Friday, September 26, 2008

Biblical Counseling - Some Clarifications

Below are very helpful published responses to Dr. Powlison's articles "Sane Faith." This is published in its entirety from "" (And for more on this particular topic of how to view physiological factors our problems read Dr. Ed Welch's book, "Blame It On The Brain?" - here he gives a very helpful, charitable, humble and biblical look at how physiological factors are to be viewed when dealing with matters of our hearts.


Biblical Counseling, a Clarification
by David Powlison

Dr. David Powlison — author of the “Sane Faith” series on Boundless (part 1, part 2 and part 3)
— appreciates the comments you’ve written on a blog post I wrote yesterday. This morning he sent me an e-mail responding to some of them. Among other things, he writes that “faith actually changes how you perceive [someone] and respond to [them].” Later he adds, “How you’re relating to God and how you’re relating to [others] are not controlled by your body, but by your heart.”

I find his clarifications helpful as I wrestle with the principles laid out in “Sane Faith.”

* * *
[now from Dr. Powlison...]

I so appreciate the honesty of blog responders. Life is not easy street, but a hard road. Contrary to the glib self-confidence and easy answers that define our culture’s style, the Bible respects that our lives are fundamentally fragile, vulnerable to coming unglued. The psalms are the voice of honest strugglers, which is why Psalm 23 (and the anti-psalm) play such a key role in the lead article I wrote.

I want to make sure that the purpose of those articles is not lost. Ted Slater’s blog comments
are right in saying that these articles are not about medications at all. They are about affirming our humanness. They seek to shine a light on our common bond in the human struggles. We’re all in this together, and God comes to take us in hand. I’d hate to have the main point obscured by the discussion getting swallowed up in the medication issue. That is an important issue in its own right. Here are some thoughts to put in the mix in thinking about medications. But I hope that readers will also go back and ponder my original articles further.

About 10 years ago I watched a PBS special on the state of psychiatry in America. The head
of the National Institutes for Mental Health (NIMH) was interviewed. He can fairly be called America’s “top psychiatrist.” He sits at the top of the pyramid that funds medication research, sets standards for care, and so forth. He knows his field. His comments were insightful and fascinating. He said that society has given psychiatrists an impossible job. They are charged with trying to help people solve all their woes and struggles. Then he said that psychiatric medications can sometimes take the edge off symptoms, but they can’t give people what they really need. People need meaning and relationships. Psychiatry can’t give that. Medication can’t give

You might want to reread that last paragraph. It contains a philosophy of medication that is sane and realistic, as well as knowledgeable. It’s so different from what our culture tells us. This psychiatrist was also seeing something about people that I believe can only be truly addressed by Christian faith. People need to find personal meaning and meaningful relationships. My articles are about what people really need. I fully agree with the head of NIMH that medications can “sometimes take the edge off symptoms.” He credits medication with possibly doing some modest good, not all the time, but sometimes. Modest good does not mean no good, or all bad, or useless. Nor does it mean the best good. People most need meaning and relationships. And “sometimes” does not mean always, or without the possibility of negative side effects. It means what it says, sometimes.

Most people who’ve tried medications would say that their experience mirrors what the head
of the NIMH said. He knows the literature. He knows people. He knows that people might be helped a bit, but that they need more help and deeper help. In my 30 years of counseling, I’ve seen the same thing countless times. I’ve also seen that when people find more help and deeper help they often drop the meds and don’t go back. They don’t need the symptomatic relief, because they’ve found more significant change. (That’s not always, but in my counseling experience it’s more often than not.)

More help and deeper help is what my articles are about.

Here’s an analogy you might find helpful. Let’s say you go to visit your mother for lunch. The relationship can be a bit strained. She can be “difficult.” When you are with her, and things take a wrong turn, you get tense. You feel a bit edgy, anxious, and irritable. You can get sarcastic. Later you might vent to your friends, “She’s impossible!” Let’s say you’ve also learned that your relationship with God makes a huge difference. You love this promise and response: He himself has said, “I will never leave you or forsake you.” So we can confidently say, “The Lord is my helper. I will not fear. What can man do to me?” (Hebrews 13:5-6) When you remember that, live it, take it to heart, you’re calmer. You don’t take your mom so personally. You’re more constructive. You’re able to forgive her. You pray for her rather than vent negative gossip. You’re able to get on with the rest of your day in a positive frame of mind. You say to your friends, “I’ve got to say, it’s hard to relate to my mom. But I’m very thankful to God for helping me not to return evil for evil.” That passage of Scripture speaks sweet promises to you, in God’s own voice: He himself says it! It also portrays how your faith comes to life: I can confidently say. Your thinking changes. What you say changes. How you feel changes. It doesn’t mean your mom changes. But your faith actually changes how you perceive her and respond to her.

