Depression hurts. Abraham Lincoln, in a bout of depression said: “I am the most miserable man living…. Whether I shall ever be better, I cannot tell.” C. H. Spurgeon expressed his own trials: “I could weep by the hour like a child, and yet I knew not what I wept for.… The iron bolt … mysteriously fastens the door of hope and holds our spirits in gloomy prison.” Another sufferer reflected: “I feel as though I died a few weeks ago and my body hasn’t found out yet.” To experience depression is to endure a most trying burden and any who are spared need to be most compassionate to those suffering with it.
Most people will experience regular ups and downs in life, but some enter the deep, persistent, and chronic symptoms of depression, namely, low mood, loss of pleasure, lack of energy, sleep disturbance, feelings of worthlessness, and thoughts of life not being worth living. Some struggle with thoughts of self-harm and suicide.
Solving the problem of depression can be difficult and complicated. The world offers various approaches, some helpful but others at variance with scripture. Many of them are based on a denial of man’s sin and depravity. Undiscerning Christians have allowed much ungodly psychology to creep into the church. We need to be very careful in this area and to resist the temptation to allow our thinking to be conformed to the world. We need to pray to have our minds renewed (Romans 12:2) so that we may think clearly and biblically with the help of the Spirit.
To get to grips with how to help those suffering we need to give some thought to potential causes of depression. An over simplistic approach can lead to difficulties in pastoral care and a lack of compassion within the church. Why a soul suffers from depression is not always an easy question to answer. The psalmist asks with poignancy, “Why art thou cast down, O my soul? and why art thou disquieted in me? hope thou in God: for I shall yet praise him for the help of his countenance” (Psalm 42:5). Sometimes an obvious cause will be apparent, but at other times not.
At this point we must recognize that the experience of depression can be the result of conviction of sin. Many of the symptoms are consistent with profound guilt and the psalmist in Psalms 38 and 51 reveals many physical and psychological consequences of conviction. Saul’s experience of depressive symptoms in 1 Samuel 16:14–23 arises as the Lord rebukes and chastens him for sin. When conviction arises with depression-like symptoms the only remedy is in Christ. The sufferer must be counseled to flee to Christ. His death and resurrection secure the promise of the blessing: “Blessed are they that mourn: for they shall be comforted” (Matthew 5:4). That is not to say, however, that all depression is a response to unresolved sin and guilt.
Sometimes depression is a reaction to life’s trouble and disappointments. Bereavement, unemployment, and disappointment are examples of things that can have a dramatic impact upon our moods. While Elijah’s despair after the victory of Carmel is multi-facetted in origin, yet surely at least part of it was the disappointment at the lack of change in the land following the manifestation of the power of God (see 1 Kings 19:4). The Lord’s direction to us to deal with our cares in prayer is an implicit proof that our cares can disturb our peace (Philippians 4:6–7; 1 Peter 5:7). The peace of God, the tranquility of soul that is promised, is placed in opposition to the troubled heart (John 14:27). Life’s events, under the providential hand of God, can trouble our souls. Be aware and never forget the friend we have in Jesus. He promises peace to the soul that rests in Him (Psalm 55:22).
Depression can occur along with a physical illness. It has been demonstrated that depression may be present alongside cancer. It is a symptom of hypothyroidism and even heart disease. One of the most difficult occasions in which we find depression is just following the arrival of a baby. A woman may find herself suffering in deep despair, even in the context of expected delight. If depression arises in these circumstances it is vital that appropriate medical help be sought out.
At times souls may find themselves in a depression that cannot be explained. Such a person may, in all sincerity, say, “I have no idea why I feel this way.” Is it unreasonable to see depression as an illness in itself?
This is controversial but the brain is an organ and as such is susceptible to illness be it infection, inflammation, cancer, etc. The fall affects all the body. The brain is clearly affected in conditions such as dementia and stroke. Why not depression? While I wouldn’t say Elijah was depressed, the symptoms he expresses in 1 Kings 19 are caused by a complex mixture of physical and spiritual factors. He is helped by food and sleep before the Lord corrects his wrong thinking.
Furthermore, we should acknowledge the potential for a spiritual depression that is not due to sin but due to the Lord’s withdrawing himself. The Westminster Confession of Faith in chapter 18:4 reads, “True believers may have the assurance of their salvation divers ways shaken, diminished, and intermitted; as, by negligence in preserving of it, by falling into some special sin which wounds the conscience and grieves the Spirit; by some sudden or vehement temptation, by God’s withdrawing the light of His countenance, and suffering even such as fear Him to walk in darkness and to have no light” (emphasis added; see also Psalm 77:1–10; Isaiah 50:10).
