The Depressed, Lonely Spouse
"The love of husband and wife is the force that welds society together." St. John Chrysostom
This chapter will present the numerous origins of sadness and depression in married life and related a number of strategies to diminish this often-disabling emotional pain. The intervention into the pain of sadness will include uncovering its origins, the resolution of the anger associated with it, marital therapy, the use of cognitive-behavioral approaches, growth in virtues which is referred to as a positive psychology and the utilization of faith when appropriate.
If you would be interested in watching now my lonely, sad spouse 90 minute webinar, please feel free to go to www.maritalhealing.com/maritalwebinars.php .
Unfortunately, depressive illness in married adults is not uncommon. A 2011 study revealed that about one in 10 Americans aged 12 and over takes antidepressant medication. Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years. From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%, (Center for Disease Control and Prevention, NCHS Data Brief, 76, October 2011).
Difficulties in the marital relationship can play a major role in the development of depressive illness. Epidemiological data demonstrated that unhappy marriages were a potent risk factor for major depressive disorder, associated with a 25 fold increase relative to untroubled marriages in one major study from Yale, (Weissman MM. 1987, Am J Public Health 77:445-451). Another study found a 10-fold increase in risk for depressive symptoms associated with marital discord (O'Leary KD, et al. 1994, A closer look at the link between marital discord and depressive symptomatology, J Soc Clin Psychol 13:33-41.)
C. Proulx's 2009 paper, Moderators of the link between marital hostility and change in spouses' depressive symptoms, demonstrated spousal anger as a contributing factor to depressive illness in the other spouse. She stated, "The more hostile and anti-social behaviors exhibited by husbands, the more depressed their wives were after three years." Her research also showed that warm,positive behavior from husbands lessened the negative impact of their hostile behavior.
Loneliness can play a major role in the development of depressive illness. In the study of angry husbands the wives probably began to lose their ability to feel safe with their husbands, put up walls to protect themselves from the anger, experienced increased loneliness and then depression.
Loneliness can arise not only from marital hurts, but also from unresolved hurts in significant relationships prior to the marriage such as parental divorce or a distant and weak parental attachment relationship. In fact, some individuals who have healthy loving and giving marital relationships experience depressive illness caused by a number of factors unrelated to the marriage. It is important for couples to realize that, while marital love is very powerful and comforting, it cannot fill a void in the heart left by a lack of warmth, affirmation or love in a parental relationship or in important previous relationships. Unfortunately, family of origin or other non-marital emotional pain can confuse spouses who may mistakenly believe/feel that their marriage is the primary cause of their depression or that their spouse should be able to make them completely happy.
Fortunately, in spite of the high divorce rate, many couples do report marital happiness. An important research study in 2006 of what makes women happy in their marriage revealed the following factors as important:
- a husband's emotional engagement
- a bread winning husband
- a commitment to marriage
- staying at home
- shared religious attendance
- traditional gender attitudes.
(Wilcox, B. & Nock, S., 2006. What's Love Got to Do With It. Social Forces 83:3)
In my experience, many husbands would express similar views and might add being treated with respect, being appreciated and being trusted and not controlled.
Origins of Spousal Sadness
Let's now look at common causes of unhappiness and sadness in spouses arising from disappointments and hurts from within and from outside the marriage. Please identify any of the following issues, which might apply to you or to your spouse or to a depressed spouse whom you know.
Marriage and family life
- Loneliness in married life
- Lack of a close marital friendship
- Lack of a romantic marital relationship
- Lack of affection
- Poor intimate relationship
- Poor marital communication
- Loss of trust in spouse/ in loving relationships
- Lack of emotional support from spouse
- Lack of praise from spouse
- Failure to spend quality time together in the evenings
- Loneliness for another child
- Lack of balance in one's life
- Emotionally distant spouse
- Controlling spouse
- Critical, negative spouse
- Angry spouse
- Spouse with difficulty in receiving love
- Fear of trusting or of being controlled by one's spouse
- Selfish, materialistic spouse
- Lack of a sense of purpose in life
- Unhappy in work
- Workaholic spouse
- Inability to discuss honestly stressful issues
- Anxious, worried spouse
- Depressed, sad spouse
- Spouse who is not home for dinner
- Preoccupied with financial worries
- Spouse who spends evenings in a different room
- Excessive work travel
- Spouse who lacks balance in his/her life
- Spouse who can't let go of work worries
- Lack of faith in spouse
- Cognitive distortions/negative thinking in spouse
- Spouse with serious health problems
- Financial fears
- Spouse who has difficulty in letting go of burdens/worries
- Confidence too dependent on financial/career success or physical appearance
- Substance abuse in spouse
- Unhappy childhood and adolescence
- Negative parental legacies including modeling after a depressed, negative, controlling or anxiety parent
- Lack of same sex friendships
- Lack of happiness in one's spiritual life
- Conflicts and distance with children or grandchildren
- Conflicts with siblings or parents
- Conflicts with controlling or critical in-laws
- Unresolved sadness from the father relationship
- Unresolved sadness from the mother relationship
- History of serious parental conflicts and mistrust
- Parental divorce or separation
- Hurts in significant relationships prior to marriage
- Unresolved sadness from sibling or peer trauma
- Loneliness for a brother or a sister.
Now whom do you identify as having the most emotional conflicts leading to sadness, your spouse or you?
The most common conflicts within the depressed spouse are loneliness, excessive worries and fears, unresolved anger, weaknesses in confidence, selfishness, work related conflicts, and unresolved family of origin loneliness. The most common marital conflicts leading to spousal depression in our clinical experience arise from having a spouse who is controlling, emotionally distant, angry and negative, selfish, faithless, overly responsible, insecure and who lacks balance in life. Frequently these conflicts arising from personal or from marital conflicts are not fully uncovered and addressed for a numerous reasons. The major factors here are pride or the lack of humility for personal issues and the fear of the marriage becoming worse, the fear of the spouse's anger, a lack of confidence and unresolved childhood fears for the marital issues.
A thorough history of the self-giving to romantic aspect of the marriage, to the marital friendship and to betrothed love, which includes, but is more than, sexual intimacy of each spouse is an essential aspect of the evaluation of a depressed spouse. In addition we regularly ask the spouse to rate himself/herself and the other spouse on the checklists which evaluate difficulties in marital self-giving in the evaluate your marriage chapter of this site.
Development of Emotional Pain
A number of pathways lead to the development of depression and other emotional conflicts. These are most often the result of significant disappointments and hurts in relationships and of weakness in one's personality. The primary personality weakness leading to intense sadness over time is selfishness in our clinical experience because this conflict turns a person in on upon himself/herself.
Sadness arising from loneliness
In God's first words about the human condition He stated to Adam, "It is not good for man to be alone. I will make him a helper fit for him (Genesis 2:18)." Note that God did not tell Adam to find fulfillment in his work or in the pursuit of his own pleasures, but in the relationship with another person who would be a helper. In our view, God could have gone on at length in Genesis describing the many negative emotional, behavioral, cognitive, medical and spiritual difficulties caused by being alone.
Nature of Loneliness
Loneliness differs from solitude in which one may be physically alone but has a sense of being deeply connected to others, appreciated and loved and is a response to a hurt or disappointment and there is significant denial and anger is associated with the hurt. In the experience of loneliness, the person does not feel closely bonded to others and usually does not feel loved. Loneliness can enter at one stage of life and become encapsulated with anger toward those who have not met one's needs. This loneliness can lock in at different life stages only to emerge years or decades later, which explains why someone can be in a healthy loving marriage and still feel sad and lonely. It is not resolved until uncovered and addressed and the memory "purified."
Since loneliness is so painful and so difficult to face and address, many individuals deny its presence from their family background, from important significant relationships or from their marriage. This denial is accomplished primarily through the action of the intellect. However, this defensive action does not last indefinitely and often difficulties develop in one's emotional life or behaviors because of the power of this loneliness.
Unless loneliness is identified and addressed, the sadness it causes can lead people to make many decisions, which are harmful to them, to their marriage and to their family life. This pain can lead one wrongly to blame their spouse for their unhappiness and decide to leave their commitment. For many of these individuals the loneliness/sadness/anger complex was present within them for many years before their marriage, but never addressed. In essence, to abandon the marriage is like "throwing away the baby, the great gift from God, with the bath water."
