The Causes of Depression

When we recognize depression as suffering (our main point last week), we see that Scripture embraces complexity, shuns simplistic answers and points to five relevant causal elements relevant to all suffering (including depression). Let’s consider each as it may apply to depression.

Our social context consists of people who will, in varying degrees, sin against us. This is going to profoundly hurt us, because God created for loving relationships. So when relationships do the inverse of what they were created for, it hurts profoundly. In other words, when relationships get negative and painful, we get negative and hurt. About half the Psalms are the cries of the oppressed, and beneath the depression of some people you may find victims of others' sin. Take a look, for example at , .

Psalm 55:1–8 NIV

Listen to my prayer, O God, do not ignore my plea; hear me and answer me. My thoughts trouble me and I am distraught because of what my enemy is saying, because of the threats of the wicked; for they bring down suffering on me and assail me in their anger. My heart is in anguish within me; the terrors of death have fallen on me. Fear and trembling have beset me; horror has overwhelmed me. I said, “Oh, that I had the wings of a dove! I would fly away and be at rest. I would flee far away and stay in the desert; I would hurry to my place of shelter, far from the tempest and storm.”

Psalm 55:12–14 NIV

If an enemy were insulting me, I could endure it; if a foe were rising against me, I could hide. But it is you, a man like myself, my companion, my close friend, with whom I once enjoyed sweet fellowship at the house of God, as we walked about among the worshipers.

Victims can struggle with depression. But perhaps in less obvious cases, the sins and failures of others still need to be considered—for example, the depression a teenager is battling may be related to the divorce of her parents. In this example, it may be hard to identify who sinned, but clearly the impact of sin-affected relationships is having a toll on this teenager. In seeking to understand and respond to depression, we must be aware of the impact our social context makes. That’s the first relevant causal factor.

If an enemy were insulting me, I could endure it; if a foe were rising against me, I could hide. But it is you, a man like myself, my companion, my close friend, with whom I once enjoyed sweet fellowship at the house of God, as we walked about among the worshipers. Victims can struggle with depression. But perhaps in less obvious cases, the sins and failures of others still need to be considered—for example, the depression a teenager is battling may be related to the divorce of her parents. In this example, it may be hard to identify who sinned, but clearly the impact of sin-affected relationships is having a toll on this teenager. In seeking to understand and respond to depression, we must be aware of the impact our social context makes. That’s the first relevant causal factor.

The curse of sin has negatively affected everything, including our physical bodies. So we don’t quite function as we should. Ed Welch, a psychologist who has a PhD in Counseling Psychology with a neuro-psychology speciality, says that “diseases, deterioration from old-age, post-partum struggles, and possible chemical imbalances are just a few of the physical causes relevant to depression.” [1] The Christian perspective recognises the important role of the body, this biological component of depression. Charles Spurgeon, the revered Baptist preacher who struggled with depression, says: “Man is a double being: he is composed of body and soul, and each of the portions of man may receive injury and hurt.” [2] If you take a look at v 16-18, you see that physically we are deteriorating.

2 Corinthians 4:16–18 NIV

Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal.

2 Corinthians 4:16-18

There is an inward renewal, but there is a real external decay. Consequently, pastoral caregivers and biblical counsellors must take into account the body’s contribution to depression, and therefore consider a team approach when it comes to helping those with depression. We will consider this in more detail when we think about the recovery from depression. But it’s worth saying now that a Christian approach is holisitic, and the idea that someone could recover from depression through moral extertion or pure willpower is a nonsense.

Let's briefly pause here. What we've considered so far could be described as the “nurture and nature” causes of suffering. These two elements alone cause enormous complexity in the case of depression. Yale University professor Charles Barber has said that there is an “infinitely complex dialogue between genes and the environment...an intricate, infinite, dialectical dance between experience and biology.” [3] This ought to caution us to recognize the inherent complexity in depression. However, from the Christian perspective, there are other ‘partners’ in the dialectical dance that are even less accessible but even more decisive! Let’s consider them.

Before conversion our hearts are incomprehensibly wayward (cf. ) and even after conversion, our hearts can behave inconsistently with our new identity (cf. 1 Corinthians). We should not be surprised to find inordinate fears, anger and selfish desires lurking beneath some experiences of depression—because it's from the heart that the cognitive, affective and volitional aspects of our lives flow.

Proverbs 4:23 NIV

Above all else, guard your heart, for everything you do flows from it.

Thoughts, emotions and actions come from our hearts; it's the home-base for what we think, feel and do (). Our heart is the causal core of who we are and how we think, feel and choose. However, psychiatric issues (like depression) require both wisdom and tentativeness in differentiating the role of the body and the role of the heart.

