Depression: Its Nature and Symptoms

Let's begin by exploring the nature of depression. What is it? What does it feel like? What are its symptoms? If you're like many people, you may not recognize your own depression and so may need the help of someone else to understand your situation. If you do recognize it, you may regard it as an unnatural condition, and indication of failure or weakness.

   The questions and answers given here are intended to provide you with an accurate understanding of depression and to correct mistaken notions you may have about this widespread condition.

WHAT IS DEPRESSION?

   Depression is the most complicated of all our emotions and yet one of the most common psychological problems a person can experience. Someone has called it the "common cold" of the emotions.

   It's a feeling of gloom or sadness that is usually accompanied by a slowing down of the body. It is not just in the mind but is experienced throughout the whole body. It's in the stomach as much as in the head.

   We are all designed to experience depression. At some time in their lives, probably one of every five people will experience depression seriously enough to hinder their normal way of life.

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WHAT IS THE NATURE OF DEPRESSION?

   Depression can be seen as a symptom, a disease, or a reaction. As a symptom, depression is part of the body's warning system, calling attention to something that's wrong. It alerts us to the fact that there has been a violation of some sort. Something is missing or lost. It can also be a symptom of something physically wrong. Depression accompanies a wide variety of physical disorders, such as influenza, cancer, and certain disturbances of our endocrine system.

   But depression is also a disease in itself. In its most severe form, the psychotic depressions, it is an illness category all its own. Known as a major depression, it has two forms: unipolar depression (one just gets severely depressed) and bipolar depression (alternating manic and depressed moods).

   Finally, depression can be a reaction to what is going on in life, or more specifically, to significant losses one experiences. This last form is known as reactive depression. It's the kind most people have to contend with in their daily lives. If we are emotionally healthy, we deal with those losses promptly, and the depression is short-lived. If we're not, the depression lingers and may even get worse or chronic.

   Are there different categories of depression?

   Broadly speaking, there are three major categories of depression. First, there are endogenous depressions. These come from within the body. They are generally understood to be cause by biochemical disturbances in the brain, the hormonal system, or the nervous system. Some are the direct consequence of disease or infection. We don't fully understand everything about how the brain's chemistry can be disturbed, but these depressions respond so well to antidepressant medication that it's generally accepted that they have a biochemical basis.

   These depressions often occur in a cyclical manner. Every now and again the person becomes depressed, and there seems to be no reason for it. Such depressions are aggravated by fatigue and stress.

   Psychotic depressions are the severest form of endogenous depression. They have nothing to do with personality and can overtake even a cheerful and upbeat person. They're called psychotic because the symptoms are extremely severe. Often there are delusions of hopelessness and wickedness so bizarre that it's evident the person is out of touch with reality.

   The second group of depressions is known as exogenous depressions (meaning "from without"). These are reactions to what is going on externally, the depressions we experience in day-to-day living. They are psychological in nature.

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   I would characterize these as a form of grief. They are reactions to loss — part of a grieving process in which we come to terms with that loss. It's a process of "letting go." It takes us into a low mood so we can resolve our experience of the loss. This is such an important category of depression that I have devoted most of chapter 2 to it.

   The third group of depressions I call the neurotic depressions. These differ from the reactive depressions in that they're responses to the stresses and anxieties of life that have built up over a long period. They happen when we don't grieve our losses in a healthy way. Rather than coming to terms with them, we develop a lifestyle of self-pity. We begin to wallow in feeling down and sad. We retreat into depression as a way of escaping from anxiety.

   Clearly, neurotic depression is unhealthy. It feeds on its own misery. A person suffering from it refuses to get out of bed and engage life. There's a pervasive sense of fear, and the depressive feelings are an escape from life. These depressions, therefore, are chronic and can easily develop into life-long patterns. They are also the most difficult to treat, especially if the sufferer doesn't want to be helped.

   As we proceed, the differences between the kinds of depression will become clearer.

WHY IS DEPRESSION SO HARD TO DIAGNOSE?

   Because depression can mimic many illnesses, it can often go undiagnosed for a long time. The many illnesses it can mimic include general health problems, central nervous system disturbances, gastric problems, muscular problems, heart problems, respiratory problems, and even skin problems. Depression can mask itself with anger, headaches, backaches, fatigue, irritability, hypersensitivity, and a whole range of disturbing sensations.

   The gastro-intestinal tract (stomach and colon) is a common site for depressive symptoms. Often there is weight loss or the opposite, weight gain. Food and alcohol are common tranquilizers used to cover depression. Sometimes the symptoms are merely a lump in the throat or having difficulty swallowing.

   Other symptoms that can mask depression include:

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   Headaches of all sorts also frequently mask depression. Often a person with depression undergoes extensive neurological testing, brain scans, spinal taps, and the like, but the underlying problem eludes the physician.

