The Potential for Suicide
Luther knew depression could sometimes prove deadly, since depressed persons may become weary of life and preoccupied with death. Such was the case with Jonas Von Stockhausen. To help ensure his safety Luther gave the following instructions to his wife: (1) Ensure that his surroundings are not so quiet that he sinks into his own thoughts. (2) Do not leave him alone for a single moment. (Luther believed that solitude is poison for such a person.) (3) Leave nothing around with which he might harm himself.6 Sound advice by any clinical standard!

Brief Conclusions on Luther's Understanding of Depression

In many regards the views Luther expressed in his writings appear consistent with current knowledge. I marvel at his insights into the role of cognition. He possessed an excellent grasp of the variety of cognitive distortions that maintain depressive states. And why not! Given his own struggles in this area, he knew well its internal mechanisms. Luther also looked within the environment to discover the presence or absence of behaviors linked to depression. For this reason he placed great emphasis on helpful behaviors such as playing games, having fun and getting involved with others.

Luther's spiritual emphases separate his ideas from modern secular approaches. Luther gave prominent place to both God's and Satan's activity. Luther reminds us that we cannot ignore Satan's role in human difficulties. Ample biblical evidence points to a tempter who desires to destroy believers. But Luther emphasized God's power to bring change. Most therapists likely dismiss such views as archaic and out of touch with modern notions. Yet the serious Christian cannot readily dismiss spiritual activity.
Having said that, we should exert care regarding the degree to which we emphasize Satan's activity. Some believers too readily see a demon behind every case of depression. That's not Luther's intention. Can the Christian be oppressed by depressive thoughts? Luther answers with a resounding "yes." Can the Christian be possessed by some demon that stimulates depression? His answer would be a resounding "no." Christians must steer this delicate middle ground. We must affirm spiritual activity (both God's and Satan's) in the many events touching human lives. However, we also must avoid taking positions that heap heavier burdens on sincere Christians caught in the grips of depression.

Combating Depression

The caregiver's attitude can make a great deal of difference in treating depression. Judgmental and guilt-provoking attitudes never help. Fortunately, Luther displayed no such attitudes. He accepted people and helped them understand they were not alone in their suffering. For him, depression was in some regards a universal occurrence afflicting even the people of God.7 This type of attitude often saves sufferers from unnecessary guilt and shame.

Given Luther's complex understanding of depression, his multifaceted approach to its treatment should not surprise us. First and foremost, Luther emphasized spiritual factors. Luther assured his "clients" of Christ's nearness, His love and esteem. He told them that Christ cared and would help believers carry their burden. They needed to trust His atonement as a buttress against Satan's accusations. In addition, Luther counseled depressed persons to use prayer and suggested that they read or have read to them comforting words from Scripture. Luther also knew the soothing qualities of music. Therefore, he advised believers to sing and play spiritual songs unto the Lord until their sad thoughts vanished.

Second, Luther emphasized God's work through other believers. He understood that God uses believers' words to strengthen and comfort struggling persons.8 Depressed persons should receive these words. Luther advised one severely depressed person, "cease relying on and pursuing your own thoughts. Listen to other people who are not subject to this temptation. Give the closest attention to what we say, and let our words penetrate to your heart. Thus God will strengthen and comfort you by means of our words."9 In this emphasis, Luther espoused a concept similar to Larry Crabb's "eldering." Like Crabb, Luther believed godly believers can successfully help one another. The church needs to take this more seriously.

Believers also serve a second function. Their company pulls depressed persons away from dangerous solitude. In Luther's view, solitude fosters depression. Therefore, he counseled sufferers to seek the company of believers not caught in the web of depression. He knew that godly company serves several purposes: it affords an opportunity to receive a different and brighter perspective on life; it serves as a precaution against suicide; and it provides an opportunity for good, clean, wholesome fun. Luther repeatedly recommended playing games, joking, jesting and enjoying other forms of merriment.

