Reflection on Depression

Senseless suffering from childhood mental illness

CNN published a great article on childhood OCD this week.  One reader left a heartbreaking confession in the comment section:

"I had this [OCD] when I was little, too. I'll never understand why an "all-loving" god would put a defenseless child through this inescapable hell. I still deal with OCD to this day, albeit not in physical displays. There's absolutely no excuse for suffering like this.  Just further proof that we're all alone in this Universe."

I thought exactly the same thing when I was 15 -- and I still wonder why a benevolent God would permit this kind of suffering. Children have an innate sense of fairness that condemns undeserved pain. In light of the "inescapable hell" that the commenter (and countless other defenseless children) experienced, his conclusion that we're alone in the universe is intuitive and understandable.

I tried to address the problem of evil in this post and this one, but I don't have an answer.

Tragedy, trauma and the loss of innocence

In Laura Bush's new memoir, Spoken From the Heart, she reveals how a car accident that she was involved in at 17 affected her profoundly. The accident, which killed one of her high school friends, happened after she ran a stop sign while chatting with a friend (although other factors, including the positioning of the stop sign and the poor design of the victim's car, played a role). 

I was moved by her account of the trauma and her confession that the accident shook her faith:  

“The whole time, I was praying that the person in the other car was alive. In my mind, I was calling ‘Please, God. Please, God. Please, God,’ over and over and over again . . . . I lost my faith that November, lost it for many, many years. It was the first time that I had prayed to God for something, begged him for something, not the simple childhood wishing on a star but humbly begging for another human life. And it was as if no one heard. My begging, to my seventeen-year-old mind, had made no difference. The only answer was the sound of Mrs. Douglas’s sobs on the other side of that thin emergency room curtain.”

Although my experience with depression was far less tragic than Mrs. Bush's car accident, it put me in the position of praying for deliverance from suffering too, only to find a frightening void where I thought help resided. I even bargained with God--couldn't he take an arm or a leg, put me a wheelchair, or give me cancer in exchange for my depression? Instead, I spent months experiencing suffering that was completely senseless and undeserved. It eviscerated any childish illusion I had that life is just or fair, or even pleasant. I don't think I'll ever be the same. Nor, do I think, will Mrs. Bush.

This isn't to say suffering doesn't have benefits. It cultivates empathy and inspires action against injustice. But I don't know if its dividends are worth the burden.

A good day's work

Many people dread the beginning of the workweek, but for me it's a happy reminder that I'm healthy enough to work. Having been sidelined at times by my depression, I can really appreciate just what a privilege working is, especially in this economy where a good job is hard to find.

Acute, melancholic depressions have prevented me from working or getting my schoolwork done a number of times. These are the dangerous depressions--the ones in which I'm barely able to get out of bed or eat more than a few bites. They rarely last more than a few days or weeks, but they feel much longer, the way having your hand on a hot stove for just a second feels like an eternity. Medications swiftly lift me out of these depths, and returning to work or school after recovering feels like coming back after appendicitis or a bad bout of the flu.

For much longer periods though, my capacity to work has been reduced, but not eliminated, by a lower-grade depression where my ability to feel positive emotion is blunted. Rather than intense negative emotion, during these episodes I'm plagued by anhedonia (the inability to experience pleasure).

Anhedonia creates a day to day dreariness that dampens productivity and weakens attention. Moreover, its symptoms can be so subtle and long-lasting that the sufferer doesn't realize she has a treatable disorder. She may feel that her gloominess is part of her personality, unlikely to ever change.

A depression caused primarily by anhedonia produces apathy, causing those afflicted to appear lazy and unmotivated. And indeed, when I'm experiencing this sort of depression I am less motivated (although I hesitate to apply the term "lazy" because of its undeniably moral overtone). Unable to feel any satisfaction from my activities, I am predictably less likely to engage in them.

Dysregulation of the brain's reward system is probably to blame. Running silently and almost invisibly in the background of the mind, this system creates the impetus we feel to undertake everyday tasks and pursue long-term goals. Only in its absence do we realize its force. 

Simple tasks like going to the grocery store or paying bills may not seem particularly rewarding, but even such mundane activities reward the healthy with a feeling of satisfaction, or at least relief, when completed. Without this reward, sustained effort becomes almost impossible. Routine tasks feel like insurmountable mountains, and working full time becomes an unrealistic aspiration. 

