Defining “Depression”

What is depression? One of the biggest challenges in addressing this topic is developing a clear definition of what depression actually is. As a pastor, I have been counseling people with depression on a regular basis for over twenty years in different contexts and to varying degrees. And the greatest number of counseling scenarios I deal with are related to the topic of depression.

It is not uncommon for someone to come for counseling and then tell me their problem is “depression.” I inevitably will ask, “What is depression?” I hardly ever get the same answer—the responses are all over the map. And when I ask the follow-up question, “What do you think causes depression?” the disparate answers abound even more; many times the counselee can’t even answer that question. And sadly, most of these dear folks have been programmed by the world to believe that the only real solution is medication. But the main point here is that rarely does the person seeking help have an accurate, objective, biblical definition of depression. But one can’t make a diagnosis, give a prognosis, or recommend a cure if one doesn’t begin with a proper definition of the problem at hand. For this reason, it is vital to understand what depression is.

Formulating a clear and accurate definition of depression is no easy task. The “Christian” community does not have a homogenous definition of depression. The secular world fares no better—they also have their competing factions, camps and schools of thought. Nevertheless, the most popular medical and health institutions in the secular world do have some complementary presuppositions that come to the surface upon close scrutiny. For illustration I have selected three such sources to highlight what the secular health experts have concluded about depression. These three sources include The World Health Organization (WHO), the American Psychiatric Association (APA), and the U. S. government’s National Institute of Mental Health (NIMH). Consider their definitions of depression below.

World Health Organization (WHO): In its online source, WHO defines depression as follows:

Depression is a common mental disorder, characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. In addition, people with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide. Depression is treatable, with talking therapies or antidepressant medication or a combination of these.[1]

There are a few important details to note in this proposed definition. First, it is not really a definition; it is a description. The closest thing to a definition in the statement is when it says depression is “persistent sadness” that lasts “for at least two weeks.” Second, most everything else in this paragraph is a delineation of symptoms, not a definition. Third, this definition states no cause for depression. Most technical definitions of real, organic medical diseases include the cause of the ailment or condition.

American Psychiatric Association (APA): In answering the question, “What is Depression?” the American Psychiatric Association defines depression as follows:

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.[2]

This so-called definition is more of a description than a proper definition. And it makes two bold assertions that are misleading. First, it states that depression is a “medical illness,” which I will dispute in forthcoming articles. Depression is more than a medical illness; but I also believe it can contribute to causing other medical conditions and even illnesses.

The problem with the APA definition is in the statement, “Depression causes feelings of sadness.” But just the opposite is true: feelings of sadness can cause depression. If one reads carefully, you will notice the APA definition never gives a proposed cause of depression, just as the WHO failed to do. But in the sentence we just examined the APA asserts that depression causes sadness.

National Institute of Mental Health (NIMH): The NIMH is a center sponsored by the US Health and Human Services. It is the primary governmental agency responsible for health-related research. This seventy-year-old, tax-payer-supported entity boasts of being the largest research organization in the world specializing in mental illness. Here’s how they define depression:

Everyone feels sad or low sometimes, but these feelings usually pass with a little time. Depression—also called ‘clinical depression’ or a ‘depressive disorder’—is a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, symptoms must be present most of the day, nearly every day for at least 2 weeks.[3]

Like the two previous sources, the NIMH definition is scant on giving any substantive details in defining depression. Their proposed definition, like the others, is really a description more than a definition. The closest they get to defining depression is when they say it “is a mood disorder.” The rest of the paragraph describes the symptoms and effects of depression. It also contains a backwards and wrong assumption when it asserts that depression “causes distressing symptoms that affect how you feel, and think.” Again, I would assert the converse: depression is caused by wrong thinking and emotions that result in distressing symptoms. In other words, I am arguing that these secular authorities on health and medicine are turned 180 degrees upside-down when trying to assess the complexities of depression.

Another popular and authoritative source for information on health issues is WebMD. This respected source answers the question, “What is Depression?” as follows:

when intense sadness—including feeling helpless, hopeless, and worthless—lasts for many days to weeks and keeps you from living your life, it may be something more than sadness. You could have clinical depression—a treatable medical condition.[4]

This brief paragraph proposes several notable elements that constitute a “definition” of depression from a secular, non-biblical perspective. According to WebMD, depression,

is “intense sadness…something more than sadness”
“lasts for many days to weeks”
“keeps you from living your life”
is synonymous with “clinical depression”
is a “medical condition”
is “treatable.”

Like so many other alleged authoritative sources on depression, WebMD is thin on actually defining depression. In the above six elements, only point (1) hints at a real definition, and it’s skimpy and general at best. Depression is “intense sadness.” Points (2)-(6) are not definitions of depression, but rather elements of the pathology (effects), diagnosis (the symptoms) and prognosis (the proposed cure) of depression.

