This is the second installment in our series on mental health and the church. You can read the introduction to the series here. Vanessa Felhauer, MA, NCC is a member of Summitview's Counseling ministry.
Last week, I called my new insurance company to find a primary care physician. The admin who helped me asked a couple of quick questions to get my medical file started. She asked if I had any chronic medical conditions and if I had been to the ER or been hospitalized in the last year. Then she proceeded to do a depression screen similar to what I as a counselor do during an initial intake. That was it. But it startled me that checking for depression seemed to be a top priority for this HMO.
I shouldn’t have been surprised. According to the National Institute of Mental Health, major depression is one of the most common mental disorders in the United States, and nearly 10 percent of the population is struggling with some form of mood disorder during any given 12-month period. Billions of dollars are spent on antidepressant medications each year in the United States.
We in the Church are not immune to depression, whether we are talking about a clinically diagnosable depressive episode or just feeling “down in the dumps.” The care and cure of the soul should be the domain of the Church. However, the underlying causes for depression, and the approach to dealing with it, can be a source of contention among believers.
Faith in the Midst of Chemistry and Circumstances
There are two broad categories of theory regarding the etiology of depression. One is the idea that it is purely biochemical or genetic in nature. And research does point to changes in brain chemistry with depression, as well as genetic predispositions. The problem is that we don’t know what causes those changes. There is currently no way to measure serotonin or dopamine levels in order to receive a diagnosis of any of the mood disorders. It becomes a chicken-or-the-egg question: Is my brain chemistry off so I feel depressed, or did something circumstantially cause me to feel depressed, which thus changed my brain chemistry?
The second broad theory is that depression originates from my response to external circumstances — a traumatic experience or discontentment with current life circumstances. Many evangelical Christians reject the biochemical theories in favor of this theory. But I think it’s important that we consider both.
The Bible talks about both the inner and the outer man (Hebrews 4:12, 1 Thessalonians 5:23). We live in fallen bodies that don’t always work correctly (Genesis 2:16-17). If I came to church and said I had cancer or arthritis or Parkinson’s or some other “medical” condition, I would (hopefully) not be told to just pray more or read my Bible more. I would (hopefully) be prayed for and grieved with. Now, praying more and reading my Bible more would probably change how I handle a difficult medical condition. Not because it is a moralistic prescription for my troubles, but because I am engaging relationally with a God who cares about my troubles. In the midst of these difficult medical situations, we are faced with choosing to respond in faith or in fear.
Depression should be viewed the same way. Determining the order of the chicken and the egg is irrelevant when caring for the heart. The person struggling with depression may have a biochemical imbalance or a genetic predisposition, or they may just be discontent. But prayer and Bible reading should never be a moralistic prescription for matters of the heart. The person sitting in the pew next to you is a hurting image-bearer. We need to have the courage to get involved compassionately in the messiness of one another’s lives. Charles Spurgeon battled depression and his thoughts here are stern but sobering: “. . . they [depressed individuals] are . . . to be viewed with compassion, and if those who blame them furiously could once know what depression is, they would realise the cruelty of scattering reproof where comfort is needed.”
A purely biological/chemical explanation for depression makes it a value-free diagnosis that negates any spiritual reality. But it cannot be value-free because I am always responsible before God for my choices, regardless of genetics or chemical imbalances. God is gracious and compassionate (Psalm 103:8), and he sympathizes with our weaknesses (Hebrews 4:15), but my weakness, regardless of the reason for that weakness, does not excuse me from obedience. The depressed person also must to choose to respond in faith or in sin.
Counselor Winston Smith comments, “Physical and mental limitations may shape the form that our faith and obedience take, but they cannot prevent a response of faith.” We all have our own set of life circumstances (Psalm 16:6) in which God has asked us to endure in faith. Depression may be part of your circumstances, and God is asking you to endure it with faith. God can use even our weak faith to mock Satan and glorify himself.
Full, Redemptive Impact
So what does it look like to minister the “gospel’s full redemptive impact” to the sufferers-sinners-saints who are struggling with depression? I think it starts by taking the time to know one another deeply. Most people struggling with depression don’t want to be fixed; they want to be heard. There is much pain, loneliness and hurt that disappear when someone else takes the time to know us.
And even when biochemical causes for depression are present, medication is no more effective than non-medical treatment, on average. Drugs are no substitute for a friend who cares deeply.
We also need to take the time to know our own hearts. Has the truth of the gospel deeply affected you? Do you understand what you have been rescued from, or is the gospel a moralistic prescription in your own life? Are you deeply known by another? In a culture where depression is so prevalent, we must be able to answer these questions well and minister well to one another if we are to have any hope of impacting our culture relevantly and graciously.
If you are struggling with depression, the gospel can have a redemptive impact, regardless of the etiology in your particular case. But you must be willing to look beyond the biochemical to experience the God who created the biochemical. Seek out someone who can help you to know your heart and know your God. Join one of our small groups, our women’s Bible studies or men's groups and build community with other suffering, sinning saints. Summitview also offers free counseling to members. Go to our Counseling page for more information.