Psychogenic Depression: The Orthodox View

    

Depression (from the Latin word depressio, which means to press, oppress) is a subnormal, depressed mood, accompanied by lethargy, fatigue, and a dull and pessimistic assessment of the situation. Mankind has known this suffering since time immemorial—since the time when the Fall of a man occurred. Yet Hippocrates described a similar mental state, which was referred to as "melancholy." Bouts of depression are repeatedly described in the Scriptures on the pages of the Old Testament. It is sufficient to recall, for example, King Saul, to whom the psalms of David brought relief from melancholy.

The modern understanding of depression as a disease starts in the middle of the nineteenth century.

The World Health Organization (WHO) compares depression with an epidemic that has spread to all mankind. In 1997, 146 million people in the world lost their ability to work due to depression. According to the Ministry of Health of the Russian Federation, depression affects 10% of the population of over 40 years of age, of which two thirds are women.1 According to some estimates, the number of patients with depression in Russia is increasing by 3-5% annually.2 Women get depression twice as often as men. Most likely, this is not due to the "immunity" of the stronger half of humanity to depression, but the fact that men much more seldom than women seek medical help, preferring to suppress their symptoms by drinking alcohol, immersing themselves work, and so on. Special studies have shown that depressive disorders of varying severity are detected in 60% of patients who come to the clinic. Meanwhile, depression is usually diagnosed in not more than 5% of all depressive patients who visit polyclinics. Depressed patients commit 45-60% of all suicides in the world. According to the forecasts, in the twenty-first century depression will be the number one killer of mankind.

Not so long ago the peak of depression occurred between the ages of 30 and 40 years, but today depression has "gotten younger" appreciably and affects people under 25. In only 2-3% of the cases, depression is not dependent upon external circumstances (endogenous depression), and in the rest it occurs mainly as a reaction to stress. The annual catalog of new antidepressants reaches a thickness of three centimeters. Therefore it is difficult to overestimate the importance and complexity of the problem concerned.

Neurotic depression, reactive depression (occurring after severe stresses and shocks), and exhaustion depression are referred to as psychogenic depressions. Thus, let’s consider neurotic depression. But first a few words about neuroses. Neurosis is a personality crisis. This is the clash of the desired and actual. And this is often a spiritual problem.

An unrestrained growth of neuroses in our time is not only caused by stresses and scientific and technological progress with its information overloads (which researchers have repeatedly pointed out), but above all, by the "progress" of human fallenness.

In all times throughout human history there were wars, different natural disasters, floods, droughts, tornadoes, etc. It's hard to compare, let’s say, to what extent the present time is more anxious and restless, than, for example, the era of the reign of Ivan the Terrible. Why has the problem of neuroses become so acute only recently? The reason, I think, is only the growing faithlessness, the loss of a spiritual foundation by humanity, and with it a true sense of life.

It turns out that the main origin of neurosis is not stress and troubles, but a person’s personality. And this personality is internally upset. Sin, as the root of any evil, brings neurotic disorders with itself. Acting in the depths of the human spirit, it arouses passions, disorganizes the will, and removes emotions and imagination from the control of consciousness. According to St. Theophan, "The inner world of a human sinner is filled with self-will, disorder and destruction." Deep neurosis is an indicator of ill health, and moral and spiritual disorder.

St. Theophan the Recluse St. Theophan the Recluse
St. Theophan the Recluse points out that, "The natural attitude of the human components should be according to the law of subordination of smaller to larger, weaker to stronger; the body must obey the soul, the soul obey the spirit, and the spirit by its nature has to be immersed in God. A man must remain with his whole being and consciousness in God. At this, the power of the spirit over the soul depends on its co-present Divinity, and the power of the soul over the body depends on the spirit possessing it. After our falling away from God the perturbation occurred that was bound to happen throughout the entire human composition—having been separated from God, the spirit lost its strength and submitted to the soul, and the soul, having not been elevated by the spirit, obeyed the body.”

Professor Dmitry Melekhov believes that the basis of many psychiatric disorders is rebelliousness. Neurosis in this sense is not an exception. It is generally accepted that the disease is developed due to the person’s the conflict with himself (intra-psychic conflict) or with other people (inter-psychic conflict). Neurosis is a clash between the desirable and the real. The stronger the clash, the worse is the illness. "Faith is humility," says St. Barsanuphius of Palestine.

