One Introduction to Psychology defines depression as "a morbid sadness, dejection, or melancholy. H. Norman Wright puts it this way: "In simple terms, depression is merely a negative emotion due to self-defeating perceptions and appraisals. However, it may also be a sign of serious, even malignant disease." A person can be depressed because of a neurotic or psychotic disorder. It can be mild or moderate depression. It can also be a severe depression. "It can be harmless or life threatening." What are some of the characteristics of depression?
1. It is a feeling of over-all gloom. When you feel depressed, you feel down, you lose perspective, and you feel you are not able to carry on your daily activities, or are able to function only at 50% or 70% of your capacity.
2. You experience changes in physical activities.
3. It is a feeling of over-all hopelessness.
4. It is a feeling of utter loss of self-confidence.
5. You withdraw from others because you fear you are not understood and are being rejected.
6. There is a desire to escape from problems and even from life itself.
7. You tend to be over-sensitive because of mistaken perceptions.
8. You feel angry and bitter.
9. You feel guilty.
10. Clinical depression is defined as "a state of sadness that is severe enough to have observable physiological symptoms, such as insomnia, anorexia (loss of appetite), and fatigue.
11. Manic depressive illness is defined as a "relatively infrequent disorder marked by severe mood swings from delusional, grandiose elation to severe depression with suicidal compulsions."
Who Suffers from Depression?
The book Introduction to Psychology, first printed in 1982, indicates that 1 out of 20 Americans are medically diagnosed as suffering from depression, and that many more persons are having symptoms of depression but have not sought treatment. The March 5, 1990 edition of U.S. News and World Report indicates that 1 in 12 Americans suffer from depression. H. Norman Wright wrote in 1989 that medical practitioners diagnose 7 out of 10 patients whom they see for emotional problems as having depression, that altogether there were 35 million depressed persons in the USA, and that "25 percent of the beds in public mental-health facilities, and 50 percent of the beds in private mental-health facilities have patients that suffer from depression." H. Norman Wright goes as far as saying that at some time in our lives depression affects every one of us. It affects both sexes, people of all ages, the rich and the poor. It also affects ministers of the Gospel.
Causes of Depression
The writers of Introduction to Psychology: Christian Perspectives and Applications suggest that "pent-up anger ... is the root of nearly all clinical depression." Children, they say, easily pick up a tendency to repress anger from a parent. Apparently many parents discourage their children from sharing angry feelings, even appropriately. So these children learn to fear anger. They grow to feel that being aware of their anger or expressing it will result in rejection or punishment. They therefore repress anger. What often happens is that they displace their anger on to something or someone else.
Perhaps you know from experience what it is to grow up in a home with chronically depressed parents. Perhaps you have learned similar attitudes. Your pent-up anger eventually affected your nervous system which adjusted to the depressed lifestyle and produced harmful and far-reaching effects. Perhaps you too have used depression as a powerful way to manipulate others or as a mechanism to vent your anger on others or to get even. Perhaps you found too, that that sometimes relieves the anger, but you make life quite difficult and miserable for others.
Some use depression to gain attention from others. Others use depression as a conscience-pleaser, so that when a person is depressed, the self is turned against self, and then when I as a pastor speak with such persons, they say to me, "I feel I am getting what I deserve." Others who suffer from depression mask their depression by way of physical complaints such as headaches or bodily aches and pains that seem to have no basis in organic pathology. I am not suggesting that all headaches or bodily aches and pains are face-saving mechanisms to cover up emotional conflicts. If there does not seem to be a basis in organic pathology, it may well be that this is the problem.
Depression may also be the result of the stress of adjusting to change. For instance, a change of residence can result in depression. When we move from Strathroy, Ontario to Abbotsford, BC, we suffer loss of friends.
Depression as Related to Spiritual Problems
In pastoral experience we often see that depression is related to spiritual problems. Although there are more, allow me to highlight two of them.
