Travels With George: Depression Takes a Backseat

A year ago, I started to volunteer at a Church on the East Side of Buffalo, the poorest and most segregated section of town rife with a high crime rate, violence, drug trafficking, and prostitution. And right in the middle of it all is St. Luke’s Mission of Mercy.

St. Luke’s was an abandoned Catholic Church twenty-five years ago that had become empty and useless after the Polish immigrants who built it in 1930 left for the suburbs.  Into this void cam Amy Betros, a big woman, with an even bigger smile and hug, who owned a restaurant where college students hung out.  Amy decided, moved by something deep inside her, to chuck it all and do something for the poorest of the poor.

So, she sold her restaurant and together with a guy named Norm Paolini, bought the broken-down church. It quickly became a place where people could go to sleep on the church’s floor to get out of the elements and get some hot food.  But just as important, that got some food for their souls. They got big servings of hope and seconds if they wished.

St. Luke’s has since grown into a huge community with an elementary school, a food and clothing shelter, and one of two “code blue” places where desperate street people can go to find warmth and a cot to sleep in the transformed for the emergency school cafeteria.

Depression and Suicide: A Catholic Perspective

As a psychiatrist, I had been aware, prior to his death, that Robin Williams struggled with a severe mood disorder – major depression and bipolar disorder, depending on the source of the reporting – along with related problems and drug dependence.

The vast majority of suicides are associated with some form of clinical depression, which in its more serious forms can be a sort of madness that drives people to despair – leading to a profound and painful sense of hopelessness and even delusional thinking about oneself, the world and the future.

I knew all of this, and yet this death still shocked and surprised me, as it shocked and surprised so many others. Williams seemed to be the consummate humorist, the funny man who would be just so much fun to be around. Unlike some comedians who trade only on irony and cutting humor, Williams appeared to us as a warm, big-hearted, endlessly fun, brilliantly quick, incredibly talented man. Though he was a celebrity, he was the kind of person that people felt like they knew – like the cousin, everyone just adores and hopes will show up at the family reunion.  Williams was the kind of guy that people wanted to be friends with, the kind of person that one wanted to invite to the party.

This is not the typical stereotype of mental illness, which why the typical stereotype must be relinquished: Quite simply, it is false.

Mental illness can afflict anyone, of any temperament and personality. In the wake of his death, the strange truth gradually began to sink in: In spite of outward appearances, Williams’ mind was afflicted by a devastating disorder that proved every bit as deadly as a heart attack or cancer. He suffered in ways that are difficult for most people to imagine.

Why couldn’t Williams see himself as other saw him – as a person of immense gifts and talents, a man who stood at the pinnacle of achievement in the world of comedy and entertainment?

Why couldn’t he see himself as God saw him – as a beloved child, a human soul of immense worth, a person for whom Christ died?

This is the tragedy of depression, which is so often misunderstood by those who have not suffered its effects.

Novelist William Styron – whose memoir Darkness Visible represents one of the best first-person attempts to describe the experience of depression – complains that the very word “depression” is a pale and inadequate term for such a terrible affliction.  It is a pedestrian noun that typically represents a dip in the road or an economic downtown. Styron prefers the older term “melancholia,” which conjures images of a thick, black fog that descends on the mind and saps the body of all vitality.

Indeed, the title of his book – Darkness Visible – comes from John Milton’s description of hell in Paradise Lost. We’re not talking about hitting a rough patch in life or the everyday blues that we all experience from time to time. We are talking about a serious, potentially fatal, disorder of mind and brain.

Fortunately, in most cases, depression is amenable to treatment. Because the illness is complex – involving biological, psychological, social, relational and, in some cases, behavioral and spiritual factors – the treatment likewise can be complex. Medications may have a very important role, but so do psychotherapy, behavioral approaches, social support and spiritual direction.

In some cases, hospitalization may be necessary, especially when an afflicted individual is in the throes of suicidal thinking or when one’s functioning is so impaired from the illness that he or she has difficulty getting out of bed or engaging in daily activities. For the severely depressed, even brushing one’s teeth can seem like an almost impossibly difficult chore.

