Is depression a sin or a spiritual problem?

Question 11070.

Depression and sin have been tangled together in Christian thinking for a very long time, and a great deal of harm has followed. I have sat with believers who were told that their illness was evidence of unrepented sin, and I have watched what that does to a person who is already at the end of their strength.

So let me say at the outset where I stand. Depression is not in itself a sin, and treating it as one is both bad theology and bad pastoral care. That said, the relationship between depression and sin is not simple either, and pretending it is would be a different kind of failure. Let us take it slowly.

What we are actually describing

The word depression covers a considerable range. It is used of a passing low mood, of a heavy season following a bereavement, and of a clinical condition that flattens a person for months or years and interferes with sleep, appetite, concentration and the will to live.

Those are not the same thing, and much of the confusion in discussions about depression and sin comes from using one word for all of them. A believer feeling flat on a wet Tuesday and a believer who cannot get out of bed and has stopped eating are not in the same situation.

I am mainly addressing the deeper and more persistent form, because that is where the accusation of sin does the most damage. But the principles apply across the range.

Scripture is full of depressed believers

This is the first thing to say, and it should settle a great deal. The Bible does not present its heroes as uniformly cheerful. Elijah, immediately after the greatest public victory of his ministry, sat under a broom tree and asked the LORD to take his life. The account is at 1 Kings 19:4.

Job cursed the day of his birth. Jeremiah did the same, at length. Jonah told God that it was better for him to die than to live. Moses asked God to kill him rather than let him carry the people any further.

None of those men is rebuked for the feeling itself. God’s dealings with them vary, but not one of them is told that despair is proof of sin. That fact alone should make us cautious about how we link depression and sin.

The Psalms give us the vocabulary

The Psalter is the most honest book about the inner life ever written, and it does not tidy up. Psalm 42:5 has the psalmist asking his own soul why it is cast down and why it is in turmoil within him, and the same refrain returns twice more because the answer did not stick the first time.

The Hebrew word for cast down there, shachach, carries the sense of being bowed down or sunk low. It is physical language applied to the inner life, which is exactly how depression feels to those who have it.

Then there is Psalm 88, which is the darkest chapter in Scripture. It ends with the words that darkness is his closest friend, and there is no resolution and no upturn. God saw fit to put that in the Bible without a happy ending attached, which tells us something about how he regards the honest cry of a suffering believer.

The laments make up a substantial portion of the Psalter, and the church has largely stopped singing them. That is a loss, because a congregation that only ever sings triumph teaches its members that darkness is abnormal and shameful. When the connection between depression and sin is assumed in a church, it is often because the church has no other language available for grief.

Paul was not exempt

The New Testament is no different. Paul tells the Corinthians that he was so utterly burdened beyond his strength that he despaired of life itself. That is a strong statement from a man not given to exaggeration about his own weakness, and you can read it at 2 Corinthians 1:8.

He also describes being afflicted at every turn, with fighting without and fear within, and says that God, who comforts the downcast, comforted him by the coming of Titus. Notice the means of comfort. It was a friend arriving.

If an apostle writing under inspiration can describe despair without confessing it as sin, then any framework that automatically links depression and sin has a serious problem with the New Testament.

Why the question gets asked at all

It is worth understanding where the instinct comes from, because the people who link depression and sin are usually not cruel. They are working from a genuine conviction that Scripture is sufficient, and they are afraid that conceding ground to medicine means conceding the soul.

There is also a strand of teaching which holds that joy is commanded, that Paul told the Philippians to rejoice always, and that a believer who is not rejoicing is therefore disobedient. I understand the logic and I think it misreads the text badly. Paul wrote that letter from a prison cell, and the same man wrote that he despaired of life itself.

Behind it all sits a discomfort with mystery. If depression can strike a faithful believer for no discernible reason, then the world is less controllable than we would like. Turning it into a sin problem restores a sense of order, because sin can be repented of and fixed.

That comfort is purchased at the expense of the sufferer. It is a good deal easier to tell a depressed friend what to repent of than to sit with them for two years while nothing improves.

