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Sadness, Depression, and the Dark Night of the Soul

Sadness, Depression, and the Dark Night of the Soul

Glòria Durà-Vilà | Professor Roland Littlewood


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Revealing a tension between the medical model of depression and the very different language of theology, this book explores how religious people and communities understand severe sadness, their coping mechanisms and their help-seeking behaviours.

Drawing from her study of practicing Catholics, contemplative monks and nuns, priests and laypeople studying theology, the author describes how symptoms that might otherwise be described as pathological and meet diagnostic criteria for a depressive disorder are considered by some religious individuals to be normal and valued experiences. She explains how sadness fits into the 'Dark Night of the Soul' narrative - an active transformation of emotional distress into an essential ingredient for self-reflection and spiritual growth - and how sadness with a recognised cause is seen to 'make sense', whereas sadness without a cause may be seen to warrant psychiatric consultation. The author also discusses the role of the clergy in cases of sadness and depression and their collaboration with medical professionals.

This is an insightful read for anyone with an interest in theology or mental health, including clergy, psychiatrists and psychologists.

A balanced account of one of the most unbalanced topics in cultural psychiatry, psychiatric anthropology, and religious studies. An important study for inclusion in courses on religion and medicine, and an empirical provocation to psychiatry, anthropology and religious studies to reconsider what it means to struggle, endure, succumb, and overcome a ubiquitous form of human misery.
Professor Arthur Kleinman, Department of Social Medicine, Harvard University, author of 'Rethinking Psychiatry: From Cultural Category to Personal Experience'
In her preface, the author writes "I would like you to think of it [the book] as a sort of diary of my travels, a witness to my experiences and to the lessons I learned along the way." This is indeed how I experienced reading the book - I had a sense of journeying alongside the author in her study.
Andrew Clark
Royal College of Psychiatrists' Spirituality and Psychiatry Special Interest Group

In The Lost Art of Healing: Practicing Compassion in Medicine (1999), Dr. Bernard Lown, a Nobel laureate and physician, writes about the fundamental need for human relationships between doctor and patient, pointing out how true healers make use of sympathetic listening and a trusting relationship, which affects outcomes from cardiac illness to depression. If medical care values meaning and context, with a strong alliance between
provider and patient being crucial to outcome, they are even more critical in psychiatry, psychology, and religion, three fields in which emotion is at the forefront of care (Greenberg, 2016). Cure, in Latin, means to care! Durà-Vilà's work goes a long way toward this good end.

American Psychological Association
Durà-Vilà's rich ethnography of spiritual sadness is as haunting as it is beautiful. By giving us intimate glimpses into participants' spiritual lives, this work illuminates how, for some, sadness can become a source of deep reflection, and even grace, as well as what is potentially lost when medicalization strips sadness of its resonant meanings. Deftly and sympathetically weaving together spiritual and biomedical perspectives, this is a "must-read" book for anyone interested in depression, spirituality, and how institutions like religion and psychiatry shape our inner worlds.
Professor Rebecca Lester, Department of Anthropology, Washington University, author of ‘Jesus in Our Wombs: Embodying Modernity in a Mexican Convent’
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.
Revd Anne Holmes
Church Times
We need a much better understanding of, and antidote to, the all-pervasive but often pointless medicalisation of human sadness and anxiety. This book engages with this problem from a fresh vantage point - that of men and women living a secluded religious life who not only make sense of psychological torment but face it head on, accommodating and transforming it as a kind of spiritual alchemy. Based on rich ethnographic research, Glòria Durà-Vilà explores the spiritual conceptualisation of human angst and loneliness with insightful compassion. In doing so, she permits us a unique and revealing account of dwindling religious communities that will stimulate anyone interested in the human condition.
Professor Gerard Leavey, Director of the Bamford Centre for Mental Health and Wellbeing, Ulster University
This is a truly ground breaking publication. By bringing together insights from psychiatry and spirituality Dr Glòria Durà-Vilà has provided an exceptionally helpful guidebook for all involved in helping people in situations of personal distress, sadness and trauma.
Professor Bernadette Flanagan, author of 'Embracing Solitude'
Glòria Durà-Vilà is a consultant child and adolescent psychiatrist working in the Surrey and Borders NHS Trust. She was brought up as a Roman Catholic and has an interest in both religion and psychiatry. She is Honorary Lecturer in the Department of Mental Health Sciences at University College London and author of My Autism Book, also published by Jessica Kingsley Publishers. She is based in London, UK.
In this substantial study, Glòria Durà-Vilà has stepped boldly into the conflict between sacred and secular understandings of sadness, and revealed it to be a remarkably interesting, important and fertile area of study. The book presents detailed and careful research which not only shines light into contemporary and traditional experiences of darkness and depression, but also into the often murky ways that religious and medical professionals think about each other. The work is certainly illuminating; it deserves to be influential.
Dr Stephen Cherry, Dean of King’s College, Cambridge, author of ‘Barefoot Disciple’, ‘Beyond Busyness: Time Wisdom for Ministry’ and ‘Healing Agony’
Lucid scholarship and sensitive ethnography situated in the ecclesiastical landscape of Spain provide grist for Durà-Vilà's cultural critique of a psychiatric check-list approach to diagnosing depression devoid of context. Clearly written and engaging, the study explains strengths and limitations of medicalising and spiritualising normal sadness and pathological depression. As a timely study of challenging issues, it demonstrates the value of a cultural formulation of religious faith. The book is an important contribution to cultural psychiatry, psychological anthropology and religious thought.
Professor Mitchell Weiss, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel
This book deepens our understanding of the complex distinction between normal sadness and depressive disorder. Through a penetrating study of Catholic help-seekers in Spain the author clearly illuminates the ways that individuals interpret their distress and take various kinds of actions to relieve it. This book makes an important contribution to knowledge not just about depression but also about the process of medicalization more generally.
Professor Allan Horwitz, Department of Sociology, Rutgers University, author of 'The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder'
A novel book that tackles in a creative and original way, as well as being empirical, documented and rigorous, one of the great topics of today: the relationship between spirituality, religion and mental health in a globalised world in a state of deep transformation. This brilliant analysis highlights the differences among sadness, the Dark Night of the Soul and depressive disorders in a social framework with a strong tendency to medicalise human suffering.
Professor Joseba Achotegui Loizate, Department of Psychiatry, University of Barcelona, Secretary of the World Psychiatric Association - Transcultural Psychiatry Section

