“Why, my soul, are you downcast?  Why so disturbed within me? Put your hope in God, for I will yet praise him, my Savior and my God.” ~Psalm 42:11
 
“The nature of the enemy’s warfare in your life is to cause you to become discouraged and to cast away your confidence. Not that you would necessarily discard your salvation, but you could give up your hope of God’s deliverance. The enemy wants to numb you into a coping kind of Christianity that has given up hope of seeing God’s resurrection power.” ~Bob Sorge, Glory: When Heaven Invades Earth
 
 “She found, too, that now as she was accepting [Sorrow and Suffering’s] companionship in this way, she seemed more alive than ever before to beauty…” ~Hannah Hurnard, Hind’s Feet on High Places

I hold a photograph of my beautiful, innocent babies and I make my decision. Convinced they would be better off without me as their mother, I decide to take my life. I am barely 29 years old. Self-loathing consumes my waking hours. Nightmares intrude into my sleep. I am torn by uncertainties: As unworthy and empty as I feel, do I have a right to exist? Do I have a right to the comfort and support of others and to love and be loved? I decide not. At my very core is a spiritual crisis. How on earth did I get to this place?
 
Suicide has to be the ultimate act of self-loathing. For those unfamiliar with its undercurrents it is almost impossible to comprehend. It is now almost impossible for me to comprehend the depth of that young mother’s struggle. The following piece of writing powerfully articulates the self-hatred and shame that festers beneath suicide

Goodbye my dear loved ones.
Shall I spend 2 years hugging each of you goodbye?
No it suffocates and stunts and binds
And anyway, I must go.
And anyway, I must go.
 
I cannot stay now.
I am empty, ashamed, hollow, and dead already.
The death in me already smells.
I can see your noses wrinkling at the stink and I love you all too much
to cause you such discomfort.
 
Do not shake your heads and say too bad.
This is best.
Those of us who do this really understand how broken we are; menaces.
This is my public duty.
It’s a favour to you all.
 
Exhale relief: one less broken life to cope with.
Lift your hands and praise your Lord who has given you all life.
I will bow before Him and beg – my eyes down.
Should He lend me His hand to stand I will sing a new song.
If not, I will crawl ever downward from his presence understanding why. (Author Unknown)
 

I remember first wanting to escape this world at nine years old when, after years of incessant fighting, my mother asked me who I wanted to live with when my parents separated. At fifteen, the pain of life became so unbearable that I seriously began to contemplate non-existence. It held a seductive pull promising relief from constant inner torment. Bound by shame, suicide was the ultimate way to hide from the world forever. Shame forbade me telling anyone about this deepest struggle. Feeling abandoned and alone in the world, I felt like an imposter and a stranger to my own life.
 
Depression often visits the shame-bound individual. It is hard to describe clinical depression to those who have never experienced it. In a dark, foreboding place of alienation and fragmentation, it was like being stuck between anger and grief and left only with acute longing. All the losses of life bore down on me, but I was too overcome by shame to actually believe I was significant enough to grieve. I asked myself, “Doesn’t everyone experience loss? Why does it debilitate me?” I was not special enough to think my losses were more momentous than others.

Yet, the greatest loss was impossible to grieve – that of me or my sense of myself – for I believed I was not worthy to continue taking up space in the world. Deprivation and lack of nurture were deserved. I put more weight on my capacity to fall down than on God’s ability to hold me up and this left me with an unrequited ache.
 
Curiously, writing my story feels like writing about someone else. That empty person, filled with anguish and shame, is now barely recognisable to me. Depression no longer enslaves and binds me. That is why I deeply believe that no one is beyond healing and that change truly is possible. Yet, my experience with depression led to an attempt to understand how and why it occurs and what, if anything, heals it.

Thoughts on Depression
 
At the outset, it is important to note that clinical depression requires medical intervention. There are biochemical components that respond well to medication and psychotherapy. Sometimes depression is so debilitating that the person cannot function on a day-to-day basis, or is too depressed to benefit from counselling. Medication can be helpful to bring them to the place of receptivity. Out of ignorance, some Christians refuse psychiatric medications because they believe it is not “natural” or they erroneously believe that all psychiatric problems are spiritual and the sufferer needs to rely totally on prayer and faith. I believe it is demonstrably possible for any believer to live a life of deep faith and devotion while on medication. If our car runs out of power-steering fluid, we may pull over and pray, but we also phone roadside assistance. In the same way, when our brain runs out of its power-steering fluid (serotonin), it needs replenishment.
 
The fallout from COVID-19 has left many significantly depressed. Even though genetics plays a role in one’s propensity towards depression, it is highly influenced by this type of environmental stress and also by any type of loss. While depression is a normal part of grief and loss, for some there is a profound sadness and grief that has somehow miscarried. Yet, what if depression is a signpost pointing toward what needs healing and changing in our lives? What if the pain of depression is redemptive?
 
