This week is National Suicide Prevention Week, and today specifically is National Suicide Prevention Day. To Write Love on Her Arms is at the forefront of leading the charge against the hold depression, self-harm, and suicidal thoughts and feelings has over many people, and I love them for it. These are topics that aren’t addressed often enough or accurately enough within the church. So I want to write today about what Christians should know about people with depression, not as an expert, but as the husband of a fantastic Christian woman who has depression. It has become apparent to me over the years that Christians generally do not know how to respond appropriately to people with depression, because they often don’t know much about it, and in many cases, choose not to put in the effort to learn enough to respond appropriately. I am equally sorry and not sorry for the length of this post. I am sorry in the sense that I know it’s not as digestible as a 4-paragraph quick read. I am not sorry for this including things that are deeply personal, while some of it will be strictly informational, the combination of which is what will lead to the length of the post. Hopefully you can glean truth and advice for how to respond to a person with depression from both approaches.
I know there is a stigma associated with depression or really any mental illness. I know that it’s not something many people care to talk about, because it’s not an easy subject matter to tackle. It’s not a problem that is easily fixed. It’s uncomfortable to be around at times. People with depression generally do not like to talk about it, much less show it, because by and large, they will be judged, treated differently (and not in a good way), and even even excluded if they ever let on that they are suffering. Around other Christians, they even have to worry about being told they just don’t have enough faith or a solid enough relationship with God, because if they did, they’d be “too blessed to be depressed.” It rhymes, so that’s nice, but it’s an egregious statement based on false assumptions. So people, like Sarah, wear a mask around other people, pretending everything is okay, unable to be themselves for hours at a time, and then they go home exhausted from the role they had to play to make sure everyone else is comfortable.
Sarah is prone to wearing a mask, because she has let very few people in on her suffering, and even fewer have chosen to stand in the storm with her. Most she has ever let in seemingly found it too uncomfortable or just too confusing to stay too close to her. It is a real shame, because it only further cemented her desire to be by herself and keep her struggles hidden. It’s also a shame, because it’s never an easy decision for her to let someone into that part of her life, and when she does, it’s because she thinks that person will be different. Sadly, too few have been different.
For years, neither Sarah nor I understood or accepted depression either, so we didn’t know what to do with it. We thought it was a passing feeling. Fueled by false teaching within the church, Sarah tried to lean on God more. She would read her Bible more. She would pray more. But the depression never went away. What was wrong with her? Why couldn’t she be what God expected? I believe Sarah came to understand the truth about depression well before I did, though, which is truly unfortunate and the greatest regret in my life. Out of not understanding, I wasn’t sympathetic to it. I admit to being a less-than husband during that time. It wasn’t that she wasn’t who God expected her to be; I wasn’t the husband she needed me to be, so she couldn’t be honest with me about what she was experiencing. She knew I wouldn’t understand.
The severity of depression can ebb and flow, and it did for her. Sarah went a long time without showing too many signs of it, and because she did wear a mask around me, everything appeared fine to me. But after she had Jakob, postpartum depression hit her hard, and it drained her to the point she couldn’t fake it anymore. She was exhausted, listless, sad, distant. She was different. There were things she knew she should and wanted to care about, but she couldn’t care about them. She couldn’t even care about herself. And so I was confronted with the truth of depression, and I didn’t know what to tell her or do for her. But I knew I loved her, and because my love for her is genuine, I wasn’t going to be anywhere but right by her side during her fight.
Ultimately, the answer was that she went to see a doctor. I called and pleaded with a doctor’s office to get her in earlier than the appointment she had been given for 8 weeks down the road. I was afraid of what could happen in 8 weeks, and even if nothing too severe happened, the thought of waiting 8 weeks in misery to even begin researching answers was unacceptable to me. She has been back to the doctor and to see different counselors periodically since to manage and treat it, though that hasn’t stopped it from flaring up at times due to different life events (like having another baby and needing to come off meds that work, for instance).
I am back in school now, working towards a psychology degree, with a focus on counseling. I didn’t choose that to understand Sarah. I chose it, because I felt it would help me do my job as a pastor better. But through my studying, I have had the opportunity to learn a great deal about depression, so I can at least understand it from a factual standpoint. It doesn’t make me an expert. I don’t think anyone who’s not battled it could be an expert on it. But I have learned, and it has helped me understand Sarah and others with depression better, and so I would like to share things with you.
1. Depression is a physical condition.
Depression results from a shortage of chemicals called neurotransmitters in the brain. The human brain naturally produces different neurotransmitters, but the brain of a person with depression does not produce the right amount to keep things in balance. Depression is a mental illness, but it is actually a physical condition that manifests in mental and mood related symptoms. It can also manifest in feeling sick or hurting all over with seemingly no reason for the discomfort, as well as other symptoms listed further down in the post.
2. Depression is not a sin, nor is taking doctor-prescribed anti-depressants.
Because depression is a physical condition, caused by a physical problem within the body, it is a shame that some Christians feel like it is a sin to have it or treat it. I have not met any Christians that would tell the diabetic to not take insulin. Why? Because his body doesn’t produce insulin, and we’re generally okay with his taking care of that physical need. So why is there a concern with a person with a shortage of neurotransmitters in his brain using medication to correct that issue? Ignorance is probably the answer, but it certainly isn’t much of an excuse.
3. Depression is not a choice.
Happiness may be a choice in some sense, but that does not mean that depression is the opposite choice. Telling a person with depression that they should snap out of it and just be happy is like telling a man with amnesia to just snap out of it and remember already or a man who’s been shot to snap out of it and quit bleeding. It doesn’t work that way. The person with depression doesn’t choose it, and offering cliches as a means of encouragement will not help that person. It will probably have an opposite effect, as they may convince themselves that you are right, and therefore feel even more defeated.
4. People with depression may want to be left alone, but they don’t need to be left alone.
Studies have shown that regular interaction with people is healthy for a person with depression, even if it adds to their anxiety in the short term. If you ask them to do something, you may be rejected. Ask again. Don’t give them space in the sense that you stop asking and stop inviting. Yes, they’ll tell you no more often than not, but they’ll take your choosing to leave them alone as rejection. And maybe instead of cheering them up, express your willingness to allow them to be themselves. Romans 12:15 says, “Rejoice with those who rejoice, weep with those who weep.” It doesn’t say to try to cheer them up and throw your hands up when it doesn’t work. Keep after them.
5. The Diagnostic and Statistical Manual – Fifth Edition (DSM-V) lists the following criteria for identifying depression:
Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, notmerely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may bedelusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day(either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideationwithout a specific plan, or a suicide attempt or a specific plan for committing suicide.
- The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
- The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
5. If you need help, get help.
See a doctor (preferably a psychiatrist and/or a psychologist (some fill both roles)). You do not need to walk alone, and you shouldn’t walk alone. There is no need to be embarrassed. I have asthma. I’m not embarrassed by it. I didn’t choose it. It’s a medical condition. My lungs are just wimps. So what? I’d rather get help when I need it than die. I’d rather you get help, too.