1. Do not expect too much from yourself too soon, as this will only accentuate feelings of failure. Avoid setting difficult goals or taking on ambitious new responsibilities until you’ve solidly begun a structured treatment process.
2. Break large tasks into small ones, set some priorities, and do what can be done, as it can be done.
3. Recognize patterns in your mood. Like many people with depression, the worst part of the day for you may be the morning. Try to arrange your schedule accordingly so that the demands are the least in the morning. For example, you may want to shift your meetings to midday or the afternoon.
4. Participate in activities that may make you feel better. Try exercising, going to a movie or a ball game, or participating in church or social activities. At a minimum, such activities may distract you from the way you feel and allow the day to pass more quickly.
5. You may feel like spending all day in bed, but do not. While a change in the duration, quality and timing of sleep is a core feature of depression, a reversal in sleep cycle (such as sleeping during daytime hours and staying awake at night) can prolong recovery. Give others permission to wake you up in the morning. Schedule “appointments” that force you to get out of the house before 11 a.m. Do this scheduling the night before; waiting until the morning to decide what you will be doing ensures you will do nothing.
6. Don’t get upset if your mood is not greatly improved right away. Feeling better takes time. Do not feel crushed if after you start getting better, you find yourself backsliding. Sometimes the road to recovery is like a roller coaster ride.
7. People around you may notice improvement in you before you do. You may still feel just as depressed inside, but some of the outward manifestations of depression may be receding.
8. Try not to make major life decisions (such as changing jobs or getting married or divorced) without consulting others who know you well and who have a more objective view of your situation.
9. Do not expect to snap out of your depression on your own by an exercise of will power. This rarely happens. Many churches and communities have depression support groups. Connect with people who understand depression and the recovery process.
10. Remind yourself that your negative thinking is part of the depression and will disappear as the depression responds to treatment.
“So Naomi and Ruth went on until they came to the town of Bethlehem. When they entered Bethlehem, all the people became very excited. The women of the town said, “Is this really Naomi?”
“Naomi answered the people, “Don’t call me Naomi. Call me Mara, because the Almighty has made my life very sad.”
“When I left, I had all I wanted, but now, the Lord has brought me home with nothing. Why should you call me Naomi when the Lord has spoken against me and the Almighty has given me so much trouble?”
Naomi has traveled from Moab to her hometown of Bethlehem. People were pretty excited and her arrival must’ve brought out the crowds. It’s great for her to be around happy people who were genuinely pleased to see her again.
But a new Naomi returns. She makes it clear that something has happened. She has been fundamentally changed by the Lord. She can no longer be called Naomi (“Pleasant”) but insists she is now “Mara”. Her reasoning is painfully clear, she grasps the reality of her condition. “I am now Mara (“Bitter”), that is my new name. It’s what I’ve become.”
“Call me by this new name, because the Almighty has acted “bitterly” against me. I am not the same person I was went I left here. I am different, when I left here I was prosperous, everything was going very well. But now, its different, and I come home with absolutely nothing. And it’s all because the LORD has hurt me deeply.”
I read Ruth the other day, and something intrigued me by her perception, and of her theology that recognized God’s handprints on her life. I believe she was a broken person, and therefore essentially changed. I believe she had a measure of peace in seeing the Lord was in control of her life. She was becoming aware. Ruth was now attuned to the deep purposes of God.
It wasn’t fate, karma, or destiny after all. It was God!
With my many, many issues, I find a comfort in this. God has touched me, and I am not the same person I was five years ago. I know hard things, even bitter things, about myself and the world around me. I went out healthy and strong and have returned weak and empty. Bipolar disorder will do that. Pain will do that. God’s dealings will do this. He loves us far too much to allow us to go unchanged.
God is not malicious, but He is very thorough. And all that He does is for our good.
There are distinct times when the Lord works to bring us to Christlikeness. That involves a refining and the smelting process. Crisis becomes the ‘new normal’. This is never “pleasant” and it’s almost always “bitter.” Naomi was finding this out first-hand, to the point of even changing her name.
“I have refined you, but not as silver is refined. Rather, I have refined you in the furnace of suffering.”
I’d like to encourage you to recognize (and announce) your weakness and your brokenness to the Lord in prayer. See God’s hand in your bitterness. You’ll be surprised at the release that will come to you. It shouldn’t engender anger, but surprisingly it can bring you healing and salvation. It helps to understand. Consider the following:
There often two sides of living–the life we’ve lived and the life we’re becoming. Both are filled with grace and they’re as different as ‘night-and-day’
God is stealthily working good on our behalf, even when things are awful. He has full authority to do so.
