Understanding and Overcoming Depression
Andy J. Johnson, Ph.D.
Bob was a fifty-four-year-old accounting executive with a life full
of success and happiness. He spent time with his family, enjoyed
his work, played sports with his friends, and was active in his church
and community. But then his employer had financial problems and had
to lay Bob off. Bob did a thorough job search but openings were just
not available. He even tried finding other types of work but potential
employers said he was overqualified.
Over time, Bob became increasingly discouraged and sad. He had
difficulty concentrating and his thoughts often wandered to how
worthless he
felt. He believed everything was his fault and was certain things
would never get better again. He no longer enjoyed his family,
recreational activities, friends, or even his church and relationship
with God.
Bob would wake up in the middle of the night and have a hard time
getting back to sleep. His family noticed how he had lost weight,
slowed down, withdrawn from others, and felt sad or irritable much
of the time. Bob told me, "I feel like I'm behind a glass wall.
I can see and hear things that used to make me happy, but they don't
any more." Even reading the Bible and praying did not provide
Bob the encouragement they used to, although they sometimes helped
a little.
Tonya is a thirty-two-year-old lawyer who feels depressed and pessimistic
and has very low self-esteem. She cannot remember a time in many
years when she has not felt depressed. She is unhappy with her
family, her job, and her entire life. It is as though a black
cloud of gloom
covers her entire world. Although she has a job in a successful
law firm, Tonya believes that she does not measure up to her
co-workers. She purposely married a man she considered "average" because
she thought he would be less likely to leave her.
Bob and Tonya both suffer from depression. Bob suffers from Major
Depression, a condition that causes enormous suffering for
the depressed person and often for his or her loved ones. Research
studies have
found that between 5 to 9 percent of adult women and 2 to 3
percent
of adult men in the United States suffer from Major Depression
at any given time.1 Tonya suffers from Dysthymia, a rather
common form
of depression with fewer and less severe symptoms than Major
Depression, although it can last for years unless treated.
Depression robs
people of joy in living, and in its severe forms, drives some
to end their
lives through suicide. Feeling absolutely worthless and believing
they have no hope for a better future, they choose to take
their lives in order to find relief from unrelenting sadness
and despair.
| "Research studies
have found that
between 5 to 9 percent of adult women
and 2 to 3 percent of adult men in
the United States suffer from Major
Depression at any given time." |
People who are suffering from depression may experience more
pain and physical illness than others and have a more difficult
time
in social relationships. Depressed
Christians can be riddled with guilt, preoccupied with feelings of
failure, and have difficulty believing God loves and forgives
them.
Even though they intellectually
know that God loves everyone, they don't feel as if God cares for them.
Fortunately, depression can be effectively treated, and
the earlier it is detected the
easier it is to treat.
Signs and Symptoms of Depression Everyone feels sad or down at times. But Depression and
Dysthymia are different from ordinary sadness. Ordinary
sadness is
temporary and a normal part of
life. Depression is much worse, lasts longer, and involves terrible
feelings toward
one's self. Major Depression interferes with the person's ability
to function on the job, at home, in social situations, or
in other important roles
for an extended period of time. Dysthymia also interferes
with an individual's
ability
to function at work or in relationships while normal sadness does
not.
Someone with Major Depression will have at least five of the
following symptoms most of the time every day for at least
two weeks. Someone
with Dysthymia
will have fewer of these symptoms but will be depressed most
of the day, on most
days, for at least two years.
- A depressed, irritable, or cranky mood most of the time
nearly every day
- Greatly reduced interest or pleasure in daily activities
- Changes in appetite that result in a significant weight loss or gain
- Sleep disturbance (difficulty sleeping or excessive sleeping)
- Agitation or slowing down
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Decreased ability to concentrate
or make decisions
- Decreased ability to concentrate or make decisions.
Similar Conditions
Several other problems have symptoms or side effects that are
similar to depression, but different enough to require a different
kind
of help. These
include:
- Bereavement or grief following the death or loss of
a loved one
- Postpartum Depression—around the time a woman
gives birth, or shortly after
- Seasonal Affective Disorder (SAD)—a
type of Major Depression that develops in winter
- Bipolar Disorders—previously
called Manic-Depressive Disorders—characterized
by mood shifts from extreme feelings of elation, enormous
amounts of energy, irritability, moodiness, increased risk
taking, and
little need for sleep, to
periods of deep depression
- General medical conditions
(e.g., Parkinson's disease, multiple sclerosis, heart attack,
stroke, vitamin B12 deficiency, hyper-and hypothyroidism,
lupus, hepatitis,
mononucleosis, human immunodeficiency virus [HIV],
diabetes, certain kinds of cancer, etc.)
