Adam on the King’s Highway Radio Podcast
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Why Are You ‘Depressed,’ O My Soul? (Part 3)
Part 3: Body and Soul
“My flesh and my heart may fail, but God is the strength of my heart and my portion forever” (Psalm 73:26).
(Note: See the “Blog Disclaimer” at the main blog page before reading this article.)
There’s a quote you may have seen floating around cyberspace that’s often falsely attributed to C. S. Lewis: “You don’t have a soul. You are a soul. You have a body.” Unfortunately, as well intentioned as that statement may be, it falls short of the biblical testimony about what makes up a person. For Christians, while we will eventually be rid of the dying bodies we have now, our eternity will be spent in new incorruptible bodies, living face-to-face with God as part of a new and perfect universe (1 Cor 15:35-49; 1 Thes 4:16-17, 2 Pet 3:10). Heaven and earth will be one and the same (Rev 21:1-8). In fact, one of the most amazing aspects of our faith is that we will be resurrected—bodily—exactly like our Lord and Savior Jesus Christ (Rom 6:5; 1 John 3:2) to future glory (Rom 8:18-24)!
But what does this matter when it comes to the topic of depression? It’s impossible to understand who we are and what it means to have a healthy mind without consulting the One who made us and knows us better than we even know ourselves (Psalm 139:1-16; Jer 17:9-10; Rom 8:27). If it weren’t so neglected, a biblical understanding of this issue would relieve boatloads of confusion about how to address problems of human psychological suffering. But this disregard has not always been so prevalent in God’s church. Take the catechism for example:
Q1: What is your only comfort in life and death?
A: That both in soul and body, whether I live or die, I am not my own, but belong wholly unto my most faithful Lord and Savior Jesus Christ…
Addressing psychological problems and experiences starts with understanding how the spiritual part of us relates to the physical part. Are we aware, for instance, that the brain and the mind—while linked—are not the same thing? Both the biblical and historical Christian witness is that a complete person is made up of “soul and body” [1]—as a unity of two parts—a dichotomy. [2] To put it another way, you and I are psychosomatic creatures—embodied souls uniquely made in the image and likeness of our Creator God (Gen 1:27). God made all mankind out of the material “dust of the ground” and breathed into us the immaterial “breath of life,” resulting in our being made “a living creature” (Gen 2:7). Christians specifically—as new creations (2 Cor 5:17)—are to “not lose heart” because “Though our outer self [our present, corruptible body] is wasting away, our inner self [our regenerate, everlasting soul] is being renewed day by day” (2 Cor 4:16). Though “My flesh [my material body] and my heart [the affectionate core of my immaterial soul] may fail…God is the strength of my heart and my portion forever” (Psalm 73:26). All this means that psychological change should be pursued as an “inside-out” process. This view gives special attention to the soul while refusing to neglect the body—yet it also recognizes the constant interplay happening between the two as a connected whole [3]. But how do we know when something is a physical issue versus a spiritual one?
Making Distinctions
When speaking of depression, a helper’s first response is to be compassionate. The next is distinguishing between the physical and the spiritual (or soul-related). Physical symptoms of depression may include low energy, changes in sleep or appetite, a decreased ability to concentrate or focus, and a slowing down of physical motor activity/an anxious physical agitation. Spiritual symptoms may include feelings and expressions of sadness and/or irritability, a diminished desire to take initiative/action, feelings of guilt/shame or purposelessness, and thoughts of suicide/self-harm or death.
Physical Problems
Physical problems that are not depression—There can be depressive effects to certain physical illnesses that are not depression but can cause some of the same physical symptoms, while being absent the spiritual ones. This can include things like low thyroid, heart disease, certain autoimmune diseases, and others. For this reason, if you are experiencing the physical symptoms listed above, especially if the onset was sudden or if this is your first episode, you should first check with your physician. I typically recommend that people explore this avenue before immediately seeking out an antidepressant or other psychiatric medications, unless the person is in more immediate danger of harming themselves or others. The presence of these physical symptoms alone does not necessarily mean that depression is the culprit.
