Researchers at Emory University have discovered a brain scan that can predict whether medication or Cognitive Behavior Therapy (CBT) is the best for each person’s depression. At present the treatment plan is often based on the doctor’s or patient’s preference, but only 35-40% of people see any improvement with their first choice of treatment. It’s basically been trial and error.
But Dr. Helen Mayberg and her team of researchers used PET scans to measure brain glucose metabolism in the interior insula region of the brain, and found that scan patterns prior to treatment can provide important clues as to which treatment will be best. Patients with low activity in the anterior insula showed remission with CBT, but poor response to medication, while patients with high activity in the insula did well with medication and poorly with CBT.
Until now brain-imaging has been primarily a research tool, but the National Institute of Mental Health director Dr. Thomas Insel believes that “these results demonstrate how it may be on the cusp of aiding in clinical decision-making.”
Speaking personally, I’ve never seen a medication-only approach work in the long-term. I have seen medication work well in treating moderate to severe depression, but only when combined with counseling and lifestyle changes (e.g. diet, sleep, exercise, relaxation, Christian fellowship, etc.). However, this research might help explain why antidepressants just don’t seem to work at all for a large number of people.
If the success or otherwise of anti-depressants can be predicted, then that should build confidence in some cases and avoid weeks of frustrating and futile experimentation in others.
“Depression is simply a modern idea dreamt up by God-defying psychiatrists, soul-denying psychologists, money-making drug companies, and blame-shifting sinners.”
You’ve almost certainly heard it.
However, depression has been around for much longer than you might think, and it has been accepted as genuine and treated seriously by some of the greatest Christian experts in soul care that God has ever given to His church – the Puritans. Yes, way back then, in days of spiritual revival and reformation, these spiritual giants and geniuses had deep insights into depression’s causes and cures that we would do well to learn from.
“Ah-ha! See. By faith. They saw it as a spiritual problem with a spiritual cure! So much for the Puritans backing up your modern theories.”
Read on, my friend. For sure, most of Baxter’s book is taken up with describing and curing spiritual depression. However, he does this only after carefully distinguishing spiritual depression (which is cured by faith) from physical depression (which is cured “by physic,” or as we would say, “by medicine”). In fact he has a whole section on “Medical care for those with depression” which we’ll get to tomorrow.
Causes and cures
Baxter asks, “What are the causes and cure of melancholy?” and answers:
“With many people most of the cause is in distemper, weakness, and disease of the body, and by it the soul is greatly disabled to any comfortable sense. But the more it comes from such natural necessity, it is the less sinful, and less dangerous to the soul, but still just as troublesome.”
He then goes on to identify “three diseases that cause too much sorrow.”
Those that consist in such violent pain as natural strength is unable to bear.
A natural passion, and weakness of that reason that should quiet passion (often seen in the elderly or debilitated).
When the brain and imagination are impaired, and reason partly overthrown by the disease called melancholy, or depression.
Baxter then goes on to list the signs and symptoms of this third category of disease.
Symptoms of clinical/medical depression 1. The trouble and disquiet of the mind becomes a settled habit. They can see nothing but matter of fear and trouble. All that they hear or do feeds it…In a word, fears, and troubles, and almost despair, are the constant temper of their minds.
2. If you convince them that they have some evidences of Christian sincerity, and that their fears are causeless, they may not disagree, and yet it does not take the trouble away, for the cause remains in their bodily disease.
3. Their misery is so much that they cannot but think of it. You may almost as well persuade a man not to shake in an fever, or not to feel when he is pained, as persuade them to cast away their self-troubling thoughts, or not to think all the enormous, confounding thoughts as they do, they cannot get them out of their heads night or day.
4. And when they are grown to this, they often seem to feel a voice within saying this or that to them, and they will not believe how much of it is a diseased imagination.
5. In this case they often think they have had revelations from God, often confusing Scripture or falsely applying it, and sometimes taking up errors in religion.
6. But the sadder, better sort, feeling this talk and stir within them, are sometimes apt to be confident that they are possessed by the devil
7. Most of them are violently haunted with blasphemous suggestions of ideas about God or Scripture, at which they tremble, and yet cannot keep them out of their mind.
8. When it is far gone, they are tempted to lay some law upon themselves never to speak more, or not to eat, and some of them starved themselves to death.
9. And when it is far gone, they often think that they have apparitions or some spirit touched or hurt them.
10. They avoid company, and can do nothing but sit alone and muse.
11. They cast off all business, and will not be brought to any diligent labour in their callings.
12. And when it comes to extremity, they are weary of their lives, sometimes become strongly tempted to take their own lives, which, alas, too many have done.
13. And if they escape this, when it is ripe, they become quite distracted.
Tomorrow we will look at the cures Baxter suggests for this kind of melancholy, but note that at least part of it is medical. He says: “Choose a physician who is specially skilled in this disease, and has cured many others.” He advises against consulting “young, unexperienced men” and “hasty, busy, over-worked men, who cannot have time to study the patient’s temper and disease, but choose experienced, cautious men.”
No credible Christian I know of says that all instances of depression, anxiety, etc., are always mental illness and never the result of personal sin. Yet sometimes that impression is given because of language and emphasis.
Similarly, no credible Christian I know of says that all instances of depression, anxiety, etc., are caused by personal sin and are never the result of mental illness. Yet sometimes that impression is given because of language and emphasis.
As we saw yesterday, part of the reason for these false impressions is the absence of mutually agreed terminology that would cover both physical and spiritual causes. However, there are steps we can all take to bring Christians who disagree on these matters a bit closer together.
I’m going to ask “mental illness maximizers” (those who speak mostly in illness/disease categories) to reach out to “sin maximizers” (those who speak mostly in moral categories), and then I’m going to reverse the process. I realize that these are not two totally distinct groups and that most of us fall somewhere on the spectrum between them. But, wherever we fall, we can all make an effort to bridge the divide and work more cooperatively and respectfully.
