Thursday, October 11, 2018

Depression, Anxiety, and the Christian Life {Book Review}

A theologian, a psychiatrist, and a Puritan pastor walked into a book….

Joking aside, in Depression, Anxiety, and the Christian Life: Practical Wisdom from Richard Baxter, theologian J. I. Packer, psychiatrist Dr. Michael Lundy, and the seventeenth-century Puritan pastor Richard Baxter join forces to introduce Baxter’s counsel on these mood disorders to twenty-first century readers. Dr. Packer provides the preface and a chapter of biographical-historical context about Baxter. Dr. Lundy provides a “Perspective and Retrospective” chapter describing his professional and church experiences with the shortcomings of both the medical-only and counseling-only approaches to treating mental illness. The bulk of the book comprises 3 substantial messages on the topic by Baxter, with language updated for modern readers by Dr. Lundy.

Why Baxter? Here is Packer’s explanation:

We believe that in the wisdom of God thorns in the flesh—mental and emotional thorns included—may become means of spiritual advance that would not otherwise take place. And we believe that greater wisdom in this matter than we are used to is found in the pastoral heritage of seventeenth-century Puritanism. Supreme here is the wisdom of Richard Baxter, who in his day was viewed and consulted as a top authority regarding ministry to Christians afflicted by what was then called “melancholy,” but would today be labeled depression. Our hope is that by presenting what Baxter wrote in this field we may contribute to wise pastoral care in Bible-believing, gospel-centered, Christ-honoring churches at this time (12).

Richard Baxter served as a pastor from 1638 to 1662, when changes in religious freedom laws in England forced him out of the pastorate and into a full-time writing vocation for the final 3 decades of his life. In that day, many towns and villages did not have a resident physician. In those cases, the pastor, as most educated member of the community, served as a lay physician providing care for the parish’s bodies as well as souls. His counsel as reproduced in this volume reflects that holistic approach. Packer sums this up:

…never letting melancholics lose sight of the redeeming love of God, the free offer of life in Christ, and the greatness of grace at every point in the gospel; not attempting to practice the “secret duty” of meditation and prayer on one’s own, but praying aloud in company; cultivating cheerful Christian community (“there is no mirth like the mirth of believers”); avoiding idleness; and making good use of a skilled physician, a discerning pastor, and other faithful Christian mentors and friends, for support, guidance, and hopefully a cure (28-29).

Dr. Lundy describes Baxter’s approach as a rudimentary forerunner of today’s cognitive behavioral therapy. His counsel is both compassionate and tough, kind and sometimes admonishing. Lundy writes, “he does not permit a particular inability to license a general unwillingness, or excuse his readers for failing to do what they can do on the grounds that they can not do all that they should or would do” (55). When the patient is truly incapacitated by the depression or anxiety (“melancholy”), Baxter directs his exhortations to the family, friends, pastor, and physician of the sufferer.

In the addresses by Baxter himself, I found his lists of attributes of melancholy and directions to the patient to be helpful and consistent with other books and articles I have read on depression. The passages I would have underlined and dog-eared in a physical copy reoriented the suffering person outward and upward: outward to Christian community and the duties within reach (while not minimizing the strong depressive impulse towards solitude and inactivity) and upward toward God and His work, away from self. He compares the “broken imagination” of a depressed person to a broken leg and urges temporary mental rest. During episodes of depression, he cautions against attempts at lengthy times of prayer, confession of sin, and meditation as too taxing for the ailing mind and as a danger of a downward spiral of negative thought and emotion. He encourages short prayers, praying aloud in the company of more emotionally healthy believers, and “getting out of one’s own room” to take up some good, diverting task that requires more action than rumination.

His comments in the second address on the relationship of excessive sorrow and Christian hope resonated deeply with my experience from periods of depression in my own life and from trying to love depressed friends well and faithfully:

Excessive sorrow interferes with hope even more than with faith. This happens when those who consider themselves believers perceive God’s Word and promises to be true and applicable to everyone but themselves. Hope is that grace by which one not only believes the claims of the gospel but also rests in the comfort that those same gospel promises will be his own specifically, and not just generally. It is an act of application. The first action of faith is to acknowledge that the gospel is true and promises grace and future glory through Christ. The second action is when that faith says, as it were, “I will trust my soul and my all upon that gospel and take Christ to be my Savior and my help.” Hope then looks with anticipation to that salvation from him. Melancholy, excessive sorrow, and dismay, however, quench such hope, as water quenches fire or ice heat. Despair is the essence of such opposition to hope. The depressed desperately would hope for themselves but find themselves unable to do so. Their thoughts about such matters are filled with suspicion and misgivings, and so they see a future of danger and misery, and feel helpless. In the absence of hope—which we are assured is the very anchor of the soul—it is no wonder that these are continually tossed about by the storms of life (110).