He’s always (lovingly and passionately) trying us; probing to see if we draw closer to Him when we’re tested. He is patient when we fail our tests. Every test will be repeated until we overcome it
We can’t escape Jesus’ work in our lives. He is the Master Carpenter. He is building a cathedral!
“God rescues us by Breaking us, by shattering our strength and wiping out our resistance.”
“Do the things that show you really have changed your hearts and lives. “
Matt. 3:8, NCV
When we evaluate change, the Biblical definition is crisp and solid. It has everything understood in results (or fruit) and less to with my posturing. Just simple words or emotions aren’t enough when we consider authentic transformation. We can’t relate to feelings, they need actions to become visible. You may feel ‘warm and fuzzy’ when you think about Jesus, and yet somehow that’s not enough. Especially if you’re beating your wife.
Actions do matter. Your actions will define what you believe about God. What you decide to do, will delineate what is really real. Jesus made it clear to his congregation that their definition of repentance needed adjusting.
I struggle with many things, I seem to be a magnet for all things dark and lost. So this proper way of evaluating reality will become a tremendous blessing those of us with ‘mood disorders.’ My feelings are definitely mercurial. I really can’t trust them. So I won’t.
Thomas Merton once said that we’re so motivated to climb the ladder of success that when we finally get to the top we discover it’s leaning against the wrong wall all along! To waste your life to climb one more rung is incredibly tragic.
And yet, down deep, I do understand. I don’t like it, but it truthfully seems oddly rational and real. It seems to be something God would do to lovingly correct us. If I place my bets on what I think God wants, and behold, I discover am completely mistaken. He delights in confusing the proud in heart.
We need a basis on what is real, and important. It may shake us, but the result is being able to realize what is the truth. Our feelings, and idealistic ideas are like a bucket with many holes. What we receive from Him can’t be maintained–it runs out almost as fast as it collects.
We must recalibrate our senses. We need to rearrange many things, and completely reevaluate our momentum and focus. These seem to be abstract and vague ways of making determinations like this, but if we get honest we realize that these things are critical.
“No one can sum up all God is able to accomplish through one solitary life, wholly yielded, adjusted, and obedient to Him.”
“I’m sure about this: the one who started a good work in you will stay with you to complete the job by the day of Christ Jesus.”
Philippians 1:6, CEB
I was ‘saved’ in my early twenties. With that salvation came a sense of what really was true. And perhaps a real hope of what life could become. I’m now 55, I can only shake my head. It certainly has not been as rosy as I first thought. I blame myself, and go on to understand that maybe this is the way it was supposed to turn out.
But my walk with Jesus has been real. I haven’t given up on my pitiful faith and I haven’t apostatized. And yet I am aware of a confusion, and a disconnectedness that is a bit odd. I sort of realize that my soul has been hunted, and that I’m vulnerable.
But I can’t let go of Him who I call Savior. It certainly has not been easy. Sometimes it seems that I am perhaps the most troubled of all His followers. I’m sure some of you might understand.
You see, I have a disease called “loving Jesus” from which know I will never recover.
The promises that have been given to me can’t be diminished or revoked. He has dedicated Himself to reaching me. I’ve been told that He not only plucks me out of my darkness, but His intention is to heal and balance me. My confusion is not enough to sidetrack His will.
I don’t know what my future holds. But to be honest, I don’t anticipate anything magical, or some fantastically creative spirituality. I do not think things will suddenly get bright all of a sudden. But I can tell you this much, that I will never turn from His grace or goodness. I hang on them as a shipwrecked man clings to a log, out in the middle of the ocean.
I am most unorthodox, I know. I do not fit the mold of the average believer. I am too blunt, direct and disconnected. I have considerable issues, compounded by my mental illness. But I do know Jesus. He has come to save the broken-hearted, and come as a physician to a very sick soul. I trust Him to fix me. In 2 Timothy 1:7, Paul writes us:
“For God has not given us a spirit of fear, but of power and of love and of a sound mind.”
It seems we stand on the threshold of a real and authentic life. For some, we must work especially hard to understand this walk of authentic discipleship. Unquestionably, we must trust in His love. But being stable and established will not save us. (Although, it would be nice). Salvation has always been by grace through faith.
My dysfunctional life doesn’t incur His rejection, the opposite is true. He loves losers, and looks especially on losers who know they are very lost.
I especially want to encourage my brothers and sisters who struggle with a mental illness. You’ve been dealt a severe blow. Others will never understand your “limp.” But Jesus does. You have a gift to bring to the table. He can pour much more grace into you. Don’t be discouraged by the resistance coming out of your thinking. You are especially His. He holds you with a transforming love.
