Depression is probably the most common personal problem for which people seek counseling. There are physiological as well as nonorganic causes for this condition. I would like to take a brief look at three of the most common nonorganic causes of depression—at least, three of the things I look for when counseling someone who is depressed.
The most basic cause of spiritual depression is living out of harmony with Scripture. But to simply call something “sin” without identifying its exact biblical designation does not help us effectively treat the problem. Just as a physician can prescribe a specific antibiotic once he’s identified the exact strain of bacteria causing an infection, biblical counselors must strive for a more accurate diagnosis of (and remedy for) any functional (nonmedical) depression those they counsel may be experiencing.
Please keep in mind that there is a bit of overlap between these three categories. In other words, the walls between these rooms (the three causes of depression) do not go all the way to the ceiling. Technically, they all fall under the same roof—the rooms are all covered by the roof of sin.
The first category of sin that causes depression is, of course, unrepentant sin. By this, I mean any sin about which a person “feels guilty.”(I put quotations around that last phrase because guilt is not primarily a feeling. It is first and foremost man’s culpability before a Holy God.) Guilt makes people feel nervous, unhappy, and miserable. Someone has likened guilt to the physical exhaustion that occurs when an individual exercises too long. Overexerting oneself during physical exercise will eventually result in a temporary depletion of strength and vigor. Running around the track too many times, for example, will sap a person of his physical energy and cause him to become physically exhausted. Similarly, living day in and day out with guilt over sin that has not been confessed and forsaken expends a certain amount of emotional energy¾it saps our emotional strength and causes us to become emotionally exhausted (i.e., depressed). God didn’t design guilt to be something that His people were to live with for long periods of time. His intention is for us to confess our sin and forsake it. In so doing we experience both forgiveness through Christ and sanctification through the Holy Spirit. (Forgiveness deals directly with man’s guilt. Sanctification deals with man’s corruption and thereby helps to eliminate guilt that is associated with being in bondage to sin. As we see our lives being brought into conformity to Jesus Christ, any guilt associated with particular enslaving sins we know we will likely commit in the future is purged from our consciences.) These two provisions eliminate guilt. Appropriating God’s forgiveness removes the guilt of past sins. Cooperating with Him in the sanctification process removes the guilt we sometimes experience due to the knowledge that we are bound by a particular sinful habit and will, therefore, likely commit the same sin in the future.
It is very important to probe not only for sins of commission, but also for sins of omission. Depressed individuals are often depressed because they have given in to their feelings and given up on their responsibilities. For every responsibility they neglect, they experience guilt (and its subsequent misery that leads to depression). Because they continue to follow their feelings rather than the Bible, they continue this pattern of giving in to depression (rather than fighting against it by fulfilling their responsibilities). Hence, a string of omitted responsibilities slides the counselee deeper into guilt, depression, and despair.
There are certain sins that, in addition to producing guilt, have other “side effects” which will sap emotional energy and produce depression. The greatest of these is bitterness. Bitterness (or resentment) is the result of an unwillingness to forgive those who have sinned against us. It requires emotional energy to maintain a grudge. Resentment, like guilt, will deplete our energy if allowed to reside in our hearts too long. Persistent painful emotions are God’s “smoke detectors” designed to call attention to a particular fire issue in our lives. They can’t be ignored without long-term damage to the body and soul. Other sins that drain our emotional energy (above and beyond any guilt they might cause) include anxiety, unrighteous anger, selfish fear, and jealousy. Keep your eyes peeled for these in depressed individuals. This leads us to the second category of nonorganic depression.
Mental Attitude Sin
The next classification of nonorganic depression has to do with mental attitude sins. These are sins relating to one’s thoughts and desires. Perhaps the best way to categorize them is as wrong values. When people do not view life as God does, misery results. As Christians, we must train ourselves to think as the Bible says we should think, to love the things He loves, to hate the things He hates, to long for the things He wants us to long for, and to not want the things He doesn’t want us to have. In other words, for us to be happy (the antithesis of being depressed), we must think and be motivated biblically.
Depression often occurs when people have sinful thoughts and motives. They think thoughts that God says they shouldn’t think. They fear the things He doesn’t want them to fear. They do not fear Him as much as He wants them to fear Him. They worry about things about which He says not to worry. They interpret circumstances in ways that do not reflect God’s sovereignty, love, or goodness. They are unthankful for His blessings. They want what God says they can’t have. They love what God says they shouldn’t love (or love too much what God has given them to enjoy in moderation). They value too highly things God doesn’t value highly (if at all). They don’t value the things He values most. Is it really any wonder that so many people in our society (in your counseling office) are depressed?
Mishandling Difficult Situations
The third cause of spiritual depression is mishandling difficult situations. God leads His children into a variety of trials designed to perfect their character and to ultimately produce happiness in their lives
(“Happy are those who hear the word of God and do it;” Luke 11:28; See also Romans 5:1–5). But when they do not avail themselves of the resources He has given them to respond biblically to a trial, they often grow discouraged, bitter, guilt-ridden, anxious, and fearful. All of these can lead to depression. How we respond to the difficult circumstances God brings into our lives determines the extent to which we will be depressed about those circumstances.
How your counselees respond to a loss will have a direct bearing on how depressed they will be in the weeks and months that follow. Warn them against continuing to interpret and respond to the difficult situation sinfully —be it in thought, word, or deed. Make every effort to help them view the trial as from the Lord, (God’s decreed will sometimes involve allowing others to sin against us; c.f. Acts 2:23) depending on Him to teach them to think and behave in a God-honoring way.
Hope and Help
More often than not at the end of the first session (after collecting data about possible organic and non organic factors), I am able to offer hope to my depressed counselees by saying something like this: “I’m not a physician and am not qualified to diagnose any medical factors that may account for your depression, but based on what you have just told me, I can see several reasons from a spiritual perspective as to why you might be depressed. If I had those things going on in my life, I would probably be more depressed than you. But the good news is, the Bible provides solutions to all of these problems.”
Encourage the counselee to ask himself, as the psalmist did, “Why are you cast down, O my soul? And why are you disquieted within me?” This question was meant to be asked as a self-rebuke. “In light of God’s wonderful provisions” the psalmist asks himself, “what right do I have to be despairing and troubled?” After thoroughly explaining these three categories of depression’s etiology, encourage your depressed counselees to diagnostically ask themselves the question, “Why (for what reasons) am I discouraged and depressed?” Then help them find specific biblical solutions to whatever you believe has caused (or exacerbated) their depression. A great resource for your depressed counselees is Wayne Mack’s small book entitled Out of the Blues.