Lutherans are often portrayed as being a “Lent” sort of people. Somber, slow chorales. A generally dark disposition. Anyone who looks too cheerful and happy must be a charismatic or something. Yet, if anyone is too sad or (ahem) depressed, they must not know Jesus loves them. Sometimes it’s hard being Lutheran

Yet in comes the season of Advent! Advent, which it’s joyous and hopeful hymnody, yet penitential character, seems to me to reflect perfectly the paradox which is Lutheranism, and dare I say Christianity itself. We receive the Gifts now, but they are not here in their fulness. We look for the coming of the Savior, but we do so with both repentance and joy. Our readings for the season do not reflect simply a period of pre-Christmas. Rather, they focus on Jesus entrance into Jerusalem to die, his return in glory, and the preparation of repentance preached by John and all the prophets.

So as a Lutheran pastor who suffers from clinical depression, I find a great deal of joy in the season. In a chemically toned down sort of way, of course. The season reflects perfectly what it means for me to be a Christian today. I am torn between rejoicing in God’s gifts now and wanting it all to be over so we can get to the good stuff.

For most people suffering from depression, we are entering into the darkest period. It is winter, so less sunlight. It is the “holiday” season, so we have extended interaction with family, and all the conflict which inevitably ensues. For pastors, this is the start of the 3-4 busiest months of the year in terms of preaching and catechesis. EVERYTHING happens from December to early April. I always feel like I should get a medal after Easter.

Yet there is hope in this season. It stands in stark contrast to the fake and plastic joy of our culture. The hope which Christ offers is real, not contrived. There is an end, there is joy now, and Christ Himself is coming.

Be at peace, brothers and sisters. Our Lord is coming. Amen, even so, come Lord Jesus!

-DMR

In the last few years I have had the opportunity to speak or correspond with many people who struggle with depression or other mental illnesses. Pastors, teachers, DCEs, laity, each story is different, yet there are common themes.

One of those themes is how often the church, either at the congregational level or at the district/synod level, has failed these people. In all too many cases, their faith has been shaken to the point of disappearing. Now I don’t believe that there is any malice on the part of congregations or our church body. Far from it. But the sad reality is that we are driving people away from Christ by how we approach the mentally ill.

Why?

I have several theories about this. Here they are, in no particular order:

1. Because we so often equate clinical depression (or any mental illness) with some sort of character flaw, it is viewed basically as a sin. I think people instinctively know that this isn’t quite right, but they don’t have any other categories in which to place mental illness.

2. Everyone has weaknesses, and we work very hard to hide them. For many, depression unmasked is too close to home. It forces us to view our own struggles and failings, and that may just be too painful.

3. If we view the church as a place for the spiritually strong to work out, and not a hospital for the sick, then the mentally ill have no place.

4. The fundamental notion of “depression is in your head, get over it!” is so strong that we can’t help but judge others whose weaknesses are in public view.

5. Lutherans just aren’t very good at areas which aren’t “spiritual” in nature. If it isn’t about justification, then we just don’t get it. Hence, we try to place depression and mental illness simply into the “spiritual” box, and it doesn’t fit there.

Those are off the top of my head. What’s on your list?

I have been in a good mood lately. Yesterday was a little down, but generally I feel good right now, I’m interacting with my children well, and I am getting along with people. This is all good.

The problem is that I have no motivation to do anything at all.

So my question for the day is this: at what point does one look at the symptoms of depression and say, “yep, that’s a part of my illness,” and then at what point do you say, “get off your butt and get to work!”

I don’t like the idea of blaming every mood swing, every lack of motivation or odd behavior on the disease. There must be a sense of personal responsibility as well. Otherwise, we end up like the song from West Side Story:

:

Officer Krupke, you’re really a square;
This boy don’t need a judge, he needs an analyst’s care!
It’s just his neurosis that oughta be curbed.
He’s psychologic’ly disturbed!

ACTION
I’m disturbed!

JETS
We’re disturbed, we’re disturbed,
We’re the most disturbed,
Like we’re psychologic’ly disturbed.

So how do we draw that line as Christians? Sickness is the result of sin, and yet sin is also my own responsibility. I am trapped by the Fall, yet I participate in that same Fall every day. Maybe my problem is that I just want someone or something to blame other than myself.

So am I nuts here?

-DMR

It is hard to overestimate how important preaching the resurrection is to the mentally ill, including the clinically depressed. That’s the illness I know best, but I firmly believe that this holds true for anxiety, manic depression, schizophrenia and a host of other mental illnesses.

The reason is simple. For the mentally ill, you are trapped in your own mind and body. Your brain is not processing as it should, and so the chemical changes in your body interact in a very bad way with the sinful nature which infects us all. If your sickness is telling you that things are far, far worse than they really are, and your sinful nature is telling you that God hates you, put these two together and you have a recipe for personal and spiritual disaster.

Mental illness works as a magnifying glass and amplifier for so many of the doubts and fears which infect us all. Everyone has doubts about the future. Everyone has moments of despair. Everyone has fears about what they cannot control. Everyone questions their own worthiness before God and before their fellow human beings. We all go through these. But for the mentally ill, especially the clinically depressed, these feelings are all consuming. The physical illness can easily lead to anfectung, the struggle of the soul.

