The great depression

By David Bruce Rose and Amy Stone

"I don’t always know how to help make depressed people feel better, but I know how to make them feel worse. All I have to do is say, ‘Don’t be depressed.’”—Aaron Beck, M.D. author of Cognitive Therapy for Depression

Before I (David Bruce Rose) began as associate professor at MB Biblical Seminary, I had a private practice as a psychologist and served as a parish associate pastor in Fresno. A few years ago, that church’s head of staff asked me to teach an adult Sunday school class on depression. He said that depression was a recurrent theme as he visited with people.

Since this man was usually very sensitive to the needs of the congregation, I agreed despite my concerns that only a few might attend. After all, while the scientific research shows that Christians are less likely to be depressed than the general population, believers are no more immune to depression than they are to cancer or heart disease.

We were completely surprised by the response. So many people attended the class that we had to move from the normal classroom to the sanctuary. Question after question came regarding the relationship of depression to faith, the causes of depression and ways to alleviate depression. Clearly depression was more important to the people in my church than we thought, and I imagine that is true for most churches.

Despite being called the “common cold of mental health,” many Christians feel alone, cut off from the church and our Lord when they are depressed. But the promise that “neither death, nor life, nor angels, nor rulers, nor things present, nor things to come, nor powers, nor height, nor depth, nor anything else in all creation will be able to separate us from the love of God in Christ Jesus our Lord” (Rom. 8:38-39) includes depression. While depression may cause us to “feel” cut off from God, those feelings are not accurate.

More than a low mood

Everyone feels sad, tired or irritable from time to time. Sometimes we just don’t want to face the tasks of the day. But, most of us have ways that help get us back on track—take a walk, have a nap, call a friend, etc. With self-discipline we can do what’s necessary, and on reflection we may even enjoy it. These “down” feelings and lack of energy are sometimes labeled depression, and it is normal for people to experience worries, sadness and negativity. But it is important to know that the illness called depression is more complex than an occasional low mood.

Depression (sometimes called Major Depression, Unipolar Depression or Clinical Depression) is one of several mood disorders. These affect the whole person: feelings, thoughts, behaviors, physiology, relationships and even one’s faith. Depression disrupts normal life. It is debilitating and at times can even lead to death.

Unlike the times when we feel “down,” willpower alone does not help depression. In fact, fighting depression by sheer force of will can even make the problem worse. The inability to power through the pain can often lead us to feel worthless, helpless or guilty. These feelings are especially true for those who believe that depression demonstrates a failure of faith. And this is why talking about depression in our homes and churches can be critical to our spiritual health and our relationship with God.

The invisible illness

Mood disorders, like depression, are often more frustrating to cope with than physical illnesses or injuries because they are “invisible.” When you look at a person who has depression, you don’t see a wound. They don’t have a fever, and there is no lab test to diagnose the problem. Rather, depression is diagnosed based on a person’s feelings, thoughts and behaviors.

Depression causes many people to feel sad, helpless and hopeless most of the time, while causing others to feel irritable and angry. Some describe feeling numb, without any emotion. They don’t enjoy activities that once brought them pleasure. Their thoughts change as well. Life seems gloomy, and they perceive themselves, their environment, and their future more negatively than other people do. Surprisingly, the objective facts about their life may be relatively positive.

On the other hand, people with depression are sometimes more accurate in their assessments of reality, but have lost the capacity to manage their negative feelings. In either case, even if they can remember good times, they frequently cannot imagine enjoying life again.

Physical effects

Depression is not just “in your head.” In addition to excessive negative emotions and thoughts, this illness affects people’s physical bodies as well. Depressed people have less energy and may avoid physical activity not because they are “lazy,” but because they simply don’t have the energy.

Sleep problems are common, such as difficulty falling or staying asleep or sleeping far too much. Appetite changes can also occur—loss of interest in eating or wanting to eat more than usual—and can result in significant weight changes. In addition, depressed people are frequently more sensitive to pain and may develop aches and pains they never had before.

With this in mind, it is not surprising that depression affects more than just feelings, thoughts and physiology. It also affects relationships, making it much more difficult to connect with others. Normal activities may feel exhausting, leading depressed people to avoid friends and family. They may resign from volunteer positions or perform poorly at work. Many find that family life becomes unusually stressful as spouses and children are also affected. Depression is isolating and significantly limits one’s ability to be present in ways that build relationships.