When in depression, consider:

Jonah 4:1–8 NIV

But to Jonah this seemed very wrong, and he became angry. He prayed to the Lord, “Isn’t this what I said, Lord, when I was still at home? That is what I tried to forestall by fleeing to Tarshish. I knew that you are a gracious and compassionate God, slow to anger and abounding in love, a God who relents from sending calamity. Now, Lord, take away my life, for it is better for me to die than to live.” But the Lord replied, “Is it right for you to be angry?” Jonah had gone out and sat down at a place east of the city. There he made himself a shelter, sat in its shade and waited to see what would happen to the city. Then the Lord God provided a leafy plant and made it grow up over Jonah to give shade for his head to ease his discomfort, and Jonah was very happy about the plant. But at dawn the next day God provided a worm, which chewed the plant so that it withered. When the sun rose, God provided a scorching east wind, and the sun blazed on Jonah’s head so that he grew faint. He wanted to die, and said, “It would be better for me to die than to live.”

Proverbs 12:25 NIV

Anxiety weighs down the heart, but a kind word cheers it up.

When Judas, who had betrayed him, saw that Jesus was condemned, he was seized with remorse and returned the thirty pieces of silver to the chief priests and the elders. “I have sinned,” he said, “for I have betrayed innocent blood.” “What is that to us?” they replied. “That’s your responsibility.” So Judas threw the money into the temple and left. Then he went away and hanged himself.

Matthew 27:3–5 NIV

When Judas, who had betrayed him, saw that Jesus was condemned, he was seized with remorse and returned the thirty pieces of silver to the chief priests and the elders. “I have sinned,” he said, “for I have betrayed innocent blood.” “What is that to us?” they replied. “That’s your responsibility.” So Judas threw the money into the temple and left. Then he went away and hanged himself.

Ruth 1:19–21 NIV

So the two women went on until they came to Bethlehem. When they arrived in Bethlehem, the whole town was stirred because of them, and the women exclaimed, “Can this be Naomi?” “Don’t call me Naomi,” she told them. “Call me Mara, because the Almighty has made my life very bitter. I went away full, but the Lord has brought me back empty. Why call me Naomi? The Lord has afflicted me; the Almighty has brought misfortune upon me.”

When they arrived in Bethlehem, the whole town was stirred because of them, and the women exclaimed, “Can this be Naomi?” “Don’t call me Naomi,” she told them. “Call me Mara, because the Almighty has made my life very bitter. I went away full, but the Lord has brought me back empty. Why call me Naomi? The Lord has afflicted me; the Almighty has brought misfortune upon me.”

How exactly he acts as an agent in an individual's culpable selfish desires and how he exacerbates inordinate fears is unknown. How he affects psychological and physiological functioning is something of a mystery. How his agency plays out in misshaping sociocultural values is inaccessible. But we know that he is at work in all these, and we cannot dismiss his influential role.

Finally, it is worth remembering that God is at work in the midst of all the above: God our Father is always with us, and always at work. Our Heavenly Father is in control over everything; He is in control of our social context, in control of our bodies, He is even (mysteriously) in control of our hearts, and, yes, even at work over and through the strategies of Satan. Even though suffering has multiple causes, God's sovereign hand is always over them all. Even though we know His good character, we cannot fathom his sovereign purposes; and we need to recognise that He sometimes ordains what he hates in order to accomplish what he loves. We need to balance the truths of and .

When a trumpet sounds in a city, do not the people tremble? When disaster comes to a city, has not the Lord caused it? .

Amos 3:6 NIV

When a trumpet sounds in a city, do not the people tremble? When disaster comes to a city, has not the Lord caused it?

Though he brings grief, he will show compassion, so great is his unfailing love. For he does not willingly bring affliction or grief to anyone. .

Lamentations 3:32–33 NIV

Though he brings grief, he will show compassion, so great is his unfailing love. For he does not willingly bring affliction or grief to anyone.

There is nothing outside of God’s control, which raises questions but ultimately provides comfort. Thus, even whilst recognizing complexity, we always seek to remember God’s presence and mercies in Jesus Christ.

It is a great wonder to consider that God has had his sovereign hand over every moment and every detail and every influence that has made me the person I am. From the moment he began to knit me together in my mother’s womb (), he has been the loving heavenly Father, who has shaped me physically, psychologically, temperamentally, in every way to be the person I am. I am not who I ought to be, nor who I will one day be, for God is determined to change me and make me like Jesus (as we shall see in following chapters); and yet, with all my struggles, the person I am now is the person a loving heavenly Father has shaped me to be at this point in time. I may trust him. Dare I say it— and some will have to say this through tears— even where there are distressing, even genetically-inherited disabilities, we may trust that our heavenly Father has shaped us as we are, or a loved one, as he or she is.

Christopher Ash. Why did God let that happen? (Kindle Locations 515-525). The Good Book Company.

Christopher Ash. Why did God let that happen? (Kindle Locations 521-525). The Good Book Company.

