O.C.D. and me

When I was in my late teens and early twenties, I started struggling a little bit with anxiety.  That anxiety became especially severe one summer and persisted to various degrees over the following years.  At times that anxiety turned into bouts of depression.

The nature of my anxieties changed slightly in my thirties, as I began to struggle to keep certain thoughts out of my mind.  When I found out that my grandmother had suffered severe mental health issues, I began to wonder if my anxiety had a medical root.

So, at a time when my thoughts seemed unmanageable, I went to the doctor.  In God’s kindness there happened to be both a couple of General Practitioners and a Psychiatrist in the church where I was working.  Rosie could see that I was struggling, gave me some tablets and arranged for Stephen, the psychiatrist, to visit me that night.

Stephen heard what I was saying and immediately diagnosed the problem.  He described my thoughts as being ridiculous, resistant, repetitive and repulsive to me.  He said that I was suffering from Obsessive Compulsive Disorder.  He told me to take two months off work, prescribed some special tablets and recommended that I take a course in Cognitive Behaviour Therapy.

My Obsessive-Compulsive Disorder is much better than it used to be.  The Cognitive Behaviour Therapy taught me how to understand my thoughts, and I still take tablets every day.

I want to look at the issue of depression and anxiety from a Christian perspective and answer some questions concerning them.

1.  What causes depression?

Ed Welch writes: ‘Depression is a form of suffering that can’t be reduced to one universal cause.  Many factors may cause depression, and often more than one of these factors is at work in the depressed person.’

Depression can be the result of other people.  People hurt us in a variety of ways.  Many victims of abuse struggle with mental health issues in later life.  Many people carry the wounds caused by an unloving parent, a harsh teacher or a school bully.  In recent years I have wondered if a traumatic incident of bullying from my first year as a boarder in school has had more of a long-term impact on me than I have often assumed.

Depression is the result of living in a fallen world.  The book of Genesis teaches that, because of human rebellion, God has subject humankind to decay and death.  Our bodies ache and deteriorate, and we are prone to physical and mental illness.  Shona Murray points out that to deny the existence of mental or emotional illnesses is to deny an aspect of the Bible's teaching on the fall.  We know that our thought processes can be influenced by brain chemistry and we know that the damaging effects of the fall affect all of our body, including our brain.

Sometimes we are the cause of our depression.  For example, anger is a notorious cause of depression.  We can’t expect a joyous life if we are critical, bitter and unforgiving.  I heard a very good warning about the effects of anger: anger is an acid that eats its own container.  The Christian gospel both challenges us and enables us to forgive.  That forgiving is very good for us. 

Lifestyle issues can trigger depression.  You may be overworked and under-rested.  There may be issues of illness and grief that you can do nothing about.  

I have noticed that many depressed friends have a tendency to feel an exaggerated sense of responsibility.  They blame themselves for everything and take the concerns of the world on their shoulders.  Some are prone to self-doubt and insecurity.  Another feature I have noticed in the depressed is a tendency to be overly harsh or critical of themselves.

False beliefs can be a factor.  If you think you are of no value, you will be prone to feeling depressed.  If you believe that God does not love you, you will suffer from morbid fears.  One of the tasks I feel I have as a pastor is to always be teaching myself that God is good and then to show others that goodness.

Satan is a factor in depression.  Not in a wacky sense, but in the fact that he will remind you of past guilt, tempt you towards bitterness and seek to implant in you doubts about the goodness of God.

In Psalm 32, King David links a time of depression to God’s discipline.  He had refused to face up to his sin, after his adultery with Bathsheba.  So, God’s hand was heavy upon him until he acknowledged his guilt.  However, never assume that someone’s depression is God’s discipline, but always examine your heart to see if God might be drawing attention to issues that he wants to deal with you.

