of Intermediate Biblical Counseling. It is a great joy to meet in this online community and to continue our study of God's Word. I trust that you are doing well and that your life is filled with the blessings of Christ, and it's just a great privilege to be able to study God's Word with you.

I want to thank you again for your faithfulness to our time and to our training. I just received last night an e-mail from one of our counselors in training, Coral Castro. She let me know that she just received an e-mail from ACBC, telling her that she just passed the ACBC written exams, both the theology and the counseling exams, and she is now clear to start phase 3 of ACBC certification.

That's a great joy to hear, that news just thrills my heart, and it was our privilege last year to go through this material together pre-COVID. It's just a joy to see counselors move through this training and show themselves faithful. You all are a great joy and encouragement to me as you work your way through this material.

I pray for God's blessing upon your study of God's Word and trust that this will be a fruitful time of study for all of us. Well, tonight we are looking at a very important topic in the ACBC counseling exams. We're looking tonight at counseling exam number 5, which is the topic of dealing biblically with depression.

Dealing biblically with depression. Just to prime the pump for our study tonight, as many of you know, I've been a Christian now for almost 30 years. Looking back over the years, there have been two seasons in my own Christian life where I can remember, I did battle with some type of depression, some form of depression.

Thankfully, that's not been something that goes on all the time, but there have been two distinct seasons in my own Christian life where I have battled with some form of depression. I suppose John Bunyan would describe this as the Christian walking through the slough of despond in his classic work, The Pilgrim's Progress.

Whatever you might call it, I've experienced this where intense discouragement and sadness led to a type of depression where it was difficult to function in everyday life. I remember the first time I was battling with the slough of despond. I heard a sermon from one of the pastors that I looked up to greatly.

In that sermon, near the conclusion, this pastor mentioned that he himself had battled with a season of depression and with God's help, and he was able to move past that. I didn't know who to talk to, so I emailed this pastor, and he graciously offered to meet me at Panera Bread.

I'll always remember what he said to me. He said, "Dan, since I gave that sermon and just briefly mentioned my own struggle with depression, I have gotten more phone calls and more requests to meet for counseling than any other sermon that I have given. All of a sudden, there are all these people coming forward in my life saying, can you talk to me and help me move past this issue." I think that's just an illustration of how common this struggle is.

Oftentimes, people don't know who to talk to. They don't know where that they can find help. We know that some Christians are more prone to struggle with depression. They may have a bent towards a melancholy personality or a proneness to pessimism and they need to battle for joy in the Christian life.

Other Christians may spend most of their spiritual lives doing just fine and just rejoicing in the Lord and finding great peace in Christ. But in certain specific seasons of life, they may find themselves walking through the slew of despond, walking through a great season of discouragement and sorrow that may lead to a form of depression.

We do know that depression is very common in the world today. It is very common in society. If you do a survey on the Internet, you'll find that even many celebrities in our societies, men and women who have everything that you would think that they would want in life, health, and wealth, and fame, that they do struggle with depression.

We note that antidepressants are one of the most commonly prescribed medications in our society today. C.H. Spurgeon once said, "I'm the subject of depression so fearful that I hope none of you ever get to such extremes of wretchedness as I go to." How many of us are going to be brave enough to say that Spurgeon struggled with depression because he wasn't godly enough or because he didn't read the Bible enough?

I do believe in reading Spurgeon's biography that one of the contributing factors to his depression may have been just overworked, just overtaxing his body, moving his work capacity past the point of physical exhaustion. As we'll see in our study tonight, that is a contributing factor to depression. But the point is that even godly saints of God, even great spiritual men and women of the faith can struggle with a form of depression.

I never counsel anyone who came into the counseling ministry saying, "Dan, my struggle is I just have too much joy," or "Dan, my struggle is I just have too much hope." But I have counseled with many who struggle greatly with depression. In many cases, these are saints of God whom I greatly respect and greatly am encouraged by that these are faithful servants of the Lord, and yet there is just the recognition of this struggle.

Many of you know that I just completed my doctor of ministry project on the subject of midlife crisis, which is a struggle for many men and a struggle for many women as well. I took the position and perspective that midlife crisis can be a form or a type of depression that is experienced by many in midlife, spiraling down of thoughts and emotions that lead to a person living in despair.

My wife Mina did a session for the mops group at our church. Mothers of preschool children is the group, and she taught on the subject of postpartum depression, which is a form of depression that many mothers experience. We need to be wise in how we handle this topic. We need to think through this issue with biblical discernment.

We need to be careful in how we handle the subject of depression because we are ministering to souls and they deserve our utmost care and compassion. I trust that tonight's teaching will be a help for you not only to write this essay, but to minister to those who are battling in the slough of despond and to help them have hope and to fight for joy.

We're going to need God's help to get into our studies. Let me pray for us briefly and we'll dive into our handout for tonight. Let's pray. Father, we thank you for your mercy and your compassion. We thank you that you are near to the broken-hearted. We thank you that you walk with us through the valley of the shadow of death, that you never leave us or forsake us.

We thank you for Christ, our great savior, who is the one who is our faithful shepherd, and will guide us through every season of life. We pray that as we look at the subject, that we would be biblical, that we would be pastoral, that we would be practical, that you would help us to think carefully and deeply, that we might be of the most help to those who are in need.

We thank you for this time. Thank you for each student who's joined us for this class. We pray this in Jesus' name. Amen. Amen. Well, let me just read the question for tonight. We're looking at counseling exam number 5, and the question is this. Provide a biblical definition of depression.

