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Biblical Psychosomatics

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Series
Topics Biblical Counseling and Psychology
Context

Let me start with a little bit of background. This talk grew out of the world that we live in as it relates to counseling. I don’t need to tell you that the vast majority of what we would call “counseling problems,” as the world defines them, are moving more and more toward a medical disease diagnosis. Just as a footnote, I want to say up front that I believe that there are legitimate medical diseases and when those things happen, we should absolutely send people to the best physician and the best treatment we can find. However, the problem is that there’s a growing movement to see and understand issues that the Bible would call spiritual issues or heart issues (things that really originate with our inner man) as being body problems in some way. This talk really grew out of the idea of how to understand people from a biblical point of view. To do that, we have to start with this big, hundred-dollar, theological word: psychosomatics. Do you know where the word psychosomatics comes from?

The Greek word psuche actually would be translated soul or mind in Scripture. Then the other word that’s represented is soma, which means the body. You’ve got psuche and soma to create psychosomatic, so it’s the relationship between the heart or the soul and the body. What we want to do in the first part of this talk is I want to unfold for you what I believe is a biblical view of people who are both body and heart, or body and soul. Then in the second half what I want to do is take that paradigm that we develop and apply it to three areas of counseling that I hope will be very helpful to you.

THE NATURE OF PEOPLE

Please turn in your Bible with me to 2 Corinthians 4. How does the Bible describe the nature of people? I think we can get started by looking at 2 Corinthians 4:16. Now, you know that in context, 2 Corinthians is a book where Paul is defending his apostleship. He’s being attacked and you really find that one of the themes of the book of 2 Corinthians is suffering. We know Paul had a thorn in the flesh. We know that he was afflicted by the Jews. He was afflicted by the Gentiles. He was just getting persecuted on all sides. This was a man very, very familiar with affliction and he says in verse 16: “Therefore we do not lose heart, but though our outer man is decaying, yet our inner man is being renewed day by day” (NASB95).

In context, what he’s saying is: we get older, our bodies fail, we can be persecuted, we can have diseases, we can have accidents, but in the midst of our outer man (our body) failing, as a Christian we can be being renewed and be growing on the inside with the inner man. That’s really his point here. But what I want you to notice is not really the big point. I want you to notice his anthropology. In other words, How does he view people according to this verse?

We see that in his view—and we know that he is speaking the God-breathed Scripture as he says this, so this is God’s view—people are both an outer man and an inner man. If you will, we can think of people as duplexes. A duplex is a house that has two sides to it, right? There’s an inner man and there’s an outer man. The inner man is the immaterial part of people; that’s the part you can’t see. The Bible would use the term heart or soul or inner man, as we see here. Sometimes the word mind is used synonymously, but it all really means the same thing. It’s that inside, who you really are, the real you on the inside.

I have a number of what I hope will be helpful quotes to you about the heart and people. This one is from the Puritan John Owen. He says: “The heart in Scripture is variously used; sometimes for the mind and understanding, sometimes for the will, sometimes for the affections, sometimes for the conscience, sometimes for the whole soul. Generally, it denotes the whole soul of man and all the faculties of it, not absolutely, but as they are all one principle of moral operations, as they all concur in our doing good or evil. The mind, as it inquireth, discerneth, and judgeth what is to be done, what refused; the will, as it chooseth or refuseth and avoids; the affections, as they like or dislike, cleave to or have an aversation from, that which is proposed to them; the conscience, as it warns and determines – are all together called the heart.”

That’s a little wordy and there’s some 17th-century language there, but what he’s basically saying is: all the operations of who you are as a person flow out of your heart. Solomon actually said it much more simply than that in Proverbs 4:23. He said, “Watch over your heart with all diligence, For from it flow the springs of life.” That’s a good fundamental verse.

The first thing that I want you to see as we think about the nature of people is that people have an inner man. They have an inside. All I want you to see at this point is that there is an inner man, what we call the heart, the spirit, the soul, all basically the same thing. Some truths from Scripture that are very helpful are:

The heart is like the mission control center. If we go down to Cape Canaveral where shuttles take off, the moment a shuttle passes the tower, control of the mission passes from the guys in Florida to Johnson Space Center in Houston, where we know Mission Control exists. Think of your heart as the mission control center of people. It’s the CEO. It’s the master computer. It’s the pilot in command. Whatever analogy you want to give it. In Scripture, the heart is the mission control; it’s the wellspring of life; it’s where everything that we discover in life originates.