Christopher Ash. Why did God let that happen? (Kindle Locations 517-521). The Good Book Company.

Christopher Ash. Why did God let that happen? (Kindle Locations 515-525). The Good Book Company.

When we apply the biblical teaching of suffering to depression, we see that a quest to find a single cause is likely too narrow. We may never know THE single reason for a person's depression. Yet we have also seen that external conditions are significant but not sufficient for causing depression: our hearts are always somehow involved. Welch: “Circumstances must connect with an internal system of beliefs or an interpretive lens that will then plunge you down into depression.” [4]

Scripture, then, instead of teaching us how to always diagnose a single cause for suffering, embraces complexity. Are you depressed because of other people, or because of your body, or because of your beliefs and desires, or because of Satan? The answer is: probably a bit of everything. Now, in some cases it may be far easier to pinpoint something but this broad perspective should give us pause for thought. The Bible is not scared of complexity, and neither should we be. And it embraces complexity while recognising the importance of the heart and also redirecting our focus onto an all-knowing God. All suffering, in a general sense, is intended to train us to fix our eyes on the Living God.

Depression is a form of suffering, and has a variety of relevant causal factors. Let’s end on a note of hope by reflecting on how God works in us through times of suffering.

James 1:2-4

James 1:2–4 NIV

Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance. Let perseverance finish its work so that you may be mature and complete, not lacking anything.

The first thing to notice here is that James says trials are like grow bags—fertilizer bags that enable plants to grow really quickly. Trials help us grow quicker than we normally would, and they make us stronger than we would otherwise be because faith grows fast and strong when persevering through trials. Faith grows when it is put to work, and when you go through suffering, you have to bring out and use your faith. so here’s something to think about: going through depression can strengthen your faith. a journey through depression, painful and arduous though it may be, can actually strengthen you spiritually, because in that difficult place your faith is being put to work and growing like never before. Secondly, it’s important to recognise that James says we should “consider” trials to be pure joy. He doesn't say that we should feel joyful. There’s a difference there: James is not commanding us to feel something but to think something—he is saying: “Painful and difficult though this, remember that God grows your faith through this. Therefore, when you think about your suffering, consider what God is going to accomplish through it. You don't need to feel the emotion of joy, but you need to consider trials in this way because you know that God will produce good in you through them.”

We can have hope because we know, as Christians, that our lives are comedies not tragedies. I really don’t mean to glib—my point is that a tragedy inevitably ends with death. But a comedy is a narrative that, however dark and tragic certain scenes may be, inevitably ends with the triumph of life. If you’re a Christian, because of Christ, your life is a comedy—ultimately, your narrative will end with the triumph of life and joy. Therefore, we can have hope. We know that suffering, ultimately, only strengthens and refines us—ushering us towards glory. Therefore, we can rejoice in suffering. Not because trials are good, but because of how God uses trials to refine us. Suffering relates to our character like fire relates to gold—it purifies us.

The first thing to notice here is that James says trials are like grow bags—fertilizer bags that enable plants to grow really quickly. Trials help us grow quicker than we normally would, and they make us stronger than we would otherwise be because faith grows fast and strong when persevering through trials. Faith grows when it is put to work, and when you go through suffering, you have to bring out and use your faith. so here’s something to think about: going through depression can strengthen your faith. a journey through depression, painful and arduous though it may be, can actually strengthen you spiritually, because in that difficult place your faith is being put to work and growing like never before. Secondly, it’s important to recognise that James says we should “consider” trials to be pure joy. He doesn't say that we should feel joyful. There’s a difference there: James is not commanding us to feel something but to think something—he is saying: “Painful and difficult though this, remember that God grows your faith through this. Therefore, when you think about your suffering, consider what God is going to accomplish through it. You don't need to feel the emotion of joy, but you need to consider trials in this way because you know that God will produce good in you through them.”

Therefore, we can have hope. We know that suffering, ultimately, only strengthens and refines us—ushering us towards glory.

Therefore, we can rejoice in suffering. Not because trials are good, but because of how God uses trials to refine us. Suffering relates to our character like fire relates to gold—it purifies us.

[1] Welch, Depression, 39.

[2] Eswine, Spurgeon’s Sorrows, Loc. 357.

[3] Charles Barber, The Brain: A Mindless Obsession? The Wilson Quarterly, 2008 http://www1.umn.edu/macke/A%20Mindless%20Obsession.pdf accessed 3 April, 2012.

[4] Welch, Depression, 111.

The Causes of Depression

Depression: Causal Complexity

The sins of others

Our bodies are a cause of suffering

We are a cause of suffering

Anger

Fear:

Fear:

Guilt (Legalism):

Dashed Hopes

Satan is a cause of suffering

The Sovereign Providence of God

Conclusion