Chapter OneLike Nailing Jell-O
to the Wall
Some people see depression as the designer disorder of our age,
implying that this disorder somehow became more prevalent with
the introduction of effective medications to treat it. Prozac, an antidepressant
that helped vault depression into prominence a few years ago,
is so well-known there are jokes about it. Yet behind the laughter, for
many, the biblical proverb is true: "Even in laughter the heart may be in
pain" (Prov. 14:13 NASB).
The truth is that depression is as old as humanity, at least since Adam
and Eve were driven from their place of perfect peace. In what may be
the Bible's oldest portion, Job, the paragon of patience, says, "Sighing
comes to me instead of food; my groans pour out like water. What I
feared has come upon me; what I dreaded has happened to me. I have no
peace, no quietness; I have no rest, but only turmoil" (Job 3:24-26).
Obviously, depression is no respecter of faith-affecting believers and
Depression is also no respecter of persons, as it afflicts politicians
and world leaders, recipients of various prestigious awards, athletes,
authors, actors, musicians . and garden-variety folk like you and us. It
affected Sarah, as follows in her own words:
"By my late thirties," she writes, "I had suffered a series of losses over
a period of a few years, and though I had grieved, I believed I had weathered
the losses well. After years of struggling with infertility, I had conceived,
only to loose my unborn child through miscarriage in the fourth
month. The grief was deep and painful, but I was not debilitated by it.
In fact, I experienced newfound strength in the wake of it as my faith
sustained me. Then a near-adoption of two adorable little preschool sisters
ended abruptly when the birthmother changed her mind.
"A few years later, to our delight, my husband and I adopted a nine-year-old
boy who had known great loss and trauma in his own short life.
A few months later I conceived again, this time ending in a ruptured
tubal pregnancy that almost took my life. There were new waves of grief,
but once again I also felt inner strength and resolve. I felt God's power
in very tangible ways and knew that God would weave the grief into my
life in healing ways.
"Within a short time, we began to experience major upheaval as we
tried to help our son forge a new life for himself. We had expected this,
given his prior life events, but it still stretched us in every way. I loved
being a mom, though I also experienced the drain and discouragement
of realizing that all the love in the world for our son could not meet his
deepest needs. In his young adolescent years we watched in pain and the
worst kind of helplessness as our son descended into a life of drug abuse.
As we struggled to anchor him through this time, one of his birthparents
swept back into our lives, which sent our son into a tailspin. At the
tender age of fifteen he left us to live with this birthparent, dropped out
of high school, and adopted the chaotic lifestyle of drugs and poverty.
This was a new kind of grief and loss that lacked the resolution of my
earlier losses, leaving me feeling empty and hollow, dejected and demoralized.
I was grieving deeply, but my faith was secure.
"A year later I was still filled with intense sadness and having some
difficulties managing anxiety, but I did not consider myself depressed. I
was grieving, and grieving hurts. I was also worrying for my husband,
whose grief was deep but beyond my reach to help. I did realize, however,
that I had lost a sense of knowing what 'normal' was. I felt I was
"Then we sold the business we had nurtured together for nearly two
decades and took positions at a company in another state, leaving behind
our home church, close extended family, and lifelong friends. The new
job did not turn out to be what I had expected. I found myself in a company
embroiled in internal struggle and the upheaval of major changes
in philosophy and mission-coming apart at the seams.
"My anxiety level became toxic. I became unable to eat or sleep,
fearful of getting out of bed and facing the day. I felt guilty for being so
weak and ashamed that I felt like I was falling apart. At work, others
perceived me as all together because I hid my fears, but at times I was
unable to stop trembling, my heart pounded, and my breathing was
labored. By the time I got home from work, I just wanted to curl up on
the sofa with a pillow and blanket and watch television, hoping for sleep
to come. I couldn't rest or relax-all I felt was turmoil and stress, anxiety
"In retrospect I can see the depression clearly, but at the time I was
blind to it. All I saw was that I was weak and filled with worry-and I
felt guilty about both. It did not occur to me to see a medical doctor. I
was sure my coping problem was due to my emotional weakness and
was actually failure. So I kept trying to talk myself into being stronger
and getting myself through this, while berating myself for not being able
to pull out of it.
