John Koopman, pastor of Chilliwack Free Reformed Church in British Columbia,  sent me this helpful piece explaining how he has learned to avoid extremes in dealing with depression. I’m very grateful to John for taking the time to write this and for doing so in such a compassionate, balanced, and brief manner.

There is a great deal of debate in biblical counseling circles on how depression should be addressed.  On the one extreme there are those who claim that depression is simply a disease like cancer – and expressions have been used like ‘cancer of the mind’ and so on.  On the other extreme are those who claim that it is simply a lifestyle choice; a lack of discipline; stressful circumstances – and they usually point out that this is the result of sin – perhaps not exclusively but for the most part sinful.

Two extremes
The individuals in these two extremes – often godly and caring people – want us to choose either one or the other extreme. As a result they are often intolerant to individuals who are of the other extreme.  Most of us don’t fall into either of these extremes.  Those who have personal experience with depression – either themselves or their family members – tend to be more sympathetic to the medical model.  Those who have little or no personal experience tend to be attracted to the “it’s a sin” model.  We do need to recognize that it is often our own personal experience which taints our perspective on this issue.  However, as a pastor I don’t want to choose either extreme – nor does either have a huge impact on how I care for someone pastorally.  Pastoral care of them doesn’t depend on the reason for their depression.

Personally, I think we need to be very careful and look at each case individually.  Further, I don’t like to be forced to take an either/or approach but prefer the both/and approach when dealing with someone who is depressed.  Even with sickness like cancer there are always spiritual aspects to this physical disease.  The reality is that regardless of the reason for their depression (and we often can’t determine this absolutely) the person needs help.  What do I do when someone calls me that they are depressed?  Actually they don’t usually call but I become aware through a family member or friend. How should we pastorally respond to someone who is depressed?

First, we need to be compassionate regardless of the reason (or reasons!) for their depression.  For arguments sake, even if the depression is a result of someone’s sin or circumstances (even if those circumstances are of their own making) we need to show compassion.  Unfortunately some who have taken the “sin model” have used the approach of the Pharisees in addressing the woman caught committing adultery (John 8). We must show compassion to all individuals who are suffering from depression regardless of its origin.

Second, we need to recognize that man’s various parts (physical, spiritual, emotional) cannot be compartmentalized but must be considered as one whole person.  Therefore, I always recommend someone who suffers from depression to make an appointment with their family physician.  In the case where it is a “disease of the mind,” medication may be necessary to give stability for the rest of their life.  This is clearly the case where genetics are involved – where because of man’s fall into sin the mind has fallen as well.  Hopefully, these treatments will become more precise over the years as they continue to study the brain.  In the case where there the depression is largely the result of personal sin (and I do believe there are such cases) medication is often needed to give stability so that the depressed person will begin to hear counsel that is given to them.  To try to counsel someone who is depressed is very ineffective if their mind is not functioning well.  These individuals may only be on medication for a period of time until stability is restore in their lives.

Gentle Promises
Thirdly, when there is stability continue to show pastoral concern and give appropriate counsel in a kind gentle manner.  Often the promises of scripture are most helpful in this regard rather than the exhortations.  To lay further obligations on someone who is already depressed will only lead to a heavier burden being laid upon them and actually increase their depression.  There may be times that sin needs to be addressed (regardless of the origin of their depression) but that is best done by showing them a better way – the way of life in the gospel!  Be on guard because our natural tendency is to judge.  Be very careful that you understand their life!  Some of these people have struggled for years with something you have only heard second hand.  Think about living in their situation – and be compassionate!

Double nonsense
In conclusion I’d say that the fact of the matter is that some depression can be mainly physiologically (although perhaps include sinful responses) since depression very clearly runs in families who members live in different settings.  Therefore, to deny a link to physical causes in all cases is absolute nonsense in my view.  However, to make the argument that depression is always physiological is equally nonsense.  I have frequently dealt with people whose sinful circumstances or responses to their circumstances have led to depression.  Both are cases that require our pastoral care and sensitivity.  The one may be the “blind man” of John 9, while the other might be the “woman caught in adultery” of John 8.  Both need our help, although in a slightly different way.   As a pastor I often cannot distinguish into which of these two categories a depressed person belongs – but I don’t need to put them in one category or the other in order to help them pastorally.  Each requires our pastoral compassion, sensitivity, and counsel.

