Overcoming Darkness: An Interview with Dr. Philip Mitchell

Dr. Philip Mitchell

Professor Mitchell, what is the difference between being depressed and just feeling bad about yourself?

Sometimes it’s easy to tell the difference; sometimes you’re not certain. I look for clinical indicators of depressive illness: whether the person’s life is becoming impaired by these bad feelings, when it’s starting to interfere with people’s sleep, appetite and weight, when it’s interfering with their work and concentration, they’re having suicidal thoughts, they can’t buck up. Those symptoms help me to sort out whether it’s just life problems or whether it’s more.

So depression is an illness?

Yes. Even though there are both psychological and physical parts to it, it makes sense to think of severe depression as an illness. There are good medical and psychological treatments that can help people get out of it.

What proportion of the population is depressed?

Figures vary, but over a lifetime about 15% of the population are prone to getting depression on at least one occasion. So it’s relatively common. Some people only have one episode, but for at least half of those who suffer depression once, it is a recurring experience.

Is depression the sort of thing that certain personality types are likely to suffer?

I think that’s true. Anybody is vulnerable to becoming depressed, if things get difficult for them, but some personality types are more prone than others. For instance, if you tend to look for your own failings and weaknesses, if you expect disasters, you are prone to becoming depressed. People who have fragile self-esteems are prone; people who are excessively perfectionistic can be thrown when things don’t go quite right; people who have long-term high levels of anxiety.

Can you describe what it is like to be depressed?

Patients find it quite hard to describe. They often use analogies, like there is a ‘black cloud’ or a ‘weight’ on them. They say that they just can’t enjoy things any more, that they can’t get the drive to do anything; they stay in bed because they just have no energy or enthusiasm. They tend to ruminate and think about their failings, their hopeless situation. But many people find it hard to communicate the experience; even very articulate people have told me how difficult it is to communicate the experience to other people.

On the other side of the fence, what is it like to be close to someone who is depressed?

I think it’s very wearing. It never ceases to amaze me how couples stay together, particularly when it’s prolonged. Even with the best of good will and human kindness, long-term depression can be a very tiring experience for a spouse or close friend. You may get little response from a depressed person, little enthusiasm, withdrawal. They don’t want to interact socially and sometimes they can be quite irritable. Within a marriage, tension may be increased because the depressed person has no interest in sexual activity. So these things exacerbate the problem.

I sometimes hear it said that depressed people ought to just ‘snap out of it’.  Can they do that?

Not when the depression is severe in the way we have been talking about. If someone can snap out of it, usually they have by that stage. In general, a depressed person doesn’t like the experience and if it was a matter of just getting on and doing something, they would have tried it. Sometimes people need to learn psychological ways of getting out of the depressed state. But sometimes there is a biochemical process going on that means the person isn’t physically able to snap out of it, without professional help.

Often there is a mixture of the physical and the psychological. It’s very rarely one or the other. The more I see depression, the more I see a complex interplay between personality, the biology of our brains and our life experience.

So depressed people can’t snap out of it, but they also can’t explain very easily what is actually troubling them. It’s a very frustrating illness!

Absolutely. It’s hard for people who haven’t dealt with it professionally to have any idea what it’s like to be depressed. So people have this difficulty understanding it, and this tendency to think that the person should be able to get out of it, and the depressed person has difficulty explaining the experience and feels frustrated and stigmatized when people are telling them to snap out of it, because they know they can’t snap out of it. There is enormous tension.

I suppose the big question is, for both the depressed person and those around them, can depression be cured?

Most people with depression can either be cured or significantly helped by available treatments. These days, we have very good treatments. We can’t help everybody, but we can help the vast majority of people we see.

Is it always a long-term cure, or can it happen quickly?

It varies. Often within a few weeks many people have benefited significantly. Some forms of depression require more long-term psychological treatment, others respond very quickly to medication. And there are grades in between.

Is depression like alcoholism, where you can get it under control but never really be beyond its reach?

