Depression is a serious condition experienced by many people. There is even talk of a depression epidemic today. There is a connection between depression and faith, but the two should not be confused. What can a pastor do? Can pastoral care and psychological care work together? And if you are not a pastor, how can you support someone? We look for hope where there is despair.

Believers with depression⤒🔗

Believers also experience depression. It can vary in severity from occasional depressive feelings to a depressive disorder. For the latter, five of the following symptoms must be present for at least two weeks: persistent dejection, loss of interest, weight loss, insomnia, fatigue or loss of energy, feelings of worthlessness or excessive guilt, loss of concentration, thoughts of death or a death wish. Depressed people are often very misunderstood. With the best of intentions, others try to cheer them up and convince them that life is worth living, or that God is good. This only makes the depressed person feel even more hopeless.How is it possible that believers become depressed? Don’t they have enough reasons not to be discouraged and listless? Life is a gift. God gives us his promise of life and support. We may place our trust in him, even when we ourselves fall short. It has been suggested that a strict Reformed faith promotes depression. The reason put forward goes something like this: people are told that they are sinful and, as a result of original sin and election, they cannot do anything about it. They are helpless but guilty. Aleid Schilder developed this hypothesis in her controversial doctoral thesis. However, research has not confirmed this. Worldwide, believers appear to be less depressed than non-believers, including the relatively small number of members belonging to conservative Reformed churches. Feeling helpless and guilty is part of the clinical picture so naturally believers also suffer them. And these feelings are automatically projected onto things that are important to them: in this case, their relationship with God.

Two different things←⤒🔗

A strict faith does not in itself cause depression. But how is it possible to become depressed in the context of faith and church? Many factors can contribute to this, depending on the situation. The first thing to note is that faith and depression are two different things. The first has to do with spiritual life, the second with mental health. The one is not a consequence of the other, although they do influence each other, because they both affect the soul, the psyche. Faith is not an antidepressant, according to the Reformed psychiatrist Arie Jan de Lely. However, depression can paralyse the functioning of faith when, for instance, you cannot concentrate on a sermon or on prayer; you doubt whether God wants to accept and forgive you; you feel as if God does not care about you; you also have no energy to seek God; you feel aversion to overly positive gospel sounds; you experience a death wish in conflict with the motivation to seek life with God. Faith can shield against a complete slide into darkness, but it does not always automatically do so. Neither is it a matter of “not believing enough” if drawing strength through faith fails. All these afflictions are part of the condition that make it so confusing.

Depression epidemic←⤒🔗

Depression is not caused by a strict faith in God; rather, the opposite is evident. The Protestant professor Frits de Lange has pointed this out. He and others are looking for reasons that depression is spreading so strongly. He even considers it being—in the Netherlands—the foremost national disease. This ties in with the well-known term introduced by Professor Trudy Dehue: the depression epidemic. In a modern, neoliberal culture people have become totally self-dependent. In the past they were part of traditional communities and had their recognised place and task in it. It was about discipline and should one fail, there was guilt. These communities were imbued with Christian values, meaning that people critically assessed and judged themselves in this way, yet there was also room for recognition of guilt and the grace of forgiveness. That is different now. In the nineteenth century, Friedrich Nietzsche proclaimed that people had declared God dead and that they were now on their own. De Lange tries to explain the spread of depression along those lines. Everything now depends on the person himself.

He must make himself into someone who means something in the eyes of others and himself. He or she is expected to be the director of his or her own success: enterprising, flexible, stress resistant, communicative, energetic. It leads to a constant pressure to surpass yourself. The pressure can lead to depression. You can lie awake at night because of an inability to meet your own standards. That does not lead to guilt, but to shame. It can go so far that you wish to erase yourself. This is what happens to a society when it encourages people to rise above themselves. De Lange distinguishes between classic and modern depressions. The former are said to be more related to an unprocessed past—for example, due to an insecure attachment to parents resulting from their capriciousness or absence; the latter to a weighty and difficult future. He quotes a well-known saying, something to the effect of  “if you set the bar too high for yourself, you will inevitably fail.”

Pitfalls in the faith conversation←⤒🔗

Are you able to support someone who is experiencing depression? First, let us start on an encouraging note: that depressions do not usually last. If they do, professional help is required. More about that later. But often the patient eventually recuperates from it. This does not mean that we can simply dismiss it with a casual response of “Oh, that will go away by itself.” Someone who is suffering depression needs serious support. And sometimes the condition can be chronic. How can you best provide that support? There are various pitfalls of which you need to be aware.

