I’ve never been a fan of straightforward biological explanations for depression, but is anyone? I guess the idea that depression is “only” a result of neurotransmitter imbalances in the brain offers an immediate causal story for a bout of extremely low mood. Reading between the lines, maybe there has always been a certain clinical restraint in not saying to people “there’s probably an obvious or an overly convoluted cause, but it’s good enough for now if you treat it as purely bio-chemical.”
In the past I would have had no patience for such an approach. I would have wanted to identify the real-life causes as quickly and efficiently as possible. I don’t know if it is therefore a sign of maturity or simply a change in circumstances, but I now appreciate the merits of being able to identify this low mood as a discrete phenomenon worthy of some form of respect.
In other words, while I may indeed be able to trace the causative factors and do something to remedy them, I can also now recognise that the low mood itself is significant in its own right and deserves its own response. Knowing the causes – or that there are causes – does not negate the real symptoms of the low mood.
In Aquinas’ work, we can interpret depression as an extreme form of sorrow. Sorrow is understood to be our natural response to a perceived evil. Evil in this case does not mean necessarily a moral or spiritual evil; it refers to anything the intellect interprets as bad, harmful, unwanted, and so on.
Aquinas’ discussion of the effects of sorrow show that “depression” is metaphorically apt as a kind of “pressing down” on the individual’s soul:
For a man is said to be depressed, through being hindered in his own movement by some weight. Now it is evident from what has been said above that 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. And if the evil which is the cause of sorrow be not so strong as to deprive one of the hope of avoiding it, although the soul be depressed in so far as, for the present, it fails to grasp that which it craves for; yet it retains the movement whereby to repulse that evil. 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.
Aquinas held what we might now call a “holistic” view of mind and body, hence among his recommendations for the alleviation of sorrow we find both spiritual and physical remedies – contemplation of truth, warm baths, and wine.
But we also find in Aquinas the basic logic of modern psychological remedies such as Cognitive Behavioural Therapy. CBT teaches us to recognise negative thoughts that contribute to anxiety and depression, and to challenge those negative thoughts.
The experience of sorrow is dependent on the presence of some evil, and our perception of it. CBT puts a greater emphasis on perception, armed with the knowledge that our perceptions of evil are often distorted, exaggerated, or overly pessimistic. Aquinas was perhaps more focused on sorrow as a natural response to actual evils.
Either way, in my experience the causes of a low or depressed mood can be a mystery to the sufferer absent further self-examination. It might feel as though the low mood has come out of nowhere, but if one takes the opportunity to reflect on and summarise one’s circumstances, paying particular attention to one’s hopes and the sense of future options, the experience of debilitating sorrow might turn out to be quite natural and reasonable.
Nonetheless, I would not wish to imply that there are easy answers available. As Aquinas notes, this form of sorrow is particularly injurious and should not be taken lightly:
Of all the soul’s passions, sorrow is most harmful to the body. The reason of this is because sorrow is repugnant to man’s life in respect of the species of its movement, and not merely in respect of its measure or quantity, as is the case with the other passions of the soul. For man’s life consists in a certain movement, which flows from the heart to the other parts of the body: and this movement is befitting to human nature according to a certain fixed measure. Consequently if this movement goes beyond the right measure, it will be repugnant to man’s life in respect of the measure of quantity; but not in respect of its specific character: whereas if this movement be hindered in its progress, it will be repugnant to life in respect of its species.
What this means is that sorrow directly stifles our natural vigour. Where other afflictions might subvert or disturb us, sorrow crushes us to the very core.
In terms of remedies, then, Aquinas begins by quoting Aristotle:
“sorrow is driven forth by pleasure, both by a contrary pleasure and by any other, provided it be intense.”
I suspect this provides a rationale for various addictions: we seek a remedy in intense pleasures or distractions, even if they create other problems and renewed sorrows for us.
Aquinas goes on to examine weeping and tears as sources of relief:
Tears and groans naturally assuage sorrow: and this for two reasons. First, because a hurtful thing hurts yet more if we keep it shut up, because the soul is more intent on it: whereas if it be allowed to escape, the soul’s intention is dispersed as it were on outward things, so that the inward sorrow is lessened. This is why men, burdened with sorrow, make outward show of their sorrow, by tears or groans or even by words, their sorrow is assuaged. Secondly, because an action, that befits a man according to his actual disposition, is always pleasant to him. Now tears and groans are actions befitting a man who is in sorrow or pain; and consequently they become pleasant to him. Since then, as stated above, every pleasure assuages sorrow or pain somewhat, it follows that sorrow is assuaged by weeping and groans.
“Secondly, because an action, that befits a man according to his actual disposition, is always pleasant to him.” I’m not really one for weeping and groans – heavy sighs perhaps? – but I have discovered that as a general rule if I am too depressed to write, I can always write about being depressed.
For his third remedy, Aquinas recommends the company of sympathetic friends:
When one is in pain, it is natural that the sympathy of a friend should afford consolation: whereof the Philosopher indicates a twofold reason (Ethic. ix, 11). The first is because, since sorrow has a depressing effect, it is like a weight whereof we strive to unburden ourselves: so that when a man sees others saddened by his own sorrow, it seems as though others were bearing the burden with him, striving, as it were, to lessen its weight; wherefore the load of sorrow becomes lighter for him: something like what occurs in the carrying of bodily burdens. The second and better reason is because when a man’s friends condole with him, he sees that he is loved by them, and this affords him pleasure, as stated above. Consequently, since every pleasure assuages sorrow, as stated above, it follows that sorrow is mitigated by a sympathizing friend.
Not every depressed person has sympathetic friends available to them, which is in itself quite a depressing thought. However, there exist a plethora of online and real-life support groups and, in this country at least, government-subsidised counselling available to some extent. There are options if sympathetic friends are hard to come by.
For his fourth remedy, Aquinas recommends the contemplation of truth, quoting Augustine:
“It seemed to me that if the light of that truth were to dawn on our minds, either I should not feel that pain, or at least that pain would seem nothing to me.”
Contemplation of truth is a tricky one. As Aquinas notes, it is a pleasure with no corresponding sorrow. In fact it is considered the greatest pleasure for the connoisseur who develops a taste for it. At the same time, it is somewhat elusive and not easy for a beginner to find comfort in, especially while struggling with the other facets of depression.
And yet contemplation of truth is implicated in the kind of self-analysis that uncovers the causes of a person’s sorrow. Examining one’s life does lead to the consideration of the greater meaning and purpose to our existence, indeed to the very nature of our existence and hence to the kind of transcendent truths that Aquinas had in mind.
Ending on a softer note, Aquinas recommends sleep and baths – and by extension any physical restorative that can combat the depleting effects of sorrow.
It might seem a bit strange to put contemplation of truth neither first nor last in the list when it is clearly regarded as the supreme pleasure and greatest response to sorrow. This could be because contemplation is still an indirect response to sorrow, but I think it might also be because contemplation is such a difficult work in its own right, and Aquinas – perhaps being sensitive to the needs of the depressed individual – did not wish to utterly demoralise an already suffering and weakened person with a pious exhortation to a universal yet abstract remedy.
So he slips it in as the third of four remedies:
O sorrowful soul, have a bit of a cry, chat to a good friend, maybe consider the profound reality of existence, the transcendent metaphysical order, the incomprehensible mystery of divine love, or just skip ahead to a hot bath and a lie-down.