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Wednesday, April 2, 2014

When Darkness Is Your Only Friend

Darkness Is My Only Friend


I do not know if "darkness is my only friend" is the correct translation of Psalm 88:18 (the ESV gives “darkness is my only companion” as an alternative translation). But I do understand the feeling.

Psalm 88 is the darkest of the Psalms and, as such, there have been times when I have found not only that it uniquely gives voice to the way I feel but that it uniquely gives me a little hope, for, despite the Psalmist's frame of mind, his faith is evidenced by his calling out to the “God of my salvation.” In this Psalm there is “no light at the end of the tunnel.” At the end the Psalmist is still in the dark waiting for God to do something. And, since what he was experiencing in the now is what he had experienced from his youth onward, we do not know if he ever experienced deliverance from his afflictions and and feelings of despair. Perhaps he continued to struggle until he departed this vale of tears and awoke to find that “in your presence there is fullness of joy” (Psalm 16:11).

I know what depression feels like. It feels like being in a dark hole with no way out. It can actually feel better to get past irritability to isolation, past panic to resignation, past fighting to giving up. 


But I do not know what depression is (nor do I think anyone really does).

There may be a genetic-bio-chemical component. The conventional wisdom now is that depression is to some extent a medical problem; hence the first line treatment is provided by medical professionals who give medicines (family practitioners and internists). But, if depression is a medical condition, there is no laboratory test for it. Medicines are given, but no one knows how (not so important) or if (very important) they work. There is serious debate about the effectiveness of the medicines. One of my internists insisted that they do work, but the examples he gave were from the lives of people who were not “normally” depressed but who were prescribed medicine and helped when they became depressed after the loss of a spouse, used the medication temporarily, and eventually regained their equilibrium. My present doctor agreed with me when I told him I was doubtful that the medicines make any difference. What I know by experience is that I fell into an abyss when I stopped taking the medicine (stopped after reading a magazine article in my former doctor’s office that was skeptical of medications being effective). But did I fall into the pit because I stopped taking the medicine or did I stop taking the medicine because of deepening despair?

There is, no doubt (at least in my mind), often a spiritual component. Martyn Lloyd-Jones (or as some call him “The Doctor” - though a minister he was first a medical doctor) wrote a whole book on Spiritual Depression. Despite the (well-founded in my opinion) warnings of Dr. Ralph Davis, who objects to psychologizing rather than exegeting the text, ministers keep preaching on depression from the post Carmel experience of the prophet Elijah. I did till I read Dr. Davis' article on the text.

Looking at depression from a spiritual perspective, what is its relation to sin? Is the depression itself a sin of a believer’s refusing, for whatever reasons, to believe God and his Word? Or, is it a failure to to make use of the spiritual resources that belong to a Christian by the work of Christ and the indwelling of the Spirit? Then, is sin the cause of depression (you disobey and you get depressed) or does depression make a person more vulnerable to sin? It probably works both ways and sometimes both at the same time.

Then what about the psychological aspect?

That is, IF there is aspect of humanness that psychiatrists and psychologists can deal with and is distinct from the spiritual (contra the “nouthetic” approach). It’s not so simple, especially if you are a di- not tri- chotomist. (Some believe man consists of a complex of body and soul/spirit while others believe that he is a complex of body and soul and spirit.) “Psychology” means “knowledge of the soul," the word “psyche” being the Greek word for “soul.” 

It seems to me that there is something about depression that falls into the realm of our common humanity where the sons of this world (non-believers who study, describe, and seek to alleviate depression) may be wiser and more helpful than the sons of light (Christians). To put it another way, a depressed person’s coming to believe in Christ does not necessarily relieve the depression nor does being a believer mean one is protected from depression. Depression is human. Those who experience it may be non-believers or believers. Those who are immune (except for the infrequent and occasional “blues”) may just as well be believers or non-believers.

Dr. Martin Seligman, professor of psychology at the University of Pennsylvania, has along with others debunked the classic Freudian psychoanalytic explanation of depression as “anger turned inward." And, he does not have much confidence in the medical approach, believing medical treatments are both overused and of limited effect. His understanding of depression is that it is a result of “learned helplessness.” Learned helpless results from a “pessimistic explanatory style" which is often developed in childhood in response to painful events and the way parents tend to interpret life.

Animals exposed to pain, which they have no way of escaping, eventually give up and become depressed. His research has shown that something similar happens with humans who explain bad events in terms that are personal (it’s my fault), permanent (it will always be this way), and pervasive (this undermines my whole life). The more pessimistic your explanatory style the less likely you are to bounce back from the down emotions everyone experiences and the more likely depression will be ongoing and debilitating.