Physical problems that contribute to depression—At the same time, since our bodies are constantly affecting our souls (and vice versa) physical pain, illness, injury, and affliction of all kinds can precede experiences of depression by creating the opportunity for a depressive spiritual response in us. These sufferings can be self-inflicted (e.g., substance abuse or neglecting proper diet and exercise) or merely the result of living in a fallen world (e.g., pain from an accidental injury, postpartum hormonal imbalances, or a chronic illness). Grief over physical suffering that maintains hope is very appropriate though difficult. But temptations toward hopelessness and discontentment can also be very strong when experiencing physical suffering and weakness (see my previous article for differences between righteous versus sinful depression). For example, those with neurological or brain abnormalities like various forms of autism, dementia, some aspects of Obsessive-Compulsive Disorder, or possibly a traumatic brain injury—being no fault of their own—can sometimes find it very difficult to resist temptations to lash out at others, be impatient or worrisome, or hopelessly give up on God, life, and others. We should give extra measures of patience to individuals who struggle with these pathologies (1 Thes 5:14), while also remembering that we are all people, made in the image of God, with a conscience, and therefore responsible for how we respond to both sweet and bitter providences in our lives. Our physical circumstances don’t cause but can contribute to depressive experiences.
Spiritual Problems
Notice how I gave no option for actual physical depression absent of spiritual components or consequences. That’s because “Psychiatric problems are always spiritual problems and sometimes physical problems…Most psychiatric problems are hybrids—a combination of spiritual problems and physical ones” (Welch, pp. 106-107) [4]. Our brains and bodies cannot make us sin (pp. 49-61), which is why you “will never find a psychiatric problem where biblical counsel—counsel directed to the heart—is anything less than essential” (p. 106).
Spiritual problems with immediate physical consequences—We must understand that a person’s spiritual/psychological state will affect their physical state, albeit to varying degrees. A hopeless person will likely lack motivation, which can manifest in low energy and diminished physical vigor. A person who feels guilty, whether justified or not, can have crying spells and might choose to self-harm. Spiritual/psychological pain can tempt a person to abuse substances that have intoxicating physical results and the accompanying consequences. The same principle is true, of course, for joy. A person who finds their identity in the Christ who saved them and is thankful to the Father God who has adopted them—that person can find lasting joy in spite of suffering and unhappy feelings (James 1:2-4; 1 Pet 1:6-7). Somehow, someway our internal spiritual reality will expose itself in our physical existence—for better or for worse (Matt 15:18; Luke 6:45).
Spiritual problems with delayed physical consequences—You may not always be able to immediately tell that a person’s adrenaline has just spiked, they’re blood pressure is rising, they have a tension headache, they aren’t getting proper nutrition, or their focus is diminished—but that doesn’t mean it isn’t happening. Usually there are signs that these things are occurring, but we are self-deceived if we believe that our spiritual problems are not having physical consequences even if they aren’t immediately apparent to us—“Do not be deceived: God is not mocked, for whatever one sows, that will he also reap” (Gal 6:7). It is also important for us to remember that though sin has negative consequences, that in righteous living there is great reward—always spiritual, sometimes temporal (Psalm 19:11; Prov 10:16; Psalm 1; Isaiah 40:30-31). This is not a promotion of a health, wealth, and prosperity “gospel”—righteous living will never allow us to escape physical death, and will never guarantee us temporary, earthly treasures including the life we expect or desire (Job 1:21; Matt 6:19-21; Matt 16:24-26). But God is a good and gracious parent to his children and knows how to give them good and perfect gifts (Matt 7:11; James 1:17), including appropriate and timely rewards for their obedience as well as loving discipline when it is required (Heb 12:3-17). At the same time, we must communicate to those who do not believe, that they sit under God’s judgment and should flee from it by coming in empty-handed faith to his Son (Mark 1:15; 1 Cor 6:9-11). All of us have those areas of our lives where we should have experienced greater consequences but somehow did not. Thank God today for his patience and mercy. He owes us nothing, yet he gave everything for his people (John 15:13; 2 Cor 5:21). “Or do you presume on the riches of his kindness and forbearance and patience, not knowing that God’s kindness is meant to lead you to repentance?” (Rom 2:4).
