Helping the Clinically Depressed
In the last issue of the Immanuel Home Messenger (October 2004), we began a study of clinical depression. The first part of this article studied the nature, causes, symptoms, and treatment of clinical depression. This month we conclude our study by considering the question, “What can we do?”
Part 2
How then should we proceed when seeking to help those who are clinically depressed? The first and foremost thing that we must provide is preventive, spiritual medicine! We need to take every possible opportunity to instruct our children thoroughly in the principles of both Law and Gospel. We need to reinforce those principles, especially the Gospel, for ourselves and for our children by attending worship services regularly. There are many Christians who have struggled with clinical depression for long periods of time who have appreciated the early instruction they received from their parents and pastors. At times it was instruction concerning the grave consequences of committing suicide and the ultimate hope that Jesus alone can provide which prevented them from taking their own lives.
Helping those who are clinically depressed takes time, care, and compassion. It takes time to listen, and listen we must because there can be so many facets to the problem. Spiritual issues may well be tied to physical concerns, which in turn are complicated by psychological problems or physiological imbalances. Just being there and listening attentively as fellow Christians suffering from depression share their thoughts and feelings will go a long way toward creating an atmosphere of trust and confidence which is essential to any effort to help. We must be careful not simply to tell people “to read their Bibles” and then assure them “everything will be all right!” Thinking patterns are altered during clinical depression. Those who are depressed frequently do not believe that Gospel promises apply to them. They focus on the Law and tend to dwell upon past sins, condemning themselves for their weakness of faith. Helping the clinically depressed takes great compassion for it is so easy to victimize those who are already depressed.1 While the Law must be used where impenitence is the root of a person’s depression, in general we will want to apply the healing balm of the Gospel in generous and consistent doses! Individuals with clinical depression will tend to think less of themselves as they compare themselves, for instance, to the heroes of faith. Should they be asked, “Where is your faith?” they can easily begin to doubt that they even have saving faith. Should it be suggested that “true” Christians either do not suffer from depression or should be able to overcome these issues on their own and relatively easily, they can quickly be convinced that even God is against them. Consequently, we will want to choose with great care those sections of Scripture we suggest for reading. We will want to find devotionals, which emphasize God’s grace and love.2 We will want to visit our fellow Christians regularly, discuss directly the situations and circumstances at the root of the person’s depression whenever possible, and share Gospel-centered advice and devotions addressed specifically to the issues they are confronting. Let us never assume that we are being too obvious. Rather, let us make the effort to connect the dots leading from the principles we share from the Scriptures to the applications our fellow believers are to make in their lives.
Individuals suffering from clinical depression frequently find themselves focused primarily on themselves, the regrets of their past, and their fears of the future. The solution ultimately lies in pointing the eyes of the depressed individual away from themselves and up to their God, while helping that individual keep focused not on the past or the future, but on the present. Fortunately, many of the very Bible passages we memorize in Confirmation instruction and which are most familiar to Christians help in this area. “The LORD is my shepherd; I shall not want” (Psalm 23:1). “The LORD is my light and my salvation; whom shall I fear? The LORD is the strength of my life; of whom shall I be afraid?” (Psalm 27:1) “God is our refuge and strength, a very present help in trouble” (Psalm 46:1). “I will lift up my eyes to the hills-from whence comes my help? My help comes from the LORD who made heaven and earth” (Psalm 121:1). “Fear not, for I am with you; be not dismayed, for I am your God. I will strengthen you, yes, I will help you, I will uphold you with My righteous right hand” (Isaiah 41:10). “Therefore do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For after all these things the Gentiles seek. For your heavenly Father knows that you need all these things. But seek first the kingdom of God and His righteousness, and all these things shall be added to you. Therefore do not worry about tomorrow, for tomorrow will worry about its own things. Sufficient for the day is its own trouble” (Matthew 6:31-34). “Lo, I am with you always, even to the end of the age” (Matthew 28:20). “We know that all things work together for good to those who love God, to those who are the called according to His purpose” (Romans 8:28). “If we confess our sins, He is faithful and just to forgive us our sins and to cleanse us from all unrighteousness” (1 John 1:9). These are truths to which we can return time and time again as we help those suffering from clinical depression.
Clinical depression is an illness, the recovery from which may require medical as well as spiritual assistance. It is important that we as Christians understand this fact. This was not understood years ago and many Christians suffering from depression were encouraged not to seek professional help. The result was that Christians often suffered unnecessarily and consciences were at times burdened without just cause. Just as we should encourage our Christian friends to seek help from their pastor, so we might also encourage them at times to seek medical advice when we believe they are clinically depressed. Diet, sleep, exercise, and possibly medications may well be critical elements of successful treatment. It is very helpful if a Christian doctor or counselor can be found. There are Christian counselors available who want to work with pastors and at times have them sit in on their counseling sessions, recognizing that pastors have a call to serve the spiritual needs of their members. While there is good reason for us to be skeptical of many aspects of secular psychiatry, we must also realize that in certain cases psychiatric help will be necessary and, fortunately, there are a growing number of Christian counselors who are sensitive to many of our concerns.
Families who are well-informed about clinical depression will be in a good position to help those they love who must deal with this illness. As families we ought to: pray for and with our loved ones; assure them of God’s healing love and His forgiveness in Christ Jesus; share favorite Bible verses or stories with them; involve them in family devotions; encourage them and join them in regular congregational worship; spend time with them and listen attentively to their concerns; offer to go with them to seek out help from the pastor, counselor, or doctor; encourage loved ones regularly to accompany us on walks, errands, or shopping trips; and help them with self-care (exercise, diet, etc.) on a daily basis.3
While we can and should help those with clinical depression, we ought also to be very aware of the effects that clinical depression may have on other family members. Children, especially, can be affected by the depression of the adults in their lives and the issues which brought that depression. A divorce and its ensuing family break-up, for instance, will certainly affect the children involved in significant ways, possibly leading to depression. Wise Christians will visit with all family members in such situations in order to determine whether or not additional family members are in danger of becoming depressed. In general, when dealing with children and discussing their depression with others, it is wise not to do so in front of them. Depressed children are still children and often simply want to have things their own way. It is not uncommon for children to use their dark emotional state to manipulate their parents in order to get what they want from a sympathetic parent.4 As is so often the case with other children, a depressed child getting what he wants is not always what is the wisest or the best!
