Harold G. Koenig, MD and John R. Peteet, MD

Editor’s Note: Downcast: Biblical and Medical Hope for Depression is the newest addition to CMDA’s published resources, and it was intended to be released at this year’s National Convention. Due to the cancellation of the convention, we encourage you to enjoy this excerpt from the book. To order your copy when it’s released, visit CMDA’s Bookstore at www.cmda.org/bookstore.

Since the time of Job, people have struggled with depression. Depression isolates, as it causes sufferers to withdraw from others. Unfortunately, the stigma surrounding depression often reinforces the isolation. Not only do others stigmatize those who are depressed, but depressed individuals often believe these misunderstandings about themselves and experience shame. This shame arises from ignorance and misunderstanding about the nature of depression.

Unfortunately, the church, rather than being a place of healing for those who suffer, can become a place of judgement. In 2014, LifeWay surveyed 1,000 Protestant pastors about mental illness. The study found that 74 percent personally knew one or more people who had been diagnosed with clinical depression, and 23 percent of pastors reported having personally struggled with mental illness themselves. Yet, 49 percent of pastors rarely or never spoke to their church about acute mental illness.[1] In the absence of teaching from the church, many Christians adopt the misconceptions about depression that pervade our culture. And, unfortunately, often when pastors do speak up about depression, it may be to perpetuate the falsehood that “real Christians” do not get depressed.

Do Real Christians Get Depressed?
There are many people of deep faith who struggle or have struggled with depression. Some of the well-known Christians whose stories we share in this book include Charles Spurgeon, Abraham Lincoln, Joni Eareckson Tada and Lottie Moon. The journey of depression can take many trajectories. Some experience depression in the face of a tragedy, whereas others may experience repeated bouts of depression despite apparent success.

One might compare depression to the apostle Paul’s thorn in the flesh. When Paul beseeched God repeatedly to remove this thorn, God answered, “…‘My grace is sufficient for you, for my power is made perfect in weakness.’ Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong” (2 Corinthians 12:9-10, ESV). Depression, too, is a weakness in which God’s greatness can be magnified.

Myths and Misconceptions
There are many myths and misconceptions related to depression, including its causes and treatments often contribute to misunderstanding or frustration with people suffering from depression. We address several of the significant ones here.

Myth 1: Depression is due to a lack of willpower.
When we choose to align ourselves with God’s will, He gives us both the will and the ability to work for His good pleasure (see Philippians 2:12-13). That good pleasure is that ultimately all things in heaven and earth will be brought under the lordship of Jesus Christ (see Ephesians 1:3-10). How our lives witness to His power, including His power over depression, is part of that process. We cannot will ourselves well; instead, we can only willfully entrust ourselves and our needs to Him, asking Him to enable and empower us to live with our depression in a way that will honor Him.

Depression is a difficult battle, and willpower is an important strength to bring to the fight against depression. However, some individuals who pride themselves on their self-sufficiency may find it difficult to acknowledge weakness and their inability to overcome depression solely by willpower. It requires humility to acknowledge depression, humility to seek help and humility to rest on God’s will for our lives.

Myth 2: Depression is due to unconfessed sin. Suffering is punishment from God.
Sin and its consequences can certainly cause depression. The consequence of all sin is death, but God, in His mercy, does not give us what we deserve. As Romans 8:1 declares, “There is therefore now no condemnation for those who are in Christ Jesus” (ESV).

The main problem for depressed believers is their guilt over sins God has already forgiven. Depressed Christians are sometimes so painfully aware of their sins that this is all they can focus on, and they are unable to hear the reassurance of grace. Depression can often produce a feeling of guilt, even without any basis in reality. At times, depression can distort a person’s thoughts so much that Christians may even become delusional about their sinfulness. In these cases, depression is not a product of sin. Accusing them of sin may make matters worse.

