Prague, Czech
Republic
April 2001
Mental illness
is a term that covers a large number of complex conditions. So, before we proceed
any further, I would like to state what aspects of mental illness I am going to
focus on in this series of addresses. The area I am particularly concerned with
is the most common mental illness – depression. As anxiety and panic attacks
are also very commonly associated with depression (so much so that doctors are
increasingly using the term “depression-anxiety” when referring to depression),
we will look at these distressing conditions also.
But firstly,
why should we study this subject, depression? Here are eight reasons.
1. Because the
Bible speaks about it
There are
numerous Bible verses which refer to depression and severe anxiety – its
causes, its consequences, and its cures. The Bible does not address every
cause, every consequence or provide every cure. But, as we shall see in later
addresses, it does have an important role to play in the treatment of
Christians who are suffering from depression and anxiety.
It must be
admitted that the Bible never states that “Bible Character X had mental illness,”
or “Bible Character Y was depressed.” However, it does frequently describe men
and women who manifested many of the symptoms of depression and anxiety. In
some cases, it is not clear whether these symptoms reflect long-term mental
illness or simply a temporary dip in the person’s mental health, which everyone
goes through from time to time. For example, symptoms of depression/anxiety can
be seen in Moses (Num.11:14), Hannah (1 Sam.1:7,16), and Jeremiah
(Jer.20:14-18; Lam.3:1-6). In these cases it is difficult to say whether the
symptoms reflect a depression or a dip. Martin Lloyd-Jones argues from biblical
evidence that Timothy suffered from near-paralyzing anxiety.
A more persuasive case for depressive illness can be made for Elijah (1 Kings
17:7-24), Job (Job.6:2-3, 14, 7:11), and various Psalmists (Ps.42:1-3, 9a;
Ps.88).
“The Psalms treat depression more realistically than
many of today's popular books on Christianity and psychology. David and other
psalmists often found themselves deeply depressed for various reasons. They did
not, however, apologize for what they were feeling, nor did they confess it as
sin. It was a legitimate part of their relationship with God. They interacted
with Him through the context of their depression.”
Another
significant verse is Proverbs 18:14, “The spirit of a man will sustain his
infirmity; but a wounded spirit who can bear?” The human spirit can help people
through all kinds of sickness. However, when the healing mechanism is what
needs healing, then even more serious problems arise.
2. Because it
is so common
1 in 5 people
experience depression, and 1 in 10 experience a panic attack, at one stage in
their lives. An estimated 121 million people suffer from depression. 5.8 % of
men and 9.5% of women will experience a depressive episode in any given year.
Suicide, often the end result of depression, is the leading cause of violent
deaths worldwide, accounting for 49.1% of all violent deaths compared with
18.6% in war and 31.3% by homicide.
It is also
common in Christians. Indeed, these days there would appear to be an epidemic
of depression, anxiety, and panic attacks among Christians – both young and
old. This is at least partly because of the depressing state of the Church and
of the Nation. Every few days there is discouraging news about Church splits or
problems, and Christians backsliding or falling into temptation. Then there is
the secular and anti-Christian direction of the Government as it continues to
dismantle the Judeo-Christian laws and standards that our civilization was
built upon, and as it attacks and undermines family life. On top of this, there
is the relentless audio-visual misrepresentation and persecution of Christians
through the print and broadcast media. To top it all there seems to be an
unceasing diet of bad news on the international stage, with wars, terrorism,
and “natural” disasters ever before us.
In these
conditions, it is therefore little wonder that Christians react adversely, and
get depressed and anxious about themselves, their families, their Church, and
the world they live in.
3. Because it
impacts our spiritual life
We might say
that there are three main elements in our make-up that affect our overall
well-being: our body, our soul, and our mind (our thoughts). These are not
three watertight and disconnected entities. There is considerable overlap and
connectivity. When our body breaks down, it affects our spiritual life and our
thinking processes. When our spiritual life is in poor condition, our thoughts
are affected, and often our bodily health and functions also. It is therefore
no surprise that when our mental health is poor, when our thinking processes go
awry, that there are detrimental physical and spiritual consequences.
The depressed
believer cannot concentrate to read or pray. He doesn’t want to meet people and
so may avoid church and fellowships. He often feels God has abandoned him.
Moreover, it
is often the case that faith, instead of being a help, can actually cause extra
problems in dealing with depression. There is, for instance, the false guilt
associated with the false conclusion, “Real Christians don’t get depressed.”
There is also the usually mistaken tendency to locate the cause of mental
illness in our spiritual life, our relationship with God, which also increases
false guilt and feelings of worthlessness.
4. Because it
may be prevented or mitigated
Many people
have a genetic pre-disposition to depression, perhaps traceable to their
parents’ genes, which increases the likelihood of suffering it themselves.
However, even in these cases, knowledge of some of the other factors which may
be involved in causing depression can sometimes help prevent it, or at least
mitigate and shorten it. Others, with no genetic pre-disposition to depression
can also fall into it, often as a reaction to traumatic life-events. And,
again, having some knowledge of mental health strategies and techniques can be
especially useful in preventing or mitigating and shortening the illness.
One great
benefit of having some knowledge about depression is that it will prevent the
dangerous and damaging misunderstanding which often leads people, especially
Christians, to view medication as a rejection of God and His grace, rather than
a provision of God and His grace.
5. Because it
will open doors of usefulness
Increased
understanding of depression will make us more sympathetic and useful to people
suffering from it. This is taught by the converse truth in Proverbs 25:20, “As
he that taketh away a garment in cold weather, and as vinegar upon
nitre, so is he that singeth songs to an heavy heart.” If we saw someone
fighting for life in the midst of a freezing blizzard, the last thing we would
do is take his coat away. Such an action would be cruel and heartless, and
could easily lead to death. But, says the Bible, similar dangerous
heartlessness is displayed by the person who tries to help their depressed
friend with superficial humor and insensitive exhortations to “Cheer up!”
6. Because it
is so misunderstood
“Being depressed is bad enough in itself, but being a depressed
Christian is worse. And being a depressed Christian in a church full of people
who do not understand depression is like a little taste of hell.”
As we all know
there is a terrible stigma attached to mental illness. This is the result of
widespread misunderstanding about its causes, its symptoms, and the “cures”
available. Some of the misunderstanding is understandable. Unlike cancer or
heart disease or arthritis, there is no scan or test which can visibly
demonstrate the existence of depression/anxiety. It is a largely “invisible”
disease. We want to be able to point to something and say, “There’s the
problem!” When we can’t, we often wrongly conclude, “There is no problem!” Or,
if we are Christians, we may, usually wrongly, conclude, “My spiritual life is
the problem!”
This
misunderstanding is addressed in the excellent book, I’m not supposed to
feel like this (a book written by a Christian pastor, a Christian
psychiatrist, and a Christian lecturer in psychiatry). Near the beginning of
the book, they summarize what they believe and what they do not believe about
depression:
“What we believe: We believe that all Christians can
experience worry, fear, upset and depression. We also believe that being a
Christian does not prevent us or our loved ones from experiencing upsetting and
challenging problems such as illness, unemployment, or relationship and other
practical difficulties.
What we do not believe; Although at times we all choose
to act in ways that are wrong and this can lead to bad consequences for us and
for others, we do not see anxiety and depression as always being the result of
sin; neither do we
believe that mental health problems are the result of a
lack of faith.”