This level of impairment is often puzzling to outsiders – to the spouse or parent who is trying to help the loved one. Unlike cancer or a broken bone, the illness here is hidden from sight. But the functional impairments can be every bit as severe.

I recall one patient, a married Catholic woman with several children and grandchildren, who had suffered from both life-threatening breast cancer and from severe depression. She once told me that, if given the choice, she would choose cancer over the depression, since the depression caused her far more intense suffering. Though she had been cured of cancer, she tragically died by suicide a few years after she stopped seeing me for treatment.

Depression is neither laziness nor weakness of will, nor a manifestation of a character defect. It needs to be distinguished from spiritual states, such as what St. Ignatius described as spiritual desolation and what St. John of the Cross called the dark night of the soul.

Tragically, even with good efforts aimed at treatment, some cases of depression still lead to suicide – leaving devastated family members who struggle with loss, guilt, and confusion.

The Church teaches that suicide is a sin against love of God, love of oneself and love of neighbor.  On the other hand, the Church recognizes that an individual’s moral culpability for the act of suicide can be diminished by mental illness, as described in the Catechism: “Grave psychological disturbances, anguish or grave fear of hardship, suffering or torture can diminish the responsibility of the one committing suicide.”

The Catechism goes on to say: “We should not despair of the eternal salvation of persons who have taken their lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives.”

Robin Williams’ death – like the death of so many others by suicide who have suffered from severe mental illness – issued from an unsound mind afflicted by a devastating disorder. Depression affects not just a person’s moods and emotions; it also constricts a person’s thinking – often to the point where the person feels entirely trapped and cannot see any way out of his mental suffering. Depression can destroy a person’s capacity to reason clearly; it can severely impair his sound judgment, such that a person suffering in this way is liable to do things, which, when not depressed, he would never consider. Our Lord’s ministry was a ministry of healing, in imitation of Christ, we are called to be healers as well. Those who suffer from mental-health problems should not bear this cross alone. As Christians, we need to encounter them, to understand them and to bear their burdens with them.

We should begin with the premise that science and religion, reason and faith are in harmony. Our task is to integrate insights from all these sources – medicine, psychology, the Bible, and theology – in order to understand mental illness and to help others to recover from it. In cases where recovery proves difficult or impossible, we pray for the departed and never abandon those who still struggle.

Aaron Kheriaty, M.D., is associate professor of psychiatry and human behavior at the University of California-Irvine School of Medicine. He is the co-author with Msgr. John Cihak of The Catholic Guide to Depression.

Christianity Can’t Replace My Zoloft

From Time Magazine, Brandan Robertson writes, “The fact that my depression and anxiety didn’t go away when Jesus “came into my heart” and the reality that I had to be medicated to live a normal life made me feel like a second-class Christian.”  Read the Article

Spirituality and Depression: A Talk with Dr. Hamdy El-Rayes

I had the opportunity to interview Dr. Hamdy El-Rayes about his new book, Mental Wellness: A Spiritual Journey. In his book, he explores the connection between spirituality and depression and how the lack of spirituality can be a cause of depression.  Dr. Hamdy grew up in Egypt in the Muslim faith and experienced depression as a young man.  He found a spiritual healer in the Sufi Muslim tradition who helped him recover, but found that his depression returned when he came to North America. 

Dan:          Can you tell us about your background?

Hamdy:     I have a MBA and Ph.D. in Electrical Engineering and currently live in British Columbia in Canada. I also teach at the British Columbia Institute of Technology and work in upper management there.  I became interested in the subject of depression because I have suffered from depression and anxiety.  I found that there was no help out there that could help me heal with spirituality and that’s when I decided to take my own future in my hands and decided to use my skills and research background to find a way out.   That is what led me into this work.  That is what led me to write a book, Mental Wellness: A Spiritual Journey, on depression and found the H.R. Mental Wellness Center here.

Dan:           How old were you when you first experienced depression?

