IN PREVIOUS articles we have briefly viewed the physical and psychological aspects of depression. Now let us concentrate upon its spiritual dimensions. From what we have already presented it would be easy to deduce, as indeed many who have studied this problem have erroneously deduced, that a religious approach to the depressed person would be precisely what is not indicated! Is he not already too conscientious, too driven toward living up to high expectations? Does he not already tend to berate and condemn himself too much? Is he not only too ready to consider himself a "worm"?
Surely he does not need higher expectations, a stronger conscience, or a more authoritarian "superego" to insist that he shouldn't do this or that he should do that; e.g., that he should pray more, that he should read his Bible more, that he should do more missionary work, that he should just buck up and try a little harder!
It is small wonder that in many quarters today a religious approach to the depressed person is in ill repute. It deserves to be so long as it is the type of religion just described a legalistic, pharisaical, righteousness-by-works-oriented religion. Such religion breeds depression. It always has, and it always will. It did for Luther. It did for Wesley. And it has also bred depression for innumerable other would-be Christians who have earnestly labored to win Cod's favor by the performance of meritorious works.
A British psychiatrist who formerly was superintendent of the Christian Medical College in Vellore, India, and more recently has had extensive experience in training clergymen in England in what he calls "clinical theology" writes as follows regarding the contrast between legalistic religion and the gospel of grace:
"Books of spiritual direction which continue to harp on the category of what ought to be, are entirely unsuited to parishioners in the crisis of depression. The depressed man has got beyond the state when he can respond to any more of the 'oughts' of his life. Such counsels emphasize trying harder. They direct us in the first place to the performance of our religious duties. They do not direct us first to rest in Cod's activity in making holiness possible. God as infinite succour is less apparent than Cod as infinite demand. He is both, for He is holy. But the order is all important. A dynamic clincal theology exists to get the order right. . . .
"A clinical theology must . . . affirm . . . that to direct any man to the attainment of righteousness by trying not to do bad things is not Christian direction at all. It is hopelessly under the law. It entirely misunderstands the radical transformations of personal dynamics which grace achieves. . . .
"Such mild depressions or 'one-day blues' as are cured by this method leave the moralist even more firmly in the grip of depressive dynamics and joyless egocentricity than he was before. A severe case of depression will be driven to despair by it. He can only be helped by what is, the freely given grace of our Lord Jesus Christ. He cannot be helped by what ought to be if only he had the strength to try harder."1
This same author, sharing his wisdom distilled from fifteen years of working closely with Christian ministers, also writes:
"This is no syllogistic method. 'One, two, three, four, five and there! You are no longer depressed!' The cure of depression by Christian counselling is to call for a miracle in the spiritual order. This can always be obstructed by unwillingness. We must recognize that God's method of redemption, the absolutely free gift of a saving relationship to the Son of God, is an offence to that inner core of the depressive personality which is determined to do whatever needs to be done by itself. To offer a way of escape by grace strikes the depressed person as unlawful and unreasonable." 2
After extensively quoting from Luther's commentary on Galatians, Dr. Lake depicts the necessity of personal involvement on the part of the therapist:
"The task of pastoral therapy is to make God's new way for righteousness, that is to say, for rightstanding in His heart and joy, both plain and desirable. Free grace, thought costly, was felt to be an offence. It is now good news. But it is personal news which demands deep personal involvement and conviction in the teller of it." 3
Another passage from the work of this extraordinary Christian psychiatrist underscores the paradox that depression is to be cured by despair!
"The man ... in his hell of restlessness ... is invited to despair. But this is an entirely new kind of despair, active, confident and already taking account of the amazing act of God. This despair is, as Kier kegaard showed, the first act of faith. There is nothing more joyful, as Charles Wesley wrote in one of his hymns, than to be 'confident in self-despair.' If a man has any desire to be led into the way of peace, to abide in Christ and to rest in His perfect satisfaction of the law of holiness before God, there will be no long delay now that he has come so far. The long two-hour journey, and the months of preparation in pain that have led to this day, are focused in a crucial moment of decision and his whole being and state of mind are transformed. The Holy Spirit has promised that all those who come to Christ, in trust, will know His shepherding of the lost, will experience His welcome, be made one in the family of the forgiven, be made an heir of eternal life and a son in the household of Cod. It is for this, which most delights the heart of God and en joys the benefits of His Son's passion, that a clinical theology must exist." 4
His mention of the "two-hour journey" and "months of preparation" refers to his insistence that the pastor, like any good therapist, must take a careful history and get some "feel" for where the person is on the psychological plane before venturing to move into the spiritual dimension in that vital step that Thurneysen aptly terms "the breach in pastoral conversation." 5 This may take from a minimum of two hours up to eight or ten or more sessions.