IS DEPRESSION A MENTAL ILLNESS?

   Most depressions are not forms of mental illness. Only the severest should be called that. I don't really like the term, as it's not always clear at what point on the range of intensity, from mild to severe, we can say for sure that depression is a mental illness. Often depression is a biological illness. But when it is severe enough to disrupt an individual's life, preventing him or her from working and/or threatening life, it certainly would be considered a mental illness.

   Most of us will suffer from "normal" depressions, and it would be inappropriate to label ourselves as mentally ill.

HOW DO GRIEF AND DEPRESSION DIFFER?

   Grief is a form of reactive depression. Not all depression is grief, but there can be no grief without depression or sadness. An important distinction, though, is that in pure grief, hypothetically speaking, there is no self-blame or loss of self-esteem. In depression, however, there is a tendency to feel worthless and guilty. Seldom is grief pure, so even bereaved people feel some guilt about their departed loved ones, and they may also feel a degree of worthlessness.

WHEN DOES APPROPRIATE GRIEF BECOME AN INAPPROPRIATE DEPRESSION?

   Mostly under two conditions. First, it happens when we blame ourselves for not being as loving, kind, and so on to our departed loved ones as we might have been, or when we experience guilt for things we did to them while they were alive. We then move from grieving the loss to being enmeshed in unhealthy feelings about a relationship that cannot now be repaired.

   Second, grief becomes inappropriate depression when the grief process is unduly prolonged. This usually is a result of excessive feelings of guilt or self-blame.

ARE THE "BLUES" A FORM OF DEPRESSION?

   Yes, although they're a minor form. For instance, the "Monday morning blues" are experienced by many people as they prepare to meet the demands of

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the week. For some, the blues are the low periods in their cycle of emotions that normally follow high periods of excitement. Those cycles are quite normal and are determined by our individual physiology, by the weather to some extent, by infections, and by many other circumstances. They are the body's way of regulating immune function and forcing us to rest. The blues should not alarm us. If we just cooperate with them, we'll improve our overall state of body and mind.

CAN WE BE ANXIOUS AND NOT BE DEPRESSED?

   Anxiety and depression are separate emotions, but they can coexist. We can be anxious and not depressed, and we can be depressed and not anxious. When they coexist, such as in depression with a lot of anxiety, we have a most disturbing condition called an agitated depression. The anxiety intensifies the depression and is very disabling.

WHAT IS THE RELATIONSHIP BETWEEN DEPRESSION AND WHAT WE COMMONLY CALL A NERVOUS BREAKDOWN?

   This is a complex relationship made even more confusing by fuzzy definitions of the term nervous breakdown. The name is really a lay person's term used to describe many problems. It can be either a physical or a psychological problem. It's often used to describe extreme exhaustion when, due to failure of one of the body's systems, an individual is unable to continue coping with the ordinary demands of life.

   But the relationship between depression and a nervous breakdown is even more complex. Sometimes depression accompanies a nervous breakdown. At other times it's the cause of a nervous breakdown. In other words, a nervous breakdown is simply a severe case of depression. A person reacts to some loss with a depression, which in turn puts him in a downward spiral until his body can no longer sustain him. This can lead to a collapse from extreme fatigue and exhaustion.

   Sometimes nervous breakdown is a psychotic disorder, like schizophrenia, which is a severe biological illness that can be treated effectively in most cases. There is no connection between schizophrenia and the depressions I am discussing here.

WHAT ARE THE EARLIEST SIGNS OF DEPRESSION?

   The strange thing about depression is that we often can't recognize it in its early stages. We only become aware of it when it's fully developed. One of the early

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danger signs, though is finding we are going deeper and deeper into depression. This intensification should alert us to the fact that something is wrong. We can't shake off the feeling, and it slowly gets worse.

IS IT POSSIBLE TO BE DEPRESSED AND NOT KNOW IT?

   Yes, very much so. In fact, it's common. Depression eludes recognition. It seems to dampen our awareness of our feelings. Not only that, but the low mood, the sadness we normally associate with depression, is often a very minor aspect of depression. It's quite possible for people not to realize they're depressed when the sadness component is missing and all they feel is lethargy and lack of interest.

HOW CAN I TELL IF I'M DEPRESSED?

   Most people with depression don't get appropriate treatment because they don't recognize their symptoms. They often misdiagnose their condition and seek the wrong remedy. Because depression makes you feel less valuable as a person, it's quite common to spiritualize a depression and blame it all on Satan. That's not helpful.

WHAT, THEN, ARE THE COMMON SYMPTOMS OF DEPRESSION?

   In nearly all depression there is a state of fatigue. That's one of the essential symptoms. There's also a general lack of interest in life and of energy to perform usual duties or to engage in normal activities. The sufferer becomes lethargic, lying around a lot, refusing to get out of bed, or escaping into television watching or activities that make no demands.

