When we talk about ‘causality’ in the mental health conversation, we are trying to answer the question: Why did this happen? What causes mental health struggles? The answer is: It’s complicated!

Causality is complicated when it comes to mental health. Thus we must be careful not to be too reductionistic or categorical. While there is often a “straw that breaks the camel’s back,” there is usually a huge pile of straw the camel was already carrying! There are often multiple factors at play in cases where someone is struggling with their mental health; all of them should be acknowledged.

There are often multiple factors at play in cases where someone is struggling with their mental health.

When we turn to scripture to try to understand the issue of causality, we see an intellectually comprehensive understanding. The perspective that we think the Bible teaches (and the one we advocate in this article) has been linked with an approach known as complex theocentrism.

To keep this discussion concrete, we will explore this issue of causality using depression as an example. We realise that every struggle will have its own nuances. So this is not meant to comprehensively explain every mental health struggle. With that in mind, let’s think through the nature and causality of depression.

The Complex Nature and Causes of Depression

Let’s begin with a definition: depression is a form of profound sorrow. This is not a technical psychiatric definition. Nevertheless, this is our attempt at using simple biblical language to define an experience many would call depression.

We think this definition lines up with the description of sorrow from the Dictionary of Biblical Imagery, which captures the heaviness and despondency that is a recurring feature of this experience: “Every kind of human grief, sadness and sorrow is depicted in Scripture, whether as the result of adverse circumstances, sickness, parting, personal loss, failure or sin. In sorrow the heart, the core of the emotions… becomes heavy and is downcast.” Another definition we find helpful is Ed Welch’s: “Depression is a form of suffering that can’t be reduced to one universal cause.”

Notice the multifaceted causal nature of the sorrow.

Did you notice the multifaceted causal nature of the sorrow in that quote? Taking our cue from there and following the paradigm suggested by David Powlison, we want to offer five relevant causal factors regarding mental health in general.

1. The Sins of Others (Our Social Context)

Our social context consists of people who will, in varying degrees, sin against us. This will profoundly hurt us, because God created us for love. Social evil can also become systemic. The sins of others can morph into systemic problems and societal evils. About half the Psalms are the cries of the oppressed, and beneath the depression of some people, you may find victims of others’ sin. See, for example, Psalm 55.

The sins and failures of others need to be considered.

But even in cases where the person has not been directly sinned against, the sins and failures of others still need to be considered. For example, the depression a teenager is battling may be related to her parents’ divorce. It may be hard to identify who sinned. But, clearly, the impact of sin-affected relationships is taking its toll on this teenager. If we included experiences of loss and grief, we could also include the significant role of suffering that is a feature of our social context.These experiences can also be historically rooted, and those, too, must be taken into account.

Therefore, in seeking to understand and respond to depression, we must be aware of the impact of our social context. That’s the first relevant factor, when considering causality within mental health.

2. Our Bodies (or Physiological Context)

The curse of sin has negatively affected everything, including our physical bodies. We don’t function as we should. Ed Welch says that “diseases, deterioration from old-age, post-partum struggles, and possible chemical imbalances are just a few of the physical causes relevant to depression.” The Christian perspective recognises the vital role of the body. Our physiological context matters. Charles Spurgeon, the revered Baptist preacher who struggled with depression, puts it well: “Man is a double being: he is composed of body and soul, and each of the portions of man may receive injury and hurt.”

The idea that someone can simply recover from depression by scripture memorisation or willpower is untrue.

So pastoral caregivers and biblical counsellors must consider the body’s contribution to depression. If necessary, they should have a team approach to helping those suffering. A Christian approach is holistic. The idea that someone could recover from depression simply through moral exertion, scripture memorisation, or pure willpower is untrue. Our physiological context is the second causal factor.

Let’s briefly pause here. What we’ve considered so far could be described as the nurture (social context) and nature (bodies) causes of suffering. These two elements alone cause enormous complexity in the specific case of depression, not to mention causality and mental health more broadly. Yale University professor Charles Barber says there is an “infinitely complex dialogue between genes and the environment…an intricate, infinite, dialectical dance between experience and biology.”