Sadly, those that are in positions to help often fail to understand the dynamics of depression and are unable to enter in. As Jones (1989, pp. 42-53) observes: “Unfortunately, too much of both religion and therapy has to do with passing on mere information. The notion is that, once our ignorance of something has been lifted, all will be well. Recovery and new life is bound up with “understanding” something or other.” Jones believes that this is like “the distribution of menu cards to those suffering from a severe famine… A mere description of mystery or the numinous doesn’t feed the soul any more than the words “filet mignon” satisfy hunger… Many a priest, minister, or counsellor seems to be playing the game of a distributor of menu cards.” This common approach excludes the possibility of hope and trust that is ultimately only found in God.
 
The ache of depression is permeated by a deep, pervasive sense of hopelessness and despair. The depressed person believes that life will never be any different and the longings of the heart will never be satisfied. Giving up appears to be the only solution to find relief from profound pain. This leads to questions about depression that are: Can depression be understood Biblically? Are there gender differences in the way depression strikes us? What is the impact of stress on depression? How are loss and depression linked? Is family background a predisposing or precipitating factor?
 
Therefore, to understand the causes of depression, a good starting place is to explore the following three questions:

1)     Are there gender differences in depression?
2)     How is stress related to gender differences in depression? and,
3)     What is learned helplessness?

1)     Are There Gender Differences in Depression?

It is important to mention that the following gender differences are based on generalisations, as there is much variation in depressive symptoms and responses. Nevertheless, according to Piccinelli and Wilkinson (2000) there are regularities:

• Men typically blame others, while women blame themselves;
• Men act out their depression while women turn their feelings inward;
• Men can become hostile and irritable while women want to cry;
• Men attack while women withdraw;
• Men turn to distractions (such as sport) while women turn to friends;
• Women tend to become sad, while men tend to become mad;
• Women “feel” their depression, while men “act out” their depression; and,
• Men typically experience less sadness and more irritability and aggression. Many angry, abusive men are, in fact, suffering from depression. Male depression is better diagnosed from its behaviours.

Interestingly, before puberty and after menopause, men and women have the same risk factors for depression. During a woman’s child-bearing years, her risk increases every time her estrogen levels drop. While Estrogen plays havoc with some women’s emotions, “Hormonal changes might be a major factor in one woman’s illness, but not in another’s” (McEvoy, Payne & Osbourne, 2018). Therefore, several theories exist about women and depression. These are:

• The roles of women make them targets;
• Women experience more “learned helplessness”;
• Women tend to ruminate more than men; and,
• It’s all in the hormones!

 Probably, they are all accurate. Women are disproportionately affected by depression, experiencing it at roughly twice the rate of men (Gregory, 2018). The reasons range from developmental, reproductive, hormonal, genetic, and other biological factors to abuse and oppression, interpersonal factors and certain psychological and personality characteristics (Gregory, 2018). Generally, women tend to be socialised towards depression and across the world women typically do suffer from depression more than men. This cannot be explained away. Female depression is epidemic.
 
The risk of female depression is increasing, making it the most significant health risk for women. Two thirds of women are undiagnosed and untreated and women are getting depressed younger. Statistics report that between puberty and menopause, women are three times more likely to get depressed than men and the findings are similar across all cultures (Albert, 2015). The only exceptions are the Jewish and Amish populations (Rutz & Rihmer, 2009). Speculation is that men feel and express their emotions and this lowers their chance for depression. There is also strong social and extended family support where the role of women in the home is valued, thereby lowering frustration and social pressures.
 
How is stress related to gender differences in depression?

A stressor is an external force or pressure (for example, COVID-19 or losing a job) or an internal force or pressure (for example, failure) that is experienced as a real or perceived threat to our wellbeing. Stress is our physical, mental or emotional response to a demand, pressure, or disturbance, whether good or bad. Distress or overstress occurs with chronic stress. Stress disease occurs from the prolonged negative effects of stress and it is a non-recoverable and debilitating condition. There are always warning signs that tend to go unheeded.
 
Depression and stress are bedfellows, often caused by overloaded emotions that lead to exhaustion. Stress coping styles tend to differ in men and women. Women’s styles typically involve rumination and the “tending and befriending” response, referring to protection of offspring (tending) and seeking out or forming alliances of a larger social group for joint protection (befriending) (Brent, Chang, Gariépy & Platt, 2013). In contrast, men show less of a tendency toward tending and befriending by attaching more to the fight-or-flight response. The adaptive value of fighting or fleeing may be lower for females who often have dependent young, thereby risking more in terms of reproductive success if they are injured (Brent, Chang, Gariépy & Platt, 2013). Females of many species also tend to form tight, stable alliances, possibly reflecting an adaptive tendency to seek out friends for support in times of stress (Brent, Chang, Gariépy & Platt, 2013).
 