His treatment approach is cognitive and based on research that shows that people can learn to think differently, unlearning helplessness and learning optimism. With the psychotherapeutic understanding debunked, and with the medical approach having its limitations, the cognitive has gained favor. The current preferred treatment for depression is medication plus cognitive therapy.

What should we make of the apparent epidemic of depression since serious depression is debilitating and can lead to death? Why are people in the West, who live longer and more affluent lives than ever before, more depressed? Some argue that it is because there is so much more stress in modern life. But Seligman sees it differently. He thinks the increase in the percentage of the population that is depressed is related to (1) the rise of individualism (the big “I"), (2) the loss of community experienced in institutions such as family, church, neighborhood, and country (the “we"), and (3) the rise of the self-esteem movement. Other possible factors occur to me: (1) With regard at least to the milder forms of depression, it may be, as has happened with disorders like autism and attention-deficit disorder, that it is more frequently diagnosed and perhaps over diagnosed today. (2) It may be that we have the luxury of time and money to be depressed. When your family had to farm to eat or when your country had to fight for its survival you may not have had the time or money to be depressed.



Well, then, a few comments.

1. While I would not recommend that anyone cultivate pessimism as an outlook, there is an advantage to pessimism. Generally speaking pessimists are more objectively realistic than optimists. Optimists frustrate the heck out of pessimists who want to ask, “Do you hear yourself? Have you lost touch with reality?” I find the sunniness of some people like a dessert that has too much sugar. If the price of being free of depression is saying things like, “Let’s turn a negative into a positive,” the price is too high for me. Optimists are too optimistic about themselves, others, and circumstances. Optimists overestimate the amount of control they have, while pessimists are much more accurate gauging how much control they have. In a business you want optimists as salesmen but maybe not as engineers or accountants. Think about the implications of this for church life with some optimists thinking nothing can’t be done and some pessimists thinking nothing can be done. Or, consider the implications for a Christian’s self knowledge. The biggest danger for the pessimist is susceptibility to falling into the abyss of innervating depression.

2. There can be another advantage to being a depressive. Just as having had a serious disease can make you more empathetic toward others who experience serious disease, so depression can make you more empathetic toward others who have their struggles with life. I have had people tell me that certain sermons and prayers have helped them, and I have known that they were saying that they felt “understood” - that the minister felt the feeling of their infirmity. I am not saying that there are not big disadvantages both to the minister and the congregation if the minister experiences depression. I am pointing out what I think may be an advantage.

3. It is heck to try to deal with a pessmist who is depressed. I say that from the perspective both of being depressed and of trying to help the depressed. At first you may be sympathetic and want to help. But, as you find that the things you say and try to do are not helping, you may become frustrated. You want say, “Get a grip; stop feeling sorry for yourself; do something to help yourself,” punctuated with a boot to the backside. This is understandable because the one who initially wants to help knows there are people who have similar or worse circumstances than the depressed person but do not become depressed, because the depressed person is so self-absorbed, and because the depressed person’s unhappiness affects the happiness of your life. You can feel like General Patton who, coming upon a soldier with battle-fatigue in an Army hospital in Sicily, slapped him and called him a “yellow bellied bastard.”

4. While the frustrations experienced by those who try to help the depressed are understandable, it is also true (or at least I think it is) that when a person is severely depressed all the “buck up and pull yourself up by your bootstraps” exhortations are not going to produce the intended effect. They can make matters worse. It may be in some cases that depression is so “normal” for the person that he/she does not know what it feels like not to be depressed. Depression may be the most comfortable place to be. In other cases, it may be that the person feels, “I would like to get out of this hole, but I can’t. I don’t know how, and if I did, I don’t have the energy.” The really depressed person's tank is empty of hope and fight. 


5. We delude ourselves thinking that every problem can be prevented or resolved. Some can. But some can’t. In our lives neither sin nor suffering is going to be eradicated in this world. We can fight against sin. We can mitigate suffering. But there is no victorious Christian life. We groan. The universe groans. We can be thankful that for most people depression is infrequent and soon passes. But for others depression is a black dog that always follows, sometimes at distance, sometimes nipping at the heels. Not infrequently the dog pounces, sinks its teeth into the flesh, and won’t let go. With depression we can use the means of grace, take the medicines, and try to change our pessimistic explanatory styles. But for some at least relief will come and joy arrive only when the eternal morning dawns.

"O LORD, support us all the day long, until the shadows lengthen and the evening comes, and the busy world is hushed, and the fever of life is over, and our work is done. Then in thy mercy grant us a safe lodging, and a holy rest, and peace at the last. Amen."














9 comments:

Rootietoot said...

