Defining Depression

He… a short tale to make,
Fell into sadness, then into a fast,
Thence to a watch, thence into a weakness,
Thence to a lightness, and by this declension,
Into madness wherein he now raves
And all we mourn for.⁶

Depression is a mental illness. Non-mental illnesses are typically classified according to their pathology or what causes them. Each disease is cataloged with a list of distinguishing symptoms to help the medical practitioner identify the disease. If enough symptoms are present, the doctor can perform a series of well-defined tests to concretely identify the illness.

Depression is not so easily categorized, defined, or identified. In 1992, the Royal College of Psychiatrists launched a campaign to increase the public’s understanding of depression and found that most people had great difficulty even defining the term.⁷ Depression is classified by the presence of a series of fairly well recognized symptoms, but it is often difficult to determine if those symptoms are in fact actually causes of depression. Depression also has a wide range of forms and severity. While the range of symptoms is generally agreed upon, there are no medical tests for identifying depression.⁸ There is also a heavy negative stigma around mental illnesses, especially in religious circles, causing many people to avoid treatment. These problems leave many cases of depression unidentified or improperly treated.

Clinical Depression and the Blues

One of the first difficulties in classifying depression is distinguishing clinical or major depression from the up and down moods of everyday life sometimes called “the blues.” When asked to explain the blues, Louis Armstrong is supposed to have said, “If you have to ask, you’ll never know.”⁹ Some of the symptoms of depression such as loss of appetite, depressed mood, and decreased energy are normal responses to stressful events such as performing poorly on an exam, caring for a dying parent, or a failed relationship. Most of the time individuals with a healthy outlook and strong relationships come out of these moods and “pull themselves together” within a few days.

The following is a list of symptoms associated with depression from the NIMH (National Institute of Mental Health). If the symptoms are present for more than two weeks, a person is likely to be suffering from clinical depression:

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain¹⁰ 

Not everyone who is depressed experiences every symptom, and not everyone with any of these symptoms is suffering depression. In addition to the above list of psychological and physiological symptoms, the experiences of Christians are further compounded by more specific thoughts, such as:

• Wondering if one is truly saved
• Feelings of failure to live a worthy Christian life
• Irrational guilt over perceived sinfulness

A Broad Definition

A useful definition of depression must take into account the complex nature of the illness. Depression is both a distinct disease and a symptom of other illnesses. Regarding the nature of depression, on the one hand, “Scientists, researchers, and mental health practitioners erroneously insist on rigidly viewing depression as either a psychological illness or a biological one.”¹¹ On the other, “many well-meaning [Christian] writers have caused a lot of unnecessary emotional pain by condemning depression as sin.”¹² Depression cannot be seen in only spiritual terms, because humans are not only souls, but also have bodies which directly affect one another; and it cannot be seen in purely psychological or biological terms for the same reason. Kristina Downing-Orr, an academic and professional psychologist who is both familiar clinical research and active in treatment, proposed the following definition: “Depression is an illness, several illnesses, or symptomatic of another health problem that strikes both the mind and the body.”¹³

Her definition, while not necessarily accounting for any spiritual factors, is helpful because it considers the variety of causes and effects of depression.