Mental Illness Maximizers
Christians who use mainly “mental illness” language and fully accept the possibility of physical damage and disease in the brain’s ability to process thoughts and emotions, should:
1. Be careful not to give the impression that “mental illness” is all we believe in. While offering compassionate help to those who suffer due to having fallen bodies and brains, or because of factors outside of their control (Job 1), or because of direct divine intervention (John 9), we must also carefully identify where people have brought much or all of their suffering upon themselves due to sinful personal choices, and adjust our language, counsel, and help accordingly.
2. Even where there is a physical cause or element to a person’s suffering, we should still allocate time and energy to helping sufferers respond to these physical issues in a spiritually beneficial manner, reserving an important place for God’s Word in the healing process.
3. We should usually not run to the “medical model” too fast, too over-confidently, or to the exclusion of spiritual factors. Where medical intervention is necessary, we should make clear that it’s very rarely a full cure on its own.
4. Even if there has been physical damage to the brain, undermining its ability to process thoughts and emotions, in addition to medical treatment, we must also have confidence in God’s Word playing a role in reversing bad thinking and feeling patterns, and substituting them with biblical ones.
5. We need to be sure that we are also helping people to get spiritual benefit from their suffering. While we do not agree with the idea of somebody suffering depression to the maximum to get the maximum spiritual advantage (who would do that with a broken leg or cancer?), yet we must question the common demand for the speediest and most complete deliverance that can be found in this world.
6. While being open to medical research, we should be more discerning in reading and believing it due to the secular assumptions that drive most scientific work.
7. If we involve other caring professionals we must stay involved in the caring package and ensure that people are not led astray by false philosophies or dangerous therapies.
8. We must keep the local church, Christian fellowship, the means of grace, and prayer central in all care packages.
The vast majority (95%+) of biblical counselors I speak to accept the existence of “mental illness” to some extent. However, some of them are (understandably) so afraid of losing biblical categories of “sin,” “redemption,” “sanctification,” etc., that they sometimes give the impression that there is no such thing as “mental illness,” or that it’s so extremely rare that it’s hardly worth a cursory glance.
I know this impression is often unintended and sometimes denied, but it’s the impression I and many others have at times received. As someone who sadly used to be 100% in the “denial of all mental illness” school, I’m probably more sensitive to this impression than others, but I know that the impression is widespread among a wide range of people. And we’re not all dummies.
As the effect of this impression is that many people who desperately need at least some spiritual help turn away from Christian pastors and counselors, and go to more “compassionate” secular counselors, I would offer the following suggestions to lessen this impression and hopefully increase the involvement of biblical counselors in these situations:
1. If you accept the possibility of mental illness, try not to state that in very small print, with very few words, and with a very quiet voice. If you do, don’t be surprised if people think that you in practice deny it.
2. If you accept the possibility of mental illness, don’t allow any other statements in your speech or writing that seem to deny it. People will see the inconsistency and make their own conclusions about what message is really intended.
3. If you accept the possibility of mental illness, don’t limit root causes to one or two glandular problems. This not only makes it look like the last medical research you read was 30 years ago, it also effectively reduces the number of “genuine” mental illnesses to a negligibly small number.
4. If you accept the possibility of mental illness, provide holistic help to people by going beyond searching for sin and calling to repentance.
5. If you accept the possibility of mental illness, do not indulge in generalized criticism of psychiatrists, psychologists, pharmacists, etc., unless you really know what you are talking about. If there are things to critique – and there are – be specific, but also recognize the valuable contributions that these other caring professionals can make.
6. If you accept the possibility of mental illness, build relationships with trustworthy professionals in those fields, so that you can confidently involve them (not “punt” to them) in caring for sufferers God has brought into your life.
7. If you accept the possibility of mental illness, don’t insist that a person who is suffering in this way endure it as long and as deep as possible in order to get maximum spiritual advantage. You wouldn’t do that if he had cancer. Remember that the person’s family members and churches are often suffering the consequences of waiting for the sufferer to get his “spiritual growth.”
8. If you accept the possibility of mental illness, be open to reading current medical research and learning about the knowledge God is sharing with scientists for the benefit of His church. Try to avoid latching on to a few pieces of research that prove your prejudice against, say, medication. If you are going to quote research, make sure you read a breadth of material and stay mainstream. There are quacks on both extremes of this divide.
If there’s one thing we can all do, it’s to avoid making our own experience the rule for others. That’s the most common mistake I’ve seen people falling into here (and I’ve done it myself as well). Just because medication worked for you, does not mean it will work for everyone else. Just because biblical counseling alone worked for you, doesn’t mean it’s the answer for everyone else. Just because you’ve never been depressed, doesn’t mean depression does not exist. Cases are so different, and causes are so complex, that we need to exercise charity, sympathy, and patience in all our dealings with one another.
What else can we do to bridge the gap and communicate more clearly? This is no academic question. It’s sometimes a matter of life or death.
I wish there was a word or phrase to cover the mental and emotional disorders (e.g. depression, anxiety, schizophrenia) that result from both personal sin (for which we are responsible), and personal suffering (for which we are not – or not wholly – responsible).
For example, when I sometimes write about “mental illness,” some Christians hear such “disease” terminology as denying sin, minimizing personal responsibility, undermining the sufficiency of Scripture, and ignoring the divine provisions of repentance toward God, faith in Jesus Christ, and the indwelling of the Holy Spirit. That’s not my intention.
On the other hand, I and others react against the way some Christians reject all (or most) “mental illness” categories. We see this as a serious denial of biblical anthropology, a denial of the extensive damaging effects of the fall upon humanity. Our reasoning for believing in such damage is rooted in Scripture and goes something like this:
Step 1: As a result of the fall, my body’s chemistry, physics, and electricity are damaged.
Step 2: My brain uses physical structure, chemistry, and electricity to process my thoughts and emotions
Step 3: My brain’s ability to process my thoughts and emotions will be damaged to the extent that my brain is affected by the fall.
Step 1 is a biblical fact. Step 2 is a scientific fact. Step 3 is the logical result of Steps 1 and 2.
