We all experience periods of sadness from time to time but clinical depression is not just a passing mood – it is falling into a funk that refuses to go away. In this case, is coping with depression even possible?
Symptoms of Depression
Depressed people report having feelings of despair, helplessness, and hopelessness, and their depression tends to worsen when they attempt to shake it off. Their self-esteem suffers and their view of themselves is extremely negative. They lose interest in things and the world around them. What they once counted as pleasurable (i.e., sports, hobbies, taking walks, etc.) is no longer is enjoyed. They experience a loss of hope for anything to change for the better.
Physical symptoms (i.e., changes in appetite, sleep, energy levels) are associated with becoming listless, lethargic, and apathetic. People with severe depression are often plagued by death wishes, suicidal thoughts, and/or psychotic symptoms (i.e. paranoid or grandiose delusions and/or visual/auditory hallucinations.) Also, other adverse physiological effects are common (i.e. psychomotor agitation and constipation) and other various health issues. Needless to say, depressed people have great difficulty functioning at home, work, school, and/or church.
Major depression is by far the most common psychiatric disorder in the United States. Healthline reports that the diagnoses are growing at an alarming rate. This source claims that “states with higher rates of depression also show high rates of other negative health outcomes [and that] individuals suffering from depression are more likely to be unemployed or recently divorced.”
It is estimated that depression affects at least 10-12% of the American population at any one time. It is a condition often preceded by an excess of negative events (especially losses) but occurs most often among those who have no close interpersonal relations and are divorced or separated. Women are most vulnerable to being depressed, with an estimated 25% of middle-age women in the United States on prescribed anti-depressant medication.
Other risk factors include individuals having a family history of depressive illness and perhaps individuals with creative dispositions (such as artists, poets, and musicians). The World Health Organization tells us that depression is a global health issue, estimating that 350 million people of all ages suffer from depression. This organization claims that it is the leading cause of disability worldwide and a major contributor to the overall global burden of disease. It reports that it is a condition that claims the lives of over 800,000 people to suicide each year around the world.
Treatment for Depression
Healthline reports that only about 20% of individuals having symptoms of clinical depression in the United States receive treatment for this condition. The 80% that do not receive professional help may not do so for many reasons. They may be fearful of being labeled and stigmatized as being mentally unfit or fear being marginalized by associates, family, and friends. Christians may not seek treatment because they will be criticized by their church for lacking faith or for suffering from secret or besetting sins. Others are in denial – believing that to admit it would jeopardize their jobs and reputations. Many choose to suffer silently and withdraw into themselves.
There are others who rely on the internet as a resource to deal with their depression. Google searches provide simple recipes on how to proceed: (a) establish a routine to keep yourself busy, (b) set goals for yourself in harmony with what is important to you, (c) exercise to boost “feel-good chemicals” called endorphins, (d) eat healthy, and (e) get enough sleep.
In fact, lifestyle management is beneficial. Improving diet, ensuring adequate sleep, engaging in recreation and exercise, limiting exposure to toxins such as tobacco and alcohol, nurture supportive relationships, and pursuing important goals lower the severity of depression and improve overall mental well-being. Unfortunately, depressed persons are often not sufficiently motivated to overcome their ambivalence to put these kinds of recommendations into practice.
When depression causes significant distress or impairment in social, familial, occupational, educational, or other important areas of functioning, a better option for depressed people is to consult a mental health professional who is not only familiar with the medicalization of depression but also well versed in dealing with its spiritual dimension. Both orientations are important considerations.
A medical orientation is research-based and incorporates evidenced-based counseling with pharmaceaudical intervention. On the other hand, a Christian-based spiritual orientation relies heavily on biblical and theological material and conceptualizations. It would appear that both should be taken into consideration and that both can be integrated in a treatment approach.
Medical Considerations for Coping with Depression
Mental health clinics provide consumers with bio-psycho-social assessments and assistance in making informed decisions about treatment options. Depression is considered a mental illness and the Stress-Vulnerability Model is often used to explain that it has a biological basis that is worsened by stress, trauma, and substance abuse.
