Depression Management: Psychological and Spiritual Approach
Abstract
Depression has become a predominant mental health problem that affects a significant majority of people across the world. A section of society considers it a medical condition that requires a psychologist to properly diagnose it and prescribe the necessary medication. The other section believes that it is a socio-religious issue that requires the intervention of spiritual leaders. The problem is that spiritual leaders and psychologists often take completely different approaches to manage the condition. Data in this study were obtained from secondary sources, including journal articles, books, and holy books such as the bible and Quran. The study suggests that although this condition is psychological, it requires both medical and spiritual intervention to find a lasting solution.
Introduction
Depression is a major mental health problem that affects many people around the world. According to Schnittker (2020), the problem has been in existence since the history of humankind, taking different definitions over time. In modern society, the condition falls in the field of psychology as a branch of medicine. The evolutionary changes and studies have led to a detailed understanding of the condition as a medical problem that requires the attention of a medical expert. Religion had been playing a major role in the management of depression long before it was classified as a mental health problem. In the bible, various accounts are provided where prominent people suffered from the condition. The Quran also identifies it as an issue that creates a lack of comfort for the affected individual.
It is important to start by defining this mental health problem that has become common in the global society. From a psychological perspective, Koti (2019) defines depression simply as “a mood disorder that involves a persistent feeling of sadness and loss of interest.” Psychologists consider it a neurochemical medical problem that affects how one feels, thinks, or acts. Fruehwirth et al. (2019) further explain that this medical condition causes an individual to lose interest in activities that were previously done with ease and enjoyed. Psychologists have identified the problem as a neurochemical issue, which means that when correctly diagnosed and proper medication is provided, one can easily overcome their problem. Psychologists also believe that it is critical to avoid factors identified as the primary causes of the problem for the individual.
A theological and spiritual approach to depression significantly varies from the perspective of psychologists. Theological scholars have made an effort to define depression as an emotional condition that is defined by how people relate with others, their environment, and the divine being. McCauley and Graham (2020) define depression as “a deep sense of despondency, discouragement, and sadness, often linked with a sense of personal powerlessness and a loss of meaning in and enthusiasm for life.” This definition by a theologian uses specific words such as discouragement, sadness, personal powerlessness, and loss of meaning for life. The diction used in this definition is deliberate and directly linked to religion.
A comparative analysis of the two definitions helps in bringing out the differences in opinion and belief that psychologists and theologians have towards depression. In the second definition provided by a theologian, depression causes one to lose meaning in life. That is significantly different from the definition of the psychologists who defines it as a melancholic condition that is often caused by a neurochemical imbalance in the body. The spiritual and psychological differences in defining depression have a major implication in the approach that is taken to manage it. In this paper, the researcher seeks to investigate the separation/difference of psychological versus spiritual implication on depression.
Scientific Analysis of Depression: Secular Views
Depression is becoming increasingly common in global society because of various factors. A study conducted by Hsiao (2020) revealed that about 6.7 million American adults, which is equivalent to 16.2 million people have been diagnosed with at least one episode of depression. The number could be higher because many people do not even realize that they have a medical condition that may need medical attention. They associate their sadness with excess work, negative encounters with colleagues at work or family members, or the inability to meet specific goals in life (McCauley & Graham, 2020). These people rarely visit the medical facilities, hence their data is not captured. There is also another group that associates their condition with religious belief. They believe that the solution to their sadness and loss of meaning to life is primarily caused by their sins. As such, they seek religious solutions and guidance to their problem. Such data are rarely tallied, which means that they are not captured in national statistics. It means that their number could be significantly higher than the current statistical provisions, mainly provided by medical institutions.
According to a study by World Health Organization (WHO), China, India, the United States, Brazil, and Bangladesh were identified as some of the most depressed countries. It is necessary to note that although these countries are significantly different socio-politically and economically, the common factor is that they are the most populous nations in the world (Novalis et al., 2020). However, it is not possible to infer that a higher population would automatically cause higher rates of depression in a country. Japan, which is also one of the most populous nations in the world, is considered one of the least stressed, with only 2.5% of the population reporting episodes of the condition in a year (Koti, 2019). It means that there are unique factors that are associated with depression beyond the population of a given country. Depression has a major impact on the quality of life and how people relate to one another and their environment. In this section, it is important to critically assess symptoms, causes, characteristics, and forms of depression from a scientific point of view.
