an unclinical definition of depression

So in my past three years doing sleep research, I've developed a working familiarity with depression. We measure depression with Beck's Depression Inventory, which asks how much you agree with statements about guilt, failure, suicidal thoughts, dislike of self, social withdrawal. The other self-report measures for depression look at similar symptoms. But it's funny, nothing seemed to capture depression (at least my experiences with it) as well as a letter I received in the mail from a Christian organization that I support:

"We are hope guzzling machines...When we're hopeful, he world is full of wonderand possibilities. We have drive and curiousity. We want as much life as we can get. We take on challenges and see adversity as something to be overcome.

But wn we lose hope the world becomes a fearful, threatening place, full of chaotic futility. Hopelessness sas us of energy and dee. It robs us of interest and appetite. We just want to curl up and protect our soul. We call it depression. The Bible calls it hopelessness."

- Jon Bloom, May 2007 letter to The Philippian Fellowship

And that's precisely it! When I'm depressed, it is not because I feel guilty, nor because I can no longer sleep, or hate myself. Those are merely symptoms. But my depression, at heart, is a loss of hope. I have nothing to look forward to. Nothing to dream about. There is no hope for change in me, or no hope for changing the world, nothing at all. At its heart, self-hate, guilt, self-loathing, are a loss of hope.

How do we address hopelessness? The solutions the health profession give are psychotherapy, antidepressant medication, or shock therapy. All those fail to provide the antidote - Hope!

"Why are you cast down, O my soul and why are you in turmoil within me? Hope in God; for I shall again praise him, my salvation and my God (Psalm 43:5)" Hope is the only real lasting treatment. And the only one who can give such an audacious hope? A God who loves, a God who is Just, a God who is Sovereign, a God who will redeem our broken souls and this cursed creation.

I struggle to really believe all this. I have had my times of darkness, when all I saw was the gaping abyss of my black heart, when I could not, would not love nor forgive. (and forgotten that God changes hearts) I've had those moments of bleakness, when I've believed that I would never find a job, or friendship, or love (and denied that God is a good provider). And I've been tormented by guilt, wracked by how I've wounded others, and wondered if I've ruined everything - the lives of those I care for, the possibility of being in a relationship where I wouldn't mess things up. (God paid for that sin in full on the cross, and I do not hold that kind of power . He is a loving Father to them too.)

One song has become my anthem during those times of darkness. In the middle of the chorus of voices casting stones and burying me alive, I hear a still small voice singing:

"Sometimes a light surprises
The Christian while he sings;
It is the Lord Who rises
With healing in His wings:
When comforts are declining,
He grants the soul again
A season of clear shining,
To cheer it after the rain

In holy contemplation
We sweetly then pursue
The theme of God’s salvation,
And find it ever new;
Set free from present sorrow,
We cheerfully can say,
Let the unknown tomorrow
Bring with it what it may.

Tomorrow can bring us nothing,
But He will bear us through:
Who gives the lilies clothing
Will clothe His people, too:
Beneath the spreading heavens
No creature but is fed;
And He Who feeds the ravens
Will give His children bread.

Though vine nor fig tree neither
Their wonted fruit should bear,
Though all the fields should wither,
Nor flocks or herds be there
Yet, God the same abiding,
His praise shall tune my voice;
For, while in Him confiding,
I cannot but rejoice."

- William Cowper

Crossing the Styx: Death and Medicine

I've just started working in a job where we are studying palliative medicine, which cares for patients who often are past curative treatment, often many cancer patients, and to provide quality of life, symptom and pain management, and help with transitions for the patient and the family as they prepare for death. This has made death and dying now a part of what I daily face.

In many ways, medicine sees death as a failure - a failure of the physician, maybe, or a failure of the science to move quick enough in finding treatments. What medicine is unconsciously denying, I think, is that death is really a natural end. Is it really best to "Not go gentle into that dark night, rage, rage against the dying of the light?" When the physician must say, "there is nothing more I can do," he fails to realize that there is still more he can do - he can ease that transition into death, decrease pain, help the patient reconcile to himself/herself that the end of life is near. And that is precisely what palliative medicine aims to do. I'd imagine that the ideal case is that palliative medicine wouldn't have to be a separate unit, but that eventually all doctors would be prepared to be with the dying patient, and not abandon them.

Sometimes when I read about the research on aging, and how some investigator here or there may believe he knows why cells fail and humans die, whether we are in fact a society petrified by fear of death. Our culture is funny, isn't it, that even as we try to erase the effects of aging with exercise, botox, and plastic surgery, we also have a remarkable crop of "thrillers" in our box office. And those thrillers bank on the fact that death is the more fearsome threat we will face, and use sudden deaths to get our adrenaline pumping.

In On Death And Dying, Elizabeth Kubler-Ross, MD writes,
"in our unconscious, death is never possible in regard to ourselves. It is inconceivable for our unconscious to imagine an actual ending of our own life here on earth, and if this life of ours has to end, the ending is always attributed to a malicious intervention from the outside by someone else. In simple terms, in our unconscious mind we can only be killed; it is inconceivable to die of a natural cause or of old age."

In that thought may lie the answer. Although everything has been dying since life began, we are still unreconciled to the termination of existence. There is still something about death that seems unnatural, that seems wrong. And that consciousness of death's wrongness, I think, is evidence of general revelation to us by God that there is a curse - that man's immortal souls were meant to dwell in bodies just as immortal. I have trouble with the idea that death could have occured before the Fall. How could bodies programmed to die be "good"?

But since the resurrection of Christ, death has lost its power, and it merely is the door between one existence and eternity.