It can now be seen that the depression-prone person, if he be religiously inclined, will tend to ward a righteousness-by-works experience rather than one of righteousness by faith in what Christ has done. As he has striven by hard work and conformity to live up to his parents' high expectations in hopes of regaining full love and acceptance, so will he heavily labor to come up to Cod's high standard and thus become acceptable to Him. What he needs is to experience grace, to know God's agapelove, to feel His unconditional acceptance prior to any good works on his part, to grasp the saving fact that "while we were yet sinners, Christ died for us" (Rom. 5:8).
It can now be seen that an abiding faith and trust in God's boundless and inexhaustable love is the radical cure for precisely that which most psycho analysts have found to be the root cause of depression frustrated dependency needs. The real basic fundamental of Christian anthropology is that man was created to be continually dependent upon his heavenly Father. The essence of sin and the fall is that man ignores this fact and attempts to live in self-autonomy. The Swiss theologian Emil Brunner forcefully points out that the entire question of faith vs. unbelief hinges upon the question of dependence vs. independence.
"Whatever else may be said about it, faith means in relation to human existence, the knowledge that I do not belong to myself, but that I have a master, that I 'belong to another,' This knowledge that I belong to another reveals that the consciousness of belonging to oneself, of independence, which the natural man takes for granted, is false, is a denial of the truth and a lie. Before he believes, that is, before he is brought into subjection through Jesus the Lord, a man does not know this. He has indeed always had a certain inkling of it, but this inkling is ever and again obscured by the natural instinct of self-assertion, of self-protection and of self-reliance." 6
"Thus what is actually at stake in faith and unbelief is nothing other than the issue between dependence and independence, and therefore at the same time between true and deranged humanity." 7
In the vocabulary of most psychoanalysts, whether they be of Freudian persuasion or not, there has developed a term for the heightened receptivity and the inordinate dependency needs that are characteristic of the depression-prone person. The term, borrowed from Freud, is orality. A person is said to be an oral character, or to have oral traits. Obviously, this pictures a person oriented about the mouth, about receiving and taking in.
In any comparison of psychological and spiritual frames of reference one cannot fail to notice that in Scripture the Christian life is frequently depicted in terms and figures that are essentially oral. "As new born babes, desire the sincere milk of the word, that ye may grow thereby" (1 Peter 2:2). "Blessed are they which do hunger and thirst after righteousness; for they shall be filled" (Matt. 5:6). "I am that bread of life" (John 6:48). The eucharistic symbols obviously are germane to this theme of orality in the Bible. Ellen White writes:
"To eat the flesh and drink the blood of Christ is to receive Him as a personal Saviour, believing that He forgives our sins, and that we are complete in Him. It is by beholding His love, by dwelling upon it, by drinking it in, that we are to become par takers of His nature. What food is to the body, Christ must be to the soul. Food cannot benefit us unless we eat it, unless it becomes a part of our being. So Christ is of no value to us if we do not know Him as a personal Saviour." 8
Classic psychological studies of the mother-child relationship in the first year of life, such as those by Rene Spitz,9 stress the vital psychological nurture that flows from mother to baby through eye contact and through the love and acceptance that radiates from mother's smiling face, and without which the baby would suffer severe psychological yes, and spiritual crippling, even though all of its physical needs were abundantly supplied. Here in the first months of life is laid down the foundation of basic trust.
Parents stand in the place of God to their children. Even Christ was given a saintlike mother to mold His earliest years. He was not emotionally deprived in babyhood. Not all are so fortunate. Some suckling children are forgotten by their mothers. (See Isa. 49:15.) They are those most likely in later years to be seen in psychiatrists' offices. What then, according to the best psychiatric knowledge obtain able, is the essence of the treatment that such adults should ideally receive in their psychiatrists' offices? It is that they should enter into a trusting relation ship with a therapist, who in effect must be to each one of them the kind of caring, nurturing motherfigure that they lacked in childhood.
