Depression affects more than 264 million people globally and is a leading cause of disability, says the World Health Organization. Although a 2013 Johns Hopkins Bloomberg School of Public Health study suggested that depression is overdiagnosed and overtreated in the United States, most health professionals today say it is highly underdiagnosed and undertreated. Without professional intervention, depression can have a significant negative impact on a person’s social, physical, and mental well-being, and places an enormous burden on society.
There are multiple reasons for this. Depression is often dismissed as ordinary sadness or mood fluctuation. Anxiety is mistaken for everyday spikes of stress or worry. Intensity and duration transform both conditions into serious health issues. Yet because mental disorders carry a stigma, sufferers delay seeking professional help and instead attempt self-help or self-medication.
The stakes are high. Besides lost work and productivity, severe depression and anxiety disorders often trigger substance abuse. They also are a known risk factor for suicide. In the United States, where some 48,000 suicides occur annually, an estimated 60 percent of victims suffer from a major depressive disorder.
Ironically, depression is among the most treatable of mental disorders. Nearly 90 percent of patients eventually respond well to treatment, according to the American Psychiatric Association, and practically all gain some relief from their symptoms through prescription drugs and/or counseling.
The role of the spiritual life
Yet depression can encompass biological, psychological, social, and spiritual causes as well as effects. Because the human person is integrated as body and soul, the state of an individual’s interior life can play a significant role in mental health.
“The relationship between mood disorders and our spiritual life is complex,” according to Aaron Kheriaty, a California psychiatrist and co-author of the 2012 book The Catholic Guide to Depression, published by Sophia Institute Press. “Often it is hard for a person to know whether he or she is simply going through a difficult time — a dry spell in prayer, a period of demoralization in life due to external circumstances — or whether these ordinary trials and challenges may have led to, or may have been caused by, depression.”
While a “pray it away” approach might suffice for the former condition, a more holistic and broad-based approach is often necessary for the latter.
“Christians who suffer from depression, or those close to them, can make the incorrect assumption that their lack of energy and dejected mood are caused exclusively by a spiritual problem,” Kheriaty said. True depression is not a matter of mere sloth — spiritual laziness — nor is it strictly a spiritual trial akin to the “dark night of the soul” described by St. John of the Cross. Sometimes well-meaning friends and family suggest prayer, Confession, or other pious acts as the panacea for what ails them.
Although attention to the interior life is helpful, one ought not rely on spiritual measures to the exclusion of professional therapy any more than for a serious physical condition. “When science or medicine can help cure medical or psychological afflictions, we should not avoid those helps and instead grasp at religious practices as though they contained magical powers,” he explained.
Yet depression, like all disorders of human nature, has its ultimate origin in the fall of Adam, in original sin. Therefore, given our holistic view of the human person, “[A] Catholic approach would not consider overcoming depression apart from the spiritual life,” said Kheriaty.
At the same time, however, a strong religious faith and practice does not inoculate a person from mental health struggles, he pointed out. And although the roots of depression are spiritual, that doesn’t mean its immediate cause is a spiritual matter. Complicating matters further is that deep depression often makes it difficult to pray or even to feel God’s presence in his or her life, he added — hence the need for a holistic approach to therapy to clear away such obstacles.
A ‘Catholic’ way?
Along with carefully prescribed and titrated pharmaceuticals, mood disorders can be managed successfully through psychotherapeutic methods. Cognitive-behavioral therapy (CBT), for example, seeks to change negative habitual patterns through rational thought and an act of the will.
Kheriaty sees particular value in the methods of psychodynamic or depth psychotherapy, which often involves probing for old unhealed emotional or psychological wounds in order to effect healing. Such healing most effectively takes place through forgiveness therapy, whereby the therapist helps the patient identify his deep-seated anger or resentment, overcome the defenses that insulate these wounds, make the intellectual decision to forgive, and then extend that forgiveness at the emotional and behavioral levels.
Forgiveness therapy relates to positive psychology, a newer movement started by psychologist Martin Seligman. In positive psychology, the emphasis is not on treating mental disorders, but in building the positive habits and virtues that lead to mental health, happiness, and human flourishing. These six central virtues are identified as wisdom, justice, temperance, courage, humanity, and transcendence. Each of these covers particular character virtues including forgiveness, mercy, prudence, humility, self-control, integrity, love, and hope.
