Ep. 086: Anxiety and Depression

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*Below is an edited transcription of the audio conversation.

With me again this week is Christian counselor and author, Brad Hambrick. Once again, if you’re listening and you didn’t hear last week’s episode, Brad serves as the Pastor of Counseling at the Summit Church in North Carolina. He’s the instructor of Biblical counseling at the Southeastern Baptist Theological Seminary, and he’s also a counsel member of the Biblical Counseling Coalition. Thank for being here again with us Brad.

My pleasure.

For those who didn’t listen last week, Brad, can you just give us a basic rundown of who you are and sort of what you do?

Yeah, I am a husband and father. I’ve been married for close to 20 years. I have two children who are 10 and 13 so we’re in a fun season of life there. My ministry responsibilities vary between serving as a Pastor of Counseling, which is, at a church of our size, predominately serving as a consultant for our staff and overseeing counseling ministries of our church. Then also as an instructor at Southeastern Seminary, helping people who are wanting to go into counseling related ministries get trained for that.

Cool. That’s awesome. I just was reminded in my time at Bible College, I had one Pastoral Counseling class and our text book was called the BYB, The Big Yellow Book, which was Gary Collins. I don’t know if that’s a resource that you use or not.

It has been updated several times, so the Big Yellow Book is now The Bigger Yellow Book. In terms of overviewing and assortment of mental health concerns and giving some initial best practices, it is. It’s a quality resource.

That’s cool. Anyways, can you briefly give us the definition of mental illness? You’ve sort of worked through that definition. For those who didn’t listen last week, might be helpful for them to hear where you’re coming from while we’re talking about mental illness.

I think the big pieces in that kind of definition is that

mental illness is not a unique experience that some people have and other people don’t.

Anything that fits in the basket of mental illness is something that we all experience to some greater or lesser degree. When we designate something as mental illness, we’re just saying the depth or duration of that struggle has crossed, somewhat subjective, an arbitrary threshold that would say, direct attention to this as needed, because the passing of time and just ignoring it, is not going to make it better. It’s going to continue to deteriorate and disrupt the quality of my life if I don’t look into addressing it more directly.

Now, the two most common mental illnesses, you could say, or manifestations of mental illness, that I hear and I think many people would agree, would be anxiety and depression. They seem kind of common. It’s very normal to hear someone say, “I struggle with anxiety.” Or “I have anxiety.” They say it like, “I have this.” Or “I have depression.” I want to talk to you just quickly about anxiety and depression, as these are, again, two titles that we hear often.

Let’s first look at anxiety, Brad. When someone says, “I suffer with anxiety.” Or “I have anxiety.” What exactly are they saying and what’s going on in their minds?

I think you’re right, depression and anxiety are largely the common cold of the mental health experience. It’s kind of like a fever. When you have a fever, it may be symptomatic of something else, it may be that the fever is what you have.

When somebody says, “I’m experiencing anxiety. I’m really anxious. I have anxiety.” I don’t mean this in a simplistic way, but, we have no idea what they mean.

At that point, assumptions are not our friend. What we want to do is we want to ask, “What’s that look like? Is this something that’s been longstanding? Can you point to some key events in your life?” Because it may be that they have final exams next week and they are pressing for some tests. It may be that their parents are going through a divorce and there is great uncertainty about what’s going on in the next stage of their life.

Sometimes what I find is that anxious people are really, really sweet people. That the ability to empathize and place themselves in the life of another is real. So if we just take, for instance, two people are out, they’re getting dinner together, one of them steps away, they say they’re going to the restroom and their friend who is left at the table, it’s two minutes, it’s five minutes, and they begin to think: “What’s going on with my friend? Are they okay? Did they get a phone call? Did I offend them? Did they get food poisoning?” That constellation of thought. If I ask you, is that compassion or is that anxiety? The answer really is both.

Even at the neurological level. The differentiation between those experiences is the same neurobiological cocktail.

We just place a different meaning on it. If that person is somebody that we really like and we appreciate their concern, we call them sweet and compassionate. If they don’t, and they kind of get on our nerves and we kind of feel like it’s over bearing or they do this too much, then we go, “No that’s anxious. That’s not compassion.”

Just like dispositionally, there are some people who are just naturally nice. And some people have to work at being nice. There are some people who are naturally anxious and just the degree of certainty that they want and how much information they feel like they need to have confidence in a decision, well we all have different degrees of risk adverseness.

When our friend says, “I’m struggling with anxiety.” We should assume nothing and we should ask caring, compassionate questions.

The direction that we want to go with them is

“What does it look like for you to honour God by stewarding all of your life well?”

We’re going to have to get to know them in their circumstance. Maybe we get to know our friend and they were in a major car accident three weeks ago, where they thought they were going to lose their life and their emotions just have never settled since that point in time, and there may be a mental illness category that’s a very good fit for what they’re going through. Post traumatic stress and what they’re experiencing is what would be called, hyper vigilance.

