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I have been doing a series of radio broadcasts on 90.9 KCBI through Criswell College’s “For Christ and Culture” spot on the topic of depression.
This week I further discussed some of the treatments that we use to help people who are depressed. As I have said often, there is a difficult tension between how much we should “let go and let God” and/or “work out our own salvation…” (I use that verse figuratively of course :)) I have firmly stated that I am unwilling to go to one extreme or another on the matter, even though it would be easier to do so. With each individual, I must wrestle with all aspects of their humanity: biologically, psychologically, and spiritually. With that understanding, what are the most common psychological and biological treatments offered to help those suffering from depression?
1. Psychotherapy (Talk therapy):
- Solution-focused therapy (SFT) – many individuals come to counseling with a specific problem that they would like professional help to address. It may be a specific conflict with a spouse, child, friend or coworker. It may be an educational or occupational decision that must be made. Whatever the specific problem, the therapist works with the client to generate solutions, test the solutions, and then see what worked and what did not. This can be just as valuable an experience as meeting with a lawyer to get legal counseling, a CPA to get financial counseling, or a pastor to get spiritual counseling. The appointments are usually limited to between 5 to 10 sessions.
- Cognitive Behavioral Therapy (CBT) – the practice of this form of talk therapy is very much in line with Christian principles. In fact, many Christian counselors use the practical methods of this therapy in their counseling office, whether they realize it or not. Formal CBT is very structured and involves active engagement of both the therapist and client in session as well as ongoing homework for the client between sessions. Because of its structured and formalized nature, it is easier to study scientifically than other forms of therapy, and by all reports, it is an effective means of treating depression. In this therapy, the counselor works with the client not just on solutions to specific problems (although this can certainly be incorporated) but more on analyzing the clients thoughts, emotions, and behaviors during an array of problematic situations. The goal is to change faulty patterns of thinking that negatively impact the client’s life.
- Insight-oriented or Psychodynamic Therapy - In this form of therapy, clients engage in a kind of “thought-behind-the-thought” analysis. It goes beyond simply challenging and changing faulty beliefs to deepening the client’s understanding of where and how they developed these thoughts. It addresses issues of psychological defensiveness (ways we protect ourselves from negative urges or emotions), personality styles, and past relationships and experiences that have solidified our view of ourselves and our world. This form of therapy can be very time intensive and requires a certain level of psychological-mindedness on the part of the client, but can still be extremely helpful to someone dealing with chronic depression.
- I will touch on medical treatment modalities in Part II.
My point in describing these various treatments is to give hope to individuals who are suffering. Science has come a long way in helping people who suffer from depression. My caveat, however, is this: suffering is a part of life. We will never find the magic pill to take away all pain and suffering. We seek to enjoy this life as much as possible while realizing that this was not the real life we were made for. Sometimes it feels like we are playing an endless game of “Whac-a-Mole.” Having just beaten down one problem, others surface for us to beat down. It is helpful in times like these to remember that we are called to praise God for the suffering He relieves (through whatever means including medical treatments) and trust Him with the suffering we continue to endure.
Question: What about you? What is your view on medical, psychological and spiritual treatments for depression?
I recently did a series of radio interviews on the topic of depression. Specifically, is it possible to identify someone with depression, what causes the symptoms, and can medication help? If you are in Dallas, you can hear the programs on Wednesday and Thursday of this week, June 20th and 21st, on 90.9 KCBI at 6:30pm and 10:30pm. For those of you out of state, you can check out the website www.forchristandculture.com and click on the “on the air” tab.
In the second program, I focused on the issue of chemical imbalances. Are there such things? If so, how relevant are they to our psychology and spirituality? Can medications help?
This is an important topic for me because I continue to find myself within a sphere of tension where the physical, psychological and spiritual aspects of a client’s mental health may not be readily apparent.
I’ve said before that it is easier to focus on one of the three areas to the exclusion of the other two. This may be easier for the therapist, but it is not helpful to the client. In the radio interview, I read some statements from a professor at a Christian University in Texas who believed that the chemical imbalance idea was not practical or relevant to mental health. Here is a direct quote from the article:
“[The article stated] Counseling must go beyond merely symptom relief, and it must aim at spiritual transformation, to get people to conform to the likeness of Christ…a new professor was asked for his views on counseling those who have been diagnosed as having a chemical imbalance…’There’s no concluding evidence in science that it [a chemical imbalance] is real,’ he said, adding that neurotransmitters are not measurable in a living human being so nobody knows for certain whether anybody has an imbalance… The chemical imbalance diagnosis is problematic because, even if the imbalance could be proven, one still wouldn’t know if the imbalance caused the mood disorder, or if the mood disorder caused the imbalance.’” (Citation provided upon request.)
