Coping with Depression - Part
2
Perhaps you wonder if you can simply "grow out" of having depression. It depends on the type of depression. Many endogenous depressions stop spontaneously. Others get better when you reduce the stress in your life. You can grow out of reactive depressions by maturing out of them. One of the advantages of growing older is that you develop a measure of maturity from the experiences life gives you. You learn that some losses are temporary and that other losses, while permanent, are not that important.
You don't grow out of depression in the sense that you'll be free of all depression. If anything, you'll be more prone to depression as you get older. Your physiology is aging, and your systems are less resilient. Added to those physical losses, there are economic and social losses as well. But there's the counterbalance of maturity. If you learn to master life, then the older you get, the more of a master you become. That's why you need to maximize your sanctification (your spiritual growth and development) early in life. The better you adjust to an early stage, the better you'll be able to adjust to later stages.
That's not to say you can't reduce a lot of unnecessary depression, however. Much of what I've talked about so far is designed to reduce the frequency of depression. Probably half the depressions most of us experience can be avoided if
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we really work at changing our value systems and allow ourselves to grieve in a healthy way. God helps us to heal our selfishness and self-preoccupation through our depressions.
WILL A CHANGE OF CIRCUMSTANCES HELP ME OUT OF A DEPRESSION?
If your circumstances are causing you many losses or too much stress, a change will help. Taking a vacation or a trip may enable you to see things differently. Changing your circumstances may also give you a chance to rest and relax by taking you out of your regular routine. Busy people, especially, need a change frequently.
IF MY DEPRESSION IS TRIGGERED BY CIRCUMSTANCES THAT SEEM UNLIKELY TO CHANGE, HOW CAN I HOPE TO AVOID A RECURRING DEPRESSION?
This is the case for the many people who face losses that can't be replaced. Bereavement, including the grief that follows, is a good example. In losing a loved one, perhaps a husband who was the sole source of income, you face an irreversible situation. Besides grieving the loss through your depression, you must also begin to adjust to the permanent nature of the loss and to take control of your circumstances. It may require several major changes in your life.
To use another analogy, if you're running an obstacle race and come up against an insurmountable obstacle, you have to find a way around it. It's exactly the same way when you encounter circumstances beyond your control. You have to learn to compensate for what you cannot change in order to find a way around. For some, this may involve drastic changes, such as selling a home or reducing your standard of living. But you must take control and find a way around your obstacles.
I must also emphasize again that when circumstances seem to be beyond your control, the tendency is to revert to a state of helplessness. That only intensifies the depression. A loss of control, which is part of the helplessness, can cause the most intense form of depression. So it's vital that you take control of your circumstances and begin to design your life around a new set of "givens." If you fail to do that, your depression will not lift.
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THE CAUSE OF MY DEPRESSION HAS DISAPPEARED, BUT I STILL FEEL DEPRESSED. WHAT'S THE MATTER WITH ME?
That brings up an important point that needs to be driven home. Depression is not just in your head. It's not just a psychological experience. It may be triggered psychologically, but it affects the whole body. A fairly massive biochemical shift takes place when you become depressed. Glands, muscles, and many other parts respond with changes. In fact, the low, sad mood and the lethargy you feel are all a result of those biochemical changes. Primarily the depression is designed to slow you down and remove you from your environment.
When the cause of the depression is removed or resolved, the feeling does not immediately go away. It may hang on for many hours, even days, depending on how long you've been depressed. Your biological system needs time to restore itself. The disturbed chemistry has to "burn" itself out and pass from your system. Only then will the feeling of depression disappear. It's important, therefore, not to become impatient and react to the lingering feeling. That will only chain other emotions and prolong the depression.
IF IT'S IMPORTANT TO MAINTAIN SOME LEVEL OF INTROSPECTION, HOW DO I ACHIEVE A BALANCE BETWEEN TOO MUCH AND TOO LITTLE?
You need to maintain a balance between avoiding all introspection (which is quite common) and becoming preoccupied with what goes on inside. The balance is not in the amount of inward looking you do but in what you do with what you find there. Clearly, we all sometimes need to do some looking deep within ourselves.
