Dichotomy of Man & Suffering with Depression

Written by M. Ashley Evans

July 2, 2019

Trichotomy vs Dichotomy

Nouthetic Counseling, also known as Biblical Counseling, holds to a Dichotomist view of man, as opposed to a Trichotomist view. Dichotomist state that man consists of two, and only two parts: body and soul.

The Westminster Confession of Faith, says this about the parts of man: “The bodies of men, after death, return to dust, and see corruption: but their souls, which neither die nor sleep, having an immortal substance, immediately return to God who gave them: the souls of the righteous are received into the highest heavens. And the souls of the wicked dare cast into Hell. Besides these two places, for souls separated from their bodies, the Scripture acknowledgeth none.”

The Trichotomist view states that man has three parts: body, soul, and spirit.  But what does the Bible teach?  Why is this important?

Scripture gives us no solid support for the Trichotomous view. And unfortunately, this view is the basis for grievous errors such as Apollinarianism. We can see several times in the New Testament that Deuteronomy 6:5 is quoted in several different variations. Let’s analyze them:

“You shall love the Lord your God with all your heart and with all your soul and with all your might.” Deuteronomy 6:5

“And he answered, “You shall love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind, and your neighbor as yourself.”  Luke 10:27

“And he said to him, ‘You shall love the Lord your God with all your heart and with all your soul and with all your mind.’” Matthew 22:37

“And you shall love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength.’” Mark 12:30

It would appear by these different variations that each author held to a different understanding of the nature of man.  Since the Bible is inerrant, we know that this cannot be a contradiction. If the Spirit and Soul are two separate parts, then Heart must be different from Soul. And that doesn’t fit within the orthodox understanding of scripture either. Nor does anyone attempt to make that claim.  What we can say definitively is that each of these verses is affirming that we must love God with our entire being and that God sanctifies us completely and wholly.

“Now may the God of peace himself sanctify you completely and may your whole spirit and soul and body be kept blameless at the coming of our Lord Jesus Christ.” 1 Thessalonians 5:23

We know that the Trichotomist view is false also because of the interchangeability of terms found in Scripture. At times man is said to be compromised of “body and soul” (Matthew 6:25, Matthew 10:28, etc,) and in other portions of Scripture man is said to be “body and spirit” (Ecclesiastes 12:7, 1 Corinthians 5:3-5, etc.) Death is described as “giving up the soul” in some places (Genesis 35:18, Acts 15:26, etc.) whereas in other places it is known as “giving up the spirit” (Psalm 31:5, Luke 23:46, etc.)

In counseling, a Trichotomist view of man can be detrimental. This view is commonly found in a counseling movement that attempts to combine Biblical counseling with secular psychology. They claim that thoughts and feelings are primarily understood through a psychological lens primarily, though they may have some minor spiritual implications. Their very foundation is psychology. These counselors will use Scripture, but only to validate a psychological theory. This is in contrast to Nouthetic Counseling, or Biblical Counseling, which sees Scripture as the foundation, and any psychology theory that happens to be correct is just that – an occasionally useful tool within its limitations (for example, in providing descriptions for groups of symptoms.)


Union of Life



Louis Berkhof, in his Systematic Theology, called the Dichotomist union of soul and spirit the “union of life.” Berkhof affirmed that man is not purely spiritual nor is he purely material. There is a union of two ontologically distinct parts. In the book of Matthew, Jesus affirms the Dichotomist view. He clearly says that a person as an aspect of himself that man cannot kill. He uses “kai kai” construction in the Greek, which emphasizes “both and” construction of the subjects. Jesus is, therefore, saying that man is “both, and” body and soul. Both aspects are present, both aspects are separate, AND both aspects are uniquely joined together as a whole Person.

“And do not fear those who kill the body but cannot kill the soul. Rather fear him who can destroy both soul and body in hell.” Matthew 10:28

The Body and Soul are not two opposing forces, as they are illustrated throughout Greek philosophy and Gnosticism. These are two parts of a whole, beautifully joined together.  The Components of Man is not Dualism, but Man is a Duality in himself. The Body without the Soul is lifeless.

