Dealing with Depression Part 2

IV. As a pastor, I try to be careful to not make clinical diagnoses beyond obvious cases (e.g. “Not only your nagging hangover headaches but perhaps even your depression might be tied to your alcohol overconsumption since alcohol is a known depressant.”), nor take hard-line binary approaches to treatment protocols that might include a special therapy, prescription drug or OTC medication. This is not to say that I might not make some cursory observations based upon years of living and I especially will speak when there are likely spiritual issues underlying a disorder. A. In the medical profession, depression was once treated almost exclusively by counseling and psychiatric therapy. B. A shift began in about the 1950’s to deeming the condition of depression to be the result of chemical imbalances in the brain or body and this spurred the introduction of a series of classes of drugs to counter the assumed imbalances. C. Electroconvulsive Shock Treatment (ECT) was a controversial treatment that began in yhe 1930’s. It electrically induced convulsions called Grand Mal Seizures and it was supposed to “clear the cache and re-boot the system.” The procedure and after-effects were sometimes disturbing. D. Speaking generally, the medical community does not consider spiritual problems which can be alleviated by repentance and faith to be part of the regimen for treating mental/emotional/mood disorders. 1. In overview, the medical model embraces a naturalistic view of man and tends to address disorders with a view to man being a victim of chemical, physiological or organic forces. Personal volition and responsibility are downplayed. 2. “Today, everything is physiological and genetic and treated with drugs. Nothing is your fault. You’re an innocent victim. Furthermore, many of us like it that way. We like the idea that whatever is wrong with us is an organic disorder, that there’s no sin, no weakness, no deficit of character on our part. Our egos love that, it comforts us.” (David Kupelian, Why So Many Americans Today are Mentally Ill, 8-14-2007) ( http://www.wnd.com/2007/08/43033/ ) 3. “The biblical position is this: the ravages of brain injury, disease, or dysfunction cannot rob us of spiritual vitality. At the core of our being we are moral creatures, image-bearers of the Most High. Certainly, this center can be defaced or suppressed, but the culprit is sin, not sickness.” (Edward T. Welch, Counselor’s Guide to the Brain and Its Disorders, p. 291) E. “Severe depression has many different symptoms that are placed together in DSM-III-R. From a biblical perspective, however, they fall into roughly two categories: those related to the body and to the heart... The phenomenon of depression may by caused by the body, the heart, or both. The cause that is most familiar is the heart. When difficult circumstances encounter a heart of unbelief, responses might include guilt, anger, feeling defeated and ‘down in the dumps,’ or despair. Persons who base their meaning on personal performance (i.e., works righteousness) rather than the finished work of Christ are particularly susceptible. Then, because of the unity of heart and body, the heart might initiate a cycle that leads to bodily feelings of depression. These bodily feelings, in turn, can continue the cycle and make the heart more prone to despair. Depression may also be caused by the body---physical processes that are unrelated to personal sin. Disease may produce bodily weaknesses such as fatigue, insomnia, poor concentration, and a sense of alienation. Then affected persons might think, ‘I feel depressed. Why? What has been happening to me? What have I done?’ They look to the heart for answers, and, not uncommonly, the heart attributes blame to itself or bad circumstances, and the whole person plummets into despair.” (Edward T. Welch, Counselor’s Guide To The Brain And Its Disorders, p. 212) V. Following are two anecdotal cases which highlight opposing scenarios of treating depression with antidepressant drugs (some of which are prescribed to offset the side-effects of other drugs). A. “Not surprisingly, although many diseases can cause depression, the number one culprit remains the unwanted and unpredictable side effects of prescription drugs. The documented offenders are nearly endless.” (Edward T. Welch, Counselor’s Guide To The Brain And Its Disorders, p. 212) B. “In July 2005, actress Brooke Shields told the New York Times about her postpartum depression: ‘In a strange way, it was comforting to me when my obstetrician told me that my feelings of extreme despair and my suicidal thoughts were directly tied to a biochemical shift in my body. Once we admit that postpartum is a serious medical condition, then the treatment becomes more available and socially acceptable. With a doctor’s care, I have since tapered off the medication, but without it, I wouldn’t have become the loving parent I am today.’ ” (David Kupelian, Why So Many Americans Today are Mentally Ill, 8-14-2007) ( http://www.wnd.com/2007/08/43033/ ) C. “I began to suspect psychiatric meds were problematic three decades ago after a conversation with a friend who, to relieve her anxiety, had been taking the sedative Valium — then the nation’s top-selling pharmaceutical. A spiritually perceptive lady, she summarized her experience this way: ‘David, do you know what the Valium did for me? It deactivated my conscience.’ And just recently, another Christian lady anonymously wrote a highly thought-provoking essay — primarily for the benefit of other female members in her church — on the effect antidepressants had on her. Stressed-out and depressed, she had sought her pastor’s spiritual counsel — and he told her to go on antidepressants. ‘Not a word was said about my sinful attitudes regarding my responsibilities, and there were no offers of practical help,’ she wrote. ‘Just go to the doctor. He proceeded to tell me about many other women in our church who had taken his advice and were doing great. In retrospect, this makes sense — ours was a ‘happy church.’ No one seemed to struggle with any serious life issues. Only smiling, happy greetings and small talk. Imagine the ‘Stepford Wives’ at church and you’ll get the picture.’ Within weeks, she wrote, she was feeling better. ‘By two months into treatment I was doing swimmingly, smiling and small-talking with the best of them. I was handling the stress better and sleeping well. Most of my physical complaints were gone, and I felt very capable. Life went on.’ Five years later, unhappy with their ‘happy’ church, she and her husband sought out and joined a more traditional and biblical church “’ sin is called sin, and people are held accountable.’ At the new church, she said, ‘I met people who grieve over their sin. This was foreign to me. I have never cried over my sin. I have felt bad for my sin, but I have never truly grieved over it. I began to think that perhaps that little pill that was meant to ‘take the edge off’ was preventing me from grieving over sin. One thing I had noticed since being on it was that I could not cry. Nothing could bring me to tears, and I mean nothing. I didn’t even cry when my dad died, not even as I watched him take his last breath, uncertain where he would spend eternity. No tears.’ After much thought and prayer, she finally decided to get off her medication. As a result, she wrote: ‘Last week, after I sinned in anger at my son, I was grieved! I had asked for forgiveness from him and from the Lord, but I could not deny a deep sense of grief in my soul as I realized this had been a pattern of sinful anger for years. I had committed this same sin many times before, but felt justified, either by stressful circumstances in my life or by my son’s bad behavior. I had never before felt such grief over my own sin, and I knew I could not indulge one more outburst like this. The antidepressants, she concluded, had ‘blurred the ends of the emotional spectrum, so that I experienced neither deep sadness nor great joy. I have now come to appreciate that both are vital to the Christian life. Oh, I was somewhat happy, and able to cope with life quite well, but the edge was off, not only from my sadness, but from my joy as well.’ She added: ‘In the beginning, the drug was good, because it enabled me to think rationally and come out of my basement. If I had used that rational thinking to get a grip on the sin that was pulling me down into depression, I could have dealt with it biblically, and been off the drug in short order. But I did not. I became dependent on those pills and was gradually numbed to the seriousness of my sin. By God’s grace, I came to the recognition that this drug could be stunting my spiritual growth, and that turned out to be exactly the case.’ The possibility that psychiatric drugs could impair our conscience should not come as a shock. We know people do bad things under the influence of alcohol, crack and meth that they wouldn’t do otherwise. Is it so hard, then, to comprehend that some legal drugs can also obscure or eliminate our awareness of conscience? After all, what does ‘feeling better’ often involve but the elimination of conflict? And what is conflict but the evidence inside us that we’ve done something wrong — something contrary to our conscience? Getting rid of conflict, then, often involves blotting out our conscience! But the problem with that is, conscience is literally the presence of God in us, the friction between the way we are and the way He wants us to be. We experience this correcting and illuminating presence — which is actually our greatest friend (like Jiminy Cricket in Disney’s ‘Pinocchio’) — as a psychic pain when we deviate from its urgings. Thus, many of us foolishly come to regard conscience as a problem, even an enemy.” (David Kupelian, Why So Many Americans Today are Mentally Ill, 8-14-2007) ( http://www.wnd.com/2007/08/43033/ ) D. “Nearly 150 million U.S. prescriptions were dispensed in 2004 for SSRIs and similar antidepressants called SNRIs, according to IMS Health, a Fairfield, Conn., drug data and consulting company — more than for any other drug except codeine. Perhaps one out of 20 adult Americans are on them now, making brands like Zoloft, GlaxoSmithKline’s Paxil, Forest Laboratories’ Celexa, and Solvay Pharmaceuticals’ Luvox household names. Though they don’t work for everybody — many people have gone off the medicines because of side effects such as dampening of sexual response — they’ve done more than any other class of drugs to spur psychiatry’s substitution of pills for couches. In fact, we’re popping so many SSRIs that their breakdown products in urine, gushing into waterways, have accumulated in fish tissues, raising concerns that aquatic animals may be getting toxic doses, according to recent research at Baylor University.” (Fortune