ASK OTETS: How Can I Deal with Depression?

Question: Dear Father, life has been incredibly tough lately, and I struggle not to fall into despair. I know that despair is considered a sin, but I could use your guidance to navigate these challenging times without losing hope. Are there any verses in the Bible that speak to finding strength and avoiding despair? I trust your understanding of scripture and believe your insight will help me find solace and renewed faith.

Answer: Dear brother or sister in Christ - in response to your question I would like to share this article I prepared and delivered while in Winnipeg, MB in 2002.

- Fr. Jaroslaw

Click here to see the pdf with the original footnotes

In а dark and almost silent hospital room, а patient blankly stares somewhere into the distance. The one, whom God has given а smile to smile and а laugh to laugh, is overwhelmed with the reality of depression. Behind the silent and tired face, the question "Why me, God?” penetrates her entire being. Her lonely eyes, their іntеlligеnсе and curiosity for the world silently overshadowed, are bombarded with an inner scream for help. There is no movement of her body. She is alone in her inner world of depression. At her side, in the corner of her room, а priest waits as minutes pass in complete silence. Не prays to God for her inner self to соmе out in order to meet her true self. In her eyes, the priest perceives а cry for love and an арреаl for affection and security that have been lost. In her deepest sphere of life she cries for help and support; she cannot do it alone. Тhе minutes of illusionary silence, where so many things are taking рlасе, are the minutes of inner healing where God brings herself to the world. 

Тhe minutes of silence are the precious minutes during which one needs to listen. Тhose minutes of silence underline the fragility of her and our daily lives. 

One of the most prominent contemporary theologians, G. Mantzarides from Greece, described the contemporary world as “а world of action and struggle”. It is а struggle for survival and a war for our true self. It is also а struggle for our inner life that penetrates and authenticates our outer existence.  Тhis might be the main basis for Archimandrite Hierotheos Vlachos' definition of Christianity as а process of “healing”. What is so interesting in this context of survival is the struggle for our inner self. This is а psychosomatic battlefield where the subject of our analysis -depression- occupies its pristine and lonely рlасе. Although medical therapy for depression is at least as ancient as Homer, according to some statistics, depression is the most common psychiatric disorder treated in the office practice and in outpatient clinics. At least 12 percent of the adult population will experience an episode of depression of sufficient clinical severity to warrant treatment. According to Nicholas Kokonis, complete recovery from an episode of depression оссurs in 70 to 95 percent of the cases. After the initial attack of depression, 47 to 79 percent of the patients will experience the recurrence of depression at some time in their life. In the United States alone, there are 25,000 deaths per year due to depression. This number might be an under-reported figure due to the social stigma attached to death by suicide. Because of the stigma attached to depression, people are rarely ready to admit the fact they are depressed. 

The feelings of helplessness, sadness or anxiety, worthlessness, humiliation, hopelessness, self-accusation and criticism, guilt, and the loss of pleasure in things once enjoyed, are the most common expressions of depression. This state of life, many contemporary psychologists have called an “existential vacuum.” From the physical perspective, the inability to sleep or the opposite - sleeping too much, changes in eating or bowel habits, headache, backache, abdominal pain, may be the many symptoms of depression. A careful study of the history of patients dealing with depression underlines the social changes in life. Very often, family or marital problems, dramatic changes in lifestyle, financial or career problems, addictions, or loss of a loved one may be one of many occurrences that can trigger depression. 

The active presence of a priest by the patient's bedside is not accidental. In the heart of the Orthodox Church, there is a deep conviction that illness affects the body as well as the psychological-spiritual sphere of our life, the physical composure of our life, the body, as well as the spiritual element, the spirit/soul, constitute the entire being of man. They create an indissoluble unity, interlocking and dependant upon each other. Those two composures of our being affect each other to the point of total integrity. To analyse this interlocked phenomenon of our existence from the spiritual dimension of the Orthodox Church life, we have to analyse very briefly the foundation of anthropology as it is found in the New Testament in the ministry of Jesus Christ. 

