The biblical counseling movement has a persistent reputation for being anti-drug. Every time I write about counseling and medical issues I make clear that physical care for the body is important, and that counselors should not function as physicians and try to take people off their medications. In spite of those qualifications, people regularly accuse me and others in the biblical counseling world of being against medicine.
Will the Person Hating Medicine Please Stand Up?
It makes me wonder where the accusation is coming from. Who is saying that medicine is unimportant? Someone must be. In fact, I was told during a recent conversation, “Well, you might not be saying that, but other biblical counselors are.” When I asked for the identity of these other biblical counselors no names could be produced.
That got me thinking about leaders in the biblical counseling movement and their statements in this regard.
I think any objective evaluation of the biblical counseling movement would point out four big leaders in the development of our model. I think those four leaders are Jay Adams and Wayne Mack (who had an instrumental role in founding the biblical counseling movement) and David Powlison and Ed Welch (who have significantly developed the movement in recent years.) Every person embracing and practicing biblical counseling today has learned about biblical counseling from at least one of these four men.
So I looked at the statements about counseling and medical issues from the teaching of these four men. Here is an incredibly brief summary of what I found.
In Competent to Counsel, Jay Adams’s very first book on counseling, he clearly acknowledged the presence of disease and the need for medical doctors, including psychiatrists in caring for people who need help. In a book, What about Nouthetic Counseling? written a few years afterCompetent, Adams said this:
It is perfectly clear that . . . illnesses can and do affect behavior. In such instances, medical help should be sought and administered prayerfully.
Writing in Counseling: How to Counsel Biblically, Dr. Mack has this to say about counseling and medical issues.
Sickness can sometimes be caused by personal sin (Psalm 32:3-4; 38:3; Proverbs 14:30; 1 Corinthians 11:30). But sickness that is not caused by personal sin can also be an important factor in the struggles and temptations our counselees face. For instance, viral infection, hepatitis, mononucleosis, diabetes, and hypothyroidism are all associated with depression. In many cases, when Christians suffer from those conditions their depression symptoms may simply be a consequence of the exhaustion and discomfort cause by the malady. So we must not assume that in every case depression is a direct result of personal sin. It may be relieved or eliminated simply by the correct diagnosis and treatment of a medical problem.
He goes on to say that, “It is not our place as biblical counselors to prescribe drugs or remove counselees from drug regimens.”
Welch’s book Blame it on the Brain is a wonderful effort at reaffirming the Bible’s teaching that human beings are composed of a body and a soul. He walks through chapter after chapter with sophisticated analysis emphasizing the importance of the body, the importance of the soul, and the importance of caring for each one. The point of the entire book is to help Christians know the difference between spiritual issues, physical issues, and combinations of the two in order to help people most effectively.
Since we approach physical and spiritual problems in different ways, we need to be able to distinguish between them. Physical problems are met with understanding, compassion, and creative teaching. Spiritual problems are also met with understanding, compassion, and creative teaching, but the content of the teaching is the law of God and the Gospel of Jesus, and the response is repentance and faith rather than intellectual understanding or simple behavior change.
Throughout his book, Welch assumes and encourages medical care for medical problems.
Powlison penned an Affirmations and Denials document, which many in our movement have used as a standard for faithfulness in biblical counseling belief and practice. Powlison says in that document,
We affirm that God’s providential common grace brings many goods to people, both as individual kindesses and as social blessings: e.g., medical treatment, economic help, political justice, protection for the weak, educational opportunity. Wise counseling will participate in and encourage mercy ministries as part of the call to love.
Where’s the Beef?
Each of these men have had much more to say about the importance of medical care for medical problems. Many in the biblical counseling movement besides these men have had plenty to say as well.
My point is that even a cursory reading of the leaders in the biblical counseling movement indicates that they have carefully articulated a belief in the importance of the physical body and medical treatment. I can find no indication that the intellectual leadership of the biblical counseling movement has ever given voice to the dangerous practice of ignoring organic illnesses or encouraging the rejection of medical care.
If this is true then where did the biblical counseling movement get such a reputation? I have four responses.
1. I’m told that some counselors really do tell their counselees to stop taking medication.
I say, “I’m told” because I don’t actually know anyone who has told a counselee to stop taking their prescribed medication. I believe the reports that some have given me, but I am not able to verify this from a first-hand perspective.
Counselors who engage in such behavior should not do it. In fact, counselors certified with ACBC are not allowed to do it. It is simply not the role of a counselor to function as a physician.
If you have been told by a counselor that you should quit taking your medications, or if you know someone who has been told this I have a message for you. Such counsel is wrong, and stands outside of the biblical counseling movement that ACBC has participated in for decades.
