Listening to sadness

Within herself, Nina feels cheated. She cannot quite figure out who she is, and why she is. The world outside seems dark, lonely, and oppressive. She writes of herself: “When you are in it there is no more empathy, no intellect, no imagination, no compassion, no humanity, no hope. It isn’t possible to roll over in bed because the capacity to plan and execute the required steps is too difficult to master, and the physical skills needed are too hard to complete.… Depression steals away whoever you were, prevents you from seeing who you might someday be, and replaces your life with a black hole.”1

For every Nina, there are hundreds more lost in the world of depression.

Depression can be devastating. I know it. I have been there.

Too often we rush to quickly cure depression. We live in a quick-fix society of pills and surgical procedures with little tolerance for pain or desire to learn from it. But before we deal with depression, I want to underscore two factors.

First, we must make a clear distinction between chronic depression and situational depression. The former is a natural tendency to feel negative; the later is located in a particular situation—when the situation is resolved, depression disappears. This article deals with the first kind. Second, I do subscribe to the concurrent use of medications and other forms of therapy. I am also in favor of using spiritual tools to address feelings of negativity.

Depression: the facts

One out of four individuals in the United States is likely to experience at least one episode of depression in his or her lifetime. Out of this group, only a quarter will receive appropriate diagnosis, and of these, only a quarter will receive appropriate treatment. The risk of depression for people who were born in the past 30 years is 10 times higher than those who were born 70 years ago.2

The severity of this illness is reflected by its persistence. A study by psychologists Gayle Belsher and Charles Costello shows that approximately 50 percent of those treated will experience relapse within two years of successful treatment.3 Ian Gotlib and Constance Ham-men state: “Only recently have we come to understand that for many sufferers of major depression the disorder is recurrent, if not chronic.”4

Studies have also shown that treated clients, even though they improved, were still more depressed at the end of therapy than non-depressed control subjects. The functioning level of depressed persons who received treatment was within one standard deviation lower than that of the general population, while those who did not receive treatment were functioning at two standard deviations below norm.5 Even after treatment, many continue to experience symptoms of depression in a less-intense form. For them, the struggle will be continuous. This has significant implications for the development of spirituality because it promotes positive feelings as opposed to negativity that destroys meaning. Since meaning-making is the function of theology, meaninglessness runs against its very core.

Depression: the problem

One of the most damaging features of chronic depression is that individuals become trapped in a cycle of negativity. Karp writes, “Depression is a unique case since the most critical assaults on self come from within. . . . In the midst of an episode of depression individuals feel a self-hatred far greater than could possibly be expressed by others toward them.”6 These “critical assaults on self” emerge concurrently with the desire to correct oneself. This process begins with setting goals and striving toward them. What depressed individuals are not aware of is that negativity negates.7

They try to correct themselves while blaming themselves at the same time. The more they strive, the farther they are from where they want to be. They are trapped within the cycle of depression.

In my experience at a counseling center and in a psychiatric facility, and of working with church members, I have observed this common cycle among depressed individuals. They try and try and get really tired of fighting. It is a cycle from which they don’t seem to be able to escape. They’re really sick of themselves, and don’t want to fight any more. Depressed individuals are fighting something illogical where rationality has no control over emotion. “When the thought is triggered and the emotion stirred, the cycle spirals downward. People who are in this state often say, ‘I know it is illogical, but I just can’t stop it.’ They are caught in a cycle that does not seem to end. The trying keeps on even when the body experiences extreme fatigue. The deep wish is often expressed as ‘Please stop this spin and let me rest for a while.’ Yet one cannot help but keep on trying in an ocean of irrationality, wishing that perhaps just one more effort may lead to liberation from the vicious cycle. But the wish becomes a deeper pain. The yoke gets heavier. The downward spiral hits a new momentum.”8

The mechanism of negativity

What causes this cycle of self-blame and despair? In the late 1970s, Tom Pyszczynski and Jeff Greenberg in their research noticed a relationship between depression and self-awareness. This observation resulted in numerous studies and experiments. They found that depressed individuals are highly self-focused, with a tendency to be self-absorbed. They are usually more self-focused after failure than after success. Pyszczynski and Greenberg asked: Why are these individuals so highly self-focused, and why do they focus more on themselves after failure than after success? They write: “Essentially, we view depression as the consequence of perse-verated efforts to regain a lost object when it is impossible to do so. This perseveration is believed to occur when an individual has lost a primary basis of self-worth and does not have sufficient alternative sources from which to derive self-worth. The resulting self-regulatory perseveration is posited to entail a chronically high level of self-focus which produces a spiral of escalating negative affect, self-blame and disparagement, and motivational deficits that ultimately result in a negative self-image and depressive self-focusing style which perpetuate the depressed state.”9

A similar research by Paula Ray Pi-etromonaco revealed that the self-structure of people with depression tends to be less conceptually complex and is organized more around affect and less in terms of other aspects of the self.10 This is significant because the self-structure that organizes itself around negative affect while disregarding other aspects of the self will only lead to greater intensification of the negative experience. “Depressive self-schema intensifies one’s negative affect, which, in turn, draws attention onto the self. Increased self-awareness leads to self-evaluation and motivates one to try to reduce the discrepancy. This is where negation takes place, and the cycle is perpetuated.”11

Every attempt at correcting oneself is accompanied by this depressive self-schema. One finds oneself focusing only on one’s failures. The mind remembers only negatives while attributing positive outcomes to external factors. The wider the gap gets, the more one becomes conscious of failure to meet the goals. “The intensified negative affect, self-blame, self-evaluation, and disruption of successful, competent behavior in other domains pushes the recently destabilized self-concept toward negativity.”12 Intensified negative affect, in turn, leads to greater awareness of discrepancy, which leads to more trying, and so the cycle continues. The depressive self-schema negates every attempt to close the gap. The harder one tries, the worse one feels about oneself.