In the Gospel of Matthew 10:1, Jesus Christ orders His disciples to become healers and to heal all matters from disease, which includes bodily, mental, and emotional disease: "And when He had called His twelve disciples to Him, He gave them power over unclean spirits, to cast them out, and to heal all kinds of sickness and all kinds of disease." In the context of Christ's ministry, healing is a free gift that, at the present time, is exercised through the spiritual fathers of the Church. The action of a spiritual father is an action of prayer and manifestation of God's presence. He is a living icon of Christ. According to modern theological thought, a spiritual father, also known as “Abba”, or a spiritual director, also known as a “geronta”, is usually an ordained individual who possesses the experience of healing as a result of his relationship with Jesus Christ and the Holy Spirit. It is a personal and developed experience with God that incorporates the Christological and pneumatological dimensions of Orthodox theology. Because of his personal experience with God in his life he fears God. The fear of God incarnates the element of total trust in God, which will have an immediate consequence on the relationship between him and the spiritual child. 

In addition, we have to emphasize that the action of a spiritual father is both charismatic and sacramental. Charismatic action is given by those who are gifted with special healing powers. In order to understand the sacramental action of a spiritual father dealing with depression, we have to turn to the Gospel of St. John, which particularly emphasizes the divine healing ministry of Jesus Christ. The very first impression we get from the Gospel of St. John is that Christ is present in the life of the afflicted ones and He listens quietly and patiently. The presence of Christ in the context of suffering and illness gives the fundamental basis for healing. He restores the order of nature, which excludes suffering and sickness. God brings order to the afflicted world. In addition, in the action of Jesus Christ, we can also perceive the return of dignity to the human being. Jesus Christ restores the original place for humanity. Based on the observation of those afflicted with depression, we can definitely state that depression damages their sense of dignity in what it means to be human. Depression puts the afflicted one into a vulnerable condition, which might be the most intense limitation of human life. The afflicted one, within the stages of depression, is being robbed of his/her dignity. Depression alienates the individual from the rest of the community where the dignity and "true self' is being actualized. What is more painful, depression, as an illness, alienates the particular person from his/her family. It destroys the family unity that has been built during so many years. Depression destroys faith in God and attacks the integral part of the human being: free will. Another condition that creates isolation is deep anxiety, which also affects the ability of being one's true self. The presence of anxiety in the context of depression presupposes strong uncertainty of the present and the conditional future. The other indication of the recovery of the afflicted one with depression is the idea of belonging to a larger community-Church. Jesus Christ restores in those who are sick the sense of belonging to a particular family and community. In the context of illness, depression isolates people and removes the sense of unity with the one afflicted with depression. In the healing action of Jesus Christ, there is a sense of solidarity with those who are suffering. In the ministry of Jesus Christ, there is also a deep sense of compassion for the afflicted ones. Consequently, the presence of a priest at the side of the ailing one brings the sense of solidarity, compassion, dedication, and concern for the one who deals with the illness. Depression creates the potential for a disruption in the experiences of life. It causes disruption not only for the afflicted one but also for those who surround him or her. In this case, depression extends its effects to others. It also affects the spiritual father of the Church who is involved in the process of recovery. 

