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Biblical Counseling Coalition: Grace & Truth

Mental Illness, Psychiatric Drugs, and Counseling Education

Mental Illness, Psychiatric Drugs, and Counseling Education

BCC Staff Note: You’re reading Part One in a multi-part series written by biblical counseling educators. You’ll enjoy great diversity in this series, not only related to the authors, but also to the topics. We simply asked a number of biblical counseling educators to craft a blog post about anything they wanted to discuss related to biblical counseling and education. Some are focusing on their teaching ministry. Others are focusing on their personal educational journey. Still others are focusing on relating important theological issues to everyday life. Enjoy!

A Compassionate Conversation

In the very public aftermath of Matthew Warren’s tragic suicide, the evangelical community rallied around the Warren family with an effusion of prayers and condolences. As a counselor and fellow Christian my heart breaks over the incredible pain Matthew must have been enduring to take such tragic action to end it. As a father, I have wept over the agony that Rick and Kay Warren must still be experiencing in the midst of such a devastating loss. As a minister, I have been overwhelmed with gratitude for the strong testimony Rick Warren has given for Christ in the months that have followed. I have never met any member of the Warren family, but I have tremendous love and respect for them as a result of what I have witnessed in the months following Matthew’s suicide. I continue to join with many other Christians as we pray for God’s continued comfort to that dear family.

Matthew’s loss occasioned a widespread and important conversation in the larger Christian community about mental illness and the use of psychiatric drugs. All sorts of people have weighed in on this issue—some have provided incredibly helpful insight, while others have offered more misleading counsel. I won’t try to weigh in on all of that. Here, in this series, I want to speak to this issue from the perspective of a counseling educator. I teach counseling students at the seminary and Bible college level, as well as at the professional and lay-level through the National Association of Nouthetic Counselors (NANC). One of the most persistent set of questions we must answer when training counselors is how to think through the use of psychiatric medication when we counsel people who are using them.

I want to share with you the three categories that are operating in my head whenever I think about, speak on, or answer questions about the use psychotropic drugs in counseling.

1.  God Made Human Beings Body and Soul

When God made mankind He breathed life into dust (Gen. 3:7) thus creating a human being with an outer physical substance and inner spiritual soul (2 Cor. 4:16). Each of these elements are of crucial importance, and each of them are good (1 Tim. 4:8). This means that if we think about people according to the Bible, we won’t be Gnostics or behaviorists. We’ll believe that both the body and the soul are good, and be willing to do effective ministry to both.

2.  Physical Treatments for the Body Are as Good as Spiritual Treatments for the Soul

When we’re thinking correctly about the goodness of the physical and spiritual element of humanity, we’ll embrace the use medical treatments for physical ailments just as readily as we embrace spiritual remedies for problems of the soul.  Ten minutes ago, I took a Claritin to help with my allergies. That is just as holy as the prayer I prayed earlier this morning that God would remove the fuzziness in my head. One is physical. The other is spiritual. They are both good. Christians shouldn’t give anybody a hard time for honoring the body with medical interventions that God intends, in His common grace, to be a blessing.

3.  Psychiatric Medication Is Different Than Other Medications

Many Christians who evaluate the use of psychiatric medications evaluate the first two concerns in my triad, but neglect this one. As I have reviewed the observations of many Christians weighing in on this matter, they don’t express understanding of what is common knowledge among those working in the field of psychiatry from practitioners to drug manufacturers. Psychiatric medications are pressed from a different mold than other kinds of medications like the Claritin I just swallowed.

This is not an obscure observation. The Journal of the American Medical Association, to cite just one source, released a study showing that the actual pharmacological benefit of antidepressant medications for most people is basically non-existent and often worse than a placebo. This means that what happens when you take psychiatric medication to help with sorrow is very different than what happens when you take insulin to help with diabetes. Whereas insulin conveys a physical and medical benefit, psychiatric meds typically work—when they work at all—because we want them to work.

Some Implications for Counseling Education

I think there are several different implications of these three principles for those of us doing counseling education.

First, honor people—body and spirit. We need to teach counseling students to honor God’s creation of humanity in each of its constituent parts, body and spirit. One of the ways we can do this is by teaching counselors not to reject, but rather embrace, medical interventions that help physical problems. Another way we can do this is by training students to be suspicious of medical interventions that are dubious with regard to their physical benefit or else attempt to treat as a medical pathology a problem that is actually spiritual in nature.

