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About the Book
"A Citizen of Two Worlds" is a spiritual autobiography of Gordon Lindsay, a prolific writer, preacher, and founder of Christ for the Nations Institute. The book documents Lindsay's journey from his early years as a skeptic to becoming a dedicated follower of Christ, and his experiences in ministry and missions around the world. Lindsay provides insights into living as a Christian in a secular society and the challenges of balancing his faith with his worldly responsibilities.
Anne Bradstreet
Anne Bradstreet was the first woman to be recognized as an accomplished New World Poet. Her volume of poetry The Tenth Muse Lately Sprung Up in America ... received considerable favorable attention when it was first published in London in 1650. Eight years after it appeared it was listed by William London in his Catalogue of the Most Vendible Books in England, and George III is reported to have had the volume in his library. Bradstreet's work has endured, and she is still considered to be one of the most important early American poets.
Although Anne Dudley Bradstreet did not attend school, she received an excellent education from her father, who was widely readâ Cotton Mather described Thomas Dudley as a "devourer of books"âand from her extensive reading in the well-stocked library of the estate of the Earl of Lincoln, where she lived while her father was steward from 1619 to 1630. There the young Anne Dudley read Virgil, Plutarch, Livy, Pliny, Suetonius, Homer, Hesiod, Ovid, Seneca, and Thucydides as well as Spenser, Sidney, Milton, Raleigh, Hobbes, Joshua Sylvester's 1605 translation of Guillaume du Bartas's Divine Weeks and Workes, and the Geneva version of the Bible. In general, she benefited from the Elizabethan tradition that valued female education. In about 1628âthe date is not certainâAnne Dudley married Simon Bradstreet, who assisted her father with the management of the Earl's estate in Sempringham. She remained married to him until her death on September 16, 1672. Bradstreet immigrated to the new world with her husband and parents in 1630; in 1633 the first of her children, Samuel, was born, and her seven other children were born between 1635 and 1652: Dorothy (1635), Sarah (1638), Simon (1640), Hannah (1642), Mercy (1645), Dudley (1648), and John (1652).
Although Bradstreet was not happy to exchange the comforts of the aristocratic life of the Earl's manor house for the privations of the New England wilderness, she dutifully joined her father and husband and their families on the Puritan errand into the wilderness. After a difficult three-month crossing, their ship, the Arbella, docked at Salem, Massachusetts, on July 22, 1630. Distressed by the sickness, scarcity of food, and primitive living conditions of the New England outpost, Bradstreet admitted that her "heart rose" in protest against the "new world and new manners." Although she ostensibly reconciled herself to the Puritan missionâshe wrote that she "submitted to it and joined the Church at Boston"âBradstreet remained ambivalent about the issues of salvation and redemption for most of her life.
Once in New England the passengers of the Arbella fleet were dismayed by the sickness and suffering of those colonists who had preceded them. Thomas Dudley observed in a letter to the Countess of Lincoln, who had remained in England: "We found the Colony in a sad and unexpected condition, above eighty of them being dead the winter before; and many of those alive weak and sick; all the corn and bread amongst them all hardly sufficient to feed them a fortnight." In addition to fevers, malnutrition, and inadequate food supplies, the colonists also had to contend with attacks by Native Americans who originally occupied the colonized land. The Bradstreets and Dudleys shared a house in Salem for many months and lived in spartan style; Thomas Dudley complained that there was not even a table on which to eat or work. In the winter the two families were confined to the one room in which there was a fireplace. The situation was tense as well as uncomfortable, and Anne Bradstreet and her family moved several times in an effort to improve their worldly estates. From Salem they moved to Charlestown, then to Newtown (later called Cambridge), then to Ipswich, and finally to Andover in 1645.
Although Bradstreet had eight children between the years 1633 and 1652, which meant that her domestic responsibilities were extremely demanding, she wrote poetry which expressed her commitment to the craft of writing. In addition, her work reflects the religious and emotional conflicts she experienced as a woman writer and as a Puritan. Throughout her life Bradstreet was concerned with the issues of sin and redemption, physical and emotional frailty, death and immortality. Much of her work indicates that she had a difficult time resolving the conflict she experienced between the pleasures of sensory and familial experience and the promises of heaven. As a Puritan she struggled to subdue her attachment to the world, but as a woman she sometimes felt more strongly connected to her husband, children, and community than to God.
Bradstreet's earliest extant poem, "Upon a Fit of Sickness, Anno. 1632," written in Newtown when she was 19, outlines the traditional concerns of the Puritanâthe brevity of life, the certainty of death, and the hope for salvation:
O Bubble blast, how long can'st last?