- Side effects from certain
types of medicines including some for pain, high blood pressure,
cardiac conditions, ulcers, and Parkinson's, as well
as muscle relaxants
and steroids
- Reactions to metals and toxic substances
like paint, lead, gasoline, insecticides, nerve gases, carbon
monoxide, and carbon dioxide
- Intoxication or withdrawal from substances,
such as alcohol, cocaine, etc.
Spiritual and Existential Struggles
Jodie came to see a counselor because she felt depressed much of
the time. She traced the start of her symptoms to the time she
began asking questions about the meaningfulness of certain aspects
of the Christian faith. This upset Jodie because she valued her
faith in Christ and was afraid she might be losing her salvation.
She was terrified and feared that she might be doomed to hell
for her questioning and doubt.
When Jodie tried sharing her concerns with others in her church,
they told her she should just have more faith. One "friend" made
things worse by reinforcing her fears that she was losing her faith.
Another told Jodie that perhaps she was never a Christian in the
first place and that everything she had been doing and saying was
a lie. Others did not take her seriously and treated Jodie like a
child, saying she was just going through a phase that she would soon
outgrow. No one understood her doubts and questions, and Jodie felt
all alone. Nevertheless, she could not put away her suspicion that
some of the things she had been taught about Christianity over the
years were untrue.
As Jodie began re-examining the beliefs she had uncritically accepted
as a child, she found that some rang true with the Bible and
her experience of Christ while others did not. Some of the things
she
had been taught seemed to be more a product of her church's subculture
than that of the Bible. And some of the hard questions she was
asking had never been discussed in her church or family and seemed
threatening
for her friends and family even to consider. In time, Jodie's
counselor helped her see that rather than losing her faith, Jodie
was actually
growing in her Christian faith by examining what she believed
and making it hers for the first time.
"Some individuals
and church
subcultures do a better job than others
of providing encouragement for people
with questions and doubts. " |
Like Jodie, many people go through periods of doubt and struggle
as they re-evaluate their faith. These periods of questioning
occur on a rather predictable basis
and have even been written about in books and articles on faith development.3
For some, these struggles are relatively mild and painless. For others
it is a lengthy and painful struggle. This happens most often
in two
types of situations.
First, extra sensitive or introspective individuals-especially late
adolescents, young adults, people in new subcultures, and people
facing great hardship
or tragedy-may ask hard questions about the fate of people
who have never heard
of Christ and those who sincerely follow other faiths. They reflect
on injustices that have been carried out in the name of God,
realize
that some of the things
they have been taught are questionable at best, see people who have
been hurt or neglected in their church, or wonder why some of
their
earnest prayers seem
to have gone unanswered.They don't want to lose their faith, but they
are too honest to ignore these problems.They wonder if there
really is a God. And if
there is, is He the God of the Bible? Second, some individuals and church subcultures do a better job
than others of providing encouragement for people with questions
and doubts.
People
who offer quick advice, look down on the person, or who are uncomfortable
with
those who ask hard questions can make growth and transitions more
difficult. This happens even when the person acting this way
is trying to help
out. Others who do not judge while they listen in an active and caring
way
to the questions
and concerns of the person can help smooth the transition by reducing
the isolation and other unpleasant feelings that the person may have.
Another kind of intense struggle can combine with a tendency to
be excessively self-critical or to suffer from guilt and discouragement,
triggering
serious depression. This happened to Carl. At thirty-five years
of
age, he no longer
felt the joy or enthusiasm he used to feel in his relationship
with God. Over a relatively lengthy period of time, Carl talked
his experiences
over with
his pastor and a couple of good friends. Gradually, he realized
that he was going through a shift in his Christian experience
but that
didn't mean
he
had to "throw the baby out with the bath water." True, he was outgrowing
his less mature sense of excitement and the naïve aspects of his faith.
But he found that he had the potential to shift from finding his pleasure in
the good feelings he got from his faith to a deeper level of commitment and
loving God for who God is, not so much for what God did for him.
Fortunately, Carl's pastor was spiritually and psychologically
sensitive and was able to help Carl navigate through this phase
of spiritual
life that is
so common that it has a name-the dark night of the soul. It is
a period of shifting to a deeper type of faith that often requires
a time of
struggle and apparent loss of intimacy with God.
Jodie and Carl's spiritual struggles both helped create their
depression, and their depression was significantly relieved
as they worked
through their struggles
of faith. Sally was different. She had a Major Depression first,
and then noticed that she lost the feelings of joy and enthusiasm
in her
life with
Christ. The
guilt and self-condemnation and loss of interest in life caused
by Sally's depression carried over into her relationship with
God, leaving
her feeling
distant from Him and feeling like a failure in her Christian
life. She wondered if God could really love someone as worthless
as she
believed herself to
be. Instead of spiritual struggles causing Sally's depression,
depression caused
her spiritual struggles.