Trauma tends to catch us off guard and so after you’ve been through a trauma, you feel like the most important thing for you to pay attention to is whatever you’re not paying attention to, because that’s what got you last time. This elevated sense of being on guard is a very common experience after a trauma and so we’re asking the question, “What is the best way for you to honour God and steward your life after this event?” We go into the discussion of trauma through the route of anxiety through trauma.

Again, somebody else may be a young professional and they’re trying to work to get a promotion, they’re putting in 70, 80 hours of work per week while they’re in their first two years of marriage and we look at it and say, “You are cramming too much life into too small of a week.” This isn’t about trauma. This is about life management.

Other people, they may faithfully steward their life and just from the youngest time, the smallest test as a child amped them up and even though they knew the material, they would do more poorly on the test, because the level of anxiety they felt over a minor thing would impair their ability and we might say, “You know, just dispositionally, you’re set to anxiety in a way, that something that takes the edge off of anxiety, maybe medication, maybe it’s some good mental health practices that we’d go through. That’s what would serve you best. ”

It’s by talking to our friend that we figure that out.

I remember last week when you said that it’s important to not label the “I am” and insert mental illness cause, first, our identity is in Christ. A question for you would be if you’re counseling someone who is saying, “I have anxiety and that’s who I am,” would you ever get to a point after sort of talking to them and learning more about them, would you ever get to a point where you sort of counsel them, instead of saying “I am” and identifying yourself with being anxious, start saying things like, “I have a tendency to be anxious.” You know what I’m saying? How would you counsel that?

There is a common proverb. Not a biblical proverb but kind of a modern psychological proverb that says,

“Genetics loads the gun and the environment pulls the trigger.”

One of the things that a counselor that I follow and think a lot of, David Powlison, he raises a question to that proverb. “Where’s the person?”

“The genetics load the gun. The environment pulls the trigger.” Where’s the person who has a will and a voice and decision? Another counselor I follow a good bit, Paul Tripp, he says,

“Nobody in your life is more influential that you are, because nobody talks to you more than you do.”

We do want to get to the point where if we go through the three scenarios we played out earlier, the person who experiences anxiety as a result of trauma, that “Yes, I did go through this horrific event. It has shaped me in some ways, but now I can shape this experience that shaped me by the way that I respond to it.”

To the person who is over scheduled, we’re probably going to have some strong driving desires that reach the level of idolatry. That I think these things are going to give me life. For that person, it may be success, it may be material possession. Whatever that thing is, but these things are going to have to be less important for you, in order for you to manage your life in such a way that you can enjoy the life that God has for you.

To the dispositional person, you know we might take a passage where Paul talks about his thorn in his flesh. He doesn’t say, “I am a thorn in my flesh, “or “I am a thorn.” He says, “I have this.” It keeps me humble and it proves to me time and again that God’s grace is sufficient in any circumstance and so without creating a false sense of guilt over things from which we have no control, we do not want people to lose their sense of personal agency. That at creation, God gave us ourselves.

It’s one of the things that… I’m a Narnia fan, I love it and so when you’ve got Aslan and he draws all the animals to himself, one of the lines that stood out to me that initially I was like, “That’s just weird.” But Aslan says to the animals,

“I give you yourselves.”

That there’s this sense of which we should, by God’s design, have more influence over our life, than anything else outside of His providence. God’s providence and His sovereignty, that has more control than anything else. But outside of those things, when we lose the sense that our voice is the greatest influence in our world, then the degree to which we’re going to go passive and fatalistic and emotions like depression and anxiety are going to mushroom, are going to be much, much greater.

Right. Speaking of depression. Let’s talk about that a little bit. Sort of the same way that I asked about anxiety. What does it mean when somebody says, “I am struggling with depression.” Some people see this as discouragement, they’ve talked about those two different things so are there differences there? What does it mean when someone comes up to you and says, “Hey, I have depression or I’m struggling with depression.”?

Again, short answer is, we have no idea.

I’ll take us on a different angle here. There is an author, his name is Allen Frances, he wrote a book, Saving Normal. To my knowledge, he’s not a believer, he just doesn’t say anything in his book that makes him a very faith forward person, so at least in his practice as a psychiatrist, he doesn’t attempt to be a Christian psychiatrist. He is just a psychiatrist.

But his book is entitled Saving Normal because the thrust of his book is that we are medicalizing everything. He’s in a unique position to make that argument because he was the Chairman of the DSM4, the Diagnostic and Statistical Manual. The big thick book that gets to define all things mental illness.

He was Chairman of the DSM4.

He was very dissatisfied with the DSM5 because he felt like the definitions were being broadened so much that everything was now a medical concern.

He’s in that unique position where he can look at it and the way the pharmaceutical companies operate and their advertising strategies and they want to expand their populations and profit margins and that kind of thing. If you do decide to read his book (I say this as a complement), he writes in the delightful style of a grumpy old man. So it’s like you are on the porch, with Grandpa, and he knows this stuff, and he is talking about his life’s work. I consider that to be an absolutely delightful style of writing.

But he wants to save normal. He’s not anti-psychiatry, he views medication as a blessing and a thing that can be used, but he speaks frequently about the normal remedies of taking a vacation, of connecting with a friend, of exercise, and those things that for much of the history, of not just pastoral care, but good inner personal care, that were vitally important.

