Lessons from sacred texts

Professor Cook has written a stimulating article on ‘an important opportunity to engage psychiatry in a critical and constructive way with religious texts’. ¹ He concentrates on evidence for schizophrenia, but possibly the contribution of sacred texts may be even more helpful in the case of depression. In addition to the unfortunate King Saul, ² there are probably many accounts of depressed mood, but two examples stand out because the mechanism of the relief of the depression is apparent in the texts.

Job in the Old Testament and Arjuna in the Bhagavad Gita, which is a part of the Mahabharata (the Hindu equivalent of the Bible) both suffered from depression. ^3,4 Job was depressed because the Lord had allowed Satan to have his children killed, his livestock driven off and his body to be covered with boils. He felt this was unjustified according to the current philosophy of retributive justice, so he was angry with God. Arjuna was depressed (and had a typical panic attack) because Krishna (the eighth avatar of the god Vishnu) told him to slaughter many of his relatives and mentors, and he was reluctant to take Krishna's order. Both Job and Arjuna have lengthy dialogues with their gods, who express their majesty and omnipotence in marvellous poetry. These displays of dominance have some effect, but final and complete submission is not achieved in either case until the god shows himself in person. Submission is then unqualified in both cases, and both then recover from their depressions and lead successful lives. We concluded from these examples that whereas belief in god may relieve anxiety about the meaning of life and what happens after death, it requires submission to god to relieve depression. ⁴ Those who believe but do not submit are liable to spiritual struggles, as pointed out by C. S. Lewis in The of Problem of Pain. ⁵

The Book of Job is of particular interest to psychiatry because the story can be read in two ways. The usual interpretation is that Job suffers from a reactive depression, understandable considering the degree of his misfortune. The other is that he has a psychotic depression and his misfortunes are delusional. Favouring the latter is the fact that his three comforters do not offer condolences on the deaths of his children, and that finally his children are restored to him in the original proportions (seven sons and three daughters), which is more likely to be due to the loss of a delusion than to further childbearing effort on the part of Job and his wife. If the latter is the case, it shows how a delusion may appear real not only to the patient, but to generations of biblical scholars who have read of Job's situation.

The lessons from these extracts from scripture are three-fold. First, that those treating depressed believers should ensure that the patient has made a total submission to the will of God. Second, those studying the relation of mental health to religion should construct a scale which measures the degree of submission v. rebellion, or ‘my will’ v. ‘Thy will’. Third, those treating depressed agnostics should look for a secular equivalent to joyous total surrender to God.