Some Christians become depressed because they are members of a spiritually
abusive group.4 Characteristics of spiritually abusive systems include
a preoccupation with power, a primary focus on performance and on
how things appear on the surface in order to make a leader or group
look good, an emphasis on controlling people through rules, and a
powerful unspoken rule that you cannot talk about problems. Effects
of spiritual abuse on others can include developing a distorted image
of God, a preoccupation with spiritual performance, a distorted or
shame-based identity of yourself as a Christian, and having a hard
time with grace, personal boundaries, authority, personal responsibility,
and trust.
How Depression Develops
Depression can have physical, spiritual, and/or emotional causes.
Physical Causes Some people appear to have a higher genetic predisposition
to becoming depressed. They are more likely to become depressed
even after a relatively minor loss or stress. Others may have
a lower
genetic predisposition but develop depression if exposed to traumatic
loss or extremely stressful conditions. Some have glandular problems,
such as a thyroid disorder. Some people develop depression in
winter when there is not enough sunlight. Others develop depression
due
to lead poisoning, head injuries, strokes, or other medical conditions.
Psychological Causes Robert's mother died from multiple sclerosis
when he was six years old. Her death was so painful for Robert
and his father that they never talked about it. They tried
to push their
feelings deep inside or distract themselves by getting lost
in work or school. This left Robert particularly vulnerable to
feeling
abandoned
or left alone. When his college girlfriend suddenly broke off
their relationship. Robert's unresolved feelings of grief,
hurt, and
abandonment welled up and left him feeling depressed. He was
already away from
the little security he had left at home and his girlfriend's
rejection was too much for him to handle.
Childhood losses and emotionally traumatic events can make
us vulnerable to feeling overwhelmed or depressed if we encounter
a similar event
or loss later in life. Children are emotionally vulnerable
and
they typically cannot resolve severe emotional pain, so they
shove it
out of awareness. But since it isn't resolved, the painful
feelings or expectations of being hurt or abandoned just
lie there waiting
for a trigger. When an adult experience of rejection or failure
stirs up those buried feelings, the person isn't just dealing
with the
adult pain. His or her childhood feelings of depression,
abandonment, and fear are triggered as well. This is why adult
depression
can seem irrational or inappropriate to observers in light
of what
they know about the adult's actual life. To observers, the
depressed person
seems to be a fine person and have a lot going for him or
herself. But internally, the depressed person is being flooded
with
unresolved childhood pain.
| "Depression
can be understood as a
melding together of sadness over
losses and unresolved anger in such a
way that neither emotion can be
fully experienced and resolved." |
The loss of a job or meaningful responsibilities, freedom,
status, or security, can all trigger feelings of depression.
Sometimes
childhood losses make someone
more vulnerable in these situations. At other times, the loss itself
may be severe enough to cause the depression. Robert was also struggling with unresolved grief, another
common cause of depression. Since his father was too
upset to talk
with Robert and share
their sadness
over losing their mother and wife, Robert never resolved his
grief. Instead, he was left with a lingering expectation that
those he loved and needed
would ultimately abandon him. The depression he felt
was the delayed depression
of a sad boy who lost his mother.
When most of us lose a loved one, we go through a normal process
of grieving and gradually come to grips with our loss. We may
initially deny the
loss. Sometimes we may bargain with God to try to bring our loved
one
back. At
other times, we may experience anger and perhaps some guilt over
losing our loved
one or our lacks in the relationship. But eventually we reach
a point of acceptance and healthy sorrow at our loss. Then we
are
able to
hold onto
our memories
of our lost loved one without being depressed because we have
grown stronger in the process. In time, we are able to start
moving on
with the next
phase of our lives. It can be difficult for children to process
losses and grieve
in such a healthy way, however. This is especially true if adults
around them do not model appropriate ways of grieving or do not
discuss the
loss with the
child in a healthy manner.
Repressed anger usually plays a role in depression. In fact,
depression can be understood as a melding together of sadness
over losses
and unresolved anger in such a way that neither emotion can
be fully
experienced and
resolved. The
role of sadness over loss is relatively easy to understand,
but the dynamic of anger is more complex. It often works this
way.
The child
is angry
at the parent for abandoning him or her through divorce, death,
workaholism, or physical
or emotional separation. But it seems wrong to be angry at
a dead or departed
parent, so the child represses his or her anger. But shutting
his eyes to
the upsetting feelings doesn't make them go away, so the child
eventually ends
up directing the anger that was originally targeted at the
parent toward him or herself. Instead of thinking, I'm angry
at you
for leaving me,
the child
thinks, I must be a bad person for my parent to have died or
left. This kind of depressive self-hatred and self-blame cannot
be resolved
until
the mixed
feelings toward the parent are faced and resolved.
Anger over other things beside loss works in much the same
way. Children naturally feel angry if they are punished harshly,
ignored,
criticized
excessively, unable
to please their parents, compared unfavorably to siblings,
overprotected, motivated by guilt or fear, or abused verbally
or physically.
