As part of his comment, Dr. Ron Pies provided the link to another of his articles, “The Anatomy of Sorrow: A Spiritual, Phenomenological, and Neurological Perspective,” which I found incredibly fascinating (of course, I’m obsessed with the brain and how it works). The article synthesized all of the information I had learned both as part of my theology degree and in all my reading of Johns Hopkins studies. I had difficulty deciding which part to excerpt, because it’s all great stuff, but given our question today focuses on grief versus depression, I decided to feature the section called “The Phenomenology of Sorrow.” To get to his article, click here.

Just as the English scholar, Robert Burton, was able to develop an “anatomy of melancholy”, we can develop a rough anatomy of sorrow. Burton himself recognized sorrow as related to, but distinct from, melancholy. Citing Hippocrates, Burton writes that sorrow is both “…mother and daughter of melancholy [depression]…” and that the two “tread in a ring…for sorrow is both cause and symptom of this disease.” In modern parlance, Burton describes a vicious circle, in which sorrow and depression are part of a mutually reinforcing feedback loop. 

But though the boundaries between ordinary sorrow and significant depression are sometimes vague, there are experiential or “phenomenological” features that help us distinguish these conditions. For example, when we experience everyday sorrow, we generally feel-or at least are capable of feeling – intimately connected with others. Thus, Shakespeare has Romeo and Juliet parting in “…such sweet sorrow” (Act 2, scene 2). In contrast, when we experience severe depression, we typically feel outcast and alone. Sorrow, to use Martin Buber’s terms, is an “I-Thou” or relational experience; clinical depression, a morbid preoccupation with “me”. Indeed, William Styron, in Darkness Visible, describes depressed individuals as having “their minds turned agonizingly inward.” 

The sense of time is also different in sorrow and depression. When we experience sorrow, we have the sense that, someday, it will end. As Psalm 30 tells us, “Weeping may last for the night, but joy returns in the morning.” Commenting on this passage, pastor John Phillips notes, “Sorrow is but a passing wayfarer who only tarries for a night; with the dawn, he leaves and joy takes his place.” In contrast, severe depression envelops us with the sense that it will last forever. Indeed, Dr. Nassir Ghaemi, drawing on the work of Leston Havens and Eugene Minkowski, has called attention to the sense of temporal distortion in depression; i.e., the subjective feeling that time itself is slowed. Havens observes that for the depressed person, “…the future is lost, and the past becomes fixed, immovable, bad, the place of irredeemable mistakes.” Indeed, one recent empirical study demonstrated that during depression, the experience of time itself is slowed; in mania, it is accelerated.

Sorrow, unlike severe depression, is curiously ambivalent: sorrow has the capacity to contain joy within it, or at least to find solace within its own essence. Sorrow, in this sense, is dialectical: it generates an inward “conversation” between hopeful possibility and foreclosure of hope. Thus, when Martin Luther was confronted with the imminent death of his beloved daughter, Magdalena, he is said to have uttered these words to the girl, as she lay in his arms:

“Lena dear, my little daughter, thou wilt rise again and shine like a star-yea, as the sun! I am happy in the spirit, but in the flesh I am very sorrowful.”

Another experiential difference between sorrow and depression is brought home in an anecdote concerning the writer James Joyce, and his daughter, Lucia, who was eventually diagnosed with schizophrenia. Although apparently apocryphal, the vignette makes an important existential distinction. Supposedly Joyce had brought Lucia to the eminent psychoanalyst, Dr. Carl Jung. Joyce was perplexed, regarding the difference between his own idiosyncratic thinking, and the convoluted thought processes of his daughter. Jung is said to have replied: “She falls. You leap.”

Indeed, we might say that depression is to sorrow as falling is to leaping. Put another way: we are overtaken by depression, but give ourselves over to sorrow. There is, in short, an intentional dimension to sorrow. The priest Francisco Fernández Carvajal tells us that, “…like love, sorrow is an act of the will, not a feeling.” More than that, Fernandez insists, “Sorrow is a gift we must ask for.”

