The Ambiguity of Diagnosis and the Social Power of Medication
The social power to define and categorize another person’s experience is not a power to be ignored…. In order to support persons who are trying to recover, we must attend to the fullness of their experiences, and not be distracted by their medical diagnoses.
BEING DIAGNOSED IS OFTEN A PIVOTAL POINT IN A PERSON’S MENTAL health journey. We have previously reflected on challenges that the DSM diagnostic system poses. It was suggested that its diagnostic descriptions are too thin; they identify some aspects of people’s experience but fail to recognize other vital dimensions. The DSM cannot and does not capture the meaning and impact of diagnosis, and indeed is not intended for such an interpretative task. It is meant to offer a minimal amount of descriptive information that can guide certain aspects of clinical practice. This can be helpful for clinicians and for those living with unconventional mental health experiences. For the former, it gives a basic descriptive structure that enables certain treatment decisions. For the latter, it provides a name and an explanation for a series of experiences that can be baffling to the individual and to others.
Jane lives with bipolar disorder and finds her diagnosis useful insofar as it names her experience in a way that is helpful for her and for those around her.
It’s helpful when you are trying to tell your story to someone of what happened. If I said I had a bipolar-depressive episode, they’re like, Oh! OK, I understand that. Whereas if I say I had “this breakdown in my life,” they’re a bit like, what? What does that mean? So, for people to kind of understand, or even just for me to be able to explain it to myself—what was going on during that time in my life—it is helpful. And for me it helps me to explain things like depersonalization, derealization, high anxiety, posttraumatic stress, and all that comes out of childhood stuff. Diagnosis has been helpful for understanding those things and having names for the symptoms, perhaps more so than having a label that fits the psychiatrist’s diagnostic thing.
Diagnosis can name certain forms of experience in ways that make them understandable to self and others. The personal utility of diagnosis (how it relates to personal experience rather than its therapeutic utility) emerges not from the technical dimensions of the process of diagnosing but in its personal and social consequences.
Brian puts it like this:
I’ve found it very helpful. It helps to sort of identify what medication can assist, but also provides me with an awareness around lifestyle and also around possible triggers for future relapse. This becomes much clearer with a diagnosis. I think … probably one of the things I struggled with early on was accepting the diagnosis as being helpful, but I think after many relapses that I’ve had since the first one, I’ve resigned myself and basically come to view it in a positive way as the best approach to take, not only for me but also for my family and loved ones and my friends who are supporting me. I think it’s helpful … taking onboard all the years of research and how other people have experienced similar behavior for a similar diagnosis.
Brian’s diagnosis of bipolar disorder helps him make sense of experiences that sometimes feel quite random. Randomness leads to anxiety and fear. Receiving a diagnosis can be a way of controlling the situation and driving out fear. Jane is a medical doctor. She is used to working with diagnoses and schemes of categorization. She says, “I need the diagnosis. I would be very uncomfortable just having experiences. It’s very important to me to put something in a box and be, like, it has these characteristics and I can expect this, and these are the treatments. Of course, when I’m ill I don’t feel like I have an illness at all because it’s just what I’m doing. But when I am well it helps.”
For Jane, diagnosis brings peace and a sense of control, at least when she is not experiencing those elements of her experience that she and others consider difficult. It also offers hope. If it is a recognizable condition, then she knows there are treatments available and that she is not destined to be “crazy forever”!