Anger can be a useful protective
device in situations like these. But anger can also be frightening
to a child.
What if I yell at my father and my father gets angry back?
What if he punishes me? What if my parents won't love me
if I'm angry?
What
if they
give me
away or abandon me? To avoid these frightening imagined
reactions to their anger,
many children unconsciously push their anger from awareness.
But as in cases of loss, the repressed anger doesn't disappear.
Instead,
it
is
turned upon
the self. Instead of saying, "I hate Mom or Dad," the child with
repressed anger ends up hating himself or herself thinking, I'm worthless.
I'm no good. No one should love me. Can you imagine a person telling someone
else, "You're worthless." "You're no good!" "You deserve
to die." No,but that's the way seriously depressed people talk to themselves
all day long. They repeatedly take out their anger on themselves until they
resolve it or find acceptable, direct ways of expressing their anger.
Robert was also susceptible to depression because
he had never learned to soothe himself or make himself feel better
when he faced failures
or difficult times. When Robert's mother was alive, she talked with
him and helped him feel better when he was troubled about something.
But she died before Robert had developed this ability to soothe himself
and make himself feel better on his own. And since his father was
not very good at dealing with emotions, he was unable to help Robert
handle difficult feelings. This left Robert unable to calm and reassure
himself, so he relied on others-especially women-to help him in this
area of his life. When his girlfriend broke off their relationship,
Robert didn't just lose a girlfriend, he lost the one person who
was helping him feel good about himself in life.
Sometimes individuals can face a series of defeats or situations
where they are not able to succeed or get their needs met regardless
of what they do. For example, Jill was treated like a scapegoat
in her family. At first, her husband treated her very lovingly
but he
slowly changed over the years. She was blamed if something did
not go well regardless of whether it was her responsibility or
not. Her
children even joined in the criticism. Sometimes she was placed
in a double bind. When she did one thing, she was told that was
wrong
and that she should do something else. When she followed that advice,
she was told that she shouldn't have done that either. She couldn't
win. No matter what she tried, she failed to please her family
and to feel good about herself.
Naturally, this made Jill frustrated
and resentful. But if she tried to express her feelings or her
sense
of being treated unfairly, her husband lost his temper. So she
pressed her anger deep inside and concluded the problem was
really hers.
If she was just a nicer, better wife, her husband wouldn't get
so mad. And if she could read his mind and do just what he
wanted, her
family would be fine. Who wouldn't feel depressed in an environment
such as that? Experiences like Jill's contribute to people feeling
worthless, inadequate, inferior, and resentful. This combination
of feelings is at the root of much depression. Some
people become depressed because they lack social support or don't
know how to engage socially with others when they are in
a time of transition, crisis, or stress. This can make social
situations painful for them, especially if they were already
shy or socially
anxious in the first place. Sometimes these individuals find
that the least painful thing they can do is to isolate themselves
and
be alone, even though they want to be with other people.
Finally, unrealistic negative thoughts about oneself, the world,
and the future are found in most people with clinical depression.
These automatic, knee-jerk reactions can develop in childhood,
as they did for Robert, or slowly over time in adulthood, as
they did
for Jill. Depressed individuals often are either not aware
of how they beat themselves up with their thoughts or they assume
that
this just reflects the way things really are.
| "Most individuals
become depressed
when others sin against them, or when
they have suffered childhood traumas like
the loss of a parent, verbal or physical
abuse, rape, betrayal, assault, angry
punishment, or other self-esteem
destroying interactions. " |
Spiritual Dynamics in Depression
Does depression mean that a person has a spiritual problem?
No more than we all do. Charles Spurgeon, Martin Luther,
and many
other godly men and women
have struggled with depression. While all human problems can be
traced back to the Fall of Adam and Eve in the Garden of Eden,
and in that sense are
caused by sin, depression is rarely due simply to one's
personal sins. Instead, most
individuals become depressed when others sin against them, or when
they have suffered childhood traumas like the loss of a
parent,
verbal or physical
abuse, rape, betrayal, assault, angry punishment, or
other self-esteem destroying
interactions. Individuals only complicate their symptoms when they
allow
themselves to feel guilty for their depression. Some
people who intentionally sin on a
frequent basis have no depression. And some wonderful people feel
quite depressed. There is rarely a direct causal relationship
between
conscious personal sin
and depression.
Christians who are depressed, however, are especially likely
to feel completely responsible for their depression. And
they are
extremely
vulnerable to
the comments of well-meaning friends who hold the mistaken belief
that the only
reason anybody feels depressed is because he or she is sinning.
