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Stewardship of Self for Cross-Cultural Workers: Depression
Ronald Koteskey & Marty Seitz
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Christians are not immune to emotional disorders, such as depression.
Although a clinical term that is not used in the Bible, depression appears to
have been relatively common among early leaders of God’s people.
Early church musicians who wrote Psalms 69, 88, and 102 expressed the despair
of depression in the context of hope. Moses, a leader of God’s people and
well-known author, asked God to put him to death because he could not carry the
burden of the people God had asked him to lead (Numbers 11). Jonah, a successful
early cross-cultural worker, also asked God to take his life when his anger
resulted in a wish for death (Jonah 4). Elijah, a leader with the gift of
prophecy, fell into the depths of depression. He prayed to die immediately after
intense spiritual warfare and a great victory over the forces of evil (1 Kings
19). Therefore, even those actively involved in ministry can become depressed.
Depression and its causes
Although depressed Christians may have many different symptoms, the core of
depression always includes depressed moods (sadness, emptiness, tearfulness) or
loss of interest or pleasure in most activities. In addition, it may include
changes in weight, sleep, energy, emotions, and thoughts. It has many causes,
including:
- Genetic and biological—depression runs in families
- Medical—the side effects of some medical conditions and some medications
may include depression
- Background and family causes—childhood experiences can lead to later
depression
- Stress or significant loss or changes, such as separation, birth of a
child, or death may result in depression
- Learned helplessness in situations where we feel like we have little or
no control
- Thinking in ways that overlook the positive and see only the pessimistic
- Anger turned against yourself
- Sin and guilt leading to self-condemnation and hopelessness
- A lack of positive or pleasant experiences
- Having a lack of meaning in life
How do I know if I’m depressed?
The definition of depression changes slightly from time to time, but
currently a person must have at least one of the following symptoms most of
the day, nearly every day, for two or more weeks to be
considered "clinically depressed:"
- Feel sad, depressed, or empty
- Lose interest or pleasure in almost all activities
In addition, the person must have more than three or four of the following
nearly every day for the same two or more weeks:
- Great increase or decrease in appetite
- Sleeping much more or less
- Agitation or sluggishness
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Decreased ability to think or decide
- Thoughts of death or suicide
These symptoms must be bad enough to distress you or impair your daily
functioning. If you do not have at least five of these symptoms (including one
of the first two), then you do not meet the definition of "clinical" depression.
Even if you are not clinically depressed, suggestions in this brochure may be of
benefit to you. (Note that if your symptoms have been moderate and have lasted
two or more years, or if they include great swings in mood including periods of
elation, recommended treatment may be different from that recommended below.)
Although it will not give a professional diagnosis of depression, a
depression questionnaire at the following web site will help you determine if
you may need to see a mental health professional: http://mentalhelp.net/guide/dep2quiz.htm
What can I do if I’m depressed?
Consulting a mental health professional would be ideal. Also ideal would be
getting a thorough physical exam. Depression can have physical bases, and your
physician may be able to evaluate you for an antidepressant if necessary.
However, some Christian workers live in isolated areas where there are no mental
health professionals. Others have no health insurance or only insurance that
does not cover mental health, and they cannot afford to pay the bills
themselves. But if you are feeling tempted to act on suicidal thoughts, that
indicates you need immediate help from someone other than yourself. The
following are specific applications of our "General Principles of Stewardship of
Self." You may find one or more of these helpful in beginning to care for
yourself.
- Read portions of Scripture that seem particularly well-suited to
expressing the feelings and thoughts of persons when they are depressed. For
example, pray Psalm 13 with King David, leader of God’s people. Also read
Scripture passages filled with hope, such as Psalm 40, Psalm 42, or 2
Corinthians 1:3-11.
- Find information about depression on the Internet at sites such
as the one maintained by the National Library of Medicine at www.nlm.nih.gov/medlineplus/depression.html
or the one at http://mentalhelp.net/disorders/. These web sites have
numerous links to reliable information about depression. (Remember that the
domains .gov and .edu tend to be the most reliable.)
- Read good books about depression, such as Feeling Good: The
New Mood Therapy, The Feeling Good Handbook, or Ten Days to
Self-Esteem, all by David Burns. Or read Happiness is a Choice: The
Symptoms, Causes and Cures of Depression by Frank Minirth and Paul
Meier.