I agree with the first statement made. I am a firm believer in the fact that counseling must go beyond symptom relief and that our ultimate purpose as Christians is to encourage Christ-likeness. However, I have several problems with the argument that says because we do not fully comprehend all the intricacies of a particular problem, we should avoid it all together or focus on one particular aspect of a problem and ignore other potential solutions.
- The mystery of God’s creation is inexhaustible. No one would deny that the human cell is vastly more complex than what Darwin original thought when he developed his theory of evolution. Because it is so complex, should we ignore the study of it? Of course not. If our current knowledge of the cell turns out to be elementary at best, should we avoid using the knowledge we do have for practical purposes? No, we should not. Science has proven that a great deal of good can come from even the most elemental knowledge of a subject. (Note: Nerves are cells. We should study nerves.) Though we do not yet have the cure for cancer, Parkinson’s disease, autism, or schizophrenia, we don’t give up pursuing those cures. God created us as creative, curious beings and to deny that aspect of our humanity is to deny God’s sovereign design. This study should include the physical nature of our emotions.
- Chemical Imbalances are actually well studied. I explained Parkinson’s disease during the second radio interview. It is a disease that’s cause is unknown, but we do know the symptoms and that the symptoms occur because of an imbalance of acetylcholine and dopamine in the brain. By giving a precursor of a neurotransmitter (yes, that’s right! An actual neurotransmitter) we can relieve the symptoms of the disease and help people have a better quality of life. The same can be said for depression. Though we don’t have all the answers as to the cause of depression, we do have physical treatments that can help relieve suffering, and that is exciting!
- Relieving suffering can bring people closer to God and other people. I heard a comedian once say that telling someone that an antidepressant is just a crutch is like telling an amputee that his crutch is just a crutch for his one-leggedness. Um, yes, that’s exactly what it is. Thank God for crutches and prosthetic legs and for medications that can help us to live more effective lives for His glory. A person who fears that someone will turn away from God because his/her needs have been satisfied would have been appalled at some of the miracles Jesus performed. Jesus healed ten lepers knowing that only one of them would return to worship him! I think sometimes we fear that if we use means beyond our religious texts to help people feel better (diet, excercise, medication, boundaries in relationships) that somehow we will distract them from exploring the spiritual side of life. This just isn’t true and even if it was, it should not preclude us from the act of compassion!
I say all this to remind each of us that we are all guilty of being flippant about things we don’t fully understand. Let’s be careful not to make the same mistake that Christians in Galileo’s time made when they demanded that the world was flat (an issue that the Bible never even addressed!). Let us instead, remain in that constant state of tension as we earnestly wrestle with the brokenness of life, always seeking to heal, to restore, to redeem broken pasts, to relieve suffering, and in our feeble, broken way, point people to God!
This week on “For Christ and Culture,” I discussed the subject of eating disorders and food addictions. This is a pervasive problem in the United States that has taken hold of the lives of many people (women especially) and must be addressed spiritually, relationally, biologically, and psychologically. Jesus acknowledged that mankind cannot live by bread alone, yet we have made food and all that accompanies it (control, pleasure, survival) idols that have clouded our focus and enslaved us. For those of you who struggle to keep food in its proper place, let me give you some hope. There are resources that can help you to conquer your struggle. But first, you must do several things:
- Acknowledge what you really desire when you engage in eating disordered behaviors. (Control, Penance, Retribution, Mastery, Pleasure or avoidance of Pain, etc.)
- Recognize your powerlessness to overcome the struggle on your own.
- Confront the shame that keeps you from asking for help.
- Seek out a medical professional (dietician, psychiatrist, internist) who can help you take care of your physical body in a way that enables you to live the life God wants for you. (This may mean addressing the underlying depression that is perpetuating your behaviors)
- Open up to a Godly Christian counselor who can help you address the patterns of thought and emotion that keep you stuck in the addictive cycle.
- Establish a community of people (Support Group, Celebrate Recovery, a local Church body, Small group) who know your struggle and will not enable you to continue the addiction but will challenge you to move beyond it to be all that God wants you to be.
Here are some resources that may help to get you started:
- Texas Health Resources: Eating Disorders
- Remuda Ranch
- National Eating Disorders Association
- Sober Living by the Sea
- Focus on the Family
- Celebrate Recovery
Care for this individual who desperately wants to give up control and be free of her addiction. Help her to seek out a more lasting source for her significance, her purpose, and her love. Lead her to people who can empower her to break free and experience peace in her identity, past present and future.
Question: How have you overcome the internal struggles in your life? What encouraging resources have been helpful in your journey?
Note: For those of you interested in the radio program I did, it should be uploaded to the For Christ and Culture Website the week of the April 2nd.
