Notes on dealing with depressive illness

We all experience different moods and stresses at different times. We can find ourselves stressed by commitments, demands, tragedies and trials of various kinds.

Perhaps it is as if a human being has an elastic band inside which feels the tension. These stresses cause a response in us. We feel 'down' or 'low' or 'depressed.' Negative patterns of thoughts about ourselves and our situation arise.

Colloquially the word 'depressed' describes these normal struggles of life, but doctors use the term 'depression' or 'depressive illness' to describe what really is a step beyond usual feelings of unhappiness or disappointment.

In depressive illness it is as if our elastic band breaks, or at least gets so stretched that it loses its power of recovery. Our feeling down becomes very severe. Our negative thoughts may become suicidal. Everything looks dark. And this can go on for weeks or months. There is no direct medical test for depressive illness - it is diagnosed by its features and distinguished from just feeling a bit low by the nature and the extent of the symptoms it causes (see end of this article). For whatever reason, there seems to be evidence that depressive illness is on the increase, and sometimes it can affect Christians.

Why people get depressed

There are many factors and there are still some things about this which even the doctors do not understand. However, generally the causes of depression can be described as a combination of basically two things: our natural tendencies and usually some immediate trigger which has set off the problem.

Natural tendencies. Going back to our analogy, some elastic bands are naturally stronger and others weaker. Inherited chemical and genetic factors can play a part. This may show in family history. Then again our early experiences in life affect us. For example, those who have sadly lost a parent while they were children statistically seem more prone to depression than others. Our natural strengths and weaknesses we can only offer to God. Learning to understand ourselves and be contented before God with our make-up may not be easy, but it is important.

Immediate triggers. These may be life events outside our control like suffering redundancy or a bereavement. Or they may be things partially within our control like overworking, or repeated pregnancies or harbouring unrealistic ambitions in life and so putting pressure on ourselves. Our faith can speak into these latter areas.

In any particular case of depression it may never be possible to come to a complete understanding of the causes. There are always unknown factors. Triggers usually involve some kind of loss. The impact of some (but far from all) such factors may be reduced by being in God's family - for example, whether or not we are socially isolated, our source of self-worth, our view of the future.

Christians and depression

Depression is not good, but it is not outside the experience of God's genuine people. Some circles give the impression that Christians should never suffer from depression. If someone does it is a sign of a failing in their walk with God. But although sometimes we do bring trouble on ourselves by wandering from the Lord, it is harmful and far too simplistic to see this as the root of all depressive illness among Christians.

A number of the great saints of Scripture show signs of depression. Elijah was so depressed that he wanted to die (1 Kings 19.3,4). I do not think that anybody would want to accuse Elijah of not being close to God! Job and Jeremiah had similar experiences, (Job 7.15,16; Jeremiah 20.14-18). The writer of Psalm 88 recounts a prolonged time of deep gloom, with no happy ending. His closing words are 'the darkness is my closest friend.' So this is certainly not an illegitimate experience for Christians and sometimes may, as in Job's case, be related to a spiritual battle.

But on the other hand, the good news is that generally fewer Christians suffer from depressive illness than the population at large. A 1972 American study showed that people who did not attend church were four times more likely to commit suicide than frequent church attenders. Another US study showed that high levels of religious commitment generally correlate with lower levels of depression and a greater ability to cope with stress (American Journal of Psychiatry 147, no.6, 1990). The work of Professor Michael Argyle of Oxford, showing that church attendance 'induces feelings of calmness, social cohesion, joy and transcendence' (Daily Telegraph, September 23 1998), was given some coverage in the press last autumn.

But given that depressive illness is a fact, and that it can affect God's people, we now ask two questions. First : what can be done to reduce the risk of depressive illness? Secondly, (and quite differently), we ask 'if someone does go over the brink into depression, how best can we help them'?

Prevention?

There are some things which we can do personally to reduce our risk of depression.

1. Spending regular and relaxed time with God and his word brings a general promise of strength and well-being (Psalm 1.1-3; Isaiah 40.30,31). It may not prevent tragedy and darkness coming to us (see Job's case), but if we are in good shape spiritually when trouble does come, it will help. Again, spending time in God's presence will help us generally to put our troubles in better perspective.

2. We must do our best not to be perfectionists or unrealistically ambitious in our approach to life. We must avoid over-stretching ourselves. The old adage, 'do your best and commit the rest,' has a lot of wisdom in it.

