TPW 48 Depression Its Causes Symptoms and Cures

Remember God's faithfulness to you. Look at all the things that he's done already in your life. Look at his track record. That's why he carries us through things, so we can see he is indeed faithful. Welcome to the Protestant Witness.

This is Pastor Patrick Hines here at Gridwell Heights Presbyterian Church in beautiful Kingsport,.

Tennessee.

And we set a record two days ago for the most snowfall in a single day, over 12 inches. And it's beautiful, but a lot of folks were without power. Thankfully, the power lines in our neighborhood are underground, so we didn't lose power.

At all.

But the kids have been having fun. The temperature got high enough to melt some of the snow, and I made a gigantic mountain right by the camper, so the kids were sledding off of the hill onto the snow.

We had a lot of fun yesterday. But to this day, I'd like to post the next sermon in the series on depression. There's this one, and then there's one more. And this particular message is about the symptoms, the causes, and the cures for depression.

This is a crisis. It's been a crisis, really, ever since man fell into sin. But there are a lot of people in our country today that are on antidepressant medications and things like that. So we need to understand this phenomenon biblically as much as possible and understand what causes it and how we can, with God's help, overcome it.

And sometimes with the help of certain kinds of medication can help get out of a hole to start dealing with some of the causes of depression. So I hope you find this edifying. Let's pray together, please.

Our Heavenly Father, we come before you humbled by your glorious majesty and confessing our need to hear from your word, and we pray you would help us, Lord, to better understand the nature of depression and anxiety, as there is so much in your word about these topics that we need to learn, that we need to receive with faith and love, lay up in our hearts and practice in our lives.

And we pray that you would bless us to that end now, in Christ's name, amen. Please take your Bible and turn to Psalm 42 as our scripture reading for this morning. Psalm 42. Psalm 42. And this morning's message is not really an exposition of this particular psalm.

We're going to look at a lot of different passages this morning, but continuing on a sermon I've called A Breakdown of Depression. A Breakdown of Depression, sort of a continuation of last Sunday morning's message.

Psalm 42, verse 1, this is God's word. As the deer pants for the water brooks, so my soul pants for you, O God. My soul thirsts for God, for the living God. When shall I come and appear before God? My tears have been my food day and night, while they say to me all day long, where is your God?

These things I remember, and I pour out my soul within me. For I used to go along with the throng and lead them in procession to the house of God, with the voice of joy and thanksgiving, a multitude-keeping festival.

Why are you in despair, O my soul, and why have you become disturbed within me? Hope in God, for I shall yet again praise him for the help of his presence. O my God, my soul is in despair within me, therefore I remember you from the land of the Jordan and the peaks of Hermon, from Mount Mizor.

Deep calls to deep at the sound of your waterfalls, all your breakers and your waves have ruled.

Over me.

The Lord will command his loving kindness in the daytime, and his song will be with me in the night, a prayer to the God of my life. I will say to God, my rock, why have you forgotten me? Why do I go mourning because of the oppression of the enemy?

As a shattering of my bones, my adversaries revile me, while they say to me all day long, where is your God? Why are you in despair, O my soul, and why have you become disturbed within me? Hope in God, for I shall yet praise him, the help of my countenance and my God.

May God bless the reading of his infallible word. Well, this morning's a little different. I've given you the longest outline I have ever written for a sermon. So, it is four whole pages, the front of that first page there, and then the whole inside in the back.

So, this is sort of your outline and thoughts for Sabbath meditation all rolled up into.

One.

And I would encourage you to follow along in that outline. There's a lot of material I want to cover this morning, and I think it's vitally important.

For us.

Last Sunday, we started looking at the topic of depression and anxiety from a biblical perspective. There is so much that has been written on this topic over the years by great men of.

God.

The Puritans addressed these issues. Great men of the recent past, Jonathan Edwards, Martin Lloyd-Jones, and many others, have addressed these issues. And it's very important that we understand these things from a biblical perspective.

We looked at a number of key passages of scripture that show the remarkable transparency of the biblical writers with regard to the often very dark and very down ways that they felt. We also talked about the importance of understanding this issue from a biblical perspective in our day because depression and anxiety issues seem to be sharply increasing in our day due to the moral and spiritual collapse of our country, the apostasy, compromise, and lethargy of the church, and the almost nonstop barrage of bad news that we all hear on a daily basis from every media outlet.

