Thursday, October 15, 2009

Cause of Depression

I have heard it said over and over again that we must realize clinical depression to be a physiological problem and not a spiritual problem. It's medical, people say. We don't want to make it sound like people should just be able to get their act together and do a better job of trusting God. They need help from doctors and therapists. We are told that we need doctors to help with broken legs or cardiovascular disease, and depression is no different.

And I agree. Kind of.

I have some cysts. Sometimes they get bigger and give me pain I'd rather not deal with. The flare-ups are linked to stress and worry. It's not like an hour's worth of stress (or a day's worth) will result in pain. But months of greater-than-normal stress will cause a physiological problem.

High blood pressure is frequently caused by stress and worry. Not always, but often.

Acid-reflux is frequently caused by stress and worry. If it is true that worry is a sin against the first commandment, then wouldn't it follow that acid-reflux is often a symptom or an outgrowth of a spiritual problem?

Of course, people still need their medical doctors for cysts and cardio-vascular problems and acid-reflux. Of course, they still need medicine and treatment. Of course, they cannot be expected to "do a better job of trusting" so that they can "overcome" their physical problems through some me-centered attempt at Increased Faith. But that doesn't negate the fact that the physical problems resulted from worry (aka, sin).

So why would it be any different if the illness were clinical depression?


  1. I think it goes both ways. Some are physically and genetically pre-disposed to depression. But that makes them even more of a target spriritually.

    And spiritual pain certainly causes or contributes to depression.

    Two sides of the same coin. If it were not so, I would not find such succor in private confession and absolution.

  2. Okay. Must. Reply. Immediately. This is such an important question.

    I think in the sense that EVERYTHING that is wrong in our lives and sucky about the world ia the result of lack of faith, depression is, too. Adam and Eve's sin was to not trust God, to turn inward, to look to themselves rather than their Lord. That first sin became ours. "In Adam's sin, We fell all." Now we live in a broken world where nothing is as God intended it to be. It has all been corrupted. So disease and hunger and war and sadness are our lot until God comes back to destroy it all and establish the New Eden.

    But I think when people say that "depression is not the result of a spiritual problem" what they are getting at is that we can't point to some sort of specific one-to-one correlation: you don't trust; that's why you're depressed. Well, it's not that easy. Yes, the depression or the cancer or whatever is a result of the brokenness of this world. But that doesn't mean that a specific thing you did (or didn't do) has brought this on. It doesn't mean that you can point at the depressed person and say, "She's depressed because she's not trusting enough." Well, I suppose you can assert she's not trusting enough in the sense that none of us trusts enough. But you can't say therefore that is why she is depressed, any more than you can say that someone is suffering from cancer or lost a job or was the victim of a natural disaster because he didn't trust God enough. It's not that simple.

    In logic and rhetoric "cause" is one of the most difficult things to prove. The road to proving a causal relationship is fraught with potholes leading to logical fallacies. I think the same is true when it comes to trying to figure out the specific causes of all the bad stuff in the world. That's not to say we shouldn't try to figure out why people get depressed, or get cancer, or study past earthquakes so we can try to predict future ones, or try to figure out why this person became an alcoholic but not this one. But we should be very shy of ever pronouncing that we have it All Figured Out, especially with regard to individuals. Yes, the root cause is sin. But in individual lives there are just too many variables for us to be able to conclude that we know Why Something Happened. We cannot know the mind or the ways of God, and if we try too hard to do so we're going to short circuit.

  3. Nathan Fischer10/15/2009 1:37 PM

    I agree with Susan, in that I think too often we attribute depression to something physiological without realizing that's only the surface issue. The deeper issue is lack of trust in God, that we don't believe what Jesus says about the lilies of the field, His mercy, His love.

    I also fully realize that there are some people who have problems with depression because, quite frankly, it's written into their DNA. Their body gets the oh-so-precarious "chemical mix" all wrong, and they find themselves depressed. We talked about that at seminary.

    However, while that case may be true for some people, it is not true for a great many (despite what they have been told by psychologists and psychiatrists). Though it's not up to me, either, (nor would I even try) to say who is affected by what.

    I think that a large problem with our culture and society, though, is that we tend to attribute almost everything to chemicals in the brain, to a genetic predisposition toward depression, etc. We don't want to say that depression is caused by sin, because sin doesn't exist. We don't want to say that it is a lack of trust in God's promise of mercy, because we really don't even know if we like the idea of God, much less a "personal" God.