Of great significance here is that the WebMD “definition” does not include the cause of depression. The three other authoritative health sources mentioned earlier did not delineate a cause either. That is a problem. Research the basic definitions of most other known, real, organic medical illnesses and you will typically find the basic cause listed as part of the definition.

The Bible says something radically different than the secular world about the cause, diagnosis, and cure for depression.

For example, in WebMD’s definition of an ulcer, it includes the basic cause, noting that ulcers occur “when your stomach acids etch away your digestive tract’s protective layer of mucous.”[5] This is true of the definitions of a hernia, a cavity, various cancers, the mumps, the measles and poison oak—real, bona fide medical conditions and illnesses. I propose that WebMD, the World Health Organization, the American Psychiatric Association and the U.S. National Institute of Mental Health don’t include the cause of depression in their respective definitions of depression because they don’t really know the cause of depression! Herein lies the problem and the debate about defining and treating depression. The Bible says something radically different than the secular world about the cause, diagnosis, and cure for depression.

A Preliminary Biblical Definition of Depression
It is hard to find a clear, comprehensive, unifying definition among the proffered secular sources. One thing is clear from reading such literature: they conclude that one’s spiritual condition has nothing to do with depression. Religion, faith and spirituality have been banished from their presuppositions about basic anthropology. According to the secular worldview, humans are not holistic, complex creations made as persons by the Creator, Judge and Savior of the universe. They are, rather, one-dimensional, naturalistic, evolved automatons. The consensus seems to be that depression is strictly limited to the medical sphere. The Bible says otherwise. God’s Word has much to say about depression, including its cause. Here I propose a preliminary definition of depression informed by biblical principles that we will look at in more detail in further articles. Depression includes the following:

intense sadness, grief, or distress;
to be deeply troubled in mind or thought life;
to be emotionally distraught;
to be overcome with hopelessness and loss of joy;
all caused by various spiritual, cognitive and psychological factors.

A couple comments are in order about my five-fold preliminary definition of depression. First, I came up with the definition as a result of a thorough study of the Psalms, noting the dozens of Hebrew words that inform all manner of depression and distress that the various writers of the Psalms were experiencing at any given moment. The fact that the Bible uses dozens of different words and expressions to describe the reality of depression shows the complexity of the malady and should serve as a safeguard against positing one-dimensional and shallow diagnoses and remedies that are so common today. Below is a small sampling of the dozens of synonyms found throughout the Psalms that describe elements of human depression. The Hebrew term is to the right in bold:

“My soul is greatly dismayed” (6:3)….bahal

“I am weary with my sighing” (6:6)….anachah

“My eye has wasted away with grief” (6:7)….ka’ac

“the groaning of the needy” (12:5)….anaqah

“having sorrow in my heart all the day” (13:2)….yāgon

“In my distress I called upon the LORD” (18:6)….bassar

“I am lonely and afflicted” (25:16)….ani

“The troubles of my heart are enlarged” (25:17)….tsarah

“I am like a broken vessel” (31:12)….abad

“the bereavement of my soul” (35:12)….shekol

That is just ten examples of dozens that exist. In addition to the Psalms, pertinent passages from the rest of the Old Testament and the New Testament were also taken into consideration.

God’s solution for managing, battling and overcoming anxiety and depression entails a good dose of healthy biblical thinking (Phil 4:6-9), meditating on divine truth (John 8:32), and self-control of the mind (Gal 5:22-23; Rom 12:1-2).

Second, it is significant that my definition of depression does not exclude the notion of “anxiety” as something altogether separate and distinct. In fact, I would argue that depression can include anxiety and often does. They overlap. This idea flies in the face of secular psychiatric orthodoxy of the past century. Secular psychiatrists and psychologists artificially dichotomize anxiety and depression, treating them as independent diseases like athlete’s foot and lung cancer. But nothing could be further from the truth. According to the Bible, depression and anxiety have a common pathology in that both maladies frequently stem from unhealthy or defective thinking. Generally speaking, anxiety is fear (or wrong thinking) about the future and unknown events whereas depression is errant thinking about the past and regrets. Anxiety and depression go hand in hand and are two different sides of the same coin. God’s solution for managing, battling and overcoming anxiety and depression entails a good dose of healthy biblical thinking (Phil 4:6-9), meditating on divine truth (John 8:32), and self-control of the mind (Gal 5:22-23; Rom 12:1-2). This is why Jesus said that basic to true spiritual maturity and balance is “loving God with all your mind” (Matt 22:37). So from a biblical perspective depression and anxiety are directly related to thoughts in the mind not chemicals in the brain. That’s a big difference. With the above working definition, we will soon see more articles on this topic as we contend with and expose common myths about depression that clutter the landscape of understanding on this matter.

NOTES

[1] http://www.who.int/mental_health/management/depression/en/.

[2] http://www.psychiatry.org/patients-families/depression/what-is-depression.

[3] http://www.nimh.nih.gov/health/publications/depression/index.shtml

[4] http://www.webmd.com/depression.

[5] http://www.webmd.com/digestive-disorders/peptic-ulcer-overview. 