Depression is one of the most common emotional diseases of our times. In the United States it hits 10 to 12 million people every year. Statistics indicate that about one out of every 10 American males and one out of five females are likely to experience depression this year.
Depression is a very subtle disease. William Styron, out of his own battle with depression, describes it as "a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self— to the mediating intellect—as to verge close to being beyond description." 1
Donald Klein and Paul Wender write that "depressive illness can be insidious because it frequently resembles the kind of unhappiness that is a normal part of human living. Without help, most people cannot distinguish between psychological depression and biological depressive illness. One reason is that most people, when depressed, immediately trace their emotional state to problems in their current or past life, failing to recognize distinctive clues hinting that they may instead be suffering from a disease."2
Depression is a disease of the mood that seeps into the brain. It does not come in a dramatic fashion. My own experience is consistent with this notion. Perhaps ministers would find it difficult to admit the presence of such a condition, because of the conviction that we, above all others, should be able to make use of the spiritual knowledge we have to take care of our own problems. Thus perhaps clergy possess an attitude that rather complicates the process of acknowledging and dealing with depression.
I know whereof I speak. I have fought a hand-to-hand battle with this frustrating malady. The first indications that something was wrong began early on in my pastoral ministry. Almost every year, about the end of spring and beginning of summer (the significance of this I will share later), I would spend a week or two ruminating on my discouragement in ministry. As the years went by, I would actually imagine myself changing my occupation.
These episodes increased in frequency until finally I sought help about 14 years ago. I began seeing a therapist. Word spread quite rapidly through the conference office. The fact that I was receiving psychological help became the subject of much comment. Hopefully attitudes have changed in recent times.
Subsequent to the summer of 1987, when I had to have both my hips replaced, depression became quite acute. I began using medication. After a few days of taking medication, I felt extremely edgy and anxious, to the extent that I thought that at any moment I might have a nervous breakdown. (I have since learned that antidepressants can act adversely with one's body chemistry, producing the opposite effect they were designed to create.) When I told my psychiatrist my experience, he immediately changed the prescription to one that turned out to be more agreeable. For about two years I experienced normal moods. I felt so good that I discontinued the medication.
That was a mistake. I slid back into depression in about two years. And even then, when it became full-blown, I did not recognize it. I thought I was just experiencing burnout from my work. It is often the case that those who suffer from depression or manic-depression will get on a medication that gives good results, only to stop taking it. Kay Jamison writes of her battle with manic-depression, which she eventually found could be treated successfully with lithium. She repeatedly discontinued the medication, only to have the disease return with a vengeance.3
I too quit taking medication on occasion, only to have my disease return. Through the years I have experienced many twists and turns in the development of depression and in efforts to find relief. I have felt great fear and anxiety that always seemed to attach themselves to some stress in my environment. A few years ago my wife and I took a short vacation to one of our favorite places, Santa Fe, New Mexico. I was standing outside a store where my wife was shopping. Suddenly feelings of anxiety overwhelmed me. I thought to myself, I must hold on. If I don't, I'll have a nervous breakdown right here. At the time our church was experiencing a tremendous budget deficit, and all during this brief vacation I was preoccupied with this problem.
I have experienced fatigue for months at a time. Sometimes I had to think about putting one step in front of the other, just to get my work done. And I have had periods of insomnia, often waking up at 3:00 or 4:00 in the morning and not being able to get back to sleep, all the while ruminating over a multitude of worries.
Currently I am happy to have reached a point of relief. I have a lot of energy and zest for life that I haven't felt in years. (I'll tell you how I reached this state later.) In the effort to find healing, I found help in a medical maxim that says, "If what you are doing is working, don't stop; if what you are doing isn't working, try something else." This especially applies to depression.
Causes of depression
Today we know much about the causes and treatment of depression. "We now know that many mental disorders are actually biological in origin."4 Styron adds: "The madness [depression] results from an aberrant biochemical process. It has been established with reasonable certainty that such madness is chemically induced amid the neurotransmitters of the brain."5
Serotonin is the neurotransmitter that communicates a sense of calm and well-being to the cells of the central nervous system. With an increase in serotonin comes a peaceful state, but with a decrease comes a feeling of agitation.