For most people, that’s probably a realistic comparison. I tell people that they are always going to be prone to becoming depressed, so they need to be wary about relapses in the future. They need to be sensible about their medications, learn techniques to help them, think about whether there are aspects of their lives that they need to change. We can’t always prevent future episodes, but we can usually make them less likely.

William Cowper, Poet 1731-1800

The poet Les Murray recently has been very public about coming out of his depression. It’s interesting that some of the best poetry is written by people who have been depressed. Look at William Cowper, a Christian poet and hymn writer who wrote some of his most moving material during periods of profound depression. So depression can be both creative and destructive.

This raises an important issue for Christians. How do we connect our mental and our spiritual lives?

Cowper became very doubting at times, during his depression. One thing many Christian patients say is that God seems very distant during such periods. I’ve come to accept that as part of the depressive experience rather than a problem with their faith. I’ve seen people with a very deep faith, who yearn to be close to God, and who when depressed feel very barren and remote from God. For instance, J. B. Phillips, the Bible translator, was profoundly depressed for much of his adult life. He has described this sense of distance from God.

JB Phillips, 1906-1982

That is very distressing for Christians. They begin to worry that it is a lack of faith or lack of spiritual growth. But having seen it enough, I think it is just an expression of the depressive experience. Many Christians also feel that depression is a sign of weakness, of spiritual inadequacy, and they have a strong sense of guilt. Unfortunately, I think that often the church, explicitly or implicitly, has encouraged that—that if you have depression, it’s a reflection on your spiritual life. This adds an incredible burden to people who are already feeling guilty and self-critical. It’s a bit like Job’s encouragers, who basically made him feel worse.

Why does there seem to be a large number of depressed people in our churches?

It’s often the more sensitive people who become depressed, and there are often a lot of obsessional and sensitive people in churches. My experience is that there is a lot of depression in our congregations and that we don’t handle it at all well. We often infer, explicitly or implicitly, that the Christian shouldn’t have the experience of depression—that it’s not part of the victorious Christian life. And that causes enormous guilt and makes people less likely to talk about it. I think we have a lot of silent suffering going on in our churches. People just aren’t getting helped, because they feel guilty about having depression. We need to bring out into the open the fact that depression is a common experience, even within the church. And that being a Christian doesn’t stop you from getting depression. And that having depression is no more a failing than having diabetes.

In general, the church deals very badly with mental illness. In the middle ages, it was considered demon possession; in the late 20th century it’s considered a symptom of spiritual inadequacy. But it isn’t necessarily either of these things.

Are people in very demanding ministries especially prone?

They are prone; I don’t know about especially. They are in line for so many of the factors that contribute to depression: burn-out, demoralization, excessive demands, not looking after your own emotional needs, not having time to yourself. I see some of the casualties, and often by then it’s too late because someone has resigned from the ministry or become completely disillusioned. And it’s all too hidden, too hush-hush. We’re dealing with it no better than the secular world; in some ways we’re doing worse.

What then are the ways that a depressed person can be helped, both by individuals and by the church?

Well, especially in the early days, one can be supportive, help people get back into their lives—those normal things of friendship and support, being a sounding board, willing to listen to difficulties. These things might be sufficient to alleviate the early experience of depression.

But if we’re looking at a fully formed depression that’s been going on for a while, the person should be encouraged to seek proper professional help. That doesn’t always mean a psychiatrist; it might mean a GP or a counsellor. Just someone with the skills and training to help. So that’s the first thing, when the support networks have been stretched to the limit.

While that process is happening, it’s important to be around for the depressed person, accepting the fact that it might be a frustrating experience until that person picks up. Not feeling that you have to do everything yourself. There has to be a point where a friend accepts that they can’t provide everything the person needs. That point is usually indicated by signs like someone crying constantly, their work falling apart, withdrawing inexplicably, perhaps losing weight. These things indicate that the depression is getting severe.

Finally, do you think depression has become more of a problem today than it used to be?