Treatment goals typically include the reduction of biological vulnerability and coping more effectively with stress. Clients are fully engaged in learning how to best manage their depressive symptoms (improve their mood). Typically this involves using medication to manage symptoms, the recommendation to talk honestly with people that make up a social support system (especially about emotionally-laden topics), practicing relaxation exercises, focusing on the positive, and implementing life management skills.
Viewing depression as a mental illness is typically treated pharmacologically in combination with evidence/research-based psychotherapy such as Cognitive Behavioral Therapy (CBT). Medication is used to mute depressive symptoms, to increase concentration, to think more clearly, to sleep more restfully, and to help achieve life goals. Counseling provides for a personal exploration and resolution of problem areas.
CBT involves challenging, confronting, and/or correcting automatic negative thoughts with the encouragement, guidance, and support of a therapist. It posits that negative thinking gives rise to self-defeating behaviors which, in turn, initiates stress that is associated with feelings of helplessness, hopelessness, sleep problems, and/or anxiety and depression.
A modification of the CBT therapeutic model, known as Acceptance and Commitment Therapy (ACT), posits that instead of challenging autonomic negative thoughts, depressed people should accept them for what they are (rather than attempt to avoid, ignore, escape, fight, and/or correct them). ACT holds that emotions and moods must be distinguished from a person’s self-identity. It uses metaphors and clinical strategies to separate negative inner experience (i.e., memories, thoughts, and emotions) from the self. ACT considers it important for the depressed person to identify and practice values that they hold dear and to throw themselves into activities moving them toward the achievement of goals that are important to them.
Implicit in many similar therapies (i.e., Dialectical Behavior Therapy, Mindfulness-Based Cognitive Therapy, Mindfulness-Based Stress Reduction Therapy, and Mindfulness-Based Relapse Prevention) is teaching the depressed person how to practice “mindfulness.” Mindfulness is a proven skill or discipline that helps to calm the mind by focusing on the present moment in conjunction with a focus on one’s breathing to increase integration of mind and body. It is used to decrease stress by means of relaxation and increasing psychological flexibility.
It is important to understand that the theory of biological vulnerability to mental illnesses holds sway in the mental health field, but it is often not acknowledged that this is a theoretical model. The explanation that a “chemical imbalance” is mostly to blame for psychiatric illnesses has lost some favor in recent years. Also, not all clinicians and researchers are convinced of the efficacy of some evidence-based counseling mentioned above.
Spiritual Aspects of Coping with Depression
In a spiritual sense, major bouts of depression can be viewed from the lens of it being an experience of absolute despair. Webster defines this term as “an utter loss of hope, a complete domination by feelings of hopelessness, futility or defeat, wildly and bitterly expressed or quietly and pervasively dominant.”
In medieval times, despair involved lacking the will to face the future with any degree of sustained expectancy, and it was equated with one of the “deadly” sins – a sin driving one towards death, whether spiritual death or actual suicide. Of all the cardinal sins, despair was considered the most fearful; thus in Dante’s Inferno the portals of hell contained the phrase, “Abandon hope, all ye who enter here.” Hell in most Christian literature is eternal separation from God, a sphere of unrelieved despair.
In Christian counseling, a bio-psycho-social-spiritual assessment can view depression as an experience of having a “heavy heart.” This terminology captures the dark mood and pain of sadness, grief, and suffering that comes from being separated from a previous experience of connection with God, others, and even self. This can be seen as a “faith crisis.”
While there is a place for positive and overcoming talk and confrontation of irresponsible behavior, depressed people usually require support and sensitivity in counseling (Prov. 25:20). Christian counseling that values spiritual principles of living is careful not to view depression merely as a cluster of biologically determined symptoms, but as a barrier that interferes with “following a path of longing to secure rest in the grace of our Creator.”
