Promoting PErsonal Change, Centered on the PErson of Christ through the PErsonal Ministry of the Word
Biblical Counseling Coalition: Grace & Truth

Cancer, Denial, and the Sovereignty of God

Biblical Counseling and Suffering--Cancer, Denial, and the Sovereignty of God

BCC Staff Note: You’re reading Part 3 in a four-part BCC Grace & Truth blog mini-series on loss, grief, suffering, and Christ’s healing hope. In today’s post, Paul Tautges introduces us to a new resource by Deborah Howard, HELP! Someone I Love Has Cancer. You can read Part 1 by Bob Kellemen at There Is Hope and Part 2 by Pat Quinn at Infertility: Grieving the Loss of a Long-For Child.

The Dreaded Diagnosis and Denial

“I’m sorry. I don’t think I caught that. I have what?”

“I said the tests are conclusive. You have cancer. I’m very sorry.”

It doesn’t matter what has transpired before we or our loved ones hear these words, or what happens after. In that first frozen moment, we tend to go completely numb. The impact is so great it paralyzes us emotionally—perhaps for months.

Our first response to disaster is typically disbelief: “No, that just can’t be. Surely the tests are wrong. Maybe we need to see another doctor! This can’t be happening to us.”

Help! Someone I Love Has Cancer

Maybe we’re the ones receiving this diagnosis ourselves, or maybe those hateful words are directed instead to someone we love. Maybe that’s worse.

So begins Deborah Howard’s newly released eBook HELP! Someone I Love Has Cancer. After the opening paragraphs above, this caring sister in Christ shares a page from her own story—a story of facing cancer alongside her brother and then her husband. Since denial of the truth is very often the first response to the news of cancer, Deborah Howard spends the first chapter of her mini-book giving us counsel to move beyond denial toward embracing suffering as part of God’s providence in our lives.

From Denial to Candid Clinging to Christ

The first step in this journey is to progress beyond denial. Denial is a monstrous foe that prevents constructive movement. It puts a barrier between you and God when that’s the last thing you want! There should be nothing in your life or attitude to hinder your prayers to Him. When we’re in denial, we deny the providence of God. We must remember that God is the divine Master-Planner of our lives. Nothing happens to us that is not brought about by His sovereignty and intended for His purposes. Death, sickness, heartbreak—all products of Adam’s original fall in the Garden of Eden—are parts of His plan for us.

These elements of life are not given to us capriciously. They have nothing to do with chance or fate but everything to do with the careful plan of a righteous and holy Father, who brings these things into our lives for a divine purpose. It’s natural for us to try to run from disaster. This is not new to our generation. King David eloquently described this particular kind of anguish in Psalm 55:4–7 when he wrote, “My heart is in anguish within me; the terrors of death have fallen upon me. Fear and trembling come upon me, and horror overwhelms me. And I say, ‘Oh, that I had wings like a dove! I would fly away and be at rest.’”

Most of us tend to try to escape pressure. We have other unattractive tendencies as well. We may want to whine, complain, lash out, or give up. However, the Scriptures tell us, “Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing” (James 1:2– 4, emphasis added).

Meditate upon these truths. It’s important for us to understand them and to take them into our hearts and minds so we can apply them to the pressures we experience. Another verse worthy of meditation in tough times is Isaiah 26:3, which says, “You keep him in perfect peace whose mind is stayed on you, because he trusts in you” (emphasis added).

Does “perfect peace” mean we’re never tried or tested? No; but it means that we can be at peace in the midst of the trial. Our earthly struggles should not come as a surprise to us. Remember 1 Peter 4:12, “Beloved, do not be surprised at the fiery trial when it comes upon you to test you, as though something strange were happening to you.”

Scripture shows that the Christian’s life is typically peppered with suffering. In fact, we’re promised hardship! Jesus tells us, “I have said these things to you, that in me you may have peace. In the world you will have tribulation. But take heart; I have overcome the world” (John 16: 33).

Thus, the Bible doesn’t tell us that believers will not suffer; instead, it assures us that we will! But it urges us to remain steadfast under the pressures of this earthly realm. What does it mean to be steadfast? We’re told that when we remain steadfast, we will be made perfect and complete, spiritually mature and lacking nothing! Trials produce staying power and life transformation! Through trial, God molds us into the people he wants us to be: “…we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not put us to shame, because God’s love has been poured into our hearts through the Holy Spirit who has been given to us” (Romans 5:3– 5).

Looking at Our Suffering through the Lens of Scripture

Suffering takes its toll on us, sometimes emotionally, sometimes spiritually—and sometimes physically. Sickness and death are a part of life. It is important that we look at our suffering through the lens of Scripture. Thus, a cancer diagnosis doesn’t mean that God has abandoned us. Cancer is not out of God’s hands or bigger than He is; it is but another tool in His divine toolbox.

Therefore, when we go through this kind of painful trial, it is important to constantly remind ourselves that our pain and suffering have a purpose! We may not be able to see these results with our earthly eyes or conceive of them with our finite minds, but there is an overarching purpose to our lives—God’s will, which is “good and acceptable and perfect” (Romans 12: 2). Our suffering will always produce two results—good for us and glory for God. Always!

Written by a hospice nurse, HELP! Someone I Love has Cancer is a tender book filled with biblical help and hope. Get this eBook for $1.99 from Shepherd Press, publisher of the LifeLine mini-book series. You can also listen to a radio interview with the author here.

Join the Conversation

What biblical principles and what aspects of your personal relationship to Christ have helped you as you have faced a difficult diagnosis?

BCC Staff Note: This blog was first posted by Dr. Tautges at his Counseling One Another blog site. It is re-posted by the BCC with his permission. You can also read his original post at Cancer, Denial, and the Sovereignty of God.

Topics: Christian Living, Grief/Loss, People in Need of Care, People Who Offer Care, People Who Train Caregivers, Suffering | Tags: , , , , , , , ,

Infertility: Grieving the Absence of a Longed-For Child

Biblical Counseling and Suffering--Infertility--Grieving the Absence of a Longed-For Child

BCC Staff Note: You’re reading Part 2 in a four-part BCC Grace & Truth blog mini-series on loss, grief, suffering, and Christ’s healing hope. In today’s post, Pat Quinn addresses the pain of infertility. You can read Part 1 by Bob Kellemen at There Is Hope.

