Dr. Stephen Diamond, in hid Evil Deeds blog, talks about clinical despair: http://www.psychologytoday.com/blog/...treatment-depr

Diamond notes:

Despair is a common human experience. We have all felt despair during difficult periods in our lives. We may occasionally despair about our job, marriage, love life, family, finances, world events, etc. But typically this despair dissipates in time, and life goes on. At least till the next crisis. When despair doesn't dissipate but rather deepens, hunkers down, takes control and becomes chronic, diminishing quality of life, impairing functioning, and keeping us from moving toward our goals, dreams and desires, it has become pathological or clinical despair. Clinical despair can be conceptualized as a profound and existential hopelessness, helplessness, powerlessness and pessimism about life and the future. Despair is a deep discouragement and loss of faith about one's ability to find meaning, fulfillment and happiness, to create a satisfactory future for oneself.

Dr. Diamond gets to his major premise here:

Clinical despair is primarily a spiritual crisis. This is not to say that despair is never a biochemical or physiological crisis, the temporary and most immediate remedy to which may be psychopharmacological intervention. Only that the possibility of a patient's clinical despair stemming from or expressing a spiritual crisis must always be carefully considered in the psychiatric treatment of depression.

In his closing words, Dr. Diamond dismisses much of what I have been taught by mental health professionals:

Instilling some hope in the patient suffering from clinical despair seems an obvious and simple therapeutic ploy, but in practice proves much easier said than done. Counterintuitively, confronting clinical despair can be closer to taking Dante's sojourn through Hell in The Inferno, where he anxiously reads the daunting inscription on the gate: " Abandon all hope all ye who enter here." Clinging desperately to false hope, whether in childhood, adolescence or adulthood, can paradoxically be a neurotic defense against despair, a defense which, while serving the valuable purpose of survival in some cases, ultimately prevents one from facing and moving past the despair of abandonment, abuse, neglect, loss and other traumas. This is what Jung may have meant when he noted that "neurosis is always a substitute for legitimate suffering."

Sometimes clinical despair, it seems, must simply be endured, patiently accepted, tolerated and suffered through with the stabilizing and supportive presence and accompaniment of the compassionate psychotherapist until it eventually turns into something else: courage, hope, joy, love, rage, passion, spirituality, faith or creativity. (This subtle shift is something fundamentally different in intensity from the radical, dramatic, transitory, destabilizing and dangerously exaggerated mood swings seen in bipolar disorder.) Moving through this excruciating process can be likened to both a terrifying death of one's old self, and a birth of the new self, with despair being the prolonged pregnancy and painful labor. But when clinical despair is totally avoided or prematurely aborted during treatment by pharmacological and/or psychological means, there can be no true transformation. Tragically, the patient remains stuck in the destructive vicious cycle and potentially deadly snare of clinical despair.

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When I read Dr. Diamond's works or posts, I am often brought back to thinking of the soul's journey in St. John of the Cross's, Dark Night of the Soul. Dr. Diamond presents a very interesting premise.

Thank you, TheByzantine, for posting this piece. I would have otherwise missed it.