Coping with Depression

These notes on Coping With Depression were prepared by Bro Jon Mansfield MD.

What are mood disorders?

We all have good and bad days-it's a normal part of life. It's not even unusual for our mood to vary considerably in the course of a single day. In response to the ups and downs of life, we experience joy, disappointment, success and failure. Our mood may also be affected by many physical factors, like premenstrual hormonal changes, viral infections (the flu virus is a common culprit), alcohol, medications, and illicit drugs.

There is no precise dividing line between ordinary sadness and what psychiatrists call depression. This term is used when lowered mood persists, brings intense distress, and interferes with a person?s ability to cope with the ordinary demands of living, whether of work, study or personal relationships.

On the other side of the spectrum of mood disorders is that of a persistent heightened mood. This occurs far less commonly than clinical depression. There is a similar continuum, with milder states difficult to disentangle from normal joy. Moderately severe (hypomania) or very severe forms (mania) are more clear cut-the person's behaviour has serious consequences if treatment is not promptly initiated. Most people with mania also suffer depressive swings at other times as part of the condition of bipolar mood disorder (previously known as manic-depressive illness).

Depression – how do we recognise it?

Depression is common. The rate of major depression over a person's lifetime is as high as one in four women and one in eight men, but many of these people remain undiagnosed and untreated. Bipolar mood disorder is much rarer, with a lifetime rate of less than 1 per cent. The two forms may occur at any age but the usual age of onset is in the late twenties; they are far less common during childhood. Over half the people who have an episode of disordered mood suffer from one or more recurrences.

Clinical depression is a syndrome - in other words, a group of symptoms and observable mental and physical signs that commonly occur together. At least two weeks of lowered mood is regarded as the minimum period to warrant the diagnosis. The degree of severity extends from mild, blurring into ordinary sadness (minor depression), to extreme (major depression), where the risk of suicide is high and a person's health may be seriously affected by poor nutrition and self-neglect. A severely depressed person may also lose touch with reality and be severely disturbed by hallucinations and delusions.

Depressed people feel so miserable that they view the future with despair. They judge their circumstances to be hopeless, believing their prospects are bleak or that they burden their family and others. Friends or relatives usually reveal a more favourable picture, but depressed people persist in seeing their situation in the blackest of terms. They often describe their mood as one of endless misery, quite different from ordinary sadness. People who have experienced bereavement say that grief is consolable; whereas when they are clinically depressed they feel utterly beyond comforting. Given this state of despair, it is not surprising that depressed people are unable to take any pleasure in their usual activities. Loss of interest touches everything, ranging in degree from an unwillingness to join in everyday activities such as sport or hobbies, through neglecting oneself and one's family, to not caring whether one lives or dies. Severely depressed people cannot concentrate, stop working and neglect personal hygiene. Irritability is common and may cause alienation from family and friends.

People with depression not only feel bad about life, but also about themselves. They often experience overwhelming guilt and feel a great sense of personal failure. They blame themselves for the situation they are in, regarding themselves as bad and undeserving of care. Guilt may reach the proportions of delusion, with people convinced they have committed crimes or horrible sins, which never really occurred. Such people may take their own lives, and even more tragically, the lives of their family in order to „save them from a world of evil?.

Suicide is obviously the most serious outcome of clinical depression. Of all people suffering clinical depression, two-thirds have suicidal ideas or thoughts of dying, and 15 per cent actually take their own lives. Depressed people also run a greater risk of accidents, possibly due to poor concentration or because they do not care whether they live or die.

Although depression is foremost a disturbance of emotion, actual physical changes in the functioning of a person's body take place in the more severe depressive illnesses. These are called „vegetative' symptoms. These include: loss of appetite, often leading to substantial weight loss; sleep disturbance, with difficulty falling asleep, or with early morning waking (typically about three o'clock) with an inability to return to sleep; hypersomnia or excessive sleep is another kind of disordered sleep that may occur. Other changes include a variation in mood intensity during the day, the morning being the worst time with improvement towards evening (diurnal variation); the slowing down of thinking and movement, sometimes to the point when speech may be impossible to follow (psycho-motor retardation), and a sense of restlessness or agitation which causes people to pace up and down, wring their hands, or pull their hair.

Rarely, there will be a complete loss of reality seen in what are termed "psychotic symptoms", such as delusions and hallucinations. The delusions are beliefs that a person is convinced are true, although they bear no semblance to reality. These fixed false beliefs typically contain themes of worthlessness, guilt for sins committed, persecution or nihilism (a belief that the person does not actually exist). Hallucinations are usually auditory, often of voices saying judgemental or derogatory things about a person, though they may occasionally be visual. These psychotic features parallel the severity of the depression, and cease when the person recovers.

