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Tuesday, September 08, 2015

Depression, Grief, Melancholy and Guilt

Granny says she’s depressed.

Okay, she’s not my granny, and she’s probably not actually depressed either. There’s a chance she is, but in all likelihood she’s grieving, not depressed.

There is a difference.

You see, her husband of many decades went to be with the Lord earlier this year. Her ongoing grief is natural and appropriate; in fact, if at this stage she were said to be feeling fine and spending her time internet shopping for a new partner, the gossips among us would be even more troubled.

But I point this out because where sadness is concerned, our thinking is very muddled these days.

The word “depression” is used by many to describe every emotional state south of cheery, idyllic perfection. It may be useful to draw some distinctions in our thinking about different sorts of sadness:

Depression

About depression, the Mayo Clinic says this:
“Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems.”
Note that, please, because it’s important: Depression is a mood “disorder”. It is abnormal, inappropriate sadness. It is, as they go on to say, “more than just a bout of the blues”. Real depression may have any number of possible triggers or underlying causes; it may manifest in disengagement and all manner of other symptoms, and such indicators may differ from person to person; but the critical thing to remember is that it is a DISORDER.

Depression is not a normal state of being.

Grief

Grief, on the other hand, is an entirely appropriate emotional reaction to circumstances. We may also refer to it as sorrow, or a troubling of the spirit.

We know grief is appropriate in a fallen world because the responses of the Lord Jesus were always ordinate, and he was grieved on many an occasion. In fact, we are told he was a “man of sorrows, and acquainted with grief”.

He was grieved by hardness of heart in his audience. He was “deeply moved in his spirit and greatly troubled” by the sorrow of others and wept along with them, even though he fully intended to raise Lazarus from the dead and knew that their grief was about to be turned into joy.

Grief, in short, is not a disorder. It is the human spirit operating correctly. Death is sad. People fail us. Dreams die. Horrible things happen. Grief is simply the most logical emotional response to all that.

Melancholy

Another thing commonly mistaken for depression is simply disposition or temperament. There are four commonly recognized temperaments: phlegmatic, choleric, sanguine and melancholic. While these are not scriptural designations, they are useful classifications with which many people connect and which have great historical authority. Temperament theory goes back to ancient Egypt. The Greek physician Hippocrates incorporated the four temperaments into his medical theories over 400 years before Christ.

About the melancholic temperament, Wikipedia says:
“People with this temperament may appear serious, introverted, cautious or even suspicious. They can become preoccupied with the tragedy and cruelty in the world and are susceptible to depression and moodiness.”
Got that? “Susceptible to depression and moodiness”. While easily confused, melancholy and depression are two very different things. Some melancholics do become depressed. All melancholics should be careful to avoid overindulging in what comes naturally to them if they are indeed extra-susceptible to depression. But “melancholy” simply describes a certain very common sort of being. Eeyore. Puddleglum. Probably the apostle John.

Come on, would you rather be Tigger?

To suggest that a significant portion of the population needs counseling and medication simply because of who they are every moment of their life would be to stretch the medical definition of depression to the snapping point.

In fact, an acute awareness of the “tragedy and cruelty in the world” is valuable to both the believer and unbeliever. Of those spiritual souls who mourn it, the Lord Jesus promised “they shall be comforted”. And even for the unspiritual, an awareness of the fallen-ness of the world and the fallen-ness of self is exceedingly helpful. After all, “Those who are well have no need of a doctor, but those who are sick”.

So, in and of itself, melancholy also is not a disorder.

Guilt

Even sorrow brought about by one’s own behaviour cannot be said to be a “disorder” in the sense that depression is a disorder, because once again it is the natural and appropriate response of the human mind, heart and body to the crushing weight of unconfessed sin. Guilt is not a problem in itself: it’s simply the alarm bell that tells us our conscience has been violated and something ought to be done about it:

Nobody puts this better than David:
“For when I kept silent, my bones wasted away
    through my groaning all day long.
For day and night your hand was heavy upon me;
    my strength was dried up as by the heat of summer.”
There is a remedy for the sort of “groaning” and “wasting away” to which the psalmist refers, and that remedy is not medication but confession and forgiveness:
“Blessed is the one whose transgression is forgiven,
    whose sin is covered.
Blessed is the man against whom the Lord counts no iniquity,
    and in whose spirit there is no deceit.”
The word “blessed” is frequently translated “happy”. That about says it all. Where genuine wrongdoing is the problem (we’re not discussing phantom guilt here), confession is the solution. If that sounds overly simplistic … well, sorry: all the drugs in the world won’t help a guilty conscience in the long term. All medication does is attempt to shut down the alarm bell without addressing what triggered it in the first place.

Thus even guilt is not a disorder: it’s the correct operation of the human organism in a sinful world. The people with the “disorder” are those who don’t feel guilt in the first place.

Misdiagnoses and Consequences

So why is it a big deal if I call something “guilt” and you call it “depression”? Does it really matter how we label the various kinds of sadness?

I think it matters a great deal. Misdiagnosis of chronic sadness is a major problem for Christians and unbelievers alike. If we misdiagnose our mood or the moods of others, we will almost surely mishandle their treatment, assuming that they require any treatment at all. The solutions we offer will be wrongheaded and unhelpful.

Coming Up With a Treatment Plan

Depression is a disorder. It is a form of mental illness. If there is an underlying chemical imbalance, a genuine trauma or a genetic predisposition giving rise to chronic sadness, the answer is probably medication, counseling or both.

Grief is natural. It is triggered by circumstances and diminishes with time or abates entirely when the circumstances change. There is no treatment other than perhaps love and encouragement, if we are smart enough to give or take them in a form appropriate to the person grieving.

A melancholic temperament is also natural. The “solution”, if such is to be found, is probably a career in philosophy, writing or even music, or some other constructive way of giving vent to the wealth of (sometimes negative) thoughts that occupy those inclined to meditate on this world and its sinful occupants. The hope of heaven and the love of Christ are also pretty good antidotes to melancholy, but unfortunately only Christian melancholics are capable of enjoying them.

Guilt, too, is natural. It is relieved by confession and forgiveness, and bolstered by making amends where possible.

Complications, Complications

But you can see that it is critical to have a right understanding of the source of a mood problem in order to treat it constructively. Medication may temporarily mask grief or guilt, but it is simply papering over a problem rather than dealing with it. It can, however, be extremely useful in righting a chemical imbalance. A career in philosophy will not help a guilty conscience, though it may produce some pretty crazy and intriguing social theories. Time may diminish grief, but it will not help guilt. And all the confession in the world will not relieve clinical depression anymore than it would miraculously heal a broken leg.

It is also possible in any given situation to be dealing with two, three or even four of these things simultaneously. When talking to, for instance, a naturally melancholic homosexual whose mother has just passed away, one can be forgiven for misreading a symptom or two. These things are not always clear cut. Perhaps they rarely are.

What should be clear to Christians is that a chorus of “Cheer Up Ye Saints of God” is not necessarily the most useful response to a chronic mood problem.

But then neither is “You’re depressed”.

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