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Mental Illness: Is it Real or Not?

9/23/2013

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As a doctor who teaches Biblical counselors, I get to answer this question. I do it reluctantly because while the
question seems simple, it really can be complicated. I am writing about it today because once again the question has made the news. 
 
It comes this week because of the unspeakable tragedy that came to the Warren family in the death of their son.
Warren and his wife had the opportunity to share their experience on CNN. My continued response has been to pray for them. And, I am not writing about them or their interview. 

Ed Stetzer wrote about the interview and the state of thought among Christians in his part of the Church and said the
following. 

     “So, what can we do as people of faith to address issues of mental illness? Churches need to stop hiding mental illness. The congregation should be a safe place for those who struggle. We should not be afraid of medicine. We need to end the shame.”
     “The fact is, mental illness is real. And it's a real illness.”
     “It is also important that we recognize that prayer changes things. In fact, the gospel impacts every area of our lives
and God can—and does at times—supernaturally heal every kind of illness. Yet, God often chooses to do so through an approach that includes prayer, study, Christian community, and medical intervention.”
     “Medicine is not the answer to everything, and we live in an overmedicated world, but we need to treat character problems like character problems—and illnesses like illness.”[i]

I appreciate the effort that Lifeway and Stetzer have gone to in order to help people who struggle with their emotions.
But, in the article, churches and their members appear to be criticized for contributing to the problems of those who struggle by refusing to recognize the reality of their illnesses.  I said illnesses on purpose because I believe that at the heart of this article is a simple problem. Mental Illness is not a simple term. It includes hundreds of diagnoses with multiple variations. Many of them are controversial. Some of them are not. But, what happens when you lump them altogether and then ask survey questions? Here is an example from the article. 

     “Thirty-five percent agree with the statement,  "With just Bible study and prayer, ALONE, people with serious mental illness like depression, bipolar disorder, and schizophrenia could overcome mental illness."[ii]

 The problem with the question and the conclusion is that depression and bipolar disorder are not homogeneous problems. Some researchers believe that up to 90 % of those who are diagnosed with depression may be suffering with normal sadness over loss.[iii] More researchers are very concerned about the validity of the current criteria being used to make the diagnosis.[iv] A growing number believe that many of those diagnosed with depression would be better cared for by simply talking to a skilled helper instead of being cared for medically.[v]

 So I would suggest that we should not ask the Church to change its attitude towards “mental illness” on the basis of  surveys that ask general questions about a complicated matter. Instead, I think what we really need to have is a conversation about what mental illness is and what it isn’t. If we are going to change the attitudes of the church body toward those who struggle with their emotions, it will require us to stop using the generic term “mental illness” expecting everyone to respond to it in a defined way. We will need to look at the objective scientific evidence for each specific diagnosis and behavior in the light of scripture. And, no Christian in medicine or counseling should be afraid of that. Then maybe we can separate the character problems from the illnesses. And respond to them the way James told us in his letter. 
    "So speak and so act as those who are to be judged by the law of liberty. For judgment will be merciless to one who has shown no mercy; mercy triumphs over judgment.  (Jam 2:12-13 NASB)  
  
[i] Mental Illness and the Church: New Research on Mental Health from LifeWay Research.  Ed Stetzer Blog at Christianity Today 9 17 2013. 
http://www.christianitytoday.com/edstetzer/2013/september/mental-illness-and-church-new-research-on-mental-health-fro.html  
[ii]  Half of evangelicals believe prayer can heal mental illness. Blog at Lifeway.com Bob Smietana. 9/ 7/13.
http://blog.lifeway.com/newsroom/2013/09/17/half-of-evangelicals-believe-prayer-can-heal-mental-illness/  
[iii] Good Mood Bad Mood, Shepherd Press, 2012, 61-68  
[iv] Good Mood Bad Mood, 23-31



 
[v] Good Mood Bad Mood, 69. 
  

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Job, Problems, & Suspending Judgment!

9/12/2013

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Early in my career as a medical student I learned a very important lesson and it was the concept of suspending judgment. My instructor in history taking told me that I needed to become “unshockable”. I was going to see things and hear stories that would leave most people with their mouths hanging open and their eyes as big as silver dollars. But, I the physician needed to be able to see and listen without showing my approval/disapproval, amazement or disgust. 
 
It required me not to make a judgment about the person before I knew as much about their problem as I could. 
 
I have been reading Job this week on my annual tour through the Bible, and there have been several things that have
caught my attention. The first thing comes right in the first verse of chapter one. The writer under the inspiration of the Holy Spirit says that Job “…was blameless, upright, fearing God and turning away from evil.” Those are very
absolute adjectives. This story is about the suffering of a man that most would say was good by our standards. We would say that because that is what text says. 

I am not going to discuss a theology of suffering in this post. Others are far more qualified than I am to do that. But,
one important thing comes to mind about Job and his three “friends.” I have said that those three stand as a warning to anyone who is interested in trying to help a suffering struggler. They refused to suspend judgment. 
 
The story is familiar to most. Job loses his children, his possessions and his health and then while he is sitting on an
ash heap scraping his boils with a broken piece of pottery, his wife tells him to curse God and die. Job responds by telling her that she was speaking like the foolish women speak. The writer goes on to tell us that “in all this Job did not
sin with his lips.” 

