Suicide

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician.

I found 2 very useful articles against suicide. One is taken from the website of National Institute of Mental Health (NIMH) and the other is from a book "Broken Minds" written by Steve and Robyn Bloem:

1) This article is taken from the website of National Institute of Mental Health (NIMH). NIMH said "NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated."

Introduction
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Suicide
Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the
course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:
• talking about feeling suicidal or wanting to die
• feeling hopeless, that nothing will ever change or get better
• feeling helpless, that nothing one does makes any difference
• feeling like a burden to family and friends
• abusing alcohol or drugs
• putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one's death)
• writing a suicide note
• putting oneself in harm's way, or in situations where there is a danger of being killed

If you are feeling suicidal or know someone who is:
• call a doctor, emergency room, or 911 right away to get immediate help
• make sure you, or the suicidal person, are not left alone
• make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

How Can Individuals and Families Get Help for Bipolar Disorder?
Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at:
• University—or medical school—affiliated programs
• Hospital departments of psychiatry
• Private psychiatric offices and clinics
• Health maintenance organizations (HMOs)
• Offices of family physicians, internists, and pediatricians
• Public community mental health centers

People with bipolar disorder may need help to get help.
• Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness.
• A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referral to a mental health professional.
• Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment.
• A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes.
• Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.
• In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.
• Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers.
• Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors.
• Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations. For contact information, see the "For More Information" section at the back of this booklet.

2) In a book "Broken Minds" written by Steve and Robyn Bloem, Steve described in a very vivid manner the great suicidal temptation that overcomes him and other sufferers and called it "A Sin of the Broken Spirit." He shared his own distressing experiences and God's grace in preserving him from suicide. He also provided a list of the strongest reasons he had given to convince himself not to commit suicide. This will be helpful to anyone who is contemplating suicide during a severe clinical depressive episode or those with suicidal thoughts for some reasons. It may be helpful to carers of such sufferer in his attempt to dissuade him from taking his own life and I trust it will be helpful to any pastor or elders in ministering to such a one with a broken spirit.

"A Sin of the Broken Spirit

Looking at the cold statistics, we cannot forget that the numbers refer to real teenagers and young people - individual men and women of all ages - for whom daily existence has become so awful that self-destruction is preferred. Many of these people are married with young dependent children, just as I was when suicide seemed so appealing. So the human cost goes far beyong the people who die. The dying are parents, spouses, siblings, and children. They have coworkers and fellow students and teachers. They play in the park and shop at the mall. When they die by their own hand, they leave a lot of emotional carnage among the living.

The reason so many mentally ill people commit suicide is not that they are uncaring of others or morally bankrupt. They fall prey to a disease that poisons their minds. Their mood is utterly dark and alone, and a shadowy doorway beckons as the only escapte from hell. Suicide has been called a movement away from the pain. Scripture in fact recognizes the unbearable pain that leads to the temptation to suicide. Proverbs 18:14 states, "The spirit of a man can endure his sickness, But as for a broken spirit who can bear it?"

Grace alone answers the question, and it comes in different forms to bear the broken spirit through tribulation. Acccording to 1 Corinthians 10:13, God will never allow you to be tempted beyond what you are able to resist. That is true of all tempations, but we still fail to resist and do yield to sin. The difference with this sin is that, heinous though self-murder by a Christian may be, it is the sin committed by a broken spirit.

It could shock some to read that a young Christian father and husband, ordained to the gospel ministry after graduation from a conservative, Bible-teaching institution, could seriously be tempted to suicide. After entertaining such thoughts, shouldn't I be disqualified forever from the ministry? If you believe that, then you must in fairness say that no man who has ever broken any of the commandments is qualified. Humans from a broken world are the only sort God calls to lead His church. To be human is to know, and occasionally fall victim to, temptation. Most are not faced with a temptation to take their own lives. My personal struggle with that temptation has been a tough one. By God's grace, I have never actually attempted suicide, but in the midst of a severe depressive episode, the temptation to do so remains a formidable fiery dart in the Devil's arsenal.

According to 1 Corinthians 10:13, God will never allow you to be tempted beyond what you are able to resist. Too often God's gift of grace in trial and temptation is presented as a grace that alleviates suffering so that the believer can bear it. But it may be that He does not change the struggle but gives strength of mind to bear up under it.

Some counselors do not appreciate the depths of struggle and are quick to condemn. In so doing, they can help Satan push a believer toward suicide. The King James Version offers an apt translation of 1 Thessalonians 5:14 : "Now we exhort you, brethren, warn them that are unruly, comfort the feebleminded..." The Greek here literally means "small souled." A clinically depressed person does feel, as I sometimes have felt, feebleminded. I think we get the meaning in this verse turned around. We comfort the unruly and save our harshest warnings for the weak.Extracted from pages 56 and 57.

Put on the Armor

We should instead be helping the feebleminded to put on the armor of God so that they can stand against Satan. In the batle against temptation to suicide, the helmet of salvation and the breastplate of righteousness take on particular importance.......Extracted from page 57.

STEVE: MAKING THE CASE FOR LIFE

In the person contemplating suicide, the brain has been thrust into a swamp of sadness, where God seems to be either angry or missing. It is hard to fight Satan-stirred emotions when the mind does not seem to work, when the spirit is broken, when all positive feeling is gone.

