Depression, Anxiety, Stress, Hopelessness and Despair: A spiritual antidote An abridged version of this article was originally presented at an interfaith forum entitled 'Depression, Anxiety, Street, Hoplessness and Despair: Great Faiths Unite to Discuss a Spiritual Antidote' on 23 December, 2011.
Firstly tonight my thanks go to the organisers of this event. It is vitally important in building a cohesive society and working towards a better Australia that the various faiths represented here work together with each other, and with other community groups and services within our cities and rural areas for the building up of society. It is an honour to share the stage with the other speakers tonight, and to be asked to present a perspective on this vitally important issue for the well-being of our community.
Societal Issue
It is no secret, and it should come as no surprise that depression, anxiety, stress, hopelessness and despair are significant issues within our community. They are significant issues within each of the faiths represented here tonight, as they are within the wider Australian community. According to an Australian study depression will be the second largest cause of disability in the country by 2020, and through suicide, the fourth largest cause of mortality . Everyone here tonight will know someone whose life has been touched by depression, anxiety, stress, hopelessness and despair – or all of the above.
Whilst I strongly believe my own Christian faith, and other religious faith provides significant resilience and aide to mental health it is not a cure. Faith and spirituality can provide a bulwark against depression, anxiety, stress, hopelessness and despair. They can certainly aide in the recovery of those who are affected. But they are not an indemnity to them. People of faith are not immune.
I have been in Christian ministry for nearly 20 years. During that period I have worked in suburban, regional and rural churches, as a University and prison chaplain and as a lecturer in New Testament and Theology for Charles Sturt University. In all of those settings I have worked with, and ministered to, people who have ranged from being overworked, overstretched and stressed through being a little down to suffering from ongoing and severe clinical depression. They have been young and old, educated and near illiterate, rich, poor, homosexual, heterosexual, farmer, academic, housewife, Christian, Muslim, Buddhist, Jew, atheist and undecided. There is no golden ticket, no simple practice or belief or place in society which gives immunity to these feelings and concerns. However there are ways of developing resilience and coping mechanisms which can act both as preventative and as coping mechanisms.
Religion and spirituality as a positive
There has been considerable research into spirituality, religion and religiosity and how these can affect health outcomes. Most original research articles have found positive associations between increased spirituality and better health outcomes . The reasons for expecting that religious belief and practice would benefit a person’s mental health are simple and rational. Religious belief provides a world view which gives hope and meaning in the face of stress and loss. Being a part of a religious community provides a social support mechanism. Religious belief is usually associated with a healthier lifestyle including diet and exposure to smoking, alcohol and drug consumption. Those with a religious belief are likely to make more conservative, less risky decisions in marriage, the workplace and recreational activities. There is good reason to expect they will have better physical health. Religious participation tends to have a general moderating effect on lifestyle.
Most studies note that there is a difficulty in defining terms like religion and spirituality for the purpose of testing links between religion, spirituality and mental health. As a former scientist this is perfectly true. It is not possible to separate the ‘purely’ religious or spiritual aspect of belief and participation in a community of faith from what might be other associated social or psychosocial benefits. To try to do so would be to draw distinctions and delineations which cannot be drawn.
Religion is, from a sociological perspective, a powerful coping behaviour that enables people to make sense of suffering, provides control over the overwhelming forces of nature – both internal and external, and promotes social rules that facilitate communal living, cooperation and mutual support . Of course religious belief and participation is much more than that. The Christian faith – and those other faiths whose sacred writings I have read all provide a framework and/or role models which facilitate acceptance of suffering. They also give a sense of divine control over circumstances – reducing the need for personal control. They provide a community of support – human and divine, which aides in reducing feelings and experiences of isolation and loneliness. Perhaps most significantly religion is (usually) available to anyone at any time – regardless of financial, social, physical or mental circumstances.