Describe manifestations of depression in both the inner and outer man. Explain the biblical factors that drive depression, and detail several biblical strategies to respond to depression. This is a very practical topic, and one, as I mentioned, that is worthy of our careful consideration. On page 1 of your handout, I do have some resources that I want to recommend to you.

I would recommend that you get the book Spurgeon's Sorrows by Zach Eswine. That's a compilation of Spurgeon's quotes and comments on the subject of depression. Admittedly, this is not a study of biblical texts, so please be judicious in how you would use that resource in your essays. I do remember one essay coming back because the student used a number of quotes from Zach Eswine's Spurgeon's Sorrows, and the grader wanted to see more scripture in the essay.

It's not a study of biblical texts, but it is a book that is very insightful because it helps us see Spurgeon's own battle with depression and how he fought for joy in the midst of his struggle. It is a book that is filled with comfort. We have this in our counseling library, in our counseling ministry, and I give this out just as a word of encouragement and comfort to anyone who struggles, that even the best of Christians have battled with depression in church history.

One of the books that's helped me understand this issue is Charles Hodges, Good Mood, Bad Mood. Dr. Hodges is a medical physician and he's also a certified biblical counselor. He set out to study the issue of bipolar disorder, and he ended up doing a study on depression. Manic depression is a form of depression where the depressed state alternates with a period of high energy, otherwise known as the manic period.

This type of depression has been relabeled bipolar disorder in secular language, and Hodges set out to do a study of manic depression or bipolar disorder, and he ended up doing a larger study on depression. So this is a very helpful work. I would recommend it to you. I would especially recommend reading Chapter 5, which is worth the price of admission, in which Hodges does a discussion on the distinction between normal sadness in the Christian life and depression, or what the secular world might call depression.

That's a distinction that I want to talk through a little bit tonight in our study, but if you want a fuller discussion of that, read Chapter 5 of Charles Hodges' work, Good Mood, Bad Mood, Help and Hope for Depression and Bipolar Disorder. Then you have Martin Lloyd-Jones' Spiritual Depression.

Lloyd-Jones commented that this work on spiritual depression is one of the most popular things that he ever wrote, which again shows how common this issue is even among believers in Christ. In this book, Lloyd-Jones makes the great statement, "Don't listen to yourself, talk to yourself," expounding upon the theme of Psalm 42 and 43.

"Why are you cast down, oh my soul? Hope in God, for I shall again praise him." This is a classic work. It's well worth your time. It's excellent. It's been used in many Christians' life. Do get your hands on Martin Lloyd-Jones' Spiritual Depression. Then I've listed a couple of works by the faculty of the Master's University, Wayne Mack's Out of the Blues, dealing with the blues of depression.

Anything by Wayne Mack is worth buying and worth reading. Then Dr. Robert Somerville has a book that's entitled, If I'm a Christian, Why Am I Depressed? It's interesting to note that Dr. Somerville wrote that book after dealing with his own battle with depression. That's a very personal book for him and one that has ministered to many.

If I'm a Christian, why am I depressed? Then you probably want to highlight and star Ed Welch's book, Depression, Looking Up from the Stubborn Darkness. That's a fantastic read. It's probably one of the first things you should read on this subject, and I would encourage you to have Ed Welch's book on your bookshelf.

You will consult it often. There are two lectures that I would recommend to you near the bottom of your handout. Jim Neuhauser's lecture on depression at the IBCD website is excellent. One of the best one-hour teachings out there on the subject of depression. Then Tom Maxim is also part of IBCD, and he has an excellent lecture that's entitled, Gospel Rest for Depression Symptoms, Causes, and Cures.

Both are fantastic. They are very well done, biblical and pastoral, helpful, and clear. I would encourage you to make use of those resources. Those two lectures are free and on the IBCD website. Now, with that said, let me move you to page 2 of your handout for tonight, and let's look at a definition of depression that I think will be helpful for our understanding.

Gary Gilley has a work that's entitled, A Look at Depression Through the Lens of Scripture, and that's available on his website, and I'll quote from it here. He says, "We may define depression as that debilitating mood, feeling, or air of hopelessness, which results in a ceasing of the handling of life." Depression is that debilitating mood, feeling, or air of hopelessness, which results in a ceasing of the handling of life.

That's one of the best concise definitions that I have come across, at least from a biblical counseling perspective. Depression is more than normal sadness. Depression is more than the feeling of discouragement. The distinguishing mark of depression is what he says at the end of that definition, a ceasing of the handling of life.

In depression, a person shuts down. He or she ceases to handle daily responsibilities, and this is seen in both the secular and biblical descriptions of depression. From a secular standpoint, the DSM-IV has these nine characteristics of depression, a depressed mood most of the day, markedly diminished interest or pleasure in all or almost all activities most of the day, significant weight loss when not dieting or weight gain, insomnia or hypersomnia nearly every day, feeling physically restless or slow to an extent that is observable to others, fatigue or loss of energy nearly every day, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate, and recurrent thoughts of death and/or suicide.

You will note that a number of these characteristics center around the fact that the depressed person ceases to handle the responsibilities of life. He or she has a diminished interest in activities most of the day, and there's fatigue or loss of energy nearly every day. Now, that's from a secular perspective to be sure, but as we have noted, secular psychology can make accurate observations about how people behave.