It is
absolutely vital for Christians to understand and accept that while mental
illness usually has serious consequences for our spiritual life, mental illness
is rarely caused by problems in our spiritual life.
7. Because it
is a talent to be invested for God
Like all
affliction in the lives of Christians, mental illness should be viewed as a
“talent” (Matt.25:14ff) which can be invested in such a way that it brings
benefit to us and others, as well as glory to God.
Dr James
Dobson, the Christian psychologist, observed that “nothing is wasted in God’s
economy.” That “nothing” includes mental illness.
Mind over
Mood, while not
written from a Christian perspective, illustrates the possible “benefits” of
depression thus:
“An oyster creates a pearl out of a grain of sand. The
grain of sand is an irritant to the oyster. In response to the discomfort, the
oyster creates a smooth, protective coating that encases the sand and provides
relief. The result is a beautiful pearl. For an oyster, an irritant becomes the
seed for something new. Similarly, Mind Over Mood will help you develop
something valuable from your current discomfort. The skills taught in this book
will help you feel better and will continue to have value in your life long
after your original problems are gone.”
It is usually
broken people that God uses most. In Passion and Purity, Elisabeth
Elliot
quoted Ruth
Stull of Peru:
“If my life is broken when given to Jesus it is because
pieces will feed a multitude, while a loaf will satisfy only a little lad.”
8. Because we
can all improve our mental health
Most
Christians try to take preventative (and curative) measures to enjoy good
physical health and spiritual life. However, there is less consciousness of the
similar effort required to maintain or recover mental health. There is much
less awareness of the biblical strategies and sound mental techniques that can
be used to achieve good mental health, which obviously has beneficial
consequences for our bodies and our souls.
I have never
been diagnosed with any kind of mental illness. However, like most people, and
especially like most ministers, I have had low points in my life. My thinking
processes have gone wrong, causing times of mild depression, and anxiety.
What I now
know about improving and maintaining mental health, and what I hope to
communicate in later addresses, would have greatly helped me in these low
periods. What I have learned is helping me on a daily basis to overcome
disappointment and handle stressful situations without my mental health
suffering as much as before.
As I look
around me, and especially as I look around the Church, I can see many people
who have not been diagnosed with depression, and who are not disabled with it,
but who are experiencing long-term, low-level depression/anxiety which is
having its own knock-on effect on their bodily health and the spiritual lives.
I believe that
it would not be too difficult for them to learn some sound strategies and
techniques which will improve mental health, and consequently their bodily and
spiritual health.
We will here
propose two principles which should condition all our thoughts and the
expression of them in studying depression.
References
M Lloyd-Jones,
Spiritual Depression, (London: Pickering & Inglis, 1965), 93ff.
S & R Bloem, Broken Minds (Grand Rapids:
Kregel, 2005), 204.
J Lockley, A Practical Workbook for the Depressed
Christian (Bucks: Authentic Media, 1991), 14.
C Williams, P Richards, I Whitton, I’m not supposed
to feel like this, (London: Hodder & Stoughton, 2002), 10.
D Greenberger & C Padesky, Mind over Mood, (New
York: Guilford, 1995), 1.
E Elliot, Passion and Purity, Power Books (Old Tappan, NJ.: Revell, 1984).
PART 2 - THE COMPLEXITY
I. LET US
AVOID DOGMATISM AND SEEK HUMILITY
Firstly, let
there be an absence of dogmatism. Where the Word of God is dogmatic the
preacher must be dogmatic. He must clearly and boldly declare God’s Word with
all authority. He must have no hesitation or equivocation. He must not make
mere suggestions or proposals. He must pronounce, “Thus saith the Lord...”
Unfortunately,
Christian preachers and writers have often taken a dogmatic attitude into areas
where the Word of God is not dogmatic. One such area is that of mental illness.
In researching these addresses, I have been frequently shocked by the almost ex
cathedra infallibility assumed by Christian writers and speakers when
writing or speaking about mental illness. This dangerous dogmatism often
reflects not the principles of the Word of God but their own prejudices and
experiences.
It must be
admitted that confident, sweeping dogmatic certainty appeals to the writer or
preacher, and also to the hearer who craves simplicity in a confusing world.
However, it is highly damaging in this complex area of mental illness which
requires careful, balanced, and sensitive thinking and speaking.
When we look
back on the treatments which used to be offered for bodily diseases we shudder
with horror at the frequently crude and unsuitable advice and potions which
were confidently given to patients. With the advances in medical research such
advice and medicines now look ridiculous. It is very likely that in the years
to come, with increased research into mental illness and also increased
understanding of the Bible’s teaching, that much of the confident certainty
which presently masquerades as biblical or medical expertise will then also
look ridiculous, cruel, and even horrifying.
In our study,
and in our contact with those suffering from mental illness, let us avoid
unfounded and unwarranted dogmatism; and let us study, listen and speak with
humility and an awareness of our own ignorance and insufficiency when faced
with the complex and often mysterious causes and consequences of mental
illness.
II. LET US
AVOID EXTREMES AND SEEK BALANCE
There are
three simplistic extremes which we should avoid when considering the causes of
depression. Firstly, that it is all physical. Secondly, that it is all
spiritual. Thirdly, that it is all mental. Let us examine these three
propositions in turn.
1. Depression
is all “physical”
For many
years, the foundational presupposition behind the largely drug-driven solutions
offered by many doctors and psychiatrists has been that depression has purely
physical roots – one of which is that of chemical imbalances in the brain. And,
if the presupposition of a physical cause is correct (chemical deficiency), then
the prescription of antidepressants (chemical correction) is a logical
conclusion. This is often called the “medical model”. It can also be called the
“drug-treatment model”
There is,
undoubtedly, much scientific evidence to support the “drug-treatment model”.
Studies have shown that the brains of depressed patients have a different
chemistry compared to people with good mental health. To put it simply, the
brain needs chemicals to move our thoughts through the brain, and when these
are depleted, as they often are in cases of depression, then the whole process
slows down, or even stops in certain areas.
Obviously, the
“drug-treatment model” or the “all-physical model” for depression is supported
by those who wish to deny the existence of a non-physical, or spiritual element
to human beings. However, there are Christians who also take the
“drug-treatment model” approach. An example of this is found in the book Broken
Minds by Steve and Robyn Bloem. Steve is a Christian pastor who has
struggled with serious depression throughout his ministry. His book, co-written
with his wife, gives a deeply moving account of his life threatening battle
with mental illness. There is no book I know of which gives such an honest and
hard-hitting insight into the pain and distress which the mentally ill and
their families have to endure. If you wish to increase your sympathy and
compassion for sufferers and their loved ones, then this heart-rending and
tear-jerking book is for you.
However, the
book’s greater usefulness is limited by the adoption of the purely “drug treatment
model” approach to causes and cures. As we have said, there is unquestionably a
physical element to most depressions, often requiring medication. And, in Steve
Bloem’s case, there would appear to have been a very large and serious physical
problem, which required necessary and life-saving medication. However, it is
far too big a step to move from this to proposing the “drug-treatment model” as
the only model in every case, and medication as the only solution to every
case. In this complex area, it is a big mistake to use one’s own experience as
the “norm” for everyone else.
In some ways,
the Bloem’s “all-physical” position is understandable. For far too long,
Christian writers and speakers in this area have been over-influenced by the
Jay Adams extreme position of “all-spiritual” in both causes and cures (see
below). However, we must not over-react to one unhelpful extreme (“it’s all
spiritual”) by going to another (“it’s all physical”).