That always art a breaking,
No sooner blown, but dead and gone,
Ev'n as a word that's speaking.
O whil'st I live, this grace me give,
I doing good may be,
Then death's arrest I shall count best,
because it's thy decree.
Artfully composed in a ballad meter, this poem presents a formulaic account of the transience of earthly experience which underscores the divine imperative to carry out God's will. Although this poem is an exercise in piety, it is not without ambivalence or tension between the flesh and the spiritâtensions which grow more intense as Bradstreet matures.
The complexity of her struggle between love of the world and desire for eternal life is expressed in "Contemplations," a late poem which many critics consider her best:
Then higher on the glistering Sun I gaz'd
Whose beams was shaded by the leavie Tree,
The more I look'd, the more I grew amaz'd
And softly said, what glory's like to thee?
Soul of this world, this Universes Eye,
No wonder, some made thee a Deity:
Had I not better known, (alas) the same had I
Although this lyrical, exquisitely crafted poem concludes with Bradstreet's statement of faith in an afterlife, her faith is paradoxically achieved by immersing herself in the pleasures of earthly life. This poem and others make it clear that Bradstreet committed herself to the religious concept of salvation because she loved life on earth. Her hope for heaven was an expression of her desire to live forever rather than a wish to transcend worldly concerns. For her, heaven promised the prolongation of earthly joys, rather than a renunciation of those pleasures she enjoyed in life.
Bradstreet wrote many of the poems that appeared in the first edition of The Tenth Muse ... during the years 1635 to 1645 while she lived in the frontier town of Ipswich, approximately thirty miles from Boston. In her dedication to the volume written in 1642 to her father, Thomas Dudley, who educated her, encouraged her to read, and evidently appreciated his daughter's intelligence, Bradstreet pays "homage" to him. Many of the poems in this volume tend to be dutiful exercises intended to prove her artistic worth to him. However, much of her work, especially her later poems, demonstrates impressive intelligence and mastery of poetic form.
The first section of The Tenth Muse ... includes four long poems, known as the quaternions, or "The Four Elements," "The Four Humors of Man," "The Four Ages of Man," and "The Four Seasons." Each poem consists of a series of orations; the first by earth, air, fire, and water; the second by choler, blood, melancholy, and flegme; the third by childhood, youth, middle age, and old age; the fourth by spring, summer, fall, and winter. In these quaternions Bradstreet demonstrates a mastery of physiology, anatomy, astronomy, Greek metaphysics, and the concepts of medieval and Renaissance cosmology. Although she draws heavily on Sylvester's translation of du Bartas and Helkiah Crooke's anatomical treatise Microcosmographia (1615), Bradstreet's interpretation of their images is often strikingly dramatic. Sometimes she uses material from her own life in these historical and philosophical discourses. For example, in her description of the earliest age of man, infancy, she forcefully describes the illnesses that assailed her and her children:
What gripes of wind my infancy did pain,
What tortures I in breeding teeth sustain?
What crudityes my stomach cold has bred,
Whence vomits, flux, and worms have issued?
Like the quaternions, the poems in the next section of The Tenth Museâ"The Four Monarchies" (Assyrian, Persian, Grecian, and Roman)âare poems of commanding historical breadth. Bradstreet's poetic version of the rise and fall of these great empires draws largely from Sir Walter Raleigh's History of the World (1614). The dissolution of these civilizations is presented as evidence of God's divine plan for the world. Although Bradstreet demonstrates considerable erudition in both the quaternions and monarchies, the rhymed couplets of the poems tend to be plodding and dull; she even calls them "lanke" and "weary" herself. Perhaps she grew tired of the task she set for herself because she did not attempt to complete the fourth section on the "Roman Monarchy" after the incomplete portion was lost in a fire that destroyed the Bradstreet home in 1666.
"Dialogue between Old England and New," also in the 1650 edition of The Tenth Muse ... expresses Bradstreet's concerns with the social and religious turmoil in England that impelled the Puritans to leave their country. The poem is a conversation between mother England and her daughter, New England. The sympathetic tone reveals how deeply attached Bradstreet was to her native land and how disturbed she was by the waste and loss of life caused by the political upheaval. As Old England's lament indicates, the destructive impact of the civil strife on human life was more disturbing to Bradstreet than the substance of the conflict:
O pity me in this sad perturbation,
My plundered Towers, my houses devastation,
My weeping Virgins and my young men slain;
My wealthy trading fall'n, my dearth of grain
In this poem, Bradstreet's voices her own values. There is less imitation of traditional male models and more direct statement of the poet's feelings. As Bradstreet gained experience, she depended less on poetic mentors and relied more on her own perceptions.
