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"The love of husband and wife is the force that welds society together." St. John Chrysostom

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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 support of faith when appropriate.

A large 2016 research study of women reported in JAMA Psychiatry demonstrated the benefits of faith. Catholic women who attend religious service weekly have a five fold decreased risk of suicide compared to women who do not.  Furthermore, the study revealed that 6,999 Catholic women who attend mass more than once per week never attempted suicide.(VanderWeele, T.J., 2016)

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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).

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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.

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Also, 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).

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Marital Happiness

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

• fairness

• 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.

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Marital Origins of Spousal Sadness

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 or who lacks balance in life. Frequently these issues are not fully uncovered and addressed.  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. 

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Sadness from One's Family Background

Numerous disappointments and hurts in the family background can contribute to the experience of sadness and loneliness decades later.  Often, in such circumstances, the spouse is blamed for this emotional pain.  Then anger and mistrust that are meant for a parent are unconsciously misdirected at a spouse. Leading causes of sadness from one's youth include:

• Negative parental legacies including modeling after a depressed, negative, controlling or anxiety parent

• Unresolved sadness from the father relationship

• Unresolved sadness from the mother relationship

• Loneliness in a sibling relationship

• Lack of same sex friendship

• History of serious parental conflicts

• Parental divorce or separation

• Hurts in significant relationships prior to marriage

• Loneliness for a brother or a sister.

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One study from Massachusetts General Hospital 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. (Waldinger, R.J. 2007.  Childhood sibling relationships as a predictor of major depression in adulthood: a 30-year prospective study. Am J Psychiatry, 164: 949-54)

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Spousal Symptoms of Depression

These include some of the following:

• lack of energy

• poor concentration

• crying episodes

• impaired memory

• insomnia

• loss of appetite

• lack of hope

• lack of cheerful giving to children and spouse

• irritability

• anxiety

• 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 Origins of Sadness and Depression

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 sadness, loneliness, anger, mistrust or insecurity experienced prior to their marriage or in their marriage. Self-knowledge in this area is essential to personal growth and to marital happiness.

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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 were more emotionally giving, complimentary, less irritable and calmer. 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 mothers not being as present as they had been previously. 

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In one study of happily married couples in mid life 75% of the spouses reported still feeling angry about various types of childhood disappointments with a parent.

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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. 

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Newer research and clinical experience demonstrate a clear relationship between hormonal contraceptive use and increased risk of depression and suicide.

In a nationwide prospective cohort study published in 2016 of more than 1 million women living in Denmark found a 70% higher risk of depression among users of hormonal contraception compared with never-users, with the highest rates among adolescents with a two fold risk compared to adults, (Skovlund, C.W., et al., 2016).

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In a second 2017 study by the Danish group of nearly a half million women who used hormonal contraceptives compared with women who never used them were at two to three times greater risk for suicide.  Adolescents experienced the highest relative risks.   With a mean age of 21 years, 6,999 first suicide attempts and 71 suicides were identified.  The authors concluded that considering the severity of these little-recognized potential side effects of hormonal contraceptives, health professionals and women starting hormonal contraceptives should be informed about them. (Skovlund, C.W., et al., 2017).

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In my experience with hundreds of  Catholic marriages, contraceptive use can increase selfishness in the marriage and damage the marital tr friendship and sexual intimacy, https://www.thecatholicthing.org/2015/01/29/contraceptions-cascading-rampage/

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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).

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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. 

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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.

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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 Hurts, Sadness and Anger

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.

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Decision Phase

We describe the benefits of forgiveness when recommending a 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.

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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.

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Work Phase

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.

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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. 

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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.

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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.

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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.

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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 the 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.

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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.

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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.

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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.

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Obstacle to Forgiveness

A number of obstacles are encountered in the uses of forgiveness in the treatment of depression. These include:

• selfishness

• 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.

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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.

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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.

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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.

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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.

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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 can protect them from a recurrence of their illness.

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Postpartum Depression

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.  The case study below is a composite one taken from Forgiveness Therapy.

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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.

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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.

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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.

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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.

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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.

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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.

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The resolution of anger can facilitate the healing of depressive episodes, and, in many patients, helps to prevent relapses.

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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 its diminishment 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.

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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. 

 

The following research studies have demonstrated the beneficial effects of faith in regard to dealing with depressive illness.

• A large 2016 major research study that demonstrated that women who attend religious services weekly have a fivefold decreased risk of suicide, (VanderWeele, TJ, et al, 2016).

  http://archpsyc.jamanetwork.com/article.aspx?article id=2529152

• 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.co

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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.

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Additional aspects of one's Catholic spiritual life which have been 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

• 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.

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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%).

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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.  She wrote, "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.

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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.

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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).

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Suggestions for the Spouse Who is not Depressed

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.

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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.

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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.

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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.