Research has shown that there are many different sources for the decrease or increase of serotonin. Klein and Wender have found that "the majority of cases of depression and manic-depressive illness appear to be genetically transmitted and chemically produced. Stated differently, the disorders seem to be hereditary, and what is inherited is a tendency toward abnormal chemical functioning in the brain."6
One can inherit a weakness in the brain chemistry that responds more easily to external factors. Stress or inadequate sleep, for instance, can affect the body chemistry and lower the level of serotonin.
Blood chemistry can be affected by real-life events, such as the death of a loved one. Researchers believe that depression is often the result of "incomplete mourning" in a young person who in his or her early life has suffered the death of a parent or a loved one.
Howard Kushner, a social historian, has studied Abraham Lincoln in connection with the severe depression that Lincoln often experienced. At one point in his life Lincoln was heard to say, "I am now quite certainly the most miserable man alive." During his youth Lincoln often experienced suicidal impulses. Kushner believes that these feelings can be linked directly to the death of his mother, Nancy Hanks, when Lincoln was 9. His grief was further deepened when his sister died 10 years later. These losses, which probably were never adequately dealt with, most likely led to his later bouts with melancholy.
My own experience bears this out. My parents were divorced shortly after I was born. My father, who lived in the neighborhood, never came to see me. I actually thought that my grandfather, with whom I lived, was my father. One day a school mate told me that he knew my father. At the supper table that evening when I mentioned this news, I was told of my real father.
When I was 13 my grandfather, who had been a father figure to me, died. I felt so hopeless that I felt I could not go on living without him. He died on June 6, a bright and sunny day. Years later I would discover the connection of this event with how I began feeling toward the end of May and the beginning of June. I recalled how I felt that day in June and realized that this is exactly how I was feeling each year at the beginning of summer as an adult. I have come to dislike summer. Perhaps the failure to mourn adequately these two devastating events has left me with a tendency toward depression.
What depression feels like
Before we look at some possible treatments, let's consider what it feels like to be depressed. What are the symptoms of the presence of depression? There are both physical and psychological symptoms.
First the physical. One may experience an increase in appetite or a reduction of appetite. Some depressives experience a considerable loss of energy, thus feeling an almost constant sense of fatigue. Some depressives sleep more, some sleep less, finding themselves waking up much earlier than usual.
The psychological symptoms of depression include a feeling of worthlessness and an inappropriate amount of guilt; a sharp decrease in the ability to experience pleasure; a sense of sadness and a general loss of interest in life; an indecisiveness about even trivial matters; a marked decrease in the ability to remember; an increase in irritability and anger; and a lack of hopefulness about the future.
Not all of these symptoms need be present for one to be suffering from depression. Norden says that "in order to qualify for the diagnosis of major depression, one need have only five symptoms, and depressed mood need not be among them."7
What to do?
If you think you may be suffering from depression, the first thing to do is to get some help. Consult a trained, professional psychiatrist. After consultation, the professional may prescribe antidepressants. "The evidence is compelling that effective medical treatment can relieve or totally remove the symptoms in over 80 percent of people with severe depression."8 These medications are not habit-forming.
When the right antidepressant is found that fits one's body chemistry and is administered in the proper dosage, there are few side effects and no "high feelings" or euphoria.
In the initial interview you can determine the doctor's attitude toward the use of antidepressants and if he or she has had experience in their use. Remember that a psychologist cannot prescribe medications, but a psychiatrist can. Psychotherapy along with the use of medication will be greatly helpful. I have learned much about myself and my disease through therapy. I have a very comfortable relationship with my current psychiatrist, so that when we meet periodically to discuss my medication, I also feel free to talk with him about current problems that affect my emotions.
In addition to therapy, other helpful measures in depression management are: adequate exercise (30 to 60 minutes three to five times a week); at least eight hours of sleep per night; a diet low in fat and sugar; and stress-reduction techniques.
