Chapter One
Diagnosing
DepressionThe signs of approaching melancholy are . anguish and distress, dejections, silence, animosity . sometimes a desire to live and at
other times a longing for death, suspicions on the part of the patient
that a plot is being hatched against him. Caelius Aurelianus, healer
(Methodist school of medicine), A.D. fifth century
A pastor and his wife began their session in tears. Their son
had been killed in an automobile accident nine days earlier.
They had been through hard times before and were intimately
acquainted with sorrow and grief. They reminisced about
their son as we talked and prayed together. Being in ministry,
they knew of God's grace and comfort. The pastor and his wife
had helped many others work through their crises, but now he
was despondent and unable to sleep. The loss was overwhelming
to him.
Another man, Steven, had been unemployed for almost 20
weeks following a minor accident with his semitruck. No one
had been injured, but his company suspended him from driving,
and he quit out of embarrassment and shame. He had been
unable to explore new employment possibilities and made up
stories for my sake about the "activities" that he used to occupy
his time. He felt helpless and hopeless. He was hesitant to talk
about the future.
A woman in her 30s was deeply troubled and physically
shook during our meeting. A single parent of a nine-year-old
child, she worked in a nursing home and was going to school at
night. Although she had long ago left her parents, she talked of
the ongoing strain and tension in their relationship. She reflected
on her spiritual life and the terrible condition of her soul.
With trembling voice and frightened eyes, she said she had committed
the unpardonable sin. The "voices" in her mind harassed
her at every turn. They called her "slut" and "nasty" and told her
that Jesus would never talk to her again after what she had done.
She was extremely agitated and anxious.
A Sad Epidemic
These stories of loss, hopelessness and spiritual defeat seem so
different and unrelated, yet each person's diagnosis was depression.
Depression is an ache in the soul that crushes the spirit.
It wraps itself so tightly around you that you can't believe that it
will ever leave, but it can and it does! Depression is treatable. You
do not have to live like this, at least not for long.
About 10 million people in America are presently suffering
from depression. It creeps into the lives of all people regardless
of age, sex, social status or economic status. Twice as many
women struggle with depression as do men. Twenty-five percent
of college students struggle with some form of depression, and
33 percent of college dropouts will suffer serious depression
before leaving school. The number of doctor visits in which
patients received prescriptions for mental problems rose from
32.7 million to 45.6 million during the decade from 1985 to
1994. Visits in which depression was diagnosed almost doubled
over those 10 years from 11 million to more than 20.4 million.
This is an incredible increase in 10 years, especially in light of the
fact that many who struggle with depression do not seek medical
help.
Depression is a complex yet common physical, emotional and
spiritual struggle. It is so prevalent that it has been called the common
cold of mental illness. Many people will have at least one serious
bout of depression in their lifetime, and every person will
experience some symptoms of depression due to poor physical
health, negative circumstances or weak spiritual condition. Too
many Christians live in denial about their own depression thinking
that if they were spiritually mature, then they would never
have to struggle like the rest of us. Consequently, they don't reach
out to others or seek the help they need. It is actually shameful in
some "Christian" communities to be sad or depressed. You must be
living in sin is the deceptive assumption. Such erroneous or simplistic
thinking causes people to hide their true feelings instead of
believing the truth and walking in the light.
Signs of Depression
Depression is a disturbance or disorder of one's mood or emotional
state. It is characterized by persistent sadness, heaviness,
darkness or feelings of emptiness. The emotional state of depression
is usually accompanied by thoughts of hopelessness and
sometimes suicide. Depressed people believe that life is bad and
the prognosis of improvement is nil. Their thoughts are colored
by negative and pessimistic views of themselves, their future and
their surrounding circumstances.
It is critically important to realize that the emotional state
of depression is not the cause, it is the symptom. Treating the
symptom only brings temporary relief at best. Any treatment
for depression must focus on the cause, not the effect. The
goal is to cure the disease, not the resulting pain. As we will
examine later, the cause can be physical, mental or spiritual.
