I struggled through Chapter 4 but got more interested once the author focused on spirituality and depression. I, like Joy, did not realize depression is a spiritual experience. In hindsight this insight would have helped me understanding a few of the patients. The author gave great details about the various themes that emerged from the gathered data. I had no idea that all of these aspects could exist. This chapter challenged me to listen more carefully to patients and listen for some key words that might say, “I’m depressed.” Personally, I’ve experienced situational depression but nothing long- lasting. After reading this chapter I’m beginning to understand why some folks may want to end the pain they experience when there seems to be no end in sight or getting any help.