Depression is too often the silent disease, and/or mental
disorder that plagues individuals throughout every culture, race, gender, creed
and community throughout the United States and around the world. It is a
growing epidemic that needs to be better understood to help those who are
trapped in its debilitating prison of hopelessness and despair. A balanced
approach of medical and psychological treatments, emphasizing a biblical
approach to the counseling, is necessary if true healing is to occur. The
one-size-fits-all approach is not effective. Culturally relevant approaches are
needed if there is to be true healing. Without hope, those under the influence
of depression will never see the light at the end of the tunnel. Without hope,
they will continue spiraling down the abyss of depression instead. Time is of
the essence. Change needs to occur. With the help of their physician,
psychologist/counselor, friends, church family and most importantly; God,
change is possible. It is time for real hope and change for those under the
influence of depression.
History of Depression
Melancholia is the beginning in how physicians and
psychologists/counselors learned how to not only understand depression, but how
to treat their clients for depression as well. However, it would be remissive
to leave out the fact, depression has been around since the beginning of time,
recognized by the symptoms of the people under its devastating effects.
Abraham, Jonah, Job, Elijah, King Saul and Jeremiah, just to name a few of
those from the Old Testament period, all showed symptoms that could possibly be
diagnosed as clinical depression today (Genesis 15; Jonah 4; Job; 1 Kings 19; 1
Samuel 16:14-23; Jeremiah).
Melancholy was first diagnosed as a disease in clinical
psychology in the “eighteenth and nineteenth centuries” (Varga, 2013, p. 142).
Melancholia primarily refers to the disposition of a person. The dispositional
temperamental melancholic effect is identified by durations of sadness. It also
describes individuals who show states of anxiety and despair. In their daily
lives, those who are temperamentally melancholic tend to get bored easily and
are moody. The Greeks rejected the belief melancholia was the demonic
possession of a depressed person. Empedocles came up with a natural answer
instead. He believed there was an imbalance of black bile (Greek: melancholia)
in an individual's body, causing the depressive disorder. Therefore, in his
opinion, melancholia was a physical issue that could be treated medically
(Varga, 2013, p.p. 141-144).
There are two schools of thought concerning melancholia.
Those who are in the continuity camp believe melancholic and depressive
disorder are in many ways, the same diagnosis. Those who align themselves with
the discontinuity view, believe there are too many differences between the two.
In this paper, the continuity view will be the primary perspective concerning
depressive disorder, believing there is a temperamental predisposition to
clinical depression. By no means does this suggests those who are not
temperamentally melancholic will never be diagnosed as clinically depressed
(Varga, 2013, p. 141).
Causes of Depression
In their journal article, Abnormal Brain Responses to Social
Fairness in Depression: An fMRI Study Using the Ultimatum Game, Drs. Grabin,
Perez, MacFarlane, Cavin, Waiter, Engelmann, Dritschel, Pomi, Matthews and
Steele, sourcing Disner (2011), stated those who are depressed, according to
the cognitive models, biasedly process negative information while dismissing
the positives in their lives. They have come to expect only negatives in their
lives and cannot see positives even when they are experiencing them. In some
cases, individuals with clinical depression go through seasons of distraught,
instead of always being under the darkened shadow of depression (Grabin, Perez,
MacFarlane, Cavin, Waiter, Engelmann, Dritschel, Pomi, Matthews, & Steele,
J.D., 2015, p. 1248; Roiser, Elliott, & Sahakian, 2012, p. 121; Haeffel,
& Hames, 2014, p. 81).
Proving depression is not only a melancholic and/or a
genetic predisposition, in a study with college roommates, Drs. Haeffel and
Hames found that prolonged exposure with those who are negative and depressed
will cause a person who normally has a positive outlook in life also to become
negative and depressed. In other words, depression can become like an airborne
disease if a typically mentally healthy person spends too much time with those
who are negative and depressed. The darkness of depression will cloud their
mind, causing them also to trickle into a depressive state, losing hope of any
future filled with happiness and joy (Haeffel, & Hames, 2014, p. 77).