So why does preaching the resurrection matter to the clinically depressed? It matters because in the resurrection of the body, there is a future and a hope that is real, that is concrete, that will happen to matter what may be going on today or yesterday or tomorrow. St. Paul puts it best:

“If in this life only we have hope in Christ, we are of all men most miserable.” (1Corinthians 15:19 KJV)

For the depressed, there is no tomorrow.
For the depressed, there is only thick darkness.
For the depressed, there is only more misery.
For the depressed, there is no escape except the grave.

But not so the Christian!

There is a tomorrow in Christ.
There is light that shines in the darkness.
There is joy in the body of Christ.
There is escape not in the grave but through the resurrection of the body.

So, my fellow preachers, give us the resurrection. It is my only hope out of the darkness. Give me Jesus Christ risen from the dead. Nothing, nothing else will ever satisfy.

Easter is coming. I can’t wait.

Dear Blog,

Yes, I’ve been treating you like a shut-in.  I love to see you when I’m there, but you make me tired and listless.  You remind me of how imperfect I am, how much I want to just stare at the wall or watch mindless TV, or how little I like interacting with people.

Yet, I’m always glad when I’m with you.  You give me joy.  You remind me I’m not alone, and that there are others out there struggling as much if not more than I do.

I’ll try to do better.  I’ll try not to neglect you so much.  But I am ever so aware that I need you as much if not more than you need me.

Talk to you again soon.

-DMR

My recent post about reading has prompted a further question for me.  The comments, as well as the experience that I have had, tells me that people who are going through depression rarely have the mental energy (or whatever you want to call it) to sit down and read.  Even if it’s short.  Even if it’s great.  If you don’t have the energy to look at the comics, a book on the theology of the cross and depression just isn’t going to help you.

So what will?

I’m not talking about medical or psychological help.  I mean spiritual help.  What will help heal your soul?  Audio, video, something else?

I’m just thinking out loud here.  I’d like to hear your thoughts.

-DMR

Good Friday is really about life for me. Two years ago Good Friday, I was sitting at home, preparing for my minimal role in services. I had been on disability for about 2 months, and things were going fairly well. I got a phone call from the people that handle disability claims at our insurance company. They were just calling to inform me that since I had shown “some” improvement according to my doctor, that they were taking me off disability.

This began a series of events that I can only describe as surreal. I began a downward spiral that brought be to being suicidal. It was a gift from God that we had the divine service that day, for without that, I don’t know what I would have been doing. My pastor stayed with me as much as possible. I was a zombie, barely conscious, yet fully believing that there was no way I could get out of this, no way I could recover from such a blow. If I didn’t have the time and space I needed to heal, then I would only get worse. What was the point?

But God is merciful.

I lived.  Somehow our Lord got me through the Great Three Days.   After Easter I went to stay with some dear friends for a couple weeks to rest and try to recover some level of sanity and normalcy.  Things got better.  It took a long time, with setbacks along the way and all kinds of other gunk to go through, but things did get better.

So Good Friday for me is about life.  It’s about that life God gives to each one of us.  It’s about the Life that was given for my life.   It’s about the gift of seeing my children grow up, having friends and family who care deeply for us, and it’s about the ongoing work that our Lord does to keep us in the faith all the days of our lives.  No matter how dark the road.

A blessed Good Friday to you.

-DMR

One of the most difficult things to recognize is the place of faith when it comes to mental illness. Many view mental illness (or really any illness, for that matter) as a question of faith. I don’t know how many times I’ve heard variations on the theme:

• “Trust that God will take care of you. You don’t need to feel this way.”
• “If you prayed more and spent more time in the Word, you would feel better.”
• “Depression is really a faith issue. If you had more faith, you would have a better outlook on life.”
• “How can you be anxious and nervous? Haven’t you ever read Philippians 4?”

The list could go on, but you get the idea.

Faith, however, cannot be equated with:

• Intelligence
• Emotions
• Willpower
• Knowledge

A part of our theology as Lutherans is recognizing that God has wonderfully made us, body and soul. There are interconnections that we have hardly even begun to understand. This is especially true when it comes to the mind.

But when dealing with depression, understanding the distinction between the body and the soul is critical. Depression affects the mind, but the mind controls the body. So when something is going wrong with the mind, the body is bound to follow suit in some fashion or another. This is why people with depressive disorders sleep so much, complain of all kinds of pains (esp. back pain), may become oversensitive to light or noise, and may have other seemingly unrelated physical symptoms for a “mental” illness.

Where this dilemma really hits the Christian, though, is when it comes to speaking of faith. Depression is often equated with despair, which is a spiritual ailment or attack by Satan. But it is not the same. Depression has physical causes, as well as situational or possibly spiritual causes.

So what happens when depression is understood strictly as a spiritual sickness? What happens first of all we have a confusion of the Two Kingdoms. You don’t tell someone with a broken leg that they simply need to have more faith. The leg actually needs to be mended. In the same way equating a physical ailment with a spiritual one belittles the physical ailment and makes it much harder to recognize actual spiritual sickness.

I’m not speaking here about any particular type of remedy, such as therapy, medication, exercise, diet, meditation, or whatever. That is a different conversation. I’m really speaking about the basic understanding that to try and heal depression solely with spiritual remedies is a misdiagnosis and is very dangerous.

So speak up. What think ye?

-DMR

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

Sorry I’m not posting quite as much as usual right now. I am in the midst of trying to write a draft of this book I posted about earlier. It’s good, and I’m very excited about (insofar as someone on as many drugs as I am can be excited), so it’s taking more of my time. But have no fear. I haven’t left, and I’m not going anywhere.

-DMR