In the UK, 1 in 4 people suffer from a mental illness1, of which the most common mental disorder is mixed anxiety and depression1. Between 8 and 12% of the population experience depression in any one year1, and suicide remains the single most common cause of death in men under the age of 352.
Depression is something that affects virtually everyone either directly or through friendships and relationships. However, it is a topic hardly ever mentioned in the public sphere- whether secular media, church settings or social situations. Therefore, many people find depression confusing and difficult to talk about at best, and stigmatised and tabooed at worst.
The subject of depression is one that I have covered in a little depth in my uni courses (I’m a Medical Student doing a year in Psychology) and it is also an issue I’ve had to personally face. However, I’m obviously not a psychiatrist, and so my knowledge and experience is fairly limited. Therefore, my aim with this article is to:
- Briefly outline what depression is from the medical and psychological perspective
- Look at what the Christian view of depression ought to be
- See what the bible has to say to those struggling with depression
Throughout this article, I’m also going to be touching on my own personal battle with depression- something I have never voiced in public before. People who have depression often find it difficult to talk about their struggles even to close friends or their doctor; according to the National Institute of Mental Health many people with treatable depression never seek medical help3. C S Lewis, who suffered from depression, wrote: “Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say ‘My tooth is aching’ than to say ‘My heart is broken.’”4 Therefore my primary hope is that in writing this blog, I may be able to help others to see that depression is not something that we have to hide or be ashamed of, and in a small way, try to burst the taboo surrounding the suffering from depression.
1. What is Depression?
Everyone occasionally feels sad or down. But these feelings are usually short-lived and pass within a couple of days or less. However, depression is more than just “feeling down”; it is a real illness with symptoms ranging from the psychological such as lasting feelings of sadness and hopelessness, and loss of interest in once enjoyable things, to the physical such as fatigue, insomnia and loss of appetite 5. Depression also covers a large range of severities, from mild to significantly debilitating, and symptoms greatly vary between patients.
The neurobiology of depression is complex6, with much ongoing research. In the brain, information is transported by two media: electrical impulses down “neurons”, and chemicals called “neurotransmitters”. There are many different types of neurotransmitters, which carry out functional different roles. The generally accepted classical model states that depression is (at least in part) caused by the diminishment of two specific neurotransmitters in the brain: serotonin and noradrenaline. There are also other factors that appears to play a role in the illness, including increases in cortisol (the body’s “stress hormone”)7, neuronal damage in the hippocampus8 and dysfunctional immune regulators9,10. The most commonly prescribed treatments for depression are SSRIs (Selective Serotonin Reuptake Inhibitors) and CBT (Cognitive Behavioural Therapy). SSRIs are a group of antidepressant drugs that increase the concentration of serotonin in the brain, while CBT is a talking therapy that helps patients manage their problems by trying to alter thinking and behaviour.
2. What Should the Christian View of Depression Be?
As a Christian, I have generally had positive experiences when I speaking about my depression with other Christians. However, I am well aware that other suffers have had very different experiences, and there is huge diversity of Christians’ beliefs about depression. On one hand, some say that depression is a result of not being “right with God”, or that depression is a spiritual conflict that can only be healed by some sort of “spiritual healing” experience. Some people even say that depression is incompatible with having a relationship with God, which is the source of true joy and life-fulfilment. On the other hand, some have a purely medical view of depression, as a medical illness analogous to a physical ailment, and thus depression is distinct from the spiritual dimension of a person. So in all of this, can a logical, evidenced, biblically-grounded Christian view of depression be sketched out?
Is Depression Compatible with a Relationship with God?
I think it is worth initially asking whether depression is compatible with an authentic, saving relationship with God. Throughout the bible, one powerful and clear repeated message is that a relationship with God gives us joy. 1 Peter 1:8-9 (NIV) says “Though you have not seen him, you love him; and even though you do not see him now, you believe in him and are filled with an inexpressible and glorious joy, for you are receiving the end result of your faith, the salvation of your souls” while Romans 15:13 (NIV) says “May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit.” In fact, when we become Christians, the bible promises that the Holy Spirit with come and dwell within us12, and one of the “fruits” that the Holy Spirit produces is “joy”13. This doctrine is a difficult one for anyone who has gone through any amount of suffering, and can be especially tough for someone struggling with depression. For many people, depression means feeling chronically or spontaneously sad, upset or angry, and regularly unable to feel happy.