Next, what does that heart do? It desires, it thinks, it believes. We see attitudes and choices. All of those things find their origin in the heart.

I have a couple of wonderful quotes again to give you from a few sources. This one is from J.I. Packer’s introduction to the Puritan John Flavel’s excellent book, Keeping the Heart. Other than this last generation with Jay Adams, John MacArthur, and Wayne Mack, who sort of rediscovered biblical counseling, the last generation of the church that really knew and practiced biblical counseling were this group of people known as the Puritans of the 16th, 17th, and 18th centuries. This book is a short little book and is one of the best books I’ve probably read in the last five years. It ministered to my soul. It’s an exposition on Proverbs 4:23 (“Watch over your heart”). If you like to read things devotionally just to feed your soul so that you’re compelled to love Christ more and to walk with Him, I’d recommend John Flavel’s Keeping the Heart. J.I. Packer says: “The human heart is the controlling source of all that we do in expression of what we are: all our thoughts, desires, discernments and decisions, our plans and purposes, our affections, attitudes and ambitions, all the wisdom and all the folly that mark our lives, come out of, and are fueled, serviced, and driven by, our hearts, for better or for worse.”

This next quote is actually from John Flavel the Puritan himself: “…the heart is the source of all vital operations; it is the spring and original of both good and evil, as the spring in a watch that sets all the wheels in motion.” You can tell that in his day, watches didn’t have lithium batteries in them. They were run by springs and gears and whatnot. I love the Puritans. It’s as if he’s saying, “When I think about the operation of my heart, it’s like this pocket watch that has gears and springs and it all works together to make me who I am.” He continues: “The heart is the treasury, the hand [what we do] and tongue [what we say] but the shops; what is in these, comes from that; the hand and tongue always begin where the heart ends.” You get that? Do you see what he’s saying? What we do and what we say always finds its beginning where the heart ends. The heart initiates and then the hand and the tongue follow through. The heart contrives and the members execute.

A more contemporary writer, Ed Welch, wrote an excellent book, Blame it on the Brain. If you want to read one book to help you understand this topic, it would be Ed Welch’s book. The whole first section (including the first one or two chapters) is excellent. He writes this in his book: “With our minds, we are responsible before God and we respond to Him, either for or against. Our minds…”—or hearts, since he’s using the terms synonymously in context—”…are the initiators of all moral action.”

We not only have an inner man. According to Scripture, we also have an outer man, as we saw earlier in 2 Corinthians 4 that our outer man is decaying. The outer man is the material part of people. Just think with me on this. The body (the outer man) includes things like this: tissue; organs, including the brain; cells; neurons; fluids; glands; and nerves. According to Scripture, the body can be sick or healthy, strong or weak, possessing or lacking certain abilities, but the body is not the originator of moral actions. It’s very important to understand that. The body can be sick or healthy, have strengths and weaknesses, have abilities or lack of abilities, skills or lack of skills, but according to the Bible, the moral issues of a person’s life do not originate from the body. Where did they originate from? The heart. That’s very important to see. We saw that earlier in Luke 6 and Mark 7.

Just quoting again the verse we just talked about (Luke 6:45), “the mouth speaks out of that which fills the heart.” We might think of it like this: the body enacts the heart’s orders. Can you think of it like that? The body enacts, puts into place, or obeys what the heart tells it to do. We’re building our theology of understanding the nature of people. Now we can add another part to our understanding of the nature of people: an outer man and the body. We’re going to call the body the “enactor” of the heart. The heart drives the body and the body puts into action the requests of the heart.

Let’s talk about the relationship between the two—the relationship between the heart and the body. The Bible teaches, first of all—and we’ve seen this—that the heart drives the body. We saw that in Luke 6. We saw it in Proverbs 4. We saw it in Mark 7.