Studies in the late 1990’s show that after a hard day at work, women are much more nurturing toward their children, whereas men tend to withdraw from family life (Orford & Schimke, 2006, p. 46). The researchers suspect that endorphins or proteins that help alleviate pain and oxytocin – a female reproductive hormone – may play an important role in establishing this pattern, whereas considerations like learning and socialisation help to maintain it. Further reasons for women’s propensity towards stress and depression include:

• Deeply attaching and then needing to let go throughout the passages of life;
• Loss of identity/self-esteem;
• Unfulfilled dreams;
• Disillusionment with the perception of “life’s work”;
• Disappointment in marriage; and/or,
• Disappointment with children.

This was certainly true for me. I loaded all my hopes and dreams (internal) on being a good wife and mother (external). Inevitable small and large disappointments translated into failure to live up to my self-imposed standards and “all or nothing”mentality.
 
Men often have hidden causes for depression. Testosterone induced depression can display as moodiness, although stress, addiction and post-adrenaline induced depression are significant. Also significant is that men tend to work in jobs that interfere with the body’s internal clock (such as shift work). Moreover, parental turmoil and divorce can also be hidden causes of depression in men. Fifty years ago, Testosterone replacement therapy was commonly prescribed for male depression, but the treatment was all but abandoned with the introduction of antidepressant drugs (Boyles, 2003). New preliminary research suggests that this male hormone may have been rejected too quickly. A small study from Harvard Medical School’s McLean Hospital showed that nearly half of the men who did not respond to conventional depression treatment have low or low-to-normal testosterone levels (Pope et al., 2003). Several men showed dramatic improvement when the male hormone was given alongside antidepressants (Pope et al., 2003).
 
Other common causes of male depression are the tendency to become angry and moodier more often than women and they tend to be more preoccupied with fear of failure. Terry is a workaholic. At his core, he fears his business going under in uncertain economic times. As a result, he has become less social and seeks out exciting distractions (such as pornography). Terry uses sex to raise his sense of wellbeing. He often displays angry outbursts at home that he cannot control. According to Seber (2003, p. 236) men like Terry wear various masks to cover their depression, such as anger and resentment, moodiness, non-intimacy, violence, cybersex and addiction. Moreover, a man’s losses might make him more susceptible to depression including the declineof sexual prowess, unfulfilled dreams, the failure verses success dilemma, marriage

• General disappointments;
• Vocational disappointments; and,
• Relationship disappointments.

Thus, different physical, mental or emotional stressors for men and women contribute to depression.
 
What is Learned Helplessness?

Martin Seligman (1991) coined the phrase, “learned helplessness” in his attempts to understand how people perceive the cause of success and failure. From his research with both animals and humans, Seligman found that when subjects were faced with situations where they were powerless to change an annoying element, two out of three would cease trying to affect their situation. These subjects reacted to setbacks from a of presupposition of personal helplessness, believing that negative events would last a long time, thereby undermining everything they did and believing it was their fault. These subjects were more prone to depression, achieved less, had more physical problems, gave up easily and believed that the causes of negative events were permanent. They consistently used words like “always” and “never”.

Contrastingly, one in three subjects would shrug off adversity and continue acting to improve their situation. Seligman found that these subjects reacted to setbacks from a presupposition of personal power. They viewed negative events as temporary setbacks that were isolated to particular circumstances that could be overcome by their effort and abilities. They resisted helplessness and believed that negative events were temporary and transient, using words like “sometimes”. The research found that these subjects had healthier immune systems and were more likely to achieve their potential.

Locus of control

Seligman’s research highlights that our locus of control tends to be either internal or external. Those with “learned helplessness”internalise failure by blaming themselves. They often dislike themselves and experience low self-esteem. On the other hand, optimists externalise failure by blaming circumstances or others for their failure. They tend to like themselves and do not lose self-esteem in adverse situations. Seligman believes that hope depends on our explanatory style; for example, those who see specific, temporary causes for negative events tend to be more hopeful and do not view helplessness as global. Rather, they see it as limited to and regulated by the initial situation.

Learned helplessness was typically my default response to disappointment, leading to a flight/freeze response to perceived danger to and a sense of victimhood. Let me explain. Returning from India some years ago, we encountered a difficult situation involving one of our adult children. Instead of seeing it as their problem and being supportive, I felt like I was being punished by the other’s behaviour. In my already emotionally depleted state, I collapsed into a funk, feeling helplessness, hopelessness, powerlessness, persecuted and stuck. I longed for the family to care for me, to see my depleted state and be kind to me.

Immediately my old agreements with the enemy surfaced – those that were laid down in response to early pain: “This always happens to me. Poor me. I have no right to express my needs. I will always be hurt and abandoned in my close relationships.” So, I shut down, disappeared and disengaged. I hid from my own life! The fallout was painful and sad for my husband who found me unreachable in my collapsed state. He longed to soothe and comfort, but I was nowhere to be found. I retreated within myself to recover from any more shattering. It took two months and another angry incident for me to hear God saying, “This is not all about you, but about your poor response to adverse situations.” It was a pivotal moment to recognise and deconstruct my learned helplessness.

