A Biblical Case Study in Depression - Psalm 42

A Sermon by Dr. Neil Chadwick


There is a common word we all use in many ways - the word is "press." Simply, the word means "push." When I "press" the button, I simply push it. When I "press" my clothes, I push the iron down as I move it back and forth to eliminate wrinkles.

But there are also many compound words related to this word, "press." No, we’re not talking about the apple press, the wine press, or the printing press, although all of these carry a similar idea - pushing on apples and grapes brings out the juice, and pushing ink onto paper makes a book.

The compound words we're referring to are these:

    “impress” which means push into, like when an image is pushed into the paper by an official seal,

    “express” which would mean to push out, as in when you express juice or words,

    “oppress” which obviously means to push down, as when a malevolent dictator keeps the people "under his thumb," and

    “suppress” which is when something is pushed under.

The “press” word for today is “depress”, which is similar to "oppress" and simply means to press down. The word can be used in reference to material things. For example, we’ve been hearing a lot lately about tropical depressions, a weather condition just under that of a tropical storm which in turn is one step below a hurricane.

However, most of the time we think of “depression” as it relates to a mental state, what is known as a "lowering of spirits."

Abraham Lincoln, who reportedly suffered from depression most of his adult life, once wrote,

    “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would be not one cheerful face on earth. Whether I shall ever be better, I cannot tell. I awfully forebode I shall not. To remain as I am is impossible. I must die or be better it appears to me.”

For many Christians, this topic is off limits - to talk about depression is like vegetarianism being a topic of conversation around the table at the Outback Steak House, or like poverty being discussed at an Amway convention. Perhaps we think that if we don’t talk about it, it won’t happen to us.

We all understand that there are many different levels, or degrees, of depression.

    Any bit of bad news might depress us.

    The high price of gas depresses us.

    As one person said, "The coffee machine ran out. I'm depressed."

Actually, there are some who have come to believe that depression is the number one public health problem in this country, an epidemic on the rise.

    Depression in its various forms (insomnia, fatigue, anxiety, stress, vague aches and pains, etc.) is the most common complaint heard in doctors' offices.

    One in twenty Americans (more than 19 million) suffers from a depression severe enough to require medical treatment.

    One in five Americans will have a depression at some time in his or her life.

    An estimated $40 billion is lost to the direct and indirect costs of the illness each year.

    The suffering endured by people with depression, and the lives lost to suicide, inflict a great, immeasurable burden on individuals, families, and society.

Nearly 60 years ago, a European doctor, by the name of Paul Tournier, wrote a very insightful book titled, “The Healing of Persons.” Born in 1898, in Geneva, Switzerland, where his father was a minister, Tournier became orphaned by the time he was six. He was educated at the University of Geneva, where he received an M.D. degree in 1923. As a result of his interest in religion, he began to delve more deeply into the relationship between medicine, counseling, and spiritual values.

In the chapter titled, “Functional and Psychical Disturbances,” Tournier wrote:

    "The terror of past centuries was the scourge of great epidemics such as cholera, plague, smallpox, and puerperal fever. In this field . . . the success of medicine is a veritable triumph. Unhappily, a new specter menaces humanity today - its nervous state. The number of minor psychopathic conditions, of functional disturbances, of neurosis and psychoses has increased catastrophically over the last hundred years. . . .

    "Faced with this constant stream of neurotics, the doctor finds himself more or less at a loss what to do. Trained in a medical age dominated by pathological anatomy, he is almost annoyed with himself at not being able to place these patients in any precise category, and at seeing them come back again and again, each time with some new complaint, improving with every course of treatment, but never being cured completely. He senses that they are not so much diseased as the victims of the physical and moral disorders of their own lives and those of the set in which they move. They have more need of advice than remedies, but do not follow the advice he gives them. What they need to find is a spiritual axis for their lives rather than any sort of medical treatment.

    "But the fact is that present-day ideas are against the doctor’s venturing into the spiritual domain, which he feels to lie outside the province of medicine. . . . He realizes that the increase in the number of nervous complaints is due to a general moral recession. This recession, in fact, with its consequences in family, professional, and social life, increases the number of problems that are due to marital, family, and social conflicts, to emotional shocks, to uncertainty and fear, to the falling off in honesty and trust, to worry and immorality."

And may I remind you; this was written 60 years ago - how much more so would this assessment be true in our day.

When we do take a few minutes to examine this malady, we learn that there are many possible causes of depression.

    Sometimes genetics play a part, or there may be physical problems such as thyroid conditions, hormone imbalances, viral infections, medication issues, or chronic pain.

    Of course grief and loss are major factors triggering depression, or any external event such as chronic illness, financial problems, divorce or the death of a loved one.

    At times environmental factors may play a part, like poverty or abuse, or living with a depressed family member or an ill parent.