It’s an area of debate. There’s no doubt that depression has always existed. The old Greek medical writers are clearly describing patients with depression. There was a book written in the 17th century called The Anatomy of Melancholy which described what we would call depressed patients. So it goes back through the ages; it’s part of the general human experience.

The issue is whether it has become more frequent. People have looked at the occurrence of depression in groups of people born in different decades in this century, and the frequency of occurrence seems to go up as the decades continue. People born in the 60s are more prone to depression than those at similar ages, but born in the 30s. Now, the significance of that is debated. It could be that people in recent decades simply have become more willing to admit to their depression, hence the higher rate of reports. Or it could be true that it is becoming a more common experience, and presumably that reflects changes in society. What those changes are is a very difficult question to answer.

So it’s hard to say whether the loneliness of urban living is a major factor?

Well yes, and it’s a very interesting area of debate. The World Health Organization has released predictions of the impact of different illnesses over the next century. They are saying that depression will be the 21st century’s most disabling condition, in terms of the impact on the individual, frequency and cost to society, on a worldwide basis. That survey included all medical conditions, including cancer and heart disease. So there is a recognition that it is a very prevalent condition, and that it is a very disabling condition to have. Whatever is causing it, we’re going to have to deal with it.

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Philip Mitchell is a Professor at the School of Psychiatry, Prince Henry Hospital in Sydney, Australia.

This article, quoted in its entirety can be found at “The Briefing” an online Christian magazine- http://matthiasmedia.com.au/briefing/longing/3959/

 

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Without a Wound? [True Ministry]

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The subject of “the pool at Bethesda” alludes to the following excerpt from the Thorton Wilder play, “The Angel that Troubled the Waters”.The play is based on the biblical verses of John 5:1-4, but it changes the end of the parable. I first encountered this excerpt within the book “Abba’s Child: The Cry of the Heart for Intimate Belonging“, by Brennan Manning.

The play tells of a physician who comes periodically to the pool of Bethesda, hoping to be the first in the water and healed of his melancholy when the angel appears and troubles the water. Everybody at the pool also hopes to be the first in the water and thereby healed of his malady.

An angel appears and blocks the physician at the moment he is ready to step into the pool and be healed.

Angel: “Draw back, physician, this moment is not for you.”angel1

Physician: “Angelic visitor, I pray thee, listen to my prayer.

Angel: “This healing is not for you.”

Physician: “Surely, surely, the angels are wise. Surely, O Prince, you are not deceived by my apparent wholeness. Your eyes can see the nets in which my wings are caught; the sin into which all my endeavors sink half-performed cannot be concealed from you.”

Angel: “I know.”

……………Interlude………………

Physician: “Oh, in such an hour was I born, and doubly fearful to me is the flaw in my heart. Must I drag my shame, Prince and Singer, all my days more bowed than my neighbor?”

Angel: Without your wound where would your power be? It is your very sadness that makes your low voice tremble into the hearts of men. The very angels themselves cannot persuade the wretched and blundering children on earth as can one human being broken on the wheels of living. In Love’s service only the wounded soldiers can serve. Draw back.”

Later, the person who enters the pool first and was healed rejoices in his good fortune then turns to the physician before leaving and said:

“But come with me first, an hour only, to my home. My son is lost in dark thoughts. I — I do not understand him, and only you have ever lifted his mood. Only an hour . . . my daughter, since her child has died, sits in the shadow. She will not listen to us but she will listen to you.”

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For me, this story has made an incredible difference and, because the message of this excerpt—“Without your wound where would your power be?“—carries so much meaning for me. As this has taught me that its through my weakness I can see others like Jesus does.  I believe, for me, it is slowly becoming my whole foundation for ministry.

&

ybic, Bryan

 

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A Charlie Brown Kind of a Depression

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As we wrestle with our embedded issues, we realize that the battle is in largely inside of us.  The last few days have been very hard, and I have a dark presence pressing on me; there is a subsequent reaction in my heart.