Symptoms and Characteristics of Those with the Condition
One needs to understand symptoms of depression for them to find a way of dealing with it. According to Shin et al. (2017), one of the primary symptoms of depression is persistent low mood. It is normal for one to feel that they are low in spirit from time to time. It may be because of challenges faced at work, issues that one has to face at home, or any other depressing situation that an individual has to encounter. When the condition resolves itself the moment the depressing factor is eliminated or addressed, the condition is not considered a depression. However, when the condition is persistent and elimination of the perceived stressors does not fully eradicate it, then one would be considered to be suffering from depression.
Loss of interest is another common factor that is associated with depression. McClain (2020) observes that one of the factors that make depression socially and economically dangerous is that it drains out the energy in an individual. The enthusiasm and focus that they had when undertaking specific activities are lost without a proper justification. Such an individual’s performance can drastically fall within a short period. They start making crucial mistakes that not only put their lives both those of other people around them in danger. If they were doing jobs such as driving, piloting, or controlling machines, they can no longer be trusted to do their jobs accurately. Some may consider resigning as the interest and energy is lost, while others may be fired or demoted because of their constant mistakes and reduced productivity.
A feeling of low self-esteem, worthlessness, and inadequacy is one of the most negative symptoms of depression. As the condition worsens, one realizes that one cannot do things they previously did with ease. They start feeling unworthy and unwanted by their immediate family members and friends (Seaward, 2021). They end up rejecting themselves even before they are rejected by society. The problem with low self-esteem is that it directly affects how people relate to others. They may become harsh and intolerant as they feel that they are always targeted by those in power or colleagues. They develop a negative defense mechanism that only draws them away from those who could help them overcome their condition. In extreme cases, they may become violent both at home and in their workplace.
Individuals suffering from depression may develop thoughts of harming themselves. According to Morrison-Valfre (2020), almost all cases of suicide are linked to some form of depression that has not been managed. As a sense of low self-esteem grows, the feeling of being worthless intensifies. They develop a feeling that they do not have a purpose in life in the world anymore. The only solution, according to the delusion caused by their condition, is death. Such individuals pose an immense threat to life if their condition is not accurately diagnosed and managed. In 2015, a Germanwings Flight 9525 pilot, Andreas Lubitz, deliberately crashed the plane in French Alps, killing all the 120 people on board (McClain, 2020). It was later revealed that the young pilot was under depression drugs and had expressed suicidal thoughts to his doctor. The employer did not know about the condition and the medical advice that had been given, prohibiting the pilot from flying a plane until his condition is resolved. This symptom is often an indication of the extreme state of the condition when left unmanaged for a long time.
Lack of focus and general poor concentration are often common among those suffering from depression. Schnittker (2020) explains that one who is suffering from depression often have a problem concentrating on their work because their mind is focused on other things. They think a lot about their stressors, the impact of their condition on themselves and their family, the possibility of losing their jobs, or even death. In such a situation, it is almost impossible to give the maximum attention to a given work that one is doing. As mentioned above, such individuals can easily make crucial mistakes at work, not because they lack the knowledge, but because of the limited focus. At such a stage, the individual cannot be trusted with major assignments. They have to be redeployed to departments where such mistakes may not have major effects or can easily be collected without major consequences.
Lack of sleep or insomnia is another common symptom among those who are suffering from depression. The neurochemical imbalance, as psychologists explain, is the primary cause of insomnia (Sealey & Rowland, 2020). The mind is constantly racing, trying to solve problems that may not even be in existence. The inability to solve these imaginary problems causes frustration, leading to a lack of sleep. It was mentioned above that such individuals would lose interest in many activities, including sports or any other physical engagements that tire them mentally and physically, which would enable them to sleep.
Irritability is one of the symptoms that others can easily detect when a person is depressed. The constant fear of losing something valuable or the feeling of being worthless causes these individuals to find ways of protecting themselves. The problem is that they develop a defense mechanism against a non-existent threat (Park, 2019). The outcome is that they become highly irritable both at work or when they are at home. Anything that they can interpret as a threat is fought with unreasonable force.