- Keep a log of your symptoms of depression to find events or
thoughts that occur before the symptoms get better or worse. Then avoid
those events or thoughts that precede depression and increase your
participation in events or concentrate on thoughts that prevent or decrease
it.
- Find ways to reward yourself for thinking or behaving in ways
that decrease your depression when you discover what helps. For example, if
saying, "This too shall pass" helps, pat yourself on the back by also
saying, "I’m putting feet to my prayers by talking to myself this way."
- Do activities that once were rewarding or pleasurable, even if
you do not think they will bring you pleasure now. If you cannot think of
any, do something that most people find pleasurable, such as enjoying
nature, listening to music, or reading a good book.
- Take time to be out in the bright light of the sun while
protecting your skin since sunlight often helps reduce depression.
- Confess
a fault or sin to an appropriate person in order to
alleviate guilt.
- Make a caring confrontation if you need to confront someone about
things they are doing that are hurtful to you or others.
- Ask for help
from trusted friends, family members, physicians, or
counselors.
- Make a choice
to take the first step in putting feet to your prayers
for overcoming depression by deciding on one thing you can do for yourself
today. Then do it.
- Tell someone
else about your commitment to take that step to
actually do something.
- Ask that person to hold you accountable for taking that step.
- Express
the sadness, grief, and pain of loss or frustration. Isaiah
is often interpreted as referring to Jesus as the "Man of Sorrows" (53:3-4).
John recorded that "Jesus wept (11:35).
- Focus thinking
on things that are good, pure, lovely, true, noble,
and admirable (Philippians 4:8). These are things that give us hope. Take
off the "dark glasses" and look at the good that can come from your troubled
situation. Remember the old song that said, "Count your many blessings; name
them one by one."
- If no medical professional is available, several herbal supplements
are effective for the treatment of mild to moderate depression. St. John’s
Wort and Sam-E are widely available—but if you take these, be sure to tell
your physician when you see him or her.
- After checking with your doctor, if one is available, gradually work up
to exercising (after beginning to perspire) for at least twenty
minutes at least three times during the week. Such aerobic exercise has
proven effective in reducing depression.
- Force yourself to be with people even when you do not feel like
it. During depression the tendency is to withdraw from others, but being
with people may actually help relieve your depression.
- If you cannot make yourself socialize, ask someone else to coax you
to be with others even when you persistently resist.
- Find a trusted person or group
with whom you can share your
struggles. Just as you have wept with those who weep, let others weep with
you. If you are in an isolated location, numerous Internet support groups
are available on-line.
- Monitor
your thoughts for self-talk that is despairing and hopeless.
Then tell yourself, "Stop!" Do not continue to think that way but choose to
repeat true and hopeful thoughts.
- Read or sing or listen
to hymns or choruses or other Christian music
that are hopeful, such as "It Is Well With My Soul" or "This Is the Day."
- Think of things that helped in the past when you were depressed.
Then do those things again.
- Ask other people
what they have done when they were depressed. What
worked for others may work for you.
- Write
out your thoughts and feelings on paper. Create a poem.
Compose a hymn that expresses both the pain of your depression and the hope
for relief.
- Do something to help someone else with no expectation of
receiving anything in return. This will get your focus off yourself and on
to helping others.
- Do not be afraid of bringing others "down." You may be giving them an
opportunity to minister to you—and you can set an example of
vulnerability that encourages them to be honest.
- Specifically pray for direction from the Holy Spirit about what
is causing the depression and what to do about it. Remember that he is the
great Physician.
- Ask others to pray specifically
for you about your depression and
its symptoms.
- Take advantage of healing services offered in your church.
- If nothing you try seems to help, try to discern how God may use
your depression in the larger context of his kingdom.
- It may prepare you to minister more effectively to others by giving
you empathy (2 Corinthians 1:3-7).
- It may help keep you humble and dependent on God (2 Corinthians
12:7).
- It may produce spiritual blessing (James 1:12) or demonstrate God’s
power (John 9:1-7).
- It may be a sign that you belong to Christ (1 Peter 4:12-19).
- God may use it to test your faithfulness (The book of Job).
You may not be able to do all of these things, and they do not all work with
everyone. However, all of them have helped some people, and one or more of them
may be just what you need to reduce your depression.
Ronald Koteskey is
Member Care Consultant
New Hope International Ministries
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