Don't Worry

One of my favorites in biblical counseling is David Powlison.  I amazed at his wisdom.  I am also a big fan of CCEF (Christian Counseling and Education Foundation).  Powlison is a counselor and faculty member at CCEF.

On CCEFs blog there is an article from 2003 by Powlison, What Good is Don't Worry" In Times Likes These?.  It's actually the first part in a series on Worry and Luke 12.  I highly recommend it.

Depression in Christianity Today

Wow! What a great package in Christianity Today on Depression. I think it does a great job highlighting the complexities of Depression.

The church is bursting with suffering souls. People come to the church for help but even in our culture Depression is misunderstood. I want to do something to help. I see myself becoming more equipped for soul care within the church body.

Anti-depressants and Spiritual Conviction

I found an insightful story from a woman who spent years on anti-depressants, with the encouragement of her local church family, then she realized she did not grieve her own sin and something was seriously wrong. She had no conviction and she started to see a link between her apathetic state of mind (heart) and the effects of the anti-depressants. Read the whole story here: Anti-depressants and Spiritual Conviction.

The Grand Psychosis

"Sin is the ultimate disease, the grand psychosis. You cannot escape it or defeat it on your own. Look around and you will see its mark everywhere. Sin complicates what is already complicated. Life in a fallen world is more arduous than God ever intended, yet our sin makes it worse. We deal with much more than suffering, disease, disappointment, and death. Our deepest problem is not experiential, biological, or relational; it is moral, and it alters everything. It distorts our identity, alters our perspective, derails our behavior, and kidnaps our hope. As Moses noted when he described human culture before the flood, "The Lord saw how great man's wickedness on the earth had become, and that every inclination of the thoughts of his heart was only evil all the time" (Gen 6:5). This is what sin does to us. It is the ultimate disease!" Paul David Tripp, Instruments in the Redeemer's Hands, Pages 12-13.

Mentally Ill Americans

Yesterday Joey at Wide White linked to a commentary at WorldNetDaily on mental illness in America. Since mental illness is a topic I blog about often I want to post the link as well to get it in my archives.

Why so many Americans today are 'mentally ill' is a fantastic commentary even thought I don't agree with the premise that people are born with a "good side" that we just need to listen to more often.

Heads are turning, people are seeing more and more that pharmaceutical treatment of mental illness has horrendous side effects - the wonder drugs are not all they are cracked up to be. There is another explanation for all our psychosis and thus another answer. The WorldNet commentary provides another perspective.

More Help Understanding Biblical Counseling

The Christian Mind, a great blog that often posts on biblical counseling and psychology, links to a very helpful article defining Biblical Counseling.

The article covers an interview conducted with four seminary scholars all providing deep insight as to what exactly is Biblical Counseling and what distinguishes it from all other counseling.

David Powlison Discusses Depression

The Albert Mohler Radio Program recently featured a discussion with David Powlison about the darkness of depression. The discussion is insightful, biblically accurate, and filled with humility. I highly recommend setting aside some time to listen and grow in your understanding of depression.

Resource for the Depressed and Those Who Love Them

I am pleased to have recently discovered a few audio resources on depression. I do a lot of reading on the topic and had become somewhat disinterested (i.e. brain burnout) so I went on the hunt for human voices.

Back in early 2006 FamilyLife Today radio ran a few broadcasts with Ed Welch. Welch is one of my favorite authorities on depression because he is like no other in the way he speaks biblical truth (and he is educated in Clinical Psychology ). He also is the author of a fantastic book, Depression: A Stubborn darkness - A Light for the Path.

These broadcasts assist both the depressed and those who love them:

What is Depression?
Suffering Well
Help for the Depressed
Strategies for Dealing with Depression

A Sermon for Joy in Christ

Tim Porter, Pastor at Faith Community Church in Hudson, WI preached an outstanding sermon on John 16:16-33 last Sunday.

