Definition

Adjustment disorders are defined as a inability or maladaptive reaction to an identifiable stressful life event(s) / stressor(s). ( e.g., divorce,  family crises,  ... ) Symptoms must occur within three months of the event(s) / stressor(s) and persisted for no longer than six months.

What is an adjustment disorder and how does it occur..."Click"

Listed below are some of the characteristics associated with adjustment disorders:

(a)  Adjustment  disorder with depressed mood:

Depression is one of the most common psychological problems, affecting nearly everyone through either personal experience or family involvement. Most people have a sense of depression being related to a sad mood, but it is much more than that. It is normal for our moods to fluctuate, and every time we are sad, we are not "depressed."  

Depression is a psychological condition that changes how you think and feel, and also affects your social behavior and sense of physical well-being. We have all felt sad at one time or another, but that is not depression. Sometimes we feel tired from working hard, or discouraged when faced with serious problems. This too, is not depression. These feelings usually pass within a few days or weeks, once we adjust to the stress. But, if these feelings linger, intensify, and begin to interfere with work, school or family responsibilities, it may be depression.

Depression can affect anyone. Once identified, most people with depression are successfully treated. Unfortunately, depression is not always diagnosed, because many of the symptoms mimic physical malaise, such as sleep and appetite disturbances. Recognizing depression is the first step in treating it.

 Symptoms of Depression

If the following or similar... symptoms are present each day for a few weeks; and interfere with  daily activities such as work, self-care, child-care or social life; The person should  seek professional help:

 Sadness, anxiety, emptiness, restless and irritable

 Feeling hopeless, helpless or pessimistic

 Feeling guilt, worthlessness, helplessness

 Loss of interest or pleasure in sex

 Loss of interest or pleasure in activities that were once enjoyed

 Loss of interest or pleasure in work or profession

 Decreased energy, fatigue

 Difficulty concentrating, remembering, making decisions

 Insomnia and/or major sleep changes

 Appetite and/or major weight changes

 Preoccupation with death or suicide

 Suicide attempts

The symptoms of depression may vary from person to person, and also depend on the severity of the depression. Depression causes changes in thinking, feeling, behavior, and physical well-being.

Changes in Thinking - You may experience difficulty with concentration and decision making. Some people report problems with short term memory. Negative thoughts and thinking are characteristic of depression. Pessimism, poor self-esteem, excessive guilt, and self-criticism are all common. Some people have self-destructive thoughts during a more serious depression.

Changes in Feelings - Many people report feeling sad for no reason. Others report that they no longer enjoy activities that they once found pleasureable. You might lack motivation, becoming more apathetic. Sometimes irritability is a problem, and you may have more difficulty controlling your temper. In the extreme, clinical depression is characterized by feelings of helplessness and hopelessness.

Changes in Behavior - The changes in behavior common during depression are reflective of the negative emotions you experience. You might act more apathetic, because that's how you feel. Some people do not feel comfortable with other people, so social withdrawal is common. Some people complain about everything, and act out their anger with temper outbursts. Sexual desire may disappear, resulting in lack of sexual activity. In the extreme, people may neglect their personal appearance, even neglecting basic hygiene. Needless to say, someone who is this depressed does not do very much, so work productivity and household responsibilities suffer. Some people even have trouble getting out of bed.

Changes in Physical Well-Being - We already talked about the negative emotional feelings experienced during depression, but these are coupled with negative physical emotions as well. Chronic fatigue, despite spending more time sleeping, is common. Some people can't sleep, or don't sleep soundly. These individuals lay awake for hours, or awaken many times during the night, and stare at the ceiling. Others sleep many hours, even most of the day, although they still feel tired. Many people lose their appetite, feel slowed down by depression, and complain of many aches and pains. Others are restless, and can't sit still.

Now imagine these symptoms lasting for weeks or even months. Imagine feeling this way almost all of the time. If many of these symptoms are present for at least several weeks, you are probably depressed.

Bi-polar depression is a very different and more complicated form of depression with many unique problems. Formerly called manic-depressive disorder, bipolar depression is a type of depression, and usually includes depressive episodes as well as hypomanic episodes

A psychologist can assess whether you are depressed, or just under a lot of stress and feeling a little sadness. Remember, depression is treatable.

(b)  Adjustment disorder with anxiety:

1.  We have all experienced significant anxiety at one time or another, although perhaps not severe enough to warrant a diagnosis by a professional. Anxiety is a danger or an alert signal. The physiological arousal we experience as anxiety is directly related to fear of harm. When we are faced with a threat to our physical well-being that can result in either serious physical harm or death, we respond psychologically and physically. This response has been called the "fight or flight" response because it activates us to either defend ourselves, or to run away and escape injury. In a life threatening crisis, this fight or flight response can save our lives.

In our civilized world, we don't encounter genuine threats to our physical safety everyday (unless you count driving in rush hour traffic). Instead, we are faced with problems that complicate our lives. These problems do pose a threat, but usually it is not a physical threat. We may be faced with losing a job, or having our marriage break-up, or maybe our children might fail in school. These may be threats to our well-being, but have more of a psychological impact, than a physical impact. These psychological threats trigger a mild version of the fight or flight response, that we call anxiety. (Except in a panic disorder, when the response is very immediate and severe). Anxiety alerts us to a problem, and motivates us to try to resolve the problem, because we want the anxiety to go away. If we never felt anxious about anything, we would have little motivation to respond to problems, until we were faced with a genuine crisis. Normal anxiety is not a sign of a psychological disturbance, because we all experience it, and it helps us manage out lives by alerting us to problems requiring a response. Anxiety disorders develop when we experience severe anxiety in response to minor or common problems, or when the anxiety never goes away, and actually interferes with our problem solving. ...

