What does the doctrine of HUMANITY have to do with PMADs?
To properly treat and understand perinatal mood and anxiety disorders, we have to know who we are as human beings.
People are made in God’s image, which means that you’re gifted and tasked by God for dominion and fruitfulness.* Your biological design for motherhood—even though it makes you vulnerable to PMADs—is one of the many good ways this image can play out. Motherhood is good. Your childbearing is good, even though it hurts.
But while you and I carry the image of God, we’re still creatures. Your humanity is finite, as it was even before the Fall. Thus, dependence is not bad; it’s how you’re meant to be. You aren’t God. With or without PMADs, you’re going to come face-to-face with our limits and weaknesses, and PMADs just heighten your awareness of your creatureliness and your dependence on our Creator.
Our humanity also has a “psychosomatic unity.” We have souls (psyche) and bodies (soma), not as two separate parts or sides, but intertwined in such a way that one affects the other. God made us with both, and both are good. If we think that our souls are our true selves, and not our bodies, then our bodies become unimportant, which can cause us to de-emphasize nutrition, medication, and other physical components of our struggles. If we think our bodies are all we are, then we’ll only seek to address the physical, ignoring what goes on in the inner person. Proper treatment for PMADs must address both body and soul.
(For more on this, I highly recommend “Created in His Image” by Anthony Hoekema)
*There are differing views as to the relationship of the Creation Mandate in Genesis 1:27 to the Great Commission in Matthew 28. But even if mostly spiritualized now, ruling and fruitfulness is tied to the functional image of God.
What does the doctrine of SIN have to do with PMADs?
The doctrine of sin takes our understanding of humanity a step further. While we are created in the image of God, that image is now stained, twisted, and distorted by sin in varying degrees in all humans, (but being restored and renewed in believers).
Acknowledging sin means that we can’t blame everything we face in PMADs on our circumstances, brain chemistry, or hormonal imbalances. Our sin affects us too, and we must confess sin.
“This doesn’t mean that sin is necessarily the cause of suffering. It simply means that suffering tests our loyalties, and our loyalties might be exposed as being more divided than we knew. (James 1:2-4)”
Edward T. Welch, Caring for One Another, page 58
We cannot excuse sin, even when we’re more prone to it because of PMADs. We have to deal with our desires, even as we address the physical components of our suffering.
Yet sin in our hearts isn’t the only effect of sin on creation. Adam and Eve’s sin brought the curse into the world as well. We can’t always tell what’s because of blatant sin and what comes from the effects of the curse. But the curse affects our brains and bodies, making childbearing hard and work fruitless, and bringing death in and out of the womb. We need to acknowledge how this factors into our PMADs as well. This may mean taking medication. It may mean not blaming everything on sin. It may mean adjusting expectations to allow for motherhood to be harder than we expected. It may mean taking the time to lament the things that are not right, whether that’s our personal sin, the sins of those around us, or general results of the Fall (like PMADs, labor trauma, and deaths of people we love).
As we fight PMADs, we also fight the world, the flesh, and the Devil. But we don’t fight alone or without hope: Christ has guaranteed the victory.
What does the doctrine of CHRIST have to do with PMADs?
For those struggling with PMADs, there is much encouragement to be had in the person and work of the Son of God. And while much could be said about the Son’s role in creation and the intra-Trinitarian love behind creation, I want to focus on the Incarnation, and the adding of a human nature to the Son’s deity.
The implications of Christ as fully God and fully man are vast. Drawing on my doctrine of God post, Christ is the One who shatters the wall of despair built by sin between the Creator and His creatures, making the transcendent God relationally present. He does this not just in the Incarnation, but through His work on the cross, reconciling us to God so that that immanence is even more manifest—within us, in the Spirit. The atonement is only effective because Christ is fully God and fully Man: He can both take on our sin AND sufficiently bear the wrath of God for it. We’ll get to this more in justification, but for now: proper Christology says that in Christ you are not condemned for even the worst sins, in and out of PMADs. Christ’s work also demonstrates God’s constant love for His redeemed, even when depression may cause you to doubt it. Christ’s work is the answer to where God is and what God does about your suffering.
Christ’s true humanity also gives value to your humanity. His emotions demonstrate a range of godly feelings and prove to us that our emotions are not to be shut down and ignored (even the intense ones of PMADs).
The resurrected Christ is the One holding all things together (Col 1:17). You can relax and relinquish control. It’s ok if you mess up. It’s ok if the baby’s naps aren’t “right.” Christ is holding everything together.
And He’s interceding for you now (Heb. 7:25). You are not alone, not without help, not without an advocate before the Father—Jesus Christ the Righteous.
(See On the Incarnation by Athanasius and B.B. Warfield’s On the Emotional Life of Our Lord for more)
What does the doctrine of SALVATION have to do with PMADs?
When all of life is in flux in the perinatal period, we search for something sure and steady to put our hope in. All these doctrines do that, but the doctrine of Salvation can be especially encouraging when we’re bombarded with standards and expectations for motherhood, riddled with shame and even guilt.
If you’re in Christ, no matter what culture is telling you about how you should or shouldn’t mother, no matter what your shame is telling you about how you don’t measure up, no matter what your guilt is telling you about how you’ve sinned, you’re justified by His blood. Declared righteous. Forgiven by God. This is your unshakable identity when you don’t know who you are anymore. It’s what you appeal to when you think you’re not enough. It’s what you cling to when depression and anxiety accuse you. It’s how you can rest, because you don’t have to earn anything.
Zack Eswine says,
“It is Christ and not the absence of depression that saves us. So, we declare this truth. Our sense of God’s absence does not mean that He is so. Though our bodily gloom allows us no feeling of His tender touch, He holds onto us still. Our feelings of Him do not save us. He does. …Our hope therefore, does not reside in our ability to preserve a good mood but in His ability to bear us up. Jesus will never abandon us with our downcast heart.”
Zack Eswine, Spurgeon’s Sorrows
Not only does Jesus not abandon us, but His Spirit sanctifies us. Though PMADs aren’t usually caused by sin, God still uses them to rid us of sin, making us more like Him. Also, God’s purposes of sanctifying us in our suffering don’t mean we can’t use medication.
Growth in holiness is hard, and we don’t like it. But dross is being removed. Those whom He justifies, He also glorifies: your full sanctification is coming.
Put your hope in that, not in how the baby sleeps.
The Sorrows of Eve 