Examples In Scripture
What we call depression today is actually an age-old problem for people in our fallen world. There are a number of healthy and unhealthy examples in Scripture of both spiritual and physical depressive experiences. These symptoms are not something modern researchers and practitioners have discovered, but something that God has spoken about for thousands of years. David said that when he “kept silent” about his sin his “bones wasted away” [loss of appetite/weight] through his “groaning all day long” [feelings of sadness/guilt]. He felt the anxious weight “day and night” [insomnia] and his “strength was dried up” [low energy/fatigue] (Psalm 32:3-4). After Jezebel threatened Elijah’s life he asked God to “take away my life” [thoughts of death] and twice he “lay down and slept” [hypersomnia/fatigue] (1 Kings 19:4-6). Judas Iscariot, in his guilt for “betraying innocent blood” gave in to hopelessness “and hanged himself” (Matt 27:4-5). When Cain saw that his sacrifices were unacceptable to God, he “was very angry [irritability], and his face fell [hopelessness]” (Gen 4:1-7). And Jesus Christ, the completely sinless “man of sorrows” who “in agony…sweat…great drops of blood” (Luke 22:44), was “acquainted with grief”—he has willingly “borne our griefs and carried our sorrows…he was pierced for our transgressions; crushed for our iniquities…upon him was the chastisement that brought us peace, and with his wounds we are healed…He was oppressed, and he was afflicted, yet he opened not his mouth” (Isaiah 53:3-7). Instead of hopelessness and discontentment he “[laid] down his life for his friends” (John 15:13) and “for the joy that was set before him endured the cross” (Heb 12:2). He gave himself, trusted the Father, hated sin, and loved God and his people unconditionally. He was not passive but active. As God he has not destroyed us but instead had mercy (2 Cor 4:8-11; Lam 3:22). He was faithful and obedient in the midst of the trials God gave him (Acts 2:23). It is only by his death in our place and gifted righteousness that we are saved (Rom 3:23-24; Eph 2:8-9). For all these reasons we know “we do not have a high priest who is unable to sympathize with our weaknesses, but one who in every respect has been tempted as we are, yet without sin” (Heb 4:15). We are meant to trust him and follow in his footsteps by giving him our lives, faith, and loving obedience (John 14:15, 23) even when that feels impossible (1 Cor 10:13).
The Role of Psychiatric Medications
The role of psychiatric medications can be a sensitive topic that I cannot cover in its entirety. Generally, there are those who believe that depression is a purely spiritual matter and therefore psychiatric medications are not a viable option, while others see depression as purely physical and therefore medications become a necessity or close to it. I want to offer a biblical, moderated view in line with what has already been said above. I believe this to be an issue of godly wisdom and sanctified conscience. Scripture outlines the working principle here:
Let not the one who eats despise the one who abstains, and let not the one who abstains pass judgment on the one who eats, for God has welcomed him…One person esteems one day as better than another, while another esteems all days alike. Each one should be fully convinced in his own mind. The one who observes the day, observes it in honor of the Lord. The one who eats, eats in honor of the Lord, since he gives thanks to God, while the one who abstains, abstains in honor of the Lord and gives thanks to God…So then each of us will give an account of himself to God. (Rom 14:3-6, 12)
Like issues of abstaining or not from certain food or drink, or observing certain ceremonial days as holy or not, psychiatric medications are an issue of Christian liberty for which someone must appeal to their conscience before God. In other words, there is nothing inherently sinful about psychiatric medications. Taking psychiatric medications can be a good and righteous help (though never a cure) for some, but can also be a harmful or even sinful thing for others to use.