Someone suffering from anhedonia, like a well designed car without fuel, possesses all the necessary endowments for the job, but lacks the power to get going. Except for rolling down hills where gravity forecloses the need for effort, a car without gas can't move; likewise, a person without motivation may be unable to accomplish even a simple task if it requires affirmative action. 

So this week I'm grateful for a reward system that is not on the fritz, an attention span that permits me to focus, and a job that allows me to practice and strengthen these abilities. For me, there's no reward like the satisfaction of a good day's work. 

Addendum:  I ran accross this article on CNN today. It's a more spiritual take on apathy. Struggling with a "bad thought." Really interesting!

Illness, Suffering, and the Problem of Evil

During my first depressive episode I ran smack into Christianity's biggest theological dilemma -- the problem of evil. Why was God letting this happen to me? I couldn't see any possible purpose to suffering of such magnitude, especially at the tender age of 15.

Everyone collides with the reality of suffering eventually. Some face it much earlier than I did -- children who lose parents or experience abuse at a young age may never remember a time when it wasn't part of their understanding of the world. For most of us, however, it's a loss of innocence that accompanies suffering, either directly experienced or indirectly observed, that radically shifts our perspective on the human condition.

In theological jargon the answer to the problem of evil is called a "theodicy". The problem theodicies address is the seeming inconsistency of the existence of both evil in the world and a supposedly all-powerful, all-knowing, and entirely benevolent God. In Old Testament terms, it's not so much the question of why Eve ate the apple, as why God let her.  

Responses from the world's traditions run the gamut from "people bring evil on themselves" (think Pat Robertson's claim that the people of Haiti brought on an earthquake by turning away from God), to "there are two opposing forces of good and evil" (think Star Wars theology--loosely rooted in the dualism of ancient religions like Persia's Zoroastrianism and an early Christian heretical branch, Gnosticism). 

I grew up a mainline Methodist. I don't remember the Church promoting any one canonical explanation of evil -- since theologians can't figure it out I don't think the Church expected us to. But the question arose, as it always does, when members suffered pain and loss. One common explanation I heard growing up was that our limited perception prevents us from understanding God's purpose for our suffering (I'll call this the "mystery" approach).

(Theodicy is less a problem for eastern religions. As I understand it, Buddhism denies a personal God, reasoning that suffering comes from attachment. 

Here's a website that provides a short summary of the theodicies of several Christian traditions that is worth looking at if you want to explore comparative theodicies further: Explanation of Christian/Jewish theodicies.) 

Each theodicy has its shortcomings. The dualistic "Star Wars" theodicy denies the omnipotence and singularity of God (after all, it supposes an equally powerful co-existent evil force in the world); the Pat Robertson theology denies God's total benevolence; and the mainline Protestant approach seems to punt the intellectual problem into the realm of "mystery" instead of pursuing a comprehensible answer.

Another reconciliation of God with evil is presented by Rabbi Harold Kushner in his best-seller "Why Bad Things Happen to Good People," a book he wrote in response to his son's death at age 14 from Progeria, a rare disease that causes premature aging. Kushner reasons that God is all-knowing and all-loving, but not all powerful. He can sit with us in our suffering, but cannot prevent it. Again, this approach denies a fundamental trait of God. 

So why do we suffer? Can suffering and evil be reconciled with the divine attributes of God? I've never found a satisfactory answer. True, I may just be unable to see it, maybe "everything happens for a reason," but it's hard to believe that my  spiritual vision is that bad.

I have a hard time imagining why God would allow someone to experience what, in my case, I can only characterize as unadulterated suffering. When I see what others endure I'm just as perplexed. Why does God allow a person to become homeless? Why does God allow anger, bitterness, misunderstanding? Why does God allow murder, war, and rape?  

I don't know. For a long time the contradiction made me sympathetic to agnosticism and atheism--perhaps the most humane responses to the problem of evil because they fully acknowledge a sufferer's pain and the feeling of meaninglessness that so often accompanies it. They acknowledge this complexity by admitting that it makes no sense.

I'm not sure that there is a good answer. For me, suffering hasn't made me more faithful in a traditional Western sense, but I've become open to eastern interpretations of the divine, or less traditional western explanations of God's presence. What I find interesting is that some people become do more faithful in their suffering -- a testament to how individual and unique each person's experience with the same disease can be.