Sunday, August 10, 2014

Book Review: A Catholic's Guide to Depression

What Depression Is Not

For those who have not experienced the medical condition known by the inadequate name "depression," it sounds like a lot of things it's not.

It's not like feeling "blue," even perhaps a deeper shade of blue. It's not a hoax perpetrated by big pharma. "Melancholia" has a pedigree reaching back to ancient times. It's not something someone can just shake off. It is a crushing disease that has real effects on not only the mood, but cognitive functioning and physical energy. It's not a character defect, or an excuse for laziness.

For Catholics, in particular, it is not to be confused with "the dark night of the soul," or "spiritual dryness," or "the noonday devil" or acedia, or any other spiritual condition.

It is something so devastating that death is often looked upon as a release from its unremitting pain and hopelessness. Somebody commits suicide every seventeen minutes in America. (See the Bear's "A Catholic's Guide to Suicide" for more.)

A Gem of a Book

A Catholic's Guide to Depression by Dr. Aaron Kheriaty is an excellent book written by a psychiatrist familiar with Catholic beliefs, practices, and spiritual literature. What makes this book a gem is that the author explores the writings of, for example, St. Ignatius Loyola with the same confidence as he outlines drug options and therapies. He does not make the mistake of "spiritualizing" a medical condition, nor does he attempt to treat spiritual conditions as medical problems. In other books, such as Kathleen Norris' otherwise excellent Acedia and Me, the medical and spiritual issues get blurred. While acknowledging that depression (especially the wild roller coaster ride of bipolar disorder) can implicate a Catholic's moral life, Dr. Kheriaty otherwise keeps medicine and spiritual direction strictly separated, at least in the diagnostic stage.

Medical or Spiritual?

Why is it so important to separate the medical from the spiritual in dealing with depression? Too often, Catholics suffering from depression have been told or have concluded on their own that depression is a moral failure of some sort. It's their fault. A good Catholic in a state of grace has no business being depressed! Adding misplaced guilt can only aggravate depression. Or, if the problem is taken seriously, someone who does not fully understand the difference between depression and spiritual conditions might assume it is "a dark night of the soul," or acedia, or even sloth, which is one of the seven deadly sins. For a Catholic who is suffering from depression, such a mistaken "diagnosis" may lead him away from medical treatment that could -- in some cases -- be lifesaving.

For an example, some literate Catholics might have heard of acedia, and have a vague notion that it is similar (if not identical to) depression. Dr. Kheriaty analyzes the two conditions with the precision of a skilled diagnostician. His discussion of acedia is perfect.

Acedia is a moral disorder involving flight from God. It is a disorder to which the will freely consents; there is an element of choice involved. Acedia is listed among the seven deadly thoughts in Evagrius Ponticus, which later developed into the seven deadly sins in the writings of Pope St. Gregory the Great... The fathers typically writing within an eremitic or monastic context, referred to this state as the "noonday demon" that may come upon the solitary monk. Rather than engaging in work, lectio divina (spiritual reading), prayer, or other useful activity, the monk who had fallen into acedia could be seen idly watching the sun in the sky, waiting for his one daily meal.

(Page 56)  Dr. Kheriaty then finds the place where depression and acedia separate. While they may seem similar, "in the depressed person, the thoughts pervade all of his life, while in the acedic person, they have to do only with the things of God." He also says:

The depressed person may attempt a few minutes of spiritual reading. Although he wants to follow the words on the page, try as he might he cannot bring his mind to focus on words or follow their meaning. By way of contrast, the acedic individual will simply forego spiritual reading in the first place -- not because he cannot do it, but simply because he does not want to, preferring other activities.

(Page 57)  He treats the "desolation" of St. Ignatius Loyola, and the "dark night of the soul" of St. John of the Cross with equal care. He goes beyond mere diagnosis, however, and prescribes the medicine of confession to a soul mired in sin, even as he acknowledges, however, that mental illness can reduce the moral culpability of someone who commits sin. See e.g. Catechism of the Catholic Church 1735, 2352, and 2282.)

Help for the Depressed Catholic

Dr. Kheriaty explores all available treatment options for the depressed Catholic. Of course, he only summarizes options, but everything is there, from antidepressants and electroconvulsive therapy (ECT) to exotic measures like implanted vagal nerve stimulation. There is also a brief description of each of the most commonly used talk therapies with their pros and cons.

He acknowledges that diagnoses of depression have skyrocketed, but does not give a reason, other than to speculate that it may be related to the practical nihilism at the heart of Western culture. Ironically, while studies have shown a strong correlation between religion and sound mental health, and a large majority of patients describe themselves as at least "spiritual," psychiatrists are among the most atheistic of all doctors.

Dr. Kheriaty is not afraid to advocate saying the Divine Office, however. Not only is it a simple prayer even a melancholic person may read, it marks the rhythm of morning and evening, an important benefit for the depressed. He also prescribes the rosary, lectio divina, and the confessional. The book also contains a survey of relevant passages from the Bible and is sprinkled with quotations from saints like Josemaria Escriva. Yet another gift Dr. Kheriaty gives is showing the depressed person that while his illness may not be spiritual, it can have a spiritual benefit, like all suffering. The spiritual side of the book complements the medical side beautifully, and offers depressed Catholics a complete understanding of their illness that has been missing.


Dr. Kheriaty has created a perfect balm of medical and spiritual insight into depression. No Catholic whom this illness has touched should be without this book. The Bear gives it his highest recommendation. It will help the reader to distinguish depressive symptoms from spiritual conditions, and provide sure guidance in addressing both. This is the book's real service.

Depression is still misunderstood by many Catholics, including, unfortunately, many of its sufferers. No doubt it is over-diagnosed by harried general practitioners who prescribe heavily advertised antidepressants. Natural conditions such as bereavement (as well as just about any undesired feelings or behavior) are being inappropriately "medicalized." But for those who have fallen into the pit of true depression, there is no doubt that they have experienced something beyond the range of ordinary human experience.

Books like Acedia and Me, and A Catholic's Guide to Depression provide perspective and sound guidance for Catholics. (A Catholic's Guide to Depression has also been favorably reviewed by Kathryn Jean Lopez of National Review Online, and Jeff Mirus over at Catholic Culture.)

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