Tuesday, March 25, 2014

My Theology of Chronic Clinical Depression

Part 1 - I've a Confession to Make
Part 2 - Not Your Everyday Depression


How do they fit?

How can a person who claims to be a Christ-follower also claim to have chronic clinical depression?

Isn't the one supposed to cancel out the other?  Isn't faith in Christ supposed to be the all-encompassing happy stuff that cures whatever ails you?  Or, alternatively, shouldn't chronic clinical depression corrupt enough of your soul with despair to convince you that God isn't so loving after all?

Or am I simply pursuing some vain hope that a belief in Christ can be a panacea for my problems?  Is my faith merely a crutch to help me deal with chronic clinical depression?

I'll be straight-up honest with you about this, so you won't go reading any further, expecting me reach a conclusion of profound insight that nobody else in the history of humankind has ever had.  No, I don't have a lot of answers for you.  Especially if you're not already convinced that Jesus Christ is the Son of God, and that He died on the cross to take away the guilt of your sins.  Neither am I at complete peace simply accepting that God allows stuff to happen to us purely for His glory and our good, which the Bible teaches are the two basic reasons why anything happens to any of us.

I'm sorry to disappoint you, but I'm not a mighty Christian.  Hey - I'm a red-blooded, self-indulgent, 21st Century American.  Which means I'm spoiled.  I'm also skeptical, iconoclastic, and cynical, which means I've looked high and low for the easy exits, and discovered there aren't any.  There are no magic beans, and there is no tantric bliss.

However, there is the Holy Spirit, and He has assured me of eternal life in Heaven with God through Christ.  I trust in God because the Holy Spirit enables me to, just as He enables me to endure, day by day - and often, hour by hour - whatever troubles, anxiety, pleasures, and accomplishments He allows.  For His glory, and my good.

If you think this makes me a dim-witted humanoid weakling who needs to hope in a Deity to make some sense out of life, then you'll probably not find anything helpful in my perspective of how my faith and my depression fit into my body and brain.  I invite you to read on, of course, perhaps only as an experiment in having an open mind.  However, if you yourself have been convinced by the Holy Spirit that God exists, and that He loves you, and you've invited Christ to be the Lord of your life, then hopefully my rough-hewn theology of clinical depression can be helpful to you.

Because I do think there is a theology of clinical depression, and I think God is teaching me about it and Himself through this experience.

Spiritual, Physical, Emotional

Admittedly, I don't know as much about the different types of serious problems other people face.

However, my theology of clinical depression probably follows along the same lines as most other perspectives of suffering, sickness, and pain that take place in the life of every born-again follower of Christ.  God never promises anybody a life of ease and carefree, pain-free idyll.  If your life seems like one big festival for you, then the cynic in me would wonder if your faith is as genuine as you think it is.  Why?  Because the Devil, our enemy, is real, and one of his vile tasks involves trying to corrupt your faith to the point where you're willing to deny your Savior because you can't make sense of what He's allowing to happen to you.

The book of Job in the Old Testament is one massive parable about how Satan went to God and proposed that he could destroy Job's faith.  God allowed Satan to try, but even after Satan caused everything that Job had to be taken from him, with the exception of an unhelpful wife and unhelpful friends, Job remained faithful to God.  Today, some Christians think that the problems they face are cataclysmic meteors direct from Satan, like Job's were.  Or they wonder if maybe God is secretly testing them, to see how genuine their faith is.

I don't necessarily hold myself in such high regard to presume that either God or Satan have chosen me to be some pawn or allegory.  Satan may have devised my chronic clinical depression to see if my faith will collapse, which is his singular modus operandi, but I'm pretty sure God is letting this happen to me to build my faith.  And part of building my faith is trusting in God's sovereignty.  My personal sin nature did not directly cause my depression, although it certainly plays a role in how I deal with it.  If medical science is correct, and my allocation of the neurotransmitter serotonin is wonky, then I was likely born with a predisposition to clinical depression, and it won't be my fault if I have it the rest of my life.  My parents and I, as we've worked backward from my diagnosis, now suspect that some of my oddities as a child and a teen stemmed from clinical depression, only back then, hardly anybody knew what clinical depression was.  The diagnosis, after all, is relatively recent.  Nevertheless, suffice it to say, whether this is a direct test, from God or Satan, it's something that God has allowed, and something that I may overcome with His help here in this life.  And if not in this life, then most assuredly in the one to come.

Maybe that sounds like fatalism to you.  To me, it's more like hope.

Two Views for Treatment

Unfortunately, for those of us in the Christian community, even everything I've just written is not enthusiastically embraced by Christ-followers who try to treat people like me.  You see, there are two general schools of thought within evangelicalism regarding treatment methods for chronic clinical depression.  The conventional method is the one in which I've been treated, and am still being treated.  It involves traditional Christian counseling that looks similar to secular psychotherapy, except it's conducted by therapists trained in Bible-based approaches to emotional disorders.  It can include a liberal reliance on psychiatric theory and medicine, as a mixture of science and spirituality.

