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The signs of approaching melancholy are ... anguish and distress, dejections, silence, animosity ... sometimes a desire to live and at other times a longing for death, suspicions on the part of the patient that a plot is being hatched against him. Caelius Aurelianus, healer (Methodist school of medicine), A.D. fifth century
A pastor and his wife began their session in tears. Their son had been killed in an automobile accident nine days earlier. They had been through hard times before and were intimately acquainted with sorrow and grief. They reminisced about their son as we talked and prayed together. Being in ministry, they knew of God's grace and comfort. The pastor and his wife had helped many others work through their crises, but now he was despondent and unable to sleep. The loss was overwhelming to him.
Another man, Steven, had been unemployed for almost 20 weeks following a minor accident with his semitruck. No one had been injured, but his company suspended him from driving, and he quit out of embarrassment and shame. He had been unable to explore new employment possibilities and made up stories for my sake about the "activities" that he used to occupy his time. He felt helpless and hopeless. He was hesitant to talk about the future.
A woman in her 30s was deeply troubled and physically shook during our meeting. A single parent of a nine-year-old child, she worked in a nursing home and was going to school at night. Although she had long ago left her parents, she talked of the ongoing strain and tension in their relationship. She reflected on her spiritual life and the terrible condition of her soul. With trembling voice and frightened eyes, she said she had committed the unpardonable sin. The "voices" in her mind harassed her at every turn. They called her "slut" and "nasty" and told her that Jesus would never talk to her again after what she had done. She was extremely agitated and anxious.
A Sad Epidemic
These stories of loss, hopelessness and spiritual defeat seem so different and unrelated, yet each person's diagnosis was depression. Depression is an ache in the soul that crushes the spirit. It wraps itself so tightly around you that you can't believe that it will ever leave, but it can and it does! Depression is treatable. You do not have to live like this, at least not for long.
About 10 million people in America are presently suffering from depression. It creeps into the lives of all people regardless of age, sex, social status or economic status. Twice as many women struggle with depression as do men. Twenty-five percent of college students struggle with some form of depression, and 33 percent of college dropouts will suffer serious depression before leaving school. The number of doctor visits in which patients received prescriptions for mental problems rose from 32.7 million to 45.6 million during the decade from 1985 to 1994. Visits in which depression was diagnosed almost doubled over those 10 years from 11 million to more than 20.4 million. This is an incredible increase in 10 years, especially in light of the fact that many who struggle with depression do not seek medical help.
Depression is a complex yet common physical, emotional and spiritual struggle. It is so prevalent that it has been called the common cold of mental illness. Many people will have at least one serious bout of depression in their lifetime, and every person will experience some symptoms of depression due to poor physical health, negative circumstances or weak spiritual condition. Too many Christians live in denial about their own depression thinking that if they were spiritually mature, then they would never have to struggle like the rest of us. Consequently, they don't reach out to others or seek the help they need. It is actually shameful in some "Christian" communities to be sad or depressed. You must be living in sin is the deceptive assumption. Such erroneous or simplistic thinking causes people to hide their true feelings instead of believing the truth and walking in the light.
Signs of Depression
Depression is a disturbance or disorder of one's mood or emotional state. It is characterized by persistent sadness, heaviness, darkness or feelings of emptiness. The emotional state of depression is usually accompanied by thoughts of hopelessness and sometimes suicide. Depressed people believe that life is bad and the prognosis of improvement is nil. Their thoughts are colored by negative and pessimistic views of themselves, their future and their surrounding circumstances.
It is critically important to realize that the emotional state of depression is not the cause, it is the symptom. Treating the symptom only brings temporary relief at best. Any treatment for depression must focus on the cause, not the effect. The goal is to cure the disease, not the resulting pain. As we will examine later, the cause can be physical, mental or spiritual. We think it is important to understand the symptoms of depression in order to better understand the cause. A proper diagnosis is necessary before appropriate treatment can be considered.
Physical Symptoms of Depression
Energy Level: I just don't feel like doing anything.
Loss of energy, excessive fatigue and unrelenting tiredness are the characteristics of the melancholic. Walking, talking, cleaning the house, getting ready for work or doing a project can take a considerably longer time than usual. The person suffering from depression also feels that time is moving at a snail's pace and usual activities become monumental or seemingly insurmountable tasks. Fatigue and tiredness are common complaints. The lowered energy level and lowered interest in activities affect job performance. The depressed person knows his or her performance is sliding but can't seem to pull out of the depression.
Approximately 10 percent of the melancholic seriously struggle with endogenous (i.e., from within the body, or physical in its origin) depression. Many of them simply do not function on a daily basis. They don't get dressed and either stay in bed or lie around the house. They cease to function in life.
Sleep Disturbance: I didn't sleep again last night!
Having trouble sleeping is one of the most common symptoms of depression. Although some people feel like sleeping all of the time, insomnia is actually more common. Initial insomnia (sleep-onset insomnia) is difficulty in falling asleep. Depression is more commonly associated with terminal insomnia-falling asleep out of sheer fatigue but then waking up, unable to get back to sleep. The inability to sleep is a symptom of depression, but it also contributes to the downward spiral of those who can't seem to pull out of the depression. Inadequate sleep leaves the sufferer with less energy for tomorrow.
Psalm 77 is a call for help by someone who begins his lament by questioning God (see vv. 7-9). In such a state, he writes, "When I remember God, then I am disturbed; when I sigh, then my spirit grows faint. You have held my eyelids open; I am so troubled that I cannot speak" (vv. 3-4). His hope is gone because what he believes about God is not true, and the result is sleeplessness and not enough energy to even speak. That is depression.
Activity Level: Why bother!
