Can We Stop Ignoring Depression And Call It The Illness It Really Is?

Pretending a horse is a zebra doesn’t make it a zebra. Labeling depression as a spiritual deficiency doesn’t make it true. Depression is the “D” bomb among Christians. Breathe a word of it, and you are doomed … to be stigmatized, chastised, pitied, and whispered about. Instead of facing the medical fact that depression is an illness that affects the brain, we prefer to paint it with stripes and hope no one notices the disguise. We look away, or assign the person to the category of “spiritually lacking” or “unsaved.”

The truth is depression is a mental condition that cripples one in 10 Americans every year, according to the Centers for Disease Control.

God said through His man, David, that the body is fearfully and wonderfully made (Psalm 139:14). Indeed, every system in the body requires a complex set of interworking—from the way our blood moves through our veins to the way our body winds down to sleep to the way our food is digested to the way babies know it is time to make their grand entrance. Our brains are no different.
[pullquote] “I just want to live a small life. A very, very small life,” I told my mother. Can you imagine a child saying that to her mother, no matter what age? [/pullquote]
When deficiencies crop up in our ways of relating to others, don’t we know it? I grumble, accuse, withdraw—and quite quickly the relationship with the other person suffers. When I do not give a relationship the proper amount of time, attention, and care, it surely begins to show signs of stress and neglect the way a plant begins to droop or turn yellow. We cannot see “time,” “attention,” and “care,” but we can certainly feel the lack thereof. Depression is like that distant relationship, or the drooping, yellowing plant; we cannot see the brain’s chemicals, but depression is one way it signals distress and insufficient amounts of “serotonin,” “melatonin,” and “norepinephrine.”

Chemical or circumstantial?

When I was depressed, I spent months on the bathroom floor. I needed the commode close by because I was nauseated, and the tile cooled my throbbing head. I remember lying there, with my arm outstretched beneath my head, tapping the cold rim of the toilet base. I can’t sink lower than this, I thought. But I’m so tired. I just can’t do it anymore.

During those nights, lying on the bathroom floor, I wondered about the world outside my door. I wondered about my friends and what they were doing. I wondered about my now ex-boyfriend. I thought about the coming summer and the warmth I could not feel. I thought about my sister and how she had survived in a way I hadn’t—out of the same tough childhood, but with a resiliency I couldn’t seem to muster. I thought about her children—two boys at the time. They would not understand if I walked out of that bathroom one day and lay my body down in a ditch and died—willing cold or hunger or whatever to take my life.

And yet I just couldn’t get back up.

Those days turned into two years of insomnia, nausea, despair, and anguish. I isolated myself and stopped trying to tell others how I felt. They didn’t, couldn’t understand. I was tired of the “pull-yourself-up-by-your-bootstraps” speeches, the judgment that if I “just prayed … trusted in God … got counseling … focused on the positive,” I would feel better.

I didn’t. Thirty-three years was enough for Christ on earth; it was enough for me.

“Depression is not easily cured. It doesn’t go away,” Glenn Kreider, Ph.D., theology professor at Dallas Theological Seminary, told me recently. “It’s always dangerous to over-generalize, but I think one can observe without much criticism that the evangelical community responds to depression and other mental issues in two ways: 1) we have no idea what to do, and 2) strugglers are marginalized and condemned. It’s treated primarily as a problem of sin that says that if you’re a new creation in Christ, the old has gone, and the new has come, so if any of these struggles are manifest, it’s evidence of sin or that you’re not saved.

“The church is not a safe place for strugglers, especially for people with depression. If somebody has cancer, the church rallies around them. But when somebody has a mental illness, there seems to be a distancing, a marginalization of the hurt person. If I have a headache, no one judges me for taking Tylenol. But if I have depression, I am judged for taking Prozac.”