Causes
Effective management of depression requires an understanding of the causes of the condition. One of the common causes of depression is a traumatic encounter. Scrutton and Swinton (2020) argue that rape is a common cause of depression. The experience makes one develop a sense of helplessness and worthlessness. It goes beyond the physical pain of the event as one may develop self-blame. A major accident may also cause depression, such as surviving a fire accident or a plane crash that claimed many lives. As the events of the day plays in one mind, especially the helpless cries, mass deaths, and the pain that one went through, depression sets in, as Morrison-Valfre (2020) observes. Military officers who have witnessed participated or escaped from mass murders also develop depression because of the memory of such traumatic events. They struggle to overcome their condition if necessary measures are not taken to help them.
Work-related depression is becoming increasingly common in many parts of the world. Seaward (2021) observes that in the United States, it is common to find a person working two or three shifts in a day to make ends meet. They rarely have time for themselves as they have to move from one employer to the other. In each workplace, there is pressure on the individual to deliver. No employer would lower their expectations basically because an individual has already worked in a different firm earlier. The constant physical and mental exhaustion that they go through causes depression. The condition can be worsened if one is working under an abusive or highly demanding boss. The stress that they get from their workplace can easily worsen into depression. Greggo (2019) further notes that work-related stress may be caused by racial or gender intolerance. When one feels uncomfortable in their workplace because they belong to a certain gender or race, they will be stressed. When the condition remains unresolved for a long period, one can easily develop depression.
Family-related issues may also be a major source of depression. Various events within the institution of marriage can stress an individual (Gamwell & Tyson, 2020). An abusive partner is often reported as a major cause of stress among adults. When a man or a woman is constantly subjected to verbal or physical abuse that they cannot easily avoid, they become stressed. Every time they come home, they expect such abuse from their partner. It causes unexplained fear in an individual even when they are away from home. Emotional abuse or absenteeism has been identified as another major cause of concern among married couples. As Scrutton and Swinton (2020) observe, there is always the expectation that a partner will always provide the necessary emotional support to the spouse. When the same is lacking because of the deliberate actions of the partner, then the affected party may become depressed.
Change, if not properly managed, is considered to be a major cause of stress. It is one of the forces that one cannot avoid, but dealing with it has always been a challenge to many people. It may occur in many forms both at the workplace and at home. Loss of a job is a major change that one has to adjust to and remain positive about to avoid depression (Braamab & Koenig, 2019). The loss of a loved one is another change as the affected individual has to redefine their life in the absence of the departed. Getting married or divorced are both known to be stressful changes as one is forced to adjust their lives accordingly to deal with a new life with the partner or one away from the partner. Moving from one place to another may also cause depression, especially when one has to spend their lives away from the family and people they know. At work, change may increase the workload of an individual, creating work-related pressure that did not exist previously.
Chronic and terminal illnesses are known to cause depression among the affected individual. Brown (2019) explains that one of the conditions that had remained prevalent among HIV/AIDS patients is depression. When one realizes that they have the virus, will be stressed by the thought that they have to remain under medication at all times. Advanced research and availability of medicine have made the condition less worrisome. Cancer is currently one of the most feared medical conditions (Gamwell & Tyson, 2020). There is always the feeling that one has a limited time to live immediately after they are diagnosed with cancer. They have to give up most of the things they highly cherish in life, including their job and holiday with friends and family, as they struggle with the medication. The reality of the eminent death causes immense stress among the affected people, and sometimes their immediate family members and friends. If they are not offered adequate psychological support, their condition can easily degenerate into depression.
Forms of Depression
Medical experts have classified depression depending on its magnitude and the frequency of occurrence. Major depression is one of the prevalent forms of depression (Hales, 2020). It is a situation where one experiences all if not, all of the symptoms of depression discussed above most of the time. Such individuals experience weight loss or gain, struggle to sleep at night while feeling sleepy during the daytime, cannot concentrate effectively, and could be harboring suicidal thoughts. When one has these symptoms that last for more than two weeks, they are considered to suffer from major depression. At this stage, the condition should not be ignored as the individual may pose a major threat to themselves or people who are close to them. Melde and Weerman (2020) note that individuals with major depression are known to act irrationally. They need close observation and assistance from family and friends.
