Stewardship of Self for Cross-Cultural Workers: Depression

Ronald Koteskey & Marty Seitz 

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Christians are not immune to emotional disorders, such as depression. Although a clinical term that is not used in the Bible, depression appears to have been relatively common among early leaders of God’s people.

Early church musicians who wrote Psalms 69, 88, and 102 expressed the despair of depression in the context of hope. Moses, a leader of God’s people and well-known author, asked God to put him to death because he could not carry the burden of the people God had asked him to lead (Numbers 11). Jonah, a successful early cross-cultural worker, also asked God to take his life when his anger resulted in a wish for death (Jonah 4). Elijah, a leader with the gift of prophecy, fell into the depths of depression. He prayed to die immediately after intense spiritual warfare and a great victory over the forces of evil (1 Kings 19). Therefore, even those actively involved in ministry can become depressed.

Depression and its causes

Although depressed Christians may have many different symptoms, the core of depression always includes depressed moods (sadness, emptiness, tearfulness) or loss of interest or pleasure in most activities. In addition, it may include changes in weight, sleep, energy, emotions, and thoughts. It has many causes, including:

  • Genetic and biological—depression runs in families
  • Medical—the side effects of some medical conditions and some medications may include depression
  • Background and family causes—childhood experiences can lead to later depression
  • Stress or significant loss or changes, such as separation, birth of a child, or death may result in depression
  • Learned helplessness in situations where we feel like we have little or no control
  • Thinking in ways that overlook the positive and see only the pessimistic
  • Anger turned against yourself
  • Sin and guilt leading to self-condemnation and hopelessness
  • A lack of positive or pleasant experiences
  • Having a lack of meaning in life

How do I know if I’m depressed?

The definition of depression changes slightly from time to time, but currently a person must have at least one of the following symptoms most of the day, nearly every day, for two or more weeks to be considered "clinically depressed:"

  • Feel sad, depressed, or empty
  • Lose interest or pleasure in almost all activities

In addition, the person must have more than three or four of the following nearly every day for the same two or more weeks:

  • Great increase or decrease in appetite
  • Sleeping much more or less
  • Agitation or sluggishness
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Decreased ability to think or decide
  • Thoughts of death or suicide

These symptoms must be bad enough to distress you or impair your daily functioning. If you do not have at least five of these symptoms (including one of the first two), then you do not meet the definition of "clinical" depression. Even if you are not clinically depressed, suggestions in this brochure may be of benefit to you. (Note that if your symptoms have been moderate and have lasted two or more years, or if they include great swings in mood including periods of elation, recommended treatment may be different from that recommended below.)

Although it will not give a professional diagnosis of depression, a depression questionnaire at the following web site will help you determine if you may need to see a mental health professional:http://mentalhelp.net/guide/dep2quiz.htm

What can I do if I’m depressed?

Consulting a mental health professional would be ideal. Also ideal would be getting a thorough physical exam. Depression can have physical bases, and your physician may be able to evaluate you for an antidepressant if necessary. However, some Christian workers live in isolated areas where there are no mental health professionals. Others have no health insurance or only insurance that does not cover mental health, and they cannot afford to pay the bills themselves. But if you are feeling tempted to act on suicidal thoughts, that indicates you need immediate help from someone other than yourself. The following are specific applications of our "General Principles of Stewardship of Self." You may find one or more of these helpful in beginning to care for yourself.

