Depression: When a Member of the Flock Needs Special Care - Lesson 2

Dr. Greg Knopf and Dr. Gary Lovejoy
Depression: When a Member of the Flock Needs Special Care
co330-02
The Complexities of Depression
Lesson Transcript

Dr. Greg Knopf [00:00:05] In our last session, we were talking about depression as our ally, not an enemy in the sense that it is a warning sign. It's an alarm system to warn us that something is going on and either our spiritual life or emotional life or physical life. If I might, I'd like to share with you an episode that happened in my own life. I had just finished medical school and my mother was a very, very wonderful, godly woman, and she had never experienced depression in her life. But she began to experience times of just devastating feelings of hopelessness. So she went to her physician and he says, Well, you're going through the change. I think time is sort of going to just give you some shots of estrogen and hopefully that'll help. And it didn't. And so she went to her pastor and he said, well, you know, depression is really the consequence of of sin and you've not repented of your sin. And so once you do that, your depression will go away. And I can remember her pleading for God. What you know, what have I done? What what is going on that I'm feeling this way? Well, it wasn't too long after that that she began to also have some some headaches as well. And I happened to be at the hospital the night that she came in and some X-rays were taken and she actually had a brain tumor. So the cause of her depression was the pressure in the brain. So she clearly had a physical cause of her depression that was had gone unrecognized. And so it was not a spiritual issue, was not an issue of of relational problems. It was a physical issue. So that's one of the things that I think can get us into problems, because if we think that, oh, depression is caused by this and everybody who's depressed must have this problem, we do not only ourselves a disservice, but we do others a disservice by assuming that that something is going on in their spiritual life, that if they just pray hard enough or long enough or repent of that it will go away. So that is actually was a pivotal thing for my own journey to sort of saying, you know, at the crux of our life, there's so much overlap with these areas that it's helpful to have a balanced approach to sort of begin to check the various areas that we need to investigate when you're experiencing a symptom of depression. If you have a sore throat, that's not a diagnosis, that's a symptom. Now, the sore throat can be caused by a virus, by strep, by mono, by a variety of things. And every treatment is different depending upon the cause of the sore throat. The sore throat is the symptom. So you have not only biological risk factors that can create depression, but you also have the environmental risk factors. So I'm going to talk a little bit before Gary comes in and talks about some of the environmental factors, about some of the predisposing biological factors. And number one is the family history. And if you have parents or grandparents or answer uncles or brothers or sisters who have experienced depression, you are much more likely to experience depression, maybe be caused by certain stressors, but you have the potential to have the depression is just like people with diabetes. If everyone in my family has come down with diabetes, then I have the genetic potential add to have a higher risk of developing diabetes. And if I eat the wrong foods, too many sweets, that kind of stuff, it can actually trip me and cause me to fall into a diabetic issues. Some people go into periods of depression and come out of it, particularly in the Northwest. There are many people who have what's called seasonal affective disorder, and every winter time when it gets rainy and drier, dark and dreary, they experience depression and they can be on medication. Sometimes people even use light therapy, which can be helpful. And then by the spring time, they're feeling better. I mentioned previously that the female gender appears to be a risk factor. Certain personality traits can also be an issue. If you're in medicine, then you're a perfectionist because there is no room for failure. And so I never had a a professor say, Oh, yeah, you did everything perfect. No, there's always something you could have done better. And so if we have this sense that no matter how good I try or how hard I try, I'm not going to measure up. It can set us up for experiences of depression. Oftentimes, people, as I mentioned before, will turn to alcohol and. Substances to treat the depression. And then what happens is, is that as they use alcohol, circumstances begin to deteriorate and that begins to snowball. So oftentimes, particularly men who may struggle with alcohol may actually experience a depression. We also mentioned the correlation between depression and anxiety. About a third of people who experience depression will have anxiety first and then depression. About a third of people have them both together, and about a third of people can experience depression and later on, anxiety issues. And then we also know that there is a correlation with cardiovascular diseases and diabetes, with depression, that if you're depressed, you're twice as likely to develop cardiovascular disease. If