What makes a Christian feel guilt and shame instead of forgiveness and freedom, sadness instead of joy, hopelessness instead of hope, anxiety instead of peace? Why would a Christian sit in church week after week feeling lonely and discouraged rather than loved and encouraged? How can scripture lose its meaning for a Bible-believing Christian?
Surely there's a spiritual battle going on here? Surely this person has wittingly or unwittingly allowed Satan to get a stronghold in their life. Perhaps their understanding of the gospel is inadequate? Or perhaps they're holding onto some unconfessed sin. Whatever the cause (some Christians would argue), the solution is to confront the sin and confess it, be delivered from Satan's power and seek healing through prayer and the power of the Holy Spirit.
It's true that the guilt arising from unconfessed sin often produces a sense of heaviness, loss of enjoyment of life, and other symptoms similar to depression. These rapidly resolve once the sin is dealt with. Occasionally an apparently depressed person needs to be told to stop being self-pitying and manipulative and get on with life. On the other hand, one of the features of depressive illness is a morbid preoccupation with real and imagined sins and a false and unremitting sense of guilt. Repeated confession brings no relief. Yet the guilt feelings disappear when the depression is treated medically.
The malaise felt by those who have failed to grasp the full implications of the gospel was accurately described by Christian doctor and preacher, Martin Lloyd Jones in his book Spiritual Depression. Undoubtedly lack of faith or lack of understanding can lead to a form of spiritual misery, which is best dealt with by prayer, counselling and a change of mind. But again, those with a depressive illness will often attribute their illness to spiritual causes, and agonise over spiritual problems which resolve when the depression is treated.
What about demonic activity? Neil Anderson and others describe many cases where prayer and a form of exorcism were apparently effective in treating what might otherwise have been diagnosed medically as depression. In his book, The Masks of Melancholy, Christian psychiatrist and author John White also described a few cases where such a casting out of demons brought instantaneous relief. The majority of his patients, however, responded to more conventional psychiatric treatments.
Clearly discernment is needed. Treating true guilt or lack of assurance with tablets is ridiculous and unhelpful. On the other hand, denying the Christian with a depressive illness medical treatment and insisting that they overcome their problem "spiritually" is cruel and possibly tragic.
How do we distinguish depression due to spiritual causes and depressive illness? It has to be said that it's often done by trial and error. The depressed Christian may spend a long time seeking relief through anguished prayer, confession, Bible reading, prayer ministry and even exorcism before the biological nature of their illness becomes apparent. The Christian who needs prayer ministry and counselling may look to their doctor for help and find only partial relief.
The presence of physical symptoms such as early morning waking, poor appetite and poor memory make a depressive illness more likely, as may a family history of depression. The person whose depression seems to affect the whole of their life - work, home, church - is more likely to have a clinical illness than someone who finds they feel "down" in particular situations but not others.
The Christian with depression may be quite clear in their own minds about their problems, but those listening to them often find it difficult to grasp what they are describing. It all seems a bit vague and woolly. On the other hand, someone who feels depressed for a particular reason (guilt, unforgiveness, lack of faith or whatever) can usually be helped to clarify what they are describing until the real problem becomes apparent.
But is there some connection between the "spiritual depression" described by people like Lloyd-Jones and Anderson, and "clinical depression"? At one level, all illness, pain and suffering is ultimately a spiritual problem, related to the fact that we are sinful people living in a fallen world. Satan delights in using our weaknesses to draw us away from serving God. The "sins of our fore-fathers" visit us in the form of genetic traits and learned ways of reacting to the world that can predispose us to illness.
As we saw in part 1 of this paper, depressive illness seems to result from some combination of genetic tendency, childhood experience, unhelpful patterns of thinking and dealing with the world, and recent stressful experiences. There's little that we can do about our genes, our childhood experience or stressful events, but how we think and respond is more open to change. Perhaps it is at this point that "spiritual depression" and depressive illness overlap.
Those who are depressed are like people stumbling through a forest in the dark, fearful, lost and open to attack. To find their way out, they need a light and a map. Those with spiritual depression will get on well once they've been given a torch and a map in the form of prayer ministry, counselling and guidance. But those with clinical depression are like people who have fallen into a deep pit in the dark. The light and the map are of no use to them until they're helped out of the pit, usually with medication. Once they're out, the light and the map are certainly going to be helpful.
For the depressed Christian, medical treatment and spiritual healing are equally evidence of God's grace. To refuse to contemplate the use of medication (as many Christians do) or refuse to consider the sufferer's spiritual needs (as many psychiatrists do) is to deny God's provision for our wholeness.
Even depression itself may become a source of grace in God's hand. Sometimes Christians who have come through the darkness of depression discover that it hasn't been an entirely negative experience. Their faith has been strengthened by holding onto a God who at times seemed far away and uncaring. They've learned that God is still there in the dark and they are less reliant on feelings and experience for their spiritual assurance.
Humility grows through having learned to let others carry them through their dark times. Compassion for those who are suffering is increased, reliance on earthly security decreased. Scriptures that once seemed negative and uninspiring take on new depths of meaning. The love, concern and prayers of other Christians in their time of emptiness become treasured memories when life returns to normal.
Stella Budrikis