Depression isn’t a character defect, it’s an illness. It “affects not just a person’s moods and emotions; it also constricts a person’s thinking — often to the point where the person feels entirely trapped and cannot see any way out of his mental suffering,” Dr. Aaron Kheriaty writes with Msgr. John Cihak, STD, in The Catholic Guide to Depression. “Depression can destroy a person’s capacity to reason clearly; it can severely impair his sound judgment, such that a person suffering in this way is liable to do things, which, when not depressed, he would never consider.”
Behind many miserable news stories lies mental anguish. Again and again the pope who has captured the world’s attention has warned about the extreme loneliness many experience in our throwaway culture of convenience. The darkness some among us suffer from is not only spiritual, and it requires more than an occasional check-in from a friend. The Catholic Guide to Depression, along with an upcoming mental-health conference being hosted at Rick Warren’s Saddleback Church next month co-sponsored by the Catholic diocese of Orange County, seeks to get people the help they need, before it’s too late. The Warrens lost their son to depression — he took his life in 2013 — and want to spare other families the same pain. Dr. Kheriaty talks to National Review Online’s Kathryn Jean Lopez about the reality of depression in our time, what it means for our health and our souls, the event next month, silence, sanity, sanctity, and more.
DR. AARON KHERIATY: Depression is neither a new affliction nor a new invention — ancient Greek medicine’s description of melancholia makes this clear, and references to depression go back even further in ancient Egyptian medical writings. However, we could say with Franks that depression is the modern affliction in the sense that rates of depression appear to be on the rise in modern societies. The social and cultural reasons for this are complex and not completely understood — though some of them are explored in psychiatrist Dan Blazer’s book, The Age of Melancholy. Social fragmentation and social isolation play a significant role, as does work-related stress and the pace of life today. Many people in the West today are plagued by a grey fog of nihilism and a consequent loss of meaning and purpose in their lives. So the burden of depression in the modern age is tremendous: The World Health Organization ranks depression fourth among the ten leading causes of disease burden globally; it is expected to rise to second on that list in the next 20 years.
LOPEZ: Some of the symptoms of depression you list — inability to focus, disruption of sleep — are realities of life in our wired age, aren’t they? What does that say about us and our cultural sanity?
LOPEZ: How does the word “depression” “not do justice to the reality of this affliction”?
KHERIATY: In his memoir of depression, Darkness Visible, the novelist William Styron rightly complains that the word “depression” is a pale term to describe a serious and debilitating affliction. He prefers the older “melancholia,” as he says, a far more apt and evocative word for the blacker forms of this disorder. The word “depression” — a bland term used to describe a rut in the ground or an economic downturn — may prevent those who do not have this affliction from appreciating the horrible intensity and psychological pain it causes.
LOPEZ: How do we tell the difference between sadness and depression in ourselves and loved ones?
DR. KHERIATY: Depression obviously includes significant changes in our general emotional and affective state — most commonly, pervasive sadness and anger. But it is just as often characterized more by an emotional numbing and detachment from the world than by outright sadness. The ability of a depressed person to experience a cathartic sadness may actually be one sign that the depression is beginning to lift. Aside from changes in one’s emotions, depression is characterized by other bodily and mental changes. The sleep/wake cycle is disturbed with consequent insomnia or hypersomnia. Appetite changes with weight loss or weight gain are common. One’s cognition and perceptions are altered, with a general mental inflexibility and rigidity, and an inability to concentrate or focus. One is drained of physical energy and unable to enjoy things that normally bring pleasure — psychiatrists call this “anhedonia.” Hopelessness and suicidal thinking are unfortunately all too common during an episode of severe depression. All of us hit rough patches in life from time to time; we all experience periods of sadness, even intense sadness — this is normal, of course. But when this persists for weeks, along with these other physical and mental symptoms, then we need to consider that perhaps the mood changes are such that they require clinical attention.
LOPEZ: “If this book does anything, I hope it convinces those suffering from depression to obtain a clinical consultation with a competent psychiatrist sooner rather than later,” you write. Do those who are depressed always know that they are? What is a practical first step to take if someone think he is suffering from it?
DR. KHERIATY: We are not always the best judges of our own mental state, especially when we are suffering from a mental disorder. So outside consultation with someone experienced in diagnosing and treating these disorders is helpful. I suggest first a consultation with a psychiatrist, and when this is not available, a primary care physician — like a family-medicine doctor or internist — who is experienced in treating mood disorders. A physician may refer to someone else for psychotherapy — a psychologist or psychiatrist or other mental-health counselor. But a consultation with a physician is a good first step.
LOPEZ: You write that “Christianity offers the most compelling answers to the problem of suffering,” while pointing out “that faith alone does not inoculate the believer” against depression and that “a person should not suffer needlessly” from depression. What light does Christianity shed on this problem?