Unfortunately, these suggestions, no matter how well-intended,
only increase the
depressed person's depression and guilt. Depressed Christians
naturally assume
that their guilty feelings are proof that they are guilty. But
it is one thing
to know
that you, like others, are a sinner. It is quite a different
matter to despise and hate yourself and wish that you were
dead. Most
of the guilt
depressed
people feel is false guilt or neurotic guilt rather than true
guilt or godly sorrow.
False guilt is rooted in self-blame and self-hatred and lasts
for lengthy periods of time-if not for life. True guilt or
godly sorrow
is marked
by appropriate
regret or remorse for something that one actually did or should
have done but didn't. True guilt doesn't blow things out of
proportion. It doesn't
take responsibility
for the behavior of others or for consequences that are beyond
one's
control. And true guilt dissipates with confession, while the
harsh self-condemnation of a depressive person's guilt persists
in spite
of repeated confessions
to God or others. God is a God of love and forgiveness. Christians
do not
need
to be riddled with guilt feelings because they can appropriate
God's wonderful forgiveness through Jesus Christ.
TREATMENT
Fortunately, we don't have to live with debilitating depression.
There are a number of effective treatments. They all work better
the sooner one gets help.
Medical Treatments
Medication should always be considered in cases of severe depression.
If the problem is biologically caused, medication may be the
only treatment needed. More often, good counseling or psychotherapy
may be combined with medication.
Four major types of antidepressant medication are currently
used to treat depression. They are serotonin reuptake inhibitors
(SSRIs),
tricyclics, monoamine oxidase inhibitors (MAOIs), and atypical
antidepressants. These medications are either used alone or
in combination. A psychiatrist
usually prescribes antidepressant medications although some general
practice physicians may do so as well on occasion. Sometimes physical treatments other than medications are preferred
or necessary. Seasonal Affective Disorder (SAD), for example, usually
responds well to treatment using bright lights. Electroconvulsive
therapy (ECT) is still occasionally used when a person who is suffering
severe Major Depression has not responded to counseling and at least
two trials of different types of antidepressants. ECT is also sometimes
a safer alternative than antidepressant medications for patients
with serious medical conditions in addition to Major Depression because
of the side effects or possible interaction of antidepressant medications
with other medications the patient needs. Dramatic improvements in
the delivery of ECT have occurred in the past few years, making ECT
not only more effective than before but also with reduced side effects.
You should talk with your psychiatrist about these issues in detail
if he or she recommends ECT as an appropriate treatment for you or
a loved one.
Counseling and Psychotherapy
If you or a loved one goes for counseling for depression,
you should expect your therapist to be a sensitive listener
with whom you
can feel safe from judgment, criticism, anger, and pessimism.
Above all else, depressed people need to feel safe and
accepted just
as they are. This acceptance is the opposite of the internal
self-hatred that is at the root of depression.
If your depression is severe, you should expect your therapist
to discuss the possibility of a medical or psychiatric referral
to rule
out any potential physical causes and to consider an appropriate
medication. Your psychotherapist or psychiatrist should discuss
the types of treatments that might be best for your particular
situation.
He or she should explain the treatment options that you have
and help you understand the advantages and disadvantages
of each option.
In some cases, more than one treatment or treatment combination
might be the best way to gain relief from serious depression.
Once counseling begins you should expect to gradually explore
the sources of your depressed feelings. This includes unresolved
grief,
recurring patterns in relationships where your needs are not
being met, harmful self-talk, or experiences that have undercut
your
self-esteem. You may see ways in which you try to be the peacekeeper
in your family
or how you end up taking the blame for too many things that go
wrong. You may need to work on becoming more assertive or more
expressive
of your feelings. You may also learn to identify automatic, negative
thoughts that make your depression worse. When disruptive family
relationships are related to the depression, marriage and family
therapy can be helpful.
"Depression
can be effectively treated.
If you or a loved one is suffering from
depression, don't hesitate to seek out a well-
qualified professional to help you gain relief
and resolve the underlying problems. " |
At some point you
will probably face some painful experiences and some hurt and
anger over those experiences. As counseling
continues
you will begin to
understand how your depression works, what causes it, and how you
can beak the cycle of self-hatred and self-condemning thoughts.
You may also begin to sort out the difference between
false guilt and true guilt or godly sorrow. As a Christian,
you
may also come to accept
God's
love and forgiveness in a much deeper way and find new hope and
support in your
relationships with God. Scriptural passages on God's love and forgiveness
and complete acceptance of you will take on a wonderful new meaning.
In summary, depression can be effectively treated. If you
or a loved one is suffering from depression, don't hesitate
to seek
out a well-qualified
professional
to help you gain relief and resolve the underlying problems.
God wants you to have an enjoyable meaning-filled life.
Don't let depression
rob you of
it!
Helping a Loved One Who Is Depressed
It is painful to see a loved one suffering from debilitating
depression. It can also be a helpless feeling since our efforts
often seem
to be of no avail. But there is much that we can do. Here are some
specific steps that you can take to help a loved one suffering
from Depression:
- Make sure they get into treatment as soon as you
detect that they are suffering from depression.
