Candid pastoral thoughts on depression and drugs

by Dan Phillips

As always, I'm going to try to say as much as I can, as briefly as I can.

Man: body and soul. From the Bible I learn that man was created as an embodied soul (Gen. 1—2). He's not a spirit uneasily floating within a body; he's not a body with some higher functions. Being parted from his body is an unnatural and temporary state, which God will ultimately remedy (1 Cor. 15; Rev. 20).

In the meanwhile, here we are, body and soul. Spiritual realities such as guilt and unbelief, as well as faith and hope, produce physical effects (2 Sam. 13:2; Pss. 16:9; 32:3-4; 38:3, 7; 63:1; 119:120), and physical states can effect us spiritually (Pss. 6:2-7; 88:13?). We should humbly admit that there are many mysteries as to the relation of soul and body that we just can't resolve finally. Where is the person, in the body afflicted with

Alzheimers, or laid low in a coma? What is the volitional buy-in when there is what is called a bipolar or autistic pattern? Is it great? Is it nil? Certainty is evasive.

Depression: cause(s) and effect(s). Specifically as to depression, it isn't a single effect with a single cause. Ask David; ask Elijah; ask Jeremiah; ask Spurgeon; ask me. It can grow from unbelief, from exhaustion, from lazy thinking, from persecution, from a dozen, a hundred other causes known and unknown. Professor David Murray, for instance, has recently highlighted some research finding a physical indicator of depression.

Causation gnarliness. However, that said, still — which the chicken, which the egg? Plus, the very splash this story made in part relates to the paucity of such hard evidence (remember: theory, no matter how oft-repeated, is not proof) previously. When I talked to my doctor about the very serious depression I was beginning to experience some decades ago, he told me about the lack of serotonin in my brain, and wanted me to take a pill for it. It turns out that this whole model is (to say the least) not nearly as sure a thing as it is presented.

Now, think about that. Tests determine whether I have blood pressure issues, problems with my heart, lung, brains, nerves, eyes, and on and on. Tests identify the problems, surgery or medicine can address the problems, and tests will disclose whether the conditions are improving or not. With mental issues, emotional issues, behavioral issues? It's not as cut and dried as we're often told by the white coats.

What's depressing me right now is the certainty that, no matter how carefully I'm trying to write, I'm being misunderstood. One group of readers is saying "Aha! Exactly! All those pills and doctors are complete wastes of time! I agree with you!" Another, "I can't believe you're so heartless and ignorant as to banish suffering people back to the Dark Ages. What do you recommend? Leeches, dungeons, beatings?" Neither is a correct reading.

It's...complicated. What I am really saying is that it's complex, it's complicated, and we should proceed with cautious humility. I am saying that stridency of voice is not always an indicator of clarity of evidence. And I'm saying all that to come to this pastoral turn.

Both ways? Not so much. When I counsel people with depression, I find that many have already been to the doctor, and many are already taking medication.

There's a real imbalance in practice, here; a partnership that should be happening but isn't. If a person came to me with serious depression, I would encourage him to get some medical tests to make sure there's not a physical issue. However, I have never yet met one person whose doctor said "There are pills that address some of these symptoms. But since I find no physical cause, I'd like you first to work with your pastor and see if the issue isn't non-physical." Rather, it seems that doctors reach for their prescription-pad faster than James Bond for his Walther PPK.

Altered picture. So in these situations, I start out in a bind. I am, as I said, not opposed in principle to medication. However, it is undeniable that medication changes the equation to some degree, perhaps dramatically. I am dealing with a person who is taking mind-affecting drugs. What he sees and feels is colored, to some degree, by the pills he is taking. NOTE: Truly, I am saying this without the least condemnation of the suffering brother or sister. I simply state a fact.

Some drug is in the picture with which I'm being presented. I have no training in these medications, and have no expertise in dealing with drugs, so... what exactly do I do? How do I proceed?

Are the drugs helping this dear one and me in what we want to accomplish? Or are they hindering? Are they moving us towards a goal, or hiding critical information?

Curing... or masking? Think of it this way: suppose I'm wearing shoes that are far too tight. My feet hurt awfully. I go to the doctor. The doctor wants to help me, he hears I'm in pain. So he prescribes pain medication. I take it, I feel better. And I continue wearing the shoes.

