2011 Jez Bayes 1/19

Depression Toolkit Study Guide:

Introduction: This study guide is based on a presentation given at Blaze Church Newquay in September 2011. Please regard it as a starting point for study, thought and dialogue. I am fully aware that many people who could read this will know more about the issues than I do, either through professional expertise or through their own personal experiences. Although this guide is aimed primarily at an audience of church members, containing teaching and insights based on the Bible, hopefully it will be helpful to other people as well. If you are not part of a church, and you find yourself isolated and unsupported in your struggle with depression, then this forum may help you to find a church where you will be well cared for. Hopefully this will also help churches to think through their response to depression, and how to support people well. Please feel free to ask questions on the Blog, and I will try to connect you with a supportive church community near you.

Purpose and Hopes for this guide:

1: To destigmatise depression amongst us, because feelings of shame, guilt and secretiveness delay support, prolonging and deepening the illness. 2: To help sufferers in their need for Christlike patience. 3: To help their supporters & Churches in their need of Christlike persevering love. 4: To encourage faith for breakthroughs, so that we keep praying until we see healing, whether immediate or through a longer process.

Disclaimer!!! ● I am NOT a medic or a counsellor. ● I have dealt with people suffering with depression in my work, often connected to

substance misuse or alcohol, and often connected to a heartbreakingly terrible upbringing.

● My main interest now is to equip us to be real with each other as we learn how to address this, firstly within the church.

● I am not a self proclaimed or any other kind of EXPERT. ● I am just one of us. ● My goal is to help us to face up to this reality amongst us, and address it carefully,

patiently and effectively.

2011 Jez Bayes 2/19

This outline will ask 6 questions:

1: Does there need to be a stigma, can we remove it? People with depression often feel ashamed or inadequate, especially if they are Christians, because they are supposed to be full of joy. This is reflected in decades of worship vocabulary that states variations on the expectation of „Joy, Joy, My heart is full of Joy‟ and the idea that „it was there by faith I received my sight and now I am HAPPY all the day.” So, what does the Bible have to say about depression?

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2: What is depression and how is it treated? Bringing depression into the open, to define what it is, to identify the symptoms, to look at how it‟s treated; and to help others who don‟t suffer from depression to understand it a little more, and to know how it feels, what helps, what doesn‟t help, and what would help people who do struggle with this.

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3: How can we support people better in church life? Some suggestions to start a dialogue on how better to support those who are going through depression, given churches may contain more people suffering depression than you might expect. This might be God‟s calling to us, learn how to support each other in this, so that we can support people around us???

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4: What are the „Dos‟ and „Don‟ts‟, the best advice for people coping with depression in church life?

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5: Where can I find helpful resources?

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6: How can we pray into this area, and for people and families who are suffering with the impact of depression now?

2011 Jez Bayes 3/19

1: Does there need to be a stigma, can we remove it?

People with depression often feel ashamed or inadequate, especially if they are Christians, because they are supposed to be full of joy. This is reflected in decades of worship vocabulary that states variations on the expectation of „Joy, Joy, My heart is full of Joy‟ and the idea that „it was there by faith I received my sight and now I am HAPPY all the day.” So, what does the Bible have to say about depression?

Depression = Guilt, Shame, Embarrassment, Secrecy? Is this correct? Why has this become a big deal, a taboo subject, a stigma?

● Starting point observation: we have developed a fairly limited vocabulary in our worship, in that a lot of our songs tend to be positive songs of praise, as we feel that this is appropriate, and we like to advocate/demonstrate the truth of our faith by appearing whole and confident;

● But this isn‟t the case in Biblical Worship or personalities all the time. ● Biblical honest worship: ● The book of Psalms contains a very large proportion of „minor key‟ Psalms of lament,

Psalms of confession, Psalms of complaint in very strong terms. ● e.g. Psalm 22, 106. HONEST, REAL. ● People are allowed to ask God „WHY?‟ God does seem to not expect us to be polite

and positive in all our struggles, He can cope with our real feelings and normal reactions.

● Question: ● Is there a danger that our worship could encourage disconnection, dishonesty or

unreality at times? The Psalms often state faithful praise, but from a starting point of current distance, confusion, danger or disaster, and then look forward in praise to God‟s deliverance.