Intense loneliness can result in depressive illness in many spouses. Depressive illness is recurrent with sixty percent of individuals who have recovered from a depressive episode having a recurrence within five years (Solomon DA, et al, 2000).Also, the severe loneliness and sadness from childhood trauma predicts an unfavorable course of illness and treatment outcome in depression (Nanni V, et al. 2012).
Symptoms of Loneliness
Excessive experiences with loneliness produce symptoms of depression which include some of the following:
- lack of energy
- poor concentration
- crying episodes
- impaired memory
- loss of appetite
- lack of hope
- lack of cheerful giving to children and spouse
- lack of cheerfulness
- strong sexual temptations
- anger attacks with physical aggressiveness
- a feeling of being overwhelmed by the needs of the children
- substance abuse
- compulsive sexual behaviors, including internet pornography use
- excessive comfort seeking behaviors such as eating, drinking, and shopping, etc.
- avoidance of the home.
Uncovering Various Types of Loneliness
John Paul II in his encyclical on faith and reason wrote, "The admonition know yourself was carved on the temple portal at Delphi as testimony to a basic truth to be adopted as a minimal norm by those who seek to set themselves apart from the rest of creation as human beings, that is, as those who "know themselves." Fides et Ratio, n.1) Unfortunately, many spouses do not know themselves, that is, know their emotional hearts and the degree of loneliness and sadness they do or have experienced prior to their marriage or in their marriage. Self-knowledge in this area is essential to personal growth and to marital happiness.
Therefore, it is important for all spouses who are depressed to evaluate the degree of loneliness they may have experienced in their family of origin relationships, other loving relationships and in the marriage. Mental health professionals should also take such important histories and not simply focus on the here and now as many unfortunately do. Major symptoms of family of origin loneliness include a lack of energy and enthusiasm in the home, a lack of cheerfulness, excessive irritability, resentment with the demands of giving to children or one's spouse, avoidance of self-giving to one's spouse, avoidance of the home or communication with one's spouse.
The most common type of family of origin loneliness we uncover in our patients is from the father relationship. While respecting their father's hard work for the family, many adults wished he was more emotionally giving and complimentary. While, the majority of spouses we work with had close, supportive mother relationships, attachment conflicts with mothers are becoming more prevalent in young adults because of their placement in day care when young. Also, some women did not have mothers who enjoyed giving themselves emotionally to them and can experience a inner sadness and a similar weakness in self-giving to children or spouse.
In one study of happily married couples in mid life 75% of the spouse reported still feeling angry about various types of childhood disappointments with a parent.
Another important type of loneliness is that caused by the lack of an ongoing experience of cheerful giving and loving between a father and a mother. In this regard, John Paul II has written that marital love is meant to be an icon of Trinitarian love.
Next, the lack of a close relationship with a brother or a sister can contribute to adult sadness and depression. A study from the Harvard Medical School published in 2007 of 229 men revealed that poorer relationships with siblings prior to age 20 and a family history of depression independently predicted both the occurrence of major depression and the frequency of use of mood-altering drugs by age 50. This loneliness can lock in at different life stages.
The next important attachment relationship to explore after parental and sibling ones is that of same sex friendships. Children crave warmth and acceptance first by parents and siblings and then by friends of the same sex. This acceptance is essential to the child's sense of wellbeing and strengthens his or her confidence in masculinity and femininity. Loneliness for close friendships can play a major role in spousal depression.
The adolescent and young adult history of opposite sex friendships and dating relationships is also important. Some individuals have deep inner sadness and emptiness because they never experienced an enjoyable, comforting friendship with someone of the opposite sex before their marriage.
In addition to the evaluation of possible loneliness in the family background, one of the first steps we use in treating spouses who are depressed is to evaluate the quality of the self-giving to the marital friendship, the romantic relationship and betrothed love (see Marital love, faith and sexuality chapter.) Here we ask the spouses to complete the marital self-giving checklist on themselves and on their spouse (see Evaluate Your Marriage.) Then the history of secure attachment relationships is explored in the family, with peers and in other important relationships prior and in the marriage. Major sources of marital loneliness today are the failure to have dinner with one's spouse and the failure to spend pleasant evenings in the same room with one's spouse.
Spiritual writers have also described an inner emptiness, loneliness and lack of a sense of purpose in love due to the absence of healthy spiritual relationships. In Catholic depressed spouses one should explore the history of relationships with the Lord, Our Lady, St. Joseph, the Holy Spirit, God the Father, saints and one's Guardian angel, particularly in view of the research which has demonstrated the benefits of faith in dealing with depressive illness.
The treatment of loneliness/sadness
If the loneliness/sadness is determined to be the result of marital conflicts, then the couple should discuss the specific difficulty. If the issue is an emotionally distant, controlling, angry or selfish spouse, those chapters on this site should be helpful. If unresolved family of origin issues are a major source of conflict, an approach to this sadness will be presented later in the chapter. Regardless of the source of the loneliness, the resolution of anger with those who hurt one are essential in the healing process. At time of the celebration of the third millennium during which John Paul II asked for forgiveness for human weaknesses within a holy Church, he also stated that unless one forgives one is a prisoner of one's past. A person can also be imprisoned by sadness, anxiety and insecurity all of which is encapsulated in anger.
Marital loneliness can diminish as each spouse grows to appreciate more fully that love is deeds. The important behaviors/deeds which decrease marital loneliness are trying to have dinner daily with one's spouse and children, being positive and cheerful after work, communicating in a basically positive manner, spending pleasant evenings in the same room with one's spouse, and committing oneself to try to protect one's spouse from loneliness.
In addition, identifying negative thinking patterns and cognitive distortions can be beneficial (see Feeling Good by David Burns). In addition, the approach of positive psychology with a focus on growth in a number of virtues is also beneficial (see Character Strengths and Virtues and Learned Optimism). Finally, the role of faith can be beneficial in dealing with depressive illness as cited in a summary of the studies below.
Since a number of studies have demonstrated that anxiety disorders often begin before depression and can result in longer depressive episodes, an evaluation of the person's basic ability to trust is important. We ask the depressed to evaluate their anxiety/difficulty in trusting on the mistrust checklist in the Evaluate Your Marriage chapter.
After the discussion of the treatment of the anger associated with loneliness and sadness, specific suggestions will be offered in regard to the role of the Catholic faith in the healing process.
Misconceptions About Marital Love
The recognition of the common misconceptions about marital love can be helpful and these include:
- if one is not happy, it must be caused by a weakness in marital love
- it is based completely upon one's feelings
- it should make one completely happy and should heal any loneliness for parental love experience in childhood, adolescence or the present time
- it should not require hard work and sacrifice
- the loss of a romantic feeling is the fault of one's spouse
- it should be strong even if one does not work on the romantic aspect of the marriage or on the marital friendship
- when the feeling of love is not longer present, it cannot be restored
- the trust upon which marital love is based cannot be healed if it is damaged
- one has the right to intimacy even if the need for romantic love and friendship are ignored
- is not enriched by having children
- can be fulfilling even if one is selfish
- God's love does not enrich and strengthen marital love by providing another source of comfort, strength, hope and happiness.
Selfishness and Sadness
In our clinical experience of over 30 years with several thousand couples we have found that selfishness is not identified frequently enough as a causative factor in depressive states in married individuals. This depression is seen both in the selfish spouse and in the spouse who is the victim of narcissism. We know however that selfishness is one of the leading causes for the breakup of marriages within the first five years of the relationship. It is also a major reason why cohabitating couples split up so frequently and also why their divorce rate is twice that of noncohabitating couples.
In John Paul II's first encyclical, The Redeemer of Man, he wrote, "Man cannot live without love. He remains a being that is incomprehensible for himself; his life is meaningless, if love is not revealed to him, if he does not encounter love, if he does not experience it and make it his own, if he does not participate intimately in it." (n. 10.) Selfishness turns a person in on himself/herself and severely damages the ability to give oneself to one's spouse and to participate intimately in marital love. Instead, it leads one to use a spouse for one's own pleasure and purposes, thereby severely wounding the marital friendship and the romantic relationship. Also, it damages betrothed love in which the person moves from the "I" to the "We" of married life with a complete surrender of the self to one's spouse.
In addition since selfishness leads to a tendency to both control and to overreact in anger, the other spouse can lose the ability to feel safe with and to trust his/her spouse. Subsequently, walls are built and marital loneliness and unhappiness ensue.