Baxter follows that with an examination, beginning with the physical, of the potential causes of such excessive sorrow before turning to the cure and prevention. He warns against impatience and discontent in suffering as early attitudes which, if not resisted, can lead to depression. “Discontent is an ongoing resistance to God’s disposing will, and even a degree of rebellion against it, in which your own will rises up against that of God. It is atheism in practice to think your sufferings are not part of his providence” (134). And again, “when you do experience desperation to be delivered, remember that this is not trusting God. Attend to your actual duty and obey his command, but leave it to him what shall come your way. Tormenting worry only increases your sufferings; it is a great mercy of God that he forbids this kind of fretting and promises to take care of you” (134).

He balances those firm exhortations with consoling words like these:

When Christ was in agony for our sins and cried out, “My God, my God, why have you forsaken me?” he was nevertheless beloved by his Father. [Feeling does not equate to reality.] He was tempted that he might comfort those that are tempted, and suffered such derision that he might be a compassionate High Priest to others (153).
All our troubles are under God’s sovereign rule; it is far better for us to be subject to his choice and disposition than to our own or that of our dearest friends. He has promised that all things will work together for our own good (153).

His counsel to friends and loved ones seeking to care for the depressed person are no-nonsense, focused on providing them any small pleasures and removing unnecessary irritants, frequently reminding them of gospel truths that are best suited to comfort, reading encouraging books to them if they are too weary of mind to read for themselves, bringing an able Christian pastor into the mix, and not neglecting medication when prescribed by a good physician. Here is a sample in his own words:

As much as possible, distract such individuals from the thoughts that so preoccupy and torment them. Focus them on other conversation and matters. Intrude into their space and interrupt their ruminations. Rouse them from such musings with loving and unwavering insistence. Don’t allow them to spend too much time alone, but arrange for suitable companions to be with them, or take them to visit friends. Be especially careful not to let them be idle, but press or entice them into some pleasant activity that may entail physical as well as mental action (160).

It is also useful if you can engage them in providing comfort to others who are worse off than they. This will convince them that their own case is not unique, and they will actually be encouraging themselves as they encourage others. In my own personal experience, a primary way to resolve my own doubts about the state of my soul was through frequently comforting others that had the same doubts, and whose lives persuaded me of their sincerity (161-162).

If you will bear with one final quote, this bit of counsel moved me to worship, and I pray it blesses you too:

Set your thoughts on the things you know to be right and good: don’t focus on yourself and your own heart. Even the best may find within much to trouble them. As turning millstones only wear themselves down in the absence of grain to grind, so do the thoughts of the depressed when they think only of the troubles of their own hearts. To the degree that you can, direct your thoughts toward these four matters:
A. The infinite goodness of God, who is more full of love than is the sun of light;
B. The immeasurable love of Christ in redeeming mankind, and the sufficiency of his sacrifice and merits;
C. The free covenant and offer of grace, which give pardon and life to all who neither prefer sin nor obstinately refuse them to the end;
D. The inconceivable glory and joy that all the blessed have with Christ, and that God has promised with his oath and seal to everyone who consents to the covenant of grace and are willing to be saved and ruled by Christ (155).

In conclusion, Depression, Anxiety, and the Christian Life does an excellent job of introducing contemporary readers to a Puritan writer I would like to know better. It is not an easy read, even with the updated language, but it is an edifying one. The holistic approach to mental illness, combining medical therapy, pastoral counsel, and partnership with the patient’s community, presents a demanding but well-reasoned philosophy of care. I commend this book to mental health professionals and pastoral counselors. As a complete non-professional who has experienced depression and anxiety and has many friends in the throes of these afflictions, I found it instructive, hopeful, realistic, and God-exalting.