Counseling Women

Biblical Wisdom for Life's Battles

Kristin L. Kellen

• Publisher: B&H Academic
• Year: 2022
• ISBN:
  9781087737515
• Topic: Theologie & Religion
• Subtopic: Christlicher Dienst

Counseling Women, by professor and counselor Kristin Kellen, is a biblically grounded resource addressing common struggles that women face. Chapters examine issues such as depression, anxiety, infertility, trauma, abuse, disordered eating, and much more. Undergirded by a strong theological foundation, Kellen interweaves many practices of mainstream therapy alongside Scripture's teachings to provide a wise and balanced approach. Accessible and deeply practical, Counseling Women will be useful for counselors in various settings and for students in training programs.

SECTION TWO

Common Counseling Issues

7

Depression

A young woman in her late twenties, Dawn, shares with you that she has not felt like herself in a long time. “It’s like I’m walking through a cloud, but I don’t care what’s on the other side.” She appears as if she hasn’t showered in a few days; her hair is disheveled, and she barely makes eye contact. When you ask about her interactions with her family and friends, she just shrugs her shoulders and says, “I’m more of a burden than anything; they don’t need all of this.” She feels alone and hopeless, like she is fading away into nothing.

Depression is one of the most common experiences in the mental health realm; the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (hereafter cited as DSM-5) reports that it is one of the “most commonly diagnosed conditions in psychiatry.”1 Anyone who counsels regularly will encounter counselees with depression and must be equipped to provide adequate and competent care.

What Is Depression?

What distinguishes depression from general sadness or even grief? This term is used frequently in our culture to indicate feelings of despair, hopelessness, or deep melancholy, and counselees may describe their experience using common metaphors (like Dawn in the vignette above), but the term “depression” must be understood correctly. The DSM-5 provides a useful set of criteria that we might consider,2 but in providing them, it affirms what we already know as Christian practitioners, a reality we explored in chapter 1: humans are holistic beings. Our experiences of even “mental illnesses” affect both body and soul. Depression is no exception: the experience of this condition is not just cognitive or affective (emotional); there is very likely a physical aspect as well.

A brief look at the DSM-5 criteria is helpful here. Below are the criteria listed for Major Depressive Disorder;3 at least five of the following nine criteria must be met within a two-week period:

a.Depressed mood or irritable most of the day nearly every day

b.Decreased interest or pleasure in most activities

c.Significant weight change

d.Change in sleep

e.Change in physical activity

f.Fatigue or loss of energy

g.Feelings of guilt or worthlessness, or excessive guilt

h.Diminished concentration

i.Feelings or thoughts of suicide

The text indicates alongside these criteria that they must not present proportionate to or “appropriate” for a recent life event, like the loss of a loved one. Such responses are considered normal and expected. Of the criteria listed above, at least four of them are physical expressions. While presumably a person could meet the five-of-nine requirement excluding those four and have little if any physical symptoms, that certainly is not the norm.

This affirms to us as practitioners that we must understand both the complexity and the holistic experience of depression. It is insufficient to address only sadness or only despair; the whole person must be considered in any treatment approach.

Biblical and Theological Perspectives

Though the Scriptures do not use the term “depression” (that is modern terminology), the Bible has much to say about the experience. Many in biblical history experienced depressive episodes in response to a variety of situations. For instance, Elijah (1 Kgs 19:4) and Jeremiah (Jer 20:14–18) expressed feelings of deep sadness. However, there are two writers in the Bible who are worth more focused attention, to draw some principles for understanding and treating depression.

King David experienced bouts of deep sadness and despair in several situations. David reflects on the depth of his sin in Ps 38:4–8: “My iniquities have flooded over my head; they are a burden too heavy for me to bear. . . . I am bent over and brought very low; all day long I go around in mourning. For my insides are full of burning pain, and there is no soundness in my body. I am faint and severely crushed; I groan because of the anguish of my heart.” Though David recognizes that his despair and even physical pain are because of his own sin, his heart is heavy and unbearable. Further, psalm after psalm is written by David in response to his troubles or trials. He acknowledges in Ps 143:4, “My spirit is weak within me; my heart is overcome with dismay,” and in Ps 102:4, “My heart is struck down like grass and has withered; I forget to eat my bread” (ESV). These descriptors closely align with someone struggling with depression.

David writes of his own response to someone in that state, “The righteous cry out, and the Lord hears, and rescues them from all their troubles. The Lord is near the brokenhearted; he saves those crushed in spirit” (Ps ­34:17–18). David knows, and reminds us, that the Lord hears and responds to those who call to him in their despair. Almost every psalm of lament or crying out to the Lord for help in trials includes some reminder of who God is. Each one urges the reader to look to him for help rather than relying on herself (see Psalms 13, 22, 34, 69, 102, and 143 as examples).

Like David, Job also experienced great depression (see chapter 3). Job’s situation is one that is not often considered; his struggle was a direct result of Satan’s affliction. Spiritual warfare was a present reality for Job. He lost almost everything he had, understandably resulting in deep sadness and despair. There are three quick lessons to learn from Job. First, note his response to the suffering from the very beginning: “The Lord gives, and the Lord takes away. Blessed be the name of the Lord” (Job 1:21). Job acknowledged the Lord as the source of all things, and blessed him. Second, note the initial response of his friends, even though they would go on to give some poor advice: when they saw him, they wept aloud with him, and then “they sat on the ground with him seven days and nights, but no one spoke a word to him because they saw that his suffering was very intense” (2:13). Job’s friends sat and wept with him without saying a word. They observed and they listened before they spoke. Finally, remember the solution to his despair: God himself. Before restoring Job’s family and possessions, God’s answer to Job’s struggle was an encounter with the living God, Creator of all things and Sustainer of all life. Job did not need his family or possessions restored; he needed God. In his grace, the Lord demonstrated this need to Job in a very direct and personal way.

Moving to the New Testament, James, the brother of Jesus, also offers an important perspective on depression, particularly when it presents as a trial in the life of a believer. He writes, “Consider it a great joy, my brothers and sisters, whenever you experience various trials, because you know that the testing of your faith produces endurance. And let endurance have its full effect, so that you may be mature and complete, lacking nothing” (Jas 1:2–4). He is speaking here to both one’s attitude during trials and a proper understanding of the purpose throughout them, teachings certainly applicable to depression.

In a similar vein, Paul reminds us of how we should view struggles like depression. He writes in 2 Cor 4:17, “For our momentary light affliction is producing for us an absolutely incomparable eternal weight of glory.” Similarly, the writer of Hebrews says in 12:1–3 that each of us is to run the race that is set before us, pushing forward to Christ as our prize. In both these passages, the focus is not primarily on the situation, but rather on what is coming at the end of the race. That does not diminish the struggle, but it gives it the proper perspective.

The Scriptures are clear that we are holistic beings and therefore our struggles in this world are often holistic as well. They involve the entire person. Many things identify us as individuals: gender, ethnicity, personality, experiences, and so forth, but each of us as women are both body and soul, physical and nonphysical beings. Further, Scripture makes clear the inter­action between the nonphysical (heart, mind) and the physical (body, actions/behaviors). Luke 6:45 reminds us that it is from the overflow of the heart that the mouth speaks. Depression, like many struggles, ultimately flows from one’s heart. Though there may be physical expressions and perhaps physiologi­cal contributing factors,4 despair and hopelessness ultimately reflect attitudes of the heart. This is why, as James says, we can “count it all joy” when trials come, and why, as David records, we can put our hope in the Lord despite our circumstances. The presence of the Spirit in the heart of the beli...