What is depression? How is it seen by psychological, psychiatric, and religious authors? How is it related to religion and religious factors?
What Is Depression?
Depression is a term referring to a disabling and prevalent psychiatric illness: major depressive disorder (unipolar depression). But the term also refers to a number of other related states. Unipolar depression must be distinguished from (1) depressed mood, which is a normal emotional response to adversity, especially involving loss, which if transient is not considered a clinical problem; (2) bipolar disorder, a relatively uncommon psychiatric condition involving uncontrollable swings from elated manic phases to low, depressive phases; and (3) dysthymic disorder, a milder disorder involving the symptoms of clinical depression, but as few as two such symptoms (plus depressed mood) qualify the sufferer for the label dysthymic. There are a number of varieties of major depressive disorder and dysthymia, for example, seasonal disorder. Further, in clinical research, the term depression is sometimes used to refer to a measured dimension, varying in the number and sometimes intensity of the symptoms of depression.
Depressed mood most of the day, every or nearly every day
Diminished interest or pleasure in all or nearly all activities
Significant weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Difficulty in thinking or concentration or indecisiveness
Recurrent thoughts of death or suicide or suicide attempt
Although there may be some biological predisposition, the most popular view of the causes of depression involves a diathesis model, in which a causal event or difficulty involving loss precipitates depressed mood, which can become a clinical condition in individuals who are vulnerable. Vulnerability factors may include early experience of loss (such as death of a parent), inadequate social support, low self-esteem, and heavy caring responsibilities, and there is some evidence of cultural variation in the factors that make people vulnerable to or protect them from depression (Brown and Harris 1978; Butcher et al. 2012; Loewenthal 2007). Widely used treatments include medication and psychotherapy, for example, cognitive behavioral therapy. It is worth noting that of all psychiatric conditions, depression has perhaps excited the most controversy. It has been a prime target for the antipsychiatry movement, led by Szasz (1974), arguing that it cannot be regarded as an illness, though it involves great suffering. Szasz argues that the illness model of mental illness leads to medication, custodial care, and other treatments being wrongfully and coercively applied. In spite of Szasz, the view of (clinical) depression as illness remains significant.
This entry will look at views of depression in religious sources and some of the effects of these views. This entry will consider the widely cited claim that religious people are less prone to suffer from depression and will consider the factors, which may be involved in this effect. Finally, we will consider recent attempts to deploy religious and spiritual factors in the therapeutic process.
How Has Depression Been Viewed in Religious Sources? What Are the Effects of These Views?
In religious writings, it has been suggested that melancholy may be a spiritually valued, possibly chosen state (see Frost 1992), and even if not chosen, depression and melancholy may be viewed as opportunities for spiritual growth, increasing religious trust (Loewenthal 1992). Dura Vila (2017) has argued that certainly among the religious professions, the dark night of the soul is regarded as a springboard for growth and is not appropriately seen as an illness in need of therapy and medication. Much recent work in positive psychology has offered evidence in support of these pious hopes: posttraumatic spiritual growth has now been empirically affirmed as a possibility. Thus, Shaw et al. (2005) concluded that religion and spirituality are usually, although not always, beneficial to people in dealing with the aftermath of trauma. Traumatic experiences can lead to a deepening of religion or spirituality, and positive religious coping, religious openness, readiness to face existential questions, religious participation, and intrinsic religiousness are typically associated with posttraumatic growth. Positive psychology in general has been advanced as effective in the treatment of depression and as harmonious with a number of core religious teachings and spiritual values, such as the practices of helping and of forgiveness (Joseph et al. 2006; Seligman 2002). Such religiously encouraged practices are reported to have beneficial mental health effects.
Although in religious writings melancholy and depression have been generally viewed as normal responses to adversity and loss and as foundations for a deeper faith, lay religious persons may regard depression as a failure of religious faith (Cinnirella and Loewenthal 1999). For example, Sometimes we assume that depression can always be overcome through prayer – that good Christians don’t suffer from depression (quoted in Schroedel 2008). Webb et al. (2008) report that views of depression as a personal religious failure can be found in some Christian self-help books. Greenberg and Witztum (2001) quote several rabbinic leaders who suggest that prayer, religious song, and other religious coping methods may be sufficient. Indeed they may be in some cases, but where they are not, the cloud of depression thickens. In spite of the frequent helpfulness of religious ideas in coping with the miserable psychological consequences of adversity, religious coping may not always do the trick, and there is an ongoing concern that when religious coping fails, this may be seen as a personal failure, inadequacy of the individual, leading to deeper depression.
It is also important to note that clergy are often trusted as resources for mental health care, generally more so (by their congregations) than the mental health professions. Thus, religious teachings about depression and coping, as delivered by the clergyperson, may be an important resource. A minority of clergy may actively mistrust the mental health professions and warn their congregants against the use of professional help (Leavey et al. 2007). A further barrier to professional help seeking is the stigmatization of depression and other mental illnesses, said to be marked in religious communities (e.g., Crosby and Bossley 2012; Rosen et al. 2008).
Religious teachings on depression have been mixed and have had mixed effects – depression itself may have some spiritual value as a springboard for spiritual growth, religious faith, and religious practices – and religious leadership may be helpful in coping with depression. However, the failure of religious coping can have a damaging effect on a person who is already depressed, and the advice of the minority of religious leaders to avoid professional mental health practitioners may not always be in the best interests of those suffering from depression.