2. Depression
is all “spiritual”
This extreme
position takes two forms. We shall look at the first briefly, as it is not so
common in our circles, and then we shall look in more detail at the second.
Thirdly, we shall consider the rare situations when depression does have a sole
spiritual cause.
a. Mental illness is caused by demonic
possession and therefore exorcism is required
This idea is
associated with some Pentecostal and Charismatic Churches which place a large
emphasis on “spiritual warfare”. The “spiritual warfare” movement takes the
view that mental illness (just like alcoholism and immorality) is usually due
to the demonization of the believer – either demonic oppression or possession.
The “treatment” therefore is to effect “deliverance” from or expulsion of these
demons.
As we have
already highlighted, there is substantial scientific evidence that connects
mental illness with physical causes, a fact confirmed by the success of
medications in relieving many of the symptoms.
Hopefully,
such dangerous views and practices will eventually be swept away by the
increased knowledge of medical research, just like advances in research and
increased education of the public eventually swept away the once-common view
that epilepsy was caused by demons.
b. Mental illness is caused by sin and
therefore rebuke, repentance and confession are required
This idea is
widespread in the Evangelical church, largely as a result of the writings of
the American Christian counselor, Jay Adams, and those who follow him.
We shall,
firstly, summarize Adams’ approach. Secondly, we shall highlight the strengths
of Adam’s reasoning, And, thirdly, we shall look at the weaknesses.
(i) Summary
Like the
Bloems, Jay Adams’ approach is founded on his own personal experience of mental
illness, in his case as he encountered it at two treatment centers in Illinois.
He summarized his experience-based conclusion as follows:
“Apart from those who had organic problems like brain
damage, the people I met in the two institutions in Illinois were there because
of their own failure to meet life's problems. To put it simply, they
were there because of their unforgiven and unaltered sinful behavior”
On the basis
of this he argues in another place:
“The hope for the depressed persons, as elsewhere, lies
in this: the depression is the result of the counselee's sin.”
If this
diagnosis is correct, then we would expect the logical prescription to be
“rebuke and repentance”, or counseling with a view to conviction and
conversion, and that is exactly what we find in Adams’ writings. He describes
his counseling method as “nouthetic counseling”. The word “nouthetic” is from
the Greek noun nouthesia and verb noutheteo, to admonish, correct or instruct (Rom.15:14).
Following on
logically from Adams’ belief that bad feelings are the result of bad actions,
is the usual nouthetic remedy of, “If you do right, you feel right.” If you get
depressed because of sinful behavior, then, obviously, you get better by
righteous behavior.
(ii) Strengths
Adams was
reacting against the humanistic view which explained sinful addictions like
alcoholism as “sickness”, or which attributed immoral behavior to one’s genes,
and so tried to remove people’s guilt feelings by encouraging them to deny
personal responsibility for their actions and simply accept themselves as they
were. Adams’ emphasis on the need to accept personal responsibility in these
situations was very much needed.
Also, Adams’
approach is correct and pastorally useful in situations where the problem is
everyday mood swings and simply “feeling down”. There are times in all of our
lives when, often in response to difficult personal situations, we allow
ourselves to wallow in hopeless self-pity and slip into blaming everybody else
for our problems. At such times, nouthetic counseling is exactly what we need.
We need to be confronted with the sinfulness of our reactions and to be
encouraged to get on with our daily duties and responsibilities.
In addition,
though he has gone too far in saying “mental illness is all spiritual”, Adams
has shown the need for the spiritual dimension of mental illness to be
addressed, and therefore has secured the role of Christian pastors and counselors
in treatments.
Finally,
though we disagree with Adams’ argument that depression is almost always caused
by sin, we must accept that sometimes, as a result of depression, people can
adopt unhelpful attitudes and sinful behavior patterns which should be
sympathetically addressed and corrected.
(iii)
Weaknesses
While Adams is
to be commended for giving an important place to personal responsibility, he
greatly errs in placing all responsibility on the patient.
The
fundamental weakness of Adams’ approach is that he fails to appreciate the
significant difference in kind between bad moods or short-term depressions of
spirit, which are sometimes sinful and to be repented of, and the far deeper
kinds of “depression” which have far more complex causes than the sinful
choices of individuals. When comparing “feeling down” with “depression”, Adams
says:
“This movement from down (not depression) to down and
out (depression) occurs whenever one handles down feelings sinfully (thus
incurring guilt and more guilt feelings), by following them rather than his
responsibilities before God.”
In Broken
Minds the Bloems comment, “This is not Christianity, but the good old
American pioneer, self-sufficient spirit.”
To always put
all the blame for depression on the individual is wrong, damaging and
dangerous, as it can only increase the feelings of guilt and worthlessness.
Such mistaken views have been around for a long time. Almost 150 years ago the
depressed Charles Spurgeon said:
“It is all
very well for those who are in robust health and full of spirits to blame those
whose lives are sicklied or covered with the pale cast of melancholy, but the
[malady] is as real as a gaping wound, and all the more hard to bear because it
lies so much in the region of the soul that to the inexperienced it appears to
be a mere matter of fancy and diseased imagination. Reader, never ridicule the
nervous and hypochondrichal, their pain is real; though much of the [malady]
lies in the imagination it is not imaginary.”
Let us, for a
moment, allow that Adams’ diagnosis is correct in some situations. Here is a
person who has major depression as a result of his sinful handling of down
feelings or his sinful reactions to difficult life events. A knock-on effect is
that his brain chemicals are now imbalanced and his thought circuits are
malfunctioning. He is at the bottom of the black hole of depression. He cannot
do and he can hardly think. The last thing he needs is a preacher telling him
to repent and shouting down the hole, “Do right and you will feel right.” He
needs someone to shine a light and throw down a rope. Medicine can play this
role. It can restore the chemicals required to help a person think. And then,
if required, repentance can take place.
As we noted
above, the nouthetic counseling movement grew out of a frustration at the way
in which secular doctors and psychiatrists squeezed Christian pastors and counselors
out of any role in the treatment of mental illness. However, in the valiant and
commendable attempt to secure a much-needed place for Christian pastors and
counselors in the treatment of mental illness, the nouthetic counseling
movement has often gone to the opposite extreme in attempting to exclude
doctors and psychiatrists from the treatment process. In both cases the
sufferer is the one who loses out.
A much more
balanced view is reflected in the book I’m not supposed to feel like this:
“Being a Christian does not inoculate us from the
possibility of experiencing anxiety or depression; many Christians have
experienced quite severe depressive illnesses. This is true in the same way
that being a Christian does not prevent you from becoming ill or falling victim
to crime or assault.”
Finally the
Adams remedy of do right and you will feel right fails to address the faulty
thought processes which have contributed to or have even caused the depression.
Such superficial behavioristic solutions will often fail in the long-term.
c. Mental illness can sometimes be
caused by sin
When a
Christian becomes depressed, the first conclusion he usually jumps to is that
the cause is spiritual, that his relationship with God, or poverty of it, is
all to blame. While almost every depressed Christian will feel that their
relationship with God is all wrong and all to blame, this overly-self-critical
feeling is usually one of the fruits of depression and, therefore, is usually
wrong. It is important for the Christian in such situations to doubt, question
and even challenge the accuracy of their feelings as they rarely reflect the
facts.