We looked at some of the causes of depression, including poor thought control on our part as well, as well as the increasing knowledge that we have as we experience life. Remember Ecclesiastes 1 .11, as the knowledge of a human being increases, sorrow will increase as well.

This morning, we are going to consider the factors that can lead to depression as well as give a thorough biblical definition of exactly what is affected by depression. And before we do that, I want to remind you of two great biblical weapons we've been given to combat depression in order to stop it from debilitating and ruining us.

The first weapon was what Jeremiah did in Lamentations 3 .21, and this first weapon is we can control what we recall to mind. Remember Lamentations, you have Jeremiah looking over the ruins of Jerusalem after the Babylonians destroyed it, and he's weeping and lamenting over the fact that nobody listened to him as a prophet.

He kept calling them to repent. They would not repent. They destroyed the whole place, destroyed the temple, and Jeremiah's lamenting, lamenting chapter 1, chapter 2, the first part of chapter 3, and then chapter 3, verse 21, he says, this I recall to my mind, and therefore I have hope.

Through the Lord's mercies we are not consumed, because his compassions fail not. So that first weapon that we have against the depression is we can control what we call to our minds. Remember God's long track record of faithfulness to you.

Meditate on the ways in which he has convicted you of your sin, the hardships he's already brought you through in life. Very often when we come to a situation that makes us depressed, it's almost like we forget all of the ways God has already shown himself to be faithful to us.

Recall the ways that he's carried you through things already, all the ways that he has loved you and protected you and provided for you. We have a choice when it comes to what we set our minds upon, and Jeremiah shows us that in Lamentations.

The second weapon that we have is self-rebuke, self-questioning, self-instruction. In other words, tell yourself the truth. Tell yourself the truth. In Psalm 42, we see a great battle between depression and self-rebuke.

Did you hear it in verses 5 and 11? What does the psalm writer do? Why are you so downcast? He's talking to himself. He's rebuking himself. You have no reason to feel this way. Hope in God. He's commanding himself, confronting himself, rebuking himself.

So those are the two great weapons we learned last week. We can control what we're thinking about. And if your thoughts have turned dark and have stayed dark for a long time, remember God's faithfulness to you.

Look at all the things that he's done already in your life. Look at his track record. That's why he carries us through things, so we can see he is indeed faithful. And then the second weapon, rebuke yourself.

Command yourself. Hope in God. Why are you so downcast, oh my soul? Hope in God. Now, one of the major points that needs to be understood and emphasized about this topic of depression is this, and here's the first major heading in your outline there.

The Causes of Depression and the Need for Humble Diagnosis

We need to avoid being dogmatic about what's causing it, and we need to be humble in the way that we evaluate ourselves and others. Folks, the worst thing that a doctor can do is misdiagnose someone's illness and then treat them for the wrong thing.

That's one of the most dangerous things that can happen in the medical profession is thinking someone's actually got some condition when they've actually got something else wrong.

With them.

So it's critical that we do that, that we have a proper diagnosis of what's causing the depression. And so that's the first point in your long outline there, the causes of depression. And here are three extremes that we need to avoid as we diagnose what's causing depression.

The first one is that the cause is entirely physical. The cause is entirely physical. Now, if that was always the case, then the only real and effective treatment for depression would be medicine. And I want you to think about why this is the perspective that dominates our society and culture today.

Does anyone understand why? You know why? It's called evolution. It's called materialism. We are naturalist materialists. That is the worldview that dominates our society and culture. And so we look for a materialistic solution to everything.

If I feel sad, if something's wrong with my life, if something is wrong with my personality, if I've got some issues where I'm down or depressed, the issue has got to be a chemical.

One.

It's got to be a chemical solution because that's what that worldview says we are. All we are is matter in motion. You and I, all we are, are a bunch of atoms banging around. We're just chemistry and physics going on.

And so it makes sense that the solutions would just be more chemistry and physics. Now while there is much scientific study that has demonstrated that the brains of many depressed people have a different chemistry, which can be helped with drug therapy of some kind.

It is a colossal error to think that such imbalances alone are what caused depression. And there are people who think that that's the case and that's a big problem in our society. There's been an increase in emphasis upon the physical dimension of depression lately because of an overreaction to Jay Adams view that the causes are almost always exclusively sinful and spiritual.