The pills help the pain (that the shoes are causing), but they do other things as well. I'm a bit drowsy, I'm not as sharp-minded. The drug affects my work, it makes driving problematic. And then there's the problem of the law of diminishing effects, as dosage is gradually elevated.

However, the pills were immediately helpful for the pain.

The problem of pain? or of its absence? All of this overlooks the fact that this pain had a purpose, a God-given purpose. The pain was meant to alert me to the problem: my shoes were too tight. The solution was not to address the pain qua pain, but to find the source of the pain. In fact, helping me tolerate the pain — short-circuiting God's flashing red light system — might ultimately cause real damage to my feet.

So this depression... is it a hormonal deficiency? As a pastor, I can't help that by Biblical counseling. Lack of rest? Blood sugar? That's not my area, not my specialty.

But suppose (just suppose! that's all I'm saying) the depression is a result of guilt over sin? or of ignorance of God's truth? or of a faint grip of the truths of God's grace and love and promises? or of lazy unbelief? or of disobedience? These are among the many, many possible causes of depression — not to mention the causeless depression of which Spurgeon wrote. But in all of these cases except perhaps the last, not only will medicating the symptoms away not help, but it will actually retard the process, by hooding God's flashing red light.

Where are we going? And there's more. Invariably, I ask these dear souls what the doctor's end-game is, and invariably they don't know, because he hasn't told them. Does the doctor mean them to take pills the rest of their lives? (Some have already done so for decades.) But then, how can we ever know whether the person is better? One can't stop these medications cold-turkey, that causes its own problems. So where are we going with this, and how do we know when we've gotten there?

In the attempts to bring this post to a close with a useful takeaway, here is a list of questions I'd like anyone to ask his doctor, before he begins taking drugs for depression or such. These should not be combative questions. They aren't meant to be. They should simply help make for an informed patient.

As an added bonus, the answers would be very helpful to the pastor who usually is brought in late in the game.

Ask your doctor:

1. Do you think my problem is a sheerly-physical problem?
2. Is there a test that has shown, or can show, whether my problem is a sheerly-physical problem?
3. How long do you intend me to take these pills? That is, when will I stop?
4. How will we know when I can stop taking these pills?

Even answers to just those four questions would be so helpful in a counseling situation.

After all, I hope we're all agreed to hold three specific stances:

1. Our goal in life is to glorify God to the greatest degree possible (1 Cor. 10:31).
2. We don't want to try to address physical issues spiritually, or vice-versa.
3. While medicine is a gift from God, we don't want to take either more or less personality-affecting medication than is necessary.

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Spurgeon on Depression

Your weekly dose of Spurgeon
posted by Phil Johnson





The PyroManiacs devote some space each weekend to highlights from The Spurgeon Archive. Here are a few resources from the Prince of Preachers on a topic he was intimately familiar with:



From The Soul Winner (chapter 9, "The Cost of Being a Soul Winner"):

ome years ago, I was the subject of fearful depression of spirit. Certain troublous events had happened to me; I was also unwell, and my heart sank within me. Out of the depths I was forced to cry unto the Lord. Just before I went away to Mentone for rest, I suffered greatly in body, but far more in soul, for my spirit was overwhelmed.

Under this pressure, I preached a sermon from the words, "My God, My God, why hast Thou forsaken Me?" I was as much qualified to preach from that text as ever I expect to be; indeed, I hope that few of my brethren could have entered so deeply into those heart-breaking words. I felt to the full of my measure the horror of a soul forsaken of God. Now, that was not a desirable experience. I tremble at the bare idea of passing again through that eclipse of soul; I pray that I may never suffer in that fashion again unless the same result should hang upon it.

That night, after sermon, there came into the vestry a man who was as nearly insane as he could be to be out of an asylum. His eyes seemed ready to start from his head, and he said that he should utterly have despaired if he had not heard that discourse, which had made him feel that there was one man alive who understood his feeling, and could describe his experience. I talked with him, and tried to encourage him, and asked him to come again on the Monday night, when I should have a little more time to talk with him.

I saw the brother again, and I told him that I thought he was a hopeful patient, and I was glad that the word had been so suited to his case. Apparently, he put aside the comfort which I presented for his acceptance, and yet I had the consciousness upon me that the precious truth which he had heard was at work upon his mind, and that the storm of his soul would soon subside into a deep calm.