Psychotic depression is another type of condition that often requires accurate diagnosis and effective management. McGrath (2020) observes that an individual with this mental health problem will exhibit all or most of the characteristics of major depression, alongside psychotic symptoms. Such individuals may start hallucinating, often speaking with people who are not physically present. They may start speaking with people who recently died, ignoring those who are physically present around them. They become delusional even if they were previously straight in their thoughts. Paranoia is another common trait among those who have psychotic depression, always believing that some people are keen on causing them harm. It remains one of the most dangerous conditions that have to be monitored and effectively managed.
Bipolar disorder is also classified as a depressive disorder, affecting many people around the world. Also known as manic depression, it occurs when one experiences mood episodes that range from extremely high energy to major low depressive episodes. Such individuals do not have any major explanation for why they experience such lows or highs in their mood. They cannot predict when their condition may change (Watson et al., 2019). Low episodes may be triggered by minor issues such as being late to an event or failing to reach a target at work. The low episodes are easy to trigger than the highs, and they tend to last longer. During such low periods, the individual experiences all or most of the conditions of major depression.
Seasonal affective disorder, often known as SAD, is prevalent in some parts of the world, especially in Europe and parts of North America. It is a condition where an individual develops major depression during the months of winter when there is less sunlight and days get shorter (Peng-Keller & Neuhold, 2020). Scientists believe that the condition is caused partly by the low temperatures and limited access to natural light. The short days mean that those who rely on natural light to undertake their duties have limited time to do so. They have to plan their days accordingly to ensure that they can complete all their chores within a short period. Other depressive conditions include persistent depressive disorder, postpartum depression, situational depression, atypical depression, and treatment-resistant depression (Deer et al., 2019). Each of these conditions has unique ways of managing them.
Socio-Cultural and Religious Analysis of Depression
Medical experts have admitted that depression is largely caused by socio-cultural and economic factors. The problem that emerges is the approach that is effective in its management. Those who lean towards science believe that it is a mental issue caused by neurochemical imbalance. As such, administering certain drugs may easily help in managing the condition. On the other hand, those who lean towards religion and spirituality believe that depression is a social problem that can be addressed through prayer, sacrifice, and counseling (Pangarkar et al., 2021). Those who embrace the spiritual approach do not believe in scientific approaches to addressing the problem. They prefer explaining their problem to their spiritual leaders and getting advice from them.
The other group that believes in science rarely considers spiritual intervention as being necessary to manage the problem. McGrath (2020) advises that a combination of spiritual and medical intervention are critical in managing the condition. While medicine helps in addressing the neurochemical imbalance and the physical discomfort associated with the condition, spiritual intervention helps one to understand how to avoid stressors. Religion teaches about humility, the need to obey the law, and how to relate with other members of society, factors that are critical in the management of depression. It is necessary to review some of the religious views about depression and how they are managed.
Islam View: Depression and Contemporary Theology
In Islam, depression is addressed in the holy book, Quran. Islamic teachings emphasize the need for perseverance as a way of overcoming challenges in society. According to Hales (2020), contemporary theology in Islam views depression as primarily being caused by too much focus on earthly things. A person who is spiritually focused will rarely be concerned about the loss of property. It also associates the problem with one’s inability to relate well with members of society. There is extensive teaching in Quran about how one is expected to relate with the leaders, the less fortunate members of the society, peers, and Allah. Failing to observe these regulations may cause confrontation, which may lead to depression.
Unlike the secular view about the numerous causes of the condition, Islamic teachings hold that the problem primarily comes from one’s transgressions and going against the teachings of the most-high. It is necessary to note that the Quran acknowledges the fact that some events, such as the loss of a loved one, could be a source of stress. However, one should not allow the condition to worsen into depression because of the knowledge that finally people will be reunited depending on their deeds here on earth (Zangeneh & Al-Krenawi, 2019). As such, allowing depression to affect one’s life is largely considered irresponsible behavior.
