Depression - A Pastoral Response
Written by Auriel Schluter
You can download the PDF of this resource hre.
What do we do when someone we care about is deeply depressed?
The first thing is simply to be with them, not to try to make it better. Anxiety is a big factor in depression, and your friend needs to know that you can be in their presence without either being overwhelmed by their negative feelings, or needing to solve their situation. They want to be accepted as they are. Your calm presence helps to normalise their situation, and reduces their fear.
Being with someone with depression can feel like a slow-motion silent movie in comparison with life ‘outside’. So you will need to adjust your pace, and your volume, to connect with where they are. You may need to adjust your expectations of what they can concentrate on; one encouraging Bible verse might serve them for many weeks.
The physically ill tend to get cards, and flowers, and visits; but in contrast it is not uncommon for the depressed to feel ignored or an embarrassment, so they withdraw further still. It will be good to think how best you can remedy this.
Each person is unique, and their experience of depression is very personal; so it is worth asking them to describe it and to use their own analogies in reference to it. Some descriptions have been: feelings of drowning in a fast-flowing river; of trying to climb a scree with boulders raining down; of being enveloped in a black cloud; of being shut in a dark hole; of being in a deep pit; of being a piece of china shattered into pieces; of being broken down and shunted out of the way; of being behind a glass wall. Hearing these descriptions will help you know how best to be with them
The Spiritual Dimension
Many people facing depression will have lost their sense of God’s presence, and/or their own assurance of being saved; although this is not universal, and for others God is all they have left. The key for you is to remember that their mental or emotional state does not accurately reflect their spiritual state.
We should not rush to see a friend’s depression as sin. It is often an illness (half of all mothers experience some postnatal depression for example); we should no more face condemnation for depression than for having a broken limb.
To indicate a belief that your friend is spiritually in danger is unhelpful, as no personality-type is inherently more sinful than another. Many Christians will already feel guilty that they are depressed, and so to summarily judge them is to add shame on top of their guilt – and shame is far harder to shift, because it is about identity rather than function.
It is true that sin is present in all of us, and ungodly responses to life’s difficulties may have been part of the route into depression. It can be good to explore these later. Depression affords an opportunity under God to review our assumptions and responses, and so to grow. But grace and hope must be offered first.
Symptoms of Depression
A person is considered to be depressed if they have a cluster of the following symptoms that persist over a period of time. There is a continuum from `feeling blue` to total non-functioning.
· Sadness (pessimism, hopelessness)
· Apathy (inertia, non-action, no decisions, loss of spontaneity)
· Fatigue (no interest, no energy)
· Problems with sleep and concentration
· Eating problems (no appetite, or comfort-eating)
· Low self-esteem (guilt, shame, worthlessness, helplessness, hopelessness, self-criticism)
· Withdrawal (self-harm, suicidal thoughts )
A depressed person is coping with multiple losses: of energy, motivation, hope, purpose, health and relationships. Loss, perceived loss, and stress may well have been triggers.
Where there are suicidal thoughts expressed, these should be listened to seriously but calmly. Often there is a death-wish without a suicidal intention; a good response would be to acknowledge the despair this represents, and an understanding of why they might feel like this. Job, Jonah and others from the Bible could be cited as having felt this way too. Serious attempts at suicide have usually been thought through in practical detail, and are less commonly expressed openly. Nevertheless, if you feel the person seems genuinely suicidal (or if their baby is in danger in the case of postnatal depression), seek professional help urgently. This article may also be helpful
There will likely be multiple components causing the depression: physical and psychological, nature and nurture, internal and external, trigger and response. Depression is rarely either purely endogenous or purely reactive, but rather a mixture of the two. It is often triggered when a certain personality-type meets a certain set of circumstances. It is therefore well worth seeking to find appropriate counselling for the depressed person to be able to explore it for themselves.
It is also important that they are encouraged to see a doctor, not only because there are some types of persistent depression that will need lifelong medical help (watch out for cyclothymia), but also because many temporary depressions need some temporary medication to help the sufferer function well enough to do the personal exploration which will bring them out of it and give them tools to manage themselves better in the future. The physical dysfunction in the brain needs to be alleviated.
