Hope, Faith, and Depression

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Early in my career I realized that when patients come into my office with severe depression they have lost the capacity for faith, belief, and hope. Any glimmer of optimism or positivity has gone out the window. They no longer believe in themselves, trust that anyone or anything can help them, nor, if previously religious, have faith that God will come to their rescue. Faith and hope exist on the opposite side of the spectrum of their existence from which depression has excommunicated them. Depression is a black cloud which has blotted out their view of the sun.

Here Comes the Sun

Yet, as someone begins treatment, I see small hints of light emerge. “I think I’m feeling a little bit better, but I can’t tell if it’s my imagination or real,” a patient says during a follow-up appointment, after having started taking medication. I tell them it is probably both. Small but significant, early signs of response to antidepressants are usually predictive of a positive outcome in the long run.

There's also a burgeoning bond. It's not quite trust but there's a curiosity on the part of my patient. I can almost hear them say to themselves, “Maybe there is something to this. I think I'll stay for another round.” They begin to adopt my almost 100-percent belief in the power of the treatment. I say almost 100 percent because, while I've seen thousands of patients who fit the diagnostic criteria for Major Depression respond to medication, there is always the "What if?": What if this time is different? As psychiatrists, we may have our own element of doubt and issues of belief. A positive outcome isn't always a slam dunk, although almost everyone I've treated responds once the right formula is found. Psychotherapy, meditation, and other wellness practices certainly play a role in achieving a full recovery. And for those who don't respond as well, there are other treatments to explore, like ketamine and ECT. And, of course, psychotherapy, meditation, and other wellness practices play a vital role in achieving a full recovery.

From mistrust to trust

“Can I trust you with my thoughts?” my patient asks. “That is how this is supposed to work,” I answer. And they go on to reveal something about work or home life. And as they relate their story, they begin to see us as a “transformational object.” Our doctor-patient relationship has become a collaboration—an "object" that functions as a source of transformation, which imbues hope and confidence and replaces the negativity which the patient previously projected onto himself and the world.

By the end of the treatment, the patient who recovers from depression is a beacon of light and hope for other depressed people. They can be spotted across the room. Having overcome depression—having lost and now re-found faith in themselves and the possibility of a good future—they practically radiate a glow. As one of my patients put it, "Doctor, it's the like the color of my aura changed."

Unifying "The Divided Self"

In his landmark work, The Varieties of Religious Experience: A Study in Human Nature, based on a series of lectures given at the University of Edinburgh, psychologist and philosopher William James described two types of religious people. The “healthy-minded” believer is focused on the positive. Their happiness and contentedness are regarded by them as evidence of the truth of their religion. The “sick-souled believer” is deeply troubled by problems of evil, which leads to feelings of desperation, melancholy, and existential panic and gloom. The person who suffers from Major Depression battles periods of lost faith that must be unified with more positive states of mind. As the patient heals from depression, the sick soul is reunified with what James described 100-plus years ago as its "Divided Self."

Reassurance: A Vital Ingredient to Successful Treatment

As clinicians we are aware of how dangerous the hopeless, faithless states of depression can be. The ripple effect of such depression on family and other loved ones is profound. We need to reassure individuals suffering from depression and their close family and friends that as permanent as these feelings may seem when suffering from the condition, they are mere symptoms of the disease and will respond to treatment. Often that feels a bit like a miracle. And who is to say that it isn’t?