I’m going to use a quote from Dr. Laura Hendrickson, who was a psychiatrist (medical doctor) turned biblical counselor. Unfortunately, she passed away, but before the Lord took her home, she wrote many exceedingly helpful articles dealing with medical issues in biblical counseling. One of the areas that I feel like she really helped all of us with is this area of psychosomatics. Follow me on this: “Since the brain has executive function over the rest of the body…”—that’s what doctors and medical people tell us—…”we might conclude this, if we put that into our biblical theology now: the heart is really driving primarily the brain, which then controls the body.” Hence, we can think of the brain, in Laura Hendrickson’s words, as the mediator that translates what’s inside of us into physical form. Isn’t that helpful? Biblical anthropology. How do we understand people according to Scripture? I think we’re getting closer here. The heart drives the brain; the brain drives the body.

A couple more quotes here:

“The unique contribution of the body to the whole person is that it is the mediator of moral action rather than the initiator. In a sense, it is the equipment for the heart.” Isn’t that great? That’s Ed Welch; he has such good ways of putting things. The body is what? It’s the equipment for the heart. It’s the stuff you put on. If we’re going to go play football, we’re probably going to put on some equipment, right? If we’re going to play baseball, we’re going to get some equipment. You can’t go play the game until you put the equipment on. Yet we know that the actions of those sports people are not being generated by the knee pads or the bat or the ball or the helmet; those actions are coming from the player wearing the equipment, right? Will you agree with me on that? That’s the idea: the body is like the equipment for the heart. It’s putting into action what the heart commands.

Again, Laura Hendrickson in the book Christ-Centered Biblical Counseling: “Our inner being is the part of us that initiates our capacities to relate, think, make choices, act, and feel, while the body is the instrument through which we express those capacities.” Again, this helps us to see the relationship there.

Now one step further. Listen to this helpful quote again by Welch: “At the level of the brain, this unity…”—talking about the unity between the heart and the body and how the heart drives the body—”…suggests that the heart or spirit will always be represented or expressed in the brain’s chemical activity.” Now stop right there because that’s one of those sentences that we have to pull the car over and think and talk about. What Welch is saying is, if the Bible teaches that the heart drives the body—and of course the brain is part of that—Welch says this: we should expect that the heart would be represented or expressed in the brain’s chemical activity. What do we mean? Let’s continue the quote. “When we choose good or evil, such decisions will be accompanied by changes in brain activity.” Doesn’t that make sense? If your heart drives the rest of you, including your brain, and you choose to do something good or choose to do something evil, there are chemical processes in your body that translate the desire of your heart into action. Of course, we agree with that. Now, that does not mean that the brain made you do that. Look back at the quote. This does not mean that the brain causes these decisions; rather it means that the brain renders the desires of the heart in a physical medium. I love this. This is a great illustration. It says, “It [the heart] always leaves its footprints on the brain.”

I think that sentence is the most important part of this whole talk. If you miss everything else, understand that biblical anthropology (that is, a biblical understanding of people, of both heart and body, or soul and body) means that if the Bible teaches our heart as the initiator of moral action, we should expect that that moral action will be carried out and represented physiologically in our bodies. Now, when a secularist (someone who doesn’t believe the Bible) studies the brain and the body and says, “With that anger or rage, that person’s brain is different and that person’s chemical levels are different,” the biblical counselor says, “Well, yes, of course, because the heart is initiating and driving the body and the body just carries out those orders; of course, the chemical levels are going to be different.” We, as biblical counselors, are not threatened when people say, “Well, the chemical levels in the brain of this guy over here are different than somebody that doesn’t have that behavior.” We’d say, “Well, sure. Biblical anthropology assumes that that’s going to be the case.” We would expect the chemicals of the brain to be different for different heart responses. That just makes sense. That’s part of how God made us and it’s part of how our heart initiates the actions of people.

Now we’re breaking up the outer man to distinguish between the brain and the body. Obviously, the brain is part of the body, and I understand that. I did pass ninth-grade biology, so I get that. For our purposes we want to see that there’s a connection there because the brain mediates those bodily responses. Of course, it wouldn’t just be the brain. It would really be the whole central nervous system of which the brain is the most important part. Feelings, words, and actions are mediated by the brain, which is driven by the inner man (the heart). I love Welch’s phrase there: “The body is the equipment for the heart.”