1. Depression as a Result of the Wrong Attitude to Sin.
Depression can be the result of the wrong attitude to sin. The depression is then not merely the result of the fact that I have sinned, but rather the result of the wrong way in which I react to it. The difficulty is that I do not confess my sin and do not flee to Christ for pardon and thus do not disown sin nor mortify it. Instead, I despair of my sin being forgiven. The result is that I react in a way similar to Cain before he murdered his brother Abel. You will remember that he 'dropped' and hid his face. Our KJV translates: Cain "was very wroth, and his countenance [=face], fell" (Gen.4:5). It is also possible to translate the word "wroth" as "depressed." Genesis 4:5 and 6 read: "And Cain was greatly depressed and crestfallen... Why are you depressed and why are you crestfallen [=literally, why is your face fallen?]" If I do go for therapy for this depression, but this depression is not dealt with at its source, it is not dealt with properly, and I cannot become well.
If I have done things in life which hurt others and I am bitterly and deeply ashamed of them, but I find I cannot undo them and I cannot repair them, then they can bring a disabling gloom over me. The proper attitude is to ask God for Christ's sake to forgive the sins of the past, to care lovingly for the victims of my sin and to give me grace in the present to run the race set before me while looking unto Jesus (cf.Heb.12:1,2).
2. Depression as the Result of Wrong Expectations.
Depression can also result from having wrong expectations as to the way the Lord God deals with His people. When I expect the Christian pilgrimage through this life to be easy, but instead find adversities coming my way, it may well be that I begin to suspect that there is something seriously wrong. Then I fail to realize that the Lord explicitly says that "the present time" is one of suffering (Romans 8:18), and that it is through much tribulation that we must enter into the kingdom of God (Acts 14:22). Then I fail to realize that the Lord says that He chastens and disciplines every one of His children. If I fail to realize this and encounter many things that are not joyous but grievous, there is the danger that I become weary and despondent under His rebuke (Heb.12:5).
Depression and the Church's Responsibility
What responsibility does the Church have in connection with this problem? I wish to mention the following aspects.
A. The Church as Health-Giving Community
The Church is to give support and encouragement to all who are prone to depression. The apostle Paul writes that in bereavement we are to comfort one another. (1 Thess.4:18). In the next chapter he writes that we are to "comfort the feeble-minded" and "support the weak" (vs.14). The old are to comfort the young, and the young are to support the old. Pastors are to minister to the members of their congregation, but the members of the congregation are also to minister to their pastor. The New Testament pictures the Church as a health-giving community where burdens are shared, neuroses are dispelled, problems are resolved and every opportunity is given for the development of mature and well-integrated personalities.
B. The Church as a Community Radiating a Spiritual Atmosphere of Hope
The Church must exercise the utmost care as to the spiritual atmosphere with which it surrounds people. That is, in our preaching and pastoral care we may not seek to spread merely gloom. We may not put the emphasis exclusively on the law and with it on threats of doom and on searching questions as to the grounds of assurance. We are also to put proper emphasis on comfort and light, hope and encouragement. We may not give the impression that it is wrong for a Christian to be happy.
How important this is! Take, for instance, assurance. Some teach that you and I are not entitled to assurance unless we have first experienced intense inner conflict. Some who fear the Lord, but who have not experienced this, are depressed by its absence. What they do is put the emphasis on conviction of sin and the intensity of the inward struggle and not on faith in the promises of the Gospel.
This, however, is quite a shift away from the emphasis of the Reformation. The Reformers asked: "How can a man who is a sinner be right with God?" Some preachers ask: "How can I know that I have passed from death to life?" The Reformers based forgiveness and assurance on the promise of the Gospel. Some preachers base it on possession of the marks of grace. What they do, in effect, is to make possession of the marks of grace the ground of justification instead of the promise of the Gospel. Faith, whether small or great, in the promise of the Gospel contains assurance that God loves you. Some say that assurance is possible only by a voice from heaven that we are born again. In the absence of such a voice many fall victims to depression.
The message of the Church should be precisely one of hope and should create an atmosphere of joy. The message of the Gospel is: "The Lord hath sent me to bind up the broken hearted, to proclaim liberty to the captives, and the opening of the prison to them that are bound" (Isa.61:1b).