● Our songs are mainly straightforwardly positive. ● (NB: There are some current songs that are more reflective of daily struggles: Blessed

be Your Name, You give and take away ... ) ● We don‟t like or use these as much, because they focus on us. Valid point? ● But does this help people who aren‟t in a positive place to feel engaged in the

worship, represented honestly by the words we put in their mouths? ● Hence often people can feel quietly disconnected in worship

● Well known Church figures who did/do struggle with depression include Spurgeon and

Piper, both of whom speak and write on the subject.

● What‟s the solution to this problem? ● Be Honest! Speak out, but add faith as in Psalms. ● The need for more reality in worship songwriting, and especially in our „live‟

contributions in prayer in our worship.

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So, if we want reality without embarrassment, does the Bible show depression?

● If we are going to find it, we will not find it described as „Depression‟ because that is a modern term not used in Biblical language.

● Are there any Biblical characters who struggled with „depression:‟ ● The Bible is a real book, of real people, like us, more than we realise. ● Stories of people living with God and each other, not a manual or set of instructions or

rules. ● Is Depression just a modern reality, or is it found in the pages/characters of the Bible?

3 examples:

● e.g. 1: David: ● Despairing reaction after self imposed disaster after poor choices, adultery and

murder. ● Passage: Psalm 51, 2 Samuel 12. ● Symptoms: Sleeplessness, Fasting (loss of appetite?) ● Note that God does NOT reject him, but graciously restores him after David looks

honestly at what he did. ● Depression can be the result of your own actions or failings, but although it‟s

worth checking and asking the Holy Spirit to reveal to you if this is the case, most depression is probably NOT self imposed or based on your own sin.

● e.g. 2: Job: ● Bleak hopeless reaction to terrible circumstances.

Job 3: Job Deplores His Birth

1 After this Job opened his mouth and cursed the day of his birth. 2 And Job spoke, and said: 3 “May the day perish on which I was born, And the night in which it was said, „A male child is conceived.‟ 4 May that day be darkness; May God above not seek it, Nor the light shine upon it. 5 May darkness and the shadow of death claim it; May a cloud settle on it; May the blackness of the day terrify it. 6 As for that night, may darkness seize it; May it not rejoice[a] among the days of the year, May it not come into the number of the months. 7 Oh, may that night be barren! May no joyful shout come into it! 8 May those curse it who curse the day, Those who are ready to arouse Leviathan. 9 May the stars of its morning be dark; May it look for light, but have none, And not see the dawning of the day; 10 Because it did not shut up the doors of my mother’s womb, Nor hide sorrow from my eyes. 11 “Why did I not die at birth? Why did I not perish when I came from the womb?”

● i.e. Distressing circumstances as a cause: e.g. Abuse, Bereavement, Abandonment, Rejection, Addiction, Divorce, Stress, Injustice, or damage caused by other people‟s and institutions‟ sin in a fallen world.

● Normal human emotional reaction, can become depression if lasts a longer time than normal or triggers a response within a depressive personality.

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● NB: Other Biblical characters struggled with terrible circumstances and situations: ● Jesus Wept: A man of sorrows and acquainted with grief. ● Hebrews 4:15:

“For we do not have a high priest who is unable to sympathize with our weaknesses, but one who in every respect has been tempted as we are, yet without sin.”

● Jeremiah and Habakuk were devastated at the state of their world, „Why does evil prevail?„

● You‟re allowed to ask, you‟re allowed to cry, you‟re allowed to complain - in fact it‟s probably bad for you, and it‟s definitely unbiblical NOT to express these feelings when you have them.

● God wants to have a genuine relationship with the real you, and you‟re allowed to tell Him how you feel, with emotional honesty, mixed with humility.

● e.g. 3: Elijah: ● Manic, irrational low reaction after a huge high. ● Possibly physiological depression? If not, he is at least a good analogy for the

nature of and a godly response to clinical depression. ● Massive unfounded irrational over reactions. ● Note the symptoms, and how God addresses it. ● Passage: 1 Kings 19

Notice the features of depression, and notice God‟s reaction: NB: Condemnation or rejection? NO! (Just after miraculous mountain top fire from Heaven Victory)

