What do the following people have in common?
A Nigerian who describes a peppery feeling in his head
A Chinese farmer who complains of shoulder and stomach aches
A Korean woman who speaks of burning in her stomach
An Iranian who identifies tightness in his chest
An American who feels interminably sad1
These are all different ways of describing depression.
Japanese and Caucasian-American students who were studying in Hawaii were asked to identify the words they associated with depression. The most frequently occurring words for the Japanese students, in order, were: rain, dark, worries, gray, suicide, solitude, exams. For the Caucasian-American students: sadness, loneliness, down, unhappy, moody, low, gloom. Notice—the Japanese students looked outward; the Caucasian-Americans looked inward.
In Japan, they continue to have cultural arguments about the nature of suicide. Some would argue that it is a choice. It is a statement about human life and a way to deal with shame that could contaminate the family. It is an action of someone who is clear thinking and bold. Americans typically view suicide as inexorable depression that was either untreated or treated ineffectively.
When Japanese students are asked what would pick them up when depressed, they tend to think toward family and community. The Americans think in terms of personal successes.
Here is one conclusion from this type of research: depression is not simply a universal pattern of neuronal firing caused by predetermined genetic combinations. At least, it consists of an experience that is shaped by a cultural narrative. Depression has a story overlaid on it. In some cultures the story suggests that the experience is normal and is part of the process of developing character and strength. In others, such as our own, it is a brain pathology that must be treated quickly or it will leave the victim incapacitated.
Your interpretation of pain affects the experience of your pain. If the pain in your chest is from a slightly pulled muscle, you are proud that you are working out. If you believe it is from a tumor or incipient heart failure, it will hurt much worse.
If you experience peculiar sadness, and you are persuaded that God is with you and, through his love, is making you increasingly fruitful, your emotional limp will be less noticeable. But if your hardships are merely neuronal, there is nothing you can do except hope for the right combination of medications.
Our cultural narrative for depression is that it is a mental illness best treated with medication and some cognitive restructuring. This hasn’t always been the way we have interpreted depression, and it won’t always be the reigning interpretation. Even though the Western view of modern psychiatry is establishing hegemony around the world, and more and more cultures are getting in step with modern diagnoses, the psychiatric narrative is incomplete and dissatisfying. It ignores our familial, cultural and religious settings, and its treatments are by no means making us a mentally healthier society.
We are complex people.
There are so many questions.
There is a lot we don’t know.
What are we to do?
We turn to what is universal. We turn to what goes deeper than culture—the God revealed to us by Scripture. One of the beauties of God’s revelation is that we know (1) in this world there will be trouble, and (2) we don’t have to know the cause of the trouble in order to help each other know the comfort of Christ, grow in our confidence in his promises, and fruitfully abide in him. This is for everyone, in every culture.
Cross-cultural studies remind us that depression (i.e., suffering) is a broad category that includes being dumped by a 7th grade boyfriend, having physical pains of unknown origin, and receiving word that you have a terminal disease that will take your life within the year. Along that extensive spectrum of suffering we can have hope that the God who has demonstrated to us his goodness in Jesus will continue to demonstrate that goodness. Of course, we will need the Spirit of God to help us to see spiritual realities with clarity. Those who are wise plead with us to have a feeding frenzy on the Word. And we might do some repenting along the way when we notice that our narrative is that God should make our lives easy. As we grow in these things, we will learn again that the story of God’s kingdom reaches farther and deeper than any other. As a result, we can know real hope in our hardships, regardless of our cultural background.
What might we do with this? It doesn’t give us clear guidance on what to do when we are depressed, but it does remind us that while God has unique interest in our particular hardships – that is, while he cares about us as individual creatures in the midst of millions of people and thousands of cultures – he also does things big. In this case, he doesn’t simply offer a culturally-specific understanding of hardships. Instead, he speaks to the heart of all human suffering. And that can encourage our confidence in who God is and what he says.
1 Ethan Watters, Crazy Like Us: The Globalization of the American Psyche, New York: Free Press, 2010.
Also see: Laurence J. Kirmayer, “Psychopharmacology in a Globalizing World: The Use of Antidepressants in Japan,” Transcultural Psychiatry, Sept. 2002, 39 (3), 295-322; and Junko Tanaka-Matsumi and Anthony J. Marsella, “Cross-Cultural Variations in the Phenomenological Experience of Depression: I. Word Association Studies,” Journal of Cross-Cultural Psychology, Dec. 7 (4). 379-396.