Depression/Suicide
At the time of the writing of the Gospel of Mark, sometime in the 50’s A.D., the world was seen by most people as dark, brutal, and violent. The Roman Empire reigned supreme. Caesar was worshiped as a god. Any disapproval was crushed.
To most people at that time demonic forces had the upper hand. Satan was seen by many to rule the world.
In the midst of all this negativity and pessimism, a book called a “gospel” was written – a book that was a stark contrast to the mood of the times, a book that had the audacity to announce “good news.” It was the announcement of a new beginning, a new breakthrough – the “good news” of liberation. This good news was personified in an individual named Jesus of Nazareth.
The writer, Mark, announced as boldly as he could that certainly Satan was powerful, but this man Jesus was even more powerful; certainly the world was filled with demonic forces, but Jesus triumphed over them; certainly a darkness covered the world at that time, but Jesus brought the possibility of a new way of living, a new way of seeing, a new way of being – a light that would penetrate the gloom that enveloped the earth.
Satan was powerful. But Jesus was the more Powerful One.
As Mark proclaimed it, the good news was that Caesar is not the Lord of the universe; Jesus is. Caesar is not the all-powerful one; Jesus is. Caesar is not the Prince of Peace, or the Mighty God; Jesus is.
How does Mark show this? From the very beginning of his gospel, he demonstrates Jesus’ supreme power by the “mighty deeds” he performs. We usually refer to them as “miracles” – demonstrations of power that exceed normal possibilities. These miracles were so astounding that the people at that time who witnessed them proclaimed: “What is this? He commands even the unclean spirits and they obey him.” (Mk. 1, 27).
A leper is healed. Those who are “ill or possessed by demons” are healed. A paralytic is healed. A man with a withered hand, a woman with a hemorrhage, a “little child” who was deemed dead are all healed and given a whole new experience of life.
But not only does Jesus have power over the sick and the possessed, but also over nature itself.
When he is in a boat with some of his followers, “a violent squall came up and waves were breaking over the boat, so that it was already filling up …. They woke him and said to him, ‘Teacher, do you not care that we are perishing?’ …. (Jesus) rebuked the wind, and said to the sea, ‘Quiet! Be Still.’ The wind ceased and there was a great calm.” The people who witnessed all of this were filled with great awe and said to one another, ‘Who then is this whom even wind and sea obey?’” (Mk. 4, 37-41).
Then one of the most remarkable of all the miracle stories takes place. It’s extraordinary because it does not involve the external healing of a person’s body or the undoing of the laws of nature. It’s exceptional in that it concerns the inner workings of a person’s mind.
It’s the story of what is called ‘the healing of the Gerasene Demoniac,” or what one translation refers to as “The Madman.” The story according to this translation (The Bible In Contemporary Language: The Message) goes as follows:
“They arrived on the other side of the sea in the country of the Gerasenes. As Jesus got out of the boat, a madman from the cemetery came up to him. He lived there among the tombs, and graves. No one could restrain him – he couldn’t be chained, couldn’t be tied down. He had been tied up many times with chains and ropes, but he broke the chains, snapped the ropes. No one was strong enough to tame him. Night and day he roamed through the graves and the hills, screaming out and slashing himself with sharp stones. When he saw Jesus a long way off, he ran and bowed in worship before him – then bellowed in protest, ‘What business do you have, Jesus, Son of the High God, messing with me? I swear to God, don’t give me a hard time!’ Jesus asked him, ‘Tell me your name.’ He replied, ‘My name is Mob. I’m a rioting mob.’ Then he desperately begged Jesus not to banish them from the country.”
We will come back to how this story turns out at a later point.
I begin this discussion of depression and suicide with these stories of the darkness that penetrated life at the time in which the gospels were written, especially that of the demoniac or the “madman,” because together they contain a very accurate description of what millions of people to this day experience inside their brain. They also point out in a very dramatic fashion how intractable this condition we now call depression has always been, and how enormously difficult it has been to treat. In the time of Jesus, for example, it took a miracle.
In our present time, according to the latest data, some 350 million people suffer from clinical depression throughout the world.
Throughout the years, many of those who have struggled with this condition are famous people we know and admire: from Abraham Lincoln to Winston Churchill to Charles Dickens to Truman Capote to Sylvia Plath to Billy Joel to Bob Dylan to John Lennon to Robin Williams to Philip Seymour Hoffman. And on and on it sadly goes.
The list even includes my own mother – who fought it valiantly and courageously in a time when there was little if any real help. Sadly, the psychiatrist who helped her so effectively, fell ill to the disease of depression himself, and committed suicide.
Some of the great saints suffered from this same disease: Therese of Lisieux, the Little Flower, who died at the early age of 24; Mother Theresa who left a diary that told of her many years lived in spiritual desolation, to name just a couple.