Infertility—a Case Study

“The English language lacks the words to mourn an absence. For the loss of a parent, grandparent, spouse, child or friend, we have all manner of words and phrases, some helpful some not….But for an absence, for someone who was never there at all, we are wordless to capture that particular emptiness. For those who deeply want children and are denied them, those missing babies hover like silent ephemeral shadows over their lives”(Laura Bush, Spoken from the Heart).

Infertility affects one in six couples and causes significant suffering, especially for the woman. Frustrated desires, a shattered sense of identity, feelings of being defective, and misunderstanding from others can produce a profound grief—the grief over the absence of a longed-for child. So how does the gospel give a realistic radiant hope to a woman grieving infertility? I’d like you to meet Natalie.

Natalie contacted me to meet about the painful struggle she was facing with infertility. She had been diagnosed with endometriosis some years before which had caused great physical pain and the greater emotional pain of infertility. She and her husband had been unsuccessful in their attempts to conceive a child, and this had resulted in Natalie experiencing anger, shame, and depression.

Here’s how she described her feelings:

“I was in constant physical pain and (I thought) would never be able to give my husband a child, and I felt like a worthless, defective waste of space.”

She was distraught and tearful and apprehensive as we met, but we began by asking God to be present in our conversation and to bring hope. As we talked, we agreed that Natalie was grieving the “death” of hope for a child. Many women who struggle with infertility consider this grief equal to or greater than the pain of a terminal illness or divorce. Providentially, being able to identify the pain of infertility as a kind of “death” in our first session pointed Natalie to the Great Hope that only the gospel of Jesus Christ can provide:

I believe in the resurrection from the dead.”

Our counseling goal became experiencing “resurrection life out of grieving death.”

As we continued to meet over the next months, it was a glorious privilege to see the Lord work deeply in Natalie’s heart and life. Here is her testimony:

“Slowly at first, and then very rapidly, God used biblical counseling to change my heart in unimaginable ways. Through the Psalms especially, He assured me that He loved me with a steadfast love. Through Paul’s writings, God taught me that neither my endometriosis nor my ability to bear children defined me. God spoke to my heart that I was His beloved daughter, a child of incomparable value because of the imputed righteousness of Christ. In His loving kindness, God comforted me with the truth that He made me, and that He doesn’t make mistakes.

 I grew in love for God and began to value intimacy with Him as more important than anything—even children. I became thankful for the suffering God allowed me to endure because it exposed my idols, led me to repentance, and brought me to a deeper love for Christ.”

How powerfully God’s kindness led to repentance and resurrection life!

What I Learned from Counseling Natalie

1. The Scriptures speak timelessly and relevantly to all issues of life, including the grief of infertility.

In reflecting on counseling Natalie, I was struck by the fact that we never even looked at the “infertility Scriptures” about Sarah, Hannah, and Elizabeth. We certainly could have, but there were others passages that spoke deeply to Natalie’s heart and life, especially Psalms and Paul’s epistles. This has strengthened my confidence in the relevancy and sufficiency of Scripture for counseling. Natalie would say the same.

2. I saw anew that grief and pain challenge our sense of identity, expose what our hearts are living for, and can, by God’s sovereign grace, lead to redemption.

I was reminded how carefully and sensitively and relationally we must deal with the sufferings of others so that God can do His transforming work. Natalie needed a sincere welcome, heartfelt prayer, compassionate listening, and gently spoken truth to lead her to Jesus so that He could redeem her grief.

3. There is no grief or pain so deep that the gospel cannot bring compassion, forgiveness, hope, and the transforming power of God.

Jesus Himself became more precious and satisfying to Natalie, and this led her to a more heartfelt repentance and joyful intimacy. We actually began to see “resurrection life out of grieving death.”

4. God “comforts us in all our affliction so that we can comfort others in any affliction” (2 Corinthians 1:4).

After our season of counseling, Natalie joined one of my counseling training classes. By her participation in class and final exam, she has shown how much she has learned and that she is eager to share what God has done with others. She said:

“It is my hope that with God’s help, I can continue to grow in an understanding of His Word so that I can share it with others…hoping that the Lord might use me to give them even a fraction of the heart change He used biblical counseling to give me.”

Praise God that nothing is wasted with Him!

5. Finally, God reinforced what a privilege it is to come alongside God’s grieving children and walk with them as he ministers his grace to them.

It was a great joy to see God work so graciously in Natalie’s life. It reminded me that in the best biblical counseling we feel ourselves to be spectators of the power and love of God. We rejoice that “neither he who plants nor he who waters is anything, but only God who gives the growth” (1 Corinthians 3: 7). As Paul said in another place, “Let the one who boasts, boast in the Lord” (1 Corinthians 1: 31).

Christians Are Not Stoics

We often grieve in a fallen world, and infertility is a painful source of grieving. But we are called to grieve with hope (1 Thessalonians 4: 13) and to comfort those who are grieving with the comfort we have received from God (2 Corinthians 1: 3-4). Our great hope in Christ is the resurrection from the dead and the promise that one day there will be no more “mourning nor crying nor pain anymore” (Revelation 21: 4).

Topics: Biblical Counseling, Grief/Loss, Infertility, People in Need of Care, People Who Offer Care, People Who Train Caregivers, Suffering | Tags: , , , , , ,

There Is Hope

Biblical Counseling and Suffering - There Is Hope

BCC Staff Note: You’re reading Part 1 in a four-part BCC Grace & Truth blog mini-series on loss, grief, suffering, and Christ’s healing hope. In today’s post, Bob Kellemen shares the “big picture truth that in Christ There Is Hope. In this series, you will also read posts by Pat Quinn on infertility, Paul Tautges on Cancer, and Adam Embry on sexual abuse.

Losses and Crosses

Jesus promises that life will be filled with losses.