See also: "Comfort for the Desponding" "Encouragement for the Depressed" "Darkness Before the Dawn" "To the Saddest of the Sad" "Consolation Proportionate to Spiritual Sufferings" "The Christian's Heaviness and Rejoicing"

Now hear the sequel. Last night, of all the times in the year, when, strange to say, I was preaching from the words, "The Almighty hath vexed my soul," after the service, in walked this self-same brother who had called on me five years before. This time, he looked as different as noonday from midnight, or as life from death. I said to him, "I am glad to see you, for I have often thought about you, and wondered whether you were brought into perfect peace." I told you that I went to Mentone, and my patient also went into the country, so that we had not met for five years.

To my enquiries, this brother replied, "Yes, you said I was a hopeful patient, and I am sure you will be glad to know that I have walked in the sunlight from that day till now. Everything is changed and altered with me."

Dear friends, as soon as I saw my poor despairing patient the first time, I blessed God that my fearful experience had prepared me to sympathize with him and guide him; but last night, when I saw him perfectly restored, my heart overflowed with gratitude to God for my former sorrowful feelings. I would go into the deeps a hundred times to cheer a downcast spirit: it is good for me to have been afflicted that I might know how to speak a word in season to one that is weary.

Suppose that, by some painful operation, you could have your right arm made a little longer, I do not suppose you would care to undergo the operation; but if you foresaw that, by undergoing the pain, you would be enabled to reach and save drowning men who else would sink before your eyes, I think you would willingly bear the agony, and pay a heavy fee to the surgeon to be thus qualified for the rescue of your fellows.

Reckon, then, that to acquire soul-winning power you will have to go through fire and water, through doubt and despair, through mental torment and soul distress. It will not, of course, be the same with you all, nor perhaps with any two of you, but according to the work allotted you, will be your preparation. You must go into the fire if you are to pull others out of it, and you will have to dive into the floods if you are to draw others out of the water. You cannot work a fire-escape without feeling the scorch of the conflagration, nor man a lifeboat without being covered with the waves. If Joseph is to preserve his brethren alive, he must himself go down into Egypt; if Moses is to lead the people through the wilderness, he must first himself spend forty years there with his flock. Payson truly said, "If anyone asks to be made a successful minister, he knows not what he asks; and it becomes him to consider whether he can drink deeply of Christ's bitter cup and be baptized with His baptism."

And from the same book, chapter 14:

    often feel very grateful to God that I have undergone fearful depression of spirits. I know the borders of despair, and the horrible brink of that gulf of darkness into which my feet have almost gone; but hundreds of times I have been able to give a helpful grip to brethren and sisters who have come into that same condition, which grip I could never have given if I had not known their deep despondency. So I believe that the darkest and most dreadful experience of a child of God will help him to be a fisher of men if he will but follow Christ.

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Book review — Spiritual Depression: Its Causes and Cures (re-issued and enhanced), by D. Martyn Lloyd-Jones

by Dan Phillips

Spiritual Depression: Its Causes and Cure, by D. Martyn Lloyd-Jones

(Hannibal, Missouri: Granted Ministries Press, reissue of 1965 ed; 300 pages plus CD)

I first read the Eerdmans edition of this book (pretty surely) in the 1980s, and I read out of personal interest. That is, I was depressed. As I have shared, I have battled depression now and again all my life. So the title caught my eye on the shelf of the local Christian bookstore, and I looked to Lloyd-Jones hoping for help.

This classic work has now been reissued by Granted Ministries Press (and provided me for review) in an enhanced edition. That is, the book has the original text, plus a foreword by Geoffrey Thomas, and the terrific bonus of an MP3 audio disk of actual sermons on the topic by the beloved physician himself.

Let's begin with this edition's value-added features. In his Foreword, Thomas begins with the assertion, "There was no one in the twentieth century more suited to preach, counsel and write on this subject of spiritual depression than Dr. D. Martyn Lloyd-Jones." (I take it that the chronological qualification is meant to exclude Charles Spurgeon, who in the 19th century wrote and preached vividly, evocatively, frequently, and very helpfully on the subject.)

Thomas goes on to substantiate his assertion with eight specific points qualifying Lloyd-Jones for writing this book. A number of these points reflect Thomas' own personal acquaintance with the late Doctor. These specifics form a terrific little study in themselves.

