Making Space for the Sacred in Mental Healthcare: Acedia & Spiritual Practices
Rev. Dr. Christopher Jones, Associate Professor of Theology, Barry University
This paper compares Thomas Aquinas’s account of acedia with major depression. My goal is to demonstrate that the theological concept of acedia fits the psychiatric notion of a “cultural concept of distress,” and so acedia—and the spiritual practices that correct it—deserve space in mental healthcare. Aquinas views acedia as a vice that opposes the theological virtue of charity, which unites people to God and makes us joyful. He defines acedia as “oppressive sorrow at spiritual good" that results from appraising God and God’s blessings as either undesirable, aversive to one’s wellbeing, or detestable. One who has acquired this vice is unwilling to do good for others, and might also feel despair, restlessness, apathy, or listlessness (among other things). Because of this, an acediac experiences disordered thoughts, desires, and motivations. According to Aquinas, acedia can be acquired and exhibited in several different ways, as venial acedia is occasioned by situational forces that enhance one’s sorrow, and mortal acedia stems from the intellect and will sorrowing at spiritual good in ways that are less sensitive to the features of the situation. In short, acedia is a blameworthy form of sorrow at spiritual good, as one negatively appraises genuinely good things, and then acts inappropriately.
Given this analysis, acedia has a number of similarities and differences with major depression. Like acedia, depression can stem from situational forces or internal processes, and (among other things) can make one feel despair and become unwilling to act on behalf of others. Yet acedia is distinct from major depression, which is a clinically significant form of sorrow that reflects dysfunction in biological and psychological processes. Depression is also not a moral habit, as it does not stem from choices to appraise spiritual goods in ways that negatively shape one’s character and actions. Moreover, an acediac need not exhibit many of the symptoms associated with depression, such as changes in weight and sleep, psychomotor difficulties, suicidality, and the like. Depression, then, has a much broader impact on a person’s wellbeing than acedia. Given that the vice and disorder are distinct concepts yet share certain similarities, it is possible for them to co-occur, although this is not necessary.
Since acedia originates in a Christian context, it is functionally equivalent to the DSM category of a “cultural concept of distress,” as it captures how Christians “experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions” (DSM-5, 758). This label is appropriate as acedia is not only distinct from depression, but also from normal sorrow, which arises in response to loss and dissatisfaction, and can be situationally appropriate or inappropriate. This label also enables healthcare professionals to attend to spiritual realities in diagnosis and treatment, and makes it possible to utilize spiritual practices in supporting the mental health of persons struggling with acedia. Christian practices that correct acedia like contemplative prayer can help one build habits that promote joy. So accounting for acedia is a valuable way to make space for the sacred in mental healthcare.
Given this analysis, acedia has a number of similarities and differences with major depression. Like acedia, depression can stem from situational forces or internal processes, and (among other things) can make one feel despair and become unwilling to act on behalf of others. Yet acedia is distinct from major depression, which is a clinically significant form of sorrow that reflects dysfunction in biological and psychological processes. Depression is also not a moral habit, as it does not stem from choices to appraise spiritual goods in ways that negatively shape one’s character and actions. Moreover, an acediac need not exhibit many of the symptoms associated with depression, such as changes in weight and sleep, psychomotor difficulties, suicidality, and the like. Depression, then, has a much broader impact on a person’s wellbeing than acedia. Given that the vice and disorder are distinct concepts yet share certain similarities, it is possible for them to co-occur, although this is not necessary.
Since acedia originates in a Christian context, it is functionally equivalent to the DSM category of a “cultural concept of distress,” as it captures how Christians “experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions” (DSM-5, 758). This label is appropriate as acedia is not only distinct from depression, but also from normal sorrow, which arises in response to loss and dissatisfaction, and can be situationally appropriate or inappropriate. This label also enables healthcare professionals to attend to spiritual realities in diagnosis and treatment, and makes it possible to utilize spiritual practices in supporting the mental health of persons struggling with acedia. Christian practices that correct acedia like contemplative prayer can help one build habits that promote joy. So accounting for acedia is a valuable way to make space for the sacred in mental healthcare.