This ought to caution us to recognise the inherent complexity of depression along with other mental health struggles. However, from the Christian perspective, other ‘partners’ in the dialectical dance are even less accessible! Let’s consider three more causal factors.

3. Our Dynamic Hearts

Before conversion, our hearts are incomprehensibly wayward (Jeremiah 17:9). Even after conversion, our hearts can behave inconsistently with our new identity (1 Corinthians 3:1-4). We should not be surprised to find inordinate fears, false beliefs, and selfish desires lurking beneath some experiences of depression. For our dynamic hearts shape how we think and what we feel and do. Thoughts, emotions, and actions come from our hearts. It’s the home base for what we think, feel, and do (Mark 7:20-23). Moral agency and psychological intentions are significant.

Even after conversion, our hearts can behave inconsistently with our new identity.

Therefore, when we are in a depressed mood or when we experience deep sorrow for an extended time, we would do well to examine our hearts. Again, in his excellent book Depression, Ed Welch captures the role of the dynamic heart when he says: “Circumstances must connect with an internal system of beliefs or an interpretive lens that will then plunge you down into depression.”

If you have the time to reflect on this more deeply, have a look at the following Bible passages and consider the role the dynamic heart plays in the experience of the character:

  • Anger (Jonah 4:1-11)
  • Guilt (Matthew 27:1-5)
  • Dashed Hopes (Ruth 1:19-22).

The dynamic heart is vitally important when we think about the issue of causality and mental health. However, we must remember that complex problems (like depression) require wisdom and tentativeness in differentiating which factor has more influence in any given situation.

4. Satan and Demons (Our Spiritual Context)

The fourth factor is the role of Satan and demons. How exactly he acts as an agent in an individual’s selfish desires is a mystery. How he inflicts harm or exacerbates inordinate desires, fears, and sadness is unknown. But this is a relevant causal factor.

How Satan inflicts harm or exacerbates inordinate desires, fears, and sadness is unknown.

The Africa Study Bible has some helpful wisdom for us here: “The Bible teaches that an unbeliever can be possessed by an evil spirit (Mark 5:2), but it is not easy to discern whether the real problem is demonic activity or a psychological or mental disorder. Much damage has been done to people and their loved ones who needed psychological help in this area.”

5. God’s Providence

The fifth and final factor in understanding causality and mental health is the providence of God. How this works, particularly in light of what’s just been said about Satan, is also mysterious. But we know that God is sovereign over Satan, and he is sovereign over everything else we face and experience. Including our challenges with mental health.

Below is an extended quote from bible teacher Christopher Ash about how God’s providence helps us come to terms with the particular struggles we face, from Why Did God Let that Happen?:

“It is a great wonder to consider that God has had his sovereign hand over every moment and every detail and every influence that has made me the person I am. From the moment he began to knit me together in my mother’s womb (Psalm 139 v 13), he has been the loving heavenly Father, who has shaped me physically, psychologically, temperamentally, in every way to be the person I am. I am not who I ought to be, nor who I will one day be… and yet, with all my struggles, the person I am now is the person a loving heavenly Father has shaped me to be at this point in time. I may trust him.”

God is sovereign over everything we face and experience, including our challenges with mental health.

Five-factored Causality

When we apply the biblical teaching of suffering to depression, we see that a quest to find a single cause is likely too narrow. We may never know the single reason for a person’s depression. Yet we have also seen that external conditions are significant but insufficient for causing depression: our active hearts are always involved.

Instead of teaching us how to diagnose a single cause of suffering, the Bible embraces complexity. Are you depressed because of other people, because of your body, because of your beliefs and desires, or because of Satan? The answer, perhaps, a bit of everything. In some cases, it may be easier to identify one of these five factors as more relevant. In other cases, it may be more complicated.

Instead of teaching us how to diagnose a single cause of suffering, the Bible embraces complexity.

But this broad perspective on causality and mental health should give us pause for thought. The Bible is not scared of complexity. So we shouldn’t be either. Complex theocentrism recognises multiple factors even while seeking to honour God and keep him central in our recovery. So let’s trust him and keep our hearts fixed on him, even while seeking to attend to all the relevant factors.