Michael Liimatta

The unrelenting sadness and hopelessness that characterized my experience with depression is something I will never forget.   In the grips of depression I often felt paralyzed, not possessing the strength to rise from bed or even to open my eyes in the morning. I felt completely alone, unable to make contact with anyone, not even Almighty God.  

I lost interest in life and the things that make life special. I became reclusive and withdrawn, not wanting to be with friends   I alternated between insomnia and exhaustion. I couldn’t concentrate. And always, I felt inexplicably sad. Nothing made me happy.   Most frightening of all, I made intricate preparations for my death.   ¹

This year, 17 million Americans will suffer from depressive illness.   In 1988 the General Accounting Office estimated that up to half of the homeless suffer from chronic psychiatric disorders. ²     – many also addicted to alcohol and drugs.   While severe forms of psychosis are readily recognized, depressive disorders, which are more subtle, can be overlooked as factors that prevent program participants from moving forward in recovery.

People with a depressive illnesses cannot simply “pull themselves together” and get better. Without treatment, their symptoms can last for weeks, months, or years.   Depressive disorders include; major depression, dysthymia (a less severe type of depression), and bipolar disorder, formerly called manic- depression. People with bipolar disorders have alternating cycles of depression and elation (or mania).   In the depressed cycle, they experience many of the symptoms of depression; persistent sadness, feelings of hopelessness, pessimism, insomnia, fatigue, thoughts of death or suicide; difficulty concentrating, headaches and digestive disorders.   Symptoms of the manic cycle include; inappropriate elation or irritability, grandiose notions, increased talking, disconnected and racing thoughts, markedly increased energy, poor judgment and inappropriate social behavior.

While often inherited, depressive disorders occur in people with no family history of problems. Genetic, psychological, and environmental factors all contribute to the onset of a depressive disorder.   A serious loss, chronic illness, difficult relationship, financial problem, and unwelcome change in life patterns (like becoming homeless) also trigger depressive episodes.   The root cause of these illnesses is usually physiologial, having too little or too much of certain neuro-chemicals, especially the compound called serotonin.

Specific Suggestions for Helping Residents with Depression

• Evaluation from a Medical Professional– This is important because certain medications and health problems cause symptoms of depression.

• Get the Proper Treatment – This usually involves a combination of antidepressant medications and psychotherapy.

• Monitor Medications – Though not habit-forming, antidepressant drugs must be carefully monitored.   People suffering from depressive disorders often forget their medications or stop them taking without consent of a doctor. For bipolar disorder or chronic major depression, medication may have to become part of everyday life.

• Provide emotional support —   Provide lots of understanding, patience, and encouragement. Be a good listener and remind them that they will feel eventually better. Don’t expect them to take on a lot responsibility or make too many decisions until after the depression has lifted.   Watch for remarks about suicide and report them to their therapists.

• Engage Them in Constructive Activities – This could include taking walks and participating in activities such as hobbies, sports, and spiritual activities. While they need diversion and company, too many demands can increase their feelings of failure.

People can recover from depressive illnesses, if they get the right help. Here’s how one person describes his own recovery:

I am able to maintain my sanity through prayer, studying the Word, honest sharing with close friends, the support of both a counselor and a pastor, regular exercise, good eating habits, and an antidepressant drug which boosts my serotonin levels. None of these things by themselves was enough, in my case, to create balance in my emotional life. But taken as a package, they have each played a part in the restoration of my sanity and in making me a strong and productive part of the body of Christ. ³

For more information go to:

• National Institute of Mental Health
• National Alliance for the Mentally Ill
• Depression and Bipolar Support Alliance
• International Foundation for Research  and Education on Depression
• National Alliance on Mental Health

¹   Missionary Charlie Lehardy shared his experience with depression in STEPS magazine, quarterly journal of the National Association for Christian Recovery.

