Untitled Sermon (9)
Depression
The bible and depression
The Bible and Depression
Our discussion thus far shows that depression is a common, complicated condition, difficult to define, hard to describe with accuracy, and not easy to treat. Since depression is a clinical term, it is not discussed in the Bible, even though the condition appears to have been common. Psalms 69, 88, and 102, for example, are songs of despair, but notice that these are set in the context of hope. In Psalm 43 King David expresses both depression and rejoicing when he writes:
Why am I so discouraged?
Why so sad?
I will put my hope in God!
I will praise him again—
My Savior and my God.
Elsewhere in the Bible it appears that Job, Moses, Jonah, Peter, and the whole nation of Israel experienced depression. Jeremiah the prophet wrote a whole book of lamentations. Elijah saw God’s mighty power at work on Mount Carmel, but when Jezebel threatened murder, Elijah fled into the wilderness, where he plunged into despondency. He wanted to die and might have done so except for the “treatment” that came from an angel sent by God.
Then there was Jesus in Gethsemane, where he was greatly distressed, an observation that is poignantly described in the words of the Amplified Bible: “He began to show grief and distress of mind and was deeply depressed. Then He said to them, My soul is very sad and deeply grieved, so that I am almost dying of sorrow.”
These examples, accompanied by numerous references to the pain of grieving, show the realism that characterizes the Bible. It is a realistic despair contrasted with a certain hope. Each of the believers who plunged into depression eventually came through and experienced a new and lasting joy, even when their circumstances did not change. The biblical emphasis is less on human despair and more on belief in God and the assurance of abundant life in heaven, if not on earth. Paul wrote, “We are pressed on every side by troubles, but we are not crushed and broken. We are perplexed, but we don’t give up and quit. We are hunted down, but God never abandons us. We get knocked down, but we get up again and keep going.… For our present troubles are quite small and won’t last very long.… So we don’t look at the troubles we can see right now; rather, we look forward to what we have not yet seen. For the troubles we see will soon be over, but the joys to come will last forever.” Paul’s confident prayer for the Romans someday will be answered for all Christians: “I pray that God, who gives you hope, will keep you happy and full of peace as you believe in him. May you overflow with hope through the power of the Holy Spirit.
The Causes of Depression
A number of myths about the causes of depression continue to be accepted and sometimes preached from church pulpits. It is not true, however, that depression always results from sin or a lack of faith in God, that all depression is caused by self-pity, that it is wrong for a Christian to be depressed, that depressed feelings always can be removed permanently by spiritual exercises, that antidepressive medication is the best form of treatment, that happiness is a choice, or that a “depressed Christian is a contradiction of terms.” Like everyone else, Christians get depressed. There can be a variety of causes that often work together, so one of the counselor’s first tasks is to uncover, understand, and eventually help counselees deal with these causes.14 Although there are numerous theories and explanations for depression, it probably is most common for mental-health professionals to take what has been termed a bio-psycho-social approach. This groups the causes into three categories that work in combination: the biological causes, the psychological causes, and the social influences.
1. The Biological-Genetic Causes. Like most psychological problems, depression has physical implications, including chemical imbalances in the brain. Sometimes, the physical changes result from the depression; at other times physical influences are the cause. At the simplest level, we know that lack of sleep, insufficient exercise, the side effects of drugs, physical illnesses, or improper diet can all create depression. Thousands of women experience depression at part of a monthly premenstrual syndrome (PMS), and, as we have seen, some develop postpartum depression following childbirth. Less recognized is a testosterone-induced depression that comes to men during periods of reduced sexual activity. Other physical influences, like neurochemical malfunctioning, brain tumors, or glandular disorders, are more complicated creators of depression. Simpler, perhaps, is seasonal affective disorder (SAD) that, at least in part, reflects the body’s response to a lack of light.
There is considerable evidence that depression runs in families, but it can be difficult to distinguish the genetic from the possible environmental reasons. Highly sophisticated genetic research continues around the world, and there is wide agreement that genes influence the body in many ways, including biochemical activity in the brain. For the nonmedical counselor, perhaps it is enough to be aware of the genetic influences and to recognize that some of this research has a bearing on the development of new and more effective antidepressant medications. Over twenty years ago one former president of the American Psychiatric Association predicted that research in the genetics and biochemistry of depression is where a Nobel Prize will be won some day in the future.
2. Psychological-Cognitive Causes. Depression is a significant mental-health problem for as much as 10 percent of the general population, but these figures differ from country to country, rise during times of political upheaval and economic uncertainty, and differ depending on one’s age. Depression in the elderly is well recognized, especially among older people with health problems. Among younger people, about one in eight American teenagers suffers from depression or anxiety. Sometimes, this leads to physical self-mutilation that could be interpreted as a cry for help. Depression impacts an estimated 25 percent of college students, is experienced by about one-third of college dropouts before they leave school, and is high among international students who feel intense pressure to get good grades.19 All of this suggests that developmental, psychological, interpersonal, spiritual, and other nonphysical influences are at the basis of much depression.
(a) Background and Family Causes. Many years ago a researcher named Rene Spitz published a study of children who had been separated from their parents and raised in an institution. Deprived of ongoing, warm human contact with adults, these children showed apathy, poor health, and sadness—all indicative of depression that could continue into later life. Depression can occur when parents ignore or reject their children or when status-seeking families set unrealistically high or rigid standards that family members feel pressured to meet. It is a common experience for young people to strive to meet parental expectations and to feel the parents’ disappointment and rejection when the standards are not met. This can have devastating and life-long impact on the young person’s self-esteem and feelings of worth. Depression often follows and persists into their adult years.