When I read the DSM-IV, I look at these characteristics or expressions or behaviors, and I would conclude that people do behave in these ways. What secular psychology cannot do is rightly interpret why people behave the way that they do, but when the DSM-IV says people tend to behave in this way, the secular resource can make accurate observations about human behavior.

So, I don't doubt the fact that people do experience these struggles. From a Christian perspective, this isn't on your handout, but Dr. Somerville has spoken of his own experience with depression, and this is as a Christian, he writes, "With depression, there is a numbness and complete lack of positive feelings about anything.

Guilt and feelings of worthlessness consume you. Your conscience works overtime in convicting you. Everything is negative. A minor problem becomes major as you imagine the worst possible outcome. Your mind is drawn to your saddest memories, the record of your own sins, failures, and disappointments. Negative thoughts crowd out all happy ones." He goes on to talk about the fact that when he was depressed, the work that once took minutes to complete now took hours as he walked through this season of life.

And that does square with the secular description of depression. You will note that the depressed person has difficulty fulfilling the responsibilities of life. And so, we have to think through that. Now, from a biblical perspective, and I'm borrowing from Gary Gilley's helpful list here, here are some biblical descriptions of depression on page one.

And I've also put this on the screen for your viewing. You have gloom and pessimism. Psalm 32, verse 3, David says, "For when I kept silent, my bones wasted away through my groaning all day long." You have apathy and fatigue. Psalm 32, verse 4, David says, "For day and night, your hand was heavy upon me.

My strength was dried up as by the heat of summer." Now, in the case of Psalm 32, David was experiencing a type of depression that was the result of sin in his life, that he needed to confess sin and repent of sin. And when he repented of his sin, he experienced God's joy and peace.

And so, this type of depression can result from unconfessed sin or sin that is not repented of. But we want to quickly add the balancing comment that not all depression is due to sin. Some depression comes from physical causes. I've mentioned previously in our year one training that I don't want to be quick to charge a counselee with sin and then find out later that this counselee had the condition of hypothyroidism, which causes sluggishness and a depressed mood.

That would be an example of being a miserable counselor to charge someone with sin when I don't know if the issue is due to sin. But we do find an example here in David's life where his depression was due to unconfessed sin. And so, if I'm walking with a counselee through a dialogue and I find that there is a sin that needs to be repented of, then that is a time to address that biblically.

But again, what I'm pleading for here as we consider this topic of depression is really to handle this topic carefully, to be balanced, to be wise, to not make hasty conclusions, to survey the breadth of scripture and understand all that the Bible would say on this topic. If I could put it this way, it's time to play chess, not checkers, as we deal with this issue of depression.

Don't make oversimplistic judgments and just think in terms of red checkers and black checkers, but see the whole board and see that there are different nuances of what the scripture says on this topic, and then learn to minister to the person in front of you with careful wisdom and biblical discernment.

And God will give you help in doing that if you are diligent to search His Word and to pray for His wisdom. We have the description of hopelessness, Psalm 38, verse 2, "For your arrows have sunk into me and your hand has come down upon me. There is no soundness in my flesh because of your indignation." Here we see that depression is both a spiritual battle and a physical battle.

The Psalmist says, "There is no health in my bones because of my sin. For my iniquities have gone over my head like a heavy burden. They are too heavy for me." I want to present to counselees who may feel overwhelmed, not only by life's struggles, but also by their sin.

And they might be depressed because of an overwhelming sense of guilt in their life, that they don't even know how to start confessing their sins because they're experiencing somewhat of what the Psalmist is saying here. "My iniquities are over my head. They are a heavy burden." And as biblical counselors, we need to be equipped to minister Christ and to tell our counselees of Christ, the mighty Savior, whose grace is even greater than all of our sins.

I want to plead with you in this session to be Christ-centered and to be grace-centered and to minister the hope of the gospel to those who are depressed. And so even when depression is the result of sin, we can minister the good news of Christ and show his mighty work on the cross.

And secular psychology cannot do that. No secular therapist can minister the hope of the gospel to a counselee who is hurting with the issues of life. You have physical problems. The Psalmist says in Psalm 38, verse 5, "My wounds stink and fester because of my foolishness. I'm utterly bowed down and prostrate all the day.

I go about mourning for my sides are filled with burning and there is no soundness in my flesh. I'm feeble and crushed. I groan because of the tumult of my heart." Boy, the Bible just connects with real life, does it not? Depressed people can experience physical pain. There is sleeplessness.

There is irritability. Even though we as biblical counselors are not anti-medication, we don't put people on medication and we don't take people off medication. We are not physicians. We do note this observations that even when psychotropic drugs may have a desired effect that they oftentimes come with side effects.

And many counselors want to get off their medications because they don't like how the medication makes them feel. Now, we want them to have that conversation with their doctors. But we just want to note for purposes here that depression can result in physical problems, that we are spiritual and physical.

We are soul and body and that what affects us spiritually also affects us physically. Very importantly, I want you to note the description of withdrawal. Oftentimes, isolation and depression goes hand in hand. We find oftentimes in counselees who are depressed is they're not going to church. They're not going to small group.

They're not engaged in fellowship. They're not praying for others and they're not sharing their prayer requests with others so that others can pray for them. They're not engaging in relationship. And so the question is, what comes first, the chicken or the egg? Did the isolation cause the depression or did the depression cause the isolation?