Second, be humble. We need to be honest about what we know and what we don’t know. Most Christians who write about mental illness and psychiatric medications know far less about the science behind such things than the experts who deal with them every day. Our role as counseling instructors is to teach those paying attention to us about the complex nature of issues at the intersection of body and soul, and to be humble when their knowledge about these complexities is at an end.

Third, do what you’re supposed to do. I’m a counselor. I train counselors and I lead a counseling organization. I’m not a physician, I don’t train medical practitioners, and nobody wants me in charge of a hospital. I can do almost all of what God wants me to do in counseling regardless of the psychiatric medications of my counselees. This means I don’t have to try and be a physician. I don’t have to tell people to get on medication or to get off of it. In fact, I should do neither of things. I need to leave that to the people who have a prescription pad. The work of counseling is hard enough without getting onto someone else’s turf.

Join the Conversation

What categories would you add to the three listed above regarding how to think through psychotropic medications?

What implications would you add to the three listed above regarding counselor education and psychotropic medication?

This entry was posted in Biblical Counseling, Equipping, Medication, People in Need of Care, People Who Offer Care, People Who Train Caregivers, Psychology and Christianity, Suicide and tagged , , , , , , . Bookmark the permalink.
 
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  • Tom Lassiter

    There are times when you, as a counselor, must be sure you are talking with a person (the counselee), instead of a pill!

  • Carter Doyle

    I just read the study from the AMA you cited….with all do respect….can you read? The AMA study confirmed the effectiveness of antidepressants in moderate to severe presentations of depression. What medical training do you have? Oh, right, none.

    • Heath Lambert

      Carter,

      I might blow your mind here . . . but I actually agree with
      almost everything you said. In fact, most of the statements in your comments are already in my post. It makes me think that, perhaps, you are misunderstanding my point.

      I didn’t cite JAMA to say that psychiatric medications don’t
      make people feel better. I think they often do make people feel better. I was making the relatively uncontroversial point that what we know about how they make people feel better is different than Claritin, insulin, or penicillin, for example. The only disagreement we might have as far as what I wrote in the post is whether a person without a medical degree can understand language composed by people who do.

      I also don’t claim any medical training. I tried really hard in the post to be honest about my training as a counselor and not a physician.

      I also don’t believe it is my place to get people on or off any medication. I have never done that, and don’t teach others to do that. That’s why I made the whole point at the end about the importance of everyone doing what they’re supposed to do.

      It is clear that you found the things I said to be upsetting. I feel terribly about that given that we seem to have many of the same concerns on this issue. I hope my words here have been helpful. For my part, I appreciate your interest in these issues and your holding my feet to the fire to think clearly about complex things that matter to a lot of people.

      Blessings to you brother,

      HL

      • Carter Doyle

        Mr. Lambert,

        First, I want to thank you for taking the time to respond. I also apologize for anything I said that was unduly mocking, and the places where I read meaning into your article that was not there.

        I have seen a lot of people get hurt by nouthetic counseling, and people certified by NANC. One example is of a nouthetic counselor telling an adolescent male who reported remembering being sexually assaulted as a child, “it probably did not happen, it was most likely a bad dream.” Another is of a female victim of domestic violence who was told, “it’s not that bad, what is the worst your husband can do to you? Even if his wounds leave scars they will not be as bad as Christ’s wounds.” I could sit here all day and type out examples of different NANC/nouthetic counselors saying things like this to people I now personally know or came to a church I served at for help.

        I think one of the above examples helps to exemplify my concerns with the article. The above mentioned adolescent male reported night terrors, nightmares, suicidal ideations, self-harm, and sexual compulsions to their NANC/nouthetic counselor. The male was never referred to professional psychiatric help for an evaluation. His symptoms were actually made worse by the NANC/nouthetic counselors who added guilt and shame by only talking about sin, and trying to confront him with his sin. By God’s grace, a neighboring church found out about the situation through concerned friends, and successfully intervened. Despite a rebuke from the NANC/nouthetic counselors and their sponsoring church, the adolescent went on to receive the critical psychiatric care he needed and is doing well today.

        Unfortunately, I have seen this situation play out numerous times. The nouthetic counselors either completely miss the symptoms of a major depressive disorder, are too untrained to identify depression symptoms, or are willfully negligent. What angers me is it seems that NANC discourages and even condemns psychiatric intervention. Take the following quote from the NANC sample membership covenant posted on the NANC website (http://www.nanc.org/Documents/Application-Packet/13-Sample-Membership-Covenant-2011.aspx):

        “The counselor must build his counseling system, including its presuppositions, principles and methodologies solely from Scripture. His counseling must demonstrate that Scriptural truth, ministered in the power of the Holy Spirit, is sufficient to enable counselees to love God and their neighbors.