Teenagers who are in conflict with their parents, young adults who are having trouble becoming independent of their families, people who come from unstable homes, and college students who have negative opinions about their families—all are more inclined to be depressed.
(b) Stress and Significant Losses. It is well known that the stresses of life stimulate depression, especially when these stresses make us feel threatened or involve a loss. Losses of people through death, divorce, or prolonged separations are painful and known to be among the most powerful depression-producing events of life. Also influential can be the loss of an opportunity, job, career, status, health, freedom, a contest, possessions, or other valued object. One study of young adults found that members of racial and ethnic minorities experience higher than average rates of depression because of the increased stresses they encounter through prejudice, denied opportunities, or the extra effort and disappointments associated with succeeding and feeling acceptance in the majority population.
Research by psychologist Sidney J. Blatt expands on the stress explanation for depression by describing two types of depression, each having distinct roots. One type of depression comes from feelings of loneliness and abandonment. The other arises from feelings of failure and worthlessness.
(c) Learned Helplessness. One well-established theory has demonstrated that depression often comes when we encounter situations over which we have little or no control. It is easy to get depressed when we learn that our actions are futile no matter how hard we try, or that nothing can be done to relieve suffering, reach a goal, or bring about change. These are times when we feel helpless and give up trying. This could explain some of the previously mentioned depression in minority groups, in grieving people who can do nothing to bring back a loved one, or in the older person who is powerless to turn back the clock and restore lost physical capacities. Depression may subside or even disappear when people who feel helpless are able to control at least a portion of their environments.
(d) Cognitive Causes. How a person thinks often determines how he or she feels. This is a basic assumption of the cognitive views of depression. If we think negatively, for example, see only the dark side of life, maintain a pessimistic mind-set, and overlook the positive, then depression is almost inevitable. Not surprisingly, the most effective counseling for these people is to help them change their thinking.
According to psychiatrist Aaron Beck, depressed people show negative thinking in three areas.
• First, the world is viewed negatively. Life is seen as a succession of burdens, obstacles, and defeats in a world that is falling apart or “going down the drain.”
• Second, many depressed people view themselves negatively. They perceive themselves to be inadequate, unworthy, incapable of performing adequately, and lacking the skills, traits, or physical features that they value. This attitude can lead to self-blame and self-pity.
• Third, some people view the future in a negative way. Looking ahead they see continuing hardship, frustration, and hopelessness
(f) Sin and Guilt. It is easy to understand why sin and guilt can lead to depression. When a person feels that he or she has failed or done something wrong, guilt usually follows along with self-condemnation, frustration, hopelessness, and other depressive symptoms. Guilt and depression so often occur together that it is difficult to determine which comes first and leads to the other. Often a vicious cycle emerges in which guilt causes depression, which causes more guilt, and the cycle continues.
Could any of this explain the depression that Elijah the prophet experienced? Elijah was under stress when he ran from Jezebel, who was determined to use all the king’s armies to kill him. There must have been a lot of adrenaline pumping in Elijah’s body as he fled. God had used him to discredit and cause the destruction of Baal’s prophets. This in itself must have been an adrenaline-producing experience. Then he outran the king’s chariot back to Jezreel and ran again as he fled from Jezebel. He must have been having a major post-adrenaline letdown when he found a secure hiding place and his fatigue and hunger pulled him down further. Complicating all of this was the stress of being a fugitive, so great in fact that he asked God to take his life. There is no evidence that he felt angry, filled with revenge, or inclined to fight back. The diagram in this chapter shows how he might have slipped into depression after the pain of experiencing a great victory that immediately put his life in danger. Of course there were no news reports to let him know how Jezebel’s search was progressing, so there may have been more than a little anxiety. Elijah’s tired body forced him to take time to rejuvenate physically. In those days there was no alternative, and probably he wanted no alternative, but to rely on God for the protection and guidance for the next steps he would take.
As the counselee talks about the depression, you should listen attentively. Watch for evidence of anger, hurt, negative thinking, poor self-esteem, and guilt—all of which you might want to discuss later. Encourage counselees to talk about those life situations that are bothersome. Avoid “taking sides,” but try to be understanding and accepting of feelings. Watch for talk about losses, failures, rejection, and other incidents that may have stimulated the current depression.
As you work with depressed people, be aware of your own feelings. Are you impatient when you have a negative, complaining counselee? Are you inclined to let your mind wander or be pulled into despondent negative thinking yourself? Counseling the depressed can be a demanding test for your helping skills. These counselees are not easy to work with, and many need special effort and attention.
For example, many depressed people have a strong need to be dependent. As you counsel, ask yourself if you are encouraging dependence in an already depressed person. If so, might you be trying to build your own feelings of power or importance? Might you be encouraging anger or negative thinking? Could you be making so many demands that the counselee feels overwhelmed and thus inclined to cling to you? In all of your counseling, it is good to be aware of what is happening in yourself. When counselors are not aware of these tendencies, sometimes they increase depression instead of contributing to its relief.
In counseling the depressed, some combination of the following approaches can be helpful.