At the same time, we must understand that no medication can ever change the heart. That is a job for the Holy Spirit via God’s Word (2 Tim 3:16-17; Gal 3:3). There are many common misconceptions about psychiatric medications that need to be exposed. They do not do what most people think they do. Dr. Welch (1998) says it this way:
Psychiatric medication is not treating a verifiable chemical imbalance in the brain. Contrary to public perception, psychiatric medications are not chemical bullets that target one particular brain chemical. They are more like chemical blitzkriegs, strafing chemical sites in the brain and hoping for the best…The most we can reliably say is that psychiatric medication may minimize some symptoms, but it is not necessarily treating a chemical deficiency…human behavior is represented on a neurochemical level. This doesn’t mean that the brain causes all these behaviors, but that the brain expresses differences in behavior at a chemical level. (pp. 109-110)
The bottom line is that psychiatric medications can be helpful and they can also be harmful, both physically and spiritually. There are particular physical risks everyone should research and ask about before beginning a medication regimen, and all medications have side effects. But there are also spiritual risks. The moment medications become our comfort over and above God, we have slipped into idolatry, and exchanged the Creator for created things as our object of worship and source of peace and satisfaction. A person thinking about or already taking psychiatric medications should also consider the possibility that medications could numb a person to a refining work of God in them. We can all agree that in general, relief from suffering is a wonderful gift from God, but also have to acknowledge that God—in his loving mercy—allows earthly pain into our lives for redemptive purposes. God will not allow his children to trade him in for fleeting pleasures and possessions. This is quite evident from the many accounts we find in Scripture of God’s work in the lives of his people. And certainly we can all agree that Christ’s suffering was necessary for our salvation, and rejoice that he did not avoid his cross (Isaiah 53). It is an inescapable fact that suffering will be part of the life of any Christian person (Matt 7:13-14; John 15:20; Phil 1:29; 2 Tim 3:12). Are we stewarding our suffering well? What might God being doing in us through our suffering?
So what’s next?
Over the past three articles we have looked at the hope we have in Christ in the midst of depression, the differences between righteous versus unrighteous expressions of depression, and now how our body and soul interact during a depressive experience. Next time, in the last installment of this series, we will look at practical ways to think about and address depression from a biblical perspective.
Footnotes & References
[1] The term “soul” is interchangeable with “spirit” and corresponds to the “inner self” or inner person. Additionally, the inner person is made up of three faculties: the mind, the affections or “heart,” and the will. The bible uses all these terms interchangeably to describe the inner person, with different terms being used to give specific emphasis as needed. For further discussion on the issues of the psychosomatic or dichotomous nature of mankind and the three faculties of the immaterial soul see: Samuel Renihan, God Without Passions: A Primer: A Practical and Pastoral Study of Divine Impassibility (Palmdale, CA: Reformed Baptist Academic Press, 2015), 35-48. Additional free online audio resources can be found here and here.
[2] Time and space do not permit me to discuss the different views concerning the composition of a person, especially the immediately relevant disagreement between those who hold to dichotomy (that a person is made up of two parts; outer self and inner self, or body and soul) versus those who hold to trichotomy (that a person is made up of three parts: body, soul, and spirit). I believe that the trichotomy position embodies a number of significant flaws, that when taken to their logical conclusions, lead to dangerous doctrines and practices. The historical Christian view has been that of dichotomy. For further discussion on the issue of dichotomy versus trichotomy see: Louis Berkof, Systematic Theology (Grand Rapids, MI: Wm. B. Eerdmans Publishing Co., 1932), 191-201.; Charles Hodge, Systematic Theology: In Three Volumes, 6th ed., vol. 2 of 3: Anthropology (Peabody, MA: Hendrickson Publishers Marketing, LLC, 2013), 42-51.; and Wayne A. Grudem, Systematic Theology: An Introduction to Biblical Doctrine (Grand Rapids, MI: Zondervan & Intervarsity Press, 1994), 472-489. Additional free online audio resources can be found here. This issue is also addressed by Dr. Welch in the work listed below.
