Recently Dan over at Ekklesia in Southern Maine (SoMe Ekklesia) had a series of posts on depression: This Is Serious, Through: Not Out and Clarity. The series ended up sparking an in depth discussion of depression, especially as it pertains to Christians, that had commenters from many sides of the issue. I intended to write a comprehensive comment that communicated my thoughts after reading the posts and the comments, but I got so comprehensive that it took up 5 pages in my word processor! So, I decided to post an abbreviated version on his site, and the full version here, so as not to overwhelm his readers. I apologize in advance for the length of this posts, weighing in at over 3,000 words.
The topic of depression is very weighty, and very complicated. As has been stated commenters at SoMe Ekklesia, I think the topic of depression will never be fully understood by mankind. The interactions between body, soul and spirit are so complicated that I just don’t think one can make blanket, across-the-board generalizations that are 100% accurate. I do have opinions that, from my experience, seem generally correct based on the vast majority of patients I have seen, and also based on my own personal experience. However, this is based on MY experience personally and as a clinician, and therefore may not hold for each individual. Please read the entire article, as the end of the article explains further some things stated in brief earlier on, and the last thing I want is to bring hurt or offense, as can be easy to do with such a personal, charged subject.
Having said that, my experience has brought me to the opinion that much of mental illness that we see today is environmental in nature. By this I mean that a person’s past experiences determine a lot about their present condition, for good or bad. The resultant emotions, etc. invoked by these experiences can be complicated, conflicting and often times masked, so that even if one can identify an inciting event to a lot of the issues, bringing resolution to those issues isn’t automatic. It takes time, oftentimes a skilled counselor, and often a willingness to go through emotional pain to get to the issues at hand. Regarding the arguments for a physical cause of depression I will say the following: I believe that there may be a genetic predisposition to mental illness, including depression. If that is the case, one’s environment can either bring out that tendency, or prevent the expression of that tendency. I will not rule out, however, the possibility that one’s depression could possibly be purely genetic, and not environmental at all, but IMHO this would be the exception and not the rule. Regarding imaging tests that are different in those suffering from depression, etc., I think the question that needs asked is “which came first the chicken or the egg”. Is brain function or structure different and that caused the depression, or did the depression bring about chemical changes in the brain, which then caused the imaging differences? I lean towards the latter, personally.
Let me paint a picture for you. I like two things as analogies for depression. The first was offered by Bobby in a comment on Dan’s site, where he compared depression to a tube of toothpaste. I believe that the human psyche was only built to handle a certain amount of pressure, and each individual’s threshold is different. Once we get squeezed hard enough, the stuffing comes out, so to speak. This may manifest itself as depression, anxiety or even low back pain or other problems. Conversion disorder is a classic example of this. I saw a case of it in medical school, where a young lady presented to the ER with every sign and symptom of an acute stroke, only the MRI was negative and the neurologist couldn’t identify a physical cause. Turns out, when she slept she would move all extremities, but when awake she was unable to. It also turns out she was going through some marital or other difficulties, and this is how her mind “blew off steam” so to speak. Everybody has a pressure relief valve, but the manifestation of that is different from person to person. I have recognized a pattern in my own life that when I begin to feel anxious or depressed I have to look for the point of conflict. For me it usually comes down to an area where I am trying to be self-sufficient, or bucking against a circumstance I don’t like, instead of relying on His supply and understanding that His grace is sufficient for me (like Paul and his thorn). I have also realized that my “relief valve”, or physical manifestation of being overwhelmed, is fatigue, enough that at one point I was convinced I had sleep apnea (which I didn’t).
The second analogy I like is to a Rubik’s Cube. A life in perfect harmony is like a completed Rubik’s Cube. Add one twist, and it may be easy enough to get back into perfection. Add one twist on top of another, and it gets more complicated. Add a third on top of that and its worse. By the time you twist the cube 5-6 times or more it becomes more difficult to even see where things went wrong, and next thing you know you don’t know up from down, left from right, truth from lies. The result can be a life lived in total fear and confusion, because all orientation is lost. Of course a twist on the cube would be analogous to an insult to the psyche. It could be abuse as a child, loss of a loved one, loss of a job, or even just normal life circumstances (having a baby, a new job, moving to a new location, etc.) Add multiple insults on top of each other and the end result can get scary. The more disorganized the Rubik’s cube, the more complicated the presentation of the mental illness, so that what was once just mild depression becomes severe depression, and then maybe a personality disorder, or bipolar disorder, or others. Now, I realize that this may be an over-simplification of this topic, and that it doesn’t fit every circumstance, but I think as a general rule, at least in my experience, it is a fairly accurate model.
