William Styron was an award-winning US novelist, who is most well-known for Sophie’s Choice and The Confessions of Nat Turner. I haven’t read these. To me, he is the man who wrote lucidly about his depressive illness in his short book Darkness Visible: A Memoir of Madness. Based on an ancient Greek theory of medicine (the theory of humours, associated with Galen and Hippocrates), depression used to be called melancholia, the idea being that those with such melancholia had too much black bile.
In his book, Styron says of the term depression: ‘“Melancholia” would still appear to be a far more apt and evocative word for the blacker forms of the disorder, but it was usurped by a noun [depression] with a bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground, a true wimp of a word for such a major illness.’
The problem is that many Christians seem to think depression is a wimp of a condition, not the serious illness which Styron and many others have suffered. Depression, it is claimed, is something only the weak indulge in, a kind of excuse to duck responsibilities. People with any real moral fibre wouldn’t get depressed, would they?
I wish this were true. The grim reality is that depression is amongst the worst of all illnesses. And it is common. You will have people with it in your church. In a church of moderate size you will have those who have suffered this most severe type of depression, melancholia. Depression is no respecter of persons. It affects ministers and members; old and young; rich and poor. You can’t predict who will get depression any more than you can guess who will get cancer or dementia. It could be you or your spouse or your children. It could be anyone.
Timothy Rogers was a Puritan minister who was unable to serve as a pastor for eight years at the end of the seventeenth century because he was incapacitated by such a severe depressive illness: ‘It is commonly said by others who do not know what melancholy is, “Why do you think … so much? Divert yourselves; think of something else.” But it is no more possible for people, where this disease comes with violence, to divert their thoughts than it is possible for a man … who has a broken arm or leg [to] walk and act as he used to do before …they can think of nothing but what they do think just as a man with a toothache cannot forbear to think of his pain…Though others urge us to rule our thoughts, it gives no relief, but only adds to our misery to be frequently urged to do that which we cannot do…’ (Trouble of Mind and the Disease of Melancholy by Timothy Rogers).
Like many doctors from time to time I muse on which disease is the worst. In this fallen world we are afflicted with many horrible illnesses, aren’t we? Which do you think is the worst? Rheumatoid arthritis? Coronary heart disease? Cancer? I’m not sure myself but am convinced that mental illnesses such as Alzheimer’s disease, schizophrenia and depression are worse than any of these illnesses, horrible though they are. We are both body and soul, psychosomatic creatures, and the horror of mental illnesses such as depression is that they cripple our minds as well as our bodies and so disable us entirely.
You might think: ‘He would say that, he’s a psychiatrist’. But I remember when visiting my GP how she commented on someone she had just seen with a severe depressive illness. She spontaneously declared that it really was the worst of all illnesses. GPs have the broadest experience and arguably the most independent of views. John Horder was a GP and President of the Royal College of General Practitioners. In 1982 he gave an interview in which he reflected on the relative agonies he had himself experienced when on separate occasions he suffered from renal colic, a heart attack and an episode of severe depression.
He also declared depression to be the worst, nicely capturing its psychosomatic impact: ‘If I had to choose again, I would prefer to avoid the pain of depression. It is a surprisingly physical sensation, with a surprising resemblance to coronary pain, because it too is total. But it cannot be relieved quickly. It even threatens life. It is oneself and not part of one’s machinery, a form of total paralysis of desire, hope, capacity to decide what to do, to think or to feel except pain and misery.’
These melancholic illnesses are examples of the most severe type of depressive illness. For such people medical treatment is essential. Without treatment such depression can be fatal (not from suicide but the illness itself kills). It requires a complex combination of medication, ECT and psychological therapies. Whilst these illnesses occur less frequently than other types of depressive illness (I have discussed these other types of depression in my book Mental Illness: A biblical and practical approach) they are still common.
If you are in a church of even modest size you will have people who have or have had such an illness. Be kind to them. Visit them. Encourage them. Pray with them. And remember their family too. The impact of mental illnesses such as depression extends beyond the person, having a major impact on their relatives. Such relationships enable family members to provide important care for the sufferer. But the pain and suffering extends the other way too, so be kind and visit and encourage and pray for the family too.
Alan Thomas is a professor and consultant in psychiatry and elder at Newcastle Reformed Evangelical Church.