Meredith Spatola, M.A., LPC, who is in practice at The Barnabus Center, a Christian counseling center in Charlotte, North Carolina, and who counseled me for nearly two years and for whom I am deeply thankful—suggests the first thing to do if you suspect you are depressed is to interview the emotion. In other words, ask yourself if the depressed mood is connected to something in your story. How long have you felt the depressed mood? Have you noticed a pattern in your emotions? In cases of low-grade depression, you can try practicing self-care, exercising, changing your diet, and having your thyroid checked. In both low-grade and full-blown depression, tell someone you trust.

“In considering counseling or not, ask yourself if your hopelessness is high and chronic. Do you need someone to help you get out of the hole? Are you working hard just to tread water?” Spatola says. “After depression has gone on for a long enough period of time to really deepen, it doesn’t matter if the depression was triggered by something circumstantial or chemical. It’s not going to be resolved by only talking about it or exercising.”

Spatola notes that when a traumatic event happens in a person’s life, it causes brain chemistry to shift. “With medication, people need a lot of patience for side effects. You need to wait it out,” she says. “The first thing you take may not be a magic bullet—there are no magic bullets. And you might need to live with a side effect, but it’s worth it.” Furthermore, if you experience anxiety along with depression, Spatola recommends telling your psychiatrist because some antidepressants are known to increase anxiety.

Off the deep end

I stopped eating after the break-up—and for months afterward. On the surface, it seemed like I had gone off the deep end because I broke up with a boy. What people could not know is that breaking up with a man triggered a reaction of memories and emotions from a lifetime of living under an abusive father. The failed relationship confirmed as true what my father had said over and over: I was fat and ugly, and no wonder no one loved me. I grieved more than the loss of a relationship; I grieved a deep wound about which no one fully knew. My sister flew to Dallas when she realized I was suicidal because of memories of sexual abuse that were emerging like a photograph in a darkroom. She told her story. I told mine. And the horror of what was real—but clouded in confusion all those years—thundered: Our father had abused us in every way imaginable. The grief and despair I felt before her visit collapsed into an ever-sinking, deepening hole. It swallowed me, and not only could I not get out of it, I just didn’t care to try anymore. I began begging God for death. The pain was too much to bear. How in the world was I going to pick up the pieces at this stage of life? I was never going to be OK. It was just never going to be OK.

I tried to go about my routine, though. That’s what you do, right? I went to work. “I wish someone would break up with me so I could be skinny,” a co-worker said. At that moment I realized I had stood on both ends of the acceptance spectrum: judged for being too fat and judged for being too skinny. And I was also judged for not being able to snap out of it. I was broken up, brokenhearted, and flat-out broke. I had earned a master’s degree from Dallas Seminary, yet I was charging gas and groceries. I was single and alone and 33. No children. A woman in Southern evangelical Christianity. Depressed. Striped with stigmas. All the world felt harsh and I, unnecessary.

For me, the worst part of depression was that when it all came down to it, I had nowhere else to turn but to God—and He felt impossible to reach. So impossible that I clutched the Bible one night as tears streamed down my face into the soaked pillow. That rectangle of leather was the only tangible thing I could think of to hang onto … that, by chance, maybe God would honor that desperate act and show up. Instead, the night dragged on and I felt closer to the psalmists than I did to the God with whom they too pleaded.

Maybe it was true—maybe God had allowed my past so that I would submit to a life alone, full of mental and physical suffering that no one could touch or understand. Maybe I was created to be damned.

This kind of thinking is common for a hurting person yet dangerous to utter. How could a seminary graduate feel that way? Jesus died for her! She’s so ungrateful!

“Whether it’s the obvious people like Job, Joseph, Elijah, David, Saul, Moses … it is hard to find a major Biblical character that does not manifest what looks like depression,” Kreider says. “What’s the difference between someone who is blue, down, and somebody who is depressed? That’s where it requires experts. I want to remove the stigma so that people can get help. It’s hard enough to encourage depressed people to get help, but when you add the marginalization, the critical attitude, the judgment—it makes it that much more difficult.”