DR. KHERIATY: Suffering is a mystery, and Christianity’s answer to suffering is mysterious — it is Jesus Christ on the cross. Christianity does not promise a life without suffering; quite the contrary. So the answer is not that prayer, or Scripture reading, or the sacraments, will magically cure all mental disorders or other forms of suffering. What Christianity offers is hope and the strength to endure whatever crosses God allows in our life. Unlike Buddhism, which claims that suffering is an illusion and that one can be freed from suffering by being liberated from desire and attachment, Christianity takes the reality of suffering to be, well, real. It offers a God-man who suffers with us, who thus has compassion in a literal sense, and who thereby gives us the grace to endure and the hope to persevere.
LOPEZ: Why is “constructive dialogue between science and religion for the sake of shedding greater light on the mystery of man in his fullness” an important task?
DR. KHERIATY: Because science, for all its wonderful achievements, cannot provide us with all the answers. Indeed, it cannot answer our deepest and most important human questions: Why am I here? What is the purpose of my life? Why have I suffered this loss? These are philosophical and, ultimately, religious questions that simply cannot be repressed. There is a form of scientism that would dismiss these questions as non-empirical, and therefore illegitimate. But the human person cannot stop asking these questions, and cannot be fully satisfied with answers provided by science alone. As St. Augustine famously put it, God created us for himself and our hearts are restless until they rest in him. If all truth comes from God, then science and religion can and should be in dialogue, because the truths of science rightly understood, and the truths of religion rightly interpreted, can never contradict one another.
LOPEZ: To what extent is depression playing a role in violence we see today? Do we talk about gun laws at the expense of dealing with a mental-health crisis?
DR. KHERIATY: It is hard to say, and these shootings remain bewildering and at some level impossible to understand psychologically. This is what Hannah Arendt described as the banality of evil — the emptiness and vacuous irrationality of these acts. But mental disturbances, including perhaps depression, are likely a factor in many of these acts of violence. There may be prudent steps we can take to reduce access to guns among those who have been diagnosed with a serious mental illness, without abrogating Second-Amendment rights, and some of these steps may be wise. That’s a public debate for our political process. But we are fooling ourselves if we think that gun control alone, apart from addressing mental-health crises and social pathologies, is going to prevent these acts of violence. I worry that the knee-jerk reaction to these shootings among politicians appears to be simply an outcry for more gun control, without much mention of other and more important issues.
LOPEZ: Why is it important to remember Walker Percy suffered from depression?
DR. KHERIATY: Percy is one of the great geniuses of the 20th century in my estimation. His novels and essays are brilliant. As a writer who was originally trained as a physician, Percy always maintained an interest in psychiatry and in diagnosing what he called our modern malaise. Percy’s father and his grandfather both suffered severe depression and both committed suicide. It was in his blood, so to speak, but he refused to accept suicide as his fate. He recognized that regardless of biological and social factors conditioning his behavior, he always maintained at his core the freedom of the will. He could choose not to take his own life. He could resist despair and avoid following in his father’s and grandfather’s footsteps in a self-destructive way. His Catholic faith was a key factor in his will to live, even through his dark moods. In a letter to his close friend Shelby Foote, Percy wrote, “Dying, if that’s what it comes to, is no big thing since I’m ready for it, and prepared for it by the Catholic faith which I believe . . . In this age of unbelief I am astounded at how few people facing certain indignity in chronic illness make an end to it. Few if any. I am not permitted to.” In my estimation these words are a sign of great courage and faith.
LOPEZ: Practically speaking, what does the guidance that “we should avoid giving in to sadness or grief too much, if we can help it, as it can be an ally of the enemy” mean?
DR. KHERIATY: We do not, of course, have complete control over our emotions. The Ancient and Medieval philosophers called them “passions” because emotions in a sense “happen to us,” as it were, “passively.” Aristotle compared reason’s power over the passions to a ruler’s power over a city — there is an influence and governance, but not direct and tyrannical control. To some extent we can nurture and cultivate certain emotions by our pattern of thinking, over which we do have more direct control. This is the basis for cognitive therapy for depression: changing our pattern of thinking as a way to influence our emotional state. So there are some things that one can do, or avoid doing, in order to avoid giving in to sadness and grief excessively.
LOPEZ: “The only cross we should be carrying is our share in the one Cross of Jesus, which is always life-giving and always brings about a deeper union with Christ.” How can you be so sure? Where does this leave non-Christians?
KHERIATY: Let me say first that Christ cares about non-Christians every bit as much as he cares about Christians. The Catholic Church teaches that in mysterious ways known to God alone, he can offer saving grace to every person, even those who do not explicitly know Christ. Prayer and the sacraments of the Church are the ordinary means of grace, and God wants all people to benefit from them; but these are not the only means of grace. In terms of the cross, many of us create unnecessary suffering for ourselves — we invent problems, we get ourselves into one pickle after another because of our thick-headed stupidity or stubbornness — and I don’t exempt myself from this category! These are not the crosses that God wants us to carry — unnecessary problems of our own invention and making. This is among the ways spiritual direction and psychotherapy can be helpful, in making us aware of our own self-defeating thinking and behavior so that many of our self-made problems and “pseudo-crosses” can disappear. What is left are the crosses that God allows. Life is difficult. All of us will suffer, but many of us could do well to avoid many unnecessary problems that we create.