One is that we load the conversation too heavily about depression in order to try to bring the other person to a better mindset. I already alluded to that at the beginning. It is better not to argue at all. You will not be able to convince the other person anyway. And certainly do not use morally or emotionally charged arguments. The other person is sick in his or her psyche: that is, in mind, feelings and will. The person in question only feels misunderstood and runs the risk of feeling even more guilty if you go on about it. Stay interested but keep the conversation businesslike. Do not say, “You’re wrong.” Ask how things are going, try to say in your own words what you understood from the other person. Do not be afraid to ask “stupid” questions. Be honest about the fact that you find it difficult to put yourself in the other person's shoes. Do not take the other person’s reproaches personally.

Another pitfall is impatience. Impatience contains a hidden reproach: Just listen to what I say; don’t be so stubborn. It is understandable that you can become impatient as a loved one. Yes, it is hard if you are close to a depressed person and that person is not open to reason. There is no easy solution for this. Remaining loyal to a sufferer is very important. It is important that the other person experiences that you do not let him or her down. Perhaps you can model the persistent love of God. That sends out a signal, even if you have not said a word about faith.

What we should also watch out for was already briefly mentioned above: hidden reproaches, even if they arise from something other than impatience. For example, you may think that someone is very selfish: that is, only thinking of themselves. Or perhaps you have the hypothesis of Professor De Lange in the back of your mind and think, “Of course, you always thought you could do better, you overestimated yourself. That’s what you get!” In various ways there is something amiss here. First, you can not be certain whether that is the cause in this case. Moreover, the situation described may not be due to personal self-overestimation, but instead caused by a society that pressures people to improve their performance. Those who cannot cope with it are like the canaries in a coal mine: the signal of an unhealthy work environment. Others are more resilient to cope with it. Someone who falls into depression as a result of such a toxic situation becomes a victim.

Depression and the Bible←⤒🔗

Can the Bible be discussed in a conversation with depressed people? If both parties accept the Bible as God’s Word, that is certainly possible. There are passages that I think are better left unread. I am thinking of King Saul’s gloomy moods after he had disobeyed God’s command through Samuel not to keep any spoils of war after his victory over the Amalekites. Such a passage could easily lead to identifying oneself with Saul and to the idea that God is punishing him or her. That does not have to be the case at all. A more positive and suitable passage is the story of a discouraged Elijah, who says to God at Horeb:“It is enough; now, O Lord, take my life, for I am no better than my fathers” (1 Kings 19:4)

However, his request is rejected. Instead, Elijah is commanded to eat and is given a new assignment by God. In general, I think those passages are suitable, for they both touch on the seriousness of the situation and also offer hope and speak positively about God. Keep the talk about that brief. God’s words are enough; they will assist further. The passage about Elijah also provides a good pointer. Prepare something to eat for (or with!) the person and discuss an agenda for the day. Suggest the person make a to-do list of light tasks and give incentives to do them. And again: no impatience and no reproaches if this approach does not work. You can gently remind him or her that for the helpless there is help with God, and for the guilty there is forgiveness.

The pastor and the caregiver←⤒🔗

It is not the pastor’s job to help the depressed person out of his or her depression and it is not the caregiver’s task to encourage him or her from a faith perspective. However, that does not always mean that the pastor’s support cannot be meaningful in dealing with depression, and that a religious caregiver cannot offer an encouraging Bible text in appropriate circumstances.

The pastor focuses his attention on the person, prays with him or her, and reads a short Bible text, usually no more than a few verses. The attitude of the pastor ought to be more nuanced than that of a friend, relying on his professionalism to be considerate and measured. He should not delve into feelings and thoughts, but let the person express him or herself, speak well of the Lord, and give the person ample leeway. The pastor needs to communicate acceptance and respect, acknowledging the person’s feelings and that it is okay to be or to come “as you are.”   

The psychologist explores the past, identifying harmful thoughts and tries to change them with exercises practised by the patient. A psychologist has a variety of methods at his disposal that allow him to support the patient via verbal communication. The psychiatrist can prescribe medication. A combination of medication and talking often works best.

How can the pastor and the caregiver help each other? In therapy, the patient may come up with faith-related problems. It would be helpful if this is reported back to the pastor. Preferably, the patient does this himself. With the patient’s approval, the caregiver can ask the pastor for clarification about the way certain matters are perceived in the church in question. In the patient’s perception, his or her view of faith can sometimes be distorted. Conversely, the pastor can ask for clarification about the patient’s condition, again with the patient’s permission. Ideally the best thing is to convene a collaborative meeting from time to time with all caregivers, including the pastor and with the patient present, in which the situation is discussed and agreements made.

There are no easy solutions, but it is important that the person in question feels supported and knows where he or she can go. I am deliberately not using big words here. It is about small steps, in which all those involved from a faith perspective hope and pray for rays of light to emerge.