It is important to note that the authors of this website are not mental health professionals, and that this information should not be used by anyone to self-diagnose a mental illness. An outline of the psychological classification of depression should serve to show the complexity of the disease, and point to the need for professional help in its diagnosis and treatment. Anyone who feels as if they are suffering from depression in any of its clinical forms should seek professional help.
[Situation] [Depression: a clinical examination] [Clinical depression and women]
[Clergy depression] [Clergy depression and women]
Melissa is not alone in American society. More than eleven million Americans are affected by depression every year, and studies show that one in four women and one in ten men “will experience at least one debilitating episode of depression during their lifetime” (Randall, 1998, 26). Depression is three times more likely to occur in an individual with a family history of the disease (Randall, 1998, 25).
Gathering such information is problematic, however, especially among clergy and others who consider admission of depression or request for treatment to be a danger to their vocations. Approximately half of the people suffering from depression do not seek treatment. This may be because 50% of Americans still think of depression as a character defect (Randall, 1998, 27-28). In addition, it can be quite a blow to one’s self-esteem to admit to such a weakness, to seek treatment and take medication (Randall, 1998, 16). Not only are clergy more susceptible to depression due to the stressful nature of the vocation, but they are also especially unlikely to discuss their depression because of the high expectations placed upon them by themselves and by their congregations.
Before we delve into the specifics of clergy depression, however, let lay out some of the clinical definitions of depression itself.
Mental health professionals diagnose persons with presenting symptoms of mental illness using the Diagnostic and Statistical Manual of the American Psychological Association (DSM). depression, once located in the “affective disorders” section of the DSM, has been re-classified within the more illustrative heading, “mood disorders.” Even with this new organization, depression is not an easy disease to define. Mood is defined as, “a prolonged and pervasive emotional state that affects the total person: feelings, outlook, attitude, self-regard, activity level, homeostatic balance, and trends in thinking” (Webb, 1981, 82). This lengthy definition demonstrates how pervasive and complex the human mood is. And depression, as a disorder of the mood, contains this same complexity.
Not only are there are varying degrees of depression, but also many of its symptoms coincide with normal moods that all people experience during the course of their lifetimes. The pervasiveness of mood-altering situations over the lifecycle can be blamed for the widespread diffusion of the meaning of the disease depression (Schuyler, 1974, 2). It would be impossible to find an individual who had never entertained feelings of sadness, discouragement, frustration, or a plain “bad mood,” all of which, if prolonged, can be evidence of some form of depression.
The disease ranges
from mild cases of a sad mood to the most severe cases, called “major
depression,” which can include psychotic features such as hallucinations or
delusions. Attempting to encompass the scope of the disease, the National
Association for Mental Health has defined depression as, “an emotional state
of dejection and sadness, ranging from mild discouragement and down-heartedness
to feelings of utter hopelessness and despair (Schuyler, 1974, 2).”
The DSM accounts for the typological span of the disease in its
description and classification, as well.
The DSM delineates three types of depressive disorders: dysthymia, single episodes of major depression, and recurrent major depression (American Psychiatric Association, 1993, 220-233). According to the American Psychological Association, people’s moods are on a continuum across three zones (see graphic below) (Webb, 1981, 85).
Moods falling on the “high” pole of the continuum range from normal happiness to dramatic periods of “manic syndrome,” in which a person can suffer delusions and derangement. However, with depression, moods that fall into the “low” pole are problematic. These can range from ordinary periods of sadness to recurrent major depression, which is characterized by a prominent dysphoric mood, even to the extent of despair or suicidal thoughts. There are two types of mood disorders that are classified for the poles affected by them. Bipolar disorders track an individual’s mood across both the “high” and “low” poles of the Mood Continuum, while unipolar disorders are diseases that affect either the “high” or “low” pole, but not both. Therefore, depression is a unipolar disease, because it is concerned with how one’s mood falls along the “low” pole.
It is expected that someone without a mood disorder
will still fluctuate in overall mood. Every
person is sometimes in a better mood than at other times.
If the fluctuations remain in “zone-one,” they are typically
short-lived and do not affect that person’s behavior to any great extent.
(Note that “normal” moods fall into the “zone-one” range, either
“high” or “low,” on the graphic representation of the Mood Continuum.)
Depression begins with a low mood in “zone-two.”
If one’s mood is lower than average most days, and is prolonged in this
state for at least two years, that person is said to have dysthymia.
This is a common, chronic illness that begins without obvious onset, but
results in only minor behavioral or vocational disturbances.
In other words, people frequently live with this neurosis for prolonged
periods of time without an inciting incident that causes them to seek help.
Dysthymia, if unchecked, can develop into major
depression, where one’s dysphoric mood dips into “zone-three” on the Mood
Continuum. This occurs most often in
conjunction with the experience of a negative psychological reaction to a
stressful situation or event. When
major depression occurs as a reaction to such an event, it is classified as
“reactive major depression.” It
is possible for single episodes of major depression to occur, with the person
then returning to a normal, zone-one mood. However,
as the DSM reminds, “it is estimated that over 50% of people who initially
have major depression, single episode, will eventually have another major
depressive episode, the illness then meeting the criteria for major depression,
recurrent” (American Psychiatric Association, 1993, 228).