If you suffer with hopelessness, the heart issue of all joylessness, or know someone who does, then please set aside a half hour to listen to this sermon. This is a sermon of real hope. Click here.

Anitdepressent Medication

One of iMonk's recent post looks at answering the question: What About Antidepresent Medication? The post is balanced and shows how biblical wisdom in every personal experience must not be overlooked. I always appreciate iMonk's personal flair in his posts. The comments section on this recent post should be good so stay tuned.

Children Enslaved by Psychiatric Labels

The Christian Mind blog comments on an article in the New York Times on children and biopsychiatry.

Link to article: What's Wrong With a Child?

Here is a statement from the commentary that I agree with 100%:

"Multiple interpretations can be offered to account for whatever emotional and behavioral symptoms an individual reports. Likewise, multiple conceptions of what is in need of being changed and how that is to be accomplished exist. Counseling and biopsychiatry, therefore, involve placing the counselee or patient in some larger contextual framework of meaning. In other words, all approaches to counseling and/or psychiatry seek to make sense of a person and his or her situations in terms of a broad interpretive framework or worldview. Given this fact, as well as the serious health risks associated with psychiatric medications, I'm dismayed by the relative absence of Christian leaders sounding cautions against psychiatric labeling and medicating."

(emphasis mine)

Lunatic Fringe

My wife has suggested to me I need to be more open, honest and personal in my blogging about mental health issues. I've pondered for several weeks what this is suppose to look like.

It is obvious I have somewhat of an interest in mental health, namely counseling, not so much psychology. I am not as much interested in the scientific side of the human mind and soul as I am in the human side of the human mind and soul. I like to make the scientific relevant to everyday life so that life is more easily and joyfully lived. I also love theology. I love the challenge of working out theology in the context of mental health and counseling. But I digress.

Seriously though, how am I to be more personal while writing about mental health issues? You're probably on to me by know. The reason my wife is encouraging me to be more open and honest is because I do have a story to tell. A very personal journey about the way God has ordained that I be drawn closer to Him through living this life suffering, more than the average person, from health problems of the mind (did I just create a new politically correct term for mental illness?) Fraid not! I am just attempting to use humor to deflect the uncomfortable feeling everyone feels when someone else is (quasi)confessing something personal.

What I write about I've lived with. I want to keep writing about mental health issues and specifically biblical counseling. I will try to weave in bits of my own story when I think it is appropriate, and by appropriate I mean useful. I've come to an understanding that I will not ever be cured from my problems of the mind in this life. The so called problems are what God uses to extend His mercy and grace to me personally, directing me through humbling struggles, so that I pursue Him alone when all else in life seems like death. Christ is life! My "problems" have always revealed where my heart is at in relationship to God. I know in my mind I am a sinner but my behavior while living with my "problems" proves that I am a sinner. In telling my story I do not want to glorify sin, but only God! I pray that my story helps others who suffer from particular "problems" of the mind. May Christ be seen for who He is; good, merciful, loving, and Lord.

So here is a bit of my story...just a small bit to get things started:

One of my three biggest fears in life is to be found certifiably mentally insane. To be a lunatic. I've carried this fear ever since I can remember as a young boy. Even today, one of the most sobering, bone-chilling, road-straightening, to-be-feared-more-than-death possibilities is the idea of being so mentally incapacitated that I would need to be locked up. Isn't that ironic? Some would call it psychosomatic. I just think it is...crazy!

God have mercy.

How I view physical treatments for Mental Illness

Even though there is always a spiritual component to mental health problems, there are physical symptoms too to deal with. My take up to now in these posts on mental health is that both the physical (body) and the spiritual (mind, heart, soul) are involved in mental illness. Both components must be treated, not just one. In today's treatment environment, mental health sicknesses are seen as strictly medical conditions and thus the primary lead in is medication. Once medication is taken then it seems all future progress is judged based on the effectiveness of the medication in reducing the symptoms. Adjustments are made...to the medication dosage levels. Treatment becomes medication centric. The pendulum needs to swing back the other way so decisions about treatment are not so lopsided.

