Grief and Anxiety: Diseases or Not? 

A little more than two months ago, Peter Kinderman wrote an  editorial for BBC News Health and in it he said “Grief and Anxiety are not mental illness.” Kinderman also said that changes in the revision of the Diagnostic Statistical Manual of Mental Illness, due out in May, would increase the numbers of people diagnosed with mental illness. He went on to say that what they really need is “help and understanding, not labels and medication.” Kinderman is the Professor of Clinical Psychology at theUniversity of Liverpool and the Chair of the Division of Clinical Psychology at the British Psychological Society, good credentials if you want to say these kinds of things about the current state of psychiatry and psychology. 

The problem for those who use the DSM criteria to label strugglers with depression and anxiety is that the criteria have been relaxed even further than they were in 1980. The proposed changes will give an individual who loses a loved-one two weeks to make an adjustment to the loss or they can be labeled and treated as if they have a disease called depression. Anyone who has suffered this loss knows that the grief goes on well past two weeks and even into years. 

The same problems can be expected for anxiety or worry. “The criteria for “generalized anxiety disorder” will be significantly relaxed, making the worries of everyday life into targets for medical treatment.” And so it is as I practice medicine. I regularly see people who struggle with real problems in life that make them feel ill at ease. The solution that medicine offers that is widely accepted by our society is a prescription.  One commenter said about the article, “There is a no man’s land between GP’s (General Practitioners of medicine in Britain) and mental health  professionals…neither set of these professionals are the ones to provide it(the help needed)…Our GP’s can’t do it and now the US suggests medication. Wrong, we need another form of help.” 
 
When it comes to grieving loses and worry, truer words were never spoken. We do need another form of help to deal with the sadness of loss and the struggle of worry. Nearly 2000 years ago Jesus Christ offered the help that
the anxious and the grieving need. 

Jesus said, "No one can serve two masters; for either he will hate the one and love the other, or he will be devoted to one and despise the other. You cannot serve God and wealth. For this reason I say to you, do not be worried about your life, as to what you will eat or what you will drink; nor for your body, as to what you will put on. Is not life more than food, and the body more than clothing…”  “But if God so clothes the grass of the field, which is alive
today and tomorrow is thrown into the furnace, will He not much more clothe you? …for your heavenly Father knows that you need all these things, But seek first His kingdom and His righteousness, and all these things will be added to you.” "So do not worry about tomorrow; for tomorrow will care for itself. Each day has enough trouble of its own. Matthew 6:24-34


Jesus pinpoints the source of much worry and sadness in life. It is a subtle form of worship. We worship having the things we have lost or wish we had. Some worry over their health or the fact that they have lost it. Others worry about material things including food, clothing and income. Jesus tells us that we cannot serve God and stuff! God will provide our needs for food, clothing and safety. But, our needs will not always coincide with our wants. And, that is where worry and sadness often come.

 Jesus tells us that God knows our needs and instead of worrying about them, we should seek His kingdom and His righteousness. That gives an alternative to worry and it is good news for those who struggle. We can apply our lives to worshipping and serving Him in a Romans 12:1-2 sense. Instead of  focusing on the things we lose or our trials we can focus on serving Christ. 
 
I can tell you from personal experience that the truths of scripture hold the answer to worry. When Jesus tells us not to worry, He intends to enable us to obey Him by His grace. Paul deals with the problem in the fourth chapter of his letter to the Philippians. Chapter 12 in Good Mood Bad Mood deals  with worry and examines Paul’s words in more detail than I can in a blog. Philippians chapter 4 was a great help to me and I know it can help anyone who  struggles with worry.  Kinderman was right. People need help and understanding more than they need labels.

All quotations for this blog came from BBC NEWS/Health and can be found in the January 17, 2013 article “Grief and Anxiety are not Mental Illnesses” by Peter Kinderman at the web address below.


http://www.bbc.co.uk/go/em/fr/-/news/health-20986796


All
Scripture quotes are from the New American Standard Version of the Bible. 