In addition, the disk provides some of the sermons preached by Lloyd-Jones himself, which formed the basis for this book. If you've never heard Lloyd-Jones, he takes some getting used to; plus, the recordings are at times rough, not having been made with modern equipment. But it is worth every bit of the effort. Lloyd-Jones' preaching is searching, rich, and profitable. I'd say the Foreword and sermons alone warrant the price of purchase.

But then we come to the book itself, which has already been used, recommended, and reviewed by many over the past near half-century. What are some of the highlights?

Lloyd-Jones, himself a medical doctor, well brings out the truth (also reflected in the Bible) that physical issues can produce depression. In such cases, depression is not primarily a spiritual issue but one of health or diet or rest. Memorizing a Bible verse, while always a good idea, won't substitute for needed refreshment, nutrition, or other medical intervention.

Lloyd-Jones was driven by a conviction of the sufficiency of Scripture, and this sends him to the Word for the truth that depressed folks need. Accordingly, he dives at length into Psalms 42-43, finding in them both an analysis of and a cure for much spiritual depression. I found particularly helpful Lloyd-Jones' development of the idea of preaching to oneself. Here's a snippet:

But that is only a taste. Lloyd-Jones writes with a pastoral heart born of long experience. He shows from the Bible that it is not a brand-new phenomenon, and he shows in the Bible that God has given guidance and resources to encourage the downhearted. He speaks from the conviction that there is in the Gospel and in the Word of God as ministered by the Holy Spirit both help and hope and counsel for the spiritually depressed.

Pastors should of course avail themselves of this edition, as should anyone who either helps the depressed, or suffers himself.

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Need for living, challenging, "provoking" fellowship

by Dan Phillips

Recently I alluded to a particular long stretch, some time ago, that I spent in ongoing depression. One of the contributing factors to that depression, and to its eventual defeat, was my church fellowship at the time... or lack of it.

Note well: I said "contributing factor." I alone am responsible for the choices I made and make as to my own mental, affectional, attitudinal furniture. But associations are among those choices, and they can help, or they can hurt (Proverbs 13:20; 1 Corinthians 15:33).

In this case, we were attending a church in which the give and take of real fellowship just did not happen. I wrote, then deleted, descriptions of what I'm talking about — because I'm unwilling to speak critically of a doctrinally-sound church. Let's leave it at this: whatever the reason, and despite our best efforts, the fire and the wood just never met for us there. Speaking for myself, despite my regular readings in the Bible in Hebrew and Greek, readings of Spurgeon and other good sources, I was shriveling up inside.

Then one day a friend mentioned a church he'd found with terrific preaching. I went, as an advance scout. Sure enough, it was very good preaching. I brought a positive report back to camp, and we returned in force. That became our church home for years. God did us a world of good there, and we served and committed and gave to the best of our ability.

But as I cast back my memory's eye, good as all that was, the single factor that I remember most piercing and affecting me was the living fellowship arising from that passionate, Biblical preaching. I attended a Men's Fellowship meeting, and there met men who were alive, growing, excited. Each time we got together, they'd talk about Piper or Sproul, or this Biblical doctrine or that, which were really gripping and helping them and lighting them up. I found myself challenged once again, involved in the give-and-take of fellowship. One brother loaned me tapes (!) of Piper's talks based on his then-new Future Grace. In the context of the preaching, worship and fellowship, that book helped me mightily.


Extended fellowship is also very helpful, as a supplement (not a substitute). For instance, apart from whatever good God has stooped to do for others through my writing, blogging has been helpful to me. Knowing Phil and Frank has been immensely helpful to me. Our godly, growing commenters have been helpful to me. The discipline of thinking and writing, knowing that people wiser and godlier than I (a staggeringly vast category) will be reading and assessing, has been helpful to me. These are challenges, pokes, prods.

In time, I came out of the darkness that had been my daily reality. I won't say that every moment since has been sunshine and puppies; I'm afraid my temperament this side of Glory will remain susceptible. (For instance, I've already had passing winces over the scathing reviews of my two books... reviews that haven't been written yet!) But I've never gone there to live again.

