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ABSTRACT Fallow Season: Depression and its Forebears Derek McAllister, Ph.D. Mentor: C. Stephen Evans, Ph.D. This dissertation is part history, part analysis. It surveys prima facie historical antecedents to our current clinical concept of depression—a chapter each on acedia, tristitia, noche oscura, melancholia, and Tungsindighed. The analytic portion compares and contrasts each historical condition with depression, examining symptoms, etiology, historical context, and more. As it turns out, many, if not all, of these historical conditions can present with or essentially have some kind of spiritual etiology—unlike depression, which is often seen as a pathological psychiatric condition. More than a mere historical recounting, however, this dissertation also engages critically with the contemporary literature on depression and offers strategies for incorporating the “old” forgotten wisdom with the “new” discipline of psychiatry. This dissertation thus brings together the history of philosophy, philosophy of religion, virtue ethics, and philosophy of psychology and psychiatry (especially mental health), featuring themes from Thomas Aquinas, Søren Kierkegaard, and the Desert Fathers, among others. Fallow Season: Depression and its Forebears by Derek L. McAllister, B.A., M.A., M.A. A Dissertation Approved by the Department of Philosophy Michael D. Beaty, Ph.D., Chairperson Submitted to the Graduate Faculty of Baylor University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Approved by the Dissertation Committee C. Stephen Evans, Ph.D., Chairperson Michael D. Beaty, Ph.D. John J. Haldane, Ph.D. Thomas M. Ward, Ph.D. Michael P. Foley, Ph.D. John R. Peteet, M.D. Accepted by the Graduate School August 2020 J. Larry Lyon, Ph.D., Dean Page bearing signatures is kept on file in the Graduate School. Copyright © 2020 by Derek McAllister All rights reserved TABLE OF CONTENTS LIST OF FIGURES viii LIST OF ABBREVIATIONS ix PREFACE xi ACKNOWLEDGMENTS xiii DEDICATION xvi CHAPTER ONE 1 Introduction 1 1.0 - What is Depression? Differing Levels of Complexity and Explanation 7 1.0.1 - Theoretical Models of Depression 10 1.0.1.1 - Constructing and comparing models. 13 1.0.1.2 - Varieties of models of depression 14 1.0.2 - How Diagnostic Practices Influence our Understanding of Depression 22 1.0.2.1 - Absence of telos 27 1.0.2.2 - Absence of etiology 29 1.0.2.3 - Reifying depression 33 1.0.2.4 - Biomedical model reinforced 36 1.1 - Recovering the Past (& What to Do with it Once it’s Recovered) 41 1.1.1 - Opening the Door to Spiritual Etiology 43 1.1.2 - Pluralistic Kinds of Depression 45 1.1.3 - A Non-Pathological Fallow Season 46 1.2 - Conclusion 47 CHAPTER TWO 49 Acedia 49 2.0 - Rationale for Inclusion 49 2.1 - Acedia in the Monastic Tradition of the Desert Fathers 55 2.1.1 - The Desert Fathers 56 2.1.2 - Evagrius of Pontus (345-399) 59 2.2 - Acedia from the Desert to the Wider World 66 2.2.1 - John Cassian (360-435) 67 2.2.2 - Pope St. Gregory I (540-604) 71 2.2.3 - Sloth’s Lost Familiarity in Recent Times, which Coincides Historically with the Advancement of Psychiatry 76 2.3 - Acedia’s Main Features 78 2.3.1 - Acedia is Irreducibly Spiritual 78 iv 2.3.2 - Acedia Has Especially Notable Psychological Manifestations 80 2.4 - Considered Judgment on Relation to Depression 80 CHAPTER THREE 88 Tristitia 88 3.0 - Rationale for Inclusion 89 3.1 - Sorrow Over One’s Own Sin 94 3.2 - Thomas Aquinas on Tristitia and Acedia 98 3.2.1 - Aquinas’s View on Tristitia Immoderata 99 3.2.2 - Aggravatio animi: Tristitia aggravans, Anxietas, and Acedia 102 3.2.3 - Moderate Acedia 104 3.2.4 - Tristitia Alongside Agonia, Segnities 106 3.2.5 - Aquinas’s View on Acedia as Capital Vice (Acedia Immoderata) 112 3.3 - Back to Cassian & Gregory 116 3.3.1 - Gregory’s Capital Sin of Tristitia 117 3.3.2 - Cassian’s Logismos de Spiritu Tristitiæ (Spirit of Sadness) 120 3.4 - Considered Judgment on Relation to Depression 121 CHAPTER FOUR 123 Noche Oscura 123 4.0 - Rationale for Inclusion 124 4.1 - Noche Oscura in St. John of the Cross (1542-1591) 131 4.1.0 - Union with God 132 4.1.0.1 - A note on the writing/text 134 4.1.0.2 - Sanjuanist terminology 136 4.1.1 - Dark Night of the Senses — Active (A1.1—A1.15) 139 4.1.2 - Dark Night of the Spirit — Active (A2.1—A3.45) 142 4.1.3 - Dark Night of the Senses — Passive (N1.1—N1.14) 147 4.1.4 - Dark Night of the Spirit — Passive (N2.1—N2.25) 149 4.2 - The Problem of Saints in Darkness, & Whether There is a Further Night 151 4.2.1 - St. Teresa of Calcutta (1910-1997) – Spiritual Darkness 152 4.2.2 - Garrigou-Lagrange’s La Nuit Réparatrice: A Darkness Beyond Noche Oscura? 