In such times, God provides others who can come alongside. Pastors on the front line here, for they often are the ones who hear the depressed person's last call of despair. We've already seen that doctors also encounter these cries. Professionals in the field of ministry and medicine need to be familiar with the indicators of suicide. Anyone who is ever in a counseling role needs training in how to talk to someone who is entertaining thoughts of suicide.

But anyone can suddenly find himself or herself in conversation with a suicidal person. If so, some general principles can help:

If someone does bring up such thoughts, encourage the person to talk openly and honestly about them. This person is already thinking about it and may already have a plan.

Any truthful deterrant you can give is appropriate.

Since the person may not consider suicide to really be "murder," it is wise to gently remind of the sixth commandment....

... A nurse wrote, telling real stories of unsuccessful suicide in which the survivors ended up seriously disabled. ....

The thoughts and others like them were a potent restraint. Here is a lists of the strongest reasons I have given to convince myself not to commit suicide.
- It is a sin and would bring shame to Christ and His church.
- It would please the Devil and would weaken greatly those who are trying to fight him.
- It would devastate family members and friends, and you may be responsible for them following your example if they come up against intense suffering.
- It may not work, and you could end up severely disabled but still trying to fight depression.
- It is true - our God is a refuge, "and those who know Your name will put their trust in You, for You, O LORD, have not forsaken those who seek You" (Ps. 9:10). God, your Father, will deliver you through what you are facing. Paul said in 2 Corinthians 1:10 that God "delivered us from so great a peril of death, and will deliver us, He on whom we have set our hope. And He will yet deliver us."
- Help is available. If you push hard enough, someone can assist you to find the help you need.
- If you are unsaved, you will go to hell. This is not because of the act of suicide but because all who die apart from knowing Christ personally will face an eternity in a far worse situation than depression.
- If you are a Christian, then Jesus Christ is interceding for you before the Father, that your faith will not fail. He shares your afflictions. Psalm 56:8 says, "Put my tears in Your bottle. Are they not in Your book?"
- God will keep you until you reach a day when your pain will truly be over. Wait for God's time for that, not your own. According to Revelation 7:17c, "God will wipe every tear from their eyes." After going through some awful things, Paul was still able to say, "For I consider that the sufferings of this present time are not worthy to be compared with the glory that is to be revealed to us" (Rom. 8:18). Extracted from pages 58 to 60.

Depression and the Christian : 6 - The Carers

(These series of 6 messages on "Depression and the Christian" are also available on .pdf, .mp3 and video formats which can be downloaded from the website of Sermon Audio )

DEPRESSION AND THE CHRISTIAN

BY DR. DAVID P MURRAY

(6) THE CARERS

INTRODUCTION

We have been studying depression from a biblical perspective, and have covered five areas so far:

1. The Crisis
2. The Complexity
3. The Condition
4. The Causes
5. The Cures

We now come to the final area of our study – The Carers. For our purposes, the carers are the depressed Christian’s family, friends, and fellow-Christians, who will be involved to one degree or another in helping the sufferer to get better. Usually these carers will have no medical training and often they will have very limited or incorrect knowledge of mental illness. However, they have a critical role in helping a depressed person get better. Research has shown that mental health patients will get better much quicker if they have someone close to them whom they can confide in and get support from.

This lecture, then, will consider ten areas for carers to consider when trying to help a depressed person get better.

1. Study

As Christians, we surely want to be the person whom our loved ones turn to in time of need. And, when they do turn to us, we want to be able to help them and not hurt them further.

It is, therefore, imperative that we learn about depression and other mental illnesses in order to avoid the very common mistakes that lay-people often make when dealing with the mentally ill, and in order to be of maximum benefit to those who are suffering.

Apart from studying how Jesus dealt with the ill, the weak, and the distressed you might want to read some of the very helpful books, written from a Christian perspective, which are now available. In order of readability and usefulness they are:

Overcoming Spiritual Depression by Arie Elshout.

I’m not supposed to feel like this by Chris William, Paul Richards, and Ingrid Whitton Broken Minds by Steve and Robyn Bloem.

A Practical Workbook for the Depressed Christian by Dr John Lockley

Another book, of course, is the well-known Spiritual Depression by Dr Martyn Lloyd-Jones. However, you should be aware that Dr Lloyd-Jones does not deal with every aspect of depression as an illness, but rather only with some of the spiritual consequences of depression.

A book which is written from a non-Christian perspective, but which is still useful, is Mind over Mood by Dennis Greenberger and Christine Padesky.

It is important to remember that reading these books will not turn you into a mental health professional, but it will make you more useful and helpful to loved ones in distress.

2. Sympathy

Thoughtful and prayerful study of mental illness should naturally and automatically increase our sympathy for those who suffer with it. By sympathy we mean an ability to communicate that we truly understand the problem and the symptoms, that we are deeply concerned, and that we will do all that we can to help. In many cases, such sympathy can have powerful therapeutic effect on the sufferer. The lack of it can only multiply the pain and deepen the darkness. Consider the following quote from Russell Hampton, who suffered himself from depression:

"If there were a physical disease that manifested itself in some particularly ugly way, such as postulating sores or a sloughing off of the flesh accompanied by pain off an intense and chronic nature, readily visible to everyone, and if that disease affected fifteen million people in our country, and further, if there were virtually no help or succour for most of these persons, and they were forced to walk among us in their obvious agony, we would rise up as one social body in sympathy and anger. There isn’t such a physical disease, but there is such a disease of the mind, and about fifteen million people around us are suffering from it. But we have not risen in anger and sympathy, although they are walking among us in their pain and anguish."