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2.) Anxiety problems are very common. In fact, in the United States, more people visit their physician for anxiety than for coughs and colds. The prevalence of anxiety disorders varies by type, ranging from 1% of the population for some disorders, to as high as 58% of combat veterans experiencing post traumatic stress to some degree. The use of medications for anxiety management is very common, but not effective without psychotherapy. In fact, many anti-anxiety medications produce dependency, and the withdrawal symptoms are often similar to anxiety symptoms. These medications control the symptoms without eliminating the cause for the problem. Psychological treatment focuses on reducing the inappropriate anxiety response, so medication is not necessary.

2. Generalized Anxiety Disorder:This disorder exemplifies the condition of having ongoing anxiety, with excessive worrying about a lot of different life events over a period of at least six months. You might feel restless, tense and tired, have difficulty sleeping, find it hard to concentrate, and be more irritable than usual. Many people with generalized anxiety disorder describe themselves as chronic worriers, who often become more upset by problems than the average person. The key component is not worry, but excessive worry.

Many people with generalized anxiety experience a panic attack at some point in their lives, in response to more severe stress. Eventually, the person begins to worry about worrying. That is, because you see yourself as an anxious person who can't handle stress very well, you develop additional anticipatory anxiety when you must face a stressful situation. (eg. going for a job interview, entering the hospital for a medical procedure, etc.) 

Many primary care physicians treat generalized anxiety disorder exclusively by prescribing anti-anxiety medications, especially the benzodiazepines, rather than referring the person for psychotherapy. However, these drugs are not without risk. They cause impairment of cognitive functioning, including reaction time. Many individuals experience rebound anxiety if they abruptly stop taking the medications. Research has also suggested that the benzodiazepines may produce functional changes in the central nervous system that make it difficult for people to withdraw from these drugs.

This is not a biological problem, it is a psychological problem with pronounced physical symptoms. It requires psychological treatment, most often a combination of behavioral and cognitive therapy. Dr. Franklin has used behavioral treatment effectively to teach individuals how to reduce their anxiety through relaxation exercises. Cognitive therapy techniques help change identify and change the expectations you might have that triggers anxiety. A combination of cognitive-behavioral interventions shows very positive results, without the drawbacks of medication. The development of cognitive coping strategies for managing anxiety is particularly effective for individuals with generalized anxiety disorder.

3.  Social Anxiety:This problem is also called a social phobia. An individual with this problem has persistent fear of social situations, and is fearful of embarrassment. Certain social situations provoke more anxiety than others, and individuals with this problem may sometimes develop a panic attack in response to some specific social event. (e.g. giving a speech). People with social anxiety realize that their fear is exaggerated, but they still cannot control it. They tend to avoid situations in which they need to perform in front of others, and this tends to interfere with life adjustment in some way.

As many as 10 percent of the population may experience social anxiety to some degree, although they all do not seek treatment. Many people are fearful of public speaking, but manage to avoid it and cope well within a slightly more limited life sphere. Some individuals have more severe social anxiety, and are even fearful of talking to strangers in any capacity. These people have more serious adjustment problems, and are more likely to seek treatment. Social anxiety tends to develop during teen years, but often in children described as excessively shy.

psychological treatment for social phobia, using techniques appropriate to the presenting symptoms. This depends what triggers the anxiety, whether the individual has panic attacks, and the severity of the symptoms. Most often a combination of behavioral interventions is used with cognitive therapy. The behavioral treatment may include relaxation training and systematic desensitization, as well as immersion therapy. Cognitive therapy helps you to develop cognitive blocking mechanisms when the anxiety begins to build, and also helps you understand why the the social anxiety symptoms occur. This allows you to develop different ways of coping with the anxiety.(c)  Adjustment disorder with mixed anxiety and depressed mood:

Includes feelings of hopelessness, nervousness or feeling sad, worrying or crying a lot or experiencing jitteriness .

(d)  Adjustment Disorder With Disturbance of Conduct:

People with this type of adjustment disorder do not adhere to societal norms and rules. They may violate the rights of others with truancy, vandalism, reckless driving, fighting, or other endangering acts.

(e)  Adjustment Disorder With Mixed Disturbance of Emotions and Conduct:

 This category includes people with some emotional symptoms (e.g. anxiety or depression) and disturbance of conduct symptoms.

(f)  Adjustment Disorder, Unspecified:

This category includes other reactions such as withdrawal, inhibition, or physical manifestations such as stomach aches or headaches.

Countinue........
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Treatment:

Counseling (A Biblical Perspective on Depression......) and Psychotherapy

The primary goals of treatment are to relieve symptoms and assist with achieving a level of adaptation that is comparable to the affected person's level of functioning before the stressful event.

Most mental health professionals recommend a form of psychosocial treatment for this disorder. Treatments include individual psychotherapy, family therapy, behavior therapy, and self-help groups.