The Bible documents cases where people are described as being in “despair,” “mourning,” “miserable,” “brokenhearted,” “troubled, or having a “heavy heart” and gives spiritual direction in dealing with it. The author of Psalm 73 overcame what would appear to be depression or at least “stinking thinking” by receiving teaching “in the house of God” (vs 17).
David managed to turn things around when he was down in the dumps by refusing to fret over evildoers, by encouraging himself in the Lord, and by doing good (Psalm 37:1-8). In Psalm 38, David had “a burden too heavy to bear” and his soul was cast down, but his trust in God’s sovereignty assured him that he would yet praise Him.
In another case, it is quite notable how the Apostle Peter who sank into a funk after his denial of the Lord Jesus Christ on the night that He was betrayed, recovered his faith and became self/God-confident at Pentecost. His depression vanished when the Holy Spirit came upon him and enabled him to function in his pre-ordained role as one of Jesus’ most important disciples. Jesus Himself is described in Isaiah 53:3 as “a man of sorrows, and acquainted with grief” which He resolved by praying “not My will, but Thine be done.”
From a Christian perspective, spiritual resources are in play to help deal with depression. The Christian’s confidence does not rest exclusively upon science and research findings for answers to problems of living, but upon God through the person of the Lord Jesus Christ. A deep, personal, and devoted relationship with God through Christ is useful in resolving the problems of living.
The Christian believes the Scriptures to be a revelation from God and that His promises, as written in the Bible, can be trusted and appropriated by faith for salvation (John 3:16, Romans 10:9-10); for physical healing (Matthew 9:22; James 5:15); for spiritual empowerment (Luke 11:13; Acts 2:38-39; Galatians 3:2, 14); for material provision (Matthew 6:24-34); or for a variety of needs which would include mental health needs (Mark 11:22-24; Matthew 17:20).
By faith, the Christian has access to God through Jesus Christ (Roman 5:2) and can be an overcomer (Ephesians 6:16). A living faith is of great importance to the Christian, for the Scriptures admonish us with statements that “without faith it is impossible to please God” (Hebrews 6:12), and “whatsoever is not of faith is sin” (Romans 14:23).
Depression is an enemy of death, yet paradoxically, it can come to be seen as a friend. It may seem to be an enemy that has come to steal one’s peace, kill hope, and destroy life but it can serve a purpose in leading to discovering the reality of one’s true self. The efficacy of spiritual renewal combined with a study of Scripture and prayer are becoming recognized as effective elements in overcoming mental health issues such as depression.
Studies indicate that life management strategies in combination with prayer and the study of Scripture positively impact one’s life … and that receptivity to God is central to recovery, feelings of well-being, and life satisfaction. For example, religious lessons regarding inspirational verses from the Bible (i.e. Psalm 17, “A Prayer of David” and Psalm 90, “A Prayer of Moses”) with prayers of thanksgiving and requests for the power of the Holy Spirit to lead in the process is an effective intervention for those experiencing the darkness of depression.
Coping with Depression: Is it Possible?
Depression can be overcome! Coping with depression Life can become worth living, especially when open to spiritual discoveries. Recovery may not be immediate, but the redeeming quality of God’s love and divine intervention together with counseling and medical assistance, if needed, offer the help and support that is needed to overcome.
Depression does not discriminate between people of faith and the profane. Genetics, disease, trauma, emotional hurts, and spiritual oppression can be viewed as challenges that can be overcome. God meets people where they are on their journey of faith and renders assistance and healing in many ways through what could be termed “common grace.”
He stands behind the professional’s efforts to relieve suffering the same as He stands behind nature that testifies to His existence and behind governments in preserving the social order. It is generally recognized that prayer, faith, and spiritual authority are important elements in dealing with depression, but God intervenes on behalf of the Christian in many ways. He providentially cares for His own and works in mysterious ways on their behalf.
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“Despair,” courtesy of geralt, pixabay.com, CC0 Public Domain License;
“Grief,” courtesy of John Hain, pixabay.com, CC0 Public Domain License;
“Downcast,” courtesy of cocoparisienne, pixabay.com, CC0 Public Domain License