Another poem in the first edition of The Tenth Muse ... that reveals Bradstreet's personal feelings is "In Honor of that High and Mighty Princess Queen Elizabeth of Happy Memory," written in 1643, in which she praises the Queen as a paragon of female prowess. Chiding her male readers for trivializing women, Bradstreet refers to the Queen's outstanding leadership and historical prominence. In a personal caveat underscoring her own dislike of patriarchal arrogance, Bradstreet points out that women were not always devalued:
Nay Masculines, you have thus taxt us long,
But she, though dead, will vindicate our wrong,
Let such as say our Sex is void of Reason,
Know tis a Slander now, but once was Treason.
These assertive lines mark a dramatic shift from the self-effacing stanzas of "The Prologue" to the volume in which Bradstreet attempted to diminish her stature to prevent her writing from being attacked as an indecorous female activity. In an ironic and often-quoted passage of "The Prologue," she asks for the domestic herbs "Thyme or Parsley wreath," instead of the traditional laurel, thereby appearing to subordinate herself to male writers and critics:
Let Greeks be Greeks, and women what they are
Men have precedency and still excell,
It is but vain unjustly to wage warre;
Men can do best, and women know it well
Preheminence in all and each is yours;
Yet grant some small acknowledgement of ours.
In contrast, her portrait of Elizabeth does not attempt to conceal her confidence in the abilities of women:
Who was so good, so just, so learned so wise,
From all the Kings on earth she won the prize.
Nor say I more then duly is her due,
Millions will testifie that this is true.
She has wip'd off th' aspersion of her Sex,
That women wisdome lack to play the Rex
This praise for Queen Elizabeth expresses Bradstreet's conviction that women should not be subordinated to menâcertainly it was less stressful to make this statement in a historic context than it would have been to confidently proclaim the worth of her own work.
The first edition of The Tenth Muse ... also contains an elegy to Sir Philip Sidney and a poem honoring du Bartas. Acknowledging her debt to these poetic mentors, she depicts herself as insignificant in contrast to their greatness. They live on the peak of Parnassus while she grovels at the bottom of the mountain. Again, her modest pose represents an effort to ward off potential attackers, but its ironic undercurrents indicate that Bradstreet was angered by the cultural bias against women writers:
Fain would I shew how he same paths did tread,
But now into such Lab'rinths I am lead,
With endless turnes, the way I find not out,
How to persist my Muse is more in doubt;
Which makes me now with Silvester confess,
But Sidney's Muse can sing his worthiness.
Although the ostensible meaning of this passage is that Sidney's work is too complex and intricate for her to follow, it also indicates that Bradstreet felt his labyrinthine lines to represent excessive artifice and lack of connection to life.
The second edition of The Tenth Muse ..., published in Boston in 1678 as Several Poems ..., contains the author's corrections as well as previously unpublished poems: epitaphs to her father and mother, "Contemplations," "The Flesh and the Spirit," the address by "The Author to her Book," several poems about her various illnesses, love poems to her husband, and elegies of her deceased grandchildren and daughter-in-law. These poems added to the second edition were probably written after the move to Andover, where Anne Bradstreet lived with her family in a spacious three-story house until her death in 1672. Far superior to her early work, the poems in the 1678 edition demonstrate a command over subject matter and a mastery of poetic craft. These later poems are considerably more candid about her spiritual crises and her strong attachment to her family than her earlier work. For example, in a poem to her husband, "Before the Birth of one of her Children," Bradstreet confesses that she is afraid of dying in childbirthâa realistic fear in the 17th centuryâand begs him to continue to love her after her death. She also implores him to take good care of their children and to protect them from a potential stepmother's cruelty:
And when thou feel'st no grief, as I no harms,
Yet love thy dead, who long lay in thine arms:
And when thy loss shall be repaid with gains
Look to my little babes my dear remains.
And if thou love thy self, or love'st me
These O protect from step Dames injury.
Not only is this candid domestic portrait artistically superior to of "The Four Monarchies," it gives a more accurate sense of Bradstreet's true concerns.
