1. Call out to God
There are all sorts of Psalms in Scripture in which the psalmist calls out to God in distress. The Bible encourages us to call out to God and be real with Him about where we’re at.
2. Fight Against Depression’s Lies
Depression often says things like: “You have no hope” and “You’re not worth it.” Those statements, however, are in flat contradiction to what the Scripture says. For example, look at Lamentations 3:21-24: “This I recall to my mind, Therefore I have hope. LORD’S lovingkindnesses indeed never cease, For His compassions never fail. They are new every morning; Great is Your faithfulness. ‘The LORD is my portion,’ says my soul, ‘Therefore I have hope in Him.’”
3. Fight Against the Lie that says Life’s Meaningless
I agree with Matthew McCullough, “It is resurrection or vanity.” Thankfully, through Christ Jesus, “Meaningless! Meaningless!” (Eccl. 1:2) is not the end of the story. In light of the resurrection of Jesus Christ we have purpose! Because of the resurrection of Jesus Christ we are called to work hard for the Lord, knowing that our labor in the Lord is not in vain (1 Cor. 15:58). This is good news! There is something in life that counts, faith expressing itself through love (Gal. 5:6).
4. Remember the Truth: God Loves You
God shows His love for us in Christ Jesus. Look at what Zephaniah 3:17 says: “The LORD your God is among you; He is mighty to save. He will rejoice over you with gladness; He will quiet you with His love; He will rejoice over you with singing.”
John 3:16 says, Because God so loved the world He did something about it, He gave His only Son so that whoever believes in Him will not perish but will have eternal and abundant life.
Remember the truth, God loves you.
5. Humble Yourself
You can’t be your own savior. You need help. Acknowledge your need (see 1 Pet. 5:6-7). Go to a friend, to a pastor, to a doctor, and most importantly, as we see in our next action step, go to God.
6. Throw Your Cares to God who Cares for You
“Give all your worries and cares to God, for he cares about you” (1 Pet. 5:7, NLT). God can handle all your worries and cares. Give them to Him. He cares for you and He is all-powerful so he can effect change.
Further, when we give God our cares it is likely us turning away from the tight squeeze that we have on our idols and turning to the LORD who is the true God. This itself will likely be very helpful because we are not counting on lesser things—whether money, success, pleasure, or whatever—to being the deliverance and significance that only God can.
7. Listen to God
The echo chamber of our own thoughts and self-talk is often atheistic. We need to listen to God through His word. Matthew 6 is a good place to begin because it reminds us that we have a Father in heaven who cares for us.
8. Preach the Gospel to Yourself
“Why are you depressed, O my soul? Why are you upset? Wait for God! For I will again give thanks to my God for his saving intervention” (Ps. 42:5, NET Bible).
Instead of listening to ourselves, we need to, as strange as it sounds, talk to ourselves. We need to preach the gospel to ourselves. There is hope! There is salvation in Jesus Christ!
9. Ensure Others are Preaching the Gospel to You
We need to be in community. We all need help bearing our burdens and we need to help others bear theirs (Gal. 6:2). We also need to point each other to Christ (Col. 3:16-17).
10. Read the Psalms and Sing Gospel Songs
Last night my wife and I were both down and felt somewhat hopeless. We have an Alexa (I still want to rename it wiretap) and we turned on one of Leah’s all-time favorite songs, “Be Still My Soul” by Page CXVI.
We both cried as our hope was gradually renewed…
 These are known as Psalms of Lament. See e.g. Ps. 44, 60, 74, 79, 80, and 85.
 Matthew McCullough, Remember Death, p. 110.
 God used 1 Corinthians 15:58 in a powerful way in my own life to help me fight against depression. God is still using that verse to help me. That verse helps me not fall into the pit of meaningless existence. If Christ has been raised, which I believe He has, then life has immense purpose. If Christ was not truly raised, then I believe Nietzsche’s estimation of life would be correct.
 “Be Still My Soul” by David T. Clydesdale, Jean Sibelius, and Katharina Von Schlegel.
The Psalms are important for a number of reasons. For one, they take up a fairly large portion of Scripture and they have been a comfort for many. Spurgeon, known as the “prince of preachers,” struggled with depression and he found comfort and solace in the Psalms. He spent some twenty years writing his three-volume commentary on the Psalms.