It will greatly help you to sympathise if you always remember that you could just as easily be in the same position, suffering the same illness.

For who maketh thee to differ from another? and what hast thou that thou didst not receive? now if thou didst receive it, why dost thou glory, as if thou hadst not received it? (1 Cor.4:7).

If you treat depressed people with impatient contempt, you may, like many others before you, have to learn sympathy the hard way.

3. Support

Support follows sympathy. It involves being available to listen and talk either in person or at the end of a phone. It includes praying with the person, especially as the mentally ill may find it impossible to put words and sentences together in prayer. It means unconditional love, love which is maintained even when you do not agree with every decision your loved one is making, and even when they may unjustly turn on you. It requires practical help such as child-minding to enable a young mother to get a few free hours each week, or such as taking an elderly person out in the car to give them a refreshing change of scenery. It demands wisdom to know when you are getting out of your depth and more professional support is needed from medical services. The benefits of such supportive friendship cannot be overestimated:

The presence, the availability, just the existence of a friend like this provides a tremendous degree of comfort to the depressed person, as it demonstrates in physical terms how much he is cared for, accepted, loved, as he is, warts and all. It is not difficult for the depressed person to go on to realise that if individual Christians can love him that much, how much more will God do the same.

Unconditional friendship is the key, as is loyalty. The real friends are the one who can accept the depressed person as he is – on good days, bad days, sad days, frightened days and angry days. Friends like this don’t put pressure on in any way, but allow the sufferer to be himself, however horrid that may seem to be. As one of my depressed friends said, “It’s a relief not to have to put on a disguise.”

On a congregational level, pastors and officebearers should encourage a supportive atmosphere: For our churches to be really effective in supporting those with mental health difficulties, we need to establish a culture where everyone in the local church knows that it is acceptable to have problems
from time to time, and that the church as a whole – and especially its leadership – is there to support church members during these times as well as in times of success.

The Church should be especially aware of the need to “support the supporters”. To be an effective support to the mentally ill is physically, mentally, emotionally, and spiritually demanding. As Christians we need to be conscious of the need not only to support the depressed person but also to minister to the needs of their nearest and dearest.

4. Stigma

There is still a stigma attached to mental illness, and depression in particular. Ignorance and misunderstanding have filled the public mind with many prejudices and falsehoods. As a result, many still view mental illnesses such as depression as a choice, or as a sign of weakness, or as an excuse to opt-out of life. The depressed person may also share these mistaken beliefs, and so double their sense of guilt and failure. Consequently, they will often be very reluctant to admit what they are feeling, and so go for many long months or even years without asking for help or seeking treatment.

Following steps 1-3 above will help to reduce this stigma. But the Church can also help by making clear that Christians do not have to be perfect with no problems, and by demonstrating that when people do experience problems they will not be ignored or avoided.

Also, the preacher should present a balanced view of the Christian life, as represented in the Psalms, over a third of which deal with fear, anxiety, and despair. This is part and parcel of normal Christian experience in an abnormal world. Let us remind ourselves again and again:

For who maketh thee to differ from another? and what hast thou that thou didst not receive? now if thou didst receive it, why dost thou glory, as if thou hadst not received it? (1 Cor.4:7).

Almost anyone can experience mental health problems, given the wrong sequence of life experiences and stressors.

5. Secrecy

As is clear from the above, it often takes a huge amount of courage for someone to admit to depression, often due to the fear of what people will say. If someone, therefore, trusts you enough to confide in you, then you must maintain the strictest confidence. There must be no “sanctified” gossip – “I’m just telling you this so that you can pray about it…!” It is tragic that so many depressed Christians have to prolong their secret suffering because of a justified fear that no one can keep a secret in the Church! The Church is in desperate need of Christians who are known to have this simple talent – they keep confidences.

6. Self-esteem

Depression and anxiety bring to the surface deeply rooted self-doubts and self-criticism. The depressed person will often feel useless and worthless. They will have very low self-esteem. What should we do to address this?

Some Christians are reluctant to give people any praise or encouragement because of the risk of making a person proud. However, it is safe to say that pride is one of the least risky vices for someone who is depressed. Pride results from having an over-inflated view of oneself. Depression involves the opposite.

Other Christians misconstrue the doctrine of original sin and total depravity to mean that there is no kind of “good” in anyone, and so again fail to say anything positive to the person. However, without minimising the wickedness of the human heart and without denying our inability to do anything pleasing to God apart from through faith in Christ, we should feel free to encourage the depressed person to have a more realistic view of themselves by highlighting their God-given gifts, their contributions to the lives of others, their usefulness in society, and, if they are Christians, their value to the Church. For example, a depressed young mother may feel a total failure in every area of her life because she has not got a perfect home or perfect kids. We can help such a person to see that she achieves a lot in a day even though she might not manage to do everything she would like. We might remind her of all the meals she makes, clothes she washes and irons, the shopping she organised, and so on, and so help her to see herself and her life in a more accurate and realistic light.