Finally, there is a sense in which God stands behind all our depression.  After all God rules over everything that takes place in the universe.  Enemies may wound us, but God could shut their mouths.  Circumstances may have hurt us, but he is Lord of all creation.  Similarly, our brain chemistry is not beyond his control.

If depression and anxiety have many causes, often at work in the one sufferer, then we need to be open to a variety of helps.  People should go to their doctor and see if their may be a medical cause and a medical solution.  They might also go to a Christian pastor, counsellor or friend and talk about how circumstances and memories have left scares with them.  They should also be praying, asking God to show them their heart and working his love into their heart.

2.  Is it unspiritual to be depressed?

My first response to this question is to point out that there are many godly people who have passed through times of immense sorrow.  The great Baptist preacher, Charles Spurgeon, struggled with depression throughout his life.  What seems to have ignited this was a specific tragedy.  

Spurgeon was preaching to a huge congregation—of over twelve thousand people, at the Exeter Hall in London—when someone yelled, “Fire!”  In the chaos that ensured seven people were killed, and Spurgeon was inconsolable.  Other factors contributed to his depressions, including his struggles with gout and his concern for those he pastored.  Like many pastors he was good at caring for his flocks needs but sometimes negligent of his own.  

He said that there are dungeons beneath the Castle of Despair, and that he had often been in them.  ‘I could weep by the hour like a child, and yet I knew not what I wept for,’ he recounted on one occasion.

In the book of Psalms, we often hear the psalmists crying out to God in despair.  ‘All night long I flood my bed with weeping and drench my couch with tears’ (Psalm 6:6).  Over fifty of the Psalms can be classified as psalms of individual lament, which means that they are the divinely inspired words of an individual who is pouring out their pain to God.   These laments are given to us by God, in part, to help us express our pain.

We must also remember that Jesus was a man of sorrows familiar with grief (Isaiah 53:3).  Spurgeon wrote, ‘No sin is necessarily connected with sorrow of the heart, for Jesus Christ our Lord once said, “My soul is exceedingly sorrowful, even to death.”  There was no sin in Him, and consequently none in his depression.’

However, I must give you one warning: in your depression do not sin!  Depression does present us with particular temptations.  Most obviously, depression tempts us towards self-pity.  Also, some people try to find comfort in wrong ways like over-eating, overworking and alcohol abuse.

But, what about the fact that one aspect of the fruit of the Spirit is joy?  Am I less spiritual when I am depressed and full of sorrow?  I put this question to a friend of mine, who is a lecturer in a leading evangelical theological college.  He replied, ‘I guess joy is not simply an emotion.  And so, someone with depression can still (though it would be harder) rejoice—have confidence in the Lord.’  He then says that Psalm 31:7-9 might be worth looking at.  That Psalms reads, ‘I will be glad and rejoice in your love, for you saw my affliction and knew the anguish of my soul … Be merciful to me Lord, for I am in distress; my eyes grow week with sorrow, my soul and body with grief.’  Here we can see that anguish of soul and trust in God can go hand in hand.  This is surely an example of being sorrowful, yet always rejoicing (2 Cor. 6:10).  Ed Welch writes, ‘Joy is not the opposite of depression.  It is deeper than depression.  Therefore, you can experience both.’

Joan Singleton lectures in pastoral care in the Irish Bible Institute.   At one stage, when she was depressed, she wondered if her depression inhibited her witness as a Christian.  Then she realised the powerful testimony in the fact that she was still hanging on to God and believing his truth, even though her life was filled with pain.

3.  What about anxiety, isn’t it wrong to worry?

I am not disputing that worry can be a real sin, but I think that anxiety can have many roots, some of which are not sinful.

I see a parallel between anxiety and doubt.  On certain occasions Jesus rebuked the disciples for their doubt, because it revealed a stubborn refusal to accept the truth (e.g. John 20:27).  Yet in the letter of Jude we read that we are to ‘be merciful to those who doubt’ (Jude 22).  Those to whom Jude was referring doubted, not because they stubbornly refused to believe, but because false-teachers had infiltrated the church and upset their faith.   There is doubt that deserves a rebuke and doubt that needs gentle pastoral support.  Similarly, there is anxiety that deserves a rebuke and anxiety that needs gentle pastoral support.

