Depression, Anfechtung, and drugs (oh my!)

Susan over at her pendulum has posted a good and worthwhile question about anti-depressants. Read it here.

I’ve posted on this topic a few times, particularly in my review of the book, Prozac Nation.

Susan has several valid observations and questions:

  1. Does an anti-depressant treat the cause or cover up the symptom?
  2. As a result, does it actually cover up the underlying problem so that it can’t be addressed?
  3. Finally, what is the difference between clinical depression and anfechtung?

The answer to number one is yes and no. I come from a long history of distrust of traditional medicine. My family has lived on chiropractors and homeopathy for about as long as I can remember. So have have no commitment necessarily to standard “slap a drug on it and call it good” approach to medication. However, there is plenty of evidence (more and more each year) that points to the reality that clinical depression is a medical condition, where the neurotransmitters in the brain are not functioning properly. Is this condition a result of sin? Yes (duh). Are there multiple ways it can be addresses? Yes (duh).

I do think that because we are dealing with mental illness that there is an automatic connection made between clinical depression and spiritual distress or temptation (anfechtung). In my observation and deep experience, they are not the same, but one may lead to the other, either direction. This is why there is no one solution to clinical depression. It really requires a multi-pronged approach of a doctor, a counselor, and a pastor. If you take one of those out of the equation, I fear that either the clinical depression or the spiritual distress which caused it or is a result of it will go untreated.

Allow me to use an analogy. I’ve had many parishioners who have had cancer and other terminal illnesses, as well as painful but not terminal illnesses. Few things can test the faith than a terminal illness. It almost inevitably leads to anfechtung. It is also an incredible opportunity for our Lord’s healing hand to be at work, forgiving sins, providing comfort and giving consolation which only he can give. However, as a pastor I would be seriously messed up if I suggested to this patient that they should refuse treatment.

Which brings us to number two. Can anti-depressants cover up the underlying problem? Absolutely! That is why a pharmacological treatment cannot be the sole treatment. The causes for clinical depression are diverse and sometimes impossible to track down. In order to get at the heart of the matter, there is a sense where the patient must recognize the depression for what it is, and try to seek both spiritual and psychological answers. It really requires self-examination which can be very uncomfortable.

However, there is a point where anti-depressants are necessary in order to function and get to the point of asking some of those underlying questions. Sometimes the answers may be spiritual. Sometimes they may be genetic or situational. Sometimes it is nearly impossible to nail down a “cause” to depression. But the fact of the matter is that far, far more people are undermedicated or misdiagnosed when it comes to depression than the other way around.

Which brings us to number three. What’s the difference between clinical depression and anfectungen, or spiritual distress? When you physically can’t move out of bed, that isn’t a spiritual matter, or it at least is not solely a spiritual matter. When you can’t concentrate, can’t remember the day before or even the hour before, when you either can’t sleep at all or sleep 20 hours a day, these are not simply spiritual distress. They are real, physiological symptoms of a medical problem.

Life under the cross does not mean easy fixes or pill-popping solutions. It means that we follow our Lord to die, so that we might rise with Him at the last day. It does not mean that we should avoid earthly help with pain in order to further identify with our Lord and His suffering. That would be montanism, and some of the more twisted views found in monasticism.

If your leg is broken, get it set. If your mind is broken, get the help you need. A part of that help may include medication and therapy. I guarantee that a part of that help is having a pastor and a church that understand the Gospel, and will give you the balm that will heal your soul, even if your mind and body are hurting.

Thanks for the intriguing post, Susan.

-DMR

8 thoughts on “Depression, Anfechtung, and drugs (oh my!)”

