“I’m Thinking about Going to the Doctor for Depression Meds”—What Is a Compassionate, Comprehensive Response?
My friend, David Murray, recently shared an important blog post entitled, I’m Thinking about Going to the Doctor for Depression Meds.
David began his post with the following vignette.
“Someone recently told me that he had finally and reluctantly decided to go to the doctor about his painful and debilitating depression and ask about going on meds. I knew this person had tried every other spiritual and commonsense remedy but was simply not getting better.”
David then wrote:
“With his permission, here’s the advice I gave him plus another few points I’ve thought of since. Perhaps it will help others in a similar situation.”
A Mutual Desire for a Compassionate and Comprehensive Response
Knowing David, his writings, and his response in his post, I know it is David’s desire to provide a compassionate and comprehensive response to his struggling friend. David and I share that desire.
From the post and from knowing David, it seems to me that David had two primary audiences in mind:
- Any person debilitated by depression who also might feel guilt or shame over taking anti-depressant medication.
- Any organizations, churches, or individuals who might contribute to this shame and guilt through an “anti-medication mindset.”
Audience matters. So, I believe I “get” where David, was going. And there is much to appreciate in his post—especially David’s desire for a compassionate and comprehensive response.
How we respond to people struggling with depression and struggling to know whether or not they should take anti-depressants is a serious and vital issue. That’s why I am making the time to ponder what I believe a compassionate and comprehensive response might look like…
Toward a Compassionate Response
David began his response with these compassionate words.
“So sorry to hear you are still suffering in this way.”
Who among us would say anything less?
I might say more… I might gently probe what the depression has been like, especially of late. I might gently probe what the decision-making process about medication has been like—including any conflicted thoughts and feelings. Still, “So sorry to hear you are still suffering in this way,” would no doubt be a compassionate place to begin.
David then shares further counsel.
“But I’m very happy to hear that you are going to the doctor’s today. I know you are nervous but I wouldn’t worry about the visit—you will probably be just one of a dozen depressed people the doctor will see that week. He’s used to it. I’m glad you are willing to consider the meds.”
I could hear myself saying something similar, though I would not limit the potential treatments only to anti-depressants. I would encourage my friend to discuss openly with his doctor his physical symptoms, emotional moods, and potentially appropriate medical tests and medicinal treatments.
What Infuses Hope?
David then shares:
“The side-effects are usually minimal for most people and are often greatly exaggerated by opponents of medications.”
I think I understand David’s motivation in the first part of this sentence. He’s addressing someone who is apprehensive about psychotropic medications, and he wants to assure the person that they are safe and helpful.
However, the research does not support the statement that, “the side-effects are usually minimal for most people.” See Charles Hodges, MD, Good Mood Bad Mood and the extensive research he collates, as well as Saving Normal by psychiatrist, Allen Frances.
I believe it is compassionate to share honestly the research facts about potential side-effects and also about efficacy (effectiveness). I have seen far too many hurting people take psychotropic medications with unreasonable/unrealistic expectations. When side-effects do come and/or when moods do not improve, they can become hopeless…because of false hopes and unrealistic expectations about medication.
For those of you reading this post that have taken anti-depressants and experienced few side-effects along with improved moods, I truly thank the Lord. However, we must be careful not to extrapolate too much or too far from our individual experiences.
Sadly, the research indicates (and many personal testimonies concur) that for a significant percentage of people the side-effects can be significant and the effectiveness of anti-depressants can be insignificant.
I want to give hope—but not false hope. I want to encourage people to make an informed decision. That, to me, is compassionate.
Are You an Opponent of Medication?
Perhaps you are wondering if I am among those who greatly exaggerate side-effects because I am an opponent of medication.
No. I am not.
Nor is the biblical counseling movement. In the first Biblical Counseling Coalition book, Christ-Centered Biblical Counseling, a NANC (now ACBC) Fellow shared his testimony about having made the decision to take anti-depressant medication. None of the leading biblical counseling groups such as the BCC, NANC/ACBC, CCEF, ABC are “opponents of medication.” Biblical counselors are proponents of compassionately encouraging people to make informed decisions about comprehensive care.
On a church level, I have pastored three churches and been an elder or lay leader at several others. I have not seen church members discouraging people from considering anti-depressants or shaming people for taking them. I can’t extrapolate my experience to others. I know it happens in some churches. That is sad.
What Potential Audience Do I Most Need to Be Concerned About?
This leads to an important question we must consider:
“What potential audience do I most need to be concerned about when I respond to someone thinking about taking psychotropic meds?”