Elijah Flees from Jezebel

1 Now Ahab told Jezebel all that Elijah had done … 2 Then Jezebel sent a messenger to Elijah, saying, “(B)So may the gods do to me and even more, if I do not (kill you) by tomorrow about this time.” 3 And he [d]was afraid and arose and ran for his [e]life and came to (C)Beersheba, which belongs to Judah, and left his servant there. 4 But he himself went a day‟s journey into the wilderness, and came and sat down under a [f]juniper tree; and (D)he requested for himself that he might die, and said, “It is enough; now, O LORD, take my[g]life, for I am not better than my fathers.” (Note how God ignores and refuses to interact with the self pity) 5 He lay down and slept under a [h]juniper tree; and behold, there was (E)an angel touching him, and he said to him, “Arise, eat.” 6 Then he looked and behold, there was at his head a bread cake baked on hot stones, and a jar of water. So he ate and drank and lay down again. 7 The angel of the LORD came again a second time and touched him and said, “Arise, eat, because the journey is too great for you.” 8 So he arose and ate and drank, and went in the strength of that food (F)forty days and forty nights to (G)Horeb, the mountain of God.

Elijah at Horeb

9 Then he came there to a cave and lodged there; and behold, (H)the word of the LORD came to him, and He said to him, “What are you doing here, Elijah?” 10 He said, “(I)I have been very zealous for the LORD, the God of hosts; for the sons of Israel have forsaken Your

2011 Jez Bayes 6/19

covenant, (J)torn down Your altars and killed Your prophets with the sword. And (K)I alone am left; and they seek my life, to take it away.” 11 So He said, “(L)Go forth and stand on the mountain before the LORD.” And behold, the LORD was passing by! And (M)a great and strong wind was rending the mountains and breaking in pieces the rocks before the LORD; but the LORD was not in the wind. And after the wind an earthquake, but the LORD was not in the earthquake. 12 After the earthquake a fire, but the LORD was not in the fire; and after the fire (N)a sound of a gentle blowing. 13When Elijah heard it, (O)he wrapped his face in his mantle and went out and stood in the entrance of the cave. And behold, (P)a voice came to him and said, “What are you doing here, Elijah?” 14 Then he said, “(Q)I have been very zealous for the LORD, the God of hosts; for the sons of Israel have forsaken Your covenant, torn down Your altars and killed Your prophets with the sword. And I alone am left; and they seek my life, to take it away.” 15 The LORD said to him, “Go, return on your way to the wilderness of Damascus, and when you have arrived, (R)you shall anoint Hazael king over Aram; 16 and (S)Jehu the son of Nimshi you shall anoint king over Israel; and (T)Elisha the son of Shaphat of Abel-meholah you shall anoint as prophet in your place. 17 It shall come about, the (U)one who escapes from the sword of Hazael, Jehu (V)shall put to death, and the one who escapes from the sword of Jehu, Elisha shall put to death. 18 (W)Yet I will leave 7,000 in Israel, all the knees that have not bowed to Baal and every mouth that has not (X)kissed him.” 19 So he departed from there and found Elisha the son of Shaphat, while he was plowing with twelve pairs of oxen before him, and he with the twelfth. And Elijah passed over to him and threw (Y)his mantle on him.

Elijah‟s depression like symptoms:

● Physical and emotional exhaustion

● Disproportionate irrational collapse after a negative situation, despite the wider context

● Run, hide

● Loss of will to live, or interest in life

● Low value of self

● Isolation from company or support

● Lack of care for self

● Distorted thinking and perspective

● Feeling that no-one else understands

● Self pity

How God looks after Elijah during this episode, which can act as guidance for how to cope with depression and advice for how to support people suffering depression:

● Sleep,

● Eat,

● Drink

● Words, talk, asking - not left alone in silence, even if preferred.

● Restore purpose

● Instructions, clear and simple, not doing nothing

● Be obedient (despite feelings)

● Expected to act on them and be responsive, with support

● Encouraged and allowed to listen to God, which took time and careful repetition

● Allow a corrected perspective, recognise that you won't be seeing things straight. (i want to die, I‟m alone)

● Allow time to express feelings & process

● Keep in company, beware total isolation, even if you don‟t feel like seeing people

● Gentle

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● David, Job, Elijah: 3 sources of depression: ● Poor choices; Terrible circumstances; Physiological.

NB: None of these situations are mentioned as demonic. There is no Biblical foundation to thinking that depression/mental health MUST be demonic, but even if it may be in some situations, Christ‟s power defeats the demonic as much as anything else. Biblically, demonic explanations in any situation are only given when supernaturally revealed. They should not become default explanations, nor are they ever looked for.

● Conclusion: Real people, old problem, modern word: Depression. ● i.e. it‟s not sinful to be depressed, in fact some people are more „down‟ Eeyore like

personalities, and are identified as the most balanced and sane people in psychological tests, and can end up being more resilient than other personality types.