The unhealthy aspect of introspection comes when you're so preoccupied with yourself that you become self-rejecting. That leads to depression. It causes you to punish yourself and become despondent.
A healthy introspection involves looking at yourself objectively, analyzing what you're doing, and using that information as a map or plan to guide your self-improvement. You say, "Well, this part of my nature is not very good. I tend to get angry easily. And every time I get angry, I become depressed. If I want to deal with this depression, I've got to learn to become less angry."
Continuing the process, you analyze why you become angry. You learn you're very prone to frustration; you want everything to happen right away. By recognizing this tendency, you can begin to deal with it, to reduce your anger, and thus avoid some depression. This results in self-growth and self-development.
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CAN SOMEONE ELSE HELP IN THIS PROCESS?
An outside point of reference can be very helpful. You can't always trust yourself. You need a sounding board. The other person doesn't need to be a psychological expert, either, just someone who knows how to listen. You bounce your findings off the person, who either confirms or helps you to correct what you're feeling about yourself.
HOW CAN I CHANGE A NEGATIVE THINKING SPIRAL?
A negative thinking spiral is a tendency to feed your mind with negative thoughts in such a way as to keep the depression going. The negative thoughts become self-perpetuating.
I am primarily a "cognitive" psychologist. That means I lay a lot of stress on what's going on in the head. Your thinking is the key to controlling your emotions and behavior. While thinking doesn't cause all feelings, it's at least the starting point for correcting your troubled feelings.
Proverbs 23:7 tells us that "as a man thinks in his heart, so is he." There's a lot of practical truth in that idea. The gospel comes to us with a rational and logical system of values and beliefs. That system runs counter to the erroneous ideas, misbeliefs, and illogical thinking patterns of our world, which feed the negative thinking spiral.
To correct your thinking, then, you should allow the truths of the gospel to saturate your mind. That's not easy to do by yourself, so again it's wise to find someone else to help you evaluate your thinking and encourage you to make changes. A small group of supportive friends can do this for each other. We need to be in an open relationship with others to be healthy. (I'll be talking more about this in chapter 7.)
WILL ACTING AS IF I FEEL GOOD HELP ME TO REALLY FEEL GOOD?
Sometimes, but not always. It depends on where you are in your depression. When you've "bottomed out," you're through the deepest part, and your grieving is done. You can now speed up the recovery phase by just behaving as if you feel good again. That helps to build your confidence and reinforces your improvement. Get back into your normal routine. Put a smile on your face. That breaks the tendency to be self-pitying. Very soon you will find that you begin to feel good again.
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I repeat, however, that this is only helpful during the recovery phase. In the earlier phases, such behavior will usually just aggravate the depression. Your body or mind is not ready to give up the depression.
ONE OF THE MOST DIFFICULT PROBLEMS IN DEPRESSION IS THE RELATIONSHIP BETWEEN THE WILL AND FEELINGS. HOW CAN I GET MY WILL MOTIVATED WHEN I FEEL SO DOWN?
The secret is to learn to "disregard" or "step over" your feelings. Now, that doesn't mean you ignore or deny them. Feelings are important symptoms and must be attended to. But once you've recognized you have certain feelings, you can choose whether or not to continue dwelling on them. (We'll be discussing this more thoroughly in chapter 7.)
HOW CAN I DO WHAT I KNOW I SHOULD WHEN I DON'T FEEL LIKE DOING ANYTHING AT ALL?
If you know what you should do and you don't feel like doing it, you have a choice. You can just not do it, or you can exercise some willpower and go ahead and do it anyway. Depression diminishes willpower, but it doesn't take it away. If you believe you can do something, even though you don't feel like doing it, you can do it. It comes right back again to the nature of your beliefs.
Take the mother who is experiencing a depression following the birth of her child. She knows the child must be fed, but she doesn't feel like doing it. Yet she goes ahead and feeds the child because she knows it must be done.
Why should that be any different from other circumstances where a person knows what must be done but doesn't feel like doing it? The difference is simply that in the one case there is a strong conviction that the act must be done. In other words, the person doesn't really believe it's that important. What you have to do, then, is to strengthen your belief about what must be done.