It is important, therefore, to seek help for initial major depressive
episodes, in the hopes of preventing the development of recurrent major
depression, the most drastic of the unipolar depressive diseases.
Dean Schuyler, practicing psychiatrist and consultant
to the National Institute of Mental Health, has described depression’s range
of symptoms and severity as the “Depressive Spectrum” (Schuyler, 1974, 2).
This diagram simplifies the psychological jargon into a helpful tool for
laypersons hoping to understand the disease.
The spectrum is broadly divided into two parts, “normal depression”
and “clinical depression,” with more severe, chronic depression considered
“clinical.”
Normal depression encompasses mild depressive symptoms that are short-lived, what Schuyler calls “the blues” and “grief reaction.” The blues, named from the popular musical style, is a sad mood that accompanies the usual depressive occasions in life—rainy days, mild sickness, or small disappointments. An unhappy reaction is expected and normal in these situations. This mood may even result in depression-like symptoms. Someone with the blues may be apathetic, not sleep well, or lose her appetite. Even so, the sadness of the blues is short-lived, at most a few days in duration. The symptoms should not dramatically affect the person’s ability to function in the world, and do not cause marked variation in behavior.
The definition of grief reaction can be gleaned by its name. Here, the person’s mood is affected by a loss that occurs in his/her life, either through death, divorce, separation or other major transitional losses. Schuyler reminds that this is a perfectly normal reaction to personal loss, and that it is likely detrimental not to mourn a death (Schuyler, 1974, 5). Symptoms that occur with this type of sadness include those of the blues, but may also include a sense of loneliness, anger, or fear of death. These feelings can be pervasive for a short while, but should ease with time. If they do not, and the person cannot function because of her mood, the grief reaction may be developing into a “clinical” type of depression.
Clinical depression begins with “neurotic depressive reaction.” This can occur by itself or as a result of prolonged grief reaction. However, this type of depression is still reactive, meaning that a trigger event occurred prior to its onset. Precipitating incidents can be any number of things including losses, separations, or new responsibilities (Schuyler, 1974, 7). Whatever its onset, neurotic depressive reaction is exacerbated by identifiable situations of stress.
Finally, “depressive psychosis” is the clinical end of the Depressive Spectrum, and can cause severe upset in a person’s life. Though there is an extremely negative connotation to the word “psychotic,” the word’s definition is someone unable to delineate reality—there is not necessarily a violent or abhorrent side to a person suffering from psychosis. Therefore, those with this form of depression may have hallucinations or delusions. These are unreasonable beliefs, unable to be established via real evidence. This type of depression need not have a precipitating event, and includes symptoms more severe than the previous categories. The symptoms of depressive psychosis severely affect the person’s ability to function in any normal capacity. Suffering from this disease, an extreme case may even experience a vegetative state, without motivation to engage with the world whatsoever.
It has been shown that depression, in all its forms, is reported about twice as often in women than it does in men (www.apa.org). In trying to understand this substantial disparity, mental health researchers have pointed to way hormones affect the mental process. An overview of this research suggests that there are monthly fluctuations of hormones in women because of the menstrual cycle. The level of the hormone estrogen in a woman’s body waxes in an arc from the time of menstruation, to the highest point just before ovulation. Estrogen has been linked with positive feelings in women. Studies have shown that women interviewed during the early stages of the menstrual cycle, when estrogen levels are at their highest, reported feeling content, attentive and their attention was focused outward. When estrogen levels were at their lowest, these same women reported feeling stressed, belligerent and nervous (Bardwick, 1974, 31). Of course, women do vary in the extent that the menstrual cycle affects their behavior and lifestyle; however, data from many studies suggests the general hypothesis that hormones such as estrogen do affect women’s mental status in some significant way (Bardwick, 1974, 35).
As compelling as the hormonal evidence might be, it is important to remember that, “behavior is a result, an end-process, of many inputs, of which physiology is only one” (Bardwick, 1974, 29). Other factors proposed to account for gender differences in the reported onset of depression have to do with the way women are socialized differently than men. For example, it has been observed that women are more likely than men to seek psychological care for their problems (Carter, 1998, 56). However, it is not so simplistic that one can say women complain more than men. In fact, studies have suggested that gender cannot be exclusively ascribed to response style, and that, when asked about areas of life that matter to them, men and women complain a fairly even amount (Mowbray, Lanir and Hulce, 1984, 6).
Instead, many scholars blame the way women are
socialized over the course of their lifetimes.
Jean Baker-Miller suggests that, “women are taught that their main goal
in life is to serve others—first men, and later children.
This prescription leads to enormous problems, for it is supposed to be
carried out as if women did not have needs of their own, as if one could serve
others without simultaneously attending to ones own interests and desires.
