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Monday
Apr012013

Finding God in the Black Hole: Depression

Photo: Sue Careless  (Inset: www.Dreamstime.com)

By Allyson Eamer

CHRISTIANS HAVE TENDED to avoid speaking openly about depression.  It’s not a word that has fit comfortably within the Christian lexicon.  We’re acquainted, through Scripture, with downcast, weary, faint-hearted, despairing and distressed. We can cope with discouraged, troubled or even broken-hearted. These, we know. For these conditions, we have clear and legitimate explanations:  death of a loved one, loss of a job, end of a marriage.  We know they will pass.  We know that for the most part they heal with time.  Depression on the other hand smacks of self-indulgence and ingratitude, and thus seemingly has no place in the life of a Christian.  It conjures up images of lethargic, underachieving people engaged in excessive introspection and unable to cope with the demands of modern life. 

But how accurate are those perceptions? Health Canada indicates that 11% of men and 16% of women in Canada will experience major depression in the course of their lives,1 meaning that 27% of Canadians can expect to be affected. As for being lethargic underachievers, increasingly, high-profile Canadians are going public with their diagnoses of clinical depression. Olympic cyclist and speed skater Clara Hughes, tennis star Rebecca Marino, musician Steven Page, comedian Jim Carrey, retired dancer Karen Kain and former Lieutenant Governor of Ontario, James Bartleman, are just a few who shatter the myth of depression as a condition that strikes the slothful.  Indeed, some studies point to an increased risk of depression in high achievers. The World Health Organization predicts that by 2020, depression will be second only to heart disease as the most common cause of disability.2          So why have we, in the church, been reticent to talk about the condition?  The Bible tells us of three spiritual giants who struggled with depression: Job, David and Elijah. Here, in their own words, is what depression feels like:       

Job:          “If only my anguish could be weighed and all my misery be placed on the scales! It would surely outweigh the sand of the seas.”  (Job 6: 2,3) 

David:     “My heart is blighted and withered like grass;
 I forget to eat my food.
In my distress I groan aloud
 and am reduced to skin and bones.”  (Psalm 142:4,5) 

Elijah:     …I have had enough, Lord….

                  Take my life; I am no better than my ancestors.”

                  (I Kings 19:4)

Surely these biblical heavyweights lend some credibility to depression as a very real experience of blackness. Like Job, I have been buried beneath the weight of my anguish.  Like David, I have been so distressed that I have forgotten to eat, and like Elijah, I have asked God to take my life. And like each of them, I am a person of faith.  Depression feels like stepping into a sinkhole, into an abyss, completely beyond rescue and utterly separated from any source of hope or strength – even separated from God.  We can feel ourselves sinking, but without support and strategies for climbing out, we are powerless against the downward pull. We become so helpless against the onslaught of negative self-talk that we believe God himself has grown tired of us and turned away.

 Paul Scuse teaches Counselling in the M.Div. program at Tyndale University College and Seminary in Toronto, and is also an Individual, Marriage and Family therapist.  Paul describes the experience of depression for Christians:

In Galatians 5:22-23, St. Paul tells us: ‘The fruit of the Spirit is love, joy, peace, forbearance, kindness, goodness, faithfulness, gentleness and self-control.’ People suffering from depression can experience the exact opposite of the fruit of the Spirit. They will exhibit the fruit of depression: withdrawal, despair, anxiety, disagreeableness, lethargy, hopelessness and self-absorption.  Well-meaning Christians might then conclude: ‘This must be a spiritual issue.’ With all of the best intentions they start ‘should-ing’ on the depressed person: ‘You should read your Bible more; you should pray more; you should confess your sins.’  The implication is that God has brought about the depression as some form of either punishment or corrective, and that once the depressed person learns the right lesson, or prays more effectively the depression will lift.  This results in the depressed person trying harder: they try to read more spiritual books, pray more, confess more. Yet in the midst of the depression they cannot concentrate, cannot read, cannot pray, and in many cases the depression doesn’t lift.  This results in the depressed person feeling guilty that they have not been able to alleviate their own depression.  So, now they are not only depressed, but they feel guilty and ashamed about being depressed, which makes them even more depressed – and the cycle continues.