you have cardiovascular disease, you're twice as likely to become depressed. The same thing is true for diabetes, and there's these inflammatory markers that we are now beginning to understand that can have a factor here. Certain types of cancer will also cause depression, and even pancreatic cancer is more than just the the idea of having a serious illness. There are certain cancers that can predict and or can produce a depression. I also mentioned the idea of sleep issues which can be associated with depression, and some people who have a sleep apnea will also become depressed because it's when we sleep and have restorative sleep that our brain begins to replenish itself when it comes to our neurotransmitters. And if we are not sleeping well, we're much more likely to become deficient, deficient and depleted in our neurotransmitters. And then oftentimes there are male and female hormonal issues. I had a woman come to see me one time. She was 34 years old, and she says, I understand that you're good at treating depression. And I've just been feeling crying all the time, totally hopeless. And I guess my friends told me I'm depressed so maybe can give me some medication. And I said, Oh, sure, try this pill. Fortunately, I did not do that. And I said, Well, tell me your story. And she says, Well, my husband is in the military, and I was having some ovarian problems. And so my doctor up at Fort Lewis had to do a hysterectomy. And then afterwards, he put a patch on my skin to help me with my hormones. But ever since I've had the surgery, I have never experienced what I'm experiencing now. And I said to her, You know what? I don't think that you need antidepressants. My sense is, is that you're experiencing low estrogen and that for some reason the medication that you're giving is is not being effective for you. So I checked a blood level and sure enough, her estrogen level was low and I provided her a oral tablet that had estrogen in it and her depression went away. So the same thing can happen with men. Men, if they experience low testosterone, that can be a cause of depression in men. And then there are certain medications that can cause depression. There is an old medication for blood pressure called research pain. There is a medication that is used now for hepatitis C called interferon. And if you are on those medications, you have a very, very high likelihood of experiencing actual biochemical depression. And then another one is brain trauma. I had a gentleman come to see me one time. He was 35 years old. He was male. He had a good job. He had no family history. He was happily married. And yet, as I did my assessment of him, he had all the signs and symptoms that was consistent with major depressive disorder. And I said, you know what? He wrote Something is not quite right here. So finally I said to him, We ever knocked unconscious. And he says, I can't believe you asked me that. He says, Six months before my symptoms started, I was up going skiing on my snowboard up in the mountains, and I cut my edge and I did a 360 and hit my head. And this is before they had helmets. And I was knocked cold and my buddies found me. And and after a minute or so, they sat me up and and it really rang my bell. And so I just sort of, you know, got down the mountain and went home. And I'm convinced that the cause of his depression was called the post-concussion syndrome. And you're hearing a lot about it in football players, things like that of concussions, creating neurological problems, including depression. So that can also extend to people who have maybe have experienced a stroke. Oftentimes, you may have had a grandfather who had a stroke, and then every time you see him, he starts to cry. Or people who have dementia or Alzheimer's disease will oftentimes experience depression as a result of their actual brain illness. Now, one of the helpful things to understand is how the brain works as far as the neurotransmitters. You have three major. Neurotransmitters in the brain. One is called serotonin. Another one is called norepinephrine. And the last one is called dopamine, which is similar to norepinephrine. So the serotonin primarily helps with anxiety. And if you are low on serotonin, it's like you're a deer who comes out at night into the road and all of a sudden he's in the front of the headlights of the car and he freezes. So if you're low on serotonin, it's like you don't have a dimmer switch and everything becomes very intense. You have a lot of anxiety. That's why people who have anxiety issues we treat with medications to raise their serotonin rather than just treat the symptoms of the anxiety. If people are low on norepinephrine and dopamine, it's like you're driving in the fog and everything becomes very blurry and you have to slow down and and you can't concentrate and you feel exhausted all the time. And that's why oftentimes the people who have a lot of anxiety are or excuse me, who have a lot of fatigue, are given medications to raise a serotonin level. Yeah, they don't feel quite as hopeless, but they still feel blah. They just feel sort of flat because they are not given the kind of enhancement of the neurotransmitter to raise their energy. So if you'll watch this next animation, I think it's very helpful in showing how the various neurotransmitters work in the brain. And it gives