Depression How Should We View Ourselves

There are many different ways of looking at ourselves, but which way is correct?

We can view ourselves through society’s standards and expectations, which are commonly revealed through the mass media including film, television, radio, magazines, and the internet, as well as through schools, the home, and social settings.

Unfortunately, society says that our worth depends upon our intelligence, attractiveness, education, money and achievements. Our society places too much value upon being successful, and often rejects or criticises people who attempt something but fail. Such people may become so disillusioned that they stop trying.

Society also teaches the theory of evolution, telling us that humans have evolved from animals as a result of random chance, and are therefore have no significance.

We can also view ourselves through our parents’ eyes. As a person’s self-esteem is formed during the early years of their childhood, it is important that parents encourage and build-up their children so that they develop a positive self image. Sadly, this is often not the case, as some parents criticise, shame, reject or over discipline their children. Such unnecessary criticisms and negativity gives the children a negative view of themselves. Upon reaching adulthood, such children often view themselves through their parent’s eyes, and even continue to treat themselves as their parents treated them, criticising, rejecting, even hating themselves.

Many parents also place unrealistic or impossible standards or goals before their children. They expect their children to be successful or famous. If the child fails, or is not interested, the parents say that they are hopeless, or punish them harshly.

The way that our friends and peers view us can also have a large influence on the way we view ourselves.

If we do not behave like them, they can be critical or reject us. Throughout my years at school, I watched some classmates bully and mock any child who was different. Some children tried to change so that the bullies would accept them, even doing what was wrong in order to please them. Other children suffered beneath the yoke of such oppression every day.

Another way to view ourselves is through our own eyes. This is not healthy either. If we have had a difficult childhood, we tend to carry that baggage into adulthood, falling into the trap of being too hard on ourselves, especially if we have made a mistake. And if we stumble and sin, even though we repent and receive God’s forgiveness, waves of guilt and condemnation continue to plague us long after the event. Pursuing unattainable goals and setting unrealistic expectations causes us to become even further disillusioned with ourselves. If we fail when attempting something too hard, we may conclude that we are a failure, no good at anything, or that no-one likes us.

So then, how should we look at ourselves?

We should view ourselves through the eyes of the One who loves us so much that He died for us, so that we may live with Him, both now and for eternity.

Hebrews 12:2 says Let us fix our eyes on Jesus, the author and perfector of our faith, who for the joy set before him endured the cross, scorning its shame, and sat down at the right hand of the throne of God. What was that joy set before Jesus that motivated Him to die for us? The answer is in 1 Thessalonians 5:10 He died for us so that, whether we are awake (on earth) or asleep (in heaven), we may live together with him. Jesus treasures us so greatly that He wants us to share our whole life with Him.

God did not wait for us to be perfect before He loved us. While we were still sinners, He reached out to us, drawing us, dirt and all, into His loving arms. That means that we are significant, that we are special. But God demonstrates his own love for us in this: While we were still sinners, Christ died for us. Romans 5:8

God forms His children, those who believe in Jesus, into new creations, conformed into Christ’s wonderful likeness. Therefore, if anyone is in Christ, he is a new creation; the old has gone, the new has come! 2 Corinthians 5:17

God thinks of us as His treasure. Keep me as the apple of your eye; hide me in the shadow of your wings. Psalm 17:8

2 Corinthians 5:21 tells us that, God made Jesus, who had no sin to be sin for us, so that in Jesus we might become the righteousness of God. So if God looks at us and sees the righteousness of Jesus in us instead of our sinful nature and problems, we should look at ourselves in the same way.

Zephaniah 3:17 is one of my favourite verses in the Bible, because it shows so clearly how God thinks of His children. The LORD your God is with you, he is mighty to save. He will take great delight in you, he will quiet you with his love, he will rejoice over you with singing."

Instead of looking at ourselves through the eyes of society, parents, friends, or ourselves, let us look at ourselves through the eyes of Jesus. Then we will know that we are accepted, appreciated, treasured, and loved.

This was a lesson that the Lord re-taught me while stuck in the pit of severe depression:

From my diary, 15/5/1990 –
Self-hate keeps descending upon me like a swarm of angry hornets.
I look at myself and find nothing but contempt
for this pathetic person that I have become.
But I know that this is wrong.
If I examine myself through Jesus eyes, I see someone special.
I see how much He loves me, and cares for me,
how much I mean to Him, and that He understands.

How Do You Know if You Should Try Treating Your Depression With Medication

I have frequently blogged in this venue about the efficacy of antidepressants in “depression.”  I have pointed out that “depression” has a wide variety of different meanings, and that there are also several different syndromes of depressive disorders in the diagnostic manual, the DSM.  While there is considerable overlap in the symptoms of the various syndromes, some are far more likely to respond, and respond dramatically, to antidepressant medication than others.

I have also ranted against physicians who use “symptom checklists” or other self-report “tests” to make a diagnosis of depression, rather than use an extensive clinical interview.  The tests often say very little about whether a symptom a patient complains of is clinically significant for a certain diagnostic syndrome or not.  Aside from not looking at the psychosocial context in which the symptom occurs, the tests usually say very little about three important qualities of clinically significant symptoms – their pervasiveness, persistence, and whether or not they are pathological.  They also do not clearly show whether the symptoms all cluster together at the same times.

