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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A Charlie Brown Kind of a Depression

depressed=stance

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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The Mangled Earrings of Joni Eareckson Tada

Joni's Mangled Earrings

Joni’s Mangled Earrings

I once admired the earrings my friend, Ann, was wearing – they were square, smooth, flat, and made of gold. When I remarked how beautiful they were, she replied, “They’re yours!” Ann then proceeded to take them off and put them on my ears! Humbled by her gift, the earrings became a treasure. Once while wearing them at work, one slipped off my ear – looked but couldn’t find it, so I wheeled to my office door to ask for help.

That’s when I felt a clunk-clunk-clunk. The earring was impaled on my tire; it was ruined! That weekend I took it to a jeweler and asked, “Sir, can you make this mangled earring look like the smooth one?” He rubbed his chin and said, “I can’t make that one look like this one… But I can make this one look like that one!” He then took a mallet and hammered the smooth, square earring into a mangled mess! At first I was horrified, but now I realize that the misshapen earrings reflect the light more beautifully than when they were ‘normal.’ It’s a lesson reflected in this timeless poem:

When God wants to drill a man,
And thrill a man, and skill a man,
When God wants to make a man
To play the noblest part,
When He yearns with all His heart
To build so great and bold a man
That all the world shall be amazed,
Then watch His methods, watch His ways!
How He ruthlessly perfects,
Whom He royally elects;
How He hammers him and hurts him,
And with mighty blows converts him
Into shapes and forms of clay
Which only God can understand
While man’s tortured heart is crying
And he lifts beseeching hands…
Yet God bends but never breaks
When man’s good He undertakes;
How He uses whom He chooses,
And with mighty power, infuses him,
With every act induces him to try
His splendor out,
God knows what He’s about.

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Visit Joni Eareckson Tada and Friends at http://www.joniandfriends.org/. Her bio can be found at http://www.joniandfriends.org/jonis-corner/jonis-bio/.

When you visit this site you will find a lot of helpful resources to some pretty useful materials on the disability needs on an international level. 

Emails, Facebook, Podcasts, TV Series, and great teachings are just part of the daily ministries available. Anyone interested in being discipled with a strong disability emphasis not always heard anywhere else really should visit.

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The Rigidity of Evil

I have a heart--but it is broken and crushed.

I have a heart–but it is broken and crushed.

Today I realized that I was sick and very tired of myself. It’s really not disgust, or even loathing. It’s more like a weariness, an exhaustion. I’ve never felt this way. In a strange way it intrigues me. Could this definite disenchantment mean something spiritual? Does it have value, or am I just feeling self-absorbed or conceited?

There is a real rigidity to evil. As I have seen it– sin hardens all who touch it, plain and simple. My growing immobility disturbs me, as I know I’m developing a “hardness of heart.” Atherosclerosis is a condition of a sick heart where arteries become blocked. It’s also known as “hardening of the heart, or arteries.” It is a patient killer, slowly and surely making hard deposits that block the flow of blood.

The Bible speaks about having a hard heart. It also uses the metaphor of fallow ground that must be plowed up. Jesus used the same image in His “Parable of the Sower” in Matthew 13.

“A sower went out to sow. 4 And as he sowed, some seeds fell along the path, and the birds came and devoured them. 5 Other seeds fell on rocky ground, where they did not have much soil, and immediately they sprang up, since they had no depth of soil, 6 but when the sun rose they were scorched. And since they had no root, they withered away. 7 Other seeds fell among thorns, and the thorns grew up and choked them. 8 Other seeds fell on good soil and produced grain.”

There are only four real options.

  • The first is seed that never arrives.
  • The second lands on hard stones.
  • The third possibility is landing on thorns and thistles.
  • Only the fourth flourishes.

    Heart of Stone Heart of Flesh

    The Battle of the Heart

The question I have is this, can the hard soil become soft, and can the good soil become overgrown with thistles? Is this a static, set experience? Or could it be far more fluid? I seem to move from one soil condition to another.