Hamdy:     It started at a very young age. My first time was when I was 14 years old.  I then recovered and managed to find my own way through a spiritual teacher and I kind of brought spirituality into my life. I didn’t struggle with any depression again until I came here to Canada.  I found that the North American lifestyle takes you away from yourself and you lose your sense in the process of living a life here. That’s what happened to me.

Dan:           Can you elaborate on that?  What is it about our culture that creates and sustains depression?

Hamdy:      We live in a very fast-paced culture.  We are driven from the time we wake up until the time we go to bed.  We don’t have time to interact with ourselves.  We don’t have time to reflect on our life with all the technology around us to keep us moving at a fast pace – cell phones, computers, IPAD’s and you-name-it devices. Today we are distant from a sense of spirituality in our lives.  This drift really began about a century ago with the theories of Sigmund Freud.  He had an enormous influence on the university culture in Europe, the United States and the educated people of his time.  His influence and those of his protégés continue to this day. He considered religion, the more formal and institutional practice of religion, as a kind of mental disorder.

Dan:            That is a very interesting.  I think when we talk about depression in contemporary culture in the west, we often talk about treating depression with medication and psychotherapy because that is what the psychiatric and psychological establishment tells us to do.  But there is not much discussion about spirituality and how spirituality can help somebody recover from depression, let alone suggest that its absence in our lives can be a cause of depression.   

Hamdy:      Yes, it became like a taboo.  For most of the psychiatrists in the U.S., spirituality is not thought of as a solution to depression because it is not based on science and biology about how the brain work

Dan:          I agree that many in the west think of depression solely as a medical issue, as a disease, and when people think of it as a disease, they say, “ Well it’s like heart disease or diabetes.”  If it is just a medical disease, people probably don’t think that spirituality, and the lack of it, has to do with their depression.  You have a new book out, Mental Wellness: A Spiritual Journey.  In it, you say that spirituality has a lot to do with depression and healing from it.

Hamdy:     It is not really my personal opinion.  It is based on work done in past 20-25 years where doctors started recognizing that there is a powerful relationship between health and religion.   There are about 95 articles and research reports about the impact of spirituality on various physical and mental illnesses.  As we know, spirituality helps people with addiction, healing from various physical illnesses like diabetes, arthritis, heart problems.  It even helps cope with cancer. 

Dan:           Can you talk more about how a lack of spirituality contributes to depression?

Hamdy:      In developing our character, there are some qualities we develop when we bring spirituality into our lives.  This character development changes our way of thinking and when you change your way of thinking you change your perception of the world.  How we perceive the world plays an important role in depression.

Dan:          Can you give us an example of one character quality that you are talking about in terms of development in your spiritual tradition and it may relate to depression?

Hamdy:     Well I’ll give you something very close to us all: love. The capacity to love is something we can develop in ourselves and grow by practicing our spirituality.  One of the main things people struggle with is the lack of love in their life.  So often, they didn’t learn how to love themselves. And if you don’t know how to love yourself, it is tough to know how to love other people.  Most of the people who suffer from depression have something from their childhood that set the stage for depression in adult life, whether they were abused or didn’t learn to love themselves or others at home.

Dan:          Was that the case for you?

Hamdy:     I wasn’t very healthy as a child.  I was given the leeway of doing things that maybe other kids in the family were not allowed to in my culture.  I was given a little bit of freedom to be me and that may be the best thing that I got from my family although it was for a reason.

Dan:          What country were you born in Hamdy?

Hamdy:     Egypt. 

Dan:           When you spoke earlier about spirituality and your childhood spirituality, were you raised in the Muslim faith?

