Depression has nothing to do with my soul
Overspiritualizing mental illness keeps people from accessing actual help.
(Usual mental health disclaimer that I’m fine and getting professional help and all that.)
I don’t know how to describe how I’ve felt the past couple of days other than profoundly sad. After a couple of years of blogging about mental health, I think I’ve finally run out of poetic-sounding ways to say “As soon as I get home I’m half-awake binge-watching tv on the verge of tears.”
Depressive episodes can be mysterious, especially from the outside. How can a person suddenly find themselves so overcome with darkness, their very being weighted down by anchors nobody else can see? Many of the biblical authors, personally familiar with deep trauma, express this in frighteningly spiritual language. One psalmist describes his anguish as an injury to his very soul:
“Why art thou cast down, O my soul? and why art thou disquieted in me?”
Jesus himself will echo this language right before his crucifixion, in the middle of an anxiety attack so severe he sweats blood:
Then He said to them, "My soul is consumed with sorrow to the point of death. Stay here and keep watch with Me."
I find it hard to think of more compelling language to capture the sheer overwhelmingness of a serious mental health episode. But there’s also a danger here — a misconception that unfortunately I’ve heard both from friends and from the pulpit.
If I as a depressed person tell you my soul feels crushed, I am probably trying to tell you something about how strongly I am feeling. But if you start to interpret it too literally, you may start to wonder if the physical and mental manifestation of my illness is merely a symptom of something that’s happening primarily on a spiritual level.
You might conclude that my depression might be caused by a lack of faith: after all, shouldn’t the knowledge of an all-powerful God who loves me more deeply than I could possibly imagine be enough to make me happy?
Or that it’s the result of misplaced priorities: maybe if I were more focused on serving others instead of myself I’d see how good I have it.
Or even outright sin: perhaps if I’m feeling lonely it’s because I’ve made an idol out of relationships or friendships or whatever I feel like I’m missing and everything would be better if I’d only repent!
And in this case maybe seeking secular therapy or psychiatric medication would be a mistake, because that would be treating the symptoms rather than the underlying brokenness1!
A handful of Christians, including church leaders, have expressed this sentiment to me in fairly similar words, and without exception have been surprised that I was upset. But I was right to be: if they’d told me so a few years earlier, I might have believed them and it might have kept me from seeking professional help. If I hadn’t sought out professional help, I would be dead. This has happened to people in essentially the same situation.
I think most people come by this misconception honestly, out of a sincere desire to help, which is why I want to write about this week’s depressive episode in particular. I am very sad this week and I can tell you that it has nothing to do with my soul. I can tell you exactly what is causing it and even how long it will last.
Up until three weeks ago, I was on a drug called Amitriptyline to try to treat my chronic headaches. Over the past couple of months I’d started to develop confusing cognitive side effects, the worst of which completely blocked out specific kinds of abstract thinking I apparently use in both my research and my prayer life. A neurologist I saw linked these to Amitriptyline and recommended that I taper off of it, and so my thoughts and prayers have finally started to return.
Even with tapering, I’m experiencing some common symptoms of Amitriptyline withdrawal, most saliently a short (typically no longer than a week) depressive episode. This was more-or-less expected and I will be fine, but for now I’m sad and that’s okay. It is what it is, and I’ll get through it.
But I shouldn’t have to be able to tell you every step of a chemical pathway for you to take my illness seriously for what it is: a weird mix of chemical, emotional, physiological and behavioral inputs interacting in messy and painful ways. Most depressive episodes don’t have causes as straightforwards as this one, and Christianity isn’t a cure for them any more than it’s a cure for a broken arm. The bible is full of depressed characters who show great faith — but how often do they find themselves cured? This “Christianity as cure” approach risks trivializing not just mental illness, but our faith as well.
It is a sincere blessing that we live in a day where we’re starting to learn how to treat depression. Professional, evidence-based therapy is a lot of work, but it helps. Medication helps. Combining therapy and medication works better than either on its own. Getting better is a lot of hard work, and as a depressed person I can tell you that the “maybe you’re just overreacting” voice never really goes away. The reason oversimplified spiritual “solutions” are so hurtful is because they reinforce this lying, accusing voice in ways I don’t think the speaker realizes or intends.
A recent sermon at my church characterized clinical depression as something spiritual that could best be treated by “participating in the work of the Lord.” I was (as always) annoyed by the conflation of “the work of the Lord” and donating our church’s new building fund, but on a deeper level what really hurt was the idea that maybe God wasn’t responding to my prayers for deliverance because I wasn’t sufficiently devoted to him (or, put less charitably, because I wasn’t “doing enough Christian things.”)
It’s true that even as a reasonably high-functioning depressed person my capacity for ministry drops during depressive episodes. But it isn’t true that doing more would fix things: my senior year of undergrad I was leading two separate bible studies, volunteering with two ministries for people experiencing homelessness, writing plays about my faith, praying more consistently and sincerely than I ever had before, and still completely and utterly depressed.
I know this wasn’t the intent of the sermon, but messages like this reinforce the voice in my head telling me that none of the ways I’ve served God when I’m depressed “counted” because my heart wasn’t in the right place. That if I was really “participating in God’s work” my emotions would be swept along the for the ride and I’d be miraculously cured. That I should zero in on the mistakes I made while serving as evidence that everything I did was worthless.
This voice isn’t God’s. But it gains power when we pretend depression is primarily a spiritual issue, the same way it thrives on the prosperity gospel (“you’re poor because you don’t have enough faith”) and overzealous faith healers (“you’re sick because you don’t have enough faith”). If you object to the latter two (and you should), you should object to the former, too.
If you have not dealt with a mental illness yourself, you probably don’t have any good spiritual advice for how the rest of us should deal with ours. I certainly didn’t before getting depression, and even now I’m not certain I do. It’s okay to stick with basic facts like “get professional help” and “I still like you,” because we don’t really need your opinion. Your love is enough.
To the extent that mental illness involves damaging thought patterns (there’s a weird tangle of “sin” and “suffering happening to you” here that is really deeply nuanced and complicated and I promise you will not be able to sort out for anybody who isn’t you), secular therapy is designed to fix them! And the evidence is fairly clear that a combination of secular therapy and medication is better at sorting them out than any known religious intervention.