Let’s move on now. Now, it’s true that the heart drives the body. That’s what we’ve seen. But did you know that the Bible also teaches that the body affects the heart? I will prove this to you.

One example: a sickness or disease, including brain damage. I’m working with a gentleman in our church in counseling and just trying to be an encouraging pastor to him. He has Parkinson’s disease. Parkinson’s disease is a real, medical sickness. There’s obviously something going on there. Do you think, as he tries to deal with the issues in life, that Parkinson’s affects how his spiritual heart responds? Oh man. It’s degenerative too, so every week he gets a little bit worse. Parkinson’s or Alzheimer’s or things where there would be real brain damage, or a physical injury such as a brain injury when someone is in an accident and experiences some brain damage or brain trauma, certainly affect the heart. A physical or mental disability—something like muscular dystrophy, multiple sclerosis, cerebral palsy, mental retardation, or down syndrome—affects the heart.

My little brother has severe cerebral palsy. I grew up with a brother that had that physical and mental disability. For him, it was more physically than mentally severe. I had lunch with him a week and a half ago actually. The topic of our conversation often goes to: How are you dealing with the on-going realities of this body problem that you have? By God’s grace, he’s a believer and he’s walking in faith and doing really well, even in the midst of significant physical challenges that come from that.

What about just being hungry or tired? Have you ever noticed how irritable we can get sometimes when we don’t get enough sleep or we didn’t get our morning cup of coffee or anything like that? Or hormonal changes. It’s true that our bodies have times where hormones change. We can think of the time of puberty and adolescence; we can think about a woman’s cycle or later on in menopause. Hormonal changes vastly change our body and that can affect our heart.

Strengths and weaknesses affect our heart. For example, you may be a world-class basketball player, or you may have a PhD in mathematics and you can do math problems that the rest of us can’t even read. Strengths and weaknesses, talents and abilities, skills, and giftedness all affect our heart. One of the classic things with young people is they may want to grow up to be a pro football player and God didn’t give them those abilities. That can put pressure on the heart to respond in a sinful way.

Medications, illegal drugs, or other substances, certainly affect the body. Chemical dependence—when somebody becomes dependent on an outside chemical—also affects the heart. We’ll talk about brain changes in a minute, but sometimes our brains change and that affects our hearts also.

Summarizing what we’ve discussed so far, it’s true that the heart drives the body—or if we break it down, we can think of it as the heart drives the brain which mediates to the body—but both the body and the brain put pressure then back on the heart. Our body affects our heart. We see it as simply as sometimes when we’re well-rested, we tend to respond in a more godly way than when we’re not well-rested.

Now, here’s a question. Where in this paradigm would you put an emotion? An emotion is a heart response coupled with a bodily feeling. What’s anger? Anger is something that the Bible says starts in my heart. But there’s a feeling to anger, isn’t there? I can take your blood pressure when you’re really angry and show you physiologically that you’re different than when you’re not angry. As biblical counselors, we deal with emotions a lot, right? What is an emotion? An emotion is a heart response that leads to a bodily feeling. It’s both heart and body.

Let’s use anger as an example since I brought that up—where does anger originate? In the heart.

Where does worry initiate? In the heart.

Where does lust originate? In the heart.

We see that what we think of as emotions are actually heart responses. They actually start in the heart, but then there’s an overflowing of that response into the body, and thus every emotion also has a physiological component (or body component, if you will). Therefore, an emotion is both a heart response and a bodily feeling.

This is a very important point: Yet a person’s body, including their brain, cannot make a person sin. People are always responsible before God for their actions. Look up Romans 2, which says that God in judgment will render to every person according to their deeds. In the biblical view, judgment is based on what you do. You are, I am, everybody is 100% responsible before God for what we do. We can never blame our body for a moral decision that we make. We can never call something that the Bible calls sin a body problem, a sickness, or a disease. The first practical application Welch says of the biblical view of the heart and brain is that the brain cannot make us sin.

You may have counseling cases where people have serious physical issues. When I talk to my brother who has severe cerebral palsy, there are times that I want to say, “He can’t help how he responds.” But my theology rescues me in that temptation because the Bible says that no, he is responsible. What’s neat is that he’s a little younger than I am, but he’s old enough to recognize that it’s really true that though he has the severe body problem, he is responsible before God for how he responds.