I know. That’s not exactly the promise you were hoping for. At least it’s honest.

In John 16:33, Jesus guarantees that we will suffer.

“I have told you these things, so that in me you may have peace. In this world you will have trouble.”

One word says it all: trouble. “You’re gonna’ get squashed!” is a fair paraphrase. Hemmed in, harassed, and distressed. Oppressed, vexed, and afflicted.

Trouble communicates both external and internal suffering. External suffering: illness, poverty, criticism, abandonment, and death. Internal suffering: fear, anxiety, anguish, depression, and grief.

In this life, we all suffer. Life is filled with losses.

God’s Healing Hope: Creative Suffering

Of course, if all we do is talk about life’s losses, then that too fails to tell the whole story. We need to be able to deal with life’s losses in the context of God’s healing.

Jesus did.

“I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world” (John 16:33).

Peace. With one word Jesus quiets the quest of our soul. We thirst for peace—shalom, wholeness, stillness, rest, healing.

Take heart. Hope. Come alive again.

That’s what you long for. I know it is, because it’s what I want.

We live in a fallen world and it often falls on us. When it does, when the weight of the world crushes us, squeezes the life out of us, we need hope. New life. A resuscitated heart. A resurrected life.

Brilliantly, the apostle Paul deals simultaneously with grieving and hoping. Do not “grieve like the rest of men, who have no hope” (1 Thessalonians 4:13). Paul, who offers people the Scriptures and his own soul (1 Thessalonians 2:8), skillfully ministers to sufferers.

To blend losses and healing, grieving and hoping, requires creative suffering. FrankLake powerfully depicts the process.

“There is no human experience which cannot be put on the anvil of a lively relationship with God and man, and battered into a meaningful shape.”

Notice what the anvil is—a lively relationship with God and God’s people. Notice the process—battering. Notice the result—meaning, purpose. What cannot be removed, God makes creatively bearable.

Another individual, this one intimately acquainted with grief, also pictures creative suffering. British hostage, Terry Waite, spent 1,460 days in solitary confinement in his prison cell in Beirut. Reflecting on his savage mistreatment and his constant struggle to maintain his faith, he reveals:

I have been determined in captivity, and still am determined, to convert this experience into something that will be useful and good for other people. I think that’s the way to approach suffering. It seems to me that Christianity doesn’t in any way lessen suffering. What it does is enable you to take it, to face it, to work through it and eventually convert it.

Creative suffering doesn’t simply accept suffering; through the Cross it creatively converts it. Our passion in God’s Healing for Life’s Losses is to learn together how to grieve but not as those who have no hope.

Free Resources

For numerous free resources on grief and Christ’s healing hope, you can visit the RPM Ministries God’s Healing page.

Join the Conversation

How have you experienced God’s healing hope in Christ?

Topics: Christian Living, Grief/Loss, Hope, People in Need of Care, People Who Offer Care, People Who Train Caregivers, Suffering | Tags: , , , ,

BCC Weekend Resource: Responding to Criticism in Marriage

The BCC Weekend Resource

BCC Staff Note: On weekends we like to highlight for you one of our growing list of free resources. This weekend we highlight a resource video from David Powlison where he addresses the issue of Responding to Criticism in Marriage. This video originally appeared at CCEF. You can view the original resource here.

Topics: Communication, Conflict, Men/Husbands, People in Need of Care, People Who Offer Care, People Who Train Caregivers, Video, Women/Wives | Tags: , , , ,

Robin Williams: Sorrow Behind the Laughter

Robin Williams: Sorrow Behind the Laughter

BCC Staff Note: This timely article originally appeared on Faith Church’s Vision of Hope blog site. You can read the original article here.

Even in laughter the heart may ache, and the end of joy may be grief.
Proverbs 14:13

As is my custom when a celebrity dies from a suspected (or confirmed) addiction-related issue, I write a blog entry about it for the following reason: heightened awareness leads to an opportunity to teach biblical truths to shape our understanding of who Christ is and how we must respond in order to glorify Him. These blogs are not meant to demean the celebrity who no longer lives nor the surviving family. Instead, these blogs are intended to illustrate biblical truths to challenge us to respond with more urgency to reach a lost and dying world that desperately needs to hear a message of hope. It is why I continue to write books, articles, and blog posts about the topic of addiction even with a heavy heart in the wake of the very sad news about the suicide of Robin Williams.

Sometimes when a man as gifted in his craft as Robin Williams rises to stardom, we tend to think he is immortal. We elevate such stars as Michael Jackson, Whitney Houston, John Belushi, Elvis Presley, Marilyn Monroe, and Robin Williams because of their immense talent and constant screen presence in front of us. We are amazed at their God-given abilities and sometimes forget they are truly God-given. When the shocking news of their tragic deaths brings us crashing back down to earth, the reality sharply hits us that these celebrities are indeed mortal just as we are.

The cycle seems to repeat each time the multitudes of fans express shock when a celebrity dies, especially in cases of tragic suicides. The blitz of news reports about the celebrity mesmerize our culture for days, accompanied by the countless public expressions of surprise about how this could have happened to the famed person – who seemed to have it all: fame, money, happiness, and popularity along with a family, house, cars, and any material possessions one could imagine. Fans are amazed that the so-called American dream can really be a nightmare for these actors and performers, sometimes enduring everyday situations of life with throngs of people looking at them as if they really know them, and speaking to them even though they’ve only watched them on television. Fame produces an artificial world of pseudo-relationships, and for some, a prison.

While that may not have been entirely the case for Robin Williams, here are some known facts:

1) We know that he was in a hopeless state of mind, at least in that moment when he chose to take his life.

2) We know that he was admitted in July to one of the premiere secular addiction programs from the world’s perspective: Hazelden in Minnesota. He left without real hope.

3) We know he has recently been drinking alcohol excessively.

4) We know that he has a history of cocaine, alcohol (which is a drug in liquid form), and other drug use and abuse.

