By Joshua Cayetano

As Christian journeys from the “City of Destruction” to the “Celestial City” in The Pilgrim’s Progress, he and his companion, Hopeful, are captured by Giant Despair, the king of Doubting-Castle. In the dungeon, Giant Despair tortures Christian and Hopeful and, at the suggestion of his wife Diffidence, offers his prisoners the only escape: suicide. Hopeful urges Christian not to take the giant’s advice saying, “Have you forgotten the Hell where it is certain that murderers go? For no murderer has eternal life.” After more encouragement, Christian stays his hand and eventually escapes Doubting-Castle thanks to the key Promise.

Bunyan’s famous 17th-century anecdote represents an entire tributary of Christian theology which stubbornly clings to a dualistic worldview, pitting the body against the mind/spirit. Here, three interrelated beliefs dominate. 1) Despair and its cousins—melancholy, depression, anxiety, and suicidal ideation—are fleshly temptations that must be combated by spirit-driven obedience to God. Often, suffering friends and family are told to fix their mind on things above as a panacea for bodily suffering. 2) To be depressed or commit suicide is a symptom and expression of doubt. Suicide becomes the ultimate renunciation of the Christian hope and, therefore, a renunciation of heaven itself. Christian ignores Hopeful’s counsel and proceeds to Hell. 3) Because the illness is primarily spiritual, the scientific fields have very little relevance to the topic. Pastors “fight, wage war, watch, and pray” for the afflicted, but rarely do they recommend clinical or medical help—and if they do it’s as a last resort. At best, scientific explanations are palliatives, bandaids for real soul problems.

This “have more faith” theology dangerously compounds biopsychosocial anxiety with spiritual anxiety, without sufficiently addressing either. The cure for its reductionistic dualisms comes in three doses as well—a trinitarian theology that regards body, mind, and spirit as equally interrelated and supervening upon the other parts; a redemptive theology that imagines Christ working through faith and reason, theology and science; and an incarnational theology that sees Christ on the cross as the God-Man who suffers with us. Together, these understandings form a theological ecosystem that can offer a number of biopsychosocial and spiritual resources to the suffering person.

How Did We Get Here?

That parable from The Pilgrim’s Progress was the normative story in the 17th century and still is in many evangelical circles. Consider when Pat Robertson declared Robin Williams committed suicide due to his belief in a “heathen god.” Or when John Piper suggested that giving into depression is a symptom of “unbelief.” Or when revivalists wheel onto college campuses promising deliverance from anxiety and depression through an encounter with Jesus Christ. Or, recently, the forced departure of the lone advocate of Christian psychology from Southern Baptist Theological Seminary.

These trends originate, ironically, with certain Catholic teachings and medieval European superstitions. In 452 AD, the Council of Arles declared suicide to be an act “inspired by diabolical possession.” Eventually, suicide was commonly understood to be a “mortal sin.” The church’s official treatment of suicide instilled fear and legitimized ghost stories, especially surrounding those plagued by mental illness. Exorcisms became the preferred treatment for the mentally ill.

The stigma surrounding suicide was so strong that the bodies of “self-murderers” were profaned to represent their condemned souls. For example, in France, corpses were placed face-down in a north-south direction, contrary to the tradition that placed them east-west, in anticipation of the coming resurrection. In England, bodies were buried at a crossroads, pinned to the ground by a stake, to keep the evil spirits confused and immobilized.

During the Middle Ages, many believed those who rejected their bodies in this life should not receive another in the next. This belief crescendoed after the Protestant Reformation amidst a wave of hyper-spiritualization. Suicide and “melancholy” were understood as, in the words of Martin Luther, “the work of the devil.” Satan became a supernatural personality who whispered in the ears of God’s prized creation, leading them into the ultimate temptation.

By the 17th and 18th centuries, Puritan clergymen were publishing treatises on the spiritual significance of suicidal tendencies and depression. One 17th century almanac published anonymous suicide reports in order to warn readers “against the evil suggestions of the Prince of Darkness, that implacable Enemy of Mankind.” Those considering suicide experienced Satan tempting them—through dogs, the wind, or their children (MacDonald and Murphy, 300-4). This worldview pushed Puritan preachers to prematurely condemn those who committed suicide to hell. In 1637, Scottish Puritan John Sym wrote, “They all, and every of them that so murder themselves; are certainly, and infallibly damned soule and body for evermore without redemption” (Lifes preservatives against self-killing, 291-292).

