A quote in the Daily Telegraph says
““Depression is an emotional state that makes people interpret the events in their lives in a negative way,” explains Mabel Martinelli, the director of the Cambridge Centre for Cognitive and Behavioural Therapy. “It’s only by helping someone to find some space from that feeling that they are able to get back in control of their thoughts.”” https://www.telegraph.co.uk/…/the-doctor-who-believes…/
The quote is from Mabel Martinelli, the director of the Cambridge Centre for Cognitive and Behavioural Therapy.
Now, my beef isn’t with Dr Martinelli. I’m inclined to give her the benefit of the doubt that these quotes don’t give the full picture of everything that she thinks and has to say about depression. However, the way that the Telegraph takes and uses those quotes is certainly unhelpful. You see, that is not a good or helpful definition of depression, both in terms of how depression is understood, defined and described clinically and how it is experienced by patients.[1]
That is not to say that it is completely wrong, rather that it is inadequate on its own. It may be partially true in some cases but doesn’t offer the whole truth and doesn’t apply to all cases. It is fair to say that depression is to do with your emotional state and it is possible that this will then affect your interpretation of circumstances and events so that sufferers may be more inclined at times to. However, this is not always or necessarily so.
It is possible for someone to positively interpret circumstance around them whilst suffering depression. I’ve written previously about “tracing the rainbow through the rain.” I’ve used that description from the hymn “Oh Love that will not let me go” both to describe my experience of grief and of depression. In both situations I was able to find joy in my circumstances. [2]Likewise negative interpretation of circumstances doesn’t necessarily indicate depression. For example it may reflect a pessimistic character.
Furthermore, there is a risk here that we end up masking the reality that person’s circumstances may actually be negative. We wrongly deny a person’s reality. Depression often follows on from things like grief, trauma, bad news such as a terminal diagnosis. People have reported how difficult work or living conditions have affected them. In those cases it seems to me that rather than being a symptom of depressed mood, it is those negative circumstances that are causing or contributing to the depression.
From a different angle, we might also argue that the definition also gives too much power to the depression. Do I really think my depression made me view things negatively? No! I think I still had agency in those perspectives.
I think that the definition understates what the experience of depression is. For me it was like being hit by an articulated truck. I wasn’t just a bit low, I wasn’t just a bit negative. To be sure I could be more irritable and more negative but the reality was that I was completely overwhelmed emotionally and this affected me physically as well as mentally, I was completely exhausted, laid flat out.
Yes, Martinelli offers what is potentially part of the picture but I think we need to be careful about narrow descriptions that focus on one symptom. It is better to recognise its complexity and say that this can sometimes be one aspect of it
Martinelli is coming from a CBT perspective. I’m sure that CBT and mindfulness as forms of therapy have their part to play in terms of treatment options though like other approaches including medication I don’t think they offer the only solution, full solution or the right solution in all cases.
I think there is an overlap here with the challenges of approaching depression from a Christian perspective too. I think that Biblical Counselling (the specific methodology as opposed to the sense in which all Christian counsel must be rooted in Scripture) can have its part to play too but I don’t think that this is always best or right. One reason for this is that I think that we too, especially conservative evangelical types can lean too heavily on the cognitive bit. We can be quick to assume that a person’s thinking is faulty.
What I mean is this. First, in terms of how Biblical Counselling can be employed, it’s starting presumption is that the issue is either root sin in the believer, leading to guilt or, especially in more nuanced, modified forms that the believer is experiencing suffering but that the primary issue is that they need to change their response to their circumstances.
This is expressed in other theological/cultural responses in terms of the need to “have more faith.” This at its greatest extreme is seen in some word of faith contexts where you are encouraged not to name the negative thing but instead to speak affirmatively, “I am well, I am healed, I am successful.” Whilst most of us would not run to those extremes I think that Christians can at times slip into similar attitudes, especially concerning mental health when this would not be the case with physical health.
Now think of it this way. If you went to the doctor and said to him “I am in a lot of pain I think my leg is broken” and he said “Ah your pain is causing you to think negatively about your leg.” You would think that he had lost the plot. Of course, it is possible for people to suffer chronic pain with unexplained causes and sometimes that is to do with the immune system responding to things that are not there. However, our usual starting point with the physical pain is to look for the cause and to treat the cause/remove it, not try to think differently about it.
An approach which sticks at “learn to think differently about your circumstances” risks confusing the Gospel with stoicism. Of course, the Gospel does call us to think differently about circumstances and events but this is not about denying the reality of pain and suffering. Rather, it is about seeing God’s purpose in them. This means that when I was depressed, or more realistically, after I was in the midst of depression, I was able to look back and see what God was doing, though there are perhaps still a good few things I don’t understand yet. However, this did not stop me from seeking alleviation from suffering.
For the believer there can be recognition of the reality and complexity of depression as a real illness. This means acknowledging that the suffering you experience because of your depression is real and not to be understated. Because of this, just as with any other illness I would seek appropriate help whether through medication or therapy to alleviate suffering.
We would also want to recognise that causes are complex and so may include organic causes, our circumstances and yes also our own sinful failings. A twofold approach is right here. First, we want to look to see whether it is possible to remove the causes or at least mitigate them. If every morning you woke up and bumped your head, you would move the bed. You would advise someone whose lungs were compromised to stop smoking. A diabetic will seek to change their diet. As an asthmatic, I’ve decided we can’t have certain pets.
We are realistic and so we know that it isn’t always possible to remove or fully mitigate causes of suffering. In addition to therapy and mitigation of causes, Christians can keep coming back to the hope we find in suffering as outlined in Romans 5.
I picked up on the example in the Telegraph because unfortunately I think it plays into a common misunderstanding of depressive illness. Sadly, I’ve come across similar views within Christian circles. I think that Christians need both a better grasp of what depression is and a better grasp of the Gospel solution too.
[1] You can find the recognised definition and description of depression in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). “Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. Depressed most of the day, nearly every day as indicated by subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation) Significant weight loss when not dieting or weight gain (e.g., change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide F The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. F The episode is not attributable to the physiological effects of a substance or to another medical condition. Note: The above criteria represent a major depressive episode. F The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. F There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance induced or are attributable to the physiological effects of another medical condition” Cited from MDD_Adult-Guidelines-2019-2020.pdf
[2] I appreciate that this might need some further unpacking. AS noted in footnote 1, the DSM 5 definition includes “Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day”. I realise that this may sound similar to the idea of viewing events or circumstances negatively however, there is a marked difference, even if we note that this is one of a number of possible markers. Losing interest or failing to derive a sense of pleasure, so that in a sense you become indifferent to the kinds of activities and interests you used to pursue is not the same as seeing the events and things happening around you as negative. An example of the former might be not wanting to listen to music or read. It may even mean that someone no longer has the desire to attend church. An example of seeing an event negatively is that when you hear family news, a marriage, a new baby your thoughts are only about “the extra mouth to feed”, the things that might go wrong “it won’t last” or jealousy as you see someone competing for attention with you.
Faithroots 