The gift of your presence

Even when an ER doctor has muscled a dislocated shoulder into place, it’s ready and able to function properly again but it isn’t without pain. It needs time to rest and heal in this right condition before it can find a full range of motion. Even when a person is treated properly for depression, the pain may not instantly stop; the person may not rebound to normal activities for a while until she has had time to rest, heal, and test out the newly healed mind.

“All of us are surrounded by hurting people,” Kreider says. “I think the place [for Christians] to start is to recognize the pain that is around us. Counseling and medication are usually both necessary. And both of them have stigmas in our community and both of them are expensive. Both of them require a significant financial commitment. It’s not like you get a prescription for antibiotics and you’re cured. You need a series of counseling appointments and medicine. It is a long-term commitment. If you don’t know what to say, don’t say anything. If you think you know how to fix it, keep your mouth shut. Let the professionals deal with it.”

I caused my family and friends years of pain as I struggled to get better. I grieve over the pain I must have caused them, with my expressions of longing for death, my withdrawal, and my helplessness that required them to shoulder me financially, physically, and emotionally.

I watched a strange movie, Melancholia, starring Kirsten Dunst. The movie opens with a ridiculously awkward and painful wedding and ends with the earth being blown to bits by a collision with a “passing” planet. Dunst’s character, Justine, suffers from depression. Her sister is a woman who strives for optimism, and order. Yet she cannot control her sister’s illness no matter how hard she tries.

I sat mortified as I recognized myself in one scene—Justine’s sister has to physically walk her from the bed to the bath and try to coach her to lift her foot and step into the tub. Justine is trembling and slack, her limbs too heavy to lift; the effort too great. She collapses, naked, on the floor, in her sister’s arms. Her sister is angry, defeated, and frustrated. I sat there, staring at the screen with memories of that kind of humiliation, physical incapacitation, and burden of another flooding back—and the shame washed over me anew. I know what it is like to not be able to get in the tub.

Shame and humiliation were depression’s companions for me. Depression strips you not only of your sense of being covered but exposes you, naked, with nowhere to hide. I anticipated people’s criticism because I was acutely aware of my own failure, and my own fragility. “Take your shots and you’re sure to get a hit,” I said to my sister once. “I’m an easy target.” I had no defenses. I was clearly struggling, clearly without resources, and clearly unable to help myself. Arrow 1: “You should be ashamed.” (I already was.) Arrow 2: “You need to stop dwelling on the past.” (If only I could.) Arrow 3: “This has gone on too long.” (I didn’t realize there was a time limit to grief.) Arrow 4: “God helps those who help themselves.” (So, He won’t help me? Because I can’t help myself.) Arrow 5: “You are saved! You’re not supposed to be this depressed.” (Then am I not saved?)

This running commentary on my life—and my struggle—happened often, no matter if the person knew me well or not. People seemed to feel free to lob arrows. I had no energy to respond or get out of the way. I felt riddled with ridicule.

I didn’t need others to tell me how awful I was; I was telling myself. I hated being in my own skin. I hated being inside my own mind. I hated being seen.

“I just want to live a small life. A very, very small life,” I told my mother. Can you imagine a child saying that to her mother, no matter what age? With birth comes hope for a full life. With depression comes despair. It frustrated me when people gave me lists of “how-to-get betters” as if I had not agonized over a remedy for months, and had not run the same scenarios through my mind like a video loop. When you’re sick, people naturally push you to get better, but that is not what I needed. I longed for someone to let me curl up in their lap like a wounded animal to whimper and to weep.  

“It’s only going to be better when it’s better,” I said to my sister. Few of us who suffer from depression are ignorant. Few of us haven’t racked our brains for a solution. Few of us are unaware of our emotional state, and our dire condition. The worst attempts people made “to help” me came wrapped in threats. As if suddenly—because of my emotional incapacity—I had rendered myself an infant, a dependent. But I had not stopped being a 33-year-old woman—albeit deeply wounded and in crisis—who had built a life for herself, who had completed a vigorous graduate program only months before the onset of depression, who had traveled the world and lived in tough conditions, who had overcome a childhood of silent abuse. I had not stopped being her; I had simply sat down in the ash heap of her soul.