5) We know that he claims to have struggled with depression unsuccessfully over the years despite meeting with therapists and secular experts. In essence, he searched for solutions to depression and addiction from the top programs and experts that money can buy and yet was without hope as evidenced by his last actions on the earth. That is a tragic ending not unlike several Hollywood superstars in recent years.

In previous VOH blogs during the past year, I wrote about Lisa Robin Kelly’s tragic drug-related death and the urgency of the war we are in against addiction. I also wrote about Philip Seymour Hoffman’s unexpected,  tragic death and about the true heart of addiction. After the death of Cory Monteith, the young actor from the hit show, Glee, I lamented the fact that his Hollywood story is all too familiar and continues to repeat itself.  Sadly, the list of celebrity deaths due to drug-related reasons continues to grow.

Without an autopsy report, we do not know for sure if Robin Williams died directly due to an addiction but his addiction problems plagued him for many years and he was open about it. The autopsy will be completed in the next several weeks and will reveal what drugs, if any, he had taken. Regardless of that report, we know he never solved the mystery to him of the heart of addiction and was perplexed by the war inside. But for the believer in Christ who studies and obeys God’s Word, his death is a tragedy from which we can learn four redemptive lessons.

First, the only person to immortalize is Jesus because He truly is immortal. He is alive and well at this very moment in Heaven, and we await His triumphant return to establish His kingdom permanently. No person, no matter how gifted, should ever be immortalized. Even the person’s gifts must not be admired apart from the gift-Giver, who is the Lord God Almighty. God is to be praised, not man. Christians worship the Creator not the creation.

Second, the Word of God offers real hope and practical help to the alcoholic or addict. The problem is not that the Bible doesn’t speak to the topic of addiction or alcoholism but that we must re-define the world’s terms and best ideas (Col. 2:8) to understand how the Bible addresses those issues. Alcoholism is a worldly term; the biblical term is drunkenness. Addiction is a worldly term; the Bible speaks to idolatry, a spiritual worship problem in the heart of man. Until we begin addressing the heart biblically and utilizing the terminology of the Word of God, we will never find lasting solutions to problems like depression, addiction, alcoholism, and the like.

Third, heaven and hell are real places; the inevitability of eternity for every soul must motivate us to see each person on this earth as walking down a path toward one or the other. Robin Williams joked about heaven.  However, the Bible teaches us the sobering fact that everyone has sinned and fallen short (Rom. 3:23) of the perfect standards of God. Everyone needs a Savior in order to gain heaven. Without repentance and faith, everyone is destined for hell. These destinations are realities whether people acknowledge them or deny them. We all will face a holy and just God when we die – that is no joking matter. As Christ-followers, we must proclaim Him to a lost and dying world (Col. 1:28) with urgency.

Finally, many people are hurting though they hide it quite well. At Vision of Hope and in my counseling experiences from the past, counselees have been skilled at hiding behind their laughter and jokes. Some call it a defense mechanism intended to deflect attention from the matter at hand that is difficult to talk about in an attempt to avoid dealing with it. Humor is often a way to hide the sorrow of the heart. Despite his phenomenal sense of humor and hard work to make all of us laugh, Robin Williams recently revealed the truth of this verse in Proverbs 14:13: Even in laughter the heart may ache, and the end of joy may be grief. Christian brother or sister, I urge you to look for the hurt in others’ eyes around you and reach out in the love, hope, and truth of the gospel of grace. Hurting soul, let me encourage you to reach out in hope and make contact with someone – let someone know the grief and aches of your heart. Suicide is not the answer you want – it is a permanent consequence to temporary feelings. Do not allow those feelings of sadness to hide behind the mask of laughter. There is hope in Christ alone. God loves you. And we at FaithChurch do, too. Contact our counseling office at 765-448-1555 or Vision of Hope at 765-447-5900.

Topics: Grief/Loss, People in Need of Care, People Who Offer Care, People Who Train Caregivers, Suffering, Suicide | Tags: , , ,

Friday’s 5 to Live By

Friday's 5 To Live By

Each Friday our BCC staff links you to the top five biblical counseling and Christian living blog posts of the week—posts that provide robust, rich, and relevant insights for living.

26 Ways to Provoke the 1 Peter 3:15 Question at Work

In 1 Peter 3:15 we read:

“In your hearts honor Christ the Lord as holy, always being prepared to make a defense to anyone who asks you for a reason for the hope that is in you.”

Applying that verse, Pastor J.D. Greear provides 26 Ways to Provoke the 1 Peter 3:15 Question at Work

An Open Letter to My Friends Struggling with Eating Disorders

At the Desiring God blog, Emily T. Wierenga writes from personal experience and biblical perspective An Open Letter to My Friends Struggling with Eating Disorders.

3 Opportunities for Gospel Outreach in Public Schools

As school begins for many students this week and next, The Gospel Coalition shares about 3 Opportunities for Gospel Outreach in Public Schools.

Our Identity in Christ

Julie Ganschow writes about Identity and Mind Control.

Stop Accrediting Christian Colleges?

At the Stand to Reason blog, they report on an article from The Chronicle of Higher Education which argues that accreditation ought to be denied to Christian colleges that require professors to sign statements of faith or otherwise “draw lines around what is regarded as acceptable teaching and research.” Find a link to the original article and read a summary at Chronicle of Higher Education: Stop Accrediting Christian Colleges.

Join the Conversation

Which post impacted you the most? Why? What blog posts have you enjoyed this week that you want to share with others?

Topics: Five To Live By, People in Need of Care, People Who Offer Care, People Who Train Caregivers | Tags: , , , , , , ,

ACBC: 1 Conference; 3 Weekends

 ACBC--1 Conference 3 Weekends

BCC Staff Note: The mission of the Biblical Counseling Coalition is to multiply the ministry of the biblical counseling movement. The BCC is not about the BCC; the BCC is about BC. Today’s “megaphone” post is one way we fulfill our mission. We want to encourage you to consider attending the Association of Certified Biblical Counselors’ (ACBC) Counseling Discipleship Training.

From the ACBC

The Bible has answers for life. Our training conferences are about equipping disciples to help other disciples grow in godliness. The conferences are open to anyone desiring to become further trained to help others grow in godliness. Whether you are in need of furthering training for ministry in the church or want to be a better disciple maker in your neighborhood, our conferences are for you.