"All the previous losses in my life resurfaced, and I grieved them
again. All my former support systems-long-term friends, home church,
extended family-were many miles away. Eventually, I concluded that I
needed help with the anxiety, while at the same time feeling too overwhelmed
to try to find a counselor. I was certain the problem was all in
my head, and I felt ashamed of that. I simply could not muster the
strength and energy to search for a counselor, and I felt guilty about that
as well. I was caught in a negative cycle that I couldn't seem to break.
"Then I learned I needed surgery, which turned out to be a blessing
in disguise. My wise surgeon recognized my depression and anxiety and
sent me to a new primary care physician. I'll never forget that first visit
as 'the light went on' when the doctor asked a series of questions: How
was I sleeping? How was my appetite? How was work going? What was
I doing that I enjoyed? I recognized these as classic questions about
depression. How had I missed this in myself? By the time she finished
asking her questions, I already knew the answer. I was clinically
"Then she explained that, no matter what had brought on this
depression, it had become a biological problem that needed biological
treatment. She recommended medication immediately.
"I had mixed reactions to taking an antidepressant, though. I did not
want to turn to pills just because I couldn't handle life's problems, and I
was afraid of developing a dependency on them. I had always sought to
understand myself and to rise to every challenge with God as my
strength. Would this be a cop-out? Would it be escape instead of healing?
Would I only be masking deeper problems? Shouldn't my faith be
enough to sustain me?
"Yet I was desperate and I knew it. Though fearful of the medication
and its implications, I was more fearful of the darkness inside that was
smothering my ability to function. And I did hear the voice of God in
the calm voice of reason from my doctor. Her words, reinforced by a few
wise friends and family, helped ease my concerns. I agreed to treat my
medically depressed condition just as I was treating my body with its
need for surgery. Something was in need of repair, and it only made sense
to treat it. I began the medication the same week I had my surgery."
There's Nothing Easy about Depression
Have you personally struggled with depression or tried to help someone
mired in what John Bunyan, author of Pilgrim's Progress, called the
"slough of despond" (the muck of despair)? If so, you can surely identify
with some of the feelings Sarah expresses: pain mixed with faith,
drained and discouraged, helpless, empty, dejected, anxious, fearful,
guilty, ashamed, needing to hide, exhausted, immersed in and smothered
by darkness, weak, feeling like a failure, isolated and lonely, overwhelmed,
stuck, confused, torn, desperate, immobilized, having lost a
sense of normalcy. You also already know that there is nothing easy about
this disorder. Regardless of what some experts may claim, it's not easy
to understand depression's causes and cures or to comprehend the myriad
masks it wears. Only those who have experienced depression personally
can imagine its ability to thoroughly permeate a person's life,
stealing whatever joy existed and replacing it with murkiness and pain.
In addition to these challenges, a most daunting task is to define
what we mean when we use the term depression. Were you to ask people
on the street to define it, you might hear words like "sad," "the blues,"
or "down in the dumps." Nearly everyone you might ask would offer
some description, though, because depression happens to most everyone
at some time in their life.
The word depression is used in navigation to mean the angular distance
of a celestial object below the horizon. In geology, a depression is
a low point or hollow. The Stock Market crash of 1929 led to what in
the United States became known as the Great Depression and contributed
to a general worldwide economic depression. Surely during this
dark period in history, many individuals suffered deeply with the disorder
called depression. Yet to say that during the Great Depression many
people were depressed is to sound like President Calvin Coolidge, who
once said, "When large numbers of men are unable to find work, unemployment
Were you to ask a group of counselors to define depression, you
might hear words like "mood disorder" or "psychiatric condition," but
many of the terms you'd hear would classify or describe depression
rather than define it. You might also hear questions, depending on their
points of view, such as, "Are we talking about 'situational depression,'
'biological depression,' 'developmental depression,' or 'spiritual depression'?"
and "Is it serious enough to be labeled a 'clinical' or 'major'
depression?" From some you might hear terms connected with their theories
of depression's causes, stating that depression is, for example, "a
natural reaction to stress," "frozen rage," "repressed grudges," or even
"unresolved guilt." Isn't it interesting how one word can have so many
nuances of meanings? Speaking metaphorically, nailing down a definition
of depression is like trying to nail psychological Jell-O to a wall.