All sorts of symptoms may mask an underlying depressed state. For example, depressed adolescents may exhibit disturbed behaviour, truancy, promiscuity or poor academic performance. Elderly people may focus on physical symptoms like constipation and weakness, or show excessive concern over their general health. Physical pain without obvious cause may sometimes be the complaint that raises a suspicion of an underlying depression. These situations have been referred to as masked depression, but the term is misleading as careful enquiry usually uncovers the depressive symptoms. Sometimes the person may not refer to sadness at all, although their appearance and behaviour-withdrawal, poor sleep, weight loss, and loss of interest in life- indicates otherwise.

By definition, a person meets the criteria for a major depressive episode if at least five of the following have been present during the same two-week period and represents a change from previous functioning; at least one symptom is depressed mood or loss of interest or pleasure:

• Depressed mood (or irritable mood in children or adolescents) most of the day, nearly every day.
• Marked loss of interest or pleasure in activities most of the day, nearly every day.
• Significant weight loss or weight gain when not dieting (for example, more than 5 per cent of body weight in a month), or decrease or increase in appetite nearly every day:
• Insomnia or alternatively excessive sleep nearly every day:
• Agitation or retardation nearly every day;
• Fatigue or loss of energy nearly every day;
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day;
• Diminished ability to think or concentrate, or indecisiveness, nearly every day;
• Recurrent thoughts about death and suicide.

A major depressive episode usually begins gradually, over weeks. Some people recover completely and only suffer a single attack during their lifetime. Over half will have one or more recurrences but are usually symptom-free between episodes - sometimes many years later, but occasionally only brief. Typically the period between episodes diminishes with age. Untreated mania lasts about three months, and untreated major depression between six and twelve months.

There are a number of other names given to mood disorders. Bi-polar mood disorder has already been mentioned. Depression that does not fulfill the criteria for major depression is sometimes described as minor depression. To refer to 'minor' depression is not to minimise its importance, as it can thoroughly disrupt a person's life, including work performance and inter-personal relationships. In the past, this form was called reactive depression, to emphasize that mood responded to environmental influences. Milder types of depression are often accompanied by so-called 'neurotic' features, notably anxiety. Such features may also be part of major depression.

Some people experience depression regularly during autumn or winter with recovery in spring and summer termed seasonal affective disorder.

Dysthymic disorder is a continuing 'low-grade' depressive state, more common in women than men, marked by an extremely pessimistic view of life and of the future, low self-esteem, indecisiveness and lack of energy. It usually begins in late adolescence or early adulthood, adversely affecting study or adjustment to work. Clear-cut bouts of depression, breaking the long, continuing dysthymic pattern, may move the person to seek professional help.

Cyclothymia is a pattern where people experience distinct, but relatively mild, mood swings. The changes may disrupt their lives with harmful effects on career and relationships. The swings are largely not influenced by life events.

Finally, lowered mood clearly resulting from well-defined stress such as a marital break-up or loss of a job is referred to as an adjustment disorder with depressed mood. As the stress lessens, so do the symptoms.

What causes depression?

We all have good and bad days. Why is it then that some of us get depressed and not others? Well, most of the evidence points to the fact that the way we feel is governed by a variety of chemicals in our brains called neurotransmitters. These neurotransmitters are given names such as serotonin, and noradrenaline. The balance between these neurotransmitters in our brains leads to varying emotional states. If that balance is altered or disturbed, then this will manifest itself in a mood disorder.

Many things can alter this balance. Physical illness, such as viral infections, hormonal deficiencies, and strokes call all alter this balance. As some mood disorders seem to affect a number of individuals in one family, it is likely that some people are genetically more prone to disturbances in these neurotransmitters, and hence mood disorders. However, working back the other way, the way we feel can also alter our neurotransmitter balance. The way we feel is an amalgam of both what is happening in our lives, and the way we evaluate these events and experiences. The way that we evaluate events is going to depend on both our previous experiences, and that nebulous but very real thing called our personality.

It makes sense to view our mental endurance the same way as our physical endurance. When we undertake strenuous exercise we become tired and our energy stores are depleted. When we live under mental strain or "stress" for long enough, our neurotransmitters stores become depleted, and our emotional exhaustion is manifested as a depression. When we are physically exhausted we lack the ability to continue to exert ourselves. When we are emotionally exhausted we similarly lack the emotional energy to generate positive emotions or thoughts. Continuing negative emotions increase our stress and emotional exhaustion, and our depression becomes a downward spiral.

The upset balance in these neurotransmitters is also responsible for the physical changes that take place involving sleep disturbance, energy and appetite.

This way of understanding things helps us to understand some very important perspectives.

Firstly, it becomes obvious that some people may become depressed due to physical causes alone.

Myth 1 – Spiritual people don't get depressed

To blame a person and judge their spirituality negatively because they are depressed in this instance would be tantamount to blaming a person with a broken leg for their inability to run a marathon. There are people who cope faithfully and well with many trials that out of the blue are afflicted with a severe depression-in such an instance a physical cause may well be acting.

We just have to look at a couple of examples to prove this point.