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ARE THERE SPIRITUAL SYMPTOMS OF DEPRESSION?

   Yes, there are, and they are just as important as the physical and psychological ones. Spiritual symptoms can take two extremes:

   1. The most common is to pull away from God — to feel He is rejecting us. This reaction is triggered by the excessive psychological guilt one experiences in depression. Since we feel guilty, we assume God is punishing us by rejecting us. That irrational idea leads to an actual spiritual withdrawal on our part. We neglect the Bible. We neglect to pray. We don't show interest in anything spiritual. This is unfortunate, because in so doing we turn away from the very resources that could help us. Depressed people may need to be constantly reassured that God is not rejecting them and that He is there to comfort and help.

   2. The opposite reaction is to become overinvolved in spiritual things. As a desperate attempt to regain normality or cope with the depression, a person may become fanatical about religious things. This is a compensation for feelings of guilt. We spend many hours a day in prayer, not for prayer's sake, but to appease our conscience. We won't leave the Bible alone. We cling to it like a fetish. I have known some depressed people to spend five, six, or even seven hours a day in prayer and "Bible-clutching" in their desperation.

   Unfortunately, this overinvolvement is not always healthy. People actually become incapacitated by the preoccupation with spiritual things. It becomes a ritual and has no real meaning. Fortunately, God understands what's happening and accepts it for what it is. We have a very patient God who is not offended by our misuse of His resources. He may even turn this to our advantage; we can't always understand His ways.

IS LACK OF CONCENTRATION LIKELY TO BE RELATED TO AN UNRECOGNIZED DEPRESSION?

   Depression can cause problems with concentration and other mental activities. Since depression serves to remove us from our environment, we can become preoccupied with our own thoughts and not pay attention to what's going on around us. I would emphasize, though, that a lack of concentration is more frequently caused by bad habits. Some people just don't pay sufficient attention. They're easily distracted. Anxiety can also interfere with concentration. When we're worried, we can't focus our attention on what we're doing.

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WHAT IS THE SEQUENCE OF EVENTS WHEN A PERSON BECOMES DEPRESSED?

   Perhaps the best way to understand what goes on in depression is to separate what goes on in our bodies from what goes on in our minds, although when we talk about emotions or feelings, we really refer to the combination of both.

   In reactive depression, our thinking is first affected. We perceive some sort of loss. We think about it (if only for a few seconds) and realize something is now missing from our lives. Perhaps we've lost a job. Maybe we've been criticized or have even lost hope.

   This thinking is paralleled by certain alterations in the body. We don't understand exactly what subtle biochemical changes accompany our thinking, but I believe they're designed by God to slow us down, to remove us from our environment by making us disinterested in normal activities, so we can deal with the loss.

   The combination of these processes (psychological and physical) is what makes up the feeling of depression. We become sad and lethargic. But there are also exchanges between these two elements. Certain sensations we feel because of the way biochemical changes are evaluated in our thinking. We may not like those feelings, so they arouse other feelings (such as anger or disappointment), and those emotions, in turn, affect the way our bodies react. Thus, the cycle continues. We become sad, angry, and disappointed, and our bodies react. Thus, the cycle continues. We become sad, angry, and disappointed, and our self-esteem is diminished.

   This is why we speak of our "complex" emotions. Each change causes other changes in both mind and body, which interact to keep the cycle of emotion going. Eventually, when we get our thinking under control, we can stop this negative pattern. But any biochemical change that has started will take time to settle down. A process of readjustment must take place before the body's biochemistry is restored to normal levels.

   That's why it's so important to allow ourselves time to let our bodies adjust after we've corrected the thinking component of our depression. We will still feel depressed because the body's chemistry is altered. Only after the body has caught up with the mind will we feel normal again.

ARE THERE WELL-DEFINED STAGES OF DEPRESSION?

   Depression is a continuum of feelings. It goes all the way from mild sadness to severe dejection. It ranges from minor blues all the way through to the most severe form of mental illness. But that doesn't mean we go from one level to another. It's wrong for people to fear they're going to end up with severe depression

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just because they've started to feel a little down. There are big jumps between the various levels of depression. The difference between a minor reactive depression and a severe psychotic depression, for example, is enormous.

   There's no connection between the two. There are identifiable stages in a reactive depression, however. It begins with an early stage where we are busy thinking about and analyzing whatever it is we've experienced as a loss. As we start this grieving process, we find ourselves moving much deeper into depression as the implications of the loss become more apparent. Finally, however, we "bottom out" and begin to put things into perspective as we come to terms with the loss. This is the recovery phase.

   We can't really speak of stages in the severe forms of depression. They come on suddenly and can deeply intensify in a matter of days. But they also stop rather suddenly, especially if they have been effectively treated.

HOW CAN WE IDENTIFY THE INTENSITY OF A DEPRESSION?