Sinful anxiety is rooted in a failure to trust God or in the fact that we have made peripheral things too important in our lives.  David Powlison observes that, ‘if what you most value can be taken away or destroyed, then you have set yourself up for anxiety.’  However, not all anxiety is condemned in Scripture.  For example, the apostle Paul experienced the anxiety related to caring for the health of Christian churches (2 Cor. 11:28).  In many of the psalms, God gives us words to express our anxiety.  I am always struck by the depth of pain that is expressed in Psalm 88.  The psalmist ends that psalms with the claim that darkness is his closest friend (Psalm 88:18).  This is a psalm that Jesus would have prayed, and at times he could relate to that despair.

When our anxiety has roots in a distorted view of God, we need to be gently instructed in the truth of his gentleness and grace.  We are told to cast our anxieties on the Lord, because he cares for us (1 Peter 5:7), but some people need help in coming to understand that he really does care for them.  The person with an anxiety disorder may not even by fully aware as to why they are so anxious.  Their worries may have more to do with do with imbalances in brain chemistry than the actual issues they are focusing on.  It would simply be too harsh to tell them just to stop worrying.

4.  Is it okay to take anti-depressants?

John Piper was asked the following question from a listener: ‘What do you think of Christians taking anti-depressants—I have been on them, and have been accused on not relying on God?’  In his answer, Piper takes a drink from a bottle of water and then asks, ‘was that sip a failure to rely on God?’  After all, God could simply keep his throat miraculously moist!  Piper’s point is that God has given certain means to provide for our physical well-being, and these are to be taken with thanksgiving.  Piper then explains that he has reached the conclusion that there are profoundly physical dimensions to some of our mental conditions.  Since that is the case physical means can be us to help people out of their depression—just as medications are gratefully received in the treatment of many other illnesses.  In his book, ‘Healing and the Scriptures’, Martyn Lloyd Jones, the doctor and preacher, claims that it ‘is no more sinful to take drugs to put right the chemistry of the brain, than it is to substitute for the abnormal chemistry of the pancreas in a diabetic case by the use of insulin.  If it is right to use insulin in replacement therapy for the pancreas, why is it wrong to take tablets which influence for good the chemistry of the brain?’

Medications have their limitations.  For some they may be temporary measure to help them restore their equilibrium.  Others may need to take medication for the rest of their lives.  However, tablets won’t take away the scars caused by painful memories.  If lifestyle issues are contributing to your depression and anxiety, then don’t let the relief of medication stop you from addressing the core issues.  If your conscience has good reason to be troubled, then a tablet won’t give you lasting peace. 
5.  How can we deal with our depression?

During an episode of depression, I thought of the advice I had previously given and felt that it was inadequate.  I revised what I had been teaching.  I am aware that what will be helpful may change from person to person and may change with regards to where they are in working through their pain.  The following are twelve tips that might help.

Hope

That time of depression and anxiety was different than anything I had suffered before.  As a result, I feared that it might not lift.  The psychiatrist I saw at that time did not share this worry.  She said that it would lift, and it did.  The fact is that the lowest part of depression does lift.  You need to remind yourself that this too will pass.  I was struck at how important a sense of hope is.  I would urge you to do everything not to give up your hope and remind yourself that you have not always been in these depths and will not always be in these depths.

Rest

Rest is a part of God’s design for his people.  I tend to be tempted to feel guilty for talking time off.  I remember when I was first married Caroline told me that I was working too hard.  I wanted to reply to this observation by saying, ‘thanks!’  I did not realise that it is actually disobedient to God not to refresh oneself through rest.

