Medical Research and Biblical Counseling
This week has been a blizzard of interesting research and much of it has been important to those of us who are involved in biblical counseling. As a physician and biblical counselor I often find myself answering questions that fall in the no man’s land between medical illness and spiritual struggles. The questioners general want me to tell them whether or not their problems have a physical cause or a spiritual source.  This week several articles found their way to my email that have something to say about the question. 

An article published in the June, 1st edition of the American Journal of Psychiatry described research in depression that caught my eye. The authors stated that “Older patients with a long illness duration and moderate to severe depression appear to benefit from antidepressants as compared with placebo. Antidepressants do not appear to be effective for older patients with short illness duration.”[i] That would coincide with conclusions I reached in writing “Good Mood Bad Mood,”[ii] which stated that 90% of people who are labeled as depressed are simply suffering from sadness due to some significant loss in life. 

That 90% number lined up with research that has shown that up to 90% of people who take antidepressants do not benefit much more than if they took a placebo pill that looked like but did not contain the active drug. The connection that I see with the AJP article is that it looks at two very different groups of patients who were elderly. One had chronic problems for years with a depressed mood. The second had developed a depressed mood for a short period of time. 
 
I suspect that the second group would likely be among those who struggled with sorrow due to a loss in life. Loses in life seem to be common as we age and are identifiable in up to 90% of those who are labeled with major depressive
disorder. It would then be reasonable that medication meant to treat a disease would offer little benefit to those who are struggling with a recent identifiable loss in life. 

A second article published in JAMA:Psychiatry on June 12th, examined the connection between infectious disease, autoimmune disorders and mood disorders. The researchers found that “A prior hospital contact because of autoimmune disease increased the risk of a subsequent mood disorder diagnosis by 45% … Any history of hospitalization for infection increased the risk of later mood disorders by 62%+…)[iii] A third article reported a study that relapses of schizophrenia appear to be connected to loss of brain mass as measured by MRI imaging studies. The longer the relapse the greater the loss.[iv] 

The last article published in April in the journal “Social Cognitive and Affective Neuroscience” reported that individuals that meditated gained relief from anxiety and that relief correlated with changes that could be seen in MRI scanning.[v] It evidently makes a difference what we choose to think about or worry about. 

The point of all this is threefold. First, it appears that as we look at depression we are dealing with two very different kinds of people. There are those whose problem is of long duration not connected to anything in particular who make up the 10%.  And, then there are those who struggle with sadness over an identified loss for a much shorter time. 
 
Second, not all emotional struggles are caused by spiritual problems. There are medical ailments that can have significant adverse effect on our emotions. In biblical counseling we need to be aware of this. When we counsel those with sad moods, anxiety and other emotion struggles we need to be certain they have seen their doctor to rule out treatable correctable medical disease. None of us want to find out that we have been counseling someone for anxiety when they had hyperthyroidism. 

Finally, “For as he thinks in his heart, so is he.  (Pro 23:7 NKJ). What we think about has a profound effect on our emotions. It should not surprise us that when we choose worry instead of trusting in the Lord, that it might show up in a functional brain scan. The study that showed the changes in our brain scans and reduced anxiety as a result of meditation should be an encouragement to biblical counselors. When it comes to worry, and many other spiritually driven emotional struggles, Paul tells us “not (to) be conformed to this world, but be transformed by the renewing of your mind, that you may prove what is that good and acceptable and perfect will of God. (Rom 12:2 NKJ) What we
choose to think about matters! What we mediate on can change our minds literally. 

[i] http://ajp.psychiatryonline.org/article.aspx?articleID=1680036&RelatedWidgetArticles=true
 [ii] Good Mood Bad Mood, Shepherd Press,  2013   
[iii] http://archpsyc.jamanetwork.com/article.aspx?articleid=1696348
 [iv] http://ajp.psychiatryonline.org/article.aspx?articleid=1676090
 [v] http://scan.oxfordjournals.org/content/early/2013/06/03/scan.nst041.abstract


 
 
Decisions

How do we make good decisions? It is a subject that is important to me as a physician. Making decisions that include others is at the heart of what I do and who I am. So, how do we make good ones? There are lots of books written about the process. "Blink" is my favorite. Malcolm Gladwell carefully told us that maybe our intuitive first impression was the best. Jumping to conclusions could be scientifically shown to have an advantage over long term considering.

But anytime someone makes a fortune selling books telling us not to spend our lives agonizing over a decision that can be made in a "blink" someone is bound to write to the contrary. In no time another author was telling us that it would be better to be "thinking fast and slow!" And there we are caught between two opinions wondering which to choose...

As with anything in life it is always best to go to the instruction manual or the directions first. Men are notorious for failing that on Christmas morning putting the toys together even though we know we would better off if we did. Much about life is like that. We know that we should be consulting the owner's manual before we make major changes. Of course the owner’s manual for humans is not "Gray's Anatomy." It is the Bible.