WHAT'S A GOOD WAY TO START THE DAY WHEN I DON'T EVEN FEEL LIKE GETTING OUT OF BED?
Always start the day by committing it to God. Do this before you even try to get out of bed. Then you must resort to sheer willpower. A spouse or friend can also be helpful in encouraging you to just start getting up. Take it one step at a time. Slowly you will accomplish what seems to be an overwhelming task.
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IS TAKING SOME POSITIVE ACTION HELPFUL IN COMBATING DEPRESSION?
Most definitely. Taking positive action, no matter how small, helps to maintain a sense of control. You have to avoid feeling helpless at all costs. Retreating and just letting things happen to you accentuates and feeds the depression. Even so small a positive action as tying your shoelaces can build some feeling of control.
Let me give you a concrete example of beginning to take positive action. Suppose you have lost your job, and you feel a deep depression coming on. The first step may be just to sit down with a piece of paper and write out a resume. Perhaps looking in the newspaper for job openings can be the first step. Another step might be to get some vocational guidance counseling, to see if you're in the right line of work.
IS THIS TRUE ON BOTH THE DOWNWARD SIDE AND THE RECOVERY SIDE OF DEPRESSION?
Yes, positive action is helpful wherever you are in your depression. It's perhaps more effective on the recovery side, but "taking control" is a step you can begin at any point. If you don't, it's easy to get deeper and deeper into a depression. You create a sense of helplessness that puts you at the mercy of your circumstances. Often the sense of lost control creates a much greater loss than the original one.
DON'T ASSERTIVE PEOPLE FIND THEMSELVES FRUSTRATED BY CIRCUMSTANCES OVER WHICH THEY HAVE NO CONTROL?
Surprisingly, individuals who are able to take control of their personal circumstances usually have a better understanding of their limitations and are much more accepting of conditions they can't master. People who have difficulty asserting their rights often feel helpless in all areas of life.
When the apostle Paul said "I have learned to be content whatever the circumstances" (Phil. 4:11), I think he was saying much the same thing. He understood his own limitations, yet when called upon to exercise authority, he was able to do so.
HOW IS IT POSSIBLE TO TAKE CONTROL OVER GLOBAL CIRCUMSTANCES?
I'm talking here mainly about ordinary circumstances in life — your job, family, church — over which you can take control. Some circumstances are truly beyond
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your control, such as the weather, the national economy, and even world affairs. There must be a certain resignation to such circumstances in order to maintain a healthy attitude. If our country decides to go to war, it's going to happen whether you like it or not. In such circumstances, it would be impossible for you to "take control."
Unfortunately, many people become too taken up with the kinds of circumstances just mentioned and so suffer more depression than is necessary. We can't allow global events to make us feel so helpless that we're constantly depressed. We have to accept that there is much we can't control and leave it be.
SOMEONE HAS SAID, "A PURCHASE A DAY KEEPS DEPRESSION AWAY." IS SPENDING MONEY A GOOD WAY TO COUNTER DEPRESSION?
It's true that when some people are depressed, they counter it by spending money. They indulge themselves in such a way that, temporarily, the depression doesn't seem so bad. The more money they spend, the more it relieves their depression. Mind you, it can be a costly way to cope with depression. If you spend too much, you have another loss to deal with afterward.
Some people resort to spending because they're reinforcement-deprived. They either don't have many positive things going on in their lives, or they're not being positively reinforced for the things they're doing. Many housewives find themselves in such a predicament. Life can be dull when all you do is wash clothes, cook meals, and discipline kids. These women are caught up in their housework and are not adequately reinforced in their life's experiences. So they may go on an occasional spending spree to make themselves feel better and to provide the missing reinforcement.
If you're reinforcement-deprived, work at building some reinforcing experiences into your everyday life-style. Solid friendships, occasional outings, or a change in your routine can provide satisfying elements. That way you won't have to depend on spending money for your good feelings. Some spouses need to be more attentive here and help to provide more variety for the homebound spouse's life.
IF I'M ALREADY DEPRESSED BECAUSE OF FINANCIAL PROBLEMS, WON'T SPENDING MONEY ON A PROFESSIONAL COUNSELOR WORSEN THE SITUATION?