One of the great spiritual writers of our time, Henri Nouwen, stated: “I’ve had a tremendous problem with depression in my life. I’d rather not talk about it because it’s over. But I want to assure you, depression is real and it’s vicious.”
But it isn’t just depression that’s real and vicious. Even more so is suicide.
A recent article in USA Today reports that 40,000 suicides take place annually in the USA – a suicide in our country every 13 minutes. Ironically, homicides have fallen by half since 1991, but the US suicide rate keeps climbing. It is now the 10th leading cause of death in our country, and the second leading killer for those aged 15-34. Ninety percent of these suicides result from depression and other mental health issues. “And yet,” the article reports, “Americans simply shrug.”
The care we demonstrate together on behalf of the mentally ill in our country is seriously wanting. Mental health dollars go primarily toward prescription drugs and outpatient treatment. Almost all of the States have moved away from inpatient treatment for the mentally ill. For example, States cut 1.8 billion dollars from their mental health budgets during our recent recession. As a consequence, our sickest patients now end up in jails and homeless shelters and emergency rooms.
But our biggest obstacle to obtaining adequate treatment for the mentally ill is an attitude that is pervasive – an attitude of shame. “People want to solve their mental health problems on their own. They don’t want people to know.”
Two hopeful signs, however, could indicate that some of these entrenched attitudes are changing. In 2008, Congress passed the Mental Health Parity and Addiction Act which bars insurance companies from putting up financial barriers to mental health care. Recently, the Affordable Care Act, aka Obamacare, requires all insurers to include mental health treatment in their benefit packages.
So, what is this thing called depression?
It has been described in many ways:
“Depression is rage spread thin.” George Santayana
“Depression is a reality nourished by a lifetime of unforgiven and un-grieved hurts.” Penelope Sweet
“Depression is the inability to construct a future.” Rollo May
“Here’s the thing about depression: a human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious it’s impossible to ever see the end. The fog it creates is like living in a cage without a key.” Elizabeth Wurtzel
“Depression is anti-life … it’s a silencer of the soul.” John Ratey, M.D.
Clinically, there are three basic types of depression (with various nuances for each):
- Dysthymia (ill-humored): People struggling with this manifestation of depression, also referred to as mild to moderate depression, have an innate tendency to emphasize the negative. They tend to be critical, judgmental, glass-half-empty types who are easily irritated. This type can easily move into major depression.
- Reactive Depression: People suffering from this condition have suffered a significant loss in their lives – death of a loved one; loss of a job; divorce; health issue, etc. With time and help from friends and/or therapy, they usually rebound to their normal state of mind – unless the loss reaches the level of trauma.
- Major or Clinical Depression: People suffering from this level of depression exhibit the following symptoms on a recurrent basis:
- Depressed mood most of the day
- Loss of interest in normal activities and in relationships
- Fatigue or loss of energy almost every day
- Feelings of worthlessness
- Impaired concentration, indecisiveness
- Insomnia or hypersomnia
- Markedly diminished interest or pleasure in almost all activities
- Recurring thoughts of death or suicide
- Significant weight loss or gain
- Significant amount of negative thought patterns
Who’s At Risk?
Major depression affects some 7 percent of the US population over age 18. But, between 20-25 percent of adults may suffer an episode of major depression at some point during their lifetime.
Almost twice as many women as men suffer from major depression. Reasons: hormonal changes, pregnancy, miscarriage, stress at home, work, balancing family with career, and caring for an aging parent. Women are the “ultimate caretakers” in our society. The burden of that often presents itself in the tragedy of depression.
A recent article in the New York Times reports that “depression is the most common health problem women face. Outside of obstetrics, it is the leading cause of hospitalizations among women ages 15-44. It’s estimated that 20-25 percent of women will experience depression during their lifetimes, and about 1 in 7 will experience postpartum depression. For low income women, the rates are twice as high. Further, the World Health Organization ranks depression as the most burdensome of all health conditions affecting women worldwide.”
Depression in men is significantly underreported. Men who suffer from clinical depression are less likely to seek help or even talk about their experience. What happens, then, is all their “stuff” goes subterranean. It shows up often in other shapes and forms: anger, alcohol and drug abuse, pornography, and other addictions. Repressing their feelings can result I violent behavior both inwardly and outwardly, which then can result in an increase in illness, suicide and homicide.
In terms of people below age 18, experts used to believe that only adults could experience full-blown depression. We now know that at least 2 out of every 100 young children and 8 out of 100 teens experience serious depression.
What Causes Depression?