The Psalms are also important because we are exhorted to sing Psalms. The Psalms are important because they give powerful truths poetic expression. This is helpful because it not only helps us remember the truths but helps us feel the truth. The Psalms are beautiful and will have a very practical impact on us when we soak in them.
Interestingly, Scripture has laments in it and so does our surrounding culture. Most Christian circles, however, do not have laments. Why is this? Is it because Christians are always happy? And always live victoriously? I don’t think so.
Depression, OCD, ADHD, bipolar disorder, are just a few of the things we are taking psychoactive medication for. However, have we given the use of these drugs any thought? That is, if we use them, do we use them with a well-informed understanding? If we do not use them, or believe we should not, do we make the decision on the basis of hard thinking?
I want to look briefly at the question and give you my conclusion. I would also like to know your thoughts. I would also encourage you to do more research on the subject. Of course, as you read my opinion, know that I am not a M.D., PSY.D., Dr., or D.Min.; I’m a blogger that is presently employed as a heavy equipment operator.
What must we consider as we consider the question of psychoactive medication?
We Must Consider Common Grace
There are many things we can look at regarding common grace. God pours out grace on all men (Ps. 145:9; Matt. 5:45). God has given us many good things to eat (Gen. 1:29). God has given us medicine, coffee, and doctors. He keeps the universe from imploding; which He did not have to do (Heb. 1:2-3; Jn. 1:1-4). God gives some form of conscious to men (Rom. 2:14-15) which in turn means that generally speaking parents love and provide for their children (Matt. 7:9-10; Acts 14:16-17). God, through various means, has restrained much evil (Gen. 20:6, 1 Sam. 25:26; Rom. 13:1, 6). The world is not as bad as it could be. God has also graciously preserved a semblance of His image in man (Gen. 9:6: 1 Cor. 11:7). Humanity is not as evil as they could be. In fact, because of common grace, humans can give true, accurate, and even helpful descriptions of reality (think of Edison and Einstein).
As Eric Johnson says, because of common grace “unredeemed humans are capable of accurately understanding aspects of God’s creation (including human nature, psychopathology, and facets of its remediation)—except insofar as it requires spiritual illumination—and this understanding is the gift of God.” John Calvin, also agreed that there is a lot we can gain from unregenerate humanity.
Most evangelicals gratefully, or forgetfully, accept modern medicine (a form of common grace).
Yet, realizing there are extremes and overprescribing of psychoactive medication (laid out well in Carlat’s book Unhinged), why do evangelicals so often, and so easily, disregard psychoactive medication? Is it because they are well-informed? Because if that is the case then fine, let it be disregarded. So long as the decision is justified on the basis of thought; and not vain heresay.
However, I am lead to believe that many are not well-informed on this subject so I will continue. We live in a fallen world and by God’s grace we have been granted medicine to reverse or alleviate some of the affects of the curse. If there are in fact biological factors involved in someone’s depression, for example, then why not help them with medication (again, a form of common grace)?
Eric Johnson, gives a helpful point. God created marriage and food “to be received with thanksgiving by those who believe and know the truth. For everything created by God is good, and nothing is to be rejected if it is received with thanksgiving, for it is made holy by the word of God and prayer” (1 Tim. 4:3-5). Johnson says, “Paul was admittedly addressing a very different subject than we are, but a legitimate analogy can be drawn. Like food and marriage, medication for a biological problem (such as the improper production of a neurotransmitter)… is not intrinsically evil… On the contrary, when used consciously and explicitly in dependence on God, biological and psychosocial soul-care assistance is ultimately a gift of God.”
God has given us—all of us—minds. And the means by which to explore our minds. Given there is much that is shrouded in mystery. There’s probably less explored between our two ears than in the depth of the ocean and the limitless expanse in space.  Yet, we can speculate and know some things. And for that, we must be grateful to God.
Thus, because of common grace, I believe psychoactive medication can be beneficial in certain cases. See below.
We Must Consider that we are Psychosomatic Unities
Many today believe that we consist of mere biology. We, and everything about us—emotions, actions, thoughts, etc., are determined by the determinism of biological and neurological activity. This, as you can imagine, has all kinds of negative implications (e.g. think of the penal system).