● Depression is a health condition to be honest about, just like diabetes, broken leg or flu. The stigma within church circles may be connected to pride, in not allowing people who are struggling to be real with others.

● Some depression (NOT most) CAN be as a result of sin …... and needs

Confession, Repentance, Forgiveness, Grace, Confidence in God, and reinstating who you are in Christ into your thinking.

● Depression of any type CAN lead to a sinful faithless reaction (but so can

success, affluence, promotion, or practically any events God takes us through …... and needs Confession, Repentance, Forgiveness, Grace, Confidence in God, and reinstating who you are in Christ into your thinking.

● Ultimately, depression in all forms, to a greater or lesser degree, is a complex illness,

and as such you do not need to feel condemned, guilty, ashamed, embarrassed, or inadequate, any more than a christian with diabetes, flu, shortsightedness or migraines.

● Keeping it quiet could be pride, and could make you allow it to get worse before

addressing it.

● So, be honest with God, family, christian friends, church leaders, and any relevant professional help.

● Above all feeling depressed is a normal, but sad and difficult, part of human life. Even

as Christians we suffer from all manner of ailments as a result of being in this broken world that is groaning to be made new.

● Feeling depressed does not mean you are useless or rejected. ● God still loves you. ● God doesn‟t condemn you. ● God created you in love, and enjoys you, while also weeping with those who weep. ● God still has a purpose for you, so stick with Him. ● God is your ultimate only eternal hope.

2011 Jez Bayes 8/19

2: What is depression and how is it treated? Bringing depression into the open, to define what it is, to identify the symptoms, to look at how it‟s treated; and to help others who don‟t suffer from depression to understand it a little more, and to know how it feels, what helps, what doesn‟t help, and what would help people who do struggle with this.

What is depression? This definition and symptoms for diagnosis are taken from the NICE (National Institute for Clinical Excellence) Guidance, which defines best practice in the NHS, and is quite long and detailed, but relatively simple to read, It includes advice for what to ask a clinician: http://www.nice.org.uk/nicemedia/pdf/CG90NICEguideline.pdf Here are the key sections: NICE Guidance: Treating depression in adults “Depression is a common mental health problem – it affects nearly 1 in 6 people in the UK. The main symptoms of depression are losing pleasure in things that were once enjoyable and losing interest in other people and usual activities. A person with depression may also commonly experience some of the following: feeling tearful, irritable or tired most of the time, changes in appetite, and problems with sleep, concentration and memory. People with depression typically have lots of negative thoughts and feelings of guilt and worthlessness; they often criticise themselves and lack confidence. Sometimes people with depression harm themselves, have thoughts about suicide, or may even attempt suicide. Occasionally a person with severe depression may have hallucinations and delusions. People with depression may have feelings of anxiety as well. Depression may have no obvious cause, or it can be set off for a variety of reasons (such as physical illness, or difficult things that happened in the past or may be happening now, like bereavement, family problems or unemployment). Some people have what is called „seasonal depression‟, which is linked to the change in seasons (usually occurring in winter when the days are shorter). People may have just one episode of depression. However, about half of people who have had an episode of depression will go on to have further episodes. Most people will feel better within 4 to 6 months of an episode of depression, while others experience symptoms for much longer.”

2011 Jez Bayes 9/19

Symptoms associated with depression, to help to clarify the diagnosis.

Core (key) symptoms: (1 or more of these 2)

● Persistent sadness or low mood. This may be with or without weepiness. ● Marked loss of interest or pleasure in activities, even for activities that you normally

enjoy.

Other common symptoms: (4 or more of these 7)

● Disturbed sleep compared with your usual pattern. This may be difficulty in getting off to sleep, or waking early and being unable to get back to sleep. Sometimes it is sleeping too much.

● Change in appetite. This is often a poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain.

● Fatigue (tiredness) or loss of energy. ● Agitation or slowing of movements. ● Poor concentration or indecisiveness. For example, you may find it difficult to read,

work, etc. Even simple tasks can seem difficult. ● Feelings of worthlessness, or excessive or inappropriate guilt. ● Recurrent thoughts of death. This is not usually a fear of death, more a preoccupation

with death and dying. For some people despairing thoughts such as "life's not worth living" or "I don't care if I don't wake up" are common. Sometimes these thoughts progress into thoughts and even plans for suicide.

