Thepurpose of this paper was to address the issue of depression as amental disorder by focusing on its causes, treatment options,prevention, cross-cultural, and Biblical perspectives. Depression hasbeen in existence through human history. Depression is mainly causedgenetic predisposition, environmental factors, psychological factors,and hormonal imbalance. Medication (such as SSRI) and psychotherapy(such as cognitive behavioral therapy) are the most commontherapeutic approaches used to treat depression. Preventionstrategies adopted depends on the underlying causes of depression,age of the affected person, and the prevailing situation. Cultureinfluences individual’s depressive thoughts, which means that theconsideration of the cultural perspective of a depressive patient canhelp in determining the most effective treatment option. The Biblegives an indirect description of depression, but the symptoms of themain characters (such as David and Saul) match the psychiatricdescription of depression. The future research should expand thepresent study considering alternative treatment, such as genetherapy.
Keywords: Depressive conditions, therapeutic approaches, preventionmeasures, historical context, Biblical perspective.
Depressionis one of the most common mental disorders that lead to loss ofinterest, low self worth, depressed mood, low energy, loss ofappetite, and poor concentration. However, depression should bedistinguished from a feeling of sadness. People suffering fromdepression experience hopelessness, helplessness, and anxiety. Apartfrom mere feelings, depression disorders have other effects, such aspoor outcome of comorbid illnesses (including diabetes and cardiacdiseases) and economic burden on society (Cassano & Fava, 2002).Under the Diagnostic and Statistical Manual IV, most of thedepressive disorders are associated with head injuries (Katon &Ciechanowski, 2002). In addition, the DSM-IV criteria suggest thatpeople suffering from depression should have at least five of thenine symptoms, including depressed mood, decreased interest,significant change in weight, and change in sleep patterns,worthlessness, change activity, fatigue, reduced concentration, andsuicidal ideation. This paper will address depression as a mentaldisorder with the main focus on its causes, treatment, prevention,cross-cultural perspectives, and Biblical worldview of depression.
Historicalcontext of depression
Depressionhas been a widespread mental disorder throughout human history. Thepeople of the ancient Greece described depression as an imbalance inthe basic fluids of the body. This perception is based on atheoretical model known as dysregulation, which gives an explanationof the basic mechanisms that result in depression. According toNettle (2004) depression is caused is caused by circumstances thatlimit the individual’s ability to accomplish some goals in life.The biological mechanisms behind depression are intended to cope withthreatening situations. This implies that depression has always beenperceived to be an inherited mechanism that occurs as an individualtries to acknowledge social subordination without expending energy onunnecessary status competition. However, the model of dysregulationand imbalance of humor has been challenged on the grounds that itfails to explain the reason for some people to suffer from depressionwhile others do not.
Overthe years, scientists have managed to distinguish between exogenousand endogenous types of depression. Although this distinction isstill debated to date, it enhances human understanding of the twocategories factors that are responsible for depression, includinginternal and external factors (Nettle, 2004). However, the two causesof depression results in the internal conflict that leads toexcessive reaction, which in turn culminates in depression. Thecurrent psychological models associate depression with personaltraits, which explains the reason for some people to suffer fromdepression while others do not. However, the new concept that showsthe relationship between depression and heritable traits contradictsthe earlier notion that depression is an adaptation that is motivatedby the present circumstances (Nettle, 2004). The contradictions formgrounds for future research works to fill the existing knowledge gap.
Causesof depression can be grouped into four major categories. First,genetic predisposition of individuals to depression has been reportedmany cases. According to Harrington (2001) genetic factors thatincrease the risk of suffering from depression are responsible formost of the bipolar and unipolar conditions of depression. This isthe major explanation for depression that affects people withbiological relations. The effect of genetic predisposition impliesthat there are some heritable characteristics that increase theprobability of people of a given family lineage to suffer fromdepression.
Secondly,there is a wide range of environmental factors that subject people tothe risk of getting depressed. For example, acute and stressful lifeevents (such as bullying and difficulties in a friendship) triggerdepression (Harrington (2001). In most cases, stressful events thatlead to major depression are either on time or predictable events,such as the death of a loved one.