Table of Contents

Section Title Page Action Price
Sadness, Depression, and the Dark Night of the Soul: Transcending the Medicalisation of Sadness by Glòria Durà-Vilà 3
Foreword by Professor Roland Littlewood 11
Acknowledgements 14
Preface 16
What is the book about? 16
Why did I embark on this research? 19
Reflecting on the challenges of the research 24
Potential positive effect of the research 28
Organisation of the book 30
Note 31
Part I - Setting the Literary and Historical Contexts 33
Looking back at the origins of the study 33
Note 37
Chapter 1 - Depression and the Medicalisation of Sadness: Conceptualisation and Help-Seeking 38
Medicalisation of sadness and suffering 38
The role of culture and religion 40
Help-seeking and coping with sadness and depression 48
Note 54
Chapter 2 - The Role of the Clergy in the Management of Sadness and Depression, and Their Collaboration with Mental Health Professionals 55
Psychiatrists’ attitudes regarding the clergy’s involvement in mental health care 56
The clergy as a resource for mental health 57
Collaboration between the clergy and psychiatrists 62
Pastoral care, spiritual direction and the sacrament of confession 65
Chapter 3 - Sketches on the Catholic Church and Monasticism 71
The state of the Church and the clergy 71
An historical overview of the Cistercian and Augustinian Orders 77
Ethnographic research into monasticism 85
Notes 87
Part II - Unfolding the Narratives of Sadness and Spiritual Growth 89
Chapter 4 - The Participants and Their Ways of Life 92
Fieldwork and interviews 92
57 faces, 57 stories 96
Differences between the monks and the nuns 133
Notes 137
Chapter 5 - Conceptualisation of Sadness, Depression and the Dark Night of the Soul 140
Normal sadness and pathological sadness: conceptualisation and distinction 140
The Dark Night of the Soul: a case of non-pathological religious sadness 154
Religion as a cause for pathological sadness 162
Notes 165
Chapter 6 - Coping and Help‑Seeking for Sadness and Depression 167
Coexistence of religious and secular coping strategies and help-seeking behaviours 167
Medical help-seeking behaviours and an absence of causality for the sadness 203
The impact of the individual’s personality 205
Differences and peculiarities observed in the nuns, monks and priests 206
Notes 215
Chapter 7 - The Role of the Clergy in the Care of Sadness and Depression, and Their Collaboration with Mental Health Professionals 217
Pastoral care is provided for both sadness and depression 218
Views on the clergy’s pastoral care from the perspective of contemplative participants and lay people: benefits, critique and comparison with the monks 238
Clergy and mental health professionals: overlap, rivalry and collaboration 248
Notes 273
Part III - Stepping Beyond the Monasteries’ and Parishes’ Walls 275
Chapter 8 - The Medicalisation of Sadness and the Dark Night of the Soul 276
Modern tendency to define severe distress as disease 276
Contextualisation of sadness: attribution of meaning and the Dark Night of the Soul 279
Note 285
Chapter 9 - Religious Coping with Sadness and Depression 286
Religious coping strategies 286
Differences between the nuns and the monks 288
Notes 291
Chapter 10 - The Clergy’s Role in Assisting Those Suffering from Sadness and Depression 292
My findings in dialogue with the previous literature 292
The clergy’s view of psychiatrists: rivalry and opposition 294
Clergy’s explanatory models for depression and possible repercussions for their pastoral care 299
Clergy’s pastoral care for sadness and depression: compliments and complaints 302
Final reflections on pastoral care 312
Notes 314
Chapter 11 - A Framework to Differentiate Normal Sadness from Depression 315
Rationale of the framework 315
Distinguishing normal sadness and the Dark Night of the Soul from depression in clinical practice 317
Applicability of the study to a secular context 322
Notes 324
Appendix 1 - Ethical Considerations 325
Appendix 2 - Limitations of the Study 327
Appendix 3 - Finding the Questions to Get the Answers 329
Appendix 4 - Summary of Findings: Main Themes and Sub-Themes Extracted from the Participants’ Interviews 334
References 337
Subject Index 350
Author Index 355
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