you a graphic picture of what happens biologically as we look at the various factors that come into our brain mean the various factors that play into that are the kinds of depression that we can experience. This is how the brain works in the center. Part of the brain is where the cells that produce serotonin and norepinephrine modify the rest of the brain, just like a dimmer switch can control how light or dark a whole room is just from one small area. Each cell has connections with half a million other cells and you'll only have 250,000 in your whole brain. The signal comes down the nerve. It releases these chemicals, which then go across the space called the synapse. Once those chemicals fill up the receptors on the left side of the synapse, the signals sent, that's how the nerve on the right influences the nerve on the left. Here's a hard ratification of the same thing. The signal comes down, the nerve it releases, goes across, reaches critical mass now, sucks back up into the yellow vacuum system. Now the body will recycle some of it, but the rest of it is destroyed and thrown away. And how much is destroyed and thrown away is dependent upon your family characteristics. So if you don't have enough of the chemical to fill up those receptors, then you will have the signs and symptoms of depression and anxiety. Some people have problems with too much rather than too little. That's what we think happens with people with schizophrenia. And this is the dopamine system. They're being so overstimulated with dopamine, they become very agitated, they hallucinate, they can't sleep, they hear voices. So what we use is medications called atypical antipsychotics, which are represented by these green balls, which temporarily sit and block those receptors from being overstimulated, helps to calm them down. The voices go away. They can sleep much better if they'll take their medication. Now, this is what happens with depression. Chemical is released. It did not reach critical mass so sucks back up into the yellow vacuum system and a double dose is now released. Now there's enough to fill up those receptors and boom, the signal is sent and now sucked back up into the vacuum system again, waiting for the next signal. Now, antidepressants are not addicting. All they are, these white balls simply plug up that vacuum system so now the body can bring it back in and throw it away. So it helps your body conserve what you've already made. So now the concentration in that gap increases. It's like having instant hot water. When you turn on the spigot, you have hot water immediately. You don't have to wait for all the cold water to be pushed out. The hot water pipes before you get a cup of coffee or tea. This is what's addicting. This is in the pleasure center of the brain. And these are the dopamine receptors. And these purple balls represent methamphetamine and cocaine, which now begin to hit and to smash and to destroy those receptors. And it's like taking a hammer and smashing it through a border woods so the people can no longer experience normal pleasure and joy in life unless you have more and more cocaine. So if you understand that, you understand how the brain works. Now, Gary, tell us a little bit about some of the predisposing environmental factors for depression.

Dr. Gary Lovejoy [00:14:42] Right? When you were talking about the distinction between endogenous and exogenous depression, endogenous depression, which is what he used to mean talking about endo means inside of usually when we're depressed, but we have no idea why we're depressed. Everything seems to be going well, As you said, you know, all the factors, normal history factors are not there. And so and you wonder why is it I'm depressed? Oftentimes that's because it's an endogenous depression. I mean, it's biologically, predominantly biologically caused. On the other hand, exogenous depressions, which is what I'm going to talk about now, is this XO means external means, factors that occur outside of you, that is environmental factors, things that occur in your growing up experience, in your experience in adult life that can be triggers for depression. Now, before I go into the details of that, I wanted to make a brief description of some of the gender differences because there is an actual difference between men and women and the kinds of events that tend to trigger depression in men. The most common types of things that trigger depression are financial reversals where they lose a lot of money or they have some sort of indebtedness of some kind, and that breeds a sense of inadequacy. Or they could be in that regard, anything where there's a loss of physical powers, they don't have the same kind of physical powers they once had. You often see middle age men trying to play basketball the same level of intensity they did when they were in their twenties, and they're pulling muscles and ligaments and whatnot. And then they're discouraged. They can't they can't physically perform like they did when they were younger. And and so anything that has to do with a sense of adequacy really is very important to them. And therefore, when it's challenged, they have a tendency to get depressed when with women. On the other hand, it is anything that challenges their sense of security or relational connectedness, anything that challenges their