There are three additional complications to contend with here. The first is that the brain acts as a bridge between our spiritual and physical worlds (our soul and our body) in a way that no other body part does, making it difficult to achieve clear distinctions between what is spiritual and what is physical. Second, the brain is the most complex organ in our body, with so much still to be explored, discovered, and understood that some scientists call it “the last frontier.” Third, just as with all areas of my body, the “natural” damage to my brain in Step 1 can be increased by three aggravating factors:
Factor A: Damage outside my control (e.g. genes, brain injury, aging, abuse**, shock, Parkinson’s, Alzheimer’s, etc.)
Factor B: Personal sin which is my responsibility (e.g. substance abuse, the deliberate choice to think sinful thoughts/feel sinful emotions, the refusal to trust/obey God, rejection of the means of grace, etc.).
Factor C: Direct divine intervention (i.e. God, in His sovereignty, may impact my brain processes: as a chastisement to correct my faith, or as a test to display my faith – as physical suffering did in the case of Job).
As the damage under Step 1 is increased by these three factors, so the disabling suffering in Step 3 will also be increased. But what should we call the mental and emotional disorders/effects in Step 3?
Misleading and harmful
Given that sometimes the disorders in Step 3 are the result of personal choices (Factor B), to use only “mental illness” terminology can be misleading and harmful.
But given that sometimes the disorders in Step 3 are the result of a fallen brain, or damage outside of my control (Factor A), or the direct intervention of God (Factor C), to use only “personal sin” terminology can be equally misleading and harmful.
So what do we call the disorders? “Sin” is too narrow in many cases. “Illness” is too narrow in other cases. Use of either category exclusively is inaccurate, provoking suspicion and often hostile reaction.
In the ongoing absence of mutually acceptable terminology that would allow us to speak more accurately and comprehensively, I have a number of suggestions that I hope might help to bring Christians a bit closer together as we discuss these vital matters that impact millions of suffering people. Tune in tomorrow for more details.
If good can come out of the agony surrounding Matthew Warren’s tragic suicide, it’s that it forces the church to think through its response to mental illness and how to care better for those who suffer with it. I’m hugely encouraged by some of the initial responses to this terrible loss, and hope that it may mark a significant turning point in the church’s understanding of these complex issues, and turn the hearts and minds of many Christians to this large though often neglected and despised group in our churches and communities. Further to my post yesterday on 7 Questions about Suicide and Christians, here are some of the most outstanding posts I’ve read in the last 24 hours or so.
When a loved one takes his life
Timothy Dalrymple relates some of his own struggles and concludes: “When I was a child, I believed that God looked at suicides with anger. I don’t believe that anymore. I think he looks on those who commit suicide with great compassion. They have not had an easy go of life. And for those who have given their lives to God, there is no deed, even a final deed committed in despair, that can separate them from his love.”
Can a Christian get depressed?
Christian author, Adrian Warnock, a psychiatrist by training, answers the question, “Why do some Christians feel that Christians should not get depressed?”
The Asphyxiation of Hope
Michael Patton attempts to describe the indescribable, and comes as close to it as anyone I’ve read.
I am sure we all grieve deeply and pray earnestly with Rick and Kay Warren, as they mourn the shocking loss by suicide of their dear son, Matthew, after many years of struggle with mental illness. Perhaps pray especially for Kay as she has had her own battles with depression.
From all that I can gather of the circumstances surrounding this tragic situation, I believe that Rick, Kay, the church, and the caring professions did all that they could to prevent this happening, and should not blame themselves. As many of us have also experienced, when someone’s mind has gone so far and their emotions have sunk so deep, and they are determined to end their life, it’s virtually impossible to stop.
As well-publicized suicides tend to increase the suicide rate quite dramatically, I thought it would be good to address seven of the questions that arise in our minds at times like this.
How common is suicide?
It is estimated more than one million people die by suicide each year in the world, or more than 2,700 people per day
There has been a 31% increase in the number of suicides in the U.S., from an estimated 80 a day in 1999 to 105 a day in 2010.
Nearly 20,000 of the 30,000 deaths from guns in the United States in 2010 were suicides, according to the most recent figures from the Centers for Disease Control and Prevention.
Suicidal acts with guns are fatal in 85 percent of cases, while those with pills are fatal in just 2 percent of cases, according to the Harvard Injury Control Research Center.
465,000 people a year are seen in ER for self-injury.
Suicide is the third-leading cause of death for teenagers.
7% of 18-39 year olds said that they had seriously considered suicide in the last year.
In 2010, the last year for which figures are available, 22 veterans took their own lives every day, with the largest number occurring among men between 50 and 59.
Depression is the key indicator in two thirds (@20,000) of all suicides
Other key indicators are childhood abuse and confusion over sexuality.
How do I know if someone is thinking about suicide?
What should I do if I’m worried someone I know is going to commit suicide?
Although it’s counter-intuitive, the most important thing to do is to ask the person if they are thinking about taking their life. Do so in a non-threatening, non-confrontational way, to make it as easy as possible to speak openly about their thoughts and feelings. “I see you’re hurting very deeply. I’m so sorry and really want to help. Is it bad enough, that you’ve been thinking about taking your own life?” Rather than plant suicidal thoughts in their minds, this may allow the suicidal person to admit it and to seek professional help. This is vital and urgent if they tell you that they have got to the stage of making a plan. One of the best short pieces I’ve read on this is 8 Things you need to know about suicide prevention.
Trying to locate blame is not usually helpful when seeking to understand why a person has chosen to take his life, especially when that locus of blame is sought by outside observers. The reasons are never immediately obvious, even to those within the closest circles of family and friends. Moreover, the problems are never one-dimensional or easily fixed. I believe firmly that survivors of suicide heal in part as we learn to refuse the responsibility for the choice our loved ones have made.
In Broken Minds, Pastor Steve Bloem gives a number of reasons he has, at times, used to convince himself not to commit suicide:
It is a sin and would bring shame to Christ and His church.
It would please the devil and would weaken greatly those who are trying to fight him.
It would devastate family members and friends, and you may be responsible for them following your example if they come up against intense suffering.
It may not work and you could end up severely disabled but still trying to fight depression.
It is true – our God is a refuge (Ps. 9:10)
Help is available. If you push hard enough, someone can assist you to find the help you need.
