The Psychological Roots
“I’VE done every test, and nothing shows up,” the kindly doctor told Elizabeth. “I believe you are severely depressed and for good reason.”
Elizabeth, who felt that her problem was a physical illness, began to wonder if the doctor was correct. She reflected on her daily struggle for the past few years with her unruly, and often uncontrollable, six-year-old son, who was later diagnosed as having an attention-deficit disorder. “The day-in, day-out stress and anxiety that never let up took an enormous toll on my emotions,” confided Elizabeth. “I had reached the point where I felt hopeless and suicidal.”
Many depressed persons, like Elizabeth, have faced an exceptional amount of emotional strain. In fact, a landmark study by British researchers George Brown and Tirril Harris found that depressed women had a rate of “major difficulties,” such as bad housing or a strained family relationship, that was over three times greater than that of nondepressed women. These difficulties had caused “considerable and often unremitting distress” for at least two years. Severe life experiences, such as the death of a close relative or friend, a severe illness or accident, shockingly bad news, or the loss of a job, also were four times more common among the depressed women!
Yet, Brown and Harris found that adversity alone does not cause the depression. Much depended on the mental response and emotional vulnerability of the individual.
“Everything Seemed Hopeless”
For instance, Sarah, a hardworking wife and the mother of three young children, wrenched her back in a job-related accident. Her doctor said that she would have to curtail much of her physical activity because of a ruptured disk. “I thought my whole world had come to an end. I had always been an active, athletic person who played sports with my kids. I pondered this loss and felt things would never get better. Soon I lost all joy of living. Everything seemed hopeless,” confessed Sarah.
Her reaction to the accident led to thoughts of hopelessness concerning her life as a whole, and this bred the depression. As Brown and Harris, in their book Social Origins of Depression, state: “It [the provoking incident, such as Sarah’s accident] may lead to thoughts about the hopelessness of one’s life in general. It is such generalization of hopelessness that we believe forms the central core of a depressive disorder.”
But what makes many people feel unable to repair the damage of a painful loss, causing them to fall into major depression? Why was Sarah, for example, vulnerable to such a negative train of thought?
‘I’m Unworthy’
“I’ve always lacked confidence in myself,” explained Sarah. “My self-esteem was very low, and I felt unworthy of any attention.” The painful feelings associated with one’s lacking self-worth are often the critical factor. “Because of the pain of the heart there is a stricken spirit,” states Proverbs 15:13. The Bible recognizes that a depressed spirit can be the result, not of external pressures alone, but of inward misgivings. What can cause low self-esteem?
Some of our thought patterns are shaped by our upbringing. “As a child, I was never praised by my parents,” confided Sarah. “I cannot ever remember receiving a compliment until after I was married. Consequently, I sought approval from others. I have this terrible fear of people’s disapproval.”
Sarah’s intense need of approval is a common element with many who become seriously depressed. Research has revealed that such persons tend to build their self-esteem on the love and approval received from others, rather than on their own achievements. They may estimate their own worth by the extent that they are likable or significant to someone else. “Loss of such support,” reports one team of researchers, “will lead to a fall in self-esteem and this contributes significantly to the onset of depression.”
Perfectionism
An exaggerated concern about gaining the approval of others often expresses itself in an unusual way. Sarah explains: “I strove to do everything just right so that I could get the approval that I didn’t get as a child. On my secular job, I did everything just so. I had to have the ‘perfect’ family. I had this image that I had to live up to.” When she had her accident, however, all seemed hopeless. She adds: “I believed I was keeping the family going and feared that if I couldn’t function, they would fail and then people would say, ‘She is a bad mother and wife.’”
Sarah’s thinking led to major depression. Research about the personalities of depressed persons reveals that her case is not unique. Margaret, who also suffered from severe depression, admitted: “I worried about what others thought of me. I was a perfectionistic, clock-watching, organized worrier.” Setting unrealistically high goals or being overly conscientious, and yet failing to live up to expectations, is at the root of many depressions. Ecclesiastes 7:16 warns: “Do not become righteous overmuch, nor show yourself excessively wise. Why should you cause desolation to yourself?” Trying to show yourself nearly “perfect” to others can lead to emotional and physical desolation. The frustrations can also lead to a destructive type of self-blame.
“I Can’t Do Anything Right”
Self-blame can be a positive reaction. For instance, a person may be robbed because of walking alone in a dangerous neighborhood. He may blame himself for putting himself into such a situation, resolving to change and thereby avoid a similar problem later. But a person could go further and blame himself for the type of person he is by saying: ‘I’m just a careless person who is unable to stay out of trouble.’ This type of self-blame faults one’s character and undermines self-esteem.
An example of such destructive self-blame occurred with 32-year-old Maria. For six months she harbored resentment toward her older sister because of a misunderstanding. One evening she lambasted her sister over the phone. Their mother, upon finding out what Maria had done, called and strongly reprimanded her.