- Help them comply with their treatment such as
going to psychotherapy sessions, taking medications, and
making any recommended lifestyle
changes.
- Provide emotional support and encouragement. Sometimes
you can take them out to an activity. Be careful not to suggest
things they should
do on their own because they might be too depressed to
do that and will only feel worse. Instead, tell them you
will come by to pick
them up.
- Pray with and for them if they are willing. Treat
what they tell you as confidential. Do not provide information
they share with you
with prayer groups or prayer chains even if the person
says it is okay to do so. Too often things feel more out
of control for the
person when even well-intentioned individuals from prayer
groups start asking them all kinds of questions. It is better
to just tell
the prayer group or chain that you have a silent request.
God already knows what the person's needs are.
- Help them focus on passages from the Bible that
provide comfort and support. Depressed Christians tend to
focus on the commands or judgments
of Scriptures.
- Instead, give them supportive, encouraging passages
and passages that point out that God loves us just
as we are and that Christ has already paid the penalty for
all
of our sins.
- Don't criticize. Individuals who are depressed
are overly critical of themselves already. They do not need
help identifying their faults
or problems. They will only blow your criticisms out
of proportion and become even more depressed.
- Don't add to their burden. Depressed individuals
feel too much guilt, shame, and worthlessness. Remember how
tender Jesus was with people
who were aware of their sins or who felt downtrodden
or oppressed. Depressed people need compassion and understanding,
not shaming or
blaming. Indeed, one of your greatest contributions
to a friend who is depressed is to be a real friend and encourage
professional help.
FREQUENTLY ASKED QUESTIONS
1. What should I consider when choosing a counselor?
Christian psychologists, social workers, or marriage
and family therapists can be a good choice for a counselor.
They often understand your
beliefs, worldview, values, and background more thoroughly and
more quickly than other counselors might. There are some things to think about when choosing a Christian
counselor. First, consider the case of Ralph. Ralph was
very interested in his
theology of the end times. He valued his position on this part of
theology very highly. Ralph directly asked a potential Christian
counselor about her position on his theology of the end times and
insisted she give a thorough answer. Even though she agreed with
him on almost every point, Ralph was concerned that she was "soft" on
a couple of points and decided she would not be a good choice for
a counselor. This was unfortunate for Ralph because it turned out
that this counselor was well-educated, very competent, and had a
lot of experience treating depression. Ralph didn't stop to consider
that even though the theology of the end times is important, it just
doesn't come up very often in the treatment of depression. Ralph
seemed to be using his theology to avoid dealing with his problems.
No Christian counselor will be a "perfect match" in the
sense of agreeing with you on every single detail of your beliefs
or values. What is important is that they understand, respect, and
value you as a person and as a Christian.
Second, keep in mind that just because somebody is a
Christian and is a nice person, it doesn't necessarily
mean they are competent
to treat depression. It may help to ask whether the potential counselor
is licensed, what kind of educational background they have, how
long they have been practicing, what is their specialty
(e.g., working
with adults or children, individual or marriage and family counseling,
depression, anxiety, etc.), what kind of treatment they think would
work best for you and why, and how long will treatment probably
take.5 There are a number of treatments for depression
that research has
shown are effective and reliable. Most Christian therapists I have
known are either competent in practicing these treatments for depression
or they can refer you to someone who is. Unfortunately, some small
groups of Christian therapists are attracted to passing fads or
flashy approaches. These approaches usually do more
to meet the needs of
counselors to see themselves as extra-special or talented than
they do to meet the treatment needs of clients. I recommend
not choosing
that type of counselor.
Some individuals may be in areas of the country where
a competent Christian professional counselor is not
available. Others might
be in situations when their insurance or HMO does not have any
Christian
service providers on their list and they are not be able to afford
counseling otherwise, even if the fee is reduced. Situations
like this raise the question of how can I find a counselor
or psychiatrist
who will respect my Christian faith and my ethnic heritage?
You can start by asking around with people you know or
whose opinion you trust. Often the pastor or one of
the staff members
of a church
might know of a competent professional who would be appropriate.
Most psychotherapists and psychiatrists I have known try to
be respectful of someone's religious faith whether
or not they share
or agree with
that person's faith. Of course, it is possible you might encounter
one who is disrespectful. Don't give up if you run across one
of them. Keep looking until you find the help you need.
"Be
suspicious of claims that a
treatment can cure or heal depression
in a couple of sessions or in any other
very short period of time. " |
2. How long does treatment for depression typically last?
Don't expect the healing process to happen overnight.
