Read an Excerpt
CHAPTER 1
Finding a New Path Forward
Why Lasting Healing Can Feel like an Unreachable Mirage
We've all heard it before: "Depression is all in your head! Just give it time." Or worse, "Snap out of it already!"
This kind of advice is rarely loving or helpful — though, like the broken clock that is accurate twice a day, it occasionally manages to be sort of right. That is, for people who are experiencing an ordinary case of the blues or temporary emotional upheaval due to grief or trauma, time can be an ally, and natural mental resiliency usually does return in due course.
But for millions of people around the world, those more common scenarios are unfamiliar. These individuals are caught in the grip of something larger and more tenacious than that. They suffer from clinical depression, and no amount of glib advice is going to make it "go away." So, here at the beginning of our journey into Healing Depression for Life, let's orient ourselves on the map and all agree on a common starting point:
Depression is real. And painful. And frightening.
All too often, depression can even be life threatening when it drains a person of hope to the point of considering self-harm. Beyond the toll it takes on individual lives, depression places enormous strain on families, businesses, schools, and governments. In fact, no corner of society is immune to its disabling effects. That's true across the globe, not just in America. According to a World Health Organization (WHO) bulletin, "More than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015." WHO further estimates that "substance abuse and mental disorders," including depression, are the world's number one cause of disability — the loss of normal function at home and work.
Here at home, the 2016 National Survey on Drug Use and Health revealed that 16.2 million adults and 3.1 million adolescents between ages 12 and 17 had endured a recent "major depressive episode." Around two-thirds of those people suffered life impairments that were rated as "severe." However, approximately 37 percent of these adults and a staggering 60 percent of young people received no treatment of any kind, according to the survey.
To make matters worse, research in recent years has revealed that, of those who do seek help, approximately one-third receive little or no lasting benefit from treatments commonly used today. Think about that for a moment: one in three people sees little or no long-term benefit from common treatments for depression. Clearly, the typical approaches offer very limited lasting benefits.
According to the National Institute for Mental Health, symptoms of depression include the following:
• persistent sad, anxious, or "empty" mood
• feelings of hopelessness or pessimism
• feelings of guilt, worthlessness, or helplessness
• loss of interest or pleasure in hobbies or activities
• decreased energy, fatigue, or being "slowed down"
• difficulty concentrating, remembering, or making decisions
• difficulty sleeping, early-morning awakening, or oversleeping
• appetite and/or weight changes
• thoughts of death or suicide or suicide attempts
• restlessness or irritability
• persistent physical symptoms such as aches or indigestion
At The Center: A Place of Hope, we believe that if a person reports a chronic combination of these symptoms lasting sixty to ninety days — far beyond what's expected in cases of the ordinary blues we all experience from time to time — then he or she is in need of coordinated care for major depression. Our admissions specialists assess the severity of depression in those seeking help using three criteria: hopelessness, helplessness, and despair. Once a person's experience can be characterized by words as bleak as these, they have long lost the ability to "snap out of it."
That so many people do reach this point in their lives makes depression a human tragedy of stunning proportions.
No More Quick Fixes
Now that we've established the magnitude of the problem, let's agree on a vastly more important fact: it doesn't have to be this way. Healing is possible, now and for good. So why do we continue to fall so short? Why do even the lucky ones with access to care so often come away disappointed?
While the answers to these questions are far from simple, they don't take an advanced degree in medicine to understand. There is a certain lack of common sense at the root of the problem. Once you've seen that fact, there in plain sight, the mud starts to settle and the view becomes clearer.
Here's one way to get your head around it. Imagine you take your car to the shop. It's hard to describe to the mechanic exactly what seems to be going wrong. The best you can do is to say, "It's just not right." The engine doesn't fire right up in the morning the way it used to. There's no pep anymore when you hit the accelerator. The steering is sluggish and unresponsive, and the tires inexplicably lose air no matter how often you refill them. The heater is stuck at lukewarm, and all the radio speakers sound muffled, ruining your favorite music. You used to love this car. Now it's no fun to drive at all.
As you conclude your list of the car's "symptoms," the mechanic nods sagely and assures you he knows just what's causing the trouble. "You need a tune-up!" he says, with great confidence. You are not the expert, so you take his word for it. "Come back tomorrow, and everything will be back to normal."
