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I met Aaron Kheriaty, M.D., while working on a wire service story about the Psychiatry and Spirituality Forum at the University of California, Irvine, which he directs in addition to serving as director of residency training and medical education in the department of psychiatry. When my son Gabriel died by suicide the day after I submitted that 2008 story, Aaron was the first person I called. He became a good friend as he ministered to my family.

I was deeply moved when he included Gabriel in the dedication of The Catholic Guide to Depression , his new book (co-authored with Monsignor John R. Cihak). Aaron writes about what it was like for him to walk into my family’s tragedy. More importantly, he and his co-author offer hope to depression sufferers and their families. Our interview has been edited for length and clarity.

Christine A. Scheller: Why did you write a book about depression specifically for Catholics?

Aaron Kheriaty: The concept for the book originated from my publisher, Sophia Institute Press, a Catholic publisher with its own niche market, so they wanted to highlight the aspects of the book that are distinctively Catholic. Also, there are books written by Protestant Christians on depression, but we didn’t see much written by Catholics, and certainly nothing written by a Catholic mental health professional. We saw an audience that we could speak to very directly, but as I was writing the book, it was clear to me that any Christian who professes Jesus as Lord could benefit from it as well.

You say many people think depression is nothing more than an intense episode of “the blues.” Why are they wrong?

One of the things that gets in the way of people comprehending this illness as something profoundly different from everyday emotional experiences is the word depression itself. It’s a really pathetic word. Depression goes beyond a passing emotional state and really affects the whole body and the whole mind. We have to get past that word and try to explain to people that what their loved one is going through is profoundly debilitating both mentally, and in a sense, even physically. A person feels drained and sapped of vitality and they lack a normal sense of being connected to the world and even connected to their own body.

Not long after my son’s suicide, I watched a PBS special on depression in which a mental health professional described it as the feeling of being “a terrible person.” Is this common?

The sense of irrational self-loathing is unfortunately very common, especially in moderate to severe depression and bipolar depression”a real dark, nihilistic sense of worthlessness or even self-hatred.

Does the biological aspect of bipolar depression cause this self-loathing or is it working in concert with other social and/or spiritual issues?

It’s a little too simplistic to say that the biological factors in depression cause it, but this certainly contributes. We need a well-functioning brain to have clear thinking. That’s obvious. What happens with depression is that the person seems to lack cognitive or mental flexibility, so their thoughts become very constricted and it’s difficult for them to perceive or consider alternate solutions to what they see as life problems. Relational factors contribute to that, but also the biological lack of vitality will drag a person’s thoughts downward.

You say Christians don’t always treat depression like the multifaceted problem that it is, but can over-spiritualize it.

A lot of Christians come to me pretty reluctantly and oftentimes against the advice of a Christian friend or family member, sometimes even a minister, who suggests that they shouldn’t trust psychiatrists or that medications aren’t appropriate because this is really a spiritual problem. I consider that to be unfortunate. Oftentimes it delays the time between the onset of symptoms and appropriate treatment.

However, I argue in the book that a purely medical model also is not adequate to describe depression. Reducing it to a chemical imbalance in the brain or a biological disease model alone doesn’t take into account other important factors, including spiritual factors, behavioral factors, things that the person may be doing (knowingly or unknowingly) that contribute to the depressive episode. I think you can go off the rails easily in both directions. I advocate looking at depression from multiple perspectives, both in trying to understand what’s causing it and in finding appropriate treatments for it.

How does the sacrament of confession, for example, help a person recover from depression?

One of the principles of Catholic theology is the principle that we call sacramentality. The idea is that in the incarnation, God took on our flesh. He became a man. Because that is a central truth of our faith, we understand that the material world can mediate spiritual realities. As human beings, creatures of both body and soul, we relate to God, among other things, through our senses. If I’m burdened by guilt or by sins of the past, when I go to confession I’m able, in a very tangible way, to hear words of absolution from the priest who is acting in the name of Christ and the Church.

Many people who have gone to confession will describe it as a powerful experience”to be able to walk away knowing with a great deal of conviction that they have indeed been forgiven, that the burden they’ve been carrying has been lifted. I think that’s consistent with our psychological makeup as well. The other thing that I think happens in confession is that we understand that sin not only harms our relationship with God, but it harms our relationships with others. So many people experience, I think rightly so, a sense of reintegration with a community after making a good confession.

In the last chapter, you talk about “divine filiation” and the virtue of hope. Can you describe these two principles?

John in his epistle says that we are truly children of God in Christ. He has adopted us by grace to be his sons and daughters. This is not just one more religious or metaphysical truth among many. This truth has to be the foundation for our whole existence as Christians. I think of it as the glasses we put on that allow us to see everything in our life with more clarity. It’s the lens through which we experience joys, sorrows, pain, suffering.

This idea of being a child of God is so fundamental and life-altering that we have to try to live constantly with an awareness of that divine filiation, an awareness that God is near, that I’m always in his presence. Wherever I am and whatever I’m doing, he’s there sustaining me with such profound love and mercy that I can’t possibly fathom how much he loves me. That’s something of what I was trying to convey in the last chapter of the book.

It gives rise to the three theological virtues that Saint Paul mentions in 1 Corinthians, chapter 13: faith, hope, and love. I focus on the virtue of hope because it’s the one we hear the least about in terms of preaching. We hear a lot about faith and about love, but less about Christian hope. Depression is really sort of an affliction of the soul, because very often it strikes precisely there”it makes it difficult to have hope. Both on a human level and on a spiritual level, our basic hopes for this life can be shattered by depression. A sense of a future in this life can be shattered by depression.

And also, our hope for union with Christ and for heaven can be eclipsed. I won’t say that it can be shattered because hope is given to us by God’s grace; it’s not something that we manufacture. But our sense of it, our awareness of it, our knowledge and subjective feeling of hope can be eclipsed when we are depressed. And so we sometimes have to recall that fundamental truth, even when we can’t subjectively feel it.

Christine A. Scheller is a widely published journalist and essayist. She lives with her husband at the Jersey Shore.

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