Copyright 1996 by Word & World, Luther Seminary, St. Paul, MN. All rights reserved. “I Just Can’t Stop Thinking about It”: Depression, Rumination, and Forgiveness MARY LOUISE BRINGLE St. Andrews Presbyterian College, Laurinburg, North Carolina
She is forty-something years old. She has achieved a certain amount of professional
success in her career, earning the respect of many peers and colleagues. She does not have thebody she had at twenty-something, but she takes reasonably good care of herself: walks threemiles a day, watches her saturated fats. Most people, if asked, would say that they find herattractive—though attractiveness is probably not the first thing they think about in reference toher. The image she projects is more one of competence than of physical appeal.
The story she tells me over the telephone seems almost a cliché—but no less painful for
its predictability. Her husband of fifteen years has just left her for a younger woman—one whomakes him feel (so he says) more vibrant, more exciting, more alive; one who still has—it is hardnot to think it—the body of a twenty-something-year-old.
“I just feel so ashamed,” she says, sobbing into the receiver. “And I feel so stupid. I really
had no idea. I thought he liked my professional status; I thought he respected my job and myaccomplishments. But now I feel as if he thinks I’m old and boring.” She chokes back an evenlarger sob: “And fat.I can’t stand to look at myself in the mirror anymore; I can scarcely stand toshow my face in public. I feel as if everyone must be talking about me; and about him; and abouther. I hate it that I feel this way, that I’ve been reduced to this. He used to love me—I know hedid. Now I can’t figure out what I’ve done wrong, except to get older, and I can’t help that. Idon’t know that I can ever forgive him; or her; or myself.”
Sympathetic responses leap to mind. “No, you’re not fat. Yes, he did love you. No, you
haven’t done anything wrong. Yes, some people probably are talking; people find all manner ofthings to talk about to distract themselves from the problems of their own lives. No, right nowyou probably can’t forgive him—or her; it’s too soon, the pain is too raw. But what you can orcannot do right now is not a particularly good gauge of what you may become able to do in time,with a little work and a lot of grace.”
But time passes—six months, a year, more. The grace still has not descended; the work
still has not paid off ( or perhaps the effort has simply seemed too onerous to sustain). My friendcalls me back, sobbing again—or sobbing still. “I just can’t stop thinking about it,” she says. Themeaning of “it” needs no further explanation. “I hate him so much. And I hate her. I hate her!Every time I think of the two of them together, I go crazy. And then I hate myself for hatingthem. I know this is eating me alive, but I just can’t seem to let it go. My minister says to prayabout it, to forgive even if I can’t forget. But I can’t pray; I can’t even focus on anything but my
hurt and my anger. I’m all knotted up inside my head, and I don’t know what to do.”
My friend has called me largely because I am her friend—but also, perhaps, because I am
a theologian and pastor and counselor of sorts. I know her well enough to know that her anguishover being unable to forgive is not just rhetoric. She is a sincere and generous person; she hasworked for years at “training her spiritual muscles” (studying, praying, attending to the needs ofothers, trying in small daily ways to look at the world through the eyes of Christ). But at thismoment in her life, she feels as if those muscles have deserted her. She might as well be trying totrek the Himalayas a week out of back surgery. What should I tell her to do? Or what, for thatmatter, should any of us as pastors say to a person who “just can’t stop thinking about” someoffense and thereby finds it impossible to forgive?
A word comes to my mind for the obsessive thinking that my friend is doing: the word
rumination. Originally, the word referred to the way cows and certain other animals eat, storingpartially digested food in a stomach called a rumen, bringing that food up later to chew overmore thoroughly. Even in the original Latin, however, it took on a vivid figurative meaning,describing the practice of
bringing an idea back to mind for further working-over. Many of us mull over important mattersin this way, digesting them a little at a time like cud-chewing cattle.
But in certain forms of depression, rumination becomes less a deliberate practice of
extracting the juices from a savory issue, and more an involuntary and toxic spasm of thinking. The “jingle channel” (as psychologist Martin Seligman calls it)—that steady hum of phrases andimages running constantly below the level of consciousness—gets taken over by an incessantdrone of self-deprecation, tuned to an excruciating pitch.1 To say to a depressed ruminator, “Juststop thinking about it”—whatever the “it” may be—is about as helpful as telling a person who ishyperventilating, “Just stop gasping for breath.” The advice may be patently correct, but the moreimportant question remains, “How?”