It is wrong to pat ourselves on the back when something has been accomplished as a result of our initiative. It is equally wrong, however, to focus on what we have not accomplished. In 1 Corinthians 15:10 we have a clear example of humility accompanied with a healthy opinion of one's accomplishments: "But by the grace of God I am what I am: and his grace which was bestowed upon me was not in vain; but I laboured more abundantly than they all: yet not I, but the grace of God whichwas with me." Paul knew very well that he daily offended in many things (James 3:2; cf. Rom. 7; Phil. 3:12), and yet he did not go so far as to cast out all his accomplishments. I do not believe that this is God's will. In contrast to sinful forms of self-confidence and self-respect, there are also those that are good, necessary, and useful. Without a healthy sense of these, human beings cannot function well. We may pray for an appropriate sense of self-confidence and selfrespect, clothed in true humility, and we must oppose everything that impedes a healthy development of these things (be it in ourselves or others) with the Word of God.

7. Subjectivism

One of the most common tendencies in depression is to focus on feelings, and to base beliefs and conclusions on these feelings. This is especially true of Christians. They may feel forsaken and so conclude they are forsaken, etc. There is also the tendency to read Bible passages and books which address the feelings in the hope that this will help to restore true feelings, whereas such a focus tends only to make things worse.

We should encourage the depressed person to move away from the realm of the subjective and to instead think on the objective truths of Christianity – things which are true regardless of our feelings – justification, adoption, the atonement, the attributes of God, heaven, etc.

8. Speak

The general rule is to listen much and to speak little. However, here are a number of things not to say:

• Pull yourself together
• Don’t get so emotional
• O, you’ll soon get over it
• It’s a sin to be depressed
• Just believe the promises
• Smile, it can’t be that bad
• Well, things could be worse
• At least it’s nothing serious
• You should confess your sins
• You are not still on medication, are you?

The more you understand depression the less likely you will say such hurtful and damaging things.

9. Suicide

If you suspect someone is considering suicide then you should sensitively and wisely ask the person if they are thinking along these lines. This will not plant suicidal thoughts in their minds, but may allow the suicidal person to admit to this and to seek professional help.

In Broken Minds, the pastor Steve Bloem gives a number of reasons he has, at times, used to convince himself not to commit suicide:

• It is a sin and would bring shame to Christ and His church.
• It would please the devil and would weaken greatly those who are trying to fight him.
• It would devastate family members and friends, and you may be responsible for them following your example if they come up against intense suffering.
• It may not work and you could end up severely disabled but still trying to fight depression.
• It is true – our God is a refuge (Ps.9:10)
• Help is available. If you push hard enough, someone can assist you to find the help you need.
• If you are unsaved, you will go to hell. This is not because of the acts of suicide but because all who die apart from knowing Christ personally will face an eternity in a far worse situation than depression.
• If you are a Christian, then Jesus Christ is interceding for you, that your faith will not fail.
• God will keep you until you reach a day when your pain will truly be over.

10. Slow

It is important to realise that there are no easy answers and there are no quick fixes in dealing with depression. It usually takes many months and in some cases even years to recover. You should, therefore, take a long-term view and patiently wait for improvement. Don’t get frustrated over lack of progress and be aware that temporary relapses may occur.

Patience is essential, because, by the nature of illness, the depressed person is likely to go over the same ground time and again, needing the same reassurance that was given a day, a week or a month ago.

In the meantime let us take our depressed Christian brethren continually before the throne of grace and plead, “Lord, he whom thou lovest is sick.”

CONCLUSION

In the course of these lectures we have been looking particularly at how depression affects the Christians. In closing I would like to refer back to something which I have touched upon now and again – the way God will sometimes use depression to bring an unconverted person to the Saviour. If you are unconverted and feeling depressed, at least part of the solution may be repentance from your sins and faith in Christ. That is not to say that you may not need medication and counselling as well. However, medication and counselling will only be a temporary solution if you do not seriously address your spiritual state before God. Pills might get you through this world, but they will not be available in hell, the place of ultimate torment, despair, and gnashing of teeth.“Believe in the Lord Jesus Christ and you shall be saved.”

All 6 articles on Depression and the Christian:

1. The Crisis
2. The Complexity
3. The Condition
4. The Causes
5. The Cures
6. The Carer

Who to contact in Singapore

In Singapore

If you are in Singapore, and you are suffering from Depression or some form of similar mental disorders, or you know of someone suffering thus, and need medical and counselling help, do consider contacting the following to see if they can be of help, besides praying and supporting your friend or loved ones.

If you or someone is suicidal, please know that this is an emergency situation and there is hope and help. Please call 999 or see other emergency contact numbers below under number 4).

