Kirby Smith has been a pastor for 36 years, and knows a thing or two about life and Christianity. Also, about anxiety and depression.

Pastor Smith and I recently talked about his gripping battle with anxiety and depression, what helped (ECT and medication), and the theologically erroneous view that anxiety and depression are spiritual problems.

As Pastor Smith says of his battle, “This has never been a spiritual issue. It has been an absolute, 100% physical problem I’ve needed to address.”

If you think your depression or anxiety is a spiritual defect, I hope you’ll read this interview, and find comfort in the fact that a) this is something pastors go through, too, and b) it’s a treatable physical illness.

Our discussion has been edited for clarity and brevity.

HEINZE: Can you talk about your experience with depression?

SMITH: It started in my mid-30s.

I began to feel something of a malaise. I would sit in my office and wasn’t motivated to do anything. I talked about it with our director of missions, and he said, “Well, it sounds like you’re depressed.” I had no idea what that was.

On top of that, I was incredibly anxious. Tense. I could feel my insides knotting up. There were no real stressors that I could point to that would cause this.

I’d spend a ton of time in prayer in my office. I would walk through the church, praying for this to be lifted. I’d walk through the sanctuary around and around and around. I’d walk up the stairs, walk down the hall, through Sunday school classrooms, and I would do that for hours.

I got absolutely zero relief.

We have a camp in the mountains, and I went up there for a conference one time and wandered into the chapel, by myself.

I spent three hours in that chapel praying for God to lift whatever this was, and came out feeling just as miserable as when I walked in.

I thought it was a spiritual issue.

And then that Scripture, “Perfect love casts out fear” came to mind, and I kept thinking, “I need to love God more perfectly to have my fear cast out.”

Which was a complete misunderstanding of the verse.

I thought it was up to me.

But it just didn’t get any better.

HEINZE: How did it affect your faith?

SMITH: It didn’t really affect it. I still had the same amount of faith. I still believed, I was still preaching my sermons. I don’t know how effective they were. I don’t know how good they were because I was such a wreck.

I was just lucky to get through the week and come up with something to preach and still do my visitation.

But it never really affected my faith.

That went on for three or four years, and then we were called to another church, and without any sort of medication or counseling, it went away. It just lifted. And I thought, “Well, maybe the new start is just what I needed.”

I just felt so much better. That went on for a couple of years. And then things started to creep back in. We had a physician in our church. I went to him, and he put me on medication. It worked. It lifted that malaise.

I was on it for a couple years. Then I went back to him and said I was doing well, and asked about going off it. He said I could, so I did.

I came to realize later, in reading, it’s almost like alcoholism. Once a depressive, always a depressive. If you go off your meds, it tends to come back worse the second time. I went off them, and I was fine for probably a year.

Then I had a nervous breakdown.

I went to my office one morning. It was May, spring, warm, and sunny. I got there around 8:00 and all of a sudden, I felt this heat, this flush come over my body. Almost like my body was on fire. I had no idea what was going on. I called my wife and told her to come over. I thought it might be a stroke or heart attack.

She came over to the church. We went to the ER, talked to a doctor, and he basically said there was nothing wrong with me and that I should breathe into a paper bag. He kicked me out, basically!

So we went home, and two hours later, I was back in the ER. Same doctor. I felt like I was dying. My body was just rebelling. The doctor said the same thing. He said, “There’s no doctor that’s going to see you with these symptoms.”

I became a very uncooperative patient. I was furious. I knew something was seriously wrong. I didn’t know if I was going to live.

Twenty-four hours later, I was in a psychiatrist’s office, in a fetal position, at the end of the sofa. The doctor’s words are emblazoned in my memory: “This is eminently treatable.”

Just hearing that was such a blessing. He put me on an antidepressant and an anti-anxiety medication and within a couple weeks, I did feel better.

I felt better for a couple years, and stayed on the meds. But the meds started to lose their effectiveness. He tried me on a few different ones, but none worked.

And then in 2003, I was scheduled to deliver the baccalaureate address at my daughter’s graduation, and it hit again — just like several years earlier.

I had to back out of that, and found myself fetalized again. At that point, the doctor said that we’d done all we could do with pills and suggested ECT [Electroconvulsive Therapy].

At that point, I didn’t care.

Meanwhile, the chairman of our deacons came to me one night, and he said, “Kirby, we need to talk. You’re not doing your job.”

He was blunt but also very gracious. And I knew I wasn’t doing my job. For a couple years, I would sit in my office with the door closed, just staring into space until 5:00 when I could leave. My secretary left at 3:00, and I couldn’t wait for her to leave.

Because when she left, that was my time to crash.

HEINZE: That crashing you talk about. Was that more of a malaise or sense of impending doom and dread?

SMITH: Impending doom and dread.

I was thinking of ways to commit suicide without my wife finding me in a pool of blood.

It was so bad, I just felt like I couldn’t keep living like that. My depression was so bleak, I couldn’t move. I couldn’t wait to go to bed at night, and didn’t want to get up in the morning.

