Counseling Depression

Anxiety.  Fear.  Depression. Anger.  We are collegiate missionaries and not counselors, yet we are regularly encountering these emotions among students on nearly every campus we serve.  Over the next 2 weeks, as well as last week, we will be posting papers written by TJ Chesnut for a seminary class on Biblically counseling individuals experiencing these emotions.  Hopefully each paper will give you Scriptural direction as you relate with students.  - Andy

Using a more severe form of depression as their benchmark (Major Depressive Disorder), the American Psychiatric Association defines depression as, “A common and serious medical illness that negatively affects how you feel, the way you think, and how you act.”[1] While this serves as a footing from which an individual can begin to understand depression it is not so cut and dry that it can be accurately defined in its entirety within a couple of sentences. Ed Welch speaks wisely in describing depression “as a continuum of severity. On one end it is bothersome, at the other end debilitating.”[2] A depressed individual may show symptoms from three different categories ranging from emotional symptoms to physical/behavioral symptoms to mental symptoms.

Emotional symptoms of depression can include a feeling of hopelessness, apathy/a lack of motivation, numb to outside stimuli (“I do not feel anything”), sadness, isolation/loneliness, emptiness, worthlessness, guilt, and shame. On the physical/behavioral side a depressed person may experience insomnia, oversleeping (the inverse of insomnia), loss of appetite, loss a libido, withdrawal from outside relationships and events, and being in a vegetative state (a more extreme demonstration of the above physical symptoms leaving the individual in a state of extreme sadness). Mental/cognitive symptoms may include obsessive thoughts on the dark/gloomy things of life, difficulty concentrating, memory difficulties, difficulty paying attention, and difficulty making decisions. And while there are many symptoms that have been listed and maybe some that could be on this list but are not, just because an individual is experiencing depression they may not experience all or even many of these symptoms.

But not only are there a multiplicity of symptoms related to depression, but there are differing severities of depression. The least severe form of depression is Adjustment Disorder with Depressed Mood. This form of depression usually lasts less than 6 months with mild symptoms. Next is Dysthymia, which is a moderate, chronic depression. Dysthymia is characterized by a one to two year duration, not usually debilitating, and the amount of time an individual would be experiencing a depressed mood would be more than half their week (4 or more days out of 7). The most severe form of depression, Major Depressive Disorder, is distinctive because of the suffering individual’s crippling and chronic feeling of despair and hopelessness. Major Depressive Disorder is also the form of depression in which the sufferer is more likely to commit suicide.

Other forms of depression include Post-Partum Depression, which is experienced by fifteen to twenty percent of women who have recently given birth. This is a more severe form of the Baby Blues experienced by most women and can persist for up to a year. There is also Seasonal Affective Depression that is related to the amount of sunlight an individual can access due to the change of weather conditions; it is more prevalent in the winter months when there is less natural sunlight. The final form of depression is Pre-menstrual Dysphoric Disorder (PMDD). PMDD typically occurs one to two weeks before a woman’s menstruation begins and is a more severe form of depression that Pre-menstrual Syndrome (PMS).

Five Key Bible Passages

1. Colossians 3:2 – This passage reminds us of the importance of where our hearts, minds, and souls should be fixed. Desires for anything or anyone less than the One from above are desires for a counterfeit and will ultimately not satisfy our God-shaped, eternal cravings.

2. Romans 8:5-7 – This passage serves as a reminder of how we will live in accordance with the Spirit if our minds are fixed on the things of the Spirit. Conversely, if our minds are set on the things of the flesh than we will find ourselves living according to the flesh. One of the great temptations for a depressed person is to focus on things of the flesh (“My life feels empty.” “I have no real friends who understand what I am going through.” Etc.), which leads to darkness, despair, and even death. Rather, if their focus is on the things of the God Who has provided for them life, both now and in eternity, and will experience in some measure His peace in their life.

3. Mark 7:20-23 – The words spoken by an individual reveal the condition of their heart and what they believe to be true. A depressed persons words regarding themselves of their realities point to the deeper state of their heart and the lies or truths that they have come to believe in their depression. If a Christians struggling speaks in a demeaning about themselves as undesirable in God’s eyes then they have bought into a lie concerning their identity in Christ rather than the truth that they are a child of God and are co-heirs to the inheritance of life (Romans 8:17), both now and in eternity, and not just life but an abundant life (John 10:10).

4. Psalm 22 (paralleled with Matthew’s account of Jesus’ crucifixion – Matthew 27:32-54) – When reading this passage it is clear that the reality of the Psalmist’s suffering in this chapter is a mirror image of Jesus’ suffering while on the cross. It is evident by this parallel that God is not blind to the suffering of mankind – in fact, God in the God-man, Jesus, has suffered in every way that we have – physically, emotionally, and spiritually.