However, Christians believe in the material and also in the nonmaterial. We believe that we have a body and a soul. We are what is known as psychosomatic unities. The body is the vehicle of our soul. It provides the soul a means of expression. The body and soul are so closely tied, perhaps you could say interwoven even, that when the soul is absent from the body the result is death (esp. James 2:26; cf. Gen. 35:18; Ps. 31:5; Lk. 12:20; 23:43, 46; Acts 7:59; Phil. 1:23-24; 2 Cor. 5:8; Heb. 12:23; Rev. 6:9; 20:4). This understanding has historically had implications for various counseling issues and still has implications for us today.
We see in Genesis 2:7 that when God made man He made him out of dust (i.e. material, the body) and He “breathed into his nostrils the breath of life” (i.e. the immaterial, the soul). We are spiritual beings but God has provided us with bodies as our earthly habitation (2 Cor. 5:1ff). We are to be holy in body and soul, Paul tells us (1 Cor. 7:34; 2 Cor. 7:1). This implies that we are body and soul.
There should be certain implications if we believe we are body and soul. For one, we should realize that the body and soul are not unrelated. They have affects upon each other. So, for example, if you go without food or sleep (physical, bodily) you will be more irritable and prone to sin (spiritual, related to the soul). Thus as we minister to people (and think of sanctification for our self) the fact that we are psychosomatic unities should not go forgotten.
“Ministry must address the whole range of human needs if it is to minister to the whole person. God has constituted us as beings who exist as a unity but a complex unity that includes physical, psychological, spiritual, mental, and emotional faculties.”
So, we believe we are soul and body. But, is this what we really believe? If this is what we believe does it show in the way that we minister to people? If we are body and soul (i.e. psychosomatic unities), which Scripture makes clear we are, then why is it wrong to take medication? We take medication if our knees ache, we take medication if we have a headache. So, if we can be fairly sure that medication will help for psychological problems, then why should we not take it?
Thus, because we are body and soul, I believe psychoactive medication can be beneficial in certain cases. See below.
We Must Consider that We are to Have Dominion
Many today believe that man is no different than animals (1 Cor. 15:39). However, it is clear both biblically and logically that we are more. We are sentient and rational beings. We are created in the image of God. We are more than animals, we are to have dominion over the animals.
Our dominion over the earth is derived from the fact that we are created in the image of God (Gen. 1:26-28). That’s why we’re vice-regents. God is Lord over all the earth (cf. Lev. 25:23; Ps. 24:1; 50:10-11; Matt. 5:45; 6:26, 28, 30) yet He has put us over the work of His hands (Ps. 8:6). So man is supposed to work. We see this teaching in Scripture and it is often referred to as the Protestant work ethic (cf. Gen. 1:28; 2:8, 15; 4:17-20; Ps. 128:2; Prov. 12:11; 13:4; 14:23; 16:3; 20:4; 22:29; Eccl. 2:20, 24; 3:22; 9:10; Acts 20:35; 1 Cor. 10:31; 15:58; Eph. 4:28; Col. 3:17, 23; 2 Thess. 3:10; 1 Pet. 4:10-11). We are to subdue the land with our hands and our heads.
We are to bring good out of what was cursed (cf. Gen. 1:26, 28-29; 2:15; esp. 3:23). Of course, we can’t take away all the groaning, only the Lord can ultimately do that (Rom. 8:19ff). However, an implication of our dominion function and work ethic is that if we can relieve some of the strain caused by mental illness we should.
God has said, subdue the earth. Work the earth. Bring good out of what was cursed . God has also said work hard. Do a good job, and do it for my glory. I believe scientists, neurologists, and psychiatrists can do all of these things. I believe God has commanded them to.
Thus, because we called to have dominion and bring good out of what was cursed and because we are to work hard to God’s glory in whatever we do, I believe psychoactive medication can be beneficial in certain cases. See below.
Principals for taking Psychoactive Medication
- We should be fairly sure that the medication will help us before we take it.
- We should understand that psychoactive medications are not the elixir of life. They cannot, nor should we seek for them to, fix all our problems.
- We should understand that they often have negative side-affects. We should understand what the possible side-affects are and inform those closest to us.
- We should seek the advice of a competent doctor or psychiatrist; preferably with Christian convictions or sympathies.
- We should know the limitations of psychoactive medication. The medication cannot save or sanctify. However, that is not to say that God cannot use the medication to more easily facilitate the process.