1) For Medical Help - For diagnosis and medical help

i) Private Psychiatrist

Dr Pauline Sim
Consultant Psychiatrist
L P Clinic Pte Ltd
Provides psychological services for adults and children
Mount Elizabeth Medical Centre
3 Mount Elizabeth Suite #05-01
Singapore 228510
Tel: (65) 6735-4526
Fax: (65) 6735-4527

Consultation Hours:
Mon - Fri : 8.30am - 5.30pm
Sat: 8.30am - 1.30pm
Sun & PH : Closed
After Off Hrs: (65) 6535-8833

ii) Hospital

- Tan Tock Seng Hospital (TTSH)
- National University Hospital (NUH)
- Institute of Mental Health (IMH)
- Changi General Hospital (CGH)
- Singapore Association for Mental Health (SAMH)

2) For Counselling Helps

i) Singapore Association for Mental Health (SAMH)

Tel: 1800-2837019 (Mon to Fri: 9.00am to 1pm, 2pm to 6pm)

ii) Institute of Mental Health (IMH)

Tel: (65) 6389-2222 or 6389-2000

iii) Counselling & Care Centre

Block 536 Upper Cross Street
#05-241 Hong Lim Complex
Singapore 050536
Tel: (65) 6536-6366
Fax: (65) 6536-6356
Email : info@counsel.org.sg
Webwsite : www.counsel.org.sg

iv) Association of Christian Counsellors of Singapore
c/o 422-A Telok Blangah Road
Singapore 098848 (Near Grace Methodist Church)
Tel: 6274-7480 Fax: 62760024
Email: info@accs.org.sg
Website: http://www.accs.org.sg/

v) For counselling help for children and young adults up to the age of 36:

Clinical Psychologist
The Stepping-Stones Practice
112 East Coast Road #04-17
Katong Mall
Singapore 428802
Tel: (65) 6348-4002
Website: www.thesteppingstonespractice.com

3) 24 Hours Hotline - Samaritans of Singapore
Call: 1800-221-4444 (24-hr hotline)
Email: pat@samaritans.org.sg.

4) In time of emergency, especially when there is suicidal thoughts or tendency, please do the following without delay as the sufferers life may be in danger:

a) Police
Call: 999

b) Ambulance
Call: 999 / 911 / 995

c) Institute of Mental Health
Buangkok Green Medical Park
10 Buangkok View, Singapore 539747
Tel : 6389 2000
Fax : 6385 1050

General Enquiries General Enquiries enquiry@imh.com.sg
Quality Service (Toll-Free): 1800-3864541
Emergency Help Line (24 Hours): (65) 6389-2222
Outpatient Appointment (65) 6389-2200
Email: imh_appt@imh.com.sg
Admission Enquiries: (65) 6389-2003/4
Billing Enquiries: (65) 6389-2016/7/8

Behavioural Medicine Clinic
Alexandra
(8am - 12.30pm, Mon)
(8am – 4.30pm, Tue – Fri)
Tel: (65) 6474-4872 Fax: (65) 64756475

Health Promotion Board Building
(8am – 5pm, Mon – Fri) Tel: (65) 6534-5366 Fax: (65) 6534-3677

Geylang Polyclinic
(8am - 4.30pm, Tue - Fri) Tel: (65) 6746-5171 Tel: (65) 68484579

Child Guidance Clinic

IMH Clinic B
(8am – 5.30pm, Mon – Thu)
(8am - 5pm, Fri)
Tel: (65) 6389-2200 Fax: (65) 6385-1075

Health Promotion Board Building
(8am – 5pm, Mon – Fri) 64353878
Tel: (65) 64353879 Fax: (65) 6534-3677

Sayang Wellness Clinic
IMH Sayang Wellness Clinic
(8am – 5.30pm, Mon – Thu)
(8am - 5pm, Fri)
Tel: (65) 6389-2200 Fax: (65) 6385-1075

Depression and the Christian : 5 - The Cures

(These series of 6 messages on "Depression and the Christian" are also available on .pdf, .mp3 and video formats which can be downloaded from the website of Sermon Audio )

DEPRESSION AND THE CHRISTIAN

BY DR. DAVID P MURRAY

(5) THE CURES

In our last lecture we looked at some of the causes of depression. Now we will look at some of the cures. However, before we do so, we must ask the depressed person a vital question, “Do you want to be made whole?” This was the question Jesus asked of the lame man at the pool of Bethesda (Jn.5:6).

At first glance it may seem like a silly question. Surely every sick person wants to be made whole! However, Christ’s question may imply that the man was not making use of all the means available to get better. Or, perhaps he had given up hope of getting better. These are common scenarios with depression. Doctors and pastors are often faced with the frustrating situation of people who need the help they can give, and yet who are not taking the steps required to benefit from this help. Perhaps they have just learned to live with their illness. Perhaps they have given up hope of getting better. Perhaps they lack the will to play their part in the healing process. Perhaps they are frightened of all the responsibilities of life which would come upon them should they be viewed as “well” again. Perhaps they would miss the attention and sympathy which being ill may generate. These are all possibilities. So, if you are depressed, the first searching question you must ask yourself is “Do I want to be made whole?”

You have no hope of recovery from depression unless you want to recover and are, therefore, prepared to play your own significant part in the recovery process. We will look at four measures which should be considered as part of a “package” of healing.