        We deny that secular theories and practices are manifestations of General Revelation or Common Grace. We affirm that they are, in fact, attempts to substitute the “discoveries” of rebellious human thought for the truths revealed in Scripture, and are, therefore, in competition with a proper interpretation of General Revelation and with biblical counseling. They cannot be integrated with the Faith once for all delivered to the saints.”

        If I am reading that right, psychiatry, medication, and other interventions not found immediately in scripture should be denied by the counselor. This prevents the NANC counselor from referring a client to psychiatric help, or even learning the symptoms of depression that have been revealed in scientific study by common grace.

        I think I can boil everything I’m trying to get at down to one sentence: anyone who wants to counsel needs to have medical training, and not limit their understanding of counseling issues to special revelation. Even LPC’s have psychiatric training.

        What frustrated me was the way the article seemed to rip a study on antidepressants out of context, and call antidepressant’s effectiveness into question. This denial of the validity of treatments not found in the Bible is consistent with what I understand to be a nouthetic approach to counseling. Antidepressant therapy has shown to be effective in hundreds of studies, and I have a big problem with anything that tries to minimize this. It’s not that medications are a sacred cow for me, I just want to make sure any criticism against antidepressants – or any evidence based practice for that matter – is well grounded. There are a lot of people who have benefited from antidepressants, and we should rejoice that God has brought healing through that therapy instead of questioning wether they are really benefiting.

        I totally agree that when people are hurting, or seeking help with a life issue, we need to address the whole person. However my fear is that in an attempt to be Biblical and address the sinfulness of the human heart, we miss the opportunity to see God bring complete healing. Just because an issue is rooted in sin, does not mean that God’s healing cannot come from physical remedies.

        Anyways, it is getting late and I could talk about this for quite a while. I hope this helped to better explain what I was trying to get at. Thank you for being so gracious in your response to me, and I hope my words did not just tear you down.

        Grace and Peace,

        Carter

        • Heath Lambert

          Carter,

          This is helpful. I appreciate you sharing that with me.

          There is more to say here than is helpful to discuss on a forum like this. If you friend me on Facebook or follow me on Twitter I would love to follow up with you in a more personal way.

          Blessings,

          HL

        • Bob Kellemen

          Carter and Heath,

          I appreciate your interaction. Heath, thank you for your original post and for your gracious reply to the comments.

          Carter, thank you for sharing your concerns. Though I do not work for NANC, I did want to clarify the implication of their statement on general revelation.

          You interpreted their statement to mean that NANC would therefore be automatically opposed to any medical intervention because it is not found in Scripture. However, as I understand the implication
          of the NANC statement on special revelation/general revelation, they are talking about counseling theory—an understanding of people and of problems of the soul. They are not denying the potential value of legitimate scientific research including descriptive research. The BCC has had many posts in the past 18 months clarifying the important difference between descriptive
          research/scientific research/matters of the body compared to the development of counseling theory.

          Also, you note that you believe that anyone who wants to counsel needs to have medical training. Even in the secular realm of licensure, unless one is licensed as a psychiatrist they will not have
          medical training. An LPC would have a section of a course on psychotropic medications—yes, but not “medical training.” Also, increasingly, biblical
          counseling training includes discussions of psychotropic medications and increasingly biblical counselors are writing about psychotropic medications. I would encourage you to consider Laura Hendrickson’s chapter in Christ-Centered Biblical Counseling (she is a biblical counselor and a licensed psychiatrist) and to consider Good Mood, Bad Mood by Dr. Charles Hodges (who is a biblical counselor and a medical doctor).

          One final thought…I wonder how beneficial/statistically accurate anecdotal comments about counselors who are trained in one theory or
          another are? While I’m saddened that you have experienced some poor results in people you know who were perhaps counseled by NANC trained counselors,1,000s have given positive testimonies of NANC counselors. At the same time, we could
          provide anecdotal testimonies that are both positive and negative of integrative Christian counselors, of secular counselors, and of psychologists
          and psychiatrists. As someone who appears very interested in research (as am I), I would think that researched-based conclusions about counseling approaches would be more important than anecdotal testimonies. At the very least, your anecdotal comments could be interpreted to be making a sweeping generalization about all
          NANC trained counselors, and I’m sure that was not your intent.

          I would be glad to interact with you further on these issues. Feel free to email me at my BCC address: bob.kellemen@biblicalcc.org.

