We all know someone who suffers with depression. How should we, as the body of Christ, help? One thing clear among the churches is that there is a lot of variation in the way we go about helping. Not all these approaches are appropriate. We need to work towards a model for the church that is based on what God calls us to in the Bible. We need a biblical view of what is known about depression.

Do we really want to help the depressed? Can we see depression as an opportunity for profound ministry? If medical care seems to be needed, should we just hand people over to a secular system as if that will address all aspects of the experience of depression?

In recent years, a lot of public atten­tion has been given to depression. It is important to destigmatise it and educate people so they can recognise when to seek help and are not embarrassed to admit they are struggling. Feeling weak and overwhelmed should not be something to be ashamed about. It is one of the awful effects of the Fall.

Whether our weakness is psychologi­cal and spiritual, or physical, or both, all of us are finite beings facing a big world where everything groans. Nothing is entirely as it should be. Triumphalistic Christianity promotes the successful and competent Christian while obscur­ing the New Testament emphasis that God works especially in and through us when we are weak and suffering. God performs special redemptive purposes in us when we are low. It can be okay as a Christian to despair of life itself. We should not present ourselves as always coping and successful (2 Cor. 1). The Scriptures show us godly people who suffered. Some of them would meet both historical or current criteria for depression (eg Psalm 88). It is clear that some of the greatest of the leaders of the Bible went through periods of the deepest despondency.

There have always been many obstacles to helping a depressed friend. These include the unplanned time and exten­sive effort required, discouragement, impatience, and not knowing what to do if suicidal thinking is present. We also wonder if non-professionals can provide anything more than peripheral support.

Various groups promote a biological model of causation in order to destigmatise depression and increase the uptake (and sales) of medications. The idea seems to be that if the sufferer can say the problem is "my body" rather than "me", then there is nothing to be ashamed about all I need is a medica­tion to return my brain to normal. However, when this is all that people hear, non-medical help tends to be devalued.

Simple messages such as "depression is just like diabetes where you need insulin" obscure the great complexity and interplay of desires, beliefs, and cir­cumstances that are involved in depression. These factors are largely irrelevant to unambiguously medical conditions like diabetes. Since, as Christians, we do not have a lot to add to the management of diabetes, treating depression as a purely medical problem tends to devalue the help that we can offer in the church.

Many Christians think that the only real treatment for "clinical depression" is medical intervention.

However, the simple medical analogy is more complicated when we examine it closely. With childhood-onset diabetes, insulin works exceptionally well and nothing can substitute for it. Similarly, medication alone usually controls a brain disease like epilepsy. Accordingly, counselling for diabetes and epilepsy is geared towards helping people adjust to the diagnosis and use their medications well. No one seriously thinks that the talking itself will rectify the problem. However, with depression, counselling or psychotherapy is usually part of the treatment of the condition itself. In many cases, it is the only treatment. This suggests that there is usually more to depression than brain disease alone.

A medical review may be helpful in some cases and should be sought so that medical factors are not overlooked. With the current emphasis on biopsychiatry, along with common perceptions of anti­depressant medications and the practi­cal difficulties of getting good counselling and support, it is likely that a doc­tor will prescribe an anti-depressant medication. It is worth asking the doctor if there is good evidence that a prescription will be much better than counselling and support alone.

Counselling is at least as effective as medication in mild to moderate cases of major depression and remains helpful in severe cases. This raises questions of whether the problem is a brain disease and/or or a disorder of belief, desire, and thinking. That talking therapies have been demonstrated to helpfully affect the brain does not answer the causation question. It does, however, give more confidence that non-medical help is effective.

The simple messages about depres­sion also overlook the uncertainty we have in assigning a specific cause in most cases of depression. Before 1980, an expected and proportionate "normal" depressive response to adversity (normal sadness) was not diagnosable as clinical depression (major depression or melancholia). Diagnostic criteria for major depression now encompass sad and unhappy people who previously would have been considered to be responding more or less normally to adverse circumstances. If proposed changes to the diagnostic rules proceed, even normal bereavement will be diagnosed as major depression from 2013. It is inconceivable to me that most griev­ing people have a brain disease as the cause of their deep sadness.

This is not to say that depression does not sometimes have a signifi­cant medical primary cause — with other doctors, I believe this happens. Anyone who has experienced the physical and emotional slump that is brought on by caffeine withdrawal, a post viral state, or a lack of sleep, will know something of a physiologically induced low mood.

What I am saying is that diagnostic criteria no longer distinguish between a person who is deeply miserable because of a fully proportionate response to life circumstances, and a person whose mis­ery is out of all proportion to circum­stances, which may suggest a biological disorder and/or faulty desires, beliefs, and thinking. A biblical view has to also factor in problems in our relationship with God as a significant cause. Of course, secular models, by definition, have never been able to consider this important potential factor.

