Sunday, November 21, 2010

Awakening from Depression

For Your Well-being – Psychology and Jewish Wisdom

Clinical depression is a debilitating condition that impacts all aspects of a person’s life – relationships, school or career, and even physical health.   A study at Duke University has found that 17.1% of Americans suffer from depression sometime during their lives.  That’s over 5 million people.  Many suffer in silence not realizing that they are in the grip of a major psychiatric disorder – and that there is a way out of their despair.  Modern Psychiatry and Psychology have developed many effective drug and therapy-based answers to clinical depression.  The type of anti-depressant usually prescribed is called a selective serotonin reuptake inhibitor (SSRI).  Prozac is the most famous example from this family.  Research has found that combining an anti-depressant with therapeutic interventions such as individual psychotherapy, cognitive behavioral therapy, or family-based therapy has the greatest immediate and long-term impact on depression. 

In my own clinical practice I have seen how effective this combined approach can be, especially when it is supplemented by one more element – namely, traditional Jewish wisdom.  Over three thousand years of primary texts (such as the Torah, Talmud, and Zohar) and their commentaries has provided a deep reservoir of ideas and approaches that any practicing psychotherapist would be wise to explore and tap into.  For example, Jewish wisdom makes a sharp distinction between atzvut (dejection and depression) and merirut (bitterness and sorrow).  I explain to my clients suffering from depression that we need to differentiate between sadness, which is an authentic and appropriate reaction to something like a death or some other loss, and depression, which is basically a numbing out of feeling that leads to nihilistic thinking.  This is a vital point to understand because it has been my experience that we tend to move into depression when we are unable to experience sadness to an appropriate degree.  We get stuck in our grief and we shut down.

Jewish tradition teaches that there are appropriate times and places for all our emotions – including sadness and grief.  For example, there is a practice called tikkun chatzot where pious individuals wake up in the middle of the night to mourn the loss of the Temple in Jerusalem.  The Jewish mourning periods of shiva, the year of saying kaddish, and yartzeit anniversaries set aside times when it is safe to step out of our normal routines and truly feel and express our sadness.  Memorial days like Tisha b’Av and the 17th of Tammuz evoke sorrow over the losses that the Jewish nation has suffered.

In general Jewish tradition values simcha (joy) over all other emotions because a joyful person is able to accomplish more goodness in this world than someone who is dejected and depressed.  However, the reality is that we cannot be truly joyful unless we have passed through our particular sadness authentically and thoroughly.  Therefore, my goal for therapy is to create a place and time where clients feel safe to let down their defenses and find their tears over painful memories or events.  This cathartic process allows them to get unstuck from their grief and move back into the active pursuit of life.

1 comment:

  1. Thank you, this is a very helpful discussion. I agree that the distinction between atzvut and merirut--attributed to Rabbi Schneur Zalman, in his classic work, Tanya--is analogous to that between major depression/melancholia and ordinary grief, such as that following bereavement. For more on this, I hope readers will see:

    Best regards,
    Ronald Pies MD