There was a man in the land of Uz, whose name was Job; and that man was perfect and upright, and one that feared God, and eschewed evil. Job 1:1

Why died I not from the womb? Why did I not give up the ghost when I came out of the belly? Why did the knees prevent me? Or why the breasts that I should suck? For now should I have lain still and been quiet, I should have slept: then had I been at rest, with kings and counsellors of the earth, which built desolate places for themselves; or with princes that had gold, who filled their houses with silver: or as an hidden untimely birth I had not been; as infants which never saw light. There the wicked cease from troubling; and there the weary be at rest. There the prisoners rest together; they hear not the voice of the oppressor. The small and great are there; and the servant is free from his master. Wherefore is light given to him that is in misery, and life unto the bitter in soul; which long for death, but it cometh not; and dig for it more than for hid treasures; which rejoice exceedingly, and are glad, when they can find the grave? Job 3:11-22

Hannah:

And as he did so year by year, when she went up to the house of the LORD, so she provoked her; therefore she wept, and did not eat. Then said Elkanah her husband to her, Hannah, why weepest thou? and why eatest thou not? and why is thy heart grieved? am not I better to thee than ten sons? So Hannah rose up after they had eaten in Shiloh, and after they had drunk. Now Eli the priest sat upon a seat by a post of the temple of the LORD. And she was in bitterness of soul, and prayed unto the LORD, and wept sore. 1 Sam 1:7-10

Jeremiah; David; Asaph; Jonah; Paul

Myth 2 – Depressed people should just "cheer up"

When we understand that depression may result from physical factors, and certainly can lead to real physical changes in the makeup of our brains regardless of the cause, we can see why it is that people who are depressed cannot easily "just cheer up". Their brains are physically unable to respond in the same way as a person who is not depressed.

Myth 3 Depression does not have a spiritual answer

The way that we evaluate events is vitally important to the way that we feel about them. Here are a number of underlying assumptions that we can make about life which are unhealthy and may predispose us to depression.

• I can only feel good if she approves of what I do.
  People whose self-esteem is based on how others judge them are vulnerable to depression and anxiety.
• I cannot do without her.
  Those whose self-esteem depends on being loved by someone are vulnerable to depression and anxiety
• I must be the best at work.
  An excessive reliance on productivity and achievement at work predisposes to the development of depression and anxiety.
• I must be perfect.
  Only being satisfied if things are done perfectly leads to anxiety and disappointment.
• I am entitled to success, love and happiness.
  The belief that you deserve success, love and happiness leads to depression and frustration when things do not all go your way.
• It is my fault that he did it.
  People who assume that they are responsible for everything that happens in their world are prone to guilt, blaming themselves for things over which they have no control.

We can learn to examine our beliefs and way of thinking in order to increase our ability to respond positively to stress, and develop more mature perspectives that increase our awareness of the joy of the position in which we stand as chosen children of God. We cannot choose our genetic predisposition, and we cannot control the possible physical causes of our depression, but we can help ourselves by developing healthy thought patterns. This is borne out by the fact that at least with mild to moderate depression, the talking therapies are as effective as antidepressant medication (which work by physically boosting the neurotransmitters in the brain), regardless of the cause of the depression. Paul speaks of "sound doctrine" (cp. 1 Tim 1:12), and the Greek word for "sound" is the word from which we get our English word "hygienic", that is – healthy. Although the context is a little different, I believe that God's teachings are truly healthy, and a mature understanding of His ways will invariably improve our mental health.

To summarise, there are a number of different contributing factors to depression, physical as well as mental, but in most cases, developing increasingly healthy thought patterns along with positive support from others, will assist in recovery, and provide us with a way that we can help ourselves.

How do we help ourselves?

Anticipate stresses.

• Distraction; "take a break".
• Recruit help.
• Relaxation techniques.
• Physical activity.

How do we help others?

• Awareness.
• Don't make out you understand if you don't.
• Don't add to burden by blaming; instead help them to understand that they are not alone.
• Don't offer advice. Glib answers indicate a lack of acceptance of the problem.
• Listen instead. Often a solution is not necessary or available.
• Ask questions about the heart. Help expose wrong directions.
• Don't allow feelings to be used as an excuse for wrong behaviour.
• Praise their strengths and achievements.

Medication

• The role of medication is to help gain energy to face the internal work, not mask it.

Depression Is A Normal Part Of Life's Experiences

The wise man Solomon, in summing up the results of his examination of pleasure, could find no ultimate fulfilment in anything that he had discovered.

I have seen all the works that are done under the sun; and, behold, all is vanity and vexation of spirit. Ecc 1:14

Therefore I hated life; because the work that is wrought under the sun is grievous unto me: for all is vanity and vexation of spirit (meaningless, a chasing after the wind(NIV)). Ecc 2:17

The creation waits in eager expectation for the sons of God to be revealed. For the creation, not by its own choice, but by the will of the one who subjected it, was subjected to frustration, in hope". Rom 8:19-20(NIV)

The cause for this inability to find enduring happiness is readily traced back to the beginning of human history, to what happened in the Garden of Eden. Before we go there I want to introduce a concept, which although it comes from a secular source, seems to find validation in the Bible. This idea is taken from Abraham Maslow's classical needs hierarchy. He suggests that human beings have five basic needs.