Having said
that, however, it is important to acknowledge the occasional possibility of a
primarily spiritual cause. The Psalms of lament describe the depressed feelings
of the Psalmists which were usually no fault of their own. However, we do have
Psalm 32 and 51 which clearly link the traumatic physical and mental symptoms
of depression with David’s sins of murder and adultery.
In later
addresses we will examine how to decide if depression has spiritual causes or
simply spiritual consequences. However, I agree with the general stance taken
by the authors of I’m not supposed to feel like this, that we should, in
general, reassure Christians suffering with depression that most often their
damaged spiritual relationships and feelings are not the cause of their
depression but the consequence of it.
3. Depression
is all mental (“in the mind”)
“It’s all in
the mind” can mean two very different things. Some people who say it, may be
correctly identifying the seat of the depression – the chemical imbalances in
the brain. However, most people who say it are incorrectly alleging that the
depression is a fiction, a delusion, something made up. Usually implicit, and
sometimes explicit, in this view is the idea that the depressed person is
someone with a weak and fragile mind.
Charles
Spurgeon, who suffered from frequent deep depression and anxiety, and who could
hardly be accused of mental weakness, addressed this fallacy in the quote we
looked at previously. He said:
“Reader, never ridicule the nervous and hypochondrichal,
their pain is real; though much of the [malady] lies in the imagination it is
not imaginary.”
Mental
illnesses, such as depression, afflict the strong and the weak, the clever and
the simple, those of a happy temperament and those of a melancholy temperament.
Never was the caution so much needed, “Let him that thinketh he standeth, take
heed lest he fall” (1 Cor.10:12)
CONCLUSION
Let us try to recognize
the exceeding complexity of mental illness and resist the temptation to propose
and accept simple analysis and solutions. Just as no two hearts are identically
diseased, and just as no two cancers are the same, no two mental illnesses are
the same in cause, symptoms, depth, duration and cure. Therefore, we must avoid
making our own experience the norm for others.
The body, the
soul, and the mind are extremely complicated entities and the inter-relation of
the physical, the spiritual, and the mental is even more complicated. Unraveling
the sequence of what went wrong in a depressed person’s brain, soul, or
thoughts is usually a humanly impossible task. Analysis of the mental,
physical, and spiritual contributions to the situation is equally difficult.
Consequently,
the prescription of solutions is often a matter that takes much time and even
trial and error. There are no quick fixes. For Christians there will need to be
a balance between medicine for the brain, counsel for the mind, and spiritual
encouragement for the soul. Recovery will usually take patient perseverance
over a period of many months, even years.
Great care is
therefore required in coming to conclusions about our condition or that of
others. We finish by underlining our two main principles. Avoid dogmatism and
seek humility. Avoid extremes and seek balance.
References
Jay Adams, Competent
to Counsel (Grand Rapids: Zondervan, 1970), xvi
Jay Adams, Christian
Counselor Manual (Grand Rapids: Zondervan, 1973), 378.
Jay Adams, What
about Nouthetic Counseling, 4 n.7.
S & R
Bloem, Broken Minds (Grand Rapids: Kregel, 2005), p187.
Charles
Spurgeon, The Treasury of David, 3 Vols (Newark, Del.: Cornerstone,
1869), 2.132
C Williams, P
Richards, I Whitton, I’m not supposed to feel like this, (London: Hodder
& Stoughton, 2002), 33.
Charles Spurgeon, The Treasury of David, 3 Vols (Newark, Del.: Cornerstone, 1869), 2.132.
PART 3 - THE CONDITION
I. LIFE
SITUATION
Life in this
world is full of ups and downs. Our providence can change so rapidly from
smooth and happy to rough and upsetting. It is important to recognize how
providential changes (e.g.
bereavement,
loss of job, family difficulties, relationship problems) can seriously damage
our mental health. A person may feel very down and yet never link such experiences
with such life events. Therefore, one of the first steps to treating depression
is to take time to examine our lives and, with God’s help, to trace back our
present depressed thoughts and feelings to events in our lives.
This can be a
painful process of self-discovery. Although we are frail and weak creatures, we
like to think that we can cope with everything that life throws at us. We are,
therefore, often reluctant to link our depressed thoughts or anxiety to life
situations, because such a link exposes our weakness and frailty. As a result,
there is often a desperate search for a purely physical cause (e.g. a virus)
behind our lack of well-being because that will enable us to keep viewing
ourselves as “mentally strong” or as a “coper”.
This is not to
deny that there are usually, to one degree or another, physical factors
involved in causing depression (see previous lecture). Indeed, in some people,
there is undoubtedly an inherited genetic tendency to depression. However,
there is almost always a providential trigger involved to some degree. Just
because we coped with great stresses at some time in our lives, does not
guarantee that we will cope with lesser stresses at other points in our lives.
We age, our hormones and brain chemistry change, responsibility increases as
marriage and children come along. Sometimes the adverse reaction to life events
will be delayed, even for some years.
Consequently,
we often need an objective view of our lives; an independent person such as a
doctor, or counselor, or minister, who can help us look at our lives more
objectively. It is often the case that when we are helped to review our lives,
we begin to see the real and significant effects our problems or difficulties
have had on us, and the extent to which they may have contributed to the
trigger for our depression or anxiety.
II. THOUGHTS
Perhaps, the
most obvious symptoms of depression are the unhelpful patterns of thinking
which tend to distort a depressed person’s view of reality in a false and
negative way, and so add to the depression or anxiety.
While we often
cannot change the providences we have passed through, or are passing through,
we can change the way we think about them so as to present to ourselves a more
accurate and positive view of our lives, and so lift our spirits.
We will focus
on ten false thought patterns which reflect and also contribute to the symptoms
of depression. We will summarize each thought habit, and look at three examples
of each, one from ordinary life, another from our spiritual life, and another
from the Bible. The Biblical examples are not necessarily examples of depressed
person but they are examples of false thinking often present in depression.
It is
important to see how our depressed thought patterns affect our ordinary life; and
even more important to see how that is then carried into our spiritual life. It
is almost always that order in which our thoughts are transferred – false
thinking in ordinary life is eventually transferred into our spiritual life.
1. False
extremes
This is a
tendency to evaluate our personal qualities in extreme, black or white
categories – shades of grey do not exist. This is sometimes called
“all-or-nothing thinking”.
Life example: You make one mistake in cooking a
meal, and conclude you are a total disaster.
Spiritual
example: You have a
sinful thought in prayer, and conclude that you are an apostate.
Biblical
example: Despite most
of his life being characterized by God’s blessing and prosperity, when Job
passed through a time of suffering he decided he must be an enemy of God (Job
13:24; 33:10)
2. False generalization
This happens
when, after experiencing one unpleasant event, we conclude that the same thing
will happen to us again and again.
Life example: If a young man’s feelings for a young
woman are rebuffed, he concludes that this will always happen to him and that
he will never marry any woman
Spiritual
example: When you try
to witness to someone you are mocked, and you conclude that this will always
happen to you and that you will never win a soul for Christ.
Biblical
example: At a low point
in his own life Jacob deduced that because Joseph was dead, and Simeon was
captive in Egypt, that Benjamin would also be taken from him. (Gen.42:36). “All
these things are against me,” he generalized.
3. False
filter
When depressed
we tend to pick out the negative detail in any situation and dwell on it
exclusively. We filter out anything positive and so decide everything is
negative.