You can see where this story is headed. The next day after the repair work, you start the engine to head home and discover that nothing has changed. In fact, you feel worse about things, because now you're out the cost of a tune-up and the time spent waiting for the work to be done. You turn around and tell the mechanic to try again. And so, day after day, the list of ineffective repairs grows longer and longer, and you feel further and further away from your goal. Discouragement sets in, and you're about to give up on the prospect of ever driving a functional car again.
The problem is easy to see in this made-up example: the mechanic is assuming the car's troubles are caused by just one thing. Instead of looking at the vehicle's systems as an integrated, interdependent whole, he has been trained to see it only as a collection of separate parts. Repair, in his view, is about fixing the broken piece, period. No need to look in the trunk for problems he's sure are under the hood.
Not only that, the mechanic sees your car only in light of all the others he's worked on lately. Last week, a Chevrolet came in with some of the same troubles and, lo and behold, the tune-up worked! Suddenly, to him, all cars that have lost their pep fall into the same category and require the same treatment.
Now, please don't think I'm disrespecting mechanics or the caregivers they represent in this little fable. Nearly everything they are trained to do is effective under the right circumstances. Sometimes a tune-up is exactly what's called for. But if it becomes a one-size-fits-all solution to every malfunction — no matter how complex or multi-faceted its causes and no matter the differences between individual automobiles — that's an approach sure to lead to as many failures as successes. Maybe even more.
Treatment Is a Team Effort
That's what has become of standard treatments for depression these days. Care providers tend to use their favorites as singular fixes for a disorder that is never caused by one thing alone. In my experience, depression always arises from multiple factors converging in a person's life. Treating one thing at a time, with one method at a time, is akin to expecting new tires to revitalize a car with multiple systems on the blink.
Below is a list of commonly prescribed depression treatments these days — and the reasons why each on its own is unlikely to produce lasting healing.
Medication
More than thirty years ago, on December 29, 1987, the US Food and Drug Administration approved the antidepressant drug fluoxetine, now well known by its trade name, Prozac. The first drug of its kind, it marked a radical shift in how depression is treated in the world. Prozac belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs) that is thought to increase levels of the neurotransmitter serotonin by interfering with the body's ability to reabsorb it from the bloodstream. Scientists theorize that a lack of serotonin is at least partly responsible for symptoms of depression.
The discovery of SSRI drugs — and now there are many different versions on the market — was hailed as a revolution in the treatment of depression and other mental disorders. But in the intervening years, while antidepressant medications continue to be widely prescribed and many people do derive some benefit from their use, evidence has mounted that they are not the "magic bullet" doctors once hoped they would be. Here are a handful of reasons why:
• In numerous studies, SSRIs performed only marginally better than placebos.
• Patients taking antidepressants show roughly the same improvement as those being treated with talk therapy alone.
• Between 65 and 80 percent of people on antidepressants relapse into depression within a year.
• SSRIs carry side effects for many people, some of which are significant. These include trouble sleeping, sexual dysfunction, loss of appetite, dry mouth, rash, abnormal dreams, and more serious effects like seizures and an increased risk of suicide.
• It is now recognized that discontinuing the use of SSRIs can be difficult, similar to withdrawal from other addictive drugs.
Don't misunderstand: I am not opposed to the use of medications, which can sometimes stabilize an individual enduring an acute crisis. Further, I am privileged to work in conjunction with many brilliant, caring physicians who skillfully use pharmaceuticals as part of their therapeutic regimen. I believe antidepressant medications have a vital role to play in recovery for many people. They can calm the chaos of a major depressive episode to give you a chance to rest and regain your footing. What they can't do is fix the reasons you became depressed in the first place — and that is perhaps the biggest drawback of all.
Underlying the use of antidepressant medications is a mostly unspoken but powerful medical philosophy that asserts the problem is largely (if not entirely) biochemical in nature. For many decades, the medical establishment has regarded psychology and psychiatry with suspicion, calling these fields "soft science." That's because measuring mental health or dysfunction is not as simple as tracking physical markers and manifestations. Doctors trained in strict biological models are more comfortable with mechanical causes and cures for illness — even mental disorders. Some distrust talk therapy or behavior adjustment as inherently untestable. ("It's all in your head" takes on a different meaning in this context.)