Treatment of psychological, emotional and behavioral problems can take many forms.  Four broad categories can be used to classify the wide range of options available:

1.  Psychotherapy.

Psychotherapy is the use of psychological techniques to change behaviors, feelings, thoughts, or habits. It is generally employed to relieve symptoms of emotional or behavioral dysfunction or distress, however it is also used to help people achieve greater levels of self awareness and to actualize latent potential.

There are a wide variety of psychotherapeutic modalities (e.g. individual, group, family) and theoretical approaches (e.g. psychodynamic, behavioral, cognitive ).

Psychotherapy is recommended for individuals experiencing symptoms of psychological distress. If you are depressed, anxious fearful, angry or don't feel in control of your life psychotherapy might help you. If you are unhappy, having relationship problems, or feel you are not living up to your potential psychotherapy can give help develop greater self awareness and support your efforts in improving your life.

Psychotherapy is practiced by a number of different mental health professionals. Although they have similarities in their approach to treatment, their varied training backgrounds sometimes lead them to choose different approaches and/or orientations. below is a table that summarizes some of the characteristics of different practitioners. The special orientations listed are generalizations and individuals may differ.   

Discipline       Training Special Orientation
Psychologist Ph.D.(Doctor of Philosophy in psychology) or Psy.D. (Doctor of Psychology) and one year Internship or M.C.(Master of Counseling Mental Health). Psychotherapy: All modalities and orientations. Psychological Testing.
Masters Level Psychologist M.A.(Master of Arts) or M.S. (Master of Science) or M.Ed.(Master of Education) Psychotherapy: Some modalities and orientations. Psychological Testing.
Social Worker M.S.W.(Master of Social Work) Psychotherapy: Interpersonal, family, group, milieu orientation.
Psychiatrist M.D.(Medical Doctor) or               D.O.(Doctor of Osteopathy) and Three year Psychiatric Residency
 
 Biological Treatment, Psychopharmacology. Some Psychotherapeutic modalities and orientations.
Counselor M.A.(Master of Arts in counseling) or M.Ed.(Master of Education in counseling).
 Counseling. Vocational and Educational Testing.
Psychiatric Nurse Specialist M.S.N.(Master of Science in Nursing) Counseling and Psychotherapy: Some modalities and orientations.

The decision on who to choose as a psychotherapist is complicated by many variables. Here are  some of the important points to consider. 

Reputation. Does the therapist come recommended by a friend, family member or professional? Have I read or heard about their work? If they are a member of local or national professional organizations you can call and ask about them. You can verify their licensure with your state and inquire about any complaints against them. Do they practice at an organization with a good reputation?

Theoretical Orientation. Does their approach sound compatible with  your needs? If you feel relatively intact but want to change a habit now you might choose a behavioral approach over psychoanalysis.

Personal Characteristics. Does the therapist seem compatible? The age, sex and cultural background of the therapist can be important in establishing rapport . If you are a fifty five year old woman struggling with woman's issues a twenty seven year old male therapist might not be your first choice.

Cost. What is the fee? Do they accept my insurance plan? What are the alternatives in my area?

Location. Can I conveniently get there? Remember psychotherapy might take many months or even longer.

There are a wide variety of theoretical approaches or orientations to psychotherapy. The choice of approach is usually determined by the training and experience of the therapist as well as the needs and desires of the patient. Some of the more widely used approaches are briefly described below.

Behavioral Therapy employs learning theory to effect changes in behavior. It is usually symptom focused as opposed to working on unconscious material. Unlearning unwanted behaviors (even thoughts and feelings can be viewed as behaviors) and learning desired behaviors is the work of behavior therapy.

Maladaptive habits are weakened and eliminated (extinguished) and adaptive habits developed and strengthened in very small steps (successive approximations). These changes are consolidated through reinforcements (rewards, either intrinsic or extrinsic) until stable behavior change is established.

Cognitive Therapy seeks to alter habitual maladaptive thought patterns. Unrealistic expectations, wishful thinking, living in the past (or future) and over generalizing can all lead to disappointment and frustration. Cognitive therapy emphasizes a rational and positive world view. It has proven to be especially effective with anxiety and depression.

Eclectic Therapy although not a formal school of thought, is the use of a combination of approaches or theoretical orientations. It is used by most therapists. There are many different blends. It is a recognition that individuals may benefit from a variety of techniques.  The eclectic approach can be flexible and adaptive and avoid forcing treatment into one size fits all limitations. It is necessary that the therapist be well grounded in several of the more orthodox  approaches to treatment rather than using bits and pieces through a lack of familiarity.

Existential Therapy is an approach that examines some of the major issues in our existence such as the meaning of life, loneliness, mortality, and the challenge of free will. It focuses on taking responsibility for ones choices and creating our own meaning and purpose. It is especially useful with the elderly and in working on issues of death and dying. Though it emphasizes needs of the individual it usually helps patients find new meaning in their relationships.

Psychoanalysis is the personality theory and psychotherapeutic approach pioneered by Sigmund Freud. Freud is known as the father of psychoanalysis. The approach emphasizes making the unconscious conscious and thereby giving the individual choices in life rather than being at the whim of unknown forces within themselves. Psychoanalysis frequently uses dreams and free associations (spontaneous uncensored communications) as the subject matter for treatment. . The therapist (analyst) says little but guides the patient in interpreting the meaning of the intrusion of unconscious material into everyday life. Sessions are frequent, up to five times per week, and treatment usually lasts for years.

