Perhaps one of the least helpful
questions to ask a person with depression, “why are you depressed?” is
nonetheless also the most common sense question to ask.
According to the World Health
Organisation: depression is the world’s leading cause of disability
in terms of ‘Years Lived with Disability’ (YLD), and the fourth leading
contributor to global disease burden as measured in Disability Adjusted Life
Years (DALYs – “The sum of years of potential life lost due to premature
mortality and the years of productive life lost due to disability.”)
Yet ‘depression’ is not an
homogeneous condition. Rather, it is symptomatic of a range of illnesses, and
may arise from a variety of causes, both physical and ‘psychological’. For the
sufferer, none of these causes may be apparent or obvious; lending a sense of
mystery to this potentially debilitating condition. Like Churchill’s ‘Black Dog’,
we might even ascribe sinister metaphors to this ineffable thing that comes and
goes according to its own logic. The ‘why’ of depression is indeed the pivotal
question, not only in the pursuit of treatment and relief, but also with regard
to the sufferer’s own sense of understanding and control. At the very least,
knowing why you are depressed might deny this condition some of its mystery and
power.
We tend to think of depression as a
modern problem, and it would therefore seem obvious to look for modern
solutions. But in addition to seeking the best contemporary medical and
psychological care, it would at least do no harm to inquire into some
pre-modern opinions on the nature of depression. Of particular interest to me
are the thoughts and reasons of the 13th Century philosopher: Thomas
Aquinas. Let us therefore see what ‘the Dumb Ox’
had to say about the ‘Black Dog’.
It may come as a surprise to learn
that despite living in the Thirteenth Century, Aquinas was aware of
the term ‘depression’, or its Latin equivalent (aggravatio – being
weighed down), in the same general sense as we know it today:
“The soul, through being depressed
so as to be unable to attend freely to outward things, withdraws to itself,
closing itself up as it were.”
Not only was Aquinas aware of
depression, he also subjected it to analysis:
“The effects of the soul’s passions
are sometimes named metaphorically…and in this way fervor is ascribed to love,
expansion to pleasure, and depression to sorrow. For a man is said to be
depressed, through being hindered in his own movement by some weight.”
From the outset, Aquinas displays
an acuity missing from modern discussions of depression. He identifies
immediately that the term ‘depression’ is used only metaphorically to describe
the human condition. The original
meaning of depression is to be ‘pressed down’ by something, as when
a person is physically weighed down by a heavy object. Aquinas informs us that
the psychological reality behind the metaphor is in fact ‘sorrow’. This
observation shifts the discussion from the mysterious element called
‘depression’ to the much more familiar psychological condition we know as
‘sorrow’. Aquinas goes on to explain the function of sorrow:
“Sorrow is caused by a present evil:
and this evil, from the very fact that it is repugnant to the movement of the
will, depresses the soul, inasmuch as it hinders it from enjoying that which it
wishes to enjoy.”
It is important to note at this
point that Aquinas is referring to ‘evil’ in a general sense, as anything
contrary or harmful to the good. This would include ‘physical evil’ such as
injury and disease, as well as ‘moral evil’, and even more generally ‘evil’
circumstances such as misfortune and failure. Aquinas explains that sorrow is
our natural response to the presence of some evil or ill, and that the degree
of our sorrow is relative to our hope at avoiding or overcoming this evil.
Hence he concludes:
“If, on the other hand, the strength
of the evil be such as to exclude the hope of evasion, then even the interior
movement of the afflicted soul is absolutely hindered, so that it cannot turn
aside either this way or that. Sometimes even the external movement of the body
is paralyzed, so that a man becomes completely stupefied.”
Depression is the effect of sorrow,
and sorrow is a natural response to a present evil. The stronger the evil, the
less our hope of avoiding it, and hence the greater our sorrow and depression.
The problem for so many modern cases of depression is that we are not – collectively
or individually – aware of any such ‘evil’ causes in our lives. Indeed, the
lack of an obvious cause is characteristic of many depressive illnesses.
