Spiritual depression is an involved and complex condition. In dealing with the depressed we must be prepared for great anguish and heartache in the work, as well as for the richest blessings when God grants uplifting to the troubled soul. Here we weep with those who weep, call upon God out of the depths, feel all our inadequacies, and cry out for light. Working with the depressed requires much spiritual strength and wisdom and can leave the pastor/elder weary if he is not consciously trusting in the Lord and hoping in Him (Jer. 17:7).
Spiritual depression is a common ailment of the soul. The frequency with which Scripture (especially the Psalms) deals with this subject brings one to the conclusion that it is a very common condition in the lives of the saints. Almost no saint whose life is depicted in the Scriptures was without times of depression. This answers one of the great questions of the depressed: "How can I be a child of God if I feel this way?" The presence of depression does not mean one is not in a state of grace and adoption. It does not mean that my life is not consistent with what God has made me to be, and thus it is something I must seek the grace of God to overcome and change. Depression keeps us from living to the praise of His grace, and therefore is something from which I must repent (1 Pet. 2:9).
Spiritual depression is not a malady before which we stand defenseless and helpless, simply waiting for the time when the storm clouds will pass and the sun will return. The child of God can do something about it. Depression brings us to see our helplessness (and a whole lot of other things about ourselves too). However, God shows these things not to crush us, but to reveal to us the all sufficiency of the great Physician, who has carried our sorrows, and in whose wings there is healing. He instructs us as to where we have gone through His Word, the grace to change. As great as depression is, ans we must not minimize its depths if we are to deal effectively against it, the grace of Christ is far greater. Also concerning this seemingly impenetrable spiritual darkness we labor in the confidence that God's child "can do all things through Christ who strengtheneth me" (Phil. 4:13).
What is Depression?
By spiritual depression we mean more than what is meant by the popular use of the term. Commonly when we say, "I'm depressed," we mean, "I am feeling low, down, blue, discouraged." Spiritual depression is more than that. It is when the low spirit affects us our life in substantive ways, when we are down and out, when the low feelings take over and drag us even deeper. It is not just feeling bad about one's self and one's circumstances. It is being overwhelmed and governed by those feelings.
Depression is a feeling of guilt and unworthiness. It is a debilitating mood. In depression the conscience becomes overly active and introspective while the body itself slows down and operates at a lower level. In depression we become absorbed in thoughts like, "What good am I?" What's the use anyway? I just can't take it, it's too much."
The Psalmist in the 42nd Psalm gives an extraordinarily accurate picture of depression. Two figures are used: 1) Downcast - As a man bowed down under the weight of some heavy object, so the depressed soul feels itself under a crushing weight from which it cannot escape itself and which it cannot bear. 2) Disquieted - As the sea is tossed by the storm and not at ease, so the depressed heart is plunged into the depths of woe and feels itself unable to attain peace. The psalmist also speaks of the outward symptoms of depression. He looks troubled, haggard, dejected, vexed. He weeps day and night. It has affected his appetite. He is worried about himself and what is happening to him. Everything seems to be on top of him and he is drowning in a sea of woe.
The Scriptures impress on us the depth of this despair. We have already seen that it can affect us physically to the point of sickness, ulcers, weight loss, obesity, loss of memory, etc. (For this see Ps. 77:2-4; Ps. 102:3-5; Ps. 88). It can lead to a total breakdown, in which we cease to function at all (see Jer. 20:7-9). And still more, in depression the sense of God's presence is lost. In the throes of depression we can conclude that God does not answer our prayers or take pity. We become angry with Him and feel ourselves cut off from His presence forever (see Ps. 13; Ps. 77:1-10).
Thus spiritual depression is an interruption of the experience of the peace of God in the soul, a loss of the assurance of God's favor, a surrender to the monster of self-pity, an introspection which is not guided by faith in Christ but by our own pride.
What is the Cause of Depression?
The causes can be many. Anything which tends to get us down a bit can be the initial cause of depression. It can be a change of job, working too much, resentment or bitterness towards someone or something that has happened, marital strife, the waywardness of our child, a disappointment, our looks and abilities, etc. These and more can be the occasion from which depression arises. Or it can be when we know we are guilty to begin with; that is, it can come out of a known and willful sin and transgression of God's will.
However, depression is due to the response one gives to the difficulty, change, disappointment, or sin that has come into one's life. When we fail to respond biblically, and fail to have all our thinking and acting regarding the thing that has come into our lives or the thought has risen in our minds controlled by the Scriptures, then depression strikes. Depression arises when we are governed by and give in to our own feelings regarding these upsetting things, rather than being ruled in our thinking, willing, and acting by the Scriptures.
Depression can spiral. We can fail to handle a responsibility biblically. We walk in a sin impenitently and without making amends as far as we can. we fail to deal with a setback as God would have us deal with it. We look at ourselves and think of ourselves according to the standards we have devised. As a result we feel bad. Then, instead of following our obligations before God and dealing with that responsibility, sin, or lack of self-esteem as God would have-us to do, we follow our feelings on these things. We find ourselves seeking pity. And the end is that we feel worse and worse about ourselves, our circumstances, and our obligations.
We must remember that we are frail and weak saints of God who need at every turn of the way and moment of the day to have our innermost thoughts governed by the Word of the Lord. So easily we slip into viewing life's situations and ourselves from our own vision, rather than through the cross of Christ crucified. When we do this, and then leave ourselves stand for a moment before the gaping hole of our own feelings, our steps well nigh slip and we conclude: "for all the day long have I been plagued, and chastened every morning)" Ps. 73.
