How Depressing!

Rev Peter Morales, Senior Minister
Jefferson Unitarian Church, Golden, Colorado
February 3, 2002

I remember learning to recognize the earliest signs of my mother’s oncoming depressions. By the time I was eight or nine I could predict what would happen. By the time I was in high school, the pattern had become a heartbreaking routine. The first changes were very subtle. First there was the tiniest change in the way my mother would move around the house. Her movements were a little slower, a bit more deliberate. The inflection in her voice became ever so slightly altered. There was a hint of brooding and sadness in her eyes. A week or so later these changes would be more pronounced. In another week minor frustrations that normally had no effect would bother her. She would laugh less often. Once the downward slide began, the final destination was inevitable. Within six weeks of the earliest signs she would be a psychiatric inpatient.

Trips to the psychiatric ward to visit my mother became part of my life, but I never got used to them. I remember feeling haunted by the blank stares of the patients. I recall the dull way they would sit at a table working a jigsaw puzzle or playing dominoes without a hint of playfulness. An atmosphere of lifeless gloom pervaded the ward, despite the best efforts of the staff to make the place look cheerful. The ward did not feel dangerous, but it was definitely eerie.

What I remember most, though, was my mother. In those days, the late 1950s and early 1960s, the standard treatment for severe depression was electroconvulsive therapy. Luckily, I never saw it administered. Not until I watched the movie “One Flew over the Cuckoo’s Nest” many years later did I have any image of what shock therapy involved. After the shock treatments, my mother seemed dazed and weak as a kitten. Her voice was soft and frail. Her memory was spotty.

Her hospital stays lasted a few weeks. My father visited her every day; my sister and I went several times a week. By the time my mother would return home her energy level was improved. The fog of memory loss gradually lifted. After a few weeks at home she was back to normal. Her energy was back. Her sense of humor returned, as did her characteristic feistiness and stubbornness. She would begin attending church again and once more took pleasure in long chats with friends. Life at home would settle into back into our usual routines. Then, after months of normal life, I would again spot the telltale inflection in her voice. I would watch the depression gather strength like a winter storm that builds slowly but relentlessly. Mother would slide into her dark abyss one more time. It was back to the hospital and more shock therapy.

What I could not have known in my youth was how common my mother’s condition was and still is. Depression is pervasive. Depression kills tens of thousands of Americans every year.

Everyone, of course, has experienced periods of sadness and grief. Every one of us in here this morning has felt blue and hopeless. Most of us have probably wondered, at a time when our lives were in shambles, whether it was worth it to go on living. These feelings give a taste of depression, but only a taste. Clinical depression involves relentless, enduring feelings of sadness, hopelessness, worthlessness, loss of interest in life and fatigue. Sadness is not depression. Sadness is a normal emotional response to loss. Depression might be triggered by loss. However, depression is wildly out of proportion to that loss and persists far longer than normal grief or sadness. Depression often comes without any obvious event to trigger it. Severely depressed people often have nothing to be depressed about. As it did for my mother, for the severely depressed depression seems to come with mysterious rhythms of its own.

As part of my ministerial training, I did part of my clinical internship in a psychiatric ward. Ironically, the ward was for the severely depressed. Most of our patients were in for electroshock therapy, which is still being used as a last resort when drugs and psychotherapy have no effect. These extremely sick people had lives much like lives of those on the outside. Events in their lives did not make them depressed. They were not depressed because their lives were hell; their lives were hell because they were depressed.

Thankfully, you and I do not encounter such extreme cases every day. You and I can be grateful that few of us will ever sink that far into the dark abyss of depression.

And yet depression is all around us this morning. No person in here today can escape the effects of clinical depression. One out of six of us will experience depression in our lives. Let me bring it closer to home: about 20 or 30 of us in here this morning have been depressed. A handful of people in here this morning are depressed right now. And even if your disposition is as sunny as Colorado, a member of your family and/or a friend of yours suffers from depression. Depression touches each one of us.

As we learn more, we are coming to understand just how pervasive this problem is. About one out of every six people who suffer from depression will commit suicide. Suicide kills more people than AIDS. Suicide is a leading cause of death among teenagers. Most experts believe that suicide is underreported because of stigma and concerns over insurance. A significant number of fatal single car accidents are probably suicides, as are deaths from “accidental” overdoses of medications. Alcoholism is closely related to depression. Eighteen percent of alcoholics commit suicide. Colorado’s suicide rate is higher than the national average.

For reasons that no one fully understands, women are at least twice as likely to be depressed as men. Speculation as to why women are more likely to be depressed runs the gamut from biological to cultural explanations. Some believe women are simply more in touch with their feelings and more likely to seek help. Others believe women’s depression is the result of how they have been oppressed in a male dominated culture. Some have suggested that hormones associated with the menstrual cycle affect the chemicals in the brain that affect mood. Whatever the reasons, in a recent international study women in all cultures were twice as likely to be depressed.

Recent studies suggest early childhood experiences may be linked to depression, but in an indirect way. Studies in rats and monkeys show that brain chemistry is altered, possibly permanently, by experiences in infancy. Rats deprived of their mothers in infancy showed increased levels of chemicals associated with depression. Monkeys deprived of maternal contact showed not only similar chemical changes, but became less active, withdrew from interactions with other monkeys and froze in novel situations. The implications for us humans are deeply troubling. In this country we have more than three million reported cases and one million confirmed cases of child abuse and neglect every year. The worst scars from this neglect and abuse may be biochemical, rendering the affected infant less able to deal with life’s stresses.