If you are unsaved, you will go to hell. This is not because of the acts of suicide but because all who die apart from knowing Christ personally will face an eternity in a far worse situation than depression.
If you are a Christian, then Jesus Christ is interceding for you, that your faith will not fail.
God will keep you until you reach a day when your pain will truly be over (59-60).
What can the church do to prevent suicide?
The single biggest thing the church can do to reduce the suicide rate is to admit there is such a thing as mental illness. The second biggest thing we could do is for pastors to admit they need professional help from other disciplines and caring professions to minister to all the complex needs of those suffering such indescribable agonies. As Adrian Warnock, a psychiatrist by training wrote:
Please, if someone you know and love is suffering in a similar way, don’t let anyone persuade you not to reach out for everything medical science can offer. In many cases it can be literally life saving. Too many of us don’t understand just how serious these illnesses are. I pray that this shocking news may help thousands realize that although faith may be protective in such situations, medicine is often also needed to help.
Judgment Day alone will declare how many people took their lives because they were too frightened of the condemnation that would be heaped upon them in the church if they admitted to struggling with depression or suicidal thoughts. If there’s one thing that infuriates me (usually holy anger, sometimes not so holy) it’s the ridiculously ignorant and horrifically insensitive statements that some pastors and Christians make about depression and mental illness.
The church would do well to recapture the Puritan’s motto in all their counseling: “A bruised reed He will not break, and smoking flax He will not quench” (Matthew 12:20). Sometimes, however, as Matthew Warren experienced, even the most tender and loving of human care is not enough to keep us in life. But nothing shall pluck us out of our Savior’s hand (John 10:28).
UPDATE:Here are some of the best articles I’ve read on this subject in the last 24 hours.
In a church of 100 people, 20 people will likely experience an episode of depression at some stage in their life. If you are in a church of that size, there are probably 5-10 people struggling with anxiety or depression right now. But instead of finding comfort and consolation in the preaching of God’s Word, these suffering souls often find themselves battered and bruised by insensitive preaching.
What kind of sermons harm depressed and anxious Christians?
Sermons that over-stress the moral evils of the day. They are anxious enough through hearing the daily news without every church service ramping up the “we’re doomed” rhetoric. A steady diet of gloomy sermons is not going to lift up the head or heart of the cast down.
Sermons that include graphic descriptions of violence. They are deeply traumatized by preachers reciting the gory details of shooting massacres, abortion procedures, persecution of Christians, child murders, etc.
Sermons that extol constant happiness as the only valid and virtuous Christian experience. The deep pain of depression is multiplied when a depressed person is repeatedly told that sadness is a sin.
Sermons that question the faith of anyone who doubts. A lack of assurance is not necessarily a lack of faith. Believers who hang on to God despite feeling no assurance sometimes have the greatest faith.
Sermons that demand, demand, and demand.The depressed person already feels like an inadequate failure. To be regularly berated for not doing this ministry, or failing to engage in that Christian service, only crushes what’s left of their spirit.
Sermons that are too loud for too long. When a preacher pours out high-decibel words with hardly a breath between them for 45 minutes, it’s not just the nerves of the depressed that are frayed.
Sermons that condemn anyone for using meds to treat depression or anxiety. These are often preached by pastors whose medicine cabinets are overflowing with pills and potions for every other condition under the sun!
Sermons that overdo the subjective side of Christian experience. Depressed people need to focus most on the objective facts of Christianity, the historic doctrines of the faith. Facts first and feelings follow. There’s a place for careful self-examination, but remember McCheyne’s rule: “For every look inside, take ten looks to Christ.”
And that really brings me to the best way to preach to the depressed, and that’s to preach Christ. Preach His suffering and sympathizing humanity. Preach His gentle and tender dealings with trembling and timid sinners. Preach His gracious and merciful words. Preach His beautiful meekness. Preach His miracles to demonstrate His power to heal. Preach His finished work on Calvary. Preach His offer of rest to the weary. Preach the power of His resurrection-life. Preach His precious promises: ”A bruised reed He will not break, and smoking flax He will not quench.”
Preach Christ! Preach Him winningly and winsomely. Preach Him near and ready to help. Preach Him from the heart to the heart. Preach Him again, and again, and again. Until the day dawn and the shadows flee away.
In what other ways can preachers inadvertently damage the depressed? And how can preachers better minister to them?
When former Muslim Fernando Santana dos Santos heard that HeadHeartHand Media were making a documentary curriculum about Christians who suffer with depression, he sent us this beautifully inspiring testimony to God’s grace in his life.
The stigma of depression runs deep in today’s Evangelical churches. We ( the church) lack knowledge on the subject of depression , and it is imperative to educate our brothers and sisters. Instead of saying something rash, we can encourage the depressed believer, not discourage. Christ calls the church to lift up the fainthearted, the weak, the discourage (Rom 15:1; 1 Thess 5:14). We need to bear one another’s burdens (Gal 6:2). We rejoice with those who rejoice, and weep with those who weep (Rom 12:15). If we don’t care, who will?
Raised a Muslim
My name is Fernando dos Santos. I’am 29 years old, married to a beautiful women named Helnna, and together we are raising two little boys, Gabriel (8), Vinicius (3). I came to know the Lord November 15, 2006, at 11:45. Christ removing the old heart, and replacing it with a new one, is an experience I will never forget. Before my conversion, I was a sunni Muslim since birth. My mother was, and still is a wonderful women. She played, played well both mother and father. My father was intelligent and percipient man. He was an architect, and a good one too. He was strict in my up brining, and sometimes went to far when he disciplined me. It was so bad at times; to the point where my mom would have to intervene. However, I stilled admired my father. He was my hero.
Helnna and I were married on September 9, 2003. In 2004, we had our first child, Gabriel, and In 2009, Vinicius came along. I had trouble in the beginning raising Gabriel . I did not have the skills or training to raise him up. It wasn’t until my conversion to Christ, and the Lord bring godly men in my life; I was able to see, and observe the men interacting with their wives and children. It is a blessing too see a father fulfill his role; as the federal head of his home.