My salvation was sleep. The problem was that when I woke up, my anxiety was so bad I felt like I was coming out of my skin. The anxiety was worse than the depression. My body was wound so tight.

One Saturday night, my anxiety was so bad, I sat up in our living room all night long, praying that God would get rid of whatever it was I had before I had to go to preach the next morning.

I didn’t know how I was going to preach. I remember seeing the sun come up, seeing the dawn and thinking, “What am I going to do? It’s still here.” I didn’t get one second of sleep.

HEINZE: The popular conception is that depression is the leading cause of suicide.

But studies actually show that anxiety is more likely to lead to suicide than depression. It’s because of the desire to escape. The terror of living in a body riddled with anxiety.

I’ve had anxiety and depression. Depression is terrible, but it doesn’t take me to the extremes like anxiety.

SMITH: Depression is darkness, but anxiety makes you think, “I’m going to die.”

Every time I would try to take a nap, I would dread falling asleep, because I would almost jump out of bed when I’d wake up.

I’d feel like I was clinging to the ceiling. It was unbearable.

I knew I hadn’t been doing my job. So when the chairman of deacons came to me and said, “I want to help you apply for disability.” I was grateful for that. I was thrilled. I thought, “I don’t have to do this after tonight?”

We began to work with my doctor towards ECT. I got disability within two weeks. Talk about a blessing.

I went to Lynchburg General Hospital, and had nine ECT treatments in eighteen days. Then I went home and began to feel better very quickly.

One potential side effect is short-term memory loss, and I’ve had a little bit of that, but it gives me a good excuse at church if I screw something up in my ministry to say, “Hey, my ECT.”

The worst thing about it was that I was hypomanic for six months to a year. During the first few weeks, I couldn’t sleep for more than five minutes at a time. But that got better, and it’s completely gone now.

One year later, I was called to our current church outside of Richmond. We’ve been here about 14 years. My wife was able to fulfill a lifelong dream here. She was called as the minister of music, and I was called as the pastor. I’ve had an opportunity to be an adjunct seminary professor for seven years and have had the opportunity to write several articles.

I can’t tell you how many people I’ve been able to counsel who have been going through anxiety and depression many times.

I can finish their sentence for them. When they’re struggling with the name of a medicine, I can usually tell them what it is.

I’m well, I’m happy. My kids see such a difference in me.

When I was in 4^th grade, my best friend called me a “worry wart.” So I think I’ve had some of this in my system, my entire life. I used to worry a lot.

But I’m very much at peace now. More at peace in the past 15 years than in my entire life.

HEINZE: So do you see ECT as a real turning point?

SMITH: Yes, it saved my life. I honestly don’t think I’d be here today without that.

HEINZE: The evangelical community acknowledges depression and anxiety now, but there’s such pressure to point to Scripture, prayer etc as the cure.

But medicine and ECT are gifts from God.

In fact, it’s just as spiritual to say, “God gave me a great prescription drug” as it is, “He gave me a great Bible verse.”

SMITH: I have read so many articles and books by Christians about depression, and they’re basically worthless.

They’ll talk about the reality of depression, and then they’ll say you need to throw yourself into church. You need to pray. You need to do a Bible study, and then maybe they’ll touch on medication, but it’s almost like an afterthought.

It’s a very namby-pamby, uneducated, ignorant response that most Christians have.

I still take medicine. I don’t know if I need it, but the worst thing to do is go off it, thinking you don’t need it anymore.

I’m going to stay on it forever, because I don’t want it to come back.

HEINZE: In an article for Baptist News Global, you write that most evangelical material on mental illness is “shallow, trite, uninformed, and even harmful.”

How can it be harmful?

SMITH: I think it keeps Christians from pursuing medical treatment.

It keeps us in the spiritual realm, and this is not a spiritual illness.

If we have heart trouble, we have coronary disease. If we have lung trouble, we have pulmonary disease. Yet if you have a brain problem, you are told you have a spiritual problem.

I didn’t have a spiritual problem. I had a brain that was malfunctioning, and I needed to get it fixed. And it’s harmful when Christians are led to believe it’s not.

They forgo therapy that might be the very thing that can heal them.

That’s why I said it was harmful.

I was asked by a local pastor to address his church, and in preparation, he kept wanting me to talk about what Scriptures had been helpful. I kept emailing him back and saying, “There aren’t any!”

I know the Scriptures. I’ve been a pastor for almost 40 years. There were no helpful Scriptures. It frustrated him, because he wanted me to talk about Biblical help that I’d gotten. And I didn’t get any Biblical help.

Just like if I had a heart attack, Scripture wasn’t going to help the doctor fix my heart.

I have always been a person of faith – I think I was born in the church nursery — and my faith has never wavered.

This has never been a spiritual issue. It has been an absolute, 100% physical problem I’ve needed to address.

HEINZE: Has anyone ever told you that anxiety isn’t trusting the Lord?

SMITH:  No.

The first article I wrote on this was for the Religious Herald, a Virginia Baptist newspaper, which was the forerunner of Baptist News Global.

