Tag Archive - Howard Stone

Depression: Discernment in Pastoral Caregiving

July 25, 2009 in Ministry-Theology, Therapy-Psychology with 4 Comments

Discernment
As we talk and think about the issue of depression in ministry one of the most important factors that we have in helping us determine what exactly we are dealing with is discernment.

the quality of being able to grasp and comprehend what is obscure

Discerning what type of help a person needs can be tricky. Should they see a therapist? A psychiatrist? Both? Is a recommendation for meds necessary? Are we dealing with depression, melancholy, burning out, etc? Maybe it’s all, maybe it’s some, maybe it’s none. But the act of discernment is a process and often involves multiple people helping one through their difficult journey.

In the book Depression and Hope: New Insights for Pastoral Counseling (which I mention quite a bit, is a great resource, and which I will reference and quote from heavily in this post), Howard W. Stone says:

Depression disturbs one’s most important relationships; for melancholics this may mean family members or close friends. For the mystic or hermit monk, and indeed for all faithful Christians, that most important relationship is with God. When people feel the absence of God, when they doubt, when religious ritual and service lose meaning, their experiences are very similar to the symptoms of depression.

Pastoral caregivers listen in a certain way to the words of those who are disconsolate, a way that is distinct from other helping professionals. To clergy and other professionals in ministry, despair, suffering, struggle, and adversity are laden with spiritual import, because reflection on the experience of melancholy and spiritual desolation can bring depth and meaning to those who are trying to be faithful to the call of Christ (Stone, 21).

When dealing with issues of such vital importance, you can see why discernment is key.  In fact, I would say that it’s quite rare for most people entering into ministry to have a decent understanding of mental health issues and the role of the pastor in pastoral caregiving.

In his book Stone talks about four experiences that “compare strongly to depression: the dark night of the soul, ‘accidie’, desolations, and Martin Luther’s understanding of ‘Anfechtungen’”. Fascinating stuff! Let me just mention them briefly here:

Continue Reading…

Depression: Soren Kierkegaard on Actuality, Freedom and Possibility

July 22, 2009 in Ministry-Theology, Technology-Social Media, Therapy-Psychology with 1 Comment

Today, LifeChurch.tv posted the third of four videos that I shot with them on depression. Monday’s video was An Anchor in the Journey-Exodus 17:1. Tuesday’s video was Depression-At the Movies continued. Today’s video is Walking Through Depression. In today’s video I share about the prophet Elijah wanting to die, and actually asking God to take his life away.

Sometimes our depression becomes so severe that we just can’t even function. It evolves into an anguish that is difficult to cope with at times, and sometimes we wonder if we can move on. That is a difficult place to be, and it is not uncommon among humanity.

One of the things I have been reading a lot about recently is the issue of anxiety, and how anxiety lies between our knowledge of possibilities, and actuality. This is something that Kierkegaard talks a lot about, and I think he has some good things to say on the topic of depression.

kierkegaardKierkegaard is one of my favorite writers, thinkers, philosophers, theologians, and psychologists. Ever since reading Fear and Trembling when I was 22 he has continued to profoundly shape my life and thinking.

So it is not surprising that in the book Depression and Hope by Howard W. Stone, that it is Kierkegaard that has something to say to us on this issue. Let me quote at length the following passage from the book:

Soren Kierkegaard’s understanding of persons–for our purposes depressed persons–also helps us understand hope. In The Sickness Unto Death, he describes persons as possessors of actuality, freedom, and possibility. All three are a part of the authentic self, and a good relationship of all three is necessary for authentic existence. Actuality refers primarily to the past; it includes our context, our psychological predispositions, and choices we have previously made.

Freedom is what we have in the present. It is a finite freedom, exercised within the limits of our situation and abilities, our givens and past choices. Because of our actualities we cannot simply become whatever we want to be ‘if we try hard enough for it.’ We make choices, and act, from the range of options available to us.

Possibility addresses the future. It is what we can become as we use our freedom. In that respect our possibilities are not predetermined. We are not automatons. We can imagine, and within the givens of life we can become something new. Living as an authentic self, according to Kierkegaard, means looking beyond our immediate necessities or past liabilities. We anticipate the future with the awareness that we are free–however limited–to actualize whom we ought to become as faithful Christians and to take responsibility for shaping that future. Continue Reading…

Are You Experiencing Depression?

July 21, 2009 in Ministry-Theology, Technology-Social Media, Therapy-Psychology with 4 Comments

As I mentioned yesterday, I had the opportunity to share some thoughts around depression with LifeChurch.tv. The first video, An Anchor in the Journey-Exodus 17:1 appeared yesterday, and I posted a little more details on my blog, Depression: Getting Honest With Our Journey.

You can check out the second video, Depression: At the Movies continued.

Assessing Depression
There are a variety of factors and tools that one may use in assessing if someone has depression. In therapy, there are usually a few basic questions I ask to better assess what is going on. In my work as a Marriage and Family Therapist one of the main tools that we use is the DSM-IV (i.e. Diagnostic and Statistical Manual for Mental Disorders). Whether or not one believes in diagnosing individuals, some of the criteria they provide is very helpful in getting a sense of the symptoms that one is exhibiting.