Meditate on the story of Martha and Mary, and hear Jesus inviting you to take some time aside.  Make as many changes in your lifestyle as you can to ensure that you can cope.  Learn to say ‘no’ without feeling guilty.  A friend pointed out that we are to work from a place of rest rather than rest from a place of work.  Make sure that you get enough sleep.  If you are struggling to sleep at night you will need a rest during the day (however, it can be unhelpful to stay in bed when you are not resting and just worrying).

The apostle Paul told his young disciple Timothy that bodily training is of some value (1 Tim. 4:8).  We must not ignore the connection between the body and the soul.  This can be a good form of rest and refreshment.  John Piper copes with his proneness towards a low mood through regular exercise.

Talk

When a neurologist, Elijah Chiala, was doing a question and answer session with us at our evening service he reminded us of the need to talk.  Talk to your loved ones and tell them how you feel.  Talk to your pastor and people in church.   Seek help and support.  It is really important that you feel free to talk to your doctor.

Being open about your depression will have a number of benefits.  One of them is it will help deal with the stigma.  I tend to be an open person, but I still don’t always feel comfortable saying that I have Obsessive-Compulsive Disorder.  I don’t want to appear odd, and mental illnesses can come with unhelpful stereo-types (just think of some of the OCD portrayals in the movies).  But we all want to be accepted as we really are.  Your openness will also help other people who may be struggling with similar thing.

Some people’s cultural background makes this openness more difficult.  When I spoke in our evening service about mental health, I followed the talk by questions and answers.  Two young men from different countries of origin claimed that in their culture people don’t get depressed.  I have heard depression being referred to as a white-man’s illness or a western illness.  I would suggest that in cultures where there is a greater stigma around mental health, there are many more people suffering their own isolated inner turmoil than is noticed by their society.   The stigma around mental health in such cultures only adds to the pain of those who suffer.

There will be people who stigmatise mental illness.  Try not to let their ignorance hurt you.  I had one person tell me that he thought it was a mistake that I told the church that I had had a breakdown.  They thought that if I had simply explained that I was sick then people might have concluded that I was suffering from the flu!  Clearly this person sees mental illness as something to be ashamed of.  Don’t let such attitudes stop you from experiencing the support that comes through being open about the nature of your suffering.

However, there is another danger for those of us who have issues with our mental health.  We must be careful not simply to see ourselves as victims.  Our pain must not become our identity.  You are much more than your illness.  Your role as a son or daughter, brother or sister, parent and friend, and most importantly as a child of God is so much more important to your identity than and struggle you may be going through.

Pray

I used to tell people to pray the Psalms.  Yet when I was in the pits I could not pray with much focus.  I tended to go around and around in circles asking God to make me better.  I actually started typing out my prayers to give them more focus.  Journaling may also help you work through your thoughts. 

One of the important things to learn is not to feel guilty about how hard you are finding it to pray.  Your Heavenly Father understands.  He is kind and gracious to you.  Jesus taught us that he did not want to add heavy burdens to his beloved people.  Set realistic and helpful prayer goals.  Target just a few minutes of prayer a day.  Don’t beat yourself up over the fact that you can’t focus.  Don’t blame yourself for the fact that God seems absent.  He is not absent, even though your feelings tell you he is.  The fact that your feelings make him seem absent is not your fault.

I do think that the Psalms are a great resource for the depressed Christian.  Read them and you will be surprised at how honest the writers are with their complaints.  You may not have the energy to spend much time in them when you are in the pits but see them as an invitation to get real with God.  I recommend Tim Keller’s meditations of the Psalms entitled, ‘My Rock and Refuge.’  

