By Fr. Anayochukwu Henry Onoh
Someone has suggested that most of our days are of three kinds: on mountain top days – everything is going well and the world looks bright. These experiences are temporary: they don’t go on forever. It is unrealistic to expect, as some people do, that we can spend life leaping from one mountain peak to another as if there were no plains or valleys in between. Instead, most of life consists of ordinary days when we work at our usual tasks, neither elated nor depressed. Then there are the dark days when we trudge on through confusion, doubt, discouragement, and sometimes despair. These days may be occasional, or they may string together into months or even years before there is a brighter outlook and a sense of relief. When the dark days persist, they are days of depression.
For more than three thousand years, depression has been recognized as a common problem, it is a worldwide phenomenon that affects individuals of all ages, including infants. In the United States alone, an estimated seventeen million people suffer from clinical depression. One web site suggests that depression has an impact on nearly everybody if we consider both the depressed people and their family members, friends, work colleagues, and others. Depression disrupts lives, interferes with normal functioning, often causes problems at work, reduces efficiency, hinders spiritual growth, and can destroy a parish, family, and social life. It has a major impact on the economy as billions of dollars are lost annually because of depression in the workforce. Some of history’s greatest military leaders, statesmen, musicians, scientists, and theologians have been its victims, including Winston Churchill, George Frederick Handel, Edgar Allen Poe, Napoleon Bonaparte, Vincent van Gogh, and Charles Haddon Spurgeon. But depression is no respecter of persons. It is known as the common cold of mental disorders. On occasion probably all of us experience depression, sometimes when we least expect it. In its milder forms depression may come as a passing period of sadness that follows a loss or personal disappointment. More severe depression overwhelms its victims with feelings of despair, fear, exhaustion, immobilizing apathy, hopelessness, inner desperation, and thoughts of suicide. On rare occasions, when it is a part of severe mental illness, it can lead to actions like one committing murder. In one form or another, depression probably brings more people to counselors than we can imagine, unfortunately, it does not hold sway in this part of the world.
Depression covers a wide variety of symptoms that differ in severity, frequency, duration, and origin. The signs of depression might be grouped into four categories: feelings, thinking, behavior, and physical health. Each of these is a change from what the person experiences and shows when depression is absent.
- Depression can bring sadness, sometimes for no apparent reason; low self-esteem often accompanied by self-criticism and feelings of guilt, shame, worthlessness, and helplessness; pessimism and hopelessness; and sometimes irritability, so the person is more prone to impatience and loss of temper.
.Thinking. Depressed people frequently have negative thoughts. In their minds they ruminate on their own incompetence and lack of worth. Many experience difficulties in concentration, problems with memory, pessimism, guilt, self-criticism, self-condemnation, and sometimes thoughts of self-destruction.
- Apathy and a sense of inertia are common, so the person lacks motivation and finds it difficult to get motivated or to face decisions. Also common are loss of spontaneity, social withdrawal, and constant complaining. In more extreme cases, there may be a neglect of personal appearance and hygiene. Work productivity goes down and household responsibilities are neglected.
- Physical Health. General fatigue is common, despite more time spent sleeping. Depression also brings a loss of energy; a lack of interest in work, sex, religion, hobbies, or other activities; insomnia; an inability to concentrate; loss of appetite; and sometimes frequent complaining about aches and pains.
In what has become known as masked depression, a person may have many of the above symptoms but denies that he or she feels sad. The alert counselor may suspect that depression is present even behind a smiling countenance. In many cases the symptoms of depression hide anger that has not been expressed, sometimes isn’t recognized, and may be directed inward against oneself. Whether the symptoms are masked or more obvious to others, a large majority of depressed people do not get treated. Perhaps some are embarrassed by their symptoms, too depressed to go for treatment, or convinced that they can handle the problems without help. Of those that do get help, an estimation of 80 percent, do improve and see changes in their feelings, energy levels, and ability to adjust to life.