However, there is a more ambiguous side to receiving a diagnosis. Mary makes a poignant observation:
I think for some people diagnosis is a helpful way of being able to explain their story. But I think for me it is different. Yes, diagnoses can reduce anxiety, but at the same time they kind of lock the system. So, if you say to someone, Oh, you’ve got bipolar, they’re like, OK, I’ve got bipolar. But what happens then is that it can stop them moving or changing, and they just kind of use it as an excuse and as a means to reduce their own anxiety. When I got the diagnosis (depression), we talked a lot about how actually it could be really unhelpful for me to label myself in a way that would stick, and a way that would stop me moving forward. Sure it makes you feel better and it reduces my anxiety because I can blame everything on this label. There are pluses, of course, but it does mean you are kind of stunted and you can’t kind of grow. “Just take your meds for the rest of your life and you’ll be fine.” But who wants to be a patient forever!? (laughs) But then at the same time, I know that actually some diagnoses are helpful. Well, my friend, for example, was diagnosed with bipolar. It was just incredibly helpful for her, because she’d been, like, just all over the place, different diagnoses, different drugs and treatments, and it was just horrible. Awful for her, so when she was finally told actually you’ve got bipolar, she was, like, Oh, I don’t really know what that means, but great, I can explain myself in some way.
There is an uncomfortable and awkward ambiguity that accompanies the ascription of a diagnosis. It can be helpful and unhelpful at precisely the same time.
Allen was fifty-one years old. He studied divinity at the University of Aberdeen in Scotland before beginning a PhD in immunology at the University of Glasgow. That program didn’t quite work out for him, but his desire for God and his longing to help people remained a primary mark of Allen’s life. He was an interesting man—clever, thoughtful, but with a rather unusual way of expressing himself. His sharp, high voice was distinct and could be rather disconcerting. For his friends, however (and I include myself within this category), that was just how Allen was. Allen also lived under the description of schizophrenia.2
His schizophrenia began to seriously impinge on his life in January 1976. It was small things at first. Paranoia—specifically the feeling that someone was following him around—“started big time in 1976,” he said. “I kept feeling there was someone walking behind me. I just felt that if I walked around fast enough, I would see them, but I never did. They were always there but I just couldn’t quite see them.” Then came the feeling that people were against him, at first certain people, and then everyone: “There was this real fear. I was convinced everyone in the world was going to kill me if I left my room, but I’m not quite sure why. I talked to my classmates about it [Allen was a university student at the time], about what would hurt me, and that people were turning against me. They started to avoid me. That kind of made my point! People were against me, even my friends. So, it was kind of like a self-fulfilling prophecy.”
Things went from bad to worse. Allen’s feelings that people were against him became more intense. He also began to think that someone was stealing his thoughts:
I was only sleeping like an hour a night. It was the beginning of June. I felt that I had to have a hat on all the time to protect my thoughts, because I believed that people were looking at my thoughts and were interfering with them. But if I had on this hat, it protected me from that. So, I kept the hat on at all times, even like, I was having a shower. I would leave it on until the last minute, go to the shower, take it off quick, have a quick wash of my head and then put back on my hat. That sort of thing.
Gradually Allen’s life became quite disorganized and miserable. His paranoia increased, angry voices surrounded him, and his friends abandoned him (or at least that was how he felt). Even his own thoughts became his enemy. His experience resonates deeply with the experience of the psalmist:
Even my close friend,
someone I trusted,
one who shared my bread,
has turned against me. (Ps. 41:9)
How long must I wrestle with my thoughts
and day after day have sorrow in my heart?
How long will my enemy triumph over me? (Ps. 13:2)
Allen felt afraid, alone, and very lonely.
After several months of these deeply troublesome experiences, Allen finally received a formal diagnosis of schizophrenia. He knew there was something seriously wrong and that he needed ongoing help, but receiving this diagnosis did not bring relief. It made him sad: “I remember I was in the hospital when they asked if I wanted to know my diagnosis. And I said yes. They told me that I had schizophrenia. It made me a bit sad because it was sort of like, ‘Oh! that’s me forevermore now,’ kind of thing. But it was also sort of like, I sort of felt useless a bit because I wasn’t studying (I couldn’t at that point), and I wasn’t doing anything, so it’s like I’m no use to anyone. And that just made it worse.”
