Your
speakers are not experts in the fields of psychology or psychiatry. We are pastors
in Christ’s church, ministers
of the Word of God. Both of us, however, have had a great deal of experience in
providing pastoral care for depressed people. I, in addition, teach pastoral
care to prospective ministers in the Protestant Reformed Seminary.
Both
speakers are firmly convinced that there is a significant spiritual aspect to
depression. We are convinced as well that the Bible has the answer to all of
our problems, including depression.
Both
speakers have experienced depression. I struggled with depression/anxiety for
nearly twenty years. These experiences, we believe, give us unique insights
into the subject and have made us better pastors.
The
theme text for the conference is Philippians 4:4-9 with emphasis on verses 6
and 7: "Rejoice in the Lord always: and again I say, Rejoice.... Be
careful for nothing; but in everything by prayer and supplication with
thanksgiving let your requests be made known unto God. And the peace of God
which passeth all understanding, shall
keep your hearts and minds through Christ Jesus.... Those things, which ye have
both learned, and received, and heard, and seen in me, do: and the God of peace
shall be with you." This passage exhorts us to rejoice in the Lord always.
But that is impossible when we are depressed. So the Scripture says we are to be
careful for nothing. We must not be anxious for anything. Anxiety and
depression are twin. Either we are anxious and therefore become depressed or we
are depressed and therefore become anxious. However it happens, those two
almost always go together. When that happens we are called to let our requests
be made known to God by prayer and supplication with thanksgiving (v. 6) and to
think, to ponder, to concentrate on good thoughts (v. 8). God's promise is: the peace of God which passes all
understanding shall keep (guard) your hearts and minds through Christ Jesus (v.
7) and the God of peace shall be with you (v. 9).
Who
gets depressed? It is estimated that
some 15 million Americans suffer depression. These are people of all ages and
in every economic level: rich and poor, Christians and non-Christians, female
and male, young and old, farmers, factory workers, housewives, teachers,
students, lawyers, doctors, ministers, and business people. Interestingly
enough, twice as many women as men suffer
depression. It occurs most often
when people reach their forties and fifties, but can occur at any age. There is
a higher incidence among certain professions: doctors, ministers, and people in
law enforcement.
What
is depression? It is not merely feeling blue or down or sad. There is a normal
range of feeling. This normal range includes high and low points. We are
happy or sad, up or down. All of us experience this. This is not what we are
going to be discussing. What we are going to be talking about is clinical
depression, of which there are two types: depressive psychosis and depressive neurosis.
Depressive
psychosis is characterized by delusional thinking or hallucinations. The most
severe of this type develop lifelong schizophrenic disorders which are characterized
by rambling thoughts, lack of or inappropriate facial expression, withdrawal,
immobility, and "frozen emotions." These people are out of touch with
reality.
People
with depressive neurosis on the other hand remain in touch with reality,
but they are unable to function in a normal way. They cannot fulfill the daily
responsibilities of life in the work place, within the family, in church, or in
society in general. This condition used to be called "nervous
breakdown." It is about this
latter condition, depressive neurosis, that we are speaking.
What
are the symptoms of depressive neurosis? Among the most common emotional
symptoms is what may be called "sad effect." Depressed people cry
often, or at least feel like crying. They feel very, very sad all of the time.
They never laugh. They feel empty, lonely, and especially helpless, hopeless,
and worthless. And, they look very sad. Their eyes are downcast, the mouth
droops, the forehead is wrinkled. They look tired, discouraged, dejected. As the
depression worsens they often lose interest in their personal appearance and
appear untidy.
Another
symptom is painful thinking. David experienced this when he asked: "Why
art thou cast down, O my soul, and why art thou disquieted within me?"
(Ps. 42:5). Depressed people are prone to pessimism. They are prone to
introspection - constant introspection, and in a
self-derogatory way. They dwell on past mistakes, real or imagined. They have a
very negative self-concept. They blame themselves for all their problems. They
develop strong inferior feelings. They anticipate rejection by others and hence
feel rejected and unloved, all out of proportion to reality. Depressed people
crave reassurance from others, but are prevented from accepting it.
All
of this (sad effect, painful thinking) often gets transferred to God. Depressed
people are convinced that God does not love them. They are quite sure that God
does not hear their prayers. They are convinced they have committed the
unpardonable sin or that they are so bad that God could not possibly love them
or forgive them. This leads to feelings of guilt. The depressed are often plagued
by guilt. We are not, of course, speaking of true guilt. One ought
to feel guilty because of unconfessed sin (Ps. 32:3). The problem with
depressed people, however, is false guilt, i.e., that
they assume responsibility for things over which they have no control.