This is a very brief overview but the complexity shows that we must take time and care in teasing out the trouble in order to help. Furthermore, we must avoid a judgmental spirit towards those suffering. To tell a depressed soul to repent of sin or to say, “You have no reason to feel that way!” may grievously wound the wounded.
Escape from depression
One struggle that Christians with depression have is the thought that they are to “rejoice always.” Thankfully, sorrow and joy can co-exist. The Lord Jesus as sinless man was acquainted with grief, a “Man of sorrows,” yet He knew perfect joy (see John 15:11; 17:13). Even in trouble and trials there can be joy and heaviness (1 Peter 1:5–6). We are to “rejoice always” yet “weep with those who weep” (Philippians 4:4; Romans 12:15). Our joy will be constant if it is found in the Lord. Joy and happiness are not the same. Happiness arises from our circumstances; as they change so do our feelings. True joy is found “in the Lord.” Since true joy rests in the unchangeable veracities of the Lord, on gospel truth and privileges, it is not subject to the changes of providence. Focusing on these realities is vital in working through depression.
When we reflect upon the causes of depression we should acknowledge it will often be a good idea to consult a good doctor. There may be a health issue that needs addressed. There might even be a time to consider the use of anti-depressants. Anti-depressants don’t work for everyone and they perhaps treat only symptoms and not the cause of depression, but judicious use may be appropriate.
But a spiritual response to depression will always involve the application of the gospel to the believer’s mind. The believer will find refuge in the truth of God’s sovereignty. God rules over providence and over our feelings and troubles. He is the sovereign God (Ephesians 1:11) who is working for the good of His children (Romans 8:28). Emphasis on these familiar truths is necessary but should be done compassionately.
When the believer is confronted with unhelpful emotions, he must learn to apply the gospel. The Christian can sin in his emotions, the faculty of the soul being fallen in Adam. Unguarded inner emotional responses can bring the Christian down into depression. It is not unusual to trace the origins of depression in the child of God to fear, bitterness, guilt, disappointment, etc. It is beyond the scope of this article to detail every possible negative emotion, but here are some examples of negative emotions that must be dealt with by the application of the gospel:
Fear. The Christian who lives in fear of the future must remember the gospel promises. The God of heaven “knoweth that ye have need of all these things” (Matthew 6:32). He who has spared not His own Son but delivered Him up for us all has promised to give all that is necessary to conform us to the image of His Son (Romans 8:32).
Anger and bitterness. The believer struggling with anger and bitterness due to the sin of others again should find benefit in reflecting upon the character of God. Bitterness can so consume the soul that deep depression can result. Such bitterness needs to be rooted out. This occurs through a right understanding of God (see Ephesians 4:31; Romans 12:19–21). God will never overlook sin and all sin has been or will be dealt with on Calvary or in hell. We are to leave room for the wrath of God. Moreover, we are to rejoice that though other believers may sin against us their sins find atonement in the blood of Christ.
Guilt. For some believers guilt for past sin can be overwhelming. The feeling of guilt is an important aspect of conviction, but the child of God who has appropriated the gospel is free from the conscience of sin (Hebrews 10:22). The only cure for the guilt of sin is the gospel. The soul depressed through misplaced guilt must feed often at the banquet of grace.
Secular counseling is often promoted for the treatment of depression. The Christian, however, will fear the influence of ungodly views of man and sin. He will cherish the application of gospel truth to his soul. Dr. Martin Lloyd-Jones in his book Spiritual Depression comments on Psalm 42:11: “Now this man’s treatment was this; instead of allowing this self to talk to him, he starts talking to himself.” “Why art thou cast down, O my soul?… hope thou in God … who is the health of my countenance and my God” (Psalms 42:11). Trusting in the Lord and believing the fullness of the gospel promises is vital for spiritual and psychological well-being.
Those who are involved in caring for suffering friends and family members need to have great patience. In all honesty it can be infuriating to see those we love unable to get on with life. We need to pray much that the God of all comfort will minister according to His will. At times the greatest thing we can do is offer practical help and support.
Christians must endeavor to always keep their eyes on Christ and His work. He came to heal the broken-hearted in the power of the Spirit (Luke 4:18). Our ultimate hope in the midst of melancholy is that “God shall wipe away all tears from their eyes; and there shall be no more death, neither sorrow, nor crying, neither shall there be any more pain: for the former things are passed away” (Revelation 21:4).
Dr. Stephen Pollock is the minister of Ballymagerny Free Presbyterian Church in Northern Ireland and associate editor of Free Presbyterian Vision, the magazine of the FPC of Ulster. He trained as a medical doctor before entering the gospel ministry.