Psychodynamic Psychotherapy is the term used to describe treatment approaches based on psychoanalytic principals, but which are conducted less frequently, over a shorter duration and allow a small amount of eclecticism. Psychodynamic therapists are more active (communicative) than psychoanalysts.

2.  Coaching and Psychotherapy:

More and more people are hearing the terms personal coach or life coach. There have been newspaper articles and professional articles written on the subject. Several people have asked me, "what is a life or personal coach and how is personal coaching different from psychotherapy?" Until recently, personal coaching has been confined to corporations where it is known as executive coaching or executive consulting. Today personal coaching has found its way into the public domain. This issue of the Psychotherapy Update will discuss personal or life coaching as a new trend that will become more available over the next decade to assist people in achieving a more fulfilling, rewarding and balanced life. Perhaps personal coaching is just what you've been waiting for to help you enrich your already satisfying life.

Coaching has been around for a long time. It is usually associated with sports, e.g., tennis coach, golf coach, track coach, football coach or baseball coach, to name a few. You want to get better at something, whom do you call? A coach. You want to become more physically fit, you call a personal trainer. Just as there are athletic coaches, voice coaches, and acting coaches, there are personal coaches. Personal coaches, sometime referred to as life coaches, are usually professionally trained mental health practitioners, who, in most instances, have been successful in their professional and personal life. In addition to their professional training, they have developed special skills in helping individuals develop their potential and fulfill their goals. Within the past years the practice of personal coaching has mushroomed. In 1994 it was estimated that there were approximately 1000 personal or life coaches nationwide. Today it is estimated that there are close to 5000. As people seek to achieve greater fulfillment from their work, their marriages, and their life in general, the need for personal coaches will continue to increase. Previously many people sought psychotherapy for personal growth not just for treatment of emotional problems or mental illness. Others wanted some other form of assistance without the association to mental illness carried by psychotherapy. Now people can turn to personal coaches whose focus is on growth and development of all areas of one's life rather than on internal stress and emotional conflict.

Coaching and Psychotherapy

What is the difference between coaching and psychotherapy? Coaching is not therapy. Personal coaches don't work on "issues" or delve into the past. Nor do they deal much with understanding human behavior. Coaches do not focus on resolving past traumas that affect personality development nor do they try to change personality structures. Coaches do not attempt to ameliorate psychic pain, anxiety, depression, or sexual dysfunction. These are issues that are dealt with in psychotherapy.

A personal coach focuses on:

Helping people set better goals.
Asking their clients to do more than they would on their own.
Helping their clients to focus better so as to product results more quickly.
Providing clients with the tools, support, and structure to accomplish more.
Whereas psychotherapy focuses on the past and the present, coaching focuses on the present and future. The personal coach maintains a focus on the goals that the client decides s/he would like to achieve. The collaborative effort propels the individual to continually move toward the goal. In psychotherapy the assumption is that there is something wrong that gets in the way of a person's functioning that needs fixing. In coaching the assumption that there is nothing wrong with the client, but the client wants an even better life. In psychotherapy the main focus is on the client's internal world. In coaching the focus is on the client's entire life including health, relationships, career, spirituality, etc., and how it all fits together.

Personal coaches help people develop a balanced life. They do this through strengthening their client's personal foundation. Part of one's personal foundation is recognizing and clarifying one's core values. Most of us seldom take the time to delineate and clarify our values, those beliefs that are at the center of our belief. Often we act in ways that our contrary to our internalized values and we end up feeling uncomfortable, guilty, or even ashamed. Frequently, we are not aware of the causes for our disquietude. On exploration we may find that we acting in ways that are contrary to our own value system. A coach can help you explore your values and assist in developing a set of goals and actions that comport with this value system such that you feel in synch with yourself.

Coaches have no agenda but that of their clients. It is one of the few relationships where the client's agenda is the only agenda that matters. Personal coaches want to assist you in actualizing your agenda on your terms. The objective of the coach to open new possibilities. The attention in coaching is solely on you and your agenda.

How Does Coaching Work?

Similar to psychotherapy, coaching works best when there are regular appointments. In order to maintain focus and honor commitments, continuity is necessary. However, coaching is not limited to face-to-face meetings. In fact, most personal coaching takes place over the telephone. Coaching is not limited to geographical location. One can be coached from any location. Coaching sessions are usually thirty minutes in length with three or four sessions scheduled per month.

  There are many variables that contribute to the effectiveness of coaching:
  Better goals are set, ones that naturally impel you forward.
  Synergy between the coach and client creates momentum.
  Accountability. Knowing that you have to report to someone on progress or completion of an assignment, impels you to completion.
  Time limits and deadlines may set which mitigates procrastination.
  Prioritizing tasks with your coach makes it more likely that the tasks will be accomplished.
  Tasks are put into manageable pieces to avoid feeling overwhelmed with the enormity of the task.
  You can borrow your coaches belief in you, until you develop a belief in yourself.
  You have a partner in your coach; working with someone always feels more empowering than working alone.
  You develop new skills.
  When you have a coach, you tend to take yourself more seriously.
  You take more effective and focused actions immediately.
  You stop putting up with what is holding you back.
  You set better goals that are more in accord with what you want out of life.
Why is coaching becoming so popular?