But like I said, we want to avoid extremes. What we need to take seriously is the fact that most depressions do, in point of fact, have some kind of a physical component to them, which could be helped with medicine.

Okay, so that's the first extreme. The first extreme is the cause is entirely and only always physical. The second extreme we want to avoid is this. The cause is entirely spiritual. Now there are two forms that this extreme can take.

The first is among many charismatics and Pentecostal types, especially in America, depression is seen to be caused by demonic possession, and thus it requires an exorcism or something like that. And therefore the treatment is to affect some kind of spiritual deliverance in the form of the expulsion of demons.

And the scriptures do speak of our ongoing battle against demonic forces in the spiritual realms, Ephesians six, many other places talk about that. But some people erroneously think that nearly every malady a human being can have, not just depression, but everything from financial difficulties to marriage difficulties is attributable.

To a demon.

And therefore you need to get rid of the demon of this or the demon of that. And surely that's an error too. And while I think demon possession is extremely rare, I think it can happen on rare occasions.

So that's the first error. Many people think it's demonic and therefore we've got to have an exorcism over you if.

You're depressed.

The second one is more common. Depression is caused by sin. Therefore rebuke, repentance, and confession are the answer. While this can often be the case for those suffering from depression through no unconfessed sin or on their part, for them to be rebuked and called to repentance can be a rather devastating line to take with them.

I would cite as an example, Job, remember Job, Job was very, very depressed. He was very down and sad because of his losses. And we know from the book of Job that the loss of his children, his wealth, his wife, and his health were not because of sin in his life.

And yet what do his three counselors do to him constantly? They're rebuking him over and over and over. And most of the book is Job saying, but I didn't do anything. I didn't, I'm not aware of anything that I did.

Why are you guys doing this to me? I don't need repentance.

I need sympathy.

I need you guys to show some, some concern and compassion to me. So the rebukes of Job's friends for sins, which Job had not committed, were nothing more than throwing salt into his gaping wounds. And while the cause of depression can be physical in part and spiritual in part, we must not err in holding that the causes are always the same or that they're always only one thing.

And there's a great man of God that all of us should be very thankful for, Jay Adams is his name. He has been a pioneer in what is called the New Thetic counseling movement, where that term New Thetic is from the Greek verb, which means to admonish or to confront.

And that is a extremely useful way of doing counseling. We need to confront others very often with their sin. We need to confront ourselves with our sin. And Jay Adams has done incredibly helpful work and teaching us how to confront ourselves and how to confront others with sinful behavior, which can dramatically affect how we feel.

According to the author, David Murray quote, Adams was reacting against the humanistic view that explains sinful addictions like alcoholism as sickness or that blamed immoral behavior on one's genes or that tried to remove people's guilt feelings by encouraging them to deny personal responsibility for their actions and simply accept themselves as they.

Are.

Jay Adams emphasis on the need to accept personal responsibility in these situations was necessary. He was also right to expose the over prescription of psychiatric drugs and to demand that counseling actually deal with the problem of unbiblical behavior rather than simply make people feel better in their sins.

Doesn't it make some sense to you, however, that's the end of the quotation, doesn't it make some sense to you that there would be a dramatic increase in prescribing psychotropic drugs in a culture dominated by an evolutionary worldview?

Of course it would.

And Adams is saying, look, most of the counseling I've done, if you ever get a chance to read out and says, look, most of the time it's just people sinning and people are being put on drugs when the fact is they just need to stop these sinful behaviors and then they'll.

Feel better.

And so he was right. And very often he's right about that. And people just need to repent. But that's not the exclusive cause. And folks, we are certainly a culture of victims and blame shifters, aren't we?

So we like to say, well, it's not really my fault, so just give me some pills to fix it. Just like Adam and Eve, we prefer to point our finger at something else. I have a condition. I've got this problem.

I inherited these genes instead of having to admit I am the way I am because I'm evil and because I'm a bad person and because I'm wicked. That's a little harder to deal with, isn't it? Jay Adams returned to biblically dealing with personal sin is much needed in our time.

But again, we want to avoid extremes in looking at the causes of depression. Oftentimes it is sinful behaviors that cause depression, but not always. Charles Spurgeon, a man who suffered terribly from depression, wrote this very profound.

Paragraph.