Sorrow, a gift? This counter-intuitive perspective is nicely elucidated by the psychotherapist and former Catholic monk Thomas Moore:

“Sorrow removes your attention from the active life and focuses it on the things that matter most. When you are going through a period of extreme loss or pain, you reflect on the people who mean the most to you instead of on personal success; and the deep design of your life, instead of distracting gadgets and entertainments. You may be more open to the beauty of your world as a relief from distress. Beauty is always present, but ordinarily you may not notice it because of your priorities or your absorption in other things.”

In contrast, it is very rare, though not unheard of, that severely depressed individuals consider their depression per se a “gift”. Some, however, have found spiritual meaning or sources of creativity in their depression. Dr. Kay Redfield Jamison, a psychologist who suffers from bipolar disorder, has observed that

“Artistic expression can be the beneficiary of either visionary and ecstatic or, painful, frightening, and melancholic experiences. Even more important, however, it can derive great strength from the struggle to come to terms with such emotional extremes and from the attempt to derive from them some redemptive value.”

Nevertheless, the well-known association between bipolar disorder and creativity does not mean that severe depression per se is a period of creativity. More typical of the depressive period and its effect on creativity is this description from essayist Virginia Heffernan:

“Depression brought to me a new rationing of resources: for every twenty-four hours, I got about three, then two, then one hour worth of life reserves-personality, conversation, motion.” 

Psychiatrist Richard Berlin MD, editor of Poets on Prozac: Mental Illness, Treatment, and the Creative Process, has summarized his experience as follows:

“The idea that depression might enhance creativity is a myth, often based on the life stories and statements of deceased artists and writers… Contemporary poets who are alive and can tell us about their experience with depression are consistent in reporting that it was only after effective psychiatric treatment that they were able to create at their highest levels.” 

We have so far adumbrated four experiential dimensions that help differentiate clinical depression from sorrow; i.e., the relational, temporal, dialectical, and intentional realms. But this analysis is hardly exhaustive; indeed, we can hypothesize other phenomenological dimensions that may help distinguish clinical depression from ordinary sorrow. For example, do these states differ in the realm of personhood? As Berlin points out, severe depression interferes with realistic self-assessment. For example, the severely depressed individual may describe herself as “a total nothing,” “a complete failure,” or “a big zero.” In contrast, the sorrowful individual typically sees himself as a complex and full-fledged person; i.e., as one bereft but by no means rendered a non-entity.

Another (though perhaps related) phenomenological difference between sorrow and clinical depression may involve what I call mortal vulnerability – the sense, in severe depression, of being at the mercy of a hostile universe. This is wonderfully expressed in these lines from a poem entitled, “Depressive”, by J.D. Smith:

Overshadowed by a blade of grass,
Soaked by one rain-drop,
Struck down by a dandelion seed.
Carried off by a sparrow…

In summary, the sorrowful and the severely depressed inhabit two quite different phenomenological worlds, though the two “universes” intersect in certain experiential respects; for example, both the sorrowful and the depressed person will describe feelings of sadness and loss. The severely depressed person, however, endures a unique kind of suffering. Even though, as Paul Genova MD has observed, suffering may be beneficially “transformative” in some patients, others will simply be crushed by their suffering. Indeed, it is hard to find a better phenomenological description of such soul-killing suffering than in William Styron’s account of his severe and intractable depression, in Darkness Visible:

“Death was now a daily presence, blowing over me in cold gusts. Mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain…. [the] despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical disco
mfort of being imprisoned in a fiercely overheated room. And because no breeze stirs this caldron, because there is no escape from the smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion… In depression the faith in deliverance, in ultimate restoration, is absent…”

To get to the original piece, click here.

To read more Beyond Blue, go to www.beliefnet.com/beyondblue, and to get to Group Beyond Blue, a support group at Beliefnet Community, click here.