Some diagnoses may bring about a lessening of anxiety, but the diagnosis of schizophrenia had no such palliative effect. We will look at why this diagnosis is particularly destructive later in the book. Here we note that Allen equated this diagnosis with the end of a creative and productive life. “I just felt like giving up.”
His initial visceral fear and disappointment at being diagnosed with schizophrenia were compounded by an encounter he had on a bus shortly after he was diagnosed.
When I was a student I used to always see this woman on the bus, because she went home at the same time as me. We used to talk from time to time, but after she found out I had schizophrenia she stopped speaking to me and kept away from me. I think probably she misunderstood me, because I was no threat to her before and I’m no threat to her now. But I think she maybe thought of like a violent person with schizophrenia and thought, “Oh, I better watch myself and keep away.” I think she was reacting to the name: schizophrenia. Because I remember she gave this shocked look at me when I said I had schizophrenia. That’s why I tend not to tell people unless I know they’re going to be OK, like I can tell you [John Swinton] because you won’t turn against me for it, I know that.
Something in the diagnosis of schizophrenia seems to have deeply negative connotations. The shift in the woman’s attitude from friendliness to fear is indicative of spoken and unspoken connotations that accompany the name “schizophrenia.” Allen hadn’t changed the way he was interacting with her. What had changed was the way he described himself to her. From the perspective of the woman, nothing had changed since she last willingly chatted with him. However, the introduction of the description “schizophrenia” instantly closed down her relational horizon. Allen’s already-growing alienation was exacerbated by his self-stigmatizing view of schizophrenia, which was then confirmed by the bus lady’s instant withdrawal. It may be that withdrawal and social isolation can be perceived as “symptoms” of schizophrenia, but the reasons for that may be more complex than the simple outworking of individual psychopathology.
Mental health diagnoses are not like physical health diagnoses. They are sticky labels that reduce people’s vision to the shape and form of their assumptions about what people living with a diagnosis should be, how they should behave, and how best one should relate to “such people.” It is true that some things in Allen’s life had changed. His diagnosis captured some dimensions of the nature of these changes, but he hadn’t suddenly become another person! The problem was that the diagnosis of schizophrenia made it difficult for people to see Allen as Allen. The presumed connotations of his diagnosis presented an unwanted persona that blinded people to the fullness of being with him. But not everyone stopped seeing Allen as Allen.
In his book Alien Landscapes? Interpreting Disordered Minds,3 the philosopher Jonathan Glover draws attention to the alienating way in which mental health diagnoses can function in the lives of individuals with mental health challenges and those around them. He uses a rather unusual illustration to make his point. Drawing on the work of the Finnish children’s author Tove Jansson, Glover narrates a story about an incident that occurred within the mythical (and somewhat mystical) family of creatures called the Moomins, fairy-tale characters that resemble hippopotamuses with long snouts. In Jansson’s book Finn Family Moomintroll, the character named Moomintroll has a strange and difficult encounter. During a game of hide-and-seek, he crawls under a hobgoblin’s hat and experiences a radical change, so much so that no one is able to recognize him: “All his fat parts had become thin, and everything that was small had grown big. And the strangest thing about it was that he himself didn’t realize what was the matter.”4
Moomintroll wandered back to his friends, who, of course, don’t know who he is. They ask him who he is, and he, thinking it is still part of the game, claims to be the king of California! They believe him and instantly reject him. “‘Go away!’ said the Snork to Moomintroll. ‘Otherwise we shall have to sit on your head.’”5 Things go from bad to worse, and the encounter ends with Moomintroll and his friends exchanging insults and ending up in a fight. “Isn’t there anyone who believes me?” laments Moomintroll. It is then that Moominmamma (Moomintroll’s mother) intervenes: “Moominmamma looked carefully. She looked into his frightened eyes for a very long time, and then she said quietly: ‘Yes, you are Moomintroll.’ And at that same moment he began to change. His ears, eyes, and tail began to shrink, and his nose and tummy grew until at last he was his old self again. ‘It’s all right now, my dear,’ said Moominmamma. ‘You see, I shall always know you whatever happens.’”6
Glover concludes: “It would be wonderful if such recognition could dispel psychiatric changes in this way. It cannot, of course. But the recognition can still be a lifeline.”7 Such recognition may or may not be able to dispel psychiatric changes, but it can change the way we look at people and the ways we choose to describe their changes. There is a tremendous power in looking beyond diagnoses and simply recognizing someone for who he or she is.