Does this mean that modern
depression defies Aquinas’ description? Or are we somehow oblivious to the
‘evils’ Aquinas wrote about?
As a tired ethicist, I must concur
on this issue with those who suspect that ‘modern life’ is somehow contrary to
human happiness, and that we are in fact oblivious to the ways in which it
harms us. Having collectively abandoned the understanding of good and evil
handed down to us by prior generations, how could we determine for ourselves
the necessary ingredients for a fulfilled and happy human life? How can we
identify the deficiencies in our way of life, without an objective account of
the things that ought to fulfil us?
Having witnessed this illiteracy in
the context of ethics, it should come as no surprise to witness its
repercussions in a different aspect of human life.
Consider a brief list of goods held
by traditional ethics to constitute the basic ingredients of human fulfilment:
life (including health, and the provision of basic needs such as food, shelter,
clothing, and transport), friendship, family, work, play, marriage, offspring,
knowledge of the truth, appreciation of beauty, integrity, respect for others,
love of others, and even religious belief and practice. Each of these things
(and this is by no means a definitive list) has been demonstrated across the
history of humanity to provide an irreducible and irreplaceable type of
fulfilment.
If we wish to pursue Aquinas’
analysis of depression to its logical conclusions, we could start by
considering how well or how truly each of the goods on this list is
incorporated into our lives. Contemporary attempts to manage depression
correspond to this view, whether it be by advocating
better sleep, nutrition, exercise, and spending time with friends, or through psychological
treatments such as cognitive behavioural therapy, which help to
break down false and counterproductive habits of thought.
Indeed, Aquinas directly endorses
these approaches to the treatment of depression, under the general principle
that: “every pleasure brings relief by assuaging any kind of sorrow, due to any
cause whatever”. It is important to note that Aquinas defines pleasure as the
enjoyment of a suitable good, which is very different from the modern
understanding of pleasure for its own sake. For Aquinas, it follows that the
enjoyment of friendship is a suitable form of pleasure, capable of diminishing
sorrow and depression:
“When one is in pain, it is natural
that the sympathy of a friend should afford consolation”
Aquinas also advocates sleep and
baths for the alleviation of sorrow, observing that:
“Whatever restores the bodily nature
to its due state of vital movement, is opposed to sorrow and assuages it.”
His approval for ‘bodily remedies’
could even be taken as in principle support for some forms of anti-depressant
medication, where such medication helps to restore normal functioning:
“Moreover such remedies, from the
very fact that they bring nature back to its normal state, are causes of
pleasure; for this is precisely in what pleasure consists, as stated above.
Therefore, since every pleasure assuages sorrow, sorrow is assuaged by such
like bodily remedies.”
But Aquinas reserves his highest
recommendation for the pleasure implicit in the contemplation of truth:
“The greatest of all pleasures
consists in the contemplation of truth. Now every pleasure assuages pain as
stated above: hence the contemplation of truth assuages pain or sorrow, and the
more so, the more perfectly one is a lover of wisdom. And therefore in the
midst of tribulations men rejoice in the contemplation of Divine things and of
future Happiness”
It is difficult to read these final
words without immediately reflecting on the status of ‘truth’ in contemporary
Western culture. Many cases of depression have a physical component and respond
well to treatment with drugs. But surely other factors must be at work if we
are really facing an epidemic.
If the contemplation of truth is
both our greatest pleasure, and a panacea for sorrow and depression, we should
not be at all surprised by the prevalence and growth of depression in a society
that has all but abandoned the concept of truth outside of various pragmatic
enterprises such as law, finance, and the natural sciences. Friendship, we can
accept; better sleep and a long bath are uncontroversial. But truth: what is
that? as someone said about 2,000 years ago.
So it is unlikely that the contemplation
of truth, or other basic goods will be promoted as a solution to depression in
the near future – unless they can be packaged and sold in tablet form, or
somehow explored through the lens of randomised controlled trials. But until
then, will we be equipped to find a solution to the puzzling phenomenon of
depression in the midst of 21st Century abundance?
Zac Alstin works at the Southern Cross Bioethics
Institute in Adelaide, South Australia.