155 4.2.3 - Evaluating La Nuit Réparatrice against St. John of the Cross’s Teaching 157 4.2.4 - La Nuit Réparatrice and Depression 162 4.3 - Considered Judgment on Relation to Depression 164 CHAPTER FIVE 166 Melancholia 166 5.0 - Rationale for Inclusion 168 5.0.1 - Black Bile - pre-17th-c.: Hippocrates, Galen, & the Humours 170 5.0.1.1 - Symptom #1 - anger-melancholy 173 5.0.1.2 - Symptom #2 - sorrow-melancholy 174 5.0.2 - Melancholy in Medicine (17th c. - 19th c.) without Aetiology 174 5.0.3 - Elizabethan & Romanticism’s 19th-c. Poetic Melancholic Genius 175 v 5.0.4 - Melancholy as a Psychiatric Conceptual Precursor to Depression 179 5.0.5 - Religious Melancholy in 17th- and 18th-century Clergymen 180 5.1 - Our Interest, Religious Melancholy in Particular 183 5.1.1 - Robert Burton’s Analysis of Religious Melancholy in The Anatomy of Melancholy (1621), Which is a Model for Understanding Later Accounts 185 5.1.1.1 - Religious melancholy as characterized by excess: disordered approach towards God where the mode is love of God 191 5.1.1.2 - Religious melancholy as characterized by defect: disordered withdrawal away from God where the mode is love of God 193 5.1.2 - The Non-Pathological Causal Predicament Preceding Religious Melancholy: Or, Who’s to Blame? 199 5.1.2.1 - God and the devil 201 5.1.2.2 - Physick 205 5.1.2.3 - Religion 211 5.1.2.4 - Moral impulse and weakness of faith 214 5.1.2.5 - Nostalgia and return to God 221 5.2 - Considered Judgment on Relation to Depression 224 5.2.1 - Is this Dame Acedia? 225 5.2.2 - Is this Dame Noche Oscura? 227 5.2.3 - A Final Word on Religious Melancholy’s Relation to Depression 228 CHAPTER SIX 231 Tungsindighed 231 6.0 - Rationale for Inclusion 232 6.1 - Tungsindighed 235 6.1.1 - Tungsindighed in SK’s Journals, Notebooks, & Papers 236 6.1.2 - Tungsindighed in Either/Or (1843) 241 6.1.2.1 - Tungsindighed in E/O - Volume I 241 6.1.2.2 - Tungsindighed in E/O - Volume II 246 6.1.3 - Evaluation of Tungsindighed 249 6.2 - Kjedsommelighed 253 6.2.1 - Kjedsommelighed in Either/Or (1843) 254 6.3 - Fortvivlelse 256 6.3.1 - Fortvivlelse in The Sickness Unto Death (1849) 258 6.3.2 - Fortvivlelse in Works of Love (1847) 265 6.3.3 - Evaluation of Fortvivlelse 269 6.4 - Considered Judgment on Relation to Depression 272 CHAPTER SEVEN 276 Conclusion 276 7.0 - General Strategies for Synthesis 278 7.0.1 - Historical Revisionism 279 7.0.2 - Revising Present-Day Concepts of Depression 279 7.1 - Our Particular Historical Conditions 280 7.1.1 - Caveat 280 vi 7.1.2 - What to Do with Acedia 281 7.1.3 - What to Do with Tristitia Immoderata 282 7.1.4 - What to Do with Noche Oscura 283 7.1.5 - What to Do with Religious Melancholia 284 7.1.6 - What to Do with Tungsindighed 286 7.2 - Conclusion 287 BIBLIOGRAPHY 289 vii LIST OF FIGURES Figure 1.1 – Dimensions of categorization. 11 Figure 1.2 – DSM-5 criteria for MDD. 24 Figure 3.1 – The activation of passion: in the order of generation. 109 Figure 4.1 – Similarities and differences between “salutary” religious depression (what Durà-Vilà and Dein (2008) call the “Dark Night of the Soul”) and “pathological” religious depression, based on Font (1999). 129 Figure 4.2 – The Ascent of Mount Carmel. 160 viii LIST OF ABBREVIATIONS A - The Ascent of Mt. Carmel APA - American Psychiatric Association BVV - The Book of Virtues and Vices C - The Spiritual Canticle CA - The Concept of Anxiety CD - Christian Discourses CDC - Center for Disease Control CUP - Concluding Unscientific Postscript DSM - Diagnostic and Statistical Manual of Mental Disorders (by APA) E/O - Either/Or EUD - Eighteen Upbuilding Discourses F - The Living Flame of Love FT - Fear and Trembling ICD - International Classification of Diseases (by WHO) JP - Kierkegaard’s Journals and Papers (Hongs’ translation, Vols.) KJN - Kierkegaard’s Journals and Notebooks (10 Vols.) MDD - major depressive disorder N - The Dark Night NB - “Notesbog” (“Notebook”) a designation assigned idiosyncratically by Kierkegaard to a series of thirty-six quarto-sized, bound journal volumes. NIMH - National Institute of Mental Health ix O.C.D. - Order of Discalced Carmelites OED - Oxford English Dictionary O.P. - Order of Preachers (Dominicans) O.S.B. - Order of St. Benedict (Benedictines) Pap. - Søren Kierkegaards Papirer p.c. - personal correspondence PC - Practice in Christianity PF - Philosophical Fragments PG - Patria Græca PL - Patria Latina PV - The Point of View of My Work as an Author R - Repetition RCP - Royal College of Psychiatrists RDoC - Research Domain Criteria (by NIMH) RPC - The Register of the Privy Council of Scotland S.J.
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