SPIRITUAL DEPRESSION VERSUS BIOLOGICAL DISEASE

Have you ever heard a Christian say, “If you’re strong in your faith, you shouldn’t

suffer from depression”?

Although it’s a misconception that is becoming less prevalent, I have heard that

sentiment numerous times. Let’s clarify: depression certainly can be of a spiritual

nature. In this case the feelings of hopelessness and sadness will be helped by

primarily focusing on spiritual disciplines (For an awesome resource on spiritual

depression, see the classic book “Spiritual Depression” by Martin Lloyd Jones. He

was actually a physician before he trained as a pastor).

However, depression can also be caused by other factors.

In these cases, depression will actually produce biological effects in the body, and

it is what can be called a physical depression. Medical professionals would call it

major depressive disorder or clinical depression. (For simplicity, from this point on

when I mention depression, I am referring to physical depression).

This type of depression commonly gives symptoms such as sleep disturbance,

extreme fatigue and poor concentration. These can make it very difficult, if not

impossible, to successfully practice spiritual disciplines.

So if someone with a physically based depression is given the advice –however

well-intentioned – to spend more time in prayer, and in the study and meditation

of the Word, it can backfire. When one is trying, but literally can’t focus or make

sense of the Bible, damaging conclusions can be made. Things like, “I’m so

hopeless, even God can’t help me” or “This faith stuff just doesn’t work”.

Feelings of frustration, shame and guilt can easily take over. At worst, these

feelings can cause individuals to withdraw from the fellowship of other believers

and give up entirely on a pursuing a relationship with Christ.

I’ve been in such a severe depression that I stopped reading anything. When I’d

try to read a paragraph I literally could not remember a thing. Although I’d always

been a bookworm and very fast reader, I couldn’t make sense of the simplest

newspaper articles. That’s discouraging enough, but imagine feeling spiritually

inept in addition. And then, if one is getting advice from someone who doesn’t

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believe in physical depression, to possibly be judged and condemned as if not

putting forth enough effort. Not a good situation, for sure.

Why can there be such confusion as to whether depression is physical or spiritual

in origin? One big reason is that both types of depression can produce the same

end result: intense feelings of hopelessness and worthlessness. Also, since there

are no biological tests for any of the mental disorders, the diagnosis of a physical

depression is not cut and dried.

How do we know that depression even exists?

Although there are no lab tests that can be used for diagnosis, the evidence of

depression on the brain can be seen. A slide I often show in my presentations is

one of special CT scans (called enhanced CT scans) of two individuals. One

individual has clinical depression, while the other does not – and there is a huge

difference in the two images.

In these enhanced CT scans, a dye is given intravenously which then circulates

through the body and the brain. The dye is taken up by neurons that are active,

and shows up as a bright yellow color on the CT scans. Thus the normally

functioning brain, with lots of activity, is mostly yellow. The image of the

depressed person’s brain, in contrast, is much darker.

There are numerous areas in the brain where activity can be decreased by

depression. One very important area is called the left prefrontal cortex. It’s the

area of your brain behind your left forehead. You can think of it as the CEO of

your body. It is responsible for motivation, initiating activities, planning things

out. Really, everything you do in life starts with the neurons there. They have to

start firing and give the rest of the brain (and thus your body) instructions.

I saw my mom in a state of severe physical depression. She was in hospital after

major heart surgery and had slowed down so much she was practically catatonic.

She’d just lie in bed and hardly move, she wouldn’t eat and she could barely get a

short sentence out. When speaking to her, all you’d get would be a blank stare. It

wasn’t hard to accept that for her, there was something physically wrong.

However, in less severe cases depression can be much more subtle. It can show

up as having a hard time making decisions and feeling constantly overwhelmed;

becoming messy and disorganized; withdrawing from social activities and even

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close relationships; even having difficulty losing weight. The lack of activity in the

pre-frontal cortex could mean just less interest and “get up and go”.

Now, I’m not saying that everyone who’s desk is cluttered or who doesn’t feel like

going out to a hockey game is depressed! Everyone can have down periods and

certain weaknesses (I’ll admit, my struggle is keeping my desktop visible). One has

to be consider how intense and long-lasting the issues are. Are they interfering

with day-to- day life, and doing so for a lengthy period of time? In the overall

picture, even though my desk may be cluttered, it doesn’t keep me from doing

what I need and want to do.

Many psychologists now think of mental functioning in terms of a continuum or

range. At one end of the range you have optimal mental wellness and functioning,

and at the other end you have actual disease. The area in between has a

progressive amount of ‘symptoms’ and distress.

The key question is, what is most helpful in helping to overcome distress and

move toward wellness?

There is no scientific evidence that mental disorders are due to chemical

imbalances (stay tuned for a discussion on this in my next post). The best research

shows that the most effective first step for depression is to focus on lifestyle

change. The specifics of what’s most important lifestyle-wise, and tips on how to

get implement strategies will also be looked at in detail in the future. I do think

most of us already know that the basics are proper rest, good nutrition, and

physical activity.

But how can we know whether someone’s depression is mainly physical and that

the focus should be on lifestyle?

Well, here comes the good news/bad news response (sorry it can’t be all good

news, but that’s life). Bad news first: there’s no easy way to tell for sure.

Now the good news: most of the time it really isn’t necessary to know for sure. I

think the best approach – likely because most people have some combination of

both factors – is to apply fairly simple principles that support both the spiritual

and the physical life. Please note: I said simple, not necessarily easy. I recognize

that they can be hard to put into practice. That’s why I think it’s so crucial to have

social support – and why I think the Bible stresses the importance of fellowship.

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The beauty with these principles is that they are foundational for good health.

There are no risks to worry about.

If we start living in a healthier fashion and lose some weight as a “side effect”,

how many of us are going to complain? If our blood pressure normalizes and our

achy joints hurt less, is that going to be an issue? And guess what, even if

someone’s depression is more spiritual in nature, living a healthier lifestyle will

give more energy and improve concentration, which in turn will make

incorporating the principles for a healthy spiritual life that much easier.

So what are those principles? They probably won’t come as a surprise. Reading

the Word regularly (daily is definitely the best), meditating on scripture, spending

time in prayer, fellowship with other believers.

Now, in certain situations – as in my mom’s case of severe depression – it may not

be possible to apply some or any of these principles. She really could not do the

spiritual practices, nor the lifestyle changes. In her case, medication was the most

feasible choice.

For someone whose concentration is so poor they can’t focus enough to read or

pray, an emphasis on the more physical things (exercise, for example) would

make sense. I’d suggest, though, that whatever form of spiritual activity can still

be done be incorporated regularly. Things like repeating short Bible verses,

attending worship services or listening to worship music require less focus and

can still have a very positive effect. Then, as concentration and focus improve,

start doing more. Go deeper in the Word, meditate on it and have more prayer

time.

So, in conclusion, don’t be exclusive, focusing on either just the spiritual or the

physical. Life works best when you incorporate the fundamental principles for

health in both areas.

My challenge to you: Identify one thing you will work on in both areas. Perhaps

it’s committing to walk for half an hour three times a week and having a daily

devotional time. Maybe it’s making the time for breakfast every day and joining a

Bible study. Or cutting out soft drinks in favor of water and memorizing some

scripture. Be specific and get started!

Blessings and good health!

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