How are we to think about the terrible and unceasing pain of the depressed person? Is it to be comprehended as a biological disorder? And would this mean that science and medicine provide the best or only way of responding to such pain? Or perhaps it is better interpreted as a result of oppressive social structures, or the path to enlightenment, or punishment for sin.

Scrutton's aim in this important book is to tackle such questions, to show how interpretation can shape and transform the way depression is experienced and approached, and to offer a healing voice to those who are so afflicted. Christian theology is a key interpretative tool, and the book is written for a number of people: Christians who suffer from depression, and want to know what to believe about it and how it relates to their faith; the families and friends of people with depression; clergy, religious, and lay people within church communities; mental health professionals, Christian or otherwise; and academics who have an interest in religion and mental health. The interpretations at issue take us beyond explicitly held beliefs (‘I believe that depression is caused by sin’) to incorporate modes of understanding that are formed and revealed through religious practices such as liturgies and rituals. Some of these frameworks are closely tied to particular historical and interpersonal contexts – for example, ‘the dark night of the soul’ in Catholic communities – and Scrutton is concerned also with attitudes to people with depression as revealed through bodily comportment.

An initial task of the book is to clarify what is meant by ‘mental illness’. Scrutton rejects the dualist's claim that the mental and the physical are independent kinds of substance, grants that mental illness involves much that is physical, and reminds us that there are no clear-cut boundaries as far as most of the terms we use are concerned. This is not to deny that there are important distinctions, and Scrutton is happy for us to talk of mental versus physical illnesses, with the caveat that the relevant terms be understood non-dualistically. What of the question of whether we should even be describing depression as a mental illness? Scrutton sees a point to resisting such terminology, for it can diminish the depressed person's sense of self, turning them into a ‘faulty machine to be mended’. She insists, however, that the idea of depression as an ‘illness’ ensures that it is treated just as seriously as any other kind of illness; it also reminds us that those who are so afflicted deserve medical care and can benefit from such treatment.

The first chapter targets the idea that depression is a sin or a result of sin (the ‘sin account of depression’). Scrutton argues that this account is at odds with much of the Christian tradition, and that it involves a disputable conception of human free will. It also alienates the depressed person from her religious community and discourages her from seeking help for her condition. Sin is sometimes associated with demonic affliction, and the second chapter tackles the question of whether there is sense to be made of demonic accounts of mental illness. Scrutton criticizes them on similar grounds to those she levels at sin accounts of depression. Chapter 3 returns us to the idea that depression is an illness – an idea which has become increasingly attractive to the church given the aforementioned alternatives. Scrutton finds insights in this retreat to biology – we are, after all, animals of a certain kind – but not at the expense of the other explanatory factors which must be acknowledged if we are to arrive at a satisfactory position. The psychological and the social have a central role to play in this regard, and Scrutton takes herself to be defining and defending a model of depression which is biopsychosocial. Chapter 4 takes us into the dark night of the soul – which, we are told, is to be distinguished from depression, although it is not ruled out that the two things can be combined. We are treated to a fascinating study of the writings of St John of the Cross on the topic, and the question is raised of whether periods of mental distress could be occasions of divine grace. There are important implications here for an understanding of religious or spiritual distress, and whether medical intervention could be appropriate in such contexts. Chapter 5 asks whether depression can lead to spiritual growth, with reference to the Christian idea that God brings good out of evil. This is a ‘potentially transformative’ account of depression, and it involves the idea that the experience of depression (an evil) could lead to some good (one becomes more compassionate or courageous, for example). Scrutton focuses here on the Dutch psychologist and Catholic priest Henri Nouwen, and she defends such a position, making clear that this does not mean that it's good to be depressed. Chapters 6 and 7 build on the idea of a suffering God, considering what this really amounts to, and how it could be helpful to the depressed person. There is a call to churches to destigmatize mental illness, and to make the church a more welcoming place to those who suffer in this way.

It is the task of the final chapter to spell out what all of this means for the relation between Christianity and depression, and Scrutton extracts the insights from the positions she has examined and situates them in a context in which they can be properly articulated and appreciated. There is no distinctively Christian explanation of depression (depression as a result of sin, demonic possession, and so forth), but this does not mean that there is nothing distinctive that Christian theology can offer in response to one who suffers in this way. After all, Jesus is so clearly in solidarity with those who suffer, and much of this suffering arises from the systemic injustices (social sin) that make people vulnerable to violence, discrimination, and, of course, depression. So there is a point to the ‘sin account’ of depression, provided that it is resuscitated and legitimated in this social context. It should be clear from what has been said that this does not mean that other explanatory factors drop out as irrelevant. What of the demonic? Scrutton suggests that we comprehend it in social or political rather than individualistic terms (‘the social or political demonic’). Thus understood, we are concerned with ‘the demons of poverty, oppression, war, torture, injustice, and inhumane politics today, and the way these afflict people in many forms, including in the form of depression and other kinds of mental illness’ (213). Scrutton turns next to the question of how animality fits into the scheme of things. To be an animal is to be bodily and sensory, and although Christianity is often taken to involve a denial of human animality, there is a clear emphasis upon the senses, and we are, after all, ‘part of the body of Christ’ (217). The depressed person is often dead to the feeling of things, but religious practices can awaken our senses in a gentle, non-coercive way, drawing us into our communities, and giving us the space to take all the time we need. A positive pastoral implication of the book is that ‘taking Christ's solidarity with those who suffer as our example, the best first response might involve simply being with those in distress, rather than offering any kind of advice or explanation’ (219).

Scrutton's theological approach concerns what we do as well as what we say, and the book as a whole is an exercise in the practical wisdom which must be operative if we are to bring solace and hope to those who suffer. It is a timely study given philosophy of religion's burgeoning interest in questions and phenomena that exceed the familiar agendas of religious epistemology and metaphysics, and Scrutton has produced a welcome addition to this literature. She has also turned the much more difficult trick of showing how philosophy of religion and theology can be brought into dialogue with pastoral theology, psychiatry, and psychotherapy, and that all of this can have real social and political implications. This is philosophy of religion at its best and most humane.