The first day I ventured through the church doors, no one knew I fought the compulsion to throw myself off a bridge.
I had drifted about for months with a shroud draped over my mind. Joy had vanished. As a physician, I understood my anguish and could describe its chem- ical mechanisms with precision. I could define clinical depression and deconstruct it. Yet as I sat there that day with the Bible heavy on my lap, despair crowded out my will to live. Never before had living felt so much like dying.
Fellow churchgoers noticed I neither lifted my voice in song, nor bowed my head in prayer. Many rightly deduced that church was foreign to me. No one, however, could perceive the severity of my groaning, because like other mental illnesses, clinical depression is a hidden disability. It skulks behind everyday routines. We go to work and pick up our kids from school, but struggle to breathe. We force a smile, while our regard for life erodes away. As Charles Spurgeon described,
“The flesh can bear only a certain number of wounds and no more, but the soul can bleed in ten thousand ways, and die over and over again each hour.”
Unfortunately, misconceptions about depression seep into the church, tainting our words. While the Bible urges us to open our arms to those crushed in spirit, too often sufferers of depression find the church to be a home for ridicule, rather than truth and love.
REAL CHRISTIANS AREN'T DEPRESSED
In my experience of writing and teaching about depression, dialogue with other Christian sufferers has revealed an unsettling theme. As they strive to contextualize their illness within a biblical framework, they worry that depression reflects a deficit in their faith. Some chastise themselves for being unable to overcome depression without medication. Others fear that depression reflects a puny faith, an imperfect acceptance of the gospel. The implicit fear is that depression and faith are incompatible. “Real” believers hope in the gospel, and so they don’t get depressed.
Further observations suggest that the church can worsen, rather than assuage, such feelings of guilt. In her article recounting her experience with depression, Alicia Cohn writes: Unfortunately, many of us who have spoken up in church communities have been told to “pray harder” or “have more faith.” These suggestions might be well-intentioned, but they often discourage and isolate.
Such comments demonstrate a faltering in love for our neighbors, a widening crack in the foundation of Christian empathy. As Christ’s followers we gladly leap into the mission field, cook meals for the destitute, and em- brace the grieving; but when depression strikes, misconceptions can deteriorate this spirit of compassion. At best, we practice silence and avoidance. At worst, we blame the sufferer and disregard the depressed as too lax in faith to pull themselves from the depths.
MORE THAN FEELING DOWN
Clinical depression differs from grief and sadness, which are appropriate responses to a broken world. Our tears are God-given. As they dampen our faces, they provide a balm for our wounded hearts, and point to our need for a Savior.
Depression, on the other hand, differs from this God-given sorrow. In major depression, our tears flow for too long, and for reasons we can’t pinpoint. They persist long after wounds have healed. No matter how earnestly we strive to free ourselves from the depths, each day dawns bleaker, since depression originates not from the will, but from changes in the brain.
Translated into everyday language, major depression is a pervasive disorder of mood and thought that dead- ens joy. The mundane tasks of getting up in the morn- ing, getting dressed, and going to work feel impossible—with 60 percent of sufferers unable to perform these simple daily activities.
Research over the past decade reveals that the neurobiological underpinnings of this experience are intricate. These changes create profound disturbances in mood, motivation, focus, and the ability to engage in the stuff of life. Those with depression suffer from a bleakness they can neither comprehend nor control. And even when the depressed seek out help for a single episode, another descent into darkness often lurks months or years ahead.
LIFELONG AFFLICTION
Nine years after my initial steps through those church doors, my suicidal compulsions had receded into memory. As I sat in the pews with a toddler clinging to my hip and an infant fussing on my lap, I called those around me my dearest friends. I had accepted Christ into my life and knew the church as a beacon of fellow- ship and respite.
Then, seemingly out of nowhere, a shadow descended over my heart again. The urge to cry thrust me into silence while my friends and family sang praises to God. As joy drained away, my most fervent thoughts dwindled to monosyllables. Help me, I prayed. Lord, please. Not this. Not again.
As it so often does, the darkness had returned.
Depression is often a lifelong burden. Following recovery from a single episode, up to 40 percent of sufferers have recurrent symptoms within two years (Kang). After two episodes, up to 80 percent continue to have recurrences (Burcusa, Bulloch).