From the very beginning, we have to emphasize that the role of a spiritual father is functional and relational. The spiritual father authenticates his role and call only within a relational and functional context. He relates to the one who is afflicted with depression. He possesses the gift of discernment (diakrisis) and establishment in God in order to reveal the true state of our life. In accordance with the ministry of Jesus Christ, a spiritual father is present in the life of the members of the Church. He relates the message of Christ to the one who is fighting with depression. The authentic message of the Orthodox Church affirms, with the presence of a spiritual father, the presence of hope and recovery. God is hope and hope is that which many afflicted want most. The presence of a spiritual father at the time of illness of an individual strongly affirms the value of life of each individual human being. Each individual is an unrepeatable crown of God's creation where value counts with the love of God. For a spiritual father the member of the Church is not a number or a statistic but a real presence of God in the world. He sees each member of the church as a "walking icon" that needs to be sanctified. He will emphasize a strong compassion for the ailing one and the assurance of the presence of God. Together with compassion he takes upon his shoulder the weight and burdens of the afflicted one. He suffers with his spiritual child.  There might be some cases in which the presence of a spiritual father is the only evidence of his function. He might say no words and still this does not diminish in any way the effectiveness of God's action. It might be that the silence of a spiritual father is the best and the only answer for the agony of the sick one. The silence of a spiritual father, as an indication of a stillness, is not simply the absence of talk, of noise, of sound, but it is the presence of the attention of the listener. In another perspective, stillness is not the enemy of action. Stillness indicates the means of ensuring all the actions are suffused with an awareness of the presence of God. In stillness we drawback into silence to became aware of God's presence at the centre-point, where we are attentively waiting and listening. The words have the power to heal and the power to destroy any credibility of the source. The credibility of the spiritual father does not come with the multiplication of explanations and definition but it comes with the life in God. It might be better for a spiritual father to reflect in prayer or intelligent silence on the condition of the afflicted one in a meaningful divine silence that penetrates all the pain and suffering of the situation: "Intelligent silence is the mother of prayer, freedom from bondage, custodian of zeal, a guard on our thoughts, a watch on our enemies, a prison of mourning, a friend of tears, a sure recollection of death, a painter of punishment, a concern with judgment, servant of anguish, foe of license, a companion of stillness, the opponent of dogmatism, a growth of knowledge, a hand to shape contemplation, hidden progress, the secret journey upward. For the man who recognizes his sins has taken control of his tongue, while the chatterer has yet to discover himself as he should". According to contemporary Orthodox thought, a spiritual father guides and heals others not primarily by words of advice, but by his living example and relationship. He advises and helps the others by his very presence. From the other perspective, a silent state of a spiritual father might be the most profound answer of God for the particular case and situation. The interior silence of a spiritual father allows the afflicted one to be himself/herself with him. We may add that silence might be in itself a disclosure of God's presence. We should not overestimate and oversimplify the meaning of silence in the life of those who are fighting with the multiplicity of questions and personal agony. 

The second element, so characteristic of the spiritual father, is the attentive and patient manner of listening. An experienced and dedicated spiritual father knows when and how to listen. He is constantly active and vigilantly listening in order to live the pain of those who suffer. Listening is one of the most important elements in the recognition of depression. An individual coping with depression needs a compassionate listener, and this becomes the spiritual father's domain. An attentive and patient manner of listening opens the door for the element of dialogue, which may be the beginning of a process to recovery. An opened dialogue with the afflicted one creates within him/her a need to think and discuss. It also stimulates the mind to express and verbalize the thoughts and feelings. We have to learn how to deepen the understanding of the discipline of listening which is fundamental in dealing with depression. In this process, the spiritual child reveals to the spiritual father his/her thoughts essential for the recovery. One of the elements of the Sacrament of Confession of the Orthodox Church is the need to verbalize the affliction of the spiritual life. This is the most fundamental principle of the spiritual life of an individual. The verbalization of the inner self needs the presence of a community- Church which is real in the presence of a spiritual father. It is a spiritual father who enables the individual to be present in the context of the Church. 

Attentive listening is preconditioned by another very important aspect in the relationship between a spiritual father and the afflicted one. Between them there must be an absolute trust. The centrality of trust is fundamental in the life of Christianity in general. We cannot talk about any kind of relationship or process of recovery of the true self if trust is not present. This is the main reason why the idea of trust is built on a long and honest relationship between a spiritual father and his spiritual children. In addition, trust is essential in the process of recovery of the self of a person. 

