Friday, July 12, 2013

The Christian and Depression, Part VII

For God hath not given us the spirit of fear; but of 
power, and of love, and of a sound mind. 2 Timothy 1:7

As we continue our discussion of Major Clinical Depression in the life of a born-again, Bible-believing Christian, we need to emphasize the above verse: it's not man's opinion, or man's experience, but God's promise to His children.  If you've been saved according to John 1:12, born again according to John 3:3-7, you're still prone to all the problems and weaknesses that afflicted you before you were saved - - - and that afflict everyone.  But now that you're a believer in Jesus Christ, you're different, and have resources and strengths that you might never have dreamed of.  The above verse is one of them: the promise that, despite your occasional "feelings," God has not given you a spirit of fear, but of power, and of love, and  of a sound mind.  Either that verse is true, or God is a liar.

A Christian can do some weird things, of course.  And a "sound mind" is no guarantee against sin. A Christian can even go crazy: really crazy, as in  genuinely insane. (This takes a long time, and is usually the result of consistent, habitual, unconfessed sin.  Sin really will drive you crazy, if you allow it.)  But if you're a genuinely saved Christian, who prays and studies your Bible and seeks to please God on a daily basis, He's not going to let you go insane.  That's the premise and the promise of 2 Timothy 1:7.  You may not have much, you may not have the world with a pink ribbon wrapped around it, but you'll have a sound mind.  In these truly insane times, that's something worth having!

Even if you suffer from Clinical Depression?  Yes, even then: because Depression is not insanity: it's a chemical disorder, a physical disease.  I've suffered from Major Clinical Depression for over twenty years, but at the same time, my Creator and Saviour has given me a sound mind.  And thousands of Christians could make the same statement.  I have the Holy Spirit of God dwelling inside this messed-up body, with its mixed-up brain chemicals: and I have the Holy Bible, to help me, every day, which renews my mind (Romans 12:2).

So, God has promised us a sound mind, a mind that can be constantly renewed.  In fact, the Apostle Paul goes so far as to say that we have the mind of Christ (1 Corinthians 2:16)!  Someone asks (and it's a logical question), "How can a person have a sound mind, the mind of Christ, and be mentally ill?"  Because some mental illness, such as Major Depression, is a physical matter, a chemical imbalance.  If treated by a physician, it need not affect your thinking, your mind, at all.  If you had appendicitis or a broken bone, would it stop you from experiencing, enjoying, and serving your Saviour?  Of course not.  Neither does Depression, if it's treated.  Contrary to what some of "the brethren" think, Depression is not a sin, or a failure.  A Christian prays for forgiveness from gossip or drunkenness or sexual sin; but no Christian has to pray, "Oh Lord, please forgive me because the serotonin neurons are re-absorbed into my brain too quickly!"  God made you the way you are, and He understands.

I can already hear some of the "Independent Baptist" deacons and the "Truly Reformed" Presbyterian elders huffing and puffing: "Are you saying that God causes mental illness in a Christian's life?"  Don't ask me, Mr. Spiritual: if you have a Bible, and not just a set of traditions, go back to Exodus 4, where God says to Moses, Who hath made man's mouth? or who maketh the dumb, or deaf, or the seeing, or the blind? have not I the LORD (Exodus 4:11)?  And He made man's brain, too: and He made some of us with brains that don't function perfectly on a physical level.  (If you haven't read our earlier posts in this series, you should do so now; they're linked at the bottom of this one.) That's His prerogative. He's the Potter and we're the clay, remember? (Isaiah 64:8) The "preachers" and "prophets" on television who claim that God doesn't want any Christian to be sick, or poor, or afflicted, are liars, and their teachings are doctrines of demons and damnable heresies.  I'll be very blunt: Karl Marx and Mao Zedong preached more "truth" than Benny Hinn, Kenneth Copeland, Marilyn Hickey, Jimmy Swaggart, and all the rest of the false teachers who pervert God's word in order to make themselves rich.  That's the lunatic fringe of Christianity, and they deserve the contempt the world gives them.  And the "respectable" Joel Osteen, Bill Hybels, and Rick Warren, aren't much better. They might drive you crazy, but God never will!