Allen’s mother powerfully gave him this gift of recognition. Her response to Allen’s diagnosis was quite different from his own and from that of the woman on the bus. She didn’t allow his new description to change the way she saw him. She continued to recognize him for who he was … Allen. He said, “One good thing I remember when I went home and told my mum because I really didn’t feel good about it. I said, ‘Oh no, they’re telling me I’m schizophrenic!’ And my mum said, ‘No, you’re not a schizophrenic, you have schizophrenia. That’s different.’ Yes. Sometimes, if I ever feel down about it, I remind myself of what my mum said. Yes, it’s just like any other illness. It doesn’t define a person, it’s just something you have.”
The diagnosis of schizophrenia carried with it connotations of hopelessness, helplessness, and fearfulness and a sense of being at the mercy of unfixable broken biology. Allen reacted with sadness, withdrawal, and resignation. Allen’s mum’s counterdiagnosis or reframing told a very different story. Like Moominmamma, she looked at him carefully. She looked into his eyes and saw Allen. And at that moment he began to change. His symptoms did not go away, but his sense of worth and value began to return. She recognized him and continued to recognize him even in the midst of the changes. Yes, he had very difficult and debilitating experiences, and yes, he would more than probably need the assistance of the mental health professions for the rest of his life. But his diagnosis was not who or all that he was. He was Allen, and she loved him. Allen’s mother could see him for what he was: sometimes difficult but always lovable. All of us need someone like that. Not all of us find such people.
The practice of diagnosis is essentially a hermeneutical enterprise. Someone encountering unconventional mental health challenges brings a set of experiences to the attention of a psychiatrist. The psychiatrist interprets these experiences according to the particular health-care traditions in which he or she has been trained and applies a diagnosis that is more or less in line with the interpretative guidance of one of the standard diagnostic assessment manuals. Once diagnoses are applied, certain potential options for treatment and intervention become available: psychotherapy, counseling, psychopharmacological intervention, and so forth. The problem, of course, is that as these forms of practice emerge in relation to diagnostic descriptions, other modes of practice that could emerge from other descriptions recede into the background.
Diagnoses are technical stories that occur in the midst of people’s personal stories. This is an important recognition. A diagnosis contains a story; indeed, it is a story. It has a beginning, a middle, and an imagined end. It lays out the causes of people’s mental health experiences and offers a narrative (sometimes a quite fixed narrative) to explain them and to indicate the likely trajectory of people’s lives. This story then enters into the ongoing story of the recipient of the diagnoses. Such a story can bring about healing and relief. But, as we have seen, it can also prompt sadness and disruption. To receive a mental health diagnosis is to encounter a radical change in identity that can be helpful, but it can also thin out our life possibilities. No longer is life the way we had always assumed it to be. Now our narrative involves a new and alien description: schizophrenia, depression, bipolar disorder, personality disorder, or whatever. It is true that the diagnosis may be helpful in that it explains some aspects of our experience that may be disturbing or upsetting. But it also gives a person’s life a certain meaning and direction that is rarely welcomed. Hearing the words “You have schizophrenia, and you will have it for the rest of your life. You will have to take medication, and as long as you do, you may do well” may offer some understanding and control, but it can also strip one’s life of control and purpose and can push a person into the thin and limited role of patient-with-a-mental-health-diagnosis, a role that may or may not be desirable and is liberating and deeply limiting at the same time. These kinds of tensions are well illustrated within the life of the theologian Monica Coleman and her encounter with bipolar disorder.
