Infertility as a Cause of Anxiety and Depression in the Holy Bible

Dear Editor

It is known that infertility (inability to procreate, carry or deliver a baby naturally) affects an estimated 10-15% of reproductive age couples worldwide [1]. The relationship between infertility and psychological stress is complex. On the one hand, infertility has been indicated to increase the risk of developing psychological disorders (e.g., depression, anxiety) [1,2]. On the other hand, high levels of psychological distress have been indicated to increase infertility [1]. However, the association of anxiety and depression with infertility was described centuries ago in the Holy Bible. In the Book of 1 Samuel (or 1 Kingdoms according to Septuagint) of the Old Testament, the story of childless Hannah who was Elkanah’s wife is representative of this relationship.

This story goes as follows [see 1 Samuel 1:1-20]: Elkanah had two wives, Hannah and Peninnah. Peninnah had children, but Hannah did not. Every year Elkanah left Ramah to worship and offer sacrifices to the Lord at Shiloh where Hophni and Phinehas, the two sons of Eli, were priests of the Lord. Each time Elkanah offered his sacrifice, he would give one share of the meat to Peninnah and one share to each of her children. And even though he loved Hannah very much he would give her only one share, because the Lord had kept her from having children. Peninnah, her rival, would torment and humiliate her because the Lord had kept her childless. This went on year after year; whenever they went to the house of the Lord, Peninnah would upset Hannah so much that she would cry and refuse to eat anything. Her husband Elkanah would ask her: “Hannah, why are you crying? Why won’t you eat? Why are you always so sad? Don’t I mean more to you than ten sons?” One day, after they had finished their meal in the house of the Lord at Shiloh, Hannah got up. She was deeply distressed, and she cried bitterly as she prayed to the Lord. Meanwhile, Eli the priest was sitting in his place by the door. Hannah made a solemn promise: “Almighty Lord, look at me, your servant! See my trouble and remember me! Don’t forget me! If you give me a son, I promise that I will dedicate him to you for his whole life and that he will never have his hair cut.” Hannah continued to pray to the Lord for a long time, and Eli looked at her lips. She was praying silently; her lips were moving, but she made no sound. Therefore, Eli thought that she was drunk, and said to her: “Stop making a drunken show of yourself! Stop your drinking and sober up!” Hannah answered: “No, I’m not drunk, sir. I haven’t been drinking! I am desperate, and I have been praying, pouring out my troubles to the Lord. Don’t think I am a worthless woman. I have been praying like this because I’m so miserable.” Eli said: “Go in peace and may the God of Israel give you what you have asked him for.” Hannah replied: “May you always think kindly of me.” Then she went away, ate some food, and was no longer sad. The next morning Elkanah and his family got up early, and after worshipping the Lord, they went back home to Ramah. Elkanah had intercourse with his wife Hannah, and the Lord answered her prayer. She became pregnant and gave birth to a son. She named him Samuel and explained “I asked the Lord for him.”

It is obvious that Hannah’s feelings and behavior (anorexia and aphonia), which were closely related to her infertility, her husband Elkanah and her husband’s other wife Penninah who was fertile, suggest that Hannah most likely suffered from depression and anxiety due to not conceiving [3,4]. After Hannah prayed, with her lips moving but saying the words to herself, which led the priest Eli to suspect she was drunk, and then conversed with the priest and received his blessing, Hannah’s anorexia was reversed, and she began eating again. This exemplifies the well-known beneficial contribution of prayer in managing stress and regulating negative emotional reactions to stress (known as emotion-focused coping technique) [5]. Moreover, prayer and confession are special forms of verbal emotional disclosure, which are based on the patient’s religious background and faith [5]. In prayer, the reference is made to God (or a higher being) where the believer deposits his problems and expects an answer (as Hannah did), whereas in confession there is a conversation with a person (such as the priest Eli), who has experience and deep religious training and can perhaps offer a way to break free of stress and give hope for the future, turning the patient’s compass to God.

None.

There was no conflict of interest.

1. Simionescu G, Doroftei B, Maftei R, Obreja BE, Anton E, et al. (2021) The complex relationship between infertility and psychological distress (Review). Exp Ther Med 21: 306.
2. Dadhwal V, Choudhary V, Perumal V, Bhattacharya D (2022) Depression, anxiety, quality of life and coping in women with infertility: A cross-sectional study from India. Int J Gynaecol Obstet 158: 671-678.
3. Schiff I, Schiff M (1998) The biblical diagnostician and the anorexic bride. Fertil Steril 69: 8-10.
4. Stein G (2010) Hannah: a case of infertility and depression--psychiatry in the Old Testament. Br J Psychiatry 197: 492.
5. Mazokopakis EE (2021) The psychosomatic stress of the God-man Jesus Christ in the garden of Gethsemane. A religious-theological and medical approach. Chania of Crete, Greece (ISBN: 978-618-00-2186-8), pp. 96-97.