   It's helpful to classify the intensity of a depression into the following categories:

   1. Light depression: characterized by a low mood or a minor or temporary loss of interest in our environment, together with some feeling of discouragement. Usually our thinking isn't disturbed and remains rational. Physically, we experience a knot in the pit of the stomach. Our eating and sleeping habits remain fairly normal. Spiritually, we may engage in some temporary spiritual withdrawal, but it's not significant. We seem able to ride it out spiritually.

   2. Medium depression: the symptoms just mentioned are intensified, but the feeling of hopelessness is much more dominant. There may be some crying, and thinking is now somewhat painful and slow. As we become more preoccupied with ourselves, the depression seems to dominate our lives. Some self-blame emerges. There may be some appetite loss. It may be difficult to get to sleep, but once asleep, we usually survive the night. We're not really incapacitated in any way. Spiritually, there's a tendency to pull away from God. We don't pray, and we refuse to go to church or other fellowship meetings.

   3. Severe depression: everything already described occurs but is intensified. There's extreme sadness, low mood, dejection with frequent crying, extreme discouragement, and much guilt, self-blame, and self-pity. Physically, there's a severe disruption of appetite and sleep, with extremes of excess or privation. We fail to cope with our environment and begin to neglect ourselves and our appearance. We don't want to wash or change clothes. We don't want to shave or put on makeup.

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We find it extremely difficult to go about our regular duties. Spiritually, we totally withdraw from all activities, or we become intensely preoccupied with religious matters.

   In this brief outline, you can see that a depressed person can move from one level of depression to another. The differences are more in degree than in kind.

IS DEPRESSION A CAUSE OR A CONSEQUENCE OF LOW SELF-ESTEEM?

   It can be either. If we experience a significant failure in life, the failure not only causes depression, but it also robs us of any good feelings we have about ourselves. Our self-esteem then causes more depression.

   On the other hand, depression itself also produces diminished self-esteem. Part of the mood of depression is a feeling of self-rejection and hate. If we're depressed, therefore, we will also experience diminution of self-esteem. It isn't always easy to sort which is cause and which is consequence, and it probably doesn't matter. The point is that there's a strong connection between depression and self-hate. I'll have more to say on this subject in chapters 4 and 9.

WHAT BACKGROUND FACTORS MIGHT CREATE A TENDENCY TOWARD DEPRESSION?

   The experience of separation early in life seems to be a significant factor in being prone toward depression. Children who are separated even for short periods from their parents often find they become easily depressed later in life. This is tied into feelings of insecurity, and it's my opinion that people who are insecure experience depression more frequently than those who are not.

   People who have a long history of inability to relate adequately to others also find themselves depression prone. Perhaps the most significant situation creating depression proneness is growing up in a dysfunctional family. Those affected are victims of physical or sexual abuse, as well as children who suffer the breakup of their families through divorce.

WHEN SHOULD A PERSON SEEK PROFESSIONAL COUNSEL?

   When people find that their depression is lasting longer than they feel comfortable about or if they find themselves deeply depressed, beginning to think of ways of escaping, avoiding family responsibilities, or even suicide, the time has come

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to seek professional help.

   Sometimes, too, reactive depressions trigger severe biological reactions, and the grieving process is contaminated by biological disturbances. You then need professional help to sort out what's psychological and what's biological and to facilitate the recovery. If your depression is severe, therefore, talk to your pastor, or see your physician right away for a referral.

DO PEOPLE INCREASE IN NEED OF PROFESSIONAL HELP AS THEY PROGRESS FROM LIGHT TO SEVERE DEPRESSION?

   Yes, very much so. As we go up the scale of intensity to the severe depressions, the greater is the need for outside help, because we're less and less able or willing to help ourselves. Light depressions are common experiences. We should all know how to deal with them. But medium-to-severe depressions need outside intervention, and the more severe they are, the more likely it is that the helper should be a professional.

AT WHAT POINT IS PROFESSIONAL HELP ESSENTIAL?

   With the onset of a medium-intensity depression, the help that just talking to a friend can give has reached its limit. As the intensity increases, the risk that depressed people will take their lives increases. There's also a greater likelihood of a biological depression. When people begin to cry often and feel their situation is hopeless, they definitely need professional help.

IS THERE A DANGER THAT A DEPRESSED PERSON WILL ATTEMPT SUICIDE?

   Suicidal thoughts don't appear until at least the medium intensity of depression is experienced. Light depressions often move us to use our resources more effectively and to cope with our situation. In that sense, they can be healthy. If we've lost our job, for example, we go out and find another so as to relieve the depression.

   But in a medium-intensity depression, we begin to feel some helplessness and think about how nice it would be to escape all our troubles. Those thoughts incapacitate us, and we might even begin to think about ending life.

