Heath Lambert: One of the most common biblical commands is to be joyful or to rejoice. We understand that the Scriptures teach us that as Christians we are to be joyful people. This raises an issue because in the context of a fallen world we know that many people struggle with sadness or sorrow; that is particularly relevant in our contemporary culture because so many people struggle with the diagnosis of depression. One of the most common psychiatric diagnoses is that of depression and so we need to figure out what does this experience of depression mean when we think about the biblical commands to be joyful in Christ? We have invited this week to join us on Truth in Love Dr. Charlie Hodges. Dr. Hodges is an ACBC certified counselor and is a board certified medical doctor. This week, Amy Evenson, the producer of Truth in Love caught up with him to ask some questions about this topic.
Amy Evenson: I would love if you could answer for us, is depression an evidence of sin or sickness?
Charles Hodges: Well that is a complicated question for several reasons and those reasons are found in the words depression, sin, and sickness. While depression is widely understood in our society today it is not nearly as understood as well from the medical definition of what depression is. When you say “I am depressed” today it doesn’t mean what it meant thirty five years ago. Before the 1980 revision of the Diagnostics Statistical Manual of Mental Disorders you could not be diagnosed with major depression if you could tell why you were sad; if you could tell what happened to you, what you lost, or the problem that you faced then we would never have given you a diagnosis of major depression. We reserved the diagnosis of major depression for people who simply couldn’t say why they were sad. In 1980 when they changed those criteria they removed cause as a reason for sadness; cause meaning loss of loved one, loss of a job, or some significant loss in life. Now they did leave in an exception for widows, if you were widowed they would give you two months to get over it; you were suppose to adjust. After that you could be diagnosed with depression as well.
With the recent revision of the DSM to the 5th edition, they even removed the exception for widows and what has happened as a result is ninety percent of the diagnosis’ of depression today are really for what we would have called in the past normal sadness; “I am sad because I lost this.” It has become so important that I can remember reading one writer who said, “no one says that they are sad anymore, everyone says ‘I am depressed.’” It has become burned into our consciousness. So for most people depression isn’t a matter of sickness, it really is a matter of how we respond to the losses that we suffer in life. As I have practiced medicine for the last forty years, the vast majority of patients I have seen could tell me why they were sad and what they had lost. As a biblical counselor for maybe the last fifteen years I can tell you that it has been much the same. Most individuals I counsel for depression can tell me the things that they have lost or suffered at the start of their sadness.
Now that does leave ten percent and in my experience probably out of that ten percent maybe five to seven percent will have a medical condition that has a complicating sad mood that goes along with it. Then that gets us down to about three to five percent; people who will in counseling tell me that they have no reason and can’t understand why they are sad.
Sadness over loss is a normal response to life. Paul speaks of it in his second letter to the Corinthians, he says, “For godly grief produces a repentance that leads to salvation without regret, whereas worldly grief produces death.” (2 Corinthians 7:10). So sorrow in and of itself is not a sin, it is a gift from God. Yet, for that three to five percent they – and it is very reasonable to say – may have a medical problem, a medical illness that results in them being sad for which you couldn’t say that they had sinned in order to have it. I have to admit that we don’t know the pathology that underlies it, the change in the cell level that causes it, we don’t understand why those people have sadness and the medical research today doesn’t explain it either very well.
Sorrow in and of itself is not a sin, in fact is a gift from God and it is a part of our normal creation. It was meant by God to drive us to Himself. So when we face sorrow or when we face losses or when we face sorrow for which there is no cause we have a choice in the way that we are going to respond to that loss. We can choose to see it through the lens of Romans 8:28-29 where Paul said that, all things work together for good to those who love God to those who are the called according to His purpose. The purpose of course is that we would be conformed to the image of his Son. So you can look at your loss through that lens if you want to or you could do like Joseph did in the Old Testament. Looking back across the whole of his life – which was by any definition today a disaster area from point A to the time he met his brothers in Egypt – and his response to all of it was, “you meant it for evil and God meant it for good.” We can look at our losses and our sadness that way or we can choose to respond to our problem with sinful anger and worry and other responding and complicating sins. Things and people come into our lives at times and they make our hearts ache. At those times we can choose to glorify God or we can choose to respond sinfully.
