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The church is God's hospital. It has always been full of people on the mend. Jesus himself made a point of inviting the lame, the blind, and the possessed to be healed and to accompany him in his ministry, an invitation often spurned by those who thought they were fine as is. We should not be surprised, then, that the depressed populate not only secular hospitals and clinics, but our churches as well. Yet depression remains both familiar and mysterious to pastors and lay church leaders, not to mention to those who share a pew with depressed persons.

Virtually everyone has experienced a "down" day, often for no clear reason. We might say we "woke up on the wrong side of the bed," are "out of sorts," or just "in a funk." Such polite references are commonplace in America. Yet as familiar as melancholic periods are to us, the depths of a severe depression remain a mystery. We may grasp in part the distress of King David: "Be merciful to me, O Lord, for I am in distress; my eyes grow weak with sorrow, my soul and my body with grief. My life is consumed by anguish and my years by groaning; my strength fails because of my affliction, and my bones grow weak" (Ps. 31:9-10). But most of us have no idea what David meant when he further lamented, "I am forgotten by them as though I were dead" (v.12). Severe depression is often beyond description. And when such deep and painful feelings cannot be explained, they cut to the heart of one's spiritual being.

Humans are intricately complex creatures. When things go wrong in us, they do so in myriad and nuanced ways. If churches want to effectively minister to the whole of fallen humanity, they must reckon with this complexity. Depression indicates that something is amiss. But what? And what should churches be doing about it?

First we need to clarify what we are talking about. In order to distinguish severe or "major depression" from everyday blues, the American Psychiatric Association offers the following diagnostic criteria:

Major depression is diagnosed when an adult exhibits one or both of two core symptoms (depressed mood and lack of interest), along with four or more of the following symptoms, for at least two weeks: feelings of worthlessness or inappropriate guilt; diminished ability to concentrate or make decisions; fatigue; psychomotor agitation (cannot sit still) or retardation (just sitting around); insomnia or hypersomnia (sleeping too much); significant decrease or increase in weight or appetite; and recurrent thoughts of death or suicidal ideation.

This clinical definition is sterile, however, and fails to capture the unique quality of the severely depressed person's suffering.

Deep depression is embodied emotional suffering. It is not simply a state of mind or a negative view of life but something that affects our physical being as well. Signs of a severe episode of depression include unfounded negative evaluations of friends, family, and oneself, emotional "pain," physical problems such as lethargy, difficulty getting one's thoughts together, and virtually no interest in one's surroundings. Though most of us know at least an acquaintance who has committed suicide, this tragic act baffles us perhaps as much as it pains us. "I just don't understand," we say. The irony is that survivors of serious suicide attempts frequently reflect on those attempts with a similar attitude: "I have no idea what came over me." The pain and mental dysfunction of major depression are that deep.

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March 2009, Vol. 53, No. 3