Not necessarily. Seeing a counselor may help to speed your recovery. Counseling doesn't have to be expensive, either. Many medical insurance policies
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include payment for these services, for psychologists as well as psychiatrists. Every city has mental health facilities that charge a minimum fee, usually on a sliding scale tied to income. Further, many churches offer counseling by trained lay people that can provide effective help for milder depressions. If a depression is serious, I don't think you have any option but to obtain competent professional help. The consequences of not getting it can be serious.
HOW CAN I COPE WITH DEPRESSION WHEN I'VE LOST ALL HOPE AND FEEL LIKE ENDING IT ALL?
If you get to the point where your hope is so low that you're thinking about taking your life or running away, you should seek outside help immediately. You can't trust your perceptions when you're in a deep depression. You must have someone else to help you, someone you can share your problems with and who can provide support.
SHOULD I SEEK OUT A FRIEND WHO HAS ALSO EXPERIENCED DEPRESSION OR AN EXTROVERTED, OUTGOING FRIEND?
What you should look for, above all else, is a friend who is understanding and willing to listen without judging you. Whether the person has experienced depression is unimportant. In fact, some people who have been depressed are not easy to speak to because they want to talk about their own depression rather than listen to yours. An extroverted friend may want to short-circuit the process and cut you off. That won't be helpful, either. To repeat, what you need is a friend who has the ability to listen, not give advice.
HOW SHOULD I GO ABOUT DISCUSSING MY DEPRESSION WITH A FRIEND?
At the very beginning, you should make an informal agreement, "structuring" the relationship. Don't just drag someone into a corner and say, "I want you to know what's happened this last week," and then dump on him or her. Friends tend to run away from that approach. You need to ask permission to be candid. You could say, "I've been getting depressed recently, and I don't know why. I need someone to talk to about it. Would you be available? I'd be happy to do the same for you."
In this informal contract, you should spell out your expectations of your friend. Make clear that all you want him or her to do is to listen so that you can come to some understanding of your problem. You can also assure your friend that if he or
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she has some insight to offer, you would be happy to receive it. Preparing a friend in this way can be very helpful in making sure the process works properly.
WON'T MY FRIENDS MISUNDERSTAND AND THINK I'M ONLY ASKING FOR PITY?
That's all the more reason you should explain beforehand what you expect of your friends. Be straightforward. "I don't want pity from you, and I don't want advice necessarily. All I need is for you to listen." That should avoid any misunderstanding.
Many churches offer lay counseling programs that train their members to be effective listeners. This training also helps counselors to avoid feeling guilty because they can't change a situation dramatically in a short time. Such programs not only train good lay counselors, but they also produce better friends.
WHAT OTHER STEPS SHOULD I TAKE IN USING MY FRIEND EFFECTIVELY?
I would add that in structuring the relationship, you should clarify the time commitment. Don't expect your friend to be available every day for as long as you want. Set some limits, and don't abuse the privilege. It's helpful to ask your friend to give, say, an hour a week for a certain number of weeks. Be frank and honest in setting limits. That will help your friend avoid feeling guilty when the time is up; it's what you agreed to.
When you talk with your friend, explore your loss, lay it out clearly, and talk about the various aspects of it. Often just describing it and exploring its many aspects helps to put it in perspective. You may discover that the way you're thinking or feeling doesn't make sense. Your friend can then help straighten out your thinking.
AM I IN DANGER OF DEPRESSING OTHERS BY RELATING MY EXPERIENCES?
Generally speaking, if you have contracted well, explained your expectations, and set limits on your friendship, you can share your depression without fearing you'll depress your friend also. Depression itself is not contagious. There are some people, though, who are very sensitive and too sympathetic rather than empathetic. They're likely to let your feelings affect them. That doesn't help you, either, because you need understanding rather than sympathy. If you have such a friend, it's better that you don't discuss your feelings with him or her.
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HOW DO I RESPOND TO FRIENDS WHO SAY, "COME ON, SNAP OUT OF IT. THIS HAS GONE ON LONG ENOUGH"?
