Ministry to the Depressed part 2

Ministry to the Depressed (Part 2)

DEPRESSION is a malady that pervades the entire being of its victims. It operates on three important levels, the physical, the psychological, and the spiritual. . .

-assistant professor of mental health, School of Health, Loma Linda University at the time this article was written

DEPRESSION is a malady that pervades the entire being of its victims. It operates on three important levels, the physical, the psychological, and the spiritual.

Last month we looked chiefly at the physical. We saw that certain biochemical changes are often associated with depression, tending to prolong its duration, and that often these changes are amenable to treatment by physical or pharmacological means. Generally speaking, the severer the depression the more indication there is to employ these physical modalities (antidepressants and/or electric shock).

In those cases where the physician decides that they should be used, there is no need for the minister to feel excluded from the team approach. Psychological and spiritual factors are still of fundamental importance, and must increasingly be dealt with as the patient improves. After recovery, the prevention of relapse is almost entirely dependent upon nonphysical factors. Here the resources of an in formed pastor can be crucial. There is no mind-deadening effect of antidepressants that might interfere with ongoing pastoral ministry.

There is a large group of chronically depressed per sons for whom neither medication nor shock treatment is indicated. Many of them are neurotically inclined individuals who seem to have made depression a sort of life-style by means of which they more-or-less effectively manipulate significant people in their environment. This group is clearly within the province of ministers or other nonmedically trained professionals.

To begin to really understand the basic psychological elements in depression, we shall first consider some childhood experiences and influences that predispose to the development of depression in later life. Next we shall consider some typical personality patterns of those adults who are especially vulnerable to depression. Then we shall look at certain precipitating factors that typically trigger the actual onset of a depressive attack.

This introductory survey of the genetics and dynamics of depression, although necessarily sketchy and incomplete, will afford the reader a sampling of the complexities involved at the psychological level and should enable him better to comprehend the profound bearing that spiritual factors can have upon the prevention and the cure of depression.

Childhood Experiences and Influences

It has been repeatedly observed that from earliest childhood, and throughout life, depression-prone people, even more so than others, are oriented to ward receiving or accepting or taking in. Every human baby during the first months of life is totally helpless, completely dependent upon others (usually mother) for supplying its needs. Therefore the depression-prone baby appears no different from others during this early period of total receptivity. His problems may or may not begin with weaning or with the birth of a sibling. In any event, a change occurs in his blissful state sometime near the end of his first year. This change is often accentuated by certain characteristics typically seen in the parents of depression-prone children.

The editor of the American Handbook of Psychiatry, Silvano Arieti, aptly describes these typical parental attitudes and certain ways in which the child commonly reacts to them.

"This brusque change in the parents' attitude is generally the result of many things: predominantly, their attitude-toward life in general tends to evoke in the child an early sense of duty and responsibility —what is to be obtained is to be deserved. . . . Thus, the child finds himself changed from an environment which predisposes to great receptivity to one of great expectation." 1

How does the child try to cope with this changed situation? Arieti continues: "The predominant mechanism by which he finds security is acceptance of parental expectations. . . . He must live up to their expectations no matter how heavy the burden. It is only by complying, obeying, and working hard that he will recapture the love or state of bliss he used to have as a baby, or will at least maintain that moderate love which he is receiving now." 2

Anxiety about being unable to live up to these high expectations often engenders guilt feelings. If the child doesn't receive love and approval, he is liable to conclude that it must be his own fault. Thus he feels more guilty. Sometimes he wants to be punished in order to atone for his "badness" and to regain the approval of parents.

Another mechanism commonly comes into play. At the same time that the child goes along with the parents' expectations and tries to conform to them, he harbors strong resentment against them for making such impositions. Occasionally the resentment breaks out into rage, temper tantrums, and violence. This increases his guilt feelings, even if the rebellion was only in thought rather than in act.

Resentment and hostile feelings are often deeply covered up or are turned back upon the self to result in feelings of unworthiness and depression. Repressed anger, of whatever origin, is often an important component of depression. This fact has been known for centuries. Priests, even in premodern times, were instructed that "when the penitent complains of torpor, always look for the rancour!"

Typical Personality Patterns

Certain personality patterns appear with great frequency in adults who are depression prone. Perhaps the commonest is that of a self-conscious, dedicated, hard-working person with deep convictions and high standards who seems always to be driven by a sense of duty. It can be seen that the heightened receptivity of these people has led them to accept, take in, and assimilate the high goals and expectations of their parents or of other authority figures. Thus they tend to have strong feelings of patriotism, political loyalty, or religious devotion. Many such people are drawn toward ecclesiastical careers, so much so that depression has been found to be one of the occupational hazards of the ministry.

