Pastoral Thoughts on Depression

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.

Check out

The Pastor’s Family by Brian Croft
I’ve been waiting for this book, and now it’s available for pre-order.

The Trinity and the Christian Life
You won’t get a better collection of living writers on the Trinity and how this truth impacts our lives.

Christ is not just another theme in the Old Testament
Despite the overstated introduction, this is a helpful brief survey.

Marbles, Soup, and Beef Stew
Unforgettable illustration of the options for racially integrated churches.

Things I’ve learned from other women
Kim Shay reflects on some new Internet friendships

Maggie won’t jump
Funny video where an interviewer suggests to Margaret Thatcher that she might want to jump to show her humanness! Sadly, I think every present political leader would do the jump.

Blood Work

I’ve been luxuriating in the precious blood of Christ while reading Anthony Carter’s wonderful new book on the atonement, Blood Work. Come and join me, via my favorite quotes:

  • Even though my blood could potentially save the temporal life of one, how many more can be saved unto eternal life by the precious blood of Jesus?
  • Life is truly in the blood. Temporally it is in the blood running through our veins. Eternally it is in the sin-breaking, guilt removing, incomparable, inestimably valuable blood of Jesus Christ.
  • Christianity is a bloody religion not because of the blood shed by people in wars and inquisitions, but because of the blood shed by Jesus Christ.
  • At the very heart of our Christian faith is a precious red substance; the blood of our Lord Jesus Christ (R Phillips)
  • If the history of redemption is a story told in pictures, the blood of Christ is the paint with which that story is portrayed.
  • The shedding of his blood was the highest and most excellent part of his obedience (Phil. 2:8)(Stephen Charnock)
  • The blood of the Old Testament spoke, but Christ’s blood speaks better. In speaking, it also satisfies.
  • The blood of Christ is significant, not for the blood itself, but for what it represents – the perfect, sinless, life of Christ poured out in death for us.
  • The redeemed do not receive a blood transfusion from God. We receive a life transfusion – He death for our death, his life for our life.
  • Christ bought us and therefore owns us. He did not purchase His people on credit He paid in full. We are his.
  •  Jesus will not return or exchange what he has bought.
  • The only currency that is of value in heaven and throughout eternity is the blood of Chist.
  • Sin is not just breaking the rules., it’s making one’s own rules.
  • God has more right to be angry at the sin of the world than we have at a thousand terrorists.
  • The Gospel in five words: Christ died for the ungodly.
  • Jesus’ blood pleads for us. He is the Advocate and His blood is the plea.
  • The Trinity is a love triangle. But unlike the love triangles we know, this one works, bringing joy and delight to all.
  • Apart from Christ, life is nothing more than a march from the womb to the tomb.
  • Selfish Christian? There is no self at the cross, only Jesus. Stingy Christian? The cross is the greatest motivation for giving there ever could be. Proud Christian? The ground at the foot of the cross is the humblest in the history of the world. Racist Christian? At the cross there is no Jew or Gentile, black or white, Arab or Asian.
  • Racial and ethnic bloodlines are not omnipotent. The blood of Christ is.
  • The blood of Christ says not only that we can get along with each other; more important, it says that we can get along with God.
  • Pilate proposed to wash the blood of Christ away from himself, while Paul knew himself to be washed in the blood of Christ.
  • Sin is more destructive than an atomic bomb; more menacing than a terrorist plot; more ruinous than a plague of locusts; more devastating that ten tsunamis; and more horrible and scary than a thousand bogeymen.
  • “Had I the guilt of all the world, He’s able to forgive.”

Check out

Death of the Iron Lady
Hope this doesn’t lose me half of my UK readers, but Margaret Thatcher was my heroine when I was in my teens and early twenties. I campaigned for her in some of the most hostile housing estates of Glasgow, and I sometimes wish I had the same courage today in campaigning for Christ.  Gene Veith has assembled some great quotes here.

How to find your vocation in college
Another fine article by Gene Veith.

Look for a building with a cross on it: Escaping North Korea
I hope and pray that behind the tumult developing on the Korean peninsula might be God’s demand: “Let my people go!”

Why we need the Hood
Powerful words: “There are jewels, if you will, in marginalized communities that are missing from the Church’s crown. Without these jewels, the Church sparkles less.”

