2. Neurotic disorder

2.1 Anxiety disorder

2.2 Depressive disorder

2.3 Obsessive-compulsive disorder

2.4 Phobic disorder

3. Psychosomatic disorder

High blood pressure, heart disease, migraine, stomach ulcer

4. Personality disorder

4.1 Schizoid personality disorder

4.2 Multiple personality

4.3 Anti-social personality disorder

5.  Others：

5.1 Brain damage

5.2 Mental retardation

5.3 Addiction: Such as computer/online addiction, porn, gambling etc

Depression is not simply a medical problem, nor is it just a mental problem. It is not merely a spiritual problem. Depression is a “being human” problem. It involves emotional, physical, behavioral, and social changes.

Signs of Depression (Source: Counselling Insights)

Emotional: Sadness, restlessness, hopelessness, impatience, irritability, anger, unnecessary self- criticism, feelings of inferiority, feelings of excessive guilt and anxiety, unexplained mood swings.

Physical: Loss of energy, weight loss, headaches, change of eating patterns, change of sleeping patterns.

Behavioural: Loss of motivation, difficulty making simple decisions, or fulfilling responsibilities, changes in behavior such as increased daydreaming or fantasizing; thoughts, words, plans, or acts that are related to suicidal thoughts.

Social: Withdrawal from people, intense lack of pleasure in normal activities.

It is not uncommon for depressed people to question for God’s presence, character, and plan. Throughout the Bible, godly individuals experienced these emotions. Depression is neither caused by one’s spiritual level, nor is it a result of demonic possession.

In the Bible, a few godly servants experienced depression. Examples include:

• Moses (Numbers 11:10-16) – Moses experienced burning out and being overly burdened by the heavy task of taking care of His people. When one faces a heavy task, their reaction will be anxiety and a feeling of incompetency.

• David (Psalms 51) – David grieved upon his guilt due to his wrongful actions against his comrade. He felt extremely shameful of his sins. When one sins against God and men, they will hide from God’s grace. There is feeling of unworthiness.

• Elijah (1Kings 19:1-18) – Elijah felt extremely lonely when he thought he was the only one that faced the challenge. When one fears of the attack, they will feel helpless. There is a feeling of hopelessness.

Reasons for Depression

1. Biological and neurochemistry: Studies show that a chemical imbalance in the brain will cause depression. Research has pointed to problems with neurotransmitters, chemicals that pass signals from one brain cell to another.

2. Genetic disposition: Studies of identical twins show that if one twin has depression, there is a 65-75% chance that the twin sibling also has depression.

3. Socio-economic: A person with a lower status may consistently experience high levels of stress. The person has experienced a significant loss of a loved one, a job, a pet, an opportunity, or health condition.

The person may be exposed to a great deal of criticism and demands.  The person may be suffering from trauma.

4. Psychological: The person may be negative in their thought pattern and world view. The person may have an unrealistic expectation of the world and others.

5. Family: The person may be greatly influenced by a negative family background. Problems may include poor self-esteem or negative thinking.

6. Spiritual: The person may be suffering from unconfessed sins. The person may have unresolved false guilt.

How people want to be treated when they are depressed:

With love, respect I want someone to keep me safe

Kindly, gently                          I want someone to pray for me

With compassion                         I want reassurance

Want to be listened to                  I want touching

With patience                               As a normal person

Firmly

What people don’t want from others during depressive episode:

Blame me for what I cannot help.

Humiliate me, make fun of me.

Put undue demands on me e.g., “stop being depressed”. There are many people in this world who are worse off than you.

Tell me to get my act together; e.g., “Life should be beautiful for you”.

Tell me to cheer up

Avoid me

Give me sympathy

Guidelines to deal with persons with depression:

1. Refer to appropriate health care professionals – Depression is a medical illness.

2. Be serious to the person with depression: Do not laugh or joke in an effect to cheer up that person as this demonstrates a lack of acceptance.

If the person initiates humour, counsellors should not discourage it but deal with it by using open-ended questions to find out more about it or help client to express the feelings.

3. Be patient with the person, it is a slow and long helping process. The person may have flat mood, lack of response or motivation, lack of energy, may be very passive, very negative, or need lot of effort to initiate conversations.

4. Keep silence shorter than usual. Be aware that the persons with depression are not capable to make immediate response; friends can help them to express themselves through different probing.

5. Be accepting. Accept the person’s mood through words and body language. Show that you care by using listening skills (empathy).

6. Instill hope. Set small goals – Seek for counsellors who will assist the person to prioritize and set limits. The person will feel confident when the small goals are met.

7. Encourage doing more physical or relaxation exercise. Sleep and Eat – The person will find helpful if they can have adequate sleep, get to bed early, drink plenty of water, and eat healthy foods.