Even a diagnosis of severe major (or "clinical") depression does not, by itself, indicate all the causes of the depression. As such, we should not assume that our diagnosed brother or sister has a form of emotional pain that is essentially beyond the reach of the various ways we would usually respond to someone who is hurting. We still have comfort to offer that comes from God — hope in Christ to lift our spirits, prayer, companionship, the word of Christ, truth to encourage and guide, and worship to share in.

These and other things can address significant potential causes when minis­tered personally and relevantly. They can encourage others even when it might seem likely that there is a signifi­cant biological cause. Such help is never wasted or useless. When we talk with a depressed person, we are not just talking with a diseased brain unless they are comatose! In my work with Christians, these non-medical ways of helping have been very significant for bringing relief from depression, even in severe cases. Distinctly Christian help also leads to growth in our walk with the Lord.

It is worth noting again that, regard­less of presumed causation, much of the help provided by the mental health system is not medical in the sense of being physiological or pharmacological, but is talk and support-based. It addresses faulty thinking, provides daily support where needed, seeks to build hope for improvement, encourages, and pro­motes community. We should be at least as good at these things in the body of Christ. Indeed, as I read the Bible, a great deal of it addresses such things and more.

Average congregational members may feel inadequate in comparison with professional help. However, what God's people have to offer in terms of their presence, love, wisdom, and prayer is of great value and should not be under­rated. Nor should it be minimised just because someone has been told they have "clinical depression".

In practice, studies (and anecdotal experience) provide good reason to think that in most cases, non-expert help compares well with professional counselling. More importantly, we have a dear call from God to help those who are depressed. Paul urged the whole con­gregation at Thessalonica to "encourage the fainthearted, help the weak, and be patient with them all" (1 Thess 5:14). The words for "fainthearted" and "weak" cover the kinds of things that make up a 21^st century diagnosis of depression. "Fainthearted" ('little-psyched') was dearly used for depression. "Weak" cov­ers the full range of moral and physical weaknesses and weakness in the face of adversity. Together, the two words cover the basic causes of major depression. Paul's intention was that the church would provide care, even where it is so difficult that patience is required.

One implication of all this is that even where we make use of help from outside the local congregation, there are still things that we can and should do to help one another. Clearly, leaders and other members who are gifted and trained in truly Christian counselling may have an increased role in extreme cases. However, the nature of the New Testament model of mutual ministry and "one-anothering" leads us to expect that many others will also have vital help to contribute. Even where medical fac­tors seem relevant, we should not merely hand our brother or sister over to a psychiatrist. We retain a responsibility and a very important area of compe­tence that cannot be replaced.

The Lord has much to say through us to people who struggle with various forms of depression. Because He made us and has lived among us and spoken to us, we have a deeper and more solid foundation for word-based help and a more penetrating analysis of who people are and what their purpose and goals are meant to be. Because the Spirit of Christ indwells us, we have a better context for care in the community of love that is the church. We have a solid basis for genuine hope in the death and resurrection of Jesus Christ, which demonstrates the Father's intense love for us. He will hear us when we cry out to Him, even from the depths. We can let go of temporal hopes that bitterly disappoint and find satisfaction in where God is taking us. We have answers that address the weightiest existential issues that underlie some depressions. Where the futility of an "under the sun" existence is oppressive and depressing, we have the promise of God's good purposes to com­fort us. We should have songs to sing to each other that remind us of the tri­umph of God's kingdom and what it means to be on a pilgrimage through an alien land.

As Christians we have access to clear thinking and truth that addresses faulty logic and beliefs. This is commu­nicated in the context of enduring relationships in which truth is progressively better understood. When someone is afraid, we have more than rational thinking to offer. Sometimes fears are realistic and no amount of rationalisation can remove them. In these, and every other situation, our Heavenly Father's promises of His presence with us, even through fire, are the only thing powerful enough to provide comfort that can match every threat. When someone feels completely alone we can be with them and talk of our God and with our God in a way that shines the light of Christ into their darkness. Where frustrated and excessive desires contribute to depression, the work of the Spirit working through the church brings correction and good fruit —including peace, contentment, and patience. Where someone feels unloved and worthless, the concerned help of a brother or sister in Christ can begin to reveal the love of Christ especially when such help is not part of a profes­sional role. It can help to instil identity as a loved and redeemed child of God.

We must speak and act to help. Relative silence and passivity suggests that Jesus Christ, through His word, His Spirit, and His church, does not have much to offer to the sufferer by compar­ison with other sources of help. This would be a lamentable misreading of passage after passage of Scripture as well as a misunderstanding of the causes and treatment of depression.

Depression is a much more complex problem than I can cover in the space of a brief article. For an excellent overview of the problem from a counselling perspective, I would refer readers to Ed Welch's book Depression: A Stubborn Darkness. For help in equipping congre­gations for mutual ministry I would recommend the church-based courses pro­duced by CCEF, How People Change and Instruments in the Redeemer's Hands. The CCEF distance education courses are recommended for leaders and potential counsellors.