  • Bob Kellemen

    That is a helpful, balanced post. The John 8/John 9 pairing is a very wise way to look at the issue. The only caveat I would provide to the post is that I know of no author/speaker/counselor in the “modern biblical counseling world” who would have been on the extreme end of saying there is never a possible medical issue. That may be a stereotype, but I don’t believe it is a reality. From the very earliest days of the “modern biblical counseling movement,” Jay Adams worked with Dr. Robert Smith, a medical doctor, and always encouraged all counselees to see their physician. A both/and approach, where spiritual/heart issues always need to be addressed with the compassionate application of the gospel to both sin and suffering is the biblical counseling way.

    • David Murray

      Thanks Bob. I agree, I thought the balance was helpful too.

      I think there are genuine reasons why many people do believe that some counselors refuse to accept physical causes:

      1. Often there is a presuppositional limitation of physical cause to one or two glands (for some reason, the thyroid gland is usually the one mentioned). This reduces the number of depressions with accepted physical causes to a very small number.

      2. The acceptance of physical causes is usually stated in very small print and very few words. The result is that what people hear is “no physical causes/contributors.”

      3. The “small print” acceptance of physical causes is usually found alongside multiple presuppositions and assertions that rule out physical causes. People see the inconsistency and make their own conclusions about what message is really intended.

      4. The massive emphasis/proportion of words spent on seeking and confessing sin in counseling books, blogs, speeches, about depression etc. (compared to next to nothing about physical/social causes) again lead people to conclude that people are really not serious about taking account of physical (and social) causes and contributing factors.

      5. The constant broad brush lambasting of psychiatrists, psychologists, pharmacists, often by people who have little or no knowledge of the valuable work these professionals often do, again produces a fairly obvious conclusion in most objective readers/hearers.

      6. The tendency of some biblical counselors to be very loudly against physical causes/contributors in public, yet when challenged in private will admit that there are exceptions to their rules.

      7. On top of all that there is the painful experience of many, many people who have sought counseling from pastors/counselors who (despite their professed acceptance of physical contributors) focus their attention on sin alone, advise against involving medical professionals, speak harshly against any use of medication. etc.

      All this to say, that while on paper it may be true that no biblical counselor rules out physical causes, the overall message received, especially by tender and sensitive souls, is that “it’s all sin and you must repent.” I don’t think they should be blamed for drawing these conclusions. I do think that we all need to give much more careful consideration to how we are heard, which you’ve taught me a lot about, Bob, and I’m grateful for that.

      • Bob Kellemen


        I always enjoy our engaging and mutual respectful conversations.

        Just a quick reply… I would need a full blog post or a book chapter, at least, to respond to your 7 points. And I would need footnotes to see which people you are referencing and then see if, in context, I agreed with your perception of their emphasis. For, as you point out, it is not only what people write, but how a reader’s previous perceptions influence their “take” on what someone says.

        For those interested in how 55 leading biblical counselors, pastors who uphold biblical counseling, and educators who uphold biblical counseling nuance this both/and perspective with compassion/garce/love/truth I would encourage your readers to visit the Biblical Counseling Coalition’s Confessional Statement so they can make their own informed decision on how the modern biblical counseling world approaches this vital issue:


        • HV

          Biblical Counseling Must Be Grounded in Sound Theology
          This is our family’s experience with our daughter, this lack of sound theology is the number one reason she is ‘stuck’
          We are learning there is a wide spectrum of “Christian counselling”, its hard to wade through it all…..

  • Leah

    I think there is a 3rd category of “non-sinful” spiritual causes to depression….I suspect THIS is the kind of “depression” (or what Paul calls “worldly sorrow” which leads to despair/death in 2 Cor. 7) that most “Christians” struggle with, and it seems to come from a lack of understanding of who we are in Christ and what promises of God are REALLY OURS in him, and a lack with respect to knowing how to resist the enemy and stand firm in the spiritual battle (while reckoning the battle “already won” by Christ)….


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  • David MC

    I agree that medical conditions need to be examined first. Everyone needs to remember that when someone comes to us with their depression, we must take them seriously. We don’t know where they are on the road to suicide, they could very well be much closer than we imagine (even for those we think we know well) and that can end in tragedy. In that state, they don’t think anyone cares or understands anyway. For some, suicide can become the predominate thought on your mind, it is there night and day as you plot and plan the “where and when”. It is a terrible place to be, and is basically indescribable to anyone who hasn’t experienced it.

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