What is needed here is a return to some basic Biblical premises and, working towards a position where we can formulate and explore the Biblical parameters in providing a way ahead.

Allow me to begin on a very optimistic note. I believe that the key lies in understanding and coming to grips with a Biblical (yes, specifically Reformed!) understanding of ourselves as human-beings created by God in his image who, in Adam, have sinned and are, by nature, sinners.

How does the Bible Describe us Human Beings?⤒🔗

Scripture teaches us that we human beings are designed and created by God – in his image. (Gen 1:26ff) On the one hand we are a part of creation (being taken from the dust of the ground Gen 2:7; that dust we are to dust we shall return. Gen 3:19b). On the other hand we are separated from the rest of creation as well. Ours is a very special place of honour over creation which, in that sense, allows us to see ourselves as separate from it. (Psalm 8:5 'you made him a little lower than the heavenly beings and crowned him with glory and honour.') Furthermore, there is a spiritual dimension (soul/spirit) which sets us apart from the rest of creation.

The 'image' or 'likeness' that set humans apart from the rest of creation to rule and have dominion over it consisted in three essential qualities: holiness, righteousness and knowledge. (Col 3:10, Eph 4:24). Note once more that each of these qualities is understood in relation to God.

Holy: set apart from the rest of creation to serve, glorify and honour God. To reflect and imitate him. To be his representatives.

Righteous: To reflect God's way of doing and dealing with things. Do as God does. Employ the same standards.

Knowing God: living in a close relationship intimate relationship where our purposes, aims and aspirations are directed towards God and arise from a deep and intimate understanding of him.

Functionally (what we do or are meant to do) and ontologically (what we are) this sets human beings apart from the rest of creation. It also means that we as human beings will only find true peace and contentment if and when we function as we were designed to that is, are holy, righteous and in a positive relation with our creator as his servants.

Then came the fall as described in Genesis 3! Everything changed. Our bodies become corruptible and corrupted. Human ability became paralysed. Human nature was transformed. Death, corruption, decay entered every fibre of our being – physically, spiritually and emotionally. Sin and pollution corrupted:

our physical body (witness our physical deterioration, malfunction and decay inevitably culminating in death);

our spiritual life (recall that we are, before God, dead in trespasses and sins);

our mild – if  you like, our mental faculties – emotions, reasoning, thinking, became darkened, weakened and corrupt.

What does this Mean?←⤒🔗

Simply this: Illness, disease, malfunctions – all the result of sin (either directly or indirectly) – necessarily manifest themselves in the totality of our being – body, mind and spirit – and in an inextricably inter-connected manner. Yes, mind, and as an expression of it, will too! (cf Romans 1:21 thinking became futile; 1:24 gave them over to sinful desires; 1:26 shameful lusts; 1:28 depraved mind).

Therefore, when dealing with depression – both in terms of possible causes and effects – I must take into account the whole person. To focus on one or perhaps only two of the dimensions of a person – or to suggest that one only dimension is the cause of a condition like depression is both presumptuous and a failure to take account of the whole person whose whole make up is permeated by sin!

My criticism of the medical and psychiatric community is about its failure to take into account the spiritual dimension of a human being. The presence, power and involvement of a personal God in human experience – both as one to whom we are accountable and who offers us freedom from the powers of condemnation, guilt, fear and death – is almost completely ignored (or dismissed as irrelevant.) We must object! The Bible tells us that we have a spiritual dimension and that we human beings can only be understood (both functionally and ontologically) in our relation to God. By ignoring this medical people and psychotherapists are only dealing with a part of the problem. This might also account for much of the failure attributed to psychotherapies.¹

However, there is another side to this as well. Christian pastoral counselling which ignores or minimises those factors (organic, historic, etc) is equally guilty of dealing with only part of the problem. To say that the (whole) problem is sin and that the solution to depression or whatever is simply confronting that sin, confessing it and accepting God's promise and guarantee of forgiveness – whilst, in many respects true – is to grossly oversimplify things. It is just as reductionistic as the naturalistic, psychotherapeutic perceptions are.