Another important factor in marital unhappiness and sadness is the result of materialism. In a 2007 study of 600 couples higher levels of spousal materialism were associated with increased perceptions of financial problems, which in turn were negatively associated with levels of marital satisfaction. The study revealed that materialistic attitudes have a stronger impact upon spouses' perception of financial problems than do levels of couple income. (Dean, Lukas, et al. 2007. Family and Consumer Sciences Research Journal, Vol. 36, 260-28l. lcarroll@byu.)
Another major study, which demonstrated the danger of materialism and the preoccupation with money to healthy relationships, was reported in Science in 2006. It revealed that experiments suggested that a preoccupation with money brings about a self-sufficient orientation in which people prefer to be free of dependency and dependents. Reminders of money led to reduced requests for help and reduced helpfulness toward others. Relative to participants primed with neutral concepts, participants primed with money preferred to play alone, work alone, and put more physical distance between themselves and a new acquaintance. (Vohs, K, et al, 2006, Science 17 November 2006: Vol. 314. no. 5802, pp. 1154 - 1156.)
The selfish spouse tends to be very self-focused and independent and experiences little need for God's love. This self-reliance blocks the ability to experience the ongoing source of comfort and strength, which God's love can provide in, married life. St. Augustine described this phenomenon in warning that the love of self leads to the exclusion of God. Sadly today the love of self also leads to the exclusion of spouses and children.
John Paul II in his encyclical on faith and reason (Fides et Ratio, n. 33), which he described as two wings on which the person ascends to a knowledge of God, wrote, "Human perfection consists not simply in acquiring an abstract knowledge of truth, but in a dynamic relationship of faithful self-giving with others. It is in this faithful self-giving that a person finds a fullness of certainty and security." Many couples fail to realize that their selfishness severely harms their self-giving and ultimately their own happiness and that of their spouse and their children are affected.
Unfortunately, many mental health professionals who treat couples are strongly influenced by the present culture of narcissism. In failing to understand the nature of the human person and the critical importance of self-giving to happiness and fulfillment, they too often encourage self-actualization, self-fulfillment, and selfishness. This treatment philosophy has contributed to a failure to identify the serious conflicts which interfere with marital self-giving and happiness.
At the 2003 Vatican conference on depression, Msgr. Tony Anatrella, a Jesuit psychoanalyst, commented on the narcissistic conflict when he stated, "The individual is not sad for any reason, but for himself, because of his inner uncertainty and the absence of personal fulfillment. The man of today, as well as the of yesterday, experiences the need to learn to love life to fulfill himself and discover the meaning of his existence."
We attempt to uncover selfishness by taking a thorough history of the self-giving to the romantic aspect to the marriage, to the marital friendship and to betrothed love which includes, but is more than sexual intimacy. We also offer a narcissism checklist, which is available in the selfish spouse chapter.
Another measure used in research studies is Narcissistic personality inventory (Raskin,R. & Terry, H. (1988) A principal-components analysis of the Narcissistic Personality Inventory. J. Personality and Social Psychology 54:890-902.)
Further information on the role of positive psychology in the healing of selfishness can be found in the selfish spouse chapter on this site. Finally, we believe that depressed spouses should be evaluated for their degree of selfishness and that they should evaluate the degree of selfishness in their spouse.
The Healing of Selfishness
Fortunately, this major enemy of marital love, can be resolved primarily by growth in a number of virtues and in affective maturity. Unfortunately, many spouses are unwilling to work on this serious character weakness until they are in significant pain or in Alcoholic Anonymous terms "hit bottom."
In 1995 a very encouraging study from the Harvard Medical School was published which demonstrated significant decrease in the overall level of pathological narcissism in the area of interpersonal relations and reactiveness at follow-up with 60% of the subjects no longer reaching the cutoff score for the diagnosis. Interview. However, a high level of narcissism in interpersonal relationships was associated with absence of change at follow up. (Ronningstam, E., et al., 1995, Changes in pathological narcissism. Amer. J. Psychiatry 152:253-7.)
The chapter on the selfish spouse can be a helpful reference at this time. Growth in virtues is both challenging and rewarding. It's simply hard work, but it's well worth it. Growth in generosity, cheerful self-giving and love to one's spouse and others are good for the heart, contribute to happiness and diminish depressive symptoms.
Loss of Trust, Anxiety and Depression
Another important factor in the development in spousal depression is the result of the loss of trust or a safe feeling, which is essential to giving and to receiving love. As trust decreases, anxiety symptoms grow in a spouse's life. Trust can diminish as the result of hurts in the marital relationship or in other important relationships. As it decreases so too does the safe feeling with the spouse and the desire to give to and receive from the spouse. Walls go up around hearts and distancing occurs by withdrawing, overreacting in anger or needing to control. All this emotional stress leads to a marked decrease in or a loss of a feeling of love for the spouse.
Research at the Massachusetts General Hospital has shown that the presence of anxiety results in longer depressive episodes, a more chronic course of depression, worse psychosocial impairment, reduced chance of recovery from the initial episode of depression, and increased risk of suicide (Clinical Psychiatry News, July 2007.)
Many spouses today have their trust badly damaged outside the home by very difficult work environments. These men and women often come home with walls up, with excessive anger and with an unconscious fear of giving themselves and of being hurt further. In addition, they may be so burdened by their work that unconsciously they come to view their spouse as a burden rather than as "the pearl of great price" and a gift from God.
Benedict XVI comments on the second beatitude, Blessed are those who mourn, for they shall be comforted (Mt 5:4 in his book, Jesus of Nazareth,) are particularly relevant here. He writes, "there are two kind of mourning. The first is the kind that has lost hope, that has become mistrustful of love and of truth, and that therefore eats away and destroys man from within."
Marital trust can be evaluated on the mistrust checklist in the evaluate your marriage chapter with each spouse rating the other and themselves. Strategies for growing in trust can be found presently at the end of the controlling spouse chapter.
Now we'll move onto the crucial issue of resolving the anger, which is associated with, depressive illness and which often prevents its resolution.
Uncovering and Treating the Anger Associated with Depression
Clinical experience has shown us that the identification, treatment and resolution of excessive anger in depressed persons are an essential aspect of treatment facilitating recovery and protecting against relapse. The degree of anger in the depressed person should be evaluated by an adequate history and the use of objective and subjective anger measures, which are in the marital anger chapter. Many depressed individuals are able to identify significant amounts of unresolved anger, which were denied over an extended period. When used in association with other therapeutic modalities, including psychopharmacology, cognitive and behavioral therapy, or marital and family therapy, the psychotherapeutic use of forgiveness can resolve the anger associated with depressive disorders (Fitzgibbons, 1986). Forgiveness has been shown to reduce depressive symptoms in one study of women who had been sexually abused (Freedman & Enright, 1996) and has been recommended in the treatment of depression (Fitzgibbons, 1986).
The Role of Anger in Depressive Disorders
Numerous studies have shown that anger and hostility are quite common among adults and children with depressive disorders. Depressed patients reported significantly greater levels of anger and hostility than normal controls. Depressed spouses also can experience anger attacks which are major overreactions to minor annoyances and with other physical symptoms seen in panic attacks, such as a rapid heart beat, shortness of breath and a feeling of being out of control. Fortunately, these anger attacks with depression respond favorably to the use of Prozac.
Anger is associated with an unwillingness to give oneself to treatment in a number of studies. Aggressive behaviors are highly prevalent in depressed youths, with similar types and levels evident in males and females.
In the past many mental health professionals believed that sadness was anger turned inward and therefore recommended the expression of anger as the being of benefit in the healing of depression. However, numerous studies have disproved this view by demonstrating that the greater the level of depression, the greater the number of anger attacks. In addition, this theory completely overlooks the reality that many spouses bring into their marriage unresolved anger from other relationships, which can then be misdirected at one's spouse. We recommend that depressed patients focus on growing in the virtue of forgiveness and try to avoid the expression of anger.
In our clinical work we have come to the view that anger develops soon after a hurt or disappointment and it is closely associated with sadness from the injury. Individuals can deny their anger, express it, and/or forgive. Anger can easily encapsulate sadness within the unconscious and interfere with the healing of this sadness from childhood, adolescence, and adulthood. If the anger is resolved through a forgiveness process, it can facilitate the healing of the associated sadness.
Overview of the Four Phases of Forgiveness in Depressed Patients
Information and case histories on uncovering and resolving anger with spouses who are controlling, overly angry, emotionally distant or selfish can be found in those respective chapters on this site.
