The Why of Depression

Bob: Dr. Charles Hodges is a physician who treats people who are clinically depressed. He says, “If you can identify the source of your sadness—the reason why you’re sad—chances are you’re not experiencing clinical depression.” 

Charles: I remember, not long back, having a young lady come bouncing into the office to tell me that she believed she was depressed and that she thought she needed medication. I asked her when it started and what had happened. She said that, a couple weeks ago, she dumped her boyfriend. And you know, I kind of looked at her and smiled a little bit—thought maybe she needed a new haircut and a nice dress. But I didn’t think she actually needed an antidepressant. There was a reason why she was sad. She was sad because she had sustained a loss.

Bob: This is FamilyLife Today for Tuesday, May 23^rd.

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Our host is the President of FamilyLife^®, Dennis Rainey, and I’m Bob Lepine. Does God sometimes have a purpose in taking us into a valley where we will experience profound sadness or grieving?  We’re going to spend some time talking about that today. Stay with us.

And welcome to FamilyLife Today. Thanks for joining us on the Tuesday edition. You know, the subject we are talking about this week—about bipolar disorder, mood disorder, and depression—this is an issue in increasing numbers of families. Dennis—as we’ve said, it’s a disruptive issue for families—it threatens marriages / it breaks up families. When it’s diagnosed with a teenager, parents are really unsure and troubled about what to do.

Dennis: And in all of the cases that you mention, Bob, there is all this conflicting data, and voices, and opinion. You really wonder: “Who do you listen to?— 

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Bob: Yes.

Dennis: —“is it the medical community?—the vitamin community that has all kinds of solutions for things?— all kinds of therapies that are being recommended for mood disorders?” 

Well, we’re going to take our own shot at it here today. Dr. Charlie Hodges joins us again on the broadcast. Charlie, welcome back.

Charles: It’s good to be here.

Dennis: Charlie is, as I mentioned earlier, a family physician. He is a licensed marital and family therapist. He and his wife Helen have been married since 1971—have four children.

He has been studying issues like depression and bipolar disorder for a number of years and has written a book called Good Mood, Bad Mood. What causes these mood disorders like depression / like bipolar disorder? 

Charles: Nobody really knows. That is at the bottom of the problem.

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There was a good blog that was written about the fact that several of the drug manufacturers / pharmaceutical companies are shuttering their psychiatric medication research units. The reason why is because there is no novel medication coming down the road, at this point. The reason why there are no new drugs coming down the pipeline is because we don’t know.

If we understood the pathology that was behind depression / if we understood the pathology that was behind bipolar disorder, and we could define it at cell level, then, we would be able to design new medication that would be helpful and beneficial. So, the truth of the matter is—at this point in time, we do not know what the underlying cause for depression is / we don’t know what the underlying cause of bipolar disorder is.

Bob: If somebody comes to your office and says, “I think I may have strep throat,” you can do a culture. You can determine whether the bacteria or the disease is present in them. If somebody comes and says, “I think I’m depressed,” there is no swab / there is no blood test—there is nothing that you can do.

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All you can do is hear them list their symptoms and conclude, based on their symptoms, whether that’s legitimate depression or not.

Charles: And if the physician or the provider involved is doing their job, they’ll match those symptoms up against the criteria that is in the DSM. Unfortunately, that doesn’t happen very much. So, it’s all subjective. There’s almost no objective aspect to it.

Bob: So, you’re a family physician. If I came to you—you’re my family doctor—and I said: “Charlie, here is what is going on. I sleep 16 hours a day. I have no motivation to get up. I entertain suicidal thoughts. I’m just lifeless. I just—I don’t want to live anymore.”  Doesn’t that sound like depression? 

Charles: “Are you eating or not eating?” 

Bob: “I don’t have any appetite.”

Charles: “Are you still playing golf, or have you lost interest in that?” 

Bob: “No; I don’t want to play golf. I don’t even want to go out of the house.”

Charles: At that point, as long as it’s more than two weeks, you’ve met the criteria that would be necessary for you to have a diagnosis.

