1	"Depression & Hope" Depression & Hope Workshop Module Mental Health America of the Heartland The Center for Practical Bioethics with funding from The Health Care Foundation of Greater Kansas City
2	Authors The Reverend Jeanne Hoeft, Ph.D. Assistant Professor of Pastoral Care Saint Paul School of Theology The Reverend Ruth Rosell, Ph.D. R.N. Assistant Professor of Pastoral Theology-Pastoral Care and Counseling Central Baptist Theological Seminary The Reverend Judith Schwanz, Ph.D. Professor of Pastoral Care and Counseling Nazarene Theological Seminary
3	Permissions This curriculum may be accessed electronically on the following web sites: www.mhah.org www.practicalbioethics.org Use and copying are permitted with appropriate citation and attribution: Jeanne Hoeft, Ruth Rosell, Judith Schwanz, Sabbaths of Hope Depression & Hope Workshop Module, a project of the Mental Health Association of the Heartland and the Center for Practical Bioethics, © 2007.
4	Pictures of Depression “I am lost in an immense underground cavern with tangles, unending passageways. What distant light I could once see soon shrank to a glimmer and now is gone. Earlier I tried mightily to get out, to find the light of day again, but it is no longer possible and I no longer care. I’m very, very tired.”
5	Pictures of Depression “The weather of depression is unmodulated, its light a brownout.” “… the gray drizzle of horror induced by depression takes on the quality of physical pain.”
6	Pictures of Depression “…despair…comes to resemble the diabolical discomfort of being imprisoned in a fiercely over-heated room. And because no breeze stirs this caldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion.”
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12	Historical Figures in the Church St. John of the Cross (1542-1591) – Spanish poet and Roman Catholic mystic, wrote of the “Dark Night of the Soul,” that stage in the mystic path when “spiritual persons suffer great trials, by reason not so much of the aridities which they suffer, as of the fear which they have of being lost on the road, thinking that all spiritual blessing is over for them and that God has abandoned them since they find no hope or pleasure in good things.”
13	Historical Figures in the Church Martin Luther – winter of 1542, his daughter, Magdalena, had died and the plague swept through Wittenberg. The faithlessness of his fellow Germans discouraged him and he began to think of – and wish for – his own death.
14	Historical Figures in the Church John Wesley – described himself as helpless and hopeless, “Again, joy in the Holy Ghost I have not. I have now and then some starts of joy in God. But it is not that joy. For it is not abiding.” – written 7 months after his Aldersgate experience
15	Historical Figures in the Church Mother Theresa – in the 1950s and 1960s wrote letters revealing depression: “I am told God lives in me – and yet the reality of darkness and coldness and emptiness is so great that nothing touches my soul.” “In my soul, I can’t tell you how dark it is, how painful, how terrible – I feel like refusing God.”
16	Biblical Characters Who Experienced Depression Jeremiah (Jeremiah 20:14-18) Job (Job 3:3a) Jonah (Jonah 1:3, 8-9) Elijah (1 Kings 19:4) David (Psalm 42:3)
17	God’s Response God listened – God let them speak (and even record it for us to read) God met their physical needs – shade and rest for Jonah, food and rest for Elijah God did NOT scold God DID challenge their thinking – reminded them of God’s character, power, and presence Psalm 42:5b – David had a NEW vision and hope for the future How, then, should we (the Church) respond to each other?
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19	Identifying Depression Depression is a persistent mood disorder that affects the whole person – the emotional, physical, cognitive, social and spiritual aspects. There are different kinds and severities Major depressive episode Bipolar illness Dysthymia
20	DSM-IV Criteria for Major Depressive Episode Depressed mood Loss of interest or pleasure Appetite/weight loss or gain Sleeping difficulties Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or guilt Difficulty thinking, concentrating, making decisions Recurrent thoughts of death or suicide
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22	Depression as a Brain Disease Disturbance in the neurotransmitter system Neurotransmitters – chemicals that convey messages from one nerve cell to another Neurotransmitters especially involved in depression – serotonin, norepeniphrine, and dopamine
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24	Causes of Depression Genetic predisposition Stressful life events “Stress is probably the most common influence on our mood chemicals. Many depressions are triggered and maintained by stress” (Gilbert 2001, 17).
25	Causes of Depression Difficult early life experiences Social factors Negative core beliefs and distorted automatic thoughts
26	Stress Spirals Stressful life event Negative beliefs Stress hormones “I’m inadequate” “It’s my fault” “I’m failing” “Things are not going to work out” See Paul Gilbert, 2001, Understanding Depression, Oxford: Oxford University Press
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29	Understanding Depression Reduces Shame and Blame Many factors contribute to depression, most unrelated to person’s choices. Depression includes an illness process involving chemicals in the brain. Depression affects every part of a person’s life and results in terrible suffering. Rather than being stigmatized, depressed people need help to find treatment.
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36	Treatment of Depression Attention to all aspects of person best. Physical examination by medical doctor to rule out medical illness as factor. Medication Counseling
37	Medications for Depression Antidepressants work to rectify neurotransmitter deficiency. Effective with 65-70% of depression. Only 50% of people continue taking medications as prescribed. Work slowly to relieve depression. Very important for treatment of severe depression. Sometimes electroconvulsive therapy (ECT) is recommended instead of medications.
