Institute for Christian Psychotherapy

In the midway of this our mortal life,

I found me in a gloomy wood, astray

Gone from the path direct: and e’en to tell,

It were no easy task, how savage wild

That forest, how robust and rough its growth,

Which to remember only, my dismay

Renews, in bitterness not far from death.

Yet, to discourse of what there good befell,

All else will I relate discover’d there.

How first I enter’d it I scare can say,

Such sleepy dulness in that instant weigh’d

My senses down, when the true path I left;...

from Canto I of Dante’s Divine Comedy

In the midway of this our mortal life, I found me in a gloomy wood, astray... An individual depressed could not have said it better. So it is how Dante tells of his "mid-life" crisis, his entry into a depression that would in the end reveal to him the depths of a despair and the heights of a creativity that the world still honors to this day. So it is with depression.

Depression is vilified as a debilitating illness – and so it can be – but it is also the doorway to a new life and new creativity. For depression is also a descent that is called for if an ascent is to be made, for no less than Jesus Christ has illustrated this for us. He has shown us that crucifixion and burial is required before resurrection. And a descent to the dead is necessary before an ascension into heaven. Though it consequently may be an unavoidable aspect of life, depression is still to not be taken lightly, for Dante will soon find inscribed over the portals of the hell he is about to enter, All hope abandon, ye who enter here.

Here is the danger, and here is the answer to the ordeal of depression: hope. For those whose hope is striped by depression, this afflication can be deadly. For those who can find hope in their agony depression can bring about a new life far grander than the one to which they wish to return. Because, in this manner, depression is a form of exodus. Just as the Hebrews were called to leave the relative security of slavery in Egypt in order to gain the promise of freedom in a new, abundantly creative land, so too is each and everyone of us called forth in life. Just as these same Hebrews had to journey through the desert hardships to gain this new land, so too must we traverse an experience of depression to gain that to which we are called. This is one of the origins of depression, and its most profound aspect.

There are at least two common forms taken by depression, each of them in some manner the outcome of a loss. The first, and most profound, is depression as exodus, what otherwise may be termed a creative depression. The other, a potentially destructive depression, is essentially the result of the denial of death. This denial is seen in an individual’s apparent inability to detach from some lost object, whether that is a person, event, goal or even material item.

Much of the time that we encounter a person either who is in sorrow or experiencing a depression we will also unearth some loss that the individual cannot accept. In the most obvious cases this loss may be death of a loved one, or a divorce. It may be the loss of children heading off to college, the military, or their own marriages.

The loss may be of some aspect of identity. Many a person will become depressed as their hair greys, their energy wanes, or as they approach the end of their childbearing years. Others at the prospect of retirement, and even the young when it comes time to graduate from school. Depressions due to loss also need not be associated with only negative losses, either. The individual who has set their goals and attained them often will experience a depression, for now that the goal is gone the meaning of their lives to that point has been lost. Those who have been great professional athletes are certainly a case-in-point.

Why is it that such losses occasion depression and why is this seen as a denial of death, or in other terms, a denial of loss? Because depression is itself a means by which to hold onto what was lost. The psychoanalysts Silvano Arieti and Jules Bemporad once wrote, "at times the severe sorrow of the depressed person acts also as a representation of what was lost, because as long as the sorrow remains, the loss is not complete." The feeling itself takes the place of the lost person, goal or thing. And there is a contingent belief that nothing will ever be able fill the place of that which is lost.

When it comes to the loss of a love, sometimes that sense can be true. What will ever take the place of a loved one who is gone? But in other cases, such a belief is erroneous. And even in the case of death, the loss can be seen in a different light. For the treatment of all depression is dependent upon one thing: hope. Hope in a new life; hope in a new goal; hope that new meaning and purpose can be found; hope that another identity may be formed. Hope that there is a new land, a new promised land of abundance and creativity before us. Even in the case of death, hope that a belief in an afterlife is true and that the separation from the one loved is but a temporary situation. Hope of some sort must be found if the journey through and out of depression is to be successful.

Hope can be elicited in a variety of ways. One productive manner is to realize that options are always available. One of the must detrimental aspects of depression is the tendency to maintain "tunnel vision" regarding one’s circumstances. To set aside a negative mindset and to begin to look at the possibilities of a situation rather than the problems will allow an individual to see that they are not trapped and that there is hope for change. This general approach can be applied to any variety of perceived losses. The person facing retirment who sees the meaning in their life being stripped away, believing that they are now useless and without purpose can have a new sense hope in life if they understand that life still has options for meaning and purpose for them if they will but look for them. Or the man or woman approaching midlife who sees that they will not accomplish all their youthful goals may find purpose in accepting the meaningfulness that life still holds, but in a more mature and wiser fashion.