However, I think a mistake is often made in mixing the definitions of joy and happiness. The bible promises that God will give joy to our lives; however, nowhere (as far as I am aware) does it promise “happiness” on this side of Heaven. I do not think it is possible for anyone to be happy all the time, and that was certainly not the case with Jesus- the man whose life we are meant to imitate. According to the gospels, Jesus trashed the vendors’ tables and seats in the temple out of fury13, sweated blood out of stress and sorrow in the Garden of Gethsemane14, and cried out to God in overwhelmed anguish “my God, my God, why have you forsaken me?” while He was dying on the cross15 (to name but a few examples). So when the bible promises joy when we enter relationship with God, I think it is talking about something much deeper than the transient emotion of happiness. Rather than spawning from our changeable situations and aspirations like “happiness”, biblical joy is produced by something different; Romans 15:13 says that our joy is given by a filling from the “God of hope”. Biblical joy is a gift from God, which stems from our hope of eternal life, made possible through the death and resurrection of Jesus. So rather than a transient, situation-dependent mood, God-given joy is a deep, life-changing satisfaction, fulfilment, security and craving for Jesus that comes from knowing God’s saving grace. In the words of John Piper, Christian joy is “the echo in our emotions- our hearts- of experiencing Christ as precious and experiencing Christ as reliable… Christian joy is the joy of craving the preciousness of Jesus and the reliability of Jesus. You become like what you crave. Christians crave Christ. Therefore they become like Christ.”16
So can people with depression still have a strong, fulfilling, saving relationship with God? In my view, absolutely! As someone who suffers from depression, I often find it impossible to feel a sense of happiness. However, I still can and do crave the preciousness and reliability of Christ, and have the deep sense of fulfilment and security that comes with the knowledge that I have a relationship with Him.
Another reason why depression should not be seen as a blockade that can prohibit people from living life for Christ is the nature of depression. This brings me on to my second question.
Is Depression Medical, Spiritual, Both or Neither?
One man whom I have learned a huge amount from about being a Christian medic is former consultant neonatal paediatrician (UCH) Prof. John Wyatt. In a talk to the UCL Christian Medical Students (2014) Prof. Wyatt spoke to us about how humans have at least four different dimensions, all of which require care: the physical, psychological, relational and spiritual. Wyatt then went on to emphasise how integrally linked these four dimensions are; physical illnesses have psychological, relational and spiritual consequences, relational problems have physical, psychological and spiritual effects and so on. The distinction between physical and spiritual attributes are often fairly easy to discern; however, distinctions between the psychological and spiritual are often more difficult to make.
This all makes how Christians should approach depression a very complex topic.
The more I have studied the psychology and medicine of depression, and experienced it myself and through friends, the more I have come to the belief that depression is very idiosyncratic- meaning that the causes, mechanisms and effects vary greatly between individuals.
For some (including me), depression is a largely psychological and/or neurobiological illness; I know that my depression has a significant neurobiological element to it because I have responded quite positively to SSRIs. However, this sort of depression can have difficult spiritual ramifications; it can lead to doubts about God’s love, sovereignty, plan or even existence, feelings of alienation from God, distancing from fellowship, feelings of aloneness, and much more besides. In such cases, the spiritual side of a person needs to be taken care of, as well as the underlying medical causes.
I do also think that the reverse situation can occur, where spiritual problems have psychological and/or neurobiological ramifications. I have known people who went through spiritual battles resulting in depression, and have responded much better to spiritual counselling and care than antidepressants or standard (secular) CBT. This seems to indicate that their depression had primarily spiritual roots, but may have affected their psychology and neurobiology.
Therefore, people who deem depression a solely spiritual problem that just requires “getting right with God” are, in my view, misguided. If you suffer depression, it does not mean you are any less of a Christian, any less loved by God, or any less useful to God. In the past 12 months, I have been privileged to have been a part of more gospel ministry than I have ever experienced before- in the writing of my book Evidence for the Existence of God, managing the UCL Christian Union outreach events, and my church and conference youth work. However, all of this has happen while I have been struggling with depression. For reasons I do not pretend to understand, God chooses to work out His plan through flawed, frail and fragile human beings, and God promises that His “grace is sufficient…(God’s) power is made perfect in weakness”17.