The goal of treatment for the patient is for him eventually to become independent of his therapist, just as the goal in the maturation of the normal child is that he may become independent of his parents. The Christian life, however, presents a radical difference from both of these human models, for the believing Christian never outgrows his continual dependence upon his heavenly Father, for all his maturity or progress in sanctification.
Frank Lake clearly underscores this difference in the following passage, where he comes to grips with the strong resistance that this idea almost invariably engenders in sophisticated psychological circles.
"The whole Christian attitude to 'dependency needs' is very different from that even, for in stance, of Karen Horney's holistic school of dynamically orientated psychotherapy. She would admit the need for dependence, and would give the patient proper opportunities for feeling dependent. However, her ultimate goal is expressed in the words 'self-realisation' ....
"The aim of Christian therapy is 'Christ-realisation.' It clearly places Christ in the centre of the field of vision and points to His offer of a New Being through new relationships with God in Him, of sustenance by feeding on Him, of status within the Divine Family, of a daily achievement of such good works as God has for us to do, all bound up with an eternal destiny. . . .
"This is a radical difference. The implicit goal of humanistically orientated therapy is that, at the end of treatment, the patient will have ceased to be de pendent on another human being and will have all his life situations within his own independent control. For the Christian pastor this is at best an inter mediate goal. He may be properly grateful when psychotherapists undertake it and succeed in substituting a knowledge of right relationships for distorted infantile ones. At this moment, should the healed person hear the Gospel, he will recognise that dependence has to begin all over again. . . .
"Our critics may say what they like about this being a prolongation of infantile dependence translated into a theological sphere. They are free to think what they like to think. We have in mind the words of a Master who said, 'Without Me, ye can do nothing.' One who was closest to Him wrote, 'He that hath the Son hath life, he that hath not the Son hath not life.' We are not ashamed continually to be reminded of our weakness, for with Paul we find that 'His strength is made perfect in weakness.' " 10
Natural man stoutly resists the idea that man was created to be continually dependent upon God, but some profound students of human nature do recognize that true independence can be grounded only in an underlying dependence. Harry Guntrip, in concluding his discussion of the foundations of ego-identity, observes: "Two things must remain inviolate if human personality is to remain strong: (1) An inner core of the sense of separate individuality, of 'me-ness,' of ego-identity ... (2) A still deeper ultimate core of the feeling of 'at-oneness' which is the soil out of which the sense of separateness can grow. To feel separate and individual while cut off from any foundation of 'at-oneness' is terrifying and destroys the ego. . . . It is hard for individuals in our culture to realize that true independence is rooted in and only grows out of primary dependence." 11
An experience of righteousness by faith in Christ (rather than righeousness by works) provides a radical cure for depression that can far surpass the best that any human therapist can offer. It is a living relationship with One who is infinitely wiser, more caring, more available and more sustaining than any earthly parent or human therapist could ever be, yet at the same time One who is not untouched with the feelings of our infirmities, One who was in all points tempted as we are, and thus is able to succor all who come unto God by Him. "Can a woman forget her sucking child? . . . yea, they may forget; yet will I not forget thee" (Isa. 49:15). "Cast thy burden upon the Lord, and he shall sustain thee" (Ps. 55:22). "I will never leave thee, nor forsake thee" (Heb. 13:5).
We have now viewed melancholia in its physical, mental, and spiritual dimensions. No one of them is unimportant. Good treatment will give attention to all three. A team approach is well suited to this multifaceted problem. Crucial to the success of the team is the role of the informed Christian minister.
1. Frank Lake, Clinical Theology (London: Darton, Longman & Todd Ltd., 1966), p. 364.
2. Ibid., p. 333.
3. Ibid., p. 346.
5. Eduard Thurneysen, A Theology of Pastoral Care (Richmond, Virginia; John Knox Press, 1962).
6. Emil Brunner, The Christian Doctrine of the Church, Faith and the Consummation (Philadelphia: The Westminster Press, 1960), p. 141.
7. Ibid., p. 145.
8. Ellen White, The Desire of Ages (Mountain View, California: Pacific Press Publishing Association, 1940), p. 389.
9. Rene A. Spitz, The First Year of Life (New York: International Press, Inc., 1965).
10. Lake, op. cit, pp. 422, 423.
11. Harry Cuntrip, Schizoid Phenomena, Object Relations and the Self (New York: International Universities Press, Inc., 1968), p. 268.