A number of psychologists have studied the phenomenon of “dysphoric rumination”
which characterizes forms of both clinical and subclinical depression. Some of their observationsmerit consideration by the pastor confronted by a person for whom forgiveness is choked off atthe root because she simply “can’t stop thinking about” an offense. To be clear: thepsychologists’ analyses and recommendations—of cognitive behavioral therapy and occasionallyof medical intervention—do not take the place of sustained spiritual work. Nor do they supplantthat grace which restores relationships where reconciliation had formerly seemed impossible. Butthe various therapies do enable those in intolerable pain to untangle their mind- and soul-knottinghurt long enough to take on the further challenges of forgiveness. And who knows? Perhaps theyeven serve as “secular sacraments” through which grace can flow anew into our lives.
Susan Nolen-Hoeksema at Stanford University is foremost among the psychologists to
analyze rumination as both a characteristic of and a response to depression. She definesrumination as “chronic, passive focus on one’s negative emotions” which manifests itself in such
behaviors as “isolating oneself” and thinking about one’s wounds rather than engaging inconstructive coping activity or “worrying about the consequences of one’s distress (e.g., ‘What ifI don’t get over this?’).”2 Women are statistically more likely than men to ruminate following asignificant loss or other stressful situation, which may partially account for their higher incidenceof depression.3 Certainly, the repetitive negative spiral of ruminative thinking acts to prolongdepression in identifiable ways.
1Martin E. P. Seligman, What You Can Change.And What You Can’t (New York: Fawcett Columbine,
2Susan Nolen-Hoeksema, Louise Parker, and Judith Larson, “Ruminative Coping with Depressed Mood
Following Loss,” Journal of Personality and Social Psychology 67/1 (1994) 92.
3Susan Nolen-Hoeksema and Jannay Morrow, “Effects of Rumination and Distraction on Naturally
Occurring Depressed Mood,” Cognition and Emotion 7/6 (1993) 563. This greater incidence of depressiverumination in women than in men is one reason I have elected to use the feminine pronoun throughout this article inreferring to the person who has been injured and finds herself unable to forgive. Neither this pronoun usage nor thisstatistic, however, should suggest that forgiveness itself is a greater problem for women than for men. I suspect,rather, that the phenomenology of the problem differs: where women are unable to “stop thinking about” an injury,men may refuse to think about it at all, preferring to distract themselves (occasionally with destructive measures,such as alcohol or aggression). Neither strategy constructively tackles the tasks necessary for forgiving: tasks ofcreatively reconstructing one’s vision of the injuring person or provocation in such a way as to enable areconciliation.
For example, Nolen-Hoeksema notes that rumination reinforces “greater access to
unhappy memories, enhanced sensitivity to negative information about one’s current situation,[and] the probability of making negative interpretations.”4 A “semantic network” which linksthoughts with the same emotional tone strengthens the likelihood that calling one of them tomind will dredge up others of a similar resonance. Thus, once a person begins thinking about theways she has been wronged, her memory becomes negatively selective, gathering injuries to itselflike paper clips to a magnet. All she can recall are wounds and slights; all she can let herselfanticipate are more of the same.
In the midst of this dismal assessment of past and future, concentration inevitably suffers.
The ruminator becomes unable to solve problems constructively, or even to complete simpletasks. As a result, a further spiral of helpless and self-defeating attitudes ensues. She finds herselfultimately unable to think about anything but herself and her problems; as my friend soeloquently put it, she feels “knotted up” inside her own head. Such “self-focus,” thepsychologists tell us, has woeful consequences. In a pertinent sidelight, Nolen-Hoeksema refersto a study in which depressed psychiatric patients, made self-aware by the presence of a mirror inthe room with them, reported far more negative mood than patients who were not so prompted toself-consciousness—a datum which seems to confirm the deep wisdom of the Jewish practice ofcovering mirrors during a time of mourning.5
The experiential connection between “dysphoric rumination” and forgiveness thus seems
plain. Theologians reaffirm what psychologists have attested. In Forgive and Forget, LewisSmedes describes the tenacity of unforgettable hurt: “We let it assault us every time it comes tomind. It travels with us, sleeps with us, hovers over us while we make love, and broods over uswhile we die.”6 In Embodying Forgiveness, Gregory Jones (not otherwise disposed to agree much
with Smedes) acknowledges that some people are “condemned to struggle with memories thathave a life of their own, making each day’s most serious task that of beating back the past.”7Even C. S. Lewis in his Letters to Malcolm observes that forgiving “for the moment,” in a burstof good intentions, may not be so difficult: “but to go on forgiving, to forgive the same offenceagain every time it recurs to the memory—there’s the real tussle.”8
4Susan Nolen-Hoeksema, Sex Differences in Depression (Stanford: Stanford University, 1990) 164. 5See ibid., 162-164. The “mirror” study on self-focus and depressed mood is by Gibbons et al.,1985. 6Lewis Smedes, Forgive and Forget: Healing the Hurts We Don’t Deserve (New York: Pocket Books,
7Gregory Jones, Embodying Forgiveness: A Theological Analysis (Grand Rapids: Eerdmans, 1995) 282. 8C. S. Lewis, Letters to Malcolm (New York: Harcourt, Brace and World, 1964) 30.