In Practice←⤒🔗

What this means in actual practice is that we learn to approach conditions such as depression, from a full-orbed Biblical perspective which begins by acknowledging the crippling and life-destroying, strength-sapping impact and power of sin on the totality of our being. When Calvinists speak of the result of sin manifesting itself as 'total depravity' they do not mean that we human beings are as bad as could be, but rather that the totality of our lives (physical, mental and spiritual) is corrupted and disabled to the point of powerlessness and inability by sin. We also believe that the environment (all of creation) is in bondage to decay and cries out like a woman in childbirth (Romans 8:18ff).

Therefore, when dealing with depression, causal effects and impact (damage if you like) as well as therapeutic measures must include all dimensions. For example:

Address organic causes and or effects and, inasmuch as these can be corrected, alleviated or controlled in a truly helpful manner by medicinal or, if necessary, more radical procedures, consider them. The warning to all parties involved is simple: Medication is and of itself is not the whole cure! It may be a necessary part or aspect of the treatment – but to leave it at that is not enough!

Whatever else, psycho-therapy has demonstrated that the mind – how we think, what we remember and what the impact of what we remember is – does play an important role that impacts deeply on us. Alongside of that, the things that have been done to us – past traumas, etc., that are a part of our life stories – do continue to have a deep impact on us.

Speaking in Biblical categories, do not ever forget that we ourselves as sinners – that our minds ('hearts' to use one of the biblical terms² ) are impacted and malfunction (twist, change and even invent past and present events). Furthermore, because we live in a sinful broken world among sinners (still using Biblical categories here) we are also the victims at least as much as we are the cause and perpetrators of sin!

What has struck me in regard to this is two things: That much of the counselling done by Christians (all across the spectrum – including non-integrationists like Jay Adams and those who follow from that direction) is often very weak and limited in exploring and coming to grips with that area.³

In responding to the prevailing spirit of the age which is almost totally preoccupied with self (an age of 'selfism') there is a tremendous emphasis on being a victim. In this context someone like Rousas Rushdoony speaks of the 'cult of victimisation.' However, the tendency on the part of Christian critics is to go to the other extreme and emphasise personal responsibility and personal wilful choices almost to the exclusion of everything else.⁴

What this means is that someone being counselled is made to feel that he/she is ultimately personally responsible for his/her present condition and that the only solution is by now either becoming responsible enough to actually change the existing patterns or start believing (trusting, having faith) in Jesus. The trouble is that depression is precisely that overwhelming sense of powerlessness, helplessness and inability.

'I want to – but a can't! I ask, but Jesus doesn't seem to hear!' This ignores the biblical doctrine which we know as 'total depravity' the fact that the whole of our being – including the human will is crippled, disabled, paralysed and permeated by sin.

A Plea←⤒🔗

My special plea is that the kind of factors and strategies that psychotherapists are often so good as addressing ought not to be ignored. They too are a part of the experience of a person. The mistake is in focussing on this area and ignoring or playing down the others! Ignoring the organic and spiritual is a failure to deal with the whole person.⁵

The spiritual dimension of a human being must be taken into account. The human heart will find no rest or peace until it finds it in God through Jesus Christ. Whatever else, one of the major components of depression is an overwhelming sense of guilt (a sense of standing before God as someone who is a sinner and who has sinned). This guilt (also manifesting itself in a deep sense of shame, embarrassment, a damning conscience, feelings of despair and wretchedness) has a very positive side to it. It makes us realise that we need help – real help and that we are helpless in terms of helping ourselves.

Psychotherapy, whilst aware of this dimension, tries to find the way out by either turning away or deflecting the blame to others (parents, etc) OR by offering strategies or techniques that will (more or less successfully) allow the person to deal with it. (For example: stop believing in the kind of God you do!)

Biblical counselling that takes into account what the Bible says includes the spiritual dimension (and insists on it) but does not ignore the impact and crippling power of sin on the body and mind as well. To address depression the whole must be taken into account.

Finally, Biblical counselling knows about and proclaims (repeatedly, daily, until the Lord takes us home or comes back) the grace of God! Biblical counselling knows and recognises and fully takes into account that dimension. Here is the comfort, the hope and the knowledge of the promises of God.