Depression and Hope: New Insights for Pastoral Counselling
Howard W Stone
Fortress, Minneapolis, 1998, 162pp.
I’m Not Supposed to Feel Like This: A Christian Self-Help Approach to Depression and Anxiety
Chris Williams, Paul Richards and Ingrid Whitton
Hodder & Stoughton, London, 2002, 279pp.
A Practical Handbook for the Depressed Christian
It is not just my relationships that are lost to me, there is no pleasure to be found in anything. So I have lost music and birdsong, sunsets, frangipanis and my daughters’ blue eyes. I have lost chocolate and champagne, perfume and the scent of the Australian bush. I have lost back massages and the feel of salty surf on my skin. I have lost the satisfaction of a job well done. My illness has robbed me of the ability to enjoy or find contentment in these things and so it is as if they do not exist. All sources of comfort and joy are gone, and I grieve deeply and terribly for the acute loss …
There are others who enter a hell through a door they also call depression and find themselves in a very different world to mine. It may be a place where there is crippling self-doubt, even self-loathing, feelings of uselessness and utter worthlessness. It may be a place of terrible anxiety or fear or paranoia. I cannot imagine the pain in their hells.
No, mine is not the only hell, nor are the hells experienced by the sufferers of depression the only hells. But I have needed to paint a picture of my particular hell, so that those outside it can begin to understand it. So that they know it isn’t just passing mood. So that they know it can’t be fixed just by a good sleep. So that they’ll understand if I don’t make it. So that they know that the questions to be asked are not ‘Can’t you just hang in there just a little bit longer? We’ll find the right medication eventually. Can’t you see you have so much going for you, how can you even think of suicide?’1
Depression is now recognized as one of the most widespread and disabling medical conditions within our society. It has been described as the ‘common cold’ of mental health because of its high incidence in the general community. But the analogy ought not to deceive us into thinking that this is a minor concern. The impact upon sufferers and their family and friends is enormous, as are the societal and economic costs.
For the Christian, however, depression brings an added set of problems. The New Testament not only lists joy as a fruit of the Spirit, a natural outworking in the life of faith, but it even commands this emotion of the believer. Yet depression, by its very nature, involves an absence of joy. Add to this the scriptural challenges to be active in the Lord’s work, things that are at times beyond their ability, and it is easy to see how guilt is a significant issue for Christians suffering from depression.
A further difficulty for believers is a perceived divide between ‘head’ and ‘heart’. They may be able to espouse the ‘right’ theology—“God loves me because Christ died for me”. Nevertheless, the feelings within are of a profound sense of unworthiness and God-forsakenness. As someone once said to me, “You feel like God is a thousand miles away”.
Depression is a pastoral issue within our churches. It affects those sitting in the pews and those standing before them who carry the burden of Christian leadership. What, then, do these books have to offer—for the pastor, the caring Christian friend, or one suffering from the illness itself?
I found I’m Not Supposed to Feel Like This the most helpful of the three books. Its authors are a senior lecturer in psychiatry (Williams), a consultant psychiatrist (Whitton) and a Baptist pastor (Richards). This combination of authors reflects the approach of the book—the attempt to marry recent insights within the disciplines of psychology and psychiatry with a biblical and pastoral perspective.
The book makes use of Cognitive Behaviour Therapy (CBT), set within a Christian framework. CBT claims that what we believe and the way that we think affects the way we feel and the things that we do. Much of our reaction to events depends on our interpretation of those events. And when someone is depressed, these interpretations are negative, leading to unhelpful and extreme patterns of thinking. Examples of such thinking are: putting a pessimistic slant on things, seeing everything in very black and white terms, and having a gloomy view about the future. CBT challenges these ways of thinking and attempts to replace them with more helpful patterns. It is an approach grounded in scientific research and has proven to be an effective treatment for many suffering from depression.
The authors are serious about the role that Christian faith can play in dealing with depression and anxiety. They believe that a key to overcoming unhelpful ways of seeing ourselves “is to look again at how God sees us” (p. 10). Throughout the book frequent reference is made to Bible verses and gospel truths that can shape the way we think. When an individual does not feel forgiven or “if you judge yourself as useless, worthless, and a burden rather than an asset to God” (p. 197), there is the encouragement to remember that there is no condemnation for those who are in Christ Jesus and that “our status in God’s eyes is that of children and heirs of God” (p. 197). By appropriating these truths, extreme and unhelpful thoughts can be challenged so that things can be seen more realistically. One helpful suggestion to aid this process is for those suffering from depression to write out key Bible verses and carry them around as a reminder of God’s perspective on things.
As the full title indicates, this is a self-help book. It tackles anxiety problems as well as depression. Both conditions are explained in a helpful and non-technical manner, however the bulk of the book (part 3) is devoted to ‘Overcoming your problems’. There are a number of exercises that enable the reader to apply the principles outlined in this work. These include a worksheet that identifies extreme and unhelpful ways of thinking and another that assists the participant to challenge these thought patterns. While these exercises look useful, a depressed person might have difficulty completing them on their own. Enlisting the help of a Christian friend might be worthwhile.