How Can Depression be Understood?

As stated earlier, depression is sadness and grief that has somehow miscarried. Generally, it is best not to expect a sufferer to feel sad with depression, nor ask someone, “Are you depressed?” Many people will say they are not sad or depressed. Instead, ask them, “Are you happy?” In depression people lose the capacity to experience pleasure even from normally pleasurable experiences.
 
There is a mystery to depression, but there is also a large body of knowledge that sheds some understanding on it. From a Biblical standpoint, I believe that depression can be understood as a problem of misplaced dependency. A healthy Christian possesses an awareness of both dignity and depravity, but in depression there is little awareness of either. Let me explain. Depravity describes how flawed we are by our erroneous beliefs and survival strategies (largely unconscious) that permeate the core of our lives. On the other hand, dignity connotes an awareness of our true worth in Christ – our position in Christ that is incompatible with depression. Bearing the image of God (our dignity), we enter into relationship with God in dependent, obedient living and chosen, sacrificial service for others. Mark 12:30-31 proposes, “Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength.’ The second is this: ‘Love your neighbor as yourself.’ There is no commandment greater than these.” Our fundamental starting point for loving God and others is our dignity – God’s abject delight in us!
 
As our awareness of our amazing dignity increases, it tends to bring an acute awareness of our lack of deservedness. In a healthy Christian, this drives us into the arms of a merciful God in awe and dependence. However, in depression, awareness of dignity tends to be absent or limited. The failure to fully understand who we are in Christ is central to understanding depression, because a depressed individual’s core commitment is to protect themselves from the deep pain of lost dignity (seeing that they have no value). Alan Jones (1989, p. 5), in Soul Making: The Desert Way of Spirituality, helps us to understand this dilemma:

When we forget our dignity (our true worth), we forget the source of that worth. Sin is a sort of wilful forgetfulness of how great and wonderful we are. It seduces us into thinking that we have to be our own creators, that we have to be the fabricators of our own souls. It lays upon us terrible burdens. Ironically, one of the ways by which we are encouraged to forget our true worth and are seduced into trying to build up our “own” dignity is in the practice of religion.
 

In ancient times, the desert symbolised trial and temptation. Water, especially freshly flowing or “living” water, was a prominent image of God’s grace (May, 2007, p. 119). Fresh water can transform wastelands into lush gardens. In Jeremiah 2:13 God declares, “My people have committed two sins: They have forsaken me, the spring of living water, and have dug their own cisterns, broken cisterns that cannot hold water.” My story included seeking after fullness by chasing after empty wells that held no water; for example, requiring people to come through to fill me up or wanting to be recognised for achievements. I did not trust God to provide for me as I worshiped Him and served others. Ironically, the result of this strong commitment to self-protective autonomy from God was what I avoided – the loss of dignity. Determined to be full from illegitimate sources pushed me in directions where I was empty. In other words, I required certain input in order to function or gain approval. When significant others or achievements did not come through in the way I needed (they were never meant to), I became intensely angry and experienced profound rejection.
 
I later discovered that these strong reactions were actually repetitions of early rejection, pain and loss (the early emotional withdrawal of my mother). In a perfect world I would have grieved that loss and turned to God for emotional sustenance. But my survival strategy of dogged determination to be validated by another pushed me in directions of emptiness. I believe that the judgement of God was to turn me over to my own resources where I experienced a reality of darkness that nothing satisfied and where I felt neither relationship nor impact at core of my being. “For the garden is the only place there is, but you will not find it until you have looked for it everywhere and found nowhere that is not a desert” (Auden, cited in Mendelson, 2007, p. 353).   
 
Anger and misplaced dependency

I have come to believe that at the heart of depression is anger and misplaced dependency. As well as anger towards others for failing to come through for me, my anger was also directed at God. In the blackness of depression, I believed, “He has not made my world come through for me to affirm my dignity, therefore, I have none. I am counting on my world to come through.” This is not an appropriate despair. Lack of dignity is not an appropriate pain. Instead it results in self-protective anger, evident in the undertone in my words of devalue (even if said depressively), “I have no value because of the way people treat me,” or, “My world has made it clear to me that I have no value.”
 
Hence, anger at the heart of depression translates into a conflict between love and hate for someone who is needed and perceived as essential to survival (Malan, 2019). This love/hate conflict creates intense anger with considerable guilt, “most frequently due to buried hostility against someone who is also loved” (p.122). The depressed person says something like, “I love a significant other (my husband, friend, mother, father, etc.) because I need him/her. Therefore, because I am dependent on him/her for my survival in this world, I am only able to give in order to get what I need (the necessary approval) and I hate them because I need them so much.” During my depression I defended against these hidden, unacceptable feelings that would cause anxiety if expressed to significant others in the present, or to a parent in the past (the origin of the conflict) (Malan, 2019).
 