A large part of depression is the consequence of a sinful way of life, a consequence of the destructive action of a sin upon the human soul. In the first place, these words refer to the neurotic depressions, which, as it will be shown below, are similar to the sinful passions of sadness and discouragement.

In the "Basics of Social Concept of the Russian Orthodox Church", adopted by the Council of Bishops (held in Moscow on August 13-16, 2000), it is stated: "The Church regards mental diseases as one of the manifestations of the general sinful distortion of human nature. Singling out in the personal structure the spiritual, mental and bodily levels of its organization, the holy fathers distinguish the diseases evolved ‘by nature’, and afflictions caused by demonic impact, or as the consequence of passions that have enslaved the human being."

Neurotic depression at its spiritual foundation is a psychopathological condition developed as a result of "passions of despondency and sorrow that have enslaved the human soul." And each passion is "heated" even more by the demons, who find refuge in its depths.

Science knows much about the origin of depressive disorders, but it is not common among scientists to talk about sin; while the cause of many forms of depression is precisely sin, as evidenced by the fathers and the whole ascetic experience of Orthodoxy.

Long before scientific psychiatric observations regarding the origin of neurotic depression, the Fathers described this mental illness very accurately and reliably, defining it by sinful passions of despondency and sorrow. So in this case the medical diagnosis corresponds to the spiritual “diagnosis”.

Depression is a kind of a signal from the soul about its troubles or distress. However, it is not the soul’s weeping over the sins, but rather the torment of an unrepentant soul to which demons whisper: "Everything is bad, there is no hope..."

    

Depressive neurosis often begins due to life difficulties. In this case the person is in a bad mood, nothing pleases him, everything annoys him, he falls into despair, boredom, sadness, and everything around him appears in a gloomy light. These conditions arise very often, because, "life has not turned out as we would like it"; the person does not achieve what he desired, some sort of conflict has occurred, this or that offense took place...

However, not all sorrow is sinful. In days of grief and times of sorrow a man becomes indifferent to many passionate movements of his soul. Ambition, money, sensual pleasure—all this is upstaged during such periods of life. In happy times a man quickly dozes off, but in disaster he willy-nilly turns his thoughts to himself, and becomes deeper and more aware of his sinfulness.

But if not, if sorrow is for the sake of sorrow, and repentance is replaced by neurotic "self-devouring"—which besides its destructiveness, doesn’t give the soul anything—it is obvious that substitution has taken place. Such sorrow is a sinful passion.

Of course lies, low slander, and insults will not bring joy to the soul. But if a person, and moreover a Christian, is completely broken by them and durably remains in a sad mood or even worse—in state of despair, complete loss of self-control, loss of hope in God's mercy, and loss of belief in the sanctity of God’s Providence for a man, this is not a Christian attitude but a sin. In this case, the demon just waits for people to stumble and plunge into the abyss of serious worries and anguish.

Sorrow is always regret (about a loss, something that does not come true, etc...). Despondency is often preceded by laziness, idleness, excessive love of comfort, or narcissism.

St. Ignatius (Brianchaninov) determines the sinful passion of despondency and sadness as follows:

SORROW: Grief, sadness, cutting off hope in God, doubt in the promises of God, ingratitude to God for everything that happens, cowardice, impatience, sadness for a neighbor, murmuring, denial of the cross, an attempt to come down from it.

DESPONDENCY: Laziness for all good work, especially for prayerful ones. Abandoning church and cell rule... Neglect. Impiety. Idleness. Excessive sleep, lying down, and all kinds of pleasurableness. Going from place to place. Empty talk. Joking. Sacrilege. Oblivion of sins. Oblivion of Christ’s commandments. Negligence. Lack of the fear of God. Bitterness. Insensibility. Despair.

Sorrow, according to the Holy Fathers, comes when some passion couldn’t find its satisfaction. For example, a person didn’t receive the money he wanted, or his feelings were rejected by his darling, or perhaps he was not promoted, and the like.