3. Feeling isolated does not help depression. We need to nurture a small set of close relationships with people to whom we can open our hearts and so share our troubles.

There are also things we can do as churches to help one another.

1. If a church understands depression as an illness and that it is not wrong for a Christian to be depressed, we can create an accepting atmosphere in which people can talk knowing they will be loved, not rejected. Such supportive care can steer people through a low time without them going past breaking point.

2. We also need to make sure that we all do our best to pull our weight in church life. Avoid letting willing individuals take on too much for the church. That one extra responsibility could be the last straw which pushes that person beyond their limit. Anticipate circumstances which may put undue pressure on individuals.

3. We also need to support those with pastoral and counselling responsibilities who seek to help those who are suffering. We need to pray for them in their work and give them our encouragement and appreciation wherever possible. Being involved in pastoral work, can often mean working with all the problems and difficulties as you seek to help others, and that can wear you down and so make you low.

Helping the depressed

When people have actually gone over the brink into depressive illness they will need to see a doctor and in a sense our whole approach to helping them needs to be modified.

The best way to help people with depressive illness is to understand them.

1. When people are going through depressive illness there is no part of their lives that is unaffected. To think that people can be going through depression but be spiritually OK is naive. They feel emotionally numb, continually tired, and desperately worthless. They do not reason logically, and see everything in a negative light. They often can't pray and therefore we should pray for them and their families. It may comfort them to know that, though they can't pray, others are praying for them.

2. We need to understand that getting over depression usually takes a long time. There are no quick fixes. We can be disturbed by the darkness our friends are in, and so want to see them get better that we can be too impatient to see improvement, and this can cause extra stress for those suffering. They can fret: 'Why aren't I better yet? I'm letting everyone down.'

3. What people suffering from depression need most is love. Christians who have been through depression have said that what meant most to them during the dark times were tangible expressions of care. It depends on the type of personality, but kisses, hugs, or flowers can often mean far more than words or rational encouragements to a person who is not thinking straight.

4. Some Christians have problems with the idea of taking anti-depressant medication. But their fears are unfounded. Yes, drugs like Prozac can be misused, but this should not rob us of their proper use. Anti-depressants are not addictive. Depression often relates to a chemical imbalance in the brain and medication helps to restore the balance. We have no problems with taking pain killers for a twisted ankle. They ease the pain while the healing proceeds. Anti-depressants can have a similar function.

5. In the midst of darkness is not usually the time to face difficult personal issues, but later in the healing process there is often a role for some biblical counselling. Sometimes this is at the level of ordinary encouragement from Christians (see 'Dos and don'ts' below), sometimes there may be need for more specialised Christian psychiatric help.

We live in a time when everything must be seen to be successful. The church is often desperate to create a positive image. We must be careful not to be swept along by such ideas. If we are we will find that to have depressed people in our pews is an embarrassment and we will end up seeking to sweep them and their problems under the church carpet, and that is not the way of the love of Christ.

Dr. Klaus Green & John Benton

Identifying depressive illness

Main symptoms:

1. Depressed mood all day every day for at least two weeks.
2. Loss of interest or pleasure for at least two weeks.
3. Weight loss or gain
4. Sleep disturbance
5. Feeling agitated or slowed down
6. Lack of energy
7. Feeling worthless
8. Inability to concentrate or make decisions
9. Thoughts of death or suicide.

Depression consists of five of these if present for two weeks or more; one of them must be either no 1 or no 2.

Dos and don'ts for helping the depressed

* Pray and assure the person of your prayers.
* Don't worsen the situation by feeling awkward about their depression and saying nothing.
* Talk, or write a card or make a call and let the person know they are loved, and loved for who they are not just for what they do in the church.
* Think before asking 'How are you?' - there's a limit to how much soul-baring an individual can do.
* Don't tell the person how (s)he should feel in the light of a sermon or Scripture passage - if they could reason their way out of depression they would have done so already.
* Be sensitive and give space where needed.
* Don't feel time with the person has to be spent in deep conversation - sometimes just involving them in an ordinary way is far more valuable.
* Be prepared to keep taking the initiative over time - 'you know you can call me anytime' will probably not result in a phone call from them.
* Always be open and talk with the person about ways of helping. Share uncertainties you have and check that your efforts are helping rather than hindering.
* Remember those who are close to the one suffering from depression. Living with a loved one who is depressed is one of life's most difficult experiences.