| Summary: | A qualitative study was conducted amongst 57 practising Catholics in Spain: students, priests, and contemplative monks and nuns. Through semi-structured interviews, participant observation and ethnography their understanding of severe sadness and the difference with pathological sadness, coping mechanisms and help-seeking behaviour were explored. The participants clearly differentiated between sadness in response to a cause, sadness that “made sense”, and cases where sadness was not explained by the context, sadness that “did not make sense”. The former was seen as a normal reaction to adversity which should be resolved by the individuals’ social, cultural and religious resources, while the latter was likely to be conceptualised as pathological, along the lines of depression, warranting psychiatric consultation. It was also found that religion played a crucial role in the way sadness was understood and resolved: symptoms that otherwise might have been described as evidence of a depressive episode were often understood in those more religiously committed within the framework of the “Dark Night of the Soul” narrative, an active transformation of emotional distress into a process of self-reflection, attribution of religious meaning and spiritual growth. A complex portrayal of the role of the spiritual director and the parish priest in helping those undergoing sadness and depression emerged, containing positive aspects and criticisms of some priests’ lack of commitment and mental health training. This study emphasises the importance of taking into account the context of depressive symptoms, as the absence of an appropriate context is seemingly what made participants conceptualise them as abnormal. It also warns about the risks of medicalising normal episodes of sadness and raises questions about the lack of face validity of the current diagnostic classification for depressive disorder, which exclusively uses descriptive criteria. The thesis concludes by making some suggestions regarding differentiating normal from pathological sadness and how to incorporate existential issues into clinical practice.
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