Amy Evenson: So how can Christians tell the difference between if their sadness or depression is a result of sin or sickness?
Charles Hodges: Well, that is a really good question and the answer to it is that most of the time we actually can’t. The reason why you can’t is because I can’t get inside the head of the individual who is struggling and there is no way to measure their motives. I do think the most useful tool we have in trying to help people in this situation though is if we understand the difference between normal and disordered sadness. If you can get a grip on that then we can be of great help to both people who are sad because of losses or sad just because they are.
Normal sadness happens because of a loss and there will be an identifiable time when it starts. The depth of that sadness will be consistent with whatever the loss was. If you get a traffic ticket, you might cry a little bit, pay your fine, and forget about it. If you lose a child you may live the rest of your life mourning that loss. So the depth and the nature of the sadness is appropriate to the loss. It will resolve when we either get back what we lost or when we come to grip with it; when we decide how we are going to respond to it. That’s normal sadness.
Disordered sadness comes without reason and stays without any good explanation as to why or when it is going to come or go. You can recognize normal sadness in an individual by talking to them, they will tell you. In that case in biblical counseling we have just a wealth of resources in the Scriptures to help people deal with the losses of life. We can show them in the Scriptures how they should respond, also what and how God will use this in their life to His glory and to their benefit. It is understanding the difference, I believe, between normal and disordered sadness.
Amy Evenson: So how can Christians help people who’s depression is physical?
Charles Hodges: Well, we can help them in the same way we would help anyone who struggles with a physical ailment. We can help them the same way we help people who have high blood pressure, diabetes, or have arthritis and can’t get around. People who have cancer, how do you help them? I think one of the better chapters in the Bible – it is my favorite – is John 11. If you want to know how to help people go look at John 11. It is familiar to anyone who has ever read the Bible once you say the main character, who’s name is Lazarus. The whole story line is about Lazarus’ illness, his death, and then his resurrection. There is a marvelous four point sermon in it. I won’t exegete completely here but those four points tell us how we can help people who have chronic medical problems.
The first point is that Jesus knew. Jesus knew all about Lazarus’ problem. He knew that Lazarus was sick, he knew that Lazarus was going to die.
We also know that Jesus had a plan for it and the reason why we know that is because when Martha and Mary sent the messenger to tell them, “Quick Lord come, our brother is dying.” He sat down and did nothing for a couple of days waiting for Lazarus to die.
We also know that he cared because when he did go, he showed up and Martha and Mary met him asking him that question, ‘if you would have been here my brother wouldn’t have died.’ Modern translation, ‘where were you when we needed you?’ We know that when Mary came out and collapsed at his feet crying and Jesus looked at Mary and Martha and the crowd crying we know that Jesus wept. He cried. That is really paradoxical when you think about it because Jesus knew what he was going to do and in five minutes Lazarus was going to be resurrected from the dead, and so you look at that and wonder why did he cry? He cried because he cared about Martha, Mary, and Lazarus and their suffering. It affected him deeply.
So he knew, he had a plan, he cared, and then he did something about it. He acted; he raised Lazarus from the dead. It is good to know that there is a purpose in all of the struggle. At the end of it Martha, Mary, and Lazarus knew there was a reason. If you want to know the purpose go read John 12. It was said in John 12 that so many people believed in Jesus that not only did the rulers then want to kill Jesus, they wanted to kill Lazarus too. You know Lazarus’ death and his resurrection glorified God and resulted in many people believing in Christ.
So John 11 is a great pattern for helping people as they struggle with the small number of those who have a medical illness struggling with depression. The pattern is get to know something about their problem, have a plan to help them, care about them, and then act.