Uncovering Anger and Hurts
When the history of a depressed patient is taken, major disappointments and anger associated with hurts are identified in significant relationships from childhood into adult life. Most people can readily admit conflicts in adult relationships, but often they have little insight into the role of disappointments from their family of origin that may have provided the basis for their depression. This is particularly true of conflicts in the father relationship because the denial of anger in childhood and adolescence is strongest in that relationship.
At the beginning of treatment, the work of uncovering is facilitated by a valid subjective measure of anger, which rates both active and passive-aggressive forms, the anger inventory in the marital anger chapter. In addition, at times a family member is asked to complete the anger checklist in the evaluate your spouse chapter. Such measures assist the therapist in helping the patient understand both the depth of anger and the primary method of expression. When the results are presented, many people with depressive disorders are surprised to discover the high level of anger indicated. At this point, regular discussion about the masking of anger at different life stages can be initiated. The three basic mechanisms for dealing with anger - denial, expression, and forgiveness - need to be reviewed. Predominant misunderstandings that may need clarification are that anger is an emotion which can be resolved only through expression, that it is experienced only in extreme degrees, and that the absence of blatant manifestations precludes the presence of anger.
One can encounter considerable resistance and anger when telling a depressed persons that they have a problem with anger but failing to give them a safe and effective method for its resolution. These individuals may fear their anger or feel guilty about it and in the absence of a reliable method for removing it, simply deny its presence. By communicating to spouses how to resolve anger within themselves, they are more likely to put an end to their denial of anger.
Cognitive forgiveness exercises can be recommended based on the spouse's depressive symptoms and history. The spouse may be asked to think of the possibility that he or she wants to try forgiving an individual believed to have hurt the person. Making a decision for forgiveness is a firths step. At the onset, there may be little conscious awareness of the depth of the hurt and the subsequent sadness and anger that were present in the relationship. Cognitive forgiveness exercises, however, are a powerful method for bringing forth unconscious emotional pain in those with depressive illness and initially their effectiveness may depend largely upon the degree of trust in the therapist. Some depressed spouses are aware of disappointment and anger with an emotionally distant spouse, but they have limited awareness of unresolved sadness and anger with an emotionally distant parent. When they employ cognitive forgiveness exercises, they begin to discover the anger they have denied and, as a result, may begin to feel some relief from its burden and accompanying sadness.
Another strategy that can be utilized in uncovering anger is to present to spouses the possibility that failure to deal honestly with anger and hurts from different life stages may interfere with their recovery from depression. If significant resistance occurs in uncovering anger, the spouse can relate how others have overcome this hurdle; the power of story is not to be underestimated because it allows a person to step back and make important connections.
To the surprise of many, various degrees of active and passive-aggressive anger associated with depression are uncovered and even violent fantasies and impulses as well as anger attacks may become evident.
The major factor influencing a spouse's decision to begin the work of forgiveness is the knowledge that it will help with the resolution of the depressive illness. Many decide to forgive their offenders with great reluctance and they may state that they do not really feel like forgiving them at all. We usually inform these spouses that as they grow to understand their offenders and their life struggles, eventually they will feel more like forgiving. The distinction between cognitive (from the head) and emotive (from the heart with feeling) forgiveness is important to since many people believe that they are unable to begin the work of forgiveness until they really feel like forgiving the offender.
Another factor, which strengthens those trying to resolve their anger through the hard work of forgiveness, is the relief they experience from emotional and mental pain as they begin to forgive. Some, though, lose their motivation to continue the process of forgiveness because they want to experience, own, and discuss at length their anger regarding the offender before they are willing to let go of it. When we relate successful case histories of depressed spouses who have employed forgiveness in their treatment, individuals often become more willing to make a decision on forgiveness.
When dealing with spouses who have experienced severe betrayal pain leading to depressive illness, the word "forgive" may need to be omitted because it may imply that those who have caused the injury will never be held accountable for their behavior; such misunderstandings of forgiveness sometimes take time to overcome. These people are advised to state that they desire to let go of their hostile feelings and thoughts for revenge. When that step has been taken, they can comfortably move into the work phase of letting go of their anger.
Another helpful factor influencing the decision to forgive is the realization of the damage, which can be done to the oneself and to one's marriage by holding onto strong anger. The damage can include failure to overcome emotional pain, misdirection of anger toward a spouse or children who do not deserve it, the excessive expression of anger in the home, the development of physical illnesses, or continued emotional control by the others how have hurt one. We regularly describe to these negative consequences known to clients. Often we quote John Paul II's words for the millennial year that if one does not forgive, one is a prisoner of one's past.
We regularly to communicate to spouses the benefits of forgiveness when recommending the decision to forgive. These include:
- decreased feelings of sadness and hopeless
- freedom from the emotional pain of the past
- greater stability of mood
- improved marital relationship
- improved ability to express anger appropriately as the degree of denied anger diminishes
- diminished guilt arising from unconscious anger
- decreased anxiety
- the courage to be vulnerable
- decreased fear of angry impulses or thoughts
- improved loving relationships with children and other family members.
Many will decide for forgiveness only after reassurance that they do not have to become vulnerable toward the offender and that forgiveness does not preclude expressing anger or pursuing justice. The resolution of anger with an offender and the investment of trust toward that person are two related but different processes. One can forgive, and at the same time, not trust someone who has inflicted hurt.
In some people, the decision to forgive occurs only after significant pressures are applied by others in the person's life. Spouses or other family members may threaten to separate or even end a relationship unless the individual makes a commitment to work to resolve the excessive anger associated with depression. Some spouses with a difficulty in trusting may limited in their ability to try to make a decision to forgive and they have an impaired capacity to trust the process. They regularly employ anger as a defense against their mistrust and fear of betrayal. Once a difficulty in trusting has been uncovered, the origins of the conflict must be identified. When spouses learn that they may well be controlled by the offenders for the rest of their lives if they do not let go of their anger, many finally decide to work at forgiveness with clenched fists and white knuckles. Growth in trust is essential during this process.
At times with the hostile, mistrustful, depressed spouse who misdirects excessive anger regularly at their spouse, it may be necessary to consider recommending marital separation unless the abusive anger diminishes. The inappropriate expression of abusive anger may be directed toward the spouse but the depressed person should come to the realization that such anger does not benefit anyone and simply delays the resolution of the depressive symptoms.
Individuals who employ anger as a defense against feelings of sadness and insecurity are often reluctant to decide to forgive. We find that their self-esteem needs to be strengthened before such a decision can be made, especially in the case of young males. In addition, they also need to hope that the sadness and loneliness beneath their angry feelings can be healed. In the final analysis, many people decide to work on forgiving those who have hurt them in the hope that it will help in the healing of their depressive illness and their marriage and family life.
Forgiveness is possible through a process of attempting to understand the emotional development of those who inflicted hurt. As understanding grows, it usually becomes clearer that the behavior of many individuals can be attributed to their emotional scars. The process of forgiveness opens up the ability to understand that significant others have loved as much as they were capable of loving, and that the pain was not necessarily inflicted deliberately. As this understanding grows, anger diminishes.
In the work phase of forgiveness, we recommended that the person consider thinking of wanting to forgive another for certain pattern of behavior without dwelling excessively on a particularly traumatic memory. The person is asked to think about understanding and forgiving several minutes twice daily the persons who have hurt them. .
The depressed spouse may spend longer than several minutes working on daily forgiving exercises depending upon the degree of emotional pain present, ongoing hurts and other factors. Forgiveness is also recommended during times when strong feelings of sadness are present. If strong feelings of anger emerge, the patient is encouraged to spend time each day forgiving the offender and working toward understanding and forgiving others from the past who have caused similar hurt. The daily work of forgiveness in spouses with depression usually goes on for many months and in some people for years.
Regarding hurts from years ago, a past forgiveness exercise can be very effective. Here the spouse tries to understand and forgive a parent or a spouse for not meeting certain emotional needs. In trying to understand the childhood and adolescence of an emotionally-distant, controlling or irritable parent or spouse, the person usually comes to realize that the parent or spouse struggled with similar difficulties when he or she was young and that he or she had, in fact, unconsciously modeled after his/her own parent (the patient's grandparent). This understanding enhances the ability to forgive the parent or spouse. Nevertheless, such individuals may spend weeks or months thinking of themselves as children and teenagers trying to understand and forgive a parent or a spouse for specific hurts. This process rarely entails going to others and informing them that one is working at forgiving them. However, in married life, we recommend that the depressed spouse discuss with their husband or wife the marital stresses, which are resulting in feelings of sadness.