Islam provides religious solutions to those who find themselves faced with depression situations. It argues that those who believe in Allah will always find ways out of a depressing situation. “And for those who fear Allah, He always prepares a way out, and He provides for him from sources he never could imagine. And if anyone puts his trust in Allah, sufficient is Allah for him. For Allah will surely accomplish His purpose” (The Qur’an 65: 2-3). The holy books simplify the solution to the problem by embracing a strong belief in Allah. He understands our pain and suffering, and his grace is sufficient enough to help us overcome our unique challenges.
The argument presented in Islamic teachings reflects contemporary theology’s approach to the management of depression. There is a common belief that depression is largely caused by how people relate with one another and things under the earth. Those who value earthly possessions more than their relationship with God and people tend to be more depressed (Scrutton & Swinton, 2020). Their condition can easily worsen if anything affects their earthy possessions. They will also be constantly under attack because of their selfish actions that may affect other members of society. The best way of overcoming this condition is to manage greed and strengthen ties with God and members of society.
Jewish View: Depression and Historical Theology
An analysis of Jewish religion helps in understanding their views about depression both from a historical perspective and in the contemporary world. Talmud provides both ancient and modern normative and sacred teachings that guide the life of a Jew. According to Peng-Keller and Neuhold (2020), principles in Talmud take a legal focus when addressing mental health issues. It defines what someone with a mental problem should be allowed to do and those that they are exempted from based on their condition. Depression is classified as shoteh, which means that they are mentally incompetent (Melde & Weerman, 2020). Depending on the severity of one’s condition, one may not be held responsible for their action.
Rabbis were historically expected to assess the condition of a person with depression and determine if it is temporary problem that can be resolved. The rabbi will then define the limits to the actions of an individual and recommend ways of managing them. Offering sacrifice to God was the most common way of managing the condition among the ancient Jews. Modern Jews have trusted science as a way of addressing some of the mental health issues that affect their faithful. They believe that that a medical expert can help an individual to overcome their condition. Some of the traditional beliefs and practices of Jews regarding depression, possible causes, effects, and management are discussed in the next section.
Christian View and Biblical Perspective: Depression and Biblical Theology
Depression is a universal problem that affects everyone, religious belief notwithstanding. The bible talks of various instances of depression that affected some of the prominent people and how they dealt with it. One of the perfect explanations of depression and its consequences is explained in the book of First Samuel. The bible explains that Saul, King of Israel, suffered from depression. The nature of his condition fits well with the definition of bipolar disorder. There were cases when he was high in spirit and was able to perform his duties normally. However, there were cases when he would be low in spirit and would struggle to undertake his normal responsibilities as a king.
Analysis of the events in the life of King Saul shows that he was an accomplished soldier before becoming the king. He participated in various wars that helped protect his kingdom from attacks by the enemy, especially the Philistines (Martin, 2020). He was a seasoned soldier who was always at the battlefront to make Israel a safe kingdom. Saul said, “Let us go down and pursue the Philistines by night and plunder them till dawn, and let us not leave one of them alive” (King James Version, 1769/2017, 1 Samuel 14:36). This verse demonstrates that the king was actively involved in the battles. It is written that “women answered one another as they played, and said, “Saul hath slain his thousands, and David his ten thousand,” (1 Samuel 18:7). The king had to be physically present on the battlefields.
The verse confirms the active participation of the king in various wars and the outcome of such events. Theologian scholars such as Anand (2020) argues that the king suffered from posttraumatic stress disorder (PTSD). Before becoming the king, the bible says he was a young energetic, and focused man. However, he developed problems after ascending to power and participating in numerous battles. The experience of seeing his people killed and participating in the mass murder of the enemy caused him depression.
The accounts of King David helps in shedding light on strategies that were used in managing depression at that time and the perception that people had towards it. “Now, the Lord’s Spirit had left Saul, and an evil spirit from the Lord tormented him. Saul’s officials told him, an evil spirit from God is tormenting you” (1 Samuel 16:14). It is evident that at this time, they did not understand the concept of depression and it was believed to be an evil spirit. They had noticed that there were occasions when the king was in high spirit and capable of handling his kingly tasks with ease. On other occasions, however, he was low in spirit, withdrawn, and even harsh when talking to his subordinates. Given the fact that he had never behaved similarly before, they believed the condition was caused by an evil spirit sent from God.