I know now that even the threats people made were out of their concern—and fear. It is terrifying to be a family member or friend of someone suffering. The stark reality of our own powerlessness is often too much to take—so we step in. We cajole, critique, and push. We threaten. We fight, demean, and argue. We plead. We ache and hurt and go through the wringer trying to help someone who seemingly will not do anything to help herself. I regret causing my family and friends to feel this way; I regret being in so much pain that I could not stop it. The recognition of how deeply I could cut someone layered me with more shame.

I understand it is difficult to try not to push someone to get help, to try harder, but please resist. Before you speak, consider that the person who is suffering has probably weighed his or her options ad nauseam—and to no avail.

Before you speak, try to remember the person’s God-given identity and appeal to that. Speak kindly. Ask questions. Sit in silence. Hold your friend when she cries. Allow her to say ugly things. Three people exhibited this patient, long-suffering grace for me during that time. My closest friend called one night and—at the realization that I had already been crying alone for hours—she offered to come over. I struggled to accept, so she said in a calm, low voice, “I’m on my way.” She arrived, sank into the sofa beside me, and put her arm around me. We both stared at our feet. And I unleashed four hours of guttural sobbing that felt like I was flinging it from earth to the heavens in desperation. I don’t even know if she moved to use the bathroom. I don’t even remember if she uttered a word. When I had cried myself to the point of exhaustion, she simply hugged me hard—and left, promising to call the next day. And she did. Give your suffering loved one the consistency of your word—and you will give them a lifeline.

Another time, my beloved mentor and friend were listening to me—again—express sorrow over the abusive past I had known, about the loss of my dreams, about my despair. Her eyes filled with tears—and her reaction shocked me. She wasn’t reviling me? Bored sick by the repetition of my complaints? Instead, she was weeping with me just as Jesus had modeled in the Gospel of John (Chapter 11). Furthermore, she gave me one of the greatest gifts I have ever received: She said, “I promise you that I will never make you eat your words.” Tell your depressed friend or loved one that you will not use their words against them. The freedom and safety you will give them will change their life—and yours. We all need that person to whom we can verbally rail against the gates of heaven and hell—and receive grace and understanding for the pain underlining the rants.

Healing also came when a professor that I admired and secretly viewed as a father figure looked me in the eye and said, “You are gorgeous.” The rest of what I had been told, he said, was a lie. “You are gorgeous.” He said words to me that a father should say—without sexual innuendo, without ulterior motives, without flattery. And he said it as if he were seeing the whole of my heart—and pronouncing over it a blessing.

For me, the actions of these dear ones helped to heal me. They may help to heal your dear one.

“Larry Crabb’s idea in Inside Out is that the church promotes ‘the emotional prosperity gospel’—the idea that you’re not going to have to struggle internally if you are walking with Jesus,” Spatola says. “Yet the more you see the world as it is, the more you will struggle. It may be a sign of spiritual maturity. The church’s response to depressed people is often shame; people with depression already are struggling with false guilt. It makes the current emotional pain worse. The best thing to do is to offer your presence.”

The thing with feathers

Two years of misery gradually evolved into small steps of healing. I moved out of my sister’s house. I found a terrible job that forced me to get dressed in the morning. I went to work and I came home and wept, and sometimes slept. I got fired. Then I got a new job. An acquaintance recommended a counselor who happened to work in a Christian nonprofit practice. I could go for $40 a session. “You are my last resort,” I told her. “I have nothing left.”

I attended a group for victims of childhood abuse. I ate cake, alone, sitting on my kitchen floor afterward. I gained 50 pounds. I ate for comfort. I ate for anonymity. I ate because I hated myself. My relationships with my sister and mother strained to breakpoints—and snapped. Yet somehow we stayed together, although at a distance. Maybe it was memories of what we had all been through that made them give me undeserved mercy.