Our preference is to keep it simple: Depression is a state of existence
marked by a sense of being pressed down, weighed down, or burdened, which
affects a person physically, mentally, spiritually, and relationally.
In other words, depression is not a state of mind but a state of being.
A Complex Yet Common Disorder
Depression is a common disorder and a major cause of disability worldwide.
According to the two largest and best-designed studies performed
in the United States in recent years, the prevalence of depression serious
enough to warrant treatment ("major" or "clinical" depression) is
between 5 and 10 percent, although only 1 to 3 percent of Americans
receive treatment for depression in any given year. This means that
between 14 million and 28 million Americans are suffering from depression
as you read this. Women are more likely than men to experience
depression by a ratio of about three to one. According to the American
Psychiatric Association, 5 to 12 percent of women and 2 to 3 percent of
men meet the criteria for major depression.
It is possible that this discrepancy is related to the fact that, while
women often talk about their problems and verbalize their feelings, men
typically suffer in silence, immerse themselves in their work as a distraction
from their pain, and dull that pain with drugs or drown it in
alcohol (men have at least twice the rate of alcoholism as women). Some
men would prefer to develop more socially acceptable stress-related illnesses,
such as heart disease or ulcers, than to have it known that they
are consulting a professional for depression. Other masks of masculine
melancholy include difficulty forming intimate relationships, abusive
behavior, and rage.
In the year 2000, according to the World Health Organization's
project The Global Burden of Disease, major depression was the fourth-leading
cause of disability in the world overall and the second-leading
cause of disability for persons aged fifteen to forty-four. The same study
predicted that by 2020 depression would be the second-leading cause
of disability in the world, second only to heart disease. Disability, as
used here, means impairment of normal human abilities in such arenas
as maintaining relationships with family or friends, fulfilling one's job
responsibilities, or being able to relax and enjoy such things as recreation
or vacations. Lifetime occurrence of depression is estimated at
between 10 and 25 percent for women and between 5 and 12 percent for
Major depression is marked by the presence, intensity, and longevity
of a significant number of symptoms known to be associated with this
disorder, including (but not limited to) depressed mood, loss of interest
or pleasure, feelings of guilt or low self-worth, disturbed sleep or
appetite, low energy, and poor concentration. It is a complex disorder
that affects the whole person, regardless of its causes, which is why the
most effective treatment usually involves some form of counseling as
well as medical intervention, pursued as early as possible after a diagnosis
has been made.
The longer depression goes untreated, the harder it will be to treat
effectively. Thankfully, we live in an era in which the downward spiral of
depression can often be reversed through the cooperative effort of well-informed
experts willing to confront what author Andrew Solomon
called "the noonday demon" with an arsenal of medical, psychological,
sociological, and spiritual treatments. Such a multifaceted process can
facilitate the release of a depressed person from what has seemed like an
inescapable dank, dark dungeon-one that depressed people only a generation
ago often endured in agonized silence.
As persons who have benefited ourselves from some of these treatments,
we see them as gifts from God that cannot in good conscience be
withheld from those who need them on any basis-theological, philosophical,
theoretical, or otherwise. We'll have a lot more to say about
this in chapter 9 on treating depression with antidepressant medication.
Classifying depression according to its causes (the fancy word is etiology)
is not as helpful as was once thought because depression comes
with many faces, all of them sad and streaked with tears. However, classifying
a patient's depression by its apparent primary cause can aid those
who are trying to formulate and implement an effective treatment plan.