Those virtues correlate well to the Catholic understanding of our universal call to holiness and growth in the virtuous life. It is perhaps here that psychology and spirituality intersect optimally. “The virtues practiced in positive psychology are all good practices,” said Kevin Majeres, a psychiatrist at Harvard Medical School, and co-founder of OptimalWork. com. “The Faith gives them an even greater effectiveness by showing how they are a path to God.”
He offers the example of mindfulness, a technique in positive psychology that focuses on the present moment.
“Mindfulness simply means attending to ‘what is,’” said Majeres. “Being mindful of one’s breath can be a powerful means of silencing worries and breaking temptations, and can help people ‘digest’ anxiety and cravings without giving in to them. In this way, mindfulness is an integral part of the virtue of patience, which helps us grow in every virtue.”
And if we have a desire for God, we will always be seeking Him, he added.
“For a Catholic, mindfulness is always pervaded by hope: we experience God upholding and supporting us, giving us our breath and life and being, right now,” he explained. “Hope leads us to pierce through the veil of things, discovering God upholding them. Hope turns mindfulness into prayer.”
Gratitude is another example of how positive psychology and the Catholic faith can work together, Majeres said.
“Positive psychology has amassed a number of studies showing the effectiveness of gratitude practices in improving our quality of life,” he said. “The Faith only makes this practice more powerful, by showing us whom to be grateful to, and for many more reasons.”
The theological virtues
The ideals presented in the Catholic faith, Majeres affirmed, are capable of transforming our psychological struggles.
He gave the example of a person who, when facing personal challenges that appear threatening, attempts to escape the challenge either by thinking his way out of it, worrying about it, or avoiding it altogether. Such strategies tend to get a person “stuck,” he said.
Instead, the psychological solution to these strategies is called “reframing,” or discovering the hidden opportunity for growth and practice that the challenge presents. It’s a technique that dovetails well with the theological virtues.
“Reframing is the basis of what’s called cognitive therapy — and it’s powerfully strengthened by faith,” Majeres said. “Having faith in God helps us to see every challenge as actually being perfect for us, because it is coming to us from the Providence of our loving Father. Even more, we can see every challenge as the Cross, to be loved and embraced in each hour of the day. What would there be left for us to dread or complain about? Through reframing, faith can make a constant impact on our lives.”
Similarly, “psychology often uses mindfulness as a way of holding our attention in the present moment, bringing silence to our minds,” he said. “Hope strengthens this, and allows us to experience the eternal help of God in this present moment.”
And charity, Majeres explained, “strengthens our will in building every virtuous cycle and gives us the energy to break every vicious one.”
These theological virtues “have the power to transform our attitude, our attention, and our actions,” he said. “They truly can set us free.”
GERALD KORSON is a Legatus magazine editorial consultant.
Finding the right therapist
How should a Catholic go about seeking a therapist when needed?
Dr. Kevin Majeres said that if there are sensitive moral issues at play, then it’s best to get a recommendation from another Catholic who has worked with the therapist.
“It’s important for everyone to know that therapists are not trained to give advice about faith or morals, even if they happen to be Catholic,” he advised. “The most important factor in choosing a therapist is that they are good at therapy. If in the course of therapy any difficulty occurs, let the therapist know right away, and, if needed, consult a trusted spiritual director.”
Trustworthiness of the therapist is a key factor, concurred Dr. Aaron Kheriaty. A therapist’s advice “will be colored by the therapist’s own worldview, and may be distorted by the therapist’s own biases,” which is something that has resulted in bad experiences by many who have sought mental-health treatment.
“Many Christians who suffer from depression naturally have a preference for finding a therapist who shares their religious convictions,” Kheriaty said, but “shared religious and moral convictions alone do not guarantee a trustworthy therapist.”
When therapy is warranted and a competent Christian therapist is not available, “[A] skilled therapist who respects and honors the patient’s religious and moral convictions is, in my opinion, preferable to no therapist at all,” he said.