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 PrintableVersion Tales of the unexpected: anxieties and depressionTwo-thirds of us will at some time experience symptoms of anxiety and depression of sufficient severity as to disrupt our lives. Christians are not exempt, and the problems caused in churches are many. I would like to try and describe things from the perspective of the patient, the pastor, the family and the doctor. The patient's storyIn patients' tales of unexpected sadness, there are many strands. One woman said she had lost the joy of the Lord, and blamed herself for it. I mistakenly sought to help her along spiritual lines, but what she said to me later was: 'Why didn't you tell me it was a physical illness?' She got better with the medication and treatment given to her, and recovered her joy. A younger woman fell among exorcists in an Anglican church and had four hours of prayer and exorcism. She was extremely angry at what had been done to her. It had not helped her. She recovered with proper treatment and has stayed well. Many a patient is told depression is because of sin. In every case that I have seen, this has been entirely misguided. One young woman said to me: 'My sister is a more mature Christian than I am, and she is so sure depression is always due to sin'. As a result she did not accept any treatment. A patient may be told at church to pray more: but that is just what they find so difficult. Of course, for every horror story there are other accounts of prayerful support and sensible advice, and of accepting proper treatment being encouraged. Sometimes it becomes obvious that it is not just a question of illness but of a bigger problem within the person who is ill - perhaps even a personality disorder. Such a patient will tell of quarrels with many kinds of helpers, that it is hardly a story of depression at all. Many other factors can enter in: at one extreme is the histrionic patient who makes 'a drama out of every crisis' and who may be a skilled manipulator of those around. At the other extreme of the spectrum may be a quiet, careful perfectionist, often good at camouflage. But such people are much more prone to severe anxieties (just think of the young Martin Luther or John Bunyan) and also suffer more from depression. They, also, can be treated and helped. The pastor's storyMany Christians share the common suspicion of psychiatry. They will say: 'A miserable Christian is a contradiction in terms'. Slowly this approach is changing, perhaps as slowly as global warming. I find most pastors recognise the vulnerable in their churches, and seek to offer appropriate help. Like their mentor Paul they try to be gentle 'like a mother caring for her little children' or 'as a father deals with his own children, encouraging, comforting and urging'. But when a person seems to be using depression to avoid clear Christian duties, what can be done? Pastors, in temperament, are as different as the members of their flock. Some seem to have been born with understanding and sympathy, and are intuitively able to 'sympathise with our weaknesses'. Others are quite different; like sergeant majors they feel cross when one of their Christian soldiers seem to be dodging the column. One thing that should be emphasised is that a person who is depressed is often angry: not only with himself (what is a suicide if it is not anger turned in on oneself?). It may help a lot to realise that being so angry with others in the church as to seem quite paranoid - that this is part of depression. If bad feelings which are projected outwards in depression are understood, it may be easier to manage the situations and to make progress out of the illness and get back to more normal life. When I was a medical student a prominent member of the well known evangelical chapel that I attended - a young man - killed himself. All I heard was a deafening silence: that surely could not be right. Perhaps the only answer is to obtain a better knowledge of the patient causing problems: to know the background history, assess the personality - and all in a spirit of gentleness. When a caring relationship is built up, the most difficult person may respond to the love and concern being shown. As well as being a Christian response, it also pays off! The family's storyThe husband or wife of a depressed person suffers much, as do the parents of an anxious or depressed teenager. Families have many different stories too, and sometimes the stories reflect the basic beliefs: one young wife with two children said to me that her mother said: 'We don't do depression'. As a result it was many years before the patient received the help that her mother's attitude had denied her. A father said to his suffering son: 'Our family just does not have depression'. Such denial in the face of the facts is unbelievable. Shame and guilt surrounds many forms of anxiety or depression. A family may be concerned, but that concern is guilt-edged. Christian patients may feel guilty about seeking help. Depression disrupts families, affects the partner and the children and also the parents and grandparents of those in the extended family. The burden of chronic depression and anxiety upon other members of the family may be huge: the wife of the depressed man can be weighed down. The help offered to the wife or husband of someone who may be ill on and off for years is a very important part of Christian care and of 'bearing one another's burdens'. When the patient is older and the problems of old age are added, then more care is often needed. The same is true of adolescent depression which may cause mind-boggling problems to the parents and others in the family. And we might think of the frequent mid-life crises and burnout problems too ... the list is endless. A sympathy and understanding which is both wide and deep, and a willingness to care by visiting, doing many helpful acts of caring, has eased such heavy burdens for many families. We may be helped by our Lord's words: 'Inasmuch as you do it to the least of these ...you do it unto me'. The doctor's storyThe first doctor you may see is the family doctor But what can a doctor do in five or ten minutes' consultation? Perhaps, since the coming of Prozac and all the other forms of medication, doctors may now be seen as too 'quick on the draw' with prescriptions. I doubt this, but I see it as a real problem that if a GP is expected to perform a consultation in five to ten minutes, he may be seen by a patient, a pastor or a family as taking an easy way out by prescribing. One good thing is that many GPs now have others in their team to help: a psychologist for giving cognitive therapy, a community psychiatric nurse to link up with an expert team, and many others from the voluntary sector like Mind and other smaller groups that may help greatly. I believe firmly that a church can help greatly by linking up with statutory helpers and voluntary ones also. The important thing is to detect clinical depression. Asking questions about loss of weight, loss of appetite, loss of pleasure in life and sometimes loss of interest in a previously good marriage. Difficulties with concentration and memory, problems with sleep and early waking in some distress, low mood with crying, irritability and loss of interest are all signs to look for in depression. It is distressing when things like prayer, reading, worship and fellowship cannot be enjoyed - and such distress may be part of the illness. Serious depression is often masked by smiles, by physical symptoms of anxiety, and by concerns about imagined cancer or other serious illness. Some say: 'Surely unhappiness is not an illness'; but anyone who is deeply unhappy, and is ill with his unhappiness, is certainly suffering from depression. Of course, we can use a symptom to avoid something. Even the wisest parent may be unsure whether their child is crying wolf or is really ill. And so it may be in the church fellowship. 'We all may be part of the problem, and also part of the solution'. The doctor's ministry remains diagnosis and treatment for those who are sad, anxious or depressed. Every Christian called to the caring professions in whatever role is told to 'do good to all, and especially the family of believers'. A hard task, which we can all work together to try to fulfil. Dr. Gaius Davies is a retired consultant psychiatrist and the author of 'Genius Grief and Grace' (Christian Focus, 2001). © Evangelicals Now - March 2003 |
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