Granny says she’s
depressed.
Okay, she’s not my
granny, and she’s probably not actually depressed either. There’s a chance she
is, but in all likelihood she’s grieving, not depressed.
There is a difference.
You see, her husband
of many decades went to be with the Lord earlier this year. Her ongoing grief
is natural and appropriate; in fact, if at this stage she were said to be feeling
fine and spending her time internet shopping for a new partner, the gossips
among us would be even more troubled.
But I point this out
because where sadness is concerned, our thinking is very muddled these days.
The word “depression” is used by many to describe every emotional state south of cheery, idyllic perfection. It may be useful to draw some distinctions in our thinking about different sorts of sadness:
The word “depression” is used by many to describe every emotional state south of cheery, idyllic perfection. It may be useful to draw some distinctions in our thinking about different sorts of sadness:
Depression
About depression, the Mayo Clinic says this:
“Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems.”
Note that, please, because it’s important: Depression
is a mood “disorder”. It is abnormal, inappropriate sadness. It is, as they go
on to say, “more than just a bout of the blues”. Real depression may have any
number of possible triggers or underlying causes; it may manifest in
disengagement and all manner of other symptoms, and such indicators may differ
from person to person; but the critical thing to remember is that it is a DISORDER.
Depression is not a normal state of being.
Grief
Grief, on the other hand, is an entirely
appropriate emotional reaction to circumstances. We may also refer to it as
sorrow, or a troubling of the spirit.
We know grief is appropriate in a fallen
world because the responses of the Lord Jesus were always ordinate, and he was
grieved on many an occasion. In fact, we are told he was a “man of sorrows, and acquainted with grief”.
He was grieved by hardness of heart in his audience. He was “deeply moved in his spirit and greatly troubled” by the sorrow of others and wept along with them, even though he fully intended to raise Lazarus from the dead and knew that
their grief was about to be turned into joy.
Grief, in short, is not a disorder. It is
the human spirit operating correctly. Death is sad. People fail us. Dreams die. Horrible things happen. Grief is simply the most logical emotional response to all that.
Melancholy
Another thing commonly mistaken for depression
is simply disposition or temperament. There are four commonly recognized
temperaments: phlegmatic, choleric, sanguine and melancholic. While these are
not scriptural designations, they are useful classifications with which many
people connect and which have great historical authority. Temperament theory
goes back to ancient Egypt. The
Greek physician Hippocrates incorporated the four temperaments into his medical theories over 400 years before Christ.
About the melancholic temperament,
Wikipedia says:
“People with this temperament may appear serious, introverted, cautious or even suspicious. They can become preoccupied with the tragedy and cruelty in the world and are susceptible to depression and moodiness.”
Got that? “Susceptible to depression and
moodiness”. While easily confused, melancholy and depression are two very different things. Some
melancholics do become depressed. All melancholics should be careful to
avoid overindulging in what comes naturally to them if they are indeed extra-susceptible
to depression. But “melancholy” simply describes a certain very common sort of being. Eeyore. Puddleglum. Probably the apostle John.
Come on, would you rather be Tigger?
To suggest that a significant portion of
the population needs counseling and medication simply because of who they are every
moment of their life would be to stretch the medical definition of depression to
the snapping point.
In fact, an acute awareness of the “tragedy
and cruelty in the world” is valuable to both the believer and unbeliever. Of
those spiritual souls who mourn it, the Lord Jesus promised “they shall be comforted”. And even for the unspiritual, an awareness of the fallen-ness of the world and
the fallen-ness of self is exceedingly helpful. After all, “Those who are well
have no need of a doctor, but those who are sick”.
So, in and of itself, melancholy also is not
a disorder.
Guilt
Even sorrow brought about by one’s own behaviour cannot be
said to be a “disorder” in the sense that depression is a disorder, because once
again it is the natural and appropriate response of the human mind, heart and body
to the crushing weight of unconfessed sin. Guilt is not a problem in
itself: it’s simply the alarm bell that tells us our conscience has been
violated and something ought to be done about it:
Nobody puts this better than David:
“For when I kept silent, my bones wasted away
through my groaning all day long.
For day and night your hand was heavy upon me;
my strength was dried up as by the heat of summer.”
There is a remedy for the sort of “groaning” and “wasting away” to which the psalmist refers, and that remedy is not
medication but confession and forgiveness:
“Blessed is the one whose transgression is forgiven,
whose sin is covered.
Blessed is the man against whom the Lord counts no iniquity,
and in whose spirit there is no deceit.”
The word “blessed” is frequently translated
“happy”. That about says it all. Where genuine wrongdoing is the problem (we’re
not discussing phantom guilt here), confession is the solution. If that sounds
overly simplistic … well, sorry: all the drugs in the world won’t help a
guilty conscience in the long term. All medication does is attempt to shut down the alarm
bell without addressing what triggered it in the first place.
Thus even guilt is not a disorder: it’s the
correct operation of the human organism in a sinful world. The people with the “disorder”
are those who don’t feel guilt in the first place.
Misdiagnoses
and Consequences
So why is it a big deal if I call something
“guilt” and you call it “depression”? Does it really matter how we label the
various kinds of sadness?
I think it matters a great deal.
Misdiagnosis of chronic sadness is a major problem for Christians and
unbelievers alike. If we misdiagnose our mood or the moods of others, we will
almost surely mishandle their treatment, assuming that they require any
treatment at all. The solutions we offer will be wrongheaded and
unhelpful.
Coming
Up With a Treatment Plan
Depression
is a disorder. It is a form of mental illness. If
there is an underlying chemical imbalance, a genuine trauma or a genetic
predisposition giving rise to chronic sadness, the answer is probably
medication, counseling or both.
Grief
is natural. It is triggered by circumstances and
diminishes with time or abates entirely when the circumstances change. There is
no treatment other than perhaps love and encouragement, if we are smart enough
to give or take them in a form appropriate to the person grieving.
A
melancholic temperament is also natural. The “solution”,
if such is to be found, is probably a career in philosophy, writing or even music,
or some other constructive way of giving
vent to the wealth of (sometimes negative) thoughts that occupy those inclined
to meditate on this world and its sinful occupants. The hope of heaven and the
love of Christ are also pretty good antidotes to melancholy, but unfortunately only
Christian melancholics are capable of enjoying them.
Guilt,
too, is natural. It is relieved by confession and
forgiveness, and bolstered by making amends where possible.
Complications,
Complications
But you can see that it is critical to have
a right understanding of the source of a mood problem in order to treat it
constructively. Medication may temporarily mask grief or guilt, but it is
simply papering over a problem rather than dealing with it. It can, however, be
extremely useful in righting a chemical imbalance. A career in philosophy will
not help a guilty conscience, though it may produce some pretty crazy and
intriguing social theories. Time may diminish grief, but it will not help guilt. And all the confession in the world will not relieve clinical depression anymore than it would miraculously heal a broken leg.
It is also possible in any given situation
to be dealing with two, three or even four of these things simultaneously. When
talking to, for instance, a naturally melancholic homosexual whose mother has
just passed away, one can be forgiven for misreading a symptom or two. These
things are not always clear cut. Perhaps they rarely are.
What should be clear to Christians is that
a chorus of “Cheer Up Ye Saints of God” is not necessarily the most useful
response to a chronic mood problem.
But then neither is “You’re depressed”.
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