Clinicians need to be aware of the causes of depression. The
symptoms may be subtle at times, but the results can be devastating. If not
treated early and efficiently, depression can and does affect not just the
mental health of their client, but their physical health as well. Concerning
the cardiovascular system, those whose depression is moderate to severe are
five times more likely to die from diseases than those who are not depressed
(Alvarez, 2015). Effective treatment of clinical depression can be a life or
death situation.
Treatments for Depression
It is important when dealing with clinical depression, for
there to be a balanced approach to treatment. It would be unfortunate for a
psychologist/counselor to treat their client without being examined by their
physician as well. Their client may need an antidepressant to help them cope
while going through the counseling process. In the same way, if a physician
treats their patient for depression without referring them to a
psychologist/counselor, they will be doing their patient a disservice.
In their journal article, Am I Abnormal? Relative Rank and
Social Norm Effects in Judgments of Anxiety and Depression Symptom Severity,
Drs. Melrose, Brown and Wood, stated “only around one-third of anxiety cases
and under half of depression cases are identified by primary care physicians
giving an unassisted diagnosis” (Melrose, Brown, & Wood, 2013, p. 174).
Physicians cannot half-heartedly diagnose their patients. They need to use
every tool available to give a proper diagnosis. If they do not, what was a
mild case of clinical depression could become severe. Meanwhile, the physician
not understanding the symptoms of clinical depression, or their patients not
accurately depicting their symptoms, have caused them to have diagnosed and
treated their patients improperly. If there is a combination of psychological
and medical treatment, there is less of a chance of a misdiagnosis (Melrose,
Brown, & Wood, 2013, p.p. 174, 181).
In the cognitive neuropsychological model, clinicians
believe individuals have a misguided bias toward their environmental
circumstances. They also believe genetics may also be the cause of clinical
depression. These clinicians believe antidepressants affects the way the brain
processes the stimulations in their client’s lives. Because of this, they conclude
antidepressants are beneficial in helping their client effectively process and
respond properly to theirs circumstances (Roiser, Elliott, & Sahakian,
2012, p.p. 119, 130).
Individuals who have major depressive disorder (MDD), do not
believe they are capable of doing anything to change their mood. Medicinal
treatments, however, have been beneficial for those who have MDD.
Psychologically, the client, because it is not something they have to do
directly, are encouraged the medication will help. In fact, because of the
psychological influence, many have been cured by the use of placebos alone
(Kirsch, & Low, 2013, p.p. 222, 225).
Due to the success of placebos, there are clinicians who are
now treating their clients without medication. Studies have found when using
psychotherapy without antidepressants; it was just as beneficial in the
short-term. In fact, in the long-term, psychotherapy without antidepressants is
more helpful. Acupuncture and hypnosis are two of the forms of psychotherapy
that have proven to be effective (Kirsch, & Low, 2013, p.p. 225-227; Hope,
& Sugarman, 2015, p.p. 216, 226). There are several ways to treat
depression. However, in most cases, the best way to cure depression is to prevent
it from happening.
Preventing Depression
The old idiom “Sticks and stones may break my bones, but
words will never hurt me” is not true (Sticks and stones may break my bones,
2006). Words can leave a lasting impression, both positive and negative. Negative
words early in life can lead to clinical depression in adolescents and/or
adulthood for those who are born with the risk factor toward cognitive
vulnerability. Negative words continually spoken to an individual can leave
them vulnerable to life events, possibly causing instability and depression.
Adolescents can also find themselves lonely, believing they do not matter to
anyone. They need to know someone cares. Negative words need to be replaced by
positives, filling them with hope, instead of despair (Haeffel, & Hames,
2014, p.p. 75-76).
According to the cognitive vulnerability hypothesis, most
cases of depression occur due to individuals not being able to interpret, nor
respond properly, to the stresses of their lives in a healthy way. Researchers
have taken groups of people who have never shown signs of depression. They were
able to predict which ones were likely to have clinical depression in the
future by studying their personality and how they interpret events in their
lives. If their focus is always on the negatives in life, negative memories and
moodiness will take over, leaving them vulnerable to clinical depression.