Carried to its ‘perfection,’ it produces the martyr syndrome” (in
Women who do report their struggles with depression face society’s stigma of the disease. Fear of the illness often translates into society’s marginalization of the one dealing with depression. Because of this, the person dealing with depression suffers not only from the disease, but also from the public’s stigmatization. The roots of social stigma come from humanity’s base animal instincts. Studies in animal behavior have shown that a socialized group of animals is threatened by something considered “outside” the group, for example, a different species of animal. Fear of “the other” as outsider helps to promote the welfare of the species. In addition to fearing the outsider, at times members of the “in-group” are also ostracized. Pack animals will ignore or reject, for example, one of their own group, if that individual becomes ill or injured, because catering to that animal’s needs would slow the herd. Though operating on a different level of civilization, groups of humans function on these same principles.
A human group’s socialized culture shelters the people therein. When a group’s boundaries are defined, an individual’s socialization into the group serves to give meaning and worth to the human experience. In other words, by being socialized into a distinct culture, one can use the group’s beliefs to understand the world. This is “safety in numbers;” the unspoken hope is that if the group collectively holds something to be true, it must be true. Peter Berger speaks of this process as “nomization,” the “most important aspect [of which is] a shield against terror” (Berger, 1967, 22). Berger suggests that, “the marginal situations of human existence reveal the precariousness of all social worlds” (Berger, 1967, 23). These situations threaten to undo the society’s explanations of the world. Any situation that falls outside of the group’s understanding, then, is the terrible “anomy,” and is feared for its unknown nature. Because it is “outside” the group, that is, because it is not part of that group’s “nomos,” the foreign situation is pushed to the margins of that society.
Depression is a foreign situation in this same way. Jerome Frank speaks of how mental illness of any kind affects not only the sufferer’s mental state, but social construction as well. Frank says that mental illnesses, “involve the sufferer’s world-view, ethical values, self-image, and his relationships with his compatriots. These disorders result from or express the interaction of sociocultural stresses with vulnerabilities resulting from combinations of genetic, physio-chemical, and life-experience factors” (Frank, 1964, xii). Similarly, Manning states “mental illness is like and not like physical illness. In contrast to ‘bodily illness,’ mental symptoms refer to the whole of the self, are rooted in social relationships, have a potential for differential interpretation, and may be the source or cause of social and political conflict” (Manning, 1976, 9).
Depression is very serious among clergy women and men. In Walking Through the Valley: Understanding and Emerging from Clergy Depression, Robert Randall writes: “Most of us clergy will at some time experience depression, whether mild or severe” (Randall, 1998, 16). Nor would such clergy men and women be alone; nearly every biographer who has written about Martin Luther has noted that he suffered from chronic depression (Gaddy, 1991, 25).
Randall provides a helpful model (particularly from a clergyperson's view) for understanding the aspects of depression that incorporates the stressful situations, patterns of meaning, and bodily reactions, all of which interact within depression:
According to Randall’s diagram, the situation, meaning, and bodily response are three interrelated causes of depression. Any one (or more) can be the leading cause, or all three can work in equal measure. The most common leading factor is the situation, which can range from prolonged stress to a sudden trauma. The body’s chemical and genetic makeup is often the most insidious aspect of depression, difficult to detect or to link to the depression itself. The meanings an individual attaches to events are usually the most resistant to change, as they reflect patterns of thinking in the individual’s life. As these three aspects work together they magnify the total effect of the depression exponentially. All three aspects of the depression must be addressed in order to begin the process of healing (Randall, 1998, 57 and 60).
From this diagram one can also see why clergy might be especially susceptible to depression, because clergy encounter such stressful situations by the nature of their work, and because they have typical patterns of meaning that contribute to the overall depression. For example, Randall lists several ways of thinking, habits, and assumptions of meaning that can make depression worse.
Tendency toward perfectionism
Negative thoughts
Depreciation of events
Depreciation of self
Religious beliefs which lead pastors to either distort their experiences or miss the grace of God in them (Randall, 1998, 61).
All of these habits of thinking are prevalent among clergy. In addition, the onset of depression itself can be further cause for anxiety. One of our respondents, a seminarian called Marie (not her real name), describes her fear of what depression might mean in the larger context of her future ministry:
“When I realized that I was depressed, that this situation had somehow broken me, I was thrown into a despair and doubt about myself, my worth, and my calling to be God's minister. How could I ever hope to be present for others in crisis when I couldn’t help myself? How would I minister to those in pain and despair when my own despair so easily consumed me?” (see Narratives)
Similarly, C. Welton Gaddy, in his book A Soul Under Siege: Surviving Clergy Depression, tells of his own struggle with depression, and his feeling that it signaled a crisis of faith. His internal response to a well-meaning person’s statement that God would remove his depression is telling: “‘Then why in heaven’s name does God not remove it?’ I screamed to myself, fearing a serious failure of my spirit” (Gaddy, 1991, 46). Randall cautions against this feeling however, and the slippery slope of despair it can create. In this way, what begins as grief or stress can spiral downward rapidly. “Deeming ourselves weak because we are unable to push away dark moods pulls down our self-respect” (Randall, 1998, 106).