Elizabeth Scuse, also an Individual, Marriage and Family therapist, operates Emmaus Pastoral Counselling Services in Markham, Ont., along with her husband Paul. She explains that depression is a complicated illness that includes emotional, physical and spiritual components:

Clinical depression is not something that you can just take a blood test to find out if you have it.  There is no test for it. There are questionnaires out there that have come out of good solid studies over the years that can help people distinguish between whether they are experiencing ‘the blues’ – a normal reaction to difficult situations – or a mental illness called clinical depression.

   She says that while nearly everyone has occasional feelings of sadness, helplessness, hopelessness and irritability, there are distinct indicators of clinical depression:

If you have had four or more of the following symptoms continually for more than two weeks, you should seek professional, medical help: melancholia, irritability, change in appetite, change in sleep pattern, loss of energy, feelings of hopelessness or worthlessness, inability to concentrate, thoughts of death or suicide, loss of interest in things that were previously enjoyed, disturbed thinking, and headaches or chronic pain.

Many of the questionnaires or inventories that Elizabeth is referring to are available online, but should not be used as a substitute for a professional diagnosis.3

So what causes depression? And who is at risk for it?  And those who would insist that depression is all in one’s head? They are quite right.  Depression is in the head, actually the brain to be specific. Depression is a matter of brain chemistry and physiology that predisposes individuals to episodes of profound and persistent sadness, especially in the face of specific life experiences such as stress, trauma and grief.

Researchers at Harvard University have found that, in addition to the already well understood role of neurotransmitters in depression (low serotonin and norepinephrine levels), there are actual structural differences in the brains of people with depression.4 Brain imaging has demonstrated that the hippocampus, which helps us retrieve memories and overcome negative responses, can be as much as 13% smaller than normal in people who live with depression.  Imaging also shows that activity in the amygdala (a part of the brain that has key roles in the formation and storage of memories associated with emotional events) is heightened in depressed people, and remains heightened even after the depression has passed. Furthermore the thalamus, the part of the brain that processes and relays sensory information, has up to 31% more nerve cells related to emotion in depressed people than in non-depressed people.5

But what causes the brain chemistry and physiological changes? How does one develop this illness? Research indicates that genes definitely play a role. A genetic predisposition exists with respect to the biology of depression, both in brain chemistry/physiology and in hypothyroidism, a thyroid disease in which the hormone which regulates serotonin is not produced in sufficient quantity. 

Yet depression is highly complex, and is rarely attributable to only one factor. A ‘perfect storm’ of several of the following factors is required for clinical depression to develop: biology (the limbic system in the brain described above, the endocrine system or the immune system), a stressful or sad life event, or a life change of any kind, a temperament or worldview associated with decreased resilience, medical conditions such as heart disease or out-of-sync circadian rhythms, and even certain medications used to treat unrelated problems. 

The good news is that there are treatments available. The bad news is that discovering the right treatment for each individual often requires multiple successive trials. This is especially true with respect to finding the right drug, or combination of drugs, and the right dosage to affect brain chemistry. In most cases, the best results have been found when pharmacological intervention is combined with another form of treatment ranging from counselling and light therapy to meditation, electroconvulsive therapy (ECT), and Cognitive Behavioural Therapy (CBT).  Recently another alternative has emerged at Toronto’s Centre for Addiction and Mental Health. Known as magnetic seizure therapy or MST, this new treatment uses magnetic pulses (instead of the electrical currents used in ECT) to induce targeted seizures in the prefrontal cortex of the brain. Early studies show very promising results.

