John H. Timmerman is professor of English at Calvin College in Grand Rapids, Michigan.
He elaborates on his experiences with depression in his book A Season of Suffering (Multnomah, 1988). This article appeared in the Christian Century, March 2, 1988. Copyright by the Christian Century Foundation and used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted & Winnie Brock.
We should recognize depression, not as a stigma, but as an illness entailing specific spiritual and psychological needs, and requiring specific treatments. One great need of depressed people is for human contact, whether through greeting cards or visits. To the depressed person, the well of human kindness seems to have hit dry rocks; there never seems to be enough love available.
At the most unexpected moments it slips people its dark poison. One scarcely notices the initial sting. Slowly, insidiously, the poison spreads until the victim finds herself cut off from life by a gray veil. The monster, what Winston Churchill, a longtime sufferer, called "the Black Dog." is depression. Medical statistics indicate that in the adult U.S. population approximately 12 per cent of males and 18 per cent of females have had a major depressive episode at some time.
Call it what you will, the most agonizing fact of the illness is that pall of darkness laid upon the mind. Life and light seem beyond reach. Something intervenes: a gray mist of separation, the inability to feel loved and needed, a feeling of being locked away from everything and everyone -- including God.
Perhaps this is one way to distinguish between the "blues," which afflict nearly everyone at one time or another, and the blackness of clinical depression. Clinically depressed patients cry, "My God, why hast thou forsaken me?" -- and sometimes add, "But I really can’t blame you for doing so." Unworthiness. Forsakenness.
Clinical depression can generate a number of specific symptoms that are severe, persistent and disabling. Its causes may be internal (endogenous) or external (exogenous) But if it becomes severe, it is marked by a profound biological unsettling of the delicate interplay of chemicals in the brain. Into that imbalance enters the appalling cloud. It was this biological depression that sucked my wife -- and my family -- into its black maw. We became a vivid example of suffering in the Christian life.
Acknowledging that Christians can suffer from depression flies in the face of popular religious slogans that tell us about the power of positive thinking, that we should let go and let God, that all is well with the world when one is right with God.
Seven weeks following the birth of our fourth child, my wife, Pat, fell victim to postpartum depression. Though she entered the hospital diagnosed with severe, major biological depression, the admitting psychiatrist assured us that she could expect to leave within two to three weeks as antidepressant medications took effect. Her hospitalization lasted seven weeks, through a tormenting sequence of failed medication and terrifying mental affliction, culminating in a series of electro-convulsive treatments.
So many of us will worry over even a sore throat and seek condolences from others, but we are strangely reluctant to admit to mental affliction. It appears a sign of weakness or, in the perverted view of some, a sign of sin. However difficult it is to acknowledge depression, it is a fact that many Christians have experienced it. Just how many is difficult to say; statistics are often contradictory and unreliable. For many years depression, unless it required hospitalization, was something we hid in the closet (and even then we hid it if possible) As more people are recognizing the nature of the illness, more are seeking help. For all those on the continuum from "blues" to clinical depression, I want to affirm that the black dog can be tamed; depression can be healed.
But how can people recognize depression? What signs can they look for? The most recent psychiatric guidelines, given in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (American Psychiatric Association, 1981) , draw attention to persistence and severity, usually gauged as at least two weeks’ endurance (distinguishing depression from the common, passing blues) of four or more of the following symptoms: persistent feelings of guilt, sadness and hopelessness; thoughts of suicide; poor concentration; changes in appetite; alterations in sleep patterns; decreased interest in sex; and loss of interest in daily activities.
Clinical analysis generally divides depression’s signs and symptoms into four major areas. Affective signs include states of feelings, ranging from mild sadness to severe despair. The depressed person often feels some degree of anxiety, worry, anger or confusion.
Cognitive thought-process signs are the way in which the patient thinks about himself or herself, and about relationships with others or with situations. Typically, the depressed person has very low self-esteem, feels incapable of clear decisions, and seems to have little control over thought processes, into which thoughts of death or suicide intrude.