In dealing with depression, a combination of approaches is most effective. Currently I am taking a small dosage of an antidepressant. I am also eating a diet low in fat and with very little sugar. For exercise I have adopted a weekly schedule of weight lifting three times a week and walking about 50 minutes three to five times a week. The result? I am feeling good, with lots of energy and a bright and positive mood.
A Chinese proverb says before you can conquer a beast, you must first make it beautiful. In a sense, that has been my stance toward depression. I have learned about the incredible power of the subconscious. I have learned to connect feelings with events, thus moving beyond what seems mysterious to understand the real. I have learned to stay well, to value myself, and to be patient with myself. And most important, I have learned to find strength and peace in the Word of God, particularly in the Psalms. David's experience with depression and fear has helped me find a place of refuge.
Out of our wounds, an advantage
As ministers we often become aware that the wounds of our life give us an advantage in ministry and a broadening of our influence. Because I have experienced depression firsthand, I have been able to talk with those suffering from the same disease with confidence and authority. I have been with the same congregation now for 14 years. I have been honest and open with them about some of my struggles with depression. It has made me more human to them and has encouraged them to keep on with their own battles.
In The Wounded Healer Henri Nouwen shares a Jewish parable of the Messiah. The Messiah, covered with wounds, is sitting at the city gate waiting for someone to appear who needs healing. It is the wounds of the Messiah that enable him to heal. "By his wounds we are healed" (Isa. 53:5, NIV). And it is the wounds of pastors that also enable them to have influence and grace in the lives of those before whom they preach and live.
So if you are suffering from depression and you decide to get help and you find healing, don't be ashamed to share your journey with your flock. Thank God He has given you the grace of weakness that you might come to experience the strength that He provides. Your calling is to share this with your people.
1 William Styron, Darkness Visible: A
Memoir of Madness (New York: Vintage Books,
1990), p. 7.
2 Donald R Klein and Paul H. Wender,
Understanding Depression: A Complete Guide to
Its Diagnosis and Treatment (New York: Oxford
University Press, Inc., 1993), p. 6.
3 See Kay Redfield Jamison, An Unique Mind
(New York: Alfred A. Knopf, 1995).
4 Michael J. Norden, M.D., Beyond Prozac:
Brain-toxic Lifestyles, Natural Antidotes, and
New Generation Antidepressants (New York:
HarperCollins Publishers, Inc., 1995), p. 4.
5 Styron, p. 47.
6 Klein and Wender, p. 87.
7 Norden, p. 6.
8 Klein and Wender, p. 9.
Continuing education exercises:
Questions for reflection:
Because depression is such an insidious emotional disease, it may be difficult to
determine its presence, Here are some questions to ask yourself:
1. Has my general mood become "depressed"? Remember that everyone has ups
and downs and mood changes. But if you are experiencing an extended period
of feeling down, then this might be a sign of depression.
2. Am I experiencing a drastic change in my sleep pattern? Do I want to sleep all
the time? Do I find that I am waking up very early and not able to go sleep
3. Am I waking up feeling very anxious? Do I find myself not able to go to sleep
at night because of anxiety?
4. Do I find myself losing interest in those things in which I was once interested?
5. Does everything about the future look hopeless?
Burns, David. Feeling Good. New York: William Morrow and Co., lnc., 1980. A
"cognitive" approach to healing depression. The patient is taught to change the
way he or she interprets or looks at the things that are causing the condition.
Jamison, Kay Redfield. An Unquiet Mind. New York: Alfred A. Knopf Inc., 1995. A
practicing therapist's autobiographical battle with manic-depression.
Klein, Donald F., and Paul H. Wender. Understanding Depression: A Complete
Guide to lts Diagnosis and Treatment. New York: Oxford University Press, Inc.,
1993. A thorough and comprehensive work on depression, including its
symptoms, causes, and treatment.
Norden, Michael I., M.D. Beyond Prozac: Brain-toxic Lifestyles, Natural Antidotes,
and New Generation Antidepressants. New York: Harper Collins Publishers,
Inc., 1995. In addition to dealing with the nature and symptoms of depression,
the author provides different treatment approaches including the use of
Styron, William. Darkness Visible. New York: Vintage Books, 1990. Styron tells the
story of his own descent into suicidal depression and how he found healing.