When I think of making important decisions the one passage that comes to mind is Romans 12:1-2. I beseech you brethren by the mercies of God to present you bodies as a living sacrifice, holy and acceptable unto God which is your reasonable service. And be not conformed to this world but be transformed by the renewing of you mind so that you may prove what is that good acceptable and perfect will of God. There are 4 tests that I see in that passage that help us to avoid making really bad choices.

1. Is this a sacrifice to God or to me? Is this choice I am about to make going to be a gift to God or something that will satisfy my own self-interested desires? If the choice falls in the second category and not the first, it will come to no
good.
2. Will this choice continue the process of "transforming" me into the image of Christ or will it simply conform me or make me more like the world. The job that takes me out of church on Sunday morning may be justified on lots of
biblical grounds but the end result will be the same. I will be doing what the rest of the world is doing on Sunday morning.
3. Will this choice renew my mind or pollute it? This is particularly important when it comes to amusements,
entertainment, literature and television today. Our Lord's warning in Luke 21:34 to guard what we allow into our hearts was given to people who lived in the middle of an immoral society. So do we and we should think hard about the things we read and watch.
4. When the neighbors see the results of my choice will they believe I am doing the will of the God I serve or acting just like them? We are supposed to be in the world as salt and light. The world is not supposed to be in us.

 Asking these 4 questions before we choose will not help us pick between good, better and best choices. That will need to wait on another blog spot. These questions will help us avoid making really bad choices and often in life
that makes all the difference.

 
Caffeine and Romans 14

     I spent last week teaching a graduate course at Baptist Bible College in Springfield, Missouri and
during the week a news item showed up that illustrates the challenge of understanding the DSM5. (Diagnostic Statistical Manual of Mental Disorders Fifth revision) The news item related that caffeine withdrawal was supposed to be one of the new mental illness diagnoses in the DSM. Now, most of us have had some experience with the favorite "drug" sold at Starbucks and some of us have suffered the discomfort of missing that morning cup of coffee with headaches, fatigue, and irritability. A few of us have found that if we drink too much of the brew that our hearts skip a beat or even beat faster. I suspect more have struggled with the irritability and sleeplessness that comes from drinking coffee too late in the afternoon.
        But, are these effects a mental illness? Or are they just the uncomfortable outcomes of things we choose to do, eat or drink.  I would say that the latter is true. When we choose to consume any substance and then live with the effect and sometimes the undesirable side effects, it does not mean that we have a disease. Disease requires pathology or a change in our bodies that results in an abnormal function.  When our pancreas is damaged and insulin production is reduced we can develop diabetes. There will be changes that can be seen under the microscope along with abnormal blood sugars.  When we suffer withdrawal symptoms from missing caffeine, there is no pathology to speak of.
     By calling it a disease we do set in motion several things that can lead to unintended consequences. First we identify normal people as mentally ill with a significant downside when it comes to buying insurance and
finding employment. Next, we will see more people diagnosed with "caffeine withdrawal disorder" who might have sailed right on through life without a hitch simply because the diagnosis exists. Then, the opportunity (or the risk) to be treated by some sort of therapy will follow. And, then will come medication that will either be good, bad or even just indifferent in benefit that can cost as much as two or three hundred dollars a month to take. (Roughly the equivalent of two Starbucks Cafe Mochas a day)
    ow it seems farfetched, but we have watched this process happen with cigarette smoking and a host of other DSM diagnoses. As we have morphed normal sadness into depression, childhood inattention into ADHD, and the struggles of life into generalized anxiety disorder, the number of people of labeled and treated have skyrocketed. 
At some point don't we need to ask ourselves the question do we really need to turn every uncomfortable or unprofitable behavior into a disease that will eventually require treatment? Or could we just choose to be responsible for ourselves? Isn’t that part of the experiment of American Liberty?
    And, that brings us to Romans 14 a chapter in the New Testament in which Paul the apostle lays the groundwork for the doctrine of Christian Liberty. (In fact the whole idea of American liberty is anchored in the book.) The argument at Rome was over eating meat offered to idols or eating just vegetables. Paul said it did not make anyone any better if they ate or did not eat the meat. He was really upset that they were judging one another over it.
    The church in general has taken that idea and extended to include things that we can do about which the Bible does not speak. Since caffeine is not mentioned in the Bible, we are free to drink Coffee or not as long as we do not violate some other principle of scripture in the process. Not to belabor the point, as long as drinking coffee does not harm us or cause us to harm others, it simply becomes a matter of preference.
    So there, maybe it is time that we said that there are more than enough diagnoses in the DSM, and that they should leave our coffee alone! This is the kind of problem that we can figure out on our own without the help of psychology, psychiatry or even medicine for that matter.  See you at Starbucks...