James F. Drane, Ph.D., Russell B. Roth Professor of Bioethics at Edinboro University of Pennsylvania, is the author of some fifteen books in the area of medical ethics, humane medicine, hospice and home care. He has been the recipient of numerous honors for his outstanding work, among them: Distinguished Teaching Chair of Pennsylvania; Outstanding Faculty Member, Edinboro University; Martin Luther King Award; Appointment to the United States Commission on Civil Rights; and the Legends Award of Erie, Pennsylvania. This is his first book for ST PAULS / Alba House.
James Drane has provided a useful and practical guide to dealing with suffering and depression. It is based on experience and his training by Dr. Krl Menninger. Now a retired philosophy professor, Drane counseled students, friends, neighbors, and colleagues for decades. Finding Relief from Suffering and Depression: The Role of Understanding and Faith is very readable and provides the correct nomenclature, good definitions, and categories for emotional illnesses, but it is not overly technical. It lacks jargon and is readily understandable. Here and there he offers illuminating little anatomy lessons, and there is even a little pharmacology.
Understanding is seen as the first step toward healing and dealing with physical suffering and emotional problems. This study provides many insights about human feelings, and this information should be useful in dealing with our problems and understanding other persons. Finding Relief from Suffering and Depression is very good at explaining problems associated with the aging process. Much attention is given to the "down" feelings that come at certain stages of life. The author explains the different kinds of depression and gives us advice on how to cope with them. The reader is repeatedly reminded that life is bound to deal some heavy blows; we are expectred to accept that fact and deal with it. Drane stops just short of saying that even if someone else really did something terrible to you, one should not blame others. Look at how you deal with the problem and what you may have done to create it.
Drane administers sharp doses of reality therapy, telling believers not to expect God to suspend nature's laws just for them. Repeatedly he reminds readers that everything in life is not fine and the "world is the way it is." Get used to it!
Emotional suffering comes when a person's identity and security are threatened. These are tied to the soul, which is defined as the inner self, inner person, self-identity, a person's inner essence, inner identity, and even conscience. When one's identity is threatened, suffering often occurs. Others can help by simply caring about that person experincing emotional pain.
Hope is seen as essential for curing physical disorders and dealing with emotional ailments. Threats to one's identity can cause emotional suffering, but the loss of life's meaning is as great a threat as the sharp decline of physical strength. Drane recommends philosophy and religion as abundant sources of understanding, consolation, hope and meaning. A healthy sense of identity requires that a person feels significant and special in some way, and this feeling does not come automatically. Philosophy and religion provide insight about life's purpose, and this is especially valuable when the self project is not going well.
Religion and philosophy are powerful aids but not substitutes for psychiatric treatment. They offer continual coping strategies and can help ease the dying process, especially for the elderly. Today's fashionable militant atheism is effectively challenged, though Drane admits that some atheists may not have great problems with dying. A leap of faith to belief in a Creator God is recommended as a means of understanding suffering and death in the context of personal salvation and the promise of eternal life. He writes, "Not to choose a relationship with God is to leave one's life unfinished."
An excellent explanation of the sufferings of Job is offered, and there is a short but effective commentary on the Pauline epistles. It is noted that Jesus showed no interest in harming and getting even with his tormentors. Drane recommends Jesus as a therapeutic model, noting that Christ was never spiteful or hurtful toward others and said, "Do good to those who hurt you."
In addition to psychological insights, Drane offers plenty of common sense. He notes that one who has never mourned or been even a little depressed is judged by many to be happy, but this person only had a very limited life. The limits of a purely scientific approach to life are explained, and Drane notes that "Wonders fall outside the scientific lens." He notes that science is designed to only measure matter. On the relationship of science and religion, the author observes, "Science generates understanding that raises questions that cannot be answered by science alone."
Running throughout the book is a critique of contemporary American culture and the claim that its maladies contribute to mental ailments. The author notes that higher education these days is more concerned with jobs than learning to lead good lives. Post-modernism is seen as extreme narcissism. More could have been said about its anti-rational features and rejection of the Enlightenment. It is rightly noted that post-modernism, with its inflated view of self, contributed greatly to today's great increase in depression. This scholar may be a little too hard on historians; there still are some who seek objectivity. Drane notes that the elderly are not respected and that human relationships are more superficial than previously. Many in today's culture doubt that anything like goodness exists. The deleterious effects of these characteristics upon mental health are obvious.