Another common personality pattern is the overly dependent type. Such persons "have never forgotten the bliss of the first year of life and still expect or demand a continuation of it. They . . . feel deprived and sad when they do not get what they expect. They are demanding but not aggressive in the usual sense of the word, because they do not try to get what they want through their own efforts: they expect it from others. Somehow they have not developed that complex of duty and hard work typical of the accepting, introjecting [prone to incorporate the characteristics or attitudes of others] patient. These patients alternate between feeling guilty and having the desire to make other people feel guilty. They generally find one per son on whom to depend, and they make this other person feel guilty if he does not do what the patient wants." 3

A third depression-prone personality type is seen in the person who superficially is lively, active, and outgoing, but who uses his gaiety as a facade to hide his inner loneliness and emptiness. Such people sometimes protect themselves from depression by flights into mania (upward mood swing), or a variety of self-indulgences.

Common to all types of depression-prone people is the heightened receptivity, the great dependency needs, the emptiness, the need to be filled and to receive succor. Some struggle against their depend ency needs with a fierce show of independence; others passively give in to them, often only to become caught up in hostility and guilt. Trying to fill the emptiness by excessive eating is one psychological explanation of why it is that some (but by no means all) depression-prone people tend to be overweight. Some authorities believe that peptic ulcer is commoner among persons with great dependency needs; their gastric juices are continually overactive in anticipation of food.

Precipitating Factors

Turning now to precipitating factors, we find that depressive attacks are often triggered by such events or situations as the death of a loved one, the realization of failure in an important interpersonal situation such as marriage, or a severe disappointment in relation to an institution or work to which the person has devoted his whole life.

Sometimes a seemingly happy event, such as a promotion, or the wedding of one's offspring, may bring on depression, due to fear of failure to be able to cope with added responsibilities in the first instance; or loss of the child in the second, resulting in "empty nest" sadness. The birth of a child may result in depression for various reasons. Often there is no apparent cause, or triggering event, for the onset of depression, in which cases unconscious factors are often at work.

Common to most of these precipitating factors is a sense of loss, actual or threatened, a feeling of abandonment or emptiness, which reactivates all the earlier feelings of loss of parental sustenance. If the situation involves failure, the person is made pain fully aware that once again he has not lived up to expectations, in spite of all his trying.

A closely related element in the onset of depression, and one that is considered by many analysts to be the basic mechanism, is a loss of self-esteem and a resulting sense of helplessness. Thus Bibring writes, concerning several examples he has given, "In all these instances, the individuals either felt helplessly exposed to superior powers, fatal organic disease, or recurrent neurosis, or to the seemingly inescapable fate of being lonely, isolated, or unloved, or unavoidably confronted with the apparent evidence of being weak, inferior or a failure. In all instances, the depression accompanied a feeling of being doomed, irrespective of what the conscious or unconscious background of this feeling may have been: in all of them a blow was dealt to the person's self-esteem, on whatever grounds such self-esteem may have been founded." 4

Despite the lowered self-esteem and the sense of helplessness, the person does not relinquish his high goals. He still wants to be strong and worthy and good, to be loved and be loving, and not to be aggressive, hateful, and destructive. So he becomes caught up in the tension between his lofty goals and the painful awareness of his (real and imaginary) helplessness and incapacity to reach them. Thus he becomes depressed. Here again, it can be seen that it is often the conscientious, religious person, the one who is ever striving by good works to win back the love and approval of parents or of Heaven, who is especially vulnerable to depression. He easily falls into the wretched state of the man of Romans, chapter seven, who repeatedly found himself helpless to perform the "things that he would."

This is a brief overview of the psychological complexities involved in depression. Next month we will conclude this series with consideration of the spiritual dimensions of this problem.


FOOTNOTES

1. Silvano Arieti, The American Handbook of Psychiatry (New York: Basic Books, 1959), p. 432.

2. Ibid.

3. Ibid., p. 435.

4. Edward Bibring, "The Mechanism of Depression," in Affective Disorders, ed. by Phyllis Creenacre (New York: International Universities Press, Inc., 1953), pp. 23, 24,


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-assistant professor of mental health, School of Health, Loma Linda University at the time this article was written

January 1974

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