Friday, August 12, 2011

Treating Depression: An Integrative View

I just read an essay by Donald Calbreath called "Serotonin and Spirit: Can There Be a Holistic Pentecostal Approach to Mental Illness?" (in James K. Smith and Amos Yong, eds., Science and the Spirit: A Pentecostal Engagement with the Sciences) Calbreath earned a Ph.D in Physiological Chemistry from Ohio State University, and has taught at several universities, to include Duke.

Calbreath proposes an integrative approach to dealing with depression. After presenting the biochemistry of depression, he offers the following holistic approach, which I personally am attracted to. This model integrates:
  1. Biochemical issues (both neurochemical and endocrine)
  2. Psychological problems
  3. Spiritual healing
Calbreath does not claim that this model will apply to all cases of depression.


Antidepressants may alleviate some of the symptoms of depression.

Regarding the biochemistry of depression, are the changes in biochemical processes the cause of one's depression or the result of one's depression? Calbreath writes: "it is becoming increasingly apparent that both alterations in the HPA axis biochemistry and in the amounts of neurotransmitters available at the synapse are state functions (a result of the primary precipitating event in depression) and not trait functions (a cause of the depression). These data may help explain the confusing literature on the therapeutic effectiveness of various antidepressants and could help us better understand the high placebo effect seen in studies of drugs used to treat depression." Psychological

If this is correct, then we can see how biochemical treatment of depression will not be enough, and psychological and spiritual counseling and treatment will be needed.

But underlying stress must be resolved. Calbreath says that "one of the major stressors frequently encountered in depression is guilt. The DSM lists excessive feelings of unworthiness and/or guilt as one of the diagnostic criteria for depression. Guilt (real or otherwise) can place tremendous stresses on an individual. The link between depression and guilt has been widely explored in Christian thinking." (144)

"If the guilt is real, the stress needs to be resolved by repentance and seeking forgiveness. Through cognitive-behavioral therapy (a form of counseling that has its counterpart in pastoral ministry), the individual learns to recognize triggers to depressive behavior and develops successful coping strategies (changes in behavior). The patient acknowledges wrong-doing and seeks to resolve the situation." (145-146)

If the guilt is not real but assumed, "resolution comes when the person understands the erroneous source of the guilt and finds healing from that mistaken idea." (146)

Calbreath highlights the role of forgiveness in the treatment and healing of depression. First, individuals must forgive themselves. "Forgiveness has been shown to be a very effective approach to dealing with many issues in depression where someone else has done the wrong (and that may be yet another avenue that needs to be explored-letting go of the stress event and not revisiting it)." (147)

Secondly, "the individual needs to experience the power of forgiveness and the cleansing of the soul that comes from being truly forgiven." (147)


Spiritually, Jesus-followers in general, "and Pentecostal and charismatic Christians in particular, can draw upon the power of the Holy Spirit for enlightenment. Romans 8:26 tells us "In the same way the Spirit also helps our weakness; for we do not know how to pray as we should, but the Spirit Himself intercedes for us with groanings too deep for words."" (147)

Calbreath makes the interesting suggestion that the metamorphing of the heart promised in Romans 12:1-2 ("transformation") can be understood in neurophysiological terms. "Cognitive behavioral therapy (mentioned above) and its spiritual counterpart in effective pastoral counseling can literally renew the brain. There is a growing body of literature that suggests actual regeneration of brain tissue after treatment for various disorders including depression." (148) The renewing of brain tissue accompanies the lessening of one's depression.

From Calbreath's Jesus-and-Spirit-empowered paradigm, there is always the possibility of direct intervention by the Holy Spirit to heal. "The Spirit can bring direct healing, not just of the body but also of the mind. The attitudes of the mind can be changed. The person can receive insights into the reality of the situation. An understanding of the nature of the guilt taken on by the individual can then be extended to an experience of healing, both in terms of freedom from the pain of the stress experience and the acceptance of forgiveness for the assumed guilt. These roles of the Holy Spirit are integral to pentecostal/charismatic theology and are part of the ministry that we can bring to this segment of depressed individuals." (148)

I like the combination and possibilities of these three healing approaches in lots of the ministry to others I am engaged in. This means:
  1. I will refer persons to physicians who re skilled in the clinical treatment of disease, to include treatment of depression.
  2. Psychological counseling is often needed. In our area I refer persons to three counseling agencies that have a Jesus-framework. Calbreath points out that, often, physicians and hospitals that offer medical therapy to depressed patients often fall short of fail to psychologically and spiritually treat patients.
  3. Finally, we always pray for a person's healing. We have cases of persons who are healed of their depression as a result of prayer. I'm now thinking of a person in our church family who was directly healed and has not needed any more medications for the past seven years.
Calbreath's essay is scholarly and spiritually sensitive, and deserves to be read in its entirety, especially by pastors and Christian counselors and physicians.