5. 2 Corinthians 10:3-5 – This passage is reminder that the greatest struggle we face is not physical but spiritual. I like this passage because it gives a fresh perspective on the spiritual reality to our suffering. I do not mean to negate the physical side of the effects of depression but with all physical suffering there is also a spiritual component. And in fighting back against the temptation of sin we must strive to demolish the arguments of our insufficiencies brought against us by the Accuser with the truth of the knowledge of God. When we feel inclined toward sin we must take our thoughts captive and set our minds on Christ.

Five Crucial Questions

1. Does my depression come from failed expectations?

2. Does the counselee have a community of believers around them who are actively investing in their life?

3. Does the counselee still converse with God, even when they’re in the pit?

4. Does the counselee recognize that Jesus suffered in every way they are currently suffering (Hebrews 4:15)?

5. Does the counselee know that depression will not last for eternity?

Five Theological Insights about Depression

1. At the heart of depression is idolatry. When an individual takes their focus off of God and His goodness they will begin to seek out their pleasure in the thing that captivates their hearts and captures their attention. With their affections being on temporal objects (money, relationships, etc.) then their hearts will also be tethered to that objects ability to fulfill their desires and when that idol fails to do so then the individual will tailspin down into a state of depression. God is the only One who can keep every promise He makes.

2. Depression is a reality of suffering in a fallen world. Depression and suffering we not part of God’s good design but are the result of sin from the Fall. Depression is typically accompanied by loneliness and a low self-esteem; neither of which were part of the design God had for humanity, which was created to be in perfect communion with God and one another. Instead, with the introduction of sin into the descendents of Adam and Eve mankind has not lived in perfect community and harmony with either God or one another because at the heart of all sin is the desire for selfish gain. And with the ambition of selfishness so too comes the abuse of relationships and the loss of community, thus leading to loneliness. And when one feels unwanted and unloved then they will also fall into a place of low self-esteem.

3. Depression is a reality in the Scriptures. When we read the Scriptures we see, particularly in the Psalms (the darkest Psalm being Psalm 88, which ends with “darkness has become my only companion), that depression is a reality even in the people of God. We do not need to put up a façade of false happiness simply because we follow Jesus, but we are to look to Him for provision in both the moment of our depression and in eternity.

4. Community is one of the greatest tools for counseling depressed individuals. Humanity was created by God to live in perfect harmony with Him and one another. In other words, God created mankind to be communal beings. Because of our innate need for community, individuals who do not have close companionship will tend to either not develop socially or mentally to their full capacity or will regress (cabin fever, mental declination, etc.). I believe that this is part of what the author of Hebrews is telling believers when he writes, “And let us consider how to stir up one another to love and good works.”[3] The word interpreted as “stir up” can also be translated as “to stimulate” and gives the idea of being prodded or pinched into taking action. We need community around us to “stimulate” and even “prod” us to good works in faith.

5. Suffering and depression are not eternal. This is the greatest ultimatum for the Christian, that suffering – in all its forms – is only momentary. When Christ returns to set right and bring full restoration to His creation and comes to dwell with His people in perfect harmony then all will be made right for He “will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away.”[4]

Five Best Homework Assignments

1. Write out your purpose for living. Have the counselee write out the reasons to live. Doing this helps the counselee put onto paper the reasons why they can and should get out of bed everyday and live their lives. Reasons can be loved ones, passions, or commitments.

2. Listen to God’s Word. Have the counselee create a playlist of music that is focused on God and His promises. Have the counselee record their insights from reading and meditating on Scripture in a journal. Also, the counselee could be tasked with taking notes during the Sunday sermon in their local church. The main goal is for them to be immersed in the Word of God. Some great resources may include the Verses Project, a collaborative group of independent musicians and artists that take verses of Scripture and put them to music, or sermon/sermon series via podcast.

3. Look outside of your own situation. Have the counselee speak or write something that edifies another person, everyday. This will teach the counselee to look outside of the himself/herself. One of the greatest hurdles of depression is the inward focus that a depressed person has – by speaking and writing about others this will help them to look outside of themselves and see the goodness of the people and world around them.

4. Build a support network. Have the counselee find five people who will pray for them and will speak truth into their life regularly. This will help the counselee build a network of individuals that can bring life into their circumstance and can help them look up from the pit of their depression.

5. Keep a journal. When the counselee experiences a depressed mood, ask them to take a few minutes to record details in a journal – the date, time, the event that caused their downward spiral. Also in the journal, have the counselee write down what steps they will take or did take to come up from his/her depressed state. This will serve as both a tool to help them recognize any patterns or symptoms of depression that lead them to sink deeper into its grip. The journal will also serve as a testimony to the actions they took or are taking to resist depression and the root issues that bring or enhance depression’s grip on the counselee’s life.

Recommended Resources:

[1] American Psychiatric Association, What is Depression?

[2] Welch, Depression: Looking Up from This Stubborn Darkness, 16.

[3] Hebrews 10:24, (ESV).

[4] Revelation 21:4, (ESV).