    

Sinful passions are interrelated and mutually influence each other. Thus, pride and vanity are "supported" by gluttony and fornication, as are all the passions associated with avarice. And the result of this "community" is anger, sorrow, and despondency. Figuratively speaking, this is a syndrome of "spilled milk".

Despondency and sorrow lie in wait for those who have not found strong faith in God. These passions are often hosted in the soul of those who, rejecting Heaven, are firmly stuck to the earth. That means that neurotic depression in its deepest essence is a consequence of lack of faith in God's saving Providence. In this case, sorrows and sufferings seem to be disgusting and totally unnecessary. Strictly speaking, this is a natural consequence of a hedonistic philosophy—a life lived "for fun" that many seek.

Bishop Barnabas (Belyaev, 1887-1963) says, "There is one thing in the science of salvation that leads a man to God by the shortest route. This is sorrow for sins, sorrow for God ... experience and grace in the heart convince us that prayer in solitude with warm tears of repentance is the only means of consolation. It is true that at first bitter, salty tears flow, but then you feel relief, joy, and a ray of hope. The further you advance on the path of salvation, the more cheerful your soul becomes; you cry, tears are rolling down and your heart becomes clearer and warmer. A wonderful thing! An unfathomable work of grace!

“But there is another kind of weeping and a different grief. A fashionable woman cries that she does not have a new spring hat and her smart shoes went out of fashion, that ‘such-and-such’ a man began to court ‘such-and-such” a woman, and ‘that woman’ is more beautiful and happier than she is; a young man is sad because of a small amount of pocket money to spend on fun; a wife cries because her husband is unfaithful, and a husband, in turn, is sad because of his failure at work; a doctor, an engineer, a lawyer—all are unhappy because they earn little; a merchant is in despair from a loss incurred; and so on and so forth. All cry and grieve, even while living in luxury and wealth, but they lament about perishable things. They do not have something or lose something, and that's why they are sad. Sometimes, such sorrow dries them up, they become ill and even die (see 2 Cor. 7:10). This sorrow is demonic. The enemy of the human race brings it. Humanity is tormented, groans, tries to make life carefree; but without God it can do nothing."

In his main work, Fundamentals of the Art of Holiness, Bishop Barnabas conducts a fine spiritual and psychological analysis of the topic raised. Here are some excerpts from this work. (Get excerpts)

St. John of the Ladder St. John of the Ladder
“Despondency is one of the eight capital vices, and moreover the greatest,” says St. John of the Ladder. Indeed, against every passion is an opposite virtue that serves for salvation (e.g., gluttony is overcome by abstinence, avarice is overcome by generosity, and pride is overcome by humility, etc.), but there is no special virtue against despondency. That's why the Holy Fathers sometimes call it an "all-striking death", because much strength is needed to heal it, and it leads all the vices and thousands of evils—for laypeople, to the point of rejecting the idea of personal salvation itself; and for monks, the removal of monastic garb and return to the world. But no one passion delivers to the ascetic so many crowns as despondency. In the fight with this passion a person learns how someone serves God—without hypocrisy, cunning, or laziness; and he is awarded accordingly.

When, where and how does the demon of despondency attack a man?

One can speak about a certain time of attack only with respect to hermit monks.

In the days of the ancient Fathers of the desert, the enemy tempted them usually around noon when the sun was at its zenith and because of the heat by which the desert began to breathe, and the body and mind naturally weakened—especially after a sleepless night spent in prayer. Much time remained until they could eat, because they ate only in the evening and after sunset. The devil aimed at them despondency, the dread that their toil is useless, the fear that they will fall ill and no one will help them when they become old, and disgust for the long-fragrant prayer site, which supposedly is useless. The Lord convinces us not to be afraid of this particular demon, when by means of the prophet He says to the ascetic: thou shalt not be afraid for the terror by night, nor for the arrow that flieth by day, Nor for the thing that walketh in darkness, nor for the mishap and demon of noonday (Ps 90, 6.).

As for the laity who live on their own and the way they like, who sleep enough and well, eat in the morning and at noon fortify themselves with food, the demon of despondency attacks them at different times and in relation with the other circumstances. But there are cases when the demon operates very diligently and accurately in the time, as in the previous case ...