David Kingdom emphasizes this when he writes" Learn to live by faith. When we suffer from depression we often tend to forget the great truth of justification. We feel full of self-pity. And self-pity ... arises from self-justification." He suggests, that when in our depression we pity ourselves, we need to ask whether we have really learned to live by faith. He alerts us to the reality that the awareness of our ungodliness often threatens to drive us into deep depression. He asks: "When this happens have we not forgotten that God justifies the ungodly? [Rom.4:6]. Satan does indeed charge us with ungodliness, and so does our conscience. But we must meet the charges brought against us and especially the charge that we are ungodly--as indeed we are--by pointing not to God's work in us, but to His work for us... We must accept our acceptance in the Beloved. We must ever look in faith to the substitutionary death, the justifying resurrection, the glorious ascension, and the prevailing intercession of our Saviour [Rom.8:34]. This is the way of joy. It is to look to God's work for us, outside of us."
Very helpful are the directions and advice that the late Dr. John Colquhoun gave to Christians afflicted with melancholy:
(a) "Endeavour to understand well the covenant of grace."
(b) "Be firmly persuaded that the Incarnate Redeemer with his righteousness and fullness is in the gospel offered to you as sinners of mankind."
(c) "Love not the good things of this world so as to place either your happiness or your confidence in them."
(d) "Be not solitary, but as little and as seldom as possible."
(e) "Recollect frequently that, although it is a sin to yield to temptation, yet it is not a sin to be tempted."
(f) "Consider how much it gratifies Satan, to see your indulging gloomy and desponding thought."
(g) "Meditate frequently on the promises and grace of the gospel, but let each of your meditations be short and easy."
(h) "Be frequently employed in ejaculatory prayer, and let your stated prayers be shorter than ordinary.
(i) "Be not discouraged though in your holy exercises you have no lively feelings, nor elevating conceptions."
(j) "Be diligent, from principles of faith and love, in doing the work of your lawful calling."
(k) "Represent your case to some skilful, cheerful, and humble minister or private Christian, and follow diligently his direction."
(l) "If you have reason to apprehend that your malady [illness] is increasing, you ought to consult a skilful physician, and, in the hope that you shall in due time recover, to observe carefully his prescriptions."
(m) "Finally trust that the Lord Jesus, Whose infinite compassions fail not, will, as far as it shall be for his glory and your good, command deliverance for you."
C. Constructive Biblical Guidance by the Church
The Church must give constructive biblical guidance and support to those smitten with depression. How?
1. The Church should be there to help. Pastors, elders, deacons, our wives and the other brothers and sisters should give themselves to help those who are in emotional distress. Moreover, we should not immediately refer them to a family physician or counsellor or psychiatrist. Mind you, in some cases this is very necessary. In case of a tendency to self-destruction, such a referral and sometimes hospitalization is imperative. It is a great blessing that where depression is the result primarily of hereditary or environmental factors, much can be done by using anti-depressant drugs and other therapy. But even when our depressed brothers and sisters are being treated by psychiatrists or counselled by psychologists, we as office bearers should pastor them and the brothers and sisters in the congregation surround with love, such as lending a listening ear and a praying heart.
Why do I suggest that when Christians are depressed, they should not right away resort to psychiatry? One reason is that a great deal of modern psychiatry is based on anti-biblical psychology. How can a non-Christian psychiatrist, who has no understanding of the spiritual problems which often underlie depression both in Christian and non-Christians, be of real help? Another reason is that the Lord God appointed in the church pastors, elders and deacons whose calling it is to deal with the emotional as well as with the other problems of His people. I realize that as a pastor I lack the technological resources of the psychiatrist. But my elders and deacons and I have other resources: the Word of God, prayer, the comfort of the Holy Spirit, Christian experience, and the supportive resources of a Christian congregation. It is a real privilege for churches in South-Western Ontario to also have the labours of Mr. John Van Oorspronk, the counsellor of the Christian Counselling Centre in St. Thomas. What a privilege it is to have cooperation between counsellor and pastors--both engaged in caring for those in need. We need each other, under the Lord. Christian counsellors cannot function as little islands in attempting to deal with emotional states caused by 'religious' factors. Pastors likewise, cannot function well in trying to cope with clinical disorders. In many instances they can hardly be separated. What a privilege for the two to work together and help each other, not only in pooling resources, but also in the sense of helping to understand the needs of those whom they counsel or pastor.