I assume that as David penned his post, he was picturing a gathering dark cloud of opponents—counseling organizations, churches, or individual that are anti-medication.
I picture a very different audience. I picture an audience that minimizes matters of the soul, or even denies matters of the soul. The consistent message that concerns me is the one coming from the world to the church: “We are only bodies.” This materialistic worldview is “anti-soul” with the result that all hope is placed in biological cures. The result is tragic, as Dr. Frances notes: the under-treatment of the truly ill and the overtreatment of the basically well.
I’m not saying David believes the body-only, materialistic view. I know he does not.
I am saying that our perceived audience makes a huge difference. And the perceived threat makes a huge difference. Is the greatest threat from some people in the church who are opponents of psychotropic meds? Or, is the greatest threat from the world and its materialistic worldview?
David was giving person-specific counsel. Perhaps in this person’s case, David perceived that the greatest threat was from anti-meds folks. I respect that.
But David said he wanted his post to help others also. I applaud that. So, my question is, “Which ‘voices’ are most prevalent? The voices of the anti-medication folks? Or, the voices of the world’s anti-soul folks?”
At the very least, wouldn’t compassionate counsel respond to both voices, saying something like:
“I applaud you for going to a doctor, talking openly about your symptoms, discussing possible physical causes for your moods, and whether anti-depressant medication could be appropriate in your situation. When you go, I would encourage you to ask your doctor some specific questions about potential side-effects of anti-depressants—so you can make an informed decision and so you can be prepared if they occur. I’d also encourage you to ask your doctor about what expectations you might want to have about the likely effectiveness of anti-depressants in helping you with your moods.”
I would not add, “The side-effects are often minimized and the effectiveness greatly exaggerated by those with a materialistic worldview and those who benefit greatly from the sale of psychotropic medications like the medical-pharmacological-industrial-complex.” Just as I would not add that side-effects “are often exaggerated by opponents of medications.”
There would be an appropriate time for this important worldview conversation. However, when talking with a depressed friend, I would want to avoid pejorative statements about philosophical opponents.
Toward a Comprehensive Response
There are many indications in David’s post that he is concerned with a comprehensive response to depression. David notes that this person had tried “every other spiritual and commonsense remedy.” David also addresses practical issues about TV watching, exercising, eating and sleeping well, resting, therapy, talking with a pastor, maintaining Christian fellowship, Bible reading, and prayer. David discusses biblical themes like hope, suffering, God’s sovereignty, and sanctification.
There is no doubt that David wants to encourage a comprehensive approach to addressing struggles with depression. So do I.
Yet, there is a major area of counsel where David and I would part company. David says to his friend:
“Given what you’ve told me about your state of mind, you should ask your doctor about ongoing counseling, preferably from someone with expertise in CBT (Cognitive Behavior Therapy). That will help you re-train your mind/thinking patterns for long-term recovery. If it was a Christian counselor, that would be even better, but make sure they are trained in CBT.”
It appears to me that in David’s mind CBT (Cognitive-Behavioral Therapy) would be comprehensive therapy. I disagree.
Secular CBT Is Not Comprehensive
I was surprised by David’s encouragement to his Christian friend to see someone, even a non-Christian, with expertise in CBT. Granted, David did say that a Christian counselor practicing CBT would be “even better,” but there is clearly a recommendation to consider seeing a non-Christian counselor practicing CBT.
This seems inconsistent for David, who recently authored the book, Jesus on Every Page. David has a passion for a Christ-centered, gospel-saturated, grace-based approach to everything in Scripture and everything in life. So do I.
The non-Christian practicing CBT is not going to be concerned about gospel-saturated living, Christ-centered thinking, or a grace-based relationship to Christ. His belief system, by very definition, is going to be, at best a-Christ—without Christ. Theologically, it would be even worse—anti-Christ.
I understand common grace. I understand that the image of God is depraved, but not eradicated, in the non-Christian. I also understand, and I know David does, that the fallen mind is not Jesus-shaped.
When a depressed friend, counselee, or church member comes to me, and I want to point them toward comprehensive care, I am not going to point them toward a non-Christ counselor (not just “non-Christian” but “non-Christ”). That non-Christ counselor cannot offer comprehensive care. How can care be comprehensive when Christ’s gospel of grace is not the center of that care?
Christian CBT Is Not Comprehensive
I also do not believe that “Christian CBT” is comprehensive. Admittedly, I do not how David is defining “Christian CBT.” But let’s take the phrase “Christian CBT” at face value.
It is a Christian whose therapy model focuses on cognitive and behavioral matters. Even apart from issues relative to integration or non-integration of secular concepts, CBT is far from comprehensive.