Understanding that at the heart of depression is misplaced dependency was like turning on a light in the dark. For years I was unable to deal with what I did not know or could not acknowledge. Understanding the dynamics of depression changed my relationship to it. Arieti and Bemporad (1978, p. 307), in their landmark book on depression (underlining mine), shed light on my why I felt trapped and disappointed in a continual cycle of struggle:

The depressive has had a narcissistic, need-fulfilling involvement with others so that people have been important only to the extent that they could give praise or absolve guilt. There has never been an attempt to appreciate others as people in their own right. It is amazing that these individuals who are so adept at manipulating the desired response from others are so unknowledgeable about significant aspects of the inner life of the other individuals… all their efforts are directed at the effect it will produce in others…

This stereotyping appears to be a manipulative estimation of others as to whether they can become surrogate sources of self-esteem…The depressive adult life searches for a suitable individual on whom he [or she] can project the role of dominant other so that he [or she] can function in terms of obtaining esteem and escaping guilt over everyday behavior. This other is bestowed with all sorts of magical powers and directives… he [or she] modifies his [or her] own behaviour to meet what he [or she] believes the other desires. 

Thus, the essence of depression is not legitimate sadness and sorrow but anger and misplaced dependency (Arieti & Bemporad, 1978; Malan, 2019). My depression caused me to chase after empty wells; to grasp at a sense of value from people and sources other than the True Source of Living Water in order to possess what I believed I desperately needed for life. There is an incredible tenacity and strength in this pursuit that is usually out of awareness for the depressed individual, as it was for me. This is not a cause for either self or other condemnation. It is good to remember that we all have our ugly motivations that prevent us loving God and others well.
 
What Triggers Depression?

Ron slumps as he tells me his story, sinking lower and lower into the sofa until he is so hunched over, he can only lower his eyes to the floor and mumble. His hopelessness is contagious. I catch myself as I find my body mirroring his by also slumping as he speaks, my body absorbing his despair and desolation. Internally I halt and say, “This is not your hopelessness. It is his.” I lengthen my spine and am able to be present to his pain. A talented and gifted man, he tells of his involvement in missions in his youth that took him to many dangerous parts of the globe. On one particular bruising trip he witnessed the anguish of a child attempting to wake his dead mother. In that moment, something inside him shattered. The helpless, suffering child inside him collapsed, plummeting him into a deep depression that stalked him throughout his adult life.
 
Like Ron, depression is typically triggered by a clear, painful event or a subtle event with a message (an insult, job loss, the loss of a dream, etc.). The event has no power. The power is how the loss interacts with our internal condition. It triggers something we are already struggling with at an unconscious level that says, “The world has once again affirmed my lack of value (or dignity) and I am helpless to change it.” There is no awareness of the manipulative strategies to get is needed. At best, the depressed person is only aware of their longings. Ron was deeply aware of his painful longings. The belief planted by the enemy in his early pain was, “I am always left empty and alone by others. Even by God. Does He really love me?” Dan Allender (1999), in his book, The Cry of the Soul: How Our Emotions Reveal Our Deepest Questions About God, describes despair as:

Despair is a flight from desire; it is a refusal to embrace loss as a deepening of the hollowness that makes more room for God. Despair refuses to dream, to hope and to move with courage toward what we will one day become. It flees to an illusionary safe harbor where, isolated, it holds onto whatever pleasure comes from the fantasy of non-existence

This is why suicide, the choice of non-existence, is often preferred to hope. Ron’s despair allowed him to shield his heart from the agony of becoming seemingly ungodly. His stated self-image was, “I see myself as garbage having no value. I don’t make any impact on my world. Life would run more smoothly if I were not here.” His pain was very real and profound.
 
What makes loss significant?
 
We live in fallen world where none of us experience complete fullness in Christ this side of heaven, so we naturally suffer loss. The question at the core of this article is why some individuals respond to loss with depression instead of legitimate grief and sadness. Perhaps a better way of understanding depression is to reiterate the earlier point that, “grief that has in some way miscarried and has never been worked through” (Malan, 2019, p.118). Consequently, the significance of loss must be re-evaluated. Loss may be subtle, like the loss of a safety defence mechanism or a dream. In my depression I would say to myself, “I feel cheated and helpless in the face of loss (especially the loss of relationship). My world has let me down again and there is nothing I can do about it (no awareness of demand or how I manipulate others to get what I need). I am of no value (loss of dignity). What has drawn me no longer does.” The result was deeper depression and suicidal ideation. Then I would say to myself (out of my awareness), “I have no strategies to regain what I want so there is no motivation to try. I can’t, so I quit.” Life would then lose its meaning. Withdrawal into depression would leave me with some sense of revenge, recognition and attention from a world that sometimes felt sorry for me.
 