  1. >>In my observation and deep experience, they are not the same, but one may lead to the other, either direction.< < Amen to that.
    >>a point where anti-depressants are necessary in order to function and get to the point of asking some of those underlying questions. Sometimes the answers may be spiritual. Sometimes they may be genetic or situational.< < Amen to that too. I wonder, though, about situation depression. If a person has to find solutions to a situation, will medication help or hinder him in that? I can see it working either way, depending on the person and depending on the situation.
    >>Life under the cross does not mean easy fixes or pill-popping solutions. It means that we follow our Lord to die, so that we might rise with Him at the last day. It does not mean that we should avoid earthly help with pain in order to further identify with our Lord and His suffering.< < Given what Pr K commented on my blog, I fear that it’s possible that some people may think that’s what I was saying. Not at all. I agree with you, DMR: people need to look for earthly help to deal with pain. But as I am one of those people who would probably be going to an herbalist to treat cancer instead of visiting an oncology clinic (assuming I could afford it without insurance help), it seems like there should be alternative ways to deal with fever and depression and foot fungus too.

  2. >>In my observation and deep experience, they are not the same, but one may lead to the other, either direction.< < Amen to that.
    >>a point where anti-depressants are necessary in order to function and get to the point of asking some of those underlying questions. Sometimes the answers may be spiritual. Sometimes they may be genetic or situational.< < Amen to that too. I wonder, though, about situation depression. If a person has to find solutions to a situation, will medication help or hinder him in that? I can see it working either way, depending on the person and depending on the situation.
    >>Life under the cross does not mean easy fixes or pill-popping solutions. It means that we follow our Lord to die, so that we might rise with Him at the last day. It does not mean that we should avoid earthly help with pain in order to further identify with our Lord and His suffering.< < Given what Pr K commented on my blog, I fear that it’s possible that some people may think that’s what I was saying. Not at all. I agree with you, DMR: people need to look for earthly help to deal with pain. But as I am one of those people who would probably be going to an herbalist to treat cancer instead of visiting an oncology clinic (assuming I could afford it without insurance help), it seems like there should be alternative ways to deal with fever and depression and foot fungus too.

  3. This is a great topic. I don’t believe there is any one perfect answer for everyone, that’s for sure. Depression can be so different, and whether a person is making headway with therapy, or pastoral counceling, makes a big difference.

    I also have noticed sometimes that those who don’t use any “medicines”, can self-medicate with alcohol or even coffee. (No, Lutherans, I don’t mean all you coffee drinkers are depressed!)

    And it is all so different, if it is genetic, situational, or spiritual.

  4. This is a great topic. I don’t believe there is any one perfect answer for everyone, that’s for sure. Depression can be so different, and whether a person is making headway with therapy, or pastoral counceling, makes a big difference.

    I also have noticed sometimes that those who don’t use any “medicines”, can self-medicate with alcohol or even coffee. (No, Lutherans, I don’t mean all you coffee drinkers are depressed!)

    And it is all so different, if it is genetic, situational, or spiritual.

  5. Dear Dark,

    I still don’t understand the need for secular counseling in addition to pastoral counseling. As a confessional Lutheran, I most likely will be arguing (in my mind) with the professional.

    I am not referring to the psychiatrist, just the talk therapist.

    Also, If I’m depressed for the rest of my life, does that mean I have to go to secular counseling for the rest of my life (along with church, and the right medication)?

    Thank you for letting me post anonymously!
    +

  6. Dear Dark,

    I still don’t understand the need for secular counseling in addition to pastoral counseling. As a confessional Lutheran, I most likely will be arguing (in my mind) with the professional.

    I am not referring to the psychiatrist, just the talk therapist.

    Also, If I’m depressed for the rest of my life, does that mean I have to go to secular counseling for the rest of my life (along with church, and the right medication)?

    Thank you for letting me post anonymously!
    +

  7. You have got to be kidding? Depression from sin? I’m sure yes this can be correct. But that phrase hurts those who have a real mental illness that runs in the family and haven’t sinned more than anyone else.

  8. You have got to be kidding? Depression from sin? I’m sure yes this can be correct. But that phrase hurts those who have a real mental illness that runs in the family and haven’t sinned more than anyone else.

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