Third,there are three psychological factors (including neuroticism,personal attributes, and cognitive distortions) that increase thelikelihood of suffering from depression. People with higher levels ofneuroticism are more likely to suffer from depression than those withlow levels (Blazer & Hybels, 2005). In addition, people withpersonality disorders are at a higher risk of suffering fromdepression compared to the general population. Cognitive distortions(such as misinterpretation and overreaction to life events) resultsin late-life depression.
Fourth,hormonal imbalances that occur under different conditions (such asmenopause and menstruation) are associated with depression. Forexample, an imbalance between testosterone and estrogen, which mainlyoccurs during menopause, triggers depression in women (Blazer &Hybels, 2005). Although depression conditions associated withhormonal imbalance are associated with women, both men and women canbe affected endocrine changes.
Depressioncan be treated using two major therapeutic options, namelypharmacotherapy and psychotherapy. Pharmacotherapy is accomplishedusing antidepressant drugs that restore the normal functioning ofneurotransmitters. For example, a class of drug known as selectiveserotonin reuptake inhibitors (SSRIs) are widely used to treatdepression because of their significant effect of norepinephrine andserotonin neurotransmitters (Pinsky, 2005). SSRIs reduce theactivation of platelets, increase serotonin secretion, and restorethe normal variability of heart rate. This implies that drugsused to treat depressions function by controlling the underlyingbiological and hormonal changes that are responsible for theoccurrence of depression. Although the use of medical drugs to treatdepression is associated with a wide range of side effects (such ashypotension, hypertension, tachycardia, and increase in weight),their effect is more rapid compared to other therapeutic options.
Psychotherapyis used to address the psychosocial characteristics of depression,which include social isolation, low economic level, and stress.Psychotherapy is used in all levels of the management of depressionstarting from prevention, treatment of acute phase, and recovery fromclinical symptoms (Stefanatou, Kouris & Lekakis, 2010). There arethree psychotherapeutic approaches that are used to treat depression.First, cognitive-behavioral treatment is used to treat cognitivedeficits and distortions that are identified in depressed persons.This is the most preferred approach because it is patient centeredand it facilitates effective collaboration between the client and thetherapists (Harrington, 2001). Secondly, interpersonal psychotherapyis an approach that is used to help the depressed persons in dealingwith interpersonal problems that are associated with depression.Third, family psychotherapy is used in the treatment of depressionthat occurs in the context of dysfunctional families. Psychotherapyis composed of different approaches that address different conditionsof depression, but cognitive psychotherapy is the most commonapproach.
Differentinterventions are used to prevent the occurrence of depression in theat-risk population. However, all preventive measures require earlydetection of risks and protective factors that determine thedevelopment of depression. The occurrence of depression among thepre-school children can be prevented by educating parents about theneed to avoid aggressive and coercive parenting (Barrera, Torres, &Munoz, 2007). In addition, both the pre-school and primary schoolkids should be brought up in an environment that promotes optimism,ability to handle aggression, practical thinking, and acquisition ofproblem solving skills. Cognitive behavioral therapy is among themost effective approaches used to prevent the occurrence ofdepression in adolescence and adulthood. According to Barrera,Torres, & Munoz (2007) a combination of cognitive behavioraltherapy and problems solving techniques reduce the probability of theonset of depressive conditions as well as self-reported symptoms ofdepression. However, this approach is effective among the at-riskadolescents and adults and less effective among the pre-schoolchildren.
Apartfrom the prevention measures used to address depression in differentage groups, there are approaches that are designed for depressiveconditions that occur in various situations. The risk of sufferingfrom postnatal depression is predicted using Edinburgh Post NatalDepression Scale, which gives an opportunity for early preventionthrough psychosocial support (Barrera, Torres, & Munoz, 2007).Children of parents with mental disorders and alcoholism are at ahigher risk of suffering from depression. This type of depression canbe prevented by addressing the mental disorders and depressivecondition of the parents in order to provide children with a secureand healthy family environment. Moreover, short-term cognitivebehavioral programs are effective in preventing depressive conditionsrelated with life threatening events, relationship problems, andsickness (Barrera, Torres, & Munoz, 2007). This implies that thepreventive mechanisms adopted dependents on the age of the at-riskperson and specific situations.
