Some Christian teaching has given the impression that if you are depressed then the problem must be spiritual: you must have sinned or failed in some way in your Christian walk. Unfortunately, this can lead to feelings of guilt which can compound the underlying depression. Depression often leads a person to spend much time by themselves resulting in isolation. This kind of teaching can lead to avoidance of church and Christian friendships, resulting in further isolation.

Jesus always sought to be inclusive. He was frequently moved with compassion when facing human need. Stigma is still a huge problem in mental illness. We can seek to overcome this by being welcoming and compassionate as Christ demonstrated.

what is clinical depression?

These are the common features of clinical depression that one would look for in seeking to establish a diagnosis:

Two weeks or more experiencing symptoms 1 or 2, plus at least four of the other symptoms (3-9) for most or all of the time.

1. Feeling low and down nearly all the time

2. No interests or pleasure in anything

3. Unable to sleep properly

4. Loss of weight (sometimes gain in weight)

5. Agitated or very slowed down

6. No energy, tired all the time

7. Feeling worthless or guilty

8. Unable to concentrate

9. Recurrent thoughts of death or suicide

(DSM IV Classification) (1)

Depression, as above, is not uncommon and between two and three percent of the population suffer from depression like this at any one time. There is good evidence that those who practise their religious faith tend, as a group, to have less depression than those who do not. This comes out strongly from the work of Professor Patricia Casey. (2)

depression in the Bible

The Bible is very real about personal experience. We see people's struggles as well as their joys and successes. In their low times, we may not necessarily say that they suffered from clinical depression (through lack of sufficient evidence) but it certainly seems likely. Who were these people?

Job

Job was one of the leaders of his city who sat at the gate giving judgement. (3) However, there came a fateful day when in quick succession he lost everything. All his herds of animals and then all of his children were suddenly taken from him. His wife responded by turning against him. His health was broken. He sat on the ground scratching his itching skin with a piece of broken pottery. We read:

'"May the day of my birth perish'" (Job 3:3) and

'"Why is light given to those in misery…who long for death that does not come?'" (Job 3:20-21)

Job wants to die and wishes he had never been born. Job had lost so much that was precious to him and could not understand the reason why. In my experience, many people with severe depression have been through similar losses which they may not understand. In Job's situation, despite no material change in his circumstances and despite the poor advice of his friends, his faith shines through when he exclaims, '"I know that my redeemer lives!"' (Job 19:25). In difficulties that we may not understand our faith can still triumph. In the end Job receives back double for all that he had lost. (4)

Jeremiah

The prophet Jeremiah had the onerous task of warning the people for the final time to turn from their wicked ways or else risk deportation to Babylon. Jeremiah became extremely unpopular and he and his message were widely rejected. The prophets, the priests, the king and the court and even his own family turned against him. During this experience of overwhelming rejection he cries out:

'Cursed be the day I was born!' (Jeremiah 20:14)

Yet in the midst of the storm of rejection, we read of a deep and tender relationship growing between Jeremiah and his God. For example, the Lord says to him, "'I will make you a wall to this people…they will fight against you, but will not overcome you, for I am with you to rescue and save you" declares the Lord.' (Jeremiah 15:20)

Like Jeremiah, many people today experience major rejection in their lives but what does Jesus promise?

'In this world you will have trouble. But take heart! I have overcome the world.' (John 16:33)

'And surely I am with you always, to the very end of the age.' (Matthew 28:20)

Elijah & David

Similarly recorded in the Old Testament, we read about Elijah who had an episode of severe low mood, which may well have been related to near total exhaustion. (5) Also, in Psalms 6, 32 and 38 we read of many features of depression experienced by King David. Psalm 32 relates this to a sin issue in David's life. We should be aware that physical factors (Elijah) and sin issues (David) can be related to depression.

depression amongst Christian leaders

Leadership brings additional responsibility and the possibility of increased isolation. The mantle of Christian leadership may bring attack and persecution, adding to the risks of depression.

Judson

Adoniram Judson was one of the first 'modern' missionaries who went to Burma (known today as Myanmar) in 1813. During his time there, he became profoundly depressed. It is not difficult, however, to track some of the factors that lay behind this. During war in the country, he was severely mistreated and imprisoned. He then had to leave his wife and child behind to try and help in the aftermath of the conflict. In his absence, sadly both his wife and child died. He could not forgive himself for not being with his wife and child when they had needed him most. He tried to bury his grief in his work of Bible translation, but this did not help. Instead his grief became worse. He retreated into the jungle where he dug a grave and walked around it for several days in a suicidal state. He could not feel God's presence with him. However, his fellow missionaries prayed constantly for him and he gradually recovered. Following recovery, whilst previously he had preached to little effect, now thousands embraced the Christian message.

Spurgeon

The story of the depression endured by the famous preacher Charles Haddon Spurgeon is quite well known. He himself had considerable insight into some of the related factors. (6)

what may we conclude from studying these 'case histories'?

• First, there are many different factors which may lead to depression. People are very different and a commitment to understand each individual is vital.
• Second, God remained very close to these people and brought them through.
• Third, God showed himself to be gentle and loving, treating each person with respect and dignity.
• Fourth, prayer by fellow Christians proved to be very important.
• Fifth, we might also say, as we observe these historical cases, that we wish that certain effective treatments had been available. Modern treatments such as antidepressants, cognitive behaviour therapy (CBT) and even electro-convulsive therapy (ECT) could have been helpful in both reducing suffering and the length of their depressive episodes.

how can we advise and help a person with depression?

medical assessment is necessary

This helps to identify possible underlying factors (including physical factors) and enables the severity of the depression to be gauged and permits the formulation of a treatment plan.

support & help for the depressed individual

We can try to encourage the depressed person to take regular meals, a normal sleep pattern, and remain socially involved. We should be compassionate and caring and seek to remain involved with the person. We can pray with them or for them as appropriate and encourage Christian fellowship.

What other ways can we help? Accurate information about good local resources can be very valuable. Booklets on all aspects of mental health are freely downloadable from the Royal College of Psychiatrists' website. (7)

Some churches, with help and advice, have started drop-in centres which can offer friendship, structure, support and practical help.

seminars for the general public

Over the last few years I have been conducting seminars on mental health issues for the general public. I have, for example, given a series of three or four talks over a weekend, or as a weekly series, generally concentrating on the topics of depression, anxiety, suicide and addictions. With each topic, I like to give an overview followed by spiritual and biblical input for those who wish to remain to hear this (usually at least 80%). Many of these have not had a strong Christian connection and it has been a joy to point people towards the Lord. (8)

More details of this, including the talks themselves, are on my website: www.stephencritchlowmentalhealth.com, along with synopses of the talks and other issues are covered in my recent book: Mindful of the Light: practical help and spiritual hope for mental health. (9)

Stephen Critchlow is a retired consultant psychiatrist and author in Northern Ireland