In her address to her book, Bradstreet repeats her apology for the defects of her poems, likening them to children dressed in "home-spun." But what she identifies as weakness is actually their strength. Because they are centered in the poet's actual experience as a Puritan and as a woman, the poems are less figurative and contain fewer analogies to well-known male poets than her earlier work. In place of self-conscious imagery is extraordinarily evocative and lyrical language. In some of these poems Bradstreet openly grieves over the loss of her loved onesâher parents, her grandchildren, her sister-in-lawâand she barely conceals resentment that God has taken their innocent lives. Although she ultimately capitulates to a supreme beingâHe knows it is the best for thee and me"âit is the tension between her desire for earthly happiness and her effort to accept God's will that makes these poems especially powerful.
Bradstreet's poems to her husband are often singled out for praise by critics. Simon Bradstreet's responsibilities as a magistrate of the colony frequently took him away from home, and he was very much missed by his wife. Modeled on Elizabethan sonnets, Bradstreet's love poems make it clear that she was deeply attached to her husband:
If ever two were one, then surely we
If ever man were lov'd by wife, then thee;
If ever wife was happy in a man
Compare with me ye women if you can
Marriage was important to the Puritans, who felt that the procreation and proper training of children were necessary for building God's commonwealth. However, the love between wife and husband was not supposed to distract from devotion to God. In Bradstreet's sonnets, her erotic attraction to her husband is central, and these poems are more secular than religious:
My chilled limbs now nummed lye forlorn;
Return, return sweet Sol from Capricorn;
In this dead time, alas, what can I more
Than view those fruits which through thy heat I bore?
Anne Bradstreet's brother-in-law, John Woodbridge, was responsible for the publication of the first edition of The Tenth Muse.... The title page reads "By a Gentlewoman in those parts"âand Woodbridge assures readers that the volume "is the work of a Woman, honored and esteemed where she lives." After praising the author's piety, courtesy, and diligence, he explains that she did not shirk her domestic responsibilities in order to write poetry: "these poems are the fruit but of some few hours, curtailed from sleep and other refreshments." Also prefacing the volume are statements of praise for Bradstreet by Nathaniel Ward, the author of The Simple Cobler of Aggawam (1647), and Reverend Benjamin Woodbridge, brother of John Woodbridge. In order to defend her from attacks from reviewers at home and abroad who might be shocked by the impropriety of a female author, these encomiums of the poet stress that she is a virtuous woman.
In 1867, John Harvard Ellis published Bradstreet's complete works, including materials from both editions of The Tenth Muse ... as well as "Religious Experiences and Occasional Pieces" and "Meditations Divine and Morall" that had been in the possession of her son Simon Bradstreet, to whom the meditations had been dedicated on March 20, 1664. Bradstreet's accounts of her religious experience provide insight into the Puritan views of salvation and redemption. Bradstreet describes herself as having been frequently chastened by God through her illnesses and her domestic travails: "Among all my experiences of God's gractious Dealings with me I have constantly observed this, that he has never suffered me long to sit loose from him, but by one affliction or other hath made me look home, and search what was amiss." Puritans perceived suffering as a means of preparing the heart to receive God's grace. Bradstreet writes that she made every effort to submit willingly to God's afflictions which were necessary to her "straying soul which in prosperity is too much in love with the world." These occasional pieces in the Ellis edition also include poems of gratitude to God for protecting her loved ones from illness ("Upon my Daughter Hannah Wiggin her recovering from a dangerous fever") and for her husband's safe return from England. However, these poems do not have the force or power of those published in the second edition of The Tenth Muse ... and seem to be exercises in piety and submission rather than a complex rendering of her experience.
The aphoristic prose paragraphs of "Meditations Divine and Morall" have remarkable vitality, primarily because they are based on her own observations and experiences. While the Bible and the Bay Psalm Book are the source of many of Bradstreet's metaphors, they are reworked to confirm her perceptions: "The spring is a lively emblem of the resurrection, after a long winter we see the leaveless trees and dry stocks (at the approach of the sun) to resume their former vigor and beauty in a more ample manner than when they lost in the Autumn; so shall it be at that great day after a long vacation, when the Sun of righteousness shall appear, those dry bones shall arise in far more glory then that which they lost at their creation, and in this transcends the spring, that their lease shall never fail, nor their sap decline" (40)
Perhaps the most important aspect of Anne Bradstreet's poetic evolution is her increasing confidence in the validity of her personal experience as a source and subject of poetry. Much of the work in the 1650 edition of The Tenth Muse ... suffers from being imitative and strained. The forced rhymes reveal Bradstreet's grim determination to prove that she could write in the lofty style of the established male poets. But her deeper emotions were obviously not engaged in the project. The publication of her first volume of poetry seems to have given her confidence and enabled her to express herself more freely. As she began to write of her ambivalence about the religious issues of faith, grace, and salvation, her poetry became more accomplished.