Ultimately, the two issues are not helping each other. And so we need to get counselees back into relationship. And then there is the feelings and the knowledge of guilt. Psalm 51 verse three. Some counselees do spiral down into a place of despair because of unresolved guilt in their lives, whether that's sins that have occurred in the far past or sometimes it is sins that have occurred in the recently.

Some counselees are perfectionists, and so they always live with a low level of guilt in their lives. And this sense of guilt can accumulate in their life until the counselee says, well, what's the use? Why go on? Why even try? God will never be happy with me. He'll never be pleased.

And so depressed people need the gospel. They need to hear of the matchless grace of Christ. Depressed people need to hear the great news of Romans eight verse one, that there is no condemnation for those who are in Christ Jesus. That if they believe in Christ, they're justified. They're declared to be righteous because of Christ's perfect work on the cross.

Depressed people need to hear that God has promised never to leave them or forsake them. They need to hear the great promises of the gospel that Jesus Christ is a mighty savior. He is also a tender shepherd who is able to deal gently with them, that he will be faithful to them as they walk through this valley.

Depressed people oftentimes struggle with sleeplessness or restless sleep. The psalmist says in Psalm 42 verse three, my tears have been my food day and night. While they say to me all the day long, where is your God? He's not crying himself to sleep. He's crying in the night, hoping to get some sleep.

Insomnia is difficulty sleeping and it oftentimes accompanies the experience of depression. We mentioned a loss of productivity is a mark of depression, a ceasing to function with the daily responsibilities of life. Again, at some point you ask the question, which came first, the chicken or the egg? Is it are you depressed because you are not fulfilling your responsibility?

Are you not fulfilling your responsibility because you're depressed? The two issues tend to go together and feed into one another. And so we need to try to break that cycle with our counselees. And then there can be thoughts of death or suicide. 1 Kings 19 verse four, that was Elijah.

Where it says that he himself went a day's journey into the wilderness and came and sat down under a broom tree. And he asked that he might die saying, it is enough now, oh Lord, take away my life. I'm no better than my father's. So in ministering to depressed people, you do want to acquaint yourself with the issue of how to handle temptations to suicide.

Paul Toshkis has a good blog post on this. He gives the acronym SLAPDIRT, which we'll go over at the end of this session. And it's just a way of assessing the severity of a counselee's thoughts or temptations to self-harm and even suicide. That's a whole topic in and of itself.

But we do need to consider it in relation to ministering to the depressed. My counsel simply is be ready. Apply basic biblical counseling principles. Apply the things that we taught you in year one of this training. Enter the counselee's world. Be compassionate. See life through their eyes. See the temptations and discouragements from their perspective.

Make the counselee aware of resources that he or she can avail themselves of. It's not your responsibility to overcome the counselee's temptations for them. But it is your responsibility to make them aware of resources that they can avail themselves of if they are tempted in any way to self-harm or suicide.

But just note briefly that this is an issue that we need to think through in relation to depression. You have on page one of physical and spiritual symptoms of depression. Under physical, you have loss of energy, insomnia, too much sleeping, dulled senses, changing appetite or weight, high blood pressure, various illnesses, headaches and body aches, lowered sex drive.

Under spiritual, you have a soul lacking joy and peace, trouble working and making decisions, restlessness, believing lies, I'm worthless, God is punishing me, self-focus instead of God focus, spending less time in the word and prayer, forsaking the assembly, church attendance, inappropriate guilt or shame, and doubting one's own salvation.

That's not an exhaustive list, but it is a framework to understand depression and to understand what your counselee is going through. You always want to be thinking in terms of physical and spiritual, in terms of material and immaterial. You want to be thinking in terms of body and soul and realizing that the physical and the spiritual are always relating to each other and interacting with each other.

Sometimes it's difficult to know where one begins and the other ends, but it is a helpful basic framework to minister to the depressed. This isn't inspired, it's just practical. When I counsel people who are struggling with depression, I like to start with the physical and then move to the spiritual.

You don't need to follow that same pattern, you can mix and match or you can follow the spirits leading in that, but generally speaking, I like to find out what's going on physically and then move to what's going on spiritually. Is the counselee sleeping? Is the counselee eating? Have they seen a good physician?

Are they on any new medications? Are they overworking? Are they over scheduled? Is there a certain stressful season going on in this person's life? Sometimes the counselee is like Elijah, he doesn't need a lecture. He doesn't need to be told that he needs to repent of his sins. He doesn't have a sin issue in his life.

He may be like Elijah, he just needs to sleep. He just needs to rest and he needs to eat a good meal and he needs to be nourished. And I just like to ask those questions, what's going on physically before we move to what's going on spiritually. I remember when I was a brand new Christian and I was going through something that was really sad and my small group leader heard me and took me out to Korean food and that wasn't biblical counseling, but I guess it was the next best thing.

Sometimes counselees just need to eat. They just need to exercise or they need to sleep or they just need some time off from their stressful job. They need to walk or engage in some kind of physical activity. So you always want to be thinking in terms of the physical and spiritual.

Once I've asked questions about the physical, I can then move to the spiritual. Is the counselee reading the Bible? Is he praying? Is he going to church on Sundays? Is he engaged in relationship in the local church? I can ask questions that draw out the thoughts and intentions of the heart.

Is there unresolved guilt? Is there a relationship that needs to be reconciled? Is there bitterness in the counselee's heart toward a person who has sinned against him? Is there a misunderstanding of the character of God? Does the counselee need to receive gospel comfort or to be assured of the promises of God in scripture?