Life example: You get 90% in an exam but all you can
think about is the 10% you got wrong.
Spiritual
example: You heard
something in a sermon you did not like or agree with, and went home thinking
and talking only about that part of the service.
Biblical
example: Despite having
just seen God’s mighty and miraculous intervention on Mt Carmel, Elijah
filtered out all the positives and focused only on the continued opposition of
Ahab and Jezebel (1 Kings 19:10).
4. False
transformation
Another aspect
of depression is that we transform neutral or positive experiences into
negative ones. Positive experiences are not ignored but are disqualified or
turned into their opposite.
Life example: If someone compliments you, you
conclude that they are just being hypocritical, or that they are trying to get
something from you.
Spiritual
example: When you
receive a blessing from a verse or a sermon, you decide that it is just the
devil trying to deceive you.
Biblical
example: Jonah saw many
Ninevites repent in response to his preaching. But, instead of rejoicing in
this positive experience his mood slumped so low that he angrily asked God to
take away his life (Jonah 4:3-4).
5. False
mind-reading
We may often
jump to negative conclusions which are not justified by the facts of the
situations.
Life example: A friend may pass you without stopping
to talk because, unknown to you, he is late for a meeting. But you conclude
that he no longer likes you.
Spiritual
example: Someone who
used to talk to you at church now passes you with hardly a word, and so you
decide that you have fallen out of her favor. But, unknown to you, the person’s
marriage is in deep trouble and they are too embarrassed to risk talking to
anyone.
Biblical
example: The Psalmist
one day concluded that all men were liars, a judgment which on reflection he
admitted to be over-hasty (Ps.116:11)
6. False
fortune-telling
This occurs
when we feel so strongly that things will turn our badly, our feelings-based
prediction becomes like an already-established fact.
Life example: You feel sure that you will always be
depressed and that you will never be better again. This, despite the evidence
that almost everybody eventually recovers.
Spiritual
example: You are
convinced that you will never be able to pray in public. Again, this
despite the
evidence that though difficult at first, with practice almost everybody manages
it.
Biblical
Example: Anticipating
the opposition that Jesus would face in Bethany, Thomas falsely predicted not
only his own death there but also that of the Lord and the other disciples
(John 11:16).
7. False lens
This is when
we view our fears, errors, mistakes through a magnifying glass, and so deduce
catastrophic
consequences. Everything then is out of proportion.
Life example: When you make a mistake at work, you
conclude, “I’m going to be sacked!”
Spiritual
example: You focus on
your sins from the distant past in a way that leads to continued feelings of
guilt, self-condemnation, and fear of punishment.
Biblical
example: When Peter
sinfully denied the Lord, he not only wept bitterly but decided that as his
mistake was so spiritually catastrophic, there was no alternative but to forget
about preaching Christ and go back to catching fish (Jn.21:3).
8. False
feelings-based reasoning
In depression
we tend to take our emotions as evidence for the truth. We let our feelings
determine the facts.
Life example: You feel bad, therefore conclude that
you are bad.
Spiritual
example: You feel
unforgiven, therefore conclude you are unforgiven. You feel cut off from God
and so conclude that you are cut off from God.
Biblical
example: At one of his
low points, David felt and so hastily concluded that he was cut off from God.
“I said in my haste, I am cut off from before thine eyes” (Ps.31:22).
9. False
“shoulds”
Our lives may
be dominated by “shoulds…” or “oughts”, applied to ourselves or others. This
heaps pressure on us and others to reach certain unattainable standards and
causes frustration and resentment when we or others fail.
Life example: The busy mother who tries to keep as
tidy and orderly a house as when there were no children is putting herself
under undue pressure to reach unattainable standards.
Spiritual
example: The
conscientious Christian who feels that despite being responsible for meals and
raising children, that she ought to be at every prayer meeting and service of
worship, and also reading good books and feeling close to God.
Biblical
example: Martha felt
deep frustration that Mary was not fulfilling what she felt were her
obligations and complained bitterly about it (Luke 10:40-42).
10. False
responsibility
This is when
we assume responsibility for a negative outcome, even when there is no basis
for it.
Life example: When your child does not get “A”
grades you conclude that you are an awful mother. The reason may be instead
that your child has a poor teacher or that his gifts are not of an academic
nature.
Spiritual
example: When your
child turns against the Lord and turns his back on the church you assume that,
despite doing everything you humanly could to bring him up for the Lord, it is
all your fault.
Biblical
example: Moses felt
responsible for the negative reactions of Israel to God’s providence and was so
cast down about this that he prayed for death (Num.11:14-15).
IMPORTANT
1. False thinking patterns are
compatible with being a Christian.
2. False thinking patterns will have a
detrimental effect on our feelings, our bodies, our behavior, and our souls;
usually in that order.
“For Christians, depression hardly ever has a spiritual
cause…In Christians, spiritual effects follow from the depression, and seldom
the other way around.”
3. One of the first steps in getting
better is recognizing these false thinking patterns which do not reflect
reality.
4. While we can do little if anything
to change our providence (our life situation), we can change the false way we
may think about our providence.
III. FEELINGS
Obviously,
these unhelpful false thought patterns are going to give you unhelpful emotions
and feelings. If you are always thinking about problems and negatives, or
imagine the future is hopeless, or think everyone hates you, etc., then you are
going to feel down very quickly. Your feelings about ordinary life and
your spiritual life are going to reflect what you think in each arena
(Prov.23:7).
Here, we shall
briefly look at some of the emotional symptoms of depression. And, as with the
area of our thoughts, let us honestly examine the area of our feelings in order
to consider whether our emotions are related to a depressive tendency or
illness. Also, as with the area of our thoughts, in this area of feelings we
shall also highlight Biblical examples of true believers also experiencing such
emotions, in order to show that such feelings are compatible with being a true
believer.
1. Do you feel
overwhelming sadness?
Everyone feels
sad and down from time to time, but depression-related sadness is overwhelming
and long-term. It often results in tearfulness and prolonged bouts of
unstoppable sobbing.
Biblical
Examples: Job (Job 3:20;
6:2-3; 16:6, 16), David (Ps.42:3,7).
2. Do you feel
angry with God or with others?
A common
characteristic of depression, especially in men, is a deep-seated and often
irrational irritability and anger.
Biblical
Example: Jonah (Jonah
4:4,9), Moses (Num.20:10-11).
3. Do you feel
your life is worthless?
It may be that
despite your life being highly valued by others, and despite you being useful
to others and to the Lord, that because of your distorted view of yourself you
feel your life is worthless. Indeed you may feel your life is just a burden to
and blight upon others.
Biblical
Example: Job (Job 3:3ff),
Jeremiah (Jer.20:14-18)
4. Do you feel
extreme anxiety or panic?
“In anxiety,
the person often overestimates the threat or danger they are facing, and
at the same time usually underestimates their own capacity to cope with
the problem.”
Biblical
Example: David (1
Samuel 21:12), disciples (Matt.8:25)
5. Do you feel
God hates you and is far from you?
Although to
any outside observer your past and your present may be replete with examples of
God’s good favor towards you, you feel that God has either become your enemy or
else has given up on you. You feel as if you are in spiritual darkness
Biblical
Examples Job (6:4;
13:24; 16:11; 19:11; 30:19-23, 26), Jeremiah (Lam.3:1-3).
6. Do you feel
suicidal or do you have a longing to die?
