IT’S NOT THAT SIMPLE
The Complexity of Depression
Many in the church are under the misguided impression that the diagnosis of depression is simple: lack of faith and trust in the Lord. But, as the saying goes, “it’s not that simple.” This is why it’s so important for Christians not only to know why they should study depression, but how they should study depression. To approach depression simplistically is to court despair, disaster, and even more depression.
So, with what attitude and in what spirit should this subject be approach? That’s the question that Dr. Murray seeks to answer in chapter 2 of his book, Christians Get Depressed Too. Two principles, he says, should condition all our thoughts and the expression of them in studying depression.
Avoid Dogmatism and Seek Humility
When studying depression, “Let there by an absence of dogmatism”says Dr. Murray. Where God’s word is dogmatic, we should be as well. We should not hesitate to believe boldly and teach boldly what God’s Word says.
Unfortunately, preachers, teachers, and ordinary Christians have taken a dogmatic mentality to areas where God’s Word is not dogmatic. Depression is such an area. This dogmatism is dangerous and often reflects personal opinions and prejudices rather than divine principles. Dogmatic certainty might be appealing, but it is also damaging when it comes to the study of depression. Murray states, “It is very likely that in the future, with increased research into depression and also increased understanding of the Bible’s teaching, much of the current confident certainty, which presently masquerades as biblical or medical expertise, will also look ridiculous, cruel, and even horrifying”(Kindle Edition, loc. 203). Therefore we should avoid unneeded and unfounded dogmatism. Rather, we should be quick to listen, and when we speak, we should do so with humility, compassion, and a keen awareness that we are speaking on a subject that is mysterious and complex in regards to its causes and consequences.
Avoid Extremes and Seek Balance
In discussing the principle of avoiding extremes and seeking balance, Murray outlines three simplistic extremes that should be avoided when thinking about the causes of depression. They are as follows:
The cause is (almost) all physical. This is the foundational presupposition of many doctors and psychiatrists today. Depression, they say, is caused by chemical imbalances in the brain. Of course, if this cause is correct, then the remedy is to be chemical as well, and so antidepressants are prescribed. This is often called the medical model or the drug treatment model.
Murray points out that there is a massive amount of scientific support for the drug-treatment model. Studies clearly show that the brains of depressed people have a different chemistry compared to people with good mental and emotional health. So, when the brain’s chemicals are low, the whole process of mental and emotional functioning slows down, and even stops in certain areas of the brain.
While recognizing that there may be a physical cause for depression, Murray reminds us that we must be careful not to adopt an “almost always physical”approach to depression. Just as the “almost always spiritual”approach can be simplistic and damaging, so can this one. Since we believe that people are made of body and soul we cannot neglect one aspect of our self (the immaterial), at the expense of the other (physical). The “almost always physical”model then is extreme and simplistic.
The cause is (almost) all spiritual
This is the position taken by some Christians and it takes two forms. The first form claims that depression is caused by demonic possession and requires exorcism. This cause of depression is associated with some Pentecostal and charismatic churches. Though we must allow for the possibly, on very rare occasions, that mental distressed is caused by demon possession or oppression, we must remember that there is a vast compilation of scientific evidence to suggest a physical connection. This should substantially curb our appetite to rush to a “demonic diagnosis”of depression.
The second expression of the “almost always spiritual”position states that depression is caused by sin and so rebuke, repentance and confession are the remedy. This is probably the most widespread view within evangelical Christianity today and has largely been supported by the writings of Jay Adams and those who have come after him in the biblical counseling movement. While Adams and company are to be commended for giving an important place to personal responsibility, they are mistaken to place all the responsibility on the depressed person. Murray states, “Adams fails to appreciate the significant difference in kind between bad moods or short-term depressions of spirit, which are sometimes sinful and to be repented of, and the deeper kinds of depression, which often have far more complex causes than the sinful choices of individuals”(Kindle edition, loc. 271). Murray responds to this simplistic approach by saying, “To put all the blame for depression on the individual is wrong, damaging, and dangerous, as it can only increase feelings of guilt and worthlessness”(Kindle edition, loc. 275). Murray follows this observation with quote by Charles Spurgeon to give his readers some prospective on how long this, “almost always spiritual”model has been around. Spurgeon, seemingly combatting this model says, “It is all very well for those who are in robust health and full of spirits to blame those whose lives are sicklied or covered with the pale cast of melancholy, but the [malady] is as real as a gaping wound, and all the more hard to bear because it lies so much in the region of the soul that to the inexperienced it appears to be a mere matter of fancy and diseased imagination. Reader, never ridicule the nervous and hypochondrichal, their pain is real; though much of the [malady] lies in the imagination thought-processes] it is not imaginary”(Kindle edition, loc. 279).
In the end, Murray believes that the nouthetic counseling movement, in wishing to secure a place for Christian pastors and counselors in the care of soul, has gone to the extreme by attempting to exclude doctors, psychologists, and psychiatrists from the treatment process, or to limit them simply to brain-based diagnoses.
When looking at the modern biblical counseling movement, Murray notes that there’s been much more care taken by this movement not to be overly simplistic. However, the default conclusion of sin as the root cause of all depression still remains. In reflecting on this default position Murray states, “My skin is broken down by psoriasis, my eyes are broken down with shortsightedness, my nose is broken down with rhinitis, my joints are sometimes broken with arthritis, my bowel has required two operations, my legs are broken down with varicose veins, my body is covered with dangerous moles (two of which have been removed), but I am actually very healthy! I do not believe any of these ailments are the result of personal sin but simply either the consequences of being a fallen creature living in a fallen world or of inheriting genes from my mother and father who have also had similar health issues. Why then should we always have to conclude that brain disorders are the result of personal sin? (Kindle Locations 323-327). Murray goes on to clarify that he’s not denying that brain illness is never caused by sin. He simply does not believe that our default position in understanding how the brain can experience problems should be any different from that of understanding other physical problems.
The third expression of the “almost always spiritual”position states that depression can sometimes be caused by sin. Murray says that when a Christian gets depressed, the first conclusion they typically jump to is that the cause is spiritual and that their relationship (or lack of relationship) with God is to blame. Murray points out that this self-critical feeling is usually one of the first fruits of depression and therefore is often wrong. He states, “It is important for Christians in such situations to doubt, question, and even challenge the accuracy of their feelings, as they usually do not reflect the facts.
The cause is (almost) all mental (“in the mind) is the third simplistic extreme Murray tells his readers to avoid. Those who adopt this approach can mean one of two things. Some who use this expression may be correctly pinpointing the heart of depression—the chemical imbalances in the brain. But most people who take this approach are simply saying that depression is imagined rather than real, that the depressed person is simply weak-minded. Murray helpfully points out that depression can be found in both the weak and strong, the clever and the simple, those who are generally happy and those who are generally sad.
In pointing this out, Murray reminds us, again, that we need to recognize the exceeding complexity of depression, and resist the temptation to accept simple solutions. He goes on to quote men such as Martin Lloyd-Jones, William Perkins, and Jonathan Edwards to highlight that some of the greatest theological minds have recognized just how complex the question of depression truly is.
“Therefore,”Murray says, “great care is required in coming to conclusions about our own condition, or that of others. It is important to remember the two main principles that govern our understanding of depression: Avoid dogmatism and seek humility. Avoid extremes, and seek balance”(Kindle edition, loc. 378).
In our next installment, we’ll blog through Murray’s third chapter in which he considers the daunting question: What is depression?