As a person with bipolar disorder, I am intimately acquainted with depression. In my case medicine works. Spiritually speaking, even when very depressed and pretty sure there isn't any point in carrying on with living, the nugget of knowledge that I am loved by God and His mercy and grace will see me through has kept me from suicide. Still depressed, still in that grey fog of nothing that is depression, but still loved by Him. Until I came to Christ, suicide was an option that was very real. Now, it isn't. That is the biggest difference. It is difficult to explain to someone who has never been clinically depressed. There is no "snap out of it!" and no tangible reason (like the death of a loved one) for the depression, when one has a mental illness like bipolar disorder, but recognizing Christ for Who He is, and accepting God's grace and mercy for what it is, is truly the difference between life and death.

Eutychus said...

Years ago,I suffered from severe depression -- days full of fatigue, deep and unrelenting sorrow, and a very "doable" suicide plan. I could feel it coming on, and my wife graciously "took over family duties" until I felt better. Ironically, even though I understood the some of the pharmacology of depression and recommended that my depressed parishioners see their physicians, I don't think it ever occurred to me that I should! Somehow, after an incredibly bad year in which I tried to leave my church, quit the ministry, and give up on life, I gradually realized that I was no longer experiencing those depressive episodes, nor the migraines that accompanied them. I have no idea what happened, but in the 25 years since, I have had an effective ministry with fellow depressives who understand that "I know." No one -- not our wives nor our colleagues -- really "knows" the depths of despair you're going through if they haven't been there, do they?

Eutychus said...

Years ago,I suffered from severe depression -- days full of fatigue, deep and unrelenting sorrow, and a very "doable" suicide plan. I could feel it coming on, and my wife graciously "took over family duties" until I felt better. Ironically, even though I understood the some of the pharmacology of depression and recommended that my depressed parishioners see their physicians, I don't think it ever occurred to me that I should! Somehow, after an incredibly bad year in which I tried to leave my church, quit the ministry, and give up on life, I gradually realized that I was no longer experiencing those depressive episodes, nor the migraines that accompanied them. I have no idea what happened, but in the 25 years since, I have had an effective ministry with fellow depressives who understand that "I know." No one -- not our wives nor our colleagues -- really "knows" the depths of despair you're going through if they haven't been there, do they?

Eutychus said...

Years ago,I suffered from severe depression -- days full of fatigue, deep and unrelenting sorrow, and a very "doable" suicide plan. I could feel it coming on, and my wife graciously "took over family duties" until I felt better. Ironically, even though I understood the some of the pharmacology of depression and recommended that my depressed parishioners see their physicians, I don't think it ever occurred to me that I should! Somehow, after an incredibly bad year in which I tried to leave my church, quit the ministry, and give up on life, I gradually realized that I was no longer experiencing those depressive episodes, nor the migraines that accompanied them. I have no idea what happened, but in the 25 years since, I have had an effective ministry with fellow depressives who understand that "I know." No one -- not our wives nor our colleagues -- really "knows" the depths of despair you're going through if they haven't been there, do they?

The Christian Curmudgeon said...

Right you are Eutychus.

The Christian Curmudgeon said...

Right you are Eutychus.

Jaime said...

>>>There may be a genetic-bio-chemical component.<<<

I absolutely believe there is a biological component to depression. The brain is an organ like any other, and it was just as affected by the Fall and sin as any other part of the human body. It becomes diseased like any other part of the body, and like any other part of the body, it can even be diseased from birth.

But the brain is the last, great biological frontier. It is very complex, and we really hardly know anything about it. And mental illness has been so stigmatized (and remains that way in many circles, including Christian circles) that we're only now starting to study it from a scientific point of view. I do believe that depression has cognitive and spiritual components to it. But in terms of the cognitive/psychological aspect, I would just point out that thoughts do not exist apart from the brain, and if the brain is not healthy, the thoughts may not be, either (i.e., overly pessimistic). This is not a new concept:

http://www.policymic.com/articles/53157/depression-physically-changes-your-brain-scientists-discover

CBT (my personal preference for dealing with anxiety and depression) works because changing the way you think physically changes your brain.

Someday, I believe, we will know enough about the brain to develop truly effective medicines for mental illnesses.

I don't think depression is exclusively a biological issue, but I do think biology plays a significant role. I also believe the Fall touched every aspect of the human experience, and while we know how to transplant organs that no longer function and cure many other types of diseases, we just don't know enough about the brain right now. Until then, we stumble along the best we can.

Mrs.H said...

This is a good balanced article

http://headhearthand.org/blog/2013/04/22/optimism-and-faith-in-a-pow-camp/

mozart said...

It doesn't help those who tend to the depressive side when the church insists on singing nothing but "praise songs" or even insipid Fanny Crosby hymns in our worship services. It's no wonder that Good Friday services are so sparsely attended--all that dying stuff is a bummer. And singing "Smitten, Stricken, and Afflicted." For me, Good Friday is what it's all about.