Throughout the year, we host regional Counseling and Discipleship Trainings. If you’re interested in pursuing certification, this is one way to obtain hours towards your Basic Training Course. Each of our Counseling and Discipleship Trainings is one conference that spans three weekends.

Counseling Discipleship Training events are designed to help equip disciples of Christ to grow in their faith and help others do the same. These conferences will cover a wide range of issues dealing with various problems in the Christian life. Whether you are a pastor, counselor, or church member, this conference is for you. Learn More.

Join the Conversation (Added by the BCC)

What testimony can you share about how the ACBC’s Counseling Discipleship Training has impacted your life and ministry?

Topics: Conference, People in Need of Care, People Who Offer Care, People Who Train Caregivers | Tags: , , , ,

Biblical Counseling and Medicine: Trying to Wear Two Hats Fairly

Biblical Counseling and Medication--Biblical Counseling and Medicine--Trying to Wear Two Hats Fairly

BCC Staff Note: You’re reading Part 3 of a three-part BCC Grace & Truth blog mini-series on “Biblical Counseling and Medication.” You can read Part 1 by Brad Hambrick at 6 Steps to Wise Decision-Making About Psychotropic Medications. And you can read Part 2 by Mike Emlet at Listening to Prozac… and to the Scriptures.

My Dual Roles…

As a family physician, I am often asked about taking medicine for depression and other disorders. Also, as a biblical counselor, I have been involved in counseling people who struggle with depression and worry for the past 25 years. I counsel them every Monday night, and again I am answering the same kinds of questions about medication.

More than anything else, I want to do both roles (family physician and biblical counselor) well and fairly. When it comes to the question of taking medicine for depression, I want to make an accurate diagnosis and provide the best care possible in a kind and caring way. That sounds simple enough but sometimes it is difficult to meet everyone’s expectations.

When patients come to the office and believe they are depressed, they are almost always expecting me to prescribe medication. They have been educated over the past three decades by governmental agencies and pharmaceutical companies to believe that all sadness is depression.[i] They have also learned depression is a disease that should be treated with medication.

Good Science

I also know that there are many good people who have differing opinions about this subject, and that sometimes there are disagreements that can be a little contentious. In part, the disagreements exist because we lack scientific factual evidence to confirm the diagnosis of depression. Many believe that depression is over-diagnosed and over-treated for the same reason. I think that all of us in medicine and biblical counseling can do better on both counts. There are other problems in medicine that have suffered with the same over-diagnosis and over-treatment that have changed when we decided to apply facts to the problem.

One such example is the over-diagnosis and over-treatment of gastro-esophageal reflux disease or GERD in healthy infants.[ii] Over the past decade it has become well understood that when the diagnosis was made without testing, it was being over-applied to otherwise healthy infants. The lack of objective testing led to over-diagnosis and treatment with medicines that have significant side effects and which did not help the child.

Recently a research project examined why this diagnosis was being made so frequently and why so many children were taking medication. Researchers found that if otherwise healthy thriving children who were crying and irritable after spiting up were taken to see a doctor, what the doctor said made all the difference. If the doctor mentioned the possibility of a diagnosis of GERD to the parents and then offered to give them medicine, the parents most likely would agree to treat the child.

If the doctor did not use the term GERD, but only described the normal spitting that 80% of children do, that made the parents less likely to want to treat. And, if the doctor informed the parents that the acid-reducing medicine had been studied and shown ineffective in treating the irritable crying, then the parents were least likely to want a prescription.

The key to over-treatment was how the parent was educated by the physician and others. The same holds true for using antibiotics needlessly for viral infections. And, it is also true for depression.

The 2 Questions We Should Be Asking

When most patients present to a physician for treatment of depression, they are not exactly looking for a diagnosis. Most will have seen the commercials on television describing depression and delivering the message that taking the advertised medication will help their problem. They come already “educated” and they expect a prescription.

There is no objective testing to do. There are no blood tests, x-rays, or specific findings on physical exam that can verify the diagnosis. The only thing we have to go on is the history and the criteria found in the Diagnostic and Statistical Manual of Mental Disorders.[iii] Unfortunately the criteria are only used about half the time by practitioners when making the diagnosis. And, without any laboratory testing, the criteria cannot be confirmed to be valid.

The patient tells the doctor about their sadness and depression. If things go well, the doctor checks off the criteria in his or her head, and when enough are met, the diagnosis is made. The physician agrees with the patient. Generally a prescription will follow. And, just like the children in the study, antidepressants have become the number one drug prescribed for people aged 18-44. Their use increased 400% from 2005 to 2008.[iv]

There is good reason to believe that the diagnosis of depression is being applied to people who are simply normally sad over loss.[v] The questions we should be asking are, “How can we make a better diagnosis?” And, “How can we do a better job of helping?”

Time and trusting patients have allowed me to develop an approach to helping when sadness and depression are their problems. The following is what I do to help the patient work through the process. Please keep in mind that I work in a secular office with a good employer who has reasonable expectations of my interactions with patients. I am also limiting the discussion to depression as it is one of the more common problems treated.

In the Office

The first order of business is a complete history of the patient’s problem, a complete physical, and then appropriate blood work. I am looking to find emotions and actions that will meet the criteria set for the diagnosis of depression. I am also looking for any indication that they may have another medical diagnosis that might contribute to a sad or anxious mood. The patient’s medicine list is very important as we know that there are many medications that can affect mood.

The most important part of the history has to do with the onset of their problem. I need to know what happened when their sadness started. Current research has told us that nearly 90%[vi]of those labeled as depression today are struggling with normal sadness over loss.[vii] An event has happened in their life that has taken away something that they value most in life.

Those who cannot tell me of any event or loss make up the remaining 10% that we have labeled in past years as having disordered sadness or sadness with no apparent cause. Prior to 1980, physicians limited the diagnosis of depression to those with disordered sadness who could not tell us why they were sad.