Thomas Leonard, founder of Coach University, says that coaching is becoming so popular for several reasons:

"Many people are tired of doing what they think they "should" do and are ready to do something special and meaningful for the rest of their lives. One problem is that many can't see what this is or, if they can, they can't find a way to reorient their life around it. A coach can help them do both.

People are realizing how simple it can be to accomplish something that several years ago might have felt out of reach or like a pipedream. A coach is not a miracle workerbut a coach does have a large tool kit to help the Big Idea become a Reality. Fortunately, people now have the time and resources to invest in themselves in this kind of growth.
Spirituality. If you track the phenomenal success of James Redfield's Celestine Prophecy on the NY Times best-seller list back in 1994, you got a sense of just how many people are willing to look at, and consider, the notion of spirituality. Wow. Many coaches are spiritually based - even the ones who coach IBM or AT&T. America is growing more spiritual very quickly. ([My] working definition of spirituality? How connected you are with yourself and others.") The coach helps the clients to tune in better to themselves and to others."

Generally people have turned to a psychotherapist when they experience psychological pain that interferes with the conduct of their everyday life. They may experience anxiety, depression, sexual dysfunction, dysphoria, low self-esteem, lack of identity, obsessions, compulsive rituals, or a feeling that they are not functioning to capacity. Many people have turned to psychologists and other psychotherapists when they want to enhance their life. They seek therapy for personal growth and greater self-understanding.

Coaching begins where psychotherapy leaves off. The coach assumes that the client is well-functioning and is facing a roadblock or finding it difficult to get over the next mountain to greater fulfillment. People turn to coaches when their life is going well. Usually they are high-functioning people who want to expand their lives, their businesses, and their general outlook. They tend to be successful people who have a vision that they could go beyond where they are, but feel that they would like someone to work with them to achieve their goals. These are the same people who would seek a coach to improve their golf or tennis game, seek consultation in their business, or utilize a financial planner to assist with their finances. They seek a coach to accelerate their growth or maximize an opportunity. Some people choose a coach to help in the short-term for a specific task or project, while others engage a coach to restructure their life.

People choose their coach on the basis of whether there is reason to believe that this person can help me to accomplish my goals. If they feel comfortable with their coach and believe progress is being made, they continue. Otherwise, they terminate the relationship. Coaching is not about "the doctor knows best" model. It is about what works for you.

3.  Biomedical Therapy.

4.  Milieu/Community Therapy.

Studies continue........
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six major adjustment disorders
There are six major adjustment disorders:

(a)  Adjustment disorder with depressed mood;
(b)  Adjustment disorder with anxiety;
(c)  Adjustment disorder with mixed anxiety and depressed mood;
(d)  Adjustment disorder with disturbance of conduct;
(e)  Adjustment disorder with mixed disturbance of emotions and conduct;
(f)  Adjustment disorder unspecified.
What are the characteristics associated with an adjustment disorder?

A person with adjustment disorder often experiences feelings of depression or anxiety or combined depression and anxiety. As a result, that person may act out behaviorally against the "rules and regulations" of family, work, or society. In some people, an adjustment disorder may manifest itself in such behaviors as skipping school, unexpected fighting, recklessness, or legal problems. Other people, however, instead of acting out, may tend to withdraw socially and isolate themselves during their adjustment problems. Still others may not experience behavioral disturbances, but will begin to suffer from physical illness. If someone is already suffering from a medical illness, that condition may worsen during the time of the adjustment disorder. People in the midst of adjustment disorders often do poorly in school or at work. Very commonly they begin to have more difficulty in their close, personal relationships.

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Gender differences in depression

There Is No Shame In Depression

Gender differences in depression

After puberty, women are 2 to 3 times more likely than men to get depressed. Before they get to 21, about a third of young women have had at least one depressive episode (Lewinsohn & Clark, 1999). Why are women more depressed then men but not less happy? The answer isnt clear. There are several possibilities why 25% of women will be depressed sometime in their lives, but only 10% to 15% of men. Women tend to feel helpless and hopeless when they are depressed while men are more likely to be angry and irritable (which may hide their depression). Some studies have found that depression is most likely to occur in unmarried women who are poor and have little education.

What are possible reasons for the gender differences? First of all, many women are still in subtle ways taught to conform, to serve, and to please others in a society that truly values and rewards self-serving individualism, i.e., living your life the way you want to and/or feel is right. The phrase commonly used is be your own man. To do otherwise is to give up your dreams and to suffer a loss of status. When someone else takes control of your life, it is likely to be stressful. Consider, for a moment, only the sexual context of our culture, about 50% of women have been physically or sexually abused before age 21, another 25+% have been abused or coerced in relationships after 21, and 70% have at some time been sexually harassed. Perhaps more importantly, add to these statistics the discrimination against women when selecting well-paid managers, administrators, politicians, and so on. About 75% of all people in poverty are women with children. Women living on isolated farms are prone to depression. Anyone who is disadvantaged, put down or dominated, has skills that are unused and unappreciated, and given little control over ones life has some right to be unhappy.

