The Heart of Depression
by Edward Welch
The causes of spiritual depression depend on how you define it. If spiritual is narrowly defined to mean depression that is caused by sin, the quest for a cause is over. But let’s assume that all depression is spiritual depression, which, indeed, it is. Depression is a painful experience that is typically described with images of emptiness, darkness, heaviness, and even hell itself. Anything that painful, whatever the cause, is always spiritual. That is not to say that depression is always caused by sin, but it certainly raises spiritual questions, and it becomes an occasion for outright spiritual battle, and you can be sure that in the course of it, sin will become a snare.
Chemical imbalance theories of depression have shrunk the domain of the term spiritual depression, and the gatekeepers of our terms usually control the discussion. A good place to begin the search for a cause is by expanding spiritual depression to its original size.
So what is the cause of depression? That is like asking, what is the cause of suffering? There are at least five different causes.
First, we can cause our depression. Our own sin, unbelief, commitment to our interpretations instead of searching for God’s interpretation can all be causes of depression. Second, other people can cause our depression. A steady diet of discouraging words from people who are supposed to love us, or sexual violation and its shame can certainly contribute to depression. Third, our bodies can cause depression. Our bodies can’t create hopelessness or loss of purpose, but they can disrupt sleep, fog our thinking, and cause us to have the physical feelings of depression. Fourth, Satan, arguably, can be a cause of depression. He can afflict the body and heap accusations on the sensitive conscience. And fifth, God is over all things, including suffering and depression. We can say that He allows it, and we can say that there are times when He ordains it.
Of these five causes, the two that are of special interest to us are ourselves — our own hearts — and our bodies.
Regarding the second cause, the sins of other people typically need to be boosted by unforgiveness or unbelief to attain the status of depression. With respect to the fourth cause, Satan might have his fingerprints on depression, but it isn’t essential to understand the details of his influence. In the fifth cause, God is sovereign over all things, but usually when we ask about causes we look for more immediate causes that God uses for His purposes.
Physical causes. The causes that have received the most attention over the last few decades have been physical ones. There are some known diseases such as Parkinson’s disease and hypothyroidism that can cause depression, and a number of prescription medications can cause depression as a side effect. But the present discussions about physical causes of depression are referring to something other than these. They are assuming a chemical imbalance in the brain is the cause of depression. All anti-depressant medications are targeting these alleged chemical imbalances.
That the brains of depressed people are chemically different from the brains of those who are not depressed is self-evident. We are embodied people. Everything we think, feel, and do is etched into the neuronal fabric of our brains. Think about those things that are good, true, and beautiful, and your brain will demonstrate a certain chemical footprint; indulge sinful imaginations and it will have another. Those chemical differences, however, are not causes. They are physical manifestations and concomitants of thought. They do not cause us to think godly or sinful thoughts.
Depression research runs up against this same phenomenon. Even if the research could demonstrate a difference between the brains of the depressed and non-depressed, it could not tell you if those changes are a cause or consequence of depression. Yet the investigation of physical causes into depression is not that far advanced. At this point, researchers are still looking for definitive, chemical differences in the depressed brain.
Here is a fair summary of these possible physical causes: For some people, depression seems to have physical beginnings. It can emerge for no apparent reason, and it seems to be unrelated to a person’s spiritual condition. Faith in Christ can strengthen those who experience it, but faith doesn’t quiet the emotional storm. For many others, depression is intermingled with any number of problems in living. Anger, fear, guilt, shame, loss, or combinations of them all are often part of the depressive experience. Hopelessness is almost always present. The feelings and physical accompaniments of these experiences might be lessened by medication, but medication does not necessarily get to the roots of the problem.
Spiritual causes. Hopelessness alone can give away the spiritual roots of some depression. Hopelessness is not a physical problem; it is spiritual. It has lost sight of God’s kingdom purposes that use even suffering to accomplish His ends. Hopelessness knows the introduction to Psalm 22, “My God, my God, why have you forsaken me?” But its tone can be laced with frustration, and it doesn’t see the Psalm through to the end.
