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.
KATHRYN JEAN LOPEZ
: In the foreword to your book, David Franks
writes that “depression is the modern affliction,” and in the introduction you state, “the burden of depression worldwide is tremendous.” Why is this so? What’s new, so to speak, about depression today?
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?
KHERIATY: We do not yet fully understand the cognitive changes that are induced by modern technologies of communication. These technologies are wonderful tools, but at the same time potentially addictive and all-consuming. Some psychiatric researchers are inventing constructs like “techno-frazzle” and “nature deficit disorder” in an attempt to get at what many of us experience but do not yet fully understand. One colleague of mine jokes that he has developed occupationally induced attention deficit disorder, and I chuckle knowingly, but at the same time suspect that I have acquired the same virus! Smartphones and long hours on the Internet are changing our brains in ways that may not be entirely conducive to human health and flourishing. One IT employee at my collegiate alma mater monitors Internet use among students, and sees some students spending literally 18 hours a day on the Internet — most of these consuming pornography. This is a form of insanity, every bit as self-destructive as drug abuse. All of us, even those whose use of technology is not compulsive or addictive, would do well to take a “Sabbath rest” from our smartphones and computers once a week, or at least introduce limits to our use during the week, setting aside designated times to check our e-mail or text messages, then putting our smartphone in airplane mode for a while so we can get actual work done, spend time with our families, rest, reflect, and pray.
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.