One of the valuable things about this book is that a creation theology implicitly undergirds its content. There is an acknowledgement that, as creatures made by God, there are dimensions to our functioning that do not fit neatly into spiritual categories. For example, note this comment:
… it is unbiblical and generally unhelpful to classify every problem— inside or outside the Church—as only ‘spiritual’ or ‘non-spiritual’, as most problems in churches have both human and spiritual dimensions. Psychological factors are still very important in understanding how people react in unhelpful ways to each other and to various situations. (p. 84)
This sort of approach guides their views on helping the depressed Christian. They suggest that health professionals and church leaders have complementary roles to play in assisting recovery: “pastoral support and prayer is not an alternative to antidepressants or even hospitalization, but can be just as much part of the treatment” (p. 252).
The final chapter of the book is titled ‘Practical help for church leaders—how the Church can help and how sometimes it doesn’t’. This is particularly useful for anyone in church leadership. It discusses the sort of culture we create in our churches and the messages we communicate about mental illness. There are suggestions as to what can be done to assist those struggling with depression and some of the difficulties and pitfalls involved. A strong message is that ongoing support and encouragement is of enormous benefit.
Overall, I appreciated the fact that these authors were willing to think about depression in a Christian manner. They identify many of the questions and issues that are distinctive to being a Christian suffering from depression. They also constantly reassure the depressed Christian reader of their standing before God as a loved and accepted individual despite what they might feel. It is theology well applied in the pastoral context.
Howard Stone’s book, Depression and Hope: New Insights for Pastoral Counselling, is written for the pastor rather than the sufferer. It contains a large amount of useful information in fairly short, pithy chapters. There is a good introduction to the causes and characteristics of depression. Then follows a chapter on some of the history of Christian thinking about ‘spiritual desolation’. Evangelical readers will find some of this section a little unusual, but it contains a few valuable comments. One gem is a quote from Martin Luther on what to do with depressing thoughts: “Grit your teeth in the face of your thoughts, and for God’s sake be more obstinate, headstrong, and wilful than the most stubborn peasant” (p. 28). This chapter also makes the point that one can have a genuine hope in the Lord but still have abnormal feelings and thoughts, an important reminder for those seeking to support a depressed Christian.
The chapter on suicide is very good. The key point is that pastors should “never underestimate a depressed person’s desire to escape the pain” (p. 32). This means that they must be prepared “to ask direct questions concerning thoughts about suicide” (p. 35). Talking about suicide does not make someone more likely to do it. Those in pastoral ministry are warned of the need to have thought through these issues before they face a potential suicide crisis (p. 36).
“When one person is depressed, many suffer” are the words that open the chapter on ‘Family Life of the Depressed’ (p. 39). Mention is made of how there is often a correlation between marital discord and depression, and the differences in depression between men and women and children and adolescents are outlined. Pastoral care will need to be offered to other family members as well as the individual with the illness (p. 46).
Part two of the book sets out a range of pastoral interventions for depression. While there is much useful information here (on pharmacological and cognitive treatments, etc.), it raises one of my reservations with Stone’s approach. The author’s view is that the pastor can be significantly involved in the treatment of mild to moderate depression. I think this probably extends beyond the biblical picture of pastoral ministry with its focus on prayer, the word of God and setting an example to the believers under their care.
This connects with my other reservation. When it comes to these aspects of the pastor’s role, Stone doesn’t have much to say. There are statements I concur with: “Pastoral conversation … has a clear purpose: helping people to live faithful Christian lives” (p. 69); “Recent tendencies in the church to minimize or even ignore sin … is an immense sense of loss for depressives” (p. 120); “… ministers of the Gospel … are messengers of grace, redemption, and hope” (p. 145). But these thoughts are not developed. The chapter on hope focuses more on envisaging a positive future than the clear hope held out to us in the gospel of our Lord Jesus Christ. Yet it is this message that reaches to the deep needs of the depressed Christian, the need to know of God’s love, forgiveness and affirmation. The ministry of the word is at the periphery rather than the centre of the pastoral approach of this book.
Finally, we consider A Practical Handbook for the Depressed Christian by Dr John Lockley. Again, it is a book filled with useful information. The author effectively taps into the feelings and experience of being a Christian with depression, no doubt aided by having suffered from the illness himself. He considers a wide range of issues related to depression (stress, loneliness, guilt, anger, etc.) and has useful exercises at the end of most chapters. As in the book by Williams et al., a strong theme in this book is the unconditional love of God for the depressed Christian—“Do you think God loves you any the less because of your depression?” (p. 17). For Lockley, “if there is a sin involved in being depressed, it’s a refusal to accept forgiveness, not a failure to seek it, nor a failure of faith” (p. 301).
While occasionally I would differ with the author at the theological level, my main concern with the book is its size. I think it is too big and tries to do too much. The colloquial style makes for fairly easy reading, but I wonder how the depressed Christian would find the motivation and stamina to complete it. To be fair, the author recommends that a depressed Christian reads the first four chapters and then any others that seem relevant, or to get someone else to read it out loud to them if they have trouble concentrating. I believe it would function best as a reference book for the depressed. For pastors, however, this is a useful book to work through so that they might know what would be helpful for people to whom they are ministering.
The Scriptures are given by God for our teaching and encouragement. The Christian believer struggling with depression certainly needs that encouragement. But it is possible to use the Bible in a way that is unscriptural, that shows no consideration for the nature of this illness and thus fails to bring comfort and healing. A good pastor is a wise pastor, who not only understands biblical truth but also the nature of the realities of life into which he or she ministers. These books will help readers to understand depression and its treatment. To differing degrees, they also provide insight into how the message of God’s grace and love can assist those seeking to serve Christ whilst suffering this terrible affliction.
Keith Condie is Dean of Students at Moore Theological College, where he lectures in Ministry and Church History.