The question is asked whether depression can have physical causes. It would be a denial of Scripture to rule that out. Scripture teaches that God has made us one, yet soul and body, and thus there is an inseparable relationship between the physical life and the spiritual. This is powerfully illustrated in the life of our Lord. We read that the devil came to tempt Jesus after He had been in the wilderness forty days and nights fasting, and therefore in a weakened physical state. He, the devil, chose this moment because he was and remains a careful student of human nature, playing every contributing factor in our makeup for his advantage. Because of the close relation between soul and body, we may not dismiss physical factors which either can enter in or lie at the root of depression. A complete physical examination, as well as the use of drugs which supply the body what it normally produces and is not producing can be helpful in the treatment of depression.
Nevertheless, to place depression in the category of physical illness would be a mistake. Then, as with a toothache, so also when my soul is in the depths and I find fear and guilt on every side. I should take myself to a medical doctor for the cure. Then I need perhaps an injection, but I do not need the present power of Christ's grace delivering me from the bondage of my sinful self. To make depression primarily a physical ailment is to negate the need for the real delivering mercies of God working in the heart and soul. Besides, even the aspects of depression which are physically related only underscore and make vivid the problems which are present in the life of the particular saint suffering depression. Depression has to do with sin. Ultimately it has to do with unbelief, the greatest sin against which we struggle. It is the failure to trust in God, even though He slay me. As hard as that is for me to hear, hear it I must, for then, and only then, can I rejoice in the power of Christ Jesus who came to save sinners also from the pit of depression.
How Should We Deal With the Depressed?
First of all, we must handle the Word of God skillfully, compassionately, and believingly.
I trust we need not work to establish the case among us that the Word of God is the powerful tool for treating depression. Depression can and does lead God's saints to be unable to read the Bible and even to become angry at the Bible itself. For a time they cannot use it right. Or they can be using it but not applying it. Therefore, I want to stress the modifiers above: skillfully, compassionately, and believingly. To bring this out, we should be aware of two dangers in this regard.
The first danger is that of compassion without actually bringing the Word of God. Now compassion is essential for the work of the pastor/elder as Paul sets forth in Acts 20. But there must be more than mere empathy. If all that is accomplished is that the distressed of soul says, "How understanding and sympathetic you are," but he is not told what the Word of God says to him in his need, what good is it? The goal of much shepherding today seems to be to establish the reputation of ministers as sympathetic men. If we are to help our people in their need, the Word must be brought, for it is in the Word that we believe Jesus comes with His healing grace. More, we will make matters worse. The child of God has come to us and told us his woe. It is out there as big as ever. If no word from God comes, the preoccupation with the problem has only increased as a result of the talk with the pastor. We must not only talk about the problem, we must through the problem to see what God says about it. Even the pastor of pastors, the apostle Paul, did not allow his warm heart for the sheep to keep back the Word of God. He reminds the elders of Ephesus, "I kept back nothing that was profitable for you..."
The second danger is to use the Word of God as some kind of magic wand. This is to use Scripture simplistically, to read a few texts and explain them in a general sort of way and then send the person off reciting a favorite passage. We must be faithful and honest with the Scriptures, using them skillfully- that is, practically, substantively, concretely, pointedly. The Scriptures must be brought to bear on the specifics of the depression the person is enduring.
Secondly we must work with the depressed in the framework of the truths of justification and the adequacy of God.
Justification is the truth which, when it rests in the heart, must soothe the troubled soul. Justification humbles pride by teaching that my acceptance with God cannot be based on myself even if I were as good as my pride would want me to be. Justification proclaims to the soul in the depths that there is no condemnation to it. Justification is truth which supplies the motivation for sanctification and thus the reason why I as a despairing saint ought not despair and can do what I find so impossible to do. It was the knowledge that God had cast all his sins behind His back that delivered Hezekiah from the pit. The sins and failures he saw and could not hide from his view had been hid by God. This knowledge got him up again to praise God and busy himself with teaching his children (Is. 38).
The adequacy of God is the answer to every conceivable feeling of inadequacy in ourselves. "Hope thou in God!" was the counsel David gave to his downcast and disquieted soul. We labor in the conviction that in knowing God in His being there is a balm for every wound, correction for every thought, strength for every duty. God delights in having His people know Him in the full array of His virtues (Ex. 34:5-7). He is Jehovah, and, therefore, though we are so weak and sorrow is so strong, He abides stronger. To the fear which the depressed have that He will not help me, He proclaims His name as merciful, gracious, and longsuffering. In dealing with depression we must never doubt the adequacy of our God.
And thirdly, we must take depression seriously, watching for the warning signs, and spending the needed time and energy in counseling which depression requires.
Our eyes should be sensitive to the beginning of depression in the lives of the saints. Some of the indications of depression are: withdrawal from family and friends; loss of interest or satisfaction in one's calling; a feeling of isolation and loneliness; slowed thinking; feeling a burden; feeling helpless and without hope; problems on the job or in the family; sleep difficulty and weight loss; irritability; talk about dying; prolonged grief.
Depression should be something we address in the preaching, frequently in fact, as the struggle against depression is in one form or another common in the lives of God's people, and will be so long as they are in the body of this death.
We should be prepared to spend the time that is needed and deal as thoroughly as we can with the cases of depression that come to our attention. Seldom is one visit to the pastor or elder going to alter a pattern of depression in the life of a child of God. It does not work that way. "This kind can come forth by nothing, but by prayer and fasting" (Mark 9:29).
As difficult as this work can be, we engage in it, as with all our work, in the undefeatable confidence that "The Lord redeemeth the soul of His servants: and none of them that trust in Him shall be desolate" (Ps. 34:22).
Carl J. Haak
Pastor of the Protestant Reformed Church of Lynden, Washington
The Standard Bearer
Volume 69/1993
Issue: 11, 3/1/193