Once having attacked the man, the demon of despondency will exhaust all its means on him to distract him from good deeds. The demon acts in the way specified at the beginning of this article.

SORROW

What is sorrow?

"Sorrow is the obstacle to all good," says St. Nilos of Sinai. St. Seraphim of Sarov describes the action of this passion as follows: "When an evil spirit of sorrow seizes the soul, then filling it with sorrow and trouble, it does not allow the soul to pray with due diligence, prevents it from reading the Scriptures with the proper care, deprives it of humility and peacefulness in dealing with the brethren, and creates an aversion to any conversation. For the soul, full of sorrow, becoming as if insane and frenzied, cannot safely accept any good advice or meekly respond to the proposed questions. It flees from people as the causes of its troubles, and does not understand that the cause of the disease is inside it...”

What is the cause of sorrow?

Sorrow is usually a consequence of angry thoughts or failure while satisfying any desire. Thus, the person who overcomes his desires and passions will banish sorrow from his heart forever. Thus, the abstinent person does not grieve because he failed to have dinner, nor does the virtuous person grieve if he did not succeed in unreasonable lasciviousness; the person without anger doesn’t lament that he did not avenge an insult; the meek and wise perosn who has humility does not lament when he is deprived of human glory; and the generous person will not grieve even if he loses every last thing...

But passionate people sometimes become sad for no apparent reasons. Then, as St. John Cassian says, "By the influence of our sophisticated enemy we are suddenly subjected to such tribulation that we cannot with the usual affability endure a visit even from our good friends and relatives; and no matter what they might say in polite conversation, it seems to us ill-timed and superflous..."

However, this only proves that sorrow does not always have its own causes in external sources. No, inside us, deep in the heart, the seeds of hidden sins are laid, which, when a rain of temptations pour on the soul, immediately produce shoots and fruits. Therefore, we must say again that if we were not dispassionate only in appearance, but rather truly quiet in soul, no tricks of the demon of sorrow could affect us. The soil of heart withered by fasting, vigils and prayers, could not have conceived the seeds of passions inspired by demons.

Thus, there is no need to run from people in order to escape from sorrow. However, it is impossible for a person to avoid perturbations living in the world and constantly entering into contact with people who are not close him in spirit, possessed not only by passions, but as it sometimes happens, by the demons themselves. But it is wrong to think that by simply changing place you will make your life easier. By changing the environment, a person will change only the causes that excite the passions. He doesn’t need this; he needs patience, and something else—which will be discussed below. If a person has patience and for the most part purity of heart, then he is able to say with the prophet David: With them that hate peace I was peaceable (Ps 119, 6).

Then he will easily get along not only with people but also with the wild beasts, and they will respect him as it is written in the Scripture: For the wild beasts of the field shall be at peace with thee. (Job. 5, 23).

Murderers of sorrow

We have already mentioned that sorrow is powered by a man’s passions. Take away the passion for things, lust, or gluttony, and you will never have any sorrow. But we can point out the positive means by which these passions can be also radically cut down. These are especially prayer, charity, and generosity.

A man suffers, he is racked with sorrow and gloom, and his soul languishes. Therefore he goes to see a doctor, who prescribes him soothing and mood improving drugs in order to artificially relieve suffering and reduce emotional pain. But as Orthodox doctor V. Nevyarovich rightly observes, the sick soul is often not cured at all by this, and the person is only led away from suffering, which almost always has a curative meaning. We emphasize that we are talking here about neurotic depression. When endogenous depression occurs, the treatments are different.

When depressive disorders are of the neurotic form, then its direct contact with the moral and ethical state of a man is defined. As a physician, I of course alleviate the sufferings of patients with medicines, talks, and just human sympathy; but satisfaction when consulting the patient comes only when we begin to talk about the soul, faith, and repentance. With the patient's consent and at his request, we try to evaluate the symptoms of the illness from a spiritual viewpoint.

The only right way to heal nervousness, despondency, and sorrow, and attain peace of mind, is through the true Orthodox faith, repentance and reformation of one’s life according to God's commandments. The main thing for a man to understand is the origin of his sinful mental state, to be deeply aware of his weakness, hate the demonic sins of pride, vanity, anger, despondency, lying, and fornication, and want to change himself, to turn to the Lord with sincere repentance.