With that difference in mind, I will tell the patient the following things as we work towards their choice of care. Keep in mind that most of all of the patients who come to see me because of depression expect to receive a prescription.

1. The first thing I do is acknowledge that the patient is struggling with sadness and that they meet the current diagnostic criteria for depression. They need to know that I believe that they have real problems. I want them to know that I want to help them as much as I can.

2.  I discuss the options for care. I point out that the current research tells us that 80% or more of people who struggle with sadness and depression will benefit just as much from talking with someone skilled in helping as they would if they took medication. And, that the long term benefits appear to be better.[viii] I tell them that they have a choice to make. They can either talk with a counselor about their struggle, they can take a medication, or they can do both.

I also tell them that if they choose to talk with someone that they can pick from one of three options. They can see a psychiatrist, a psychologist/social worker, or they can talk to a pastoral counselor.[ix] The latter category opens the door for me to direct them to someone skilled in sharing the solutions found in Scripture if they choose that option.

3. I discuss the benefits and side effects of the medication at length. No patient should take any medicine prescribed to them without a good understanding of what problems might come from taking it. I tell them that for very severely depressed patients that the medicine does seem to help. I also tell them that for nearly 90% of those who take them that our current medications have not proven to be as helpful as we had hoped.[x] There are also significant side effects that go beyond the scope of this article and every patient should discuss these with their physician carefully. We discuss the changes in personality that are seen with the current medicines used for depression.

4. For those who have no identifiable loss, I still emphasize the importance of counseling.

5. Then I let them choose. I have found that over the years most patients want a medication. That has become our societal norm. An encouraging trend I have seen is that most patients who are coming now for sadness and depression will ask for medicine, but will also take the advice to seek counseling. And, that gives them a greater opportunity to find help.

On Monday Night

A large percentage of those who come for counseling at our biblical counseling center are taking medicine before they come. They come because the medicine has not solved their problems. They come sometimes as a referral from a physician or a friend.

It is uncommon for individuals who come for counseling who are not taking medicine to ask me if they should be taking it. The more common question that comes is from those who are already taking it. They want to know if I think it is right or wrong to take the medicine.

My response to them is to share that taking medication is neither right nor wrong. In fact, it’s the wrong question. The questions we should be asking are: 1) Whether or not the medicine works and, 2) If the benefit is worth the side effects.

I tell them that taking medication for depression is a Romans 14 issue. From that chapter the church has derived the doctrine of Christian Liberty. If the Bible does not say exactly what we ought to do in a certain situation, then we as believers have the privilege to choose what we wish to do in the light of the rest of the Bible. Nothing in the Bible talks specifically about the right or wrongness of taking medicine for depression, and it becomes a matter of our choosing. Whether we choose to take medication or not for depression, it should not become a matter over which we judge others. And, that must be true in both directions. As in Paul’s day, those who did not eat were not to judge those who did and vice versa.

Sometimes counselees will want to know the benefits and risks of taking medication. I work through the same research that I do with patients in the office. That gives them a good understanding of the benefits, limits, and side effects of the medicine they are taking.

The goal of the office process and in counseling is to make a better diagnosis. This requires careful listening in order to identify the majority of those who struggle with normal sadness and those with disordered sadness. The most important thing I can do then is educate them as to what their best options are for care.

This allows the patient and the counselee the opportunity to make an informed choice about taking medicine for depression. It gives them the opportunity to make that choice in the framework of our liberty as Christians. At the end of the day as a physician and biblical counselor, I am glad to be able to help.

Join the Conversation (Added by the BCC Staff)

Having read all three blog posts in this series, how would you compare and contrast the perspectives shared?

What is your perspective on biblical counseling and medication?

[i]Charles D. Hodges, Good Mood Bad Mood (Wapwallopen, PA: Shepherd Press, 2013), 61-71.

[ii]“Influence of ‘’GERD’ Label on Parents’ Decision to Medicate Infants,” DOI: 10.1542/peds.2012-3070 Pediatrics 2013;131;839; originally published online April 1, 2013; Laura D. Scherer, Brian J. Zikmund-Fisher, Angela Fagerlin and Beth A. Tarini.

[iii]Diagnostic And Statistical Manual Of Mental Disorders, DSM5 (Washington: American Psychiatric Publishing), 160-161.

[iv]“Antidepressant Use in Persons Aged 12 and Over: United States 2005-2008.” NCHS Data Brief, Number 76, October 2011. Laura A. Pratt, Ph.D. et al.

[v]Hodges, Good Mood Bad Mood, 65-66.

[vi]Jay Fournier, Robert DeRubeis, Steven Hollon et al. “Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-Analysis,” Journal of the American Medical Association, 303: 1 (January 6, 2010), 51. “True drug effects (an advantage of antidepressant medication over placebo) were non-existent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms.

[vii]Alan Horwitz, Jerome Wakefield, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (New York: Oxford University Press, 2007).

[viii]Irving Kirsch, The Emperor’s New Drugs (New York: Basic Books, 2010), 158.

[ix]Keep in mind this is a secular setting that requires offering all reasonable options.

[x]Sharon Begley, “Anti-Depressants Don’t Work, Do Work: The Debate Over the Nation’s Most Popular Pills,” Newsweek (February 8, 2010), 36-39.

Topics: Biblical Counseling, Medication, Psychology and Christianity | Tags: , , , ,

Listening to Prozac… and to the Scriptures: A Primer on Psychoactive Medications

Biblical Counseling and Medication--Listening to Prozac and to the Scriptures--A Primer on Psychoactive Medications

BCC Staff Note: You’re reading Part 2 of a three-part BCC Grace & Truth blog mini-series on “Biblical Counseling and Medication.” You can read Part 1 by Brad Hambrick at 6 Steps to Wise Decision-Making About Psychotropic Medications. In Part 3, Dr. Charles Hodges provides his perspective on this important issue.

Mike Emlet and David Powlison of CCEF have graciously granted our BCC readers free exclusive access to Dr. Emlet’s Journal of Biblical Counseling article Listening to Prozac… and to the Scriptures: A Primer on Psychoactive Medications. You can read the full article here.

