Pastor, I’m depressed … doctor says it’s some sort of major depressive disorder.”
We don’t take for granted the amount of trust displayed when someone discloses the diagnosis of a psychiatric disorder. And that’s why we respond gently and compassionately. But we also need to respond accurately. Here are three common myths about depression to keep you from misleading those you care so deeply for.
Myth #1: Scientists know exactly what causes depression
Even though pharmaceutical ads say that major depression may be caused by chemical imbalances, many people assume that depression is caused by chemical imbalances. But it’s not that simple. As Dr. Joseph Coyle of Harvard Medical School was quoted by National Public Radio, “Chemical imbalance is sort of last-century thinking. It’s much more complicated than that.”
And Dr. Coyle isn’t alone in his sentiment. PLOS Medicine collected an eye-opening list of quotes from medical researchers who don’t share the confidence that the general public, some doctors, and even pharmaceutical companies have about the cause of depression.
To get a better idea of what causes depression, scientists are exploring whether the depression is due to problems with brain structure, diminished activity levels in certain parts of the brain, and psychosocial factors like stress. But to date, scientists have not been able to make a clear link between physiological factors and depression. A Scientific American article puts it this way:
[N]o studies have established a cause-and-effect relation between any brain or psychosocial dysfunction and the disorder. In addition, depression almost certainly does not result from just one change in the brain or environmental factor. A focus on one piece of the depression puzzle—be it brain chemistry, neural networks or stress—is shortsighted.
Even though we hear a lot of promising news about the latest in brain and genetic code research, it’s important to realize that scientists aren’t even close to being able to explain what causes depression or any other mental disorder. Dr. Allen Frances, former chair of the DSM-IV Task Force1 and of the department of psychiatry at Duke University School of Medicine, writes:
Although we have learned a great deal about brain functioning, we have not yet figured out ways of translating basic science into clinical psychiatry. The powerful new tools of molecular biology, genetics, and imaging have not yet led to laboratory tests for dementia or depression or schizophrenia or bipolar or obsessive-compulsive disorder or for any other mental disorders. The expectation that there would be a simple gene or neurotransmitter or circuitry explanation for any mental disorder has turned out to be naive and illusory.2
Frances goes on to quote Roger Sperry, who won the Nobel Prize in medicine:
“The more we learn, the more we recognize the unique complexity of any one individual intellect, the stronger the conclusion becomes that the individuality inherent in our brain networks makes that of fingerprints or facial features gross and simple by comparison.” Teasing out the heterogeneous underlying mechanisms of mental disorder will be the work of lifetimes.3
Even if scientists are able to identify which parts of the body produce a state of depression, that would be incomplete as an explanation of the cause of depression. Why? It would not take into account man’s makeup as a spiritual and physical creature created in the image of God. Dr. Sam Williams, a former psychologist who is now a counseling professor at Southeastern Baptist Theological Seminary, explains:
That which makes us distinctively human, our spiritual and moral facets, is neglected by secular definitions of mental order, disorder, and reordering. Thus, the secular concept of mental disorder is not a thorough description of nor does it provide an explanation for people’s problems. A more thorough biblical psychology must factor God (and subsequently the moral and spiritual valence of each symptom) back into the equation if we are interested in a diagnosis that is consistent with our worldview.
This is important for the people you care for to understand, because many of them become less receptive to nonmedicinal treatments when they accept a biomedical explanation for their depression. Dr. Todd B. Kashdan, psychologist and professor of psychology at George Mason University, explains in a post on myths about what causes depression:
They become pessimistic that recovery is possible. They become less confident that they can manage and regulate negative moods that arise (and they always do)…. Essentially, they become less flexible in their options for treating depression and less confident that they will escape its clutches.
Just because depression scientists don’t know exactly what causes depression does not mean that biological factors don’t play a significant role in why people experience depression. But, again, as Dr. Williams observes, “Superficial, deterministic explanations dehumanize people, rendering them as automatons rather than persons with the dignity and honor ascribed to us in Psalm 8.”
Myth #2: A diagnosis of depression explains a person’s symptoms
According to the Diagnostic and Statistical Manual, Major Depressive Disorder is characterized by nine symptoms: a depressed mood, diminished interest or pleasure in anything at all, significant weight loss or weight gain, insomnia, psychomotor agitation, fatigue, inappropriate feelings of guilt, inability to concentrate, and recurrent thoughts of death. For a person to be diagnosed with Major Depressive Disorder, he must experience at least five of these symptoms, at the same time, for a minimum of two weeks.
It lists numerous symptoms—but gives no explanations for why those symptoms occur. Unfortunately, many people view their diagnosis as an explanation for their behavior. Perhaps you’ve heard people say things like:
“I don’t have any energy because I’m depressed.”
“I don’t want to go out because I’m depressed.”
“I don’t feel like studying the Bible because I’m depressed.”
Dr. Michael Emlet explains why people tend to think of the diagnosis as an explanation for their behavior.
Giving a summary label to a set of symptoms gives the appearance of explanation, particularly in our medicalized culture. It suggests that each diagnosis is a discrete and largely brain-determined entity, and there is simply little evidence for that except in the major psychiatric categories of schizophrenia, bipolar disorder, and severe depression.
