Lesson 18

Counseling the Depressed

  1. Understand what you’re dealing with. Don’t assume you know what a person means by depression. What is depression? Is this a case of depression or discouragement? What is the difference between depression and discouragement?
  1. What is depression?
  1. What is the chemical imbalance theory? In his book, The Christian Counselor’s Medical Desk Reference, Robert D. Smith, M.D. says it this way “an impulse travels down a nerve until it comes to a junction with another nerve ending. The connection between the two is called a synapse. An impulse gives off chemicals which cross the synapse to a receptor in the next nerve. In this way impulses are passed from one nerve cell to another. These chemicals are called neurotransmitters. ‘Chemical imbalance’ is the term used for the theory that one of the chemicals (selective serotonin reuptake inhibitors – SSRI’s, i.e., serotonin and norephinephrine) is too high or too low in this synaptic junction. It is concluded that the abnormal level of one of these chemicals interferes with the transfer of impulses and thus produces the bad feelings and behavior problems.” However, the fact is, there is no instrument, no blood test or tissue test that has proven 100% that such an imbalance exists so this is, at this point, still a theory and not a fact.
  2. What is the difference between a disorder and a disease?
  1. Disorder – based on subjective tests regarding what a person thinks and feels as described by DSM-IV-TR.
  2. Disease/illness – based on subjective symptoms and objective tests of tissue and blood tests.
  1. Are there imbalances in other places of the body? Yes. But, they aren’t called chemical imbalances. They are called hormonal imbalances. Their cause is determined through objective tests and is found to be organic so they are labeled a disease or diagnoses. For example,
  1. Hypothyroid – Low, under active or nonfunctional thyroid – depression, dulled thinking/mental processes, personality changes, fatigue, cold intolerance, moderate weight gain, dry skin, deepening voice, menstrual irregularity, forgetfulness, listlessness, confusion, paranoia, hallucinations, agitation, etc.
  2. Hyperthyroidism – Overactive thyroid – may produce nervousness, tremors, anxiety, increased eating, sweating and increased activity, fatigue, weight loss, insomnia, weakness, frequent bowel movements, hyper excitable, irritable, difficulty concentrating, emotions such as crying easily or anger.
  3. High blood sugar – diabetes
  4. Brain tumors, diabetes, MS, anemia, stroke, hyperventilation can produce some of the same symptoms
  1. What about med’s (Celexa, Prozac, Luvox, Paxil, Zoloft, Wellbutrin, Serzone, Desyrel, Effexor)? Do they help? What is help?
  1. Medications sometimes/often do improve a person’s feelings. And, when feeling-oriented people feel better, they may function better. Sometimes, they also help improve the other symptoms of depression such as insomnia, anxiety, fatigue, irritability.
  2. However, it is unknown how they make people feel better. And, in some cases, it is unknown if the med’s were actually the reason for better feelings.
  3. No one, as of yet, has proved that a chemical imbalance has been corrected.
  1. Well then, is it wrong to take medication? What could be wrong?
  1. It isn’t sin, though it could be.
  2. If the med’s are removed, the bad feelings may return.
  3. You may not have gotten to the root of the issues yet. The med’s may be a Band-Aid.

Note: The bottom line is that people are either given a diagnoses based on changes in the body (using medical science and usually called a disease) or changes in behavior (using psychiatry and called a disorder). There are some symptoms given names by medical science for which there are no tests and yet are not called a disorder such as; chronic fatigue syndrome, fibromyalgia and even a migraine headache.

  1. What is the difference between “clinical” depression and discouragement?
  1. In “clinical” depression:
  1. The person lives by their feelings versus the Word of God. The person is refusing to do what is right because of those feelings.
  2. A person is usually immobile some areas of their life.
  3. There is no known cause.
  1. In the case of discouragement:
  1. The person keeps going.
  2. There is a known cause.
  1. How, then, is one to help others to deal with discouragement/depression?
  1. Prepare yourself:

1.Where is your walk? (Matthew 7:1, 5; Galatians 6:1-2)

2.Are you ready to be compassionate?

3.Will you mourn with those who mourn? (Romans 12:15)

4.Pray for deliverance. (2 Corinthians 1:9-11)

  1. Don’t fill in the meaning from your own experience. Find out what it means to the person. Let them describe it to you. You could ask:
  1. What is it like for you?
  2. What do you feel?
  3. What do you think about?
  4. Could you describe the intensity?
  5. Have you considered suicide? Have you made any plans in this regard? Do you have the means?
  6. Are you handling life by making decisions biblically?
  7. Have you stopped functioning because of bad feelings?
  8. Are you immobile in some significant area of life?
  9. Is there an event that may have started the whole thing?
  1. Look for both physical symptoms and spiritual symptoms.
  1. Physical:
  1. Insomnia or hypersomnia
  2. Significant weight changes
  1. Feeling of being restless or slowed down
  2. Fatigue, loss of energy
  3. Problems concentrating
  4. Sense of alienation from things once deemed beautiful and pleasant
  5. Feeling sad, blue, down in the dumps
  1. Spiritual:
  1. Shame
  2. Guilt
  3. Fear and worry
  4. Thanklessness
  5. Unforgiving heart
  6. Hopelessness
  7. Unbelief
  8. Anger

D.Actively be discerning as to how you can encourage faith and knowledge of the presence of God.