   In severe depressions, people become totally preoccupied with escape and death wishes. Let me emphasize again that having suicidal thoughts does not mean a person is planning suicide. However, we must assume there is a high risk and take steps to deal with such thoughts. An estimated 15 percent of depressed people will ultimately take their lives.

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WHAT ARE THE CLUES TO A SUICIDAL DEPRESSION?

   Let me answer in two parts. First, certain conditions must exist before suicide is a possibility. One is that the depression is a consequence of a severe loss, one that cannot be replaced. (See chapter 2.) It's true that in some of the endogenous forms of depression, the biochemical disturbance producing the depression also creates a desire to escape. But most suicides occur as a result of a significant, irreplaceable loss. Second, there is usually intense anger at the loss or at someone responsible for it. When those two conditions are combined, there is a high risk of suicide.

WHY DO DEPRESSIONS SOMETIMES OCCUR IN CYCLES?

   This goes back to what I said about the cyclical nature of our emotions. They are heavily dependent on our bodies, and our bodies go through high and low cycles. Those cycles are often caused by changes in hormones or in immune system fluctuation. During the high points, it is remarkable how easily we're able to cope with life, and we seldom experience depression. During the low times, just the slightest loss can put us into a depression. We need some understanding of how our bodies operate so we can allow for those low periods. We shouldn't expect so much of ourselves during those times but should let our systems recover. If each of us did this, we could avoid much depression.

IS THERE SUCH A THING AS A BIORHYTHM, THEN?

   Absolutely not in the way the concept is presented in some literature or in New Age teaching. The idea that certain physical, emotional, and intellectual cycles can be computed from your birth date is too simplistic. There are fluctuations, but they are not determined by when you were born.

   We know normal physiological fluctuations do occur. Even the weather affects them. The most obvious one is the menstrual cycle in women. But even this doesn't operate with absolute regularity. Menstruation is influenced by illness, stress, and many other factors. (See chapter 3.) To try to predict any physical, emotional, or intellectual state on the basis of fixed cycles is nonsense.

WHAT IS THE DIFFERENCE BETWEEN BIORHYTHM AND BIOFEEDBACK?

   The two are not the same. Biofeedback is a highly scientific technique (unlike biorhythms) using sensitive instruments to monitor physiological changes such as muscle tension, skin temperature, blood pressure, heart rate, and so on. This information

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is then fed back to the individual to help him or her learn how to control those bodily functions. Basically, it's a technique for teaching deep relaxation as a way of coping with or reducing stress. Biofeedback clinics help to treat headaches, painful menstruation, high blood pressure, and a host of other stress disorders.

ARE THE SYMPTOMS OF DEPRESSION DIFFERENT IN WOMEN AND MEN?

   Basically, the symptoms are the same. The causes, however, may be different. There may also be slight differences in the way the sexes experience depression. Women are clearly more prone to depression. (See chapter 3.)

IS DEPRESSION RELATED TO SOCIOECONOMIC VARIABLES?

   To some extent, reactive depression ought to be tied to poverty, yet the lower socioeconomic groups seem to be less prone to it. They face loss as a reality every day and so are better able to cope with life and its losses than more-affluent groups. The middle and upper classes, on the other hand, are much more prone to depression because they have so much more to lose and because their values are so much more materialistic.

   Endogenous depressions, of course, play no favorites. They occur with much the same frequency right across the socioeconomic spectrum, as they're biological and even genetic in nature.

ARE UNSUCCESSFUL PEOPLE MORE LIKELY TO SUFFER DEPRESSION THAN SUCCESSFUL PEOPLE?

   Very much so. The experience of failure is a significant loss in our culture. We worship success and don't know how to receive failure gracefully. That sets us up for one depression after another. It also leads to a depressive life-style where one learns to cope with life's disappointments through depression. In fact, some psychologists have tried to develop a formula by which they can predict depression proneness based on the ratio of success to failure in a person's life. The greater the experience of failure, the greater is the frequency of depression.

ARE SOME TEMPERAMENTS MORE SUSCEPTIBLE TO DEPRESSION THAN OTHERS?

   Yes, depression proneness is often related to personality. The combination of inherited factors and the effect of environment can develop a particular personality

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that is depression prone. Such a person has an exaggerated reaction to loss and views life negatively. He or she almost searches for opportunities for self-pity and pessimism.

DO WE HAVE ANY CHOICE IN BECOMING DEPRESSED?

   Sometimes we do; sometimes we don't. We have a degree of choice in how we set ourselves up for life and in the values we adopt. In that sense, we determine whether we become depressed. Even at the point of experiencing a loss, we often have a choice. We can choose to allow our depression to continue. But sometimes we're able to avoid the depression that would otherwise inevitably follow by developing our understanding of what God values and appreciating His perspective on our lives.