These troublesome changes are, in part, biological. Commonly called a “chemical imbalance,” depressed people show lower levels of certain neurotransmitters, chemicals that help the neurons in the brain “fire.” Because of the low levels of these chemicals and the damaging effects on the neurons themselves, the parts of our brains that we use to feel hope and joy are impaired, as are the parts that help manage our stress levels.

Depression and faith

Finally, depression can affect our faith. The negative perceptions, hopelessness, discouragement, confusion and lack of energy all make it difficult for us to relate to God and his people. For depressed people, prayer often seems empty and ineffective. Worship may become difficult and painful. Fellowship can become awkward and Bible study can result in increased confusion, guilt and hopelessness. It is very easy to confuse an episode of depression with a crisis of faith.

Depression can be discouraging, both to people suffering from the disorder and to the people around them. But there is hope, and, as seen in other articles in this issue, we, the church body, have power and resources we can use to help ourselves and one another. Counseling, medication and behavior changes, along with spiritual practices such as worship, prayer and Bible reading can help.

When symptoms of depression seem apparent in members of our congregation, we need to carefully consider how to minister to them. Sometimes we try to help church members struggling with worry and cynicism by telling them to remember God’s goodness and care. While this is true, it is important to see that because depression can affect our thinking, encouragement to simply trust God more may actually increase feelings of self-condemnation.

Sometimes these messages can make us feel more alone, as though no one understands how hard we are trying. Or they can make us feel even more hopeless, as if even God cannot help us. We may wonder why other people are able to walk in faith while we cannot. We may ask, “What is wrong with me that God has abandoned me?”

What can churches do?

So, what kinds of faith expression can we expect from those of us with depression? Maybe showing up at church and trying to worship may require all the strength they have. Maybe our meager offerings of silent attention to them are as appreciated as much as the widow's last two coins.

What practical things can congregations do? First, we can speak against the powerful stigma that still surrounds mental illness. We can communicate messages of love, hope and acceptance in sermons, small groups and through prayer. We can encourage those of us who are chronically sad or worrisome that they are not simply lazy Christians. Faith and hope that one day God will relieve the pain, in spite of present emotions, can be a powerful demonstration of Christ-like character.

Second, we can be a resource for members who need the expertise of professional helpers. Pastors cannot do it all, but they can offer themselves as a resource in the church for connecting people with physicians and licensed counselors who are sensitive to the special concerns of Christians while they continue to help the depressed person address their spiritual needs. A resource list may include: licensed counselors, clinical social workers, psychologists, family practice physicians, psychiatrists and specialized support groups.

Share our own suffering

Third, we must all consider the ways that depression may have affected our own lives, whether in ourselves or in our families. Often our own experience with suffering is the best place to start when helping others. Henri Nouwen writes about giving real help in his well-known book, The Wounded Healer. Nouwen encourages us to minister in the way that Jesus did, sharing our pain. Likewise, the prophet Isaiah describes the servant of the Lord as “a man of sorrows, and familiar with suffering” (Isa. 53:3).

Nouwen goes on to say that transparency about our own experience with suffering “does not call for a sharing of superficial personal pains but for a constant willingness to see one’s own pain and suffering as rising from the depth of the human condition which all men (and women) share.”

Nouwen describes a young man named Peter who came to him for help. Peter’s life was filled with the loneliness, apathy, and despair that many depressed people know.

Nouwen writes, “I did not paint this portrait of Peter to show you a picture of a man in need of psychiatric help. No, I think Peter’s situation is in many ways typical of the condition of modern men and women…which we too recognize in our own life experiences.”

Nouwen does not see Peter’s life, though painful, as uniquely disturbed. Likewise, in serving those with depression, we must not create a special category of troubled persons. Instead, when we know the shape of our own suffering, leaders can empathize with the depressed person’s struggle and offer help even more effectively. As some of the writers in this issue found, knowing that the church is walking alongside us to Jesus, our common source of help, without condemnation, is a powerful blessing.

David Bruce Rose is associate professor of Marriage, Family and Child Counseling at MB Biblical Seminary. He received his doctoral degree from the California School of Professional Psychology and his master’s degree from Fuller Theological Seminary. Amy Stone is the first student in MBBS’ new combined masters of divinity and masters of marriage, family and child counseling degree program in Fresno, Calif., and is the mother of five children.