-Depression

Depression is an issue that can be simple to identify, though not always. We’ve all experienced at least a taste of depression. Even biblically we see many individual’s who likely struggled with depressive episodes. It would be hard to conceive that Job in the midst of all his struggles did not meet clinical criteria for depression. As you read some of the Psalms, it becomes pretty obvious that David had some very distraught moments in his life. Even Jesus experiences some element of depression in the garden before his crucifixion. I’m not saying that He met clinical criteria, but it is hard to believe that he didn’t have moments of despair.

Yes depression can be simple to identify, but quite complicated in its causes. The complication comes from the variety of elements that influence its origin and continuation. I see depression as a Biopsychosocialspiritual problem. It has all those influences in its makeup.

Biology
We know that there is a biology to depression. I could go into all of the neurological details, of course I’d need another three years in grad school to actually understand it fully. I do know that there has been direct correlation of serotonin levels and depression. Specifically, postmortem studies have noted a strong pattern of low serotonin levels in those who’ve committed suicide. I have dealt with enough clients who simply did not respond to talk therapy. Their chemistry was imbalanced enough that they needed medical intervention to get out of the pit of depression. The percentage of my clients in that situation is relatively low. More often than not my clients are dealing with a more moderate level of depression. With those clients, I discuss medication as an option. If the client wants to go that direction initially I’m willing to encourage it. If they would prefer try talk therapy alone for a while, I’m all for that as well. A lot of my clients don’t even like the idea of medication. Somehow they feel inadequate or like a failure if they need psychotropic meds. Yet these same individuals may be on a variety of meds for high blood pressure, low thyroid, diabetes, and any other number of issues. So why is medication dealing with the brain such a sensitive area. Lets be honest, we think of our thought process as somehow different from other bodily functions. To a large extent I agree there is something different about how we think and feel. As a Christian I have to believe that we are more than a pattern of nerve interactions in our head. However, we cannot deny that part of healthy brain function is the appropriate balance and interactions of our brain chemistry. So just like some of us need medication to balance our insulin levels, others of us need meds to balance our neurotransmitter levels.

Psychology
While I realize that all of the elements I’ve identified can be included under the broad umbrella of psychology, in this conversation I am specifically identifying thought patterns. If you do a series of interviews with depressed individuals, you will pretty quickly notice that they have great difficulty identifying with anything positive. When you try to get them to notice the positive they often respond with a “yes but”. I tend to agree with the cognitive school of therapy that says that our emotions are a direct result of our thoughts. People who tend to see the good things in life tend to be happy. Those who tend to see the difficult side of things tend to be more sad or anxious. Biblically we are encouraged to live hopeful, encouraging thought lives.

Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things.
Philippians 4:7-9

In the treatment of depression, we must address this pattern of negative thinking.

Relationships
Our social lives, that is, our relationships, can have huge impact on our moods. For example, it is very rare that you see a bride and groom in the throws of depression. When our relationships are good, often our mood is good. When they are bad, our moods are bad. God created us for relationships. It is pretty obvious that we were created to be in relationship with one another. When God made Adam, He said pretty quickly in Genesis 2:18 The LORD God said, “It is not good for the man to be alone. I will make a helper suitable for him.”

In the diagnostic manual used by the psychotherapy world, many categories have some type of relationship difficulty as criteria for diagnosis. In fact, for a few categories, persistent difficulty in relationships is the predominant criteria.

Some clients have relationship issues from the past that impact their mood now. They may need to do work to heal those relationship, or to overcome the impact of that dysfunctional relationship.
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If our relationships are in a difficult place then it will effect our emotions. As such the effective treatment of depression will often involve marital or family therapy.

Spirituality
Our spiritual life also has great impact on depression. Many Christians struggle with depression. Then they feel guilty for being a Christian with depression, making them more depressed. Our relationship with God can have great impact, positive and negative, on our mood. A number of spiritual topics can impact mood. Some of them include, sin, poor theology, inappropriate guilt, spiritual abuse, lack of forgiveness and many more. Helping clients to sort these things out, and helping them understand the love and grace of God can be incredibly healing.

Also, our relationship with God has significant impact on the other three areas I’ve discussed. Scripture has much to say about taking care of ourselves physically, psychologically and relationally. We must let God’s word guide us in these areas of our life as well.

Conclusion
I do believe that we must manage our lives in all of these dimensions. It is my goal to help my clients to evaluate their circumstance in all these areas and to effectively seek change in the most effective way possible. Each case is different, and I must admit that there are often elements of a client’s life that do not easily fit into just one of these areas. However, organizing things in this way is very helpful, and gives us a solid foundation from which to begin.