Managing depression that affected King Saul had to be based on the belief that people had about the condition at the time. The bible says, “Your Majesty, why don’t you command us to look for a man who can play the lyre well? When the evil spirit from God comes to you, he’ll strum a tune, and you’ll feel better,” (1 Samuel 16:16). The king trusted the solution of his advisors and ordered them to find someone who could lyre. “Whenever God’s spirit came to Saul, David took the lyre and strummed a tune. Saul got relief, from his terror, and felt better, and the evil spirit left him” (1 Samuel 16:23). As shown in this bible verse, they equated depression to a form of terror. The pain and frustration that the affected individual went through were always unbearable. Most importantly, the proposed solution worked well for the king. Whenever the music was played, his mood improved, and this was believed to be a process of driving out the evil spirit.
In the analysis conducted in the previous chapter, it was noted that constant reminders of the stressing factors may worsen the condition of an individual suffering from depression. The solution that was presented to help King Saul can effectively work even in modern society. It is currently defined as music therapy in the management of depression (Scrutton & Swinton, 2020). The music has a therapeutic effect, enabling an individual to vacate from stressful thoughts and focus on the pleasure that it brings. In this biblical account, the evil spirit, depression, could only be combatted effectively through music.
The case finally demonstrates the dangerous effect of depression if its management is not taken seriously. It had been explained that one with depression tends to create enemies even with people who try to help them. “Saul was afraid of David because the Lord was with David but had departed from Saul” (1 Samuel 18:12). The king suddenly felt that David was a threat to his throne, and he had to be eliminated. “Saul sent men to David’s house to watch it and to kill him in the morning. But Michal, David’s wife, warned him, “(1 Samuel 19:11). The verse shows that the king’s paranoia made him dangerous to his subordinates. He made a concerted effort to pursue and kill David, but he was not successful. “Then the king ordered the guards at his side: Turn and kill the priests of the Lord because they too have sided with David.” The king became a danger to society as he neutralized anyone who he believed associated with David. According to him, that was a sign of betrayal that he could not tolerate.
Depression and Dogmatic and Practical Theology
The detailed discussion of the biblical perspective to depression also encompasses the dogmatic and practical theology views and approaches to managing depression. As Buttaro et al. (2020) observe, dogmatic theology, focuses on theoretical truths of a given faith regarding the work of God. The case above has focused on how depression affected King Saul and the effect it had on his relationship with David. The events are accurately recorded in the bible and they have defined the beliefs of many organized churches such as the Roman Catholic and Anglican Church. Theological scholars agree that these accounts are true and they defined the path towards David’s ascent to power. The biblical accounts also talk about King Herod and the emotional challenges, which can be interpreted as depression, that he went through when governing his kingdom. The actions of this king during his reign have partially been proven through archeological studies. From a religious perspective, it is easy to understand why spiritual leaders believe that this mental health problem requires a spiritual solution.
Practical theology seeks to align, improve, and where necessary change religious theories and practices. It is a field in theology that assesses the theory and practices of a religion and assesses its relevance to the current realities in society. As shown in the discussion above, depression was identified in different religions as a major mental health problem that affects the way one reason and acts. Some of the proposals provided in the case of King Saul are realistic and can be applied in modern-day medication. The massive research that has been conducted to find a solution to the problem of depression has proven that music is one of the best therapies that one can use. It shifts the focus of the mind from the stressors to a firm of entertainment that creates happiness. When done regularly and effectively, this therapy helps a person to lower their level of stress. In practical theology, this form of religious solution to the problem can be supported, alongside other available medical solutions.
Summary and Conclusion
The psychological and spiritual approach to the management of depression is significantly different. The discussion above reveals that depression is a common mental health problem around the world. The socio-economic and political stressors are pushing many people into depression. It is necessary to find ways of effectively managing this problem. While spiritual leaders advocate for counseling and avoiding sins, as demonstrated in the holy books, psychologists believe the problem needs to be addressed using antidepressants and other related medications. Although science has proven to be more effective in managing health problems, some of the solutions proposed by holy books, such as the use of music therapy, have also proven to be effective. Psychologists, therefore, need to find ways of integrating spiritual principles and solutions in managing depression.
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