femininity, for example, mastectomies or hysterectomy, they begin to question their sense of being a full woman and they and their adequacy as a woman. There are, if they've been abandoned by men in their lives, starting usually with their fathers, then often with men in their adult lives, including their husbands, are often. Factors that will trigger depression and any problems that may occur in the home. Despite the fact that many women have have poured into the workplace and have develop careers over the past 20, 25 years. Nonetheless, women are much more affected by domestic problems than actually are men. If there are problems with the kids, the women will tend to get depressed and the men will tend to get angry. And so it's an interesting distinction, in fact. Often when I have a couple come in to see me and they sit down, they start talking. The man will say something like this Hazard will say, Well, it doesn't make any difference what I what I do. She's never going to be happy with what I do anyway. I never can measure up to what she wants. What is he talking about? He's talking about issues of adequacy. When I turn to her and I say, What? You see, the problem is she says, Well, you know, we never have any time together anymore. He comes in the door, he goes straight to his computer or to the TV. I'm like window dressing. I feel so alone. And I ask her, Do you feel lonely? And oftentimes the tears start to pour because she feels so such a lack of intimacy. She wants the security and the intimate connection and bond of the relationship. A lesson Leslie Parrott had a favorite comment that they would make with regard to these distinctions when he said, When a man comes home from from work, he he wants a report. You know how the day go, how are the kids go, blah, blah, blah. What she wants is rapport, a close, intimate connection to be heard that she's loved and that she's cherished, that he missed her that day. So it's one letter difference between a report and a rapport. But that's the difference between a man and a woman. And so it tends to deter change. What is effective in terms of arousing feelings of anxiety and depression in men and women? Now, there are some specific environmental conditions or factors which increase your risk for depression. Now, Greg mentioned one when he was talking about his own profession of doctors, and that is perfectionism and actually perfection. Perfectionism is the number one causal variable for depression. You say, well, why is that? And in fact, oftentimes people who suffer from a great deal legalism with the church are perfectionists. They're very performance oriented and and they are usually very obsessed with rules and order and and shoulds, insurance and do's and don'ts. What Karen Horney, the psychologist called the tyranny of the shoulds, they are obsessed with a strict, regimented life. They have it. They find it very difficult to relax. They have they keep their emotions under a tight lid. Everything is pressed down oftentimes to anger, which is turned inward, becomes a source of depression. And in addition to that, they can never live up to their own unrealistic expectations of themselves or or what they perceive to be the expectations of others for them. And and so they never measure up. They never do enough. They always fall short. They always fail. I've had students come to me who who would I remember one in particular who came to me. He got a 97 on the exam, highest grade in the class. But he was distraught over the fact that he had missed those three questions and he to know why he missed them. You see, a lot of people are high. A lot of these perfectionists are high achievers, but they are they're high achievers, not because they enjoy success, but because of fear of failure. So they don't even when when they are successful, they can't enjoy it. They're just waiting for the next shoe to drop to show that they're really inadequate. Many of these people who are perfectionists are really highly competitive people, and beating out others is a major theme in their life. And so when they don't do well, envy is a major problem among perfectionistic people who are therefore quite depressed. And so you can see how if you never measure up, you're envious of people who seem to perform better than you do, even if they really, really don't. And you're always waiting for the other shoe to drop for fear that your failure will be and your inadequacy will be made known to everyone. You can quite easily see why your life is filled with anxiety and depression. But there are other risk factors as well. For example, a loss of a parent early in life when you're old enough to understand it, but young enough that you don't have the coping skills to really deal with that that kind of loss. I remember when my grandmother died and she lived with us, and and I remember my mother just sobbing over her. Lost. And that was the first time I'd ever experienced any major loss in my life. And I remember the the emptiness and the fact that her bed would never be occupied again. And and I remember that. And that's just a small, small stressor compared to some people who lose their parents and their remaining parent is not are the the remaining people in the family are not nurturing, are not loving. I fortunately had a loving family, but other people don't. They have