In the fall of 2009, my appendix erupted, and I was rushed to the emergency, where they performed emergency surgery. I was in intensive care for 6 days. I was discharged on a weekend, and by God’s grace, my wife was able to take time off work to care for me. I was so weak, when I was discharged and was now at home, it was tough to walk up the stairs, to take a bath, I was immobilized. I looked in the mirror and I looked like Mr. Burns from the Simpsons. I weighed in at 145 pounds before the surgery. After the surgery, my weighed in at 115 pounds. It took a lot out of me (literally).
That same year, I was scheduled to go back to University, and that fell through because of my health. I also had to take a temporal leave of absence at my part-time job. Helnna’s pay check from her part-time job (at the time) was the only income coming in. It was a difficult time. But glory be to God! my church was able to come along side, and help with the bills. I saw God’s providence and His grace at work. But it again, they were those days when it was difficult. I started to lose hope. I saw myself as a loser, and a less of a man, because it was my wife who was bring in the manna, and not I. At that time, I was blind to see my behavior. I was prideful. Instead of casting and my anxiety and fears on the One who cares, I looked to other means, which were prescription pain-killers. Oxycontin was the drug of choice. Who would have known that a pill the size of a dime would do so much harm and damage to myself and my family.
Fake joy and false promises
I had that fake joy, the one the world craves for. It wasn’t like I was going to a back alley in the hood and getting the pain-killers from a guy; I was getting them legally from my doctor, whom I failed to tell I had a problem. I would sit in bed all day and night, and not move from there. I had the blind close, it was like I was the phantom of the opera, in total darkness. I spent little time with my children, I made false promises to them, and my wife who waited hands and foot on me, I was ignoring her. I wanted to be alone. The thought of suicide bounced back, and forth in my head. One night when I was left alone, my wife and kids weren’t home. The thought of suicide emerged and it was so intense. I went to into my closet; got my belt; made my way to the bathroom to end my life. I looked at myself in the mirror, “worthless” I thought.
Then my practical theology kicked in (praise God for Wayne Grudem’s systematic theology) and I thought of Calvary, and the atonement. Christ died so thatI can have eternal life and forgiveness, Thoughts of Helnna, and Gabriel, and Vinicius started to appear. Who is going to instruct and discipline my children in the Lord? Who will love my wife as Christ loved the church, and gave Himself up to her? It was right there and then; I dropped the belt, and fell on my knees, and cried out to my Lord and Savior, Jesus Christ. If it weren’t for the Lord’s sovereignty, mercy and grace, you wont be reading this letter.
I sought help after that night. We called our pastor and told him everything. He was able to counsel me and I was able to get help from the local center of addiction and mental health clinic in Toronto. I praise the Lord He let me grow through that. Theology matters, and having a solid biblical view of God help through it. I still battle with depression, but now I’m on medication, and being on meds is not a stroll through the park. I read a book by a pastor and his wife, Steve and Robyn Bloem, “Broken Minds” a huge help in my life. The Bloems made reference to another book, “Christians Get Depressed Too” Again it was a super huge help in my life. One of the things I had to pray about, was being honest and seeking not to glorifying my story. I take this very serious. May God (if He so wills) use my petty story to bring glory to Himself, and to help the those who need it.
Let us remember the words of Christ, “For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.’ Then the righteous will answer him, saying, ‘Lord, when did we see you hungry and feed you, or thirsty and give you drink? And when did we see you a stranger and welcome you, or naked and clothe you? And when did we see you sick or in prison and visit you?’ And the King will answer them, ‘Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.’ (Matt 25:35-40)
I’ve just finished two days of filming various Christian counselors for the HeadHeartHand Media documentary on Depression and the Christian. It was a huge privilege and a fantastic learning opportunity to pick the brains and explore the hearts of three experienced Christians who have dedicated their lives to caring for God’s hurting people. Here’s what I carried away from these interviews:
1. All kinds of people get depression: Depression smashes caricatures about depression. It’s not a choice that weak losers make. No, it affects rich and poor, the very old and the very young and every age in between, Type A and B…and every other type too.
2. Build relationship in order to build trust: It’s the old “People don’t care how much you know until they know how much you care.” As with pulpit ministry, our words carry so much more weight and credibility when there is a relationship between the speaker and hearer.
3. Good listening is massive medicine: Sometimes we run out of things to say or don’t know what to say. However, don’t underestimate the healing power of real listening. I experienced this recently when I shared with my wife an anxiety I had been carrying. There wasn’t much she could say to resolve the problem, but I slept so much better after she simply listened to me.
4. Jumping to simplistic conclusions is extremely damaging: I never cease to be amazed by the cruel things that are said to and about depressed people. Quick fixes fix nothing. First conclusions are usually wrong conclusions. Depression is usually a complex, multi-layered problem that does not lend itself to simplistic answers from simple minds.
5. Holistic approaches to cause and cure produce most success: As causes are usually a complex mix of physical, spiritual, social, and psychological factors, cures often involve all these areas too.
6. A Christian approach to counseling is hope-filled and optimistic: A film about depression runs the huge risk of being thoroughly depressing! However, all the counselors communicated how much joy they experience in seeing God work His grace and joy even in the most desperate situations. With that hope, thet can look forward to their work every day.
7. The Bible has something to say to every situation and every problem: I was deeply impressed by these counselors’ confidence in God’s Word. They have seen its power at work in many lives, including their own. One counselor, a Christian Child Psychologist, said that although she often points depressed teens to certain passages of Scripture, her greatest aim is to get the teen reading the Bible for themselves again, because that’s where God meets His people and does His healing work.
8. Christians have nothing to fear from true scientific research: It deeply distresses me to see the way some Biblical counselors are so dismissive of science, tending to jump on any research that reflects negatively on psychology or pharmacology, and ignoring any research that fails to support their presuppositions. Each of the counselors we interviewed respected science as God’s gift, and reading it through the spectacles of Scripture, found help from it in ministering to God’s hurting people.