As just mentioned, many studies have found, in terms of interviews, diagnoses, and test results, that twice as many women are depressed as men. However, there are other ways of assessing the severity of depression. For instance, one might consider how many people get so miserable they decide to escape the pain by dying. In this country (and in most countries) there are about four times many men who kill themselves as women. This situation is referred to as the gender paradox, i.e., women are considered more depressed but men kill themselves much more often. Men commit 80% of the suicide deaths but women make two to four times more suicide attempts than men. Thus, women fill 60% of the hospital beds allocated to suicide-related injuries.

The Signs of Depression

Depression is a loss of an important life goal without anyone to blame. Such a loss affects our behavior, our moods or subjective feelings, our skills, our attitudes or motivations, and our physical functioning and health.

Behavioral excesses --complaints about money, job, housing, noise, poor memory, confusion, loneliness, lack of care and love... acting out (adolescents), running away from home, rebellious, aggressive... obsessed with guilt and concern about doing wrong, about being irresponsible, about the welfare of others, and about "I can't make up my mind anymore"... crying... suicidal threats or attempts.

Behavioral deficits --socially withdrawn, doesn't talk, indecisive, can't work regularly, difficulty communicating, slower speech and gait... loss of appetite, weight change, stays in bed... less sexual activity, poor personal grooming, and doing less for fun.

Emotional reactions --feels sad, feels empty or lacks feelings of all kinds, tired ("everything is an effort")... nervous or restless, angry and grouchy (adolescents), irritable, overreacts to criticism... bored, apathetic, "nothing is enjoyable," feels socially abandoned and/or has less interest in relationships, sex, food, drink, music, current events, etc.

Lack of skills --poor social skills, frequently whiny or boring, critical, lack of humor... indecisive, poor planning for future and unable to see "solutions."

Attitudes and motivation --low self-concept, lack of self-confidence and motivation, pessimistic or hopeless, feels helpless or like a failure, expects the worst... self-critical, guilt, self-blaming, "People would hate me if they knew me"... suicidal thoughts, "I wish I had never been born."

Physical symptoms --difficulty sleeping or sleeping excessively, awaking early... hyperactivity or sluggishness, diurnal moods (worse in the morning)... low sex drive, loss of appetite, weight loss or gain, indigestion, constipation, headaches, dizziness, pain, and other somatic problems or complaints.
These signs of depression have been found in several different kinds of sadness and depression (see the various diagnoses mentioned in the first section of this chapter). Few people would have all these signs and some depressed people would have only two or three of these symptoms. The number of symptoms you have doesnt say much about how serious your depression is. Different symptoms characterize different types of depression. Remember, major depression is serious enough to interfere with work and social life. In fact, a person given this diagnostic label is likely to miss twice as many days at work as a person with a diagnosis of lesser depression. Psychiatrists often call this depression endogenous because it seems to arise from within and not clearly caused by external events, such as a serious loss. Major depression is likely to affect sleep, appetite, energy level, self-esteem, work and social activities, and thoughts of suicide. Unipolar depression, which might also be described as situational or reactional, might have somewhat different signs, since it is a serious down or blue spell following a loss but usually not disabling. If a mild-to-moderate sad mood lasts for two years it may then be called dysthymia. After being chronically sad for a long time, a person may no longer know why he/she is feeling low. We also discussed bipolar disorders earlier. Their signs depend, of course, on where the person is in his/her up and down cycle, sometimes they are deeply depressed but at other times they are in a good mood and hyperactive. The mania may involve being overly happy, being so active or excited they cant sleep, talking very fast and a lot, and having grandiose, irrational, or bizarre thoughts. Bipolars are equally likely to be males as females but women are twice as likely to be unipolar. Bipolar and unipolar depressives respond to medications differently and for that and other reasons they tend to be seen as two different disorders.

Secondly, the symptoms found and the judgment of how serious the symptoms are, vary according to who is making the diagnosis and how it is being made. For instance, the judgment that a particular person is depressed might be made by a therapist, family doctor, friend, spouse, psychological tester, or by self-evaluation. There is often little agreement among these judges; for instance, MD's miss the diagnosis in 7 of 10 depressed men and 5 of 10 depressed women. On the other hand, mental health workers overdiagnose depression by 15% to 20%. Sometimes even the psychological tests don't agree with each other. This is a serious problem both for diagnosis and for treatment as well as for research. Don't be surprised if you get conflicting opinions.

In most instances, the person knows when he/she is unhappy. If you feel sad, that's it; you are the final authority. However, the victim doesn't always recognize his/her own depression (so the "final authority," i.e. you, may need to re-think the situation). Physical complaints sometimes hide depression.

Consider this: Gillette and Hornbeck (1973) reported a case of a 54-year-old housewife who went to an emergency room with a painful earache. She had seen three other MD's in recent weeks. None could find the cause. Again, nothing could be found wrong with her ear and she was sent home with pills (aspirin). Three days later she jumped off a bridge. She hadn't opened the aspirin bottle. Accurate diagnosis of depression is a problem. Depressed people frequently have physical complaints; ill people are often depressed. Certainly some don't tell their doctor even if they are aware of sadness. This concealed gloom is called masked or smiling depression.