And negative
Freud famously wrote that religion results in depressing the value of life and distorting the picture of the real world in a delusional manner, which presupposed an intimidation of intelligence . There has been a significant view, particularly within the 20th century that considered religion and religiosity as a primitive and negative social and intellectual state. Aspects of this belief continue today with militant atheists. Certainly religious delusion is not unknown among those suffering schizophrenia and bi-polar disorder. I have encountered a small number of those convinced they are, or they speak for, Moses, Elijah and Jesus. I suspect that in other places and religious communities the names and identities probably change, but the broad corollary of religious delusion remains. This however does not mean that religion can only be negative to human intelligence and mental health.
There is no denying that historically religion has sometimes been used to justify hatred, aggression and prejudice. Religion can be judgemental, alienating and exclusive. One of the great benefits of an event such as this is that by working together as people of faith this negative aspect of religion is countered, and a cohesive, co-operative model and image of religion is promoted, fostered and strengthened. The mere fact that we can gather tonight as speakers and people of different faiths yet learn from each other, and work together for the common good of the society in which we live counters this negative experience of religion and can assist in removing fear and uncertainty of the ‘other’ in our community – reducing one significant agent of societal stress.
It is also true that although religious participation and membership of a religious community can provide a community of social support, this social network may also at times become a source of stress. I have seen this in particular within some ethnic Christian congregations within the Uniting Church where the generational differences and cultural expectations of migrants and their Australian born or raised children can create significant stress and tension within the religious community. Failure to conform to community norms and expectations can bring open criticism by other congregation members or by clergy and religious leaders. Feelings of guilt and the failure to meet expectations or cope with fears can contribute to stress and illness. I suspect that this is also an issue within other religious communities with a significant number of first generation migrants. Of course in such circumstances it is difficult to draw distinction between what is a religious and what is a cultural or ethnic expectation or norm. I would suggest that in any case such a distinction is somewhat arbitrary and in many cases impossible to define.
Faith as an aide to resilience
Many of the studies looking at the effect of religion on mental health draw an important and salutatory distinction in the attitudes of religious believers. They speak of extrinsic and intrinsic religious orientation.
People with an extrinsic religious orientation are disposed to use religion for their own ends. Their religious belief is held because it serves other, more ultimate interests – whether they be political, social or societal. Their religious belief and practice may be useful in a variety of ways – to provide security and solace, sociability and distraction, status or self-justification. The embraced creed is generally held lightly and selectively shaped to fit other needs. Extrinsic religiosity is associated with dogmatism, prejudice, fear of death and anxiety.
Conversely intrinsic religious orientation describes those who find their master motive in religion. Other needs, strong as they may be, are regarded as of less ultimate significance, and they are as far as is possible brought into harmony with the person’s religious beliefs and prescriptions. Having embraced a creed the individual endeavours to internalise it and follow it fully. Perhaps not surprisingly most studies indicate that it is those who have an intrinsic rather than extrinsic religious orientation whose mental health tends to benefit from religious belief and participation . It seems that the behaviour which is consistently associated with better mental health is precisely the lack of self-interest and willingness to be humble, self-sacrificing, compassionate and empathetic that characterises intrinsic religious orientation.
As I stated earlier, religious belief can provide some preventative assistance to mental well-being. Here I feel at a little of a disadvantage being the Christian speaker as I cannot point to a rejection of alcohol or an advocacy of vegetarian or other dietary practices particular to my own faith tradition. However it remains true that Christianity, along with the other religious traditions advocates a moderation of behaviour and a responsible attitude towards self and others. Religious practitioners tend to be more conservative and less prone to risk taking behaviour. Religious attitudes to diet, to responsible and moderated social behaviour, to moderated and controlled sexual activity all tend to provide a more secure, stable and less risky behaviour, and a consequent benefit to physical and mental health.
Christian aides to resilience – community, support networks, counselling, spiritual guidance, meditation, prayer.