In her memoir Bipolar Faith: A Black Woman’s Journey with Depression and Faith,8 Coleman lays out in sometimes painfully raw detail her journey with bipolar disorder.9 In a chapter titled “Diagnosis,”10 she helps her reader understand both the problems and the blessings that diagnosis can bring. She describes two incidents—one medical and the other theological—that were formative in her experience and understanding of diagnosis. In this chapter, Monica is wrestling with severe depression and how best she should deal with it. At that stage in her journey she wasn’t on medication, and she had been reluctant (partly on theological grounds: “I should depend on God …”) to get involved with mental health professionals. Eventually she gives in and visits a mental health nurse:
I told the nurse that I was sad, tired, and uninterested in eating. She told me that I was depressed and needed medication. In fact, she added, I would probably have to be on medication for the rest of my life. “Can’t I just see a doctor? Isn’t therapy included in my health plan?” The nurse refused to schedule an appointment with a doctor until I agreed. Until I told her I would take medication for the rest of my life. I was desperate, but there was no way I was letting these people give me another pill. Ever. I took my weak sad self home.11
This encounter illustrates well a clash of descriptions. “I’m sad, tired, and uninterested in eating.” “You are depressed, and you can only get help if you describe your situation in the way that I tell you to!” There is no discussion and no other descriptions are allowed, just a statement about how the world really is for you, even if your experience doesn’t mesh with that declaration. What we find here is an uncomfortable mixture of medical paternalism and biological explanation: “You have an illness like any other illness. You will have to take your medication and continue to take it for the rest of your life.” The nurse here describes depression as a fundamentally incurable illness that can be ameliorated only via medication.
But how accurate is this description? We have already seen that, on their own, biological explanations are too thin to help us understand the fullness of the experience of mental health challenges. In Monica’s story, it is clear that while biology and biochemistry may be involved in her depression, trauma and sexual abuse are also fundamental to her experiences of depression. Does it really make sense to suggest that medication can eradicate the significance of her memories and the impact of her historical exploitation? The nurse seemed to view depression as similar to a viral infection. She considered it to be a “thing,” like an elephant or a tree. Depression, however, is not like that. The Duke University psychiatrist Dan Blazer highlights the dangers of this kind of reification of depression and an overemphasis on biological roots: “The assumption seems to be that there is a ‘real disease’ called major depression and, by attaching the label, the psychiatrist pronounces that the patient has this disease. (This process of making an idea real has been labelled ‘reification.’) Reification numbs us to the possibility that depression can be more a signal of the emotionally toxic society in which we live than a thing in and of itself. And if the effects of this toxicity are initially expressed through depression, then depression should signal a need to better understand and improve society.”12
There may be such a thing as purely biological depression. Biology certainly plays a part in all our experiences. But many people’s depression is most likely deeply rooted in their history. If depression is reified and assumed to be nothing but a biological disorder, serious problems arise. Monica’s lament, “Can’t I just see a doctor? Isn’t therapy included in my health plan?” is basically a cry for someone to listen to her story and her history without imposing deterministic biological frameworks. It is a cry for the nurse to let go of her thin account of Monica’s situation and to hear and recognize that she has a story to tell that cannot be understood by thinking about her biology apart from her life as a person. Some things cannot be healed by medication alone.
At that stage in her journey, Monica was avoiding taking medication, but not simply because of the unpleasant side effects. She looked upon it as being forced to make a major change in her identity. She had no desire to become a “chronic mental health patient.” She saw the taking of medication as a transition point from one identity into another, less valued identity: a spoiled identity. She knew that there were other ways in which her situation could be described, different ways to respond to it.