Many Puritans continued to connect depression, or “melancholy,” to spiritual weakness. Foremost among these Puritan doctors was Richard Baxter, a widely published Nonconformist in the 17th century. In his treatise, “The Signs and Causes of Melancholy,” Baxter names the chief cause of depression to be “SINFUL Impatience, Discontents and Cares, proceeding from a Sinful Love of some bodily Interest, and from want of sufficient Submission to the will of God, and Trust in him, and taking Heaven for a satisfying Portion.” In other words, depression was primarily a consequence of sin and, therefore, could be corrected by obedience to God.

The late nineteenth and early twentieth centuries saw the Puritan spiritualization of mental health compound with a strong distaste for the scientific field. Psychotherapy, a field dominated by Sigmund Freud, was an anathema to most fundamentalists. The field’s general hostility to religion only confirmed the Puritan separation of body and mind/spirit. Psychotherapy was a worldly science that could not touch the spiritual root of the problem.

Today, these sentiments and its concomitant theology persist. David Powlison, editor of the Journal for Biblical Counseling, wrote in the 1990s, “Biopsychiatry will cure a few things, for which we should praise the God of common grace. But in the long run, unwanted and unforeseen side effects will combine with vast disillusionment….Only intelligent repentance, living faith, and tangible obedience turn the world upside down.”

John Piper cites both Richard Baxter and John Powlison at length in When I Don’t Desire God in ways that can be particularly harmful. For example, as an alternative to medication, Piper offers a number of suggestions, including an adage from George MacDonald: “Heed not thy feelings, do thy work” (220). MacDonald’s phrase is a peephole into the Puritan ascetic movement that helped sustain the culture of bodily self-loathing so natural to theologies with an unhealthy dualism. In this worldview, the chief cause of depression is “sinful love of bodily interest” (this-worldliness) and its cure according is hope (other-worldliness). To his credit, Piper does acknowledge the “deeply connected” nature of the soul and the brain (213). Yet he offers no theological meat as an offering to this reality. Instead, the next sections are committed to shoring up the faith of the depressed. The equation stays the same: more mind/soul to fix depression.

How Can We Heal?

Trinitarian. We must reject any Gnostic, Manichaean, or Cartesian dualism of body and mind/spirit. Somehow worldview, mind-dominated Christians forgot the old medieval understanding that our physical body—which includes the full spectrum of human emotions and desires—is a conduit of grace through which we can know God. The desecration of corpses in Europe was significant precisely because the spiritual was made manifest in the physical. To harm the physical was to harm the spiritual; to tend to the physical was to tend to the spiritual—and vice versa. The Sabbath rest is a perfect reflection of how the physical supervenes the spiritual. Christ saying, “Your faith has made you well,” is a reflection of how the spiritual supervenes the physical. A trinitarian expression of body, mind, and spirit suggests each must be cared for, without marginalizing, demonizing, or elevating one at the expense of the others.

Redemptive. There have been echoes from some theological circles calling for a return to harmonious relationship between science and faith, according to the understanding that God’s redemptive power sufficiently permeates his creation. The loudest voice was, in fact, Pope John Paul II. In his famous encyclical letter Fides et Ratio, Paul II argues faith and reason (under which is scientific inquiry) are “the two wings on which the human spirit rises.” The truth is one, he explains, and both faith and reason suffer from the other’s absence. A theology that shuns scientific findings will quickly find itself alienated from the truth that can be found in nature. And, as we have seen, a science absent the horizon of faith forgets the meaning of its discoveries. Never losing sight of the ontological and moral framework faith offers, theology only serves to benefit from science’s insight.

The hesitation to trust the medical field regarding mental health is slightly ironic considering we trust it with practically every other aspect of our physiology. Dentistry, chemotherapy, physical therapy, surgery—the list is quite long. The psychological and neuroscientific communities can now observe more than ever how the brain processes depression, anxiety, and trauma—three factors that can lead to suicide. With an appreciation for the unity of truth in all things, pastors should be quick to contextualize and utilize the findings of the scientific community for the benefit of the anxious, depressed, or suicidal.