As a “born-again” believer who gets deeply challenged by depression, I simply cannot fathom life outside my faith in Jesus.  How do unbelievers do it?  The Holy Spirit meets me, holds me, and speaks peaceful things to me.  I have been promised things of wonder and of grace.

I’ve discovered that self-pity and discouragement are main ingredients into my excursions through bleakness and sadness.  In my more profound plummets into the pit, I find myself seeing the physical world around me drained of color.  Everything around me is in “black and white.”  (I have been told this is one of many symptoms of depression.)

Charlie Brown hits the nail on the head.  Often I catch myself smiling, and I immediately stop and say, “Wait. I’m very depressed.  I can’t be seen smiling, or talking with a dear friend.”   Often we choose to act in ways that reinforces our illness.  We think we have to be a certain way, stand in another, or even walk like we think a depressive walks.  (After all, we have an image to live up to.)

Depression is very real.  Medication is mandated for many.  But truthfully, there is this other element of extending this image to others.  Our self-pity works hand-in-hand with our image and identity.  It seems we have to be somebody, even if we are “crazy people.”

I know this blog has been a challenge at times.  I write these daily blogs out of my attitudes, and issues and problems.  But there is a “Charlie Brown Depression,” the type where we feel like we are inconsolable all the time.  (Maybe Mr. Brown should be our new patron saint of “lost causes?”)

If while in the pit, and for some reason you think of something that’s funny, go ahead and smile, its okay.  I’m learning that things are never as sad or grim as I think, nor are they rosy and joy saturated either.  Be real.  Be real to yourself.   Walk in the truth.  And take your meds, lol.

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When Our Troubles Help Us Find Jesus

Jesus loves his lambs.

“When this man heard that Jesus had arrived in Galilee from Judea, he went to him and begged him to come and heal his son, who was close to death”.

John 4:47

Without his troubles, it would be highly improbable that this man would go find Jesus. His son is very ill, and close to dying. Undoubtedly the father has tried all of the conventional methods but to no avail. Somebody has mentioned that Jesus has just arrived in Galilee, and that remains the best option. He will find Jesus, the healer, and bring Jesus to his son.

Very often this is how it works for us. Life is good and there is no reason for us to go to Jesus. We’re content and reasonably happy with how things are going. But this man– a royal official, is desperate. Life has detonated in his face and he is completely undone. He is in a good place, although he can’t see it.

Believe it or not, our trials and troubles are often wonderful visitors.

Without these we would not look for Jesus. They are frightening and they are difficult, but they are necessary for us. Over the years, it is likely that this man has been insulated and protected from life’s difficulties. There has been nothing to cross him as his life unfolded. He believes that he has an immunity to suffering.

This official desperately seeks out Jesus. His son is dying. He must locate Jesus and bring Him back. He is frightened and frantic. Jesus is his only hope. But even this is not automatic.

“God never withholds from His child that which His love and wisdom call good. God’s refusals are always merciful- “severe mercies” at times, but mercies all the same. God never denies us our heart’s desire except to give us something better”

Elizabeth Elliot

The answer is not what this man was looking for. He wanted Jesus to return to Capernaum with him, but instead Jesus decides to stay right where He is. Instead He speaks, and the boy is healed, long-distance. As we seek the Lord’s grace, forgiveness and healing into our own lives, and our family, let us let the Lord be the Lord. Let Him decide how to do it. This man simply trusted, “The man took Jesus at his word and departed.” But he would never, ever be the same.

For those of us afflicted, with either physical or mental disabilities, we discover Jesus who leads us into a special place. We may find ourselves serving others in a new way that our illnesses have opened.

“All our difficulties are only platforms for the manifestations of His grace, power and love.”  

Hudson Taylor

 

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Being Sick

Potter shaping a ceramic plate on a pottery wheel

Potter shaping a ceramic plate on a pottery wheel

“So Miriam was kept outside the camp for seven days, and the people waited until she was brought back before they traveled again.”