Take any spiritual problem — anger, fear, unbelief, guilt, or shame. Allow it to persist without hearing the truth and comfort of the Gospel and responding to it. The result, in susceptible people, can be depression.
Emotions are a kind of language. They say something. Listen to depression and hear what it says. Sometimes it simply says, “I am in pain.” In these occurrences, the causes of depression are not apparent. Other times, however, you can hear the cry of the heart, “I want,” “I am afraid,” “I am not okay,” “I am a failure.” These might point to spiritual causes of depression. They, at least, point to spiritual matters that have been
revealed by the pain of depression.
Discernment. How can you determine if depression has a physical cause or a spiritual one? The answer, at first, might be disappointing, but it is actually quite profound. The answer is that it is not necessary to discern the actual cause. You can minister effectively to someone without knowing the cause of it.
The prototypical case study is Job. Job endured the harshest of sufferings, and he never knew the cause. He understood that evil marauders were a cause, but they are never mentioned in his questions. The basic question was, “Am I the cause or not?” God’s answer was not to divvy out percentages to different causes. Rather, He simply said that He was the sovereign God, and He could be trusted. Severe suffering is not primarily a time for speculation about causes. It is a time to trust the One who is over all suffering. It is a time to know God’s comfort
(2 Cor. 1) and trust in His ways. From this perspective, suffering and depression are sometimes from a physical cause, other times spiritual. Yet they are always about the depressed person’s relationship with God. Will we trust God in the midst of our suffering?
This doesn’t mean that the search for a cause is either wrong or futile. It does mean, however, that a clear cause is not always forthcoming. When it isn’t, we trust God, walk by faith — with the encouragement of God’s people — and repent when sin is exposed. We also have the freedom to try to minimize our suffering, if that is possible.
Ministry Direction. The wisest way to approach depression is to categorize it as suffering and, at least initially, to remain agnostic about its causes. Move toward suffering people and walk with them. Pray for the alleviation of their suffering. Seek to offer words of encouragement. Recognize that depressed feelings might mean that they cannot even imagine anything good, such as love. In that case, they have to learn more deeply the skill of walking by faith. They must be suspicious of the atheistic or deistic interpretations that flow naturally from depression and learn to live by the words of Christ (Deut. 8:2–3). Along the way they will invariably be ensnared by “sin which clings so closely” (Heb. 12:1). Depressed people are, after all, like everyone else.
As they cling to Christ by faith, and as they repent of the sin that is revealed, they might, in fact, experience a lightening of their depression, in which case there may have been a fundamental spiritual cause. But wise helpers don’t have to draw such connections. They simply need to minister with love and skill to people who are going through some of the most difficult times of human suffering.
The only time a diagnosis of a physical cause might be useful is when someone asks about psychiatric medications. If there is a physical cause, medication might be warranted. If not, it wouldn’t be less so. But here again, we don’t have to find a definitive cause.
At this time, it isn’t possible to find a definitive physical cause. There are no medical tests that reveal a chemical imbalance. The closest analogy is that medication, for some people, functions like Aspirin in that it might alleviate symptoms, but not necessarily treat causes.
People, of course, are free to take medication. Medication should, however, come with a warning. Medication cannot address spiritual matters. It can help a person sleep, and it might alleviate some pain, but it does not have the power to build faith. Too often, those who take medication adopt the medical perspective that comes with it, that is, that the cause of depression is the physical body. Then they are less inclined to fight the spiritual battle that inevitably emerges with depression, and they are slower to turn to Christ for spiritual strength. Regardless of the cause of the depression, the deepest reality is that suffering, on this side of the cross, has redemptive purposes. When sufferers understand that God has a purpose in suffering, they tend to pause before they reach for psychiatric medication.