The purpose of medication I believe is to calm down extreme physical symptoms of psychiatric conditions. Medication is helpful in this regard. For example, if someone is depressed, so depressed they can't even keep their eyes open or see straight because light is literally blinding (this happens) then medication could be used to get the person out of a state of suffering from the physical symptoms.

As I've state before, medication should be used to treat symptoms not an underlying irreversible chemical imbalance. Medication should used when necessary to help restore a person to a state where rigorous work can be done on issues of the heart.

There are other treatments available beside prescription drugs that could also be explored such as diet, megavitamins, full spectrum lights, shock treatments, etc.

Every treatment that is geared toward physical symptoms should be considerd for both its pros and cons. Every treatment has side effects and long term unknowns.

The general mind set I believe is to see medication as a tool to treat symptoms of mental illness. Great wisdom is needed though because treatment of heart issues should always be the most important and they are the hardest to deal with. There is much more value in working on those conditions that are much more difficult to restore. Isn't that the case with everything in life?

Flowchart for Mental Health Problems

When things get really complicated I find I look for ways to simplify them. The following chart (I like flow charts too) helps me to stick with the basics when considering mental health problems:



This chart comes from Blame It On The Brain?, Edward T. Welch, page 116.

Very simplistic? Yes. Too simplistic? No. There is much value in being reminded that there is always heart/spiritual roots with mental health problems that must be addressed.

Possible Physical and Spiritual Symptoms in Depression

When you understand the range of symptoms a depressed person experiences, the totality of it all, best described by one word, pain, compassion screams out. No one can sit still and not feel for a person who is in so much pain.

The pain of depression usually expresses itself in physical symptoms but the pain itself usually originates from conditions of the heart (aka spiritual problems.) The physical problems are so obvious though, and sometimes so intense, they are seen as the problem.

I have found a list like the following to be helpful, seeing in black and white, what a person suffering from depression could be experiencing all at once:

Physical	Spiritual
Insomnia or hypersomnia Significant weight changes Feelings of being restless or slowed down Fatigue, loss of energy Problems concentrating Sense of alienation from things once deemed beautiful and pleasant Feelings of sadness, being blue, down in the dumps	Shame Guilt Fear Thanklessness Unforgiving Spirit Hopelessness Unbelief Anger

Notice that feelings (i.e. emotions) are categorized as physical symptoms rather than spiritual. This I think is a stumbling block for those people living with depression and those treating depression. Feelings aren't right or wrong, there is no morality to feelings, they just are. But a lot of life is experienced through feelings. What a person does with, how they respond to, their feelings or the feelings or others is where moral action takes place. I personally believe that the blurring of other symptoms of depression with feelings is very confusing and leads to more depression - this is one of the reasons why it is so helpful to separate physical problems with spiritual problems.

The Experience of Depression

In order to help someone, or yourself, with dealing with depression the experience itself needs to be understood. This is the first step. Makes sense, when someone is dealing with a physical, medical problem, isn't the first step to listen and learn and find out what the person is going through.

When you think about it, depression is a big word. What I mean is that is covers a lot of ground and like I said yesterday, what depression is all about can mean different things to different people. "Don't assume that you understand what someone means by depression. Don't fill the meaning from your own experiences, which may or may not be similar.", Welch, Blame It On The Brain, page 117.

When a depressed person is really listened to, heard for what they alone are experiencing, there will be pain, fear, hopeless, dread, terror, silent screams, and emptiness - all these at a level that threatens to destroy. Physically, the senses are dulled as well. Sounds are muted, colors seem less vibrant. Technically, the DSM-IV defines depression with a little less "feeling" I think. Although helpful for pointing out some symptoms that may not be expressed, the DSM-IV is too clinical and less personal. The DSM-IV definition of depression makes it easier to view depression as a strictly medical condition.