And, just when things looked like they couldn’t get worse for poor Job, those three friends show up. Those men did
fairly good job of comforting for the first seven days. They sat with Job and said nothing. They don’t get into trouble until they start talking. And, then they go after Job with their minds made up. Nothing this bad could happen to Job
unless he had sinned. And, for most of the book they hound him from their position of ignorance. 

Proverbs 18:13 tells us “He who gives an answer before he hears, It is folly and shame to him.” When we try to help
people who are struggling perhaps the most important thing we can do is the one thing Job’s “friends” missed. Suspend judgment, listen long and avoid deciding the cause of the strugglers suffering until you’ve heard the whole story! And, sometimes as in Job’s case, there won’t be a conclusion to make because part of the story is unknown. 

As we approach people who suffer we need arm ourselves with scripture such as James 2:12-13. “So speak and so act as those who are to be judged by the law of liberty. For judgment will be merciless to one who has shown no mercy; mercy triumphs over judgment.” It will keep us from jumping to conclusions based on our own prejudice. It will also keep us from adding to a suffering struggler’s misery instead offering comfort and help. 

And by the way, it is our ability to suspend judgment that allows us to watch SciFi movies and enjoy them. Everyone knows that engaging the warp drive on the starship Enterprise would crush the crew on the back wall like bugs. We just choose to ignore it long enough to enjoy the movie.


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Women, Men& Depression: Are Women Really Depressed More?

9/1/2013

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 “The moment a person forms a theory, his imagination sees in every object only the traits which favor that theory” Thomas Jefferson
 
From the first day in medical school at Indiana University that we talked about depression, one thing seemed absolutely clear. Women made up the vast majority of those who presented with the symptoms and the diagnosis. The difference in the rate of diagnosis for men and women wasn’t ten or twenty percent. It was 2 to 1 women over men. We had lots of explanations for the phenomena. Women were and still are more likely to see a physician than men for any kind of health problem. Surveys done over the years will vary some, but generally show women seeing doctors from 50 to 100% as often as men. 
 
As a result, for reasons not entirely clear, physicians, psychiatrists, and psychologists of all varieties have
operated with the bias that depression is primarily a problem that women face. And that would be helpful, if
it was true
. In research published this week in the online version of the Journal of the American Medical Association, it appears that the reason why men are not diagnosed with depression as often as women is because we in
medicine are simply not asking the right questions. 
 
The research done at the University of Michigan by Lisa A Martin, PhD and others, found that if you ask men the usual DSM4 (Diagnostic Statistical Manual of Mental Disorders) criteria questions that include a sad mood, men will tell you they are not depressed. “Direct admission of sadness and emotional weakness or vulnerability in men is seen as socially unacceptable.”  It appears that men want nothing to do with being identified as weak, sad, or vulnerable. [i]

 This response appears to be tied to a man’s “adherence or rejection of hegemonic masculinity.”[ii] In English, the more a man agrees with a “John Wayne, Bruce Willis, or Tom Cruise view of manhood the further he will distance himself from anything that looks like sadness or depression. To do great damage to the 1960’s Four Seasons song, “Big Boys* Don’t Cry!”(*Girls in the original) Or, to quote Tom Hanks, “there’s no crying in baseball!”

 So, the researchers did what they often do as they search for the answer they believe is “true.” Instead of asking
themselves if they are over diagnosing women, they changed the questions as Jefferson said they would. The researchers used what is called a “Gender Inclusive Depression Scale.” That scale uses questions that identify anger, aggression, and irritability in men as the signs of depression. And, when they were done men had the same rate of depression that  women did. 

I suppose that we could take this conclusion in several directions. As a physician, I guess I might say that I am not one bit surprised that men and women might suffer sad moods at exactly the same rate. In the book Good Mood Bad Mood, I have reviewed considerable research that tells us that depression as a disease has no easily identified unique pathology (change in our bodies or brains) that would make the diagnosis certain.[iii]  
  
At the same time, research tells us that the DSM4 and now DSM5 criteria are very subjective and are likely to over-diagnose depression as much as 90% of the time. I doubt that changing the criteria to make it more likely that men are diagnosed with depression because they are angry, aggressive or irritable will help them much. Instead of finding
solutions to the anger, aggression, irritability and sadness, we may just be increasing the number of people who will be labeled. 
 
There is something that would help the 90% of men and women who are labeled as depressed because they struggle and suffer due to an identifiable loss in their lives. It would help them to find someone who knows about their loss, who has a plan for that loss, and cares deeply about their struggle and suffering. And, to find out that someone will act on their behalf. I think that would help. 

And, there is a great place to look for that something or someone who could help. I would start in John 11. Jesus knew, had a plan, cared deeply and acted to help Martha, Mary and Lazarus. And He will do the same for anyone who comes to Him bringing their anger, aggression, irritability, and sadness over loss. As He said, “Come unto me all you who labor and are heavy laden, and I will give you rest.”(Matthew 11:28-30)  
  
[i] The Experience of
Symptoms of Depression in Men vs Women, Analysis of the National Comorbidity Survey  

Lisa A. Martin,  PhD1; Harold W. Neighbors, PhD2; Derek M. Griffith,  PhD3,4 
JAMA Psychiatry. Published online  August 28, 2013. doi:10.1001/jamapsychiatry.2013.1985 
[ii] ibid  
[iii] Good Mood Bad Mood, Charles Hodges MD,  Shepherd Press, 2012, www.shepherdpress.com, Wapwallopen, PA.


See chapters 3-5.

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    Author

    Charles D Hodges Jr. MD
    I have been counseling people with mood problems and other family issues  for 25 years.  

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