nothing to give them. The the the strength and endurance to be able to handle those kinds of losses. So they're sensitized to loss later in life. In fact, I remember a man who came to me who was very depressed and he couldn't figure out why his marriage was good, he had a good job. Everything was going well. You might think initially, well, maybe it's an endogenous depression. But actually it turned out that as we began to talk about it, he and I talked about it a little bit as family, that his father had died 20 years earlier, and he was very close to his father and but had never really grieved because he had to be, quote unquote, strong for the rest of the family. And so he just toughed it out. And and and in 20 years, he had never visited his father's grave. And so I told him, I said, well, why don't you do this? It sounds to me like you haven't said goodbye to your father because he died suddenly, had a heart attack and just drop dead. I said, You probably haven't had a chance to really say goodbye. So what I suggested to him is to go to the cemetery, which he had never frequented before, and said and said to him, Just. Just tell him what you really want to tell him is his final words to you before you say goodbye. And so he did. He said, okay, I'll try that. And a couple of weeks later he came back and he was entirely different person. I mean, he said, You will never believe what happened. He said, I didn't even expect. He said, I went to my father's grave. And I. I said, you know, I just started out. I thought, well, this is just going to be an exercise, a check exercise. He's I began talking and all of a sudden it just gushed out and I fell prostrate on the ground holding that that gravestone in my hands and sobbed for 3 hours in that cemetery. But he said, when I got up, I felt like a £10,000 weight had been lifted off my shoulders. And for the first time in years, I feel free, you see. So this was an event that had happened 20 years earlier, but he never had processed it. His depression was that alarm signals Italian. Something was was hurting him and that he needed to did it face it? There's another there are other risk factors. For example, I mentioned physical and sexual abuse. A lot of times depression, which has a lot of dissociative elements to it, are the result of physical and sexual abuse, especially sexual abuse. I've talked to women, for example, who who are suffering depression and have a history of abuse. And I asked them what happened as a child when you were being physically abused, when your father was molesting you, for example, What what were you doing? She and they would often say, Well, I went to a different place. And that was they dissociated. It was so it was so horrendous, so unacceptable to them that they just had to mentally disassociate from it to go someplace else so they could tolerate that. And there was an interesting study that was done by the Kaiser Foundation, a massive study, over 17,000 patients. And they and what they were exploring was the the frequency of negative child or adverse child events, childhood events and people in their patients lives. And they found something very interesting and not terribly surprising, but perhaps to some people in mind is that the greater the number of adverse childhood experiences that occurred in a patient's life, the greater the likelihood that they would have episodes of depression in the future and in their adult lives. And they drew a very interesting conclusion from this, which I know really kind of bleeds over into into doctor and US expertise. They they drew this conclusion. They said they felt they felt that they had found a key to understanding that some of their patients natural proneness to undefined illnesses such as fibromyalgia or irritable bowel syndrome or chronic fatigue syndrome or chronic nonmalignant pain syndrome. And they said that we can maybe understand that perhaps as we look at further, deeply buried, far deeper underneath, covered by the patient's shame, secrecy and even amnesia, that we find these issues at stake, which are destabilizing that person's life both physically and mentally. And that's where we see the delicate mind body issue going on. There's another another risk factor, and that is living and growing up in an overprotective home. And you say, well, why is that? Well, when a parent, no parent wants their child to experience adversity, but actually it's a good thing that they experience adversity at least some of the time, because and so therefore, you can help them work through and develop coping skills and dealing with adversity. Because if you run around running interference for your children and never let them experience adversity, then they will have no coping skills to deal with it, because adversity will most assuredly come sometime in your life, if not when you're younger. It will when you're an adult. And if you have never developed any coping skills of dealing adversity, you are naked to that adversity and you and your coping skills will be inadequate to the task. And that oftentimes happens as well. There's another risk factor and that's being raised in emotionally repressive families. These are families that can't deal with positive and negative emotions. At the same time, they either really love a person or you can't stand a person, you know, living