[3] While it is true that the separation of soul and body results in physical death and that our souls will live temporarily in an intermediate state without a body (2 Cor 5:6-10)—either the believer in paradise or the unbeliever in hell/hades (Luke 16:19-31; Rev 20:14)—our ultimate and eternal destinies are to be experienced in both soul and body—either in the new heavens and new earth with resurrected, incorruptible bodies and souls (1 Cor 15:50-58; Rev 21:1-7), or in the lake of fire along with Satan and his demons (Rev 20:11-15).
[4] Edward T. Welch, Blame It On the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience (Phillipsburg, NJ: Presbyterian and Reformed Publishing Company, 1998).
- Published in Depression
Why Are You ‘Depressed,’ O My Soul? (Part 1)
Part 1: Where Is My Comfort?
“Why are you cast down, O my soul, and why are you in turmoil within me?” (Psalm 42:5). [1]
(Note: See the “Blog Disclaimer” at the main blog page before reading this article.)
I hear frequently enough from pastors, laypeople, and clients to know that there is an elusive struggle in the church today with what we might broadly call “depression.” So naturally, as a biblical counselor, I am simultaneously intrigued and concerned. Intrigued because I care to know and help address, by God’s grace, what makes this so prevalent among the saints. Concerned because I love my fellow brothers and sisters in Christ. I often witness how difficult this can be for those struggling and for anyone supporting them as they do. However, I also have concerns that we as Christians have gotten the wrong idea about what “depression” really is and how we are to understand and respond to its presence in our lives. I purposely misquoted Psalm 42:5 in the title, then began by correctly quoting the passage. That’s my less than clever way of pointing out how, at times, we may be tempted to believe that God doesn’t have much to say about this issue, either because we have become so discouraged, or because the terminology of clinical psychology isn’t found neatly packaged in Scripture. But those things don’t have to stop us from receiving the real hope and help available to us in God’s word concerning this issue. Would we be more willing to listen if the Scriptures used words like “depression”? That shouldn’t be the case. I would like to contend that this issue has existed long before the dawn of modern psychology or psychiatry, and that God has always had something to say about it, even if the words we are used to don’t appear on the pages of his word. This should give us confidence, not concern.
As you read, I would ask you to keep an open mind. I am very aware of the sometimes-sensitive nature of this topic. I also know that I don’t have all the answers and that this can be a complex issue. There may be times when what I say is challenging or goes against some of what you’ve been told about depression or mental illness. But nothing I say is meant to be insensitive or dismissive of the very real suffering that any person who experiences this will go through. I know this struggle personally and I’ve watched loved ones endure it as well. What I want to communicate is that we must not minimize or neglect God’s word along the way. We must instead turn to God’s word as we wrestle with the turmoil within our souls. To do this we cling to the power of the gospel (Rom 1:16), rely on the sufficiency of God’s word to us (2 Tim 3:16-17; Heb 4:12), remember that he has given us all we need (2 Pet 1:3), and embrace our only hope (Rom 5:1-5; 1 Thes 5:9-11).
Our Only True Comfort
“Why are you cast down, O my soul?” Many of us can relate to that question. When all is said and done, the solution from the Psalmist to that kind of internal anguish is to, “Hope in God” (Psalm 42:11). Easier said than done, right? That may sound like a simplistic answer, but I assure you it is not. We have but one true hope and comfort in the midst of suffering and misery—God—and we must fight to keep from losing sight of him. God has allowed suffering into this world and our lives for good reason, and we should not believe the lie that immediate escape from pain and discomfort is the same thing as redemption, peace, or salvation. It is the Christian alone who can truly say that their suffering has lasting purpose (Gen 50:20; Rom 8:28). What the person suffering through an episode of depression needs is not clever advice about how to instantly escape the misery or the numbness. Instead they need real hope that there is purpose in their suffering, true joy to be found in the midst of their sorrows, complete forgiveness for their sins, and that there is coming a Day when our Lord and Savior will set everything right once and for all. Only our sovereign, holy, covenant-keeping God can offer such hope.
