Role of Spirituality in the Treatment of Depression
Over the last thirty years, one of the most interesting paradoxes in the study and treatment of depression has been that increased knowledge about the biomedical and genetic causes of the disease has been coupled with a renewed interest in the effect of religion and spirituality on human mental health and well-being. No matter how religion and spirituality are defined -- and many scholars and laypersons see no great distinctions between the two -- there are now hundreds of studies that demonstrate the beneficial effects of religion on both mental and physical health. Indeed, the more firmly held and intrinsic a person's religious convictions are, the more salutary the effect. Religious people are more optimistic, hopeful and trusting, and have more purpose and meaning in life than those with weak or no religious views. All of these qualities are of course lacking in depressive patients, which is why strong religious or spiritual beliefs serve as a protective against depression. There are also many studies that demonstrate that prayer and meditation also have a positive effect of physical, emotional and psychological well-being. This is not to suggest that the biomedical model be abandoned or treatment with antidepressants discontinued, only that holistic and spiritual concerns are a very important aspect of any integrated treatment plan for depression.
Define Spirituality and Discuss the Differences between Spirituality and Religion
A person can be 'spiritual' without being religious in the sense that they believe if God or a supreme being and an afterlife without being a member of any formal religious organization or following its theology, doctrines and precepts. In recent times, even this religion/spirituality dichotomy may be breaking down, as many people define themselves as religious without taking part in any organized religions. They may borrow ideas and traditions from many different religions and spiritual traditions, creating their own personal, individualized religion no longer subject to any other outside authority or text but only to their individual conscience. By 2002, for instance, only 18% of U.S. Catholics had a great deal of confidence in organized religion, while 30% had an unfavorable view of the Catholic Church. These trends affected other religions as well, apart from evangelical and fundamentalist Protestants. There has been a large decrease in participation in organized religion in the U.S. In the past decade, with many believers "looking for alternatives: what many call 'spirituality'" (Honeygosky, 2006, p. 3).
Spirituality is a more ambiguous and nebulous term than religion, more inward-looking and subjective, not based in formal religious organizations or traditions, and indeed, spirituality often "dismisses religion" (Honeygosky, p. 5). There are many spiritual and religious activities that now take place outside of formal settings, such as retreats, prayer, meditation and devotional reading -- either alone or in groups. A study of 500 young adult Catholics in 1997 found that only 10% were "core" believers while 90% were "peripheral," and did not "hold their Catholic identity as central" and did not "find meaning in parish life." They were skeptical of the Pope, organized religion, the clergy and the doctrines of the church, and many described their real faith as independent of any external church authorities. Even though few of them turned to New Age, Eastern or non-Christian religions as was common in the 1960s and 1970s, they did not really participate in any formal or even informal religious activities at all (Honeygosky, p. 7).
In surveys in the U.S., Japan and other countries, most respondents do not make any distinctions between religion and spirituality that so trouble academics, but see them as related. Even so, most scholars insist that such distinctions do have validity. Cox et al. (2005) define religion as "the cognitive, behavioral and systematic aspects of a person's belief system" while spirituality is more generalized and concerned with "the transcendent and emotional qualities of life in relation to the ultimate meaning," or as the German theologian Paul Tillich called it, the "ultimate concern" (p. 285). In the traditional meaning, religion meant "all aspects of the human relationship to the divine or transcendent -- that which sis greater than us," while for modern psychologists and social scientists, it means a way of life, faith communities, and their habits, practices and beliefs (Nelson, 2009, p. 4). Islam emphasizes the transcendence of God, while in Eastern religions God is immanent within and among us, while in Christianity God is both. Strong transcendence refers to something totally beyond human control or understanding, unlike weak transcendence which social scientists study as a normal part of human life and communities. For modern science and philosophy, this is "just another word for human power and ability," with considerable doubt about whether a God who cannot be seen truly exists at all. Glock and Stark also defined religion as consisting of certain specific aspects such as ritual, experience, morality and ethics, while Ninian Smart (1998) also described it as having legal, emotional, doctrinal and mystical aspects (Nelson, p. 6).
Theologians and religious philosophers make less of a distinction between religion and spirituality than other scholars, given that religious people are also spiritual and vice versa. Spirituality can mean "our search for the transcendent" or for personal knowledge (Gnosos) and experience of the divine. It can simply refer to values, meaning and inner awareness beyond the self or ego, or a "search for higher values, inner freedom, and things that give life meaning." Certainly Christians are spiritual in that they claim to have personal experiences with God, Jesus Christ and the Holy Spirit, and theologians prefer a "thick" definition of spirituality that places it firmly within the context of a specific religious tradition (Nelson, p. 9). Both religion and spirituality seeks answers to ultimate questions about why we are here and the meaning and purpose of life, or why suffering and evil exist in the world. Jews, Christians and Muslims worship a transcendent God who is also personal, while for Buddhism the transcendent Being is impersonal. Christianity in particular is full of paradoxes about why an omnipotent God also allows evil and suffering in the world, and why human free will allows the choice of evil, at least within certain environmental limitations.
For purposes of psychology, the main interest in religion or spirituality is functional rather than substantive, in studying their effects on individuals and communities rather than the truth or false hood of their particular doctrines and teachings. Intrinsic religious faith that has a deeper, more internalized and personal meaning is more likely to benefit those who pray during periods of stress and illness than an extrinsic faith that offers only "social and other personal benefits" (Cox et al., p. 290). For John Swinton, spirituality "relates to such things as love, hope, meaning, purpose," all of which are dimmed or extinguished in depressives (Swinton, 2001, p. 93). In a 2002 study, Pargament concluded that psychological well-being correlated with an "internalized, intrinsically motivated faith based on a secure relationship with God," and that while fundamentalism was linked to increased prejudice it also "increased well-being." In addition, religion was "most helpful to socially marginalized groups" (Cox et al., p. 296). A 1998 study revealed that there was a stronger relationship to well-being with organized, public religion than with private spirituality, although a 2000 study also concluded that those with spiritual meaning in their lives generally had higher levels of well-being (Cox et al., p. 297). People who use religion "for their own self-interest or personal gain tend to have a higher likelihood of depression," and a 1998 study of Korean-Americans showed higher levels of depression in those who were only extrinsically religious (Cox et al., p. 300).
Define and Discuss Depression
Beck and Alford list the following as symptoms of depression: dejected mood, loss of emotional attachments, negative feelings toward self, indecisiveness, distortion of body image, self-blame and self-criticism, paralysis of the will, avoidance, escapist and withdrawal wishes, loss of appetite, sleep disturbance, loss of sexual desire, worthlessness, nihilistic and somatic delusions (Beck and Alford, 2009, p. 84). In James Joyce's The Dead, "the characters are paralyzed by life and caught in a living death" that seems very similar to severe or clinical depression in the modern sense. St. John of the Cross called depression "the Dark Night of the Soul," while F. Scott Fitzgerald described it as a condition or state of being where it is always four o'clock in the morning (Auer and Ang, 2007, p. x). According to Biebel and Koenig (2010), depression is "a state of existence marked by a sense of being pressed down, weighed down, or burdened, which affects a person physically, mentally, spiritually and relationally." In the United States, 5-10% of the population is clinically depressed at any given time, yet only 1-3% of these receive treatment. Other studies indicate that about 6.7% of the adult population in the U.S. suffers from major depression in any given year, with episodes lasting 4-8 months, and that it is the second leading cause of disability (Hutchinson et…