We are not only cognitive beings and behavioral beings. We are, at the very least:
- Everlasting Beings: Created by God to live through and for God by grace.
- Socially Embedded Beings: God designed us to be embedded in, impacted by, and influenced by our cultural, social setting.
- Embodied Beings: God designed us as complex mind-body, soul-body beings.
- Emotional Beings: God designed us to feel and experience life deeply.
- Volitional Beings: God designed us with the capacity for behaviors and also with the capacity for motivation—purposeful behavior.
- Rational Beings: God designed us with the capacity to think in stories, images, and beliefs and we can do so either wisely or foolishly.
- Relational Self-Aware Beings: God designed us with the capacity for self-awareness, which as Christians means that our identity is in Christ.
- Relational Social Beings: God designed us so that it is not good for us to be alone and so that we could mutually love one another sacrificially.
- Relational Spiritual Beings: God designed us so that the holy of holies of our soul is our capacity for relationship with God. We are worshipping beings.
Even in this brief summary of comprehensive care, it is evident how incomplete, inadequate, partial, and insufficient “Christian CBT” is.
So, rather than giving counsel that tells my depressed Christian friend to ask his doctor for a referral to a non-Christian counselor or a Christian counselor who practices CBT, I would say something like:
“Given what you’ve shared with me about the state of your body and soul, in addition to seeing your doctor, I would encourage you to connect regularly with an equipped, compassionate biblical counselor who practices comprehensive, Christ-centered, gospel-based, grace-focused biblical soul care. As you meet with this Jesus-focused counselor, I’d encourage you also to embed yourself in your local church—in the Body of Christ. You are hurting right now, and Christ does not want any of His children to suffer alone…”
My prayer for my friend would be that he find Jesus-care—care from Jesus, from a Jesus-like counselor, and from a Jesus-like church as he decides if anti-depressants would be a part of that compassionate, comprehensive care. My prayer would be that he find a Jesus-like counselor—one who is full of grace and truth, one who is richly, robustly, relational, one who cares compassionately and comprehensively.
Join the Conversation
A friend says to you, “I’m thinking about going to the doctor for depression meds.” What would your compassionate, comprehensive response sound like?
RPM Ministries: Equipping You to Change Lives with Christ’s Changeless Truth
Thank you for this post, Bob. I felt the same things when reading David’s post but did not feel competent to craft a response. Your post says exactly what I was thinking and how I would approach a counseling situation.
Mindful that I cannot extrapolate too far from my personal experience, I will share my own testimony. Eighteen years ago, my wife suffered from depression — Christian CBT was all we had and we found it inadequate. I am thankful for medication, as it did make the symptoms of depression more managable, but it was not a cure. It was not until she spent time with a NANC counselor (at Faith in Lafayette) that my wife was able to find healing and wholeness. There was no shame in taking medication, but they rightly identified the spiritual issues that were keeping her from being free from depression. She is now 15years depression free and psychotropic-free.
Secular counseling models and their Chritianized counterparts have some value, but they ignore what is often the most significant factor in healing — the spiritual, gospel component. The helpfulness in David’s article in removing shame from medication was countered by the harm in its back-handed criticism of and leading people away from biblical counseling.
Thanks for your engagement with both posts, Todd. And thank you for sharing your testimony. Bob
Dear Bob, I am always a little leery, albeit curious of articles about “mental health” issues. I am so glad that I read your article! Many years ago, as a Christian, I was diagnosed with manic-depression. At the time I thought it was an answer and began the quest for information on how to tackle this problem and be better. I started, what became several years of hell, trying to find the right drug combination. I went through many awful side-effects from these drugs. At the same time, the church was telling me; pray more, read more, have more faith! I finally started taking a combination that immediately made a difference. My thinking was dramatically different! I thanked God for this. Long story short; ended up in a divorce, lost my insurance, and through several failed programs to keep taking the medicine, I had to stop as I could not afford it as a single mom. I “stepped” out in faith and have not taken medicine for over 12 years. I have had no symptoms. Although I quit taking medication, I encouraged those that were suffering to not discount it and that it might help them along the way. I have come full circle! As a Christian, I hated having a secular label that inhibited me from doing certain things. As much as I now believe the psychiatric community is contrary to the Word of God and psychiatric treatment is not even science based, I was re-evaluated last year by a psychiatrist and was told I was misdiagnosed. He said because there is no cure for manic-depression, medicine must be taken for a lifetime. No one could go that many years without symptoms if they were truly bipolar. Ha! So now how do I explain it? My symptoms were real! Sin habits. My thinking had changed alright but it was because I had finally understood the need for a Savior. I came face to face with the cross and my sin. My thinking had to be changed just like a car’s wheels goes into a rut on a muddy road so had my thinking processes. The Word of God, good and Godly counsel, prayer and repentance was the treatment I needed. There are times when people are truly mentally ill; after head trauma, birth defects, debilitating disease, etc. but most of the time meds only bandaid the true problem. I hope to get across as well, those suffering from depression or manic-depression or whatever shouldn’t be condemned or ostracized for taking medication. But as you put it so eloquently in your article Bob, they need to know the alternative to psychiatric treatment and psychotropic drugs, especially for Christ followers. Thank you!
