In the fall of 2007, Mother Teresa graced the cover of Time magazine when her private writings were published. Many of the excerpts were filled with surprising doubt, despair and a kind of spiritual anguish. Some journalists questioned whether she was clinically depressed.

Did this modern saint have an untreated mood disorder or did her pain fall into the category of a “dark night of the soul” – a concept introduced by Saint John of the Cross, a Carmelite friar who lived in Spain during the late 1500s? I believe it was the latter, given her incredible productivity during the years of her struggle.

The distinction is important because many religious and spiritual people forego treatment thinking that the pain they endure is necessary to purify their souls. For example, when I was a young girl I thought that my desire to die meant that I was a mystic.

Gerald May, MD, a retired psychiatrist and Senior Fellow in Contemplative Theology and Psychology, discusses both in his book, The Dark Night of the Soul. When a person is clinically depressed, Dr. May explains, she loses her sense of humor and the ability to see comedy in certain situations. The sufferer is also too shut down to reach out to offer compassion to others who are in pain. She can’t see beyond her own discomfort. Clinical depression can render apathetic an otherwise energetic, sensitive person, so that all her senses are disabled. Her very being seems to disappear beneath her illness.

With a dark night of the soul, the individual stays intact, even though she is hurting. While a person in the midst of a dark night of the soul knows, on some level, there is a purpose to the pain, the depressed person is embittered and wants to be relieved immediately. “In accompanying people through dark-night experiences, I never felt the negativity and resentment I often felt when working with depressed people,” explains Dr. May.

Kevin Culligan, OCD, a psychologist and the former chair of the Institute of Carmelite Studies, also distinguishes between the dark night and clinical depression in his chapter in the book, Carmelite Spirituality, edited by Keith Egan (a wonderful professor of mine at Saint Mary’s College and my thesis director for a paper I wrote on John of the Cross’ The Dark Night).

Fr. Culligan explains that a clinically depressed person has a loss of energy and pleasure in most things, including hobbies and sex. The sufferer will sometimes exhibit a dysphoric mood (think Eeyore) or psychomotor retardation. The person in the midst of a dark night experiences loss, too, but more as a loss of pleasure in the things of God. Culligan can often tell the difference between the two based on his response to the person with whom he’s interacting. After listening to a depressed person, he often becomes depressed, helpless, and hopeless himself. He feels the rejection of self, as if the depression is contagious. In contrast, he is not brought down when people speak of a spiritual aridity.

I found this paragraph in Culligan’s chapter to be especially helpful:

“In the dark night of spirit, there is painful awareness of one’s own incompleteness and imperfection in relation to God; however, one seldom utters morbid statements of abnormal guilt, self-loathing, worthlessness, and suicidal ideation that accompany serious depressive episodes. Thoughts of death do indeed occur in the dark night of the spirit, such as ‘death alone will free me from the pain of what I now see in myself,’ or ‘I long to die and be finished with life in this world so that I can be with God,’ but there is not the obsession with suicide or the intention to destroy oneself that is typical of depression. As a rule, the dark nights of sense and spirit do not, in themselves, involve eating and sleeping disturbances, weight fluctuations, and other physical symptoms (such as headaches, digestive disorders, and chronic pain).”

Psychologist Paula Bloom posted an article awhile back on PBS’s “This Emotional Life” platform called “Am I Depressed or Just Deep?” She talked about how people confuse being depressed with being philosophical or deep. And I would add, “spiritually sophisticated,” the kind of person who knows what a dark night is, and believes God has allowed it to happen for a reason. Dr. Bloom explains that life is hard, it involves inexplicable tragedies, and yes, to not ever feel fear or despair or anger in light of this might make suspect a person’s humanity. But to stay in that place — disabled by life’s blows — may mean you’re dealing with a mood disorder, not a depth of perception. In her blog, Dr. Bloom writes:

“There are a few basic existential realities we all confront: mortality, aloneness, and meaninglessness. Most people are aware of these things. A friend dies suddenly, a coworker commits suicide or some planes fly into tall buildings — these events shake most of us up and remind us of the basic realities. We deal, we grieve, we hold our kids tighter, remind ourselves that life is short and therefore to be enjoyed, and then we move on. Persistently not being able to put the existential realities aside to live and enjoy life, engage those around us or take care of ourselves just might be a sign of depression.”

Culligan and May agree that a person can be experiencing BOTH a dark night and clinical depression. Sometimes they are impossible to tease apart. “Since the dark night and depression so often coexist, trying to distinguish one from the other is not as helpful as it might first appear,” writes May. “With today’s understanding of the causes and treatment of depression, it makes more sense simply to identify depression where it exists and to treat it appropriately, regardless of whether it is associated with a dark-night experience.”

Continue the conversation in the Faith & Depression Group on Project Beyond Blue, a new online community.

Originally posted on Sanity Break at Everyday Health.

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