Myth 3: Depression is self-pity. If you’re depressed, you’re just feeling sorry for yourself.
The underlying accusation here is that a person is responding in grief that is out of proportion to their loss. However, people respond to challenging situations in various ways. What may not amount to much of a loss for one person, may be devastating for another. This may be due to an individual’s values, previous losses they have experienced in the past or a genetic disposition that renders them more sensitive than others. Indeed, those who are depressed often have lost hope and meaning that used to give direction and purpose to their lives.

Somebody may tell the depressed individual, “A lot of people have it worse than you. You have nothing to be depressed about.” This information may be given with good intentions. They are attempting to give perspective to the depressed person’s suffering or may be trying to encourage a spirit of gratitude rather than complaining. Unfortunately, such advice is usually not helpful. The depressed person is often aware that there are those who suffer more than they do and are ashamed about it.

Myth 4: Depression is due to a chemical imbalance.
The myth that depression is just a chemical imbalance or deficiency can be a particularly insidious one, as it leads to a different kind of stigma. This popular misconception can lead some people to a feeling of helplessness, as they feel there is nothing they can do and they are dependent on medication for help. Belief in this myth can also lead people who are depressed to neglect the other strategies—physical, psychological and spiritual—that often help in the fight against depression.

This myth betrays a misunderstanding of how the brain works. While antidepressants affect the neurotransmitter pathways involving serotonin, norepinephrine and dopamine, , the brain does not function simply as a bank of neurotransmitters. Rather, the brain is an intricately designed organ that stores information within its neurocircuitry, and it is constantly adapting and changing.

A better over-simplification would be to consider depression to be a problem with faulty brain wiring. There are multiple ways the brain can be wired for depression, which includes not only genetics, but also traumatic events, negative thought patterns and spiritual beliefs (see chapter 3). In the same way, there are several ways to “re-wire” the brain, and these involve medication and other strategies (see chapter 5).

Myth 5: Depression is due to lack of faith.
Christians often erroneously believe that if a person is walking closely with God, he or she should not be depressed. Instead, the person should be confident in God’s goodness, experience hope and joy, and trust God whatever the circumstances. There is the belief a spiritually mature person should be stoic, unperturbed to aversive life circumstances and immune to suffering.

Spurgeon offers this critique to those who would judge the depressed as lacking in faith:

“There are a great many of you who appear to have a large stock of faith, but it is only because you are in very good health and your business is prospering. If you happened to get a disordered liver, or your business should fail, I should not be surprised if nine parts out of ten of your wonderful faith should evaporate.”[2]

Some people judge the depressed from the security of their own comfortable situations. It is easy for a person to have faith when things are going well, because they need not lean on their faith. It is when circumstances become difficult that one’s faith is tested, and a person must hold tight in desperation to God’s promises (Hebrews 11:1, James 1:2-3).

Many modern Christians only depend on God to do for them what they cannot do for themselves, and as a result, God is more or less an addendum to their lives. Those who have journeyed with Him into and out of depression know they can only survive when God is present at every moment, the first and only focus of their faith.

God has a purpose in all that He causes or allows. He is going somewhere in our lives. The question is: Are we willing to go there too—on His terms, not ours, wherever that takes us—even depression?

To read the rest of the chapter, order your copy today from CMDA’s Bookstore at www.cmda.org/bookstore.

About the Authors
Jennifer Huang Harris, MD, is a psychiatrist at the Brigham and Women’s Hospital in Boston, Massachusetts and an instructor in psychiatry at Harvard Medical School.

Harold G. Koenig, MD, is Professor of Psychiatry and Behavioral Sciences and Associate Professor of Medicine at Duke University, and director of Duke University’s Center for Spirituality, Theology and Health.

John R. Peteet, MD, has been a psychiatrist at Brigham and Women’s Hospital and Dana-Farber Cancer Institute for more than 40 years, and associate professor of psychiatry at Harvard Medical School.

[1] http://lifewayresearch.com/wp-content/uploads/2014/09/Acute-Mental-Illness-and-Christian-Faith-Research-Report-1.pdf
[2] Charles Spurgeon, “Night and Jesus Not There,” in MTP, Vol 51 (Ages Digital Library, 1998) p457. From Eswine, Spurgeon’s Sorrows, p76).