In discussing physical versus environmental causes of depression, one might ask what it matters which one it is. I think the question is important. In a previous comment on Dan’s site Bobby made the observation that the enemy uses the idea of mental illness as a physical ailment to keep believers in bondage. I wholeheartedly agree, and have previously witnessed that exact thing. If I view my depression to be largely environmental I may have hope that those environmental issues can be addressed and my condition improved if not cured. If my depression is viewed as a medical illness, like diabetes, then I consign myself to living with it the rest of my life, thus removing a great deal of hope. Now certainly we can have hope of His provision in the midst of any physical ailment, and depression would be no different. However, I would rather trust in Him to see me out of the depression than to live the rest of my life with it, even if He does sustain me through it. In my opinion, much of the mental illness that I see is very treatable, with hope for full resolution in Christ. This is not to say that treatment is a simple process, as usually it is not. More about treatment in a bit.
There are varying degrees of depression, obviously. Although the DSM V gives strict criteria for the definition of different mood disorders, I see depression as more of a spectrum, ranging from mild to severe, but with no clear dividing line between a)depressive symptoms that aren’t true depression and b)true depression itself. In other words, depression is not as easy to quantify as a heart attack. Now, I am sure the DSM V has all of this mapped out and organized, but that is a topic for later. At the higher end of the severity scale, I personally think that another issue comes into play, and that is spiritual oppression. I strongly believe that the enemy uses our thoughts and emotions against us, and when these things get out of control that may be a sign that there is more at work than just plain depression, or more than just our own illogical emotions. I do believe there is a spiritual battle that goes on for our minds, as the enemy does not want us to reach our full potential in Christ. The closer he sees us getting to making a change the harder he fights us, which is why the battle is always fiercest before the victory (or the night is darkest before the dawn).
Depression among believers is really my pet topic. The sad truth is that many of us have grown up in a system where being depressed is not an option. Being depressed is a sign of spiritual weakness, or a lack of faith, etc., and therefore we strive to prove to others, and often ourselves, that we are fine. As has been mentioned previously, the typical Christian response is to point a finger, or give simple platitudes, that aren’t helpful at all, and in fact bring greater shame and depression to the individual already suffering. What the depressed person REALLY needs to hear is “I understand because I have been there as well.” Unfortunately, though, Christians are not very good at being real with God, with ourselves, or with our brothers and sisters around us. We tend to not be very transparent. As I look back on my journey out of depression, I see that my church upbringing (charismatic) directly worsened my already underlying depression, because I never could measure up to what I thought I needed to. Interestingly, the more my mind was cleansed from the stench of “church” the more my depression cleared. The more of the truth of Christ I saw, the more healthy I became. I can point to others that are close to me that were harmed by the system more than I was. As Christians we need to feel free to JUST BE!!! Its okay if I am depressed. It doesn’t devalue me. It doesn’t hamper the Lord’s ability to work in my life. It doesn’t make me a second rate kingdom citizen. It doesn’t make me weak (although if we take it as an opportunity to BE weak, we might actually find HIS strength in us). We must be able to LET God accept us where we are, be content to be there for the time being, while still looking forward to our deliverance (more on that in a bit). We must be able to find His help for us, in the midst of our depression (as Dan has stressed in his posts).
Finally I would like to talk about treatment of depression, just briefly. For many people that I see, medication would be harmful, analogous to putting a bandaid over a wound that will never heal, and not treating the wound. If we fully mask the symptoms it makes it harder to get at the root of the problem. For others, medication is a necessary modality, to lighten the severity of the depression sufficiently to allow the person to concentrate on the issues at hand and make progress. So, I do not see medication usage as a sign that a person lacks faith. I see it as a blessed help to those that would otherwise drown without it. Also, how I approach depression in a believer may be different than in a non-believer. Apart from Christ, deliverance or healing from depression is much less likely than being in Christ. So, I might be more likely to start medication in a non-believer, all things being otherwise equal, because their hope for symptomatic improvement without it is less than a believer who has hope in Christ.
