Depression and Spiritual Growth

B. A Spiritual Model of Healing and Wellness

Major depression and bipolar disorder are among the most searing experiences of life. I know people who have had an episode of major depression, and also have had a serious heart attack. When asked which they would choose if they had to go through one or the other again, most of them said they would choose the heart attack! It is therefore wise to try to obtain some kind of framework and perspective in which to view the illness and the progression back to wellness.

The initial phases of the model offered here resembles somewhat the model for dying developed by Dr. Elizabeth Kuebler-Ross in her famous book "Death and Dying". But I want to point out right away an essential difference: in Kuebler-Ross's model, the end state is that you get to die; in this model the end state is that you get to live, perhaps for the first time ever.

When one comes to the full realization that he/she has a chronic mental illness, the most common natural reaction is denial: the insistence that "there must be a mistake; this can't be true!" The trouble with denial is that it doesn't accomplish anything. It neither retards the course of the illness, nor facilitates its cure (quite the contrary, it typically delays meaningful treatment). How long this state lasts depends on how severe the illness is: if it's mild, denial can be sustained for a long time; but once grinding, crushing, mind-breaking major depression sets in, the luxury of denial falls by the way, and survival becomes the issue of the day.

In the Kuebler-Ross model of dying, the next stage is typically anger: "why me?!". In contrast, strong anger is not typically a part of the progression of events in severe depression. Indeed, some psychiatric theories attribute special significance to its absence, and go so far as to say that depression is actually caused by "suppressed anger". From my own experience and contacts with many severely depressed people, I am skeptical of those ideas. The fact is that the scientific evidence shows severe chronic depression is biochemical, and requires treatment with antidepressant medications. Also, it is unreasonable to expect depressed people to show anger because they are in misery; rather than angry, they are passive. Furthermore, they often feel guilty about everything in their lives, and even believe that in some tortured sense they "deserve" their illness.

As one comes finally to acknowledge the indisputable presence of the illness, one feels a sense of loss, grief, and mourning. One senses that life may never be the same (aside: it may actually become better, but one usually can't believe that at this stage). That some of the opportunities we thought we had may not be there anymore; that we may not have or do all the things we had hoped to, and believed we would -- this is loss. As the loss sinks in, we feel grief: grief for that part of our own life that seems likely to be dead now; grief for the loss of ourselves as terrible as the grief we experience for the loss of others. And then we mourn; this is a painful, tearful time, in which there is no consolation.

But the human spirit is amazing; it can survive, singing, under the most adverse circumstances. And the will to survive leads us to a new position: acceptance. It is impossible to overemphasize how important acceptance is: it can be the choice between life and death. To illustrate, suppose some terrible disaster befalls you: your beloved spouse dies, or your child dies, or you are permanently injured and scarred in an accident. These are events that you really don't like; but you don't control them, and therefore cannot change them; nor are they going to change by themselves or by someone else's intervention. So you have a choice: you can forevermore be caught up in your loss, grief, and mourning, or you can say (out loud if it helps!) I don't like this situation one little bit; I never will; but I can't change it, so I must accept it so that I can get on with living.

Once we can do that, once we can simply acknowledge what is, even if we don't like it, a wonderful thing happens. We begin to experience release. That is, the loss is still there, and we still don't like it; we acknowledge and accept its existence; but now we refuse to have it dominate every waking moment of our lives. In effect we say "Yes, you are there. And I have dealt with your presence as well I can. But I have other things to do now." This cuts the string that otherwise would have you jumping like a puppet for the rest of your life, and allows you to move forward again.

Once you are released, healing can begin. You gain the insight and courage to carry out your decision to continue living. You grow stronger. The ugly scars are still there; but they aren't painful anymore when you press on them, even hard. You will be different then. The event changed your environment and it changed you. There is no going back to what was before.

And there is more. You might conclude that the process I have described thus far leads only to a state in which you have suffered permanent loss, or some aspect of your life is permanently degraded. But here the analogies with a friend dying or a physical injury begin to break down. In those cases, your friend will remain dead; the limb you lost is gone. Whether your life is degraded or not depends on how you deal with these losses. But in the case of mental illness, radically different outcomes are possible. For example, if one experiences a strong remission, then one can look back at the period of severe illness with an awareness of the loss of some things, which, with the help of successful psychotherapy we can replace with other things (habits, beliefs, insights, stance towards life, and so on) which we like better. My own experience, and that of other CMI people I know, is that the trip through the "fire" of depression can be purifying, burning away the worst of us, creating new openings through which we can proceed into the future.

It is at the end of such a trip that one can begin to understand fully the meaning of the following quote, which once appeared on the cover of the Friends Journal:

The crucible is for silver.
But the fire is for gold.
And so God tries
the hearts of men.

Those who have felt this Fire, and realize how it authenticates the depth and reality of their experience, and their experiential knowledge of God, are on the road which leads beyond healing to Grace, a subject to which we shall return.

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