Tami, I really appreciate your courageous response. Thank you for sharing your compassionate and comprehensive insights. Bob
My brother and I both suffered from anxiety and depression all our lives. I have had counseling and have also been on mental health drugs prescribed by a Christian psychiatrist. My brother was influenced by our Christian parents to do neither. They thought it was a sign of spiritual weakness. They thought all mental health docs were quacks. My brother did try to get help but never took his meds consistently. A few months ago, he killed himself. Do not fail to support those with depression or anxiety with every possible tool that is available. I’m sorry but churches are LOUSY at this. You cannot pray depression away. Do you think you can pray cancer away? It is no different. Lives are at stake. My brother found healing only by exiting this life.
Linda, I am so sorry for your loss of your brother. Thank you for passionately sharing your convictions. I agree with you 100% when you say, “Do not fail to support those with depression or anxiety with every possible tool that is available.” That’s why a comprehensive approach–including a comprehensive medical work-up is so vital. I am sorry that the churches that have engaged you on this have been so lousy at compassionate care. You raise a very important question, “Do you think you can pray cancer away?” Anyone who would claim that cancer or depression are to be dealt with only by prayer, would be wrong. Prayer, in both cases, would be an essential response, but never the only response. In both cases, I would encourage people to ask their doctors about the side-effects and efficacy of the suggested treatment. Having relatives who are even now battling cancer, they continue to have very candid discussions with their oncologists about side-effects and efficacy of treatment. Because, as you rightly say, “lives are at stake,” we must encourage pastors, counselors, friends, and doctors to pursue a compassionate, comprehensive approach to the treatment of depression. You also mention that your parents thought that taking medication was a sign of spiritual weakness. I am sorry you were told that. I agree with David Murray when he mentioned in his blog that the decision to take medication can be a sign of spiritual humility and thus of spiritual strength–we are recognizing our need for God and all that He generously provides. I am praying for you and with you. In Christ’s Grace, Bob
Tami, thanks for sharing your story. You encouraged me.
My dad was diagnosed a manic depressive in the 1970s when I was in grade school. After a scary manic incident — I called it “the night of twisted chairs — he was hospitalized and began medication. Then, lithium was the only (???) medication. While it had side effects the great improvement in his mood and thinking outweighed them. Life was far from perfect — my parents divorced, my brother used pot and LSD, I felt “not enough, never enough.”
Once or twice my dad stopped taking meds thinking he was “cured” but the racing thoughts, grandiose thinking, paranoia, and deep deep sadness returned. He resumed his medication and his mood and thinking improved again.
Now he’s pushing 80 and was switched to a newer medication with fewer side effects a number of years ago.
I truly believe that straighter thinking helped him SEE THE TRUTH of the GOSPEL and in humility, become BORN AGAIN.
And so while I despised his need for medication, could it be that God used this condition to help him see his need for the Gospel?
Lucy Ann, Thank you for sharing your story. I think it indicates the “both/and” of our complicated mind/body unity. We need to be open to all the (comprehensive) ways God has generously given us to face and address our struggles. Bob
I just fought this battle a month or so ago. I don’t want to write my life story but suffice it to say that I have struggled with depression for years. This struggle was compounded by the well-meaning by ill-informed comments of some friends and, sadly, some pastors. I usually just hid behind a smile and kept the pain to myself. This began to really bug me while I was attending Capital Bible Seminary in the early 2000’s (I graduated in 2004 with an MDiv). I’d ask myself this question over and over: “How could I have depression since I’m a Christian…especially one being trained for pastoral ministry?” Things got very complicated when I got married in 2002..and even more complicated when we started having children! My private shame was no longer private since my wife knew. As time went on, my symptoms grew worse. I had a worsening work situation…I struggled with ministry experiences that went bad…I withdrew more and more and yes, thoughts of suicide entered my mind.