8. Help to build a support system.

9. Promote independence gradually.

10. Take care of one’s emotions – The person becomes aware of, accept one’s feelings, and cope with the response toward the stress. The person will learn the meaning attached to these stressors.

Signs of suicidal ideation and intervention

There might be times when a person with mental illness has suicidal thoughts (suicidal ideation) and loses interest in living. Family members should be aware of certain signs.

Warning signs:

• Talks about committing suicide

• Is preoccupied with death and dying

• Shows signs of depression

• Has trouble eating and sleeping

• Experiences drastic changes in behaviour, for example, from feelings of depression to a sudden and unexpected cheerful attitude

• Takes unnecessary risks

• Loses interest in personal appearance

• Withdraws from friends and/or social activities

• Loses interest in hobbies, work, school, etc.

• Prepares for death by making out a will and final arrangements, such as taking out insurance, and expressing final wishes to someone close

• Gives away prized or valuable possessions

• Has attempted suicide before

• Has had recent severe losses

• Increases use of alcohol or drugs

Family members might be afraid to deal with suicidal ideation because they’re concerned that opening up the subject could trigger suicidal behaviour. Here are some general pointers.

Do’s

• Be direct. Talk openly about suicide. This gives room and permission for the person to express his or her thoughts and challenges.

• Be willing to listen. Allow expressions of feelings. Accept the feelings.

• Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad.

• Get involved. Become available. Show interest and support.

• Offer hope that alternatives are available, but do not offer glib reassurance.

• Take action. Remove dangerous items, such as guns or stockpiled pills.

• Maintain contact with the person.

• Work with the person to plan what he or she can do for the next few hours or days.

• Encourage the person to seek help.

• Work with the person to identify resources and services that may ease his or her situation. If possible, go with the person to get help.

• Obtain advice/support from agencies specializing in crisis intervention and suicide prevention.

Don’ts

• Don’t dare him or her to do it.

• Don’t be judgemental and criticize the person.

• Don’t minimize the person’s feelings.

• Don’t lecture that he or she shouldn’t have these thoughts as things cannot be that bad.

• Don’t act shocked. This will create distance between you and the person.

• Don’t uphold secrecy if a life is clearly in danger, even if you promised. Seek support.

Bible verses

And we know that in all things God works for the good of those who love him, who have been called according to his purpose. (Romans 8:28)

• Encouragement from the Bible: Seeking for prayer intercessors will share the burden of the person. The below Bible verses may instill hope and faith during their treatment.

• Christ Jesus is our hope. The Lord says “…Call upon me in the day of trouble; I will deliver you, and you will honor me” (Ps. 50:15). Hopelessness leads to depression.

“He has delivered us from such a deadly peril, and He will deliver us. On Him we have set our hope that He will continue to deliver us” (2Cor. 1:10). God’s deliverance is stressed three times in one verse. Indeed, He is our personal Savior and also daily saver.

• Christ Jesus is our joy.

“Why are you downcast, O my soul? Why so disturbed within me? Put your hope in God, for I will yet praise Him, my Savior and my God” (Ps. 42:5, Ps. 11: 43:5). The person will personalize these verses which are the Word of God and trust in the healing power of the Lord.

These Bible verses will bring hope and light to the person. By the grace of God, the Word of God will lead the person to enquire positive thinking. The presence of the Lord will open the person to new perspectives and facilitate effective coping. Hopefully, the person will be more open to more options that are outside their negative thinking system.

More words of encouragement from the Bible:

But you, Israel, my servant, Jacob, whom I have chosen, you descendants of Abraham my friend, I took you from the ends of the earth, from its farthest corners I called you. I said, “You are my servant”; I have chosen you and have not rejected you. So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand. (Isaiah 41:8-10)

Listen to me, you descendants of Jacob, all the remnant of the people of Israel, you whom I have upheld since your birth, and have carried since you were born. Even to your old age and grey hairs I am he, I am he who will sustain you. I have made you and I will carry you; I will sustain you and I will rescue you. (Isaiah 46:3-4)

I waited patiently for the Lord; he turned to me and heard my cry. He lifted me out of the slimy pit, out of the mud and mire; he set my feet on a rock and gave me a firm place to stand. He put a new song in my mouth, a hymn of praise to our God. Many will see and fear the Lord and put their trust in him. (Psalm 40:1-3)

Truly my soul finds rest in God; my salvation comes from him. Truly he is my rock and my salvation; he is my fortress, I shall never be shaken. (Psalm 60:1-2)

Yes, my soul, find rest in God; my hope comes from him. Truly he is my rock and my salvation; he is my fortress, I shall not be shaken. My salvation and my honour depend on God[a]; he is my mighty rock, my refuge. Trust in him at all times, you people; pour out your hearts to him, for God is our refuge. (Psalm 62:5-8)

I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world. (John 16:33)

(Rev. Sophia Wong is pastor of RHCCC.)