   To put it another way, many of our minor depressions arise because we fail to see things as God does. We exaggerate our losses and make catastrophes of our failures.

DO SOME PEOPLE SUBCONSCIOUSLY WANT TO BE DEPRESSED?

   Yes, very much so. Some people have experienced depression for such a long time that it has become a life-style, a way of coping with their problems and anxieties — even with all of life. At the slightest hint of trouble, they immediately retreat into depression. In that sense, they unconsciously want to be depressed.

IS DEPRESSION HABIT FORMING?

   For those who develop a depressive life-style, depression becomes a habit in the sense that they use it to escape from life's realities. Their body's chemistry may become adapted to a depressed state to such a degree that it demands depression as a condition to keep the body comfortable. It then becomes difficult for them to give it up even when there is no longer any psychological or physical need to be depressed.

WILL A SEVERE DEPRESSION LEAVE A PERSON A PSYCHOLOGICAL CRIPPLE, UNABLE TO DEAL WITH LIFE'S CIRCUMSTANCES IN AN ORDINARY WAY?

   Not really, and certainly not if the depression is handled properly. Even the severest form of depression — the psychotic depression or manic-depressive psychosis

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(now called bipolar affective disorder) — is time-limited and will pass and leave no crippling effects whatsoever. Only when people develop a depressive and neurotic life-style over a long period is their ability to cope with life impaired. We need not be afraid of those severe depressions. As we will see, they can be treated effectively in most cases.

CAN DEPRESSION SOMETIMES BE A HEALTHY RESPONSE TO CIRCUMSTANCES?

   Yes. If we can learn to cooperate with it, depression can be a healthy response, even a healing emotion. The positive side can be seen in two of its functions: it alerts us to a loss, and it helps us to detach from the lost object in a process of "letting go." These are normal and necessary steps.

   Perhaps the best example I can give of this is in the experience of bereavement. A lot of evidence shows that the emotion of grief following bereavement (or the loss of a job, etc.) must be allowed full expression for healing to occur. The more freedom we give ourselves to grieve (become sad, etc.), the more rapid is our recovery from the grief. We speed up the "letting go."

   Depression can also be a positive factor in the physical realm. It is a symptom of many illnesses, including the flu. The depression helps the healing by detaching us from activity. If we didn't detach and slow down, the illness could kill us. So our sadness and loss of interest in normal activities aids the healing process.

   I believe depression is designed by God to warn us that we're getting into deep water, to slow us down, to remove us from the business of life, and to pull us back so we can pay attention to what's happening. It's designed to drive us back to God, to turn our trust to Him and find resources for help.

IS THERE A DIFFERENCE BETWEEN SPIRITUAL AND PSYCHOLOGICAL DEPRESSION?

   Yes, there are important differences, and we need to clarify them.

   Spiritual depression has to do with the deep feeling of discontent or dissatisfaction with one's life that we feel when we're out of touch with God. This feeling may be focused sharply by breaking one of God's laws, or it may be a more general feeling brought on by living under a wrong set of values. In either case, this type of depression results from a loss of the awareness of God, or a loss of being comfortable with Him. In other words, spiritual depression is what we feel when alienated from God. There may be psychological components, but it is more a spiritual than

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a psychological experience.

   True psychological depression has to do with just being human. It is in many respects a normal and natural response to life's losses. As such, psychological depression should not separate us from God. For many of us, however, psychological depression does alienate us from God. It may cause us to feel He has abandoned us. But nothing is further from the truth. We need to hold to our faith and believe God is always there, comforting us in our losses.

CAN YOU GIVE AN EXAMPLE OF HOW THESE DIFFER?

   Spiritual and psychological depression differ in several ways, although they often commingle. Suppose we have a young man who is very ambitious. He wants rapid promotion and is prepared to do anything to get it. So he engages in a dishonest sales promotional activity. People are ripped off by being misled. Soon he finds himself trapped in a situation that he knows is clearly unethical, perhaps even illegal. The sales promotion fails, everything is brought into the open and he is "let go." The young man finds himself very depressed. His reputation has been sullied. Where will he get another job?

   I would call this a spiritual depression, with psychological consequences. The primary cause is the violation of principles he knows are right and which he believes he has received from God. As a result, God convicts him of his sin. He feels the loss of God. He also feels the loss of his job, so he becomes deeply depressed. He misreads God's conviction, and that complicates his depression. If he could only hear what God was really saying to him, his depression would be spiritual and far easier to deal with.

   What is God's message? "I am displeased. Something is not right. I want you to put your life back on a righteous track." God is not pulling away from him to punish him. Neither has God abandoned him, though that's what he feels. Rather, God is calling him to healing. The very loss of God he's feeling is designed to point him to the real problem. He needs to hear it and take correction so the loss can be restored.