James Drane has written many books on bioethics, and he includes comments criticizing physicians who are aloof and too clinical in their treatment of patients. The role that pharmaceutical companies play in medical education comes in for blunt criticism. He denounces the so-called "liberation" of patients from mental institutions, when they were sent out onto the streets with nothing to occupy them and prescriptions they often did not fill or use. The intrusion of free market capitalism upon medicine has created multiple problems. The volume ends with a careful and lengthy discussion of assisted suicide, in which the problems it could create stand out in clear relief.
Finding Relief from Suffering and Depression is a useful book that should find a wide audience, that would reward care-givers, social workers, clergy, and just about anyone who could use help dealing with down feelings and the problems life presents. --Donald C. Swift, Ph.D.
In his Postcript the author reveals that this book represents his life. And what a full life James F. Drane has lived and continues to live to the present time. In his graduate studies Drane's pursuit of knowledtge embraces four different disciplines: theology, philosophy, medicine and bioethics. In this book he weaves back and forth in culling the wisdom of these interrelated fields to help the reader understand some of the key dimensions of suffering and depression.
With this rich background the author brings a holistic approach to his subject that combines sound reason and common sense together with a human interface between physician or therapist and the patient.
The book is comprised of two sections: Part One deals with Suffering and Part Two covers Depression. Early on in the section on Suffering there is a distinction made between pain and suffering. Pain helps us respond to "it hurts," whereas suffering may accompany pain that involves a loss of one's own identity.
The causes of suffering are numerous, such as emotional illness, serious physical illness, aging, death and dying, failed relationships, social violence, natural catastrophes, immoral behavior, the loss of feeling empathetic, and torture. What is critical, regardless of the type of suffering, is coming to some kind of understanding. The attempt to understand suffering is essential to our human existence, and in many cases will bring relief from the suffering.
For the Christian believer "the suffering that Jesus endured provides a way of understanding suffering in all lives.... The good news of the Gospels is that Jesus' suffering and death have meaning and so do the suffering and death of every person" (p. 62). The suffering and death of Jesus opens to new life and that indeed is good news.
Just as good medicine may bring relief of suffering every effective caregiver must also continually plant the seeds of hope, lest the dying person give way to despair.
Chapter Five entitled, "Humane Medicine for Relief of Suffering," provides a challenge to all professional caregivers to combine competence with compassion. The healing bedside manner that instills hope together with expertise and skill from years of study is what elevates medicine and therapy to a genuine art.
The second part of the book treats the subject of depression. There is a lengthy discussion of the effect of the period in history known as "the enlightenment," which brought about the breakdown of the partnership between science and religion. This breakdown, in turn, has produced a culture that glorifies the self and is one of the leading causes of an increase of depression in society today.
"According to the World Health Organization (WHO) depression is the leading cause of disability in the U.S., in Western Culture, and around the world. Its costs in treatment and lost productivity is more than that of any other condition. Because depression is so pervasive, suicide rates are rising" (p. 115).
The book looks at two types of depression: situational and structural. Situational depression arises from money problems, problems at work, friendship loss, a marriage in trouble, death of a loved one, etc. Situational depression is ordinarily relieved when the situation changes. However, it may lead to a more serious depression.
Structural depression is based on the structure of human life and the failure to move on to the next stage of life. Three stages are mentioned, namely: Stage I - Focus on Self. Depression comes from the failure to move on toward maturity from self-centeredness. Stage II - Commitment and Responsibility. At mid-life a person looks back at their life and suffers from a sense of limitation and inadequacy and as a result they experience a depression. Stage III - Aging and Dying. Physical, emotional, intellectual, and social losses, the inevitable decline that takes place with the aging process. And if these losses cannot be understood to have a meaning, depression rears its ugly head.
As we saw in the discussion of suffering that coming to some understanding of what is happening in order to move beyond it, so it is with depression. Instead of accepting despair, loss, and death as the final reality, belief in God may offer another possibility.
Chapter Nine stresses the important role of feelings as a way of coping with depression. In both situational and structural depression, it is the key to finding the source and identifying the associated feelings. To accept and own the feelings is a way to move beyond them.
The final chapter deals with the critical issues of suicide and the necessary protection against that choice. Patients have to be helped to die. Ethically how far should the help go? What are the ethical limits to what doctors can do and still remain true to their Hippocratic Oath: ""Do no harm." There are many stories how sick and elderly people are kept alive by unwanted medical procedures. This constitutes a violation of medical ethics and could push some elderly persons toward choosing suicide.
Religious beliefs have influenced law in every culture and Christian moral teachings have influenced anti-suicide legislation throughout the Western World.
Over all, Dr. Drane has provided a comprehensive view of suffering and depression and our responsibility to understand how to treat these realities from the perspective of reason as well as faith. --Joseph D. Dillon, Ph.D.