“I got mad at my mother, but I was even more upset with myself, for I learned how much I had hurt my sister,” explained Maria. Shortly afterward she yelled at her nine-year-old son, who was misbehaving. The boy, who became very upset, later said to her: “Mommy, you sounded like you wanted to kill me!”
Maria was crushed. She reported: “I felt that I was a terrible person. I thought, ‘I can’t do anything right!’ That’s all I could think about. Then the deep depression really began.” Her self-blame proved destructive.
Does all of this mean that everyone with major depression has low self-esteem? Of course not. The causes are complex and varied. Even when the result is what the Bible calls ‘pain of heart,’ there are many emotions that cause this, including unresolved anger, resentment, guilt—real or exaggerated—and unsettled conflicts with others. (Proverbs 15:13) All of these can lead to a stricken spirit, or depression.
When Sarah realized that her thinking was at the root of much of her depression, at first she was crushed. “But then I felt a measure of relief,” she confided, “because I realized that if my thinking caused it, then my thinking could also fix it.” Sarah said this thought was exciting to her, explaining: “I realized that when I changed the way I was thinking about certain things, this could affect my life from here on for good.”
Sarah made the necessary changes, and her depression lifted. Maria, Margaret, and Elizabeth likewise won their fight. What changes did they make?
[Blurb on page 10]
‘When I realized that my thinking caused my depression, this gave me some relief and comfort because I believed then I could also fix it.’
[Box on page 8, 9]
Childhood Depression: “I Wish I Weren’t Alive”
An interview with Dr. Donald McKnew of the National Institute of Mental Health, who has researched this subject for 20 years.
Awake!: How prevalent do you consider this problem to be?
McKnew: A recent New Zealand study of a thousand children found that by the age of nine, some 10 percent of the children had already experienced a depressive episode. And we get the impression that 10 to 15 percent of schoolchildren have mood disorders. A smaller number suffer from severe depression.
Awake!: How can you tell if children are severely depressed?
McKnew: One of the key symptoms is that they find no pleasure in anything. They don’t want to go out and play or be with their friends. They’re not interested in the family. You see loss of concentration; they can’t keep their mind even on television programs, much less their homework. You see a feeling of worthlessness, a personal sense of guilt. They’ll go around saying they think they’re no good or nobody likes them. Either they can’t sleep or they oversleep; they lose their appetite or they overeat. Plus you hear suicidal ideas such as, “I wish I weren’t alive.” If you see a conglomeration of these symptoms, and it’s lasted for a week or two, then you’re talking about a seriously depressed child.
Awake!: What are the key triggers of childhood depression?
McKnew: When you get down to the specific factors in any given child’s life, the major thing is probably a loss. While this usually means a parental loss, it could include friends, close relatives, or even a pet. Second to losses I would put depreciation and rejection. We see an awful lot of children who are maligned and made to feel they’re small or insignificant by their parents. At times a child is made a scapegoat. He is blamed for anything that goes wrong in the family whether he is at fault or not. Hence, he feels unworthy. Another factor is a mood disorder in a parent.
Awake!: The book Why Isn’t Johnny Crying?, which you coauthored, states that some children who are depressed engage in drug and alcohol abuse or even delinquent behavior. Why is this?
McKnew: We believe they’re trying to hide the depression, even from themselves. Their way of dealing with it often is to stay busy with other things, like stealing cars, taking dope, or drinking. These are ways of disguising how badly they feel. In fact, trying to hide their depression is one of the clearest ways that children differ from adults.
Awake!: How can you tell when it is depression and not a child just misbehaving?
McKnew: By talking with these children, getting them to open up, you will often find the depression. And if the depression is properly treated, their behavior improves. Though something else was showing up on the surface, the depression was still there underneath all the time.
Awake!: How can you get a depressed child to open up?
McKnew: First of all, choose a quiet time and place. Then ask specific questions like, ‘Is something bothering you?’ ‘Have you been feeling sad or blue?’ ‘Are you upset?’ If there has been a loss, you could ask, depending on the circumstances, ‘Do you miss Grandma as much as I do?’ Give the child a chance to ventilate his feelings.
Awake!: What would you tell severely depressed children to do?
McKnew: Tell their parents about it. This business of detection is a serious one because generally only the children know they’re depressed. Parents and teachers usually don’t see it. I have seen adolescents who have gone to their parents and said, “I am depressed, I need help,” and they’ve gotten it.
Awake!: How can a parent help a depressed child?
McKnew: If the depression seems to be debilitating, then it’s not something to be handled at home, any more than is pneumonia. A debilitating depression must be taken to a professional because there may be a need for medication. We use medication in well over half of our cases, even with children down to five years of age. We also try to readjust the child’s thinking. And by these means the depression is eminently treatable.
Awake!: If it’s not a debilitating illness, what can a parent do?
McKnew: Take an honest look at yourself and your family. Has there been some serious loss that needs to be talked about and dealt with? When losses occur, don’t belittle a child’s sadness. Allow him the freedom to work through his grief. Give a depressed child special amounts of attention, praise, and emotional support. Spend extra time with him alone. Your warm involvement is the best form of treatment.