Incarnational. Pastors and friends need not only defer care of depressed or suicidal loved ones to therapists. There is a call to embody the incarnational nature of Christ, who understands and is with our sufferings and forsakenness. Because Christ became human, He is capable of empathy (patheia) with his creation. Theologian Jürgen Moltmann explains:

“The crucified God is near to him in the forsakenness of every man. There is no loneliness and no rejection which he has not taken to himself and assumed in the cross of Jesus. There is no need for any attempts at justification or for any self-destructive self-accusations to draw near to him. The godforsaken and rejected man can accept himself where he comes to know the crucified God who is with him and has already accepted him” (The Crucified God, 414-5).

In the fourth most viewed TED Talk of all time, “The Power of Vulnerability,” Dr. Brené Brown describes empathy to be the equivalent of, “Hey, I know what it’s like down here. And you’re not alone.” Is there anything more succinctly incarnational than that? Christ descended first before he ascended. The same is true of our brothers and sisters struggling through anxiety, depression, and suicidal thoughts.

Joshua Cayetano is a Marquand Scholar who will begin his M.A. in Religion at Yale Divinity School come Fall ‘18. He graduated summa cum laude from George Fox University and is a graduate of the inaugural class of the William Penn Honors Program, which employs a great books curriculum and the Socratic method. You can follow him on Twitter @JoshPCayetano for more on religion, politics, and the Golden State Warriors.

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  • Benjamin Bush

    There is nothing I exactly disagree with here, I don’t think, except the rhetoric. It sounds almost like an inverted dualism which pits the body against the mind. Depression is not simply physical, which is what makes addressing it so complicated. Mental illness is both mental and physical.

    “Heed not thy feelings, do thy work.” Indeed, isn’t this bodily? Exertion is amongst the best treatments for depression, and being invested in community is another great help. Certainly these can be hard treatments to pursue while depressed, yet having a MacDonald to call us out of ourselves to work with him helps. In depression I am most reliant on structures and people which make it harder to mope than to go outside of myself and which can tell me when I am acting as I ought not.

    Among the best things I can do when depressed, when feeling worthless and as though everything is too hard for me, is to recognize the accuracy of those feelings and answer them with the cross, which makes them obsolete. It is no cure, but it does temper the feelings.

    I would also submit that many of the writers you criticize may be speaking from their own experience. Depression feels spiritual. The combat we must engage in, in the moments, days, years of depression, when drugs do not work or are not available, is spiritual as well as physical and social. The effort of answering the guilt and shame with the cross of Christ is not otiose.

  • Elizabeth Johnston

    Good overall, except that I don’t think that the evidence for a tripartite understanding of the human person is very solid, Biblically speaking (and how is it a good idea to bring the Trinity into this?). I don’t really see people like Piper or Powlinson being willing to drop a biparte view–the real issue may be more that some people who hold the biparte view treat body and soul as existing in pretty separate categories, while others (e.g. Aquinas) emphasize a closer relationship between them. I think modern psychology pretty clearly backs up the latter view. People are messy. The body can affect the soul, which will affect the spiritual life–but just because there isn’t a spirit independent of the soul does not mean someone has committed a sin or is spiritually immature because they suffer from depression.

    Maybe the way forward is something closer to what Matthew Lee Anderson tried to do in his response to Denny Burk. There are a lot of ideas about inner struggle and sin that need to be sorted out–and I can see how some of the same ideas that support a Biblical counseling view are leading to the lack of nuance in the way Burk and others have approached sexual temptation.

    Personally, I’ll always associate biblical counseling with a scandal at my undergrad institution, when it came out that PTSD victims were being told that they wouldn’t be experiencing PTSD symptoms if their hearts were right.

  • Samuel James

    The citation of Piper’s “When I Don’t Desire God” is very misleading, and borders on misrepresentation.

    In the location where Piper quotes McDonald’s line “Heed not thy feelings,” he actually evaluates that line from a Christian Hedonist perspective, specifically, the perspective of a spiritual theology that places *great priority* on the inner emotional life. Contrary to what this article implies, Piper does not simply parrot McDonald’s logic. He evaluates how it could be applied rightly and wrongly, e.g, “When MacDonald says heed not thy feelings, do thy work, he means: don’t let *wrong* feelings govern you.” (220) The link that the paragraph draws between Piper’s counseling theology and “ascetic” spirituality is not a credible link, especially given Piper’s Christian Hedonist framework.