38	Counseling Medications with counseling is best. Supportive counseling Counseling for life stressors Marriage and family counseling Cognitive-behavioral therapy
39	Cognitive Tools Regardless of the original cause of depression, almost everyone who experiences depression becomes trapped in a trio of negative thinking about: The self The world The future
40	Cognitive Distortions This negative thinking is reinforced by cognitive distortions (or “stinking thinking,” as some like to call it) All-or-nothing thinking – black and white; absolute; perfectionism Mental filter – either filtering out or disqualifying the positive Magnifying errors – “catastrophizing” Mind reading (of others) Accepting feelings as facts “Should” statements
41	Referrals – Who to Refer Those who can be helped more effectively by someone else. Those with problems for which effective specialized agencies are available in the community. Those who do not begin to use pastoral help in four or five sessions. .
42	Who to Refer Those whose needs obviously surpass the minister’s time and/or training. Those with severe chronic financial needs. Public welfare agencies with trained social workers are appropriate referrals. Those who need medical care and/or institutionalization.
43	Who to Refer Those who need intensive psychotherapy. Those about the nature of whose problem one is in doubt. Those who are severely depressed and/or suicidal. Those toward whom the minister has a strong negative reaction or an intense sexual attraction. From Howard Clinebell, Basic Types of Pastoral Care and Counseling
44	How to Make Referrals Create this expectation. Mention the possibility early, explaining why specialized help may be needed. (Be careful not to communicate that they are “too sick” for you to handle!) Start where persons are in their perceptions of the problems and help needed.
45	How to Make Referrals Work to bring their perceptions of problem and possible solutions close enough to yours to make the referral “take.” Help person resolve emotional resistance to referral. Interpret the general nature of the help they may expect to receive. Establish strong enough rapport so your relationship serves as a bridge over which they may walk to another helping relationship.
46	How to Make Referrals Encourage them to try it, even if they are only mildly willing. Let them know your pastoral care and concern for them will continue Don’t let the person drain energy from the problem by continuing to see you. From Howard Clinebell, Basic Types of Pastoral Care and Counseling.
47	Other Helpful Responses Reduce stigma through conveying an understanding of depression. Encourage physiological interventions: Get more active and achieve small successes Get regular exercise Eat healthily Get enough sleep
48	Other Helpful Responses Help find ways to reduce stress. Provide spiritual support. Allow expression of anger at God. Help build connection to God. Compassionately explore spiritual issues impacting depression. Remain supportive
49	Other Helpful Responses Support family members. Education about depression. Encourage to take care of themselves. Education about signs of suicide and preventive actions. Possible need for family counseling
50	The Role of the Congregation Support Social Instrumental support (financial, physical needs, etc) Spiritual – coping resources
51	The Role of the Congregation Givers of Hope Advocates Facilitators of Healing Unconditional love and acceptance
52	The Role of the Congregation Act for a more Just and Loving World Break down the social stigma Advocate for more equitable employment policies Advocate for more equitable, available and accessible physical and mental health care
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54	Bibliography Backus, William. Telling Yourself the Truth. Minneapolis: Bethany House, 2000. Burns, David D. Feeling Good: The New Mood Therapy. New York: Quill, 2000. Cooper-White, Pamela. Many Voices: Pastoral Psychotherapy in Relational and Theological Perspective. Minneapolis: Fortress, 2007. DePaulo, J. Raymond, Jr. 2002. Understanding Depression. Hoboken, N.J.:John Wiley & Sons. Dunlap, Susan J. Counseling Depressed Women. Louisville, KY: Westminster John Knox, 1997. Gilbert, Paul. 2001. Understanding Depression. Oxford: Oxford University Press. Halaas, Gwen Wagstrom. The Right Road: Life Choices for Clergy. Minneapolis: Fortress, 2004. Hart, Archibald D. Coping with Depression in the Ministry and Other Helping Professions. Waco, TX: Word Books, 1984. Hunter, R. Lanny and Victor L. Hunter. What your Doctor and your Pastor Want You to Know about Depression, St. Louis: Chalice Press, 2004. Joiner, Thomas. Why People Die by Suicide. Cambridge, MA: Harvard Univ., 2005. Koenig, Harold G. 2002. Spirituality in Patient Care. Philadelphia: Templeton Foundation Press. Lester, Andrew D. Hope in Pastoral Care and Counseling. Louisville, KY: Westminster John Knox, 1995. Neuger, Christie Cozad. Counseling Women: A Narrative, Pastoral Approach. Minneapolis: Fortress Press, 2001. Randall, Robert L. Walking through the Valley: Understanding and Emerging from Clergy Depression. Nashville: Abingdon, 1998. Stone, Howard. Depression and Hope. Minneapolis: Fortress Press, 1998. Solomon, Andrew. The Noonday Demon: An Atlas of Depression. New York: Simon & Schuster, 2001. Styron, William. Darkness Visible: A Memoir of Madness. New York: Random House Waterhouse, Steven. Life's Tough Questions: What the Bible Says About Suffering, Depression, Demon Possession, Abortion, Suicide, Pastoral Care and Death Issues, Mental Illness. Amarillo: Westcliff Press, 2005.