Some of you may have heard about the recent article published in the Archives of General Psychiatry calling into question the wisdom of the FDA’s 2004 decision to issue a “black box warning” about the purported link between antidepressant use and suicide. I have found it interesting to study the trends associated with antidepressant prescribing and its effects on depression and suicide after the issuing of the black box warning. Ironically, suicide rates in teens actually increased after the issuing of the warning. It is believed that many doctors became fearful and stopped prescribing antidepressants even though many who were suffering needed the help.
I thought about how this mass hysteria created by the news media is a parallel to our own lives. Each of us has a black box that we carry around with us. It may be the fear of an impending job loss, a spouse’s betrayal, a financial crash, an injured child, or a potential life-threatening illness. We carry this black box with us whereever we go, allowing it to rule our thoughts and our behaviors, but never once do we consider opening it to examine the evidence for what we fear. The ultimate fear that all of us carry is the fear of DEATH, or as I like to call it, the fear of “an unlivable life.” In confronting this fear we must do three things:
1. Live Realistically. Don’t ignore the black box. Unpack it. Examine it’s contents. Consider what it would really mean for you if the dreaded contents came true in your life. I had a client who had a morbid fear of having his personal identity stolen. He never thought beyond this fear to the end result. He just knew that he could never survive it. As we unpacked his black box, he realized that his identity being stolen would mean significant hassle in getting his bank accounts changed, his money refunded from his credit card company, and his credit resecured. As we walked through the steps of doing each of these things, he came to realize that, YES, it would be difficult but it would not destroy him. The mysterious fog that loomed over him lifted and he could come through sucessfully on the other side.
Live Responsibly. We’ve all heard that Tim McGraw song, “Live Like You Were Dying.” I get his point but I disagree with some of the things he would change. If we knew that we were dying, I don’t think we would need to quite our jobs, move to the mountains, sky-dive, or party until we drop. I believe the truly responsible act would be to continue our normal daily activities but with a deeper intentionality and commitment, knowing that we may be doing them for the last time. With this attitude, even the most mundane of activities would be magnificent.
Live Resiliently. Our fear of the unlivable life can stir within us a desire to give up on life completely. Fight against that desire! Even as treasured aspects of life are lost (your health, your job, your loved-ones, your valuables), recognize that you can always draw deeper from the LIVING WATER and discover that the depths of HIS LIFE are unfathomable. How do we do this practically? I was once asked in a Florida Television interview what I would say to the elderly invalid watching the program from the prison of their bed. My answer was this. “Even if you can’t make it from your bedroom to the kitchen. You can still do something more powerful than any human act imaginable. You can commune with an Almighty God and intercede on behalf of those who desperately need God’s presence in their lives.” Oswald Chambers said, “Prayer does not fit us for the greater work. Prayer is the greater work.” The older I get in this life, the more I believe this is true.
So what is your black box? How are you dealing with it? Can you say that you are living realistically, responsibly and resiliently in the face of death? I hope your answer is a resounding “YES!”
Relationships are full of conflict. If you have managed to avoid it this far in your life, I guarantee you that you have also managed to avoid people. Avoiding conflict is not the answer, although we can certainly try to steer clear of meaningless squabbles and debates. The true sign of a healthy relationship is one that navigates the stormy seas of conflict with intentionality and precision. The only way to do this is to first understand why and how conflict tends to arise. We discussed the first source of conflict in the previous post: POWER. The second source of Conflict is Power’s mirror image: Preservation.
Preservation. Preservation of self is a natural response when we feel we are being manipulated, mistreated, overlooked, or attacked. Our physical bodies even generate responses that alert us to potential threats. Our heart rate increases, our face flushes, our eyes dilate, and our muscles tense. This does not just happen when we feel physically threatened, but emotionally threatened as well. Unfortunately, we can become super-sensitized to possible threats in our relationships, especially if we have been hurt before. If we are not careful, we can perceive threats where there are none. It takes a great deal of intentionality and persistence to recalibrate our system and raise the “conflict threshold” in our minds. So how can we manage our sense of self-preservation as we engage in conflict?
1. Consider the threat. What has been done to you that has caused you pain? Was it intentional or unintentional? If unintentional, can you let it go? (1 Peter 4:8) If it was intentional, what was the motive? Sometimes people hurt us for good reason. No one likes criticism but sometimes there is truth in what people say. If they were simply being hateful, then what about their actions or words penetrated and threatened your sense of self? We need to take time to consider the threat before we can effectively deal with it.