I have found that my own  heart drifts. Manic Depression is a mental illness where emotions fluctuate constantly. They gallivant around, floating here and than there. I maybe depressed and suicidal in the morning, and then I can be euphoric in the evening. It’s having the identity of a “wandering star.”

I want my heart to soften. I want to sit with Jesus and hear His words. I need Him to share what He is thinking about. Any sin I entertain has a hardening effect in my spiritual heart. This really scares me. *

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ybic, Bryan

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When Despair Empties You

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“It is through much tribulation that we enter the kingdom of Heaven.”  

Acts 14:22

As a broken believer this happens. I breakdown, my faith is questioned, and I feel all alone. Issues like a simple hot shower and eating something seem impossible. I’m embarrassed to say I once went 34 days with a shower. I laid in bed unable to function. That is the insidious truth about chronic depression, I know it well. God seems far, far away from me. Life doesn’t matter anymore.

There is much I can do before  it gets to this point. And although life seems insurmountable. Clinical depression kills people. It slowly devours “a sound mind.” It cripples before it takes away your life. There is nothing quite like it; people tell you it will pass, and that you’ll see the sun again. But at the time that seems to be the worst advice ever given.

For God has not given us a spirit of fear, but of power and of love and of a sound mind.”

2 Timothy 1:7

Meds help a lot. I take Zoloft and that is a godsend. I never miss a dose. I know I’m not bulletproof. I’ve taken it for several years now. (It’s like insulin for a diabetic).

Afflicted souls are special to God. And that truly comforts me. Sometimes it seems like there is an invisible tether that holds from completely dropping off the edge. When I do pray, it is desperate and brief. More like a quiet scream for help. There are no frills and no eloquence, but I know I’m being heard by Him who guards my soul.

People for the most part, are of little help. I admit that my attitude can be less than stellar. “Unless you have been lost in this section of hell yourself, it’s best if you just shut up.” (I don’t really say this, but I’m tempted to.)

But there are a few that can speak. Almost always these are the ones who have been through some affliction themselves. They have been hurt and they ‘walk with a limp.’ I’m convinced that they can speak in direct proportion to the pain they themselves have suffered. I once woke up to another pastor praying prostrate on my bedroom floor. He didn’t have to do or say anything else. He left without saying some ‘pious’ word to me, what he did was wonderfully done.

“I will trust Him. Whatever, wherever I am, I can never be thrown away. If I am in sickness, my sickness may serve Him; in perplexity, my perplexity may serve Him; if I am in sorrow, my sorrow may serve Him. My sickness, or perplexity, or sorrow may be necessary causes of some great end, which is quite beyond us. He does nothing in vain.”   

John Henry Newman

Take care of yourself. If this isn’t your first major depression, prepare in advance spiritually for the next. Identify those ‘dear-hearts’ who can help you in advance. Keep taking your meds, even if you think your o.k. And speak often with the Lord, and learn to listen to His voice. That “sound mind” is a promise for those who truly need it.

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Paranoia for Beginners

No Escape

No Escape

A person who is paranoid has fears, such as being watched, harmed or poisoned. He or she does not trust others and is suspicious that others are “out to get” him or her.

It is normal to wonder if people are talking about you when you hear them whispering as you walk into a room. These thoughts are usually passed off and not dwelled upon for most people.

A person who is paranoid, however, does dwells upon suspicious thoughts. He or she goes out of their way to prove their suspicions even though no evidence exists to confirm their thoughts. It’s very hard to reason or speak what is real. Paranoia is usually found in small degrees in almost every mental illness.