- We should receive psychoactive medication, like all medication, with thankfulness. We must consciously thank God for His common grace in the provision of modern science and medicine.
- We should take psychoactive medication, like all medication, in reliance on God asking Him to bless its use.
- We should realize that people, you and me, and even psychiatrists and neurologists, come to the data with a certain worldview biases that shapes the interpretation of things.
- We should realize that the use of psychoactive medication does not do away with the need for reformational counseling (when counseling is needed) and vice versa, the presence of counseling does not mean that medication may not be needed.
- We should understand that sometimes, as Hezekiah says, it is to our benefit that we have great bitterness (Is. 38:17). It just may be the fire alarm of our soul. It may be sounding to warn of imminent danger. Thus, to “smash” the “fire alarm” in this case would likely not be helpful. Instead, we should seek counsel to root out the real underlying heart issue.
- We should understand that there is quite a bit of speculation involved in our understanding of how exactly psychoactive medications work. We cannot, for example, cut a patients head wide-open and see what’s going on.
- We should understand that some physical ailments are the result of direct sin in our lives (Ps. 31:10; Prov. 14:30), others are not (e.g. Jn. 9:3), and still other ailments are a complex and interwoven mix of the two. It can be very difficult to know the difference between a spiritual and physical issue.
- We should understand that the issue is complex. We must ask God to guide us with His wisdom. We must also remember His grace and love in the midst of uncertainty.
- We should hope in Jesus in the midst of suffering. It is through Jesus’ death and resurrection that all those who trust in Him have hope of glorified bodies where suffering and sin will be done away with (cf. Rom. 8:29; 1 Cor. 15:35-49; 2 Cor. 3:18; Phil. 3:21; 2 Pet. 1:4; 1 Jn. 3:2). We also have the hope of Jesus wiping every tear from our eyes and making all things new (Rev. 21:1-8).
Mike Emlet agrees that there are times to use medication. He says, “Medications are a gift of God’s grace and they can be used idolatrously. Any good gift can be used in a way that displaces God, his glory and his good purposes and makes something else (comfort, escape, even ‘normality’) more ultimate. We have freedom to use—but not abuse.”
So, my perspective is one of caution and thankfulness. I praise God that He has allowed medication that can relieve great suffering. And I am cautious because we must realize that psychoactive medication is not anyone’s savior and it can be overprescribed. I conclude by echoing Jeremy Pierre’s words:
“Applying this teaching practically is no simple matter. The psychiatric medication industry is largely driven by naturalistic assumptions and compelled by profit margins, and mental illness has been stigmatized in many of our churches. Thinking about how to navigate the process practically would require a discussion beyond the present one.”
 Psychoactive or psychotropic substances can cross the blood-brain barrier and affect brain function. They impact alertness, perception, consciousness, cognition, mood, and behavior. They alter brain function and subsequently behavior (E. John Kuhnley, “Psychopharmacology,” 58 and Frank Minirth “Psychoactive Drugs,” 66 in The Popular Encyclopedia of Christian Counseling).
 LifeWay Research has come out with a “Study of Acute Mental Illness and Christian Faith” that helps us to see where American evangelicalism is in regards to this question.
 I encourage you to read at least three things; (1) “Listening to Prozac… and to the Scriptures: A Primer on Psychoactive Medications,” by Michael R. Emlet, (2) “Psychiatric Medication and the Image of God,” by Jeremy Pierre, and (3) Blame it on the Brain? Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience, by Edward T. Welch.
 I am happy to see that the Association of Certified Biblical Counselors came out with a “Statement Regarding Mental Disorders, Medicine, and Counseling.” I believe that their statement is helpful, biblical, and balanced.
[v] It may be helpful to realize that along with alcohol and nicotine, caffeine is also a type of psychoactive drug. And notice that Paul thus, in a sense, told Timothy something like, take some psychoactive medication (see 1 Tim. 5:23). Some have construed Paul’s words in in 1 Thessalonians 5:23 as showing the importance of whole person care. Paul says, may your whole spirit (the theological), soul (the psychological), and body (the physiological) be blameless (v. 24 may lend to this view because we will in fact be made finally “blameless” in all of these spheres). Also, notice that the Bible does not speak negatively about doctors or medication; Luke himself was a doctor (Matt. 9:12; Col. 4:14; 1 Tim. 5:23).
