by William Van Ornum, Ph.D. on
In today’s New York Times, Gordon Marino raises tantalizing and taboo questions in his essay “Kierkegaard on the Couch”:
Many of us mental health professionals are quick to see any despair that is made up of themes related to spiritual sadness as indicators of depression, small or major. Freud of course made this one of his themes, and made religion not a phenomenon to be studied in its own right but an epiphenomenon, a reflection mostly of one’s experiences from birth to ages 4 or 5.
How many physicians or therapists have enough knowledge, theoretical and experiential (with large numbers of clients), to even attempt to enter that dangerous and delicate diagnostic area of distinguishing “the dark night of the soul” from “major depression.”
Marino tackles this head on and coins or uses a beautiful phrase. He asks, “Where are those Galileos of the inner world”? With wisdom he reminds us of the life and writings of the Danish theological and philosopher, Soren Kirkegaard, whose too-brief life spanned the years 1813-1857.
Kierkegaard distinguished between depression and despair. In his own life, he seems to have been born into a family that possessed a genetic predisposition to depression. Yet he sees in his own life and soul a difference between this temperament, or feelings of depression, and the despair of his soul. Were he alive today, I have no doubt that he would recommend the judicious and efficacious use of antidepressants and all of the behavioral and talk therapies we have at our disposal for psychological depression.
But for this second condition, the dark night of the soul, he would bring to our attention that a different approach, a spiritual treatment, an active leap of faith that transcends empirical understanding, needs to be summoned. Spiritual Direction would be one tool, used alone or in combination with the treatments of modern mental-health practitioners.
It will surprise many who have not read Mother Teresa’s book, Come Be My Life: The Private Writings of the “Saint of Calcutta,” that this contemporary saint shows us exactly what Kierkegaard is talking about when he contrasts despair with depression.
Throughout her life, her biographer Brian Kolodiejchuk, who has access to her letters and journals, brings out in high relief Mother’s painful and spiritual struggles. Here is one excerpt from her diaries:
“The darkness is so dark, and I am alone, Unwanted, forsaken. The loneliness of the heart that wants love is unbearable. Where is my faith? Deep down, right in, there is nothing but emptiness and darkness. My God, how painful is this unknown pain. It pains without ceasing. I have no faith. I dare not utter the words and thoughts that crowd in my heart, and make me suffer untold agony. So many unanswered questions live within me. I am afraid to uncover them because of the blasphemy. If there be a God, please forgive me.” (p. 187)
Learning the distinction between spiritual pain and psychological distress was important to Kierkegaard, and now, two centuries away, is of utmost import to the American Mental Health Foundation.
We encourage the pursuit of thinking and research to distinguish between spiritual despair and psychological depression, or to see them in combination, and to suggest whatever treatment or blend of treatments may be most effective.