Even when depression is clearly expressed, physicians often ignore it. A follow up of 25 people who committed suicide showed that 23 had visited a physician within the last few weeks--and, according to the doctors' own notes, 80% "showed clear evidence of depression." Yet, few were actually diagnosed as depressed and none were given anti-depressant medication! Physicians might do better if they used a brief, simple questionnaire. But don't expect your doctor to read your mind or even to ask about depression, you must be very clear about your feelings and your needs. It is crucial that doctors know and DO SOMETHING about your emotional state. And, if your doctor or anyone thinks you have a psychological problem, please listen carefully.

Thirdly, the diagnostic picture is often complex, i.e. a person isn't just depressed and that's all. On the negative side, many depressed people are also anxious, and they may have personality disorders, such as cyclothymic, borderline, schizoid, dramatic, passive-aggressive, avoidant, and so on. On the positive side, perhaps more than half of well known poets, playwrights, and novelists have mood disorders, unfortunately several have severe manic-depression as well as great creativity and sensitivity.

Fourthly, it is tempting to believe there are two separate, unrelated processes going on in depression, one biological-chemical and one psychological, each causing a different kind of sadness. Several experts (Free & Oei, 1989) say the evidence for this basic assumption is scant, because the organic and the cognitive components seem to be very interrelated.

Even the professionals often have difficulty detecting depression, so recognize that self-diagnosis may be hard. When in doubt, get help. In its serious form, depression is a dangerous illness. Even in its milder forms, it is a miserable condition. This is a sickness that can not be simply "willed" away.

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Approach to Solutions In a Biblical Way

UNDERSTANDING THE PROBLEM FROM GOD'S POINT OF VIEW

Isa. 55:8-9 , Prov. 14:12 -We are to look at life from God's perspective, His view, not from our way, experiences, ideas, opinions, what others say, the world's philosophy or its psychology. The basic problem and the supreme challenge you will face in making Christ-honoring changes is dying to self. The biblical perspective concerning 'self' is exactly opposite to what the wisdom of this world proclaims, Lu. 9:23-24 . Accordingly, to live biblically is to respond to life's challenges in a manner that pleases and honors God, no longer pleasing and gratifying self, l Cor. 3:19-20 , l Jn. 2:15-17 , l Cor. 2:12-13 , l Jn. 2:20,27.

Solution
Accordingly, we are to view the problem from 'God's perspective', and His word provides the solution, the 'hope', and with hope are 'changes' that are necessary, and the 'practice' of these changes to conform you to the image of Christ.

More Things To Do By The Counselor:
 
1. First, Have a Problem Solving Worksheet

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What Happened? (Describe the problem)

What I did? (Describe my response)

What should I have done? (Cite and explain biblical references)

What I now must do? (What steps must I take to rectify matters?)

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Eph. 4:22-24 , l Jn. 2:3-5 -We are to identify areas that need changing, being specific to identify put-offs and appropriate put-ons.
 
2. Think and Do list. Schedule worksheet. Freedom from Anxiety list.
 
3. Give Devotions: memory verses, meditation process, prayer, praying in the spirit, Homework Assignments to the person.( James 1:21-25 -Through the meditation process, we change our inner man, the root, and from the godly root, our thoughts, our speech, and our actions would then be consistent with God's standards. This continues until the person experience the fullness of God and express His Presence wherever he or she go).

4. BSAF: Selected verses related to the problem area. (See: Heb. 6:18-20 -Hope is an anchor of the soul because it affects our mind and emotions. Christ within me, the Anointed One, breaks the yoke of life's pressures on me, and my job is to develop this inner image of Christ within me, that in Him, I am more than a conqueror, never under but always over circumstances, no matter what I face in life. To really believe this in the inner core of my being that all God's promises are mine depends upon my living in and by the living word of God, John 16:33 , James 1:2-4 .
Eze. 36:26-27 -God gave me a heart of flesh, put His Spirit within me, and gives me power to carry out His commands.
 
l Cor. 2:12-13 -Being a child of God, I receive revelation knowledge by the word of God in and through my human spirit.
 
Rom. 8:28-29 -No matter what happens to me in life when I call upon God He will intervene in my life, He will reach into my experiences, redeem my past, and cause things to work out for my benefit.
 
l Cor. 10:13 -God is the One Who is faithful. As I put my faith in Him, He will bring me out successfully.
 
Heb. 4:15-16 , 7:25 -All I have to do is ask boldly, and God's Grace is available to me, and the blood of Jesus Christ intercedes always, washing and cleansing from all sense of guilt and shame whether real or imaginary.
 
Rom. 6:3-6 -My old human nature and all my past has been buried with Christ when I was baptized into His death. At the burial I was also raised with Him into the newness of life, freed from the power of sin, and free now to do acts of righteousness).

5. Word study: Use of concordance to study the problem area.

6. Think and Do list. Schedule worksheet. Freedom from Anxiety list.
 
7. Lastly, always give a word of HOPE:-
Don't beat yourself up

Unfounded guilt is one of the symptoms of Depression. Don't pile more guilt onto yourself by wondering if a lack of faith is the cause of your illness. And don't burden yourself with needless shame for fear of what others might think of you. We need to come out of the closet, so to speak, and stop hiding our illness.