I could go on and on. I could tell you about neurotransmitters melatonin and seratonin. I could talk about the chemical links among carbohydrate craving, seasonal affective disorder and premenstrual syndrome. I could rattle on about receptors on neurons and selective seratonin reuptake inhibitors. (I might even fool a few of you into believing that I actually understand the dizzying research findings that are flooding out.)

The most important fact about depression, however, is that there is more hope now than there has ever been. More than 80 percent of depressed people respond to treatment and the number is rising. There is much we do not know, but we know enough to help people feel much better and to save thousands and thousands of lives. New drugs and better psychotherapy together are making a dramatic difference in millions of lives. In my own mother’s case, drugs made it possible to stop the terrible cycle of psychiatric wards and shock therapy. Her life continued to have its struggles and she was never free from the disease, but she was saved from the hell of hospitalizations and shock therapy.

If you remember nothing else from this morning’s sermon, remember this: there is hope. If you are depressed, you do not have to live like that any more. If someone you care for suffers from depression, help them get treatment. Don’t wait until it is too late.

So, is that all there is to it? Is our task simply to see to it that the depressed among us get take our medication and talk to a therapist? Has surviving the dark night of the soul become simply a clinical matter of finding the right pill? Has depression become a matter of “take two Prozac (or Paxil or Zoloft or Wellbutrin or Serzone) and call me in the morning”? Are there any spiritual, ethical, or religious issues left for a community of faith?

In my view, our new scientific knowledge of depression does not make depression any less of a religious issue, but it makes it a different kind of religious issue.

First, to say that depression is biochemical does not get us very far. I mean, everything that happens in our brains is, at some level, biochemical. To say that a human experience is biochemical is ultimately redundant. We are biochemical creatures. Love is biochemical. Joy is biochemical. Ecstasy is biochemical. So is hate, fear, faith, paranoia, anger, boredom, sleep, prayer, meditation, frustration and envy. Life is biochemical. The age old separation between mind and body, between the physical and the spiritual, is a lousy idea. The separation ultimately breaks down. The spiritual is physical and vice versa.

We live in an environment that is simultaneously physical, biochemical, cultural, psychological, emotional and spiritual. All of these dimensions coexist, overlap and intertwine.

Just because we can take medications to alter our moods doesn’t mean that we should not pay attention to other factors. Depression clearly has a genetic component, but that does not mean that we should not listen to depression. People who live in an area of ongoing war are more much more likely to be depressed. That does not mean that the solution is to send Prozac to war torn areas. We need to stop the war. The same is true in our individual lives. Depression may be the result of a genetically based biochemical imbalance, but it can also be a sign that something is fundamentally wrong in our lives and that we need to make some changes.

Someone who is ill and isolated from human contact can easily fall into a depression. Once they are depressed they may need the help of medication to get better, but they also need love, friendship and community.

What then, is our task as a community of people who care deeply for each other? First, we must be sensitive, open and compassionate with each other. We need to understand depression and how it operates. A person in the depths of a clinical depression needs help and support. They do not need to be told to cheer up and stop feeling sorry for themselves. Believe it or not, depressed people spend enormous amounts of energy trying to cheer up.

We can look out for people we know. As a minister, one of the most difficult things about dealing with depression in our community is that depressed people tend to withdraw. They are less likely to come to worship services and to other activities. Depressed people disappear. If you have not seen a friend here for several weeks, give him or her a call. If you suspect someone is having a difficult time, take the time to see how he or she is doing.

If you suspect that you or someone you know is struggling, let me or Todd know. Call or use one of the cards in the pew to drop us a note. Let us not lose someone to depression because we hesitated to reach out.

I know that if I asked for everyone in here who has ever been treated for depression to stand up, people would pop up all over the sanctuary. I would never ask you to do that. And yet I think that those of us who have lived with depression might become more open. It would help dispel the stigma that still exists. It might help someone else seek treatment.

After seeing my mother’s struggles, I lived with the haunting fear that someday I would end up like her. Ironically, when my own, much less severe, depression came on some years ago, I did not see it for what it was. I had been feeling tired for months. I would wake up feeling like I had been up all night. I thought maybe I had mononucleosis or something. Finally I went to my physician because I felt rotten. All my tests turned out normal. Luckily, he suspected depression and referred me to a psychiatrist. I wish I had received treatment sooner. I now realize that I had been mildly to moderately depressed for years. Today, with newer drugs, I feel better than I have for years. Psychotherapy helped me see things I was doing to make matters worse. Yet, like most people who have been treated for depression, I have been reluctant to talk about it. I now believe that my own reticence and the reticence of people like me contributes to the problem.

In the next year or two or three, you or someone you love will sink into a depression. That dark abyss can lead to a living death and to death itself. But we need not be afraid of the dark. We must not deny depression in ourselves or in others. We must help each other face and overcome depression. Now, more than ever, there is hope. We need not dwell in darkness. Hope, life and joy can be ours. Amen.