I planted a church and that just aggravated my symptoms. Though there were some really encouraging times, I had issues at my job and a “friend” that I had asked to help turned out to be one in whom no one should place trust. I tried taking St. John’s Wort and it helped a little. Well the church I planted was split by this long-time “friend” and the church died shortly after. Now, not only do I deal with the guilt and shame of being depressed, I am also a “failed” pastor! YIKES! My wife still encouraged me to seek medical help to deal with the depression. I steadfastly refused. My depression has gotten so bad that I had to tell my wife to hide the bullets for the revolver I own. It was really bad for some time. I learned to hide it well from most, but my wife knew.
After the church died, I started receiving taunting messages from an anonymous emailer/mailer. Hurtful things were said, lies told about me, and my depression intensified. I felt worthless, rejected, and almost hopeless. The thoughts of suicide came back. In December 2013 I finally got so depressed and discouraged that I finally “gave in” and spoke to my doctor about it. I figured things couldn’t get any worse. He put me on medicine and it has helped immensely. The side effects have been mild for me. My family life has improved, and while I have bad days, they are kept in perspective instead of spiraling out of control. I have been somewhat open about taking medicine for depression though I’m still embarrassed a bit (and I don’t know why) that I need help.
So I said all that to say this: if I knew of someone that was thinking of getting evaluated for medical intervention for depression, I would encourage them to do so. I would also share my story. I struggle with taking the medication I take. Sometimes I wish I could just “get over it.” But that is the problem: I can’t “just get over it.” I see depression as a medical issue not unlike diabetes or high blood pressure. But the stigma of a “mental illness” prevented me from seeking the help I so desperately needed. We really need to rid ourselves of that stigma. While there is a very real spiritual dimension to depression, sometimes I think we neglect a possible medical issue when trying to sort out the spiritual dynamic.
I’m thankful for the medicine that has helped me. I’m thankful for my wife who lovingly endured my increasing depression over the last few years. I am thankful for my seven children who love me in spite of me. But most of all I am thankful to the Lord for preserving me through the depression so I could seek help from a very talented man whom He gifted. I thank God that I am on medication. I feel like I can now serve God better since my thinking is much clearer.
This is, of course, my story and not everyone’s story. People are unique and the experiences and responses to various things are unique as well. But for me, nothing helped until I sought medical intervention.
Patrick, I am so sorry for the pain you have endured in so many ways. You are so courageous to share your story here. Thank you. I appreciate your balanced, comprehensive approach as you say, “While there is a very real spiritual dimension to depression, sometimes I think we neglect a possible medical issue when trying to sort out the spiritual dynamic.” I (and biblical counselors) would never want someone to neglect a possible medical issue–which is why we always encourage/insist on a full medical work-up. It is also why we encourage people to talk to their doctors about a comprehensive approach–is it biological depression, is it thyroid-related, etc.? I pray that your story encourages people to seek medical intervention sooner. And I pray that they heed your counsel that there are always multiple dimensions to any of our life struggles. Praying for you and with you. Bob
My wife suffered from depression immediately after I was fired from my career. It was a difficult time until she received proper medication. From our experience, I would like to say the following:
Not all anti-depressants are the same or have the same effect. Because of the side effects, a particular medication may not be suitable or effective for a person. That’s when he needs to consult his doctor and describe exactly what that medication is doing to him. The doctor can then prescribe a different type of anti-depressant. Often, it is a matter of trial and error to discover the medication that works best. The problem, however, is that after trying a few recommended prescriptions, the doctor may begin to think that the patient is a hypochondriac, esp. if the patient also has fibromyalgic pains.
As far as “anti-medication” views, I’ve been told by a pastor that no woman should ever have depression. The fault for depression in women, he said, is due to her husband.
John, Thank you for sharing your story and your wife’s story. The struggles can be excruciating. And they are only made more difficult when doctors misdiagnose or assume something is hypochondria. Or, when a pastor makes the types of statements that this pastor said to you and your wife. I am sorry you had to experience all of that. I wonder if the fear of these poor responses (from the pastor and the doctor) cause some people to move to the thinking that medicine is always the answer for everyone (you are not saying that)? I pray for the day when our medical knowledge is more advanced and thus there is much less of the trial and error of which you write. And I pray for the day when more doctors and pastors respond more consistently with compassionate wisdom. Bob
Bob,
Thanks for interacting with my short piece. I hope this will be a good educational exercise for us all.
I suppose I’m at a bit of an advantage in knowing more of the facts of this particular case over a period of time. Still, I think we’re probably about 80-90% agreed on the possible ways forward.