Eventually she got to a stage where she could no longer cope with the darkness of her depression. She didn’t want to become a “mental patient,” but she also didn’t want to live within the exhausting shadow of depression. Medication loomed large on her horizon, but still she hesitated: “I held the green-and-white rectangle of pills in my hands. It was a simple question that required a tectonic shift in my own understanding of myself.”13
She stood on the precipice, gazing across at the possible new identity that she was about to take onboard. She hesitated, but her friend called her attention to something she hadn’t considered: faith. There is a lot of evidence to suggest that faith helps people cope when they are depressed.14 However, the form of faith into which Monica’s friend invited her was not faith as a mode of coping. It was something quite different. Monica was a lover of Jesus. She had faith. But the faith toward which her friend urged her was different:
“You have to have faith,” he insisted. “I do,” I immediately replied. “I don’t think God hates me or anything. I believe in God.” “No. Listen. You have to have faith in the medication. You have to believe it will help you. Or it won’t. You’re going to have to trust this too…. It’s not idolatry. If you really believe God is in everything, if you really believe that, then you have to know that God is in the medicine too.”15
This was a breakthrough moment for Monica. Nestling at the back of her theological concerns was the fear that taking medicine was an act of faithlessness. Her friend’s reformulating the act, from a secular, medical perspective to a spiritual perspective, gave her the sense of safety that she needed. She took the medicine.
Theologically, I am not convinced that “God is in the medicine,” or that God is in everything in the way that Monica’s friend articulated it. I am not certain that is the best way to conceptualize the relationship between God and creation. Nevertheless, there remains something powerful about recognizing that medication and faith do not belong to two different realms and that God can work through the medicine. Depression is a certain kind of pain. Pain prevents us from relating to ourselves, to one another. Having faith that medication can open up new spiritual connections—with God, self, and others—draws the mundane practice of taking medication onto a spiritual plane where this technical human practice can be transformed into a mode of divine relational healing. We will explore this suggestion in more detail later in the book.
Monica’s encounter with her medical diagnosis was ambiguous. That ambiguity became even sharper when she encountered something strangely similar within the Christian community. The practice of administering a diagnosis to unconventional mental health experiences is not confined to the realm of medicine. One might have assumed that the perfect counterstory to the kind of thin medical reductionism that Monica had encountered would be the gospel. The gospel’s wonderful and transformative story about God, who in Jesus and through the power of the Holy Spirit offers love, acceptance, salvation, and a place of belonging for all in the coming kingdom, seems like the perfect counterpoint to perspectives that place all hope in inducing biochemical changes within individuals. Jesus the healer promises to end our suffering and heal our brokenness.16 What better way to redescribe experiences such as Monica’s? Yet what Monica encountered was something quite different. She loves and trusts Jesus very much, but his followers … not so much.
Monica tells the story of her encounter with two Christian psychiatrists, one of whom happened to be the mother of her best friend:
[The assessment of the Christian psychiatrist was that] I wasn’t depressed. I was lonely. I just needed better social connections. She recommended a local church I might like. I had a church. I had God. I knew the difference between loneliness and illness. I tried another psychiatrist—the mother of a good friend. She knew I was a minister. She even knew my Nashville church. I began to feel comfortable. As we talked on the phone, I told her about the terrible HMO people. I told her about the woman at the counseling center. I told her that I was looking for a referral for a psychiatrist in my part of town. She told me that I didn’t need a doctor; I needed Jesus. I didn’t hear a word she said after this. I made up an excuse to get off the phone. I tried to be polite because she was my friend’s mother. But no, this was not about religion. The conversation added an hour to my daily crying session. Why was it so hard for people to understand? Aren’t I telling people I am sad?17
The first psychiatrist, to her credit, did seem to push toward a perspective that recognized that Monica’s depression may have had social and relational dimensions. However, she simply didn’t listen to Monica’s description of her story. Had she listened, she would have known that Monica loved Jesus and was deeply engaged with God’s people even if, at times, that was a hard thing to hold on to. Instead she explained Monica’s sadness via a social model, as if Monica were somehow incapable of seeing the difference between loneliness and the deep darkness she was going through. Had the psychiatrist listened to her story instead of trying to write her story for her, things might have been quite different.