Please listen carefully to this. Quote, it is all very well for those who are in robust health and full of spirits to blame those whose lives are sickly or covered with the pale cast of melancholy. Always remember, when you read people in the 1800s and 1700s, they call depression melancholy.

But the malady, the sickness, is as real as a gaping wound and all the more hard to bear because it lies so much in the region of the soul that to the inexperienced, it appears to be a matter of fancy and diseased imagination.

Reader never ridicule the nervous and hypochondrical. What is a hypochondriac? Someone who's convinced they're always sick, even when they're not. And Spurgeon says, don't ever ridicule those people. Their pain is real.

Though much of the malady lies in the imagination, thought processes, it is not imaginary, end.

Quote.

In other words, they really do feel these things and it really is painful to them. And we need to have a culture of compassion on people who have these issues. Think of it like this, if you say that the cause of all depression is exclusively sin, and so no matter what depressed situation you look at, we've got to get this person to repent and change their behavior, think of it like this, let's say that Adams is correct and a person is experiencing very dark depression as a result of sinful behaviors that he needs to repent of.

But a side effect of his depression is that vital brain chemicals are now depleted because he's been suffering in this condition for a while. Because of this, the man is now in a black hole of depression.

He can't do anything and he can hardly function at all. Now although this condition was brought on by sinful actions, telling this guy to repent of his idolatry is not going to help him. Medicine therapy could in this case be the initial step to restoring his brain to normal levels so that he can then address the sinful behaviors.

You see very often it's going to be a combination of things and we don't want to err in being.

Extreme.

It's rarely exclusively physical or exclusively sin or exclusively something else. What caused his depression was sinful behavior, but drug therapy can be a lifeline for people to stabilize their minds enough to start addressing sinful actions and behaviors.

Usually depression is a somewhat complicated matrix of causes and issues. It's rarely just one thing in a person's life. It's a mistake to categorize the cause of all depression to be heart idolatry and repentance of that heart idolatry always to be the only cure.

David Murray said this, quote, listen to this paragraph, I think this is very profound. He says, quote, we would never take this view that sinful and spirit, the sinful cause slash spiritual solution when counseling people with cancer, strokes, broken legs, diabetes or Alzheimer's as reformed Christians.

Our default position is that these physical problems are most likely the result of living as fallen creatures in a fallen world. When you see someone that has a physical injury, you don't think, well, he needs to be called to repent of something.

Well, you might've just slipped and fallen and that's not a sin, is it? Murray continues. Why should our default position with the brain problems be any different? Are we saying that the brain, the most complex organ in our body is somehow exempt from the effects of the fall?

My skin is broken down by psoriasis. My eyes are broken down with short sightedness. My nose is broken down with rhinitis. My joints are sometimes broken with arthritis. My bowel has required two operations.

My legs are broken down with varicose veins. My body is covered with dangerous moles, two of which have been removed, but I'm actually very healthy. I do not believe any of these ailments are the result of personal sin, but simply the consequences of being a fallen creature, living in a fallen world or of inheriting genes from my mother and father who have also had similar health issues.

Why then should we always have to conclude that brain disorders are the result of personal.

Sin?

Why are our brains messed up? The same reason our bodies are messed up. The same reason my knees hurt. The same reason my hearing is starting to go away. The same reason my eyesight is getting worse. We live in a fallen world.

It makes sense that they would affect our brains, and yet sometimes it seems that people really think that our brains are unaffected, and if there's anything wrong, it's a personal sin problem, but that's not always the case.

So we want to avoid the extremes of believing that personal sin is always the cause of depression, and we want to avoid the extreme of thinking it's all physical and all chemical and can be solved that way.

The third extreme we want to avoid is there in your outline. The third one is that the cause is entirely mental. It's all in the mind. This view argues that depression is actually not real at all, and that it's just an illusion we make up.

It says that only the weak-minded experience depression. Those who think this way, I just would give you this warning, 1 Corinthians 10, 12, therefore let him who thinks he stands take heed lest he fall.

Some people who have never experienced depression, never had a panic attack, will be humbled by God by being carried through a season of it. So always be careful that you don't look down at others who experience these kinds.

Of issues.

So to summarize the first section here, we want to avoid those three extremes, that depression is entirely physical slash chemical, that depression is entirely sinful, or that depression is just an illusion.