To be perfectly frank, we don’t know for certain. Some of it may have to do with genetics. Some of it may have to do with family of origin issues. Some of it may have to do with domestic abuse issues, school bullying, sexual abuse, traumas of one kind or another, abuse of alcohol and other mood altering chemicals … and the list could go on and on.
What we do know for certain are two things: 1. Depression is real and vicious; 2. Depression ultimately has to do with a malfunction of the brain.
“All of us are a little bit crazy,” as one psychiatrist put it. We all have brain glitches of one kind or another. But most of our flaws are within the Bell Curve of Normalcy. The issue is the degree to which our brain is malfunctioning.
To answer the question of “what causes depression” as accurately as possible, we have do a quick review of the development of brain science. So much of the treatment of major or clinical depression is dependent on the revolution that has taken place in our lifetime in terms of the understanding of the brain and the application of what we have learned to make it possible to bring relief to countless people – and with even greater promise for the future.
The February 2015 issue of National Geographic Magazine contains a lead article entitled “The New Science of the Brain.” This commentary gives an update on the new technologies that are shedding light on what the author refers to as “biology’s greatest unsolved mystery: how the brain really works.”
Historically, at the time in which Jesus lived on earth, people in general had no idea what the brain was made of or how it operated. The heart was the major emphasis for people in that time. All feelings, thoughts, drives, urges were believed to originate in the heart which pumped blood, the lifeline of all creatures, throughout the body. In the Bible, for example, there are at least a hundred references to the importance and value of the heart. Not a single reference is made to the brain.
It wasn’t until the 17th century that all that began to change, and scientists realized that the brain was where our mental world existed. But even then all scientists had to determine exactly what function the brain provided was through the examination of the brains of dead people.
Even someone as brilliant as Sigmund Freud in the 19th century said that all he theorized about would prove to be practically irrelevant when scientists were able to see inside a living, fully functioning human brain.
And that’s just what happened in our lifetime!
In the mid-1990’s, a major scientific revolution took place: for the first time ever human beings were able to see inside the brains of other humans while they were living. Alive brains!!
As a consequence of this breakthrough, scientists were able to identify areas of the brain, being to discover which part of the brain was responsible for what activity, map the brain, and, as a consequence, begin developing medications that could hopefully assist human beings who were suffering from a multitude of human disorders. One of the first of the diseases to be treated was depression.
Among the many highly instructive graphs and photos of the brain which this article provides, the author also tells us that the brain contains “100,000 miles of nerve fibers, called white matter, that connects the various components of the mind, giving rise to everything we think, feel, and perceive.” Furthermore, neuroscientists “are starting to identify differences in the structure of ordinary brains and brains of people with disorders such as schizophrenia, autism, and Alzheimer’s disease. As they map the brain in greater detail, they may learn how to diagnose disorders by their effect on anatomy, and perhaps even understand how those disorders arise.”
This article further admits, however, that we still don’t know all that we’d hope to about what causes depression and autism and a host of other mental health issues. As one brain scientist puts it: “We have so far to go before we can affect treatments that I tell people, ‘Don’t even think about that yet. We’re on a voyage of discovery.’”
The good news is that it’s a voyage that will ultimately lead to the identification of the differences in the structure of ordinary brains, and brains of people with disorders like depression.
One neurosurgeon, for example, suggests that “brain implants may become as common as heart implants.”
Along with all of the exciting developments in the world of neuroscience is the continued development in the whole field of genetics. Together these two fields will usher in a whole new way of being able to treat so many disorders that we’re admittedly stumped by now.
How Do We Treat Clinical Depression NOW?
As powerful as biology is in determining our immediate brain responses, biology is not destiny. There is much that can be done now to help people deal with this frightening disease. There are four ways in particular: medication therapy, brain stimulation therapy, psychotherapy, and lifestyle therapy.
- Medication Therapy (anti-depressants): In order to properly understand anti-depressants, allow me to give a brief background on three major neurochemicals that are key to our present view of the brain. The first is serotonin. This neurochemical is a neurotransmitter largely believed to be a mood stabilizer. It is primarily responsible for feelings of well-being and happiness. The second is norepinephrine. It is a stimulant neurochemical responsible for vigilant concentration and cognitive alertness. The third neurochemical is dopamine. This neurochemical plays several important roles in the brain. One of those is that of the pleasure, reward system. Whenever we do something that creates pleasure, the brain shoots out a certain level of dopamine. It also has important implications in terms of motion and movement. Parkinson’s disease, for example, is caused primarily due to the lack of dopamine in the system. The earliest drugs to treat depression were called Tri-Cyclics. Though helpful for some, they were generally considered to have too many negative side effects. Then came the next phase of anti-depressants called the SSRI’s: selective serotonin re-uptake inhibitors (Prozac, Paxil, Zoloft, etc.). These are based on the belief that most depression was due to a lack of the brain chemical serotonin. The medications were designed to increase the serotonin in the brain which would then, at least theoretically, lift a person’s mood. Again, many people found significant relief in these, but too often they produced negative side effects such as weight gain and sexual dysfunctioning, took too long to become fully operative, and the long term efficacy of them began to be questioned. We are now entering into a time period in which a new stage in medication therapy is being developed. The latest drugs used for depression are, at least theoretically, quicker acting, combine a dual mode of acting, such as combining serotonin and norepinephrine. These appear to have a longer term of efficacy. Pindorol is one of these newer drugs.
