Thursday, October 10, 2013

Review: The Catholic Guide to Depression

First, let me say that I am not suffering from depression, or at least not at this moment.  But I will admit that I have had moments and periods in my life when the well I was in felt very deep, and I couldn’t see the light at the top.  I think we all have been there.  Maybe that’s why I picked this book up, even as I thought “this will be boring.”  But as I began to read, I found it wasn’t.
Aaron Kheriaty, a Catholic psychiatrist, wrote a very readable book.  He took a very serious topic and broke it down into manageable pieces, so you could look at depression, understand its complexities, and yes, ask yourself: “Is that me?”  And he did it in a very non-threatening way.  Perhaps someone suffering from depression might read this book and think: “Woe is me,” but that’s part of the illness speaking.  I think it more likely, however, they will say: “Gee, I didn’t know that about me, or what might be causing my feelings.”  Or perhaps more importantly, “what I might reasonably do about it.”  And Dr. Kheriaty is blunt right up front about the purpose of his book:  “If this book does anything, I hope it convincers those suffering from depression to obtain a clinical consultation with a competent psychiatrist sooner rather than later.And unlike any other book you might read about depression, I think the author’s Catholic background brings his perspective on his patients to the foreground.  As he points out:  “According to its Greek root, the work psychiatrist literally means “doctor of the soul.”
In his Introduction, Dr. Kheriaty puts forth the spiritual aspect of the treatment of depression:  “When a patient asks whether he should pray more or take a medication to help with an episode of major depression, my answer is yes to both.”  He notes: “Of all the religions of the world, I would suggest that Christianity offers the most compelling answers to the problem of suffering.”  He chastises Freud’s common descriptions of our unconscious mental life:  “repressed, active, bestial, infantile, alogical, and of course, sexual,” as “hardly sounding consonant with the Christian view of the dignity of the human person.”  Perhaps that is why psychiatrists are the least religious physicians.
Those suffering from depression usually exhibit some common traits:  inability to focus, changes in sensory perceptions (negative viewpoints), disruption of sleep, low energy, changes in appetite, changes in psychomotor movements (restlessness), inappropriate feelings of guilt, anhedonia (pleasure-less), frequent thoughts of death, and anxiety.  “Generally if a person has half or more of the symptoms described for more than a week, it is worthwhile to get an evaluation from a psychiatrist or at least a primary care physician who has experience diagnosing depression.”  Dr. Kheriaty explains how the brain becomes “primed” with each bout of depression, setting itself up with an expectation of more bouts, and so they become increasingly common because of a self-fulfilling mindset.  Treatment can change that mindset.
Having recently lost my mom, I was interested in his section on bereavement and grieving.  “Someone who is grieving may frequently experience some of the symptoms of depression described above.  Bereavement is considered a normal rather than a pathological state, … a normal part of human life.  Occasionally, normal grief can over time, develop into a depressive disorder that requires treatment.  Depression, on the other hand, more often impairs our ability to pray and weakens our capacity to connect with and find solace in others.”  But, “Alienation from others, an inability to be consoled, self-hatred, or suicidal thinking all could be signs that bereavement has morphed into depression.”  He notes, “The grief-stricken individual focuses on the loss of the loved one, whereas the depressed individual focuses in an exaggerated or unrealistic way upon his own perceived limitations and inadequacies.”
In going into the causes of depression, the author notes that “there is no simple answer to the question.”  Genetics may play a part, although there is no “depression gene,” and depression cannot be predicted.  Of course stress may trigger depression; perhaps that’s why he notes that 13% of people will experience an episode of depression during their lifetime, and it is twice as common in women as in men.  He even notes evidence of a role in shifting levels of estrogen and progesterone as having  a role in some cases of depression. 
It is not surprising to read that depression may also depress our spiritual life.  The author notes the many saints who suffered from depression.  “As with Saint John of the Cross’ dark night of the spirit, this is a clear reminder to the soul that there is only one God, and I am not he.”  Trust in God declines during depression, but “how we act has an effect on how we feel; our choices over time shape our characteristic emotional responses.  Repeated virtuous action can work to change how the acting person feels over time.”  This is the approach of “such thinkers as Aristotle and St. Thomas Aquinas.” 
This book has chapters devoted to medical and psychotherapy treatment of depression.  I found them very interesting.  I found some of the words about cognitive therapy resonated with me:  “Cognitive therapy aims to keep the patient focused on the here and now and does not tend to look at the past or delve deeply into prior experiences. … Research suggests that it has beneficial effects comparable to those of medications, at least for mild to moderate depression.”      
I would recommend this book for anyone going through a difficult time in their life, or for the friend of someone who is.  While ultimately any actions to change the thinking of a depressed person must begin with themselves, we can have a role, particularly a faith-based one.  I found it summarized in this sentence:
“An important spiritual task for all of us is this:  to become convinced that God has placed us here in this family, or with these friends, or in our job, for a reason.  There is something divine, something beautiful, hidden there – not on the other side of the fence, where we believe the grass must be greener.  And it is up to us, with God’s help, to discover that ‘divine something’ right where we are, in the ordinary events and circumstances of life.”
This book has a short appendix of prayers.  I don’t know who picked them out, but I rarely have found such a perfect (in my view) summary of thoughts, about myself and about God.   

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