 "Don't be afraid of people. I am with you, and I will rescue you," declares the Lord. Jeremiah 1:8
There IS hope I've always asked God to show me a way to help other people with Depression. I believe the first step for me to help others is to stop hiding my illness. There was a time when my children were still in grade school where I was totally unable to function because of Depression. It took everything within me just to get in the car and drive them to school each morning, and pick them up in the afternoon. I used to lie down on the front seat while waiting for the three of them to come to the car. I didn't want any of the other moms to see me for fear that I'd have to make up some story about why I hadn't been around and why I looked so awful. I'd always be fighting back the tears on the way back to our house.
Fortunately, medication has caused those days to be a thing of the past. Every so often I sink back into the depths of Depression, but it is always due to some sort of alterations with my meds or because I've wanted to see if I could do without them. During these times, I now try to be honest about my situation. Surprisingly, because of this honesty, I have met many people who admit to having the same problem. Because of this we are able to support one another which is much better than suffering alone. The apostle Paul wrote:
 "Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all of our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God." 2 Cor 1:3-4.

If I ask the person to take anti-depressant medication,
does it mean that I am lacking in faith ?

The stigma of Depression

In today's society there is a huge stigma attached to Clinical Depression. It is an illness that is widely misunderstood. Any illness that causes a change in a person's emotions or affects the way a person behaves such as Depression, Bipolar-depression, Anxiety disorders, Schizophrenia, etc., is often regarded as a weakness in a person's character or thought of as insanity or that the person is just plain crazy.

When a Christian suffers from Depression there is even more of a stigma. A true believer shouldn't be depressed. At least that's the message we often get from well meaning fellow Christians. I'm not denying the fact that God teaches us through His word [the bible] exactly what a person needs to find true happiness in life. The most important and first step is:
1: Realize that by ourselves, we humans can do nothing apart from God.

 "Not that we are competent in ourselves to claim anything for ourselves, but our competence comes from God" 2 Corinthians 3:5

2: Because of the blood shed by His Son, Jesus Christ, we can receive the gift of eternal life.

 "Praise be to the God and Father of our Lord Jesus Christ! In his great mercy he has given us new birth into a living hope through the resurrection of Jesus Christ from the dead, and into an inheritance that can never perish, spoil or fade - kept in heaven for you" 1 Pet 1:3,4

People aren't perfect

 
Every human being whether Christian or not, has and will continue to have sin in their life.
 "for all have sinned and fall short of the glory of God" Romans 3:23

If a Christian chooses to partake in a sin that they know is against Gods Word, and for whatever reason they do not confess it to God and turn away from it, then problems which may include depression are sure to plague them.

Sometimes Depression needs medication

If you have been diagnosed with Clinical Depression by a doctor, usually part of your treatment will require the use of anti-depressant medication. This is also a topic that is widely misunderstood.

Once again, being a Christian in this situation causes a lot of added stress and guilt. We must first understand the facts about anti-depressants.
1: Anti-depressant medications are not the same thing as tranquilizers.

Anti-depressants treat Depression by adjusting the neurotransmitter levels in the brain. ( See What is Depression ?).

You do not get "high" or experience a quick fix for your "nerves" from taking anti-depressants. Once a person begins treatment with anti=depressant medication it usually takes weeks before the Depression lifts completely.
2: You cannot become addicted or "hooked" on anti-depressants.

Because anti-depressants are not in the same drug classification as tranquilizers, sedatives, or pain killers the body does not become addicted to them. If a person whose brain chemistry is functioning properly takes anti-depressant medication, they will not experience any benefit.

In the same manner that a person with Diabetes does not become addicted to their insulin injections or pills, a person with Depression doesn't either. In both of these medical conditions, the medication is used to enable the body to function normally.
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***** DISCLAIMER *****
I want to make one thing perfectly clear. I am in no way trying to lead you to believe that by taking anti-depressant medication your life will be free from trials or stress. The reason I support medication to treat Depression is because that is the kind of illness (Clinical Depression) that I have. I have experienced life without medication and have doubted my own worth as a Christian for not being able to overcome it through faith and prayer alone. For me, my medication is a gift from God. I will eternally be thankful that He has provided the help that my body needs. It allows me to break away from the chains of Depression that imobilize my life. Without it, I would be of no use to anyone. I would be unable to make use of the time God has given me in this life.

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It isn't your fault !

If you have Depression, and you need to take medication in order to function...IT IS NOT YOUR FAULT ! No one is immune from illness and disease. As long as we live on this earth, our bodies will continue to age and be suseptible to sickness. It is only through the blood of Jesus Christ that we can look forward to a day where our bodies and minds will be whole and perfect the way God originally designed them to be.

 "He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away." Revelation 21:4
But in the meantime we are able to take advantage of the miracles of medicine that God has given us. He has given man the wisdom to invent treatments and cures for thousands of physical ailments. We would never think of someone with pneumoia as being less of a christian for taking antibiotics. Or condemn a person with cancer for not being strong enough in their faith to pray away their tumor. It is no different for a person with Clinical Depression.

God loves you. He has created you and redeemed you in Christ so that you can live a full and meaningfull life. Unless God chooses to heal you of Depression you need not suffer in vain.

 "We are hard pressed on every side, but not crushed;...perplexed, but not in despair;...struck down, but not destroyed." 2 Cor 4:8-9
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