To help structure this discussion I’ll be looking at different elements of the first two questions found in An Orthodox Catechism [2] by Hercules Collins [3][4]. Each answer has something unique to say about Christian suffering, which includes depression. So, let’s take a look:
Q. 1. What is your only comfort in life and death?
A. That both in soul and body, whether I live or die, I am not my own, but belong wholly unto my most faithful Lord and Savior Jesus Christ… [5]Q. 2. How many things are necessary for you to know that, enjoying this comfort, you may live and die happily?
A. Three. The first, what is the greatness of my sin and misery. The second, how I am delivered from all sin and misery. The third, what thanks I owe to God for this delivery.
Now, possibly, you read that and didn’t see how it applies. If that’s the case then hang with me. In reality, it contains our only hope—the Good News that for everyone who believes, Jesus Christ who is fully God and fully human, has restored us to right relationship with God by taking the penalty for our sins and clothing us with his righteousness by his sinless life, atoning death, and victorious resurrection—and that by so doing he has defeated for us the powers of sin, Satan, and death and given us a perfect example of what it means to live freely as image-bearers of God. That gospel touches every moment, every molecule, and every motivation of our existence. That truth is an anchor of encouragement and hope when our feelings or experiences tell us otherwise (Heb 6:19). God keeps his promises even when we don’t feel like that’s true. “God is faithful” (1 Cor 1:9) even when we are faithless, and he is good even when life seems like it’s not (Lam 3:18-33). What is my only true comfort? I belong to Christ and therefore I have hope, now and forever.
So What’s Next?
This article is introductory, so moving forward I want to focus on what is meant by “depression” and how we as Christians should think about experiences of sadness or lethargic mood. It would be easy to get lost in the ever-growing and changing multitude of theories and therapies out there. Next time we’ll see how God brings simple clarity to this kind of speculation that mere human observation and effort cannot—giving guidance and wisdom in the process.
Footnotes & References
[1] I will always use the English Standard Version (ESV) of the Bible unless otherwise indicated.
[2] Don’t let the word “catechism” scare you away. Everything that is old or theologically focused is not evil or irrelevant. A catechism is simply a tool for teaching truth. It takes concepts that are evident in the Bible and then teaches them to the reader via a question-and-answer format so they’re easier to remember.
[3] Hercules Collins, An Orthodox Catechism: Being the Sum of Christian Religion, Contained In the Law and Gospel. Published for preventing the Canker and Poison of Heresy and Error., ed. Michael A. G. Haykin and G. Stephen Weaver, Jr. (Palmdale, CA: Reformed Baptist Academic Press, 2014), 41-42.
[4] There does not appear to be any significant difference here between An Orthodox Catechism and the Heidelberg Catechism written in 1563. Collins utilized the Heidelberg Catechism to write An Orthodox Catechism in 1860 for his Baptist brothers and sisters. See the forward and introduction on pages 7-39 of this 2014 edition for further details.
[5] The complete answer is as follows: “That both in soul and body, whether I live or die, I am not my own, but belong wholly unto my most faithful Lord and Savior Jesus Christ. By His most precious blood fully satisfying for all my sins, He has delivered me from all the power of the devil, and so preserves me, that without the will of my heavenly Father not so much as a hair may fall from my head. Yes, all things must serve for my safety and by His Spirit, also He assures me of everlasting life, and makes me ready and prepared, that from now on I may live to Him” (pp. 41-42).
- Published in Depression