2. Bandage fresh wounds. The Vikings had great warriors called Berserkers who would psych themselves into a frenzied rage before charging into battle. Once they started, there was no stopping them. These soldiers would fight to exhaustion, often ignoring their wounds until they bled to death in the heat of battle. I know too many people who fight like this when they feel attacked. We forget that it’s okay to call timeout. Step back, look at where you have been hurt, and do some damage control before you confront someone. Maybe you need to meet with a trusted friend or advisor to sure up your sense of self. Maybe you need to pray and ask God to give you wisdom and discernment moving forward. Words can penetrate deep into our soul and taking time to heal a little before we jump into a conflict will allow you to resolve it more effectively. If not, you just might cut deeper wounds and bleed all over everyone around you. What a mess!
3. Hide yourself in Christ. “The name of the Lord is a strong tower. The righteous run into it and are safe.” (Proverbs 18:10). What does it mean to “run into the name of the Lord like a strong tower?” In regard to our relationships, it means that our identity becomes so wrapped up in who He is, that people can’t see us anymore. They see Christ. This, then, becomes our truest source of protection. The more we are like Christ, the more He is being attacked and not us. He will fight our battles, the more we place our identity in him. Then, we can worry less about preservation and more about resolving the conflict and strengthening our relationships.
Question: What has helped you in situations where you feel attacked by others?
If you click on the link to the left titled “Bullying and Teen Suicide”, you can hear an I did with Barry Creamer on Live from Criswell. This is an issue I think is important to address, not just for Teenagers but Adults as well. I’d love to hear your thoughts as you listen.
Is there a psychological, even a physical benefit to forgiveness? Studies show that there are. Forgiveness has been associated with all of the following:
1. lower heart rate and blood pressure
2. Greater relief from stress
3. Decrease in medication use
4. improved sleep quality and decrease in fatigue
5. decreased physical complaints such as aches and pains
6. Reduction in depressive symptoms
7. Strengthened spirituality
8. Better conflict management
9. Improved relationships (not just with the offending party but in other relationships as well)
10. Increase in purposeful, altruistic behaviors
So, are you holding on to anger? Is there someone that you are “punishing” by choosing not to forgive? Why not let go of the bitterness and start enjoying all of the above. It takes practice and effort to forgive, but it is well worth it in the long run (spiritually, physically, and psychologically.)
Karremans JC, Van Lange PA, Holland RW. Forgiveness and its associations with prosocial thinking, feeling, and doing beyond the relationship with the offender. Personality and Social Psychology Bulletin, October 2005.
Lawler KA, Younger JW, Piferi RL, Billington E, Jobe R, Edmondson K, Jones WH. A change of heart: cardiovascular correlates of forgiveness in response to interpersonal conflict. Journal of Behavioral Medicine, Octover 2003.
Lawler KA, Younger JW, Piferi RL, Jobe RL, Edmondson KA, Jones WH. The unique effects of forgiveness on health: an exploration of pathways. Journal of Behavioral Medicine, April 2005.
I had a great interview with Greg Wheatley of Prime Time America today. One of the questions he asked me was “How do those of us who are not trained counselors help a friend who is hurting without being cliche’ or flippant.” I thought I would expound on my answer and give a few helpful tips:
1. Provide Comfort. Use words if necessary. When you don’t have the right words, say so. Your presence, your touch, your time, your listening ear, your shared mourning may be enough to provide comfort to someone who is in pain.
2. Ask Good questions! What would you need to know in order to fully grasp your friend’s situation? Rather than jumping in with quick words of encouragement that might be misconstrued, try to put yourself in your friend’s shoes. This is the essence of empathy. What might be a comfort to you may not be to others. Knowing a friend is important to properly encourage them. So what are they thinking, what are they feeling, how have they tried to fix the problem, have they had similar problems in the past? “Now you know…and knowing is half the battle.”
3. Be intentional in your prayers. This is one of the best questions you can ask a hurting friend. “How can I pray for you?” When they tell you, make sure you follow through. This will not only show them that you are genuinely interested, it will also bring you a great deal of joy when you start seeing your prayers answered.
4. Be careful with self-disclosure. One way we can get in trouble with friends is to start talking about ourselves. “Oh, I know exactly what your are going through. When I was…” may not be the best response to someone in immediate pain. Self-disclosure may be important, but if you do this before you have followed step 2, you are making an assumption that you understand when really, you may not. Remember, the focus should remain on the person in pain.
5. Speak true in love. No one can question your motives. If you are genuinely concerned about a friend, they will be able to see it and be more forgiving of any faux pas on your part. Once you’ve shared your heart, check in with your friend to see if there is anything you said that they did not understand or may have taken the wrong way. Be willing to follow up on your words with action. As James 2:16 says, “If one of you says to him, ‘Go, I wish you well; keep warm and well fed,’ but does nothing about his physical needs, what good is it?”
Question: What struggles have you had in trying to counsel or comfort a friend in their pain? How did you handle it?