Americans are decidedly ambivalent about depression. As a credit to the mental health field, organizations such as The Committee for the Prevention and Treatment of Depression, National Foundation of Depressive Illness, Depression and Bipolar Support Alliance, or the DART program have worked hard to destigmatize the illness. We are a country with strong roots in Calvinism, and hence the tradition of hard work and stiff upper lip. We also have inherited the puritanical views which has linked mental suffering with moral and spiritual trials. In 1972, Gerald Klerman wrote a famous piece in the Hastings Center Report (“Psychotropic Hedonism vs. Pharmacological Calvinism”) in which he argued that those who criticized drug therapy for depression held “basically a secular variant of the theological view of salvation through good works” (1972, 3).
The history of depression--medical, moral, philosophical and theological treatises describing and offering treatments for depression--is full of examples of construing depression as essentially a moral struggle.
I don't think that it is wholly wrongheaded to perceive a moral dimension to depression. But, what I mean by "moral dimension" is the opportunity that depression offers patients to do some soul searching. Upon recovery from a dark moment, we may come to have a deeper capacity for empathy with others, or a immeasurable gratitude for the loved ones who see us through our struggles. I also think that depressive episodes give us an opportunity to rethink the structure of our lives: our priorities, the pressures that threaten to cave in on us, and the cultural/social/interpersonal triggers of depressive episodes. I think many women who suffer from depression might come to reevaluate the culture that surrounds them, and how it often reinforces in us feelings of inadequacy, shame and low self-esteem.
I do not think, therefore, that depression is a spiritual struggle if you mean a test from our maker. I do think its a spiritual struggle, if by that you mean an opportunity for self-transformation. I think that turning to moralizing treatises that upbraid us for our narcissism, moral lapses, or essentially weak nature are not at all helpful in the treatment of depression. If you study the treatises on depression from the middle ages, you will find countless examples of this sort of understanding of depression. Many a theological tract was written on "tristitia" or "acedia" (the latter a sin). Depression in this context was also referred to as the Noon-Day Demon who tempted many away from living a humble and moral existence.
There is one excellent exception to this tradition, written by the Hildegard of Bingen (1098-1179). Hildegard viewed melancholia (excess black bile), which was the ancient diagnostic term for depression, more as an illness than a moral struggle. She also was--to my mind--the only one who wrote about how melancholic men affect their wives and families.
Here is an excerpt of what Hildegard wrote about melancholic men:
"There are men whose brain is fat. Their scalp and blood vessels are entangled. They have pale facial color. Even their eyes have something fiery and snake-like about them. These men have hard, strong veins that conduct dark, thick blood; large, firm flesh; and, large bones that contain but little marrow. However, this burns so strongly that their behavior with women is improper and undisciplined as animals and snakes. The wind in their loins comes out in three forms: fiery, windy, and mixed with the smoke of bile. For that reason they really love no one; rather they are embittered, suspicious, resentful, dissolute in their passion, and as unregulated in their interaction with women as a donkey."
Whenever I read this passage it conjurs up images in my mind of disaffected, brooding rock n'roll guys--what my friend yehudster calls "poet dude." Poet dude is always eliciting female sympathies in high school and college. He plays guitar, wears torn up t-shirts and jeans, has disheveled hair and seems really, really sensitive. But, the closer you get to "poet dude" the more you see his improper snakelike behavior.
What is revolutionary about this treatise from the Middle Ages is that it is unique in its indictment of men's melancholic-sexual-moral depravity toward women. Consider this passage:
"The storm of desire that invades the two receptacles of these men comes as unmastered and suddenly as the wind that shakes the entire house mightily, and it lifts the stem up so powerfully that the stem, that should stand in full blossom [don't you love these euphemisms], curves in the disgusting manner of a viper passes on its malignity to its off-spring. The influence of the devil rages so powerfully in the passion of these men that they would kill the woman with whom they are having sexual relations if they could. For there is nothing of love or affection in them."
Hildegard, then, emphasizes the social damage of these melancholic men, and danger they pose to the women come to near to them. Again, this is pretty revolutionary stuff from a German, medieval nun. But, what is even more amazing, is what she writes about melancholic women:
"These women are heedless and dissolute in their thoughts and of evil disposition if they are grieved by any irritation."
Don't agitate a depressed woman!
"During the monthly menses they lose much blood, and they are infertile because they have a weak, fragile womb. For that reason, they can neither receive, retain, nor warm the male seed. For that reason they are more healthy, more powerful, and happier without a mate than with one because they become sick from relations with a husband. However, men avoid them because they do not speak in a friendly manner to men and because men love them only a little."
Hildegard's prescription for depressed women: don't marry.