This should supply direction and dialogue on the issues faced by every church member. It is a great opportunity we have been given— to minister to every person in the Body of Christ. —Bryan
by Ken Camp, Associated Baptist Press —
Living with depression — or any other form of mental illness — is like viewing life “through a glass darkly,” according to Jessy Grondin, a student in Vanderbilt University’s Divinity School. “It distorts how you see things.”
Like one in four Americans, Grondin wrestles with mental illness, having struggled with severe bouts of depression since her elementary-school days. Depression is one of the most common types of mental illness, along with bipolar disorder, another mood-altering malady. Other forms of mental illness include schizophrenia and disorders related to anxiety, eating, substance abuse and attention deficit/hyperactivity.
Like many Americans with mental illness, Grondin and her family looked to the church for help. And she found the response generally less-than-helpful. “When I was in the ninth grade and hospitalized for depression, only a couple of people even visited me, and that was kind of awkward. I guess they didn’t know what to say,” said Grondin, who grew up in a Southern Baptist church in Alabama.
Generally, most Christians she knew dealt with her mood disorder by ignoring it, she said. “It was just nonexistent, like it never happened,” she said. “They never acknowledged it.” When she was an adolescent, many church members just thought of her as a troublemaker, not a person dealing with an illness, she recalled. A few who acknowledged her diagnosed mood disorder responded with comments Grondin still finds hurtful. “When dealing with people in the church … some see mental illness as a weakness — a sign you don’t have enough faith,” she said. “They said: ‘It’s a problem of the heart. You need to straighten things out with God.’ They make depression out to be a sin, because you don’t have the joy in your life a Christian is supposed to have.”
A Baylor University study revealed that among Christians who approached their local church for help in response to a personal or family member’s diagnosed mental illness, more than 30 percent were told by a minister that they or their loved one did not really have a mental illness. And 57 percent of the Christians who were told by a minister that they were not mentally ill quit taking their medication.
That troubles neuroscientist Matthew Stanford. “It’s not a sin to be sick,” he insists. Stanford, professor of psychology and neuroscience and director of the doctoral program in psychology at Baylor, acknowledges religion’s longstanding tense relationship with behavioral science. And he believes that conflict destroys lives. “Men and women with diagnosed mental illness are told they need to pray more and turn from their sin. Mental illness is equated with demon possession, weak faith and generational sin,”
Stanford writes in his recently released book, Grace for the Afflicted. “The underlying cause of this stain on the church is a lack of knowledge, both of basic brain function and of scriptural truth.” As an evangelical Christian who attends Antioch Community Church in Waco, Texas, Stanford understands underlying reasons why many Christians view psychology and psychiatry with suspicion. “When it comes to the behavioral sciences, many of the early fathers were no friends of religion. That’s certainly true of Freud and Jung,” he noted in an interview.
Many conservative Christians also believe the behavioral sciences tend to justify sin, he added, pointing particularly to homosexual behavior. In 1973, the American Psychiatric Association famously removed homosexuality from its revised edition of its Diagnostic and Statistical Manual of Mental Disorders. As a theologically conservative Christian, Stanford stressed that scripture, not the Diagnostic and Statistical Manual, constitutes the highest authority.
But that doesn’t mean the Bible is an encyclopedia of knowledge in all areas, and all people benefit from scientific insights into brain chemistry and the interplay of biological and environmental factors that shape personality. Furthermore, while he does not presume to diagnose with certainty cases of mental illness millennia after the fact, Stanford believes biblical figures — Job, King Saul of Israel and King Nebuchadnezzar of Babylon, among others — demonstrated symptoms of some types of mental illness. “Mental disorders do not discriminate according to faith,” he said.
Regardless of their feelings about some psychological or psychiatric approaches, Christians need to recognize mental illnesses are genuine disorders that originate in faulty biological processes, Stanford insisted. “It’s appropriate for Christians to be careful about approaches to treatment, but they need to understand these are real people dealing with real suffering,” he said. Richard Brake, director of counseling and psychological services for Texas Baptist Child & Family Services, agrees. “The personal connection is important. Church leaders need to be open to the idea that there are some real mental-health issues in their congregation,” Brake said.
Ministers often have training in pastoral counseling to help people successfully work through normal grief after a loss, but may lack the expertise to recognize persistent mental-health problems stemming from deeper life issues or biochemical imbalances, he noted. Internet resources are available through national mental-health organizations and associations of Christian mental-health providers. But the best way to learn about available mental health treatment — and to determine whether ministers would be comfortable referring people to them — is through personal contact, Brake and Stanford agreed. “Get to know counselors in the community,” Brake suggested. “Find out how they work, what their belief systems are and how they integrate them into their practices.”