Research has demonstrated that roughly half of individuals
receiving
competent psychotherapy show measurable
improvement by the end of the eighth weekly session. This increases
to 74 percent after the twenty-sixth weekly session.6
Measurable
improvement
is not necessarily
the same thing as resolution. Although minor or sudden bouts with
depression may show measurable improvement with medication
and 10 to 25 counseling
sessions, most clinical depression has been years in
the making and will take time
to resolve. Serious, deeply ingrained depression can
easily take a year or two
to work through, and sometimes longer.
Be suspicious of claims that a treatment can cure or
heal depression in a couple of sessions or in any other
very short period of time.
I would
be
suspicious
even if someone made these claims using Christian terms and by
quoting all kinds of Bible verses. Occasionally God does heal
someone in
a quick and
dramatic manner. More often than not, however, God works by healing
slowly and by helping
us deepen and further develop our character along the way. It
is not uncommon for self-professed miracle workers
to turn and blame
the person
when the
miracle cure doesn't work. They might tell the person they don't
trust God enough,
have enough faith, pray enough, read the Bible enough, and things
like that. Needless to say, this does not help the depression
get better.
On the other hand, individuals usually begin to experience
at least some relief with treatment over time. Although
parts of
counseling
involving
the discussion
of unpleasant experiences and memories can be upsetting in
the short term, people usually begin to feel better
as they work
through them.
It is best
to discuss any questions or concerns you have with your counselor
if you feel
the depression is not getting better. It may be helpful or
necessary for the counselor to change approaches. In
rare cases where the
counselor blames
any
lack of progress on you, makes sexual advances, or does other
inappropriate things, it will be necessary to change counselors.
3. Can children be depressed?
Yes, they can. At one time, it was thought that children
could not develop depression because childhood is such
a happy time. It turns
out, however, that children can become severely depressed, but
their depression is often hidden under behavior problems such
as throwing things or aggressiveness towards others,
or just being
cranky most of the time. Sometimes their depression is misunderstood
as a conduct disorder or Attention Deficit-Hyperactivity Disorder.
Other children with depression are extremely well-behaved, quiet,
and compliant at home and school. Some withdraw and stay by themselves
whenever they can, so they can cry and feel the sadness they
try to hide from others. Parents and teachers are often
shocked or
surprised when they find out these children are depressed. If
your child is almost always quiet, prefers to withdraw
from others,
or be alone most of the time, or frequently looks teary eyed,
you might talk with him or her to see if he or she
is depressed.
4. Can elderly individuals with depression be treated?
Yes. As with people in any other age group, a psychiatrist
or physician will need to know about any medical conditions
the person has,
his medical history and medications he or she is taking, to determine
what may be causing the depression. Sometimes choices of antidepressant
medication might need to be made based on the possible side effects
of the medication. This is the same as it is for individuals
in any other age group.
5. How is Postpartum Depression different from the "baby blues" that
many mothers experience after delivering a baby?
It is not unusual for mothers to experience sudden swings
or changes in mood, including periods of both happiness
and sadness, in the
first several days after having a baby. This is normal. It can
be due to extreme fluctuations in hormone levels, the
sheer physical
exhaustion associated with the birthing process, and all of the
changes in her life and the life of her family.
Postpartum Depression is more severe.
Sometimes it involves an inability to feel any happiness
or joy about the arrival of the baby at all.
Sometimes it includes suicidal ideation or obsessive thoughts about
violence to the baby. It is even possible in severe cases for someone
with Postpartum Depression to lose touch with reality.
It is important to talk with a doctor or a psychotherapist if you
or your loved one is concerned about the possibility of Postpartum
Depression. Support from others, especially the father of the child,
and counseling can be helpful. Severe cases and situations where
someone has lost contact with reality (e.g., they have delusional
beliefs that are obviously not true, etc.) will require medication
and possibly a brief period of hospitalization.
6. What are the warning signs of suicide?
Suicidal thoughts, plans, and attempts are more likely in individuals
with depression. While it is difficult to predict whether or not
someone will attempt suicide, there are several warning signs.
- First, making sure that one's will, house
and belongings are all in order and ready to be left
behind. Any of a number of different
things can suggest that he or she doesn't plan on being around
much longer.
- Second, giving away prized possessions or
special gifts. Sometimes this serves as a last good-bye
to a loved one or indicates that he
or she just doesn't care anymore because of the decision
to commit suicide. Ask them why they are giving away
these possessions or gifts.
- Third, talking about suicide. You may have
heard that people who talk about suicide won't end their
lives. This is not true. Most
people who end their lives do say something that shows
they are thinking about killing themselves. Some make
veiled statements that suggest
they might not be around much longer. Others say they wish
they were dead. Take these statements seriously even
if the person acts as
if he or she is joking. Directly ask the person if he or
she is thinking about suicide (see below) and make sure
he gets treatment as soon
as possible.
- Fourth, be especially attentive to a depressed
loved one who starts to get better. Often individuals
do not have enough energy to attempt
suicide when their depression bottoms out. They can be
temporarily at a greater risk for suicide or self-harm
when they are starting
to get better, because they might have the energy then
to make the attempt.
