Dichotomy or Trichotomy? How the Doctrine of Man Shapes the Treatment of Depression

aspect of life. It affects one’s cognition, emotions, spiritual faith, and physiology. Given such diverse symptoms, is depression best understood as a spiritual, psychological, or medical problem—or some combination of the three? This is not simply an academic question: your answer will profoundly shape your approach to depression. The majority of Christian counselors seem to have adopted a three-fold, or trichotomistic, approach to depression, trying to understand depression from the perspectives of body, soul, and spirit. It is reasoned that if depression arises from and affects these three constituents of human life, it should be understood and treated from all three perspectives. The logic is appealing, and seems to resonate with helpers’ experience with depressed persons as well. Pastors often find themselves dealing with problems that feel more “psychological” than “spiritual” (or at least they feel their seminary training didn’t equip them to deal with these sorts of problems). Doctors find themselves treating patients with aches and pains that they suspect result from stress and other emotional factors. Psychologists find themselves dealing with problems that stubbornly persist and have both a biological feel to them (substance abuse, bipolar disorder, etc.) and a “spiritual” feel (substance abuse is “idolatry,” substituting for God). But trichotomy fails to produce a unified understanding or treatment for depression. For instance, there are certainly physical symptoms that a doctor could treat with sleeping medications or a host of psychoactive drugs. A psychologist could employ cognitive-behavioral strategies to address irrational fears, thoughts, and anger, or could offer presumed insight into the impact of past events. A pastor could certainly address how faith in God produces hope and gives meaning to life. So who should treat depression? Does any one perspective address the cause of depression? Does one perspective have authority over the others, or are they equals? Do we simply add together all three perspectives to be holistic in ministry? Or do the three per-