    Second, after the mentioned quote in which Piper acknowledges a link between mental and spiritual states, Piper immediately says “With or without medication there are other things that can be done in the midst of a prolonged darkness.” This doesn’t sound like the theology this author has attributed to Piper. Piper *clearly* does not discount the value of medication in healing the body. Rather, this section of When I Don’t Desire God is oriented toward spiritual disciplines that can be pursued alongside medicinal options. Perhaps the author wishes to critique Piper for not deferring to a Christian psychiatrist or for not putting forward an exhaustive theology of medication. But as it stands, the critique made in the piece is spurious.

  • Physiocrat

    The reason to doubt doctors more with respect to mental illness than physical is that what constitutes mental health is significantly less straight forward than physical health and comes with many additional philosophical assumptions. Without a robust sense of what actually is mental health the only conclusion is that of Thomas Szasz.

    • Steven Searcy

      The distinction between mental and physical health is not completely clear, and there is an awful lot we don’t understand. We continue to learn new things that reveal just how much we don’t really understand how all the various aspects of our persons are connected. For example…

      “Biological psychiatry research has long focused on the brain in elucidating the neurobiological mechanisms of anxiety- and trauma-related disorders. This review challenges this assumption and suggests that the gut microbiome and its interactome also deserve attention to understand brain disorders and develop innovative treatments and diagnostics in the 21st century. The recent, in-depth characterization of the human microbiome spurred a paradigm shift in human health and disease. Animal models strongly suggest a role for the gut microbiome in anxiety- and trauma-related disorders. The microbiota-gut-brain (MGB) axis sits at the epicenter of this new approach to mental health. The microbiome plays an important role in the programming of the hypothalamic-pituitary-adrenal (HPA) axis early in life, and stress reactivity over the life span. In this review, we highlight emerging findings of microbiome research in psychiatric disorders, focusing on anxiety- and trauma-related disorders specifically, and discuss the gut microbiome as a potential therapeutic target. 16S rRNA sequencing has enabled researchers to investigate and compare microbial composition between individuals. The functional microbiome can be studied using methods involving metagenomics, metatranscriptomics, metaproteomics, and metabolomics, as discussed in the present review. Other factors that shape the gut microbiome should be considered to obtain a holistic view of the factors at play in the complex interactome linked to the MGB. In all, we underscore the importance of microbiome science, and gut microbiota in particular, as emerging critical players in mental illness and maintenance of mental health. This new frontier of biological psychiatry and postgenomic medicine should be embraced by the mental health community as it plays an ever-increasing transformative role in integrative and holistic health research in the next decade.”

      https://www.ncbi.nlm.nih.gov/pubmed/28767318

      • Physiocrat

        There’s definitely more to mental health than than the brain. I remember hearing a story, I don’t know if it is true, that a man developed a skill for painting after having a heart transplant from a painter after never being artistic at all. That said my original point about the relative ease of diagnosing more ostensibly physical maladies than mental ones still stands. Szasz’s take on this avoids the nental physical distinction but it is a just a consistent subjectivist one.

  • Steven Searcy

    A big challenge in discussing this topic is that “depression” (as a medical term), which affects a subset of people, is not the same as despondency or discouragement, which undoubtedly happens to everyone at times, in varying degrees. The two are often conflated, or too-closely linked, in casual discussions or in offering spiritual guidance. There is little doubt that the encouragements and insights of Bunyan, Baxter, MacDonald, and Piper are helpful in dealing with general, “healthy” discouragement and despondency (as exemplified perhaps in Psalm 42). But spiritual encouragement is unlikely to be sufficient in dealing with severe mental health issues, depression or otherwise.

  • Overall, I agree with the theological framework presented here. And I also agree with a previous commenter that the article does seem to shift the pendulum back to the body side of the dualism, perhaps for rhetorical effect.

    I think an analogical view of causation to be one of the more helpful tools in a theological arsenal, and that’s not brought up here. If we are truly trying to restore a mind/body dualistic rift, then we need to understand the answer to this question, of a range of many possible questions: is someone tempted to suicide for biological predispositions or because Satan wants it? Analogically, the answer must be both.

    This means we still need to heed the warnings of the old Puritans, as well as encourage all forms of health including godly psychotherapy. But believe me, as a pastor who has long dealt with these issues, there aren’t many counselors/therapists/psychiatrists with the theological resources described in the article. Alternatively, pastors can’t give out medications nor make diagnoses. The framework is nice, but the resources for the person-on-the-way-to-healing is much much harder to come by. That’s all to say, if all someone has is prayer, it’s still better than nothing.

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