Up to this point I have endeavoured to reflect principally in terms of what we can together share as religious believers – now I would like to speak particularly – although not necessarily exclusively, from my own Christian perspective.
The development of health care, the building and running of hospitals and the early care of the mentally ill was, at least in the Western world, largely the work of Christian religious orders and churches. The monastic world is largely responsible for having developed and resourced medical care in the West. The first hospital designed specifically to care for the mentally ill was established in Spain in 1409 under the guidance of priests . This is not to claim that the care provided to the mentally ill by the Church was always compassionate – unfortunately this is not the case. However, overwhelmingly the motivation and attitude of the Christian churches has been one of compassion and care. The Church today, in Australia, continues to provide extensive resources in these areas – from welfare in congregations and local communities to mental health, hospital and community chaplaincies. The Christian church continues to reach out seeking to provide security, stability and hope. Those who struggle with depression, anxiety, stress, hopelessness and despair need security, a sense of safety, and a compassionate community within which to rebuild their mental health and stability. The Christian church has sought throughout its history and continues today to seek to provide just such communities of care.
However it could be argued that the purely ‘social’ side of belonging to a religious community (if there indeed can be such a construct) is essentially no different to belonging to any other social grouping. After all other groups can provide supportive communities which care for members and form an effective social support network – I would however argue that I suspect that religious communities develop such a support community better and more quickly and tend to be more responsive to need – although proving this in a reliable way would be difficult.
There are, however, other aspects of resilience that religion can prove that are not so easily questioned.
Spiritual practices of meditation and prayer are certainly not the exclusive province of Christianity – but within Christian tradition the practice of meditation, the example of the mystical tradition provides a resource to strengthen and increase the resilience of the individual. The mystics, whether they be Christian or those of other faith traditions, are all deeply aware of the transcendent; that there is what I as a Christian would call God beyond us, and infinitely greater than us. Within the Christian tradition this God is infinitely loving, all compassionate and all merciful. By deepening the individual’s awareness and reliance on this God the individual becomes a part of a much greater whole, a part of a wider community of time and space. The life and practice of prayer likewise takes the individual beyond their own concerns to a wider awareness of others and of the divine. Thus these religious practices and disciplines assist in the development of precisely those attitudes and attributes I referred to earlier – the attributes of intrinsic religious practice which take us beyond the self and which have been shown to contribute to positive mental health.
One of the greatest contributors to resilience to depression, anxiety, stress, hopelessness and despair is the building up within the individual the knowledge that they are not alone in facing the problems, issues, stresses and failings that contribute to their state of mental health. Both the stories and experiences of others, and a worldview that sees a wider, hopeful and purposeful future contribute very significantly to both prevention of, and resilience within experiences of depression, anxiety, stress, hopelessness and despair.
In preparing for tonight, as well as talking to people I know in the Uniting Church who work extensively in the area of mental health chaplaincy I asked a number people I know well – all regular attenders at churches in Sydney, all of whom have had or continue to have struggles with depression, - what aspects of their faith had been helpful to them in their struggle with depression. As I said at the beginning of my talk, faith is no immunity to such problems. These people and many others I have met over the years are sincerely devout religious people who have – and in some cases continue to, and will always struggle with depression. If faith is to be a positive contributor to mental health and resilience then there can be no notion, feeling or understanding that to suffer from such feelings is a sign of inadequate or false faith. Faith can help as a preventative measure – but that is not the same as preventing. Faith can assist in resilience within and recovery from such situations – but that is not the same as a cure. To place such expectations upon ourselves or upon those who struggle with such issues will only reinforce feelings of stress, inadequacy anxiety and failure.
This is far from a scientifically valid study or even a statistically significant sample – however I find that in such circumstances the personal is more memorable than the theory. For all those people, prayer had been a very significant source of strength; both their own life of prayer and their experience of knowing that others in their churches were praying for them.