Now here’s where our little analogy get interesting. Let’s also say that when you drink three
cups of coffee on an empty stomach and don’t eat a good breakfast, you go into your day feeling tense. You get a bit edgy, anxious, and irritable. (Sound familiar?) Eating a good breakfast and laying off the caffeine makes you feel better. Similarly you find that healthy exercise and a good nights sleep also make you feel better, less prone to that tense frame of mind.

Here’s the million dollar question. Will eating a healthy breakfast, taking a brisk walk and being well rested make your relationship with your mother tension-free and happy? No, it won’t. It might help you go into that lunch visit a bit less keyed up. It might help you not cancel because you can’t face her. Maybe you won’t be quite so reactive. But your relationship with your mother is a matter of “meaning and relationships.” How you’re relating to God and how you’re relating to her are not controlled by your body, but by your heart. Jesus puts all this in His usual pithy way. “Man does not live by bread alone, but by every word that proceeds from the mouth of God.” Bread means bodily sustenance: breakfast, exercise, sleep. But bread alone can’t bring energy and light, hope and love, to the meaning of your life and to your relationships. Whenever we make the connection, life makes much more sense. It’s a connection to make every day, like eating a healthy breakfast. The same sort of thing is true with medications. When they help, they tweak your body to feel and function better. But they can’t touch your need for the things that Hebrew 13:5-6 touches. Perhaps this paraphrase catches the right sense of proportion: “Man does not live by meds alone, but by every word that comes from the mouth of God.”

Our society attaches such inordinate hopes to medication. Pharmaceutical advertising makes such grandiose promises (not just about psychoactive drugs, but about many classes of meds). We want to say, things that help your body are good: healthy diet, exercise, and sleep, always; medications, sometimes. But they aren’t the best. See these things for what they are and aren’t, and you’ll keep your life struggles in proper perspective. The human touch that the articles seek to elicit and portray is always the most important. Those articles are about the YOU on the inside of who you are. They are about the YOU in your relationships.

I’d encourage readers to go back and read the lead articles again. As Ted Slater mentioned,
Boundless and I have been working on this project for a year. In a culture of online information, people are not used to reading something more than once. But anything worth thinking about carefully is worth reading a second time. Print it out. Take it slowly. Underline. Write in the margins. Ponder what it means. Take it to heart. I’d describe medication questions as a riff off from those articles — an important question in its own right, but a sidelight, even a distraction. You’ve probably seen how easily that happens in blogs. A riff carries the discussion far afield from the original topic. I hope that what really sticks in your mind is Psalm 23. Verse 4 brings a true perspective on all our woes, including a body that gets out of sync and mothers who can sometimes be difficult.
* * *
P.S. Here are some further thoughts, and something for further study for those so minded.
Joseph Glenmullen, a research psychiatrist at Harvard, summarized hundreds of studies on
the effects of psychiatric medications for anxiety and depression (Prozac Backlash, Simon &
Schuster, 2000). He takes a balanced view, similar to the director of NIMH. He simply gives
the research data. Research shows that most of the positive effect comes from placebo effect,
not psychoactive ingredients. Perhaps two-thirds of those who take medications feel better
because they expect the medication to make them feel better. In other words, even with a
pill, the issue of one’s faith plays a significant part. How can you know whether you’re getting a psychoactive bump in mood or a placebo bump? You can’t. That’s part of why paying primary attention to meaning and relationships puts medications in their proper place as second-tier items. A person getting a placebo bump will continue to feel better when off medications because the meaning and relationships in his or her life improve. Glenmullen also gives details on the negative side effects that frequently arise and the frequency of drug ineffectiveness. People in these categories need not despair. Fruitful dealing with meaning and relationship issues always makes a difference in a person’s life, even if they must live with lifelong tendencies towards depression and anxiety — which many wise and godly people in history have done. Even if there’s no medication to make the tense-and-anxious reaction in your body go away, if the tense-and-anxious reactions in your relationships improve, then your life improves.

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