All of this has been by way of "review," because it's been awhile (in Internet time) since our most recent post in this series.  In that post, we discussed the role of medication in the treatment of Major Clinical Depression.  For some people with the disease (about 25%, according to the Mayo Clinic), medication is enough, and it can often be prescribed by your primary care physician.  (These medications are not "mood-enhancing" drugs; they have no immediately observable effect at all.  They gradually correct the imbalance in your brain chemistry.) It may be, if you suffer from this disorder, that you might be referred to a psychiatrist, but don't assume that such will be the case. In this post, we'll look at the other main therapies: the "talk therapies," such as a psychiatrist or psychologist or counsellor might offer.

(Before continuing, I should mention [if you don't already know] that there are some decent, loving, but ignorant Christian people who believe that any and all treatment by a mental health professional is a snare and a delusion.  They love to quote verses like vain is the help of man [Psalm 60:11, Psalm 108:12].  Those are great verses, but they only quote half the verse, and quote it out of context.  [If their house was burning down, would they refuse to call the Fire Department, because "vain is the help of man?"]  This goes back to something we discussed in the first post in this series: the old antagonism between the mental health community and the Christian community.  Sadly, a lot of that antipathy still exists.  There are still Christians who say "Psychiatry is of the Devil," and there are still psychologists who say "Religion is the root of man's problems."  We'll try to avoid these people, but we need to be aware that they're still out there.  Don't fall into their traps; God is on your side!)

The first thing that comes to most people's minds, when they think of mental illness, is psychiatry.  One definition of psychiatry is "the branch of medicine that deals with the diagnosis, treatment, and prevention of mental and emotional disorders."  That's correct; but the phrase you need to notice is "the branch of medicine." A psychiatrist is a licensed medical doctor, who's been to medical school just like an obstetrician or a cardiologist, and has had the same basic training; he or she has just chosen psychiatry as his or her specialty.  (A psychiatrist can probably sew up an injury or deliver a baby with no problem; those things just aren't his specialty.)  The psychiatrist differs from the psychologist in that he or she can prescribe psychotropic medication, and a psychologist can't.  And medication is one of the main tools in most psychiatrists' practice; the other is talk therapy, in which the doctor discusses the patient's life, thinking, and emotional state, and tries to help the patient find answers.  For most people with Major Clinical Depression, a psychiatrist will be consulted sooner or later; but it probably won't be necessary to see the shrink very often.  Psychiatrists spend a lot of their time dealing with people who have severe mental disorders, such as neuroses, psychoses, multiple personality disorders, etc., which are quite a bit more extreme than Clinical Depression.  Psychiatry has often been misused and abused, from the days of Freud to the totalitarian states like Nazi Germany and the Soviet Union, where people considered "enemies of the state" were sent to "hospitals" that were really prisons.  This will probably happen again before God wraps up human history, but that doesn't make all psychiatrists bad guys.  In my own life, as an educated, experienced Christian man, compassionate and understanding psychiatrists have been used by the hand of God to help me.  Don't be scared of them, but don't think of them as either demons or "little gods," either.  They're just doctors.

"Talk therapy" is also practiced by psychologists. Psychology is not a branch of medicine, but an academic subject, in which the mind and behaviour are studied. Psychologists can do all kinds of tests and measurements of an individual (such as determining if a person has Major Depression), but their "treatment options" are limited to some form of talk therapy.  Very often, they don't see "patients" at all; or, if they do, they end up referring them to psychiatrists.  However, psychologists often see couples and/or children in "family therapy," or other specialized practices. (Obviously, "family therapy" doesn't require a psychiatrist; the problem isn't mental illness, but dysfunctional behaviour, which is the psychologist's forté.) They're often employed by corporations or political campaigns to study people in groups, but the really academic study of group behaviour is done by sociologists. Psychologists work with many people suffering from Major Depression, but their therapy is limited to talk, and/or directed exercises, about which we'll have more to say.