Once a person accepts this view and starts taking medication with the expectation that "everything will be fine now," then doctors and patients alike stop considering all the other causes and remedies we now know have a role to play. These are the puzzle pieces we look for in the whole-person model of treatment: diet, other medications, built-up toxins in the body, physical conditions, life circumstances, emotional environment (past and present), allergies, spirituality, sleep habits, addictions, and more. Uncovering and correcting problems in these areas of your life takes commitment, sacrifice, and work, so it's easy to see the appeal of a pill that does it all for you.
Talk Therapy
Again, it's important to understand that there are many gifted therapists in the world doing excellent work to provide hope and healing to their clients. I have great admiration for caring, trained therapists who consistently offer wisdom and compassion to their clients. These professionals create a healing space where a person can feel safe — perhaps for the first time — to explore painful wounds from the past or confront present-day circumstances that are intolerable. Like the car tune-up, this may be exactly what someone needs who is suffering a typical case of doldrums or who is in the process of recovering from the grief of loss.
But for those in the grip of major depression — remember, these are people who are hopeless, helpless, and despairing — talk therapy alone is unlikely to produce lasting relief and healing. Here's why:
• Talk therapy rarely integrates a thorough exploration of physical conditions that contribute to depression.
• Talk therapy is generally a slow process, which is not always suitable for someone who may be considering suicide or who is sliding toward an inability to function on a basic level.
• Talk therapy tends to look backward, searching for old wounds to account for current patterns of thought and behavior. Most often we find plenty of immediate causes in our patients, things that can be addressed here and now.
Working through deep issues with a therapist can be an outstanding component of a whole-person treatment plan, one of many simultaneous avenues for healing. As powerful and helpful as counseling can be, I still believe it should be utilized among other treatment approaches to experience lasting progress in overcoming depression.
Cognitive Behavioral Therapy (CBT)
While psychotherapy is focused on understanding the root causes of a person's symptoms — often buried out of sight in the subconscious mind — CBT is chiefly concerned with developing strategies for managing those symptoms right now. The idea is to help people see that changing distorted thoughts, beliefs, and attitudes about themselves, others, and the future can have a direct effect on how they feel about those things. Distorted thinking is usually accompanied by maladaptive behaviors that can likewise be reprogrammed to improve a person's outlook.
Research has shown that CBT alone is at least as effective as antidepressant medication at treating less severe forms of depression, but it is usually recommended in combination with drugs for people experiencing more severe symptoms. Once more, it's clear that CBT has an important role to play, but used in isolation it has the following shortcomings:
• CBT ignores underlying medical conditions that contribute to depression.
• CBT does not address environmental factors, such as exposure to toxins and electromagnetic radiation.
• Being focused on reducing present-day symptoms, CBT does not consider depressive emotions like fear, anger, and guilt or the toxic effect of refusing to forgive someone for a perceived offense.
• As a treatment for depression, CBT is less likely to find and deal with associated mental conditions, such as addiction or anxiety.
Pray (or Meditate) It Away
Seeking spiritual connection is a powerful and effective part of any healing strategy for people with depression — or anyone else, for that matter. It is absolutely a part of the whole-person model. God truly is the Great Physician.
I want you to know that I believe wholeheartedly in prayer, and in fact, I pray to the God I have faith in nearly every day. What's more, I have witnessed countless answers to prayers in my own life and in the lives of others. As you'll see in part 2, spiritual practices are a central part of the whole-person approach I advocate.
My concern arises when people suffering from depression rely only on prayer, at the exclusion of other resources available to assist in their healing. Prayer without appropriate attention to other obvious avenues for wellness runs the same risks as other single-focus approaches. If you believe prayer by itself is all you need to heal, you may be less likely to explore your diet, sleep habits, possible addictions, toxic chemicals lurking in your home, harmful emotions that hold you captive, and so on. Spiritual resources are meant to empower you in confronting and changing all those kinds of things, not to distract you from the need to deal with them. I encourage my clients (and myself) to pray especially for wisdom and guidance in dealing with life's many challenges, including depression.
But the most important reason why prayer as a solitary healing strategy can disappoint you in the end is that it runs the risk of deepening your sense of unworthiness and failure — emotions that are key contributors to depression. The inner dialogue goes something like this: If I were a better Christian (or a more spiritual person), I wouldn't be depressed in the first place. So to turn this thing around, I will double down and be the best child of God I can possibly be.
(Continues…)
Excerpted from "Healing Depression for Life"
by .
Copyright © 2019 Dr. Gregory Jantz.
Excerpted by permission of Tyndale House Publishers.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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