Bradstreet's recent biographers, Elizabeth Wade White and Ann Stanford, have both observed that Bradstreet was sometimes distressed by the conflicting demands of piety and poetry and was as daring as she could be and still retain respectability in a society that exiled Anne Hutchinson. Bradstreet's poetry reflects the tensions of a woman who wished to express her individuality in a culture that was hostile to personal autonomy and valued poetry only if it praised God. Although Bradstreet never renounced her religious belief, her poetry makes it clear that if it were not for the fact of dissolution and decay, she would not seek eternal life: "for were earthly comforts permanent, who would look for heavenly?"
In a statement of extravagant praise Cotton Mather compared Anne Bradstreet to such famous women as Hippatia, Sarocchia, the three Corinnes, and Empress Eudocia and concluded that her poems have "afforded a grateful Entertainment unto the Ingenious, and a Monument for her Memory beyond the stateliest Marbles." Certainly, Anne Bradstreet's poetry has continued to receive a positive response for more than three centuries, and she has earned her place as one of the most important American women poets.
Christian Depression and the use of Medication
An acquaintance of mine, Becky, is a grandmother who cites her chief joy in life as âpleasing the Lord and walking faithfully with him.â She delves into Scripture daily, and for decades has shepherded others through Bible studies. Christ has claimed her heart, and daily stirs her mind. Yet seasons of guilt and uncertainty have punctuated Beckyâs walk with her Lord, because while she remains steadfastly devoted to Christ, she also struggles with clinical depression. To maintain her clarity and focus on Godâs word, she needs help from an antidepressant medication. As is often the case, depression runs in Beckyâs family. When despair first gripped her in her twenties, Becky had already watched her mother slide through the deep darkness into a mental breakdown. Sheâd witnessed firsthand how depression can ravage a life, as well as the critical roles that medication and counseling can play in drawing sufferers back into the world again. But even these experiences didnât banish Beckyâs concerns about taking antidepressants herself. She wondered if she were right to take medication for an issue that seemed spiritual. Her guilt only deepened when someone in authority at church claimed, âItâs rare for someone to really need antidepressants, because usually things can be solved biblically.â âHearing that from the pulpit sent me into the depths of guilt,â she relates. âI feel so guilty that I must take this medication that has kept me well for years.â A Troubling Subject The doubts swamping Becky trouble so many of us who suffer from depression. Some of us worry that reliance upon medications implies a paltry faith. Others confuse antidepressants with opioids, and fear addiction. In an opposing scenario, our pain-averse culture, which prioritizes comfort and instant gratification, can mislead us toward chemical prescriptions for normal, refining grief. Throughout, questions churn: Are antidepressants permissible? Or sufficient? Does our need for them reflect a deficit in faith? How do they factor into other means of grace with which God has blessed us, such as prayer, study of the word, and counseling? After a careful exploration of depression, its treatment, and how the Bible guides us in suffering, these questions should give way to discernment and gratitude. No medication can sponge away the blackness in our hearts. But in his steadfast love and mercy toward us, God has gifted us with medical science as a means of common kindness. In the right circumstances, when carefully combined with counseling and spiritual disciplines, antidepressants can ease some of us back into daylight. While we should never rely on medication exclusively, neither should we demonize those who use it as part of a comprehensive approach. More Than Sadness At this point in the discussion, we need to define terms. In the undulating course of life, seasons of grief, tears, and bleakness can trouble all of us. In most cases, these valleys have limits. We may sink low, but we retain our capacity to climb, and eventually we crest into the bright air again. Clinical depression, also called major depressive disorder , falls outside these usual variations in emotion. The fact that depression increases the suicide rate by 27 times  that of the general population should alert us to something gone terribly awry. 1  In major depression, hopelessness, despair, and lack of motivation persist long after wounds have healed, for reasons even the victim canât always pinpoint. Sufferers canât control their descent into darkness, nor can they wrench themselves from its clutches by sheer will, because the social, spiritual, and practical factors we can easily see interact with changes deep in the brain, hidden from view. The ramifications are not only spiritual, but also physical (see the table below), 2  hampering engagement in even the most basic stuff of living. Laughter, conversation, and interaction feel impossible, even with those we love. 3  Routine self-care overwhelms, and some of us find ourselves bed-bound, too bereft of joy to drag ourselves into the world. In many ways, living through depression resembles dying. Itâs crucial to distinguish this affliction from