With the right sort of help depression can be used by God for a deep exploration of assumptions, thinking patterns, and habitual responses that can be life-changing. Encouraging the person to see this is an opportunity for personal and spiritual growth may take time, but it is well worth it.
As a Christian would expect, love, faith and hope are key elements. People are relational, and isolation needs to be met with love. It needs people who are willing to `be there` even when there is nothing more they can do. Tears shed in the presence of someone who can cope with it is a healing experience. Let them know you are praying for them.
People are rational, but their thinking will be clouded by depression, and often may cease to be based on biblical truth. An assurance may be helpful that faith is dependent on what Jesus has done, and not on the person’s ability to pray, or read the Bible, or feel that God is close.
There may be a loss of will, and seeing someone else still holding out hope for them when they feel hopeless may rekindle their own. Depression is scary, and reassurance will be needed; not a negating of their feelings, but a holding out of real hope. Encourage them to be patient, because signs of improvement may be slight and slow to appear; to focus on anything positive they still feel; and, meanwhile, not to withdraw into solitude.
Since promoting a healthy body can aid healing, you may need to encourage the depressed person to eat sensibly and to take gentle exercise. They will probably sleep a lot, but encourage them to keep a good rhythm of night and day if possible.
Genesis 1:1 is where God started – with darkness, chaos and emptiness. This is how a depressed person feels. Assure them that it is God who brings light and order and fruitfulness, and it takes time.
See how God dealt with Elijah in 1 Kings 19 - time, space, sustenance, and gentle questions leading gradually to a new perspective: to a recognition again of community; and, crucially, taking him right back to the place where God initiated his covenant with his people.
Only God has the whole picture. Job’s comforters thought they knew more than they did, and they misapplied truth. But Job’s understanding of God was greater than theirs in the end.
Psalm 88: one example of bringing honest feelings to God – he already knows! Psalms 42 and 43 show David talking himself around.
2 Sam 9:7: Mephibosheth. There is always a place for the (emotional) cripple at the King’s table – even if rejected by others, including church folk.
Lamentations also have their place and purpose, as they did for Jeremiah; and for many others since, such as the hymnwriter William Cowper, who faced colossal depression.
Finally, Jesus faced it all - betrayal; misrepresentation; abandonment, all of them common triggers for depression. He knows, and he invites us to bring our burdens to him (Matthew 11:28).
DON’T – judge, cajole, minimise, catastrophise, generalise, attempt to fix, share their anxiety, or leave them in isolation; don’t collude with their helplessness, hopelessness or victimhood.
DO – stick with them, go at their pace, refuse to despair; never be shocked or overwhelmed; encourage exploration and responsibility; assure them of God’s love and presence, and model it; hold onto faith and hope; encourage an attitude of opportunity; constantly hold out hope to them.
And finally - do look after yourself! You can pick up their depression. Keep good boundaries, don't let the depressed person become too dependent on you, give yourself space, have good support, and underpin all you do with prayer.
Christian Counselling by Gary Collins has a comprehensive section on depression which gives a broad overview. It is a book that pastors could usefully have on their shelves for a lot of pastoral issues like this, and very broad in its scope.
Spiritual Depression by Martyn Lloyd-Jones and Conscience by Ole Hallesby are older classics giving valuable insights.
And from secular authors:
Curse of the Strong by Tim Cantopher, a doctor who sees depression as a physical illness caused by stress and malfunction of the limbic system. But he also cites personal questions that need to be asked if the person is to avoid relapse.
Depression by psychologist Dorothy Lowe offers many good insights of the routes and choices that lead into depression, and therefore are clues to ways out.
http://www.rcpsych.ac.uk - Royal College of Psychiatrists site; put `Depression`into the search engine
http://livinglifetothefull.com/ - set up by a Christian psychiatrist following a CBT approach. Very useful for those wanting a 'self-help' approach, and may well be something a friend or pastor could work through with them.
http://careforthefamily.org.uk has a number of resources on postnatal depression – put ‘postnatal’ into the search box on their home page.
© Auriel Schluter.