Churches do have personalities, as Revelation 2-3 attests. Verses like Proverbs 13:20 and 18:15 and 17 are instructive here. We must set our hearts individually (Proverbs 4:23) to seek God-fearing wisdom with singular devotion (Proverbs 1:7; 4:25-27). But at the same time, in our seeking of society, of fellowship, we need to be with people who also have this commitment. We need their iron to sharpen our iron (Proverbs 27:17). We need their faithful, foul-weather commitment (Proverbs 17:17) and their loving rebukes (Proverbs 27:6). We need to "provoke" to good works, and to be "provoked" (Hebrews 10:24). We need wise brothers and sisters to examine our opinions (Proverbs 18:17).

The alternative is the great and arrogant folly of isolation (Proverbs 18:1), in faithless disobedience (Hebrews 10:24-25), and all the miseries and spiritual retardation that attend that path (Jeremiah 2:19).

At the same time, we should do our best to assure that our friends are not themselves charitably "slumming" by their association with us, locked into a "take-and-take" relationship in which we alone benefit, and they only give and give. Find people who can challenge you, and give yourself to returning the favor.

It makes a big difference.

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Battling depression

by Dan Phillips

Many folks never know a moment's real depression. The very notion is a strange one to them. If someone spoke of being depressed for years, their response might be an honestly incredulous "—years?" I knew a pastor of this temperament once, a really good guy, who simply was unable to tell a depressing story in the first-person. Every time he tried, his stories wound up with happy endings.

This post is not addressed to such happy souls. You have my envy and good wishes. You may just want to sit out the meta to this post, though it's possible that reading it could be instructive.

I speak to folks who hear about years-long depression, wince in empathy, and find nothing whatever hard to believe in the thought. In fact, you could add your own story. Perhaps your episodes aren't so protracted or free-floating. A disappointment (small or massive) can send you into a depression.

It won't be a pretty post, nor as literary as some have tried to be. But if experience is a requirement, I have the cred to say a word to you. My temperament lists in that direction. I'm about eight (+/-) years into a steady recovery — glory to God — from a deep, serious, years-long period of depression, preceded by patches of varying length, all going back years and years. I'll not natter on about it further; picture bad, and you'll not be far off.

You don't need me to describe depression to you. You don't need me to go into what you'd say are the causes and reasons. What I have to say may not "reach" you at this moment, but I hope it sticks with you, and that by God's grace you soon can connect with it in a helpful, encouraging, redemptive way. This could be a series of posts, but I'll be relatively brief and pointed.

Disclaimer one: you should possibly see a good doctor. I do not mean for happy-pills, and I do not mean for psychological treatment (my focus is neither). I mean to eliminate the possibility of physical causes. I met a lady once who, after years of serious depression, had a doctor identify a physical hormonal deficiency. When that was addressed, everything instantly changed for her. Anyone exploring sin problems, psychological problems, or anything else would have been barking up the wrong tree and making things worse. Depression can be caused (or worsened) by lack of rest and nutrition (1 Kings 19:4-8).

Disclaimer two: you should definitely talk to your pastor — and I'm not him. I'm just a guy in a blog; a pastor, perhaps, but not your pastor, responsible for the watch-care of your soul (Hebrews 13:7, 17). It will contain a number of links for side-reading. But if you email me for counseling, I'll refer you to your pastor. It isn't that I'm uncaring, it's just that I'm not him. Just so we're clear up-front.

HSAT, let's go.

First and above all: you must see depression as your enemy, to be killed and buried and replaced. It is not your friend. It has come to feel comfortable and comforting, even friendly. Your real friends may not understand this, but I do. They see you wrapping a sopping-wet blanket around yourself, and think you're nuts. But I do understand, more's the pity. The sodden blanket is comforting because it's familiar. It has assumed your body-temperature. It has sapped you of strength in the process, too, so that the thought of doing anything different simply seems like too much to ask.

Now, I'm assuming you're a Christian. If you're not, you should be depressed. You should be depressed, despairing, haunted, and filled with terror. I have not one bit of ultimate good or encouraging news for you  — except to tell you that you being alive right now means that God graciously is giving you yet one more chance to learn how you can know God, and actually to come to know Him. If you reject Christ and His Gospel, I feel pity and sorrow for you, but I have no comfort or encouraging to offer. This really is your best life now, and that's not good. He who disobeys the Son will not see life, but the wrath of God abides on him (John 3:36).

But if you're a Christian, you need to understand that Christ's bequest to you is joy (John 15:11), and that God's will for you is that you rejoice (Philippians 3:1; 4:4). You need to see, understand, and embrace — hear me, now — that right now, you have the very best reasons to be the very happiest that you could ever be.