Biblical
Examples: Job (Job.3:20-22;
6:9; 7:15-16), Moses (Num.11:14), Elijah (1 Kings 19:4)
These deeply
depressed feelings are movingly articulated for us by the depressed Charles
Spurgeon, when commenting on the experience of Heman in Psalm 88.
“He felt as if he must die. Indeed he felt himself half
dead already. All his life was going, his spiritual life declined, his mental
life decayed, his bodily life flickered; he was nearer dead than alive. Some of
us can enter into this experience for many a time have we traversed this valley
of death shade, and dwelt in it by the month together. Really to die and to be
with Christ will be a gala day's enjoyment compared with our misery when a
worse than physical death has cast its dreadful shadow over us. Death would be
welcome as a relief by those whose depressed spirits make their existence a
living death. Are good men ever permitted to suffer thus? Indeed they are; and
some of them are even all their lifetime subject to bondage….….It is a sad case
when our only hope lies in the direction of death, our only liberty of spirit
amid the congenial horrors of corruption.... He felt as if he were utterly
forgotten as those whose carcasses are left to rot on the battle field. As when
a soldier, mortally wounded, bleeds unheeded amid the heaps of slain, and
remains to his last expiring groan, unpitied and unsuccoured, so did Heman sigh
out his soul in loneliest sorrow, feeling as if even God Himself had quite
forgotten him. How low the spirits of good and brave man will sometimes sink.
Under the influence of certain disorders everything will wear a somber aspect,
and the heart will dive into the profoundest deeps of misery.
IV. BODILY
SYMPTOMS
“A merry heart
doeth good like a medicine: but a broken spirit drieth the bones”
(Prov.17:22). Thus does the Bible confirm for us the link between distorted
thoughts or emotions and many of our bodily ailments. Every day, doctors are
faced with patients complaining of various physical symptoms whose root problem
is their depressed thoughts and feelings.
These bodily
symptoms include abnormal sleep patterns (Job 7:4, 13-15), fatigue and loss of
energy (Ps.6:6, 69:3), weight fluctuations (Job 17:7; 19:20), digestive
problems (Lam.3:5), loss of appetite (Ps.102:4; 42:3), pain in various parts of
the body (Ps.32:3-4 31:10; 38:3), choking feelings and suffocating
breathlessness (Ps.9:18; 42:7; 69: 1-2) . In Psalm 32:3-4 the Psalmist
describes the bodily consequences of true guilt, but the same can also be the
result of false guilt.
V. BEHAVIOUR
AND ACTIVITY
As we might
expect, the impact of depression on our thoughts, feelings and bodies will
inevitably have an effect on our behavior and activity. This is usually seen in
two ways. Firstly, we may stop doing things we enjoyed or that we were good at,
or that were good for us. This may involve no longer going to church or
fellowships, not contacting family and friends, or the cessation of hobbies and
other beneficial leisure interests. Secondly, we may start doing things that
make us feel worse like staying indoors, drinking alcohol, or pushing away
people who care.
CONCLUSION
1. Assess the five areas of your life
as outlined above, perhaps with the help of a trained professional, and try
make an honest judgment about yourself. Remember that even one false thought
pattern will have an adverse effect on your feelings, physical health, and
activity patterns.
2. Try to remain open to the
possibility that physical symptoms may well be related to depressed thoughts
and feelings.
3. Seek medical advice regarding the
suitability of anti-depressants for you.
4. Focus particularly on the area of
your thoughts and try, with God’s help, to reverse false thinking patterns and
recover and maintain a true view of God, of yourself, and of others.
5. Pray for yourself and others. Tell
the Lord exactly how you feel. Neither Job, David, Elijah or Jeremiah “hid”
their feelings from God.
6. Seek the sympathy of Christ. The
words used to describe his mental sufferings in Mark 14:33 and Matthew 26:37
may be translated “surrounded with sadness” or “deeply depressed”. Charles
Spurgeon wrote:
“When our Lord bore in His own person the terrible curse
which was due sin, He was so cast down as to be like a prisoner in a deep,
dark, fearful dungeon, amid whose horrible glooms the captive heard a noise as
of rushing torrents, while overhead resounded the tramp of furious foes. Our
Lord in His anguish was like a captive in the dungeons, forgotten of all
mankind, immured amid horror, darkness, and desolation.”
7. Believe the depression is part of
the “all things” that are working together for your good (Rom.8:28).
If He had said, ‘Go out and preach ...', you'd have gone. If He'd said, ‘I want you to be a missionary', you'd have gone (possibly reluctantly, depending upon your own hopes and desires!). But because He has said. ‘Sit there and be depressed for a bit, it will teach you some important lessons', you don't feel that it is God calling you at all ... do you? Do you remember Naaman, who wanted to be cured of his leprosy? (See 2 Kings 5.) If he had been asked to do something glorious he would have been happy. Because he was asked to bathe in the murky old Jordan he wasn't so keen - yet this was God's plan for him, and it cured him. God has better plans for us than we have for ourselves - unfortunately, as we can't see into the future, we don't always appreciate just why God's plans are better. With hindsight it's somewhat easier! However strange it may seem to you, God wants you to go through this depression - so look at it positively, not negatively. What does He want you to learn from it? What can you gain from going through it? When you begin to think in this fashion your guilt feelings start to drop away. You can begin to understand that what is happening is part of God's plan for you - and so your depression is not a punishment from God. You are actually where God wants you to be, even if it is emotionally painful. To put it another way, if God wants you to go through this it it would be wrong for you to avoid it, wouldn't it?
PART 4
THE CAUSES
Depression is
often divided into two main categories – reactive or endogenous. Reactive
depression is usually traced to some obvious trigger – perhaps a stressful life
event or unhelpful thought patterns. Endogenous depression is the name usually
given to depressions which seem to have no obvious trigger and are often traced
to genetic pre-disposition. For no obvious reason, the brain chemistry becomes
unbalanced and a person becomes depressed. However, this distinction between
reactive and endogenous is not as clear-cut as it once was, as skilled
investigation of many so-called endogenous depressions will often reveal a
“trigger event”, though a genetic pre-disposition may mean that the trigger is
relatively small. We will consider four triggers of depression: stress,
psychology, sin, and sovereignty.
1. Stress
When you
stretch a piece of elastic, you can often extend it to two or even three times
its size. However, the further you stretch it, the greater the tension on the
rubber, the less flexible it becomes, and the greater the danger of it
eventually snapping. Like rubber bands, we are all “stretched” from time to
time. We are stretched by life events, which we have little control over, and
by our lifestyle which we do have considerable control of. Let’s look at each
of these stretching forces.
a. Life events
Life events
include marriage, moving house, exams, bereavement, illness, unemployment,
birth of children, etc. Each of these events put a strain upon us, to one
degree or another. When we are “stretched” in this way, our body and brain
chemistry changes, and one of the results is often a dip in or lowering of our
mood. This is normal. And, as the stressful events pass, our chemistry usually
returns to normal along with our mood.
Sometimes,
however, these stressful experiences can continue over a lengthy period, or
they can occur one on top of another, or they can affect us more seriously than
other people. The result is that our brain chemistry remains abnormal and so
also does our mood. We just can’t “pick ourselves up”, no matter how many
people urge us to. This is depression. At the very worst, like an elastic band,
we can “snap”, sometimes unexpectedly. This is what some call a “nervous
breakdown”.