Why the body matters

Human beings are not souls temporarily housed in machinery. We are spirit, soul and body, and the three are woven together in a way that makes crude separation impossible. What happens in the body registers in the soul, and what happens in the soul registers in the body.

This is why the first thing God did for Elijah was not to correct his theology. He let him sleep, fed him, let him sleep again, and fed him again. Only after that came the still small voice and the conversation. God treated the body before he addressed the man.

Depression frequently has physical roots or physical components, including thyroid disorders, chronic pain, hormonal change, medication side effects, long term sleep disruption and post viral illness. Preaching at somebody whose thyroid has failed is not ministry. Any account of depression and sin that ignores the body has left out a third of the person.

Where depression and sin genuinely intersect

Having said all that, I would not be honest if I stopped there, because Scripture does describe states of soul that are both painful and sinful, and pretending otherwise leaves people stuck.

Sin can cause misery. David describes exactly that in Psalm 32, saying that when he kept silent his bones wasted away through his groaning all day long, and that his strength was dried up as by the heat of summer. That was not clinical illness. That was a man refusing to confess adultery and murder, and the wretchedness lifted when he did.

Prolonged bitterness, unforgiveness, envy and self pity also produce a heaviness that looks a great deal like depression from the outside. So depression and sin can overlap, and a wise friend will gently leave room for that possibility without assuming it.

The point is that this is a possibility to be explored with the person, not a diagnosis to be pronounced over them. And it must never be the first thing said.

Sin can also follow depression

The traffic runs the other way too, and this is less often discussed. A person in the grip of depression may sin in it, through irritability, withdrawal from the people who need them, neglect of responsibilities, self medication with drink, or a settled refusal of every offer of help.

Naming that is not cruelty. It is treating the sufferer as a moral agent rather than a patient with no agency at all, which is itself a form of respect. But timing and tone are everything, and it takes a real relationship to say such things well.

There is also the temptation to believe things about God that are not true, that he has abandoned you, that he is punishing you, that grace has run out. Those beliefs are false and they deepen the pit, though I would call them wounds needing truth rather than crimes needing prosecution.

So the relationship between depression and sin is a genuine two way street, and it is complicated in both directions.

There is a further cost worth naming. When depression and sin are treated as the same thing, the genuine spiritual work that a suffering believer might do gets buried under a pile of false guilt. Real repentance becomes impossible in that climate, because everything is guilt and nothing is specific.

The damage done by the simple answer

I want to be direct about the cost of getting this wrong. When a suffering believer is told that their depression is a sin problem, several things happen at once, and none of them help.

They add guilt to despair, which is the last thing a depressed person needs, since self accusation is already a symptom of the condition. They conclude that the church is not a safe place to be honest, so they stop telling anyone. And they often stop seeking help of any kind, medical or spiritual, because both now feel like admissions of failure.

I have known this to end very badly. The pastoral stakes here are not theoretical, and anyone tempted to make confident pronouncements about depression and sin ought to weigh what happens if they are wrong.

The opposite error exists too, where a church treats every difficulty as purely medical and never asks a spiritual question at all. That is a failure of a different kind, but in my experience it has produced far fewer casualties.

Suffering, sin and the wider question

This question sits inside a larger one, which is the relationship between suffering generally and personal sin. The disciples asked it about the man born blind, wanting to know who had sinned, and Jesus answered that neither this man nor his parents had.

That answer is worth memorising, because the instinct to trace suffering back to a specific fault is very old and very persistent. Job’s friends built an entire argument on it and were rebuked by God for their trouble.

Sin did bring suffering into the world, and every illness we experience is downstream of the fall in a general sense. But that is a statement about the human condition, not about the individual in front of you, and collapsing the two is exactly the error Job’s comforters made.

I have written more on this in whether all suffering results from personal sin and in the relationship between suffering and sin. The question of depression and sin is a particular case of a much broader biblical pattern.

What about medication?