If the “real tussle” lies with recurrent memories, then the pastor’s challenge is to help find
ways to interrupt the cycle of recurrence—silencing and ultimately supplanting those imageswhich the unforgiving person initially “just can’t stop thinking about.” Here again, thepsychologists offer recommendations to supplement their analyses. Since social isolation or “lowquality social support” intensifies a person’s proneness to dwell on grievances, help in counteringsuch propensities comes when other people are willing to “allow one to confide emotionaldistress,” to “provide practical support,” to “encourage.active coping strategies,” and to“challenge.negative ruminative thoughts.”9 Clearly, the church as a supportive community hasthe potential to offer much in these areas.
Beyond social supports, individual therapies are also critical in breaking the ruminative
cycle of recurrent memories. Cognitive behavioral therapists are specifically trained in helpingpeople learn ways to combat patterns of dwelling on hurts and angers to the exclusion of all otherattitudes. Seemingly simple suggestions can prove genuinely effective: suggestions like splashingcold water in one’s face or snapping a rubber band on one’s wrist whenever the obsessive loopthat one “just can’t stop thinking about” intrudes.10 Before too quickly disparaging the place ofsuch techniques in pastoral ministry, we might recall the story of Naaman’s chagrin wheninstructed by Elisha simply to wash seven times in the Jordan to be healed of his leprosy. As hisservants wisely remonstrated: “If the prophet had commanded you to do some great thing, wouldyou not have done it?” (2 Kings 5: 8-14).
In some cases, “dysphoric rumination” may need more than interpersonal and cognitive
therapies; it may even require medical treatment, although attitudes toward such treatmentremain reluctant-perhaps especially within the religious community. The term “pharmacologicalCalvinism,” coined by Gerald Klerman and popularized in Peter Kramer’s best-selling ListeningtoProzac, aptly names a widespread suspicion of the use of medication to treat “mental” or“emotional” disorders.11 Pharmacological Calvinists see drug use as a facile way out of the hardwork of spiritual discipline, a cheap substitution of pill-popping for prayer-without-ceasing. Yetsuch criticisms verge on becoming a modern-day gnosticism, denying the involvement of thebody (including brain chemistry) in the health of the soul. On the eve of the twenty-first century,they—and we—would do well to remember Robert Burton’s seventeenth-century counsel on theuse of “physick” in treating spiritual afflictions: “’Tis God’s instrument, and not unfit.”12
Indeed, recent research on depression suggests that early medical interven-
9Nolen-Hoeksema et al., “Ruminative Coping,” 94. 10Martin E. P. Seligman, Learned Optimism (New York: Pocket Books, 1990) 276. Aaron Beck is the
acknowledged founder of cognitive therapy. See, for example, his Diagnosis and Management ofDepression(Philadelphia: University of Pennsylvania, 1973).
11Peter Kramer, Listening to Prozac (New York: Viking, 1993) 274-275 and 365n. 12Robert Burton, The Anatomy of Melancholy (New York: W. J. Widdleton, 1867) 497-498.
tion may be crucial for staving off an ever-worsening spiral of suffering. By means of aphenomenon known as “kindling,” nerve pathways in the brain change anatomically in responseto stress, “hard wiring” reactions which become increasingly easy to trigger and increasinglydifficult to reverse. Thus, seemingly minor depressive episodes can lead physiologically to theestablishment of more and more serious mood disorders. Kramer cautions:
What is [too little] appreciated, especially in the case of mental health, are theunanticipatable consequences of failure to treat. Living with rejection-sensitivityand inevitably sustaining a series of perceived losses may lead to continued andworsening injury, further enhanced sensitivity and even severe depression.13
The health risks of such failure to treat are severe—physically, emotionally, socially, and evenspiritually.