The real reason for depressive disorders usually lies in the sins a man has committed. The holy Fathers believed that the basis of all mental suffering is pride. Therefore, in order to get rid of neurotic depression we should strive to acquire humility. An overstated level of human aspirations not carried out in life, a conflict between what is desired and what is real, always leave a feeling of sorrow, frustration, bitterness, and disappointment in the soul.

Of course, the essential thing for every Christian is to attend Orthodox services, especially on Sundays and feast days, and participate in the Church sacraments. In the prayer that the priest reads before confession are the words, "You have come to the spiritual hospital, so you would not leave uncured.” One must have recourse to the Holy Sacraments with a remorseful heart, deep faith and trust in God's mercy.

Let us keep the marvelous and great words of Saint Paul in our heart: Rejoice evermore. Pray without ceasing. In every thing give thanks: for this is the will of God in Christ Jesus concerning you (1 Thessalonians 5, 16).

1 Depression statistic for the U.S. according to the NIH: 3.7% of all U.S. disability-adjusted life years (DALYs); and, 8.3% of all U.S. years lived with disability (YLDs)—O.C.

2 The depression statistics for the U.S. according to the CDC: Percent of persons 12 years of age and older with depression in any 2-week period: 7.6% (2009-2012). According to the Anxiety and Depression Association of America: Major Depressive Disorder The leading cause of disability in the U.S. for ages 15 to 44.3 Affects more than 15 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year. While major depressive disorder can develop at any age, the median age at onset is 32.5. More prevalent in women than in men. Persistent depressive disorder, or PDD, (formerly called dysthymia) is a form of depression that usually continues for at least two years. Affects approximately 1.5 percent of the U.S. population age 18 and older in a given year (about 3.3 million American adults). The median age of onset is 31.1.—O.C.

Comments
Emile8/12/2017 7:29 pm
I have a lot of experience in promoting medications,also anti-depressiva,and,indeed,it seems to me that this article confounds two models of mental illness,there are also two extremes,the totally materialistic,atheistic point of view and the opposite,the spiritual one.To make the difference,even for professionals,is not easy at all,the more if they are faithful.Let's take the example of one of the most terrifying examples of mental diseases:schizophrenia.Is this "natural" is there "something"more...? In this case I can follow,or understand,what Prof.Avdeev means. Anyway,as orthodox christians it's always good to remember that the sin of Adam had consequenties on the entire cosmos...
JJ3/30/2017 5:17 pm
This article confounds two models of mental illness - the psychological and the spiritual. Depression (reactive, neurotic, endogenous etc)belongs to a medical model, while despondency and sorrow belong to a spiritual model. The two models demand different modes of treatment - one church based, the other clinic / medical based. This is not really made clear, because the article is rather long and rambling, confusing even; and not expressed in clear succinct English. In addition I don't think the article would be helpful to anyone dealing with their own depression, or that of depressed friends, relatives, fellow believers.
Maria 1/3/2017 12:54 am
To me there is alot I can recognise from my own life. Kyrie Eleison! This gives me hope.
Matthew Fisher11/11/2016 7:20 am
This article gives the impression of talking about rather than to the depressed person. To my mind, it is less than helpful. For whom was it written? The author is both a medical doctor and a doctor of philosophy. Why he bothered to study medicine at all if he doesn't bring that training to bear on mental illness is a mystery. It strikes me as a form of malpractice. I think sometimes that our religion itself is a mental disorder. It can certainly be practiced as if that were the case. A person with mental illness owes it to himself to see if it will respond to medical treatment. It makes no sense to only bring a wound like this to a priest unless he has a reputation for healing the sick and raising the dead. But if you do see a doctor, and the first thing he wants to talk about is demonology, run! That doctor is a quack.
Maria11/5/2016 4:24 pm
''A wife cries because her husband is unfaithful..." doesn't seem to be in the same category as not having the most fashionable shoes. A bill of divorce has been granted for mankind due to our hardheartedness (adultery). Am I misunderstanding something?
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