Just one little factoid: I did ask him to discuss more than anti-depressants with his doctor. “Tell the doctor everything – don’t hold back, don’t minimize, don’t play it down – just tell exactly how you are feeling.”
I deeply appreciate your supportive words about medications. They cannot be repeated often enough. I just wish that everyone’s experience of encouraging church and counseling environments was the same as yours.
You’re right, there was a context-specific reason for the wording of my para on side-effects. From what I’ve seen the side-effects are most marked in two situations: (1) When meds are all people rely on and do nothing else to improve their overall physical, mental, spiritual health or (2) People are taking meds who don’t actually need them. There are other scenarios, of course, but these are two disasters waiting to happen and account for a lot of the med side-effects statistics.
I’m kind of surprised that you see CBT as the “major” area of disagreement between us. I could perhaps understand that if I was proposing CBT as a comprehensive therapy. However, I’m pretty sure I made it clear that this was only a part of a holistic approach that included the body, the mind, the soul, Christian friendship, pastoral counsel, and church worship. I do not believe CBT, even Christian CBT, is comprehensive, but can be part of a comprehensive package of holistic care. I think any fair reading of my piece would recognize that.
I hope to post a fuller explanation of this at my blog tomorrow as I fear you are beating a bit of a straw man here. In fact maybe two straw men – (1) CBT as the only solution and (2) CBT as antichristian. I did not propose (1) and I don’t believe (2) is true.
I probably should have included a recommendation to seek out a biblical counselor. However, that was not available to me in this situation. Also, I have not found many biblical counselors who are good practitioners in changing the kind of thinking patterns that I had in view here. They are good for many, many human problems, including some aspects of depression, but there are areas of anxiety/depression that I’ve found need a few sessions of specialist help and can have hugely beneficial impact not just in the short-term but in building new habits of thinking and acting for the long-term. Nothing spooky here! Just well-trained and experienced practitioners who have helped many to see themselves and their world more truthfully and realistically.
You know I love your own holistic model – which you summarized on your blog – and I use it to train my own counseling students. I continue to learn a lot from you, Bob, and hope you can see that I’m striving after that comprehensive compassionate care that we both believe is nothing other than biblical Christianity.
David,
Thank you for interacting with my post about your post. I look forward to your follow-up blog post.
When I first saw your post, it raised the two concerns I highlighted in this post (concerns especially for the reader who was struggling with depression): 1.) Is it compassionate to omit the side-effects and efficacy of anti-depressant?, and 2.) Is CBT, with a non-Christian or Christian counselor the best, most comprehensive, Christ-centered, gospel-centered counsel to recommend to a depressed person? (I did note in the post that your overall approach emphasized a comprehensive focus; so my concern was and is about CBT as the therapy of choice.)
But I had no plans to post a public response or even a comment response on your post. You know my commitment to “a positive presentation of biblical counseling,” which typically leads me to avoid public disagreements…especially with a good friend like you.
However, a significant number of people contacted me asking me for my thoughts, my response, etc., because they had the same two concerns. And most of those people who contacted me either had struggled with or currently struggle with depression. They in particular were concerned about what felt like a pejorative “shot” at those who have concerns about meds side-effects and efficacy (your “opposition to medication” comment). And they in particular had concerns about your recommendation for CBT with a non-Christian or a Christian counselor. So, I reluctantly penned this post. Most posts take me an hour at most. This one took me a good 8 hours over the course of several days. I wanted to be that careful to be fair and balanced in my response to you.
I’m sure that in your response to my response, you can make a case for your compassionate and comprehensive focus. I tried to make that overall case on your behalf. I guess my question to you would be, “Do you see how your comments about those who oppose meds and your comments about non-Christian CBT could cause concern for some people struggling with depression and for people committed to biblical counseling—compassionate and comprehensive soul care?”
Trust me, I get it about blog posts–we can’t say everything in the less-than-1,000 words you used in your post. I saw my post not as “anti-your-post,” but as providing additional context to support that parts of your post (the 80%-90% agreement you note) that I could cheer on!
Perhaps another way of saying this is, “Could you see that there may have been 10% of your post about this significant issue that could cause concern or some confusion—not just for other counselors, but for the very people you want to help—those struggling with depression?”
That’s what ultimately led me to post—my concern that someone struggling with depression would read your post and assume that meds have few side-effects and are always effective. And my concern was for someone struggling with depression who would read your post and assume that since David recommended it, CBT with a non-Christian will be something that would support and advance their Christ-centered worldview. You are currently posting much on worldview—another reason your recommendation of a non-Christian CB therapist seemed to me to be a bit confusing a tad inconsistent.