One of things Good Mood Bad Mood examines  is the epidemic increase in the diagnosis of bipolar disorder in our country. I said in the book that the increase did not represent an increase in real disease, but a change in the way we make the diagnosis. In an article published this past November in the Canadian Journal of Psychiatry, there are
psychiatrists who agree with me. 

Dr Phillip B Mitchel who is the head of the department of Psychiatry at the University of South Wales in Sidney Australia voiced his concern about the changes in the criteria. In his article he says, “The increasing rates of diagnosis have largely related to BD II (Bipolar Disorder 2[1]), for which there has been a dramatic broadening of the criteria.”[2]

 Dr Mitchel goes on to say that this change really matters because it will result in over-treatment with medications that have significant side effects. He also believed that the process of making the diagnosis would be oversimplified and“de-skilled” with a loss of credibility for psychiatry. And, finally, Mitchel feared that “etiologic research” for bipolar
disorder would suffer. In the field of medicine, when we find what we think is the cause of a “disease,” the result will be a decrease in research in that area. This is devastating if the discovered “cause” is not correct because it stops research. 

I believe that Mitchel is correct on all the points he makes. We are over-diagnosing bipolar disorder in the Bipolar 2
category because the criteria have been reduced to the point that it is easier to qualify. This same process has affected the way we make the diagnosis of depression. In 1980, the criteria for making the diagnosis of depression were changed removing cause as a one of the important markers of the disorder. Until then, an individual was considered to have a disease called depression only if there was no obvious cause. If the struggler could identify a loss in their life that made them sad or sorrowful, then they would be considered normally sad. Depression was disordered sadness that had no cause. 
 
The treatment of people labeled as depressed who had simple normal sadness led to another unintended consequence. People struggling with normal sadness were then treated with medication that had side effects. Those side effects could be interpreted as hypomania which is a necessary criterion for the diagnosis of bipolar disorder 2. 
 
The combination of the changes in criteria for depression, and the relaxation of the criteria for bipolar disorder is the
source for the explosion of the diagnosis of bipolar disorder. In Good Mood Bad Mood, I have said that the best way to help reduce this epidemic is to help people deal with sadness over loss before they get to a disease diagnosis. 
 
Paul spoke of the role of normal sadness in our lives and noted that it was a good thing. “For the sorrow that is according to the will of God produces a repentance without regret, leading to salvation, but the sorrow of the world produces death.” (2Co 7:10 NASB) You can find more information on how sadness relates to the current diagnosis of
depression and how the Bible can help in the book “Good Mood Bad Mood.” 

As I always say when I write about medical subjects, no one should change the medication they are taking or change the dosage without first consulting their physician.


 
  


 
 

 
 
 
[1]The parenthesis is my addition to explain author’s BDII




[2]Can J Psychiatry, 2012 Nov, 57(11):659-65 

This past weekend I spoke at the IBCD Spring Conference about Good Mood Bad Mood and other medical subjects. Right now I am flying home at 30000 feet while enjoying the view. An unusual thing happened in one of the
question and answer periods during the conference. A question was asked about Christian liberty and smoking pot. Several states are legalizing the recreational use of marijuana and this counselor had been confronted by a
struggler who said that if the state said pot was legal then he should be able as a Christian to smoke it.  After all he said, the Bible says nothing about pot and there really wasn't much difference between smoking pot for pain
and taking Vicodin.  So, Christian doctor, what do you think? Is it ok to smoke a joint in the pursuit of pain relief or anxiety relief? 

I was a little surprised by the question even though I have been asked it recently because of the changes in law in Washington, California and Colorado. But, I was not expecting it to show up so soon among us evangelicals. I must
admit that it was a little hard to keep a straight face and answer the question. The whole idea just seems to lend itself to pharmacologic humor. 
 
So what does Medicine say about using marijuana? It says a lot. First, marijuana is addictive in the same way nicotine is addictive. It has its own withdrawal effects that drive use. This is very important since marijuana is
smoked. Currently our society is crucifying those who use tobacco, and it seems strange to be legalizing a drug that is smoked! Smoking pot has the potential for all the same kinds of diseases that smoking tobacco does. Imagine what
people say if a doctor would recommend smoking tobacco for the medicinal benefits of nicotine!