There are other ways in which we as a congregation can help those who are clinically depressed. First and foremost, the topic can be addressed regularly in Sunday sermons. Individuals who suffer from clinical depression frequently and falsely believe that they are alone in their suffering. It is helpful for them to know that this is a problem endured by a significant number of their fellow believers and to hear that God’s Word addresses this issue frequently and plainly. In spite of all the various aspects that go into treating clinical depression, God’s Word remains the most important, powerful, and useful agent we have to deal with this illness and so to address the needs of the whole person. Secondly, the topic of clinical depression can and should be addressed in Bible Class or other seminar forums for in this way detailed information on the illness can be shared which might not be appropriate for a sermon. Such forums encourage questions and provide opportunities for discussion which will help clarify the situation and prepare individuals to address it effectively. Thirdly, general information and additional support can be provided through our Parish Nurse program. Information can be placed in the medical tract rack. Our parish nurses are in a wonderful position to provide a listening ear and solid Christian and medical counsel to fellow Christians who suffer from clinical depression. Finally, congregations can form support groups where individuals afflicted by clinical depression are able to share their experiences while joining in a study of and growth in God’s word.
One final area of concern which must be mentioned is suicide. Suicide is often connected to and results from clinical depression. While depression itself is not necessarily an indicator that someone will become suicidal, thinking about suicide is an indication of depression. As mentioned earlier, it is important for all Christians to be carefully instructed regarding this sin. Suicide is extremely dangerous for it cuts short our time of grace (cf. Isaiah 55:6-7). Of particular interest are the results of recent studies which show that people in the depth of clinical depression are less likely to commit suicide than those facing less severe situations. The reason for this, it is thought, is that people in the midst of severe clinical depression do not have the energy to act upon their suicidal thoughts. In fact, the greatest number of successful suicide attempts occur shortly after beginning medicinal treatment when matters appear to be improving. What happens, however, is that the body comes out of its depressed state while the mind remains depressed. Then individuals have the energy to do what their mind is thinking! Consequently, Christians will want to pay especially close attention to the needs of their fellow Christians as they begin their medical treatment so that their minds might be healed by the Word of God even as the physiological needs of their bodies are being met.5
Resources Available to Help Us Understand and Assist One Another in Dealing with Clinical Depression
The Bible will remain our greatest resource in assisting our fellow Christians with clinical depression. It is the inspired Word of God revealing an absolute truth that saves and unfailingly serves! As stated earlier, it must be applied carefully, specifically, and generously, but it must be applied in order for our fellow Christians to enjoy both the temporal and eternal blessings of our God.
In addition, we will want to find devotional resources, which will stress God’s grace in Christ and His providential care of His believing children. In connection with this, it might be wise to note that many of the popular devotional books, especially those written from a Reformed perspective, may not be good for people suffering from depression. Often these books stress God’s lordship in our lives and the importance of sanctified living, which are not unbiblical concepts in and of themselves, but they are Law oriented rather than Gospel oriented. Individuals struggling with depression frequently apply the Law primarily as a mirror to show them their sin, rather than as a guide. For this reason, books that are Law oriented will generally be of little comfort and may cause further problems because of the mental state of the depressed person.
There are numerous resources available today for information regarding the medical aspects of clinical depression. Christian counselors can provide reliable pamphlets for personal use or the use of others. The Centers for Disease Control have numerous technical booklets available covering many aspects of depression. You may find them at www.cdc.gov. Information from the National Mental Health Association may be accessed at www.nmha.org (click on "mental health"). These two websites are the primary resource outlets for professionals. Examples of websites offering information tailored more for laymen are: www.depression.com and www.psychologyinfo.com.
Overcoming Depression by Demitri and Janise Papolos is recommended by Dean Marzofka as the best book available on the medical/psychological aspects of clinical depression. Happiness is a Choice by Fran Minirth and Katie Meier is recommended by Daniel Loe as an excellent book to share with those who are depressed.
In Conclusion
If we return to the Apostle Paul’s words from 2 Corinthians 1:3-4, we can summarize the goals of our help for the clinically depressed. “Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our tribulation, that we may be able to comfort those who are in any trouble, with the comfort with which we ourselves are comforted by God.” It is our goal as Christians to help our fellow Christians by sharing with them the comfort God has given us, so that they too might be comforted by the unchanging and eternal truths of God’s word.
This article is the conclusion of a condensation from a study paper presented to the Minnesota Pastoral Conference in October 2004.
End Notes
[1] It should be noted that individuals suffering clinical depression are quite vulnerable and can be influenced more easily by outside influences including radio and television evangelists or members of the various sects who visit them in their homes. This danger is compounded by the fact that depressed people have a tendency to aviod “crowds” and so often refrain from attending worship services.
[2] Professor Emeritus Clifford Kuehne has recently recommended “Together with Jesus: Daily Devotions For a Year,” by Richard E. Lauersdorf (Northwestern Publishing House, 2003).
[3] Suggestions by Daniel Loe found in Understanding Clinical Depression.
[4] Notes from an interview with Dean Marzofka, M.S.
[5] Notes from an interview with Dean Marzofka, M.S.