Changes in
brain chemistry greatly affect our ability to think and feel in a balanced way.
Stressful events make our minds go into overdrive, exhausting and depleting the
chemicals we need to think and feel in a normal and helpful way. Think of a
computer with too many programs open and working at the same time, and how this
slows down all the processes until eventually the machine “crashes”.
b. Lifestyle
While we have
little if any control over life events, we do have substantial control over our
lifestyle – the proportion of time and energy we give to work, socializing,
shopping, travelling, recreation, exercise, rest, sleep, etc. Much of the
increase in depression and anxiety today is largely the result of an unbalanced
lifestyle where people are on the one hand working too hard and spending too
much, and on the other hand are exercising, resting, and sleeping too little.
This deliberate overstretch
beyond our
capacities and abilities is not glorifying God in our body and spirit (1
Cor.6:20). It is also in breach of the sixth commandment which requires us to
take “all lawful endeavors to preserve our own life” (Shorter Catechism 68).
The effects and result of a stressful lifestyle will often be the same as that
of stressful life events – depression.
2. Psychology
(the way we think)
In Lecture 3
we looked at 10 false thinking patterns which contribute to depression. It
cannot be emphasized enough how vital it is to learn to recognize these
unhelpful thoughts by prayerful self examination. It is also important and
useful to note that some of these habits of thinking may be involuntarily
absorbed or learned in early life and so may be deeply ingrained. When we feel
down, or when we are stressed, these latent false thinking patterns tend to
occur more frequently and tend to dominate. This can often lead to depression,
worsen an existing depression, and, if persisted in, make recovery from
depression so much harder. Sometimes, the Church can reinforce or add to false
thinking patterns by over-emphasis on the negatives in the Bible and in
people’s lives, or by setting standards of commitment which may discourage or
depress those who are unable to attain them.
3. Sin
A
non-Christian may be depressed because of their sin, in which case the cure is
repentance and faith in Jesus Christ. Sadly, many depressed unbelievers are
being treated with chemicals when what they need is conversion. If you are
unconverted and depressed then seriously consider whether your depression is
related to a guilty conscience and conviction of sin. If so, then what you need
is repentance from sin and faith in Jesus Christ. There are many Christians who
will testify that this was the key to relieving their depression.
While sin may
be the last thing an unconverted person may think is causing their depression,
the opposite is true for Christians. When a Christian becomes depressed, there
are often spiritual consequences, and so the depressed believer jumps to the
conclusion that there is also a spiritual cause – usually their own sins or
hypocrisy or failures of one kind or another. Skilled and experienced Christian
pastors, doctors, and psychiatrists unite in affirming that depression in
Christians is not usually caused by problems with their spiritual life. In
Christians, depression is usually caused by stressful life events and
lifestyles, or unhelpful thought patterns (see 1 and 2 above). Here are some
sample quotations from various experienced Christian pastors, psychiatrists, counselors,
and doctors to prove this point:
“For
Christians, depression hardly ever has a spiritual cause…In Christians,
spiritual
effects follow
from the depression, and seldom the other way around.”
“True
spiritual causes of depression are not common. Most Christians with an
apparently religious content to their depression in fact have one of the
mental/emotional causes rather than a true spiritual cause. I cannot emphasize
enough that solely spiritual causes of depression are infrequent in Christians.”
David and
other psalmists often found themselves deeply depressed for various reasons.
They did not, however, apologize for what they were feeling, nor did they
confess it as sin. It was a legitimate part of their relationship with God.
They interacted with Him through the context of their depression.”
“We completely
agree that there are always spiritual aspects to anxiety and depression (as
there are in everything in life for a Christian). However, we see these as
being a secondary consequence of the emotional distress that is part of these
illnesses. Strong claims that all anxiety and depression is spiritual in origin
are unhelpful because they miss the point that the actual problem is anxiety
and depression.”
I emphasize
this point again and again because blaming our depression on our sin is not
only usually wrong, it is also very harmful. It is harmful because it increases
false guilt and deepens feelings of failure. It also makes depressed Christians
seek a spiritual solution to a problem which is actually being caused by life
events, lifestyle, or unhelpful thinking patterns. However, having said all
that, we must still leave open the possibility that the depression may
sometimes be the result of specific sin or sins (e.g. Ps.32). The Westminster
Confession of Faith says: “The most wise, righteous, and gracious God doth
oftentimes leave, for a season, His own children to manifold temptations, and
the corruption of their own hearts, to chastise them for their former sins…”
(WCF 5.5).
How then does
a Christian know if his depression has a spiritual cause or simply spiritual
consequences. The Practical Handbook for Depressed Christians puts it
like this: “For the Christian, truly spiritual causes of depression
usually involve behavior which the Christian knows to be wrong, but which he
still deliberately and arrogantly persists in…I am not talking about repeated
sins that the Christian wishes he could control but can’t…but a deliberate and
continued rebellion against God….”
4. Sovereignty
One final
cause of depression in the Christian is the sovereignty of God. Hard though it
may be to accept, the ultimate cause may be, “It pleased God.” This however is
not some sheer arbitrary, sadistic and pointless infliction of suffering. Not
at all. God has wise and loving motives and aims in all His dealings with his
children. The Westminster Confession of Faith proposes another reason
why God will sometimes allow his children to descend into the depths of
depression. It is “to discover unto them the hidden strength of corruption and
deceitfulness of their hearts, that they may be humbled; and, to raise them to
a more close and constant dependence for their support upon Himself, and to
make them more watchful against all future occasions of sin, and for sundry
other just and holy ends (5.5)".
A well known
example of this is Job. A lesser known example is Hezekiah. “God left him, to
try him, that he might know all that was in his heart” (2 Chronicles 32:31).
This does not mean that God actually left Hezekiah. God will never leave nor
forsake His people. This, then, is not an objective leaving, but a subjective
leaving. God withdrew Himself from Hezekiah’s spiritual feelings, so that he
lost his feelings of God’s presence, protection, and favor. So, Hezekiah felt
God had left him. But God had a wise and loving purpose in this. It was to test
Hezekiah and to reveal to Hezekiah what was in his heart when God’s felt
presence was withdrawn.
Sometimes we
can take God’s presence in our lives for granted. We forget what we might be
without him. And so He wisely, temporarily, and proportionately withdraws the
sense of his favor and presence to remind us of our state without Him and to
lead us to greater thankfulness and appreciation for Him
Dr John Lockley, A Practical Workbook
for the Depressed Christian (Bucks: Authentic Media, 1991), 53-54.
S & R
Bloem, Broken Minds (Grand Rapids: Kregel, 2005), 204.
C Williams, P
Richards, I Whitton, I’m not supposed to feel like this, (London: Hodder
& Stoughton, 2002), 121.
Dr John Lockley, A Practical Workbook for the Depressed Christian (Bucks: Authentic Media, 1991), 57
PART 5 THE CURES
At first
glance it may seem like a silly question. Surely every sick person wants to be
made whole! However, Christ’s question may imply that the man was not making
use of all the means available to get better. Or, perhaps he had given up hope
of getting better. These are common scenarios with depression. Doctors and
pastors are often faced with the frustrating situation of people who need the
help they can give, and yet who are not taking the steps required to benefit
from this help. Perhaps they have just learned to live with their illness.
