Care Manual: Depression

A Manual for Counseling People Who Struggle with Depression
Jason Poling

I. Definitions, Descriptions and Symptoms

  • A. Psychiatric Definition: “a persistent mood lasting two consecutive weeks that is characterized by certain intense feelings of inadequacy, sadness, hopelessness, pessimism, irritability, apprehension, and a decreased interest in or ability to enjoy normal activities.” (The Christian’s Guide to Psychological Terms, Asher and Asher, p. 56)
  • B. Common Symptoms: (DSM-IV)
  1. Loss of interest in job or family
  2. Serious lack of energy
  3. Change in sleeping or eating habits
  4. Feeling worthless or hopeless
  5.  Preoccupation with guilt
  6. Recurring thoughts of death
  7. Diminished ability to think and concentrate
  8. Psychomotor agitation or retardation
  • C. Spiritual Symptoms and Descriptors to Diagnose Depression:
  1. Suffering
  2. Emptiness
  3. Sadness
  4. Hopelessness, Aloneness, Isolation
  5. Apathy, Numbness
  6. Anger
  7. Spiritual Battle
  8. Fear/Anxiety
  • D. Basic Summary Descriptors: Hopelessness and Suffering

II. Key Truths and Principles (Jones, BC401 Course Lectures)

A. Remember that Depression is a “whole-person problem with medical/bodily impacts” (Jones)

  1. A strictly biological approach to depression does not make sense of all the data. For example, can we really pinpoint an exact chemical that causes specific feelings of worthlessness when it is imbalanced?
  2.  Medical science is not far enough advanced to understand that depression, although affecting the body, is a whole-person problem (including body and soul).
  • a. The psychiatric criteria used to establish a diagnosis are based on subjective reports and observations and not on tangible, scientific, laboratory data.
  • b. Many of the symptoms described are value-laden expressions of suffering and internal pain. They involve cognitive tasks of thinking, interpreting and concluding. They are not simply somatic.
  • c. Even the act of controlling the establishment of criteria to categorize symptoms and make diagnoses invites a significant amount of subjectivity in practical assessment of depression. Whoever controls the definition of criteria in any given debate, wins, even if they are not right. Might does make right in a relativistic society.

B. Components of non-organic, functional depression:

  1. A ruling, inordinate desire (craving, demand, idol) – perhaps even for a good object.
  2. The disappointment or expected disappointment of that ruling desire.

C. Depression usually appears along with various other behavioral components.
D. God’s answer for (functional, non-organic) depression involves repenting, believing and obeying God (R.B.O.), in growing measures
E. Golden Guideline to avoid depression: “Never put your hope in what God has not guaranteed!”

III. Key Verses (Jones, BC401 Course Lectures

A. There is not a clear verbal description of what depression is in Scripture. However, we do have anecdotal case studies to get a general idea:

  1. Genesis 4:5 – Cain becomes downcast
  2. 1 Samuel 1:9,18 – Hannah was originally downcast and was encouraged
  3. Job 22:29 – Eliphaz says the Lord saves the downcast
  4. Psalm 42:5-6,11; 43:5 – the Psalmist preaches to himself not to be downcast in his soul
  5. Lam. 3:20 – Jeremiah is downcast in his soul while remembering affliction from God
  6. Haggai 2:1-9 – the returning exiles are saddened by the loss of the “glory days”
  7. Luke 24:17– the two disciples are sad because of Jesus’ death
  8. 2 Corinthians 7:6 – God comforts the downcast and comforted Paul in his trouble

B. Depression occurs in Scripture when people have hopes that are not met. God gives the remedy of repenting of the false idols/hopes, believing His promises, and obeying His commands.

IV. Ministry Strategies and Steps to Counsel(Jones, BC401 Course Lectures)

A. Ministry Guideline: Refer person to a primary care physician if the depressive symptoms emerge suddenly, emerge without warning, or emerge with other physical symptoms.
B. Preliminary Assessments about Organic and non-Organic Depression

  1. Depressive symptoms can originate from organic (bodily) problems. Our bodies, including our brains, are fallen, finite, mortal, decaying, sin-cursed, etc. (2 Cor 4:7-16; 12:7-10)
  2. It is also possible (likely?) that some people, by physical constitution or emotional temperament, may be more prone to depression.