2. We should help the brother or sister suffering from depression to work his or her way through the depression in such a way that we honour their confidentiality and the depth of their depression. Grief is something very intimate and personal and not just about everybody should be allowed to intrude. As far as possible, work your way through it with them, keeping confidentiality and helping them fight their emotional battles. If too many persons get involved in all the details, the brother or sister suffering from depression may lose all self-respect.
3. We must remind brother or sisters suffering from depression that their condition is not unique. They may feel a sense of utter isolation and hopelessness and conclude that no Christian has ever had such an experience, and that they therefore are not Christians. This, however, is not what the Word of God teaches. It teaches that many saints in the past have plumbed the depths of depression: Elijah under the juniper tree, the Psalmist crying from the depths and Paul declaring that he was pressed down beyond measure and despaired even of life (1 Cor.1:8). They knew what it was to be in an abyss of gloom and even of bitterness against God. Their experiences are recorded in part to prevent us from feeling utterly hopeless.
4. We need to be aware that some Christians become depressed because they nurture depression. What I as a pastor then try to do is challenge the depression itself. "Do you have a right to be depressed?" This is the approach we frequently find in Scripture. For example, the author of Psalm 42 asks his soul: "Why art thou cast down, O my soul?" Similarly, the Lord challenges Elijah (1 Ki.19:9), "What doest thou here?" The Lord Himself approaches even Cain this way (Gen.4:6): "Why are you wroth [=depressed] and why is your face fallen?" The thought that underlies these questions is that the depression to which they refer is unjustified. Sometimes it is only a sinful reaction to the ordinary problems of life, retreating from the real life into a pseudo-illness in which I pity myself and look for the sympathy of others. Sometimes it is an act of regression, in which I try to escape into my childhood, to absolve myself from responsibility, to escape the burden of decision-making and exempt myself from the ordinary rigours of my daily tasks.
These motives are not behind all depressions, of course, but they are behind some. We need to probe the depression delicately but thoroughly. Otherwise, lives are wasted and talents squandered by unjustified depressions. Moreover, we need to be aware that when brothers and sisters in their depression use religious language, it does not necessarily mean that their depression is spiritual. Clinical depression often clings to and feeds on religion. It may well be that some one who is convinced that he or she has committed the unpardonable sin or is reprobate, is not suffering from spiritual depression, but from a clinical one which is fuelling itself with religious considerations. In such an instance psychiatric referral is imperative.
You see, clinical depressions are usually caused by a combination of factors. In some instances there is a biochemical problem. This is particularly true of manic depression, where the individual alternates between highs and low. Such depressions, however, reflect a complex interaction between internal and external factors. Some people have an inborn predisposition to depression and when they come under stress their psyche goes under. An already vulnerable personality becomes even more so in the event of illness.
D. Be Realistic
Finally, we must all learn to live with our own mediocrity. To some extent, depression is rooted in unfulfilled dreams. It can be very difficult, indeed, to realize that we do not achieve what we had anticipated in life. It may well be that we must recognize that we have fewer talents than we thought we had, and that at many points we have performed poorly. We must learn that God for Christ's sake forgives failure; that no one is condemned for not being talented enough; and that we must do our duty while looking to Jesus. We must learn to see ourselves through God's eyes. He knows the very worst about us; yet He loved us and gave Himself for us.
E. Pastoral Depression and Recovery
What if pastors or counsellors suffer from melancholic temperaments themselves? David Kingdom, who spoke on "Ministerial Depression" in March 1982 at a Leicester Ministers' Conference, recommended the following pastoral counsel:
1. "If you suffer from a melancholic temperament learn to discipline it. When you feel yourself beginning to brood, centre your thoughts upon Christ. Meditate on him. See him as he gives himself for others. Then you will be less absorbed in yourself and less inclined to pity yourself. Seek to bring every thought into captivity to Christ..."
2. "Do not be afraid to complain to God when you are depressed. David complained when his soul 'refused to be comforted' (Ps.72:2). Only the last three lines of this psalm are a prayer--the rest is a complaint, although in the context of prayer... David did not bottle up his anguish within himself. No, he complained, he cried, he unburdened himself to his God..."