1. Correct your lifestyle

It is vital to lead a balanced lifestyle in order to reduce the “stretch” that threatens our physical, mental, emotional and spiritual well-being. Some of the practical points made here also apply to depressions resulting from stressful life events.

a. Routine

One of the keys to a balanced lifestyle is regular routine. This is also one of the first things to fall by the wayside when someone becomes depressed. The depressed person often finds it very difficult to resist being guided by their feelings. When a person feels down they will often only do what they feel like doing and avoid what they don’t feel like doing. For example, if we don’t feel like getting up, we won’t. If we don’t feel like working, we won’t. If we don’t feel like doing the ironing, we won’t. If we feel we want to drink or eat to excess, we do it. A positive step in recovering from depression is to restore order and discipline in our lives. Regular and orderly sleeping, eating, and working patterns will rebuild a sense of usefulness and healthy self-esteem. It is also glorifying to God who is a God of order, not of confusion (1 Cor.14:33).

b. Relaxation

We need to build times of relaxation into our lives. This may involve finding a quiet spot at various times throughout the day to simply stop, pause, calm down, and seek the peace of God in our lives. Jesus recognised and provided for this need in his disciples when he took them “apart into a desert place to rest a while” (Mark 6:31). Also, moderate physical exercise helps to expel unhelpful chemicals from our system and stimulates the production of helpful chemicals.

c. Rest

Regular sleep patterns enable the body and mind to repair and re-charge. The Sabbath Day was graciously made for us (Mark 2:27), partly to ease the tension of our busy overstretched lives.

d. Re-prioritise

Examine your life and see what you can do to reduce your commitments and obligations. Areas to consider are your family, your work, your church, your neighbours and travel. Once you are better you may be able to pick up some of these activities again. But the priority is to get better.

2. Correct your false thoughts

As we have noted throughout these lectures, one of the most common contributory factors to depression is wrong and unhelpful thoughts. Many Christians, who wouldn’t dream of viewing God’s Word in a false way, yet view God’s world in a false way. As they view themselves, their situations, and their relationships with others, they tend to dwell on and magnify the negatives and exclude the positives. This distorted view of reality inevitably distorts and depresses their mood. Christians are obliged to challenge falsehood and distortions of reality, especially when found in themselves. In the appendix to this lecture you will find two questionnaires to help you do this. The first is to help you examine your thoughts, and the second is to help you challenge your false and unhelpful thoughts. Questionnaires such as these are recommended for use by many Christian and non-Christian psychiatrists. They may look a bit strange to you, and you may wonder, “Is this not all just psychological mumbo-jumbo?” However, I would like to show you here how each step is grounded in Biblical Christian experience. In Psalm 77 we have a perfect example of Asaph investigating and challenging his thoughts with God’s help, in order to raise his mood and spirits. There are also slightly more abbreviated versions of the same biblical strategy in Psalm 42, Psalm 73, Job 19, Habakkuk 3, etc. So, this is not “psychological mumbo-jumbo”, but true Bible-based Christian experience. Let us look at Psalm 77 to prove this.

Download the following file :

asaph.pdf

3. Correct your brain chemistry

This is not an area I have any expertise in and so I shall keep my comments to a minimum. I would refer you to sympathetic and trained medical personnel for diagnosis and prescription of appropriate medication. Even a low dose of anti-depressants is sometimes enough just to begin to restore depleted brain chemicals and so pick up your mood sufficiently to enable you to begin to take the steps necessary to correct your lifestyle, thoughts, etc. However, more serious depressions sometimes require medication for 2-5 years in order to permanently restore the brain’s chemistry and processes. There are a number of myths and false ideas about anti-depressants which have lodged in the public mind.

Here are some examples: “If I take anti-depressants I won’t be my true self…there will be horrible side-effects…I might get addicted…people will look down on me…it will mean I am crazy.” Your doctor should be able to refute these myths and reassure you. However, as mentioned above, anti-depressants don’t replace the need for you to identify and work at changing false and unhelpful thinking and harmful behaviour.

4. Correct your spiritual life

a. Correct the spiritual consequences

We have tried to emphasise that for Christians their depression is usually not caused by spiritual factors. However, there are spiritual consequences in all depressions. There are a number of steps a depressed Christian can take to help reverse at least some of the spiritual consequences. You may find Martyn Lloyd-Jones’ book Spiritual Depression to be helpful in this regard – although he can be a bit sweeping and dogmatic in his generalisations. Here are some practical things you can do to help address the spiritual consequences of depression.

(i) Accept that being depressed is not a sin and indeed is compatible with Christianity. Many Bible characters and many of the greatest Christians passed through times of depression.

(ii) Try to understand that your loss of spiritual feelings is not the cause of your depression, but rather the depression has caused a general loss of feeling in all parts of your life, your spiritual life included.

(iii) Patiently wait for the corrections in your lifestyle, thinking, or brain chemistry to have an effect on your feelings as a whole and your spiritual life will pick up at the same time also.

(iv) Have a set time for reading your Bible and praying. Depressed Christians may either give up reading and praying, or they may try to read and pray “excessively” in order to try and bring back their spiritual feelings. Both approaches are unhelpful. Instead, set aside a regular time each day to read and pray. If concentration is a problem, keep things short (5-10 minutes) until you feel better. Depression will only be deepened by setting unrealistic spiritual goals.

(v) Bring objective truth to mind (e.g.: the doctrine of justification, or the atonement), especially “positive” verses which set forth God’s love, mercy and grace for sinners (e.g.: Rom.8:1; 8:38-39; 1 Jn.4:9-10; 1 Jn.1:9). You may want to write out a verse and carry it around with you. When negative thoughts overwhelm you, bring out the verse and meditate upon it.