Symptoms

  • Use and/or withdrawal of certain drugs, such as marijuana, crack cocaine and angel dust (PCP)
  • Alcohol withdrawal
  • Deafness or problems with hearing
  • Illnesses that affect the central nervous system, such as Alzheimer’s disease or other dementias, a stroke, a brain tumor
  • Mental illnesses, such as bipolar disorder or schizophrenia
  • Paranoid personality disorder, (PPD)

How to Recognize Paranoia

A person with paranoia may also:

  • Appear cold and aloof
  • Be withdrawn and anxious in social situations
  • Act stubborn and combative
  • Appear “on guard” at all times, out of fear of being harmed

A paranoid person also:

  • Complains about his or her health and often feels vulnerable and inferior to others
  • Holds grudges easily
  • Displays bitterness and resentment toward others
  • May be easily drawn into religious cults or other groups with strict beliefs
  • Can have delusions of being persecuted

Treatment

Treatment for paranoia depends on its cause. If it is a symptom of another condition, treatment for the condition will often take care of or lessen the paranoia. Paranoid personality disorder is treated with counseling, support therapy and often with medication. Treatment for this disorder is not easy, though, due to the nature of paranoia. Persons who are paranoid often do not trust others including doctors, therapists or family members trying to help them get treatment. It is likely that you will need to intervene, patiently and gently.  Paranoia treatment requires a huge commitment.

What You Can Do for a Friend or Relative

The most important thing you can do is to encourage your friend or relative to get professional help. Be aware that you may need to make the initial appointment with a professional. You may also need to take them to the appointment and stay with them. Be supportive. Paranoia requires patience, understanding, love and encouragement of the person’s loved ones and friends.

Be aware of the types of medication your friend or relative takes and when they should take it. You should also alert their physician or psychiatrist to any side effects that you notice when they do or do not take their medication.  If I may, I would suggest a film for you to watch, “A Beautiful Mind“.  This may give you insight into what you are dealing with.

Further Resources

Cleveland Clinic PPD Intoduction Site http://my.clevelandclinic.org/disorders/personality_disorders/hic_paranoid_personality_disorder.aspx

Suite 101 PPD Site http://personalitydisorders.suite101.com/article.cfm/paranoid_personality_disorder

The Part of My Depression That Terrifies Me

“Must I then, indeed,  Pain, live with you

All through my life? –sharing my fire, my bed,

Sharing–oh, worst of things!–the same head?–

And, when I feed myself, feeding you, too?”

 Edna St. Vincent Millay

The critical issue we face is the reality of  living with ourselves through an acute episode of depression or mania.  I think that cohabitating with something that is trying its darndest to kill you is especially frightening.  Depression is my mortal enemy, and here I am, actually enabling it. How disturbing.

In a way it is sinister, the stuff of scary movies and bad novels.  It is the parasite is making its residence in the body of its host.  It sounds like something from a crazy ‘story line’ out of Star Trek.  I know how strange it sounds, but we some of us are enmeshed to melancholy.  It is in essence, part of our personality. We instinctively carry a dark despair and a savage despondency wherever we go.

When it slumbers, life can proceed on.  I can play with my kids, be a good husband, friend and neighbor.  Everything seems quiet and normal.  But when the dragon awakes, there will be ‘hell to pay.’  But exactly when, you can never be too sure. But living with this fear is equally as hard as the depression itself. How will I handle it next time? Will I be in shape for Christmas, or will my ‘cheese slide off my cracker’ again this year? I just don’t know. Under the veneer things can get very rough— very, very quickly.

My wife and kids lived in Mexico for almost three years.  We had a trailer, and part of that time we parked on the slanted slopes of a volcano.   Trust me on this, living on it was like living on a bomb!  I reasoned and rationalized, but each day I spent time thinking about it.  It wasn’t a big deal, but it worked its way into my thinking. Living on a volcano will do that to you.

There is this promise found in Psalm 139—

“You go before me and follow me.
    You place your hand of blessing on my head.
Such knowledge is too wonderful for me,
    too great for me to understand!”

Psalm 139:5-6

I am glad that God decided to intervene in my life.  Without question, I need Him to watch me and deliver me ‘day-to-day.’  As a believer in Jesus, I know he has put his hands on me.  He shields me from the dragon.  I believe that he protects me from the worst of it.  The Holy Spirit absorbs much of the venom Himself.  I am glad I belong to Him! I’m thrilled that He loves me. The fear of a plummeting relapse is now His concern. I bear it no more.

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