-
Fifth, be suspicious if someone with depression becomes dramatically
better overnight or in a very short period of time. This is referred
to as a "flight into health." Sometimes these individuals
have gone through so much emotional pain that once they have decided
to end their life they feel better. This is why it is important to
talk with someone who exhibits a flight into health. It is good to
just come right out and say, "I noticed you seem to be feeling
much better very quickly. I want you to feel better but am concerned
because I understand that sometimes people might feel this way because
they have decided to end their life themselves. Has this happened
to you? Are you planning to kill yourself?" It can
be embarrassing if the person has not made a suicidal
plan, but this is much better
than to risk losing him or her to suicide.
7. What should I do if someone talks about suicide?
- Don't be afraid to talk with the person about
it. Listening, asking questions, and talking about it
are almost always helpful.
- Make sure the person gets into treatment as
soon as possible, preferably within the next 24 hours.
- Ask if he or she has picked a method, a time,
a place, or a date for the suicide. If he or she has,
immediately contact a suicide
hotline, the police, dial 911, or take the person
to a hospital emergency room.
Predicting whether someone will make a suicide attempt
is extremely difficult even for specialists who
have treated suicidal clients
for years. If you are going to err, do so on the
side of seeking competent professional help and
getting it immediately.
A little
bit of embarrassment over seeking help if it turns
out the
help was not necessary is better than risking losing
someone you love
to suicide.
Postpartum Depression is more severe. Sometimes it involves an inability
to feel any happiness or joy about the arrival of the baby at all.
Sometimes it includes suicidal ideation or obsessive thoughts about
violence to the baby. It is even possible in severe cases for someone
with Postpartum Depression to lose touch with reality.
It is important to talk with a doctor or a psychotherapist
if you or your loved one is concerned about the possibility
of Postpartum
Depression. Support from others, especially the father of the child,
and counseling can be helpful. Severe cases and situations where
someone has lost contact with reality (e.g., they have delusional
beliefs that are obviously not true, etc.) will require medication
and possibly a brief period of hospitalization.
6. What are the warning signs of suicide?
Suicidal thoughts, plans, and attempts are more likely in individuals
with depression. While it is difficult to predict whether or not
someone will attempt suicide, there are several warning signs.
- First, making sure that one's will, house
and belongings are all in order and ready to be left
behind. Any of a number of different
things can suggest that he or she doesn't plan on being around
much longer.
- Second, giving away prized possessions or
special gifts. Sometimes this serves as a last good-bye
to a loved one or indicates that he
or she just doesn't care anymore because of the decision
to commit suicide. Ask them why they are giving away
these possessions or gifts.
- Third, talking about suicide. You may have
heard that people who talk about suicide won't end their
lives. This is not true. Most
people who end their lives do say something that shows
they are thinking about killing themselves. Some make
veiled statements that suggest
they might not be around much longer. Others say they wish
they were dead. Take these statements seriously even
if the person acts as
if he or she is joking. Directly ask the person if he or
she is thinking about suicide (see below) and make sure
he gets treatment as soon
as possible.
- Fourth, be especially attentive to a depressed
loved one who starts to get better. Often individuals
do not have enough energy to attempt
suicide when their depression bottoms out. They can be
temporarily at a greater risk for suicide or self-harm
when they are starting
to get better, because they might have the energy then
to make the attempt.
-
Fifth, be suspicious if someone with depression becomes dramatically
better overnight or in a very short period of time. This is referred
to as a "flight into health." Sometimes these individuals
have gone through so much emotional pain that once they have decided
to end their life they feel better. This is why it is important to
talk with someone who exhibits a flight into health. It is good to
just come right out and say, "I noticed you seem to be feeling
much better very quickly. I want you to feel better but am concerned
because I understand that sometimes people might feel this way because
they have decided to end their life themselves. Has this happened
to you? Are you planning to kill yourself?" It can
be embarrassing if the person has not made a suicidal
plan, but this is much better
than to risk losing him or her to suicide.
7. What should I do if someone talks about suicide?
- Don't be afraid to talk with the person about
it. Listening, asking questions, and talking about it
are almost always helpful.
- Make sure the person gets into treatment as
soon as possible, preferably within the next 24 hours.
- Ask if he or she has picked a method, a time,
a place, or a date for the suicide. If he or she has,
immediately contact a suicide
hotline, the police, dial 911, or take the person
to a hospital emergency room.
Predicting whether someone will make a suicide attempt
is extremely difficult even for specialists who
have treated suicidal clients
for years. If you are going to err, do so on the
side of seeking competent professional help and
getting it immediately.
A little
bit of embarrassment over seeking help if it turns
out the
help was not necessary is better than risking losing
someone you love
to suicide.
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