(vi) When you pray, tell God exactly how you feel. Be totally honest. Ask God to help you with your doubts and fears and to restore to you the joy of salvation. Thank Him for loving you and being with you even though you do not feel His love or presence. Praying for others who suffer can also help to turn your thoughts away from yourself for a time.

(vii) Keep going to church and seek out the fellowship of one or two sympathetic Christians you can confide in, and ask them to pray with you and for you. Be careful about who you talk to. Sadly, some Christians cannot keep confidences, and others will have little understanding of or sympathy for your condition.

(viii) Remember God loves you as you are, not as you would like to be.

b. Correct the spiritual causes

In the lecture on the causes of depression, we mentioned the possibility that a Christian’s depression may be the result of some specific sin or sins. If having examined your life you find that there is a sin which you are deliberately and stubbornly persisting in, or grave sins which you have never really repented of, it is time to fall on your knees and seek God’s pardon for the sin, and God’s power over the sin. See Psalm 32 and Psalm 51 for examples of how to do this.

APPENDIX

Download the file : Thought Investigation Questionnaire.pdf

Download this article in .pdf format - 5TheCures.pdf

All 6 articles on Depression and the Christian:

1. The Crisis
2. The Complexity
3. The Condition
4. The Causes
5. The Cures
6. The Carer

Depression and the Christian :4 - The Causes

(These series of 6 messages on "Depression and the Christian" are also available on .pdf, .mp3 and video formats which can be downloaded from the website of Sermon Audio )

DEPRESSION AND THE CHRISTIAN

BY DR. DAVID P MURRAY

(4) THE CAUSES

In previous lectures we mentioned some of the causes of depression. We also noted the complexity of trying to analyse the causes of depression, and concluded that it is often a combination of various factors. In this lecture we will look in a bit more detail at the various causes of depression, and then we will consider some of the cures for depression.

Depression is often divided into two main categories – reactive or endogenous. Reactive depression is usually traced to some obvious trigger – perhaps a stressful life event or unhelpful thought patterns. Endogenous depression is the name usually given to depressions which seem to have no obvious trigger and are often traced to genetic pre-disposition. For no obvious reason, the brain chemistry becomes unbalanced and a person becomes depressed. However, this distinction between reactive and endogenous is not as clear-cut as it once was, as skilled investigation of many so-called endogenous depressions will often reveal a “trigger event”, though a genetic pre-disposition may mean that the trigger is relatively small. We will consider four triggers of depression: stress, psychology, sin, and sovereignty.

1. Stress

When you stretch a piece of elastic, you can often extend it to two or even three times its size. However, the further you stretch it, the greater the tension on the rubber, the less flexible it becomes, and the greater the danger of it eventually snapping. Like rubber bands, we are all “stretched” from time to time. We are stretched by life events, which we have little control over, and by our lifestyle which we do have considerable control of. Let’s look at each of these stretching forces.

a. Life events

Life events include marriage, moving house, exams, bereavement, illness, unemployment, birth of children, etc. Each of these events put a strain upon us, to one degree or another. When we are “stretched” in this way, our body and brain chemistry changes, and one of the results is often a dip in or lowering of our mood. This is normal. And, as the stressful events pass, our chemistry usually returns to normal along with our mood.

Sometimes, however, these stressful experiences can continue over a lengthy period, or they can occur one on top of another, or they can affect us more seriously than other people. The result is that our brain chemistry remains abnormal and so also does our mood. We just can’t “pick ourselves up”, no matter how many people urge us to. This is depression. At the very worst, like an elastic band, we can “snap”, sometimes unexpectedly. This is what some call a “nervous breakdown”.

Changes in brain chemistry greatly affect our ability to think and feel in a balanced way. Stressful events make our minds go into overdrive, exhausting and depleting the chemicals we need to think and feel in a normal and helpful way. Think of a computer with too many programmes open and working at the same time, and how this slows down all the processes until eventually the machine “crashes”.

b. Lifestyle

While we have little if any control over life events, we do have substantial control over our lifestyle – the proportion of time and energy we give to work, socialising, shopping, travelling, recreation, exercise, rest, sleep, etc. Much of the increase in depression and anxiety today is largely the result of an unbalanced lifestyle where people are on the one hand working too hard and spending too much, and on the other hand are exercising, resting, and sleeping too little. This deliberate overstretch

beyond our capacities and abilities is not glorifying God in our body and spirit (1 Cor.6:20). It is also in breach of the sixth commandment which requires us to take “all lawful endeavours to preserve our own life” (Shorter Catechism 68). The effects and result of a stressful lifestyle will often be the same as that of stressful life events – depression.

2. Psychology (the way we think)

In Lecture 3 we looked at 10 false thinking patterns which contribute to depression. It cannot be emphasised enough how vital it is to learn to recognise these unhelpful thoughts by prayerful self examination. It is also important and useful to note that some of these habits of thinking may be involuntarily absorbed or learned in early life and so may be deeply ingrained. When we feel down, or when we are stressed, these latent false thinking patterns tend to occur more frequently and tend to dominate. This can often lead to depression, worsen an existing depression, and, if persisted in, make recovery from depression so much harder. Sometimes, the Church can reinforce or add to false thinking patterns by over-emphasis on the negatives in the Bible and in people’s lives, or by setting standards of commitment which may discourage or depress those who are unable to attain them.