Is it possible that in your desire to encourage someone to get help, there were two pieces of your counsel that might have ended up being a little less helpful…?
One final thought…as you know, I did highlight that your original counsel was person-specific and situation-specific. However, you did specifically say in your post that you wanted your words to be helpful to others and that you added more counsel that went beyond this one person. Given that, I think it is fair for someone to engage with you about whether your public counsel was 100% compassionate and 100% comprehensive… Granted, nothing I say or write is 100% anything!
One aspect of your comment could take not only a blog post, but a book to respond to was when you said that:
“I have not found many biblical counselors who are good practitioners in changing the kind of thinking patterns that I had in view here. They are good for many, many human problems, including some aspects of depression, but there are areas of anxiety/depression that I’ve found need a few sessions of specialist help and can have hugely beneficial impact not just in the short-term but in building new habits of thinking and acting for the long-term. Nothing spooky here! Just well-trained and experienced practitioners who have helped many to see themselves and their world more truthfully and realistically.”
I’m sorry you have not found many biblical counselors who are good practitioners in these areas. I have found many who are. In fact, if we are not good in these areas, I don’t think we are good, compassionate, comprehensive biblical counselors.
That does not mean that every individual counselor is an expert in every area. It does mean that, as Stuart Scott and Heath Lambert’s book, Counseling the Hard Cases http://amzn.to/1gmvaww indicates, biblical counseling by definition should be able to address the types of issues you mention.
A compassionate, comprehensive biblical counselor should be skilled in the very areas you raise: 1.) changing thinking patterns, 2.) addressing anxiety/depression (see my work Anxiety: Anatomy and Cure https://rpmministries.org/writing/anxiety/ as one example, 3.) in building new habits of thinking and acting for the long-term, and 4.) helping others to see themselves and their world more truthfully and realistically.
I believe that biblical counselors do much more comprehensive work than those four areas you outline—but they at least should be able to provide loving and wise counsel in those four areas.
Thanks again for your friendship. And I agree with you—our hopefully somewhat mature interactions could be instructive to many—not just in the content of what we say, but also in the manner in which we interact with each other.
Bob
PS: This time my comment/post took about 20 minutes—no “editing,” just my “gut” response to your comments, David.
Bob,
Like others who’ve commented here, I too have encountered church leaders who are against medication for depression, anxiety, ADHD and other similar conditions.
One pastor’s wife (a baptist church) told me taking such medication is morally wrong and may indicate the person is not a true believer in Jesus.
Generally speaking, from where does this anti-medication stance among church leaders come?
Thanks, Lucy
Lucy, You ask a good question about where an anti-medication perspective might come from. I can only speak globally and hypothesize since I don’t encounter that.
*Some of it is simply wrong and uncaring.
*Some of it may be a response to “over-medication” and “mis-diagnosis.” Even in the “secular” psychiatry world there is much concern about “over-medication” and “mis-diagnosis.”
*Some of it may be a response to the materialistic, “body-only” view that many people in the world have.
*Some of it may be a response to a sense that medication might at times be used as an excuse not to accept responsibility. I’m not saying that is a good reason for this response…simply brain-storming possible reasons. For example, a parent who perhaps too quickly accepts a diagnosis of ADH rather than work on their heart and their parenting. Perhaps people are reacting to that mindset that they sometimes see.
*Some of it may simply be a misunderstanding of the complex mind-body connection.
*Some of it may be a response to the side-effects and lack of efficacy of some of these medications. We truly are in the infancy of the science of psychiatry.
What reasons might come to mind for you, Lucy?
Bob
“What reasons might come to mind for you…”
Can I name some of my reasons for opposing meds, except for in the short term, for treatment of crisis situations? Because I was equally disturbed by Dr. Murray’s minimization of psychotropic’s side effects, and probably wrote a less nuanced response to his post at his site, and at Challies. I was quite frankly, shocked. When most general practitioners are using the myth of the chemical imbalance theory to explain how SSRI’s work, telling their patients that the drugs are like insulin for diabetes, and also are unable to give proper informed consent about drug side effects because drug trials in the case of the SSRI drugs during the 1990s and 2000s, animal lab studies typically lasted only hours, days or weeks and the human clinical studies only lasted, on average, 6-8 weeks , far too short to say anything about long-term effectiveness! An average 6-8 weeks who is really informed by such a study?
