of recovery. The principle of “sacramentality” in Catholic theology, based on the central Christian doctrine of the Incarnation, affirms that the material world can mediate spiritual realities. As creatures of both body and soul, we relate to God through our senses. If I’m burdened by guilt or by sins of the past (often the case in depressed persons), when I go to Confession I’m able, in a very tangible way, to hear words of absolution from the priest who is acting in the name of Christ and the Church.
Many people who have gone to Confession describe this powerful experience of psychological healing. They are able to walk out knowing with total conviction that they have indeed been forgiven, that the burden they’ve been carrying has been lifted. The Catholic sacramental system is indeed consistent with our psychological make-up: we need to hear these words of absolution in order to more tangibly experience God’s mercy. We also know that sin not only harms our relationship with God but with others as well. In Confession there is the experience a sense of reintegration with a community: the priest represents the Church, the community of Christians, with whom the penitent is reconciled. All this is powerfully healing, and lifts a burden spiritually and psychologically.
Likewise, in participating at Mass, one’s own psychological suffering is united to the suffering of Christ – who suffered for me psychologically and physically. In Holy Communion, I receive his flesh offered for me and his blood poured out for my redemption and my healing. While this does not magically cure all physical or mental afflictions, the grace of the sacrament does strengthen me to bear these burdens in union with Christ. Our Lord says now to those who suffer 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” (Jn 16:20), and he assures us: “In the world you will have tribulation, but take courage, for I have overcome the world” (Jn 16:33).
Dr Aaron Kheriaty is the director of residency training and medical education in the Department of Psychiatry at the University of California, Irvine, School of Medicine. A Catholic Guide to Depression is published by Sophia Institute Press (Sophiainstitute.com)
and available on Kindle from Amazon.co.uk
This article first appeared in the print edition of The Catholic Herald dated 3/5/13