   It's also most important to realize that spiritual depressions have psychological dimensions. Our young man may need some psychological help. But his is primarily a spiritual depression, and the spiritual components have to be dealt with before he can expect any healing. Sadly, this distinction is not made by secular psychotherapists.

   Let me give an example of a psychological depression with no spiritual components. You're driving to work one morning when out of the blue, you're not quite

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sure how, you're involved in an accident. You've hit the car ahead of you, and the one behind has run into you as well. All three cars are severely damaged. You don't know whether your insurance will cover the cost or whether the accident was even your fault. Still, you feel responsible and stupid.

   Very soon you're in a depression. That's natural. You've suffered a loss. You may or may not have been responsible. But accidents happen. Dogs run into roads; people are startled and jam on their brakes. Who knows why the accident occurred? You're depressed, however, and it may last several days or even weeks.

   This depression has no spiritual component to it. It is purely psychological, with some biological reaction following shock. You have not alienated God or violated His principles in any way. You have just had an unfortunate accident.

   The accident may cause some spiritual reaction, however. You may blame God for not protecting you. You may become angry at Him for allowing this accident to happen and so withdraw from Him. (It's the adult form of pouting.) That's unfortunate, because now you're not using God's resources to help you through the depression.

   Fortunately, God understands how you feel. What you should do is accept the fact that you're experiencing a psychological depression and turn to God for help. He can assist you with the grieving process.

   While spiritual and psychological depressions are different, then, the resources for healing them both are available to us through our faith in what we believe God is able to do for us. God should never be shut out of our depressions, no matter what their cause. He desires to help us get through them and to learn more about ourselves as we do.

WHY DO MANY CHRISTIANS ATTACH A STIGMA TO DEPRESSION?

   Unfortunately, this stigma does exist, especially in evangelical Christian circles. It is born out of ignorance. People are afraid of what they don't understand. There are probably many reasons for this stigma, but let me suggest three.

   First, in our culture we have strong expectations that people should be in control of themselves and their emotions. Depression is seen as a sign that we're out of control, so we fear it.

   Second, this general fear is exaggerated in Christian circles by our emphasis on notions of "perfection." No one should be weak, we erroneously believe. Depression is seen as a failure and is therefore stigmatized.

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   Third, we fear that depression in its severest form is a mental illness. To some extent that's true, but it's really a physical illness, not a mental one. Only the symptoms are mental. We may feel we're on a downward path toward a severe mental illness. Such a fear is unwarranted, just as is stigmatizing depression.

WHAT DOES THE BIBLE HAVE TO SAY ABOUT DEPRESSION?

   As a Christian, I find a lot of comfort in knowing from Scripture that depression has been around a long time. But the Bible helps in other ways as well. First, it's an excellent resource in coping with depression. The Psalms, for example, have been a comfort to depressed people in every age. Scripture restores our trust in God and helps us put things in perspective, a vital step in resolving depression.

   The Bible also says to me that depression is the common lot of humanity, a normal reaction to life. Saints in both the Old and New Testaments experienced it. Scripture reminds me I'm only human. But it also encourages me to realize I don't always have to be depressed. If I get my values straight and develop a meaningful faith and trust in God, I can avoid a lot of depression.

IS DEPRESSION A SIN?

   Not everything we believe as Christians is necessarily biblical or truthful. Some beliefs make us more prone to depression than non-Christians, and many well-meaning writers have caused a lot of unnecessary emotional pain by condemning depression as sin. Unless we have a sound biblical understanding of sin, it can cause significant depression.

   However, when a person becomes a Christian, it's quite common to experience an intensified awareness of one's sinfulness. Unless that is coupled with a deep sense of God's forgiveness, it can deepen depressions associated with sin. That's a legitimate depression, a symptom that something is wrong. But it should not be the cause for further despair. Our increased awareness of sin should instead be a means of spiritual growth. Unfortunately, some Christian groups exaggerate this awareness of sin to the point that it becomes pathological. The sufferer is incapable of receiving God's forgiveness. Let me say again that all depression is not sin. Depression may be the consequence of sin, but it may also be a natural and normal reaction to loss. Not to feel those losses would be to deny our humanity.

   In the case of endogenous depressions, labeling them as sin is as wrong as calling appendicitis a sin.

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IS DEPRESSION CAUSED BY SIN DIFFERENT FROM THAT CAUSED BY LOSING A LOVED ONE?

   Yes. When depression is caused by sin, we not only experience a loss of self-esteem and a loss of control over the events surrounding the sin, but we also lose the peace of God in our lives. That can have a much greater effect than experiencing a loss of something legitimate, like losing a loved one. The loss of spiritual resources available to us as Christians is very significant when depression is caused by sin. So there is both a quantitive difference (intensity is greater) and a qualitative difference (the emotional pain is deeper). One might also say the loss of a loved one is likely to drive us back to God, whereas the depression caused by sin is likely to drive us away from Him.