I am asked this constantly, usually by people who feel guilty for taking it or for considering it. My answer is that the body is part of the person, that biochemistry is part of the body, and that a believer taking an antidepressant is not thereby confessing weak faith.

Medication does not make anyone holy and it does not resolve a spiritual issue. What it can do is lower the volume enough for somebody to sleep, to think, to pray, and to do the work they could not previously face. That is a legitimate mercy.

It is not a substitute for the rest. Someone taking medication still needs the word, the church, honest friends and whatever practical changes their situation requires. I have written more about the wider framework in what Christians should make of psychology.

How to help somebody well

I would also say something about the Spirit’s work in this. He is called the Comforter, and his ministry is not suspended when a believer cannot feel anything. He intercedes with groanings too deep for words, which is a description that fits the depressed believer better than almost anyone. I have written on this in the Spirit’s work in depression.

Start by staying. Depression is isolating and most people quietly drift away after the third unanswered message. The friend who keeps turning up without needing a response is doing more good than they will ever know.

Do the ordinary things. Bring food. Offer a lift to the doctor. Sit with them and say nothing much. Job’s friends were at their best during the seven days they said nothing, and everything went wrong the moment they started explaining his suffering to him.

Speak truth gently and repeatedly, without demanding a response. A depressed believer often cannot hold onto a promise for more than an hour, which is not unbelief but exhaustion. Read a psalm aloud and leave it with them.

And do not make the conversation about depression and sin unless the person raises it or you have earned the standing and the moment to ask carefully. Even then, ask rather than announce.

Hope that does not depend on improvement

There is a comfort available here that no clinical framework can supply. The believer’s standing with God does not fluctuate with their mood. You are held by his faithfulness rather than by the strength of your grip on him, and a person too ill to feel anything is held exactly as securely as one on a mountaintop.

There is also a horizon. The promise held out to the suffering is not that this life will be repaired but that these bodies will be raised, and that he will wipe away every tear. For some believers that promise is the only thing standing between them and despair, and it is enough.

And there is the company of the suffering. The Man of Sorrows was acquainted with grief, and he is not a high priest unable to sympathise. Whatever else is true in the dark, you are not being observed from a distance by someone who has never been there.

So, now what?

If you are in it, tell somebody this week. A doctor, a pastor, a friend who will not flinch. Depression thrives on secrecy and shrinks a little every time it is spoken aloud to a person who stays in the room.

If you are helping somebody, resist the urge to explain them to themselves. Bring soup, keep turning up, and let the question of depression and sin wait until you have earned the right to raise it, if it ever needs raising at all.

If you are in a church, ask whether your congregation has any language for darkness at all. A church that can only sing about victory will quietly teach its members that depression and sin belong together, however carefully the pulpit avoids saying so.

If you are a church leader, decide now what you will do when this walks through your door, because it will. Know a good doctor, know your own limits, and know that referring somebody on is a form of care rather than an abdication.

And if you are reading this at the very bottom, please tell someone today rather than tomorrow. You do not have to be able to explain it. What would it mean to believe that you are held by his faithfulness rather than by your own, exactly as you are this evening?

“The LORD is near to the brokenhearted and saves the crushed in spirit.”

Psalm 34:18, ESV

For Further Study

Anyone wanting to go further should begin with the biblical material itself, particularly the laments, since the Psalter shapes how Scripture expects us to speak in darkness. Millard Erickson’s treatment of human nature and Anthony Hoekema’s work on the image of God both bear on how we understand the unity of the person, and Lewis Sperry Chafer and Charles Ryrie are worth consulting on the spirit, soul and body distinction that underlies the argument here. J. Dwight Pentecost’s writing on the believer’s inner life and progress in holiness is useful for keeping sanctification and suffering distinct. On the practical side, the long standing debate between biblical counselling and integrationist approaches is worth reading in primary sources from both camps rather than in summaries by their opponents, and anyone in pastoral ministry should also acquaint themselves with current medical literature on depression so that they can work alongside doctors rather than against them.