The second psychiatrist was so deeply immersed in her spiritual projections that she was unable to hear any story other than her own. Worse, by implying that Monica was out of touch with Jesus, she engaged in what we might call lazy theodicy. Lazy theodicy is a form of thinking in which Christians ascribe sinful distance from God, sin, or the demonic to explain the presence of unexplainable (in their view) psychological distress. Lazy theodicy often ends up blaming the individual, locating the problem not in the social realities of a person’s experiences but in the realm of individual spiritual alienation, sin, and ultimately evil. This is a trope we will see again and again as we move on. It is lazy because it takes no time and makes no effort to explore the processes and experiences involved in the development of mental health challenges and the complexity of what is required for people to move toward healing and understanding. This way of thinking is not just lazy, it is also malignant, choosing to point the finger of “evil” at some of the most vulnerable people in our society rather than taking the time to work through the complexities of living with a mental health challenge. It would be rather unusual (but not unimaginable) for a person stricken by cancer to be advised by a pastor that what is needed is not chemotherapy or radiotherapy but simply Jesus. Thin theological diagnoses can bring out the worst in Christian people.
The beauty, courage, and elegance of Monica’s story of diagnosis are highlighted in the way she refuses to yield to reductionist descriptions and explanations, be they medical or spiritual. She keeps things thick. In the end, she accepts the necessity for diagnosis and medication. However, that acceptance is as much theological as it is medical. The reasons for her taking medication become clear only as we read them through the thickness of her story. Her thick story helps us see that depression, like all human experience, is multifaceted and multistoried. Depression, like all diagnoses, needs to be narrated in its fullness if it is to be understood and responded to with compassionate faithfulness.
1. Juli McGruder, “Life Experience Is Not a Disease or Why Medicalizing Madness Is Counterproductive to Recovery,” Occupational Therapy in Mental Health 17, nos. 3–4 (2002): 59–80, here 60.
2. The study that underpins this book was approved by the ethics committee of the University of Aberdeen, Scotland, UK. The people whose voices fill this book have all given permission for their words to be used. All of the participants’ voices have been fully anonymized, apart from Allen’s. Tragically, Allen died by suicide before this book was completed. His mother has granted permission to use his real name as a sign of respect and in the hope that his posthumous testimony can help others.
3. Jonathan Glover, Alien Landscapes? Interpreting Disordered Minds (Cambridge, MA: Harvard University Press, 2014), 373.
4. Tove Jansson, Finn Family Moomintroll, trans. Elizabeth Portch (London: Puffin Books, 1961), 23.
5. Jansson, Finn Family Moomintroll, 24.
6. Jansson, Finn Family Moomintroll, 26.
7. Glover, Alien Landscapes?, 374.
8. Monica Coleman, Bipolar Faith: A Black Woman’s Journey with Depression and Faith (Minneapolis: Fortress, 2016).
9. This conversation around Coleman’s experience of diagnosis originally appeared as a discussion piece in the online book discussion forum called Syndicate and is available at https://syndicate.network/symposia/theology/bipolar-faith/.
10. Coleman, Bipolar Faith, 271.
11. Coleman, Bipolar Faith, 273.
12. D. B. Blazer, The Age of Melancholy: “Major Depression” and Its Social Origins (New York: Routledge, 2005), 6.
13. Coleman, Bipolar Faith, 285.
14. Artin Mahdanian, “Religion and Depression: A Review of the Literature,” Journal of Psychiatry and Behavioral Health Forecast 1, no. 1 (February 23, 2018): 1–6.
15. Coleman, Bipolar Faith, 285.
16. Coleman, Bipolar Faith, 276.
17. Coleman, Bipolar Faith, 276.