The emphasis on merriment might surprise us. It should not. Luther knew that depressed persons give up pleasurable activities. They restrict life to narrow, confining limits. In this sense they sap the vigor and fun out of their lives. What else but depression can result when joy is sucked from life? But Luther emphasized merriment for a second reason: some Christians avoided pleasurable activities, thinking them sinful. This rigid scrupulosity threatened the hope of defeating depression. To counteract this tendency Luther reminded Christians that "proper and honorable pleasure with good and God-fearing people is pleasing to God."10

Third, Luther suggested strategies to combat cognitive distortions. He understood that depressed believers sometimes should not trust their own thoughts because depression distorts reality. Instead they should seek the company of non-depressed believers. Such persons can pull them away from distorted thinking and bring them back to reality. Scripture serves a similar function. It presents the ultimate reality, an antidote to distorted views of one's circumstances. Scripture also reminds us of God's love, esteem and presence in our struggles. These truths represent the opposite of what Satan would have us believe; namely, that we are unloved, worthless and abandoned.

Luther also gave insight into handling the depressive thoughts Satan instills. The believer must resist the devil. Sometimes this means avoiding any disputation with the devil. At other times, Luther endorsed disputation. He did not seem to hold to a fixed rule. Much depends on one's condition. For example, Luther advised against disputation when a person is fasting. In general, one might conclude that disputation is unwise whenever one is vulnerable in body or mind. At those times, believers should draw strength from spiritual persons and from Scripture.

Ultimately, Luther was a realist. He recognized that depressed persons sometimes plunge deep in despair and need protection. Caring persons should take every possible precaution against the threat of suicide. Providing a safe environment is fundamental, which in modern times sometimes means hospitalization until the threat passes. When necessary, such actions do not represent callousness. They represent genuine Christian love in action.

Finally, Luther impresses me with his "commonsense" approach. I cite three examples that illustrate this approach.

Eat, don't fast!
Luther suggested that spiritual disciplines used at inappropriate times contribute to greater difficulties. For example, Luther believed disputing with the devil requires one to be well fed, not fasting. This sounds unspiritual but makes good sense. Depressed people need sustenance to combat the loss of appetite and subsequent weight loss characterizing depression. In addition, unlike Luther, I see solitude as a legitimate Christian discipline. However, for the deeply depressed individual, retreating alone does not make sense, but going out with a friend does. There is a time and place for everything, even legitimate spiritual disciplines.

Be realistic -- improvement may be slow!
While remaining optimistic and encouraging dogged determination, Luther kept a realistic perspective. He knew improvement could be slow.11 This sounds discouraging but needn't be. Sometimes persons focus too much on what is not right and what has not changed. Instead they should focus on what is right and even take note of small incremental changes. Such improvements represent hope for a better day.

Time is a great healer.
Though he did not advocate inactivity and passive waiting, Luther viewed time as a great healer. He once noted that "old age and other circumstances will in time render present depression and melancholy superfluous."12 There is some truth to this statement. Age and maturity can bring new perspectives that help foster healing. Matilda Nordtveldt reflects this perspective. She wrote, "At age 71 I still struggle with my desire to bolster my self-image as well as my reputation by overworking. ... Even if I have not learned my lesson perfectly yet, I am on my way. I know that my value in His sight is not determined by what I accomplish but [by] my relationship to Him, and I have learned that giving thanks in every circumstance brings joy and peace."13 Time still does its work! Luther's insights into depression are still instructive as people seek treatment in this modern-day world.
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Tony Headley is a professor of counseling at Asbury Theological Seminary, a licensed psychologist and author of Achieving Balance in Ministry (Beacon Hill Press, 1999).

1 See Preserved Smith, Luther's Table Talk, New York: Ams Press, 1907, for a critical study of the table talks.
2 Martin Luther, Letters of Spiritual Counsel. Translated by Theodore G. Tappert. Philadelphia: Westminster Press, 1955.
3 This story is told in Luther's letter to Francis Burkhard, Letters, 182.
4 Letter to Matthias Weller, Letters, 96-97.
5 The terms in italics represent the current labels for these cognitive errors. These labels are used by cognitive theorists such as Aaron Beck.
6 Letter to Mrs. Jonas Von Stockhausen, Letters, 90-91.
7 Table talk recorded by Anthony Lauterbach, Letters, 100. The letter concerns the depression of Jerome Weller.
8 For example, Letters, pp. 96ff -- especially third paragraph on p. 97.
9 Letter to Jonas Von Stockhausen, Letters, 89.
10 Letter to Prince Joachim of Anhalt, Letters, 93.
11 Letters, 94.
12 Letters, 93, paragraph 1. Paragraph 2 may be a reference to Luther's own experience.
13 "My Life-Changing Discovery," Light and Life, July/August 1999, 27.