"Well," you say, "that's not me. I believe in Christ, but I still don't have that joy. I don't seem to be meant to know that. I have deep and insurmountable reasons why I can't have joy. I can explain to you at great length and in exhaustive, heartbreaking detail why I am not fated to have joy, with pictures and footnotes and poems."

Ah, now this is who I'm addressing. Glad you're here. Hope you hear, because I do have a word for you.

First, I would ask you to read this article, and think hard about it.

Second, take the time to think through this series of hard-won truths, from me to you:

1. You say you believe Jesus, and I believe you.
2. Jesus says you should have joy (cf. John 15:11). His apostles agree (cf. 1 Peter 1:5-9).
3. If you say you don't or can't, are you still believing Jesus?
4. If you realize that this betrays a lack of faith, what should you do about it? (HINT)
5. If your response is that you are waiting on God to change that for you or in you, or to change your circumstances so that you can have reason for joy, what is that called? In other words, what is demanding that God do something before you will believe called? (HINT)
6. Have you realized and "owned" just how depressing unbelief is, all by itself?
7. Here's a hard one: have you realized and "owned" how much laziness there is in the unbelief that fuels depression, how much pride and stubbornness too? Remember: everything we do, we do because we think (perversely, sometimes) that it will make us happy. Have you come to take pleasure in being seen as a noble sufferer, a tragic victim — has that become an important element of your self-image? Have you seen these vices in the insistence that things really are exactly how they seem to you and your feelings right now, and the refusal to bring in God's Word and re-think them all Biblically? 
8. If so, have you identified that as sin to be repented of and mortified, rather than a quirk to be embraced, coddled, excused, explained, leaned on and enabled?

I think facing up to those last two was the single most pivotal element in my turnaround. I knew that temptations to lust, to lying, to laziness in other areas were enemies to be targeted and destroyed. I had not seen these familiar, friendly, customary ways of depressive thinking in the same light.

A big help to me at the time was John Piper's Future Grace — not that it's inspired Scripture, but Piper helped me see my need to learn, memorize, believe, embrace, and live on God's happy and joyous promises for His child. I'll always be grateful to him for that.

So what I'm calling you to see is that you need to battle depression, as surely as you would battle temptation to immorality or violence or theft. It is equally your enemy; it is not your friend.

You can't do it by trying you talk yourself out of it alone. You can't do it by telling yourself not to be depressed. In fact, you can't do it by yourself at all. You need God and His grace. Above all, you need living, vital faith in His promises. You need to be ruthless about your lazy, stubborn, habitual unbelief. Challenge it, confront it, lay Scripture to it. Challenge yourself — as I had to do. Ask yourself, "Are you going to be a Christian, or not?" Face the fact that going about as if Romans 8:28 weren't a golden promise that should give you hope and joy right now is every bit as faithless as being a PoMo or an Emergent or any other waffler you despise. You don't dare sneer at Rob Bell or Brian Maclaren, while refusing to believe the burstingly happy nature of God's good news for each and every last one of His children.

Briefer: God says something that clashes with the Emerg*s love-affair with the world; the Emerg* retorts, "Not for me." God says something that clashes with our (dare I say it? sometimes?) love-affair with our depression, and we retort, "Not for me."

What is the difference?

The defector says (for instance) that the command to preach the Word (2 Timothy 4:2) isn't for him, and you curl your lip at him. But what of you, when you say that the command to rejoice in the Lord always (Philippians 4:4) isn't for you, that the prospect of being filled with all joy and peace in believing (Romans 15:13)  doesn't reach to you? How are you different, except in particulars?

As I close inelegantly, let me point you to the post that moved me finally to write this: 25 ways to pursue joy in Christ. If you're going to get off the mat and start fighting this battle, that's a good place to start.

I am not holding out one spoonful of spinach that I haven't had to swallow first, myself.

May "the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope" (Romans 15:13).