  • Austin Murphree

    @carterdoyle:disqus the AMA study states “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.” – which Lambert is pressing, “the benefit for most people is non-existent”, this would be the average. The AMA study goes on to state that medication helps in severe cases of depression but that level of depression has far more layers and issues at hand, but this was not pressed by Lambert. I don’t believe he was ignoring that, but his emphasis was on the average, “most-people”, which is where majority of counseling is taking place – Lambert even states that he is not trying to be a physician, but a counselor who cares for the individual.

    • Carter Doyle

      If he has no medical training (which most nouthetic counselors lack) how is he in a position to counsel people on wether or not they should consider a pharmacological intervention? Nouthetic “counselors” are not trained to identify clinical conditions, and therefore could not even know how depressed someone is to provide good counsel on wether someone could benefit from medication. How would he know if people he “counsels” fall into the “most-people/mild or moderate category”

      Medicine, therapy, and psychiatric care is for professionals – not people who went online and read an article from the AMA and/or have a “certification” from a fringe organization. Please, leave healthcare to healthcare professionals. Doing otherwise is dangerous (and illegal in some jurisdictions).

      Also, one research paper presented by the AMA does not negate years of study that show the effectiveness of antidepressant therapy – although those studies do not fit his agenda so i’m not surprised he fails to acknowledge them.

      • Paul Fuller

        Carter, it sounds like you have encountered some very foolish and frankly, bad, so-called nouthetic counselors. It also sounds like you might be foisting those impressions back on to what Dr. Lambert is saying. The reason I say that is because it almost sounds like you didn’t see this line in his concluding remarks: “This means I don’t have to try and be a physician. I don’t have to tell people to get on medication or to get off of it. In fact, I should do neither of those things. I need to leave that to the people who have a prescription pad. The work of counseling is hard enough without getting onto someone else’s turf.”

        So if you take Dr. Lambert at face value in this article, he is saying that when it comes to counseling depressed individuals, he does, as you’ve put it, “leave healthcare to healthcare professionals.”

        I think Dr. Lambert’s use of the AMA article is to remind those of us who are biblical counselors to consider carefully our own thinking about the use of psychotropic drugs and their effects. As a counselor, people come to me who are taking various kinds of medications. Yes, I am not medically trained. But it is immensely helpful for me become educated as to how those medications may affect my counselee and what benefits they may or may not provide. A brief post like Dr. Lambert’s or a more extended article like this one (http://www.ccef.org/jbc/listening-prozac-and-scriptures-primer-psychoactive-medications) by Mike Emlet help me orient myself a bit towards this topic. It doesn’t make me an expert nor does it really even make me a skeptic. It motivates me to learn more. And in this particular post, it drives me towards worship of our amazing God who made man and woman as such complex creatures–not assembling us as physical and spiritual compartmentalized beings (though, we as humans have to think in these categories to some extent) but creating us as whole beings made in His image.

      • colin mattoon

        Carter, I encourage you to print out every comment posted and take them to some older wiser believers in your church including your pastor and ask them what they think about the comments you and others have posted. I’m not talking about the content and beliefs but the attitude and spirit of the posts. I take it you are a believer. I dont know you or anything about you but I really hope you do this because I find the spirit of your comments concerning. Hopefully some older wiser believers who know you and/or a pastor responsible to give account for you can give their assessment and speak truth in love to encourage, rebuke, and help you however you need grace.

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  • Steven R. Owensby

    Brother Lambert,

    Thank you for you helpful and thoughtful analysis of the need to treat medical issues as one facet of the whole person.

    To that I want to add one more fundamental category that I think must be addressed if we deal with the whole person. Since we deal with the person in biblical counseling, what interaction does a person’s sin nature, history, and current situation of suffering (sin done against them) have with regard to mental medical issues?

    I also would add an implication that’s absence I hope is unintended. The way you fashion your comments, I think that you mean to say that one should pursue BOTH physical and spiritual treatments for problems he faces as a person. I say a hearty AMEN. However, the way your heading is worded, some may read that physical treatments are as good as spiritual treatments. Do you mean to imply that physical treatment for our temporary body is as effective as the spiritual counsel to save a man’s eternal soul? If so I cannot agree. Consider adding this implication. First, honor God as the eternally wise creator of man’s temporary body and eternal soul (Ecc. 3:11). Treat your body only so well as you also have addressed the needs of your soul.

    Thank you brother for tackling this most important issue.