- Brain Stimulation Therapy: this involves various methods of stimulating the brain in order to activate it.
- Trans-Cranial Magnetic Stimulation: which uses magnets to treat depression.
- Deep Brain Stimulation: which involves placing an electrode in deep brain structures. This has been used for some time to treat seizures and Parkinson’s disease. One person described this form of treatment as being “somewhat akin to rebooting an errant computer.”
- Electro Convulsive Therapy, or ECT: still another form of brain stimulation which currently is used with over 100,000 Americans annually. Much more sophisticated and regulated than the 1975 film One Flew Over the Cuckoo’s Nest use of this technique.
- Psychotherapy: usually employed along with drug therapy, offers five major options, many times used in combination:
- Cognitive Therapy, Behavioral Therapy: all focus on how your own thoughts and behaviors contribute to your depression
- Interpersonal Therapy: focuses on how your relationships with other people play a role in your depression
- Psychodynamic Therapy: focuses on the exploration of behavior patterns and motivations that you may not be aware of and which can contribute to a person feeling depressed.
- Dialectical Behavioral Therapy: helps clients deal with four major life areas, such as: Mindfulness skills; Emotion regulation skills; Distress tolerance skills; Interpersonal effectiveness skills
- Group Therapy and Support Groups
- Lifestyle Therapy: “A lot that passes for depression these days is a body saying that it needs work.” Geoffrey Norman
- Diet: fat, sugar, salt
- Exercise: “Exercise is medicine.” John Ratey, M.D. Exercise boosts dopamine and norepinephrine, wakes up the brain, jump starts the attention system, improves mood, and provides a feeling of satisfaction when we have accomplished something.
- Proper amount of sleep: sleep apnea insomnia, sleep deprivation, and restless leg syndrome are all very disruptive. Web MD claims: “Sleep is the brain’s housekeeper serving to restore and repair the brain …. If sleep is disrupted on a regular basis, then the processes that help restore the brain will be less effective.”
- Yoga
- Prayer/Meditation
- Eucharist/Sacrament of Penance/Spiritual Direction
Allow me now to return to the scene that the gospel of Mark creates – the story of the “madman” who Mark describes as “dwelling among the tombs … bound with shackles and chains … crying out and bruising himself with stones.” He is perhaps a man who would fully understand and sing along soulfully with Paul Simon as he mouths these haunting words:
“Hiding in my room, safe within my womb
I touch no one and no one touches me.
I am a rock,
I am an island.
And a rock feels no pain;
And an island never cries.”
The story of the demoniac, or the madman, fortunately has a very uplifting ending. He comes into contact with the man named Jesus who has just stilled the winds and calmed the seas. And now this same Jesus is about to do the same to the fury and the terror of the storms that rage inside this man’s brain.
And just like the first story where Jesus gets up in the boat and says: “Be still,” here again he does a similar thing. He simply turns to the man, looks directly at him, and speaks to him.
And the man is healed.
Mark’s point is made: Jesus is the Lord of the universe and the Lord of the inner spirit of human beings. He is the Lord of all.
Listen to how Mark puts it: “As he (Jesus) was getting into the boat, the man who had been possessed pleaded to remain with him. But Jesus would not permit him, but told him instead: ‘Go home to your family and announce to them all that the Lord in his mercy has done for you.’ Then the man went off and began to proclaim … what Jesus had done for him; and all were amazed.” (Mk, 5:18-20)
We – you and I – are the family in this story. We are the ones to whom these people who are so tortured and so defeated and so alone because of the disease of depression can come to and be recognized, be touched, be talked to, be held, be comforted, be lead slowly and lovingly into healing.
That’s what the church is all about, as Pope Francis is trying to help us see: we are to be the “field hospital,” the place where our care, our sharing of the great sacraments we believe in, our prayers, our guidance can help these people to find a place of light in the midst of so much inner darkness, a place of joy in the midst of so much sadness, a place of peace in the midst of so much pain.
As Mark did some two thousand years ago, let our lives be a “gospel,” an announcement of “good news of great joy,” to a world so immersed in darkness and despair.
Ted Wolgamot, Psy.D.
11809194.1
7/9/15