We think it is important to understand the symptoms of
depression in order to better understand the cause. A proper
diagnosis is necessary before appropriate treatment can be
considered.
Physical Symptoms of Depression
Energy Level: I just don't feel like doing anything.
Loss of energy, excessive fatigue and unrelenting tiredness are
the characteristics of the melancholic. Walking, talking, cleaning
the house, getting ready for work or doing a project can
take a considerably longer time than usual. The person suffering
from depression also feels that time is moving at a snail's
pace and usual activities become monumental or seemingly
insurmountable tasks. Fatigue and tiredness are common
complaints. The lowered energy level and lowered interest in
activities affect job performance. The depressed person knows
his or her performance is sliding but can't seem to pull out of
the depression.
Approximately 10 percent of the melancholic seriously
struggle with endogenous (i.e., from within the body, or physical
in its origin) depression. Many of them simply do not function
on a daily basis. They don't get dressed and either stay in bed or
lie around the house. They cease to function in life.
Sleep Disturbance: I didn't sleep again last night!
Having trouble sleeping is one of the most common symptoms
of depression. Although some people feel like sleeping all of the
time, insomnia is actually more common. Initial insomnia
(sleep-onset insomnia) is difficulty in falling asleep. Depression
is more commonly associated with terminal insomnia-falling
asleep out of sheer fatigue but then waking up, unable to get
back to sleep. The inability to sleep is a symptom of depression,
but it also contributes to the downward spiral of those who can't
seem to pull out of the depression. Inadequate sleep leaves the
sufferer with less energy for tomorrow.
Psalm 77 is a call for help by someone who begins his
lament by questioning God (see vv. 7-9). In such a state, he
writes, "When I remember God, then I am disturbed; when
I sigh, then my spirit grows faint. You have held my eyelids
open; I am so troubled that I cannot speak" (vv. 3-4). His hope
is gone because what he believes about God is not true, and the
result is sleeplessness and not enough energy to even speak.
That is depression.
Activity Level: Why bother!
Depression is accompanied by a decreased involvement in meaningful
activities and a lack of interest in life and commitment to
follow through. Sufferers don't have the physical or emotional
energy to sustain their ordinary levels of activity, and their performance
is often hindered. Many find it difficult to pray because
God seems distant. Perhaps they used to enjoy playing the piano or
some other instrument, but they no longer find it relaxing or satisfying.
Tragically, the need for self-expression and to be involved in
a community goes unmet, which contributes to their depression.
Lack of Sex Drive: Not tonight!
In depression there is often a decrease in sexual interest, or drive.
Accompanying this loss of desire for sex is a wish for isolation,
feelings of worthlessness, criticism of one's own appearance, loss
of spontaneity, and apathy. The emotional state of depression
usually creates problems in relationships, which obviously further
curtails the desire to be intimate.
Somatic Complaint: I ache all over!
Many depressed people report physical aches and pains such as
headaches, stomachaches and lower-back pain, which can be
quite severe. Depression headaches are often present. Unlike
migraine headaches, they are dull and feel like a band around
the head with pain radiating down the neck. In a state of depression,
David wrote, "I am bowed down and brought very low; all
day long I go about mourning. My back is filled with searing
pain; there is no health in my body" (Ps. 38:6-7, NIV).
Loss of Appetite: I'm not hungry!
Depression is often accompanied by a decrease in appetite.
Indigestion, constipation or diarrhea contribute to weight loss
during depression. Those who struggle with anorexia are usually
depressed as well. However, in 20 percent of depression cases,
there is an increase of appetite and craving for food.
Mental and Emotional
Symptoms of Depression
The most noticeable symptoms of depression are emotional.
There are also resultant mental states that indicate severe to
mild depression, but keep in mind that what a person thinks or
believes is also a potential cause for depression. The following
are the most common emotional symptoms and resultant mental
states of those who are depressed.
Sadness: I feel awful!
Depression is most commonly characterized by a deep sadness.