But "talk therapy" can also be practiced by licensed social workers, Marriage and Family Counsellors, and others.  (Sometimes, a social worker or other counsellor will work within a psychiatrist's practice, conducting "talk therapy" while the psychiatrist monitors the medication.) Which begs the question: how good, and how bad, is "talk therapy" as a treatment?

That depends on the therapist, and on the patient.  And it's particularly complicated for the born-again Christian.  There are at least two reasons for this.

When a born-again, Bible-believing Christian finally makes the decision to seek help from a mental health professional, he or she has very, very mixed emotions.  In almost every case, he feels like he's "failed" in the Christian life, and if he just had more faith, he wouldn't be so screwed up.  (Far too often, this impression will be reinforced by the loudmouthed opinions of ignorant brethren in Christ.)  Sometimes, she will feel that, by consulting an "outsider," she's betraying her pastor, or her Christian friends.  In either case, they'll feel guilty.  So, they'll be on the defensive when they walk into the therapist's office.  That's not a good way to start.

Then, the therapist, even nowadays, might have a deep-seated suspicion of "religion," and the more the patient talks about his or her faith, the more the therapist will focus on this as the patient's "problem."  And there are very few fields of study that are more thoroughly humanistic than psychology. Many psychologists, and not a few psychiatrists, may have abandoned Sigmund Freud's various sexual theories, but they retain his hatred of "religion."  A person with that attitude, however well-intentioned, cannot help a born-again Christian.

The past few paragraphs have dealt with psychiatrists and psychologists in their general approach, and have not been focused on the patient suffering from Major Clinical Depression.  So, let's bring it all together: how helpful is "talk therapy" in the treatment of Depression?

In my opinion, both as a patient who's been through the various therapies and methodologies and as someone who's studied the subject for decades (and who has numerous acquaintances in a similar position), I'd have to say that "talk therapy" is not very effective in the treatment of Depression (in a Christian), and can be actually damaging.  But this depends almost entirely on the therapist. At the absolute lowest point of my life, after attempting suicide, God somehow arranged, in His loving, mysterious ways, for me to have a psychiatrist who was ... a born-again Christian!  He understood me perfectly, and God had sent him into my life as surely as He sent Philip to the Ethiopian eunuch.  So, despite our fears ... God has His people everywhere, even within the psychiatric profession.

Since then, I have experienced "talk therapy" with a Jewish atheist (a social worker, in the practice of my psychiatrist at the time), and by a "lapsed Baptist" homosexual (another social worker); both men were younger than I, and both had the best of intentions, and both were respectful of my faith.  They both stated that my faith was my greatest asset.  But when I look for a positive contribution that they made to my condition, I can find none. (On the other hand, they didn't make things any worse!)  Because it wasn't a condition that required "talk:" it required chemicals, to correct the chemical imbalance.  And, as a somewhat experienced Christian, I wasn't really reaching out to them for help; I was reaching out to the Lord, in my time with Him.  So why did I talk to them at all?  Because, at that point in time, my Depression was so severe that my psychiatrist demanded it.  The talk sessions were a prerequisite to get the medication.  (It is also difficult for me to ignore the fact that these "talk" sessions represented income for the practice; but that's okay.  I don't expect treatment for free.)  In her opinion, I needed both.  Looking back, I disagree, but I was in no position to quibble.

Today I am in a far different position, not seeing a mental health professional at all, but having my condition monitored and medicated by my primary care physician.  God has healed me: not completely, but gradually.  The time will come when the medication I now take will be discontinued.  I won't miss it; it's not like taking "happy pills," but more like taking insulin or blood pressure medication.  When my doctor and I determine that I no longer need it, I'll stop.

I apologize for talking at such length about my own experience; yours, if you have Major Depression, will be different.  (And, as I've said in every post, you probably don't have this condition; less than 10% of the North American population does.) I also apologize for the length of this post; I assume that only those who are genuinely concerned with the subject will have gotten this far!