Concisely put, I believe depression says, “I am dependently committed to finding what I need in another person or my achievements and there is no acknowledgment that this preoccupation is self-consuming. My behaviour is geared to approving relationships and to some way of finding recognition or approval. Nothing is done as a chosen act, but only according to how a significant other will respond or an obsession with achieving. When this fails, I give up.”
 
The significance of early loss

Researchers believe that early maternal loss has a significant influence on depression (Malan, 2019). A child needs basic trust for emotional health. They need to believe, “There is a stability external to myself I can depend on.” Winnicott’s (2005) “good enough mother” is warm, accepting and giving. She is comfortable with intimacy and unafraid of it in all relationships (some mothers are able to be intimate with a baby, but not others). She is aware of her value and is comfortable with her baby’s demands. She is a warm, smiling mother who holds her baby. She is content and comfortable with her body. All this produces freedom and growth in her infant who believes, “I have what I need, now I can move ahead without an absorbing self-concern.” This is the cornerstone of emotional health. It does not lead to selfishness but to freedom.
 
However, during the “crucial period for laying the initial groundwork of later depressive episodes” (Arieti & Bemporad, 1978, p, 190), Ron described his mother as “dutiful” and conveyed how she found it difficult to relate warmly to her child. Cohen (cited in Arieti & Bemporad, 1978, p, 191) affirm that, “The mothers of later depressives were uncomfortable with their child’s emergence from a passive infant into a wilful toddler.” A dutiful mother like Ron’s is physically there for the infant, giving and nurturing, but she has learned throughout her life that closeness hurts. In fact, Ron described his mother as hardworking, self-sacrificing and efficient, but not warmly loving. As Ron grew, he knew deep down that his mother loved him, but she was scared of emotional closeness and retreated into hard work. She took care of practical matters well, but as Ron grew into a separate being, she gave with less and less emotional involvement and was less and less physically demonstrative and emotionally expressive. She didcare and provided appropriate physical nurture, but retreated emotionally when Ron became a threat.
 
Ron’s image of his mother was that of a nanny in a stiff uniform, uncomfortable with rich intimacy. An overly inhibited child, Ron’s experience of the primary loss of his mother’s emotional involvement predisposed him to later depression whenever he experienced loss. Ironically, this awareness gave him hope to see that his struggle had been handed down. His mother’s withdrawal set him up with the belief, “I had what is now not there. I must protect myself from losing it altogether. I must regain what I have lost.” So, Ron adopted certain beliefs and strategies to survive – a desperate, disproportionate dependence on others and manipulation to get what he needed from them. Adult symptoms were expressed as difficulties with intimacy, fearfulness, anxiety and depression.
 
Infant responses to lack of emotional intimacy from a mother fall into two styles of relating. Early loss, typically of a warm, emotionally connected mother during a period of profound dependency, can lead to a manipulative and dependent style of relating based on pride that says, “I can’t perform well enough to gain approval. But I have the resources to pull this off and get what I need. I can accomplish it.” Hence, a dependent style of relating is formed on approving relationships. This dependent mode is based on the image of a helpless child wanting to win approval. Behaviour is geared to finding approval or avoiding disapproval. It is twofold; such as:
 
1)     Self-enhancing or finding what was lost; and,
2)     Self-protecting or protecting against further loss (Arieti & Bemporad, 1978).
 
This leads to a struggle with autonomy where nothing is done as a chosen act, but how it impacts a significant other. Felt images of helplessness become clothed with words; for example, if a parent expresses silent disapproval, the child’s image of themselves becomes a helpless child wanting to win approval (Arieti & Bemporad, 1978) that matures into the belief, “I can only gain respect through gaining the approval of others. If someone fails to express approval, they must hate me.” Lack of emotional intimacy and conditional love leads to profound helplessness and unbearable pain.
 
If the loss occurs later in childhood, it tends to result in performance behaviours designed to always be noticed or visible; such as, “I can only gain approval and respect through achievement.” The result tends to be chronic unhappiness. Arieti and Bemporad (1978, p. 347) conclude, “In general, the common thread that runs through families with a depressed child is that the child has been unfairly burdened, at too early an age, to feel responsibility for either the happiness or the aspirations of the family unit.” The child becomes hyper-vigilant and responsible to calm any upset in the parental relationship or the family. They become the care-taker and approval is based on how well they perform their role.
 
Therefore, with early maternal loss the infant tends to become addicted to dependency and/or manipulation to gain what was lost, whereas in later childhood loss, the child tends to become addicted to performance and noticeability to gain what was lost. As an adult, loss comes along in the form of either disapproval or poor achievement that activates earlier underlying loss and produces depression. What hurts the most is the profound pain of rejection, rather than the loss itself. The resulting pain of depression is very real and legitimate.
 
Can Depression be Overcome?