Article Abstract

Michael Emlet’s “Listening to Prozac…and to the Scriptures” updates the answer to a perennial question. What is the relationship between biblical counseling and the use of psychoactive medications? Historically, biblical counselors have sought to walk what Emlet calls the “wisdom tight-rope,” not acquiescing to claims of medical panacea but also not denying that medications can sometimes serve as a helpful adjunct to primary pastoral care. Emlet articulates this tight-rope in a fresh way. He invites us to humility, caution and balance about medicines—while asserting strong convictions about the cure of souls found in Jesus Christ.

Read Dr. Emlet’s article here.

Join the Conversation (Added by the BCC Staff)

After reading Dr. Emlet’s article, how would you compare and contrast Dr. Emlet’s perspective to the perspective presented by Brad Hambrick in Part 1?

Topics: People in Need of Care, People Who Offer Care, People Who Train Caregivers | Tags: , , , ,

6 Steps to Wise Decision-Making About Psychotropic Medications

Biblical Counseling and Medication--6 Steps to Wise Decision-Making About Psychotropic Medications

BCC Staff Note: You’re reading Part 1 in a three-part BCC Grace & Truth blog mini-series on the important issue of “Biblical Counseling and Medication.” You will also find future posts in this series by Dr. Mike Emlet and Dr. Charles Hodges.

Author Note by Brad Hambrick: This post is an excerpt from a larger article entitled “Towards a Christian Perspective on Mental Illness.” In that article, before addressing the subject of psychotropic medications, four prior questions were addressed:

  1. How do we learn to frame the discussion about mental illness in a way that helps us remove our personal biases, which we all have and need to be aware of, as we enter this conversation?
  2. What is mental illness; both how is the term actually used and how ought the term to be defined?
  3. How do we determine if a given struggle is primarily rooted in biological, environmental, or volitional causes; or some combination of these influences?
  4. How would Scripture speak uniquely to a given struggle based upon these various possible causes or combination of influences?

It is after laying the foundation of attempting to answer these questions that the subject of how to make a wise decision about psychotropic medications is addressed. I hope you enjoy and benefit from this excerpt.

Decision-Making and Psychotropic Medications

Let’s begin this discussion by placing the question in the correct category—whether an individual chooses to use psychotropic medication in their struggle with mental illness is a wisdom decision, not a moral decision. If someone is thinking, “Would it be bad for me to consider medication? Is it a sign of weak faith? Am I taking a short-cut in my walk with God?” then they are asking important questions (the potential use of medication) but they are placing them in the wrong category (morality instead of wisdom).[i]

Better questions would be:

  • How do I determine if medication would be a good fit for me and my struggle?
  • What types of relief should I expect medication to provide and what responsibilities would I still bear?
  • How would I determine if the relief I’m receiving warrants the side effects I may experience?
  • How do I determine the initial duration of time I should be on medication?

In order to answer these kinds of questions, I would recommend a six-step process. This process will, in most cases, take six months or more to complete. But it often takes many months for doctors and patients to arrive at the most effective medication option, so this process does not elongate the normal duration of finding satisfactory medical treatment.

Having an intentional process is much more effective than making reactionary choices when the emotional pain (getting on medication) or unpleasant side effects (getting off medication) push you to “just want to do something different.” With a process in place, it is much more likely that what is done will provide the necessary information to make important decisions about the continuation or cessation of medication.

Preface: This six-step process assumes that the individual considering medication is not a threat to themselves, a threat to others, and is capable of fulfilling basic life responsibilities related to their personal care, family, school, and work. If this is not the case, then a more prompt medical intervention or residential care would be warranted.

If you are unsure how well you or a friend is functioning, then begin with a medical consultation or counseling relationship. If you would like more time with your doctor than a diagnostic and prescription visit, then ask the receptionist if you can schedule an extended time with your physician for consultation on your symptoms and options.

Step One: Assess Life and Struggle

Most struggles known as mental illness do not have a body-fluid test (i.e., blood, saliva, or urine) to verify their presence. We do not know a “normal range” for neurotransmitters like we do for cholesterol. The activity of the brain is too dynamic to make this kind of simple number test easy to obtain. Gaining neurological fluid samples would be highly intrusive and more traumatic than the information would be beneficial. Brain scans are not currently cost effective for this kind of medical screening and cannot yet give us the neurotransmitter differentiation we would need.

For these reasons, the diagnosis for whether a mental illness has a biological cause is currently a diagnosis-by-elimination in most cases. However, an important part of this initial assessment should be a visit to your primary care physician. In this visit you should:

  • Clearly describe the struggles/symptoms that you are experiencing.
  • Describe when each struggle/symptom began.
  • Describe the current severity of each struggle/symptom and how it developed.

As you prepare for this medical visit, it would be important to also consider:

  • What important life events, transitions, or stressors occurred around the time your struggle began?
  • What is the level of life-interference you are experiencing as a result of your struggle?
  • What lifestyle of relational changes would significantly impact the struggle that you’re facing?

Step Two: Make Needed Non-Medical Changes

Medication will never make us healthier than our current choices allow. Our lifestyle is the “ceiling” for our mental health; we will never be sustainably happier than our beliefs and choices allow. Medication can correct some biological causes and diminish the impact of environmental causes to our struggles. But medication cannot raise our “mental health potential” above what our lifestyle allows.

Too often we want medication to make-over our unhealthy life choices in the same way we expect a multi-vitamin to transform our unhealthy diet. We assume that the first step towards feeling better is receiving a diagnosis and prescription. This may be the case, and there is no shame if it is, but it need not be our guiding assumption.

Look at the lifestyle, beliefs, and relational changes that your assessment in step one would require. If there are choices that you could make to reduce the intensity of your struggle, are you willing to make them? Undoubtedly these changes will be hard, or you would have already done so. But they are essential if you want to use medication wisely.