Still
another symptom of depression is anxiety. By this we mean not just worry, but
excessive, constant worry. The depressed person is virtually paralyzed by
anxiety and fear. So affected is he by worry that he is unable to function
normally. Anxiety makes the depressed person function at a very low energy level
and with a sense of futility about the future. He loses interest in activities
he once enjoyed. He loses interest in and avoids people, even close friends. He
wants to be left alone. He loses his sense of humor and becomes indecisive.
Suicidal
thoughts are another symptom. Suicide is the tenth leading cause of death in
the United States, and depression is the leading cause of suicide. Ten percent
of those who threaten suicide actually carry out the threat. Often the threat
of suicide is a manipulative gesture, an attempt to gain attention and
sympathy. But such threats obviously must be taken seriously.
There
are physical symptoms of depression. Bodily movements are decreased. The
quality of sleep is affected. A depressed person is either troubled by insomnia
or sleeps too much: Appetite is also affected. One either eats too much or too
little, to the point of causing significant weight gain or loss. The depressed
are often bothered by constipation or diarrhea, the former being the more
frequent complaint. In women the menstrual cycle may become irregular,
sometimes stopping entirely for months. Sexual interest may decline or
disappear. Other common symptoms are headaches, dry mouth, rapid heartbeat, and
heart palpitations.
What
causes depression? There may be physical causes. Some of these are in fact
quite common and usually of rather brief duration. There is post-partumdepression.
Some women experience depression after giving birth. There is post-operative
depression. Some experience depression after undergoing surgery. There is
pre-menstrual syndrome (PMS), and some women become deeply depressed during
menopause. Alcohol and drug abuse often cause depression.
There
are also emotional/spiritual causes. A highly respected trio of Christian
psychiatrists write, "Pent-up anger is the root of nearly all clinical
depression" [Paul D. Meier, M.D., Frank B. Minirth, M.D., Frank B.
Wichern, M.D., Introduction to Psychology and
Counseling: Christian Perspectives and Applications (Grand Rapids: Baker
Book House, 1982), p. 261]. Children often
learn to repress anger from their parents who repress anger. Many parents
discourage their children from expressing angry feelings, even appropriately.
Having learned to fear anger, such children grow to feel that expressing their
anger will result in rejection and punishment. Repressing anger often leads to
displacing it on someone else. Pent-up anger then may be directed towards
others and take on the form of holding grudges. Or it may be directed towards
oneself, resulting in true or false guilt. The Bible says, “Be ye angry and sin not, let not the
sun go down upon your wrath" (Eph. 4:26). Be angry. That is a command.
There is a righteous anger. But do not be sinfully angry. Get rid of your anger
in a proper way - that is Scripture's teaching. Get rid of your anger before
you go to bed! Do not bottle it up inside and bear grudges.
Certain
personality types are very susceptible to depression. There is the
obsessive-compulsive personality. He is the person who wants everything done
right and wants it done yesterday! And he has to do it. He is the
perfectionist, the workaholic, the "take charge" type who cannot
delegate anything to others. Never wanting to say “no"
he allows others to make impossible demands of him. In a sense this is a good and
commendable trait. These are the people who get things done. But trouble comes
when this becomes an obsession! A person will then work too hard and too
long and often become physically run down. What is more, the
obsessive-compulsive person is never satisfied with his work. This is where
anxiety enters. If this person does not, by God's grace, learn to take control
of his life, he will likely become depressed.
Poor
self-concept or low self-esteem is another cause of depression. This may have
been caused by parents who were never satisfied with the child's school work,
who were hyper-critical, who seldom if ever praised him, or who were overly
protective and never allowed him to "grow up." Or the person may have
been excessively teased by his peers, and as a result he just does not feel
accepted. Or the person is constantly comparing himself to others, and in his
mind he just does not measure up. The result is often excessive, unrealistic inferior
feelings.
There
are also precipitating causes. This refers to those events in our lives
which may become the immediate cause of depression. Included are such
things as: the death of a spouse or close friend or family member, divorce or
marital separation, a large mortgage or other debt, changing jobs, retirement,
marriage, last child leaving home, etc.
Having
said all of this we conclude by noting that sin lies at the root of all these
problems. We do not mean merely sin in general. It is true, of course, that depression
is one of the consequences of the fall of Adam. Were it not for the fall of
mankind into sin, and were it not for our sinful natures, there would be no
depressed Christians. But specific sins, unconfessed sins, produce depression.
The adulterer and habitual drunkard are likely to become depressed as long as
the sin remains unconfessed. More than this, to be obsessive-compulsive as
described above is sinful. The Bible tells us often and in many different ways
that we may not live that way. To feel inferior is sinful. I must accept my
God-given talents and calling and with these gifts serve my Lord. And, I must
accept changes in my life in faith.
I
must rejoice in the Lord always! And when, because of the burdens and trials of
life I find this difficult if not impossible, I must not be anxious. Rather I must by
prayer and supplication let my requests be made known to God. His promise is
that His peace will keep my heart and mind through Christ Jesus!
Robert D. Decker