    If those aren't the causes, then what is? It can't be what the person has done or is doing, so it must be an external factor, chemicals wreaking havoc on their brain, etc. And so they get told to pop a pill and it will make them feel better. Well, it very well might do just that. But is that really the cure for depression, especially if that depression is rooted in worry, in not trusting God?

    Many people will suffer from depression their entire lives. Even hearing the Gospel won't necessarily bring them out of it. The Gospel isn't a "solution" to our problems. It is the message of Christ Jesus. While the Gospel may not 'solve' the 'problem' of depression, it is the only answer to the lack of trust that is at the heart of depression. All need to be called back to their baptism, back to the altar, back to the waiting arms of the Father where He can tell them again and again, "You are my child, and I will not forsake you." They need to hear this calling, this word of grace in Christ, precisely because of the source of their depression.

    In this, Cheryl, we can indeed know the mind and ways of God. We know that we have turned away from the life that God has offered us, and we know that this turning away has had ramifications in our world, including depression because of worry (lack of trust in God). But God's mind is always on Christ, and His way is always to call us to Christ.

    I've heard others talk like Susan (and I hope I'm understanding her correctly and am right there with her), and the general disagreement is, "You just don't understand!" But I think that disagreement is born out of a desire to *fix* the depression, and they think that Susan is offering the solution that fixes it, which, indeed, appears a pretty weak solution.

    She's not, though. She's simply identifying the root of the problem. And the root is something that can only be handled in the light of the Father's love for His children through the death of His Son, Jesus. This might not make the depressed person feel better - but it is what they need. More than pills and doctors and other such worldly things.

    Not that we disdain pills or doctors - not at all. But let our hope be in the Lord, and if He so chooses to cure our symptoms through this world's physicians, God be praised. Only let us understand that it is the Great Physician who heals souls, which is the heart of the problem of depression, and to whom all who do not trust in the Lord (which is all humanity) need turn.

  4. Nathan, I think we basically agree. The root cause of depression, and all our other ills, is sin, and the only forever answer is Law and Gospel. You say that "too often we attribute depression to something physiological without realizing that's only the surface issue," and all I'm saying is that all of our woes are "surface issues" with sin the root cause. The devil uses our weak bodies (that sometimes have chemical imbalances or handicaps or chronic illnesses) against us. He uses our weak minds and spirits against us. He uses whatever he can against us. For me, there have been times in my life that if you were to look at me you would not have known there was anything wrong. The devil was using my desire to be in control, to keep up appearances, to keep it all going, against me, convincing me that if I only tried harder I would be able to Get It Right. I have never struggled with depression until the last few years, but in my forties I think something hormonal happened and my ability to "maintain" changed. And it actually turned out to be a blessing because it showed me my weakness, which I was trying so hard to deny before. I woke up one day and realized I couldn't keep going as I was anymore--I was hurting my family as well as myself--and I went to the doctor and got help. I am doing better now with the depression, which probably only means that now the Devil is going to have to get at me some other way.

    I guess what I'm trying to say is that I think there is a stigma associated with depression that more than other things makes people point and say, "Lack of faith." I'm just saying that lack of faith is in all of us as the essential human problem and can manifest itself in a multiplicity of ways depending on the individual. And the message to "Have more faith" is not something that is helpful in my opinion because it puts the work of healing on the individual instead of on God. Certainly we turn to the Great Physician for healing of souls since sick souls are the root cause of all our problems. But at the same time I don't think that it is denying the root problem to also seek temporal help for how the root problem manifests itself in our lives (and I don't think that's what you're arguing).

    Last thought: I totally agree that as a culture we are too quick to look for some sort of "syndrome" or illness that we can blame our problems on rather than realizing that the essential problem sin. We should not be too quick to label with "depression" or "ADD" or whatever. But there may come a point when such a diagnosis becomes a lifesaver for someone because it does lead them to seek assistance, medical or otherwise, that makes them able to once again live a "normal" life (realizing that normalcy, too, is relative).

  5. Susan,
    I think part of what you are trying to express is the sin of ascedia. This is described as spiritual listlessness. The ancient church fathers described it as sounding something like depression.

    Don't get me wrong, I had a younger brother who died from Bi-Polar disease, so I know that major depression and other such mental illness is a very real thing. I simply think that these are two seperate things. I also think that a better understanding of ascedia would help the church to better help those who suffer from both mental illness and ascedia.

  6. "Have more faith" was not Jesus' follow up to "o, ye of little faith." When depression results from sin, worry, idolatry, etc, the solution is never to try to "have more faith." If anyone says that, he has a wrong view of what faith is.