Black Churches’ Missing Missionaries
“Black churches are booming, why are they not sending?”

The tyranny of the recovered
Kim Shay: “If people want to change their lives, I’m all for it.  Seriously.  If you lose weight, I’m happy for you.  If you hate blogging and the internet now, and that suits you, you’re allowed to feel that way.  Just don’t regard my participation in it as some kind of moral failure because I’m not choosing to leave.” 

Mental Illness & Suicide: The Church Awakes

If good can come out of the agony surrounding Matthew Warren’s tragic suicide, it’s that it forces the church to think through its response to mental illness and how to care better for those who suffer with it. I’m hugely encouraged by some of the initial responses to this terrible loss, and hope that it may mark a significant turning point in the church’s understanding of these complex issues, and turn the hearts and minds of many Christians to this large though often neglected and despised group in our churches and communities. Further to my post yesterday on 7 Questions about Suicide and Christians, here are some of the most outstanding posts I’ve read in the last 24 hours or so.

How Churches can respond to mental illness
Ed Stetzer with a nicely balanced piece on what the church can do for those suffering with mental illness.

When a loved one takes his life
Timothy Dalrymple relates some of his own struggles and concludes: “When I was a child, I believed that God looked at suicides with anger.  I don’t believe that anymore.  I think he looks on those who commit suicide with great compassion.  They have not had an easy go of life.  And for those who have given their lives to God, there is no deed, even a final deed committed in despair, that can separate them from his love.”

Can a Christian get depressed?
Christian author, Adrian Warnock, a psychiatrist by training, answers the question, “Why do some Christians feel that Christians should not get depressed?”

The Asphyxiation of Hope
Michael Patton attempts to describe the indescribable, and comes as close to it as anyone I’ve read.

Matthew Warren, His Family, and Guidelines for the Rest of Us
Some strongly stated Don’ts and one simple Do.

Someone you love is deathly sad and you don’t even know it
This one will sensitize you to the suffering of those who may be under your own roof.

How do we as a church respond to mental illness?
Singer Sheila Walsh’s father committed suicide and she has suffered with deep depression also. Two very moving interviews with her here and here.

Lets stop keeping mental illness a secret
“For years, we’ve reserved the term “mental illness” for only the most extreme cases, but 26% of us in any given year suffer from depression, anxiety and a serious number of other mental illnesses, according to the National Institute of Mental Health. It’s a dirty little secret few people want to talk about, a devastating statistic implying that, in each of our families, we all care for someone who faces this pain.”

7 Questions about Suicide and Christians

I am sure we all grieve deeply and pray earnestly with Rick and Kay Warren, as they mourn the shocking loss by suicide of their dear son, Matthew, after many years of struggle with mental illness. Perhaps pray especially for Kay as she has had her own battles with depression.

From all that I can gather of the circumstances surrounding this tragic situation, I believe that Rick, Kay, the church, and the caring professions did all that they could to prevent this happening, and should not blame themselves. As many of us have also experienced, when someone’s mind has gone so far and their emotions have sunk so deep, and they are determined to end their life, it’s virtually impossible to stop.

As well-publicized suicides tend to increase the suicide rate quite dramatically, I thought it would be good to address seven of the questions that arise in our minds at times like this.

How common is suicide?

  • It is estimated more than one million people die by suicide each year in the world, or more than 2,700 people per day
  • There has been a 31% increase in the number of suicides in the U.S., from an estimated 80 a day in 1999 to 105 a day in 2010.
  • Nearly 20,000 of the 30,000 deaths from guns in the United States in 2010 were suicides, according to the most recent figures from the Centers for Disease Control and Prevention.
  • Suicidal acts with guns are fatal in 85 percent of cases, while those with pills are fatal in just 2 percent of cases, according to the Harvard Injury Control Research Center.
  • 465,000 people a year are seen in ER for self-injury.
  • Suicide is the third-leading cause of death for teenagers.
  • 7% of 18-39 year olds said that they had seriously considered suicide in the last year.
  • In 2010, the last year for which figures are available, 22 veterans took their own lives every day, with the largest number occurring among men between 50 and 59.
  • Depression is the key indicator in two thirds (@20,000) of all suicides
  • Other key indicators are childhood abuse and confusion over sexuality.

How do I know if someone is thinking about suicide?