appropriate sadness or grief, because God works through our suffering to refine us (Genesis 50:20; Jonah 2; Romans 5:2â5). We should never seek chemical means to buttress ourselves through the typical  peaks and valleys of our emotions. Not only can melancholy and anguish be worthy responses to the travails of a sinful world, but God also disciplines us, shapes us, and draws us closer to himself through our ordeals. Even Jesus wept in the face of loss (John 11:34â36). Depression, however, isnât typical grief. It can persist even when our days unfold free from catastrophe. Itâs a complex beast, whose sufferers desperately need prayer, Christian love, and professional help. A Complicated Problem Too few sufferers of major depression actually receive the help they need. Guilt â which is a feature  of the disorder (see the table) â and stigma discourage many with depression from seeking assistance. 4  In a survey of 5.4 million adults in the US reporting an unmet need for mental-health services, 8.2% did not seek mental-health treatment because they did not want others to find out, 9.5% because âit might cause neighbors/community to have a negative opinion,â and 9.6% due to concerns about confidentiality. Some 28% believed that they could handle the problem without treatment, and 22.8% did not know where to go to receive treatment. 5  Such statistics reveal that the road to healing slouches uphill. Many tread it alone. Yet even those who seek help embark upon a tortuous path, without easy remedies. We have no quick-fix cures for depression, because the neurobiological underpinnings that fuel our despondency are much more elaborate than a simple chemical imbalance. Regions of the brain responsible for memory and executive function shrink in depression, as do the pathways connecting these areas to sites controlling mood, fear, and drives. 6  Brain cell loss is accelerated among the depressed. 7  The actions of chemical signals between nerve cells are disrupted, especially serotonin, a neurotransmitter that helps regulate mood, sleep, appetite, and pain. 8  While we donât know in all cases whether these changes cause  depression or arise as a result  of the disorder, they hint at why sufferers struggle to recover. In depression, the architecture of our own brains traps us in the dark. And yet, while neurological changes abound in depression, even biology doesnât tell the entire story. While some individuals are genetically prone to major depression, 9  a first episode requires the intermingling of this risk with social, psychological, and spiritual triggers. Medical illnesses contribute in up to 15% of cases, and depression increases the risk of a future heart attack by two to threefold among people with heart disease. 10  People with seasonal affective disorder, who struggle with depression during the winter months, respond well to bright-light therapy, while others without this temporal pattern donât. Some sufferers struggle with anxiety in depression, others with melancholy, and still others with catatonia or psychosis. This variability hints that the current diagnosis we call major depression  is probably an umbrella term, a catchall phrase encompassing multiple related syndromes with similar effects, but distinct causative mechanisms. This diversity in depression creates treatment challenges, as one personâs struggle doesnât resemble anotherâs. Promising research suggests that MRI scans of the brain may differentiate between depressive subtypes and allow for more precise, targeted treatments. 11  But this research is preliminary. In the meantime, depression continues to wreak havoc upon its victims, earning the eleventh spot on the World Health Organizationâs list of conditions causing the greatest disability and mortality. 12  Treatment of such a highly convoluted, variable, and debilitating disorder doesnât proceed simply. Imperfect Options The two mainstays of treatment for clinical depression are antidepressant medications and psychotherapy or counseling. While both these avenues can provide life-giving support, neither offers a quick fix. And while both play vital roles in recovery, neither diminishes the importance of spiritual disciplines as we strive to reclaim our joy. Most antidepressants work by increasing the concentration of serotonin in the brain. Given strong evidence for reduced serotonin transmission in depression, for decades we hoped that replenishing serotonin would reverse the disorder. Given what we now know about brain structure and circuitry in depression, itâs no surprise that antidepressants produce modest effects. Although these medications can promote crucial improvements  in symptoms, when used alone they facilitate full remission  in only about 50% of cases. 13  While this effect can be life-giving for half of sufferers, itâs disappointing for a class of medications we hoped would definitively treat the illness. (Imagine our predicament if insulin reduced blood sugar in only half of diabetics, or if antibiotics eradicated the most common bacterial infections only half the time.) Research also reveals only a small benefit of antidepressant therapy over a placebo pill. Just meeting with a health care provider to receive a placebo constitutes personal connection and care, and ameliorates symptoms in up to 35% of cases. 