An episode of depression is usually diagnosed if:

● You have at least five out of the above nine symptoms, with at least one of these a

core symptom; and ● Symptoms cause you distress or impair your normal functioning, such as affecting

your work performance; and ● Symptoms occur most of the time on most days and have lasted at least two

weeks; and ● The symptoms are not due to a medication side-effect, or due to drug or alcohol

misuse, or to a physical condition such as an underactive thyroid or pituitary gland (but see section later on depression and physical conditions).

Many people with depression say that their symptoms are often worse first thing each day. Also, with depression, it is common to develop physical symptoms such as headaches, palpitations, chest pains, and general aches. Some people consult a doctor at first because they have a physical symptom such as chest pains.” NB: Manic/Bi-polar, massive mood swings, more down than up, loss of inhibitions, danger of risk taking and poor decisions, followed by isolation, despair, numbness.

2011 Jez Bayes 10/19

Treatment options for moderate or severe depression: Antidepressant medicines

My comment on medication:

Always know as much as you can about anything that you put in your body.

If a GP or Doctor prescribes something, ask why, what will it do, how long for?

Talk to the GP or Doctor, have your treatment and medication reviewed regularly, don‟t just get into multiple repeated unsupervised doseage.

Antidepressant medicines are commonly used to treat moderate or severe depression. A medicine cannot alter your circumstances. However, symptoms such as low mood, poor sleep, poor concentration, etc, are often eased with an antidepressant. This may then allow you to function more normally, and increase your ability to deal with any problems or difficult circumstances. (or id. root causes) An antidepressant does not usually work straight away. It can take 2-4 weeks before the effect builds up fully. A common problem is that some people stop the medicine after a week or so as they feel it is not helping. You need to give it time. Also, if it is helping, follow the course that a doctor recommends. A normal course of an antidepressant lasts for at least six months after symptoms have eased. Some people stop their medication too early and the depression may then quickly return. There are several types of antidepressants, each with various pros and cons … some antidepressants work better in some people than in others. Therefore, tell your doctor if symptoms do not start to improve after about 3-4 weeks of taking an antidepressant. In this situation it is common to advise either an increase in dose (if the maximum dose is not yet reached) or a switch to another type of antidepressant. At the end of a course of treatment it is usual to reduce the dose gradually over about four weeks before finally stopping. This is because some people develop withdrawal symptoms if an antidepressant is stopped abruptly.

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Psychological (talking) treatments Various psychological treatments have been shown in research trials to be good treatments for depression. These are briefly listed below. In general, a combination of an antidepressant plus a psychological treatment is better than either treatment alone. Those most commonly used for moderate or severe depression are: Cognitive behavioural therapy (CBT). Briefly, cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as depression … identify any harmful or unhelpful ideas or thoughts which you have that can make you depressed. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful. Behavioural therapy aims to change any behaviours which are harmful or not helpful. CBT is a combination of cognitive therapy and behavioural therapy. In short, CBT helps people to achieve changes in the way that they think, feel and behave. Interpersonal therapy (IPT). This is sometimes offered instead of CBT. IPT is based on the idea that your personal relationships may play a large role in affecting your mood and mental state. The therapist helps you to change your thinking and behaviour and improve your interaction with others. For example, IPT may focus on issues such as bereavement or disputes with others that may be contributing to the depression. Other types of therapy sometimes used, depending on circumstances, include: Behavioural activation. The basis of this therapy is that behaviours such as inactivity and ruminating on certain thoughts can be key factors in maintaining depression. The therapist aims to help you to combat these unhelpful behaviours. Couple therapy. This may be an option for people who have a regular partner and where the relationship contributes to the depression. Or, where involving the partner is considered to be of potential useful benefit. Other treatments Electroconvulsive therapy (ECT) may be advised as a last resort if you have severe depression which has not improved with other treatments. Exercise: In addition to the above treatments, regular exercise is thought to help to improve symptoms (if you are able to do some exercise). Some research has shown exercise to be as effective as medication in some cases.

THIS IS BASED ON GOOD EVIDENCE.