Numbers 12:15

To be numbered among the chronically ill often can mean a transition into frustration. We can not do what we want, we are ‘trapped’ by a disease we never asked for, and held hostage by our minds and bodies. It seems apart, from the management of our symptoms, we have little time to do anything else. We once had a job– a career… and our time was occupied by that. We were accustomed to something more than this illness.

I once was a pastor of a small church here in Homer, Alaska. I also taught Gospels for many years at the Alaska Bible Institute. I loved both. They defined my identity and gave me purpose. I loved helping people and teaching the Word. I strived to be faithful in the ministry. My wife and two children were also significant and all of these things led me to think they would always be there. I was living my dream (in a good way.)

With the sudden onset of a brain tumor, followed up by a diagnosis of Bipolar disorder (BP), I knew I had to step out of the ministry. I simply could not function. My depression grew more profound with the stillborn death of our third child. Things suddenly ground to a stand-still as we tried to process what has happening to us. I guess I just couldn’t understand and more or less just shut down. I spent months in bed, unable to function.

Some people were jewels. Others were mean and uncaring. (I had to learn to take the good with the bad.) I suppose I should have been more forth-coming, but things were so tangled up inside I couldn’t verbalize a thing. The post-op surgery was an ordeal, as I had to learn many things all over again. Years later I ended up on disability; I was unable to work, and no one would hire me. My symptoms were so unpredictable, and things were too erratic. The BP was giving me it’s customary depression, as well as paranoia and hallucinations.

Sometimes, like Miriam, we are quarantined by the Lord for his purposes. The isolation is worse that the pain it seems. We wonder why this is happening, and fabricate lies about our worthiness or God’s goodness. In our isolation things seem polarized to extremes. Our value seems to be ripped apart by our illness. We can feel cursed, or worse.

I have been slow to learn this: God brings good out of the dark. I’m embarrassed by my lack of acquiring this truth.

“We now have this light shining in our hearts, but we ourselves are like fragile clay jars containing this great treasure. This makes it clear that our great power is from God, not from ourselves.”

2 Corinthians 4:7

This light must shine. The treasure is found in clay vessels. Brokenness only means the treasure is now seen clearly. It’s important to note: treasure loses none of its value by being surrounded by broken clay.

“We are pressed on every side by troubles, but we are not crushed. We are perplexed, but not driven to despair. We are hunted down, but never abandoned by God. We get knocked down, but we are not destroyed.”

2 Corinthians 4:8-9

Troubles of various ilk come to us. They are variegated and unplanned. No matter what their nature, God holds his people in place while everything else is falling apart. But there is no magic wand; the pain will probably continue. But for the broken believer, there comes another dimension; a new supernatural layer of grace to bolster our beleaguered faith. We will triumph through this thing, and we will stand– because He makes us stand.

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Antidepressants for Believers?

What do you think of Christians taking antidepressants?

By Pastor John Piper, given on March 30, 2010

The following is an edited transcript of the audio.

What do you think of Christians taking antidepressants? I have been on them and have been accused of not relying on God.

That relates to an earlier question about how any physical or personal means that you use can signify that you’re not relying on God. So eating might be a failure to rely on God, because he might just fill your stomach by miracle, and you don’t have to eat. Or not sleeping would be a way of relying more on God, since you don’t have to have your psyche made stable by sleep at night. And so on.

God has ordained physical means. Aside from the ones that seem more natural, like food, there’s medicine: aspirin, Nyquil, etc. This water is helping my throat right now. [Sips it.] Was that sip a failure to rely on God?

Could be. “Just throw this away and rely on God! He will keep your throat moist. You don’t need to be drinking. You’re an idolater, Piper. You’re idolizing this because you’re depending on it.”

Well, the reason that’s not the case is because God has ordained for me to thank him for that. He created it and he made this body to need a lot of fluid. And it’s not a dishonor to him if I honor him through his gift.

