Q. Dr. Hart, you have said that surviving ministry is, for many, surviving depression. What do you mean by that?
A. It is my contention that ministers are more prone to depression. ion than people in most other jobs. One of the major causes of depression in ministry is the idea that because it is "sacred work," certain obstacles should not occur. "If God is with me in this, then how is it things don't go smoothly?" This sets up an incredible level of expectations and frustration.
There are other factors also. Ministers tend to "spiritualize" the relative importance of their work as a way of psychologically compensating for the low wages. Depression can also be a problem because of the singleness of purpose many ministers have. Then there's the matter of time pressure. Ministers have no clearly defined time boundaries to their work. And ministry is depression-prone because it is primarily people-related. People cause stress. People cause conflict. People cause depression.
Q. What exactly is depression?
A. Depression is one of three things. Occasionally it may be a symptom of another illness. Some cancers and other diseases give rise to significant depressions. Then, for about one person in ten, depression can be a disease entity of itself. We call these biological or endogenous depressions, which seem to be caused by biochemical disturbances within our bodies. Most commonly depression is a reaction to loss or deprivation. We are designed such that we enter the strange emotional state of depression whenever we experience loss, and this we call the grieving process.
Endogenous depression responds very well to antidepressant medication, whereas purely psychological depression doesn't respond to such medication at all.
Q. What kinds of losses can trigger depression?
A. I divide losses into four categories: real losses, such as loss of a loved one, a job, or possessions; abstract tosses, such as the loss of self-respect when someone criticizes a sermon, or the loss of love when someone rejects us; imagined losses, by which I mean the imagined hurts that others are causing us; and threatened losses, which are the most difficult to resolve because there is nothing to grieve over yet.
Q. Does depression have a purpose? .
A. Yes! I call it the healing emotion. It's designed to facilitate healing by removing us from our environment. If we can help the depressed person recognize that there is a reason for his depression, we've made a step in the right direction. Then we must help him deal with the cause of depression instead of just telling him to resist the depression itself.
Q. How can a person recognize depression?
A. I divide symptoms into three main clusters. First is loss of interest or ambition—loss of interest in one's environment, loss of interest in hobbies, loss of interest in sex, loss of interest in friends, not wanting to answer the telephone. The second cluster I call psychomotor-retardation. It results in fatigue, lethargy, and a loss of energy, so everything slows down. The third cluster has to do with the feeling of sadness that goes with depression. Of the three, the low mood, which most people identify as depression, is the least important. So many people, when you tell them you think they are depressed, reply, "But I'm not feeling sad." They fail to see the psychomotor-retardation — the loss of interest in their environment — as evidence that they are depressed.
Q. Is it possible for a person to diagnose depression accurately in himself or herself? /
A. Not usually, because it clouds a person's awareness of what's happening; it requires some feedback from an alert individual. We all experience depression, but we do not all label it accurately because it is masked by other emotions. Anger or loneliness can mask depression. We also mask depression by becoming compulsive. I have learned to recognize my own depression because there is a vague feeling of discomfort in my stomach that goes along with depression. Whenever I feel that, I ask myself, "Am I depressed?"
Q. Depression is a continuum, obviously, between mild depression and psychotic depression. How can people gauge the seriousness of depression in themselves or others?
A. Again, you really need an objective outsider to help you understand that. You can't trust your own feelings, because the more depressed you become, the less interest you have in whether or not you're depressed. In an extreme form of depression you're not interested in the existential state of being depressed. You're preoccupied with the consequences of the depression.
Q. Meaning what?
A. Meaning that you're so unhappy, you're so miserable, you don't care about whether you're depressed or not. Your attention is on how miserable life is, how this matter is bothering you, and how worried you are about that event occur ring. You are so caught up in the experience of the depression that you can't stand back and view it objectively.
Q. Can you categorize different levels of depression by their symptoms?
A. In mild depression we continue to function normally; we can tolerate the feeling. Medium depression begins to affect us. We start canceling out on obligations. In severe depression, people are totally incapacitated and unable to take care of themselves, and that can be dangerous. They won't eat. Their wish to die is so strong that suicide is a real threat.
Q. What do you do to help people in that kind of severe depression?
A. Very often you have to force them against their will to go for treatment. You must make sure that they are placed in a safe environment, that they are given fundamental care, that they are given nutritional care. Sometimes that can be provided in a home where people are available, but often it means hospitalization.
Q. At what point should a person seek professional help for depression?
A. That's a very difficult question. I think you should seek help for your depression when it is not getting better. I think a depression that lasts for more than a month needs professional help, because most reactive depressions will clear up sooner than that. If it's not being resolved, either you're not coming to terms with your loss or else there is a complicating physiological variable. Also, if your depression incapacitates you, if you're canceling out on any significant appointments, it's out of control. You need help. Third, you need professional help if any close acquaintance says to you, "You need help!" because he wouldn't say it unless he could detect a significant problem.