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Now, I’d be asking the question, “What happened when this started?” 

Bob: You say I meet the criteria. A lot of doctors, at that point, will go: “That sounds like depression. Here is your prescription.”  But you say, “They ought to go a step farther.” 

Charles: Yes—going back into the history and find out whether or not this is an issue with regard to normal sadness versus disordered sadness.

There is a very good book by Jerome Wakefield and Allan Horwitz—the title of it is The Loss of Sadness, and the subtitle is How Psychiatry Turned Normal Sadness into Depressive Disorder. What those two write about, for a good long time, is the fact that, in our society, we no longer talk about being sad. As one writer said, “People no longer say, ‘I’m sad.’  They say, ‘I’m—

Bob: —“’depressed.’” 

Charles: Yes; that’s right.

Bob: Yes.

Charles: And the reason why they do that is because we’ve been taught to do that since the 19—late 1980s—with the advent of medication that could be used to treat.

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So, when I’m talking to someone who is depressed, what I want to know from them is: “What’s happened?  When did this start?  What happened when it started?” I can remember, not long back, having a young lady come bouncing into the office to tell me that she believed she was depressed and that she thought she needed medication. I asked her when it started and what had happened. She said that, a couple weeks ago, she’d dumped her boyfriend. And you know, I kind of looked at her and smiled a little bit—and thought maybe she needed a new haircut and a nice dress—but I didn’t think she actually needed an antidepressant. There was a reason why she was sad. She was sad because she had sustained a loss.

You could say the same thing about men who lose jobs. When they lose their job, their mood will decline. Their mood will worsen, depending on how long the situation is; and then—when I’m teaching this, I always look out across the class and say: “When does the young lady get better?” and “When does the guy get better?” 

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And they know the young lady gets better when she finds a new boyfriend; right?  Then, the guy gets better when he gets his job back.

Dennis: You’re both a physician—family physician—and a licensed counselor. I want you to take off your physician hat for a moment, put your counselor hat on, and help us look at loss through a biblical grid. What do you think God was up to when He allowed loss to come into our lives? 

Charles: Well, I would say, like C.S. Lewis said: “Pain is God’s megaphone.” If He wants to get our attention, He allows something to come into our life that is most disagreeable. I believe that, actually, sorrow is a created part of our being—I believe that God put it there. It’s there on purpose, and it’s there—meant to drive us to Him—lots of good examples in the Bible.

I like Hannah because Hannah spoke to my heart; right? 

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A couple of years ago, I had something really, really ugly happen in my life. I always smile and say: “I’m not going to give you the details. I won’t bore you with them, but I can tell you that it was a major loss.”  And I—for days, the only way I would get along was I knew I had to get up and get out of bed; I knew I needed to keep breathing, and I knew I had to keep running. If I quit doing those two things, I was lost.

And shortly after that, I had to go on a vacation. It’s one of those kinds of deals where—you planned the vacation, you bought the airline tickets, your cousins in Southern California are expecting you to be there—and you wouldn’t have gone for any reason, under the circumstances; but I had to go. So, I went off to Southern California. The first Sunday I’m there, I’m in church with my cousins. The pastor, Stan Van Den Berg, is preaching on Hannah. And there were two things that I wrote on the edge of my bulletin—and that are in my book. One of them is that God never lets anything come into our lives without purpose and without reason. Then, the other is that Hannah’s name means “grace”—that’s what it means in Hebrew.

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Hannah’s name means” grace.”

And of course, she had no children. Her rival had ten children; but you know the truth of the matter of that story is—is that the story isn’t about infertility. The story is really about how God chose to change Hannah. That was what the story was about. The story is how God is going to change Hannah by grace. And the passage in Samuel says that God had closed her womb. I mean, she wasn’t infertile by accident—she was infertile on purpose.

And what you see, as you read through the text, is that God uses this to change her from the woman who said, “Give me children or I’ll die,” to the woman who, on that given day, can take Samuel, and give him back to God, and leave him—leave him in the temple, and walk off, and leave him. She went from being a woman who couldn’t live without children to a woman who no longer worshipped having children. That’s what the story is about. And I listened to that—that gave me strength.