The use of marijuana is also associated with an increased incidence of schizophrenia and psychosis. While it is unclear that how these two are associated, smoking pot seems to bring on the worst symptoms of schizophrenia, hallucinations and psychosis. The use of marijuana during pregnancy is associated with lower intelligence levels for the children who are exposed to the drug in the womb. 

A recent long term study looked at IQ (intelligence quotient) before regular use and after 10 years of it. And surprise! After a decade of use IQ in regular users dropped! It was a lot like the movie title...Dumb & Dumber. (Please forgive me I could not resist that line…) I have watched individuals who smoke the drug over long periods of time and I can tell you they really do not think as well as they did when they started. 
 
Marijuana is a Drug Enforcement Administration (DEA) Schedule 1 drug. That means that the federal government recognizes no useful indication for the use of marijuana in medicine. They may be some very narrow indications for
the active ingredient but as such none have been approved. I have reviewed the California Medical Associations indications for medical marijuana and they say the following. “The…list of serious medical conditions is broad, and in most cases not supported by solid clinical research.”[i] And, there are approved medications for use for the problems for which marijuana might be useful. 

As a physician I can only say that marijuana is an addictive drug with dangerous side effects. There are alternatives for treatment for any problem that it might be used to treat. I could not recommend its use to any patient. If we are as Paul said supposed to be good stewards of our bodies which are the temple of God, I can no good reason to use a drug for recreation that will damage it. (See 1Cor. 6 esp.12-20)


So, then what does the Bible say about Marijuana? Nothing. Nothing directly that is. It also does not say “smoke a little pot for your mood’s sake.” (Humble apologies to Paul and Timothy) The question then does fall in the realm of Christian liberty, but even that freedom is restrained by the  rest of scripture. 

How should we then look at a substance that is addictive, harmful to all who smoke it, a danger to the unborn, expensive, and illegal in 47 of the 50 States and federally in all 50? We should abide by the law as a Romans 13 response to government and abstain from the use of pot. And, we should oppose legalization. Just because any government says that something is legal does not make it right. Abortion is just such a problem, and prostitution is legal in Nevada. 

Marijuana is addictive. Christians are not to give their bodies over to the control of any substance. Paul told us not to be drunk with wine in Ephesians 5:18, but to be controlled by the Holy Spirit. The idea that Christians should give themselves over to a mind altering addictive drug is beyond any reasonable interpretation of Christian liberty. 
 
Christian Liberty is limited in any situation by the way it could harm others. Paul said that he would not eat meat or drink wine or do anything that causes a brother to stumble. (Romans 14:21) As I have practiced medicine, I have watched men and women destroy their own lives and bring heartache into the lives of spouses and children through drug use of all kinds including marijuana. Smoking pot for recreation is amazingly self-centered. Those who use it are not asking how it will benefit others. They only seek their own pleasure. Paul said, “Nobody should seek their own good but the good of others.”(1Cor. 10:24) 

Another important question that a believer must answer is “how  does smoking marijuana effect our service to Christ?” People who are known to smoke marijuana regularly rarely do anything important. While it is fashionable
to have smoked pot a long time ago, no politician wants it known that he or she currently  smokes a joint now and then. It is hard to think of anyone in Christian service who could be so addled by the drug and be of much use. 
 
Finally, as Christians we should not be using medical ailments as an excuse to permit the recreational use of marijuana. Smoking pot is a bad idea.  Maybe it is just time that we all grew up and acted like responsible adults. 
 
[i]  http://www.mbc.ca.gov/medical_marijuana_cma-recommend.pdf. There is a considerable list of “indications” all of which have currently tested medical  treatments. This is California at its best. 
 

Doing & Depression

When I counsel with people who are struggling with a sad mood there are many things that can help lift them from their melancholy. One of them is serving others in the sense of Christian service. When I was a young physician I remember reading a newspaper column by Dr. George Crane. At the time Crane was a well known and widely read physician who wrote about lots of subjects. The one that has stuck with me was a column in which he told the story of how an older doctor told him how to help patients who were depressed.