The Association Between Religiosity and Low Levels of Depression
Social support: religious groups endorse and encourage helping in times of adversity. This includes in-group as well as out-group helping (Inaba and Loewenthal 2008). Additionally, the existence of a social circle of friends and sympathetic listeners can be an important protective factor. Thus, Shams and Jackson (1993) found that unemployed Muslim men in the north of England were less likely to become depressed if they were religiously active, meeting regularly in the mosque for friendship and support, as well as prayer and religious study. Brown et al. (2005) concluded that social support is an important factor enabling the improved adjustment associated with spirituality and religion.
Religious coping: religiously active people are likely to engage in religious worship, study, and prayer, and this will develop a repertoire of religiously based coping beliefs which are drawn on in adversity, such as “this is all for the best,” “I feel that G-d is supporting me,” and “there must be a reason for this even if I can’t see it now” (Loewenthal et al. 2000). The study of religious coping has been effectively established by Pargament (1997), who has reported a number of robust effects. Particularly important is the effect that good psychiatric outcomes (in adversity) are associated with positive religious coping beliefs, such as those listed above. Poor psychiatric outcomes are associated with negative coping beliefs, such as “G-d is punishing me (because I am bad),” “There is no purpose in this,” and “G-d has abandoned me” (Pargament et al. 2003).
Lifestyle factors: religions endorse and encourage aspects of lifestyle which can have an important impact on well-being. Thus, for instance, religious Jews and Christians have been shown to report fewer disruptive life events – particularly, they report fewer family-related disruptions, less arguments, family violence, and divorces. Disruptive life events are strongly associated with the onset of depression, and thus, the lower prevalence of depression in the religious groups studied may be (at least partly) traced back to the religiously supported value placed on harmonious family life and marital stability (Loewenthal et al. 1997; Prudo et al. 1984).
The finding that religious coping can have an impact on clinical outcome – sometimes positive and sometimes negative – has led to the development of exciting attempts to bring spiritual and religious factors into stronger focus in the course of psychotherapy. After many years in which religion and spirituality have been excluded from the psychological therapies, Pargament and his colleagues (among others) have introduced a wide range of suggestions about how religious and spiritual factors may be included (Cook et al. 2009; Pargament 2007, 2013). Spirituality – defined as the search for the sacred – is central for many clients in psychotherapy, and therapists need the tools and the sensitivity to address the spiritual dimension in a systematic way. Spiritual coping may be used to conserve, protect, and develop the sacred; it may lead to growth, it may lead to decline, it may be part of the solution, and it may be part of the problem. For example, one woman was in despair because she felt she had committed an unforgivable sin. The therapist was able to liaise with the client’s priest, and the priest, therapist, and client were able to develop a successful reconciliation. A strong merit of the work led by Pargament is the emphasis on an evidence base for findings, which may do much to enhance the scientific acceptability of clinical work involving spiritual and religious factors.
This entry has defined depression, considering how it has been viewed in religious writings, and considering some of the ways in which it may be affected by religious factors and, finally, the ways in which religious and spiritual factors have been brought to bear in therapeutic work.
- American Psychiatric Association. (2014). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
- Brown, G. W., & Harris, T. O. (1978). The social origins of depression. London: Tavistock.Google Scholar
- Butcher, J. N., Mineka, S., & Hooley, J. M. (2012). Abnormal psychology (14th ed.). Boston: Pearson.Google Scholar
- Cook, C., Powell, A., & Sims, A. (2009). Spirituality and psychiatry. London: Royal College of Psychiatrists.Google Scholar
- Dura Vila, G. (2017). Sadness, depression and the dark night of the soul. London/Philadelphia: Jessica Kingsley Publishers.Google Scholar
- Inaba, K., & Loewenthal, K. M. (2008). Religion and altruism. In P. B. Clarke (Ed.), Oxford handbook of the sociology of religion. Oxford: Oxford University Press.Google Scholar
- Koenig, H. G., King, D. E., & Carson, V. B. (2012). Handbook of religion and health (2nd ed.). Oxford: Oxford University Press.Google Scholar
- Loewenthal, K. M. (2007). Religion, culture and mental health. Cambridge, UK: Cambridge University Press.Google Scholar
- Pargament, K. I. (1997). The psychology of religion and coping. New York: Guilford Press.Google Scholar
- Pargament, K. I. (2007). Spiritually integrated psychotherapy. New York: Guilford Press.Google Scholar
- Pargament, K. I. (Ed.). (2013). APA handbook of psychology, religion and spirituality. Washington, DC: American Psychological Association.Google Scholar
- Schroedel, J. (2008). A fresh view of blue: Thoughts on depression. http://www.boundless.org/2005/articles/a0001231.cfm. Accessed 15 Mar 2008.
- Seligman, M. (2002). Authentic happiness. New York: Free Press.Google Scholar
- Worthington, E. L., Kurusu, T. A., McCullough, M. E., & Sandage, S. J. (1996). Empirical research on religion and psychotherapeutic processes and outcomes: A 10-year review and research prospectus. Psychological Review, 119, 448–487.Google Scholar