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Sigh of Despair, Song of Triumph

by Phil Johnson

How long, O LORD? Will you forget me forever? How long will you hide your face from me?
How long must I take counsel in my soul and have sorrow in my heart all the day? How long shall my enemy be exalted over me?
Consider and answer me, O LORD my God; light up my eyes, lest I sleep the sleep of death,
lest my enemy say, "I have prevailed over him," lest my foes rejoice because I am shaken.
But I have trusted in your steadfast love; my heart shall rejoice in your salvation.
I will sing to the LORD, because he has dealt bountifully with me.

salm 13 is a fascinating look into a side of David's prayer life we can all easily relate to. This man after God's own heart pours his soul out in frustration, fear, and ultimately faith as he struggles through the ordeal of tribulation.

The psalm is first of all a great prayer. There's nothing typical about it; in fact, it shatters our presuppositions about what really "spiritual" praying is like. But a close look shows it is in perfect harmony with how Jesus taught us to pray. Brevity and honesty—two qualities sadly missing from most of our prayers—stand out as its hallmarks.

More than a lesson about prayer, however, this psalm is a model response for those of us going through deep trials. David wrote it in anguish over the apparent success of an unrelenting enemy. We don't know which enemy—it might have been Saul, the renegade king, who chased David like an outlaw; or it could have been the Philistines, who as a nation epitomized all that God hates.

Imagine David's frustration, seeing enemies like that prosper while it seemed God was hiding His face from him! If we're honest, we have to admit that we understand David's inner turmoil in the opening cry of this psalm all too well.



But that initial, desperate groan is only the beginning of the story. In the six brief verses of Psalm 13, David moves from doubt to deliverance, teaching us the sublime and emancipating principle that victory depends chiefly on how we look at our trials.

The Inward Look
At first David looks inside himself, and sees only his own sorrow (vv. 1-2a). See how many times in these early verses he uses the first-person pronouns: "I," "me," "my," "my soul," "my enemy," "my heart." He's questioning God, wallowing in his own defeat, wondering why God seems to be hiding His face.

Was God hiding His face? Of course not! David was merely looking in the wrong place.

There's a serious danger in the wrong kind of inward look. Healthy introspection, the kind that leads to confession of sin and the humble brokenness of which Jesus spoke in Matthew 5:3-5, is critical to our spiritual survival. But looming in the face of those who look within themselves is a monstrous peril: a morbid preoccupation with our own inadequacies that breeds depression and debilitates us spiritually.

The difference between the two kinds of self-reflection is not so subtle. A wholesome look inside becomes hurtful when we begin looking within ourselves for a solution to the problems we find there. The solution doesn't reside in us; we must look elsewhere.

The Outward Look
David turns his focus from within and begins to look around (vv. 2b-4). Now all he sees are his surroundings. What a different David this is from the young shepherd who strode confidently into the presence of the mighty Goliath with no armor and only a few pebbles for weapons! Pay careful heed to the lesson: one great victory does not ensure future triumph.

This time David is fearful. We can sense his trembling, as he grapples with a paralyzing dread that this trial might ultimately kill him (v. 3).

I've felt that way, too, and in trials of much less consequence than David's. Such fear is the inevitable result of looking at circumstances and hoping some kind of help will come through them.

But deliverance doesn't come through circumstances, either.

The Upward Look
Finally, in verses 5 and 6, David looks to the Lord, and there he sees his salvation. Compare this passage to verses 1 and 2. "Me . . .I . . .mine" has given way to "thy mercy . . . thy salvation . . . the Lord."

Thus what in the beginning sounded like a dismal wail of unbelief becomes an exhilarating hymn of faith. What's the difference? The trial has not changed—but David's point of view has. Now his eyes are clearly directed upward.

Salvation belongs to the Lord (Psalm 3:8)—that goes for deliverance from trials as well as salvation from sin. No other truth emerges from everywhere in Scripture so definitively. If we look around or within—or anywhere but to God—for a way of escape, we are condemned to disappointment and ultimate failure.

It is God who provides the way of escape—not out of our trials, but rather through them. He enables us to bear testing, not avoid it (1 Cor. 10:13). And He uses our tribulations to accomplish His wonderful purpose in us (Rom. 5:3-5, James 1:3-4).

Thus God works all things—including our hardest testings—together for our good. That's the ultimate victory, and it's how even in our darkest hour of trials, we can fix our eyes on Him and say confidently with David, "He hath dealt bountifully with me" (v. 6).

