Depression and Dualism

Lately I’ve been thinking (yet again) about depression, and particularly about the ways in which it gets discussed. I periodically run into disputes between those who are convinced that depression is at its core a biological illness, and those who are convinced that it’s a spiritual one. I find myself uncomfortable with both positions, because they both arise from a dualist understanding of the human, one in which spirit and body are qualitatively different things and not really connected to each other. If you take this perspective, you’re likely to conceptualize depression as either a spiritual problem or a physical one–and I’m not crazy about either version.

For those who see depression as purely a spiritual problem, the proposed solution is likely to involve spiritual practices: prayer, scripture study, priesthood blessings, church attendance. If these don’t help, it’s likely to be attributed to a lack of faith. Some might even assume that despair must be a result of sin, and therefore point to repentance as the cure. Medication is seen as suspect, perhaps even as a kind of cop-out. I think this attitude is becoming less common, but once in a while I still hear a comment in this vein. (A secular version of this might be “The Power of Positive Thinking” approach.)

However, I don’t think that defining depression solely as a physical problem is really a better alternative. From this point of view, depression is nothing more than a “chemical imbalance.” But the problem with looking at it only through the lens of the medical model is that it ignores the meaning it has for the person experiencing it. Taking medication, for example, is far more than the simple physical act of swallowing a pill–it touches on difficult questions of identity. Everyone I know who’s tried antidepressants has wrestled with the issue of what it means for their sense of themselves that they’re taking meds. To define depression solely in terms of brain chemistry is to overlook the human who’s experiencing it, and also to overlook the real ways in which depression can in fact affect things like spirituality.

In recent years, I’ve also sometimes encountered a kind of either/or view which divides the depressed into those who have “real” depression (e.g., a chemical imbalance), and those who just need to exercise faith or a positive attitude and pull themselves out of the dumps. However, I’m not sure that this is any kind of improvement. I also find it somewhat ironic that the fiercest advocates of viewing depression as a kind of spiritual illness, and the strongest proponents of a strictly medical model approach, seem to agree that the two are mutually exclusive.

But it’s actually rather difficult, I think, to draw clear lines between physical and spiritual. Not only does your brain chemistry influence the way in which you see the world, after all, the reverse is true as well–your experience of the world alters your brain chemistry. It makes little sense to conceptualize the two categories as isolated and unrelated components of a person. Spirituality isn’t some ethereal aspect of our lives that has no connection to our embodied selves; our entire experience of life, includings its spiritual aspects, is shaped by the fact that we are corporeal beings. (Seraphine has written some good posts, here and here, on this issue of embodiment.)

I’m sometimes astounded by the fervency with which people proselytize for their personal depression cure, be it medication, therapy, faith healing, some amazing book, herbal supplements, or whatever else. More than once, I’ve seen people get called to repentance for not selecting what someone else deems to be the one true treatment. As I see it, we have a number of potential resources for treating those who suffer from depression–and putting these resources into competition, telling people that they have to choose between them (e.g. “you can either trust God or you can trust meds”), simply doesn’t make sense.

My experience with depression, which includes having observed its devastating effects both in my own life and in the lives of a number of people I care about, is that it defies easy categorization and one-size-fits-all answers. I find it difficult to neatly label my own depression as being just a physical illness, a spiritual one, or even an emotional one, because it touches on so many areas of my life. I’m still in the process of finding the ways to cope with it which work best for me, a process which may last the rest of my life. And I find myself equally uneasy with the notion that this is simply a matter of faith, and the notion that it’s simply a matter of finding the correct drug.


  1. Lynnette,

    I find this post very timely to my own situation. I’ve had some serious medical problems over the last year, and it’s also been one of my most difficult years in the church. As my health is improving somewhat, I’m also noticing that some doctrinal and cultural issues aren’t bothering me as much as they were several months ago. In some ways, it’s nice not to be so annoyed by things that I can’t change, but I’m also a little frustrated with the idea that what I was going through was a mere byproduct of overexhaustion and stress — that it wasn’t “real.” In some ways I think I’d feel better if I’d found a spiritual means of dealing with these issues.

  2. Katya, your observation about the connection abetween physical, emotional, and doctrinal/cultural (?) stress rings very true for me too. And I’m really glad to hear that you’re feeling better.

  3. it touches on difficult questions of identity

    It does.

    Though, many ideas about depression date to the time before successful drugs. At that point, it becomes hard to separate some things out.

    Things like depression have made me think about just what “I” really am vs. all the inputs and illusions in the world and life.

  4. A couple of years ago I read (via audio CD while driving) Dark Nights of the Soul, by Thomas Moore, a religiously inclined therapist and writer. It certainly deepened my view of depression and dark episodes.