    Cheryl said, "in the sense that EVERYTHING that is wrong in our lives and sucky about the world ia the result of lack of faith, depression is, too." Just to be clear, that's not what I'm saying.

    The doctors tell us that all sorts of diseases are caused by stress and worry and taking too much upon ourselves. Those who are clinically depressed may need medical treatment every bit as much as others whose diseases are closely linked to stress and worry. What I don't understand is why the physiological component prompts us to deny the sin that is such a big part of the disease.

  7. "Just to be clear, that's not what I'm saying."

    You mean I wrote all of that for nothing? ☺

  8. Okay, now I am depressed. My finger slipped and my whole long comment disappeared. And it was really good. This one will probably pale in comparison. It will probably also be much shorter, perhaps a good thing.

    Susan, you wrote,

    "What I don't understand is why the physiological component prompts us to deny the sin that is such a big part of the disease."

    I had to go think about this over coffee. And I guess I don't see that this is necessarily the case. If anything, I think the prevailing attitude with depression, unlike with other illnesses related to stress, has always been to first "blame" the patient (which by extension would include his sin). We seem to think that it's all in his head and his fault he's depressed and we expect him to make himself better in a way that we don't with people with other types of health problems. So maybe what we are seeing these days in the emphasis on the physiological component is something of a backlash against that? An attempt at balancing the scale?

    Nothing is solely determined. In my thirties I had more stress than I do now. But I wasn't depressed. When I hit my forties something happened to me physically that made me unable to handle half of what I used to be able to handle. It opened my eyes to the physical nature of depression and gave me great compassion for those who struggle with it not just for a season but for their entire lives.

    I guess the way I look at is is that the sin is a constant. It is always with me. I am by nature sinful and unclean and always in need of the Gospel, whether I'm depressed or not. So since the sin is a given, I want to move on to figuring out the other, more temporal factors contributing to my depression so that I can address those as well!

  9. Cheryl, in response to your "I wrote all that for nothing?" :)

    I have heard people say, "Welllll, okaaaaaay, I guess you can say depression is a result of sin IF we are saying that all pains, illness, and trouble are a result of the fact that there is sin in the world." I think that's what you were saying. That's not what I was saying, though. I'll try to respond after math and history to your other comment.

  10. Cheryl, it crosses my mind that maybe we're operating with different definitions of the word cause. I notice now that when you are talking about cause, you have said things like "there's not a one-to-one correlation"; that we cannot tell why this person becomes depressed and that one becomes an alcoholic; that we can handle a certain amount of stress at one point in our life but at another time the same stresses completely undo us.

    I guess I meant something different by cause. What IS depression? Does it not manifest itself in anxiety about the future? Despair? A focus on oneself and one's own pain instead of focusing on the neighbor's needs? Hopelessness? Lethargy? Guilt? Loss of joy? Irritability?

    You're saying that depression may be brought on by hormonal changes or age or life's circumstances or any number of other things. And I agree with that. But what I am saying is that the guilt and sorrow and hopelessness and turned-inwardness and fear are themselves sin.

    As for "blaming the patient" for his depression, you're right that a depressed person cannot just try to get his act together and snap out of the depression -- that's no more likely than it is for someone to cure himself of heart disease or cancer. I think we often see an attitude that flows from a false theology: what's wrong with you is your fault and it's your job to overcome it. But we cannot overcome sin ourselves.

    But isn't there a problem when we then say that the hopelessness and the selfishness and the worry are not sin but are symptoms of a disease that's out of my control? I've heard alcoholics excuse drunkenness. I've heard ADD kids excuse obnoxious behavior. It's not their fault, you see; it's the disease. But that's not true. My sin is my fault, my own fault, my own most grievous fault, even if there's something adverse going on in the chemistry of my brain that I cannot control without medication.

    I guess when you say "cause" depression, you're talking about the events that precipitate a change in a person from being normal to being depressed. And when I said "cause" depression, I meant these are the attitudes (and yes, sins) that make depression be what it is.

  11. Ding, ding, ding! Susan, we reach. Thank you. I totally get it now. The alcoholic may have a predisposition to alcoholism, but that doesn't excuse the resulting sinful behavior. The homosexual may have a genetic predisposition to homosexuality, but that doesn't excuse homosexual behavior. The depressed person may have a predisposition to depression, but that doesn't excuse the sinful behavior that results. It's all so clear now. Why was it so hard to get to this point? :-)