51yeqm7b52l_bo2204203200_pisitb-sticker-arrow-clicktopright35-76_aa240_sh20_ou01_As a pastor, leader, or volunteer in the Church you most likely will not look at the criteria in the DSM-IV, but it’s important to have a baseline of criteria that one’s symptoms can be measured against. A book that I have found really helpful is Depression and Hope: New Insights for Pastoral Counseling by Howard W. Stone. In this great book Stone says the following:

Criteria for Depression

Depression, or melancholia, is known in psychiatric terminology as major depression to distinguish it from the normal low periods that many people go through. The psychiatric diagnostic criteria for major depression lists nine symptoms, as follows:

  1. Depressed mood, sadness, irritability part of each day, nearly every day
  2. Diminished pleasure or interest in daily activities
  3. Considerable weight loss or gain, change in appetite
  4. Significant change in sleeping patterns (The most common result is early waking.)
  5. Marked increase or decrease in movement (Most commonly the person physically slows down.)
  6. Fatigue and loss of energy
  7. Feelings of worthlessness or guilt (The feelings are beyond the scope of how people would usually feel.)
  8. Difficulty in concentration
  9. Ideas of suicide or death

To be diagnosed with major depression according to the American Psychiatric Association criteria, persons must exhibit at least five symptoms for a minimum of two weeks, and have either depressed mood or diminished pleasure or interest on most days for at least part of the day (APA 1994). These criteria are a good basis for determining if someone really is depressed. The certainly are not exhaustive but signal that a person’s story may be one of melancholia. (pp. 65-66)

Have you, or are you experiencing any of these symptoms? Have you sought out help for them? Continue Reading…

Depression, Burnout & Ministry: Assessment

February 2, 2009 in Ministry-Theology, Therapy-Psychology with 7 Comments

Assessing Depression
This is the 4th post in my series on Depression, Burnout & Ministry, and it is the one where I hope to provide some critieria of symptoms that might help us out if we are wondering about this issue.

There are a variety of factors and tools that one may use in assessing if someone has depression.  In ministry, there were usually a few questions I may have asked a student to better assess what was going on.  I still ask those questions of people in ministry, as well as in my clinical work.  In my work as a Marriage and Family Therapist one of the main tools that we use is the DSM-IV (i.e. Diagnostic and Statistical Manual for Mental Disorders).  Whether or not one believes in diagnosing individuals, some of the criteria they provide is very helpful in getting a sense of the symptoms that one is exhibiting.

51yeqm7b52l_bo2204203200_pisitb-sticker-arrow-clicktopright35-76_aa240_sh20_ou01_As a pastor, leader, or volunteer in the Church you most likely will not look at the criteria in the DSM-IV, but it’s important to have a baseline of criteria that one’s symptoms can be measured against.  A book that I have found really helpful is Depression and Hope: New Insights for Pastoral Counseling by Howard W. Stone.  In this great book Stone says the following:

Criteria for Depression

Depression, or melancholia, is known in psychiatric terminology as major depression to distniguish it from the normal low periods that many people go through.  The psychiatric diagnostic criteria for major depression lists nine symptoms, as follows:

  1. Depressed mood, sadeness, irritability part of each day, nearly every day
  2. Diminished pleasure or interest in daily activities
  3. Considerable weight loss or gain, change in appetite
  4. Significant change in sleeping patterns (The most common result is early waking.)
  5. Marked increase or decrease in movement (Most commonly the person physically slows down.)
  6. Fatigue and loss of energy
  7. Feelings of worthlessness or guilt (The feelings are beyond the scope of how people would usually feel.)
  8. Difficulty in concentration
  9. Ideas of suicide or death

To be diagnosed with major depression according to the American Psychiatric Assocation criteria, persons must exhibit at least five symptoms for a minimum of two weeks, and have either depressed mood or diminished pleasure or interest on most days for at least part of the day (APA 1994).  These criteria are a good basis for determining if someone really is depressed.  The certainly are not exhaustive but signal that a person’s story may be one of melancholia. (pp. 65-66)

How Does Depression Manifest in Ministry
I think there are many ways that depression manifests itself in ministry, but what I would like to do is mention how in a few different areas I think it has manifested for me on occasion, and I’m curious to hear from you.  The tricky thing with depression and burnout is that we can experience symptoms along the spectrum without being considered clinically depressed.  Here is how I experienced it at some levels, even though I have never been clinically diagnosed myself.

Emotionally:  Not being able to enter into, or handle anymore conversations, meetings, encounters with people in ministry.  My fuse was short and I was unable to pay attention at a certain level.  It’s an emotional exhaustion.  Often this mosts manifests itself at home with the people we love.  We give all we have at work, but have little energy for home.

Spiritually: Not being able to pray or read Scripture.  In fact, most of that was masked by ministry prayer (in meetings, services, etc.), but little of my own prayer life.  Also, most of my Scripture reading was for sermon preparation, but very little of my own prayer devotion and meditation.  I think this is very common in ministry, where pastors spend hours upon hours in sermon preparation and consider that to be part of their devotion and meditation.

Physically: Being so exhausted that you don’t have the energy for one more event or meeting.  In fact, when you are doing your yearly calendar, your relief comes from looking at the date about 9 months out when you can rest.  That is depressing.

I would love to hear from you.  How have you experienced depression in ministry?  Can you share some examples?

The next post in this series I will be taking a look at the history of depression in the Church and spiritual writings.  But for now, don’t forget to check out the three previous posts:

Depression, Burnout & Ministry: Deciding to Get Honest About Our Journeys

Depression, Burnout & Ministry: Anne Jackson Interview, Part 1

Depression, Burnout & Ministry: Anne Jackson Interview, Part 2

Disclaimer: This blog post is not to be a substitute for professional help or advice.  Please consider seeking out professional help if you consider yourself to be at risk for depression.