2011 Jez Bayes 12/19

Treatment options for mild depression:

The following are the commonly used treatment options for people with mild depression. Also, for people with subthreshold depression that has lasted a long time and not shown signs of improving. Some people prefer one type of treatment to another. So, personal preference for the type of treatment used should be taken into account when discussing the best treatment for yourself with your doctor. A guided self-help programme Computer-based cognitive behavioural therapy An exercise programme Group-based cognitive behavioural therapy Group-based peer support Antidepressant medicines Antidepressant medication is not usually recommended for the initial treatment of mild depression. However, an antidepressant may be advised for mild depression in certain circumstances. For example, in people: ● With mild depression that persists after other treatments have not helped. ● Whose depression is associated with a physical illness. ● Who have had an episode of moderate or severe depression in the past.

Second-line treatment: For mild depression, the above treatments often work well and symptoms improve. However, if symptoms do not improve much with the above treatments, then it is usual to move on to the treatments usually advised for moderate or severe depression, as discussed earlier. That is, an antidepressant and a more intensive psychological treatment such as individual one-to-one CBT.

Herbal Remedies: What about St John's wort (hypericum)? This is not advised. St John's wort is a herbal antidepressant that you can buy, without a prescription, from pharmacies. It recently became a popular treatment for depression. However, national guidelines for depression do not advise that you take this because:

● It is not clear how well it works. Although some studies suggest that it may help depression, other studies have failed to confirm this.

● Side-effects sometimes occur. (Some people think that because St John's wort is 'natural' then it is totally safe. This is not true. It contains many chemicals which sometimes cause problems.)

● It may react with other medicines that you may take. Sometimes the reactions can cause serious problems. For example, you should not take St John's wort if you are taking warfarin, ciclosporin, oral contraceptives, anticonvulsants, digoxin, theophylline, or certain anti-HIV medicines. Also, you should not take it at the same time as certain other prescribed antidepressants.

(End of NICE Guidance and advice quotes)

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Real Life: At this point, it‟s useful to hear real life stories. I conducted a 4 question survey of Blaze church members, and I have compiled this into a separate anonymised document also available with this study guide.

These are the questions that I sent round: 1: What are the main symptoms or experiences of depression for you? 2: What do Blaze/Blaze people do that you find helpful? 3: What do Blaze/Blaze people do that you do not find helpful? 4: What else would you appreciate or do you need from Blaze/Blaze people?

Thanks to everyone who took part. If this topic is going to be addressed in a presentation or meeting, it‟s a good idea to interview some people who have suffered with different types of depression. At Blaze, 2 people offered to be interviewed, one of whom had been through and recovered from postnatal depression, and had identified triggers and habits that act as warnings for her and her husband. The other person had an ongoing experience of depression connected to an accident in which a leg was lost, resulting in constant pain and health issues. Useful resource on healing: PJ Smyth downloadable talk and notes after his experience of cancer, on struggling with suffering, illness and healing in this fallen world. Study Guide: www.newfrontierstogether.org/Publisher/File.aspx?ID=75935 Audio: http://media.project1.com.s3.amazonaws.com/157fe12f-7ae3-4e46-ac87-4ec588392eb0.mp3

What‟s needed, Prayer or Support? ● Some will be healed miraculously, quickly. ● Some will recover slowly through a longer process, with medication/counselling etc. ● Some will need to demonstrate Godly patience through a long trial while others

demonstrate Godly love by standing alongside and supporting them in whatever way it takes for as long as it takes, being the Body of Christ, and embodying again His selfless sacrificial patient love for another, and for others to see.

The key principle here is this: http://www.biblegateway.com/passage/?search=John+13:35&version=NASB

BY THIS SHALL ALL MEN KNOW THAT YOU ARE MY DISCIPLES, IF YOU HAVE LOVE FOR ONE ANOTHER:

● i.e. our pastoral care for each other is Jesus‟ plan for how the Church reaches out, by being attractive to other people who come in and „feel the love.‟

● That means that how we help you to handle your depression can become a demonstration of God‟s love, through us Loving One Another.

● So trust in His Sovereignty, Control and LOVE. He knows that we are dust.

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3: How can we support people better in church life? Some suggestions to start a dialogue on how better to support those who are going through depression, given that we have a fairly high number for a small church. This might be God‟s calling to us, learn how to support each other in this, so that we can support people around us???

As a Church/Churches:

● No stigma. Treat depression first as an illness. If anything lies behind it, allow God to reveal it in His own time, don‟t jump to judgmental conclusions.

● NO STIGMAS for anyone from any background or with any social issue. PLEASE! ● Try to maintain „normal‟ social contact, not steer round or avoid people. ● BUT don‟t bombard sufferers with a grilling about how they‟re doing every time you

meet them. Keep it normal.