And as a Church, I believe that we can and should take the medical side of depression more seriously. Last year, a friend of mine came into a Christian Union meeting in crutches and her foot in a cast, having broken it in an accident. People immediately came to her practical aid- holding doors for her, offering to take her bags, ensuring she had a seat, and so on. We should have the same approach to mental illnesses; rather than over-spiritualising the situation we should be offering practical aid and support. Often this can be in the form of seemingly simple things such as offering to chat, being a shoulder to cry on, or even just saying “I’m here if you ever want to chat”.
However, we also shouldn’t go too far the other way, and assume a reductional physicalistic approach; in other words, we should not assume that the physical is all that there is. With depression in Christians, the medical illness can often lead to negative consequences on the spiritual well-being of the person, and that is certainly my experience. Therefore, spiritual support and care is often essential in the church context, to complement medical treatment, whether in the form of spiritual counselling, having fellowship, or simply showing God’s grace and love.
3. What Does the Bible Say to Those with Depression?
I have been battling depression for around a year, which, compared with many people who suffer from depression, is a very short amount of time. Therefore, my experience and knowledge-base is somewhat limited. However, there are some solid bible truths that have hugely helped me live as a Christian battling depression.
God of Love; God of Empathy
In a church communion service not too long ago, I was going through a particularly bad spontaneous low point. As the bread and wine passed down the rows, I had this feeling of depressed aloneness that often comes with my lows. However, as I picked up the bread and wine, a truth that every Christian is very familiar with hit me like a train- God’s incomprehensible love of us. The bread and wine symbolise Jesus’ body being broken and blood being shed, as He died at Calvary so that we may have eternal life. And as Jesus said in John 15:13, “Greater love has no one than this: to lay down one’s life for one’s friends.” God loves us all more that we can possibly imagine, and when I get depressed and feel alone or unloved, I try to always turn to the cross, as the proof and eternal reminder that no matter how unloved I feel, God loves me.
But the cross not only demonstrates that the God of the bible is a God of love; it also is a powerful reminder that God is a God of empathy. As Philippians 1:5-8 unpacks: “Christ Jesus: who, being in very nature God, did not consider equality with God something to be used to his own advantage; rather, he made himself nothing by taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself by becoming obedient to death- even death on a cross!” The cross shows us that God understands what it is like to suffer pain, feel alone and abandoned, be betrayed, and cry out in anguish. This brings me neatly onto my second subheading…
The God who Heals; The God who Doesn’t
One important point that I can’t avoid in an article about mental illness is the topic of healing. There is commonly repeated, but wholly unbiblical claim that some people make, that I feel I ought to address; the bible never guarantees healing of physical or mental ailments while we are on Earth. This is a tough doctrine to swallow, for someone like me who has repeatedly cried out to God to remove the pain of depression from my life. God does promise to heal all our illnesses and pains, but only when we get to the New Creation, and everything is be renewed. And I do believe that God can and does heal on Earth today, and beckons us to present all our desires and requests to Him. However, no minister or preacher or any other Christian can guarantee supernatural healings “on demand” while we live in this broken world; this even included Jesus, who prayed before His crucifixion: “Father, if you are willing, take this cup [of God’s wrath] from me; yet not my will, but yours be done.”18
However, God promises something very significant to those going through suffering; as I unpack in much more detail in my article Suffering: A Good God?, Romans 8:28 (NIV) says “For we know that in all things, God works for the good of those who love him”. This means that if we love God, no matter what suffering we are going through, whether the ache of a broken relationship, the heartbreak of loss, the anguish of physical pain, or the darkness of depression, God is working through our situation for our good. There may come a time when we realise the reasons for our suffering; however, we will almost inevitably go through suffering with reasons behind it that we will never know until we get to Heaven. But the awesome truth of Romans 8:28 is that in all things, including depression, God loves us, cares for our well-being and is always working for the good of those who love Him.
People are Great; People Let You Down
As well as homing on the truths about God’s character, the other thing I have found helpful to deal with my depression is to look at God’s guidance. There are two specific pieces of guidance that I have found particularly useful in my personal battles.
