Despair and Depression (from 'The Neurobiology of Sin') - Archbishop Lazar Puhalo

“Despair” is often considered to be a sin, though it seldom is. While despair always causes one to “fall short of the mark,” guilt cannot be assigned to it, especially when it is clinical. It must not be regarded simply as resulting from a lack or loss of faith. Depression, too, is often thought of as being somehow sinful, or caused by demons. While these are possibilities, adding such burdens of guilt to a person who has a clinical depression can be devastating. When left untreated, clinical depression can cause the hippocampi to atrophy, and this process is irreversible. Such depression can lead to alcoholism, use of narcotics and suicide. Depression can also be an effect or a symptom of other illnesses. People suffering from borderline personality disorder (BPD) can manifest many symptoms of depression, despair, loss of appetite, difficulty in sleeping, gastrointestinal problems, fatigue and agitation. The same can be said for anyone who is suffering from dysthymia. We are aware of how the chemical sources associated with clinical depression go beyond the problem of serotonin uptake or dopamine malfunctions. Priests should, therefore, be careful not to assign guilt to feelings of despair or depression, but rather treat them with the same anointing prayers with which all illnesses are addressed, while recommending medical intervention. Assigning guilt to feelings of dispair and depression can certainly exacerbate the symptoms and could even incline a person toward suicide.

There are clear neurobiological causes for clinical depression and a sense of despair, and these have nothing to do with weak faith, loss of faith or any specific sins. Let me specify here that I am not speaking about occasional depression or a short-term event-motivated sense of hopelessness. These can be responded to well enough by prayer, confession and dialogue therapy. We are speaking of clinical (long-term and chronic) depression and a sense of hopelessness and despair which are not simply short-term reactions to an event such as the breakup of a marriage or a loss of a job. Another far too often overlooked source of depression is celiac disease. A priest who lies to a person and tells them that depression is not real, that it only a “temptation” may be preventing a person with celiac disease from seeking treatment, and this is a very serious matter indeed. Great physical harm can come to a person with untreated celiac disease. Instead, the sensible and sober priest who hears in confession that a person is in a long-term state of depression or despair will immediately recommend that they consult their doctor about it. One might even suggest that celiac may be at the root of the problem.

In fact, prayer and the healing service are useful and helpful even in the deepest clinical depression and despair, but professional intervention is absolutely necessary in these cases. Despair, hopelessness and clinical depressions are linked to a specific area in the prefrontal cortex of the brain. While this illness is complex and involves other brain regions, the Brodmann area 25 is the generator or motor for a despair/depression loop in the brain. A priest cannot deal with this problem alone, but can be an important part of the therapy, especially if he is cooperating with a mental health care professional. One should never discount the possibility of a tumour, cyst or other medical condition underlying what may appear to be either a mental disorder or habitual sin (especially when such con-ditions appear suddenly or over a relatively brief period of time).

Anxieties, obsessive-compulsive disorder (OCD) and other prob-lems present special cases – and risks – that must be responded to in cooperation with medical professionals. We had mentioned the problem of giving a person suffering from OCD a highly repetitious prayer rule, but what happens when a person in a florid psychotic state reads constantly from the lives of the saints? Let me offer an example of the possibilities. We once had such a person staying in our monastery. After reading the newspaper on one occasion, he suddenly disappeared. Three weeks later, he called us collect from Cape Kennedy in Florida asking for help to return. He had read about a planned launch from the space centre and had become convinced that his presence at Cape Kennedy was absolutely essential to the launch. In his mind, he had become inseparably blended with the events that he had read about.

On another occasion, I was telephoned by a priest because a schizophrenic woman in his parish had read the life of St David of Thessaloniki, climbed into a tree in front of the church and announced that she was going to spend the rest of her life there as “a podvig of holiness.” The priest was reticent about calling the authorities to remove her and he hoped for some advice about how to get her down. In her psychosis, she had totally identified with the life of the Saint that she had read. Dealing with such issues requires guidance from mental healthcare professionals. These are neurobiological problems. We might want to identify despair as a sin, as we read in some paterikons, and we might see a kind of sinful pride, intransigence, arrogance and vainglory in some of the actions of people for whom these manifestations are generated by or mediated by some neurobiological construct. This is, of course, not always the case, but we should be alert to the possibilities and not ignore them, even while we try to lead a person to combating them through spiritual disciplines.

Even the problem of apparent arrogance and an inability to accept one’s own errors and mistakes can have biological underpinnings such as borderline personality disorder or what I like to refer to as trianic syndrome (after a word coined by J.P. Keenan). The problem can lie in an incomplete function of the orbital-frontal cortex. This region of the brain mediates our self-perception, and it can also contribute to addictions. This area of the brain is part of a self-regulatory system, and these problems arise when there is low activity in this region. Certain kinds of therapy can help, and this problem does often improve in a monastic environment where there is obedience and regular interaction with a confessor. All things are helped by sincere prayer. However, helping a person come to grips with such problems requires discretion and discernment. Confession, when it includes discussions between priest and sufferer, can be very helpful. Indeed, we need to remember that confession should not be limited to “breaches of law,” but rather involve all that is causing grief, sorrow, confusion or disorientation to the person. Since this group of symptoms is also manifested in borderline personality disorder, we have to realize that in this latter case we really cannot accomplish anything. As with other illnesses such as schizophrenia, the priest also needs to be alert to the natural tendency of manipulation at which such persons are quite skilled, and set strict and clear limits to the times and length of time that he permits discussions with the subject. The dialectic therapy necessary for borderline personality disorder personalities requires three years of intensive work, and it may only have a 30% improvement rate in the end.

All of these matters, any of which could be considered “sinful” have clear neurobiological causes. The priest can be a significant part of the therapy in all these cases but he must realise that he is dealing with neurobiological problems and not simply moral or personality failings or breaches of some concept of law even when the manifestations are clearly sinful. This reality indicates a need for healing, not punishment, even though sometimes stern disciplines can be necessary in order to accomplish such healings.
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1. Julian Keenan, director of the neuroimaging laboratory at Montclair State University in New York coined the word “trianic” as a meaningless test word while examining “overclaiming phenomenon.” OCP is a circumstance in which a person has a compulsion to know things that he or she does not actually know. This condition appears to be silenced through electro-stimulation in the medial prefrontal cortex.