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Hannah is a great example of someone who had sustained serious loss and who—if she were alive today, what would happen to her?  She would be diagnosed with what? 

Bob: —with depression.

Charles: Certainly, with depression.

Bob: Right.

Charles: And certainly, would be treated and would be worse for the wear. It probably wouldn’t make any difference. The reason why it wouldn’t make any difference is because you can’t treat sadness with a drug that’s meant to treat a disease; you know?  When you say that depression is a disease, then, the medicines that are meant to treat a disease really don’t work in dealing with human sadness.

Dennis: I know some parents who had a teenage daughter—that they felt like was depressed and was dealing with real depression. They took her to a counselor, and the counselor put her on Prozac^®. The child said to the parents, “You can’t give me a pill that will make me happy.” 

Charles: No.

Dennis: And the interesting thing about that is she was right. The parents found that out through the experience of that.

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I sometimes kind of pinch myself that I get the privilege of talking with men, like you, who’ve made a lifetime study out of certain things and that I get the privilege of gleaning wisdom. One man we had the privilege, a number of years ago, to interview really introduced the theme of loss to me on a whole new level. It was Dr. Jerry Sittser. Bob knows the story—he wrote a book called A Grace Disguised—interesting, it goes back to Hannah—A Grace Disguised.

Since that time and, really, since that conversation with Jerry Sittser and how he dealt with loss, I’ve viewed what God’s up to a little differently in my life because I think life is one long process of having mountaintop experiences; but along the way, you’re going to have losses. How you deal with the losses, biblically, can determine your hope, how you live, your perspective, the peace about which you live life, and whether you do become profoundly sad and withdraw from other people and end up not being used by God.

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Charles: I think the best chapter in the New Testament to help people who have an identifiable loss—people who are struggling—is John, Chapter 11. It just speaks volumes to the individual who has sustained loss about what God is up to in their lives.

Bob: This is the account of the death of Lazarus and Jesus coming and raising him to life again; right? 

Charles: Oh, yes. From the outset, we know that Jesus knows what is going on. He knows entirely what is happening. He sits down and waits until Lazarus has died. So, I think that—

Dennis: So, He waits until he is stinking. [Laughter]

Charles: Yes—in the grave for four days. And from that, we also then know he had a plan—none of this is happening by accident. Then, you see the tender interaction between Jesus and Martha: “Where were You when I needed you? 

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“If You had been here, my brother would not have died.”  Then, her request—you know, “I know whatever You ask God for,” at this point, “He’ll do for You.”  Then, He says plainly, “Your brother will rise again.”  And she—poof—she dismisses it / it goes right by.

And then, we see the same interaction with Mary and, then, the weeping. Then, we see Jesus weep, which is strange when you think about it because, in minutes, Jesus is going to raise Lazarus from the dead. This is already done—it’s going to happen—and He weeps, anyway, which means that He cares. We know that Jesus knows all about it. We know that He has a plan for it and that He cares about it. And then, when Jesus had wept enough, He acted.

I say, “You know, if you really want to help people who have lost something, that’s the pattern.”  You have to be willing to know something about their problem. You have to have a plan in process for how you’re going to help them. You really do have to care about them; and then, it requires action. So, I always take people, who are struggling with big losses—I take them to John, Chapter 11—not on the day.

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I always say that the lady who just lost her husband—she needs something out of Psalm 46 in place—but, usually, by the time they get to me, they’ve struggled with this for a while. This is going on weeks, months, maybe even years. At that point, they are looking for the exit. So, I take them first to John, Chapter 11.

Bob: You know, it’s interesting to me—and this is kind of a new “aha” for me—but you look at the hymn book of Israel—and you look at how much anguish, and despair, and depression, and discouragement, and sadness there is. You see every word there is inspired by the Holy Spirit. Then, God says: “Now, sing that back to me as a congregation. I want to hear you singing this about your despair.”    