Usually the answer to that last question is yes. Whether the counselee is depressed or not, the counselee needs to receive gospel comfort. And so we look to sermons and books and devotionals to give to the counselee that will soothe the soul. And we want counselees to walk with their shepherd.

The devotional "Besides Still Waters" by C.H. Spurgeon is a very helpful devotional that we have in our counseling library and that we give out to many who are struggling with the issues of life. Also, C.C.E.F.'s devotional "The Heart of the Matter" has been used by our counselees to great blessing and great effect.

And so these are just good books and devotionals that bring comfort to the troubled heart. And so moving from the physical to the spiritual and then back to the physical, it's just a helpful framework to think through this issue. Now with that said, let me move to page three of your handout.

And I have the category of "Carefully Thinking Through the Issue of Depression." If I were to give an encouragement to you as counselors in training, I would ask you to circle and star the word "carefully." Let's carefully handle souls. You'll see in this discussion that we can be imbalanced in different areas.

We can go to the imbalance of only addressing the physical issues and not addressing the spiritual. Or we can be imbalanced on the other side of neglecting the physical and only focusing on the spiritual. We can place not enough emphasis on going to see a medical physician or we can place too much emphasis on going to see a physician.

We just need to be careful and balanced. And ultimately, what my purpose in teaching this to you today is I want to lay before you a foundation. And then you need to take this foundation and do your own study. And when you are given the opportunity to counsel a counselee who is wrestling with depression, you need to minister to the person in front of you.

And that person will be unique. That person will have unique temptations and unique struggles. And you need to pray for wisdom and ask God to lead you and depend on the Holy Spirit of God and depend on the word of God as you have studied it. And then love and minister to the person that is in front of you.

And so we just want to be careful in how we handle this topic because we want to be careful in how we handle souls. And so how do we carefully think through this issue? Well, letter A, I would just lay before you in understanding that depression is an issue in the church.

Christians do struggle with depression. It's not just a struggle for unbelievers. It's a struggle experienced by believers as well. Read church history and you will find even great saints of God who struggled with this issue. I think it just highlights the fact that we live in a broken world, that we are finite, and that we are possibly weaker than we think ourselves to be.

And we just want to not be surprised when people in the church come to us for counseling and they share of their struggle with depression. Scripture speaks to this issue with great compassion and clarity. You see the example of Job in Job 7, verse 3, who endured great suffering.

And sometimes people will go through a season of depression after a great loss or after a great season of suffering. And Job said, "I'm allotted months of emptiness and nights of misery are apportioned to me. When I lie down, I say, 'When shall I arise?' But the night is long and I'm full of tossing till the dawn.

My flesh is clothed with worms and dirt. My skin hardens, then breaks out afresh. Our days are swifter than a weaver's shuttle and come to their end without hope. I loathe my life. I would not live forever. Leave me alone for my days or a breath." So just the intense struggle there with despair after going through a great season of suffering and still being in that season of suffering.

Psalm 88, verse 3 is a go-to psalm when ministering to those who are depressed. The psalmist says, "For my soul is full of troubles and my life draws near to Sheol. I am counted among those who go down to the pit. I'm a man who has no strength. Like one set loose among the dead, like the slain that lie in the grave, like those whom you remember no more.

For they are cut off from your hand. You have put me in the depths of the pit and the regions dark and deep. Your wrath lies heavy upon me and you overwhelm me with all your waves." And we're waiting for the uplifting conclusion to the psalm which never comes.

The psalm ends with this statement in verse 18. "You have caused my beloved and my friend to shun me. My companions have become darkness." So just a note here that depression is an issue that sometimes takes a long time to resolve. It's not easily solved. Sometimes the depression will even be a struggle that is a lifelong battle.

Sometimes there are Christians who don't struggle with depression for years and they then experience an injury or some kind of traumatic loss. And for the rest of their lives, this becomes a lifelong struggle. And by the way, we want our churches to be hospitals for the sick. We want our churches to be hospitable to those who are struggling and those who are weak.

I would love to place a banner over my church. I don't think they'll let me here, but I would love to do it. Just put a banner over the sign of our church saying, "Depressed people welcome here." Because we have hope and help to offer for the word of God.

If your church is only bringing in healthy people, then why do we need the great physician? We want to be equipped on this subject because this is what we want our churches to be. We want them to be hospitals for the sick. I mentioned Spurgeon's battle with depression. He said, "Personally, I know that there is nothing on earth that the human frame can suffer to be compared with despondency and prostration of mind." William Cooper wrote the hymn, "God Moves in a Mysterious Way." He struggled all his life with despondency and despair.

He said, "I was struck with such a dejection of spirits as none, but they who have felt the same can have the least conception of. Day and night I was upon the rack, lying down in horror and rising up in despair." Very interestingly, John Newton, who wrote the hymn, "Amazing Grace," was the pastor to William Cooper.

Newton ministered to Cooper his entire life. For years, he displayed great patience and kindness and walked with Cooper through his struggles with depression. Dear friends, God is going to give you, many of you, this type of ministry. Just a long-term friendship and counseling relationship with one who struggled with depression will never fully be resolved until glory.

And yet, God is going to bless your ministry and going to use you to bring encouragement to a believer in Christ. Martin Lloyd-Jones said this on the subject of spiritual depression. It is interesting to notice the frequency with which this particular theme is dealt with in the scriptures. And the only conclusion to be drawn from that is that it is a very common condition.