 See The Institutes of the Christian Religion 2.1.8; 2.2.18-25. “In reference to the science and philosophy of which he was aware, Calvin argued strongly that Christians are to make constructive use of it. ‘If we regard the Spirit of God as the sole fountain of truth, we shall neither reject the truth itself, nor despise it wherever it shall appear, unless we wish to dishonor the Spirit of God'” (Johnson, “Reformational Counseling: A Middle Way,” 20).
 Daniel Carlat, a secular psychiatrist who trained at Harvard Medical School, wrote Unhinged: The Trouble with Psychiatry–A Doctor’s Revelations about a Profession in Crisis (New York: Free Press, 2010). In it he says, “The term ‘chemical imbalance’ is commonly used by laypeople as a shorthand explanation for mental illness. It is a convenient myth because it destigmatizes their condition—if the problem is a chemical imbalance, it is not their fault” (Ibid., 13). Later he says, “When psychiatrists start using what I call neurobabble, beware, because we rarely know what we are talking about” (Ibid., 74-75). Thus Edward T. Welch has said, “As Christians, we can’t just ‘listen to Prozac’; we need a biblically-based philosophy to guide the use or non-use of medications. We need to know not only the ‘what’ and ‘how’ of psychoactive medication use, but also the ‘why’ or ‘why not’ (“Listening to Prozac… and to the Scriptures: A Primer on Psychoactive Medications” in the The Journal of Biblical Counseling, 12). He goes on to say that the medications are “less like ‘smart bombs’ that work with laser precision, and more like conventional bombs with widespread effect on systems of neurotransmitters in the brain” (Ibid.). In fact, “in the majority of trials conducted by drug companies in recent decades, sugar pills have done as well as—or better than—antidepressants” (Shankar Vedantam, “Against Depression, a Sugar Pill Is Hard to Beat,” in Washington Post (May 7, 2002): A01. See also David Powlison, “Biological Psychiatry,” in Journal of Biblical Counseling 17 (Spring 1999). Richard Baxter, writing in the 1600s said, “If other means will not do, neglect not medicine” (“The Cure of Melancholy and Overmuch Sorrow, by Faith”).
 It is important to note here what Welch has said. Antidepressants “do seem to work—that is, improve mood and other symptoms of depression—in some people, some of the time, but they certainly are not the ‘silver bullet’ that some make them out to be. Even if we conclude that medications are or might be effective for a particular person, they comprise only a part of the total approach to the person” (“Listening to Prozac… and to the Scriptures,” 16).
 Johnson, Foundations, 375-76.
 There is still an awful lot that is still a secret. So, for example, in response to a study on a piece of a mouse’s brain the size of a piece of salt, Jeff Lightman, a neuroscientist and Professor at Harvard said, “It’s a wake-up call to how much more complicated brains are than the way we think of them” (“Secrets of the Brain“).
 The three contrasting anthropologies are: (1) tracheotomy; humans are made up of three parts, spirit, soul, and body, (2) dichotomy; humans are made up of two parts, soul and body, and (3) monism; humans are simply made up of physical organisms; what is commonly considered soul or mind is rather chemical and neurological processes.
 “Scripture does presuppose and explicitly teaches a distinction between the body and the soul—the view known as dichotomy—especially in its affirmation of the soul’s living presence before God at bodily death. However,… this view in no way entails, much less requires, a radical anthropological dualism. In that light, I would prefer a term such as psychosomatic holism, since dichotomy implies that the distinction between soul and body is more basic than its unity. The important point is that human nature is not to be identified exclusively or even primarily with the soul; the ‘real self’ is the whole self—body and soul” (Michael Hortan, The Christian Faith, 377).