Magazine, Nov. 2005) E. “The biblical position is this: the ravages of brain injury, disease, or dysfunction cannot rob us of spiritual vitality. At the core of our being we are moral creatures, image-bearers of the Most High. Certainly, this center can be defaced or suppressed, but the culprit is sin, not sickness.” (Edward T. Welch, Counselor’s Guide to the Brain and Its Disorders, p. 291) F. I do not utterly discount the value of drug thereapy but if professional clinical help is needed, and drug therapy is recommended, strive to be accurately well-informed about the drug(s) and side-effects, especially sudden termination. G. My pastoral advice to someone struggling with something like depression is to not dismiss the importance of examining yourself, your decisions and your understanding in light of God’s Word. Sin, error and ignorance are well-addressed in Scripture. Pray for help to repent as needed. 1. Faulty rationalizations of sinful thought and behavior do not eliminate the underlying guilt that fosters depression; they only mask the issues that demand change, somewhat like a drug does. 2. Faulty perceptions of God, and one’s ability to serve and please Him while yet a sinner are not uncommonly factors in mental and emotional distress and spiritual stagnancy. MAT 25:24-25. 3. Faulty expectations of personal perfection while in mortal flesh can breed discouragement unto depression when times of moral/spiritual failure occur. That we are to “...press toward the mark for the prize of the high calling of God in Christ Jesus” presupposes that we are not there yet, even though we are a fine example of a Christian with weakness, and this is as perfect as we should expect to be until the resurrection. PHIL 3:13-15 c/w ROM 7:22-25; ECC 7:16. a. Beware of an unbearable obsession with absolute perfectionism which paralyzes personal growth and spiritual liberty, and can push one towards isolation and compulsive rituals. b. “The compulsive rituals become legalistic means of neutralizing or atoning for obsession. Afraid, unwilling, or untaught---those who persistently obsess don't go to God for forgiveness and the assurance of 'no condemnation.' Instead, they use their rituals to appease God or assuage his perceived wrath.” (Edward T. Welch, Counselor’s Guide to the Brain and Its Disorders, p. 222) 4. Faulty expectations of one’s role in the midst of a lost culture can breed discouragement unto depression and so need to be adjusted by applying the principle of putting on your own oxygen mask first and saving yourself from an untoward generation. ACT 2:40; PHIL 2:12-16. a. “O God, give us the serenity to accept what cannot be changed, the courage to change what should be changed, and the wisdom to know the one from the other.” (The Serenity Prayer, variation) b. It is possible to have hope-filled peace through a God-centered moderate view of life in this world and all the troubles and anxieties that would consume us. PHIL 4:4-7. 5. Whereas the gospel pointedly shows us sinners who we are by nature and how much we need Christ, it also shows us that Christ met our need when nothing else or nobody else could. Wherever the gospel pricks our hearts, it also pours in healing oil, even for the spirit of heaviness. ISA 61:1-3. VI. Guilt can be a fertile source for depression that can end up in complete burnout. A. The symptoms arise from the burden of guilt. PSA 38:1-l1. B. Guilt can arise from actual sin or from imagined sin as in the case of thinking that we must be constantly “on the go and on fire for Jesus,” consumed with false spiritual responsibilities to the disregard of practical Christian living such as not being slothful in business or tending to one’s own family needs. ROM 12:11; TIT 3:14; 1TI 5:8. C. Guilt that arises from actual sin should not be ignored nor numbed away by intoxicants or antidepressant drugs which are substitutes for what is really needed: earnest confession of one’s sin, seeking God’s forgiveness, believing it has been granted, and then, “...sin no more, lest a worse thing come unto thee.” PRO 28:13; 1JO 1:9; JOH 5:14. D. Guilt that arises from imagined sin is best cured by applied knowledge of the truth which saves from destruction by casting down the false condemner. HOS 4:6 c/w 2CO 10:5. VII. Unfulfilled expectations or deferred hope are another major source of depression. LUK 24:17-24; PRO 13:12; PSA 13:1-2; JER 15:16-18. A. One can become so absorbed with an unfulfilled expectation that it is all he thinks about. 1. This continuous thinking is exhausting and frightening. 2. In such a state even small problems and decisions become major hurdles. 3. In such a state a person may begin to fear he is “losing it.” B. This is the parent who poured himself into his child only to have that child turn out to be a fool. PRO 17:21, 25. C. It is the parent who keeps hoping that a wayward child will get his act together. D. It is the spouse who longs to see positive change in their spouse but their spouse is not amenable to change. E. It is the person who has been betrayed by a friend he thought he could trust. PSA 41:9; 55:12-14. F. This is the person who thought he could please everybody and discovers that he cannot. G. This is the person who is running out of time on earth and sees so many missed opportunities, things that should have been done, things that should be done, and things that are increasingly beyond his capacity to do.