Deal with feelings of guilt 

I did say that there can be a relationship between guilt and sin.  However, I have found that many people who struggle with sin are too quick to assume that they are being punished by God.  God is our gracious heavenly Father.  He is slow to anger and abounding in love.  He does not treat us as our sins deserve, but according to his loving-kindness.  If there are things that you need to confess to God and repent of then do so.  Then thank God for the fact that there is no condemnation for those who are in Christ and that he delights to forgive.  God wants you to rejoice in his forgiveness.  It does not honour him to hold on to feelings of guilt over past sin.  I asked a depressed friend if he realised God sings over him (Zephaniah 3:17).  He replied by saying that seemed too good to be true.  But it is true!

Avoid sinful responses to depression and anxiety.  Your relationship with food will change.  I struggle to eat when I am anxious, but others are tempted to comfort eat (I am prone to do this when I am not ill).  You might be tempted to escape into a world of sexual fantasy.  When I am mildly depressed, I am prone to enjoy self-pity (I try not to listen to soppy eights music at such times).  Such attempts to find comfort will only leaving you feeling worse.

Have faith

Do you remember the ad that the British Humanist Association placed on the side of buses in England?  It read, ‘There’s probably no God.  Now stop worrying and enjoy your life.’   Actually, people tend to enjoy life more with God rather than without him.  Professor Andrew Simms, former President of the Royal College of Psychiatrists, comments that: ‘The advantageous effect of religious belief and spirituality on mental and physical health is one of the best-kept secrets in psychiatry and medicine generally.’

Compare the Christian gospel with society’s teaching on self-esteem and ask yourself, ‘which has more potential to help the depressed person?’

Society tells us to seek our value by searching for the hero inside ourselves.  The problem is when I examine my life, I see many things that could make me feel ashamed.  I don’t often see a hero inside myself.  In fact, I often see a villain.  If my happiness is built on the existence of my inner hero, then I am going to struggle within.  Self-esteem is a poor foundation to build our sense of worth upon.

The gospel tells me a much better story.  It says that I am a flawed and rebellious person who is loved by a kind and forgiving creator.  This creator has given each of us intrinsic worth, making us in his image.  This God cares for us so much that he sent his Son to die for our guilt.  This God treats me, not as I deserve, but according to his loving-kindness!  Now I can examine my life, see things I wish were not there and be secure in the fact that my relationship with him is not about earning his favour but living in the light of his undeserved, unmerited and unearned grace.  In fact, because of his grace in my life, I can delight in the fact that he is in the process of changing me and transforming into the likeness of Jesus.

However, I need to be balanced here.  When people grow up with a distortion of Christianity that can result in emotional and mental suffering.  A friend told me that he grew up with a mother who seemed to want to frighten him into wanting to follow Jesus.  What was also damaging was the fact that this parent actually lived in a way that did not reflect the inner change that life in Jesus should bring.  This obviously had many negative effects on him.

Grow in your confidence in the character of God.  

One of the cruel things about depression and anxiety are that when we are depressed is that we are vulnerable to believing lies.  We must combat these lies with the truth.  What many sensitive people need is to realise that God is a loving-Father who always seeks the good of his children.  Martin Luther struggled with depression even after he had come to understand the gracious nature of the gospel.  He said that his depression always centred on two questions: 'Is God good?'  and 'Is God good to me?'  Ed Welch writes, ‘Just think what it would be like to be certain that the God of this universe loved you.  That alone would probably change the contours of depression.’

One of the ways that God shows his love is through his people.  Look to Christians who reflect the gracious character of God.  If you focus on Christians who are harsh and unloving, especially Christian leaders who are not merciful, then your image of God may become distorted.  Look to people who know God and reflect God well to you.  Remember that it is God who makes them the way they are.  

I had a family friend who had a book dedicated to him.  The author talked of the pastor of my teenage years who ‘influenced me in the beauty of godliness.’  George was both gentle and godly, and he helped you believe God was too.  Such people are good for your mental health.   

Put your faith into practice 

It is always important for us to put our faith into practice.  You may not be able to do this when you are very depressed however there is healing power in doing things for others for the glory of God.  Listen to the healing words of Isaiah (58:10): ‘… and if you spend yourselves in behalf of the hungry and satisfy the needs of the oppressed, then your light will rise in the darkness, and your night will become like the noonday.’