Hamdy:     Yes.  I was raised as a Muslim in a conservative family where religion was very important.  I was kind of rebel and was given the freedom not to go to the Mosque because I really didn’t like it.  I didn’t like it because I found that many people who went to Mosque were not as my mother told me:  all good people, very kind, very caring and all those things. I didn’t see it in the people who went there.  So I said no, I don’t want to be there.  So I was allowed not to go.   Although my father, I remember, he was kind of ashamed.  He was embarrassed that his son was the only kid that didn’t go to the Mosque.   Everyone else went to the Friday prayers.  My friends would meet in the morning before prayers and then go to the Mosque.   I was the only kid who went home.    My father got to the point where he would say “Hamdy, I will give you something.  I will give you money every time you go to Mosque”.   The sum of money he offered would be like the equivalent of $50.00 today.   To a child, $50.00 is a huge amount of money!   I told him no, I don’t want money.  That’s why I got depressed and started talking to this spiritual teacher. He was a wonderful man. 

Dan:          Was he a Muslim as well?

Hamdy:     Yes, he was a Sufi.   He was a very spiritual man and every discussion you had with him was very deep.

Dan:          How is a Sufi Muslim different than just a regular Muslim?  What is it about Sufism that’s different? 

Hamdy:     Sufism is the mystical part of the Muslim religion.  A Sufi is a person who is focused on the depths of developing themselves.   They don’t attach to the rituals as much as in being.   Religions are wonderful.  I have studied Judaism and Christianity and you know they have the same foundations. When it comes to practice, we most of us tend to focus on the rituals and forget where the rituals where supposed to lead us, how they were supposed to transform us in our daily life experiences.

Dan:        I am a very liberal Catholic, a religion that has many rituals.  We can also get caught up in the rituals to such an extent that we go through the motions with rituals and neglect the practice of our spirituality.  It doesn’t transform us in some positive way.  I read a book by Brother David Steindl-Rast who wrote that there is the belief in God and the trust in God.  There are many beliefs, but only one trust in God.  Belief comes from the mind and trust from the heart.  In my tradition, I trust in Jesus as a “Person”.  I have a personal relationship with Him and I try to practice and nurture that every day.  In doing so, I feel more aligned with my true self.

Hamdy:     In my book, the most important part of spirituality is to come to know yourself and develop your character.  Developing your spiritual skills becomes easy as you practice and becomes like second nature to you.  Rituals when not combined with true spirituality will not help us to know ourselves.

Dan:           Can you tell me, why did you write this book?

Hamdy:     I wrote it because  I had developed  this program for myself to help me heal and I had outstanding results, I couldn’t even dream of getting the results I got.  So I decided to offer this to people on my own.  I set up a charity and I started offering this program to people in the community.

Dan:           For those of our readers who are interested in your book and would like to know basically what it’s about, can you give us just a brief synopsis or an idea of what kind of things your book addresses?

Hamdy:     I start with really trying to kind of correct the erroneous conclusions about life that we formed in childhood and carried into our adult lives. The past we are moving in today leads to depression and anxiety and other mental illnesses.    That is the essence of the book.  So we start with learning how to manage stress to get us to a place where we can function well in our daily lives.  That is the most important step.  Then I talk about, in the introduction, how the American community has distanced us from spirituality which is an integral part of our human experience. Our life is incomplete without incorporating spirituality in our life.

Dan:           And I think that sense of spirituality, I think one of the key elements of it, at least in my own experience, is a sense of community and a sense of belonging.  A lot of people find that experience absent in modern society.  Do you feel that way too?

Hamdy:      Absolutely, it is part of the process because if you look into how we develop ourselves, when we develop our spiritual skills, in every skill, it has as a part of it community and how we relate to our community.  So that is an important thing. 

Dan:           When there is an absence of that relationship to community, I guess we could think of it as a form of stress; we don’t feel the support, we don’t feel the positive energy of other people and we are kind of left alone to battle in the world.  We become estranged from humanity and alienated.

Hamdy:     You know we are social beings and if we don’t have the community that we are a part of, we are lacking something and that can be a kind of contributing factor to our depression.

Dan:            Did you find that in your own experiences of depression that you had difficulty managing stress?

Hamdy:      Yes. You know, the problem with stress is that there are smaller stresses along the way and stress is cumulative. So we have small stresses and we don’t manage this stress which is cumulative and affects us in a very significant way whether physically or mentally without us noticing because we kind of become numb to the impact of stress and we don’t see its cumulative effect, unfortunately, until we are burned out or we are suffering from a major mental or physical illness.