14 Such research, coupled with criticism that studies supporting antidepressants often suffer from publication bias, has sparked debate about whether antidepressants work at all. Last year, a research group attempted to put the issue to rest by conducting a large meta-analysis of FDA data on antidepressants, and found that all twenty-one agents studied were more effective than placebo. The study garnered significant media attention, with exuberant headlines proclaiming, âThe Debate Is Over!â But the data warrant a more restrained response. We can confidently glean from the review that antidepressants can lessen  symptoms of depression after eight weeks of therapy. Thatâs good news for those clambering in the gloom, for whom even a minor improvement can provide stability to engage with the world. But it still doesnât mean antidepressants have earned a reputation as a miracle cure. 15 Taken in total, research on antidepressants supports their use as one component  of a comprehensive approach. Antidepressants are often necessary  to equip us for the hard work of recovery, but they are not typically sufficient . While antidepressants can lift our darkened mood, full recovery also requires attention to elements that pharmacology cannot penetrate: our social support, our patterns of thinking, our habits and histories, and especially our walk with Christ. While antidepressants improve serotonin signaling, psychotherapy and counseling can help us navigate the social and cognitive barriers to recovery. And a rich life of prayer and Bible intake, with support from the body of Christ, is essential to usher us through the storm. Non-Pharmacological Support The term psychotherapy  often scares Christians, as they automatically associate it with the atheist Sigmund Freud. The term, however, refers to multiple approaches in clinical psychology, many quite different from Freudian psychodynamics. According to the medical literature, cognitive-behavioral therapy and interpersonal therapy are most effective in depression, but other methods also garner favor. 16 Psychotherapy and counseling can be crucial to keeping depression at bay. Studies show that antidepressants and psychotherapy have similar efficacy in treating acute depression, but after treatment ends , those who discontinue antidepressants commonly relapse. 17  By contrast, the benefits of psychotherapy persist long after treatment stops. Dr. Karen Mason, associate professor of counseling and psychology at Gordon-Conwell Theological Seminary, has witnessed this phenomenon firsthand. âThereâs a biological vulnerability that antidepressants address, but people are also dealing with social and behavioral issues that reinforce their depression,â she relates in personal correspondence. âYou might be on antidepressants alone for six months, and they help, but as soon as you stop them you become depressed again because patterns of thinking are still there.â In Dr. Masonâs experience, spiritual support can also be crucial to recovery. âPeople struggle through the lens of their faith,â she remarks. âIn depression, usually the person has a low sense of self-worth, and faith can influence this.â For the believer, our value in Christ, and as Godâs image-bearers, helps us sift past the shadows and cling to life. Whether we enroll in psychotherapy or use an antidepressant, our identity in Christ, and what God has done for us through the cross, remain central. A Multifaceted Approach For those of us with mild cases of major depression (as determined by a professional using validated instruments), itâs reasonable to begin with a trial of therapy or counseling alone, and to consider an antidepressant after several months if thereâs no improvement. But those with severe cases are at high risk for suicide. In such harrowing circumstances, the precaution of an antidepressant in addition to counseling can be lifesaving. Indeed, given the benefits of psychotherapy and antidepressants together, the American Psychiatric Association (APA) recommends combination therapy in moderate to severe cases of major depression. 18 The APA further recommends that sufferers who improve with antidepressants continue these medications for four to nine months after a first episode, as the risk of recurrence is high before this period. For those who have endured three or more major depressive episodes, the APA recommends continuing an antidepressant for life . Such recommendations can unnerve us. We might worry about addiction, and question the strength of our faith. We read headlines announcing that primary care physicians now prescribe 40% of antidepressants, often without documenting a psychiatric diagnosis, and we wonder if weâre aiding an epidemic of self-medication to numb the ordinary ripples of life. 19 Before we chastise one another, consider that while half of people recover from a first episode of depression without further issues, after three episodes the risk of recurrence approaches 100%. 20  In chronic and recurrent depression, maintenance antidepressants donât imply addiction, but rather a vital precaution to safeguard against future episodes. Addictive drugs produce euphoria, sedation, or other states that veer from reality and dishonor God (1 Corinthians 6:19â20). Our craving for such substances never abates as long as we continue taking them. Few people, by contrast, covet antidepressants. About 60% of people who take an antidepressant complain of uncomfortable side effects, including diarrhea, nausea, vomiting, insomnia, drowsiness, weight gain, sexual dysfunction, and anxiety. 