Perhaps they have given up hope of getting better. Perhaps they lack the will
to play their part in the healing process. Perhaps they are frightened of all
the responsibilities of life which would come upon them should they be viewed
as “well” again. Perhaps they would miss the attention and sympathy which being
ill may generate. These are all possibilities. So, if you are depressed, the
first searching question you must ask yourself is “Do I want to be made whole?”
You have no
hope of recovery from depression unless you want to recover and are, therefore,
prepared to play your own significant part in the recovery process. We will
look at four measures which should be considered as part of a “package” of
healing.
1. Correct
your lifestyle
It is vital to
lead a balanced lifestyle in order to reduce the “stretch” that threatens our
physical, mental, emotional and spiritual well-being. Some of the practical
points made here also apply to depressions resulting from stressful life
events.
a. Routine
One of the
keys to a balanced lifestyle is regular routine. This is also one of the first
things to fall by the wayside when someone becomes depressed. The depressed
person often finds it very difficult to resist being guided by their feelings.
When a person feels down they will often only do what they feel like doing and
avoid what they don’t feel like doing. For example, if we don’t feel like
getting up, we won’t. If we don’t feel like working, we won’t. If we don’t feel
like doing the ironing, we won’t. If we feel we want to drink or eat to excess,
we do it. A positive step in recovering from depression is to restore order and
discipline in our lives. Regular and orderly sleeping, eating, and working
patterns will rebuild a sense of usefulness and healthy self-esteem. It is also
glorifying to God who is a God of order, not of confusion (1 Cor.14:33).
b. Relaxation
We need to
build times of relaxation into our lives. This may involve finding a quiet spot
at various times throughout the day to simply stop, pause, calm down, and seek
the peace of God in our lives. Jesus recognized and provided for this need in
his disciples when he took them “apart into a desert place to rest a while”
(Mark 6:31). Also, moderate physical exercise helps to expel unhelpful
chemicals from our system and stimulates the production of helpful chemicals.
c. Rest
Regular sleep
patterns enable the body and mind to repair and re-charge. The Sabbath Day was
graciously made for us (Mark 2:27), partly to ease the tension of our busy
overstretched lives.
d. Re-prioritize
Examine your
life and see what you can do to reduce your commitments and obligations. Areas
to consider are your family, your work, your church, your neighbors and travel.
Once you are better you may be able to pick up some of these activities again.
But the priority is to get better.
2. Correct
your false thoughts
As we have
noted throughout these lectures, one of the most common contributory factors to
depression is wrong and unhelpful thoughts. Many Christians, who wouldn’t dream
of viewing God’s Word in a false way, yet view God’s world in a false way. As
they view themselves, their situations, and their relationships with others,
they tend to dwell on and magnify the negatives and exclude the positives. This
distorted view of reality inevitably distorts and depresses their mood.
Christians are obliged to challenge falsehood and distortions of reality,
especially when found in themselves. In the appendix to this lecture you will
find two questionnaires to help you do this. The first is to help you examine
your thoughts, and the second is to help you challenge your false and unhelpful
thoughts. Questionnaires such as these are recommended for use by many
Christian and non-Christian psychiatrists. They may look a bit strange to you,
and you may wonder, “Is this not all just psychological mumbo-jumbo?” However,
I would like to show you here how each step is grounded in Biblical Christian
experience. In Psalm 77 we have a perfect example of Asaph investigating and
challenging his thoughts with God’s help, in order to raise his mood and
spirits. There are also slightly more abbreviated versions of the same biblical
strategy in Psalm 42, Psalm 73, Job 19, Habakkuk 3, etc. So, this is not
“psychological mumbo-jumbo”, but true Bible-based Christian experience. Let us
look at Psalm 77 to prove this.
Download the
following file :
asaph.pdf
3. Correct
your brain chemistry
This is not an
area I have any expertise in and so I shall keep my comments to a minimum. I
would refer you to sympathetic and trained medical personnel for diagnosis and
prescription of appropriate medication. Even a low dose of anti-depressants is
sometimes enough just to begin to restore depleted brain chemicals and so pick
up your mood sufficiently to enable you to begin to take the steps necessary to
correct your lifestyle, thoughts, etc. However, more serious depressions
sometimes require medication for 2-5 years in order to permanently restore the
brain’s chemistry and processes. There are a number of myths and false ideas
about anti-depressants which have lodged in the public mind.
Here are some
examples: “If I take anti-depressants I won’t be my true self…there will be
horrible side-effects…I might get addicted…people will look down on me…it will
mean I am crazy.” Your doctor should be able to refute these myths and reassure
you. However, as mentioned above, anti-depressants don’t replace the need for
you to identify and work at changing false and unhelpful thinking and harmful behavior.
4. Correct
your spiritual life
a. Correct the
spiritual consequences
We have tried
to emphasize that for Christians their depression is usually not caused by
spiritual factors. However, there are spiritual consequences in all
depressions. There are a number of steps a depressed Christian can take to help
reverse at least some of the spiritual consequences. You may find Martyn
Lloyd-Jones’ book Spiritual Depression to be helpful in this regard –
although he can be a bit sweeping and dogmatic in his generalizations. Here are
some practical things you can do to help address the spiritual consequences of
depression.
(i) Accept
that being depressed is not a sin and indeed is compatible with Christianity.
Many Bible characters and many of the greatest Christians passed through times
of depression.
(ii) Try to
understand that your loss of spiritual feelings is not the cause of your
depression, but rather the depression has caused a general loss of feeling in
all parts of your life, your spiritual life included.
(iii)
Patiently wait for the corrections in your lifestyle, thinking, or brain
chemistry to have an effect on your feelings as a whole and your spiritual life
will pick up at the same time also.
(iv) Have a
set time for reading your Bible and praying. Depressed Christians may either
give up reading and praying, or they may try to read and pray “excessively” in
order to try and bring back their spiritual feelings. Both approaches are
unhelpful. Instead, set aside a regular time each day to read and pray. If
concentration is a problem, keep things short (5-10 minutes) until you feel
better. Depression will only be deepened by setting unrealistic spiritual
goals.
(v) Bring
objective truth to mind (e.g.: the doctrine of justification, or the
atonement), especially “positive” verses which set forth God’s love, mercy and
grace for sinners (e.g.: Rom.8:1; 8:38-39; 1 Jn.4:9-10; 1 Jn.1:9). You may want
to write out a verse and carry it around with you. When negative thoughts
overwhelm you, bring out the verse and meditate upon it.
(vi) When you
pray, tell God exactly how you feel. Be totally honest. Ask God to help you
with your doubts and fears and to restore to you the joy of salvation. Thank
Him for loving you and being with you even though you do not feel His love or
presence. Praying for others who suffer can also help to turn your thoughts
away from yourself for a time.
(vii) Keep
going to church and seek out the fellowship of one or two sympathetic
Christians you can confide in, and ask them to pray with you and for you. Be
careful about who you talk to. Sadly, some Christians cannot keep confidences,
and others will have little understanding of or sympathy for your condition.
(viii)
Remember God loves you as you are, not as you would like to be.
b. Correct the
spiritual causes
In the lecture
on the causes of depression, we mentioned the possibility that a Christian’s
depression may be the result of some specific sin or sins. If having examined
your life you find that there is a sin which you are deliberately and
stubbornly persisting in, or grave sins which you have never really repented
of, it is time to fall on your knees and seek God’s pardon for the sin, and
God’s power over the sin. See Psalm 32 and Psalm 51 for examples of how to do
this.