My counselor recommended seeing a psychiatrist. “I’d feel better with you seeing a psychiatrist because they specialize in neuro-medicines,” she said. I went. And for the first time in 35 years—after struggling with depression from as early as I can remember—a doctor prescribed two medicines, Wellbutrin and Celexa, that eased the anxiety, depression, and lethargy that had seemed like old friends that you stay in touch with only because you know them so well, even when they are bad for you.

I’m 36 now. I’ve been dating, but no answer to my prayer for a husband and a family yet. I’m still scared about the prospect of being alone forever. I still fight the lies that I am fat and ugly and that no one could ever love someone—choose someone—like me. I bought a home, and I plant flowers, I talk to my neighbors, and I thank God when I crawl into bed at night that I do not have to clutch a Bible to feel that He is real.

Slowly, I am hearing again—through a church community, through people who have experienced or who are compassionate toward people who have depression, through the forgiveness of my family and friends for the hurtful ways I related to them and the chilling remarks I made (I once said I wouldn’t kill myself in my sister’s house, leaving her to swing in the wind and feel fear), through a quality counselor, and through life-saving medication—the thing with feathers about which Emily Dickinson wrote:

Hope is the thing with feathers
That perches in the soul,
And sings the tune—without the words,
And never stops at all

No matter what your circumstances are, no matter what your genetic make-up, no matter what others may say—don’t ever give up. Keep fighting. Please hold on. Paul’s idea that nothing could separate me from the love of God—not depression, not death (even at my own hand), not anything, helped to carry me through that darkness. It’s the opposite of what the world tells you—that if you trust in God, you cannot despair. But despair is the language of depression; express it as often as you need to. It’s OK to wail to God.

Close to the brokenhearted

There is no easy way for me to end this piece on depression … because depression is not easy. I can only offer you a perspective of one who has suffered—and who has had to come to terms with my physiology as much as my theology. This is the bottom line: If you think you are depressed, ask someone compassionate to help you find a therapist who specializes in treating depression, and to make an appointment with a psychiatrist to discuss if medication will help.

Christ may seem like a liar like He has abandoned you, but He will not. We change, thank God; He does not. He promises me, and He promises you or your loved one, that He draws close to the brokenhearted. If that is you, reach out for help. If that is someone you know, reach out to help.

“Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword? As it is written: ‘For your sake, we face death all day long; we are considered as sheep to be slaughtered.’ No, in all these things we are more than conquerors through him who loved us. For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth nor anything else in all creation, will be able to separate us from the love of God that is Christ Jesus our Lord” (Romans 8:35–39).

Signs and Symptoms of Depression

• You lose pleasure in things you once enjoyed.
• You withdraw from relationships.
• You have a lack of energy.
• You experience sleep disturbance—“This is often the first red flag you are depressed,” Spatola says. “Usually the pattern is that you can go to sleep, but you can’t stay asleep.”
• You experience a loss in appetite or feel like eating all the time.
• You think about death or suicide.
• You feel hopeless.

Resources

• Tom Nelson, the senior pastor of Denton Bible Church, gave a talk——in a chapel message at Dallas Theological Seminary (March 27, 2007). To listen, go to and search Tom Nelson, “A Christian Looks at Depression” (March 27, 2007).A Christian Looks at Depression www.dts.edu/media/chapel

Books:

• The Healing Path by Dan Alexander
• Inside Out, by Larry Crabb
• Shattered Dreams, by Larry Crab
• Breaking through Depression: A Biblical and Medical Approach to Emotional Wholeness, by Donald Hall
• Darkness Is My Only Companion: A Christian Response to Mental Illness, by Kathryn Greene-McCreight.

Julie Cramer is a graduate of Dallas Theological Seminary and lives in Charlotte, North Carolina. Unlike most, she misses the Texas heat and long summers.