How can depressed individuals exit this cycle of self-criticism? I believe Christianity offers a tool for depressed individuals to use in coping with the negating power of depression.

Exiting the cycle: a theological reflection

Causes of depression may be varied. We may be born with a tendency toward depression or experience traumatic events that sink us into despair. However it develops, when individuals are exposed to prolonged stress and do not receive appropriate treatment, they face the increased likelihood of future depressive episodes.

Negative affect also causes a perception of unworthiness: “I’m not good enough. I’m undeserving.” In social relations this may express itself in the idea of not belonging, of having to earn the right to belong. Depressed individuals, therefore, tend to confuse self-consciousness, which is chemically based, with social relations and social acceptance.

In my struggle with depression, I found myself trying to run away from myself. The sense of discomfort plus the constant negative affect that filtered my interpretation and assessment of the world around me enticed me to abandon myself in the pursuit of another self that I thought would create a greater sense of comfort. The discomfort led me to try to be other than who I really was. This turned into a complex spiritual quest, leading to a sense of spiritual distress.

I learned that the dark side of me followed me like a shadow. The only way to hide from it was to be in the dark. Depressed individuals keep moving toward the “ought,” not realizing that the mechanism of negativity keeps pushing them farther behind. “The harder the struggle, the tighter the grip.” Depression is a symptom of a depleted self. To “run away from” is to further deplete the self. This is often the case with individuals with chronic depression.

This “running away from” is theologically unsound. Instead, the depressed should run to the cross of Christ. There is no better resting place than at the foot of the cross. The cross is an invitation to come as we are. Striving for the “ought” tempts us to minimize the power of the cross to embrace us. It suggests that the redemptive event is not complete, and we need to help God save us. The Bible is clear on this point, however. We cannot run away from ourselves. Through the cross God says to depressed individuals, “Stay—stay right here. You do not have to go anywhere else. I am coming to you.” Our resting place is not found in attempting to be what we think we ought to be. Grace is where we find rest, and grace comes to us.

To exit the cycle of depression we need to learn to be present in it, remain there, and learn to sit in the dark despair and listen. God has given each of us an inner healing process that utilizes pain as a natural part of human development. This healing is not necessarily “curing depression” or “getting rid of the depressive symptoms,” but a call to rest and let this inner driving force toward wholeness do its work. As we listen, our understanding of who we are will deepen and this will enhance the process of self-differentiation. In this world where we struggle and fight, God’s grace invites us to listen so we may find a resting place.

Finally, two practical suggestions. First, if you are struggling with negativity on a day-to-day basis, don’t try to fix it. Depressed individuals want to fix depression. By not fighting so hard, you can reduce its power to control your life.

Second, remain in God’s presence. Depressed individuals need to learn to see themselves as they really are, not through the negative lens of depression. We are invited to rest in God. We may not always feel good, but we can always be at home there. It is important to learn that we can remain in the presence of God even in the midst of negative feelings and thoughts.

Born in Thailand, Siroj Sorajjakool (Ph.D., Claremont School of Theology) teaches religion at Loma Linda University. His mailing address: School of Religion; Loma Linda, California 92350; U.S.A. E-mail: ssorajjakool@rel.llu.edu

Notes and references

  1. David Karp, Speaking of Sadness: Depression, Disconnection, and the Meanings of Illness (New York: Oxford University Press, 1996), p. 24.
  2. Martin E. P. Seligman, “Why is There So Much Depression Today? The Waxing of the Individual and the Waning of the Common,” Contemporary Psychological Approaches to Depression: Theory, Research, and Treatment, edited by Rick E. Ingram (New York: Plenum Press, 1990), p. 5.
  3. Gayle Belsher and Charles G. Costello, “Relapse After Recovery from Unipolar Depression: A Critical Review,” Psychological Bulletin 104 (1988)1: 84-96; see also Gerald L. Klerman and Myrna M. Weissman, “Course, Morbidity, and Costs of Depression,” Archives of General Psychiatry 49 (1992): 831-834.
  4. Ian H. Gotlib and Constance L. Hammen, Psychological Aspects of Depression: Toward a Cognitive-Interpersonal Integration (New York: John Wiley and Sons, 1992), p. 1.
  5. Leslie A. Robinson, Jeffrey S. Berman, and Robert A. Neimeyer, “Psychotherapy for the Treatment of Depression: A Comprehensive Review of Controlled Outcome Research,” Psychological Bulletin 108 (1990)1:40.
  6. Karp, p. 47.
  7. Aaron T. Beck, Depression: Causes and Treatments (Philadelphia: University of Pennsylvania Press, 1972), pp. 17-23.
  8. Siroj Sorajjakool, “Wu Wei (Non-Trying) in Pastoral Care of Persons with Depression: Coping With Negativity,” Ph.D. Dissertation, Claremont School of Theology, 1999, p. 5.
  9. Tom Pyszczynski and Jeff Greenberg, Hanging On and Letting Go: Understanding the Onset, Progression, and Remission of Depression (New York: Springer-Verlag, 1992), pp. 8, 9.
  10. Paula Ray Pietromonaco, “The Nature of the Self-Structure in Depression,” Ph.D. Dissertation, University of Michigan, 1983, abstract in Dissertation Abstracts International 44 (1983) 10B:3243.
  11. Sorajjakool, p. 111.
  12. Pyszczynski and Greenberg, p. 107.