Crosscultural issues of depression
Thereexist cross-cultural differences and similarities of depressionsymptoms. For example, research has shown that lack of joy, low mood,anxiety, lack of interest in the surroundings, and lack of energy arecommon symptoms of depression across all cultures (Rouillon, 2011).However, most symptoms of depression vary in different cultures. Thefeeling of guilt, which is a common feature of depression among thewestern communities, is rarely experienced by non-westerncommunities. For example, the feeling of guilt during depression ismore common among the Swiss clients than among Iranian patients(Rouillon, 2011). This implies that delusions are built arounddifferent themes (such as religion and physical health) innon-western communities instead of inferiority and guilt like thecase of western communities. Moreover, most of the non-westerncultures use narratives that contain metaphors to describe bodyfunctions and emotional state instead of using psychological terms.
Culturedetermines the way in which people express depressive thoughts invarious situations. The acceptability of suicide as a way of solvinginternal conflicts that cause depression is cultural dependent. Somecommunities consider depressive reactions that occur afterbereavement as normal conditions that do not require interventionssince they are part of life (Rouillon, 2011). Although the westerncommunities appreciate the need for psychiatric interventions aftertraumatizing events, some of the diagnostic criteria used lead to theinterpretation of depressive symptoms as normal reactions. Thisprevents the administration of adequate therapy to affected persons.The interaction between culture and depression implies that thetherapists should take account of cultural influence on depressivethoughts in determining the most effective prevention and treatmentstrategies. This means that cultural competence is important whendiagnosing depression, especially in a multicultural society.
Biblicalworldview of depression
TheBiblical description of major or severe depression is similar to thedefinition given by contemporary psychiatrists. The Biblicaldescription of depreciation can be seen from the experiences ofdifferent characters, such as King David. There are six majorsymptoms of depression that can be derived from the life of David asdescribed in the book of Psalms chapter 38. Verse six of BiblicaIncorporation (1984) states “I am bowed down and brought very low:all day long I go about mourning” (p. 399). This suggests thatDavid was in a depressed mood. Verse 8 of chapter 38 states” I amfeeble and utterly crushed …” (p. 399), which shows anxiety anddespair. Verse 10 of the same chapter states “My heart pounds, mystrength fails me even the light has gone from my eyes” (p. 399).This represents the symptom of loss of energy and anxiety. Verse 14states “I have become like a man who does not hear, whose mouth canoffer no reply” (p. 399), which suggest that King David had lostthe ability to concentrate. In verse 18 Biblica Incorporation (1984)states “I confess my inequity I am troubled by my sin” (p. 399).This implies the symptoms of depression are similar in both theBiblical context and in the field of psychiatry.
Althoughthe Bible gives a similar description of depression to thecontemporary psychiatrists, characters in the Bible used differentapproaches to address depressive conditions. The Biblical charactersperceived depression to be caused by factors beyond their control andtheir mental distortions could only be resolved by supernaturalpowers, that is God. For example, King David states in BiblicaIncorporation (1984) chapter 38: 1 “O Lord, do not rebuke me inyour anger or discipline me in your wrath” (p. 398). This suggeststhat David believed that his depression was a form of punishment fromGod’s, which could only be removed my God. In the case of KingSaul, it is evident that music was instrumental in the treatment ofdepression. Saul was relieved and could feel better whenever Davidplayed lyre (Stein, 2012). This suggests that the modern therapeuticapproaches (such as medication) were not used by the Biblicalcharacters.
Depressionis a mental disorder that has been in existence throughout humanhistory. The complexity and commonality of this disorder haveattracted a large number of researchers who have developed differentmodels, such as the model of dysregulation. The diagnosis, treatment,and prevention measures are taken in consideration of the underlyingcauses of depression. In addition, cultural backgrounds have asignificant influence on the interpretation of depressive thought,which creates the need for cultural competence during diagnosis andtreatment of depression. Although the Bible does not give an outrightindication of depression, there are many characters whose lifeexperiences indicate symptoms of depression and the approaches theyused to address their depressive conditions. The present studyfocused on psychotherapy and pharmacotherapy treatment approaches.The future studies should address the effectiveness of alternativetreatment, such as gene and electro-convulsive therapies. Inaddition, the future study should address the issue of prevention ofdepression in Biblical context, because the present study focused onsymptoms and treatment.
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