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Helping people: beware category-confusion

by Dan Phillips

Four propositions:

1. There is no therapy for sin
2. Repentance is inappropriate for brokenness
3. Category-confusion / misdiagnosis can be very harmful
4. However, the sin and brokenness can work in tandem
   

Expansion. A wrongheaded, un-Biblical compassion has led to the abandonment, by many, of the categories of sin and repentance. We don't like making people feel guilty — more to the point, people don't like being made to feel guilty! So, rather than speaking of actions as sins, and people as sinners, and urging repentance, many prefer more psychological terms.

So, now, people don't sin; they make mistakes. They aren't sinners; they're broken. They don't need repentance; they need healing, and therapy.

You know what I'm going to say next, don't you? Maybe not.

Truth is, people do make mistakes. People are broken. And people do need healing. But people also sin, are sinners, and need repentance.

Here's where it gets dicey.

The first problem is in correctly diagnosing which is which, so as to point this soul in the right direction. Misdiagnosis can be absolutely disastrous.

Take for instance a woman I met some twenty years ago. She told me she had spent years in a deep, dark depression. She had packed on a lot of weight, and her life had pretty much gone down the toilet.

What do you say, doctor? What is your diagnosis? Sin can cause depression, can't it? Yes, indeed it can (cf. Genesis 4:5-7). So shall we urge this woman to root out the sin in her life, and repent — and, if that doesn't work, tell her she clearly either hasn't confessed all her sin, or hasn't sincerely repented?

In this case, that would have been some serious soul-malpractice. This woman's doctor diagnosed (if I recall correctly) an issue with her thyroid, and prescribed a supplement. The change was dramatic and almost instantaneous. She saw herself in the mirror as for the first time, and completely changed her life. Cause: strictly glandular.

However, suppose someone comes to us with all sorts of physical and emotional symptoms. This person is in physical pain, can't sleep, is plagued with fatigue, free-floating fears and anxieties, and with a sense of impending doom. Physical symptoms... must be physical cause, right? This is clearly a broken person who needs encouragement, medication, affirmation, and assurance. Right?

Except Scripture shows that unconfessed sin can cause symptoms both emotional and physical.

For my life is spent with sorrow, and my years with sighing;
my strength fails because of my iniquity, and my bones waste away.
(Psalm 31:10)

For when I kept silent, my bones wasted away
through my groaning all day long.
4 For day and night your hand was heavy upon me;
my strength was dried up as by the heat of summer. Selah
(Psalm 32:3-4)

What to do?

Treebeard's counsel is good: "Do not be hasty." If you know there is sin in someone's life, then the loving thing to do is point him to the only remedy for sin: the blood of Jesus Christ (Ephesians 1:7; 1 John 1:9).

Counseling will not alleviate the guilt, power, nor dreadful side-effects of sin; therapy will not, medication will not, self-help will not, self-talk will not, positive thinking will not, possibility thinking will not, living our best life now will not, being purpose-driven will not, Jabez' prayer will not — nothing is a sovereign remedy sin except the blood of Jesus Christ, which is applied to us through repentant faith.

In fact, if any of those "remedies" does succeed in dulling the ache and misery of guilt and its accompaniments, then the person is twice as bad-off as he was before. That he can now stick his hand into the flame without feeling pain is not a good thing.

But at the same time, remember that there can be an interplay in the same person. Elijah was very depressed (1 Kings 19:4). Why? I reason from the cure to the cause. God did four things for Elijah, directly and mediated:

1. Got him some food (vv. 5-8)
   
2. Got him some rest (vv. 5-6)
   
3. Gave him some corrective counsel (vv. 9-18)
   
4. Got him some assistance (v. 16b)
   

From this, I reason that Elijah's depression had physical, spiritual, and cognitive elements to it. Dealing with any one aspect, in exclusion to the rest, would not have truly helped him.

What is the practical, perhaps pastoral upshot? Caution, care, and humility are called for. Wisdom is called for. Depression can have any one or five of a dozen causes, easily. Piling guilt on someone who is simply overworked, oppressed, abused, or melancholy, will exacerbate the problem. Equally, affirming and encouraging someone who has rebelled against the Word of God is worse than worthless.

In our culture, too many rely on formula's and quick-fixes. Beware the pastor with 5 "P's" to banish depression. Don't be that pastor. People aren't reducible to snappy formula's. We were created complex, and then sin made us complicated.

"Flee fornication" is not complicated. "Why do I always feel so sad?" can be very complicated. You like being treated as an individual, and not as if you're mass-produced widget? Then do unto others.

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