The National Suicide Prevention Lifeline says three major signs of immediate suicide risk are:

  1. Talking about wanting to die or to kill oneself
  2. Looking for a way to kill oneself, such as searching online or obtaining a gun
  3. Talking about feeling hopeless or having no reason to live

Other behaviors may also indicate a serious risk, especially if the behavior is new; has increased; and/or seems related to a painful event, loss, or change.

What should I do if I’m worried someone I know is going to commit suicide?

Although it’s counter-intuitive, the most important thing to do is to ask the person if they are thinking about taking their life. Do so in a non-threatening, non-confrontational way, to make it as easy as possible to speak openly about their thoughts and feelings. “I see you’re hurting very deeply. I’m so sorry and really want to help. Is it bad enough, that you’ve been thinking about taking your own life?” Rather than plant suicidal thoughts in their minds, this may allow the suicidal person to admit it and to seek professional help. This is vital and urgent if they tell you that they have got to the stage of making a plan. One of the best short pieces I’ve read on this is 8 Things you need to know about suicide prevention.

Do Christians who commit suicide go to hell?

The short answer is “No!” and this is explained further in two great articles: Suicide, Salvation, and Eternal Security by Bob Kellemen and Do people who commit suicide automatically go to hell? by  Michael Patton. Every Christian dies with unconfessed sin and suicide is not the unpardonable sin.

Who is to blame?

The best answer I’ve come across is In the wake of suicides, why blame is never the answer. There Jen Pollock Michel says:

Trying to locate blame is not usually helpful when seeking to understand why a person has chosen to take his life, especially when that locus of blame is sought by outside observers. The reasons are never immediately obvious, even to those within the closest circles of family and friends. Moreover, the problems are never one-dimensional or easily fixed. I believe firmly that survivors of suicide heal in part as we learn to refuse the responsibility for the choice our loved ones have made.

What if I’m thinking of suicide myself?

Ask God to deliver you from temptation and talk to your loved ones, or your pastor, or your doctor. Or phone National Suicide Prevention Hotline  at 1-800-273-TALK (8255).

In Broken MindsPastor Steve Bloem gives a number of reasons he has, at times, used to convince himself not to commit suicide:

  • It is a sin and would bring shame to Christ and His church.
  • It would please the devil and would weaken greatly those who are trying to fight him.
  • It would devastate family members and friends, and you may be responsible for them following your example if they come up against intense suffering.
  • It may not work and you could end up severely disabled but still trying to fight depression.
  • It is true – our God is a refuge (Ps. 9:10)
  • Help is available. If you push hard enough, someone can assist you to find the help you need.
  • If you are unsaved, you will go to hell. This is not because of the acts of suicide but because all who die apart from knowing Christ personally will face an eternity in a far worse situation than depression.
  • If you are a Christian, then Jesus Christ is interceding for you, that your faith will not fail.
  • God will keep you until you reach a day when your pain will truly be over (59-60).

 What can the church do to prevent suicide?

The single biggest thing the church can do to reduce the suicide rate is to admit there is such a thing as mental illness. The second biggest thing we could do is for pastors to admit they need professional help from other disciplines and caring professions to minister to all the complex needs of those suffering such indescribable agonies. As Adrian Warnock, a psychiatrist by training wrote:

Please, if someone you know and love is suffering in a similar way, don’t let anyone persuade you not to reach out for everything medical science can offer. In many cases it can be literally life saving. Too many of us don’t understand just how serious these illnesses are. I pray that this shocking news may help thousands realize that although faith may be protective in such situations, medicine is often also needed to help.

Judgment Day alone will declare how many people took their lives because they were too frightened of the condemnation that would be heaped upon them in the church if they admitted to struggling with depression or suicidal thoughts. If there’s one thing that infuriates me (usually holy anger, sometimes not so holy) it’s the ridiculously ignorant and horrifically insensitive statements that some pastors and Christians make about depression and mental illness.

The church would do well to recapture the Puritan’s motto in all their counseling: “A bruised reed He will not break, and smoking flax He will not quench” (Matthew 12:20). Sometimes, however, as Matthew Warren experienced, even the most tender and loving of human care is not enough to keep us in life. But nothing shall pluck us out of our Savior’s hand (John 10:28).

UPDATE: Here are some of the best articles I’ve read on this subject in the last 24 hours.