Mental-health providers include school counselors and case managers with state agencies, as well as psychiatrists and psychologists in private practice or associated with secular or faith-related treatment facilities, he noted. Stanford and Brake emphasized the vital importance of making referrals to qualified mental-health professionals, but they also stressed the role of churches in creating a supportive and spiritually nurturing environment for people with mental-health disorders. Mental illness does not illustrate lack of faith, but it does have spiritual effects, they agreed. “Research indicates people with an active faith life who are involved in congregational life get through these problems more smoothly,” Brake said.
Churches cannot “fix” people with mental illness, but they can offer support to help them cope. “The church has a tremendous role to play. Research shows the benefits of a religious social support system,” Stanford said. They stressed the importance of creating a climate of unconditional love and acceptance for mentally ill people in church — a need Grondin echoed. “There needs to be an unconditional sense of community and relationships,” she said. She emphasized the importance of establishing relationships that may not be reciprocally satisfying all the time.
People with mental-health issues may not be as responsive or appreciative as some Christians would like them to be, she noted. “Others need to take the initiative and keep the relationship established. People don’t realize how hard it can be (for a person with a mood disorder) to summon the courage just to get out of bed,” Grondin said. Christians who seek to reach out to people with mental illness need to recognize “they are not able to see things clearly, and it’s not their fault,” Grondin added.
Mostly, Christians need to offer acceptance to people with mental illness — even if they don’t fully understand, she insisted. “Just be present. Offer support and love,” Grondin concluded. “You won’t always know what to say. Just speak words of support into a life of serious struggles. That means more than anything.”
(EDITOR’S NOTE — Camp is managing editor of the Texas Baptist Standard.)
For more information: National Alliance on Mental Illness (800) 950-6264 Anxiety Disorders Association of America (240) 485-1001 Depression & Bipolar Support Alliance (800) 826-3632 American Association of Christian Counselors (800) 526-8673 Stephen Ministries (314) 428-2600
“So stop telling lies. Let us tell our neighbors the truth, for we are all parts of the same body.”
Ephesians 4:25, NLT
I intend to be simple. I am worried and distressed by my own confusion and a simple disorientation about my own detachment to what is spiritual. I confess a trust in Him, but am wary of an evil attachment to things that take me away from Him. I know this sounds confusing, please bear with me.
I turn to Him, and yet I know that I know that a small part of me does not really belong to Him. I want to belong, but am conscious that I just don’t work into the Kingdom. I am a liability. I quickly will admit to some confusion, but I have no real intention to deceive anyone. I desperately want to be His, but I’m aware of issues that would defy such a connection.
I have an incredible infatuation with Jesus, and His teaching. He is the most amazing man to step out out of the ‘river’ of the human race. I see in Him so much, and deep down I want to fall on my knees and worship Him. The things He did are honestly the most sublime in the history of man. He is astonishing.
And yet, I continue to struggle. I see all of this and yet I’m confronted with my own issues. I know what I would like to be. But if I press, I begin to short-circuit. I do, certainly turn it over to Him. But I also am aware of a certain antipathy or rebellion (although that word seems too harsh) against the whole idea of grace. I can not figure ‘grace’ out. Grace perplexes me. It is the ‘Gordian Knot’ of the entire human race.
But I do connect with Him. My bipolar would quickly render me a traitor. I vacillate much more then the average person. Ultimately, I do turn and trust Him. He has led me to a wonderful place. If it is all a delusion, then so be it. But I will still believe in Him who gave Himself for me.
If that makes me a disciple, then so be it. But I know I am the least of His. I guess faith would venture more. But I scrape up all that I have and a saving hope it is enough. I look at the accounts of Him and am pretty much astonished. Jesus did things, consistently, above others before Him and after Him. He is quite exceptional.
I am a follower. I will struggle, and then have to deal with that sin. But I do believe and intend to keep believing. I only wish I was more consistent. I sometime wonder that in the “Book of Life’ if my name would include an asterisk. (“Made it, but by the skin on his teeth.”)
Don’t fret, I am under His hand. He deals with me, and fully intends to lead me, home. I so do want that. If on that Day, you hear someone hollering, it will be me back in the 715,426,488th row, shouting ‘I am finally here”, in the fellowship of heaven.
Some will understand this:
“He who has this disease called Jesus will never be cured.”
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.
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.
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.
Philip Mitchell is a Professor at the School of Psychiatry, Prince Henry Hospital in Sydney, Australia.