As you identify these changes, assess the areas of sleep, diet, and exercise. Sleep is vital to the replenishing of the brain. Diet is the beginning of brain chemistry – our body can only create neurotransmitters from the nutrition we provide it. Exercise, particularly cardiovascular, has many benefits for countering the biological stress response (a primary contributor to poor mental health). Your first “prescription” should be eight hours of sleep, a balanced diet high in antioxidants, and cardiovascular exercise for at least thirty minutes three days a week.[ii]

A key indicator of whether we are using psychotropic medication wisely is whether we are (a) using medication as a tool to assist us in making needed lifestyle and relational changes, or (b) using medication as an alternative to having to make these changes. “Option A” is wise. “Option B” results in over-medication or feeling like “medication didn’t work either” as we continually try to compensate medically for our volitional neglect of our mental health.

Step Three: Determine the Non-Medicated Base-Line for Your Mood and Life Functioning

This is an important, and often neglected, step. Any medication is going to have side effects. The most frequent reason people stop taking psychotropic medications, other than cost, is because of their side effects.

If we are not careful, we will merely want to feel better than we do “now.” Initially “now” will be how we feel without medication. Later “now” will be how we feel with medication’s side effects. In order to avoid this unending cycle, we need to have a baseline of how we feel when we live optimally off of medication.

One of the reasons postulated for why placebos often have as beneficial an effect as psychotropic medication is the absence of side effects. Those who take a placebo get all the benefits of hope (doing something they expect to improve their life) without any unpleasant side effects. Getting the baseline measurement of how life goes when you simply practice “good mental hygiene” is an important way to account for this effect.

“As I practice medicine these days, my first question when a patient comes with a new problem is not what new disease he has. Now I wonder what side effects he is having and which drug is causing it” (Charles Hodges, in Good Mood Bad Mood, 191).

There is another often over-looked benefit of step three. Frequently people get serious about living more healthily at the same time life has gotten hard enough to begin taking medication. This introduces two interventions (medication and new life practices), maybe three or four (often people also begin counseling or being more open with friends who offer care and support), at the same time. It becomes very difficult to discern which intervention accounts for their improvements.

Writing out your answers to these questions will help you discern if you need to move on to step four and make the needed assessment in step five.

  • What were the struggles that initially made me think I might benefit from medication?
  • How intense were these struggles and how did they manifest themselves?
  • What changes did I make in my lifestyle and relationships to alleviate these struggles?
  • How effective was I at being able to make the needed changes?
  • How much relief did the lifestyle and relational changes provide for my struggles?
  • How do I anticipate medication would assist me in being more effective at these changes?

Step Four: Begin a Medication Trial

If your struggles persist to a degree that is impairing your day-to-day functioning, then you should seek out a physician or psychiatrist for advisement about medical options. As you have this conversation, consider asking your physician the following questions:

  • What are the different medication options available for the struggle I’m facing?
  • What does each medication do that impacts this struggle?
  • What are the most common side effects for each medication?
  • How long does it take this medication before it is in full effect?
  • If I chose to come off this medication, what is the process for doing so?
  • What have been the most common affirmations and complaints of other patients on this medication?

These questions should help you work with your doctor to determine which medication would be best for you. Remember, you have a voice in this process and should seek to be an informed consumer with your medical treatment; in the same way you would for any other product or service you purchase.

In this consultation you also want to decide upon the initial period of time for which you will remain on the medication (unless you experience a significant side effect from the medication). In determining this length of time, you would want to consider:

  • Your physician or psychiatrist will make recommendations based upon additional factors not considered in this article
  • A minimum of at least twice the length of time it takes the medication to reach its full effect
  • Significant life stressors that would predictably arise during this trial period (e.g., planning a wedding)
  • How long it would take to make and solidify changes that were difficult to make without medication (see step three)

Once you determine this set period of time, your goal is to continue implementing the changes you began in step three while monitoring (a) the level of progress in your area of struggle and (b) any side effects from the medication.

Step Five: Assess Level of Progress Against the Medication Side Effects

Near the end of the trial period, you want to return to the life assessment questions you answered at the end of step three. Compare how you are able to enjoy and engage life at this point with your answers then. The questions you want to ask are:

  • What benefits have you seen while you were on medication?
  • What side effects have you experienced?
  • Is there reason to believe your continued improvement is contingent upon your continued use of medication?
  • Are the side effects of medication worth the benefit it provides?

The more specific you were in your answers at the end of step three, the easier it will be to evaluate your experience at the end of step five. At this point, try to be neither pro-medication nor anti-medication. Your goal is to live as full and enjoyable a life as possible. It is neither better nor worse if medication is or is not part of that optimal life.

Step Six: Determine Whether to Remain on Medication

At this point in the process there are several options available to you; this is more than a yes-no decision. But any option should be decided in consultation with your prescribing physician or psychiatrist. You can decide to:

  • Remain on medication because the effects are beneficial and the side effects are minimal or worth it.
  • Opt to stage off of your medication because the benefits were minimal or the side effects worse than the benefits.
  • Stage off medication to see if the progress you made can be maintained without medication; knowing you are free to resume the medication if not without any sense of failure.
  • Opt to try a different medication for another set period of time based on what you learned from the initial experience.

Regardless of what you choose, by following this process you can have the assurance that you are making an informed decision about what is the best choice for you.

Join the Conversation

Do you believe someone could follow these steps to make a wise decision about whether to take psychotropic medications in a way they would follow consistently through upon without fear of not getting the help they need if they choose not to use medication or shame for disappointing God if they do?

What do you believe would make this process clearer, easier, more God-honoring, more medically-informed, etc…?

[i]For more on understanding the choice about psychotropic medications as a wisdom issue, I would recommend the lecture “Understanding Psychiatric Treatments” by Michael Emlet, MD at the 2011 CCEF conference on “Psychiatric Disorders” which can be found here.

[ii]Additional guidance on this kind of “life hygiene” can be found at

Topics: Biblical Counseling, Medication, People in Need of Care, People Who Offer Care, People Who Train Caregivers, Psychology and Christianity | Tags: , , ,

About the BCC

The BCC exists to strengthen churches, para-church organizations, and educational institutions by promoting excellence and unity in biblical counseling as a means to accomplish compassionate outreach and effective discipleship.