So we need to recognize that this is an issue in the church. Don't be surprised. Be equipped. Be ready. I don't know how you could become an ACBC certified biblical counselor and then never counsel anyone who struggles with depression. And especially if you learn to tenderly and compassionately minister to people's souls, there will be many who need your help.

And God will use you. So just understand that this is an issue in the church. Letter B, we want to carefully think through distinguishing depression from normal sadness. Now this is very practical. Let's say a person comes in for counseling and he says he's depressed. He may have gone to a doctor and the doctor has measured his behaviors up to the standards of the DSM-IV, given him a clinical diagnosis of depression, and placed him on antidepressants.

And the person comes in for biblical counseling. I find out in the counseling process that the counselee has just lost a job that he loved or is grieving the loss of a loved one. And the truth is that in this scenario, it may be, and again, we want to be careful with this, but it may be that the counselee is not actually depressed in an abnormal sense.

But it may be that the counselee is just experiencing normal sadness, normal grief, the sorrows which are part and parcel of living in a fallen world. And we need to distinguish depression from normal sadness. It is normal to grieve. It is normal to experience. Even great sadness is normal in the Christian life.

Jesus was a perfect man. He was the only perfect man who ever lived, and he is known as the man of sorrows, well acquainted with grief. That is normal. If the loss is large, then it is normal for the sorrow to be intense. And it is even normal for the sorrow to be prolonged.

Again, I want to reference chapter 5 of Charles Hodges, Good Mood, Bad Mood. I would encourage you to read that chapter. Hodges notes that sadness and grief are normal in life. Genesis 23 verse 2, Abraham went in to mourn to Sarah and to weep for her. It would have been abnormal and ungodly for Abraham to lose his wife Sarah and not to mourn and not to experience sorrow and grief.

2 Samuel 18 verse 33, the king was deeply moved and went up to the chamber over the gate and wept. And as he went, he said, Oh, my son, Absalom, my son, my son, Absalom, would I had died instead of you? Oh, Absalom, my son, my son. There is an intensity to the emotions and the sorrows of life.

And that intensity is justified when the loss is large. I do understand when families in the Christian world want to call the service celebration of life service instead of a funeral service. But I do get concerned that possibly we are not giving people permission and space to grieve our loss.

It is good to celebrate life and it is also good to mourn our loss that is natural, that is biblical, that is part of life. Acts 8 verse 2, devout men buried Stephen and made great lamentation over him. And so we say, well, you know, Stephen's in heaven, so let's all just be happy.

It was an appropriate emotion to lament over the church's loss. And so Hodges says that normal sadness is something that happens to us when we lose something very important to us. It doesn't have to be a loved one. It can be a relationship. It could be a job. It could be an opportunity that was lost or it could even be a ministry that is concluded.

We lose something that is important to us and we feel sad. And dear friends, people need to hear that that's normal. They need to hear that Jesus is going to meet you in your sorrow. He's going to meet you in your sadness. You don't have to clean yourself up.

You don't have to get over it before Jesus is going to minister to you. He is a sympathetic and merciful high priest. He will walk with you in your sorrows and eventually, not immediately, but over time, he will turn your sorrows into joy. But in the meantime, there is normal sadness.

Hodges writes that the intensity and duration of our sadness corresponds to the size and duration of the loss. There are some losses, friends, that we never get over. We never turn the page. We learn to live with the sorrow. We learn to be sorrowful but always rejoicing, as Paul said in 2 Corinthians 6, verse 10.

We learn to have hope in the midst of sorrow. We learn to trust God. We learn to confess that he is faithful. We confess that through tears. We learn to look to that which is eternal and lasting. We are comforted by the promises of God but we just don't get over it in terms of nothing ever happened.

The intensity and duration of our sadness corresponds to the size and the duration of the loss. Now, if you have someone mourning greatly over a loss that is small, then you do have to do some heart work there. If you have someone, for example, who's mourning for years over a beloved car that may have gotten dinged a number of years ago, you might have to do some heart work there and ask the question, "Does that person need to reevaluate their priorities?" Sadness and sorrow are normal in life.

Normal sadness goes away when the problem goes away. That is, it corresponds to the situation or the circumstance. So what is depression? Zach Eswine says it helpfully. Depression is ordinary sadness that gets stuck. I think that's a good description. You see, friends, normal sadness needs to be expressed to God.

We have the Psalms of lament given to us in God's Word to help us express our sorrow to God. God is near to the brokenhearted. Those who are sorrowful need not be ashamed. They can come boldly to the throne of grace and find God's presence and His comfort. But depression is where normal sadness leads to unbiblical thoughts and unbiblical attitudes, unbiblical perspectives, and leads a person away from God instead of leading a person into the presence of God.

There is a spiraling down of a counselee's thoughts and emotions away from God. So we just need to distinguish depression from normal sadness. Now Hodges makes the helpful observation that I'll just note here that the DSM categories are so broad that they are unable to distinguish between normal sadness and depression.

Going back to the DSM-IV and the criteria for depression, if you look at this list, the nine characteristics of depression, these are broad enough that a person may just be experiencing normal sadness due to a large loss and just normally grieving, but it is possible that this person will receive a diagnosis of clinical depression and then be placed on antidepressants when they really just need to be taught to express their sorrow to the Lord.

Again, every case is different. I'm not saying that's true for everyone. I'm saying that's possible. One of the possible scenarios that a person needs to be taught how to biblically grieve, how to biblically lament, but instead has been diagnosed with depression because he or she measures up to some of these criteria in the DSM-IV.