Dennis: You’re talking about the Psalms.

Bob: I’m talking about the Psalms. I’m talking about God delighting in His children singing: “Oh, Lord, how long will You forget me?  How long will You withhold Your favor from me?”  You would think God would say: “Enough of your nagging! 

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“Sing Psalm 100”—you know—“because that’s a good one”; but here’s God saying: “No; I want your mountaintops and your valleys lived out in My presence. I want you to bring them to Me—together, there’ll be a sanctification that will happen here”; right? 

Dennis: He’s saying: “I want you to bring them to Me. In the end, embrace Me in the midst of suffering”—

Bob: Right.

Dennis: —“these losses.” 

Bob: Right. So, my question for you is—the patient who comes and says: “I feel like, in this tremendous loss I’ve just experienced—I know why I’m sad; but I’m sad to a point where I’m in despair, where I don’t want to function. I just think it would be good if I went on antidepressants for a little period until I got passed it.”  What would your counsel back to that person be? 

Charles: I had a patient come through, a while back. I sat down and listened to the story that he told. He had some really bad things going on in his life.

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They would be enough to cause a normal person to be struggling with sadness. I told him: “Well, from what you’ve told me, I know that your situation is going to change. Given time, this will moderate. We have two options here. I can send you to talk to someone.” If they say they want to go talk to somebody, then, I have the opportunity to send them to somebody who can do pastoral counseling / biblical counseling, or send them to the psychiatrist, or whomever they want to go to. But I can send them to talk to somebody—which, according to the research that we’re doing right now, it works just as well as the medication. That’s the current research for 90 percent of the people who get labeled “depressed”—just going and talking to somebody works just as well.

“Or I can give you the medicine. But I tell you this: ‘The medicine that you will take will change your personality.’” 

Bob: “While I’m on it or for good?” 

Charles: “Just while you’re on it.” 

Bob: “Okay.” 

Charles: “And you really need to think about whether you want that part of you changed.” 

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The individual took the medicine and came back later and said: “You know, I thought about what you said a lot. I decided I didn’t want to do that.”  So, I would not refuse a person’s request for an antidepressant who wanted it, as a physician; but I really do try to offer them what I know, from the current research, works better.

Bob: Would there be—with the one or two percent who fit the old definition of depression—they don’t have a cause for it / they don’t know why—they are just chronically clinically depressed. Is there medicine that will help them or will talking it through with somebody help them? 

Charles: I’d say both. The medicines that we have seem to work for the people who are the very seriously depressed. That means that, if you look at the difference between the placebo group and the treated group, it separates enough to be what we call clinically significant—you know, there is enough difference in the treated group versus the untreated group so that we could say, “We think this probably works.”  So, yes; there is some benefit.

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But certainly, going and talking to someone is always going to be of benefit. I always smile and say that’s where I think biblical counseling has the greatest hope to offer people, because we have real hope to offer.

Dennis: I had a friend who was in a marriage, where his wife was—I don’t know how else to describe it—it just seemed like depression took her out of the game / it took her out of life; and she couldn’t function. You’re not saying, in those situations, that that’s not a real disease or a real illness, or are you saying that?  Do you believe depression is a “disease” or illness? 

Charles: For the 10 percent—the people who cannot tell me why it is they are sad—then, the question is: “What is going on in their life, medically?”  And the answer to that question is that: “We don’t exactly know.”  So, I have to say, “I don’t know.”  That doesn’t mean I don’t think it’s a disease. It just means I can’t give you an absolute answer about that.

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I would tell you that I think the best part of what’s going on, now, in medicine is—like at the National Institute of Mental Health, Thomas Insel—he is a psychiatrist, who runs the National Institute of Mental Health—he said that, concerning depression—that we have never been able to demonstrate a chemical imbalance that’s associated with depression. It’s not an exact quote, but that’s pretty much what he said. He indicated, in that interview, that, actually, the National Institute of Mental Health was turning their interest towards cognitive behavioral therapy—talking to people about their problems—because they believed that there is a lot more ground being made doing that than investing more money in research for medication.