Individuals may decide that they want to try to understand and to forgive anyone in the past that has influenced their adult feelings of sadness and anger. These spouses can benefit from reflecting on the following thought: "Dad or Mom, I want to try to understand and forgive you for all the ways you disappointed me when I was young" and "Honey, we both know that I am far from perfect but there were times we hurt each other in our marriage. At this time, I want to try to forgive you for all the ways you hurt me in the earlier years of our marriage." In addition, this person can ask the spouse to try to overcome emotionally distant, controlling, selfish or angry behaviors, which contribute to the feelings of sadness.
We refer to this as a past forgiveness exercise and find it highly effective in the treatment of depressive illness because it resolves the anger, which encapsulates feelings of sadness. In therapy sessions we give spouses a written statement that asks them to try to understand specific conflicts in the offender's life and to think of forgiving an offender from the past. At follow up sessions, the forgiveness exercises relating to both past and present relationships are reviewed in a manner similar to the way in which cognitive exercises are examined after being assigned and difficulties or resistances are discussed.
Many spouses with depression find themselves developing a conscious awareness of the need for forgiveness in daily living as a way to gain control over intense angry feelings. Those with anger attacks report that the regular use of forgiveness diminishes the intensity and frequency of those attacks. Other benefits that people report are relief from their sadness, a greater stability in their mood, the ability to seek and give forgiveness, and renewed energy that comes as the need to control angry impulses and thoughts diminishes.
For most people, forgiveness begins as an intellectual process in which there is no true feeling of forgiveness and many have difficulty believing that they are really forgiving. As their understanding grows of their offenders, particularly a parent or a spouse, they will experience more compassion and feelings of forgiveness may follow. The process moves slowly, but meanwhile cognitive forgiveness exercises in which one forgives from the head so to speak without feeling forgiveness, is very effective.
Often, the depressed spouse blames those closest to him or her now for their symptoms and is unwilling to examine past disappointment prior to the marriage or career conflicts. This is especially the case when there have experienced serious childhood emotional trauma with parents. These people can be helped by the suggestion that they are, in part, misdirecting their anger and by clarifying how anger can be masked and then later misdirected. If these persons are willing to employ past forgiveness exercises with a parent, they often come to realize the sadness and anger, which was experienced early in life and denied is now contributing to their depressive symptoms.
If the depressed spouse is forgiving a particular individual and the anger is not decreasing, this may point to either a misplacement of the anger or an unconscious association with someone else from the past that hurt the depressed person in a similar way, such as a controlling or critical parent.
For those depressed spouses with anger attacks or very intense anger, the resolution of resentment can be facilitated by a process, which begins with the physical expression of anger in a manner in which others will not be hurt. In this process the person does not visualize the offender as a target of the anger. This is followed immediately by cognitive forgiveness exercises aimed at letting go of the desire for revenge. Relief from intense anger also may be experienced if the person imagines the verbal expression of hostile feelings against the offender and then attempts to give up the desire for revenge. In addition, the use of the sacrament of reconciliation on a regular basis is beneficial in decreasing such anger. Finally, spouses with intense anger can benefit from a medication evaluation since antidepressants can be very effective in diminishing feelings of sadness and the anger, which develops in response to the hurt, and the sadness.
As depressed spouses experience the marked beneficial effects of forgiveness, they tend to rely strongly upon this method of resolving their anger and often gradually cease expressing excessive anger. This growth in forgiveness is very effective in diminishing their depressive symptoms and in improving the quality of the marriage.
Marital or family therapy at times can be of great value in the resolution of the spouse's resentment and depressive symptoms. In fact in our work we want the non depressed spouse to participate in every session either on the phone or in the office. Some spouses or parents have detailed their childhood experiences and marital stresses and asked for understanding and forgiveness for the times when they hurt the depressed spouse. Such steps have often included promises to improve the relationship in the future and to work on identified conflicts.
Again, the use of antidepressants can be very helpful in diminishing the level and expression of anger, but they do not resolve the basic conflicts, which give, rise to the anger.
A number of obstacles are encountered in the uses of forgiveness in the treatment of depression. These include:
- the need to control
- the lack of parental modeling for this process
- role models who regularly overreacted in anger
- powerful denial of resentment from family of origin
- inability of loved ones to admit they were wrong
- difficulty in growing to trust others
- overwhelming impulses for revenge
- substance abuse
- significant others who continue to disappoint regularly.
Since anger is used to defend against feelings of fear, especially the fear of betrayal, many individuals are not able to move ahead with the forgiveness process until their basic ability to trust is enhanced or until they feel more hopeful.
Misconceptions About Forgiveness
Misconceptions that arise are: the belief that forgiveness occurs quickly and that there is no need to spend time working on it, that a one-time cognitive decision to let go of anger resolves all anger from past or present hurts, that forgiving precludes healthy assertiveness, that the process holds more benefit for the one forgiven than for the forgiver and that one has to trust immediately the person forgiven.
Some people hold onto their anger because it may make them feel alive. Others believe it gives them a feeling of power or it may form a bond of intense passion with a former loved one and cover a feeling of emptiness. Revenge, too, is sometimes seen as a sign of strength and intelligence, while forgiveness may represent weakness. Anger, it is believed, gives offenders the attention they want and projects a strong image. There are spouses, too, who have no real desire to be healthy or who derive benefit from self-pity or playing the sick role which gives them a great deal of power in family life. Finally, some individuals are aware that as they forgive they will be led into the reality of disappointments in relationships. Therefore, they will not forgive until their marital relationship has begun to improve.
Although forgiveness diminishes the level of anger in depressed clients, it does not fully heal the sadness from different life hurts. However, most persons experience emotional relief as they are able to overcome their angry feelings and then discover a lessening in the intensity of their depressive symptoms and less control over their lives from past hurts.
Deepening Phase and the Limitations of Forgiveness
In the deepening phase, clients have become familiar with the benefits of forgiveness and use it more often when they feel sad or irritable. Absorption of the pain that brought about the sadness and anger can be a slow and arduous process. For many who sustained a major loss or betrayal at a particular life stage, an improved marital relationship can strengthen them and enable them to accept the pain from the past.
Over time, many are able to let go of past hurts and accept them by recalling that parents, spouses and other family members loved as much as they were capable of loving given their life conflicts. However, a harsh reality may be that some were betrayed so deeply that they may never be able to fully absorb their pain. This response to forgiveness is found frequently in those who were abandoned by loved ones. Some betrayals can be broken down into smaller hurts that can slowly lead to forgiveness with absorption of the pain.
There are a number of life experiences in which the process of forgiveness is particularly arduous and lengthy. These include, in addition to abandonment by loved ones, spousal abuse, child abuse, loss of a career, prolonged insensitivity by a loved one, economic injustice, a legacy of mistrust, narcissism, , rape or incest or hatred, that has been passed from generation to generation.
In the deepening phase with those depressed spouses who are also mistrustful and hostile, therapeutic efforts to build their trust can help in the diminishment of their anger, since this anger is often a defense against their fears of betrayal. Their therapy continues to employ forgiveness against offenders from different life stages, but incorporates cognitive decisions to try to trust people of proven reliability. If the person has an active faith life, meditating upon trusting God more or asking God to help one feel safer can be very beneficial. In addition, the absorption of the pain can be enhanced by uniting it to the cross of Christ or placing it upon the altar at Mass.
In this phase spouses are often relieved from the burden and weight of their inner resentment. The resolution of anger helps to stabilize their mood and protects them from a recurrence of their illness.
We now present several case studies that illustrate the use of forgiveness within depressive disorders.
Correcting An Offending Spouse
If the sad/depressed spouse recognizes that his/her emotional and mental suffering is influenced by a major weakness in the other spouse, then it is important to discuss this issue. Unfortunately, for numerous reasons such an honest communication often does not occur resulting in needless suffering and, at times, in marital separation or even divorce because the sad or depressed spouse does not believe the other can change. However, in our clinical experience with several thousand couples, we believe that most marital conflicts can be identified and resolved, particularly if each spouse is willing to grow in virtue, self-giving and in trust.