 Early on various puritan writers knew the significance of the fact that we are psychosomatic unities. Here’s a clip from Jonathan Edwards: “This seems to be the reason why persons that are under the disease of melancholy, are commonly so visibly and remarkably subject to the suggestions and temptations of Satan: that being a disease which peculiarly affects the animal spirits, and is attended with weakness of that part of the body which is the fountain of the animal spirits, even the brain, which is, as it were, the seat of the phantasy. ‘Tis by impressions made on the brain, that any ideas are excited in the mind, by the motion of the animal spirits, or any changes made in the body. The brain being thus weakened and diseased, ’tis less under the command of the higher faculties of the soul, and yields the more easily to extrinsic impressions, and is overpowered by the disordered motions of the animal spirits; and so the devil has greater advantage to affect the mind, by working on the imagination” (The Religious Affections, 289-90). Also, earlier in the same work, he said, “Also, early on Jonathan Edwards realized this. He said, “Such seems to be our nature, and such the laws of soul and body, that there never is any case whatsoever, any lively and vigorous exercise of the inclination, without some effect upon the body.” Thus, he shows the interrelatedness of our body and soul. Richard Baxter, writing in the 1600s said, “If other means will not do, neglect not medicine” (“The Cure of Melancholy and Overmuch Sorrow, by Faith”). Martyn Lloyd-Jones, also considered a puritan in a sense, talked about the physical and the spiritual. And he was a medical doctor and in a sense doctor of theology. Lloyd-Jones said, “You cannot isolate the spiritual from the physical” (Spiritual Depression, 9).
 “The body is the material component of human nature distinct from–but intimately linked with–the immaterial component, commonly called the soul (or spirit)” (Gregg R. Allison, “Toward a Theology of Human Embodiment,” 5). It should also be noted that our human bodies are not in themselves bad. The Bible teaches that we will receive resurrection bodies (cf. 1 Thess. 4:13-18; Rev. 21:1-22:5). So the physical is not bad. It is good. But it needs resurrected.
 “More than 6,000 years from Eden, God’s creation is marred with many biological defects, including defects of brain structure and function. Sometimes these defects result in alterations in our abilities to reason, think clearly, and accurately perceive reality. In such a state, it is more difficult to discern truth and come to the knowledge of God. To the degree we can intervene with medication and restore the ability to reason clearly and perceive reality accurately, we increase the ability to know God and work with the Holy Spirit to restore the image of God in man. Antipsychotic medications are tools we can utilize to help those suffering with physical brain illness to think and function more clearly” (Timothy R. Jennings, “Antipsychotic Drugs,” in The Popular Encyclopedia of Christian Counseling, 66).
 I think Sarah Rainer is a good example of this. See “The Integration of Christianity and Psychology: A guest post by Sarah Rainer” Jeff Forrey also offers some helpful thoughts on her comments in “A Response to ‘The Integration of Christianity and Psychology: A Guest Post by Sarah Rainer.’”
 John Piper has said, “I do not want to give the impression that medication should be the first or main solution to spiritual darkness. Of course, by itself medicine is never a solution to spiritual darkness. All the fundamental issues of life remain to be brought into proper relation to Christ when the medicine has done its work. Antidepressants are not decisive savior. Christ is. In fact, the almost automatic use of pills for child misbehavior and adult sorrows is probably going to hurt us as a society (When the Darkness Will Not Lift: Doing What We Can While We Wait for God , 27).
 “Taking depression medication that improves brain function gives God some glory, since God is the ultimate source of all medical improvement, and because he designed brains to function properly. However, if the medication is taken in God’s name, that is, with conscious and explicit gratitude to God (e.g., by thanking God for the creation grace that led to its use), God is given much greater glory, because the biological order is transposed into the spiritual by thanksgiving” (Johnson, Foundations, 374).
 As unregenerate humanity wades into the areas where Scripture is more explicitly relevant we will see that they bring more distortions. “Christians ought to expect that human scientific activity will yield some distortions in human understanding, particularly when dealing with the issues of ultimate significance” (Johnson, Foundations, 101). “Counseling concepts, in particular, are loaded with connotations shaped by worldview beliefs” (Ibid., 94 cf. 97).
 “Many mild conditions respond to non-medication approaches. For moderate to severe impairment, medication is often necessary. Studies indicate that medication alone may be sufficient for a few individuals. More commonly, an integrative approach is necessary to achieve optimum results” (E. John Kuhnley, “Psychopharmacology” in The Popular Encyclopedia of Christian Counseling, 60).
 cf. Jay Adams, Competent to Counsel (Grand Rapids: Zondervan, 1970), 103.
 See for example Blaming the Brain: The Truth About Drugs and Mental Health by Elliot Valenstein. On page 65 he gives a helpful and brief overview of his opinion.
 See Heath Lambert, “How Can Christians Tell the Difference Between a Spiritual Issue and a Physical One?”