However, for anyone depressed, the assistance of someone walking through this life situation is a necessity. When depressed the importance of a trained person to help is vital. To deal with depression alone is extremely difficult, but to walk through it with someone who does not understand depression can also be detrimental. A consequent result of depression – because it is a loss of life energy – is that the individual does not have the motivation or the drive to do alone what is necessary to overcome the depression. Even the seemingly easy feats of getting more exercise, eating in a more healthy manner, and getting sufficient sleep are often overwhelming tasks for the depressed person. Psychotherapists, friends, and family are significant resources for the depressed person to urge them onto healthy behaviors and new ways of thinking and understanding themselves and their lives. But if the counselors, friends, and family are not understanding they can also drive the depressed person deeper into despair as they may facilitate a greater sense of that person’s meaninglessness, guilt, and narrow perspective on life.

Depression of some form may not be avoidable to us during this life, but the debilitating aspects of depression need not take hold if we can hold to the hope that is God-given to us. When the debilitating aspects do possess us, then professional help is prescribed. But for each person it is required that they will at some time need to enter the dark wood of Dante’s description. For depression is often the signal of a new move in life, a change that must take place if we are to continue to mature into the image of God in which we were all created. If, like Dante, and all the saints of old we accept this journey, we may also find our way through the darkness to a new creativity and more meaningful life. As Dante speaks to his readers after traversing this path he concludes:

Then, Reader! Might I sing, thoughbut in part

That beverage, with whose sweetness I had ne’er

Been sated. But , since all the leaves are full,

Appointed for this second strain, mine art

With warning bridle checks me. I return’d

From the most holy wave, regenerate,

E’en as new plants renew’d with foliage new,

Pure and made apt for mounting to the stars.

Canto XXXIII , The Divine Comedy

I return’d from the most holy wave, regenerate, E’en as new plants renew’d with foliage new... The accomplishment of the journey through depression leads to regeneration, it leads to newness, the newness of a tree that has died for the winter only to find itself older, stronger and fuller the next spring as its foliage once again reaches for the heavens.

Everyone experiences times when they are sad or in an unhappy mood. Oftentimes when someone says, "I'm depressed," what they really mean is that they are sad. So how do you know if what you're feeling is just a sad mood or maybe a serious sign of depression?.

Just a mood . . . or am I really depressed? A mood comes and goes; it usually doesn't last very long. Moods change depending on the situation. Feelings of depression are harder to push away and usually last much longer than a mood. It's when you can't control the changes (or length of time) in your mood that these mood swings may be a sign of depression or bipolar disorder, which is sometimes called manic depression (extreme highs and lows). So it's very important to find out whether what you're feeling is truly just a mood or a form of depression. Depression in children and teens can result in more serious problems, even suicide. In 1997, suicide was the third leading cause of death in 10- to 24- year olds. So if you or someone you know is talking about suicide, it's important that an adult who can be trusted is told - a doctor, teacher, parent, school counselor, priest or pastor.

How common is depression in children and adolescents? More common than you might think. One in ten teens will experience some form of depression or bipolar disorder. Children and adolescents are not immuned to feelings of depression. Stressors such as family problems, parents' divorce, criticism, and school troubles hit kids just as hard as they do adults. Sometimes though kids with depression can't describe their feelings or moods. Unlike adults, many young people do not have the same coping mechanisms to process and deal with the changes in their lives. For example, instead of saying how bad you feel, you may act out and be irritable toward others. Or you may use drugs and alcohol as a way of dealing with your feelings. Unfortunately, depression in young people often goes unrecognized by families and physicians alike. Signs of depression are viewed as normal mood swings typical of your particular developmental stage. Yet without early diagnosis and treatment of depressive illness, you are at a higher risk for poor self-esteem, problems with relationships and symptoms of depression. Oftentimes, many children and teens wind up taking increasing risks, leading to smoking, drug abuse, and pregnancy.

Are there different types of depression? Yes. Here is a list describing the difference between moods and depressive illnesses.

• Bad Mood -- Moods are frustrating but temporary. They are normal feelings which come and go and don't last for very long.

• Mild Depression -- When you are mildly depressed, you probably feel sad, but you can still enjoy your family and friends and look forward to upcoming activities.

• Situational or Reactive Depression -- This type of depression results from a normal (and healthy) sadness about some recent loss, or major life change such as the death of a loved one or pet, a break-up with your girlfriend or boyfriend, or the divorce of your parents. Sometimes disappointment in receiving low grades can trigger situational depression. .

Situational or reactive depression usually lasts no more than a couple of weeks. If your feelings of sadness continue any longer than two weeks, you should talk to a trusted adult, doctor, or counselor. Most people are surprised (and relieved) to find how much talking about their feelings really helps.