  5. You are right to think of it as a false dichotomy. Both factors are without doubt involved and intertwined. We have thought pattern that lead to beating ourselves down in depression. These may or may not be secondary to sin, but are often secondary to perfectionism. These thought run on a relay that strengthens itself while deadening our ability to feel joy or happiness. After a while this signal is simply a monster out of control.

    Medication serves to quiet the monster, but addressing the way we think, straightening things out spiritually becomes critical for any lasting relief from depression. We have to fix the circuit, and the Savior has been an integral part of this in my life and experience with depression. I hope this point of view is helpful, coming from a neurologist, active Mormon, and a patient. I have had to figure this out from all sides.

  6. I struggle constantly with feelings of depression and despair. My dilemma is that these feelings stem from many different areas, my health isn’t good, I’ve had a hard life, and I take everything in the present hard. I’m not a strong person in any way. I’ve never tried anything that gave me lasting relief.

    I read the Book of Mormon last year when the prophet asked and I started reading it again, hoping I could get more spiritual and less depressed. I was thinking yesterday it didn’t help, but then I thought maybe I’d be a real mess if I wasn’t trying to get with God.

    I’m going to a therapist now who thinks he can help me.

    I’ll keep you posted.

  7. Really thought-provoking post. Thanks for posting it.

    In my experience, mental illness has seemed to have multiple causes. I know that I have a natural, hereditary susceptibility to anxiety and depression. But at times I have lived almost entirely free of its effects, without therapy or drugs, while at other times, events in my life have brought about and exacerbated the devastating effects of the illness. I think the best treatment is a combination of therapy and, if needed, medication.

  8. I think you make an important point when you talk about the “one true treatment.” The problem I have seen is that there really isn’t one single thing that works. I have seen people close to me search in vain for the one therapy style, the one medicine, that will make the darkness go away. It has to be a combination of things.

    I like what Doc says about medication quieting the monster so we can take other steps to deal with the depression. In one case I am very familiar with, art therapy is incredibly healing. I have been amazed at seeing how powerful it can be to include in depictions of pain depictions of the Savior there, too, offering comfort.

  9. Thanks for the thoughtful comments, everyone.

    Katya, that’s a fascinating observation (and like Eve, I’m glad to hear that you’re doing better!). I’ve also noticed in my own life a relation between physical/emotional health and perceptions of church. When I’m depressed, church can be absolute torture–the thought of having to go make small talk with people (who probably hate me) is in itself enough to convince me that I should go permanently inactive, not to mention that every talk I hear comes across as telling me that I’m a vile sinner worthy of damnation. It’s always amazing how different things look when I’m less depressed. And yet I too am uneasy saying that those feelings aren’t “real.”

    Stephen, I’m also intrigued by those questions of identity. I’ve dealt with depression for so long that one of my challenges in recent years has been to think about who I might be separate from it.

    Dave, that sounds like an interesting book; I’ll have to check it out. I like the idea of the “dark night of the soul,” that periods of darkness are actually an intrinsic element of the religious life; if religion is only about happiness and cheer, it seems poorly equipped to speak meaningfully to the range of human experience.

    Doc, I like the way you combine various factors in the way you think about this. I’ve thought about this a lot from a theological perspective. We often talk about grace, the love of God, as an experience that’s immediately available to everyone who looks for it. Yet it seems to me that many people are in situations where they actually can’t get to a place where they can feel it without outside help.

  10. I do not like the idea of thinking as depresison as a problem but rather a state of mind. i feel the healthier trajectory of person experincing depression often is a matter of adopting new coping skills in this ever changing world. Sometimes is it purely chemical, and meds, can be a part of healthy coping, for others, narrative therapy, reframing and active self care could remove one from the depressed state. I think that spirituality can be a part of the process but not THE process. We can know what we need to do/feel spiritually, but not know how to get there. I am a big suppoprter of therapy. I think it helps, with proper direction medication can help to, perhaps then we will be able to be more spiritually fulfilled. If you look at maslow’s heierarhy, self fulfillment (i lomp spirituality into that) is one of the last things to obtain, I feel we need the basics before we can come wells of spiritual strength.

  11. Annegb, I’m sorry to hear that you’ve been struggling–I relate a lot to your comment about taking things hard. I really hope that you’re able to find some relief; depression’s a tough thing to live with.

    Steve M, I think I’m in a somewhat similar situation. I think, looking at those related to me, that it’s quite likely that I have some inherited vulnerability or predisposition to depression. However, there are also clearly environmental factors which trigger it for me. (And some of them are religious in nature, which can certainly make questions of faith more complicated . . )

    CS Eric, that’s a great observation about seeking the “one thing” that will fix it all. I think the way that depression gets portrayed in popular narratives can feed into this–so many stories about it are written like mysteries in which the protagonist follows a lot of false leads before finally solving the riddle at the end. I would guess, though, as you say, that for most people it’s a combination of things that helps.


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