Researchers have also found those who have suffered from major depression in
the past, are more vulnerable to depression in the future (Haeffel, &
Hames, 2014, p. 75; Roiser, Elliott, & Sahakian, 2012, p. 123; Joormann,
2010, p. 161).
Cognitive vulnerability toward depression is not due to
indifference nor listlessness. Cognitively being vulnerable toward a life of depression
is because of a person’s loss of hope. The inability to believe life will go
well causes a lack of motivation (Cholbi, 2011, p. 40). One of the greatest
preventions toward clinical depression is a person’s ability to perceive a
bright future. They need to believe there is hope and a purpose in life. If
there is no hope; if there is no perceived purpose; their life will be consumed
by the darkened cloud of defeat, distraught, and possibly; depression. They
need to retrain themselves in seeing the value in themselves. They need to have
self-worth (Sadhwani, 2012, p. 147).
More attention also needs to be given to the elderly.
Executive dysfunction and the inevitable deterioration of their physical health
can lead someone living in the later stages of life filled with hopelessness.
Loneliness needs also to be addressed. Too often, their family stop visiting,
and life-long friends begin to die. Though cognitive-behavioral treatments
(medication) has been beneficial in helping the elderly in their depressive
state, loneliness eats away at the soul of the one who once was active. The
elderly need to feel wanted and necessary, or they will give into depression,
leaving them an empty shell of the person they used to be (Manning,
Alexopoulos, McGovern, Shizuko Morimoto, Yuen, Kanellopoulos, & Gunning,
2014, p. 146; Lalayants, & Prince, 2014, p.p. 173-174).
Cross-Cultural Differences When Assessing and Treating Depression
Clinicians need to be aware of the cultural differences
within communities all across America. Clinicians cannot properly treat their
clients if they have a one-size-fits-all psychological approach to counseling.
Research has shown, minorities are at a greater risk of being misdiagnosed and
treated improperly for depression, especially MDD, due to the physician and/or
counselor not understanding their patient’s culture. Because the majority of
minorities solely get their care from doctors, there has been a concerted
effort in transforming primary care centers in minority neighborhoods. Dealing
with language barriers, cultural differences, inserting family support workers,
and understanding how to interpret the symptoms of their patients, has become a
priority for these centers (Hails, Brill, Chang, Yeung, Fava, & Trinh,
2012, p. 336).
Clinicians also need to be aware of the financial struggles
in many minority neighborhoods in the United States. Without financial
stability, prospective patients dealing with depressive issues will not be able
to afford the diagnosis/treatments they desperately need. Something needs to be
done to lift these communities out of poverty. For instance, too many
African-American men living in poor neighborhoods, do not see a way out of
their poverty. Their self-esteem is lost in the daily reminder of their
helplessness and hopelessness. Their desperation has turned into depression,
leaving them unable to take care of their families. Because of their
circumstances, depression seeps deeper into their lives. Preventative measures
need to be addressed to stop this never-ending-impoverishment-mentality and
reality that plague the soul of too many African-American men. Without hope,
their lives will continue to spiral into the depths of depression (Ball, 1983,
p. 406).
The result of the hopelessness and despair of
African-American men is devastating. Too many African-American women have
decided they do not need a man in their lives. The consequence, though more
stable than African-American men; they are not as financially stable as their
white counterpart. African-American women are also more prone to depression
than white women. Focusing only on their children and career, African-American
women do not make the time to seek help for their depression or any other
physical/mental needs. There has to be a change in the mentality of
African-American communities along with an adjustment in how physicians and
psychologists diagnose and treat them. Preventative measures need to be
implemented. If not, generations of African-Americans will continue not being able
to enjoy a healthy fulfilled life, living in the fog of depression and
ill-health instead (Mengesha & Ward, 2012).
For both African-American men and women, there is a
desperate need for support groups. White Americans can be beneficial in this
process. A recently published research from Berkeley’s HAAS School of Business,
found that a simple act of kindness, not even spoken, can help relieve the
racial tensions that are prominent in too many societies today (Willard, 2015).
