The Soul of Therapy
Spirituality and Depression
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Therapist Kevin Anderson reflects on the connection between spirituality and depression. "I tell depressed people that I have given up on self-esteem and I hope they will too. Focusing on increasing self-esteem amounts to trying to prop up the small-i self."
This article about spirituality and depression is intended for information purposes only and is not intended as a guide for any reader’s specific mental health situation. If you are struggling with mental or emotional symptoms, see your physician for a physical checkup and consult a mental health professional.
Sometimes a severely depressed patient says to me, “Doc, you have no idea how relentless, hopeless, and dark my depression is.” Using what therapists call “self-disclosure,” I respond: “Well, actually I do; I’ve been there—I spent nearly two years in a hole deeper and darker than I knew existed, believing I’d never find a way out.” My dark night of the soul was brought on by a simultaneous struggle with chronic pain and my father’s death due to poisoning by a medical error. After getting an up-close tour of the terrain I’d helped so many others with, I realized that medicines and standard “medical model” therapy are not adequate to healing the deepest parts of human suffering.
I can no longer think of any mental health diagnosis only in terms of treatment protocols such as “antidepressants plus cognitive behavioral therapy.” Healing the human spirit may include such approaches, but it requires something more that addresses the whole person.
If you or someone in your life has ever been seriously depressed, you may know that depressed people will reject help if it is packaged in the pseudo-wisdom of “look on the bright side” or “you’ve got so much to be grateful for.” It was Ronald Seigel, Psy.D., from whom I first learned: “The premature offering of hope is an empathic failure.” When we try too hard to fix depressed people, all they feel is, You can’t tolerate my suffering or be present to me in it. Presence is perhaps the most healing spiritual energy for depression. It is important initially to be with the darkness without fixing it, to offer empathy and nonjudgment, and—when the person feels and trusts your nonjudging presence—to hold out hope and a gentle challenge to actions that promote recovery.
Being present with depression requires mindfulness, which is not just a hot topic in spiritual circles but also in mental health. Since the turn of the millennium, nearly 4,000 studies have been published on the usefulness of mindfulness in mental health. As important as another person’s mindful presence can be, if a depressed person has practiced mindfulness prior to the onset of depression, she or he can use the habit of nonjudging awareness to stay present to the depression and come through it.
How does mindfulness help heal depression? Looping over and over through negative thoughts and problems is typical in depression. Mindfulness can help break the loop. Instead of cycling repeatedly through What’s wrong with my life? we can learn to say to ourselves: The depressive feeling is here again, I am aware of it again …”
What does this do for us? The part of us that is aware of the depression, that notices it without trying to fix it, is a version of us that is not caught in the depression. I call it the large-I Self that can be compassionately, gently, nonjudgmentally present to the small-i self that is struggling with depression. Often in a session, I write the following on a piece of paper to clarify this idea:
i am depressed,
but I am not.
The idea that there is a large-I Self (or sacred Self) that is not caught in the depression can be the beginning of hope.
Sometimes, to get beyond mere conversation, I spontaneously unscrew the lightbulb from the lamp next to a patient. Placing the lightbulb on the couch, I start doing therapy with it. “What seems to be the problem?” I ask it. “Constant darkness,” it says, “and a total lack of energy.” I tell the lightbulb about something called electricity and ask whether it’s ever heard of a light socket. But it keeps saying, “Don’t you have some meds or techniques for me? I don’t believe in all this electricity stuff!”
This kind of nonsense can bring a bit of humor into my work with a depressed person. It’s also a way to move us toward an in-session guided meditation about imagining ourselves as a filament for an energy source bigger than ourselves. I want the depressed person to begin to feel, as we meditate together, even a small, brief trickle of the large or sacred Self flowing through the filament of her or his spirit.
I tell depressed people that I have given up on self-esteem and I hope they will too. Focusing on increasing self-esteem amounts to trying to prop up the small-i self. Better, I tell them, to go for even a half-second of awareness of the large-I Self. I call this increasing Self-awareness (the capital S indicating access to an energy or source of healing larger than oneself).
In practicing meditation with patients in session, I always adopt a child’s mind—a willingness to be amazed, as we once were, by the simplest of things. Especially for a depressed person, this can be the beginning of grace. When we get even one second of sensing the peaceful feeling between hands placed palm-to-palm over the heart, we sense that depression is not in complete control. When we have a moment of childlike awe imagining that we are immersed in an ocean of God (however we might understand “God”) like a fish in water, and pretend that we can breathe in every possible healing energy from that Ocean, we get a brief respite from the illusion of separateness that depression magnifies.
A spiritual approach to depression also includes the possibility that depression can be a spiritual wake-up call. Perhaps it’s telling us we need to accept a loss, let go of an outdated understanding of ourselves, deal with a dysfunctional relationship, or find more meaning in work or life. When we see depression only as a set of symptoms to get rid of, we may miss that it is asking us to transform our habits, thought patterns, and lives so that we can live closer to peace and joy.
In the end, beyond all my ideas about how to try to help someone with depression, the most spiritual energy of all is the sacred connection the patient and I make with each other as human beings living in the same beautiful and difficult world. Theologian Martin Buber called the highest form of human relationship I-Thou (vs. I-it). To him, “God” is the energy that flows like electricity in such relationships. The creation of an I-Thou relationship is crucial to psychotherapy at its best. It is the most active healing ingredient in the process.