Depression is accompanied by a decreased involvement in meaningful activities and a lack of interest in life and commitment to follow through. Sufferers don't have the physical or emotional energy to sustain their ordinary levels of activity, and their performance is often hindered. Many find it difficult to pray because God seems distant. Perhaps they used to enjoy playing the piano or some other instrument, but they no longer find it relaxing or satisfying. Tragically, the need for self-expression and to be involved in a community goes unmet, which contributes to their depression.
Lack of Sex Drive: Not tonight!
In depression there is often a decrease in sexual interest, or drive. Accompanying this loss of desire for sex is a wish for isolation, feelings of worthlessness, criticism of one's own appearance, loss of spontaneity, and apathy. The emotional state of depression usually creates problems in relationships, which obviously further curtails the desire to be intimate.
Somatic Complaint: I ache all over!
Many depressed people report physical aches and pains such as headaches, stomachaches and lower-back pain, which can be quite severe. Depression headaches are often present. Unlike migraine headaches, they are dull and feel like a band around the head with pain radiating down the neck. In a state of depression, David wrote, "I am bowed down and brought very low; all day long I go about mourning. My back is filled with searing pain; there is no health in my body" (Ps. 38:6-7, NIV).
Loss of Appetite: I'm not hungry!
Depression is often accompanied by a decrease in appetite. Indigestion, constipation or diarrhea contribute to weight loss during depression. Those who struggle with anorexia are usually depressed as well. However, in 20 percent of depression cases, there is an increase of appetite and craving for food.
Mental and Emotional Symptoms of Depression
The most noticeable symptoms of depression are emotional. There are also resultant mental states that indicate severe to mild depression, but keep in mind that what a person thinks or believes is also a potential cause for depression. The following are the most common emotional symptoms and resultant mental states of those who are depressed.
Sadness: I feel awful!
Depression is most commonly characterized by a deep sadness. The blues seem to creep up slowly and bring a spirit of heaviness. Crying and brooding are common for those who are in a funk. Some can hardly control the steady stream of tears. Depression is the antithesis of joy, which is a fruit of the Spirit: "A joyful heart makes a cheerful face, but when the heart is sad, the spirit is broken" (Prov. 15:13).
Despair: It's hopeless!
Despair is the absence of hope. Despair sees no light at the end of the tunnel, no hope at the end of the day and no answers for the endless round of questions that plague the depressed mind. Three times the psalmist cried out, "Why are you in despair, O my soul? And why have you become disturbed within me? Hope in God, for I shall again praise Him for the help of His presence ... for I shall yet praise Him, the help of my countenance and my God" (Ps. 42:5-11; see 43:5). Hope is the present assurance of some future good. The psalmist knew where his hope lay. Jeremy Taylor said, "It is impossible for a man to despair who remembers that his helper is omnipotent." The problem is that depression seems to impede the normal process of memory.
Irritability and Low Frustration Tolerance: I have had it with you!
Depressed people have very little emotional reserve. Small things tick them off, and they are easily frustrated. They have low tolerance for the pressures of life. One lady said, "How can I plan for tomorrow when survival for the day is at the top of my list?"
Isolation and Withdrawal: I'm going to my room!
John Gray observed that men retreat to caves and women climb into holes. Men tend to isolate more readily but spend less time in their caves than women do in holes. Most men are generally less image conscious and less introspective than women are. Many men will go away and lick their wounds and then come back as though nothing happened. It is hard for some men to reveal their souls. They tend to cover their pain with work or vices. Consequently, they are more likely to become workaholics or alcoholics.
People who suffer with depression pull away from others. They feel embarrassed to be with people when they feel so low. They don't want to be a wet blanket in the group and drag others down by their depression. Although some may think that isolation is a viable short-term solution, avoidance often adds to the downward spiral of depression.
Negative Thought Patterns: Nothing is working; I'm such a failure!
Generally speaking, depressed people have trouble thinking, concentrating and staying focused. Constant distractions rob them of mental peace. Just as water seeks the lowest ground, depression seeps into a person and drowns out optimism. It seems easier to see a problem, think the worst, predict failure, find fault and focus on weakness. First, depressed people have difficulty believing positive and good things about themselves. Feelings of worthlessness become the breeding ground for thoughts of self-destruction. They struggle with guilt that prompts them to become irrational, unreasonable and even delusional. Second, they cannot think positively about the future. They cannot stop worrying about tomorrow. It is not something they look forward to; it is something they dread. Third, the circumstances in which they find themselves are also interpreted as negative. This is the well-known depression triad that cognitive therapists see repeatedly in their patients.
Thoughts of Suicide: Everybody would be better off if I were dead!
Sadness, isolation, loss of energy, strained relationships and physical problems contaminate the depressed person's perspective of self and the future. Believing themselves to be helpless and hopeless, many depressed people begin to think of suicide as a way of escape.
In depressed states, people become self-absorbed. Mental exhaustion causes many to think negatively about themselves and less of others. They don't want to hear any more bad news or take on any more responsibility. It is a syndrome filled with misery, shame, sadness and guilt.
In Psalm 38, David expresses almost every symptom of depression listed above:
somatic complaints (see v. 3)
guilt and despair (see v. 4)
irritability, low frustration tolerance, loss of appetite, sadness (see vv. 5-8)
low energy and diminished activity (see v. 10)
isolation and withdrawal (see v. 11)
negative thoughts (see v. 12)
thoughts of suicide (see v. 17)
David shares two keywords in this psalm that are necessary for recovery from a sense of helplessness and hopelessness: "For I hope in You, O Lord" (v. 15, emphasis added), and "Make haste to help me, O Lord, my salvation!" (v. 22, emphasis added).
Excerpted from OVERCOMING DEPRESSION by NEIL T. ANDERSON JOANNE ANDERSON Copyright © 2004 by Neil T. and Joanne Anderson. Excerpted by permission.
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