Guard your thoughts

The reformer, Martin Luther, said that you cannot stop a bird landing on your head, but you can stop it making a nest.  He was saying this regarding our thoughts.  I find that when I am struggling with anxiety my thoughts gravitate towards the worst possible scenario.  It can be very difficult to control your thoughts, and to stop catastrophic thinking making a nest in your mind, but it is important to try and guard your thoughts.

A friend of mine gave me the wise advice of writing down things that I am thankful to God for.  Thanksgiving is a good way to help your mood.

I have noticed that many depressed people struggle with an extreme and exaggerated sense of responsibility.  Allow God to be God and trust him to look after your life and the life of others. 

Work on your self-worth

David Murray points out that deep rooted self-doubt and self-criticism will often emerge will often emerge and strengthen during a depression.  Depressed people often feel worthless and useless.  But some Christians are reluctant to give people any praise or encouragement because of the risk of making a person proud.  However, Murray points out that pride is one of the least risky vices for the person who is depressed.   Pride results from having an over-inflated view of one-self.  Depression usually involves the opposite.  Without minimising the wickedness of the human heart and our inability to please God apart from Christ, ‘we should feel free to encourage depressed people to have a more view of themselves by highlighting their God-given gifts, their contribution to the lives of other, their usefulness to society, and, if they are Christians, their value to the church.’     

Deal with issues in your past

There are wounds that we carry from the past.  We may have developed wrong ‘core beliefs’ about ourselves from our upbringing.  There may be hurtful things said to us, or traumatic incidents that need to be worked through.  Start by opening up to a trusted and wise friend.  But don’t be too proud to seek the help of someone who has more expert care.

Try to remember that God is in control

One quote that was particularly helpful to me at that struggle with anxiety.  It was from the slave-trader turned hymn-writer, John Newton.  He said, 'everything is needful that He sends; nothing can be needful that he withholds.'  The fact that God is in control leaves us with difficult questions.  Why would God allow us pass through such pain?  I had no idea.  But I would rather be in the hands of a mysterious God who is love, than be at the mercy of blind chaos.   

It may be that God will use your struggles to help others.  When I was in a dark place, a friend at a small group blurted out, 'Paul, I am so glad that you struggle with depression.'  She did not mean to be insensitive.  In fact, I knew what she meant.  She felt that she could relate her own brokenness to me because I too struggled. 

Conclusion: The fellowship of suffering

Maybe we are too one-dimensional with regards to what a truly spiritual person looks like.  Maybe we have failed to understand what the joy of the Lord looks like.  If we think that Christians are only Christlike when they are walking around with a serene smile on their faces, then we have not read the gospels with a lot of depth.  The lives of many godly Christians, the experiences of the psalmists, the suffering of our Saviour and the teaching of Scripture all show that one of the ways that we honour God is actually in holding on to him for dear life in the midst of inner turmoil and pain.

Remember that depression and anxiety has a variety of causes, often at work in any one person, and therefore needs a variety of cures.  I have been helped in my struggles with depression and anxiety by medication, Cognitive Behavioural Therapy, time off work, Christians who reflected the grace of God and a supportive family.  I would have to say, that through all my anxieties God is at work humbling me, helping me to lean on him more, causing me to seek to understand him more and giving me a little bit more empathy for others.

So let's close with some wise words from Bible commentator, J. B. Phillips.  He wrote in a letter: ‘These periods of spiritual dryness which every saint has known are the very times when your need of God is greatest.  To worship him may or may not bring back the lost ‘feeling’, but your contact with God in prayer and praise will strengthen you spiritually whether you feel it or not … Times of spiritual apathy are the very times when we can do most to prove our love for God, and I have no doubt we bring most joy to his heart when we defy our feelings and act in spite of them.’