In my opinion, some cases of depression may very well be amenable to treatment by an insightful, compassionate and skilled Christian counselor. Other, more severe cases may need to be in the hands of a trained counselor, be it a social worker, licensed therapist, etc. In my office, my wife works as a counselor. Her social work training, combined with her spiritual understanding, makes her a powerful tool in the life of a Christian suffering from these issues. Even she, however, has to refer on patients that may be dealing with, say, alcohol and drug abuse. I think that counseling on Christian ideas has merit, and traditional counseling has merit as well. Combined, the two are phenomenal in the life of a believer. To simply write depression off as failure to properly apply spiritual principles, or worse yet to sin, is to do injustice to the person suffering from depression. My wife has had a certain degree of success with non-believers, as much as might be expected, but truly exceptional results only occur when the Spirit of God brings enlightenment to the believer’s heart, accomplishing in seconds what might otherwise take years to accomplish with counseling alone. The key to this process is understanding that there is no cookie cutter. What “works” for one person may not “work” for the next. The counselor can not put unrealistic expectations on the counselee (although the counselor sometimes has to nudge the counselee along at times, gently, in love). Another key, as Dan has mentioned, is that the person with depression must have unwavering support and love from their family. Finally, the person with depression has to be willing to deal with painful issues, while at the same time not fixating on the same things, permanently. Sometimes, I know, those old record players are hard to turn off in our heads.
So, having discussed all this, the last question I will ask and answer is this: What part does faith play in dealing with depression? Is faith simply a tool to help us live with depression, or can it be a tool to help us out of depression? In my opinion, faith can be what leads us out of depression, but it must first lead us through our current circumstances. Let me explain better.
“Without faith it is impossible to please God”. This quote is so true. I believe that faith moves God. God wants us to learn to walk as mature sons and daughters, and mature sons and daughters walk in faith. Simply put, God just wants us to believe that what He said is true! Now, this is all very simple sounding in theory, but the practical application ends up being anything but that. If we had total faith, we would have no sickness, no depression, no financial lack, etc. But who among us has total faith? I sure don’t. So, where does that leave us? It leaves us seeking Him. It leaves us on the journey towards eternity, towards resurrection, the end of which we will likely never see in this life. There is no magic potion to get enough faith to be delivered from depression. We can’t muster it up by listening to Christian music, reading Christian books or even by just reading the bible. So, even though I believe that faith is the key to deliverance from depression, we must still walk it out. You see, where my charismatic roots steered me wrong (among other things) was in the failure to understand that it is OK to NOT HAVE ENOUGH FAITH FOR A GIVEN TASK!! It was also wrong in that, as a charismatic, I sought after the healing, instead of seeking the healer. Matthew 6, starting around vs. 26, makes it clear that we are to seek God first, and all these things (in that case food and clothing) will be added to us. I believe that this principle applies here as well, that if we seek Christ, the Spirit of God will transform us into His image, eventually bringing healing to the areas that need it. The beautiful part about this is that it obviates the necessity to live back through every painful circumstance we have ever lived through, as traditional counseling seems so prone to do. As stated previously, this process can accomplish in seconds what traditional treatment may never accomplish (analogous to pulling all the squares off the Rubik’s cube and fixing it that way). All this being said, there is still no cookie cutter. I can’t say “just seek God and He will heal you”. I think we have to avail ourselves to what modern medicine and counseling have to offer, as appropriate, take advantage of the support of our loved ones, and trust Him to sustain us in the hard times. I also think that we must not lose sight of our ultimate goal, to be delivered. We must realize, however, that just as Abraham waited 10 years (by my calculation) from the initial promise of a son to the birth of Isaac, the journey from here to recovery may take awhile, it will probably be hard and it will likely be painful. Along the way, however, we will find ourselves walking as Sons and Daughters in the Kingdom, learning more and more to walk in faith, growing ever and ever closer to our dear Savior and looking and acting more like Him (see 2 Corinthians 3:18). The end result of the pain is incredible beauty in the life of the believer.
After writing all of the above, can I offer an easy solution to someone in the throes of depression and angst? No. I can not. The things I have written are guidelines I believe are true, but there is no 12-step program to freedom. Sometimes, when I am fighting these issues, I have to continually speak the truth of the Word to myself, to combat the illogical thoughts that come against me. Some days I win, some days I lose. The overall theme, to me, is that we must endeavor to keep Him foremost in our thoughts, as much as possible. Again, some days we’ll succeed, and some days we’ll fail. In the end, if we persist, if we don’t lose heart, we will overcome, because He has already overcome for us!