Depression, to be fully understood, needs to be observed and listened to. The experience ranges from one extreme of the desire to die to emotional numbness and feeling like a living death. Sometimes a depressed person experiences both extremes at the same time. What is universal though in all descriptions is "pain", in that it is the most common explanation of what a depressed is going through. It is this feeling of "pain" that bridges the gap between spiritual and physical experiences of depression. The "pain" of depression manifests itself in physical symptoms but mostly it originates on the spiritual side of things. Most secular treatments for depression try to eliminate the physical symptoms and do nothing to heal the spiritual issues.

There has to be then a process to go through so that physical symptoms are distinguished from spiritual symptoms and then both need to be dealt with accordingly. If physical problems are confused with spiritual then the depressed person will be held morally responsible for something physical. Also, if spiritual symptoms are confused with physical then sin could be excused and seen as insignificant, worse yet, this could lead to hopelessness for spiritual growth when someone has a psychiatric diagnosis. The spiritual problems will be easier to attack and seek healing for because they always deal with the heart. The physical symptoms are more difficult to pinpoint but the process has become a bit more manageable.

Depression

Depression is HELL! Literally, living with depression is painful and like living in a box contained by all your worst fears, horrors, anxieties all swirling around crying out for attention. Depression can squash a person's will to live - hope does not seem real. The most caring and dedicated people can be incapacitated and absolutely trapped in a prison of hellish depression and seeming so unable to change and "pull themselves out of it." Not all the time but sometimes depression seems so resistant to change. Depression itself breeds hopelessness.

Millions of people suffer from depression. Some describe depression like I did in the above paragraph. Some know when they are depressed. Some can accurately diagnose their own condition, it is either a good day or a bad day. Some are not so sure. Some have a feeling something is wrong but can put their finger on it.

The point is, the depression experience itself can mean different things to different people. I really don't think anyone knows exactly how any particular depressed person is feeling. No one knows for sure because there are so many descriptions of what depression is like to live with.

For the next few posts I want to move into practical application in dealing with mental health issues. Up to this point I've stated my belief that there is always a spiritual component in the complexity of mental health problems - always! Contrary to the conclusions of brain science research, psychiatric problems are not one hundred percent physical and related to chemicals only. Although there is a physical element involved, solutions to mental health problems should not be one hundred precent medication based (which only deal with the physical.) People with mental health issues can be renewed by faith in the midst of pain and trials.

So, in the treatment of psychiatric disorders both the spiritual and physical need to be dealt with. But what do I know? What do I have to say about treatments of psychiatric disorders...I am not a Doctor much less a professional!? What counsel could I possibly offer to anyone suffering from mental illness? What about you? What business do you have in helping that friend or co-worker who is depressed?

I do believe there is very practical help most caring people can provide others in dealing with mental health issues. The help comes in the form of listening and assisting the suffering while they describe their suffering and then helping them distinquish between heart issues from physical issues. Heart issues will be uncovered and so those can be tackled one by one, physical symptoms will be more clearly identified and thus easier to deal with.

I realize this is over simplification. Mental health issues are complex!!! But, if not reduced to just matter and physical causes only, there is much help a good friend can provide a suffering person - when the soul is brought back into the equation, friends can help friends, soul to soul.

Mark Dever Interviews Dr. Ed Welch

The Grand Difference Between Secular and Biblical Counseling

Dr. Ed Welch covers a lot of ground discussing co-dependency, substance abuse groups like A.A., medicating depression, "integrationism," "nouthetic" counseling, the role of counseling in the local church, and much more.

What Does the Bible Say About Psychiatric Medication ?

Like most topics, the Bible says nothing explicitly about whether one should or should not take psychiatric medication. Some in the church claim medication is satanic and others say God made it, so it must be good.

Like most topics in life, the Bible provides guidelines only, principles, boundaries of God's will. There is biblical freedom with the choice to take medication or not. Contrary to common thought, the Bible is (all) about God not man, but this is a topic for some other post.

