On Doubt and Depression

In offering pastoral counseling over the years, especially to my college students, one of the things I've noticed is an overlap between doubt and depression. And it can be hard, at times, to suss out what is going on, which is cause and which is effect.

For example, has the onset of depression triggered a season of religious doubt and deconstruction? Or has a season of doubt and deconstruction, a loss of faith, brought about some depression? 

Of course, it is more complicated than that, and there is likely a feedback loop at work as well, depression and doubt fueling and reinforcing each other.

The reason this makes a difference, from a pastoral perspective, is trying to get to the root of the issue. If a person is struggling with an underlying depression any talk about God, faith, or church is going to be affected. In such instances, it might be better to address the depression before turning toward conversations about, say, "the problem of evil." Frankly, a lot of people approach me with spiritual questions, like the problem of evil, but the deeper issue is an underlying mental health issue that needs to be addressed. The presenting problem is God, but the real issue is depression.

And yet, a loss of faith can lead to depression. Faith goes to the root of our meaning-making structures. So when that meaning-making structure is dismantled, deconstructed, or derailed there will often be a season of dysphoria and existential angst. The loss of God can be deeply painful and destabilizing, triggering the onset of mental health symptoms. And if the depression has deepened it will have to be dealt with on its own terms. And yet, given that these symptoms have a spiritual etiology, pastoral conversations would be getting to the source of some of the emotional disturbance. 

In clinical settings, we often describe the co-occurrence of mental disorders as "comorbidity." In the face of comorbidity, clinical psychologists will often try to sort out the primary disorder. This is often done by assessing the temporal ordering of the symptoms. Which symptoms appeared first? 

I'm suggesting that doubt and depression are often comorbid and that their temporal sequencing--Which came first, the doubt or the depression?--might illuminate pastoral and clinical interventions.