3. Sin

A non-Christian may be depressed because of their sin, in which case the cure is repentance and faith in Jesus Christ. Sadly, many depressed unbelievers are being treated with chemicals when what they need is conversion. If you are unconverted and depressed then seriously consider whether your depression is related to a guilty conscience and conviction of sin. If so, then what you need is repentance from sin and faith in Jesus Christ. There are many Christians who will testify that this was the key to relieving their depression.

While sin may be the last thing an unconverted person may think is causing their depression, the opposite is true for Christians. When a Christian becomes depressed, there are often spiritual consequences, and so the depressed believer jumps to the conclusion that there is also a spiritual cause – usually their own sins or hypocrisy or failures of one kind or another. Skilled and experienced Christian pastors, doctors, and psychiatrists unite in affirming that depression in Christians is not usually caused by problems with their spiritual life. In Christians, depression is usually caused by stressful life events and lifestyles, or unhelpful thought patterns (see 1 and 2 above). Here are some sample quotations from various experienced Christian pastors, psychiatrists, counsellors, and doctors to prove this point:

“For Christians, depression hardly ever has a spiritual cause…In Christians, spiritual

effects follow from the depression, and seldom the other way around.”[1]

“True spiritual causes of depression are not common. Most Christians with an apparently religious content to their depression in fact have one of the mental/emotional causes rather than a true spiritual cause. I cannot emphasise enough that solely spiritual causes of depression are infrequent in Christians.”[2]

David and other psalmists often found themselves deeply depressed for various reasons. They did not, however, apologize for what they were feeling, nor did they confess it as sin. It was a legitimate part of their relationship with God. They interacted with Him through the context of their depression.”[3]

“We completely agree that there are always spiritual aspects to anxiety and depression (as there are in everything in life for a Christian). However, we see these as being a secondary consequence of the emotional distress that is part of these illnesses. Strong claims that all anxiety and depression is spiritual in origin are unhelpful because they miss the point that the actual problem is anxiety and depression.”[4]

I emphasise this point again and again because blaming our depression on our sin is not only usually wrong, it is also very harmful. It is harmful because it increases false guilt and deepens feelings of failure. It also makes depressed Christians seek a spiritual solution to a problem which is actually being caused by life events, lifestyle, or unhelpful thinking patterns. However, having said all that, we must still leave open the possibility that the depression may sometimes be the result of specific sin or sins (e.g. Ps.32). The Westminster Confession of Faith says: “The most wise, righteous, and gracious God doth oftentimes leave, for a season, His own children to manifold temptations, and the corruption of their own hearts, to chastise them for their former sins…” (WCF 5.5).

How then does a Christian know if his depression has a spiritual cause or simply spiritual consequences. The Practical Handbook for Depressed Christians puts it like this: “For the Christian, truly spiritual causes of depression usually involve behaviour which the Christian knows to be wrong, but which he still deliberately and arrogantly persists in…I am not talking about repeated sins that the Christian wishes he could control but can’t…but a deliberate and continued rebellion against God….”[5]

4. Sovereignty

One final cause of depression in the Christian is the sovereignty of God. Hard though it may be to accept, the ultimate cause may be, “It pleased God.” This however is not some sheer arbitrary, sadistic and pointless infliction of suffering. Not at all. God has wise and loving motives and aims in all His dealings with his children. The Westminster Confession of Faith proposes another reason why God will sometimes allow his children to descend into the depths of depression. It is “to discover unto them the hidden strength of corruption and deceitfulness of their hearts, that they may be humbled; and, to raise them to a more close and constant dependence for their support upon Himself, and to make them more watchful against all future occasions of sin, and for sundry other just and holy ends (5.5)".

A well known example of this is Job. A lesser known example is Hezekiah. “God left him, to try him, that he might know all that was in his heart” (2 Chronicles 32:31). This does not mean that God actually left Hezekiah. God will never leave nor forsake His people. This, then, is not an objective leaving, but a subjective leaving. God withdrew Himself from Hezekiah’s spiritual feelings, so that he lost his feelings of God’s presence, protection, and favour. So, Hezekiah felt God had left him. But God had a wise and loving purpose in this. It was to test Hezekiah and to reveal to Hezekiah what was in his heart when God’s felt presence was withdrawn.

Sometimes we can take God’s presence in our lives for granted. We forget what we might be without him. And so He wisely, temporarily, and proportionately withdraws the sense of his favour and presence to remind us of our state without Him and to lead us to greater thankfulness and appreciation for Him

[1] Dr John Lockley, A Practical Workbook for the Depressed Christian (Bucks: Authentic Media, 1991), 53-54.

[2] Ibid. 58.

[3] S & R Bloem, Broken Minds (Grand Rapids: Kregel, 2005), 204.

[4] C Williams, P Richards, I Whitton, I’m not supposed to feel like this, (London: Hodder & Stoughton, 2002), 121.

[5] Dr John Lockley, A Practical Workbook for the Depressed Christian (Bucks: Authentic Media, 1991), 57

All 6 articles on Depression and the Christian:

1. The Crisis
2. The Complexity
3. The Condition
4. The Causes
5. The Cures
6. The Carer