There are two other forms of therapy for Major Depressives which should be briefly addressed.  One is Cognitive Behavioral Therapy (CBT).  Oddly, this seems to be the most effective non-medicinal therapy for Depression; although it has a history that would make your hair stand on end. It has its roots in the "behavior modification" techniques practiced in totalitarian régimes, and in the outrageous book Beyond Freedom and Dignity (1971) by the fascist B.F. Skinner.  However, CBT is like nothing Skinner and his ilk ever envisioned.  It is simply a process in which the therapist guides the patient through a series of exercises which focus not on the deep, dark roots of his or her thinking, but on the thinking itself, and how it can be improved and made more productive.  The patient does most of the work; in fact, CBT has been successfully conducted over the Internet, with no face to face contact at all.  It is, one might say, the least "invasive" of the talk therapies, and relies the most on the patient's motivation and goals.  (I have never experienced this therapy, but have seen its results in others.) Also, CBT isn't an infinite loop of "treatment;" the entire process usually takes around 14 to 16 weeks.  As long as the Christian carefully maintains his or her spiritual disciplines at the same time (prayer, Bible study, fellowship with others), this sounds very promising.  But let me be emphatic: No therapy, and no medication, is going to "heal" a Christian if he or she abandons his or her spiritual life, and looks to the brain as the center of all life.  The center of all life is Jesus Christ, and ours is a jealous God.  Any therapy, for any disease, should be pursued only in prayer, humility, and reliance on God.  Whether a Christian has breast cancer or Major Depression, two verses must be remembered: without me [Jesus], ye can do nothing (John 15:5), and I can do all things through Christ which strengtheneth me (Philippians 4:13).

Finally, because Christians (like everyone else) suffering from Depression sometimes "self-medicate" with drugs and alcohol, they sometimes find themselves in "12-Step" groups, such as Alcoholics Anonymous, Narcotics Anonymous, and a plethora of others: the "Anonymous" movement has exploded since the late Bill Wilson started Alcoholics Anonmymous in 1938.  (Although he overcame his alcoholism, Wilson's later life would be marked by deep depression, involvement in the occult, and a flirtation with LSD.)  I would not recommend the 12-Step approach to anyone. It is reputed to have helped a number of people overcome various addictions, but I have talked to too many 12-Step participants who reported becoming discouraged and even suicidal from the experience, and there are definite cultic elements involved: unlike the brief treatment involved in CBT, for example, "Anonymous" participants are told that they must expect to participate for the rest of their lives. Statistically, the Nation of Islam (Black Muslims) has a better record of "cleaning up" addicts than the 12-Step groups. Anyway, they're geared toward addictions, not the physical disease of Depression.

The great flaw in the 12-Step programs, and in the approach of too many mental health professionals, is the notion that nobody is really "bad" or "sinful:" anyone with a problem is simply "sick."  Clinical Depression is a sickness; but sin touches every area of our lives, and cannot be laughed off by sophisticates.  That's why the late Karl Menninger, long considered "the Dean of American Psychiatry," felt compelled, in 1973, to rock the mental health community with his bestselling book, Whatever Became of Sin?  He understood the problem.

So, sin is always there, "lying at the door" (Genesis 4:7), waiting to strike at Christian and non-Christian alike.  It must not be ignored.

But it has been overcome - - - and, if you're a born again Christian, you've already overcome it, in Christ! (1 John 2:14, 1 John 4:4)  If you suffer from Major Depression, it's not because of your sins: it's because of your brain chemistry.  You haven't failed God, and you're not being punished for a lack of faith.  You have a thorn in the flesh - - - which can be treated, by the grace of God, and for which you should seek treatment.

I ought to know.  I'm with you!  And if you don't suffer from this condition, praise God, and reach out to strengthen your brothers and sisters who do!

... and, lo, I am with you alway, even unto the end of the world. Amen.
 (Matthew 28:20, Jesus speaking)

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