9. Depression is a sanctifying and equipping experience: Painful though the journey is, time and again depression proves to be a time of Christian growth. God often uses it to draw a person to Himself, increase dependence upon Him, and to equip them to be far more useful than they ever were before. I’ve found many depressed people to be the most compassionate people I’ve ever met. Sometimes that’s why they get depression.
10. Depression gives the Church a great opportunity to minister God’s grace: Depressed people do not find much sympathy in the world. Here is a wonderful opening for the church to show the heart of Christ who came to heal the brokenhearted, the brokenminded, and the brokenbodied.
We’ve really struggled to find Black, Hispanic, and Asian subjects for our DVD project, Christians get depressed too. I’ve talked to a couple of African American friends and I’m beginning to understand why. Knowing that Pastor Thabiti Anyabwile has a background in Psychology, I reached out to ask for his views, and he’s agreed to be interviewed for the DVD on this subject. I’m so looking forward to hearing his insights and hoping that his interview will help promote understanding and compassion towards many secret sufferers in the African American community.
I tried looking for more black women who had gone through this. I found three on Twitter. Three … that’s it. I talked to anyone who cared to listen, and many made me feel insecure, like I was the only black woman to ever go through this. I was told to smile, pray more, suck it up and enjoy my baby. Why are you on meds? Don’t you know you’ll be dependant for life? My very close cousin was scared of me, she told me I was going crazy. See I love how the black community is the same all over the world … like Addye said:
We don’t do therapy, at all.
Any mental illness means you are losing your marbles, hence we keep it a secret.
Women are meant to be hard as a rock; we are somehow supernatural beings.
If anything goes wrong in your life, it’s because God is punishing you for something and you are just not worthy of Him.
I made a choice to reach out. I owed it to myself to get better, to my kids, to my family. The white community in South Africa welcomed me with open arms. They all knew someone who’d gone through postpartum depression. My therapist had never ever treated a black woman. Our support group had, well, no women of colour. But I made it my mission to find more of us, and what better way to do that than sharing my experiences. I wrote to all baby magazines, and started a blog. And one day, when I least expected it, my pastor at church called me to the side and told me that she went through PPD. Two of my distant friends had gone through it, but kept it a secret. I also received two emails from strangers who had gone through this.
Have you got any insights you can offer on this subject? Anyone else I should be speaking to? We’d really like to maximize the helpfulness of this film to as many different groups and communities as possible.
Be alert to small changes. Depression can come on slowly, almost imperceptibly. Most are reluctant to recognize it and identify it. It may look different in different people.
Don’t wait for your spouse to hit bottom.
Break the ice gently yet firmly. Don’t blurt out: “You’re depressed!” or announce: “You better get help!” Approach your spouse with concern and with an action plan.
Get a diagnosis — together. Going to the doctor together helps to describe the problem and remember the advice.
Know that the odds are in your favor. The success rate of depression treatment is as high as 90 percent.
Keep on learning about depression. The more you know, the better you can cope and fight.
Be alert for relapses. 50% of those who suffer a bout of major depression will have a relapse.
Find support. Choose a trusted friend to confide in. Accept assistance when offered.
See depression as an intruder in your marriage. Like any other illness, depression is an outside force — an unwelcome visitor wreaking havoc with your spouse’s health, your marriage, and your home life.
That last point is the only one I would seriously question. I would encourage Christians to see depression as from the Lord, part of His wise providence. If it’s from His hand, it’s not a hostile intruder, but has wise and good purposes behind it. I’d also want to add to these lists:
Regularly read the Bible, pray, and sing together.
Keep going to your local church, and get involved in serving others to a limited extent.
Exercise together, preferably taking leisurely walks in Gods creation.
Keep conversation positive rather than negative, focusing on the good in others rather than their faults.
Help your spouse to establish regular & healthy eating and sleep patterns
Use Ed Welch’s book A Stubborn Darkness, to gently probe the possibility of any spiritual causes
A young mother. A middle-aged pastor. A high school student. An elderly retiree. What do all these people have in common? They’re all Christians. They all struggle with depression. They all have stories to tell.
At HeadHeartHand Media, we’re convinced that depression in the church is an issue that demands our attention, and in light of the warm reception Christians Get Depressed Too has received, we’re excited to be developing a video curriculum on that very topic!
While the book provides the reader with a short, systematic and easily digestible introduction to subject, we believe that film has incredible potential to give this problem a human face, and thus to motivate and enable us to take steps toward better understanding and response to depression.
A person’s understanding of depression cannot remain theoretical for long. All of us encounter the reality of depression on an almost daily basis. For many believers, that reality is their life. It’s our hope that this curriculum will equip churches to understand and minister to depressed Christians with greater compassion, greater understanding, and greater effect.
Do you have a story of your own?
We’ve already witnessed God’s grace in the lives of several Christians who’ve suffered with depression and can’t wait to share their stories and the lessons they’ve learned. But we need more! And that’s why we’re writing this. We’re hoping we’ll be able to connect with many different believers scattered far and wide who’ve also witnessed God’s gracious care for his sheep. If you or someone you know has suffered with depression in the past, or is still battling with it today, we’d love to hear from you. This is clearly a sensitive subject, and not one most of us would be eager to share in front of a camera; but if you believe that your story could be used for the good of Christ’s church and others suffering with depression, we ask that you’d prayerfully consider contacting us.
At the heart of this curriculum are stories from the trenches. Not stories of super-Christians who could do it all, but stories of ordinary Christians who were brought face to face with their own physical, mental and spiritual weakness. Stories of Christians, who, though they had to walk though this dark valley of depression, have found and continue to find hope in the Gospel of Jesus Christ and His provision for their physical, mental, emotional, and spiritual needs.
It’s our prayer that the church will be eager to walk with these believers, hear their stories from their own lips, and absorb the lessons they, their families, and their churches have learned as they journeyed together toward the light. We are confident that God will use this to transform congregations of Christians all throughout the world into gatherings of believers who will tenderly shepherd the hurting sheep among them.
To aid in drawing general lessons, practical helps and a way forward, the curriculum will also include interviews and analysis from several experts in the field: Christian pastors and various counselors who have years of experience to draw on and share with viewers. We believe that this combination of narrative and teaching will be a great introduction for any congregation or small group.