The five needs in Maslow's list, starting with the lowest or most basic are;

1. Physical (food, water, etc. i.e. elements necessary to sustain physical life).
2. Security (Maslow means physical security; some reasonable confidence that physical needs will be met tomorrow).
3. Love
4. Purpose
5. Self-actualisation (the expression of the highest qualities of humanness-the development of myself into a full, creative, self-expressing person).

In this country, our physical needs are reasonably met. If all our depression was based on a physical need, then the welfare committee could easily solve our problems.

What are perhaps more important needs when discussing the roots of our emotional state are the needs 3 and 4. Other writers use similar terms: love and work, security and significance, relationship and impact. These twin concepts are in keeping with the words of Solomon:

Go thy way, eat thy bread with joy, and drink thy wine with a merry heart; for God now accepteth thy works. Let thy garments be always white; and let thy head lack no ointment. Live joyfully with the wife whom thou lovest all the days of the life of thy vanity, which he hath given thee under the sun, all the days of thy vanity: for that is thy portion in this life, and in thy labour which thou takest under the sun. Whatsoever thy hand findeth to do, do it with thy might; for there is no work, nor device, nor knowledge, nor wisdom, in the grave, whither thou goest. Ecc 9: 7-10

Solomon concludes that it is by having these two needs met that we achieve a sense of happiness, at least in the temporary sense. In Eden, Adam was provided with a help meet and given a meaningful task in dressing and keeping the Garden of Eden. Before the Fall, both of these endeavours would have brought great joy and satisfaction to Adam. Yet after the Fall it was in these two areas, the security of loving relationships, and significance in meaningful work that Adam and Eve were cursed, "thy desire shall be to thy husband, and he shall rule over thee" was the judgment on Eve, "In the sweat of thy face shalt thou eat bread, till thou return unto the ground", was Adam's.

Even more crucially, God had made man in a unique way with the ability to receive and be filled by the love of God. He was not made to be complete in himself, but as a dependant being who in Maslow's term achieved ultimate self-actualisation, or ultimate and complete fullness, only when he lived in relationship with God. In the Garden of Eden Adam and Eve lived in perfect fellowship with the God on whom they depended. If an angel had stopped by the garden one evening and asked, "Adam, do you long for completeness?" Adam may well have looked rather puzzled and replied, "I'm not sure what you mean. I have God. What more could I want?"

But when God withdrew from Adam and Eve because of their sin, that capacity within them that enabled them to enjoy God was suddenly empty. All of a sudden they were flooded with negative emotions. They felt in themselves a great sense of something wrong, something missing, and rightfully blaming themselves; felt a great sense of shame. All of a sudden they felt incomplete in their natural state to the extent that they had to add to themselves aprons of fig leaves to try to complete themselves and ameliorate their shame.

From that moment onwards they lived in a state of struggle to regain that sense of fullness that they had enjoyed in connection with God, which they had lost. Their emotional currency became driven by fear. Sensing their own unworthiness and unloveliness they feared exposure, rejection, and failure, whilst craving love, acceptance, and significance. Because of their darkened minds, they more naturally looked for fulfilment of these needs everywhere except in God. So emptiness, resulting in frustration, vanity and vexation of spirit became a normal part of a fallen world.

The resultant emptiness drives us in two directions.

• Deny the emptiness
• Fill it with whatever seems to promise relief. All of us pursue, in one degree or another, avenues of fulfillment that have nothing to do with God.

Denial is a term used to describe a sort of internal blindness, which refuses to accept the presence of a problem. It's as if by telling ourselves we don't hurt, we don't struggle with a problem, will somehow make it so. Our fear of rejection by others, especially God, is so great, and we feel so threatened by the idea that we might be exposed as an unlovely failure, that we cannot admit the presence of a problem even to ourselves. The difficulty is that it takes an enormous amount of emotional energy to keep these unpalatable truths from reaching our awareness, and the cost is often a depression. And if we never admit to the problem, we can never move beyond it, and our depression persists. These problems we find hard to admit to ourselves may be;

• A failing marriage
• A failing family
• Hatred towards a brother or sister

In our community there is perhaps an idea that maturity comes from not thinking too deeply about oneself. Reflection on oneself is regarded as an unhealthy introspective focus. This sort of denial is wrong on at least two counts.

1. It contributes to the idea that the solution to a problem is to go around it, not through it.
2. The Bible expressly states that God has built us with the ability to explore our deepest parts.