Now the question is, “What medicines are like that or not like that?” Taking an aspirin?

My ophthalmologist told me about 4 years ago, “Take one baby aspirin a day and you will postpone cataracts or glaucoma or something.” He said, “I can see just the slightest little discoloration, and the way it works is that circulation helps.” So he told me to pop one of these little pills in my little vitamin thing. And I take it every day. And I just said, “Lord, whether I have eyes or not is totally dependent on you. But if you would like me to use this means, I would.”

My answer is that when you start working with peoples’ minds, you are in a very very tricky and difficult situation. But I think I want to say that, while nobody should hasten towards medication to alter their mental states—even as I say it I think of caffeine, right?—nevertheless, I know from reading history, like on William Cooper, and by dealing with many people over the years, that there are profoundly physical dimensions to our mental conditions.

Since that’s the case, physical means can be appropriate. For me it’s jogging. I produce stuff in my brain by jogging. But that might not work for somebody else, and they might be constantly unable to get on top of it emotionally. I just don’t want to rule out the possibility that there is a physical medication that just might, hopefully temporarily, enable them to get their equilibrium, process the truth, live out of the strength of the truth, honor God, and go off it.

When I preached on this one Easter Sunday a woman wrote me, thanking me that I took this approach. She said, “You just need to know that I live on these things, and I know what it was like 20 years ago and the horrors and the blackness of my life. And now I love Christ, I trust Christ, I love my husband, our marriage is preserved, and I’ll probably be on these till I’m dead.”

So I’m not in principle opposed. I just want to be very cautious in the way we use antidepressants.


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When Sin Brutalizes You

Detail of Painting by Rembrandt, “Return of the Prodigal Son”

There are three things for certain.

#1 You will never forget your sins.

#2 God has forgotten them.

#3 The Devil will try very hard to condemn you for your past.

 

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There are some days that are harder then others.  You see, I have lived profligately, harmed many, and influenced others to do evil.  I have wounded and hurt people very deeply.  There are days when I have this mental image of myself– I’m a ‘Fountain of Feces’ spewing and polluting my filth to anyone passing by.

But I am also the Prodigal.  I’ve squandered everything.  It’s gone.  I’ve been to the pig pen.  Filthy and starving.  Coming to my senses, I decide to return home, and sell myself to the employ of Him I once called “Father.”

But the most outrageous thing has happened.  It is so wildly fantastic that it defies any reason.    (I hardly dare to think it real).  The man who I once called “Father” refuses to listen to my list of sins.  He has embraced me, dressed me, established me as a son.  I have new shoes, and a signet ring.

I am a wonder to behold. A feast of unparalleled joy is waiting.  I pinch myself– is this really happening to me?  Those days in the pig pen, what a stupid waste.  I want to weep and shout for joy– all at the same time!  It doesn’t seem real.

The subject of my grossness and sin has been forgotten.  I have not been interrogated or punished.  (Since then, I’ve learned that Someone else took this on.)  But my perversity and my iniquity has never, ever been discussed.  Their is no list of my sin, no cataloging has taken place.  The promises tell me that my past sin has been put on a big barge, and shipped to the deepest part of the ocean– and dumped!

You will again have compassion on us; you will tread our sins underfoot and hurl all our iniquities into the depths of the sea.”

Micah 7:19

As critical-thinking believers, with just a modicum of divine truth, what we do with our personal sin is huge.  It determines much about our walk.  We function out of our past.  The plant is rooted in something.  But our Father has turned our prodigal past into our personal future of total redemption.

Look at your greatest pain.  The Holy Spirit will very likely take that deep, deep bruise and turn it into your greatest ministry.  And He does it without resorting to a list of your ugly, ugly sin.  You see, He has already forgotten it.

“The question is who are we going to side with? God says our sins are past, cleansed, and gone. You cannot go on with God until you stand on His Word as cleansed with the heart made pure.”  

Smith Wigglesworth

ybic,

Bryan (the Prodigal)

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