Distinguishing Despair and Depression

Hi. Been a while.

Had an interesting moment after the sermon this morning. I feel pretty good about the sermon - on point, wouldn't take back anything that I wrote or said. But sometimes you get done and you realize that while your first and main point in a sermon is sound and on target, there's the potential for extrapolations from what you've said to lead down some roads you never intended it to take. So I thought I'd take a minute tonight to expand a bit on what I said for the sake of understanding a crucial distinction that wasn't on anyone's radar 500 years ago.

The preaching text this morning was Luke 18.1-8, the parable of the widow and the unjust judge. Follow this link if you'd like to read the passage. The title of my sermon today was "Struggle and Prayer" - I talked about faith being connected to persistent struggle and even more steadfast belief that God listens to prayer even more lovingly than we can imagine. I also talked about Luther's belief that despair was one of the most powerful and dangerous embodiments of sin, evil, and brokenness. The word Luther used was anfechtung, which doesn't have a direct English equivalent, but is essentially the sum total of every doubt, fear, regret, and guilt landing on your head and heart.

I also quoted Luther twice. First, I quoted him describing anfechtung as he had experienced it:

At such a time, God seems terribly angry, and with him the whole creation. At such a time there is no flight, no comfort, within or without, but all things accuse. At such a time as that the Psalmist mourns, “I am cut off from thy sight” ...In this moment (strange to say) the soul cannot believe that it can ever be redeemed other than that the punishment is not yet completely felt...All that remains is the stark-naked desire for help and a terrible groaning, but it does not know where to turn for help.

Next, I quoted a letter Luther had written to a friend who was undergoing some severe trials and had written to Luther seeking some word of comfort and hope:

...Excellent Jerome, rejoice in this temptation of the devil because it is a certain sign that God is propitious and merciful to you.
You say that the temptation is heavier than you can bear, and that you fear that it will so break and beat you down as to drive you to despair and blasphemy.
I know this wile of the devil. If he cannot break a person with his first attack, he tries by persevering to wear him out and weaken him until the person falls and confesses himself beaten.
Whenever this temptation comes to you, avoid entering upon a disputation with the devil and do not allow yourself to dwell on those deadly thoughts, for to do so is nothing short of yielding to the devil and letting him have his way.
Try as hard as you can to despise those thoughts which are induced by the devil. In this sort of temptation and struggle, contempt is the best and easiest method of winning over the devil.
Laugh your adversary to scorn and ask who it is with whom you are talking.
By all means flee solitude, for the devil watches and lies in wait for you most of all when you are alone. This devil is conquered by mocking and despising him, not by resisting and arguing with him...
When the devil throws our sins up to us and declares we deserve death and hell, we ought to speak thus:
“I admit that I deserve death and hell. What of it?
Does this mean that I shall be sentenced to eternal damnation? By no means.
For I know One who suffered and made a satisfaction in my behalf.
His name is Jesus Christ, the Son of God.
Where he is, there I shall be also.”
Yours, Martin Luther

What started troubling me this afternoon was this: Martin Luther lived in a different time with a vastly differing understanding of how the human brain works. My fear, as I pondered my sermon in retrospect, is that I didn't give sufficient attention to the difference between spiritual despair, which is as real today as it was in Luther's time, and depression. Today, depression is a diagnosable medical condition, best addressed by some combination of treatment prescribed by medical and mental health professionals. In Luther's time, however, no one could distinguish between depression and despair/anfechtung, and so any troubled conscience would have been told that they were undergoing some attack of the devil and that the key was to resist that attack with the tools of faith. As a person diagnosed with and taking medication to address depression, I'm as thankful to live in an age where we are beginning to understand brain chemistry as I am many other medical advances.

It is crucial that the church understands and proclaims a word of hope based in its present circumstances. Where I missed the mark this morning was not distinguishing between despair and depression. A conscience troubled by sin and broken faith may certainly be comforted by the sort of spiritual care that I or another religious counselor can offer, and this is what I was addressing today. A soul troubled by deeper, darker torments, however, may be suffering from depression; in such a case, the church should be honor-bound to refer this beloved child of God to a professional who can properly diagnose and treat those conditions. Treating a mental health condition with prayer alone is no more effective than treating a broken leg with aspirin would be. It's both spiritual and medical malpractice to do so. 

The church has a terrible record when it comes to acknowledging and embracing those of us with mental health disorders, precisely because we often don't do the admittedly difficult work of distinguishing despair and depression. I wish I'd done that better in my sermon today, but hopefully this little bit of retroactive reflection might encourage others to do better in the future.