Jesus says that without Him we are nothing (John 15:5; 16:4-6) and without Him we can do nothing of value. We have no power over the enemy’s messages and the bondage of depression apart from Him. Contrastingly, Philippians 4:13 says, “I can do all things through him who strengthens me.” In Matthew 11:28-30, Jesus invites us to rest:

Worn out? Burned out on religion?
Come to me. Get away with me
and you’ll recover your life.
I’ll show you how to take a real rest.
Walk with me and work with me-
watch how I do it…

Learn the unforced rhythms of grace.
I won’t lay anything heavy
or ill-fitting on you.
Keep company with me and you’ll learn to live freely and lightly.

It has been said that “treasures are hidden in ruins…” (Rumi). In ages past gardens were designed with a shady corner where you could contemplate the ache in your soul, sit with your sadness and meet with your dark emotions. Today we tend to counter sadness with distractions; such as, social media, YouTube, etc. Instead of trying to eliminate our sadness, imagine creating a special place where we can go and sit when we feel sad, a place that allows us to enter deeply into our experience, a place where we can slow down, soften our hearts and listen to that part of us that is in the shadows. Perhaps depression is a signal to slow down, rest and listen to our souls.
 
Perhaps this place would also allow us to contemplate what Larry Crabb (2005a; 2005b) believes is the twofold cure for depression:
 
1)     Awareness of our ungodly, self-serving beliefs and strategies; and,
2)     Embracing our legitimate dignity.
 
Healing began for me when I saw and acknowledged both the depths of my sinfulness and the stubborn determination to save a false sense of dignity. Christ says that path to life is to lose our lives and let go of the stubborn commitment to find life on our own. In order to heal I understood that the path to dignity was to get in touch with the ways I tried to create a sense of dignity using my own methods and resources. When the reality hit me of how strongly entrenched my core life-and-death commitment was to self-protection, I repented of chasing after empty wells instead of running to the Source of Living Water. I turned a corner when I became aware of my demand for life to come through for me and how my entire life was oriented around that demand. My survival strategies controlled my life. Self-interest can be healthy, but for the depressed person, self-protection is pride. I was utterly self-preoccupied with my unmet longings and the demand that others come through for me in the way I demanded. This is opposite to what Jesus says is the path to joy – to give ourselves away. As Fyodor Dostoyevsky concluded, “What is hell? I maintain that it is the suffering of being unable to love.”

Hence, a depressed individual is a powerfully demanding, thirsty person who requires something from outside themselves to function – “You must come through for me and my life depends on it.” This places responsibility on others to provide the needed water for life and the experience of thirst is essentially rebellion against the Source of Living Water.
 
Consequently, depression is being dependently committed to finding what we need in this world with no acknowledgement that this preoccupation is self-consuming. Tribulation (or loss) is supposed to lead to patience and maturity. However, in depression, if we are able to recover what was lost by our efforts (for example, another job, direction or relationship), our depression will lift, but for the wrong reasons due to denial of the real loss. We will feel better, but we missed an important opportunity to move towards maturity. If the strategy works and we obtain what we believe we want, denial and distorted thinking is reinforced. Maturity is loss of what we depend on. If we look closely, we will see incredible tenacity and strength in depressed people that depends on external sources to provide life.
 
My journey of healing involved both repentance and restoration. After asking God’s forgiveness for seeking to find life everywhere apart from Him, I discovered that my depression was really a child’s helpless cry for the love and connection I had never experienced as a child. When my infant granddaughter is hungry, she cries, protests and appears to sometimes lose control to get my attention. If I resent her protests and refuse to feed her, I will inflict lasting pain. She learns that those she loves will not come through for her and that she has to face life on her own. Do I really want to inflict that kind of pain on her? No, I have infinite compassion for her helpless state.
 
What if I had the same compassion for myself? When the desolate young places in me cry for attention, do I really want to inflict further pain on my soul by resenting them and pushing them away? No, I do not wish to perpetrate what was once done to me. Rather than condemnation, there is a weeping child in me that needs to be soothed, comforted and understood. I befriended that needy, empty child part of myself. I fell on my knees and began to seek from my Heavenly Father what I so deeply longed for. I find this kind of repentance and restoration a recurring theme in scripture. Psalm 51:12 says “Restore to me the joy of your salvation, and uphold me with a willing spirit to sustain me.” Jeremiah 30:17 says, “…I will restore you to health and heal your wounds,’ declares the LORD…” He alone offered hope to me when all else seemed hopeless.
 
Closing Thoughts…
 
Certain dynamics in depression, if acknowledged and understood, can lead to redemption, transformation and freedom. These dynamics include the tendency towards being a powerfully demanding person who requires something from outside themselves to find life. Responsibility is placed on others to provide the needed life-giving water. Distorted beliefs rule the depressed person’s life and the experience of seeking satisfaction apart from Christ is rebellion against the Source of Living Water. Self-interest can be healthy, but the depressed person is utterly self-preoccupied with their unmet longings and demand that others come through for them. Contrastingly, the path to joy described by Jesus is to give the self away.
 
