This article comes out of work done by my husband and myself in writing a book for Christians with depression. The background research we did brought to light a great deal of anecdotal evidence that depression is prevalent in Christian circles. Almost wherever we turned people were quick tosay that they knew of several people in their acquaintance who were Christians and depressed. We consulted Christian therapists and counselling services, ministers and churches, and our friends and acquaintances. It threw up a surprising numberof cases of depression amongst Christians.

Depression is an extremely painful illness, and for Christians handling depression there can be added dimensions of difficulty. Not only are they wrestling with a very unpleasant and chronic illness, which affects family life, work life, social life and church life, they also struggle with their spirituality and wonder where God is in the darkness.

The depressed Christian is very likely to feel that their prayers are going unanswered. They may wonder why fervent prayers for recovery are not heard. They may feel abandoned by God and wonder why God is letting this happen to them. Surely God should be protecting, loving and caring for them, rather than allowing them to feel this desolation that has taken over their lives. Their sense of being in communion with God when they pray – that God is there listening and sending answers to their prayers – often disappears, so there is a feeling that prayer, which has been an essential fundamental feature of their daily life and their understanding of life's significance, now seems pointless. This deep sense of despair in a Christian's relationship with God is well expressed by the Revd Dennis Duncan in his moving book Towards theLight (2) written from his own experience of depression.

He writes: 'The dark night has indeed come. Morning and evening and night are all alike (I use the word again): desolate. My sense of abandonment is very real.' (3)

Sufferers from depression frequently have low self-esteem and fear their condition is something they have brought upon themselves in some way. For the depressed Christian, this can be complicatedby the Christian culture to which they belong. They may feel that Christians shouldn't get depressed,that the Christian is somebody who should be above such things and able to 'rejoice in the Lord always'. They may feel that the reason they have succumbed to depression is because they haven't had enough faith to secure healing or freedom from depression. If there is a strong culture of expectation that God can and will heal within their churches, they may wonder why God doesn't heal them. Perhaps they have put themselves in the way of prayer for healing many times. In our book, we quote Jennifer Rees Larcombe who says 'I had so much laying on of hands, it is a wonderI didn't go bald.' (4)

They may feel that their depression is attributable to some sin they committed or to something they did in the past which was wrong and about which they have guilt. They may even feel their depression is an attack of the enemy of soul, the Devil.

Professor Brian Thorne writes 'many therapists, myself included have often found their depressed Christian clients amongst the most difficult to help. For such clients it has often seemed that their belief system and the practice of their faith have proved impediments rather than aids to accepting the reality of their predicament.' (5)

Church will have been a vital place for the Christian who becomes depressed. In the church they may have found their strongest place of belonging, their deepest friendships and their most powerful sense of community. Much of this is routinely lost when a Christian person becomes depressed and it is grievously felt. Worship, singing, corporate prayers, and listening to teaching, which once inspired them may lose its savour and so leave them feeling bereft of spiritual inspiration. It is possible that too much involvement in many things, including their church, has led to them being overtaxed and contributed to their becoming depressed. Because of their depressed state, they may have had to let go of membership of the church council, or teaching the young people, or taking a central place in the social activities of the church and so on. This means that now they are not partof the 'in' talk and the regular companionship that comes with keeping abreast of current church activities. Maybe the depressed Christian has stopped going to church at all. Perhaps they feel resentful that the church doesn't care for them properly, after all they have done for the church in active membership.

They may also have been the victims of well-meaning but thoughtless handling by the church, whether from its leadership, or casual things said or done by church members. After suffering from postnatal depression, one young woman said the only comment by the church leadership was 'Oh, you've had the baby blues'. She felt angry, patronised andmisunderstood. John Lockley's book A Practical Workbook for the Depressed Christian (6) is full of examples of thoughtless things said and done to depressed Christians in a church setting.

A role for Christian doctors

What are we to make of all this? As professionals we need to be well informed, and as Christians tohave an appreciation of likely areas of particular difficulty, not forgetting that Christians are desperate and suicidal at times. As Christian doctors we should promote a realistic understanding of this debilitating illness, and its treatment and cure. Christians are still suspicious about 'therapy' and yet it can be very helpful. Cognitive BehaviouralTherapy (CBT) in particular is extremely effective in rectifying negative and erroneous patterns of thinking. The National Institute for Clinica lExcellence (NICE) recommends CBT as a first option for many with mild to moderate depression because it is so helpful and successful in improving mood. Many depressed people benefit from some form of listening therapy, and if they are reluctant to go to a secular therapist, there are Christian counselling services with suitably accredited counsellors, around the country. Christians can also be reluctant to take medication, thinking that they should rely solely on God, or worrying that they might get addicted to 'happy pills'. We need gently to remind them that depression is an illness, andthat the right medication can really help.

In all our dealings with those who are suffering with depression, we need to be gentle and cautious so that we don't inadvertently add to their suffering. People can have absorbed negative and unbiblical beliefs about God which cause them deep suffering when depressed. By being aware that underlying, core belief systems deeply influence someone's receptivity to advice and treatment, we may need gently to challenge faulty views, such as 'Christians shouldn't get depressed'. Churches may need to be encouraged to help in practical ways and to be sensitive and cautious about prayers for healing. But above all we can be hopeful, for most depression does come to an end, and let us encourage all who are affected by depression, be it the sufferer themselves or their family, not to give up hope but to hang in there, believing that light will come.

Elizabeth Procter has worked in psychiatry for 24 years, and has been a Consultant Psychiatrist for over 12 years, specialising in child and adolescent psychiatry. She is a mother of four adult children and has four grandchildren. Together with her husband Andrew, a clergyman, she has led prayer counselling teams, and is a member of the Diocesan Council of Health and Healing.