  1. Being physically present
  1. Praying with him/her
  2. Cleaning his/her house
  3. Reading scripture together
  4. Walking or exercising together
  1. Be aware that Satan may be at work but don’t get pre-occupied with it. Listen for the lies:
  1. God doesn’t care about you
  2. This is all your fault
  3. God can’t forgive you for this
  4. It’s too late
  5. This is all His fault
  6. There is no hope
  7. I’m this way because of how I grew up
  8. It runs in my family
  1. Get to the heart
  1. They are not too fragile to handle a frank discussion about sin or hard-heartedness. Guilt is an excellent warning sign.
  2. If you hear yourself being concerned about their self-worth beating them down, that is probably the culture talking, not God.
  3. Always emphasize His forgiveness.
  1. Steps for one to change:
  1. It is impossible to change a person’s feelings directly, so work should be done on the source of the feelings, the thinking and actions. What does the person think about? What actions, then, come about because of those feelings? Therefore, the first step is in changing the thinking (Philippians 4:4-9).
  2. Give hope. Philippians 4:13 says, “I can do all things through Christ who strengthens me.” And, Romans 8:28-29 gives us the promise that we all must rely on. The question then is, who is right, me or God? Who is more reliable, me or God? The fact is, there is hope. The person’s belief in this is significant. This is faith!
  3. Plan ahead to focus on praise and thanksgiving (Ephesians 5:20, 1 Thessalonians 5:18). We are to do nothing with grumbling and complaining (Philippians 2:14).
  4. The person must change the way they think about feelings, problems, and depression. The Bible teaches that good feelings are the result of right thinking and actions (John 13:17, James 1:25). Will the person continue to act based on how they feel or on what they know is right and what will please and glorify God.
  5. The person must address the real cause of those low feelings and respond biblically.
  1. When the person changes their thinking about the issue of feelings, they will also change their thinking about their problems. Rather than seeing their problems through their feelings, they are to think about them biblically, as a believer would.
  2. When the person changes their thinking about feelings and problems, they will change their thinking about depression and discouragement. They do not need to feel better to function responsibly.
  3. This change must include confession (agreeing with God that what they are doing is sin) and dealing with what they are really worshiping, those things that function as lusts of their heart (idols of the heart). What does the person want so bad that pleasing God in their life has become unimportant?
  1. More money?
  2. More good looks?
  3. More respect?
  4. More love?
  5. More relationships?
  6. More attention?
  1. This may just be consequences as a result of not living biblically (Psalms 34, 51).
  1. The final area in which the person must change their thinking is to begin to find biblical solutions to one’s little daily problems and to any major problems.
  1. Define the problem areas:
  1. Make a list of all daily tasks that need to be done.
  2. Prioritize them according to biblical principles.
  3. Establish realistic goals and plans that can be met. Daily progress is far more important than getting everything done at once.
  4. Aggressively, avoid day dreaming.
  1. Establish a schedule. If the person gets behind or doesn’t do what they know is a priority, they should take away privileges such as TV, snacks, phone time or time with friends.
  2. Have someone hold the person accountable for keeping to their schedule. This person can be a friend, church member or family. Remember the goal is not getting things done but glorifying God.
  3. Stay busy:
  1. With scheduling (“Healthy fatigue also produces profitable sleep.” – Robert Smith)
  2. In the lives of others
  1. Warnings:
  1. The goal is not to get rid of depression or discouragement or the “down” feelings. This would be worshiping feelings. The goal is to please God and become more like Christ no matter how one feels. As long as the person makes getting rid of the depression essential, very little progress will be made.
  2. Beware of allowing the person to think legalistically (living by a spiritual checklist to earn God’s blessing, including the removal of the feelings) and make excuses (I can’t). “I can’t” may mean I haven’t learned how or I don’t want to.
  3. Beware of wrong advice given to the person and correct where necessary. And, stay away from the med’s issue. If they are already taking, don’t tell them not to. If they aren’t taking any, fine. Leave it at that. We know that med’s could be replacing biblical principles and that until the crutch is replaced by biblical principles, the person will not be successful without it. Still, just teach the person the principles they need for their life and let the Word demonstrate the uselessness of the med’s, if in fact they are useless.
  4. Remember there is no scripture that promises that righteous living will always lead to physical health. God will use suffering to:
  • Teach you
  • Discipline you
  • Draw you closer
  • Expose your idols
  • Evangelism

What is the main thing you have learned from this lesson?

As a result, what is the Lord asking you to change?

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