²   A Nation in Denial, Alice Baum and Donald Burnes, Westview Press, Boulder, CO, 1993

³   STEPS magazine

Much of the information in this article can from “Depression,”   a National Institute of Mental Health publication

I like to say, “There are reasons people become homeless – and there are reasons people stay homeless.”    Some people come to shelters because of a short-term unfortunate circumstance; like losing a job, for instance. In this type of situation, temporary shelter and assistance is enough to help them to get back on their feet and move on with their lives.   Sadly, it’s the chronically homeless who use most of the services available at shelters and rescue missions.   For them, it is not just circumstances that keep them homeless – life controlling issues that must be addressed if they are to break the downward cycle.   This is especially true for women who end up in   family shelters.   Here are a few counseling strategies that are absolutely essential if we are to bring real help to them.

A.    A special strategy for people with drug and alcohol problems  –   Addicts have special needs that the “garden variety” sinner does not have.   They can be identified by using a standard alcohol screening test during the intake process.   Then we   can help them to get into an active program of recovery using such activities as support groups, addiction therapy, educational activities, etc.   Use community resources if the shelter’s staff does not have expertise in this area.   Addiction is a primary issue, so all other help giving will amount to nothing if the person cannot stay sober.

  B. The Issue of Toxic Shame – By definition, “toxic shame”   is an inner sense of being defective, faulty, unlovable, undeserving, unredeemable and hopeless.   It is a root problem for addicts, codependents and people from dysfunctional families.   Most adults in family shelters fall into at least one of these categories.   Toxic shame is the “glue” that holds the wall of denial together and prevents hurting people from accepting the help we offer them.   They think – “If I admit I have problems, it proves that I am a worthless, useless human being.”   Addiction leads to a total deterioration of a person’s moral life leading to a destructive mix of toxic shame and guilt.   The Bible tells us that admitting our problems (sin) is not an admission of hopelessness or “unredeemability.”   Instead, it is the key to forgiveness, freedom from our past and a new self-image.

  C. The Dynamics of Codependency – Another critical counseling issue for women in shelters is learning to overcome the destructive effects of codependency, which is, essentially, the result of a lifetime of abusive relationships.   If this issue is not dealt with, codependent individuals will continue to become emotionally involved with people who are not good for them. Some symptoms are:

•   A sense of little or no control over the circumstances of one’s life – Children growing up in dysfunctional families must somehow find a way to cope with all the pain and confusion.   This often results in a faulty belief system that continues into adult life that leaves people with an all-pervasive sense of powerlessness about practically every situation in which they find themselves.
• Passivity in the face of disturbing and dangerous situations – People from dysfunctional families are used to living life in constant crisis.   So, painful circumstances do not cause them to seek change as it would for most people.   Instead, their learned helplessness results in a sense of resignation about even the most painful and dangerous circumstances.
• Avoidance of social support – For those who struggle with “toxic shame”, almost everything that happens to them in life seems to support their assessment of themselves as being no good, useless, powerless, unable to change or do anything right.   They tend to be filled with fear and insecurity, especially in social situations, making relationships very difficult.
• Guessing at what is normal – An individual’s perspective of the world is formed largely by their home life.   Children from dysfunctional families grow up feeling isolated and different from others.   As adults they are forced to guess at what “normal” is.   As a result,   many people in our programs tend to be self-conscious, or have a hard time trusting, opening up and really feeling a part of things.
• Out of touch with emotions – Stuffing one’s feelings is an essential survival skill in a dysfunctional family.   This is why so many children follow their parents’ example, using drugs and alcohol to managing their emotions.   When an individual stops experiencing emotions in an appropriate, healthy way, they get pushed deep inside themselves.   As a result, they get more out of touch with who they are and what they feel.   That’s why they blame others, that’s why they keep hurting themselves.   On the other hand, one of the first consequences of coming into recovery is the revival of the emotional life.   Feelings often come out as anger and grief, often in seemingly inappropriate ways.   Yet, this can be an important sign of growth.

An important note for ministry to children:   I recommend a Christian program called Confident Kids  which is an effective tools for ministry to children in dysfunctional families.

Original version of this article appeared in RESCUE Winter 1995, journal of the AGRM