together as kind of like two porcupines. The closer it gets, the warmer it is, but the more you have the potential of hurting each other. But it's as if we were porcupines. Life would be rather pointless. But in any case, that in these most repressive homes, negative emotions are seen as dangerous. That will cause upheaval, break the delicate harmony of the family. So you're supposed to be people pleaser and be happy with everything that goes on and then go along to get along, but never express negative feelings. So you drive all negative feelings underground, which is perfect grounds for depression. And every once in a while in families like this, there's a breach in that, that family complicity, and all of a sudden somebody explodes in emotions, which only proves for the family how terrible and dangerous these emotions are. And they double down again on their emotional impressiveness. This makes you very high risk factors for further depression down the road because your tendencies to drive everything down. Another factor that affects affects depression is anger management. Many people do not manage their anger well. In fact, sometimes they've asked people, How do you handle your anger? And I say, Well, I don't do very well. I hold it in involves and I explode and spread emotional shrapnel every direction. And other people say, I have a hard time expressing any emotion. I if I just don't get angry. I remember a student I had when I was teaching in college and and the most pleasant person in the world. I mean, she was just a delightful kind of person. But she came into my office and and. And she had this kind of perpetual smile on her face and very sweet demeanor. Then she began talking about her mother and her mother. Her mother was incredibly dysfunctional and she was literally outraged with her mother. But you see, she had. She had intestinal problems. She had stomach issues. She had chronic headaches. She had an internal bowel syndrome. She was literally beating her body up with her rage because she couldn't express it openly. And she was a very depressed young woman, despite all the happy, happy talk. She was underneath, very depressed as she knew. And that's why she came to see me. So that in that situation, how we handle anger is is pivotal if we want to avoid the risk of depression. Some people are depression, either are angry because they use it to gain power. It's a habitual aggression. And why did they do that? Because they're so afraid of feeling helpless. They're deathly afraid of feeling helpless. And and they're afraid of being humiliated. And so they're going to humiliate first. So they're the classic bullies. But most bullies that you see in life are people who are very insecure and often depressed underneath. And what exacerbates the Depression is because they are so obnoxious and so bullying. No one wants to be a friend with them. So their eventual loneliness and isolation becomes another source of the depression. Other people have difficulty with anger simply because they have low frustration tolerance. This is particularly true among people who have been raised in very indulgent homes where they had permissive parents that let them just do about almost anything they wanted to. And so they get they get angry and depressed and frustrated any time they don't get something they want right away. This is the perfect profile of King Ahab. KING about everything. He was raised in the house of Omri. I mean, he was born with a silver spoon, his mouth, everything he wanted. He had one day as when he was king, he looked to his neighbor from next to the palace, was a beautiful vineyard of Naboth said, I want that. So he goes into wealth and tries to negotiate with him, for that probably never is. Now, this has been in my family for four generations. I don't plan to leave that sorry, but I'm not interested in selling. It says in records in the Old Testament that he went back and he was depressed and angry and withdrew to his room. And Salt and Jezebel, his lovely wife, came in to find out why he was so depressed. And when she discovered that or she corrected the problem, she went and had naboth killed so he could have what he wanted. But you see, this is a perfect profile. Someone who I want, what I want when I want it. And when I don't get it, I get frustrated, angry and depressed. There's another reason that people have difficulty with, with anger as well. They may have simply angry at the way life has turned out. It just hasn't turned out. And they're angry at the people who shape their their world. Some of the juvenile delinquents are frequently this kind. They are so angry and depressed. And one of the reasons you might say, well, why did they act out? They just get themselves incarcerated. But the payoff for them is this that it forces their parents to pay attention to them. They have to come down and process them in and have to go to court and all the rest. It forces them and that payoff, they're willing to sustain incarceration for that because they're so angry and they are so deeply depressed or sometimes they simply been raised by a parent who has been similarly had poor anger management problems. So they were simply modeled this kind of behavior. And they often, oddly enough, emulate the very parent they hated the most. So they had these angry outbursts and they