You can actually experience as two of these criteria and be diagnosed with a minor depressive episode. That's just a concern that we would have that the diagnosis of depression is made too early and medication may be prescribed too quickly. Again, the goal is to think carefully about this issue and then to think carefully about the person that you are ministering to.

Now, letter C under carefully thinking through the issue of depression on page four, the issue of medications in a balanced manner. I'm going to move quickly through this. This is some of the review of the material from year one, but I think it's just helpful to insert this here that we want to be balanced in our understanding of medications.

One extreme view is that Christians should never take psychotropic medications. The other extreme view is that psychotropic drugs are the only answer for Christians. We have proposed a balanced view in year one, the commandment thou shalt never take psychotropic drugs is nowhere found in scripture. I don't want our counselors to make a standard that is not found in scripture.

Yet, do we have a concern that medication may be too quickly prescribed or overly prescribed? We do have a concern, but each case needs to be handled in a careful manner. We encourage our counselors to minister God's word to the heart. If your counselor or counselee wants to go off their medication, encourage them to talk to their physician about that issue.

Just really practically, I don't think I have in my counseling ministry told any counselee to go off medication or told any counselee to go on medication. I think the only time that I've had to deal with this issue is when a counselee wants to unwisely go off medication abruptly without consulting their physician and may go off medication too quickly in a way that their behavior then becomes erratic.

That's probably the only situation where I would give some counsel there or encouragement that you probably should see your physician. If you want to go off medication, then you should do that under medical supervision. Otherwise, I just minister the word of God, just give the word of God. If the person is on medication, that's not going to block the word of God from working in that person's heart.

I just try to stick to my responsibility, which is to be a minister of God's word. Now under letter D, discerning the physical and spiritual causes of depression, you have the physical causes of depression, side effect from medication, a true medical condition, poor dietary habits, lack of sleep, lack of physical exercise, physical exhaustion.

You have spiritual causes for depression, unconfessed sin, unresolved guilt, responding sinfully to trials, unbiblical thoughts and beliefs, functional unbelief in the truth of the gospel, relational isolation. And the main point here is to simply say that if a physical cause is the root of depression, then lifestyle changes and medical treatment are the remedy.

If there's a spiritual cause, then we have to address the heart issues with the word of God. The biblical counselor must be discerning not to give spiritual remedies for physical causes and physical remedies for spiritual causes, both, as you shall see, are unhelpful. If a person has hypothyroidism, as we have mentioned, then they need more thyroid.

They don't need to be told, "Repent of your sin." On the other hand, if a person has a real sin issue and unconfessed sin in his or her life, that person needs repentance and that person needs to confess his or her sin. They don't need to go exercise or to eat better.

They need to deal with their issue before the Lord. So you want to address the physical issues and the spiritual issues wisely. So let me end here with some practical encouragements for counseling those with depression. And this will be just some practical encouragements from our Counseling Center and some things that we have learned and that I want to encourage you with as you prepare for this ministry.

Letter A would be listen well and express Christ-like compassion. Let me encourage you to be a good friend to those who are depressed. What many depressed people need is a friendship or caring relationship. They've been isolated. They've withdrawn from relationship. And they do need an instrument of Christ to come into their life and love them well.

I think probably one of the things that I've learned is don't be excessively problem-oriented with someone who is depressed. Instead, be person-oriented. Love them well. Develop that relationship. Don't seek to simply and quickly deal with or solve the problem. Realize that depression can be stubborn. Conversations with depressed people can be difficult.

Understand that some do have a certain bent towards depression. They have a constitutional sadness. Understand that depression is suffering. Whether the depression is due to sin or the depression is due to some other cause, we know in all cases depression is suffering. So the entry gate is suffering. Show compassion.

Spurgeon said, "Especially judge not the sons and daughters of sorrow. Allow no ungenerous suspicions of the afflicted, the poor, and the despondent. Do not hastily say they ought to be more brave and exhibit a greater faith. Ask not why are they so nervous and so absurdly fearful. No, I beseech you, remember that you understand not your fellow man." John Piper's prayer was that God would raise up many John Newtons in our midst who would come alongside the William Coopers in our church and minister hope and help to those who are in need.

Letter B, adopt a grace-centered, Christ-centered approach to ministering to a depressed person. Dear friends, give them Christ. When you counsel with a depressed person, give this person Christ. Give them what secular therapy cannot give them, which is the person and work of Jesus Christ. Give them the hope that is found in the gospel of Christ.

Give them good news, the good news of the gospel. Paul said, "I'm not ashamed of the gospel for it is the power of God for salvation." Review the truths, the blessings, and the benefits of the gospel with your counselee that he or she is justified through faith in Christ because of his perfect work on their behalf.

A counselee is adopted as a child of God, that he or she has access into the presence of God, can come to the Father as a child comes to a loving Heavenly Father. I mentioned the first experience I had with a bout of depression where I went to one certain pastor and he told me of his experience and there was a second experience later on in my Christian life where another pastor who's very dear to me counseled me over the phone and counseled me with the truth of Romans 9.

Dan, don't forget that Christ will never leave you, that he has loved you in eternity past and he will love you in eternity future. And that was the truth that for me broke the cycle of depression and helped me to spiral back up to hope and to joy. You need to give good news to your counselee and review these truths with your counselees.