Depressive reactions have been classified in a number of ways. Reactive depression, for example, usually comes as a reaction to some real or imagined loss or trauma, is accompanied with high levels of anxiety, is of short duration, and often is self-correcting. Endogenous depression (sometimes called psychotic depression) is more likely to arise spontaneously from within, involves intense despair sometimes accompanied by self-destructive tendencies, persists for a longer period of time, is more resistant to treatment, and has a high recurrence rate. Primary depression occurs by itself, while secondary depression comes as the side effect of some medication, the influence of one’s diet, or the result of an illness like cancer, diabetes, or even influenza. Other types of depression include the following:
- Dysthemic disorders are characterized with chronic daily depression that is not severe enough to prevent normal functioning, although the person has low energy, little enthusiasm, and not much creativity or ability to enjoy Technically, this is defined as a low-grade depression that has lasted for more than two years and without a break longer than two months, but many report that they never can remember a time when the depression was absent. Frequently, these symptoms come from physical conditions that can be treated medically, although sometimes the depression causes the physical illness. Counseling can be effective in most cases.
- Seasonal affective disorders are periods of depression, apathy, and withdrawal that most often appear in the winter months in places where the days are shorter and the periods of darkness are longer. There is some speculation that sunlight, entering through the retina, stimulates chemicals that have an antidepressant effect. Most often the symptoms disappear as days get longer in the spring. There is evidence that light therapy in the winter months can be helpful. Counseling also is effective.
- Bipolar disorders (which used to be called manic-depressive disorders: a sort of mood swing) involves periods of mania interspersed with depressive behavior. Generally assumed to be of genetic origin, the condition usually appears in young adulthood and persists throughout life. Each individual has a unique manic-depressive cycle in terms of severity and frequency. Some people have mostly manic or mostly depressive symptoms. In the mania phase there is boundless energy, uncontrolled behavior, and a willingness); or take great risks. The depressive stages reflect the more common symptoms of These mood swings can be controlled through medication, but counseling also helps, both with individuals and with the family. Sadly, many see no need for counseling during the manic phase, and there is little energy for counseling when the person is depressed.
- Postpartum disorders differ from what has been called “postpartum blues,”a relatively brief period of depressive symptoms that disappear once hormone levels stabilize. Postpartum disorders are more serious and last longer, but they can be treated with counseling and medication. They only degenerate into extreme behavior, as we saw with Andrea Yates, when there are other severe psychological issues that complicate the postpartum condition or that are triggered by it.
- Major depressive disorders are the most severe, and probably the most complex and most studied of the depressive disorders. Usually, the major depressions come in episodes and are very disruptive to everyone The causes can be psychological and/or physical, although like all depression the major disorders reflect changes in the brain chemistry. This more severe depression does respond to intensive counseling, but most professionals use antidepressant medications as well. This more serious form of depression is best treated by an expert.
- Mood disorders are a group of emotional states that include depression and
other emotions. Sometimes, the term mood disorders is used as an umbrella term that includes each of the depressive types described above.
All of the above should be distinguished from discouragement, which is a mild, usually temporary and almost universal mood swing that comes in response to disappointments, failures, andlosses.
The Bible and Depression
Our discussion thus far shows that depression is a common, complicated condition, difficult to define, hard to describe with accuracy, and not easy to treat. Since depression is a clinical term, it is not discussed in the Bible, even though the condition appears to have been common. Psalms 69, 88, and 102, for example, are songs of despair, but notice that these are set in the context of hope. In Psalm 43 King David expresses both depression and rejoicing when he writes:
Why am I so discouraged?
Why so sad?
I will put my hope in God!
I will praise him again—My Savior and my God.
Elsewhere in the Bible it appears that Job, Moses, Jonah, Peter, and the whole nation of Israel experienced depression. Jeremiah the prophet wrote a whole book of lamentations. Elijah saw God’s mighty power at work on Mount Carmel, but when Jezebel threatened murder, Elijah fled into the wilderness, where he plunged into despondency. He wanted to die and might have done so except for the “treatment” that came from an angel sent by God.
Then there was Jesus in Gethsemane, where he was greatly distressed, an observation that is poignantly described in the words of the Amplified Bible: “He began to show grief and distress of mind and was deeply depressed. Then He said to them, my soul is very sad and deeply grieved, so that I am almost dying of sorrow.”