The most common conflicts in non depressed spouse in our experience are controlling behaviors, emotionally distant behaviors with a lack of self-giving to the romantic aspect of the marriage and to the marital friendship, selfish behaviors and excessively anger behaviors. Any healthy personality which is on the receiving end of such behaviors over time will become discourage, sad, angry and even depressed. We recommend that if the depressed spouse has hurt by such behaviors that he or she read the chapters on our web site related to these conflicts before undertaking an honest discussion of them and a correction.
The benefits of correction include:
- demonstration of a love for the marriage, spouse and children.
- an opportunity for a spouse to grow
- a purification and strengthening of marital love.
- more honest communication
- the prevention of the build up of conflicts.
- growth in one's trust in the Lord with the marriage and children. The obstacles to discussing a marital conflict include:
- a failure to trust the Lord with the marriage
- a lack of confidence
- a fear of the spouse's anger
- a fear of losing the loving relationship
- a lack of hope that the marital relationship can improve
- a lack of trust
- a lack of a role model for correction
- a weak spiritual life
- a similar emotional weakness.
- a lack of understanding that Christians are called to give correction.
In discussing a marital conflict a Christian depressed spouse can be strengthened by the words of St. Paul, "In wisdom made perfect, correct and admonish one another." Corrections should not be given in anger, which can be accomplished by first trying to understand and forgive one's spouse for his/her weakness. Only after anger diminishes through the forgiveness process should the difficulty be addressed. If the depressed spouse finds it difficult to forgive, which is often the case when dealing with selfish, controlling or emotionally distant behaviors, spiritual forgiveness can be used. Here the spouse turns the anger over to God. When corrections are given in anger, the other spouse often becomes defensive and cannot fully receive the communication.
Spouses also find that correction is received when by using the "sandwich technique" in which one praises the other spouse, offers the correction and then ends with another positive comment. Some also report that prayer before a discussion is also very helpful. Correction should always relate to behaviors and not to the personhood of the spouse.
Finally, the more one can trust the Lord with one's marriage the greater freedom in marital communication over difficult, sensitive issues.
The request that a spouse grow in a particular virtue in the correction can be effective. For example, a request could be made to grow in -
- trust for a controlling tendency
- self-giving for emotionally distant behaviors
- forgiveness of excessive anger
- generosity and self-denial for selfishness
- wisdom to model after a parent's good qualities but not his/her weakness (negative parental legacies)
- prudence to establish a more balanced life with more time for the marital friendship
- sacraments for all of the above.
The depressed spouse can also suggest their spouse read the chapter on this site, which addresses the conflicts above.
Recurrent Depressive Illness
Those with recurrent depressive illness usually have significant degrees of anger with individuals who hurt them at different life stages. We have seen that the ability to face the anger and forgive offenders often times results in the diminishment of the depressive symptoms. In treating recurrent depressive illness there is great value in asking patients to work regularly at forgiving all those who disappointed them in their marriage and family life, in important loving relationships, or at work.
Joshua, a forty-year-old married father with two children, developed severe depressive symptoms and anxiety consciously related to work stress and profound weaknesses in confidence. His father, too, had suffered from depressive illness and conflicts with his confidence.
Initially, Joshua was not aware of his anger with anyone but himself. However, he soon came to realize that he had never faced or tried to resolve powerful feelings of anger toward his father and others. He deeply resented his father's inability to ever affirm him or communicate his love to him. He felt bitter that his father never pursued professional help. Guilt was experienced almost as soon as he verbalized his feelings of anger because he was aware that his father had a torturous relationship with his own father (Joshua's grandfather). Joshua was comforted by the knowledge that his anger was justified, primarily because his relationship with his father had resulted in major emotional weaknesses and conflicts in his life.
The cognitive decision to forgive his father also was based on the hope that it might help his recovery from depressive illness, but he had no emotional desire to forgive him. Joshua employed past forgiveness exercises in which he tried to imagine telling his father how much he disappointed him during different stages of his life. That was followed by reflection on the fact that he wanted to try to forgive him for past hurts. It was an intense struggle for Joshua, and, for a period a time, he experienced increasing symptoms of rage with his father. He even discovered repressed violent impulses against his father, which presented clinically as thoughts of harming his children.
Joshua was able to continue the forgiveness process as he grew in compassion and understood the emotional pain his father had suffered himself as a child and young man toward his own very angry and controlling father (Joshua's grandfather.) Joshua wept regularly both for his father's pain and for his own. The regular work of daily forgiving his father gave Joshua a sense that the hold of the pain of his past was diminishing in his life. He came to feel freer and less depressed. The awareness that his father had loved him as much as he was able to love, comforted and strengthened him. However, the work of forgiveness was arduous and many times he felt like giving up. He continued because he was determined not to be controlled by his past; he believed his own father had been deeply hurt in his childhood. Joshua stated, "I have to get rid of this anger and sadness with my father or I will never be healthy."
Some spouses with severe depression feel guilty because it takes so long to let go of anger and feel forgiveness. Others experience guilt because they find themselves, at some point, completely unable to give up their anger. Clients also experience guilt as anger emerges with loved ones who have sacrificed for them or struggled with serious family problems, but the guilt diminishes as the anger is legitimized.
His healing was also helped by growing in his faith and by asking the Lord to help him to appreciate God the Father as his other loving father. Slowly this awareness of another loving father brought help to fill the childhood and adolescent yearning for a close father relationship. His confidence as a man also grew in this manner and by thinking that he was powerless over his male insecurities and turning them over to God.
An irritable mood is a frequent clinical feature in postpartum depression. Many studies have shown that depressed postpartum women had high levels of anger. Another study also demonstrated that high hostility during the pregnancy was correlated with postpartum depression.
Jessica, a thirty-year-old married woman, had just given birth to her first child. She entered therapy because of symptoms of depression and because of fear concerning powerful impulses she was experiencing that could result in harm to her child. In her confusion and fright, there were times she believed that her baby was evil and had to be destroyed. Initially, Jessica could not understand why she should develop postpartum depression with such strong anger. She was happily married, enjoyed her work and had looked forward to the birth of their first child. However, her husband, who was a very emotionally sensitive person with a keen interest in emotional and mental health, communicated his strong views as to the origins of her depression and violent impulses. He blamed her mother.
Jessica was the oldest of three children and had grown up in a dysfunctional family. Her father's career demanded constant travel and he was rarely at home. When she was an adolescent, he died. Jessica was never able to please her mother, a very disturbed woman who had been extremely controlling, critical, and demanding all her life. She had tried to prevent Jessica's marriage because she was unable to control her fiancee. Subsequently, she treated him in an extraordinarily rude manner.
Jessica related, "My mother is crazy and probably a manic-depressive." She related that she had grown up in a home in which her mother seemed to derive pleasure from trying to make her feel insecure and fearful. Although she was high-spirited and had enjoyed many close friends growing up, she was always very unhappy in her home. She realized that she had been denying a great deal of anger with her mother for many years because essentially she was her only parent. For Jessica the most challenging aspect of the healing process was the uncovering of her anger. She stated, "It's very hard and painful for me to admit how angry I have been." As the history prior to the birth of her child was reviewed, Jessica was able to uncover powerful resentment toward her mother and she identified her as a disruptive force in her life. Finally, not only her mother's lack of acceptance of her husband, Mike, but also her offensive treatment of him depressed and angered her.
Because her mother continued in her attempts to undermine Jessica's relationship with Mike, as a first step in Jessica's treatment, she was asked to keep her mother at a distance until the time came that she could support her marriage and apologize for her past insensitive behavior. Next, Jessica was given written forgiveness exercises which requested her to think several times daily of trying to forgive her mother for the ways in which she had hurt her as a child, adolescent, and young woman. She was also requested to use this forgiveness exercise whenever she felt depressed. She decided to work on forgiving her mother when she came to understand that it was the anger toward her mother that she was misdirecting toward her baby. She understood that forgiveness could drain off this abscess of resentment, which she harbored toward her mother. As she worked on forgiving her mother, Jessica felt an enormous amount of buried rage with her mother enter consciousness and she was grateful that she did not have to deal with her mother during this phase of treatment because of the power of these emotions.
As Jessica continued forgiving her mother, her angry thoughts toward her child decreased significantly. When such painful ideas entered her mind, she would respond to them by thinking that they represented misdirected anger, which was really meant for her mother. Then she would say to herself "My mother was a very lonely, troubled woman and I want to forgive her so that she can no longer control me." After approximately six months, the angry impulses toward her child were completely eliminated and her depressive symptoms were resolved. The forgiveness process with her mother went on for several years.