The spirit of man is the candle of the LORD, searching all the inward parts of the belly. Pro 20:27

Denial can be seen in the shallow advice to simply read the Bible, and to be obedient. This focuses only on the behaviour, and not the deeper underlying dysfunctional beliefs that drive the behaviour. These wrong beliefs are not exposed to the light of God's Word and so no change occurs.

There are real dangers in looking inward. We can become preoccupied with ourselves, rather than moving forward in faith, and we can also "psychologise " sin away. But denial has its own set of dangers, the chiefest of which is to lose sight of our desperate need of salvation. Recognition of our desperate plight provides urgent motivation to look away from ourselves and to turn in dependence to the Father of Lights. 10 | P a g e

Illegitimate Fulfilment

The other sinful response to our emptiness is to try to fill ourselves with something other than God. Jeremiah records;

For my people have committed two evils; they have forsaken me the fountain of living waters, and hewed them out cisterns, broken cisterns, that can hold no water. Jer 2:13

Jeremiah indicts God's people for depending on broken cisterns in their efforts to quench thirst, cisterns which they made themselves but which can hold no water. Nothing that men can control will ever provide deep satisfaction. Yet we insist on trying to achieve satisfaction ourselves. And that fact defines our foolishness.

But our foolishness is not immediately apparent. Even wells with holes in them can hold some water for at least a while. Temporary satisfaction is available in any number of ways. Alcohol, drugs, pornography, materialism, power – all are attempts to try to fill a void that can only be filled by God. But like Solomon, if we seek to find real fulfillment through any of these avenues we will ultimately be disappointed. Though they may seem to provide satisfaction, when we are confronted with the real issues of life and death they provide no answer.

If we are struggling with depression it is always worthwhile examining ourselves to see whether we are looking for fulfillment in the wrong things. If seeking for happiness in false idols is not the root cause of our depression, we must be careful that it does not become part of the treatment. It is so easy, when our whole life is full of pain, to justify any sin on the basis that "you wouldn't judge me if you felt the way that I do". So even if there is no spiritual cause to a person's depression, a spiritual problem may develop.

Depressed people are very vulnerable, and we need to be aware of this danger, and gently confront excuses for wrong directions.

Rather than denying our emptiness, or filling it illegitimately, we instead ought to embrace it. Legitimate emptiness is a good place to start rebuilding a life dependant on God. Speaking of physical pain, one author called it the "megaphone of God". It tells us that something is wrong, and needs attention if more significant harm is to be avoided. Mental anguish is no different. Through it God calls us to understand that something is wrong with the world, that what we are currently doing to find happiness is not working. By this means He hopes that we will be motivated to return to a relationship with Him and seek for the salvation that only He can provide.

Illegitimate Emptiness

Given that without God we will never be legitimately full, why is it that we who have come into a relationship with him and ought to be full still struggle? God has met our need for security or love. In God we find significance or purpose. Our needs as Maslow defined them are met. Why then do we struggle to feel complete, settled, at peace? Why then do we become depressed? There may be a number of reasons.

Wrong expectations

If God does not act towards us the way that we think that he ought to, then our faith or security in His provision can be shaken. We sometimes view our relationship with God as did Jacob.

And Jacob vowed a vow, saying, If God will be with me, and will keep me in this way that I go, and will give me bread to eat, and raiment to put on, so that I come again to my father's house in peace; then shall the LORD be my God: Gen 28:20-21

At this stage in his life, Jacob believed that in return for his belief, God should deliver by providing him with a life of reasonable comfort. We often share a similar belief-that is, if we attend the various meetings and ecclesial activities, do our readings, and pray to God, then our marriages will be successful, our children will accept the truth, and we will be largely protected from heartache and tragedy. We accept that we will face minor hiccups on the way, but that it will all turn out O.K. in the end.

Now, a faithful life will increase the chances of a happy marriage and family life, there is no doubt about that at all, but it is no guarantee that we will not face some major tragedies. Look once again at Job, who made every effort to provide the best of examples to his family. Jacob, at the end of his life, was to admit, "few and evil have been the days of my life" (Gen 47:9), but that despite this, to him God had been "the God which fed me all my life long unto this day, the Angel which redeemed me from all evil" (Gen 48:15).

The writer to the Hebrews gives us a more mature perspective;

And ye have forgotten the exhortation which speaketh unto you as unto children, My son, despise not thou the chastening of the Lord, nor faint when thou art rebuked of him: For whom the Lord loveth he chasteneth, and scourgeth every son whom he receiveth. Heb 12:5-6

God's blessings are not of a reasonably comfortable life, but of a life that draws us closer to him by whatever means He deems will help. Even Job, in all his trouble, was at the end able to appreciate that it had brought him to a heightened awareness of God.

I have heard of thee by the hearing of the ear: but now mine eye seeth thee. Job 42:5

Asaph also struggled with an inaccurate expectation. He had believed good things should happen to the godly, and bad things to the ungodly.