So, I would say: “Yes, I believe that there is something wrong with someone who tells me that they’re sad and they meet the criteria for depression. I don’t exactly know what it is.”  I’m not saying it’s not a disease—

Dennis: And you’re certainly not saying that it’s not real.

Charles: No; absolutely—

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Dennis: Obviously, there are people who can’t get out of bed—who lose their zest for living.

Charles: And I think the most important thing is for a person like that, first and foremost, is to make sure that they don’t have some other underlying medical problem that is causing what’s going on; because there are a number of medical ailments which do affect people’s moods.

Dennis: Well, I want to talk about that a little bit later. I want to make two book recommendations to our listeners. First of all, the Bible—get in the Book.

Bob: That’s a good one— 

Charles: Yes.

Bob: —I’ve read that!

Dennis: Get in the Book. Read the Psalms, which have these emotions and these moods expressed. Get to know the God of the Bible—that, ultimately, is the message of today’s broadcast.

Then, secondly, I think Dr. Hodges’ book here, Good Mood, Bad Mood, will make for some very healthy reading—especially for people who may have a teenager who is struggling with some of these disorders, or they’re in a marriage, or they’ve got a brother / a sister / or perhaps a parent—

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—it will give perspective and help where you need it. And that’s why we’ve been talking about this today.

Bob: Well, and of course, we have copies of Dr. Hodges’ book in our FamilyLife Today Resource Center. We’d encourage listeners to order a copy from us, online, at FamilyLifeToday.com. Or call to order at 1-800-FL-TODAY.

Again, we want to stress what we’ve already said this week; and that is, a part of the protocol—if you are experiencing sadness or depression that seems to be overwhelming—is to talk to a doctor. Sit down with a medical professional—get a work-up done. See if there is something that may be going on, biologically, that would be affecting you. But I think reading a copy of Dr. Hodges’ book will provide you with some real clarity and some help here. In fact, the subtitle of the book is Help and Hope for Depression and Bipolar Disorder.

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Again, you can order a copy of the book from us at FamilyLifeToday.com; or call to order at 1-800-358-6329—that’s 1-800-“F” as in family, “L” as in life, and then the word, “TODAY.”

The reason we explore subjects like this, and have conversations like this, is because we understand that there are so many factors that can lead to either harmony or disharmony in a family—so many factors that can cause us to either pull together and rally together, as a family, or can push us apart / push us into isolation. Our goal, here, at FamilyLife is to help every home become a godly home. We’re grateful for those of you who support this ministry and support that mission through your financial gifts.

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In fact, during the month of May, we’ve been asking listeners to consider making a one-time gift that would help toward a goal we’ve set. We’re trying to raise $1.1 million during the month of May. We’ve already heard from a number of FamilyLife Today listeners, who have said, “We want to help you reach that goal.” The purpose is to have funds available during the summer to continue working on a number of projects that are underway. The summer months are when we often see a decline in funding. We’re hoping, by establishing this fund, we will be able to continue moving forward over the next several months on a variety of projects designed to help strengthen your marriage and your family.

So, “Thanks,” to those of you who have already given. If you’re a regular listener and you’ve not yet made a one-time donation in support of FamilyLife Today, it’s easy to do. Whatever amount you can afford, go to FamilyLifeToday.com and donate online; or call 1-800-FL-TODAY to donate.

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Or you can mail your donation to FamilyLife Today at PO Box 7111, Little Rock, AR;

and our zip code is 72223.

Now, tomorrow, we want to talk about Bipolar Disorder I—what happens when there are severe mood swings going on in somebody’s life? Dr. Charles Hodges will be back with us tomorrow for that. I hope you can be here as well.

I want to thank our engineer today, Keith Lynch, along with our entire broadcast production team. On behalf of our host, Dennis Rainey, I’m Bob Lepine. We hope to see you back tomorrow for another edition of FamilyLife Today.

FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas; a Cru^® ministry.

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