2. Many counselees do not like taking psychiatric medication.
In my counseling ministry I have never suggested that a counselee should quit taking their medication. I have brought up the topic of medications with counselees only rarely. My counselees, however, bring up the issue a lot. In fact, I have had very few counselees on psychiatric medication who have not brought up this issue. Many of my counselees express a strong dislike for such medication.
Sometimes counselees have very good reasons for disliking their medication. They may experience no improvement in their condition after taking the drugs for some time, or they may endure terrible side effects like nausea, sleep loss, lethargy, impotence, and on, and on. If I were experiencing such realities I would be concerned about my medications as well.
Sometimes counselees have reasons for disliking medication that are not good. For example, some people feel that if they were holy enough they wouldn’t need medicine. With such counselees we need to help them understand that a biblical commitment to the goodness of the body endorses medical treatment. When people go to their physician who prescribes medication they are honoring their body, and the God who made it when they take what is prescribed.
My point here is that I have had many counselees come off of their medications on their own regardless of whether their reasoning is good or bad. I really have no idea how many people have done this in my ministry, but I regularly have people come into my office and tell me that they quit taking their medication on their own.
I do not want them to do this. I tell them not to do it. When they tell me they’ve done it, I encourage them to see their doctor. I cannot, however, force them to stay on their medication. I know other counselors who have been in similar situations.
“Medication guilt” is a reality in counseling, but in my counseling and the counseling of those I know it is not induced by the counselor.
3. Biblical counselors practice counseling, not medicine.
I was teaching one afternoon on helping people with complex counseling problems. I was going over a general approach to help when a hand went up. The question came from a frustrated student. She asked me why I spent so little time talking about medicinal interventions. She said, “The very first thing you said is, ‘We need to send counselees with such problems to a physician for a full medical evaluation so they can be treated for any organic problems they have.’ Since then you have not mentioned it again. Why don’t you spend more time talking about medical treatment?”
That’s a good question. I think many wonder about this same reality. Biblical counselors spend energy telling people their body is important, and that they should take their medications, but usually don’t spend more time on physical issues. Why is that?
My answer to that student was simple.
I don’t spend more time talking about medical realities because I am not a physician. I think I best honor our body’s need for physical care by leaving such matters to those with expertise in addressing them. If I were a pre-med student at Yale and my anatomy and physiology professor kept talking about counseling, I would feel that he was speaking outside of his area. I would want him to cover the subject matter of the class, not something else.
When biblical counselors avoid covering detailed medical issues, we are not ignoring the importance of the body. We are fulfilling our calling. If God had wanted me to be a physician I would be doing very different work than I am right now. I discharge God’s calling for my life when I speak about counseling. I leave those with medical expertise to discuss organic matters.
4. We live in a culture that medicalizes every problem.
We live in a remarkable day that experiences tremendous advances in medical technology. There is no way that I would want to have lived in the United States 125 years ago. I also would never want to have surgery in most parts of the world today. It is a blessing to be at such a wonderfully advanced period in history and place on the planet.
One of the drawbacks of such blessings is that many in our culture assume that every extreme problem is a medical problem. Worry and anger aren’t sins, they’re illnesses that require medical treatment. Sorrow never has any spiritual correlate at all—it is always “clinical” requiring drugs.
As Christians we must reject such argumentation. The reason we must reject it is because we believe in a Bible that tells us that human beings have both a body and a soul. That means we experience problems that are physical, requiring medical solutions, and problems that are spiritual, requiring faith-based solutions. We also experience many complexities, which are combinations of the two.
As long as Christians continue to embrace this reality, known as dichotomy, we will sound like odd-balls. People will think we devalue the body simply because we believe that people can have other—and bigger!—problems than those, which are merely physical.
Here is what David Powlison said about this,
When we [say], “But we can counsel angry and anxious people to repent and to learn faith and love,” we will sound like we are asserting something along the lines of “Cast out that demon of cancer” or “Just believe in Jesus, and throw your eyeglasses away.” When anger and anxiety are seen as treatable bodily ailments, we will sound like bizarre spiritualizers—even to people in the pews and in other pulpits. We have work to do to protect and build up the body of Christ.
Powlison is correct on two counts. He is right that the Christian message sounds strange in our day and age. He is also right that we have work to do to protect and build up the body of Christ.
If the biblical counseling movement is accused of being anti-medicine simply because we do not believe every problem is medical then this justifies our need to keep writing, teaching, preaching, and counseling. Our persistence should not stem from a desire merely to be right. Our persistence should grow from a desire to help. People who have spiritual problems will not change as long as they keep taking drugs as a cure. They will only change as they draw near to Jesus in repentant faith.
When you consider that reality it is easy to see that it is not biblical counselors who are trying to keep people from getting all the help they need—medical or otherwise. On the contrary, we want to be sure that people get the kind of comprehensive care that addresses both their physical and spiritual needs.