Behold, these are the ungodly, who prosper in the world; they increase in riches. Verily I have cleansed my heart in vain, and washed my hands in innocency. For all the day long have I been plagued, and chastened every morning. Psa 73:12-14

Nothing is more natural, especially when we suffer from the wounds caused by unjust treatment from another, than to regard our immediate well-being as the final purpose justice should serve. Asaph however, realizes after entering the sanctuary of God, that in this he was thinking like a brute beast, who would in avoiding the minor short term pain of the goad, allow itself to be herded to the slaughter. Short-term pain was tolerable when the end result was salvation. He concludes,

Nevertheless I am continually with thee: thou hast holden me by my right hand. Thou shalt guide me with thy counsel, and afterward receive me to glory. Psa 73:23-24

Guilt

Guilt for past sins seems to be a particularly common problem. It may cause depression, and as we have already seen, as we become depressed we become more and more negative in our outlook, and become more ad more focused on our failings, increasing our depression. John seems to suggest that God can forgive more than we can accept,

For if our heart condemn us, God is greater than our heart, and knoweth all things. 1 John 3:20

If this is our problem we need to carefully study the examples of forgiveness that we are given. We need to increase our awareness of our forgiveness. The Bible repeatedly teaches that if we have asked for forgiveness sincerely then they are gone. The psalmist says;

As far as the east is from the west, so far hath he removed our transgressions from us. (Psa. 103:12)

How far apart are east and west? If you start due north from any part of the earth, you will eventually find yourself going south. This is not true when you go east or west. If you start west, and keep going, you will always be going west. In this sense east and west are an infinite distance apart. So when God says that He removes our transgressions from us as far as the east is from the west, He is saying that they have been removed an infinite distance from us.

When God uses this metaphorical expression describing the extent of His forgiveness of our sins, He is saying that His forgiveness is total and complete. He is not keeping score with regard to our sins. There is no weighing them against the rest of our lives. In Christ, when He looks at us, having forgiven our sins, they are completely removed from us.

Consider the words of Jeremiah;

Behold, for peace I had great bitterness: but thou hast in love to my soul delivered it from the pit of corruption: for thou hast cast all my sins behind thy back. (Jer:38:17)

The prophet said of God, "You have put all my sins behind Thy back." When something is behind our back, it's out of sight. We can't see it any more. God says that this is what He has done with our sins. It's not that we haven't sinned, or do not continue to sin. We know that we sin daily-in fact many times a day. Even our best efforts are marred with imperfect performance and impure motives. But God no longer sees either our deliberate disobedience or our marred performances. Instead He sees the righteousness of Christ, which He has already imputed to us.

Does this mean that God ignores our sins like an overindulgent, permissive father who lets His children grow up undisciplined and badly behaved-not at all. In His relationship to us as our heavenly Father, God does deal with our sins. Yet He deals with them only in a way that is for our good. He does not deal with us as our sins deserve, which would be punishment, but as His grace provides, which is fundamentally different. All His actions toward us, though they include trial and at times chastening, are done to lead us to life, not death as our sins deserve.

Note that our sins do not just happen to be behind God's back. He put them there. He doesn't just ignore them, but actively takes them and places them behind Him. Again His active initiative is seen.

Another striking metaphor is one that Micah uses;

Who is a God like unto thee, that pardoneth iniquity, and passeth by the transgression of the remnant of his heritage? He retaineth not his anger for ever, because he delighteth in mercy.He will turn again, he will have compassion upon us; he will subdue our iniquities; and thou wilt cast all their sins into the depths of the sea. (Micah 7:19)

Think about the last time you were on a boat. You look over the side and the water is deep green-so that you know that it's a long way down. Imagine if you got a heavy weight and threw it overboard. It would just keep on going down. It might fall for 7 miles in some spots. Now imagine trying to find it again. It just would not be possible. It would be lost for ever. So it is with our sins. God has hurled them into the depths of the sea, never to be recovered, never to be held against us. Again God is active in this process. Our sins don't just fall overboard. God casts them over the side. He, as well as ourselves, wants them to be lost forever.

There is never any limit to our credit with God for there is no record of credit extended. Forgiveness is always there, if we choose to accept it. That does not cheapen it, because God's offer of grace is given to us on the basis that we confess our true state. In that sense it is not completely unconditional-it requires repentance of heart, and acknowledgement of guilt. What it does not require is that we then no longer sin, because we will, without doubt, and often in the same way. There is no record of the number of sins forgiven that must not be exceeded. Once they are gone it is as if they have never existed.

The fourth passage emphasising God's forgiveness of our sins is recorded by Isaiah;

I, even I, am he that blotteth out thy transgressions for mine own sake, and will not remember thy sins. (Isa 43:25)

Here God uses two expressions. He blots out our transgressions, that is, He removes them from the record; and He remembers them no more. If we commit a crime, we obtain a criminal record. Whenever that record is opened, that crime will be there. No matter that we have now served our sentence, or that we have changed our way of life. It is still there. Yet with our sins, God has completely blotted them out. God takes that record of our sins and destroys it. If that file were opened there would be no record of it having ever existed. He doesn't keep it on record, or daily add the long list of sins that we, even now, continue to commit.

