THIS important book, written by a woman with a rare combination of skills and experience, challenges the over-medicalisation of deep sadness. A consultant psychiatrist, the author, troubled by the official DSM-5 psychiatric classification of depression, which tends to medicalise all deep sadness, set up a research study to explore the conceptualisation of deep sadness and help-seeking behaviours within a highly religious sample of participants in Spain. This account of her qualitative research complements her earlier quantitative ethnographic research.
There were five aims to the study: to provide rich anthropological data on the participants and their contexts; to find out how religious people conceptualised and differentiated pathological sadness from normal but profound sadness; to investigate the participants’ coping strategies and help-seeking behaviours for both types of sadness; to explore the clergy’s understanding of the concepts and the care that they offer and the training that they may or may not have received, and their attitudes to mental-health professionals; and to propose a framework for distinguishing pathological from normal deep sadness.
The book is organised in three parts, each one built on the previous one. Part I features the origins of the study and places it in a literary and historical context. Part II reports on the participants’ narratives of sadness and spiritual growth. In Part III, the key findings of the study are discussed in dialogue with existing literature. The final chapter offers a framework for distinguishing pathological from normal deep sadness in clinical practice.
A short review cannot do justice to this study and the key findings, but they include the reported experience that sadness has a cause, which might be secular or spiritual. A secular cause would include a bereavement, severe illness, or relationship breakdown, whereas a spiritual cause could be a cooling of a religious vocation, concern about a relationship with God, or becoming disenchanted with aspects of the Church. Such sadness might be described as the Dark Night of the Soul, as known in the mystical tradition of Christianity: something to work through with a spiritual companion. Sadness without an apparent cause would be more likely to be seen as depression, and professional help would be sought. Then medication might be prescribed as part of the treatment.
One of the more troubling findings was the paradox that clergy who knew that they needed training in mental health nevertheless thought that they could help with all kinds of sadness. The study revealed a mutual prejudice affecting the clergy and psychiatrists: each mistrusted the other’s capacity to understand their specialism. Appropriate training for each practitioner would help to dispel prejudice and enable more collaboration.
The framework emphasised the need to consider the context in which the symptoms occur; their impact on the individual’s capacity to function; and the level of risk to the person’s safety. The evidence of my own practice accords with the author’s findings that there is an important discernment needed between deep sadness and inexplicable depression. Although some readers may get weary of the detail, this scholarly presentation of a well-researched study deserves to be read widely. I hope that it will help to change attitudes in a wide range of contexts.
The Revd Anne Holmes, a former NHS mental-health chaplain, works as a psychotherapist and SSM in the diocese of Oxford.
Sadness, Depression, and the Dark Night of the Soul: Transcending the medicalisation of sadness
Jessica Kingsley £24.99