C. Diagnostic Questions:

  1. Know: Help me understand what it was like to feel depressed in that situation?
  2. Know: Help me understand what you feel like when you feel you are alone or a failure or?
  3. Know: I think I see you wanting/desiring _____ and it is causing ______. Is this true?
  4. Speak: Wouldn’t it be great to be free from this depression? I want to help you. The way to freedom starts with repentance.

D. Practical Counseling Steps:

  1. Get to know the person and gather info about him, his situation, his heart, and his “depression.”
  2. Give Christ-centered hope amid his hopelessness based on Christ and his promises.
  3. Show Christ-like comfort and compassion to the person in his suffering.
  4. Teach the Sovereignty, Goodness and Wisdom of God in his suffering (Rom 8:28-30).
  5. Teach and use the laments with him (Psalms 6; 13; 22; 32; 38; 51)
  6. Get involved. Recognize that your (and others’) ongoing, patient, personal presence is itself part of your Christ-centered ministry. (2 Cor 7:6; 2:12-13; 1 Thes 5:14-15; Isa 50:4)
  7. Encourage and mobilize other believers to do the same. Assemble a support team to assist.
  8. Establish your goal: to help them know Christ in their sufferings. The goal is not to get rid of all the depression or determine the exact cause. God hasn’t promised this.
  9. Be conscious of medical factors. Refer the person to a physician if needed.
  10. Help the person explore and repent of sinful heart issues.
    • a. Idolatry: depression as toppled idols. “I want something so badly that if I don’t get it (or don’t keep it) I will be or remain depressed.”
    • b. Unbelief: depression as remnant unbelief. I must have something other than God and his promises, or I will be depressed.”
    • c. Legalism: depression as frustrated perfectionism. “I have to be or do some required thing other than or more than what God requires, or I will be depressed.”
    • d. Control: depression used purposefully. “I will use my depression in a purposeful way, to get benefits.” (NOTE: this is a last resort diagnosis!)
  11. Don’t be afraid to wisely, caringly confront the person with Truth about his sin (Lk 24).
  12. Be patient; realize the process nature of change in this area and persevere. (1 Thess. 5:14)
  13. At every point, emphasize the gospel: Focus on God’s provisions and promises in Christ, and on repenting, believing, and obeying in light of them (Lam 3:19-20 to 21-26).

E. We must help counselees learn how to preach the gospel to themselves (Ps 42:5).

V. AssignmentIdeas

  1. Use the “God’s DZ”chart (see attachment) to determine areas of the counselee’s life that may be making a provision for their depression.
  2. Assign some of Powlison’s X-Ray questions (see link at stonebridgeadults.com) to determine the possible things the counselee might be hoping in instead of Christ.
  3. Ask other people to pray for them and to spur them on to love and good deeds (Mack, A Christian Growth & Discipleship Manual or CGDM, 87).
  4. Make a “think and do” list of profitable things you can think about and do when you are tempted to be depressed. (Mack, CGDM, 87).
  5. Journal times, dates, circumstances, responses and feelings of all the times you get depressed over a couple of weeks.
  6. I often have counselees journal 5-10 daily “Goodness of God Signs” they can see in their life.

VI. Recommended Resources

  1. Lloyd-Jones, D. Martyn. Spiritual Depression: Its Causes and Its Cure. Eerdmans, 1965.
  2. Piper, John. “Faith in Future Grace vs. Despondency,” chap 24 in Future Grace. Multnomah, 1995, pp. 298-308
  3. Piper, John. When the Darkness Will Not Lift: Doing What We Can While We Wait for God–and Joy. Crossway, 2007.
  4. Powlison, David. “Hope for a ‘Hopeless Case’: A Case Study,” Journal of Biblical Counseling 18:2, Winter 2000, 32-39.
  5. Welch, Edward T. Depression: Looking Up from the Stubborn Darkness (New Growth Press, 2011, a re-titling and minor revision of his 2004 book, Depression: That Stubborn Darkness)

Homework Assignment:

I am attaching a PDF document with my homework assignment on it. It is a chart I produced and use occasionally to help people avoid areas that tempt them to trust in idols so they can avoid falling into depressive thinking and behaving.
It is entitled: Missing Gods DZ.pdf

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