The older doctor had a drill that he used whenever a patient came that was in a dark mood. He would write them a prescription that directed them to read a chapter of the gospel of Luke daily. (Luke of course is the patron saint of physicians since he was one.) Then they had to walk 2 miles a day. The last assignment was to find someone who needed help. They had to be worse off than the patient and could not be a relative. The patient could take nothing from them. They had to serve for 2 hours a week and would do this indefinitely.

The old doctor knew something that most people do not know today. Sadness seems to focus our attention on us. It also can result in sitting around a lot. So, the old doctor aimed to focus the sad struggler first on God and then the needs of others. And, then he made certain they would be physically busy.

Counseling people with sadness will require that most of them will need to be doing things. We know that Christians do them by God’s Grace. But, what we teach them from the scriptures may not help them much unless they act on what they come to know. Jesus said in Matthew 7:24 “the man who hears my words and acts on them may be compared to the wise man…” James said that we must be doers of the word and not hearers only. Counseling that has an active component of doing the things taught has a strong benefit for the sad struggler.

For more about dealing with sadness and depression see Good Mood Bad Mood.

Yesterday I had the rare privilege of helping a person with a significant medical emergency while flying from Minneapolis to Seattle. And, it reminded me why I went to medical school and why most of the time I really enjoy being a doctor. I enjoy helping people who really need help. I enjoy the challenge of doing it in unusual circumstances.

About 20 min after take off, I heard a flight attendant announce, "any medical providers on the plane, please go to the rear now." It jolted me out of my reading and I walked quickly back to find a patient having  a grand mal seizure. The flight attendant was a nurse and shortly a recently graduated young physician and a respiratory therapist came. I found myself doing what I've done for the last 37 years. Giving orders quietly, doing my best to help, trying to look like I know what I am doing. 
As seizures usually do, the problem resolved itself and mostly we tried to keep the patient and passengers calm. I retrieved my stethescope and opthalmoscope/otoscope from my brief case. (This led to my cousin posting a youtube video of Leslie Neilsen in Airplane wearing his stethescope in his ears. :-) ) After 45 minutes, The young lady was stable and I went back to my reading leaving her in the care of the young MD, and his friend the respiratory therapist.
In the process of it all, I had been on my I-pad looking at Uptodate for doses on her medicine, and the pilot had called the University of Pittsburg for advice. My goodness technology is amazing today. At the same time, I was reminded of how little I can do when I am separated from the tools in the emergency room.  At 30000 feet there are things you just don't have.

When it was over, I was really just glad I could help. I suppose that was part of the reason I went to medical school.

I am flying at 35000 feet now headed to Seattle, Washington and the Canyon  Community Church. This weekend I have the privilege of teaching several hours on  subjects such as ADHD, Depression, Bipolar Disorder, PTSD, and the Problems of  Pain Medication. This is a diverse group of subjects, but they are held together  by several common threads.

The first is that people are looking for hope  for these problems that the labels represent. And "Hope is a good thing" to steal a  line from a well known movie. Parents with children who struggle in the classroom hope to find encouraging answers to the struggle. People who face mood disorders such as depression and bipolar disorder are looking for hope to deal with their struggles. Military and civilian strugglers with PTSD look for hope that their will calm the fears and dim the memories. People who face chronic pain will come looking for a hopeful way to deal their hurts.

The second  aspect that these "disorders" have in common is that truth is an essential ingredient in the search for hope. Understanding as best we can what secular medicine and psychology mean when they assign strugglers these labels is an important step to finding truth that helps them.  A careful examination of the claims of secular researchers is an aid to sorting out theory from fact. So people come hoping to hear what part of these "disorders" are certain scientific fact and what part is mostly speculation.  Truth is no enemy to the process of helping people with DSM labels.  If the disorder has no known change in the body that can explain the change in behavior then we have the opportunity to look at that behavior through the lens of scripture.

This weekend a common goal for those attending will be to find answers and hope from the Bible to deal with
the thinking emotion and behavior that the labels represent.  I am excited to be able to share the answers that the scriptures offer! If you are in the Seattle area, you can go to fbcmlafayette.org to find information for the
times and location.




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