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
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
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
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.
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
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
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!