As we’ve had advances in medication, we have grown to neglect those things.

He’s simply saying the pendulum has swung too far. Here is where just because a friend benefits from medication, doesn’t meet they have a biologically rooted depression. Let’s say you have a friend and they are going through a divorce and in the midst of that, there is a custody battle. It has been their dream to be a part of a family. All of that is being ripped away. It makes a lot of sense that they are going through an intense depression.

They may even benefit from medication serving as a bit of a boost that places a little higher floor under their emotions.

Now they can take advantage of that boost and still seek to honor God in every way in the midst of a situation that isn’t of their choosing and what they want and is emotionally difficult, and it should be.

They should not go through that experience as emotional Teflon, that would not honour God.

But in that case, what happens too often, whether it’s that kind of divorce or the grief of a parent, people will begin medication and because it’s helpful, they just never stop. Again, that’s not necessarily bad, in the sense of morally, “Oh you absolutely should not do that.” Now in those kinds of situations, we want to look at the best stewardship with your finances and the side effects of the medication, how is that effecting your physical health? The reason that we want to raise that conversation is not “As Christians we want you to get off that medication as soon as you can!” but “We want you to steward all of your life well. While this may have been beneficial for a season, let’s evaluate if that season is now over.” The conversation between anxiety and depression is very similar.

In the sense that comorbidity rate, that’s just a big word to prove to you I went to school, means at which the rate at which two things exist at the same time is about 80 or 90% to the point that depression and anxiety are more seen as a hyphenated word, as two sides of the same coin, as opposed to two different things.

So, I took a different route with the depression question because everything we said about anxiety is absolutely relevant in the second discussion.

I gotcha, that’s good. As a last question (and I’m sort of throwing this at you, but you are a Pastoral Counselor, so I think you can handle it), when we look at anxiety-depression (hyphenated), how does the gospel shed light on this? How can the gospel encourage us when thinking about anxiety-depression?

That’s a really good question and one of the things that is a pet peeve for me, so whenever you get ready to hear somebody and they’re going on their soapbox, you’re like, oh no, here we go, there’s this warning label disclosure.

A big deal to me is that

the gospel speaks to both sin and suffering, but yet it speaks to them differently.

Two often in a lot of the debates that go on, it’s as if we need to understand it as sin so that the gospel will apply to it, as if the gospel didn’t apply to suffering. It applies differently. It offers comfort instead of forgiveness. Now if you’re saying, “Wait, do I just need comfort? Will comfort get me to heaven?” No.

We are all simultaneously sinner, sufferer, and saint.

We need the forgiveness, the comfort, and identity that the gospel gives and it’s not like we have to choose one or the other.

If we ask how does the gospel impact or is it relevant for somebody experiencing depression or anxiety, the question I would invite is to ask, is what part of this experience rooted in sin? How much of my experience of depression-anxiety is because my beliefs, my values, and my choices are distorted in outside of God’s design? So our friend who’s working 80 hours a week because he’s pursuing some degree of success, okay we’ve got some idolatry there, we’re neglecting things in home life that part of that, the gospel would call him to repent and be content with life as God designed. How much of this is rooted in suffering? Just a disposition because my body’s not working like it’s supposed to, because a situation is hard, and what I need is comfort.

The longer we struggle with anything, the more we tend to take it on as an identity and we need that stronger identity as a child of God.

As one who’s not just been forgiven, but adopted, and brought into, and made a part of the family, that we are called to be his servants and live on mission, and that being salt and light for his kingdom is what makes life satisfying, so it’s not even that some people have sinful depression and some people have suffering depression, any experience that we have, again, I’ll do another nerd moment. Theodore Dostoevski, who I’ve not actually read any of his books but I read a quote that somebody gave and it was really good. He said, “A line between good and evil goes straight down the middle of a human heart.”

When I’m wrestling with my experience of anxiety and depression and other things, that line is going to go right down the middle of the experience and there’s going to be some parts of it that I need to repent and show great faith and trust, and other spots where I experience comfort and look to alleviate that suffering.

The gospel allows us to do both. Another example that I think can be helpful in these kinds of conversations, it is shocking to some people that

there are more songs of lament than there are songs of praise.

When God, in that book of the Bible, that God gave us, that is … it’s that one book that we are most supposed to speak back to Him, most of the rest of the Bible is Him talking to us and saying “Do this, don’t do that, here’s what’s going to happen. Don’t freak out.” In the Psalms we have God saying,

“Here are words that you can speak back to me.”

The fact that he wrote most of those in the minor key, for hard times, says when life is difficult, when you’re in these spots, and it’s suffering, here are the kinds of things that you can speak to Me. You don’t have to come back when you can cheer up and say happy clappy things. There is a lot of comfort, even in that.

Yeah, that’s so good. Thank Brad. Obviously, I really appreciate you taking the time to chat with me, both this week, and last week. Again, if you’re listening and you want to see more and read more of what Brad’s done, which includes books, blogs, videos, things like that, just head to BradHambrick.com. Again, thank you so much Brad and I hope to have you back on the show again soon.

It’s been a joy. I’d love that.