Her faith in God helped her with her depressive illness. She saw a spiritual director who worked with her on growing in an awareness of Mary as her other loving and gentle mother at each stage of her life. She placed images of Our Lady in her home, which became a source of comfort for her.
Other origins of strong anger which are uncovered in treating women with postpartum depressions are from hurts and disappointments with spouses, fathers, and significant others.
The resolution of anger can facilitate the healing of depressive episodes, and, in many patients, helps to prevent relapses.
Other Virtues for the Depressed Spouse
Other virtues have been shown to be effective in dealing with depressive symptoms, in addition to forgiveness, include:
- generosity in self-giving and in receiving to the romantic aspect, marital friendship and betrothed love in marriage
- growth in emotional self-giving to one's spouse particularly in the evenings
- courage for the need to correct others
- compassion by being in the same room with one's spouse at night
- growth in prudence so that quality time can be set aside for the marriage, particularly in the evenings and on weekends
- self-denial by being present to one's spouse in the evenings and going to bed at the same time as one's spouse
- charity in regard to being physically affectionate in the evening
- thankfulness and gratitude for the blessings in one's life
- humility and detachment for a preoccupation with materialism.
Medication for Depression
Antidepressant medication should be considered for spouses with serious symptoms of depression which include severe insomnia, a lack of energy, difficulties with concentration and memory and hopeless. It is important to release that several medications may have to be used before the relief from the depression occurs.
A July 2008 study reviewed that Major Depressive Disorder (MDD) is typically resistant to treatment. Effectiveness studies of patients of patients similar to those treated in a typical clinical practice have found that only 11% to 30% of patients reach remission with initial treatment, even after 8 to 12 months. Therefore, most patients with depression will require a second- step treatment with psychotherapy and another medication. The most empirically proven psychotherapy for depression is cognitive therapy; however, positive psychology with its focus on growth in virtues can also be very helpful, particularly in the resolution of the high levels of anger in depressive illness. The selection of second step medications presently relies on a trial-and-error approach.
The study revealed that remission from depression was less likely among participants with concurrent generalized anxiety, obsessive-compulsive, panic, or posttraumatic stress disorders; social phobia; anxious or melancholic features; more severe depression; or concurrent substance use (Rush AJ, et al. 2008.) Therefore the evaluation and treatment of comorbid anxiety is an important aspect of the treatment of depressive illness in many patients (see the anxious spouse chapter.)
Loneliness, Depression and Faith
John Paul II addressed the issue of marital loneliness in his play The Jeweler's Shop. A major theme of this play is man's longing for intimacy and the difficulty, especially in the male, to open himself to intimacy and giving fully of himself that results in a particular suffering for the female. His earlier play, Radiation of Fatherhood, was a study of the loneliness of alienation and it's overcoming in parenthood. The main character Adam expressed the desire to remain within his independent world by stating to God, "I want to have everything through myself, not through You!"
Fortunately, the writings of John Paul II are helping many men with such weaknesses to understand more fully the calling to complete self-giving in married life and to commit themselves to overcome weaknesses in their self-giving.
Numerous research studies have demonstrated the benefits of faith in regard to depressive illness including the one at Duke done by Dr. Koenig which demonstrated that patients highly religious by multiple indicators, particularly those involved in community religious activities, remit faster from depression. In addition, Dr. Herbert Benson has written of his success of using mediation in treating medical illnesses in his book, Spiritual Healing. We have found that meditation can be helpful particularly for the loneliness from childhood and adolescent hurts with parents, siblings and peers and while working on marital conflicts.
Many of the following research studies have demonstrated the beneficial effects of faith in regard to dealing with depressive illness.
In a systematic review of 850 studies the majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well being(life satisfaction, happiness, positive affect, etc.)and with less depression, suicidal thoughts and behavior, drug/alcohol abuse. Moreira-Almeida, A., Neto, F., Koenig, H.G. (2006) Religiousness and mental health: a review. Rev Bras Psiquiatr.28:242-50.
The impact of religious involvement on length of time to remission of depression was examined in older medical inpatients with heart failure and/or chronic pulmonary disease (CHF/CPD). Inpatients older than 50 years with CHF/CPD were systematically diagnosed with depressive disorder using a structured psychiatric interview. Of 1000 depressed patients identified at baseline, follow- up data on depression course were obtained on 87%. Patients involved in group-related religious activities experienced a shorter time to remission. Although numerous religious measures were unrelated by themselves to depression outcome, the combination of frequent religious attendance, prayer, Bible study, and high intrinsic religiosity, predicted a 53% increase in speed of remission after controls. Patients highly religious by multiple indicators, particularly those involved in community religious activities, remit faster from depression. (Koenig, H., 2007, Religion and Remission of Depression in Medical Inpatients With Heart Failure/Pulmonary Disease . J Nerv Ment Dis. 195: 389-395)
Religious affiliation is associated with less suicidal ideation in depressed outpatients. Moral objections to suicide and lower aggression level in religiously affiliated subjects may function as protective factors against suicide attempts. The authors concluded that these findings offer new therapeutic strategies. (Dervic, K., et al., 2006, Protective factors against suicidal behavior in depressed adults reporting childhood abuse. J Nerv Ment Dis. 194:971-4)
A study of 70,000 individuals found that those who attend frequent worship service attendees had significantly fewer depressive symptoms in a study of 70,000 individuals over 15. (Baetz, M., et al.,2004, The association between spiritual and religious involvement and depressive symptoms in a Canadian population. J. Nerv Ment Dis.192: 818-822.)
In a survey of 37,000 men and women those who attend church, synagogue or other religious services, the higher the worship frequency, the lower the prevalence of depression, mania and panic disorders. (Baetz, M., et al.,2006, How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population. Can J Psychiatry 51:654-61.)
In the treatment of panic disorder in one study the importance of religion was a predictor of improvement after one year. (Bowen, R, et al.,2006, Self-rated importance of religion predicts one year outcome of patients with panic disorder. Depress Anxiety 23:266-73.)
In the study of 37,000 adults over age 15 higher spiritual values protected against the risk of substance abuse. (Baetz, M., et al.,2006, How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population. Can J Psychiatry 51:654-61. "Spirituality is dramatically important to avoiding a destructive pattern of alcohol and drug abuse." Dr. Baetz, www.webMD.com.
At the 18th International Conference of the Pontifical Council of Health Care Workers in 2003 Cardinal Jose Saraiva Martins stated that, "If biblical anthropology already knew about the phenomenon of depression, then can we ask what answers the sacred text gives. The answers lie in some fundamental convictions which constitute a remedy: the conviction that man is always loved and appreciated by God, that God is close to him, and that the world is not hostile to him but good."
Spouses whose depression is due primarily to marital conflicts are often helped in their spiritual lives by working on a friendship with the Lord, while at the same time trying to uncover and address important marital issues. These spouses report being comforted and strengthened by spending 15 minutes twice daily meditating upon the Lord's presence with them. They describe being able to find happiness in their relationship with the Lord. Also, many spouse relate being strengthened by the regular reception of the Eucharist and the sacrament of reconciliation for anger with their spouse and others.
When the depression is influenced by unresolved loneliness and hurts in the father relationship, meditating upon the heavenly Father's loving concern and affirmation and St. Joseph's in early childhood, grade school, high school, etc., has been reported as bringing comfort as another source of love. In those whose loneliness is the result of having a distant-mother relationship, healing occurs through a process of meditating upon Mary as a joyful, loving woman who is always present and who holds the individual in her arms and heart, just as she did with Jesus.
In husband whose loneliness is the result of not having close male friends in the early stages of emotional development because of the absence of bonding with males through sports, it can be helpful to meditate upon the presence of Jesus as a loving brother and best and closest of friends during times when there was rejection from peers or siblings is consoling. For those traumatized by divorce or parental separation whose sadness is due to the failure to experience a stable family life and the flow of love between a father and mother, meditating upon the Holy Family being with one at is reported as being helpful in diminishing sadness and a feeling of being cheated.
These meditations are reported as being effective only if used regularly. They require discipline and perseverance because of the depth of the wound of loneliness within some spouses' hearts, or because of the degree of stress in married life. Spouses state that they are helped by spending 15 to 30 minutes each night asking the Lord to heal the pain of loneliness which has touched them at every life stage of their lives.