Dan:          In your book, do you have some recommendations for how we should approach healing from depression.  Can you share with our readers’ one or two?

Hamdy:     Number one is learning how to manage your daily life, how to relax with meditation and living mindfully.   It not just to practice meditation, it is to bring it into your life in every activity you do in your life right now.  Living mindfully is a very important thing and if you live mindfully, you are not distracted with things that happened in the past or concerns about things that may happen in the future.

Dan:          I agree with you and I think meditation is important.  I guess it might be fair to say, the opposite of mindfulness is mindlessness which I guess, while we are in depression, it is kind of a mindless state where we are confused, disorientated, disconnected.  Was that your experience?

Hamdy:     Absolutely, and in the process, we get more distant from ourselves.  We are really unaware of how we feel physically or emotionally until we get a wake-up call that is depression or having a mental or physical illness. 

Dan:       The culture really contributes to that. You said earliest we are driven from the moment we get up and we override our symptoms or signs that we are in trouble; maybe we are suffering from depression or heart disease or other problems.

Hamdy:     One other thing is when you start practicing your spiritual skills, you kind of are more oriented to become yourself.   One of the main reasons for our depression is conditioning from our families and fast-paced culture that allows us to become distant from our essential  self.     It is important for us to recover this true self.  In recovering our true self, you live in harmony with the world around you; you are not in conflict anymore.

Dan:           Yes, that makes a lot of sense to me.  Thanks for your time Hamdy. It was a great talking to you.

Lying in the Hands of God

Growing up in a Polish-Catholic home, I was more of a cultural catholic than a church going sort. But, my alcoholic father would make us go with him sometimes. I think it gave him a sense of normalacy; a feeling that he could be with other people without throwing down shots of Jack Daniels at a local watering hole. Only later did I develop any real sense of  my own spiritual search. I’m still on that journey.

All religions have a lot to say on the topic of suffering, but not so much on the topic of depression. I guess you could say that depression is a “form” of suffering. Personally, I think that doesn’t cut it. When someone says to me, “Well, everyone suffers,” I walk away misunderstood and feeling the worse for the encounter. Maybe there’s not much dialogue about depression in our churches because of the raw fear that faith can’t fix everything.

When I first became sick, I didn’t know I had “depression”. I just thought I was having one of life’s many existential emergencies. I would kneel and pray that God would take away my pain. But, it simply didn’t happen that way. Sometimes, I would give God an ultimatum: “You either take away this damn pain, or I’m turning my back on you fella”. I demanded “a” solution, an answer. One wasn’t forthcoming.

As time went on, something happened. I stopped trying to dictate so many of the terms of my recovery from depression. Instead, I just  began to surrender myself. I began to see that God was bigger than my depression. It didn’t mean that I wouldn’t suffer now or in the future from it. But a light appeared through cracks in depression’s armor. There’s a sense of joyous relief that comes when we stop the war against depression. We lay down our burden.

In the new album by The Dave Matthews Band, Big Whiskey and the GrooGrux King, there’s a beautiful song (listen now), called Lying in the Hands of God. In one part, Dave sings:  “If you feel the angels in your head. Tears drop of Joy runs down your face. You will rise.”

At my best, when I feel “the angels in my head”, I weep with joy knowing that depression doesn’t have the final say in my life. Yes, there will be times when I suffer from it. But, it doesn’t last.

In her article written for my website, Sister Kathryn James Hermes (who suffers from depression), author of the book, A Contemplative Approach to Depression, wrote that prayer leads us to “. . . vulnerability – the learned powerlessness of the truly powerful who can simply be: simply wait, simply be present, simply wonder, simply trust that much larger hands are holding us and knows for whom we work in view of a much larger plan that we cannot as yet understand”.

Tune out the drumbeat of depression for a bit today. We don’t have to understand or control it all. Try lying in the hands of God awhile. And rise.

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