After my mother-in-law died, I remember thinking that I finally understood the word depressed. It felt as though I had been pushed underneath a heavy boulder, one that wasn't crushing me but instead confining me and keeping out the light. Although I cried on occasion, I didn't feel unbearably sad. Rather, I felt emotionally anesthetized, as though joy and sorrow had been pressed out of my life. It didn't last forever, and as I look back, I can even say that I'm grateful for the experience. My former grief seems like an appropriate response to the reality that my husband's mother, my friend, died prematurely.
So when I read the New York Times op-ed by psychiatrist and professor emeritus Allen Frances about a recent proposed change to the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), I shared his concerns. Frances—chairman of the task force that created the previous version of the D.S.M.—is no skeptic when it comes to using therapy and medication to treat mental disorders. But he describes this scenario: "Suppose your spouse or child died two weeks ago and now you feel sad, take less interest and pleasure in things, have little appetite or energy, can't sleep well and don't feel like going to work. In the proposal for the D.S.M. 5, your condition would be diagnosed as a major depressive disorder."
This, he warns, "would be a wholesale medicalization of normal emotion, and it would result in the overdiagnosis and overtreatment of people who would do just fine if left alone to grieve with family and friends, as people always have." Although the rationale behind the proposed change—helping people before they form self-destructive patterns—is good, Frances argues that grief is a necessary part of human development. To bypass grief via medicine is to bypass a core part of our humanity.
Last spring, writing for The New Yorker, Louis Menand expressed farther-ranging concerns about the D.S.M. and the psychiatric enterprise in general. In his article, he mentions over a dozen books that explore the problems with a culture, and an industry, that pathologizes normal human emotion. One author Menand mentions calls depression "a sane response to a crazy world," and rejects the notion that we should "paste a big smiley face over a world that we have good reason to feel sick about."
Despite reasons to use caution before prescribing medication to address depression, particularly in the wake of normal human grief, Menand and Frances both recognize that there is a thriving market for these types of medical solutions. We live in a culture that tries to avoid grief. We've discarded many of the cultural indicators of mourning: Widows don't wear black for a year; mothers who lose their children no longer cut their hair; we've given up on sackcloth and ashes. Americans spend thousands of dollars per person per year on medical care. Many of these costs, combined with the cosmetics industry, plastic surgery, and other commercial examples of our pursuit of perpetual youth, provide some measure of our desire to avoid aging, and with it, death. As Rob Moll notes in his excellent book The Art of Dying: Living Fully into the Life to Come, Christians have participated in this denial. Mortality and grief are rarely mentioned from the pulpit. Many churches have moved their graveyards from the center of town to the suburbs so we don't have to be reminded of death as we walk into the sanctuary on Sunday mornings.
For Frances, "Our lives consist of a series of attachments and inevitable losses, and evolution has given us the emotional tools to handle both." Menand echoes this sentiment when he writes, "Maybe we think that since we appear to have been naturally selected as creatures that mourn, we shouldn't short-circuit the process." For Christians, we can rely on more than evolution when facing grief. The Bible encourages God's people to experience grief, to recognize that the fabric of community is torn apart when a person dies. Genesis 50 hints at some of the ancient cultural practices surrounding grief, as Joseph mourns the death of his father for seventy days. Psalm 88, which ends with the words "the darkness is my closest friend," may be the starkest example of the biblical writers' sanction of mourning. Scripture includes countless other instances of expressing grief, through official times of mourning, psalms of lament, ritual practices, and even physical markers such as short hair and special clothing.
Yet the Bible offers us more than permission to grieve. It does so within the context of hope in a God who is faithful and who has overcome death. In 1 Thessalonians, Paul writes about believers who have died: "Brothers, we do not want you to be ignorant about those who fall asleep, or to grieve like the rest of men, who have no hope. We believe that Jesus died and rose again and so we believe that God will bring with Jesus those who have fallen asleep in him" (1 Thess. 4:13-14). Paul makes it clear that Christian hope does not eliminate the need for grief; rather, Christian grief is bound by Christian hope.
It is possible, even for Christians, that a time might come when grief becomes "a major depressive disorder" requiring medical attention. As Frances writes, "For the few bereaved who are severely impaired or at risk of suicide, doctors can already apply the diagnosis of major depression." But the diagnosis need not extend to those experiencing normal sorrow over serious loss.
My husband and I talked a lot about his mother after she died. We listened to music that reminded us of her. We looked at old photos and shared stories and let the tears—and the laughter—come. I even wrote a book about the experience of getting to know her and watching her come to life as the cancer did its destructive work. Grief pressed down on us for some time, yet that boulder didn't stay overhead forever. When it was gone, I knew the reality of God's comfort in a deeper way than ever before.
Medication can be an important and appropriate response to depression. Let's hope that it never replaces mourning.
"Speaking Out" is Christianity Today's guest opinion column and (unlike an editorial) does not necessarily represent the opinion of the magazine.
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Previous Christianity Today articles about death and dying include:
A Culture of Resurrection | How the church can help its people die well. (June 7, 2010)
What 'Lost' Taught Us about Dying Well | The meaning behind "live together, die alone." (May 26, 2010)
A Chronicle of Hopeful Dying | Death is not the enemy, says cancer-stricken Walt Wangerin, but a chance for Jesus to shine. (March 2, 2010)