Depending on the loss, you may experience sadness for longer than two weeks. Grieving over the death of a loved one will likely take much longer to recover from than breaking up with your girlfriend or boyfriend. And oftentimes, the initial reaction to the loss of a loved one leaves a person in a state of shock. It may take longer than two weeks to even speak of the event. "Normal" grief varies with each individual.

Major Depression -- Symptoms of major depression include: sadness that just won't go away; major changes in your appetite (you eat more or less); difficulty sleeping or waking up; sleeping too much; loss of energy; tiredness; difficulty making decisions; trouble concentrating; feeling irritable and out of sorts; feeling guilty and worthless; unable to enjoy former interests; and/or having thoughts of death or suicide.

Bipolar Disorder -- Most people who have this illness experience periods of mania - intense "highs" of energy --followed by periods of depression. Some symptoms of mania include: heightened mood, overconfidence; less need for sleep; unrealistic plans and ideas; irritated and aggressive behavior; racing thoughts and speech; poor judgment; concentration problems; and reckless behavior such as spending sprees and driving really fast. The depressive symptoms are listed above, under major depression.

Depression and bipolar disorder may make school achievement difficult; or may cause constant anger, shouting at people, starting fights, rebellious acts, trouble with family and friends, and/or experimenting with alcohol and/or drugs.

Depressive illnesses can not be caught like a cold or the flu. Research has shown that major depression and bipolar disorder are a sign of an imbalance in brain chemicals called neurotransmitters. These illnesses also can be triggered by medical illnesses, some medications, a change in health habits, substance abuse or hormonal changes. Some studies have shown that stress can also trigger some symptoms.

If you have a depression or bipolar disorder, it may not center on any particular event, but will impact everything you do. You needn't be discouraged. . .Major depression and bipolar disorder are treatable, just like any other medical illness.

Take the following quiz to help you decide if your moods are a result of depression or bipolar disorder.

How do you really feel? Check off the feelings that fit you now or have fit you in the past.

I feel sad or irritable a lot, and it doesn't go away.

I feel guilty, I have no confidence.

I feel that I am a failure or let my family down.

I lose interest in hobbies like music or sports. Most of` the time I'd rather be alone.

I often feel restless or tired.

I have trouble sleeping or I sleep too much.

My appetite is increased or decreased.

I get unrealistic ideas about the great things I'm going to do.

My thoughts race. I can't slow my mind down.

I often think about death. Thoughts about suicide pop into my mind.

I use drugs and/or alcohol on a regular basis.

If you have (or have had) four or more of these feelings, and if they last longer than two weeks, you may have depression or bipolar disorder. You should seek help from a medical professional. If you checked any of the last three statements, ask for help immediately from your parents, another adult friend, teacher, clergy member or school counselor. It may be hard to tell someone you trust what's on your mind, but it's very important.

If You Show the Warning Signs of a Depressive Illness. . .Help yourself by getting the help you need. Suffering alone is not cool! It's not shameful to have an illness that affects your thoughts and behaviors. Dealing with depressive illness is not as simple as using will power. There is scientific proof that depression is caused by changes in the body and the brain. Millions of people with depressive illnesses lead normal lives with the right treatment, just like people with other illnesses.

Getting the help you need. . .For many people, the first step is going to a professional who is trained to recognize depressive disorders. Next is getting the right care and treatment. People with depression and bipolar disorder usually need a combination of medication, counseling and moral support from family, friends and other people who have a similar depressive illness. Talking with friends and family isn't enough to treat depression or bipolar disorder, although their moral support is very beneficial.

It's important to see a mental health care professional who can make a diagnosis and make certain that other illness are not causing major depression or bipolar disorder. Medication may be recommended. Antidepressants are prescribed for major depression, mood stabilizers are used to treat bipolar disorder. These prescribed medications do not cause artificial happiness. They do not change someone's personality, are not habit forming and don't "space people out." They help return a person to normal moods and behaviors.

As we enter the holiday season, there will be a good deal of discussion regarding the "holiday blues." It is important that we pay attention to this form of depression, which seems to take its cue from the advent of the holidays. We are called to be aware of those people without families or close friends that feel sad and alone at this festive time of year. We know enough to make sure that there are activities for the lonely and the despondent so that they feel included and accepted in what can otherwise be a cold and isolating world. As the emotional highs and festivities of the holiday season surround us, we are also confronted with the holiday lows: lows that we can perceive as the shadow of the otherwise bright season.

The homeless, the recently bereaved, the single: all of these persons are the obvious potential casualties of depression at this time of year. The more subtle casualties are those struggling to maintain the appearance of normalcy, but who are all the same lonely or troubled. Those in marriages which look good to the outer world, but which are internally empty. The person who has recently retired with a bravado of taking on a new world of interests, but feels the loss of a long-term identity. Those whose children are coming home for the holidays, which appears festive and joyful, but closely hidden behind the joy is the distressing realization that the visit is short-lived, with a subsequent amplification of the loneliness to which the person has otherwise adapted. All of these potential causes of depression are more or less hidden behind the joy of the season.