  • Read portions of Scripture that seem particularly well-suited to expressing the feelings and thoughts of persons when they are depressed. For example, pray Psalm 13 with King David, leader of God’s people. Also read Scripture passages filled with hope, such as Psalm 40, Psalm 42, or 2 Corinthians 1:3-11.
  • Find information about depression on the Internet at sites such as the one maintained by the National Library of Medicine at www.nlm.nih.gov/medlineplus/depression.html or the one at http://mentalhelp.net/disorders/. These web sites have numerous links to reliable information about depression. (Remember that the domains .gov and .edu tend to be the most reliable.)
  • Read good books about depression, such as Feeling Good: The New Mood TherapyThe Feeling Good Handbook, or Ten Days to Self-Esteem, all by David Burns. Or read Happiness is a Choice: The Symptoms, Causes and Cures of Depression by Frank Minirth and Paul Meier.
  • Keep a log of your symptoms of depression to find events or thoughts that occur before the symptoms get better or worse. Then avoid those events or thoughts that precede depression and increase your participation in events or concentrate on thoughts that prevent or decrease it.
  • Find ways to reward yourself for thinking or behaving in ways that decrease your depression when you discover what helps. For example, if saying, "This too shall pass" helps, pat yourself on the back by also saying, "I’m putting feet to my prayers by talking to myself this way."
  • Do activities that once were rewarding or pleasurable, even if you do not think they will bring you pleasure now. If you cannot think of any, do something that most people find pleasurable, such as enjoying nature, listening to music, or reading a good book.
  • Take time to be out in the bright light of the sun while protecting your skin since sunlight often helps reduce depression.
  • Confess a fault or sin to an appropriate person in order to alleviate guilt.
  • Make a caring confrontation if you need to confront someone about things they are doing that are hurtful to you or others.
  • Ask for help from trusted friends, family members, physicians, or counselors.
  • Make a choice to take the first step in putting feet to your prayers for overcoming depression by deciding on one thing you can do for yourself today. Then do it.
  • Tell someone else about your commitment to take that step to actually do something.
  • Ask that person to hold you accountable for taking that step.
  • Express the sadness, grief, and pain of loss or frustration. Isaiah is often interpreted as referring to Jesus as the "Man of Sorrows" (53:3-4). John recorded that "Jesus wept (11:35).
  • Focus thinking on things that are good, pure, lovely, true, noble, and admirable (Philippians 4:8). These are things that give us hope. Take off the "dark glasses" and look at the good that can come from your troubled situation. Remember the old song that said, "Count your many blessings; name them one by one."
  • If no medical professional is available, several herbal supplements are effective for the treatment of mild to moderate depression. St. John’s Wort and Sam-E are widely available—but if you take these, be sure to tell your physician when you see him or her.
  • After checking with your doctor, if one is available, gradually work up to exercising (after beginning to perspire) for at least twenty minutes at least three times during the week. Such aerobic exercise has proven effective in reducing depression.
  • Force yourself to be with people even when you do not feel like it. During depression the tendency is to withdraw from others, but being with people may actually help relieve your depression.
  • If you cannot make yourself socialize, ask someone else to coax you to be with others even when you persistently resist.
  • Find a trusted person or group with whom you can share your struggles. Just as you have wept with those who weep, let others weep with you. If you are in an isolated location, numerous Internet support groups are available on-line.
  • Monitor your thoughts for self-talk that is despairing and hopeless. Then tell yourself, "Stop!" Do not continue to think that way but choose to repeat true and hopeful thoughts.
  • Read or sing or listen to hymns or choruses or other Christian music that are hopeful, such as "It Is Well With My Soul" or "This Is the Day."
  • Think of things that helped in the past when you were depressed. Then do those things again.
  • Ask other people what they have done when they were depressed. What worked for others may work for you.
  • Write out your thoughts and feelings on paper. Create a poem. Compose a hymn that expresses both the pain of your depression and the hope for relief.
  • Do something to help someone else with no expectation of receiving anything in return. This will get your focus off yourself and on to helping others.
  • Do not be afraid of bringing others "down." You may be giving them an opportunity to minister to you—and you can set an example of vulnerability that encourages them to be honest.
  • Specifically pray for direction from the Holy Spirit about what is causing the depression and what to do about it. Remember that he is the great Physician.
  • Ask others to pray specifically for you about your depression and its symptoms.
  • Take advantage of healing services offered in your church.
  • If nothing you try seems to help, try to discern how God may use your depression in the larger context of his kingdom.
  • It may prepare you to minister more effectively to others by giving you empathy (2 Corinthians 1:3-7).
  • It may help keep you humble and dependent on God (2 Corinthians 12:7).
  • It may produce spiritual blessing (James 1:12) or demonstrate God’s power (John 9:1-7).
  • It may be a sign that you belong to Christ (1 Peter 4:12-19).
  • God may use it to test your faithfulness (The book of Job).

You may not be able to do all of these things, and they do not all work with everyone. However, all of them have helped some people, and one or more of them may be just what you need to reduce your depression.

Ronald Koteskey is
Member Care Consultant
GO International