Before moving on I want to get personal and state that over the last two years, on different levels, I have personally processed through what I am going to write. That is to say I have had my own personal experience with medication, over a ten year period of time. Today, I do not take anything. I have not taken medication for a year and a half. Do I have mental health problems? Well, if you've read any of my earlier posts, what is at the core of every mental health issue? In that case, everybody has mental health problems. Now though, that I am off the medication, I see all my problems as heart-related spiritual problems, period. Admitting that I once took medication, for over ten years mind you, and now I don't should serve as a credibility factor when considering what I talk about. I write from personal experience.

I mentioned in another post about people dealing with psychiatric problems are, at the core, suffering. The bible has something to say about suffering:

James 1:2-4
2Consider it pure joy, my brothers, whenever you face trials of many kinds, 3because you know that the testing of your faith develops perseverance. 4Perseverance must finish its work so that you may be mature and complete, not lacking anything.

James suggests there is value in faith being tested and strengthened through trials. Suffering is not something that should always be escaped. Some may see this as unloving, especially if they don't see the Bible as authoritative, being God's word. Life in America too is all about claiming rights to a pain-free life. But suffering is not the enemy it is sometimes seen as, and so medication is not, or should not be, considered to first be the end all answer to psychiatric problems. In the final analysis, medication is not the source of hope, Christ is.

Now that all was a pretty wide brush stroke when looking at medication through a biblical lense. Some how, things seem to be more complex than that don't they. Consider this:

1. The depth of someone's suffering is never fully known by man.
   
2. In general, alleviating suffering is a good thing.
3. Since the Bible is not explicit on medication, the issue is not the morality of taking medication, the issue is about making wise, informed decisions.

When considering medication for yourself or another person, focus on what is clear in Scripture. Dr. Ed Welch points to the following passages that offer wise pastoral care: Hebrews 11 and 12. In these parts of Scripture it is shown that there have been many before us who have experienced suffering and have demostrated strong faith. Also, suffering calls for repentance and perseverance.

Scripture does not label medication right or wrong. As always, Scripture points out the motives of the heart and calls man to examine why? Why is someone taking or not taking medication?

Once again, medication is not the source of hope - "2Let us fix our eyes on Jesus, the author and perfecter of our faith, who for the joy set before him endured the cross, scorning its shame, and sat down at the right hand of the throne of God." Hebrews 12:2

Is Medication Helpful?

Psychiatric medication does "work." The countless stories of suffering people who finally experienced some relief are true. Psychiatric medication is helpful

But another great distinction that must be recognized is that medication helps alleviate the symptoms of psychiatric problems. It is quite a logical leap to conclude that psychiatric medication therefore treats an underlying neurochemical problem. Because medication helps and provides relief doesn't mean that medication should be an end in itself in treating, as a whole, a complex psychiatric problem.

"Contrary to public perception, psychiatric medications are not chemical bullets that target one particular brain chemical. They are more like chemical blizkriegs, strafing chemical sites in the brain and hoping for the best." Dr. Welch, Blame It On The Brain, page 110.

There have been recent advancements (in the last five years or so) in understanding the chemical differences in the brains of some people with psychiatric disorders. As was stated in an earlier post in this series, a biblical understanding of the mind-body relationship points to an expectation of these differences. "Disorders" such as depression, fatigue, disobedience, bi-polar, and many more are all represented on a neurochemical level. This is a fact. Biblically, the findings of research that points to this fact can be accepted and embraced. Because of this, the issue in regards to psychiatric medication is not about its effectiveness, the issue is about pinpointing what exactly is the purpose of medication. The helpfulness of medication does not mean the brain causes chemical imbalances, but the brain expresses spiritual and heart problems in human behavior and at the chemical level.

Tomorrow's post...

Does the Bible permit the use of psychiatric medication? What do you think the answer is?