Total Depravity and Clinical Anxiety

During my senior year of college, I was lying down on my bed one evening reading some tweets from a Christian theologian. As I continued scrolling, suddenly I began to feel extremely cold. As the coldness set in, my heart — from out of nowhere — started to pound like I had just run a mile. As it pounded harder and harder, I began experiencing heart palpitations (where your heart skips beats). Then my breathing got quicker and tighter. I finally set up and vividly remember thinking, “Am I having a heart attack? Am I dying?”

After about five minutes, I walked out of my room and told my roommate what had just happened. Unsure of what really happened, I described how I felt. His girlfriend was there and said, “That’s exactly how anxiety attacks feel.”

Up to that point in my life, I had never experienced something like that before. It was dark, fear-inducing, and left me feeling vulnerable. Let me put this in perspective from my vantage point. I absolutely hate vomiting—with every fiber of my being. When I get nauseous, I get so afraid that I’m getting sick. I do everything I can to not vomit. And yet, when the anxiety attacked ceased, I remember walking to my car thinking, “I would rather throw up a hundred times than do that again.”

Millions upon millions of people suffer from anxiety attacks, panic attacks, clinical anxiety, etc. just like my story above. Many much worse than what I went through—even Christians.

Anxiety and the Church

There is a stigma within the evangelical church around the topic of clinical anxiety. Many Christians—a lot of whom I respect and admire—simply do not believe it exists. They see no evidence for chemical imbalances. I know of many close to me who would have a totally different opinion on this. And that’s okay.

However, many Christians have done damage to other Christians who suffer in this way because they don’t believe chemical anxiety, depression, etc. are real. In turn, they say the problem is not the brain malfunctioning, but their own sin. They send Philippians 4:6 to suffering Christians and say, “Just believe this more.” But this isn’t a Philippians 4:6 issue, but an issue that has its roots in total depravity.

What Does Total Depravity Have to Do with This?

As one who believes in the doctrine of total depravity, I think it’s sensible to believe in clinical anxiety (or other mental health issues). I think it’s difficult not to because of total depravity.

At its foundation, total depravity explains that sin isn’t a mere hiccup in our spiritual makeup or that, deep down, we’re good people who do bad things. No, sin affects our whole being—mind, soul, body. Ephesians 2:1 says, “And you were dead in your trespasses and sins.” We weren’t sick people, but dead people. We didn’t need to “turn over a new leaf,” but become a new person altogether.

And that was the effect of original sin. Just as original sin made us spiritually dead—incapable of obtaining salvation on our own—it also affected our whole being—including our brain.

Furthermore, total depravity doesn’t mean we are as bad as we could be, but that sin has permeated our entire self.

RC Sproul explains:

. . . it means that the fall [of man] is so serious that it affects the whole person. Our fallenness captures and grips our human nature and affects our bodies—that’s why we become ill and die. It affects our minds and our thinking (brackets and italics mine).

It affects our mind and the way we think. It impacts every part of us. And because of that is why I believe the Bible gives room for clinical anxiety. Our brains have malfunctioned because of sin. The human mind is not what it ought to be. Sin came into the world (Gen. 3) and caused catastrophic damage—to say the very least.

Dealing with Anxiety

I don’t pretend to be an expert on this. I don’t know all the science and haven’t done in-depth research on the topic. But what I do know is this: original sin affected our whole person. From that, I believe it’s reasonable to conclude that people genuinely suffer from clinical anxiety—an anxiety that is not synonymous with the anxiety spoken of in Philippians 4:6, for example.

However, how one responds to anxiety attacks (or whatever we’d like to call them) can be an issue. When I had mine back in college, even amid what I was feeling, I kept repeating, “God is in control, God is in control, God is in control.” Even though I felt like my world was collapsing, I knew it wasn’t because God was sovereign.

Even in our darkest moments—even in the times when we don’t have control over ourselves—God is still in control. He is never not in control. We may suffer from anxiety attacks, but that does not mean we stop trusting the Lord in the midst of them. We can certainly sin in our anxiety attack by not trusting Him in the process, though I would contest the anxiety itself is not sinful.

The anxiety you’re constantly feeling—or that may come all at once and then abate—you possibly could need medication for. Richard Baxter, in his work The Cure of Melancholy and Overmuch Sorrow by Faith and Physic, said it like this:

If other means will not do, neglect not physic [medicine]; and though they will be averse to it, as believing that the disease is only in the mind, they must be persuaded or forced to it. I have known the lady deep in melancholy, who a long time would neither speak, nor take physic, nor endure her husband to go out of the room, and with the restraint and grief he died, and she was cured by physic put down her throat with a pipe by force.

Richard Baxter, The Cure of Melancholy and Overmuch Sorrow by Faith and Physic in The Practical Works of the Rev. Richard Baxter, vol. 17 (London: James Duncan, 1830).

You wouldn’t think you’d read that from a Puritan, would you? I was surprised as well. But I agree. Oftentimes medicine can be the thing that gets you back to simply functioning. It is not to replace our devotion of and meditation on Scripture—not in the least. “Of course, medicine alone didn’t fix me,” Joe Thorn wrote about his personal story with anxiety in his book Experiencing the Trinity. “A new schedule didn’t really free me. God used a number of changes that worked together to rebuild me. And central to it all was the Word of God. It was Scripture that drew me back to the hope, peace, and safety I have in Jesus” (italics mine).

Read the italicized sentence again. If Scripture is not central to our fight with clinical anxiety, we are doomed. Medicine can be useful but it is not the end-all be-all. Ultimately it is God who brings us peace and calmness, for He is the one in whom we receive “peace that surpasses all understanding” (Philippians 4:7). However, I believe He uses medication as common grace to help us through the process. But there is a very fine line between using medication as help and using it to not rely on God.

Believer, let me reassure you. This anxiety you can’t get rid of—no matter how many times you pray, how many times you fast, how many times you cry out to God—is not indicative of you doing something wrong. It was brought on by original sin, just like everything else that goes wrong. Consult your pastor(s), speak with a medical professional and see if medication is something for you. Your mental health is just as important as your physical health. Ignore the stigma. Trust in the Lord and, if it’s right, get on medication. You don’t need to feel shame or guilt.


On the other side, we need to be careful in determining if we have clinical anxiety. Admittedly, it is difficult to correctly diagnose. For many, their claim to “clinical anxiety” is a mere cover-up to hide sinful anxiety—anxiety that the Bible repeatedly tells us not to have (Philippians 4:6; 1 Peter 5:7; John 14:27; Matthew 6:25-34; Psalm 55:22). Anxiety that reveals a lack of trust in the Lord is something the Bible condemns. May we not skirt around that, but repent of it.

Even more, one of the best ways to help with anxiety is to take our eyes off ourselves. When we habitually look inward and say, “Woe is me,” then we are making it worse. When these things happen, try your best, with the Spirit’s power, to fixate your eyes on the gospel. It may not take away the anxiety but will assuredly get you through it.

Again, sin has affected all of us. Not one person has escaped it—even the Son of God, who took on the sin of those who would believe in Him. Jesus didn’t have sin, of course, but was made to be sin on our behalf (2 Cor. 5:21).

Our minds, our bodies, our souls have been wholly effected by original sin. Let us not look past what it can do to any part of us, including our brains. If you need to get on medication, you should do so. But make certain that, ultimately, your trust is in the Lord.

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