God not only blots out our sins from the record, He also remembers them no more. That means that He no longer holds them against us. There is a difference between the terms. The blotting out of our transgressions is a legal act. It is an official pardon. The remembering them no more is a relational act. It is the giving up by an injured party of all sense of being offended or injured. It is a promise by God never to bring up our sins, either to Himself or to us.

Forgetting is passive and it is something that we as humans, not being omniscient, do naturally, without even trying. Yet God never forgets, he cannot-it is impossible. Therefore "not remembering" is active. God has to deliberately try. "Not remembering" is the promise where God determines by an act of His will not to remember the sins of another against him.

We can be assured that we are never too sinful for God to care about. We may think we're the worst person that ever lived, but read 2 Chron. 33 and 2 Kings 21. Have we sacrificed our children to an idol? Have we set up a brothel in our ecclesial hall? Is there blood from people we've murdered running down the hallway of our house? The answer, of course is no. Yet that is the description that we have been given of King Manasseh. Yet despite this awful record, God heard his sincere prayer, came to his aid, restored him out of captivity in Babylon, and restored him to the throne of Judah.

A Performance Mentality

There are many ways that we fall into the trap of using our performance to judge how we think that God views us. Because our spiritual performance is often poor, we feel very insecure regarding whether God loves us and will bless us. Our low self-esteem eats away at our confidence that God is there for us. When thing go bad, we need to have faith that God is there with us in whatever trial we face. If we let go of this fact, then we let go of the only assurance that we can bear the pain of our lives.

When we are depressed we often feel enormously guilty and worthless, out of all proportion to reality. In this state of mind we can feel that we do not deserve God's help, and that we are not worthy of His attention. In this we lose sight of the central facet of God's amazing grace-that by definition it does not depend on our spiritual performance.

What is grace? Grace is God's free and unlimited favour shown to guilty sinners who deserve only judgment. It is the love of God shown to the unlovely. It is God reaching down to people who are in rebellion to Him. Grace stands in direct opposition to any supposed worthiness on our part, is not based on anything that we do, but only on God's love. God's love, we are told, is an intrinsic part of His character, which He can never be untrue to. He loves because He is loving, not because we are lovable.

In this was manifested the love of God toward us, because that God sent his only begotten Son into the world, that we might live through him. Herein is love, not that we loved God, but that he loved us, and sent his Son to be the propitiation for our sins. 1 John 4:9-10

Grace is not dependant on our individual worthiness.

Who hath saved us, and called us with an holy calling, not according to our works, but according to his own purpose and grace, which was given us in Christ Jesus before the world began, 1 Tim 1:9

For we ourselves also were sometimes foolish, disobedient, deceived, serving divers lusts and pleasures, living in malice and envy, hateful, and hating one another...but...after that the kindness and love of God our Saviour toward man appeared, not by works of righteousness which we have done, but according to his mercy he saved us, by the washing of regeneration, and renewing of the Holy Spirit; Titus3:3-5

Grace ceases to be grace if God is compelled to bestow it in the presence of human merit. Grace ceases to become grace if God is compelled to withdraw it in the place of human demerit. Grace is treating a person without the slightest reference to their deserts whatsoever, but solely according to the infinite goodness and purpose of God.

A performance mentality is manifested in a number of ways. One way that it affects us if we judge ourselves by our performance we end up doing things without considering their real value. As we approach exhaustion, we continue to try to attend everything, do everything, and be everything without ever asking whether we are really benefiting from these efforts. We have said before that attendance to ecclesial activities is important, and should not be under-valued, but of itself, it will not ensure our salvation. One practical message from this is that if we find that due to the complexity of our lives we are not really coping, we should not to feel that God's gifts will be withheld from us if we take some time out to rebuild ourselves and our faith.

Over Responsibility

This could be termed the Elijah Complex.

But he himself went a day's journey into the wilderness, and came and sat down under a juniper tree: and he requested for himself that he might die; and said, It is enough; now, O LORD, take away my life; for I am not better than my fathers. And as he lay and slept under a juniper tree, behold, then an angel touched him, and said unto him, Arise and eat. And he looked, and, behold, there was a cake baken on the coals, and a cruse of water at his head. And he did eat and drink, and laid him down again. And the angel of the LORD came again the second time, and touched him, and said, Arise and eat; because the journey is too great for thee. And he arose, and did eat and drink, and went in the strength of that meat forty days and forty nights unto Horeb the mount of God. And he came thither unto a cave, and lodged there; and, behold, the word of the LORD came to him, and he said unto him, What doest thou here, Elijah? And he said, I have been very jealous for the LORD God of hosts: for the children of Israel have forsaken thy covenant, thrown down thine altars, and slain thy prophets with the sword; and I, even I only, am left; and they seek my life, to take it away. (1 Kings 19:4-10)

The work involved in ecclesial oversight can be exhausting. In fact, depression can be a result of emotional exhaustion alone, and we need to recognise when we need to look after ourselves as well as our ecclesia. The trap is to consider ourselves so indispensable that God cannot do without us. The reality is that the ecclesial world is ultimately God's responsibility, not ours.

