Title: Losing Faith in Depression: toward a more expansive relationship between religion and mental health. Abstract: By reviewing religion and depression research through a medical anthropological perspective, this paper makes two arguments. The first argument is that most of this research implicitly adopts a biomedical paradigm. Within this framework depression is treated as an individual disease with specific symptoms and religion is cast as an auxiliary remedy. The second argument is that this biomedical framework may obscure a more complex and integrated relationship between religion and depression. Religion is more than a remedy and many experiences of depression do not fit in the biomedical category. By overly emphasizing the individual, this framework elides the systemic violence that is intimately connected with alternative experiences of depression. It also misses the integral role faith plays in these experiences. By exploring a more expansive view of how religion shapes individual and communal life, we can also deepen our understanding of the relationship between religion and depression. By reviewing religion and depression research in African American communities through a medical anthropological perspective, this paper makes two arguments. The first argument is that most of this research implicitly adopts a biomedical paradigm. Within this framework depression is treated as an individual disease with specific symptoms and religion is cast as an auxiliary remedy. The second argument is that this biomedical model may obscure a more complex and integrated relationship between religion and depression. Religion is more than a remedy and many experiences of depression do not fit in the biomedical category. By overly emphasizing the individual, this framework elides the systemic violence that is connected to alternative experiences of depression. It also misses the integral role faith plays in these experiences. By exploring a more expansive view of how religion shapes individual and communal life, we can also deepen our understanding of the relationship between religion and depression. Summary: Only thing I know, he s just losing his faith and his strength. He s losing his faith and strength. (Wittink, 2009) This quote is a participant s response after reading a vignette describing someone with depressive symptoms. In many cases this response would be dismissed as eclectic, if not parochial. The empathic clinician might nod in agreement before proceeding to build a treatment plan. A clinician familiar with the research on the potentially
salubrious impact of religious coping on depression might even encourage this interpretation. The clinician will then, most likely, return to finding a way to treat the individual s depression. In this paper I will take the statement above as seriously as possible. Rather than casting it as a wrongheaded interpretation or suggestive of a potential supporting strategy, I will take the respondent at her word. What if depression is a loss of faith and strength? What comes into view when we consider the experience of depression to which such statements allude? Taking the statement seriously not only expands our understanding of depression, it also demands a deeper recognition of way religion shapes individual and communal life. In this paper I am making two arguments. The first argument is that most research on the relationship between religion and depression within African American communities treats depression as a disease with a set of distinct symptoms. This biomedical model of depression carries specific assumptions about individuals, emotions, and illness. It not only prejudges the nature of depression it also casts religion into the narrow role of treatment or coping strategy. The common research question is- what part of religion is impacting depression outcomes? To understand the prevalence of this model I review this body of research. Throughout the literature, religion, or some aspect thereof, is the independent variable and depression is the dependent variable. This is not an inherently misguided framework; it allows researchers to investigate whether the seemingly salubrious effects of religion on depression come from religious coping strategies or religious attendance or social support or seeking guidance from religion. The list goes on and the results vary. My
purpose is not to resolve these ambiguities, instead I am highlighting the point that beneath the various findings lies the common assumption that some part of religion is impacting depression outcomes; the nature of the relationship is taken for granted. The research implicitly treats depression as a biomedical disease and religion as a remedy. Arthur Kleinman and Byron Good described this model of depression nearly 30 years ago: when culture is treated as a constant it is relatively easy to view depression as a biological disorder, triggered by social stressors in the presence of ineffective support, and reflected in a set of symptoms or complaints (1985, p. 492). Regardless of the component of religion that researchers focus upon, nearly all of them adopt this understanding of depression as a biological disorder measurable by a set of symptoms. The problem is that culture cannot be treated as a constant. My second argument is that this implicit framework may obscure a more complex and integrated relationship between religion and depression. If depression really is a loss of faith, what does that reveal about its relationship to religion? To move beyond the current, mechanical framework demands a more expansive account of depression and a deeper understanding of the way religion shapes our life-worlds, imaginations, and bodies. To construct the second argument I engage Wittink et al. s (2009) in-depth interviews among African American communities that reveal a deeply spiritual explanatory model for depression. Participants describe faith as an intrinsic part of the etiology, experience, and pathway to care for depression. Exploring other accounts of
depression from the global majority reveals that many experiences fundamentally differ from the biomedical perspective. Religion is often an integral part of these experiences. The approach of critical medical anthropology builds on this by asking what is obscured when we focus on depression within marginalized communities from a biomedical perspective. With attention to hierarchies of power this approach shows how we risk missing the systemic everyday violence experienced by African Americans if we focus on depression as an individual disease. We also risk seeing religion as a mere coping strategy instead of a thread within a more complex and holistic life-world. The work of Stephanie Mitchem and Barbara Holmes helps guide us beyond this narrow perspective on religion. Both describe an experience of religion that transcends religious attendance, social support, or intrinsic religiosity. Each of these facets is real, but the whole is something else entirely. Therefore we may wonder how appropriate it is to dissect religion into elements as if they individually impact symptoms of depression. If we look outside of the individual to acknowledge the situational violence that may cause an experience of depression, then our gaze should remain outside- fixed on the complex way religion forms an individual s values, behavior, thoughts, imagination, relationships and experience while allowing persistence in the midst of everyday violence. Losing faith in such a situation could be a more severe illness than diagnosable depression. If depression is an experience of being worn down and overwhelmed by systemic violence, then perhaps loss of faith is the correct diagnosis. within this world, regaining faith may mean regaining solidarity within one s community, regaining the trust that one can thrive or at least build a coherent world with peers amidst structural violence.
Worship, praying with a community or simply sharing lunch makes more sense than seeing a clinician who may struggle to understand the inside of a marginalized social world. These acts of faith are more than just treatments for depression; they are among many actions that create a habitable life world. The relationship between religion and depression does not fit within a mechanical framework; it only makes sense within its own holistic symbolic ecology. To understand this relationship requires us to entertain these other possible worlds and to realize that religion and depression exist as threads of the same fabric, not as discrete parts of a machine.