ABSTRACT
What distinguishes depression from a spiritual problem? When both are present, how can one assess the relationship between them? Where do spiritual problems belong in a clinical formulation?
To explore these questions, in this chapter I take a finergrained look at the range of conditions that are marked by a lowered mood. These include familiar diagnostic categories of depression, as well as distressing existential and spiritual conditions with which they are sometimes confused: melancholic, bipolar, and psychotic depression; depression associated with personality, addiction, and trauma; adjustment disorder; prolonged grief; demoralization; angst; guilt; the “dark night of the soul”; and ordinary unhappiness. Others, such as medically caused
depression (for example, by hypothyroidism) and socially condi-
tioned emotional distress,* would belong in a complete list.