    Letting the Shepherd Lead,
    Steven R. Owensby

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  • Wayne Boyd

    Of course, anti-depressants are only good for some people. True clinical depression is vastly different than sorrow and the first case calls for medication while the second does not.

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  • Robert Fairman

    Heath – I am lay counselor with Valley Baptist Church in Bakersfield, CA. Our Care Connection group just finished studying Counseling the Hard Cases.

    Rick Warren said that his son “”struggled from birth with mental illness, dark holes of depression, and even suicidal thoughts”. Orthodox Christianity says that we are born with a propensity and disposition to sin – fundamentally the claim of your right to yourself – to be your own God. God has the power of life or death. Matthew exercised that power. What caused him to do this? Sin? Mental Illness? Both? Perhaps his brain never matured so he couldn’t understand the consequences of his actions and/or learned to accept the pain and tragedy of this world? I don’t know -but I’m concerned about the implications of Rick’s statement above which implies that Sin had no role to play in this tragedy. I just finished writing him an email – as sensitively as I could to ask him to consider using his platform to blend and endorse the wisdom of nouthetic + medicine coupled with presumption of sufficiency of the Scripture and the Holy Spirit’s transformative power in the heart.

    My letter to Rick and Kay below:

    Pastor Rick and Kay,

    I saw your interview with Piers Morgan tonight. I want to express to you both my deepest heart felt sympathy for what you have been through and will have to bear for the rest of your lives. I applaud you for your courage to speak out on the issue of “mental illness”. As someone who is diagnosed as clinically depressed and have been on medication that works for the last 10-15 years I have personally experienced the trauma of psychic pain, and the benefit of medication. Having said that I am also trained “nouthetically” with Peacemaker Ministries and minister as a lay Care Connection counselor at Valley Baptist Church in Bakersfield, CA. As counselors we just finished studying Counseling the Hard Cases by Stuart Scott and Heath Lambert – nouthetic.Not everyone on our team agrees with this counseling approach. Some even refuse to participate any longer because of the “danger” of bringing sin into the conversation during counseling, others don’t know what to think. All I know is that the gospel of Christ always recognizes that “sin” is a factor to be wrestled with in our thoughts, feelings, actions, motivation and desires even for those of us who are spiritually mature disciples. Jesus faced temptation, so do we. I believe in the sufficiency of scripture and the transformative power of the Holy Spirit, but know that there is a place for medical care and medication. I note in your letter above that you indicate that Matthew “struggled from birth with mental illness, dark holes of depression, and even suicidal thoughts”. At the risk of being insensitive I would value your thoughts on what,if any, role did sin play in this tragedy? I know that as Christians, particularly Christian counselors, this a difficult subject. From my perspective, it is probably the central issue of the world – the one they don’t even begin to get until their conversion. But it must also be at the center of the Gospel not only unto Salvation but to answering the question of who am I and why do we do what we do – Sanctification. As counselors this is a discussion that needs to take place. Perhaps in some way your influence and your son’s pain will help shed some light on the truth of God’s love, power, and goodness to those of us still fighting the battle in this broken world. Your son clearly had a beautiful heart which God used to touch other people for eternity. I am sorry that you all have had to suffer so much in doing so, and that he couldn’t find God’s peace in this life. My prayer is that you have and will continue to.

    From my heart to yours,

    Rob Fairman

  • Alicia

    This isn’t to anyone specific here. It’s my opinion to any and all that have held this position of mental illness and medication.
    I am a 29 yr old female and I have bipolar disorder and PTSD and I love the Lord with all that I am, I seek to grow in my relationship with God everyday and do my best to make my repentance sincere. However, without my medication I can’t function, I can’t honor God with my life as I should. The brain is an organ just like the lungs or liver etc. It gets sick like any other organ and needs medical intervention. The brain is an organ not our spirit ! How would you feel if someone told you to stop taking your heart medication and said God is the great physician ? He is but he’s also allowed us to grow in our knowledge of medicine to care for ourselves…does he physically open your mouth and put food in it ? No! He has provided us with what we need to cultivate and feed ourselves. Mental Health sufferers need support from well informed and compassionate brothers and sisters. We don’t need shame from others saying we are not sick, it’s sin ! We don’t need medicine, we need to repent. Do you realize you’re putting shame on an already suffering person. Unless you’ve experienced true mental illness you have no idea what we experience, but yet some make such definite judgements on it. I’m sorry but are you God ? Do you have supreme knowledge now ?! Judge not lest ye be judged ! Be very careful how you treat this subject and even more importantly be careful how you speak and treat the people with these issues. It can mean life and death !

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