● BUT have a nominated contact with a specific person who will keep up to date with progress and have permission to ask and pray with them.

● („Supporter‟? cf AA „sponsor‟ but not having had to suffer depression themselves.) ● This type of support is important even (especially?) when the person with depression

doesn‟t feel like it. This can be challenging! ● Permission: the sufferer should clearly allow the supporter to question or challenge self

pity carefully. ● Allow the supporter to lovingly probe for root cause and triggers in dialogue with you

and God at an appropriate time.

● Total isolation, even if it feels like the thing the sufferer wants, is not good. ● We humans are designed for community:

Genesis 1:

● At creation, God reveals his triune personality: Holy Spirit hovers over waters, God speaks, and Jesus (The Word, John 1) made all things. All 3 are involved.

● Hence before creation God in community, God IS Love. ● God creates man in his image – “not good to be alone”, community of love is the design. ● God even recognises that man alone with God before the Fall and sin needs human

companionship. Community and love: part of the image of God and the design of humanity. ● The Fall generates separation, and as part of God‟s New Creation, the Church is here to

demonstrate community restored.

● So in these issues, we need to demonstrate community, and you need to invite community and relationship even when you don‟t feel like it.

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Contact with people:

● As much normal social contact as the sufferer can cope with, and a clearly agreed nominated „supporter‟ who will ask regularly and keep up to date, and pray for/with them.

● Don‟t give up on people, support them out of love, not to be a success.

● Commit to stick with them even if there‟s no change for months or years.

● Keep asking. Keep praying. Keep loving.

● Both supporter and supported - don‟t allow yourself to act on feelings of being a failure or a burden.

● Apologise to people you haven‟t done this with up to now. Repent. Go again.

● Learn inside our church family, go on to impact outside in the community.

● If we can‟t handle this inside the Church, we won‟t be able to reach people suffering from depression in our community.

● Tim Keller recommends developing a good relationship with a qualified Christian counsellor who will understand your church, early in the life of a church plant.

● These aren‟t always easy to come by, so all church members should look out for them and let their Leaders know if they find one!

● NB: Tricky point: People who are suffering from depression may not feel supported even when they are being supported.

2011 Jez Bayes 16/19

4: What are the „Dos‟ and „Don‟ts,‟

the best advice for people coping with depression in church life?

● Do be honest and real. No facades. ○ With each other. ○ With God. Yell. Psalm 22 etc

NB: David Powlison (CCEF) “A problem admitted is the first step to finding a solution.” ● Do keep an honest journal, to monitor feelings, and to record prayers. ● Do practice early openness, honesty and humility, as this allows depression to be

addressed earlier. ● Don't bottle things up and 'go it alone'. ● Do try to tell people who are close to you how you feel. It is not weak to cry or admit that

you are struggling. ● Do keep as much normal social contact as you can. ● Do be accountable, not just to husb/wife, not just to someone with similar issues, but to

a nominated „supporter.‟ ● Don't despair - most people with depression recover. It is important to remember this. ● Do eat regularly, even if you do not feel like eating. Try to eat a healthy diet. ● Do make yourself keep a regular lifestyle, eat, drink, get up, go to bed, pray. Routine. ● Do take daily exercise, which has been proven to be as effective as medication in some

cases. As strenuous as you can manage. (NB: In Exeter University there is a ‘Mood Disorder Research Department’ and when students suffer depression they make routine referrals to an exercise regime.)

● Don't drink too much alcohol. Drinking alcohol is tempting to some people with depression as the immediate effect may seem to relieve the symptoms. However, drinking heavily is likely to make your situation worse in the long run. Also, it is very difficult either to assess or to treat depression if you are drinking a lot of alcohol.

● So, know the recommended normal alcohol levels, and drink less than these: Useful Links: Alcohol Units Drinks Chart Lots more advice about alcohol can be found here

● Alcohol (depressant) + Antidepressants = Antidepressants switched off: This risks wasting the GPs time and budget, over prescribing as the medication

battles with the alcohol, and creates the risk of exaggerated side effects of either the medication or the alcohol or both. If this is a problem for you, go to your GP and be honest!

● NB: Alcohol and Cocaine can trigger sudden severe depression, especially if combined with other factors that would also cause depression.

● Don‟t make any major decisions whilst you are depressed if at all possible. However, sometimes this can‟t be avoided.