In the past 5 years, it has come to the attention of researchers that the one thing that most people with depression have in common is a low - "depressed" - level of a particular neurotransmitter called "serotonin." So, some may think, the problem is solved. All we need to do is adjust the chemistry in the brain, and, “Walla, depression be gone!”

    This newly discovered substance, “serotonin,” is technically called "5-hydroxytryptamine" (5-HT), and popularly known as is the brain's “happy chemical.”

    Apparently, serotonin helps send electrical signals from one nerve cell to another. In the process, serotonin is released from one nerve cell (the sender) and travels to the next (the receiver), where it is either absorbed or returns back to the original sender cell.

    Through extensive research and development, drug companies have created medicines such as Prozac and Paxil which they believe can block serotonin from being reabsorbed back into the sender nerve cell. This process increases the amount of serotonin available to be absorbed by the receiver cell and can help the process of message transmission to return to normal.

    Although mental depression is associated with low levels of serotonin, it is our understanding that low levels of serotonin do not cause depression, but rather, depression causes low levels of serotonin. To use the analogy of heat control in our homes, serotonin is a thermometer, not a thermostat.

If so many of us are presently - or perhaps will be in the future - touched by depression, how can we detect its presence?

According to the National Institutes of Health, symptoms of depression can include:

    W - Worthlessness, helplessness, or inappropriate guilt

    I - Irritability

    L - Loss of interest or pleasure in ordinary activities

    D - Death thoughts, and even suicide attempts

    E - Eating disturbances such as loss of appetite and weight, or weight gain

    R - Real difficulty in remembering, concentrating, or making decisions

    N - Non-treatable chronic aches and pains

    E - Energy diminished

    S - Sleep disturbances such as insomnia, early-morning waking, or oversleeping

    S - Sadness and crying persistently

You'll notice these have been organized to spell the word "wilderness," for that's exactly how we feel when in depression, like we're in an emotional and perhaps even spiritual wilderness.

When a person experiences such problems and unwanted feelings, does that mean he or she is not a Christian? I hope not, for if that were true, there are times when I, along with everyone here, would be among those who would doubt their salvation, for some form of depression is as common as shells by the seaside. Besides, some of the very notable people in the Bible were apparently depressed, if not even suicidal, people like Job, Elijah, David, Jeremiah and Jonah.

It's time to dispel this persistent myth that claims that Christians are always happy. In fact, I'll go so far as to say that the person who says they're never depressed isn't being totally honest, for it's very normal, and to be expected that ups and downs will come and go - there are beautiful, bright mountain tops, and there are deep, dark valleys. The Christian walk takes us both up and down. But even as Jesus would not allow His disciples to remain on the mountaintop, He doesn't want them to get stuck in the valley either.

There was a time when claiming to have an ulcer would elicit attention and sympathy. Today the malady of choice is "bi-polar." Hopefully, all of us are "bi-polar," that is, we have a healthy emotional fluctuation between joy and sadness, excitement and serenity, busyness and quietness - up to the mountain, down to the valley. The very rhythm of life is suggestive of this oscillation between activity and rest - there's day and there's night, there's breathing out and breathing in.

Rather than being seen as a curse, short-lived or mild depression can be seen as a gift - it's God's way of saying, "Slow down, come apart and rest awhile."

However, when depression persists, there's some common sense advice about how to deal with it.

    1. First, one should engage in vigorous exercise. Studies have shown that serotonin levels are raised with increased activity, and the production of serotonin is increased for some days after the activity.

    2. One should also take a careful look at eating habits. Serotonin levels can also be influenced through the diet. This is not my field, but I'm told that a diet deficient in omega-3 fatty acids may lower the levels of serotonin, and complex carbohydrates raise the level of tryptophan in the brain resulting in a calming effect. Vitamin C is also helpful for the conversion of tryptophan into serotonin.

    3. Furthermore, one should seek out a caring, empathetic listener, another very effective way to deal with depression. No doubt our culture of isolation has been one of the greatest contributors to the growth of depression. A good friend may be the best therapy.

    4. At times, for a short span, treatment for depression may involve a prescribed antidepressant medication.

As helpful as are these common sense solutions, Christians are also eager to apply godly advice as found in Scripture. One such source for Biblical advice can be found in Psalm 42.

Although attributed to the Levitical family of singers known as Korahites, this Psalm is no doubt intended to be referring to David at the time he hastily abandoned Jerusalem, when his son Absalom revolted and threatened to take over the kingdom (II Samuel 16:15). David fled across the Jordan, and perhaps as he did, he could see the deer rushing to the water's edge, panting for thirst - so he opens the Psalm with these words, "As the deer pants for streams of water, so my soul pants for you, O God", identifying his own awareness of needing God during his time of extreme stress.