Both of the above may be observed in behavior signs. Because of their low self-esteem and confused thinking, depressed people may become terribly dependent and submissive, fearful of being left alone, and given to relentless crying and withdrawal. Agitation may give way to restless behavior such as pacing, trembling or handwringing. Their speech and action may become impeded. They may neglect routine activities, such as picking up the mail, reading the newspaper or making coffee. They no longer take pleasure in formerly enjoyable activities.
Depression inevitably takes its toll upon the patient’s physical functions. Initially, depressed people seem to lack energy, which may spiral rapidly into acute fatigue as sleep habits are disturbed. They may suffer physical symptoms such as constipation or diarrhea, indigestion, nausea and headaches. Despite the longing for physical contact, sexual patterns may be disturbed. Posture is often affected; the patient might slouch, bending shoulders forward as if a weight were pressing upon them. The eyes might appear dull and listless, seeming to turn inward with a kind of glazed look. Few illnesses reveal as clearly the relation between body and mind.
Having examined some of the indicators of depression, the word why inevitably arises. Here is the great perplexity of depression: Why does this happen to me? As a rule, depressed persons, because of the acute sense of unworthiness which typifies the illness, generally believe they are depressed because of something they have or have not done. They believe themselves to be responsible, even if they can find no direct cause-and-effect relationship in their lives. Since so many factors come to bear upon the illness, it is understandable that people are prone to inventing causes; they want to name, identify, pinpoint and blame someone or something specific.
Psychiatry has postulated causes that are more probable than one’s own actions. For example, genetic factors may to a certain extent make one more susceptible to depression. Those with a family
background of mental disorders are al greater risk. Second, stress can provoke emotional mood shifts. A third area, the chemical functions of the brain, has become a primary focus of medical research into biological depression. Current science provides convincin8 evidence that disruption in hormonal patterns and the neural synapses in the brain are involved in clinical depression. Because of this chemical imbalance, the use of certain drugs has become critically important to the treatment of depression.
Psychiatry generally distinguishes between two major kinds of depression: bipolar and unipolar. Bipolar, or manic, depression is characterized by recurring mood shifts which the patient cannot control. Unipolar depression is a single, progressive state, without the mood swings. One theory speculates that too little of the neurotransmitter norepinephrine causes unipolar depression; too much of it causes manic depression. More recent theories hold that several transmitters are involved -- serotonin and dopamine, for example. Treatment for both types of depression may involve pharmaceutical control, depending on the diagnosis of probable causes and background for the individual’s condition.
The use of medications in the treatment of depression, often prescribed over an extensive period of time, provokes considerable dismay in many people. They fear the possibility of physiological and psychological dependency upon the drug.
Having considered signs and symptoms of depression, the major kinds of depression and drug therapy for them, one has still skirted the medical fringes of a catastrophic human experience. Left begging is the key question: What is depression like? No single item emerges more clearly from studies of the experience of depression than the fact that it attacks the very individuality of the sufferer and is therefore unique to each person’s experience of it. It afflicts parts of us that make us individuals -- our minds, emotions and personalities.
Some indication of what the illness is like may be gleaned from a journal my wife kept during her seven-week hospitalization. As she began to respond to medication her moods bounced up and down. It seemed that depression was a dark beast, always lurking behind some huge door in her mind, ready to spring out at unexpected moments. It was always there, and its attack could not be predicted. Fear of the beast was as terrible as the attack itself.
June 23 (after one week) :
When I awaken, I have a sick feeling as I remember that I am here. Sometimes it still seems like a bad dream. I attended chapel but found it very hard to concentrate. The message seemed meaningless. June 28 (after two weeks) :
Last night was a frightening night. The overwhelming feeling of depression hit me during the night. I felt nauseated, like my nerves were in knots, and had diarrhea.
. . .Tears have flowed like rivers today. I really feel I need strength from the Lord to help me get through this hospitalization. Sometimes I feel so alone and worried about a recurrence when I get home.
