Excerpted with Permission from The Quick Reference Guide to Biblical Counseling by Tim Clinton and Ron Hawkins, pages 73-79
Finding the way out of the black pit of despair can sometimes be extremely difficult. It is an experience that leaves the individual exhausted, unmotivated, and in deep, hopeless despair. There seems to be nowhere to turn and no way to escape these horrible feelings. Depressed feelings and depressed experiences vary both in quantity and quality and therefore different for each individual.
Depression is a condition that affects 1 in 10 Americans at one point in their lives with the number of patients diagnosed increasing by 20% each year. Of those that display symptoms of clinical depression, 80% are not receiving any specific treatment for their depression. Currently it has been reported that an estimated 121 million people around the world currently suffer from some form of depression.
Depression can have a variety of meanings because there are different types of depression. Clinical depression as a disorder is not the same as brief mood fluctuations or the feelings of sadness, disappointment, and frustration that everyone experiences from time to time and that last from minutes to a few days at most. Clinical depression is a more serious condition that lasts weeks to months, and sometimes even years.
Causes of Depression
Depression can be caused by many life issues, including anger; failure or rejection; family issues, such as divorce or abuse; fear; feelings of futility, lacking control over one’s life; grief and loss; guilt or shame; loneliness or isolation; negative thinking; destructive misbeliefs; and stress. This is sometimes referred to as “reactive depression.” With this, the depression symptoms may be lowest in the morning and increase throughout the day. Note: Persistent reactive depression will change one’s chemical balances and may compound depression.
Medical and biological factors can also facilitate depression: inherited predisposition to depression, thyroid abnormalities, female hormone fluctuations, serotonin or norepinephrine irregularities, diabetes, B-12 or iron deficiencies, lack of sunlight or vitamin D, a recent stroke or heart attack, mitral valve prolapse, exposure to black mold, prescription drugs (anti-hypertensives, oral contraceptives), and recreational drugs (such as alcohol, marijuana, cocaine). When rooted in the biological, it is sometimes referred to as “endogenous depression.” With this, sufferers often feel worse in the morning.
Misdiagnosis of depression is common. It can often be misdiagnosed as anxiety, which is a common affect in many types of depression or other mood disorders. Accurate assessment is the first step to proper treatment.
Assessment Questions for the Counselor
- How long have you felt depressed?
- What was happening in your life when you first became depressed? (Someone who is depressed needs acceptance and gentleness. The counselee may already be feeling as if he or she has failed in some way. Begin by listening to your counselee’s story without judgment.)
- Have you been depressed before?
- Do you have a family history of depression?
- Do you have difficulty concentrating?
- Have you lost interest in pleasurable activities?
- Have you noticed changes in your eating or sleeping patterns?
- Are you dealing with guilt or fear about anything? (Fear is prevalent in many kinds of depression—anxiety and depression coexist in 70 percent of those diagnosed with depression.)
- What do you see in your future?
- Have you had any thoughts about injuring yourself or suicide? (Sometimes the thoughts are vague, such as “It would be better if I were not here.” Pay particular attention to anything indicating a means for carrying out these thoughts. Someone who is suicidal and imagines having an automobile accident has both a plan and a means to carry it out.)
Four Things Every Counselor Needs to Know About Depression
- Clinical/major depression is distinct in that symptoms are so severe that they disrupt one’s daily routine.
There are three types of depression:
- Dysthymic disorder is a chronic, low-grade depression.
- Bipolar disorder, previously known as manic depression, is a type of mood disorder with severe changes in affect. A person may have periods of euphoric elatedness contrasted with periods of severe major depression.
- Seasonal affective disorder (SAD) is a severe onset of “winter blues” when one experiences depression, most often believed to be due to lack of sunlight (or vitamin D).
Besides the obvious impairments in mood and relationships, untreated depression affects multiple areas of a person’s life. It is one of the top three causes of disability and diminished work productivity. The Bible recognizes the heaviness of depression. God’s love and understanding reach out to those who are depressed and discouraged. God promises to give consolation, beauty in place of ashes, oil of joy in place of mourning, and a garment of praise instead of a spirit of heaviness.
Tim Clinton, Ed. D., LPC, LMFT (The College of William and Mary) is President of the nearly 50,000-member American Association of Christian Counselors (AACC), the largest and most diverse Christian counseling association in the world. He is Professor of Counseling and Pastoral Care, and Executive Director of the Center for Counseling and Family Studies at Liberty University. Licensed in Virginia as both a Professional Counselor and Marriage and Family Therapist, Tim now spends a majority of his time working with Christian leaders and professional athletes. He is recognized as a world leader in faith and mental health issues and has authored over 20 books including Breakthrough: When to Give In, When to Push Back. Most importantly, Tim has been married 36 years to his wife Julie and together they have two children, Megan, who recently married Ben Allison and is practicing medicine in dermatology, and Zach, who plays baseball at Liberty University. In his free time, you’ll find him outdoors or at a game with family and friends.
Ron Hawkins, Ed.D., D.Min., is a licensed professional counselor and currently serves on the Executive Board for the American Association of Christian Counselors. He is the Vice President for Academic Affairs and Provost at Liberty University and also a Professor of Counseling and Practical Theology in the Center for Counseling and Family Studies. He is a pastor, author and frequent presenter at AACC’s regional and national conferences; Marriage and Family Conferences; Christian Camps and Men’s Retreats. Dr. Hawkins authored Strengthening Marital Intimacy and The Quick Reference Guide to Biblical Counseling with Dr. Tim Clinton.