In Ephesians 4, Paul writes to the church in Ephesus “Be completely humble and gentle; be patient, bearing with one another in love. Make every effort to keep the unity of the Spirit through the bond of peace. There is one body and one Spirit, just as you were called to one hope when you were called; one Lord, one faith, one baptism; one God and Father of all, who is over all and through all and in all.”19
Paul’s message to the Ephesians in this passage is clear- be united; in the space of two verses, Paul writes the word “one” seven times! Christians unite because they ultimately share a Saviour, spirit, hope and faith- things which transcend all social barriers, economic disparities, personality diversities, and health differences. When I was diagnosed with depression, it totally overturned my entire life, and the subsequent few weeks were some of the darkest in my life. However, it was in this time that I discovered just how valuable and precious my church family really are. Church was and still is one of the very few places where I can be totally open with my battles and struggles, and can unashamedly ask for help, comfort and prayer. No matter what people think of me, I know that the bonds I share with Christians in Christ are stronger and more resilient than the normal bonds of friendship which can change as people and relationships grow. But as the late John Stott summarised: “There is one Christian family embracing us all because there is only one Father- one God and Father of us all who is above all, in all and through all… The unity of the church basically is as indestructible as the unity of God Himself. In that sense you can no more split the Church than split God.”20
However, if I were to claim that Christians have only positively aided my battle with depression, I would be lying. The unfortunate reality is that even though people are capable of doing incredible good, people are also capable of letting you down. I have some very positive and very negative experiences of people in my battle with depression. In fact, my depression was probably caused and certainly compounded by Christian colleagues whose victimising and isolating actions drove me into a deep state of depression. And so as I land this helicopter-ride through Christianity and depression, I want to end on the single most helpful and precious guidance I have found in my battle with depression: go to the one who will never let you down.
In Matthew 11:28-30 (NIV), Jesus says to the Galileans: “Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.” These couple of verses revolutionised the way I deal with my depression. When I am going through a low, I find great comfort from remembering God’s love and empathy, and speaking to Christian brothers and sisters. However, the single thing that helps me most to deal with my depression is simply to bring my burdens and pain to Jesus- our sinless Saviour who will never let us down, and who beckons us to let Him share life’s load. No-one has to suffer depression alone; Jesus can not only comfort us and give us hope, He tells us that He if we ask Him, He will come alongside us like two oxen yoked together, and share the load of our emotional, spiritual and psychological burdens.
So as I draw this, the most difficult article I have ever written, to a close, I’d summarise by saying that depression is a really tough, and often misunderstood medical illness with many potential spiritual, physical, psychological and social manifestations. However, it is still possible for Christians suffering from depression to live a vibrant, fruitful, Godly life. For me, this has been helped by constant reminders that God loves me and understands my pain, immersing myself in a caring church family, and most of all, continuously coming back to Jesus as the solid rock who promises to share my burdens if I come humbly to Him.
- The Office for National Statistics Psychiatric Morbidity Report, 2001
- Five Years On, Department of Health, 2005
- S. Lewis, The Problem of Pain (1940)
- For longer list of symptoms, see http://www.nimh.nih.gov/health/topics/depression/index.shtml
- For nice review, see: Maletic V, Robinson M, Oakes T, Iyengar S, Ball SG, Russell J. Neurobiology of depression: an integrated view of key findings. International Journal of Clinical Practice. 2007;61(12):2030-2040.
- Manji HK, et al. Enhancing neuronal plasticity and cellular resilience to develop novel, improved therapeutics for difficult-to-treat depression.Biol Psychiatry. 2003;53:707–42.
- de Kloet ER. Therapy insight: is there an imbalanced response of mineralcorticoid and glucocorticoid receptors in depression.Nat Clin Pract Endocrinol Metab. 2007;3:168–79.
- Weisler-Frank J. Immune-to-brain communication dynamically modulates pain: physiological and pathological consequences.Brain Behav Immun. 2005;19:104–11.
- Tsigos C. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors, and stress.J Psychosom Res. 2002;53:865–71.
- eg. Acts 2:38
- Galatians 5:22
- Matthew 21:12
- Luke 22:44
- Matthew 27:46
- John Piper, True Christianity: Inexpressible Joy in the Invisible Christ (November 1993 Sermon). Transcript can be found at http://www.desiringgod.org/sermons/true-christianity-inexpressible-joy-in-the-invisible-christ
- 2 Corinthians 12:9 (NIV)
- Luke 22:42 (NIV)
- Ephesians 4:2-6 (NIV)
- John Stott, Sermon at All Souls Church (1975). Audio can be found at http://www.allsouls.org/Media/Player.aspx?media_id=50027&file_id=58349