July 7 (after 3 weeks) :
I feel so guilty that I can’t seem to get well. I feel like a stranger to myself. . . . I can’t read my Bible or pray. I know God knows my needs and the needs of my family, and I trust He will take care of us all. I’ve reread my favorite Bible promises. But I can’t feel them right now.
I awakened about 3:30 A.M. I feel very nauseated and very thirsty. At 5 A.M. I got up for some ginger ale and a cracker. I still feel nauseated and my head is spinning. I am very discouraged. I still am thirsty. . . "I’m trying so hard to believe all of God’s promises. I know that they are true and I thank him that they aren’t dependent upon my feeling them. I feel totally helpless today. I feel that with every depressing day a little more of me dies.
During this time Pat’s medication was not being effectively metabolized. Since switching her to a different medicine would have taken several weeks, and she had already been separated from her family for nearly six weeks, her doctors decided, with our approval, to use electro-convulsant therapy (ECT)
The use of ECT has always been extremely controversial in psychiatry, and its mere mention strikes fear into the heart of the patient. The modern use of ECT, however, is far more carefully regulated and benign than the old-fashioned "shock treatments" of the 1960s. The careful administration of muscle-relaxants and tranquilizers reduces the "shock" to the body. The small surge of electricity penetrates the disrupted activity of the brain, jarring the neurotransmitters into normal action. The most common side-effects are short-term memory loss and headache, the latter usually relieved within 24 hours. While seldom a first course of treatment for depression, ECT has resulted in considerable relief for biological depression. While the normal course of treatments runs a course of 6-12 administrations, ECT proved so successful for Pat that she was given only four. A week later she was discharged.
Discharge from a hospital, however, is only a beginning on the road back to health. A major depressive episode such as Pat’s may last as long as 18 months. In fact, it was almost two years before she was able to go completely off antidepressant medication. For some people, the battle with depression and the necessity for medication or therapy may endure for years. However long the ordeal, however, the experience will forever be a part of the person. The fear of recurrence is always there; the memory of the anguish never fully disappears.
Second. we learned how much the body of Christ must support members in need. We experienced this help in bountiful and unexpected ways, reminding us with a tremendous urgency of our corporate need and responsibility. Church members regularly lifted our need before God in intercessory prayer. Pastors and friends delivered meals to us, cared for the children and comforted us. We experienced the New Testament ideal of being one body in Jesus, and the care that each member shares.
We learned that others also suffer enormous hurt on their pilgrimage through this fallen world. It is not, however, a vale of tears with no light finally to show the way. The many helping hands that attended us testified to the opposite. But sometimes it takes the jarring impact of personal pain to remind us of the wounded spirits to whom we can minister. This need is particularly great, we found, among those who suffer psychological pain. For so many it is a private grief, borne upon lonely shoulders, hidden from the world.
Depression should no longer carry a stigma; we must recognize it as an illness entailing specific spiritual and psychological needs, and requiring specific treatments. Depressed people need recognition and urgent caring. One great need is for human contact, whether through greeting cards or visits. To the depressed person, the well of human kindness seems to have hit dry rocks; there never seems to be enough love available.
Our experience tutored us, painfully, in the reality of suffering among faithful Christians. We have no easy answers. But we felt the pulse of pain and, by looking to the cross, gained some understanding.
Jesus, the true light himself, the very son of God, stands in the form of humanity -- the very same who marred God~s perfection and cast darkness over that light. To restore that light, Jesus, the perfect light, underwent the full anguish of complete darkness. He knew separation from God thoroughly; he plumbed the deepest sea of terrifying darkness in order to build a bridge out of it for us. There he cried, "My God, my God, why hast thou forsaken me?" He felt cut off from God, forsaken. Still caught between the perfect light and the dark imperfection, we cry out the same plea. Though he was plunged into the sea of human despair, the devil could not hold Jesus. A shattered grave, blasted apart by the light of all ages, is the testimony. In the gutted wreck of that grave lies the foot of the bridge out of all darkness.