The blues seem to creep up slowly and bring a spirit of heaviness.
Crying and brooding are common for those who are in a funk.
Some can hardly control the steady stream of tears. Depression
is the antithesis of joy, which is a fruit of the Spirit: "A joyful
heart makes a cheerful face, but when the heart is sad, the spirit
is broken" (Prov. 15:13).
Despair: It's hopeless!
Despair is the absence of hope. Despair sees no light at the end
of the tunnel, no hope at the end of the day and no answers for
the endless round of questions that plague the depressed mind.
Three times the psalmist cried out, "Why are you in despair, O
my soul? And why have you become disturbed within me? Hope
in God, for I shall again praise Him for the help of His presence
. for I shall yet praise Him, the help of my countenance and
my God" (Ps. 42:5-11; see 43:5). Hope is the present assurance of
some future good. The psalmist knew where his hope lay. Jeremy
Taylor said, "It is impossible for a man to despair who remembers
that his helper is omnipotent." The problem is that depression
seems to impede the normal process of memory.
Irritability and Low Frustration Tolerance: I have had it with you!
Depressed people have very little emotional reserve. Small things
tick them off, and they are easily frustrated. They have low tolerance
for the pressures of life. One lady said, "How can I plan
for tomorrow when survival for the day is at the top of my list?"
Isolation and Withdrawal: I'm going to my room!
John Gray observed that men retreat to caves and women climb
into holes. Men tend to isolate more readily but spend less time
in their caves than women do in holes. Most men are generally
less image conscious and less introspective than women are.
Many men will go away and lick their wounds and then come
back as though nothing happened. It is hard for some men to
reveal their souls. They tend to cover their pain with work or
vices. Consequently, they are more likely to become workaholics
or alcoholics.
People who suffer with depression pull away from others.
They feel embarrassed to be with people when they feel so low.
They don't want to be a wet blanket in the group and drag others
down by their depression. Although some may think that isolation
is a viable short-term solution, avoidance often adds to
the downward spiral of depression.
Negative Thought Patterns: Nothing is
working; I'm such a failure!
Generally speaking, depressed people have trouble thinking,
concentrating and staying focused. Constant distractions rob
them of mental peace. Just as water seeks the lowest ground,
depression seeps into a person and drowns out optimism. It
seems easier to see a problem, think the worst, predict failure,
find fault and focus on weakness. First, depressed people
have difficulty believing positive and good things about
themselves. Feelings of worthlessness become the breeding
ground for thoughts of self-destruction. They struggle with
guilt that prompts them to become irrational, unreasonable
and even delusional. Second, they cannot think positively
about the future. They cannot stop worrying about tomorrow.
It is not something they look forward to; it is something
they dread. Third, the circumstances in which they find
themselves are also interpreted as negative. This is the well-known
depression triad that cognitive therapists see repeatedly
in their patients.
Thoughts of Suicide: Everybody would be better off if I were dead!
Sadness, isolation, loss of energy, strained relationships and
physical problems contaminate the depressed person's perspective
of self and the future. Believing themselves to be helpless
and hopeless, many depressed people begin to think of suicide
as a way of escape.
In depressed states, people become self-absorbed. Mental
exhaustion causes many to think negatively about themselves
and less of others. They don't want to hear any more bad news
or take on any more responsibility. It is a syndrome filled with
misery, shame, sadness and guilt.
In Psalm 38, David expresses almost every symptom of depression
listed above:
somatic complaints (see v. 3)
guilt and despair (see v. 4)
irritability, low frustration tolerance, loss of appetite, sadness (see vv. 5-8)
low energy and diminished activity (see v. 10)
isolation and withdrawal (see v. 11)
negative thoughts (see v. 12)
thoughts of suicide (see v. 17)
David shares two keywords in this psalm that are necessary for
recovery from a sense of helplessness and hopelessness: "For
I hope in You, O Lord" (v. 15, emphasis added), and "Make haste
to help me, O Lord, my salvation!" (v. 22, emphasis added).
Continues.