SHOULD A CHRISTIAN FEEL GUILTY ABOUT BEING DEPRESSED?

   Heaven forbid! One of the consequences of depression is increased guilt. That's why so many feel guilty when they're depressed. If the guilt gets out of control, it increases the depression, which is not healthy.

   Depression should be seen as something like pain. It's a warning that alerts us that something is wrong. If the cause of the depression is a sinful activity or attitude (stealing or hating), we should feel guilty about that sin. But the guilt is not over the depression.

   There's a bit of a paradox here, however. Depression itself often intensifies or exaggerates guilt feelings. If we allow the guilt feelings over the sinful activity to spread into feeling guilty about the depression itself, we can easily put ourselves into a despairing spiral in which our depression slowly intensifies and we become more and more depressed. So be very cautious about allowing yourself to feel too much guilt over your depression.

IS DEPRESSION A FAILURE TO TRUST GOD'S PROMISES?

   This is another idea often suggested by well-meaning but uninformed Christian writers. Again let me say that it's not the depression itself but what leads up to it that can be a failure to trust God's promises. For example, we may not be trusting God in the area of values or security. The depression that follows is a consequence or symptom of that failure. But the depression itself is a normal and natural reaction to the failure, and it must run its course.

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IF GOD LOVES US, WHY DOES HE ALLOW US TO BECOME DEPRESSED?

   This question really ties into the larger question of why God allows tyranny, war, poverty, hunger, illness, or all kinds of suffering. As human beings, we're designed to experience many emotions, not just joy. Sadness is also necessary.

   We don't understand fully what purpose the painful emotions serve, but they do seem to drive us to God. If we were happy all the time, maybe we wouldn't feel we needed Him. Physical pain is an essential warning system; without it, we'd be killed the moment we walked out the front door, since we wouldn't know what to avoid. And in the same way, God created us with the ability to feel emotional pain so we are warned when things are emotionally dangerous.

DOES GOD PUNISH US THROUGH DEPRESSION?

   God does not use depression as punishment. In fact, He has put all punishment "on hold" until His day of reckoning. He may discipline or chastise us, but He doesn't punish us while we live under grace. God's call to us is to repent. Christ died on the cross to bear our sins; He has become our punishment. That is past. It's finished.

   Nevertheless, depression is often the consequence of going our own way. It's the warning that something has gone wrong. We might think of it as a form of punishment at the time, but it's more like the consequence of breaking a leg if we try to defy the law of gravity.

   I see depression as a healing emotion. If we respond to its message and deal with what has gone wrong, we're the better for it. It should drive us back to God and to the resources He has made available. It should motivate us to repent and seek forgiveness. Depression, then, can be a gateway to health.

CAN DEPRESSION BE GOD'S WILL FOR ME?

   Yes and no! Yes in the sense that God has moral laws just as He has physical laws in nature. If I jump from a high wall, I will break a leg. That is God's will as embodied in His natural law.

   But no in the sense that God doesn't send depression to punish us or just to force us back on track. Many who become depressed for no apparent reason can turn their depression to good advantage. We can turn an endogenous depression into God's will for us if we can trust that He has some purpose in creating us and accept that what we're experiencing is His will.

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IS DEPRESSION A SIGN THAT WE'VE FAILED IN LIVING ABOVE OUR CIRCUMSTANCES?

   We must distinguish clearly between the major types of depression before we can answer that question. People suffering from endogenous depression cannot think about "rising above" it. Biological factors over which they have no direct control will be at work. What they need is medication for the depression and ongoing therapeutic support. To tell them to rise above the depression and master it would be like saying to a person with a broken leg, "You need to rise above your broken leg and get on with your life." What the person really needs is a doctor to set the leg so it can heal.

   In certain reactive depressions, it would be equally inappropriate to speak of rising above circumstances. In bereavement, for example, we should be allowed to do our grieving thoroughly and completely. That allows us to put the loss in perspective and to let the departed loved one go.

   There is one type of depression, however, where it's appropriate to call people to rise above their circumstances: namely, when they are depressed because they're not content with their lives (see Phil. 4:11). We all need to learn how to be contented.

DO CHRISTIANS SUFFER FROM DEPRESSION AS FREQUENTLY AS NON-CHRISTIANS?

   In my experience, yes. Being a Christian doesn't make us immune to depression. If anything, we might even become more sensitive to injustices and life's pains, so we feel with and for others who hurt. But Christians have resources available that can help them cope with life and their depressions more effectively. Unfortunately, the church hasn't adequately taught people how those resources can be applied to emotional problems such as depression. Sadly, some Christians are suspicious of any form of psychological help, even if it's offered by thoroughly evangelical psychologists. We have a long way to go before our Christianity embraces the whole person — body, mind, and spirit.

Chapter 2  ||  Table of Contents