Friends who say that are being callous and doing a great injustice. If you could snap out of your depression, you would. Basically, what they're saying is, "Hey, your depression makes me feel depressed, and I would appreciate it if you would stop being depressed so I can feel more comfortable." You can either ask them to stop short-circuiting your depression or seek out other friends.
WHAT CAN I SAY TO PEOPLE WHO INSIST THAT ALL DEPRESSIONS, INCLUDING MINE, ARE SPIRITUAL?
The tendency on the part of some Christians to spiritualize all depressions is dangerous. This is a common theme in the teaching of many popular preachers, and it has been around a long time.
Job heard that thought when God tested him with affliction. His friends tried to comfort him by asking, "Is not your wickedness great? Are not your sins endless?" (Job 22:5). Job had already responded, "Miserable comforters are you all!" (Job 16:2), and he was right! He knew he hadn't sinned, and in the end God vindicated him. But in between, he did suffer from depression. And this is true for all of us — depression is not necessarily tied to sin.
Spiritualizing depression is too simplistic and is certainly not scriptural. Many people sin but never get depressed. Unfortunately, many Christians who have not necessarily sinned get depressed. The best we can say is that sometimes there is a connection between sin and depression, but it's not always there.
Another common mistake is to think of depression as being caused or perpetuated by lack of faith in God. This implies that if you were deeply spiritual, you would not get depressed or would get over your depression quickly. If you don't you're a spiritual failure.
That idea tends to make a person more depressed. Such a person is feeling bad enough as it is. Pile more guilt on top of the depression and you can almost guarantee the individual will be depressed for a long time. Satan must surely clap his hands with glee when we do this.
Another common idea is that healing from depression is exclusively a spiritual exercise. Some preach and teach that all depression is healed by simply confessing it, repenting of it, and turning back to God.
This idea fails to recognize that many of our depressions have roots in biochemical or genetic causes, or that a legitimate spiritual discipline needs to be
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exercised through our depressions. I am a strong believer that God can help us in the healing process and that when it's an entirely spiritual matter, He provides the healing. But in many instances, our depression needs help in addition to whatever prayer or confession we need to make.
We readily acknowledge that when we come across someone whose leg has been crushed in an accident, we should quickly call for paramedics and pray that God will work through surgeons to bring healing. Well, the many depressions that have physical causes are no different from broken nerves or the biochemical disturbances that are causing the depression.
As Christians, we need to be open to God's miraculous interventions. There are times when He provides healing without any physical interference or psychological assistance. Many people, however, need to be pointed to the resources of the gospel and to see what they are doing in their personal lives that can be causing or perpetuating their depression.
The Christian counselor has a role, therefore, in facilitating the healing process. God's Spirit is as much present in the counseling room as He is in the pew. God's word speaks through the wisdom of Christian psychologists and helpers as much as it does through the voice of preachers.
We need a holistic healing approach. We need God's help, but we also need to be willing to open our hearts to God before He can heal them. Christian counselors have spiritual resources that can help you to open your heart and be receptive to His healing work.
If you are totally isolated and don't have access to a friend, counselor, or pastor for whatever reason, I want to assure you that God understands your condition and will make adequate provision for your healing. Turn now and surrender your life to Him. Pray for His healing, and then claim it by faith.
IS THERE VALUE IN ATTENDING SELF-HELP GROUPS FOR DEPRESSED PEOPLE?
Self-help groups are primarily support groups. They can be extremely helpful for many personal problems. I prefer them to be Christian, however, because some groups can be damaging to your faith if they're not. Often they're designed to break down your beliefs, and if your faith is different from that of other members of the group, they will attack and seek to destroy your faith.
Christian self-help groups should build your faith. They can provide you with
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resources to help you understand yourself and the causes of your depression. They also provide accountability for you as you contract with them to change some things in your life to help you in your depression. Finally, they can aid you through the most difficult times of your depression. If there is no such group in your church, you may want to consider starting one yourself.
SHOULD THESE GROUPS NECESSARILY BE GROUPS OF DEPRESSED PEOPLE?
No. In fact, I would generally avoid putting a lot of depressed people together in one group. Each depressed person wants to focus on his or her own depression. Such a group would have little to give each other. Recovered depressed people may be helpful in a support group; they can offer perspective on the whole process and provide encouragement to the depressed by describing their own journey. But a "mixed" group works better.