David is painfully aware that he has been cut off from the tabernacle. "When can I go and meet with God?" (v. 2) "I used to go with the multitude, leading the procession to the house of God, with shouts of joy and thanksgiving." (v. 4) He thus feels cut off from God and wonders when will he be able to return to join the congregation in praise and worship. Quite often, depressed people feel that they are cut off from God, and they will never again enjoy His love and peace.

As with Job's comforters, the people around David isolate him even more by assuming that God has purposefully abandoned David, certainly it must be because of some sin of his.

Thus David is cast into despair, crying day and night, and lamenting, "Why are you downcast, O my soul?"

In this Biblical "Case Study in Depression," let's notice some of the recognizable symptoms:

    David admitted to crying incessantly (v. 3). Instead of eating properly, he cried, replacing food (meat and drink) with tears; is sleep was also interrupted by his weeping "day and night".

    There were feelings of being overwhelmed ("all your waves and breakers have swept over me" - v. 7).

    David feared God had abandoned him ("Why have you forgotten me?" - v. 9)

    He understood that this was an inner matter of the mind - his soul was "disturbed" "disquieted" (v. 5). Literally, the word means "make a roaring noise like the sea" - as if the inner pain was drowning everything else out.

    He also experienced physical agony ("My bones suffer mortal agony" - v. 10), even to the point of fearing death.

So what did David do?

1. He let himself cry.

    Let's abandon the idea that crying is a sign of weakness - it is a healthy emotional response to loss.

2. He verbally admitted to the truth about his feelings.

    Twice in this chapter he stated, "Why are you downcast, O my soul?" (vs. 5, 11) Every once in a while I say to myself, or perhaps to my wife, "You know? I'm just feeling kind of down today."

3. David determined to hope in God.

    He said to himself, "hope thou in God." Later in the Psalm, he referred to God as "Rock" (v. 9), indicating his secure faith. Talking to oneself can be very valuable when seeking to find encouragement in the Lord.

4. He praised God in the hard place.

    Even though David found himself on the other side of the Jordan (v. 6), had lost so much, and his future appeared very bleak, yet he chose to praise God.

5. He prayed with singing - even at night (v. 8).

    Here's some good advice, don't just listen to music, sing it! When we gather for worship, one of the things we're doing is practicing our songs so that when we find ourselves alone and down, we will be able to sing the songs of praise that will lift the spirit.

    Notice here that David is able to sing because he reminds himself of God's love ("By day the Lord directs his love" - v.8)

In short, what is the Biblical pattern for dealing with depression? It can be remembered in the familiar expression, "ASAP":

    Accept it - get rest, improve your diet and exercise

    Say it to yourself and to others

    Actively seek support and counsel

    Pray about it while in praise to God

It's about time the Christian community stood up and demonstrated to the rest of the world that proper care for oneself involves taking full responsibility for the health of body, soul and spirit. As Dr. Tournier reminds us, man is a unity of all of these components, but perhaps we need to take the lead in reversing the normal stated order - give primary attention to take care of the spirit, then the soul and lastly the body. Low level, temporary depression may be part of a healthy mental state, but for millions of Americans it has nearly taken over their lives. May it not be so among Christians, but rather, let us show the world that there is peace, there is hope. When the events press us down, we respond by pressing in to God.

There are three stories in the Gospels where the old King James Bible uses the word "press." In each of these accounts, people were hindered in their attempt to get to Jesus because of the "press" - the pushing together large numbers of people. The woman with the 12 years hemorage who "pressed" through the "press" to touch the hem of His garment (Mark 5:27); Zaccheus, who couldn't get to Jesus because of the "press" (Luke 19:3) - he pressed in by climbing the tree; and the paralyzed man whose friends couldn't get him to Jesus because of the "press" (Mark 2:4) - they pressed in by opening a hole in the roof.

For us, the "press" may or may not be other people, but whatever depresses us, let's be like them and "press" into, push ourselves onto God.

Discussion Questions
"A Biblical Case Study in Depression" - Psalm 42

1. What is pushed down when there is depression?

2. What great American President is cited to have been afflicted by depression?

3. Why is it that many Christians seem to think that the topic of depression is off limits?

4. What are some of the different levels of depression?

5. If depression is the number one public health problem in this country, what would be some of the reasons for this claim?

6. Why are many doctors at a loss when it comes to treating chronically ill patients?

7. What are some triggers of depression?

8. What is "serotonin," and what is its relation to depression?

9. How does each of the letters in the word "wilderness" identify symptoms of depression?

10. If a person is depressed, does that suggest that they have ceased being a Christian? Who in the Bible apparently experienced some degree of depression?

11. Why might we consider "ups and downs" to be healthy?

12. What are some common sense strategies related to the management of depression?

13. What is believed to be the historic occasion for David's cry, "Why are you downcast, O my soul?"

14. What are some of the signs in Psalm 42 which point to David being depressed?

15. What did he do about it? How can the expression "ASAP" help remind us about these simple steps?

16. How will the effective handling of depression by Christians enhance their witness in the world?

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