As I have pointed out several times, in order to make sure the patient is giving the doc an accurate and complete picture of their mood state, a good doctor must often ask one or even several follow up questions whenever a patient says “yes” or “no” in answer to a question about the presence of a symptom.

But how about a potential patient?  How does a non-professional know whether or not to even consult a physician about their mood state?  Why not just ignore it and see if it goes away?  Alternately, why not just go to a psychotherapist and handle it with psychotherapy alone?

That’s a very important question.  A similar question has recently been widely featured in the media in response to a proposed change in the DSM.  How does a patient or a doctor know when normal grief after the death of a loved one morphs into a clinical depression that would respond to medication?  The argument has mostly been about how long a doctor should wait after such a death before making a diagnosis of clinical depression, (major depressive disorder). 

While it is good that a doctor should not be overly hasty about making a diagnosis in this situation, in some genetically-prone individual, a stress of that severity can indeed trigger a major depressive disorder in a relatively short period of time.  Should that patient have to wait to be relieved of his or her suffering?  Certainly, any proposed “waiting period” specified in the DSM would have to be somewhat arbitrary.

To help patients figure out who to consult and when to consult a physician, a new self-report instrument is available that is significantly superior to the usual ones.  It is called the Post-Bereavement Phenomenology Inventory. It is meant to distinguish normal grief from major depression, but potentially it could also be used to distinguish major depression (likely to respond to meds) from another depressive syndrome, dysthymia (much less likely to respond to meds).

It was meant for physicians and not for patients to review for themselves, but even though it is better than most self-report instruments, IMO it should still not be used in place of a complete and wide-ranging clinical interview.  Context, prior history of major depressive disorders, family history of depression, and a whole host of factors need to also be considered.

But as a screening tool for patients, I think it might be helpful.  It uses a strategy called prototype matching.  This strategy focuses on the difference between depressive syndromes rather than the similarities.  The questions contain different descriptions of how each depressive symptom would present itself in classic cases of the two syndromes, and asks the patient, “[Which of the two descriptions] better describes how you have been feeling, thinking, or behaving for the past one to two months?”

Here it is.  I hope this will help potential patients decide whom to consult.  The first descriptions in each question are of the symptom presentation seen in major depression, while the second are of depressive symptoms that are less likely to respond to medication.  Of course, this is hardly foolproof, but generally the more you answer the questions one way or the other, the more likely you are to be experiencing one syndrome or the other. 


If someone's depression seems to conform mostly to the first prototype rather than the second, there are certain things that people often say to them that are both inappropriate and counterproductive.  An excellent list of such things can be found at http://www.medicalbillingandcoding.org/blog/11-things-you-should-never-say-to-someone-with-depression/

1.       I am filled with despair nearly all the time, and I almost always feel hopeless about the future.

versus

      I feel sadness a lot of the time, but I believe that eventually, things will get better.

2.      My sadness or depressed mood is near­ly constant, and it isn't improved by any positive events, activities, or people.

versus

       My sadness or depressed mood usually comes in "waves" or "pangs;' and there are events, activities, or people who help me feel better.

3.      When I am reminded of my loss (of a loved one, friend, job, etc), I feel nothing but pain, bitterness, or bad memories.

versus

    

       When I am reminded of my loss (of a loved one, friend, job, etc), I often feel intense grief or have painful memories, but sometimes I have good thoughts and pleasant memories. 

4.      I will probably never get back to feeling like my "old self" again.

versus

       Things are really tough now, but I'm hopeful that with time I will feel more like my "old self.”

5.      I feel like a worthless person who has done mostly bad things in life, and has let my friends, family, and loved ones down.

versus

       I feel like I'm basically a good person and that, in general, I have done my best for my friends, family, and loved ones.

6.      All I can think about lately is me and how miserable I feel; I hardly think about friends, family, or loved ones, ex­cept to blame myself for some failing.

  versus

       Even though I'm less social and out­going since my loss, I still think a lot about friends, family, and loved ones, often with good feelings about them.

7.      When friends or family call or visit and try to cheer me up, I don't feel anything or I may feel even worse.

   versus

       When friends or family call or visit and try to cheer me up, I usually "perk up" for a while and enjoy the social contact.

8.     I often have persistent thoughts or im­pulses about ending my life, and I often think I'd be better off dead.

     versus

     I sometimes feel like a part of me has been lost and I wish I could be reunited with the person or part of my life I am missing, but I still think life is worth living.

9.      Almost nothing that I used to like do­ing (reading, listening to music, sports, hobbies, etc) is of any comfort or con­solation to me anymore.

     versus

   The things that I have always liked do­ing (reading, listening to music, sports, hobbies,etc)  give me some comfort and consolation, at least temporarily.

10.  I feel "slowed down" inside, like my body and mind are stuck or frozen, and like time itself is standing still.

   versus

       My concentration isn't as good as usu­al, but my body and mind aren't slowed down, and time passes in the usual way.