21  Given these unpleasant effects, the dropout rate for antidepressant therapy is high, with many stopping the medications before their depressive symptoms resolve. 22  Addiction isnât even an appropriate consideration. When used wisely in severe depression, antidepressants donât offer an escape from suffering, but rather equip us to contend with it. When used with discernment, these medications can root us in reality, and help us to focus with clarity on our risen Lord. Becky, who shared her experiences at the start of this article, emphasizes their role with this point: âThis issue has kept a short tether between the Lord and me as I seek him and stay in his word â I know I must!â Depression and Christian Suffering Even when we grasp that major depression isnât normal sadness, we can still struggle with misconceptions that depression is somehow âun-Christian.â âHow can a believer like me struggle with depression when I have the gospel?â one sufferer asked me. Another admitted, âI feel like there must be something wrong with me and my alleged âfaith.â I end up chastising myself for not having the kind of faith that would lead me out of this depression.â Such comments echo those of Dr. Beverly Yahnke, executive director of The Lutheran Center for Spiritual Care and Counsel: Far too many well-intentioned Christians are imbued with the conviction that strong people of faith simply donât become depressed. Some have come to believe that by virtue of oneâs baptism, one ought to be insulated from perils of mind and mood. Others whisper unkindly that those who cast their cares upon the Lord simply wouldnât fall prey to a disease that leaves its victims emotionally desolate, despairing and regarding suicide as a refuge and comfort â a certain means to stopping relentless pain. 23 An assumption common to such doubts is that gospel hope should guard us against maladies of the mind. But such assertions lack both empathy and biblical grounding. Christ has triumphed over death (1 Corinthians 15:55; 2 Timothy 1:10), and when he returns, all its wretched manifestations will wash away (Isaiah 25:7â8; Revelation 21:4). But for now , we still live in the wake of the fall. We must never mistake the Christian life for a prance through a garden path. Jesus warns that persecution will follow us into the world that has rejected him (Matthew 16:24â25; John 1:10â11; 15:20). All creation groans (Romans 8:22â28). Sin still seethes across the globe, stirring up calamity, infiltrating the synapses in our brains to tangle our thoughts and feelings. Our Savior himself was a man of sorrows, acquainted with grief (Isaiah 53:3), even though he shared perfect communion with the Father. While sin stains the world, even those most devoted to Christ can sink into despondency. The gospel doesnât promise us freedom from pain, but an abundantly more precious gift: the assurance of Godâs love, which prevails  over sin and buoys  us through the tempests. Christ offers us hope that transcends the crooked wantonness of this broken world. Suffering can bear down on us. Depression can crush even the most faithful among us. But in Christ, nothing can separate us from Godâs love (Romans 8:38â39). The Source of Our Hope Christians should feel empowered to consider medical treatments â whether antidepressants or otherwise â as blessings, given by God as evidence of his mercy. We clearly see from Jesusâs ministry that healing displays the Fatherâs love for us (Mark 1:40â41; 3:1â5; Matthew 8:1â3; John 9:1â7). Prophets and apostles also mention physical means of healing as instruments to nurture the hurting (Isaiah 38:21; 1 Timothy 5:23). Perhaps the best example is the parable of the good Samaritan, when the passerby stops to tend to an injured manâs wounds with bandages, oil, and wine (Luke 10:25â37). Such passages should chase away our guilt if we require antidepressant medications as part of a multifaceted, prayerful approach to depression. And yet, while we partake of these ordinary means of grace, they cannot offer us the renewal we find in Christ. We quench our parched souls only from the living water that springs from the gospel. Weâre right to accept medical advances for what they are â blessings from God, gifts to help us heal and prosper. While we seek treatment, however, we must still turn our eyes toward God (2 Chronicles 16:12). The need for a heavenward gaze does not limit itself to depression, but to any ailment of mind, body, or soul. As Christians we cleave to a hope that far exceeds any protocol or prescription. Whether we use medications or not, a vital response when we sink into despair is to pray and to meditate as best as our clouded minds permit on his living and active word (Philippians 4:6; James 1:5; Hebrews 4:12). When we kneel before our Lord in humility and supplication, and with palms open lift our burdens to him, he draws us near (Psalm 34:18), even as we struggle through the avenues of medications and counseling. In the coming age, our Savior will chase away the specters that loom over creation (Revelation 21:4). In the meantime, we take comfort that he too has walked in darkness. He too has endured deep suffering, not from brain circuitry gone awry, but willingly, for our sake, out of abundant love for us (John 3:16). And to that truth we cling, even when the shadows descend, even as we labor through medications and therapy, and breathlessly scramble for the light.