“Then the Lord God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature.” Genesis 2:7

“And the dust returns to the earth as it was, and the spirit returns to God who gave it.” Ecclesiastes 12:7

“For to me to live is Christ, and to die is gain.  If I am to live in the flesh, that means fruitful labor for me. Yet which I shall choose I cannot tell.  I am hard pressed between the two. My desire is to depart and be with Christ, for that is far better.  But to remain in the flesh is more necessary on your account.”  Philippians 1:21-24


Soul Care through Dichotomy



Care for our Soul is to be the top priority in the Christian’s life. We have a responsibility to work with God on our progressive sanctification. But where does a person’s mental health come in? Would depression be an aspect of the Body or the Soul? Depression invades a person’s entire being. It consumes his thoughts, emotions, spiritual life, and can even affect his physiology.

“My flesh and my heart may fail, but God is the strength of my heart and my portion forever.” Psalm 73:26

We err grievously if we counsel a client and say that depression is simply a spiritual matter. We also err if we say that it is only and always simply a physiological illness.  While indeed, some depression may have its roots in a spiritual matter – for example, hiding an affair. This is not only a sexual sin but often times will include lying; sin begets sin. The stress of hiding such a sin, of trying to stay on top of all the lies – will way down on a person and will cause depression.  In this case, treating it spiritually is a wise choice. However, even with a spiritual source, there will be inevitable physical ramifications. So, urging the client to take care of their physical body is highly important. By fueling the body with the correct nutrients, it will strengthen the body to be able to cope with the external stressors and spiritual depression symptoms.

Now, even the secular world is noticing that depression is much more complicated than previously thought. Psychology Today magazine published an article wherein it said that “there is no good evidence that depression is caused by a lack of serotonin.” (https://www.psychologytoday.com/us/blog/think-act-be/201706/do-you-need-drugs-your-chemical-imbalance) There are numerous physiological causes for depression (Pregnancy-related depression/anxiety/psychosis, a depleted endocannabinoid system, neurotransmitter issues, vitamin D deficiency, MTHFR gene mutation, adrenal fatigue, myelin sheath deterioration, etc.) Even more common, are physical issues that manifest depression-like symptoms but are not necessarily depression in and of themselves, like heart conditions, low thyroid, etc. Some of the symptoms of hopelessness, self-hatred, etc can also be seen in clients who have neurological issues such as autism, PAN/PANDAS, dementia, brain injury, etc. Our bodies cannot make us sin, but it can make us struggle with sin in various ways. All of our bodies are subject to the corruption to the fall – even our genetic coding. Some body’s just don’t work the way they should, and special care needs to be taken for those whose bodies are not functioning as they should be.

Adam Sandlin of Covenant Biblical Counseling wrote an article called Why Are You ‘Depressed’ Oh My Soul? In which he says, “For example, those with neurological or brain abnormalities like various forms of autism, dementia, some aspects of Obsessive-Compulsive Disorder, or possibly a traumatic brain injury—being no fault of their own—can sometimes find it very difficult to resist temptations to lash out at others, be impatient or worrisome, or hopelessly give up on God, life, and others. We should give extra measures of patience to individuals who struggle with these pathologies (1 Thes 5:14), while also remembering that we are all people, made in the image of God, with a conscience, and therefore responsible for how we respond to both sweet and bitter providences in our lives. Our physical circumstances don’t cause but can contribute to depressive experiences.”

To complicate matters, typical blood work will not show which hormones are out of balance – you can’t go and see if your dopamine is too low. If an issue is deemed to have physical origins – then, by all means, treat it physically. But do not negate the spiritual. If a problem has physical origins, there absolutely will be some carryover to the spiritual side. We all know how easy it is to become utterly self-centered when we have the flu – but how easy it is to not notice our spiritual walk stumble during a season of mental illness.

Ed Welch says this about psychiatric medications, “Psychiatric medication is not treating a verifiable chemical imbalance in the brain. Contrary to public perception, psychiatric medications are not chemical bullets that target one particular brain chemical. They are more like chemical blitzkriegs, strafing chemical sites in the brain and hoping for the best…The most we can reliably say is that psychiatric medication may minimize some symptoms, but it is not necessarily treating a chemical deficiency…human behavior is represented on a neurochemical level. This doesn’t mean that the brain causes all these behaviors, but that the brain expresses differences in behavior at a chemical level.”