Every race, culture and creed must come together, building one another up,
reaching into the depths of the desperation that consumes too many in their
communities. Once this is accomplished, businesses will be more willing to come
into poorer neighborhoods, lifting them out of the generational poverty that
have inflicted them for too long. The need for real hope and change is crucial
to the lives of those living in minority communities all across America (Ball,
1983, p. 406; Kim, Richardson, Park, & Park, 2013, p. 212).
Biblical Worldview
The answer for real hope and change can only be found in
Jesus Christ and His Word. From beginning to end, the Bible is filled with
promises for God’s Children, given them a future filled with hope. God wants
His Children to focus on what is true, honorable, right, pure, lovely, and
admirable. He wants them to not allow the frustrations, anxieties, and
impurities of the world to cloud their judgment of who they are in Him. He has
promised His presence and peace will be with those who seek and follow Him. No
longer do they have to live a life of discouragement, for God is always with
them, preparing a way for success. With their heart and mind focused on Him,
they can faithfully and patiently wait on God, trusting in His love. He is
faithful, and will deliver His Children from the struggles they are facing. He
has proved His trustworthiness by overcoming the world for those who place
their trust in Him. God will build a shield of protection around them, lifting
them up with His righteous right hand. He will place them on the solid rock of
Jesus Christ, bringing them comfort in times of sorrow. In return, they are to
bring comfort to others in their times of hopelessness and despair. God’s
unfailing love for His Children will endure forever, and nothing can separate
them from His love (Deuteronomy 31:8; Psalm 3:3, 32:10, 34:17, 37:23-24,
40:1-3, 42:11; Isaiah 41:10; John 16:33; Romans 8:38-39; 1 Corinthians 10:4; 2
Corinthians 1:3-4; Philippians 4:8-9).
These are comforting words for all Christians.
Unfortunately, this is the primary answer they hear from their pastors,
teachers and theologians concerning depression in their lives. Teaching God’s
love and promises for His Children is crucial, but most churches do not show
God’s love. Words are cheap when not backed by positive actions. Instead of
being love to those affected by depression, too many churches have chosen to
blame and condemn instead. Renowned pastors, such as John Piper emphasize sin
may be the cause of depression. Churches have failed to understand and make
aware depression can be a physical issue as well. Researchers have proven MDD
and Generalized Anxiety Disorder is a physical problem with its origin in the
brain, not necessarily in sinful acts. Churches need to focus on love instead
of apathy, reaching out instead of pushing away, helping instead of judging and
healing instead of hurting. The church needs to be a reflection of God’s love
(Sorenson, 2013, p.p. 344-345).
Biblically-based counseling is the best answer to helping
those who are dealing with depression. Without God, it is impossible for
someone to be totally free from the destructiveness of depression. Churches
need to begin the process of training others to become encouragers instead of
discouragers. In his book, Effective Biblical Counseling, Larry Crabb
introduced a program that would be beneficial for churches to implement. It
would pave a road of real hope and change, not only in the church, but within
their communities. The program teaches individuals in the church to become
counselors who encourage, exhort and enlighten those in need of true healing
(Crabb, 1977, p.p. 163-179). The time for change is now. Churches need to
become the love of Jesus to those suffering from depression.
Conclusion
Depression haunts the souls of individuals from every race,
gender, culture and creed. It is time to make the necessary changes in how
medical doctors and psychologists/counselors diagnose and treat clinical
depression. The one-size-fits-all approach has never been effective. A balanced
approach is required to reach deep into the soul of the individual shackled by
depression. If there is no hope for the future, their clients will continue
seeping deeper into their very being. Real hope and change is not possible
through only human theories, programs, and/or treatments. It can only be found
through Jesus Christ. Physicians and psychologists/counselors can help their
patients heal from their physical and mental struggles, but only God can heal
their soul. Churches need to lead in the effort in helping those who struggle
from clinical depression. They need to start using biblically-based programs
that not only assist in the physical and mental healing of their clients, but
in their spiritually healing as well. Until churches rise to the occasion,
millions will continue living a life of hopelessness and despair. Through God,
real hope and change can be found.
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