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Overview
How can we help Christians who seem unable to break out of darkness into the light of joy? Piper deliberately calls them Christians: such things do happen to genuine believers. The causes are many—sin, Satanic assault, distressing circumstances, hereditary or other physical factors—and often several combine. What makes the old Puritan books remarkable is that they reckon with all these causes, address each appropriately, and never seem to give up on anyone because of discouraging darkness.
Long before psychiatry, Richard Baxter recognized this complexity. The very first cause he names in answering “What are the causes and cure of melancholy?” is bodily: for very many, a great part of the cause lies in the “distemper, weakness, and diseasedness of the body,” by which the soul is disabled from any comfortable sense. The more it arises from such natural necessity, he says, the less sinful and less dangerous it is to the soul—though never the less troublesome. His sermon even includes a section on “medicine and diet,” comparing the diseased thinking faculty to an inflamed eye or a sprained foot.
“With very many there is a great part of the cause in distemper, weakness, and diseasedness of the body; and by it the soul is greatly disabled to any comfortable sense. But the more it ariseth from such natural necessity, it is the less sinful and less dangerous to the soul; but never the less troublesome.”
— Richard Baxter, “The Cure of Melancholy and Overmuch Sorrow by Faith and Physic” (17th century)
The Physical Side of Spiritual Darkness
Piper does not attempt to discuss the physical treatment of melancholy or its severe form, depression; that is the work of a medical doctor, which he is not. But one thing must be clear: the condition of our bodies affects the capacity of our minds to think clearly and of our souls to see the beauty of hope-giving truth.
Martyn Lloyd-Jones—a physician before he became the preacher of Westminster Chapel—began his book Spiritual Depression by warning against overlooking the physical. He pointed to Charles Spurgeon, one of the greatest preachers of all time, whose acute spiritual depression was closely tied to the inherited gout that eventually killed him. Tiredness, overstrain and illness of every kind play their part, because we are body, mind and spirit and cannot isolate one from the others; the greatest Christians, when physically weak, are most prone to attacks of spiritual depression. Psychiatrist Gaius Davies, who knew Lloyd-Jones well, recalled how eagerly the preacher sought to understand the new antidepressants of the mid-1950s so that he could advise those who asked his counsel.
The Place of Medication in the Fight for Joy
Piper is careful not to make medication the first or main solution to spiritual darkness. By itself medicine is never a solution to spiritual darkness: when it has done its work, all the fundamental issues of life still remain to be brought into right relation to Christ. Antidepressants are not the decisive Savior; Christ is. He also worries that the almost automatic use of pills for children’s misbehavior and adults’ sorrows will hurt society.
He cites biblical counselor David Powlison on the “sea change” of the mid-1990s, when biology became the dominant explanation of human personality, and Powlison’s judgment that this preoccupation will cure a few things (for which we should thank the God of common grace) but will not qualitatively change lives—only intelligent repentance, living faith and tangible obedience do that. Ed Welch, in Blame It on the Brain?, is willing to use medication for persistent, debilitating depression, but typically asks a person to postpone the decision for a time while causes are considered and God is sought together. A 2002 Washington Post report that placebo pills often performed as well as antidepressants in drug-company trials is cited as evidence that early enthusiasm was being reined in.
The point of such caution is not that depression is disconnected from our physical condition—they are deeply connected. The point is that the relationship between soul and brain is beyond human comprehension and must be handled with great care, attending to the moral and spiritual realities that may influence the brain as much as the brain influences them. So Piper closes with tenderness: if you are on medication or considering it, he does not condemn you, nor does the Bible. It may or may not be the best course; he commends you to a God-centered, Bible-saturated physician. And if there was imperfection in the choice, the imputed righteousness of Christ will swallow it up as you rest in him.