A large 40 year study, by the American Heart Association, of over 80,000 women in the USA has found that those with a history of depression had a 29% increased risk of stroke.
The researchers also found that women who had used anti-depressants particularly SSRIs (selective serotonin reuptake inhibitors) at any point in the two years prior to the study, was 39% higher.
And here’s where our prejudices and presuppositions immediately kick in.
Those who are against anti-depressants will read this as further evidence of “the cure is worse than the disease.”
Those who see a role for anti-depressants in the treatment of serious depression will try to find other explanations for the facts.
For example, in this report on the findings, the BBC found public health and stroke experts to argue against any direct link between strokes and anti-depressant medication.
Dr Kathryn Rexrode, who led the research, said the medicines were more likely to be an indication someone was more seriously ill, rather than a cause of the stroke. She said: “I don’t think the medications themselves are the primary cause of the risk. This study does not suggest that people should stop their medications to reduce the risk of stroke.”
She added: “Depression can prevent individuals from controlling other medical problems such as diabetes and hypertension, from taking medications regularly or pursuing other healthy lifestyle measures such as exercise. All these factors could contribute to increased risk.”
That was echoed by Dr Peter Coleman, deputy director of research at the UK’s Stroke Association: “This research appears to indicate that women suffering from depression may be less motivated to maintain good health or control other medical conditions such as diabetes and high blood pressure, which have an associated increased risk of stroke.”
My takeaways from the research are:
1. View depression as a serious condition with many damaging consequences.
Don’t dismiss depressed people as if they were merely suffering from a common cold, allergy, or a passing bad mood. Wherever depression starts – in the heart, in the brain, or in devastating providences – its ripple (tsunami?) effects are extensive and often life-threatening. Take this seriously, and get help early.
2. Medication alone is never the answer.
Much research into the benefits and drawbacks of anti-depressants take no account of the impact of social support, spiritual counseling, lifestyle coaching, etc.
Some research (usually funded by by talking-therapy advocates) shows that anti-depressants do little better than placebos. Other research (usually funded by drug companies) highlights a drug’s statistical success. But what help are any of these “facts” without knowing much more about the background and situations of these sufferers.
I have never seen anti-depressants work where there has not been a serious commitment to receiving and acting upon counsel about lifestyle, decision-making, social interaction, and spiritual needs. If you think that the sole answer to depression is a pill, you are in for a very long and dark journey – and possibly a stroke!
Having said that, sometimes, in really serious depression, unless there is a willingness to take medication, all the counsel in the world is going to go in one ear and out the other. The information cannot be received or successfully processed.
3. Be aware of our own prejudices and presuppositions when analyzing research.
When we read something that supports our existing conclusions, we are much more likely to believe it as true without any further analysis.
When we read something that challenges our faith, our reason, or our previously adopted public positions, out come our sharpened critical faculties to find the weaknesses and inconsistencies.
Sometimes, our response to research reveals more about ourselves than anything else.
Deeply rooted self-doubt and self-criticism will often emerge and strengthen during a depression. Depressed people often feel useless and worthless. They have low self-esteem. What should we do to address this?
Some Christians are reluctant to give people any praise or encouragement because of the risk of making a person proud. However, it is safe to say that pride is one of the least risky vices for someone who is depressed. Pride results from having an overinflated view of oneself. Depression usually results in the opposite.Other Christians misconstrue the doctrine of original sin and total depravity to mean that there is no kind of good in anyone and fail to say anything positive to the depressed person. However, without minimizing the wickedness of the human heart and without denying our inability to do anything pleasing to God apart from faith in Christ, we should feel free to encourage depressed people to have a more realistic view of themselves by highlighting their God-given gifts, their contributions to the lives of others, their usefulness in society, and, if they are Christians, their value to the church.For example, a depressed young mother may feel like a total failure in every area of her life because she doesn’t have a perfect home or perfect children. We can help such a person see that she achieves a lot in a day, even though she might not manage to do everything she would like. We might remind her of all the meals she makes, clothes she washes and irons, and the shopping she manages, helping her see herself and her life in a more accurate and realistic light. Arie Elshout comments:
It is wrong to pat ourselves on the back when something has been accomplished as a result of our initiative. It is equally wrong, however, to focus on what we have not accomplished. In 1 Corinthians 15:10 we have a clear example of humility accompanied with a healthy opinion of one’s accomplishments: “But by the grace of God I am what I am: and his grace which was bestowed upon me was not in vain; but I labored more abundantly than they all: yet not I, but the grace of God which was with me.”
Paul knew very well that he daily offended in many things (James 3:2; cf. Rom. 7; Phil. 3:12), and yet he did not go so far as to cast out all his accomplishments. I do not believe that this is God’s will. In contrast to sinful forms of self-confidence and self-respect, there are also those that are good, necessary, and useful.
Without a healthy sense of these, human beings cannot function well. We may pray for an appropriate sense of self-confidence and self-respect, clothed in true humility, and we must oppose everything that impedes a healthy development of these things (be it in ourselves or others) with the Word of God (Overcoming Spiritual Depression, 32–33).
Edited extract from Christians get depressed too. Available at RHB and Ligonier. Kindle version here.
Thoughtful and prayerful study of depression should naturally and automatically increase our sympathy for those who suffer from it. By sympathy, I mean an ability to communicate that we truly understand the problem and the symptoms, that we are deeply concerned, and that we will do all that we can to help. In many cases such sympathy can have a powerful therapeutic effect on the sufferer. The lack of it can only multiply the pain and deepen the darkness. Consider the following quote from Russell Hampton, who suffered from depression:
If there were a physical disease that manifested itself in some particularly ugly way, such as postulating sores or a sloughing off of the flesh accompanied by pain of an intense and chronic nature, readily visible to everyone, and if that disease affected fifteen million people in our country, and further, if there were virtually no help or succour for most of these persons, and they were forced to walk among us in their obvious agony, we would rise up as one social body in sympathy and anger. There isn’t such a physical disease, but there is such a disease of the mind, and about fifteen million people around us are suffering from it. But we have not risen in anger and sympathy, although they are walking among us in their pain and anguish (The Far Side of Despair, 78)
It will greatly help you to sympathize if you always remember that you could just as easily be in the same position, suffering the same sorrow (1 Cor. 4:7). If you treat depressed people with impatient contempt, you may, like many others before you, have to learn sympathy the hard way.