LOPEZ: “St. Thomas Aquinas demonstrated a remarkable insight into human nature when he wrote that no man can live without joy, and this is why anyone deprived of spiritual joy will seek joy in carnal pleasures.” Are we in danger of becoming a joyless society?
KHERIATY: It’s lapidary statements like this that demonstrate Aquinas’s genius. We read it and say, “of course,” and even, “why didn’t I think of that?” To answer your question, yes, I think we are in danger of becoming a joyless society. Fun does not always bring true joy. Entertainment does not always bring joy. Pascal understood this, which is why he pointed out that many of our efforts here are mere distractions and diversions — divertissement in his French. Drugs, porn, 18 hours on the Internet, binge eating — these do not bring joy, but rather, they bring Huxley’s Brave New World where denizens are dumbed down and doped out on the drug soma and on joyless and impersonal sex. Huxley appears more prophetic every year, but I for one hope we don’t continue down that path.
LOPEZ: Is it increasingly hard to operate in academia and practice in a secular society that tends to push religion of the type you consider — complete with the Cross — to the margins?
KHERIATY: I have found a home in academia, in a public and secular university, and I am more or less content there professionally. The postmodern world today is more open to religion and spirituality than the modern world was with its Enlightenment assumptions. The sovereignty of reason has been deconstructed, and this is not an entirely good thing, for human reason is precious and good. But this process has cracked things open a bit, and made room for other approaches to viewing reality. Again, to cite Pascal, “the heart has its reasons that reason cannot know.” Some of my colleagues may think religion and my interest in religion are mumbo jumbo, but the attitude seems to be if Kheriaty wants to do his mumbo jumbo thing, hey, we’ll live and let live. So it’s not such a bad professional environment to explore the range of my interests: scientific, medical, psychiatric, philosophical, theological. Sometimes Christians can be too timid and assume we’ll find hostility where we actually find a sort of openness and curiosity. Everyone is trying to figure out what this great drama of human life is all about. Christians need to give others some credit; we should take everyone seriously, for after all, this person is a brother or sister for whom Christ died.
LOPEZ: How important is forgiveness in combating depression? And how can it coexist with justice?
KHERIATY: In many cases it may be tremendously important and I discuss forgiveness in The Catholic Guide to Depression. Forgiveness is powerfully healing, and helps us relinquish anger, hatred, and other destructive emotions that can contribute to depression. Forgiveness begins by recognizing that one really was wronged — that an injustice was committed. So it not only can coexist with justice, but requires a sense of justice to even begin the process. If an injustice was not committed against me, then I can excuse or explain away someone’s actions, but I cannot really forgive them, for there is nothing to forgive. Forgiveness, however, goes beyond justice: It is not something I owe to anyone as a strict matter of justice. It is a free gift that I can chose to give them, even though they do not justly deserve it. For this reason, forgiveness cannot be coerced, but must be rooted in a free decision. Forgiving a real wrong — something that did indeed harm me and cause suffering — is probably the hardest thing we can do in life. I believe it typically requires God’s grace, his help. Recognizing and appreciating the forgiveness that God has extended to us can help facilitate the process whereby we extend forgiveness to others. If you think about it, the world would be a dreadful and inhuman place without forgiveness.
LOPEZ: What kind of feedback have you gotten from your book? How might it better inform your work and the upcoming conference at Saddleback Church?
DR. KHERIATY: Writing a book is something of an act of faith. Unlike teaching or speaking where you interact with your audience and can sense their reaction, when you publish a book you put it out there and hope that it has an impact on people. Sales of my depression book are strong and word of mouth appears to be playing a role, which is nice to see. So you see the sales numbers, which indicates that hopefully some people are not only purchasing but actually reading the book. Occasionally you get a new review on Amazon, which is edifying. One woman from Canada left me a voicemail to thank me for writing the book. She said it literally saved her life — that she was suicidal and without hope but the book helped her to find hope and to find her way back to God. To me, it would have been worthwhile writing the book for that reader alone. Another reader e-mailed me a few days ago saying the book affected her not only in her work as a counselor but also personally as someone who has suffered from depression. These are the things that keep you writing.
Thank you for mentioning the Gathering on Mental Health and the Church, which will be a day-long conference held at Saddleback Church in Orange County, Calif., on Friday, March 28. I will be addressing the theme of depression, and our speakers will also include Rick and Kay Warren and Bishop Kevin Vann. I’m very please to see that an influential Evangelical church is partnering with the Catholic Diocese of Orange and the National Alliance on Mental Illness in Orange County to reach out to those suffering from mental illness and to their families. We want to show that the church cares about them and about their affliction, and that Christians want to help those who are struggling in this way, and that we have something unique to offer. This is also an opportunity to educate pastors and other church staff about mental illness and the resources available to help individuals who are affected by it. (For those who cannot attend, the event will be webcast, and registration is available.
— Kathryn Jean Lopez is editor-at-large of National Review Online and founding director of Catholic Voices USA.