We want to avoid all three of those. Murray wrote this, just as no two hearts are identically diseased, and just as no two cancers are the same, no two depressions are the same in cause, symptoms, depth, duration, and cure.

Therefore we must avoid making our own experience the norm for others. Even great Reformed and Puritan theologians who have addressed this issue through the ages have cautioned against simplistic answers to what is in fact a very complex condition that people really do suffer from in this world.

Martin Lloyd-Jones said this, quote, Christians do not understand how physical, psychological, and spiritual realms interrelate because Satan muddies the boundaries. Many of our troubles are caused because we think a problem is spiritual when it is physical, or we think a problem is physical when it is emotional or spiritual.

Five hundred years ago, William Perkins, the Puritan writer, recognized the same exact distinction, quote, sorrow that comes by melancholy, or depression, arises only in that sickness annoying the bodies, meaning there's some forms of this that are physical.

It's just a kind of illness. And then he says, but this other sorrow arises from man's sins. See how he saw the distinction? Some of this is chemical, some of it is sinful and spiritual. He says, for which his conscience accuses him, depression may be cured by medicine, says Perkins.

This sorrow cannot be cured by anything but the blood of Christ, end quote. Even Jonathan Edwards followed Perkins' line of thought and said the famous Mr. Perkins distinguishes between those sorrows that come through convictions of conscience, in other words sin, and depression, passions arising only from mere imagination strongly conceived in the brain, which he says usually come on a sudden like lightning into a house, end.

Quote.

And so just to sort of summarize the first big heading here, David Murray says this, for Christians there will often be need to be a balance between medicines for the brain, rest for the body, counsel for the mind, and spiritual encouragement for the soul.

Recovery will usually take patience, perseverance over a period of many months, and in some cases even years. Now the reason I took the time to go through all this introductory material here is I think that some of those extreme tendencies exist in the church.

I myself have held to some of them before. We tend to label depression cases as nearly always one thing or always another and always needing the same reaction from us, but we need to recognize that depression is a very complicated phenomenon, and because of this, which is, and this is a sad part, very often people are not being helped in the ways they need to be.

To misdiagnose the cause, you're not going to get the proper treatment, and so we need to evaluate case by case and evaluate ourselves case by case as well. Okay, so that's the first major point. Number two, depression itself, and here's the main, the heart of this morning's message.

To you.

With these things in mind, let's look at the condition itself. What exactly do we mean when we say depression? What exactly, biblically speaking, is depression? David Murray answers this question in a very helpful way by looking biblically at five areas of our lives that are affected by sadness or depression.

The first is our life situation, two, our thoughts, three, our feelings, four, our bodies, and five, our behavior. Now under the second heading, under thoughts, there are ten sub-points, and under the third heading, our feelings, there's six questions.

But first, let's look at life situation. Life situations affect the way we feel. There's no question about it. By this we mean job loss, moving, marriage difficulties, family difficulties, financial difficulties, the deaths of loved ones when we lose people that used to be in our lives that were important to us.

That can seriously impact our emotional and mental health. People can be down and never really think of their life situation to it in the way that that's affecting the way that they feel. If you're experiencing great sadness, evaluate first your life situation.

Has something big changed recently in your life? Is a relationship that was part of your life now over? Is someone that was very important to you now dead, and so forth? Have you ever endured big changes, big losses, big stresses, et cetera?

If you haven't, you will. While some people have a natural tendency towards depression, there are almost always providential trigger points of them. And just because we've successfully dealt with depression in the past does not mean that we will always successfully do so in the future.

David Murray said this, we age, our hormones and brain chemistry change, and our responsibilities increase as marriage and children come along. Sometimes an adverse reaction to life events will be delayed even for some years.

You need to look at depression. If you are experiencing a bout of excessive sadness and heartache in your life, has something changed in the last three, four, five, six years that maybe now is just starting to manifest itself?

Life situations are very often out of our control. So that's the first one, our life situation. The second one, our thoughts. And folks, this is the key. I want you to remember these things. That's why I've given you this outline.

I truly hope that you will walk through this stuff. If you have experienced depression, are experiencing it now, or know someone else who is, I hope that you will minister to them with these things. Our thoughts.

Our thoughts are really the key to depression. Proverbs 23, verse 7, for as he thinks in his heart, so is he. As you think in your heart, so are you. As a man thinks, so he is. Thought patterns are really the most obvious symptoms of depression.