WHERE CAN I GET MATERIAL TO HELP ME UNDERSTAND MY DEPRESSION?
The first and most important resource is your Christian bookstore. Many books written from a Christian perspective are available today. Be careful, however. Some writers really don't understand depression and present it as an alien experience. Avoid such books.
HAVE YOU FOUND ANY BOOKS THAT ARE PARTICULARLY HELPFUL IN THIS AREA?
One that has been helpful to a number of my clients is Happiness Is a Choice (Baker Book House), written by two medical doctors, Frank Minirth and Paul Meier. My own books Unlocking the Mystery of Your Emotions and Counseling the Depressed, both published by Word, should also prove helpful.
WHAT ARE SOME THINGS I CAN DO TO AVOID DEPRESSION IN THE FUTURE?
The best way to prevent future depressions is to deal effectively with your present one. But there are also some prevention measures you can take. One key is to exercise.
Time and again, it has been demonstrated that a good exercise program helps seriously depressed people not only to recover more quickly from their depression,
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but also to prevent future depressions. Exercise can't do this by itself; other aspects of the depression must be treated as well. But since depression tends to create a state of lethargy, stimulating the physical systems by exercise is extremely helpful. It counters the natural tendency to give in to the heaviness that only intensifies the depression.
A balanced diet is also important. I encourage my clients to take a vitamin B complex to supplement their normal diet, since most modern foods are deficient there. That helps to prevent some fatigue problems that may develop.
Developing good relationships with others is also a preventative. If you have trouble relating to people, I suggest you seek counseling.
It's important that you have a fulfilling life. If your job is not fulfilling, for example, you may have to decide if a change would be beneficial.
Underlying all this, of course, should be a healing faith, a sound theology, regular Bible reading, prayer, and involvement in Christian activities. The development of a biblical value system is vital in preventing depression.
ARE THERE PARTICULAR EXERCISES THAT ARE BENEFICIAL?
The amount and kind of exercise you should do depends on your physical condition. Your medical doctor is the best person to advise you on how much and what type of exercise you can take. A number of good exercise books start you out with a little bit of exercise and gradually work you up to more-vigorous levels. Many health clubs and YMCAs also have well-designed programs for physical fitness.
Exercises I advocate include riding a bicycle, doing some light jogging, and push-ups and sit-ups if you're physically able. Walking is always healthy, so do as much as you possibly can. Taking a brisk walk with your spouse, children, or dog just before you retire for bed is an excellent practice.
HOW DOES BLOOD-SUGAR LEVEL RELATE TO DEPRESSION?
Sugars exaggerate the normal cycle of highs and lows in the emotions of some people. If you have a tendency to trigger a depression from sugar, see your doctor for a glucose-tolerance test, as you may be prediabetic. It's a fairly standard test to determine whether a person's insulin system is in proper balance for handling large doses of sugar. In general, we should all cut back on sugars as much as we can. We should also avoid extreme amounts of coffee and cola drinks because of the caffeine, which is quite a powerful drug. Moderation is the best policy.
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YOU'VE MENTIONED THAT EVEN A REACTIVE DEPRESSION INVOLVES THE BODY'S BIOCHEMICAL SYSTEM. CAN A PROPER DIET SPEED RECOVERY FROM SUCH A DEPRESSION?
Someone who is not in good physical health or who is not eating a balanced diet will not tolerate a reactive depression as well as someone who is fit. In other words, although the trigger for such a depression is psychological (a loss), the way your body reacts will be determined to some extent by your physical condition. A healthy body helps us to have a healthy mind. If your body is in poor shape, relatively minor losses can trigger massive depressions. But if your system is in good health, the physiological components of the depression will not be as intense, and certainly not as prolonged.
IN THE CASE OF THE PHYSICALLY UNFIT, WILL THE BODY'S BIOCHEMISTRY DRAG THEM DOWN FURTHER INTO DEPRESSION?
Yes, an unfit body also means the body's biochemistry is not well balanced. The depression makes you lethargic, and you put out less physical energy; that in turn contributes to further depression. The less healthy your physiology, the more likely the depression will intensify.