The third idea, which must be emphasized by the spiritual father in the context of depression, is the aspect of one's dignity. Any person coping with depression is confronted with the loss of personal dignity. Because there may be a tendency of uncontrolled alienation from society and even family, there may also be an uncontrolled loss of personal value and dignity. It is essential that the spiritual father not allow the afflicted person to be left to himself/herself to the point where the person disappears. According to Emilianos Timiadis, a self-centred person left to himself/herself is a living buried “someone” who is unable to communicate with the world.  Unbearable loneliness leads eventually to suicide. The feelings of helplessness, humiliation and self-accusation augment the feeling of depravation of honour and dignity. According to Eric Erickson, the person deals at this moment with complete "despair". Under those circumstances, the spiritual father has to raise the self-value of the individual and lift the whole person as one body, mind, and soul in order to help him become whole and integrated. He will emphasize that life has been given to him by God and there is no time where there is no meaning in life. There would be then more emphasis on the positive aspects of life and the achievements of the past. In the process of recovery, there must be an increase of worth-esteem. The spiritual father will emphasize the potential of the individual based on the experiences of the past. The past must be authenticated in the present in order to rebuild the true self and the potential of a future. The emphasis on the positives in the life of the individual by the spiritual father will not only authenticate the past in the present, but also allow him to direct the afflicted one towards recovery. In addition, to strengthen trust the spiritual father will share his personal life experience. In this situation the relationship is reciprocal and never ends. A fundamental principle is placed on the aspect of love and goodness in God. The positive approach of the spiritual father to the individual directs the human being towards God where he never feels lonely, isolated, or deprived of dignity. The spiritual father becomes a mediator that reconciles men to God. With time, the spiritual father will know the potential in each individual given by God. The potential is always there, although it might be darkened by the aspect of depression. 

The entire process, from the very beginning, is surrounded by the aspect of prayer which the spiritual father will know when to introduce. At the very beginning, the individual may not be ready for prayer. The symptoms of depression, described at the very beginning, might be so overwhelming to the point of anger toward God. The main function of prayer, in the context of depression, is to help us become who we really are, to gain what we really have, and to meet the One who dwells in our innermost self. In reality, it is a form of hesychia that allows the individual to "return into oneself ”. As a corporate activity, a prayer embraces and transcends each member of the Church into a great family where we learn to discern ourselves. It is a process to rediscovering the inner self of man which is, according to Novalis, the greatest and most profound secret of creation. It is a lengthy process which requires much prayer, patience and developed trust. The spiritual father will also learn to understand his limitations in the process of recovery due to the issues of chemical imbalances or other medical reasons. He will not resolve the problems, but rather his function is directed to create a proper relationship with oneself and God in order that it becomes the basis for healing to takes place. In other words, he will assist the individual to see the truth within himself/herself and enable him/her to discover his/her own being in order to grow and to become who he/she really was. He will never speculate or play the role of a medical professional when the life of an individual is at risk. Spiritual fatherhood is not a scientific profession, but a calling that is grounded in humility, charity, openness, and self-giving. He will understand that in the process of recovery, there is a symphonic balance between the physical side of the individual in the context of medicine and the spiritual dimension of human life. The preserved balance between the spiritual and the physical allows the person dealing with depression to see the depression in another dimension, where there is hope in life and God. 

In conclusion, we have to emphasize the importance of other elements and disciplines of life in the process of recovery from depression. We cannot forget the history of the depression in the individual as well as the social and psychological aspects of life. Those elements mentioned before are integral for complete recovery. The elements of one's social life, marital problems, financial or career dilemmas, and others are constitutive of the recovery as much as they were at first the source of depression. This indicates that dealing with depression includes dealing with a wide spectrum of problems with which the person was dealing on a daily basis. To ignore one or other problems creates a potential risk of recurrence in the future. Finally, our emphasis should be on God, the foundation and source of our existence. God knows and helps those who want to be helped. God is our Father whom we call for assistance in times of struggle. The element of faith in the recovery from depression and represented by the spiritual father seems to be integral and constitutive of healing. The symphonic combination of spiritual and physical spheres of human life might be the integral basis for contemporary understanding and dealing with the illness of depression. Let me conclude my presentation with the most beautiful expression of our faith in God. There are no wiser and no truer words in the world than the words of Blessed Augustine: "Unquiet is our heart until it rests in Thee".