It is important, then, to be able to recognize the indicators to this subtle depression known as the holiday blues, since depression is often misunderstood as merely being sad. However, a sad or dejected person can become happy when the prospect of pleasure is offered. The disheartened person may find encouragement when the situation changes. But the depressed person often stays stuck in misery when the merely dejected and sad will change. Depression is more than being disheartened or discouraged, it is an inner brokenness that must be mended. Proverbs illustrates the difference: "A man’s spirit will endure sickness; but a broken spirit who can bear?" (18:14). So, if you observe a friend or loved one to have consistent sense of tiredness or boredom, and a lower energy level this is more indicative of depression than sadness.

Furthermore, other indicators to watch for are: a change in appetite and eating habits; insomnia or sleeping too much; feelings of guilt or inadequacy; decreased effectiveness at school, work, or home; decreased ability to pay attention, or to concentrate and think clearly; social withdrawal from groups and friends; loss of interest in and enjoyment of sex; restriction of involvement in pleasurable activities; physical and mental slowing down; irritability; less talkative than usual; pessimistic attitude toward the future; tearfulness or crying; sad facial expressions; recurrent thoughts of death or suicide; loss of interest and motivation in activities formerly considered important. If many of these symptoms are descriptive of someone you know, a watchful eye should be kept on these persons, to make sure that they are not left in isolation, nor demanded to maintain the facade that "everything is alright". Rather, it is to these people, just as much as to the homeless, that our seasonal overflow of love needs to be directed.

These holiday blues, unfortunately, are not the end of the story. For there is a little-acknowledged, but even more insidious, part of this shadow: the post-holiday depression. Actually this is more potent than the more obvious lows because of the added fact that generally it goes unacknowledged. During the holiday season--which in many ways now begins around Halloween--there are office parties, church parties, friends' parties. There are events put on by other service organizations. Commercial events abound. It is actually more of a problem at times to get good rest between all the activities during the holidays than it is to deal with feeling alone and bored. But come New Year's Day it all ends. January is a let-down. There may be the sole post-holiday party here or there, but on the whole January is a back to business-as-usual month. And it is then that the starkness of how alone one is can be sorely felt. There is no party, no concert, no event to look forward to and to distract one from the loneliness of life. And in comparison with the exaggerated elation of the previous two months January is truly depressing.

Because of this we must also become as attuned to this post-holiday depression as we have to the holiday blues. To be aware that January and February may be the time to keep a closer eye on those who may already have been targeted as of concern during the holiday season. Watch for signs of suicide and despair: the rate is higher than during the holiday season.

An admirable job has been done in lighting up the shadow of the holiday season and overcoming it in many people's lives. But it is equally important to watch for the after-effect of these positive actions and to be ready to deal with them when they arise. Especially important is the assessment of potential suicide.

The assessment of the risk of suicide ordinarily involves the evaluating of the person in terms of the factors that have been consistently linked with a high risk for suicide and the questioning of the person about his/her intent to commit suicide. Some people hesitate to question others about suicidal intent because they fear that direct questioning will "put ideas in the person's head." This avoidance of the issue is can be more detrimental, since it is unlikely that a non-suicidal person will become suicidal as the result of another's questions and failure to ask the question will hinder your ability to determine the person's potential for suicide. (Note: Questions about suicidal intent must be nonjudgmental and nonthreatening to elicit an honest response).

As we saw with depression itself, so it is with suicide that there are certain significant indicators that are associated with a high risk for attempting to take one’s life. Some of these are: an indirect or direct communication of intent, with the presence of a plan (especially a plan involving a lethal method); having a history of a previous attempt or a family history of suicidal behavior; the person has been separated, divorced, or widowed; he or she is living alone with lack of social support. People with histories of depression, alcoholism, and schizophrenia are more susceptible to suicide, as are those who have experienced a major life change such as a recent loss or anniversary of a loss, without an adequate coping strategy. Oddly enough, experiencing a recent improvement in depression is also indicative, since the depressed person may not have had the energy to follow through on an attempt, but as they improve the energy to hurt oneself becomes available. Some behavioral patterns that are present in the suicidal person are impulsivity, rigidity, and isolation. Some physical factors are persistent insomnia, recent surgery or childbirth and intractable pain.

Whether during the holiday season, or following it, the care for others we experience arising in our hearts will be rewarded with seeing the victims of the shadow of the holidays become more hopeful and vital people as we pay attention to the indicators of depression and suicide.