For many depressed spouses there is a significant struggle initially with this process because their emotions try to convince them that they are alone and that they have been alone for long periods in their lives. In working with a spiritual director, in the faith dimension of their lives, fortunately, it is possible to respond to this error in thinking by reflecting that they are not alone and have never been alone, or that they are loved deeply and have always been loved.
What occurs is a process which may begin purely as an intellectual or cognitive exercise. However, when employed regularly, there is a movement from the intellect to the heart. In time, individuals can truly feel that they are and always have been loved in very special ways.
The use of these meditation techniques may not produce significant results for a number of weeks or months. However, if they are used with perseverance, and if simultaneous steps are taken to resolve marital conflicts, build trust and self-esteem and to resolve anger, this concerted effort has been shown beneficial to those who suffer from depression related to conflicts with loneliness.
Some depressed spouses describe being helped by regular attendance at Mass and religious service and by reading sacred scripture on a daily basis. Commonly cited beneficial passages are:
- "Do not be saddened this day, for rejoicing in the Lord must be your strength!" Neh 8:10.
- "I find joy in the Lord", Psalm 104.
- "Nothing can separate me from the love of Christ."
- "Rejoicing in the Lord should be your strength."
- "He will give a home to the lonely."
- "Take delight in the Lord and He will grant you your heart's request, Psalm 37."
Additional spiritual interventions which are related as being helpful in the struggle against depressive illness include:
- praying for the virtue of hope
- saying a rosary daily for the marriage and for emotional healing
- working to have balance in one's life by placing God first, one's spouse second, children third, friendships fourth and work fifth
- letting go and letting God with one's burdens and responsibilities
- giving oneself to God daily and then to one's spouse
- making regular acts of trust with one's worries and fears
- not allowing work to dominate one's life
- meditating upon the Lord being with one during special times of family of origin stress and unhappiness when one felt sad or anxious including holidays, dinners, Sundays, family gatherings, etc.; reading about the sacrament of marriage in the Catechism of the Catholic Church and the John Paul II, Faith and Sexuality chapter on this web site
- appreciating that it is probably God's will for severely depressed spouses to be on medication
- reading John Paul II's The Role of the Family in the Modern World (Familiaris Consortio), and Letter to Families and The Dignity of Women
- appreciating that the Lord's first miracle was for a marriage at Cana and asking daily for His help through Our Lady.
Finally, a survey revealed the positive relationship between happiness and religion. In 2004, the General Society Survey asked a sample of Americans, "Would you say that you are very happy, pretty happy, or not too happy?" Religious people were more than twice as likely as the secular to say they were "very happy" (43%-21%). Meanwhile, secular people were nearly three times as likely as the religious to say they were not too happy (21%-8%). In the same survey, religious people were more than a third more likely than the secular to say they were optimistic about the future (34%-24%).
Loneliness as an opportunity for spiritual growth
The Servant of God, Catherine de Hueck Doherty, wrote about her long struggle with loneliness and the opportunity it can provide for spiritual growth and comfort.
“When I look at loneliness, I think of standing at 42nd Street and Broadway when I just arrived in New York City. Hundreds of people were hurrying by and I didn’t know a single soul. Huge buildings full of people towered over me. I was in a new country completely different from anything I had ever known. I was overcome by loneliness.
Loneliness has walked with me all my life. Some days it becomes very acute, such as when we celebrate the anniversary of my husband Eddies’s death. When this happens I sit there and ask God, “What do you want of this? Why do you send loneliness again?” Then I seem to hear the Lord saying, “Come higher, friend.” He is handing me loneliness so that I will grow in faith. I like to think of loneliness as if it is a person with a particular job to do.
So I imagine loneliness as a fancy doorman dressed in a brilliant uniform like you see at an expensive hotel or club. He opens the door for us to enter into faith. As we pass through the door, we find steps to go up. Each step takes us a little further into faith. That is why loneliness is with us – to grow in faith. We are never friendless, for we know that Christ resurrected and promised he would always be with us. Loneliness brings us closer to Him," Magnificat, August 29, 2010.
Married love and divine Love
Pope Benedict described in his first encyclical, God is Love, the relationship between human love and God's love. He wrote, "This in turn led us to consider two fundamental words: eros, as a term to indicate 'worldly' love and agape, referring to love grounded in and shaped by faith. Yet eros and agape-ascending love and descending love-can never be completely separated. The more the two, in their different aspects, find a proper unity in the one reality of love, the more the true nature of love in general is realized. Even if eros is at first mainly covetous and ascending, a fascination for the great promise of happiness, in drawing near to the other, it is less and less concerned with itself, increasingly seeks the happiness of the other, is concerned more and more with the beloved, bestows itself and wants to 'be there for' the other. The element of agape thus enters into this love, for otherwise eros is impoverished and even loses its own nature. On the other hand, man cannot live by descending love alone. He cannot always give, he must also receive. Anyone who wishes to give love must also receive love as a gift. Certainly, as the Lord tells us, one can become a source from which rivers of living water flow (cf. Jn 7:37-38). Yet to become such a source, one must constantly drink anew from the original source, which is Jesus Christ, from whose pierced heart flows the love of God (cf. Jn 19:34).” (Deus Caritas Est, 7)
Suggestions for the spouse who is not depressed
Living with a depressed spouse can be a challenge. Fortunately, most depressive illnesses remit and spouses can play an important role in the healing process. The first step to be taken is to try to understand the cause(s) of the sadness/loneliness by exploring stressful issues in a spouse's life. A basic misconception of depressive illness is that no one can make another person depressed. This erroneous view is based on radical individualism and selfishness. One spouse's insensitive behaviors can strongly influence the development of sadness and depression in the other spouse as demonstrated by research studies cited at the beginning of this chapter.
If the exploration of origins reveals that the non depressed spouse contributes to the difficulties by being emotionally distant, controlling, angry, selfish, etc, then this person should make a commitment to work on these weaknesses in his/her personality. Chapters on these issues on this site can be helpful to resolve such conflicts. Many depressed spouses complain that their spouses do not communicate sufficiently to them in a positive, cheerful manner. Growth in the virtues, which help marital communication, are identified in the chapter on the emotionally distant spouse,
If strong loneliness is identified from the family background, the spouse can make a major commitment to try to protect their loved one from more ongoing loneliness by evaluating the quality of their self-giving to the romantic aspect of marriage, to the marital friendships and communication and to betrothed love. Then they should try to be as giving as possible while at the same time recognizing that their love and attention cannot make up for loneliness caused by a lack of secure parental attachment.
For serious family of origin loneliness if the spouse's faith is strong they can recommend some of the meditation exercises described earlier. The research noted earlier could be cited which showed that the combination of frequent religious attendance, prayer, Bible study, and high intrinsic religiosity, predicted a 53% increase in speed of remission after controls. Patients who are highly religious by multiple indicators, particularly those involved in community religious activities, remit faster from depression.
Other spousal interventions could include:
- communicating in a predominantly positive, cheerful manner
- encouraging the spouse to let go and let God with excessive fears and worries
- working to protect and build the confidence in one's spouse
- recommending spouse work to resolve family of origin loneliness
- reminding the spouse that he or she is loved deeply
- encouraging regular forgiveness of those who have inflicted hurt from any life stage
- suggesting growth in spiritual life when appropriate
- being open to God's plan for the right number of children
- protecting one's spouse from controlling, angry or emotionally abusive individuals
- correcting when appropriate those who have hurt one's spouse
- recommending self-giving in trustworthy friendships
- suggesting going to the Eucharist and the sacrament of reconciliation regularly
- advising more balance in life
- avoiding expressing anger
- correcting selfishness, materialism or a lack of balance
- encouraging same sex friendships
- recommending a reliance upon God's love in addition to human love
- encouraging treatment with medication for severe depression.
Depressive illness is not an uncommon difficulty or cross in married life. Fortunately, it can be resolved and steps can be taken to protect a spouse from relapse. We recommend that attempts be made to explore whether loneliness, selfishness, and difficulty in trusting are conflicts in the depressed spouse. Also, the uncovering and treatment of the anger present in all depressed persons is essential both for recovery and for the protection from relapse. In addition addressing marital conflicts is important and can be highly effective if each spouse is open to grow in virtue. If such steps are taken, there is every reason to hope that depressive illness can be successfully addressed in married life and that married life can become more fulfilling and joyful.
References in this chapter can be found at the National Library of Medicine web site, Pubmed.