Once again, the heart—which is where desires, thoughts, beliefs, attitudes, and choices originate and is what the Bible calls the inner man—drives the outer man, which includes the brain and the body. The brain mediates the heart’s orders to the body, and then the body responds with feelings, words, and actions. However, the brain and the body (the outer man) put pressure on or provide feedback to the heart in all of the ways that we articulated. Does that make sense?

APPLICATION

There are dozens of counseling issues that are going to come to you. What you have to do is you have to say, “Okay, here’s an issue or a topic that I’m dealing with in counseling and there’s a body component and there’s a heart component.” You have to take it and put it into this paradigm and then help your counselees to understand why they’re doing what they’re doing and what’s going on.

I want you to think through these issues with me. We’ve discussed the paradigm. Now, I’m going to give you three counseling topics and we’re going to put each one in this paradigm and try to think through it.

1. The use of psychotropic drugs

The first topic we’re going to talk about is the use of psychotropic drugs. Let’s talk, first of all, about the world’s view. The world’s view of people (the secular view of people) is not the paradigm that we just discussed (that there’s an inner man and an outer man). Here’s how the world’s view or the naturalistic or materialistic view of people goes: people only have one part; it’s material. We’re animals, theorists say. There’s just this stuff and one day this stuff dies and the person ceases to exist. In that view, the brain drives the body, the body affects the brain, and that’s it. In this world view, where do all problems have to originate from? The brain. That’s why today everything in counseling is being moved to be seen as a brain disorder. That’s not so much a reflection of the medical data as it is a reflection of the naturalistic, materialistic worldview.

Then, under that view, what do we do with people that have problems? Well, it must be a brain problem, so we’re going to give them some medication and that medication is going to address the problem in their brain. The result, we hope, is that they have improved feelings and function.

In this worldview, the brain is the final and ultimate cause of behavior. This is why the chemical imbalance theory of the brain has been so popular for very long. You’ve seen the commercials just like me. Prescription Zoloft is effective because depression results from a chemical imbalance in your brain, and prescription Zoloft will change that chemical deficiency and the depression goes away. That’s a theory called the chemical imbalance theory. It’s so popular because it comes out of this worldview.

Now, let’s think about the use of medications with our biblical view that we’ve already discussed. A person has a problem. A person is experiencing bad feelings of some sort. They’re depressed. They’re anxious. Something like that. The Bible tells us that those bad feelings should do what? They should draw our attention to and motivate us to address the heart because those bad feelings are a bodily response to what’s going on in the heart. The Bible teaches that effective feelings are the result of the heart.

You probably know the text of Genesis 4, so we don’t need to turn there. Cain and Abel bring their sacrifices; God accepts Abel’s sacrifice and rejects Cain’s sacrifice. The Bible tells us in Genesis 4 that when God did not accept Cain’s sacrifice, Cain became angry and his countenance fell. Remember that? I think that’s in Genesis 4:7. That little phrase “countenance falling” is one of the many ways that the Bible describes what we would think of as depression. Then God comes in and do you remember what God says to Cain? He says, “Cain, why are you angry and why has your countenance fallen?” Then God says something that is so profound, it’s amazing. God says this to Cain: “If you do well, will not your countenance be lifted up?” Here’s my paraphrase: Cain, if you choose right now to do what is right—which for him would have been to repent and turn back to God—if you do what is right, you will feel different. God’s telling Cain that he can change how he feels. How is he going to change how he feels? By doing the right thing in his heart, right? That’s what’s going on. In the biblical worldview, a person feels bad, and many times those bad feelings are coming because a person is responding the wrong way in their heart.

Now, why are those bad feelings there? What are those bad feelings designed to alert us to? That there’s something wrong in the heart. When a person feels depressed, anxious, or blue, that’s God’s warning system to say, (alarm sounding) “You need to look at your heart. There’s something wrong there.”

Then, if we give that person medication that makes those bad feelings go away, we’ve made them feel better, but what have we not done? We’ve not affected the heart. We haven’t helped them with the real problem. Here’s the deception: when we give a medication when the feeling is actually a result of a heart issue, we lead them to believe that the problem has been solved because they feel better when in fact, they don’t. Footnote: I’m not saying there’s never a time to give somebody medications. What I’m saying is when we give the medication to make them feel better when that feeling is a direct result of something in their heart (a spiritual problem), we do not help them, we actually harm them, because they feel better, but their heart is still engaged in the same wrong response.