hated their father for doing having those outbursts, but they end up doing the same thing. I had worked with a man who perfectly fit that profile. And then there is one other environment that is very high risk inducing for for depression is the guilt manipulation environment. Sometimes in their families and in their churches and other places, everything is built on guilt and guilt manipulation. They don't do anything without feeling guilty. I remember one young man who who said that he felt guilty as a child watching World Disney on Wednesday nights. Now, you notice I said on Wednesday nights, that was prayer meeting night. And his family went to every time the churches were out and his family was there and he wanted to be home watching Davy Crockett series on Disney. But. But one day he kind of had a little bit of a cold, so they decided to leave him home and and and the rest of the family went on to a prayer meeting. So this is by chance. So he turns on the TV to watch Davy Crockett, and he said he watched it for about 5 minutes and the guilt was overwhelming. He couldn't handle it. Oh, I should be. And he turn it off and then he'd sit there, is it? But I want to find out what's going on. So he turned back on and you watch it for another 5 minutes or so, and then the guilt would be too much, He said. This went on for the entire show. He said, I saw, oh, about half the show. But he said, I. I wanted to see it, but I was so overwhelmed with guilt. And this man was a man when he came to me was a man who was wracked with depression, guilt induced depression. And there's a difference between and I know you Greg mentioned talking about issues of guilt is there's a difference between true guilt and false guilt. True guilt is a healthy moral conviction based on transgressions of God's mosaic law, which is his standard of righteousness. But false guilt involves transgressions of rules of human sanction. That man says it's wrong, not God. And so consequently, everything becomes potentially guilt inducing. And if parents use guilt, I remember one woman who said every time she misbehave, her mother said, if you stop, if you don't stop misbehaving, you'll go to hell. God will see to it that you will never see him again. She was petrified most of her life growing up, and then as an adult, she was convinced that she was going to hell. One of the best examples of this was Martin Luther, the Grand Father of the Reformation, and he was raised by a father who wanted to become an attorney and have a family. And what did he do? He became a monk, a celibate monk. And he was so wracked with guilt because of the manipulations of his father that he would spend as much as 6 hours a day in confession. And at night he would have what he called devil sweats, which were really basically nightmares, and where he imagined the devil dragging him down the hill, kicking and screaming. He was petrified at his sense of that. He was that of his insecurity, that he would go to hell. And yet he was the one who created the basic theme of the Reformation. When he discovered that passage in Ephesians by Grace, you are saved not of words. And yet he couldn't he couldn't distance himself from his own family experience. There are many other things that can have an impact, and some of them, of course, obviously a person has very low self esteem to start with and we'll talk about that later. But oftentimes they see themselves as so undeserving of anything and so and so worthless that that it denotes a sense of deep depression, even when people are trying to constantly back them up. The the difficulty of so many of these things and this is also has to do with issues of faith. And we will talk about this more in later video. But I think the greatest tragedy is when we distort our faith in our understanding of our security and our love and our worth before God. That's probably one of the greatest tragedies. And we will expand more on that later. But but all of these are exaggerated risk factors that can increase the likelihood that you will be depressed. And when you do, that illustrates the importance of how complex depression is. We are just Greg and I have just touched on some of the major factors and dodges and dodges that affect us and increase our risk for depression. But we have included all of the factors we would be hours describing. There are whole books on just risk factors alone. So it's help us to understand that depression is not a simple, unified kind of syndrome. It's very complex both in its it's in expression as well as it is in its causation. So hopefully that will give us a greater appreciation for this thing we call depression that so profoundly affects the members of the body of the church. And every time I go to speak, I speak often in front of churches, and I want to step up to the pole when I speak. I'm aware there are good number out in front of me. Perhaps as many as half of them are struggling with some form of depression or not another. There may be bad marriages. They may be. Other kinds of physical illnesses, other kinds of things going on, maybe loss, grief. They've lost a loved one and they're they're grieving. It's grief, depression. But I am aware that so many people are depressed and it's so important because of its pervasiveness, its commonality that we need to address this as a body of believers.