Q. When a person recognizes that he or she is depressed, what action should he take to deal with it?
A. The first step is to recognize your depression. I encourage people to engage their spouse or friend to help them here. Since the depression is a signal that we've lost something, and since so many of the losses we can experience in our culture are abstract or imagined or threatened, the sooner we get in touch with the signal, the sooner we can resolve the matter of the loss.
The second step is to identify the trigger. What have I experienced as loss? If it's an imagined or threatened loss, check it out. You are far better off knowing reality than not knowing reality.
The third step is to face and accept the reality of the loss. For example, how do you counsel people who go through bereavement? You take them to see the body of the deceased, don't you? I saw a woman once who had been depressed for more than two years after her husband had died of a heart attack in his late thirties. One day someone persuaded her to come and see me. She told me that their bedroom was still just as it was when her husband died. His shoes and slippers were under the bed, his clothes hanging in the closet. She hadn't faced the reality of the loss. In her imagination somehow he was still going to come back. I called up a friend of hers and with the friend's help forced her to go home that day and clear out every single thing of his. She came back the next week and her depression was gone! She had done with her grieving the moment she faced the reality of the loss. We prolong depression unnecessarily because we play denial games instead of being in touch with reality.
Fourth, develop a perspective on the loss. If the gospel does nothing else, it puts perspective on this life and forces us to separate the essentials from the nonessentials and to stop "catastrophizing" things. I helped a young man once who'd borrowed money from everyone in the church to go into business, only to go bankrupt a year later. He called me up one day and said, "I'm about to take my life. But somehow I think God is saying to me, 'Just go once and talk about this.' " For the next two or three weeks I talked with him, forced him to face the reality of the loss, and forced him to face his friends. Then we tried to put it in perspective. Slowly he turned around, and six months later he was in mission school preparing himself for missionary service. He had turned apparent catastrophe into a glorious spiritual-growth experience.
Last, we must learn from our depression. Some of us experience the same loss over and over again. Every week, depressed. We have to work at changing our value system to avoid repeating our loss. We may need to improve our communication or the way we think, or learn to take control and be more assertive. I try to make it a principle of my life that every time I am depressed I learn from that experience.
Q. Can a minister keep on doing adequate postering during a depression?
A. It depends on the severity of the depression. In mild depression you can go about your work and probably no one will notice. But I have worked with pastors who are in very severe depression, and unfortunately, the depression has led them to be quite dishonest. Often they have found them selves saying they were out on a series of calls all morning, when they were lying in bed at home. With depression that severe it is vital to get into treatment as early as possible.
Q. Should the minister ask for time off?
A. I think that in the case of a severe depression, he should get advice from whoever is treating the depression and take a leave of absence if necessary.
Q. Can a minister who has to put out a lot of adrenaline on church day expect to experience depression as a result?
A. Yes, the minister who uses a lot of adrenaline will experience a significant drop of that adrenaline when the demand diminishes, resulting in what we call a postadrenaline depression. The day after preaching or peak demand in a typical minister's life can become a day of very deep depression.
Q. How should he or she plan to handle that?
A. First of all, try to reduce the use of adrenaline ahead of time by good relaxation during the week. The day before a heavy engagement he should be more rested up than at any other time. Then he should plan for a low level of routine activity on the day following the peak demand: paper shuffle, just doing mechanical things in order to maximize recovery. I do not advocate that the day after necessarily be the day off. That should come later in the week, preferably, when the person's adrenaline system has recovered, so he can enjoy family activities when he's not in this lowgrade, depressed, fatigued state.
Q. How does exercise fit into an adrenaline management program for a minister?
A. It can help in a number of ways. If your body is producing excess adrenaline, exercise will absorb it like a sponge and get rid of it quicker for you. Exercise also builds the system's tolerance for adrenaline. The demand for adrenaline diminishes. Exercise helps to tranquilize the system. Research shows that exercise increases endorphins, which are the brain's chemistry to both tranquilize and suppress pain.
Q. Is depression a sign of failure?
A. No, depression is a natural consequence of certain psychological or physiological events. In the case of an endogenous depression, the physiological event is a disturbed body chemistry, and the depression is a natural consequence of that. In the case of psychological depression, the depression is usually a response to loss, and it is a natural response to loss.
Q. Is it sinful to be depressed?
A. That depends on the cause. A person, for example, who has a disturbed body chemistry and refuses to get treatment for that may very well be sinning in remaining depressed. Similarly with psychological depressions. If I am depressed because the IRS has caught me cheating on my income taxes, the depression is normal and natural. What is sinful is the cause of the depression. If I put the cause right, my depression will often go away. So we need to make the distinction between the cause, which can be sinful, and the consequence, which is always a natural response.
Q. How can a spouse help a minister cope with depression?
A. By helping the pastor do some good reality testing. She can respond to imagined or threatened losses by kindly saying, "How do you know that's true? Why don't you check the figures again?" By helping the pastor to be more in touch with reality, she has a part in facilitating the healing process.