A Portrait of Depression and Recovery

If you have ever suffered with depression, and most of us have, you might find this reflection on Psalm 102 enlightening.

I came to Psalm 102 recently in my daily readings. It is a psalm of lament in which the unidentified psalmist lists an array of physical, emotional, relational, and spiritual complaints.

With many years of both living my life and wearing my clinical hat, I recognized how closely they match the criteria for Major Depressive Disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

If you are not familiar with this weighty tome, it is the guidebook used by clinicians to diagnose, treat, and bill insurance companies for treatment of psychological or psychiatric problems.

Major depressive disorder, referred to as a “clinical depression” is one of the most common psychological problems experienced by human beings. The prevalence varies by age group, gender, ethnicity, and socioeconomic status, but over a lifetime, a great percentage of us will experience this distressing condition at some point.

According to the NIH, An estimated 21.0 million adults in the United States had at least one major depressive episode in 2020, which is 8.4% of all U.S. adults.1 (2020 was an especially tough year for so many). And according to the CDC, between 2015 and 2018, approximately 13% of adult Americans were taking antidepressant medications.2

There are two cardinal symptoms of major depression. The first is “depressed mood most of the day, nearly every day” over a period of two weeks or more. This may be experienced as a pervasive sense of sadness, emptiness, or hopelessness.

The second is “loss of interest or pleasure.” Things that we normally are motivated to get up and do just no longer matter and we lose motivation to engage in life. Everything becomes flat.

After these two signs, one or both of which must be present to render the diagnosis, there are seven other symptoms that might be observed in a depressed person. To summarize, they are: marked increase or decrease of appetite, insomnia or hypersomnia, agitation or slowing of motion, fatigue, feelings of worthlessness or inappropriate guilt, impaired concentration, and recurrent thoughts of death or suicide.3

It looks different in different people because of how we are each uniquely knit together. But clinical depression with various presentations and combinations of these symptoms is not a new phenomenon.

Wouldn’t you know that depression occurs in the Bible? Scripture comes to life with stories of Bible characters encountering despair, hopelessness, and loss of the will to live (see David, Hannah, Saul, for example). But we see it most vividly portrayed in the Psalms, and Psalm 102 stands out in this regard.

When we look at some of the physical, emotional, relational, and spiritual symptoms described poetically in this psalm, we see an ancient portrait of a person in the throes of a of a depressive episode. But we won’t just witness the problem, we’ll go on to witness the path the psalmist finds to lead him from the darkness of depression into the light of hope.

Listen to his cries:

  • For my days vanish like smoke; my bones burn like glowing embers.
  • My heart is blighted and withered like grass; I forget to eat my food.
  • In my distress I groan aloud and am reduced to skin and bones
  • I lie awake; I have become like a bird alone on a roof.

Notice the loss of appetite, the fatigue, and the insomnia? And he is in pain; even his bones feel like they are burning. The DSM-V doesn’t list it as a symptom, but after 30 years of talking with depressed people, I know that depression often causes real physical pain. As the commercials say, depression HURTS.

Then he names some relational and emotional effects:

  • All day long my enemies taunt me; those who rail against me use my name as a curse.
  • For I eat ashes as my food and mingle my drink with tears
  • Because of your great wrath, for you have taken me up and thrown me aside, my days are like the evening shadow; I wither away like grass.

Clearly this is a person who feels alone and abandoned, forsaken by God and man, metaphorically “thrown aside.” He has become hopeless, a mere shadow of his former self. Do you see the loss of interest or pleasure in living?

Let’s look now at what happens next. The recovery process.

Depression can be caused by many different biological, environmental, and temperamental factors. Therefore, treatment is most effective when it corresponds to the cause. For example, if there is a physiological depletion of serotonin in the brain, an antidepressant might be called for. If there are overwhelming environmental stressors, they must be recognized and reduced, often with the use of some form of counseling or psychotherapy.   

Fortunately, depression is one of the more treatable psychological problems. Much research has been undertaken over the last century that supports the hypothesis that psychotherapy and antidepressant medication are often effective separately, but even more effective when used together.

This makes sense. I can use an analogy from my ongoing struggle with sciatica. While waiting for a steroid injection to mitigate my chronic pain and allow me to resume normal functioning, I was prescribed several medications that would at least help me get through day and night with less agony.

I finally did get that blessed shot, and I’m relieved. But the removing of the pain does not solve the problem. Whatever has been causing sharp pains to shoot down my leg is still there. Now I have to enter a period of physical therapy, get some imaging done, and change the way I move, sit, exercise, etc.

With depression, pills can pull us back from danger, “take the edge off” the symptoms causing acute suffering. Then we can begin to think about what needs to happen to improve the inner and outer conditions of our lives that triggered the symptoms.

Unfortunately, some people self-medicate with drugs or alcohol, and this compounds the problem. Long-term numbing of emotional pain with no attempt to understand its causes can be a recipe for disaster.  

Instead, the onset of a serious depression is a time to open ourselves to an outside influence—a minister, a therapist, a healing prayer partner, or God himself—so we don’t just mask our symptoms but work to eradicate the disease!

I don’t know if there were mental health professionals standing by when Psalm 102 was written. Either way, the first thing this writer does is to approach God with the problem. He prays.

Hear my prayer, Lord; let my cry for help come to you.Do not hide your face from me when I am in distress. Turn your ear to me; when I call, answer me quickly.

Before laying out his complaints to the Master Therapist, he acknowledges his need for God’s help. He is ready to surrender it and is counting on an answer from the Lord.

I am a good therapist, but I’m not God. And yet, I’ve heard time after time after a first session that the mere act of finding someone trustworthy to talk with already starts to bring hope and relief. And if I offer to pray with them, that more powerfully encourages them that help is at hand.

 We must come out of hiding when depressed and begin to share the burden with someone. Who better than God?

After telling his woes, the Psalmist begins reminding God of who he is, and of what he has promised to his people. He praises.

But you, Lord, sit enthroned forever; your renown endures through all generations.
You will arise and have compassion on Zion, for it is time to show favor to her; the appointed time has come…The nations will fear the name of the Lord, all the kings of the earth will revere your glory.For the Lord will rebuild Zion and appear in his glory.

Do you feel this shift from groaning to praising? Have you experienced it? Being stuck in an inner cyclone of distress and despair, then raising your head to praise God, and finding sudden release? The clouds part and you can see the sun again? I know I have.

Photo by Alex on Pexels.com

The rest of Psalm 102 reads like a good therapy session. The psalmist tells his story. He gives background, reciting both the causes of his despair and his unfolding revelation of the path forward. He regains perspective.

This wonderful psalmist talks it through (or maybe, sings it through) until he remembers that he is part of God’s story, and not the other way around. He’s had mountaintop experiences with the Lord, and he’s been in deep, deep valleys where he felt forsaken, but actually never was.

He remembers that he and his generation will pass away, but while in the land of the living, they can look to the Lord their God and keep their trust in him. New generations will come and live in the presence of this same faithful God and join his never-ending story.

But you remain the same, and your years will never end. The children of your servants will live in your presence; their descendants will be established before you.

While the lie of depression is often that we will always feel so terrible and there is no way out, I’ve watched hundreds of clients climb out of the pit and regain hope and health. It can happen a variety of ways. But the underlying process follows the same pattern found in this psalm.

We pray and ask for help—from human helpers and from God. We praise, give thanks, and remember that there is still much worth living for. We regain perspective that all things do pass. We trust that we will get better if we don’t give up.

1 https://www.nimh.nih.gov/health/statistics/major-depression

2 https://www.cdc.gov/nchs/products/databriefs/db377.htm

3 American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

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