As a pastor I must spell out the Christian calling to the bothers and sisters of the church and help them toward fulfilling it. In this instance, our calling is to be filled with the Spirit (Eph.5:18), have our hearts make melody to the Lord (Eph.5:19), and always and in all things be content, whatever our circumstances (Phil.4:11). It is something that we can learn. We can come to be persuaded that nothing can separate us from the love of God which is in Christ Jesus our Lord. We can learn to be content (Phil.4:11). The Word of the Lord our God holds out not only the obligation to control our temperament, but also the promise and the hope of significantly modifying it. That cannot be done by the individual alone. The whole church must focus on the wonderful works of God (Acts 2:11), accept responsibility for strengthening the weak and encouraging the feeble-minded, and for putting a melody in the hearts of brothers and sisters, young people and children.
F. An Illustration of Incurable Spiritual Depression
Allow me to illustrate what I have indicated above by reminding you of the life of William Cowper. He suffered deep depressions and even periods of severe madness. He was a British poet who lived during the eighteenth century (1731-1800). He wrote many Christian songs, such as:
He wrote many other hymns in which he extolled the mercy and forgiveness of God wile labouring under the certain conviction that he himself was damned. He wrote the hymn, "God Moves in a Mysterious Way His Wonders to Perform" on the eve of his second suicide attempt. None of his friends doubted his religious conversion, but all were appalled by his psychosis. [A brief summary of Cowper's sad and depressive life follows, relating his friendship with the famous former slave owner, Rev. John Newton], author of "Amazing Grace," who tried to reason Cowper out of his despair, but his efforts were fruitless. The last six years of his life he was "haunted by horrific dreams at night and sunk in speechless torpor [apathy] when awake. Though still cared for by friends, he died under the apprehension that he had offended the Almighty irremediably.
Why is it that some of God's children are permitted to languish in such a condition when they are in the hand of the heavenly Father Who is both loving and omnipotent? Physical suffering may already be very difficult for us to square with God's love and omnipotence, but when the suffering of a Christian lies primarily in the mind, and is therefore of a nature which debars the sufferer from all consciousness of the consolations of the Gospel, we are faced with a very painful problem. Nevertheless, then we are brought back to a fundamental spiritual fact: there are matters about which the Christian has to be prepared not to receive light in this world, for it is clear that there are some dispensations about which God is reserving the explanation until eternity. There are mysteries which He calls us to leave unsolved.
When Cowper at last left this vale of tears, Newton, seventy-five years old and looking forward to going Home, wrote to tell a friend this news, as follows:
1. Meier, Paul D., Frank B. Minirth and Frank B. Wichern, p.398.
2. A Curriculum Resource on Depression, Stress Burnout & Crisis: The Causes & Solutions, p.7.
3. Ibid., pp.7,8.
4. Meier, Paul D., Frank B. Minirth and Frank B. Wichern, Loc.cit.
5. Ibid., p.402.
6. Op.cit., p.49.
7. A Curriculum Resource on Depression, Stress Burnout & Crisis: The Causes & Solutions, p.6.
8. Cf. Kingdom, David, "Ministerial Depression," The Banner of Truth, December 1982, pp.18-29.
9. With reference to Ephesians 4:26, "be angry and sin not: let the sun not go down upon your wrath," they add that those "who can maturely rid themselves of anger at bedtime seldom get clinically depressed," Ibid., p.261.
11. See also verse 6: "And the Lord said to Cain, Why art thou wroth? and why is thy countenance fallen?" Cf. Hamilton, Victor P. The Book of Genesis Chapters 1-17, The New International Commentary on the Old Testament, R.K. Harrison, ed., pp.218,219,224.
12. Op.cit. p.29.
13. Treatise on Spiritual Comfort, 1814.
14. An ejaculation is a short, exclamatory utterance.
15. I read this chapter, under the title "Directions to Christians Afflicted With Melancholy," in The Banner of Truth, October 1971, pp.33-38. See also "The Nature and Signs of Melancholy in a True Christian," The Banner of Truth, September 1971, pp.33-40.
16. The Banner of Truth, December 1982, pp.26-27.
17. Owens, Virginia Stems, "William Cowper, Crazy Christian," Perspective, April 1993, p.11
18. Murray, Iain, The Banner of Truth, September 1971, p.29.
19. Ibid., pp.31-32.