Edited extract from Christians get depressed too. Available at RHB and Ligonier. Kindle version here
A depressed Christian’s family and friends, and fellow Christians, will be involved to one degree or another in helping a depressed person get better. Usually these caregivers have no medical training, and often they have limited or incorrect knowledge of depression or anxiety. However, they have a critical role in helping a depressed person get better. Research has shown that depressed people get better much quicker if they can confide in and get support from someone close to them. Over the next few days we will consider ten areas for caregivers to consider when they are trying to help a depressed person get better.
The first requirement is study. As Christians, we surely want to be the person to whom our loved ones turn in time of need. And when they do turn to us, we want to be able to help them and not hurt them further. It is imperative, therefore, that we learn about depression in order to avoid the common mistakes that laypeople often make when dealing with the depressed and in order to be of maximum benefit to those who are suffering. Along with studying how Jesus dealt with the ill, the weak, and the distressed, you might want to read some of the helpful books, written from a Christian perspective, that are now available. The following are listed in order of readability and usefulness:
Another book, of course, is the well-known Spiritual Depression by Dr. Martyn Lloyd-Jones. However, you should be aware that in that book Dr. Lloyd-Jones does not deal with every aspect of depression as an illness but rather focuses on some of the spiritual consequences of depression. In some ways, the book is more about spiritual discouragement than depression, but it is helpful nevertheless.
A book written from a non-Christian perspective, but which is still useful for changing unhelpful thought patterns and behavior, is Mind over Mood by Dennis Greenberger and Christine Padesky.I would also cautiously recommend Ed Welch’s Blame It on the Brain? and Depression: A Stubborn Darkness. Dr. Welch exhibits a sensitive balance when dealing with depression, and his books have a lot of excellent and helpful material. He seems to be open to non-spiritual causes of depression, although at times he still seems to revert to the “medicine only alleviates symptoms” model. A Stubborn Darkness is also helpful for exploring possible spiritual causes or contributors to depression. However, I would hesitate to put this book directly into the hands of depressed Christians, as they will often draw the worst possible conclusions about themselves, regardless of objective reality. It is better that a committed and understanding pastor or family member gently and wisely guide a depressed person through the relevant parts of the book.
It is important to remember that reading these books will not turn you into a mental health expert, but it will make you more useful and helpful to loved ones in distress. It will also help you to know your limitations so that you make the right decision about when to advise someone to see a more experienced Christian, a doctor, or a mental health professional. I would recommend that pastors build a database of local doctors and mental health professionals who share their Christian principles. Phone around, speak to people, visit hospitals, speak to the staff, and build relationships so that when you are facing a situation that is beyond your competence, you will know to whom you should turn.
Edited extract from Christians get depressed too at RHB and Ligonier. Kindle version here
One reason for the dramatic surge of depression in our Western culture is the stressful lifestyle that so many are living for extended periods of time. Addressing this is not the whole answer in recovering from depression, but it is often a large part of the answer. It is vital to lead a balanced lifestyle in order to relieve the “stretch” that threatens our physical, mental, emotional, and spiritual well-being.
1. Routine One of the keys to a balanced lifestyle is regular routine. This is also one of the first things to fall by the wayside when someone becomes depressed. Depressed people often find it difficult to resist being guided by their feelings. When a person feels down he will often do only what he feels like doing and avoid what he doesn’t feel like doing. For example, if you are depressed and you don’t feel like getting up, you won’t. If you don’t feel like working, you won’t. If you don’t feel like doing the laundry, you won’t. If you feel you want to drink or eat to excess, you do it. A positive step in recovering from depression is to restore order and discipline in your life. Regular and orderly sleeping, eating, and working patterns will rebuild a sense of usefulness and healthy “self-esteem.” It is also glorifying to God who is a God of order, not of confusion (1 Cor. 14:33).2. Relaxation We need to build times of relaxation into our lives. This may involve finding a quiet spot at various times throughout the day to simply pause, calm down, and seek the peace of God in our lives. Jesus recognized and provided for this need in His disciples when He took them “apart into a desert place, and rest[ed] a while” (Mark 6:31). Another helpful area to explore is whether you are breathing properly. It is common for depressed and anxious people to be extremely tense, which often leads to hyperventilation or over-breathing and then to inevitable weakness of body and brain. There are many helpful books and Web sites that, without straying into “New Age” ideas, give good basic advice on re-learning how to relax and breathe properly.3. Re-creation Moderate physical exercise helps to expel unhelpful chemicals from our system and stimulates the production of helpful chemicals. Outdoor exercise has the added benefit of the sun’s healing rays.4. Rest A Christian psychologist recently said to me that he starts most depressed people on three pills: “Good exercise, good diet, and good sleep!” That’s great advice, so I would encourage you to make use of the plentiful resources available today on these subjects. As regular sleep patterns enable the body and mind to repair and re-charge, set fixed times for going to bed and getting up, and try to get at least eight hours of sleep. Avoid caffeine, vigorous exercise, phone calls, TV, and Internet use within three hours of sleeping. Get into a set routine for going to bed, and try to secure cooperation from others in the house. And remember God’s gift of weekly rest. The Lord’s Day was graciously made for us (Mark 2:27), partly to ease the tension of our busy, overstretched lives.5. Re-prioritize Examine your life and see what you can do to reduce your commitments and obligations. Areas to consider are your family, your work, your church, your neighbors, and travel. Once you are better you may be able to pick up some of these activities again. But the priority is to get better.6. Repentance We may also need to look at the reasons for choosing such stressful and damaging lifestyles. What is driving us? What is motivating us? What are our aims and ambitions? What are we living for? Above all, who are we living for? Christians get depressed too at Reformation Heritage Books, Ligonier, and Amazon.