Challenges in treatment compound the problem. Many people who suffer from depression don’t receive adequate therapy, either because guilt and stigma discourage them from seeking help, or because healthcare disparities limit services (Thornicroft). Even when sufferers do seek help, treatment is an inexact science, and cure elusive.
The mainstays of therapy include antidepressant medications, which increase concentrations of serotonin in the brain, and psychotherapy. Although antidepressants can provide crucial stability, when used alone they facilitate full remission in only about 50 percent of cases (Papakostas, Gartlehner). Efficacy increases when antidepressants and psychotherapy are combined (Cuijpers).
When sufferers muster the courage to pursue therapy, they can face a plodding and debilitating course. Although some feel better within one to two weeks (Uher, Posternak), full remission usually requires six to 12 weeks of therapy (Papakostas, Trivedi, Romera). The delayed effectiveness of treatment can worsen feelings of guilt. As Zack Eswine writes, “Because of this slowness of cure, sufferers must daily withstand voices of condemnation. After all, Shouldn’t you be over it by now?” Fellow churchgoers hold the power either to fan that condemnation into flame, or to snuff it out. Our words matter (Matt. 15:18; Eph. 4:29). With them we may trample the downtrodden for the glory of our own lofty opinions. Or, we may embrace the suffering with open arms and hearts, and in so doing embody the love of Christ.
MEDICAL PROBLEM WITH SPIRITUAL RAMIFICATIONS
Sufferers desperately need reminders of Christ’s love. When we dismiss depression as an affliction of faithlessness, we crush believers during their moments of dire need. We also ignore the refining work God may accomplish through our moments of despair. Pastor Todd Peperkorn shares the following:
Overcoming depression is not a matter of “cheer up!” or “just have more faith and joy!” or some pious version of “get over it!” I knew the gospel. I knew all the right answers. I had it all figured out and preached it Sunday after Sunday. But our Lord, in his mercy, chose to crush me, to cause me to suffer with him, so that the faith he gave me... would be stronger, clearer, and more focused. By traveling down that dark road, I have come to understand what the light of Christ is all about.
As Christ’s followers, we’re called to reflect His light. We’re called to remind one another, as the Psalms constantly reassure us, that those who know and love God also struggle through seasons of despair (Ps. 13:1–2; 38:6–8; 42:1–2). David was a man after God’s own heart, with a faith so vast it steeled him against a giant. Yet in the Psalms he laments. Seasons find him in agony, crying out to the Lord whom he cherishes, but who he fears has fallen silent (Ps. 22:1–2). In their deep longing and poetic imagery, the Psalms give a voice to our own suffering. They reveal that even those rich in faith are prone to despondency.
HOPE IN CHRISTIAN LOVE
When I awkwardly stepped into that church building more than a decade ago, those present couldn’t discern my agony. But they saw me. They beheld me as another image-bearer of God, worthy of love, won by Christ. They offered table fellowship. They opened their homes and their lives to a stranger. They shared books, baked pies, and offered unconditional em- braces. They inquired. They listened.
When years later, I finally divulged the episodic tumult within my soul, they still loved me. The table fellowship continued. The books still exchanged hands. The embraces just lingered a bit longer. The house visits increased in frequency. The prayers became more fervent. They didn’t reprimand me. They simply partnered with me, holding on to me while the waves of grief ebbed and flowed.
Their efforts didn’t chase away the darkness. They didn’t cure my depression, or jolt my mind awake with a burst of hope. But they did reflect Christ’s love, and in so doing, buoyed me through turbulent seas. They reminded me, even while I was steeped in hopelessness and shame, even when I couldn’t believe their words, that Christ lived and died and rose for me. And like a shaft of light glittering through inky waters, that truth—that love—penetrates through.
DEPRESSION SUPPORT AND RESOURCES
If you or someone you know is suffering from depression, we encourage you to seek out help to begin the journey of getting the help you need for yourself or someone you know who is struggling with depression. You don't have to suffer alone.
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If you or someone you know is having thoughts of suicide, please call or text the Suicide & Crisis Lifeline at 988
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By: Dr. Kathryn Butler (MD, Columbia University College of Physicians and Surgeons) is a trauma and critical care surgeon who recently left clinical practice to homeschool her children. She has written for Desiring God and Christianity Today, and is the author of Between Life and Death (Crossway, 2019) and Glimmers of Grace: A Doctor's Reflections on Faith, Suffering, and the Goodness of God (Crossway, 2021). She also blogs at Oceans Rise.