Having established that depression has organic origins, and that as many as one in four Canadians will suffer with it, why does it not merit the same kind of compassion and spiritual support with which Christians respond to other illnesses or to other conditions involving emotions?  While many Anglican churches offer cancer and grief support groups, far fewer offer support for people with depression. In fact, we lag significantly behind Protestant churches which, in America at least, have sought, for almost a decade, to provide biblical teaching on depression to their congregations. One need look no further than online video sites such as YouTube to see how well-documented these efforts have been.  Sermons, lectures, workshops, Christian tutorials, and biblical resources are all available through links from these videos to church websites. Godly support, resulting from these concerted efforts, is well thought out and well substantiated by Scripture.  For example, one pastor, recommends the 5 R’s (Routine, Relaxation, Recreation, Rest, and Re-prioritizing)6.  The resources exist, but without someone to point us to them, we can remain imprisoned by the fog of despair.    TAP

See also Frontline page 5 “Two Churches Reach Out to the Depressed.”   

Allyson Eamer is a sociolinguist and university professor, and attends St Paul’s Church, Bloor Street in Toronto.

 

 

Christian Resources for Dealing with Depression

Websites

•      vimeo.com/52623767 The Christian and Depression (Jesse Flowers, Church of Christ, Texas)

•      www.desiringgod.org/resource-library/sermons/spiritual-depression-in-the-psalms Spiritual Depression (John Piper, Bethlehem Baptist Church, Minneapolis)

•      www.thevalorcenter.org/video/life-development-classes Overcoming Depression (Lori Wriston, Valor Ministries, Maryland)

•      vimeo.com/9897762  Surviving Depression (Gary Kent, It is Written, Australia)

•      www.scripturezealot.com/sufferingchristians  (a Christian blog)

•      vimeo.com/10784420 Overcoming Depression (Pastor Wayne Parker, Merriman Road Baptist Church, Michigan)

•      www.haventoday.org/spurgeon-on-depression-gd-434.html For the Preacher Who is Downcast (Charles Spurgeon, Haven Ministries, B.C.)

 

Books

   Neil and Joanne Anderson (2004) Overcoming Depression in The Victory Over the Darkness series). Ventura: Regal Books.

   David B. Biebel, Harold G. Koenig, M.D. (2004) New Light on Depression. Grand Rapids, Michigan: Zondervan.

   Sarah Collins and Jane Haynes (2011) Dealing with Depression. Scotland: Christian Focus.

   John Lockley (1991) A Practical Workbook for the Depressed Christian. UK: Word Ltd. (out of print but used copies can still be found at www.amazon.ca).

   Kathryn Greene-McCreight (2006) Darkness Is My Only Companion: A Christian Response to Mental Illness. Grand Rapids Michigan: Brazos Press.

   John Piper (2006) When the Darkness will not Lift: Doing What We Can While We Wait for God   – and Joy. Illinois: Crossway Books.

   Matthew Stanford (2008) Grace for the Afflicted.  Illinois: IVP Books.

   Howard W. Stone (2007) Defeating Depression. Minneapolis: Augsburg Books.

 

Medical Reference Material

•   www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/depression/Pages/default.aspx (Centre for Addiction and Mental Health, General Information)

•   www.camhx.ca/education/online_courses_webinars/mha101/depression/Depression_.htm (Centre for Addiction and Mental Health, DepressionWebinar)

•   Karen L. Swartz (2011) Depression and Anxiety. The John Hopkins White Papers.

 

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Endnotes

1   www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/depression-eng.php#is

2   www.camhx.ca/education/online_courses_webinars/mha101/depression/Depression_.htm

3   www.depressedtest.com/, www.netdoctor.co.uk/interactive/interactivetests/goldberg.php,

     and www.cawt.com/Site/11/Documents/Members/Evaluation/BeckDepressionInventory1.pdf

4   www.health.harvard.edu/newsweek/what-causes-depression.htm

5   www.sciencedaily.com/releases/2004/07/040702092133.htm

6   vimeo.com/31904633

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