One of them had found significant benefit from regular practice of Christian meditation. Here I perhaps need to note that in the Christian denominations which comprise the Protestant and Reformed traditions there has historically been a significant mistrust of the mystical and of meditation which may in part explain the lower participation. This individual found that with meditation, the setting aside of intentional time for deep awareness and focus on their own body, and on the divine presence beyond them was of great benefit in providing oases of clam and times of peace amidst anxiety, stress and depression.
All of them had also found the reading and re-reading of scripture – the Christian narrative – helpful in sustaining their faith and improving their resilience. To read and hear the stories of faith repeatedly not only strengthened their own faith, but it gave them examples of resilience, examples of struggle, and an assurance of the presence of God even in the darkest times. Remembering the faith of Abraham – even in moments of extreme stress and apparent failure. Recalling God’s choice of Moses despite his flaws and his inability to speak well to lead the Israelites out of Egypt. Re-reading the writings of prophets such as Isaiah – who begins his work with a fairly pessimistic 39 chapters warning of coming defeat and exile, but who then concludes with another 26 chapters reminding people that God is there even in the midst of exile and darkness, that the servant of God is not always recognised or rewarded by others – but s not forgotten by God, and that God will restore his people, and renew their spirits. The psalms – some of which praise God, some of which search for God, some of which cry out at a God who seems absent. And then the stories of Jesus – stories alongside each other which require the follower of Jesus to ‘take up their cross and follow me’ and then promise that ‘my burden is easy and my yoke is light’. These are stories which engage with the realities of life. The acknowledge the difficulty and the pain, but they also offer the promise and the hope of the Kingdom of God – not just in the future beyond this life, but as a growing reality and presence in this world here and now.
It is not as some have described it just the promise of hope and peace beyond this life which is of assistance – in fact my four friends noted that the promise of what lies beyond this life had not been particularly significant in reassuring or assisting them in their struggle. What was of greatest assistance to them was the idea – the knowledge – the faith that God had seen the best and the worst that humanity could be. That God had created the universe for good, and that God was working in with and through the world to make things better here and now. Perhaps it is a case of one step forward two steps back. Perhaps it does take time. Perhaps we don’t understand or experience all that God is doing. But the stories of scripture and the witness of people of faith gives confidence that there really is hope – not just in the future but here and now. And the religious communities of which they are a part provide them with a support and care network of people who also have that faith and outlook. This is what they found built their resilience most strongly. The idea that even in the worst of their struggle and in the midst of depression God was there – God loves them, and God was journeying with them, and other believers were there beside them encouraging them on the journey.
The benefit of working together
Now think of how that could be improved if we as religious followers worked together. There will always be differences in what we believe and in how we express our belief. We will not agree on the details – and I don’t think we should try to. But, if we can respect each other’s beliefs, traditions and religious practices; if we can be willing to learn from one another – then those networks of support and care can grow and flourish. If we no longer adopt the attitudes we seem to find from sections of the media – that the ‘other’ whether they be Christian, Muslim, Jew, Buddhist, Hindu, Indian, Vietnamese, Indigenous, Anglo-Australian or those two wonderfully vague terms – of Pacific Islander or Middle-Eastern appearance is someone automatically to be feared. This in and of itself is a step towards reducing stress and anxiety in our community. If we can then take another step beyond that to working together as people of a single wider community – respecting our differences but also acknowledging and celebrating those things we hold in common – particularly the value that each of us places on our relationship with the transcendent divine that is beyond us all – then there is a greater hope. Hope defeats hopelessness. The defeat of fear lessens anxiety. Together hope and the overcoming of fear reduce stress, and allows a wider community of co-operation, compassion and empathy to flourish. And such a community helps us to prevent, or to overcome depression.
There is much that spirituality can offer to increase our resilience to depression, anxiety, stress, hopelessness and despair. Let us work together where we can to build our communities of faith that they may be a beacon in times of darkness, an encouragement to each other, and a source of hope to the world.