As counselors, we need to be willing to walk with our clients on their physical health journey – and if conventional medication is not beneficial, we can help them to find a naturopath or a homeopath.

Inner and Outer Man


There is no reason to complicate this. Scripture makes no attempt to describe how this body-soul connection intermingles. At a general level, we can see the Bible describe it as “inner” vs “outer” man. The inner man is the soul of a man, often described as the “heart” of a man. The outer man , of “flesh” or “body”, being his physical body as well as the desires of the inner man through his physical attributes (such as his hands, feet, mouth. See Romans 6:13, Luke 6:45, Proverbs 1:16, and Proverbs 12:14.)

Though Scripture makes a distinction of Dichotomy, the person as a whole is what is most emphasized. We can see that God works comprehensively in a person. He is interested in relating to man as a whole and interested in working through man as a whole. (Hebrews 4:12, 1 Thessalonians 5:23.) God cares about sanctification for the whole unified person. Scripture teaches us that if a man’s actions look “right” on the outside, they are utterly defiled if his heart isn’t right with God. (Matthew 7:21-23, Matthew 23:25, etc.) This does not mean that a person who is struggling with the Body –  for example, someone with a physical cause for depression – is free from the responsibility to progress in his sanctification, or free from the responsibility to choose to live in obedience to Christ. Scripture is clear, our bodies are a stumbling block to us. (Matthew 26:41) And there is a spiritual battle going on for the control of our minds (2 Corinthians 12:7-9) But a physical condition, or even more simply, being so hungry you get angry, is no reason to allow yourself to give in to the temptation of sin and do not live in  response to faith. Physical conditions do not occur in a vacuum. We are called to evaluate our hearts – to ask ourselves what God/god are we serving? Are we serving our Risen Lord, or are we serving the god of the flesh?  All human behavior is worship. All behavior is an expression of worship that starts in the Inward Man and manifests itself in the Outer Man. We cannot stop worshipping – the question is, in every moment of our life we must ask, who are we worshipping?

This unity in our Dichotomy is a reflection of the Unity in the Trinity. The Trinity cannot be totally divided – Jesus is God. Yet Jesus is a separate being in that He is the Son and not the Father nor the Holy Spirit. So it is with the Body and Soul. We are one unified Person. Yet we consist of “both, and” body, soul.




“For the word of God is living and active, sharper than any two-edged sword, piercing to the division of soul and of spirit, of joints and of marrow, and discerning the thoughts and intentions of the heart.” Hebrews 4:12

The Word of God is alive. It has the power to get int our inmost being and to show us the “thoughts and intentions of the heart.” It is through careful analysis and application of Scripture that the counselor can help the client with their issues – whether it would mean giving the client spiritual help while they worked with a nutritionist on the physical symptoms or going with the client to a health professional to deal with the physical cause while you walk with him, discipling him, on his health journey.

So for the person battling depression – or any of the psychiatric labels such as bipolar, OCD, etc – we as counselors can help them with both their physical and spiritual dichotomy aspects. We can help the client as a friend to walk with them in their journey towards increased physical health and we can encourage them to live a life rooted in obedience and faith in the finished work of Christ, regardless of the turmoil in their body.

We as humans are spiritual – there is not a single aspect of our makeup that is set apart from its obligation to glorify Christ. We are to strive to bring Him glory in our body and soul. In every moment, in every breath, we breathe – because He is worthy.

Heidelberg Catechism:

Q: What is your only comfort in life and death?

A: That I am not my own, but belong with body and soul, both in life and in death, to my faithful Savior Jesus Christ. He has fully paid for all my sins with his precious blood and has set me free from all the power of the devil. He also preserves me in such a way that without the will of my heavenly Father not a hair can fall from my head; indeed, all things must work together for my salvation. Therefore, by His Holy Spirit, He also assures me of eternal life and makes me heartily willing and ready from now on to live for him.



Check out this article to read about Common Grace and the Human Condition


Common Grace and the Human Condition

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