That first article went out nationwide, and I got hundreds of emails, personally written cards, from people who basically said, “You nailed it.”

Then I wrote an article for the Richmond Times Dispatch, and I got a phone call from the Chairman of the Department of Psychiatry at Virginia Commonwealth University, and he said to me, “What you said was accurate and well-stated.”

Having that affirmation from him enabled me to say, “You know, Kirb, you nailed this.” So if I ever did get somebody mad at me or questioning, I could say, “Look I have medical credibility.”

Most of the feedback from the article was overwhelmingly positive. Only a few took issue with it.

Before I came here to Oak Forest, we had a Q &A time one night in the sanctuary, and I put all this out and they still called me to be pastor. We’ve had a lot of people join since we came. Not everyone is aware of the details, but a lot of people know, “Our pastor went through some stuff in the past.”

So when I joke about taking a pill, they all think it’s funny.

Negative feedback doesn’t threaten me. It only makes me want to redouble my efforts at education.

HEINZE: Can a depressed person experience the peace of God, and if so, what is the peace of God?

SMITH: First, I don’t think suicide is an unforgivable sin. Had I taken my life, I believe that I could have died at peace, knowing where I was going, knowing that I was saved, knowing that as horrible as it would be for my family, that we would see one another again.

So yes, I believe you can have the ultimate peace of God, but I will tell you that living daily in the depths of my depression, I had no peace.

I did not experience the peace of God. I just didn’t. I was crying out to God to hear me, and I felt like he wasn’t. Or if he was, he wasn’t answering. So that’s a tough question.

Ultimate peace, yes. Daily lived peace, no.

I have always been more of a thinker Christian than a feeler Christian.

On the Myers Briggs [Personality Test], I came out as huge brain, very little feeling.

So for me, my faith has never been a feeling. It has been an assurance. Or, much less a feeling. There are times where I get a feeling of, “All is well.”

Father Anthony de Millo said, “All is well, all is well, though we’re in a mess, all is well.”

There are times I get that feeling where all is well. But what lasts with me is the assurance in my mind that God is in charge.

All is well, his promises are true, his Word is true, and all of this is truth.

HEINZE: What would you say right now to a Christian who’s battling depression or anxiety?

SMITH: Same thing I say to people who come in to talk to me.

First thing you need to do is find a qualified psychiatrist. Not a general practitioner, not an internist, not a nurse practitioner, not a physician’s assistant.

You need to find a qualified psychiatrist, because they’re really the ones who can most effectively prescribe a medication and know what each medication does for the various diseases of the brain.

Then, the second thing – seek out a qualified counselor. Not necessarily Christian. Way too many Christian counselors are of the evangelical bent who will focus solely on the spiritual. I should add that, at least as of several years ago, there are two Christian Counseling Accrediting agencies. The American Association of Pastoral Counselors is, by far, the best.

I believe with mental illness that the best approach is not either/or, but both/and.

I, myself, never sought counseling; I didn’t need it. I didn’t need to talk through anything. I needed medicine.

Other people just need to talk to a counselor and work through issues and come to a healthier place. Some people need both.

But my first plan of action would be to see a psychiatrist. The best thing you can do — if you need meds — is to get them working as quickly as possible.

The Lord has brought me so many people who have dealt with depression, anxiety, and OCD. I never would have suspected that there were this many.

There are so many people out there like us, and they’re going untreated, unfortunately.

HEINZE: Finally, can you tell us some of the books that have been helpful?

“Darkness Visible, A Memoir of Madness”, 1990, William Styron.

“An Unquiet Mind, A Memoir of Moods and Madness”, Kay Redfield Jamison, 1995, Professor of Psychiatry at the Johns Hopkins School of Medicine.

“Unholy Ghost, Writers on Depression”, 2001, edited by Nell Casey, Carter Center Mental Health Journalism Fellow, 2000-2001. Includes writings by Professor Jameson, William Styron, Larry McMurtry, and others.

“Undercurrents”, Martha Manning, 1994, Clinical Psychologist, Professor of Psychology, George Mason University.

“A Mood Apart, The Thinker’s Guide to Emotion and It’s Disorders”, Peter C. Whybrow, 1997, Director of the Neuropsychiatric Institute at UCLA. 

“Against Depression”, Peter D. Kramer, 2005, Clinical Professor of Psychiatry, Brown University.

“The Noonday Demon, An Atlas of Depression”, Andrew Solomon, 2001. [To my mind, the most powerful and probably offensive (to many Christians) book in my collection. Brutally blunt. But for those interested in the truth of depression, as good as I have found.]

HEINZE: Thank you!

ABOUT: Kirby Smith was raised in Northern Virginia and holds a BA from George Mason University and an MDiv from Southeastern Baptist Theological Seminary. 

He has been a Virginia Baptist pastor for 36 years, serving four churches during that time. 

For the past 14 years he has been pastor of Oak Forest Baptist Church in Chesterfield, VA.  He and his wife Laura have two grown children.