However, a newer school of thought has developed as a reaction to the conventional Christian counseling model, and its practitioners call themselves Nouthetic, or “Biblical,” counselors.  This isn't entirely helpful for a couple of reasons, the first and most obvious one being that by calling themselves "Biblical" counselors, advocates of this school of thought are insinuating that their approach is theologically superior, and that traditional counseling methods, by contrast, are not Biblical.

This is no mistake on the part of Nouthetic practitioners, because many of them dismiss traditional counseling, no matter the clinician's evangelical devoutness, as too corrupted by worldly science and fuzzy psychiatry.  Nouthetic counselors tend to emphasize theological discipline to the exclusion of medical considerations.  They theorize that their patient's sin is the dominant problem, and believe that helping their patients confront their sin is more effective than considering biological contributing factors to clinical depression.

Understandably, conventional Christian counselors caution that Nouthetic/Biblical counseling risks being too simplistic, aggressive, and medically dangerous.  For their part, Nouthetic/Biblical advocates contend that Christian counseling flirts too much with secular theory, and it's too generous to the patient when sin issues comprise only one of several aspects to be addressed by Christian counselors - whereas Nouthetic counselors focus mostly on their patient's sin.  In other words, if I allowed myself to be treated by a Nouthetic counselor, I would likely be directed to simply confront my fears, lack of trust, selfishness, and pride - all components of my chronic clinical depression, I admit; and all sins.  And I would likely be strongly discouraged from continuing my medication regimen.

Perhaps for people who are merely wallowing in self-pity over something, such an approach is appropriate.

Meanwhile, I don't see why considering certain biological factors and medical treatments - such as prescription drugs - for clinical depression is being unBiblical.  I'm willing to explore aspects of my sin nature that likely contribute to my problems, but is science so wrong that it should be excluded from a treatment plan?  From what I've read about the Nouthetic approach, most of its advocates have never been to medical school, and seem annoyed that traditional counselors put as much faith in science as they do, as if science in general - and psychiatry in particular - is utterly unGodly.

Much of this discrepancy likely stems from continuing confusion over what "depression" really is, and the degrees of severity it can involve.  Personally, I suspect that too few Nouthetic advocates have actually ever had chronic clinical depression, and they have no idea what their patients are going through.  I had several therapists who admitted to being recovered depression patients themselves, and I could tell that they had a good handle on what I was experiencing.


Having said all of that, I am grateful to have had (with the exception of my first psychiatrist) born-again evangelical therapists to help counsel me, and they incorporated both science and scripture.  If you or somebody you know is in psychotherapy for chronic clinical depression, and your therapist is not discussing your sin patterns with you, then you need to get a new therapist.  It's possible that Nouthetic counselors have deemed some traditional Christian therapists to be inadequately incorporating difficult discussions about their patients' sin patterns in the treatment mix.  In my opinion, if you're wanting help, everything needs to be on the table.

You see, sin does not cause chronic clinical depression, but it can exacerbate it, prolong it, and even deny a patient their recovery from it.  With an illness as individualized as chronic clinical depression, even if medical science ultimately confirms that serotonin plays a causal factor in the brain, nobody can assert that sin isn't lurking somewhere deep in the soul.  No matter how physical chronic clinical depression may be proven to be, there is still an emotional component to it, and to varying degrees, I believe that our emotions can be brought under the Lordship of Christ.  Not completely, of course - even people who do not suffer from depression have imperfect emotions.  But anxiety is a form of fear, and God commands us dozens of times in His Word not to fear.  If He commands us to do something, or not to do something, shouldn't that imply that He provides us a way to do it - even if it's solely through our imperfect reliance on the Holy Spirit?

As I've struggled with my depression, I've actually been able to identify some fears that I can indeed place in His hands, and from which I can walk away.  I doubt that there's a born-again, evangelical Christian therapist out there who believes that not one fear a patient of theirs may have can be brought under the Lordship of Christ.  Any good Christian therapist's job involves helping their patients trust in God, instead of being fearful.  Even if progress in that trust is incremental.

So, why am I not cured?  I've had this diagnosis for 21 years.  Shouldn't that be long enough?

Actually, thanks to the Lord's working in my life, plus the medication I'm on, I've been able to plateau at a point that is considerably higher than where I was when my treatments began, way back in New York City.  So I count that as progress, even though it's not what anybody would call "normal."  Part of this experience is learning what I can do, what I shouldn't do, and what I can't do.  Most of all, however, the Lord has given me an all-new appreciation for the Fruit of the Spirit:  love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control.  Some therapists have their patients do breathing exercises when they feel panic attacks coming on.  One of the best ways I've found to short-circuit a panic attack is to slowly recite the Fruit of the Spirit.  And speaking of panic attacks, I'm thankful to God that I can't recall the last one I had!

This is my version of the theology of chronic clinical depression.  I can't say it's cured me of my problem, but then again, no theology can, can it?  God is the sovereign Creator and Healer; not any scientific or religious theory, no matter how accurate they may be.

So, how can a Christ-follower like me also have chronic clinical depression?  Through God's sovereignty, and with the relief of His sustaining grace.

I told you it wouldn't be a fancy answer, but at least I can testify to it now, and thank Him that it's true.

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