To be sure, I must also caution in turn: Prozac—or Zoloft or Serzone or Effexor or any of
the other highly touted new medical treatments for depression—is not shalom in a bottle. I amnot suggesting, nor is Kramer (nor Michael Norden, author of Beyond Prozac, most recent in the“Serotonin and Son series”) that any kind of pill—or diet or light therapy or exercise routine—isan easy road to “salvation.” What I am suggesting is that false and unnecessary stumbling blockson that road should be cleared away, wherever and however possible, to enable full-bodied andwhole-souled encounter with the real stumbling block, the genuine skandalon of forgiveness. Theperson who “just can’t stop thinking about” an injury may well be describing her mentalcondition accurately: emotional and physiological stresses may have caused certain thoughtpatterns and neural pathways to become biochemically “tangled.” If a medication can “untangle”them, the discipline of spiritual retraining is freer to proceed; if the lead weights can be taken off,the person is more fit to run the race to its finish.
Then, when the weight of depression begins to lift, the spiritual work of silencing and
supplanting resentful ruminations can proceed in earnest. Then—and perhaps only then—can thepastor or counselor or friend effectively help the “unforgiving” person to shift her perspective inthe radical ways which constitute the practice of forgiveness. Once the pain-knots begin toloosen, the injured person can begin to see that the one who has injured her is also a child ofGod—gifted in some ways and guilty in others; redeemed by the suffering of Christ even as he orshe is still struggling under the burden of sinning.
Moreover, once the injured person begins to grow physically and emotionally stronger,
she can begin truly—rather than self-destructively—to ponder her own weaknesses: the fact thatshe, too, has been guilty of injuring others; that she, too, stands in need of grace. As MarilynMcCord Adams has written, Christian forgiveness “involves a process of letting go of one’s ownpoint of view (regarding
13Kramer, Listening to Prozac, 125.
the situation, one’s self.and the offender) and entering into God’s point of view.”14 From agodly point of view, to see oneself uniquely as victim and the other uniquely as victimizer isdistorting; to focus on one’s private injuries to the exclusion of public problems—oraccomplishments—is destructive as well. Genuine forgiveness entails a slow process of comingto recognize and remedy these limits in one’s own vision, a process of learning to look at theworld—including the injurer—through the compassionate eyes of Christ.
But ultimately, genuine forgiveness remains more gift than achievement. Gregory Jones,
author of Embodying Forgiveness, would agree. Forgiveness, he writes, is less a deliberateaccomplishment and more “ a retrospective judgment made from the standpoint of the newlife.[which] comes to us as a gift.”15 In other words, one day we “tune in to the jingle channel”and discover—to our amazement—that we are no longer blasted by a steady current of hurt andhatred. We simply have stopped thinking so obsessively about the injury which once consumedus. In the sweet silence that follows, we are able to reconstrue—and perhaps even torestore—relationships. Compound creatures, molded of dust and spirit, we receive grace incompound ways: from physicians of our bodies and physicians of our souls, from medicationsand from ultimate mystery. The old unsnarls from our hearts and minds. Behold, the new weavesits way into our being, through the manifold healing arts and agencies of an ever-incarnatingGod.
14Marilyn McCord Adams, “Forgiveness: A Christian Model,” Faith and Philosophy 8 (1991) 293. 15Jones, Embodying Forgiveness, 235. Jones would, however, disagree with much of the rest of my
argument in this paper, finding it excessively “therapeutic”—overly concerned with psychological “technique.”
MARY LOUISE BRINGLE is a professor of religious studies whose work bridges the disciplines of theology andpsychology in a contemporary approach to the traditional seven deadly sins. Her books include Despair: Sickness orSin? (Abingdon, 1990) and The God of Thinness: Gluttony and Other Weighty Matters (Abingdon, 1992).
Cognitive Dysfunction among HIV Positive and HIVNegative Patients with Psychosis in UgandaNoeline Nakasujja1,2*, Peter Allebeck2, Hans Agren3, Seggane Musisi1, Elly Katabira41 Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda, 2 Department of Public Health Sciences, Karolinska Institute, Stockholm,Sweden, 3 Department of Psychiatry and Neurochemistry, In
Manuscript Click here to view linked References Comparing the benefits of Caffeine, Naps and Placebo on Verbal, Motor and Perceptual Memory Sara C. Mednick Ph.D.1, Denise J. Cai M.A.3, Jennifer Kanady B.S.1, Sean P.A. 1. University of California, San Diego, Department of Psychiatry and Veterans Affairs San Diego Healthcare System, Research Service2. University of California, San Diego