In the article DSM-5: The New Normal? Dr. Emlet suggests a more helpful way to think about a diagnosis like major depression: “It’s important to remember that psychiatric diagnoses are descriptions of a struggling person’s thoughts, emotions, and behaviors; they are not explanations for them. They tell you what but not why. The [Diagnostic and Statistical Manual] admits that.”
And even if the scientists were able to link symptoms of depression to particular biological markers, they still couldn’t say with certainty whether those biological abnormalities were caused by spiritual-relational-behavioral-cognitive dynamics or vice versa.
To be fair, pastors can’t say exactly why a person gets depressed either. But they can point to some of the reasons God says people can be depressed. Those reasons may not apply to everyone, but they should be considered. Here are a few examples:
- The Bible says that hope deferred makes the heart sick (Prov. 13:12). Experiencing the postponement or the loss of a dream or personal goal can result in sadness, discouragement, and lack of motivation. A person may tire of waiting for a desired result, or he may wonder why he should continue to try when his efforts seem fruitless. The sadness and discouragement are more potent when an individual’s dream was his primary driving force in life. Without that, he may feel empty and purposeless.
- In Psalm 43:5, the psalmist asks himself, “Why, my soul, are you downcast? Why so disturbed within me?” He proceeds to counsel himself to put his hope in God. Exploring what a person is hoping in, counting on to provide success, meaning, or happiness, can reveal areas in which he is not trusting God.
- Guilt is a common emotion associated with depression. The psalmist says that sin made him feel as if his bones were wasting away (Ps. 32:3). Dr. Linda Mintle has observed, “Unforgiveness is a cause of depression. Harboring anger, harboring resentment, allowing it to take root in one’s spirit and soul in a bitter way creates depression.”
- There are also biblical references to certain behaviors, thoughts, and values that can result in joy and zeal (Ps. 94:19; Ps. 122:1; Phil. 4:1, etc.). It is possible that the absence of such actions and thoughts would limit one’s experience of those emotions. Keep in mind, however, that it is possible for a person to obediently pursue God and still battle depression.
For more on how pastors can uniquely help those struggling with depression, see Jeff Forrey’s article How Pastors Can Help the Depressed.
Myth #3: Medication doesn’t help treat depression
Some people are under the impression that depression is purely a spiritual issue and that medication isn’t effective or needed in treating depression. Some who cite the ineffectiveness of antidepressants claim that they are slightly more effective than a placebo. A fact sheet produced by MIT explains the origin of that idea:
Clinicians began hearing this question from patients after news articles reported on a 2002 analysis of published and unpublished studies submitted to the U.S. Food and Drug Administration (FDA) as part of the approval process for several new types of antidepressant medication. This analysis concluded that the newer types of antidepressants are only marginally more effective than placebo.
However, these analyses do not reflect how antidepressants are used in actual practice. Drug trials measure only how a person responds to a single medication taken at a specific dose for a limited time. In clinical practice, however, the patient and clinician work together to find the dose and the medication or combination of medications most effective for you. Most clinicians believe that this process results in much better results than these analyses imply.
Dr. Michael Emlet, in an interview for our DivorceCare and Single & Parenting projects, pointed out that the Bible doesn’t prohibit taking medications for psychiatric disorders. He said, “When Jesus came, He not only forgave sin but He also healed disease. He also relieved suffering. Medications may be one way that suffering is relieved…. I would say medication is a wisdom issue. It’s going to vary from individual to individual whether or not medications may be wise. I think some people want to rush too quickly to medications. Other people refuse to even consider the possibility of medications. Both of those positions could be problematic because they reflect motives of the heart that may be off base.”
Dr. Emlet reminds us of the importance of remembering the limitations of medicine:
Medication can help treat depression and shouldn’t be written off as one of the ways that God can bring healing and relief to a person’s life. For example, with stabilized emotions and higher energy, people can be enabled to make needed changes in their lives. But people need more than drugs. Drugs, as helpful as they can be, do have limitations. They don’t treat any of the underlying spiritual or environmental issues that contribute to a depression.
Some people may not require medication to treat their depression at all. Less severe cases can be treated with nonmedicinal approaches and basic behavior changes. For example, one study reported by Reuters found that simply getting active three times a week reduces the risk of depression in adults by 16 percent, and additional exercise reduces the risk even more. You can also suggest that a person try a change in diet, since a lack of essential vitamins and minerals can result in depressive symptoms.
A strategy for effective care begins with an accurate understanding of the person’s problem. For more on how to understand depression from a biblical perspective, see Jeff Forrey’s article How pastors can help the depressed. It will help you understand the unique role pastors play in helping people deal with depression. Also check out Kathy Leonard’s article 3 reasons depression is complicated, which features interviews with counselor Leslie Vernick and Dr. Robert Kellemen. It’s a great post to share with your deacons and care group leaders to help them understand why we shouldn’t use simplistic reasons to explain depression.
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- What is the DSM-IV? Its authors say, “The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders.” Frances was the chair of the fourth version of the handbook. The DSM-5, released in 2013, is the most up-to-date edition.
- Allen Frances, MD, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (New York: HarperCollins, 2013), Kindle edition, chap. 1.
- Frances, Saving Normal, chap. 1.