I mentioned the spiral of depression. It's just helpful to note that as Neuheiser comments, "Depression begins with a problem followed by a sinful response to that problem, which leads to a complicating problem. Hopeless thoughts lead to greater hopelessness." And so you do see a spiral here and this is from Elise Fitzpatrick's and Laura Henderson's work.

You see sad thoughts and feelings leading to a lack of desire to fulfill responsibilities, leading to more sad thoughts compounded by irresponsibility and the cycle goes down. And you will find that at some point you need to break that cycle. You need to help the counselee cycle back up.

Sometimes it's helping the counselee fulfill his or her responsibilities, whether they feel like it or not, and that can help break the cycle. Some counselees are even help when you give them homework that they need to serve other people in the church or that they need to engage in fellowship or go to small group or even get as specific as they need to stay after small group ends and learn the prayer requests of two to three people.

Sometimes those type of assignments help to break the cycle so that the counselee begins to cycle back up to hope and to joy. Sometimes it's a specific truth from God's word that is targeted toward a counselee specific thoughts of unbelief and despair. Whatever the issue is, the point is that there is a place where we need to help the counselee break the cycle downward and begin to spiral back up.

And so I mentioned a few helpful ways to do that. My last thought would simply be the issue of temptations to self-harm or suicide. And it really is an issue not to open up a whole other discussion, but I do need to bring this in at this point because I just don't want any counselor in our ministry to be fazed by this or to be unprepared.

I wish I had another hour to discuss this in greater detail, but simply to say that you will come across counselees who will share their thoughts of self-harm or thoughts of suicide, and you just need to be able to assess that in some measure. And again, being careful with that.

Each counselee is different, and you need to pray for discernment, but you do need to be prepared in some measure to handle that discussion. Paul Toshkis has the acronym SLAPP DIRT, and I think the DIRT part is actually -- you can just go with the SLAPP, the first four parts of the acronym.

And four questions to ask if this comes up in a counseling discussion is, is there a specific plan? Is there a how, where, and when in the person's mindset? Lethality, how deadly is that plan? Availability of means, does your friend have or can he easily get what he needs to carry out his plan?

And proximity of help, how close help is can indicate determination. Toshkis says that if there has been a previous attempt at self-harm or suicide, then you add the acronym DIRT into the mix, and that helps you evaluate the previous attempt. But I just bring this up to simply prepare you for the discussion.

I think when any thoughts or any temptations to self-harm come into the discussion, we apply basic biblical counseling principles. As Powelson says, we seek to understand the person and his situation. We ask questions, help me understand, why are you thinking this way? We bring the hope of Jesus Christ and his multifaceted saving provisions to bear upon the conversation.

We minister the gospel. We expose the lies and the sinful desires that the person may be living by. We enlist others to help, watch, and care for this person. We take seriously the person's threats. If necessary, we alert key people and contact civil authorities. And as Dr. Jeremy Pierre has helped me with this, we inform the counselee of the resources that the counselee is responsible to avail himself or herself of in case there is temptation to self-harm.

This includes emergency rooms, local police, suicide hotlines, emergency psychiatric services, and other mental health facilities, as well as family relationships and close friendships. Powelson says this, and I'll end with this comment. He says, "Beyond a basic warning, rebuking the person who contemplates suicide is rarely helpful or needful. Most people, especially Christians, know deep down that it is wrong.

Therefore, instead of a condemning, 'Why would you do such an evil thing?' approach, consider a compassionate approach. Help me understand how or why your life is so miserable that you would see this wrong action as the only way or of escape. Focus on the causal conditions in the heart and on the better alternatives to the counselee's contemplated wrong.

Sympathetic, express sympathetic disagreement. We can agree with this diagnosis that we can disagree with the remedy that I have a way. This life that you are living needs to end. We can give the counselee the hope that in Jesus, there is a new, rich, and abundant life." I know that is a lot to process in one session.

I wish we probably need another session on this topic, but I do hope this was a helpful overview on a much-needed topic, and I do pray and hope that you will study more on this subject. We have, as I said, what the secular world cannot give. We have the gospel of Christ.

We have the provisions and the promises of the gospel. We have the inspired and inerrant word of God. We are members of the local church. We are filled with the spirit of God. We have all that we need to come alongside those who are struggling with depression. I pray that as there were two pastors in my life who met with me, who spoke God's truth to me, and helped me come out of the slough of despond, and I pray that each of you will have that ministry and that opportunity in other people's lives, and I know that if you study well and if you are trained well, that you will have that opportunity, and God will use you greatly in this ministry.

Let me pray for us, and then I'll let you go. Thank you so much for your attention tonight, and let's close our time in a word of prayer. Our Father, we are so thankful for your word and thankful for the provisions of the gospel, the provisions of Christ. We're thankful for the examples of men like John Newton, who exercised such a loving, compassionate pastoral ministry in the life of William Cooper, and we pray that you would raise up many counselors in our midst that would be able to exercise such a ministry, that we would be those who believe that the church is a spiritual hospital, that we would welcome the weak and those who struggle with the sorrows of life.

And Father, I pray that you would help us to speak the truth of God into others' lives so that the spiral of depression may be changed and be broken. Grant our students a wonderful week of study. We thank you for each one and pray that you would bring great fruitfulness from our time of study in your word.

We thank you for this time. We pray this in Jesus' name. Amen. Amen. Well, thank you so much for joining us tonight. We are going to break for tonight. We will have class next Sunday at 5 o'clock Pacific Time, and we look forward to looking at Counseling Exam #6 next week.

God bless you and thanks again for joining us tonight.