● Do tell your doctor if you feel that you are getting worse, particularly if suicidal thoughts are troubling you.

● If time off work is needed, find creative/positive distractions from negative thoughts and feelings. Don‟t mope!

● NB: Difficult root causes: Sometimes a specific (psychological) problem can cause depression, but some people are reluctant to mention it. One example is sexual abuse as a child leading to depression or psychological difficulties as an adult. Tell your

2011 Jez Bayes 17/19

church leader or Doctor if you feel something like this is the root cause of your depression. Counselling may be available for such problems.

● Do try to distract yourself by doing other positive things.

Mood Controlling:

● Do notice and then counter your HARMFUL MOOD LIFTING TECHNIQUES: e.g. alcohol, drugs, binge eating, porn, chocolate, all night computer games sessions, impulsive relationships, compulsive shopping, gambling, ...

● Do notice, learn and then be aware of your triggers for this kind of behaviour so that you learn to see it coming, and prepare in advance to sidestep it like this:

Key Verse: Philippians 4:4-9 “4 Rejoice in the Lord always; again I will say, rejoice! 5 Let your gentle spirit be known to all men.The Lord is near. 6 Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. 7 And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus. 8 Finally, brethren, whatever is true, whatever is honorable, whatever is right, whatever is pure, whatever is lovely, whatever is of good repute, if there is any excellence and if anything worthy of praise, dwell on these things. 9 The things you have learned and received and heard and seen in me, practice these things, and the God of peace will be with you.”

● Create a bank of relevant truth, prayers, verses, songs. ● Have your nominated „Supporter‟ ready to be called/texted if struggling or tempted. ● Apply these truths assertively into your situation. (This is called a ‘Stronghold Buster’

in the Freedom in Christ resources.) ● When tempted to lift mood using harmful habits, use this and remember that with

temptation comes a way of escape.

Key Verse: 1 Corinthians 10:13 “No temptation has overtaken you but such as is common to man; and God is faithful, who will not allow you to be tempted beyond what you are able, but with the temptation will provide the way of escape also, so that you will be able to endure it.”

Final „Dos and Don‟ts‟:

● Do get professional help. Be humble. ● Do pray for breakthrough. ● Don‟t give up hope. ● Do trust in a loving God and the eternal truth that He made you and loves you, more

than you trust your temporary feelings.

2011 Jez Bayes 18/19

5: Where can I find helpful resources?

David Murray: “Christians Get Depressed too” (100 pages, around £6)

http://www.bookdepository.co.uk/Christians-Get-Depressed-Too-David-Murray/9781601781000

Very simple to read, acknowledging that depression addects people‟s ability to concentrate and read. Outline: Biblical egs; Statistics; Caution against dogmatic judgmental explanations; Different Christian approaches; False tendencies and thought patterns in depression; Causes Cures and Corrections to thinking patterns (cf FiC); How medication helps; Keeping your spiritual life going; How to be a care giver.

Helpful downloadable handout: http://www.exeter.ac.uk/media/universityofexeter/schoolofpsychology/mooddisordercentre/documents/helpathand.pdf Other books by John White, or John Piper, or FiC resources – ask Jez for details.

Online: John Piper: “When the darkness will not lift.” http://dwynrhh6bluza.cloudfront.net/resources/documents/1929/books_bdnl.pdf?1281043767

2011 Jez Bayes 19/19

6: How to pray into this area, and for people and families

who are suffering with the impact of depression now.

Healing ... this can be sudden or gradual, and is an area of mystery and trust in God. Breakthrough No condemnation for sufferers Joy through the pain

Love Commitment Patience

Power Compassion Practical issues and needs, finance, work, family life, etc Guidance „Supporters‟ Families of those affected

NB: Gifts and Fruit of the Holy Spirit: Patience Love Joy Peace Faith Hope Healing

Study group Questions:

"Depression" Read 1 Kings 19: 1-19 1. What symptoms of depression does Elijah seem to have? 2. How did God address these? What lessons are there here for people struggling with depression? What lessons are there here for people supporting those struggling with depression? 3. Is there anyone in your Group who feels the need for support with their depression? If so, have they given anyone permission to keep asking how they are doing (a ‘supporter’)? This would be best done in relationship, so may not be someone in the same Group as them, but if they have never done this the Group could prayerfully help them to identify someone. 4. Pray for patience for sufferers from depression, loving commitment from the church, and breakthroughs in healing.