These examples, accompanied by numerous references to the pain of grieving, show the realism that characterizes the Bible. It is a realistic despair contrasted with a certain hope. Each of the believers who plunged into depression eventually came through and experienced a new and lasting joy, even when their circumstances did not change. The biblical emphasis is less on human despair and more on belief in God and the assurance of abundant life in heaven, if not on earth. Paul wrote, “We are pressed on every side by troubles, but we are not crushed and broken. We are perplexed, but we don’t give up and quit. We are hunted down, but God never abandons us. We get knocked down, but we get upagain and keep going. For our present troubles are quite small and won’t lastvery long…. So we don’t look at the troubles we can see right now; rather, we look forward to what we have not yet seen. For the troubles we see will soon be over, but the joys to come will last forever.” Paul’s confident prayer for the Romans someday will be answered for all Christians: “I pray that God, who gives you hope, will keep you happy and full of peace as you believe in him. May you overflow with hope through the power of the Holy Spirit.
The Causes of Depression
A number of myths about the causes of depression continue to be accepted and sometimes preached from church pulpits. It is not true, however, that depression always results from sin or a lack of faith in God, that all depression is caused by self-pity, that it is wrong for a Christian to be depressed, that depressed feelings always can be removed permanently by spiritual exercises, that anti-depressive medication is the best form of treatment, that happiness is a choice, or that a “depressed Christian is a contradiction of terms.” Like everyone else, Christians get depressed. There can be a variety of causes that often work together, so one of the counselor’s first tasks is to uncover, understand, and eventually help counselees deal with these causes. Although there are numerous theories and explanations for depression, it probably is most common for mental-health professionals to take what has been termed a bio-psycho-social approach. This groups the causes into three categories, that is: the biological causes, the psychological causes, and the social influences.
- The Biological-Genetic Causes. Like most psychological problems, depression has physical implications, including chemical imbalances in the brain. Sometimes, the physical changes result from the depression; at other times physical influences are the cause. At the simplest level, we know that lack of sleep, insufficient exercise, the side effects of drugs, physical illnesses, or improper diet can create depression. Thousands of women experience depression at part of a monthly premenstrual syndrome (PMS), and, as we have seen, some develop postpartum depression following childbirth. Less recognized is a testosterone-induced depression that comes to men during periods of reduced sexual activity. Other physical influences, like neurochemical malfunctioning, brain tumors, or glandular disorders, are more complicated creators of depression. Simpler, perhaps, is seasonal affective disorder (SAD) that, at least in part, reflects the body’s response to a lack of light.
There is considerable evidence that depression runs in families, but it can be difficult to distinguish the genetic from the possible environmental reasons.
Highly sophisticated genetic research continues around the world, and there is wide agreement that genes influence the body in many ways, including biochemical activity in the brain. For the nonmedical counselor, perhaps it is enough to be aware of the genetic influences and to recognize that some of this research has a bearing on the development of new and more effective anti-depressant medications. Over twenty years ago one former president of the American Psychiatric Association predicted that research in the genetics and biochemistry of depression is where a Nobel Prize will be won some day in the future.
- Psychological-Cognitive Causes. Depression is a significant mental-health problem for as much as 10 percent of the general population, but these figures differ from country to country, rise during times of political upheaval and economic uncertainty, and differ depending on one’s age. Depression in the elderly is well recognized, especially among older people with health problems. Among younger people, about one in eight American teenagers suffers from depression or anxiety. Sometimes, this leads to physical self-mutilation that could be interpreted as a cry for help. Depression impacts an estimation of 25 percent of college students, is experienced by about one-third of college dropouts before they leave school, and is high among international students who feel intense pressure to get good grades. All of this suggests that developmental, psychological, interpersonal, spiritual, and other nonphysical influences are at the basis of much depression.
(a) Background and Family Causes. Many years ago a researcher named Rene Spitz published a study of children who had been separated from their parents and raised in an institution. Deprived of ongoing, warm human contact with adults, these children showed apathy, poor health, and sadness—all indicative of depression that could continue into later life. Depression can occur when parents ignore or reject their children or when status-seeking families set unrealistically high or rigid standards that family members feel pressured to meet. It is a common experience for young people to strive to meet parental expectations and to feel the parents’ disappointment and rejection when the standards are not met. This can have devastating and life-long impact on the young person’s self-esteem and feelings of worth. Depression often follows and persists into their adult years.
…to be continued