Thoughts in the depressed person tend to distort their view of reality in a false and negative way which only makes the depression worse. Now folks, we cannot change God's sovereign decree and his providence for us.

We don't know what's going to happen. God knows it. He's planned it out from before the foundation of the world. But as we have already learned from Lamentations chapter 3 and Psalm 42, we can change the way we think about what happens in our lives.

David Murray in his book lists 10 very helpful and biblically addressed thought patterns that are key pointers that people are depressed and which also contribute to people becoming more depressed. Now before we walk through these 10 things, I want to tell you something that's very important.

All 10 of these things are violations of the 9th commandment. What is the 9th commandment? You shall not bear false witness against your neighbor. All 10 of these thought patterns are us lying to ourselves.

Now it's not just lying about someone else that's forbidden in scripture. It's not just lying to someone else. We can violate the 9th commandment by lying to ourselves. By having these false thought processes going on in our minds.

So let's go through some of these, see if any of these sound familiar to you. Number one, false extremes. Depressed people tend to see things entirely as black and white. There are no gray areas at all.

For each of these 10 false thought patterns, I want to try to give you a life example, a spiritual example, and a biblical example of all of them. For example, a life example of false extremes. If you're making cookies and you accidentally burn a batch, your conclusion is you're the worst cook in history and you should never make cookies again.

You are praying, for another example, you're praying and your mind is distracted with a very sinful thought. Your conclusion, I must not be a Christian at all, I'm not going to pray anymore.

Think of Job.

Despite the fact that the vast majority of his life, the vast majority of the man's life, was characterized by God's blessing, by prosperity, by health, by personal godliness. When he was going through terrible suffering, he concludes, I am an enemy of God now.

I have a question.

Was Job an enemy of God?

No.

At no point was he an enemy of God. God's love for the man never wavered. Not once during the whole book. And yet he says, I'm his enemy now. False extremes. Depressed people tend to be very black and white.

One thing goes wrong, they think everything in the world is wrong. Second thing, and just remember, that's a violation of the ninth commandment. That's lying to yourself. False generalizations. Here's another thought pattern that's false.

Depressed people, when they experience anything negative, will conclude that such will always be what they experience in that situation from then on. For example, a young man has feelings for a woman.

He expresses those feelings to that woman and she rejects him. And his conclusion, I will never get married and no one will ever love me. And sharing the gospel with someone, another example, they become hostile to you and mock.

You.

And your conclusion to that experience is, everyone I ever showed the gospel with is going to mock me and make fun of me, so I'm not going to share with anyone anymore. Remember Jacob in Genesis 42? Although God had already shown Jacob his incredible faithfulness in protecting him from Laban and providing for his needs and giving him everything he needed.

Although God had shown him how faithful he was. When Jacob was at a low point in his life, he concluded his son Joseph was dead. He wasn't. That Simeon was captive in Egypt. He wasn't. And that his son Benjamin was also taken captive and he wasn't either.

And Jacob's summary statement in Genesis 42, 36 is, all things are against me. That's a false generalization, Jacob. God is still for you. God still loves you. You still know him. You still have all these other sons with you.

And by the way, Joseph's not dead. And you're going to see Benjamin again. You're going to see all these people again. But he falsely generalized, depressed people falsely generalized that one negative experience with something means that that thing will always be negative in their life.

And folks, that is a lie.

That's not true.

Another thing, false filters. Depressed people will pick out the negative in every situation and think about it alone to the exclusion of everything else. For example, an excellent student gets a 99 on a test and spends the rest of the day bummed out about the 1 she missed instead of noticing that she got 99 of the test right.

I had a college roommate that was like that. He was the number one student in the College of Engineering. I'll never forget him up there with the calculus professor. I actually took calculus for reasons I will never understand.

I took calculus. And he was up there. He got a 49 and a half out of 50, the highest grade in the class. And he was up there arguing with the guy. He had the highest grade in the class. He had never gotten an A minus in college.

And he's up there arguing with the professor. I'm like, are you seriously arguing about half a point? And this Indian professor with real thick accent, I remember hearing him say, he said, Mr. Gibbs, this will not affect your grade.

And he just, he was all upset. I said, hey, I'd be doing car wheels if I got 49 and a half out of 50 on a test. Depressed people filter out the good and focus on the bad, even if the experience is almost entirely positive.