I am in wholehearted agreement with Dr. Peter Gotzsche, co-founder of the Cochrane Collaboration, a wiki of 30,000 researchers globally, who wrote, here http://www.madinamerica.com/2014/01/psychiatry-gone-astray/:
“I am not against using drugs, provided we know what we are doing and only use them in situations where they do more good than harm. Psychiatric drugs can be useful sometimes for some patients, especially in short-term treatment, in acute situations. But my studies in this area lead me to a very uncomfortable conclusion:
Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good. Psychiatrists should therefore do everything they can to treat as little as possible, in as short time as possible, or not at all, with psychotropic drugs.”
Dr. Gotzsche demolishes the ten worst myths of psychiatry and psychotropics in that excellent article. So when we know the benefits of sleep therapy for the insomnia that triggers depression — several studies now suggest that developing insomnia doubles a person’s risk of later becoming depressed — the sleep problem preceding the mood disorder, rather than the other way around.”
Indeed, when sleep therapy is proving to be the most promising treatment for chronic depression, as a study in Toronto found that, “87 percent of patients who resolved their insomnia in four biweekly talk therapy sessions also saw their depression symptoms dissolve after eight weeks of treatment, either with an antidepressant drug or a placebo pill — almost twice the rate of those who could not shake their insomnia: http://www.nytimes.com/2013/11/19/health/treating-insomnia-to-heal-depression.html
When sleep therapy, dietary changes, exercise, and sympathetic counsel have proven effectiveness — without the toxicity of the SSRI’s effectiveness at a rate no greater than placebo, now indisputable — I simply do not understand why we counsel others that it is a wise choice to make.
Hah! I was so tired from lack of sleep, I forgot to edit 🙂
Moderator, would you please insert a hyphen between “weeks” and “who”, so that the sentence reads,
An average 6-8 weeks — who is really informed by such a study?
Thank you! That is the most egregious of my typos.
is it recommended that people seeking relief from other serious medical problems (other than depression) also see a biblical counselor before going to a physician?
how closely is this related to relying on faith to cure illness . . . and what about children who are severely depressed?
also,
I did not know that you COULD go to a doctor for pills for depression . . . I thought you had to be evaluated and diagnosed before any prescriptions could be written . . . ?
Christine,
I’m unsure what David Murray would recommend about people with medical conditions going to a biblical counselor before seeing a physician. My recommendation would be–go to your physician. And…given that any serious physical condition brings up a host of spiritual concerns, emotional issues, etc., that people do what Christians have done for 2000 years–go to Christ and the Body of Christ for nurture, support, strength, encouragement, wisdom.
Your question seems to directly link all depression to a serious medical condition. David’s original post indicated that the individual he was counseling first explored whether the depression was or was not physically-based. So, not all sad feelings are physically-based, even intense ones. For example, sadness and grieve over loss (of a loved one, of health, of a job), is not necessarily a physical disease but a normal human response to loss–and should not necessarily be treated by medication.
You ask how closely “is this” related to relying on faith cures. I’m unclear what “this” is. My five posts clearly emphasized repeatedly a comprehensive mind/soul, body/brain approach, so I see no connection whatsoever.
You also ask about children who are severely depressed. Once again, an accurate, whole-life, comprehensive diagnosis is vital. Once again, comprehensive, compassionate care is vital–the child should see a doctor. I would encourage the parents to seek help from their church including biblical family counseling to assist in the myriad of major issues that would surround such a situation.
Finally, you said you did not know you could go to a doctor for pills for depression. You certainly can. And the evaluation often does not involve any physical tests. Ideally, a doctor would do a battery of tests to rule out physical issues like thyroid problems, etc., etc. However, for “clinical depression” there is no blood test, or even brain scan, etc. that can “diagnose” a physical cause for depression. “Clinical depression” is diagnosed on the basis of patient-described symptoms.
Hope that helps.
I would encourage you to read Good Mood Bad Mood by Charles Hodges. I link to the book in my first post in this series.
Bob
Bob, One of the objections to psych-medications is that we should recommend them as much as we should recommend alcohol, cocaine or other psychoactive substances in treating the psycho-somatic consequences of our fallenness . One obvious problem is that of the “compensatory mechanisms” of the brain which demonstrate if not prove that the brain does not “approve” of the actions of these drugs. Compensation is what causes the need for increased dosages, changing drugs and withdrawel symptoms. It is exactly the same as drug or alcohol addiction. Why don’t we just let people self medicate with counseling?
Jamie
I have never really looked at it from the other side of the fence but I suppose that depression might be a hard thing for someone else to deal with when they hear that a friend or a loved on has it and wants to get real help. I have always been one to keep my feelings inside but I found that letting them out can be a real help, I just didn’t know how others felt about it until now.