Have you ever read a book or even just a chapter in a book and said to yourself, “Self, you should have read this years ago!”? That is what I thought (and said out loud) after I read Chapter 2 in a book called On Depression: Drugs, Diagnosis, and Despair in the Modern World by Nassir Ghaemi. I was sitting on my back patio, enthralled in this chapter, underlining and starring sentences and whole paragraphs. I couldn’t help but reflect on my own journey and revisit the topic of guilt and blame.
Let me tell you a bit about this particular chapter. The author talks about depressive episodes vs. major depressive disorder, calling the former “depression nondisease” and “depression disease.” The most insightful part of the chapter is when Ghaemi defines what he calls “first cause” and “efficient cause,” where first cause is “the initial biological susceptibility to depression” and the efficient cause is the “immediate life events that trigger a clinical depression at that time” (pg. 15-16). This concept was nothing new to me, but it was particularly thought-provoking when he explained the relationship between them in regards to major depressive disorder.
“…first causes are necessary but not usually sufficient; efficient causes are often sufficient but not necessary. One usually needs both, and neither alone is the cause of depression” (pg. 16).
Here’s how I explain it in my own words: Genes have to be there, but they usually aren’t enough to bring about issues with depression. Situational triggers are usually needed, but not necessarily. Therefore, both biology and situations are at fault in cases of major depressive disorder.
At first the chapter was strangely comforting, as it reminded me that my struggles with mental illness were probably inevitable. My DNA set the stage for major depressive disorder and generalized anxiety disorder and like anything else that is less than “ideal” in our genetic makeup, God will always provide a way through it and will weave it into our purpose. Yet the chapter also brought up some old feelings of guilt. I’ve often wondered what set me off that summer and I have a few ideas. Overall, I think it was just a perfect storm of changing hormones and social situations. I remember asking my therapist if there was a point in trying to figure out what set it off. She told me that it was more beneficial to look forward and learn how to cope with it, than dwell in the past and speculate about what happened and that I should not feel guilty. Even though I knew this was true and knew that the main cause was biological, I still couldn’t help but wonder (especially in the beginning) if I did something to bring it on. Was there something I could have done to prevent it? Some sin or lack of faith that I had control over? These questions still crept up every once in a while until recently and I’m not sure what to think. The first, biological cause is something I never had control of. But what if I did have some sort of control over the efficient cause? Does that particular efficient cause even matter if some later efficient cause would have set it off anyway?
As I write this, I’m genuinely concerned that it took me about 10 years to completely let go of the guilt. There must have been sermons or messages from family and friends that I heard as a kid that made my brain zoom in on sin and not grace. I think my church was pretty balanced in these areas, but I must have heard something (or a few somethings) that messed up my thinking. It’s much better than it was ten or even three years ago, but it’s been a long journey of second-guessing and occasionally apologizing for certain sins, just in case they were the efficient cause. God has definitely been faithful in healing me and a few months ago I felt He released me from some of this by giving me clarity on one of these “sins.” But healing in this area wouldn’t have happened without the people, ideas, and books that I’ve CHOSEN to be a part of my adult faith journey as a proactive attempt to override the dangerous messages.
Ideally, it’s better for me to live in the present than dwell in the past. But I think with any traumatic experience, we’re bound to think about it every once in a while. I’ve decided that, if I’m going to look back at all, it’s more beneficial for me to analyze the messages instead of the sin. So I’m attempting to identify the messages that were my roadblocks to healing and caused me to dissociate from the church, and educate others about them. That’s essentially what the Cave Place is for me and the reason that I am comfortable with being vulnerable with all of you. I never want another teenager to go through struggles with mental disorders without the overwhelming understanding of God’s grace.