We must do the best that we can, but God will never leave His ecclesia without what is necessary. Elijah had gotten himself into a state of emotional exhaustion to the point that he wished to die. He thought that he was the only one that could do what was necessary, and the task seemed too great. But what did God say? "Yet I have left me seven thousand in Israel, all the knees which have not bowed unto Baal, and every mouth which hath not kissed him". God had provided, and Elijah was not alone.

Depression Is A Spiritual Problem

I said earlier that we cannot always point to spiritual failings as a cause for a depression. However, we cannot see it as something that has no connection with our spirituality. Joy, the opposite of depression is a fruit of the Spirit.

But the fruit of the Spirit is love, joy, peace... (Gal 5:22)

For this cause we also, since the day we heard it, do not cease to pray for you, and to desire that ye might be filled with the knowledge of his will in all wisdom and spiritual understanding; That ye might walk worthy of the Lord unto all pleasing, being fruitful in every good work, and increasing in the knowledge of God; Strengthened with all might, according to his glorious power, unto all patience and longsuffering with joyfulness; (Col 1:9-10)

Joy and feeling good are different things. Joy is independent on external circumstances because it is based on certainties that never change, on an internal awareness of blessing.

For God, who commanded the light to shine out of darkness, hath shined in our hearts, to give the light of the knowledge of the glory of God in the face of Jesus Christ. But we have this treasure in earthen vessels, that the excellency of the power may be of God, and not of us. We are troubled on every side, yet not distressed; we are perplexed, but not in despair;

Persecuted, but not forsaken; cast down, but not destroyed...Knowing that he which raised up the Lord Jesus shall raise up us also by Jesus, and shall present us with you. For all things are for your sakes, that the abundant grace might through the thanksgiving of many redound to the glory of God. For which cause we faint not; but though our outward man perish, yet the inward man is renewed day by day. For our light affliction, which is but for a moment, worketh for us a far more exceeding and eternal weight of glory; While we look not at the things which are seen, but at the things which are not seen: for the things which are seen are temporal; but the things which are not seen are eternal. 2 Cor 4:6-8, 14-18

Beloved, now are we the sons of God, and it doth not yet appear what we shall be: but we know that, when he shall appear, we shall be like him; for we shall see him as he is. 1John 3:2

Joy is felt in the knowledge of being on a journey. Suffering has a purpose:

Wherein ye greatly rejoice, though now for a season, if need be, ye are in heaviness through manifold temptations: That the trial of your faith, being much more precious than of gold that perisheth, though it be tried with fire, might be found unto praise and honour and glory at the appearing of Jesus Christ: Whom having not seen, ye love; in whom, though now ye see him not, yet believing, ye rejoice with joy unspeakable and full of glory: Receiving the end of your faith, even the salvation of your souls.1 Pet. 1:6-9

And not only so, but we glory in tribulations also: knowing that tribulation worketh patience; And patience, experience; and experience, hope: And hope maketh not ashamed; because the love of God is shed abroad in our hearts by the Holy Ghost which is given unto us. Rom 5:3-5

Joy May Not Mean Cure

The lessons for me have been hard learnt. I am no more immune than anyone else. I was depressed then and have been, intermittently, ever since. I will always remain vulnerable. But I have learned to spot the warning signs-the vicious circle of overwork, disaster and drinking to relieve my sense of inadequacy. And when that is not enough, I have the knowledge of help available and that it will get me through.

In the process, I'm convinced that recognising my own vulnerability has made me better able to help others-not by offering false "hope" from my own experience but by being able to share the blackness in the middle of the tunnel when they cannot possibly see the light at its end.

Myth 5 – God's Blessing Lies in Lifting our Burden

And lest I should be exalted above measure through the abundance of the revelations, there was given to me a thorn in the flesh, the messenger of Satan to buffet me, lest I should be exalted above measure. For this thing I besought the Lord thrice, that it might depart from me. And he said unto me, My grace is sufficient for thee: for my strength is made perfect in weakness. Most gladly therefore will I rather glory in my infirmities, that the power of Christ may rest upon me. 2 Cor 12:7-9

Summary

Depression may have a number of causes. It may be attributable to something outside our thinking, but should cause us to examine ourselves to see whether we are denying a problem that exists in our lives, replacing God with something that will never fill us, or misunderstanding the riches of His Grace. We need to re-evaluate what goes on around us, not confusing goals with desires. Whatever the cause of our depression we are called to continue to move toward God rather than our own happiness, looking forward to the future when God's work in us will be complete, and we receive that eternal weight of glory promised to us