Reflect…
 
Take a moment to become quiet in God’s presence. Without self-judgment and trying to fix things, allow yourself to become aware of the depression and/or despair in your life right now. Quietly sit with God and notice what emerges.
 
Invite God to show you what the source of your depression/despair might be.
 
Ask God to enter this place and tell you what He wants you to see.
 
Ask God to tell you what He wants you and Him to do about it together.
 
 
A Declaration…
 
I declare that You, Jesus, are the true Source of Living Water. I renounce my agreements with the enemy that I must look for life in relationships or achievements. I confess that apart from You, I can do nothing. I turn to You, Jesus, in trust and dependence. I declare that the bondage and power of depression is broken in my life and I will live abundantly in the joy of Your presence through the power of the Holy Spirit. I declare oh LORD, that You will restore my wasted years and my wasted efforts, in Jesus’ name.
 
A Prayer…

O Christ Jesus,
when all is darkness
and we feel our weakness and helplessness,
give us the sense of Your presence,
Your love, and Your strength.
Help us to have perfect trust
in Your protecting love
and strengthening power,
so that nothing may frighten or worry us,
for, living close to You,
we shall see Your hand,
Your purpose, Your will through all things.
(Saint Ignatius of Loyola)

*Names and details of those mentioned have been changed.
 
About the author: Dr. Paula Davis is a clinical counsellor, supervisor and educator specialising in psychological trauma. She has worked in higher education over many years as senior lecturer in counselling. Along with her husband she designs and delivers marriage enrichment/education programs in Australia, Africa, Sri Lanka, India and Europe.

References
Albert, P. R. (2015). Why is depression more prevalent in women? Journal of Psychiatric Neuroscience, 40(4), 219-221. doi:10.1503/jpn.150205
Allender, D., & Longman, T. (1999). The cry of the soul: How our emotions reveal our deepest questions about God. USA: NavPress.
Arieti, S., & Bemporad, J. (1978). Psychotherapy of severe and mild depression. Northvale, N.J.: J. Aronson.
Arieti, S., & Bemporad, J. (1978). Psychotherapy of severe and mild depression. Northvale, N.J.: J. Aronson.
Boyle, S. (2003). Testosterone may help depressed men. WebMD. Retrieved from https://www.webmd.com/depression/news/20030103/testosterone-may-help-depressed-men#1
Brent, L. J., Chang, S. W., Gariépy, J. F., & Platt, M. L. (2013). The neuroethology of friendship. Annals of the New York Academy of Sciences, 1316(1), 1-17.  doi: 10.1111/nyas.12315
Crabb, L. (2005a). Connecting: Healing ourselves and our relationships. USA: Thomas Nelson.
Crabb, L. (2005b). Soul talk: The language God longs for us to speak. USA: Integrity Publishers.
Freud, S. (1917). Mourning and melancholia. Standard edition, 14(19), 17.
Gregory, C. (2018). Depression in women: Types, causes, symptoms, and treatments. Psychom. Retrieved from https://www.psycom.net/depression.central.women.html
Jones, A. (1989). Soul making: The desert way of spirituality. USA: HarperOne.
Malan, D. (2019). Individual psychotherapy and the science of psychodynamics (3rd ed.). USA: CRC Press.
Malan, D. (2019). Individual psychotherapy and the science of psychodynamics (3rd ed.). USA: CRC Press.
McEvoy, K., Payne, J., & Osborne, L. (2018). Neuroactive steroids and perinatal depression: A review of recent literature. Current Psychiatry Reports, 20(9), 78.  doi:10.1007/s11920-018-0937-4.
Mendelson, E. (Ed.). (2007). W. H. Auden: Collected poems. USA: Modern Library.
Orford, M., & Schimke, K. (2006). Fabulously 40 and beyond: Women coming into their own. South Africa: Spearhead.
Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression: Critical review. British Journal of Psychiatry, 177, 486-492. Retrieved from https://www.cambridge.org/core/services/aop-cambridge-core/content/view/0770B51752F17A5A081F9878B0952608/S0007125000155989a.pdf/gender_differences_in_depression_critical_review.pdf
Pope, H. G., Cohane, G. H., Kanayama, G., Siegel, A. J. & Hudson, J. I. (2003). Testosterone gel supplementation for men with refractory depression: A randomized, placebo-controlled trial. The American Journal of Psychiatry, 160(1), 105-111. https://doi.org/10.1176/appi.ajp.160.1.105
Rutz, W., & Rihmer, Z. (2009). Suicide in men. suicide prevention for the male person. Oxford Textbook of Suicide Prevention: A Global Perspective.249-255. doi: 10.1093/med/9780198570059.003.0035
Seber, G. A. F. (2013). Counseling issues: A handbook for counselors and psychotherapists. Gordon, NSW: Xlibris Corporation.
Seligman, E. P. (1991). Learned optimism. New York: Simon & Schuster.
Winnicott, D. W. (2005). Playing and reality (2nd ed.). UK: Routledge.