Think of bad feelings as God’s warning system that there’s something going on in the heart. If their feelings improve because of the medication, now what? There’s no motivation to address the heart. They feel better, so why do they want to deal with their heart? They don’t because they feel better. Listen again to Laura Hendrickson. This is so helpful. “Emotional pain or distressing thoughts may be signs that something is not right with our heart, our inner person.” Now listen to this since it is so important. “Our feelings aren’t dysfunctional or sick. Our feelings are doing just what they were created by God to do. They’re showing us that we have a problem, and to feel better, we need to fix the problem, not just make the pain go away.”

You know, if I’m walking across the stage and I step on a nail, there’s a nail embedded into my foot and it hurts. I’ve done that before. Let’s say that someone comes up to me in great compassion and care and says, “Okay. I’m so sorry you’re hurting. Here’s a painkiller.” I say, “Oh, thank you, brother. Thank you, sister.” A few minutes after I take that pain killer, I feel much better. I feel way better, and I walk around the rest of the night with that nail in my foot.

You see the problem? We can think of it as spiritual pain is designed to do the same thing that physical pain does. Physical pain, as God designed our body, is designed to alert us to a problem that needs to be addressed. When we touch a hot burner and those pain receptors in our hand go, “Oh, there’s something wrong” — that’s designed to pull my hand off before my hand wastes away. That’s what’s going on in some counseling situations with what we might think of as emotional pain or spiritual pain.

Laura Hendrickson again says: “Painful feelings are meant to motivate us to change. When medicine masks painful feelings, there’s no motivation to learn to deal with them in a more godly way, and when the medicine is discontinued the painful feelings will return.” Doesn’t that make sense? That’s why so many doctors don’t want people who are on psychotropic drugs to come off because usually what happens is when you take somebody off a psych med, their problems come back. Why is that? Often because they’ve never dealt with the problem. They’ve never dealt with the real heart of the matter. The medicine is just making them feel better. You know what? As a pastor, as a counselor, as just a friend, I want people to feel better. I don’t want them to feel bad. But I want to help them by getting to the source of the problem and helping them change in their heart. Because at the end of the day, the goal is not just to make them feel better physically, the goal is actually to help them to honor God out of their hearts. That’s what we biblical counselors get to do.

Conclusion #1: We need to be wise in thinking about the use of psychotropic medications. While there may be situations where medication is appropriate, we don’t want to encourage counselees to take medications for clear heart issues, which may improve their feelings but not address the real problem. That’s conclusion #1 from our first example.

2. Addictions

Let’s talk about a second example: addictions.

The course that I had the privilege to teach in Russia this past summer was on addictions. Russia has one of the most, if not the most, significant alcohol problem in the world. They have a pretty serious drug problem too. Their most popular drug is something called crocodile. It’s a homemade version of meth that you can make from common items that you can find at the local drugstore in Russia. The lifespan of somebody doing it is like three years. It’s just killing people right and left.

Our paradigm for understanding biblical psychosomatics helps us with addictions also. Let me give you some examples.

Let’s go back to our secular worldview of naturalism or materialism and the disease model of addictions. When addicts are studied through the secular worldview (which is the naturalist materialistic view), noted structural changes in the brains of addicts are understood to be the cause of the addictive behavior. This conclusion is driving the large movement today to understand addiction as a brain disease, not a moral or spiritual problem.

You know what? It’s absolutely true. You can do brain imaging (MRIs or PET scans or something like that) and you can look at the brains of people who are alcoholics or people who are addicted to some narcotic drug or some prescription medication and you can show them from the pictures that their brains are structurally different. That is medically true. The problem is that they’re interpreting that data through a secular worldview, a materialistic naturalistic worldview. There’s no inner man in that world. There’s no heart. Therefore, all they say is, “Their brains are different so their brain must be causing the addiction.” Do you see that? That makes total sense if that worldview is true.

But the Bible gives us a different worldview, a different perspective on people. Let’s take that idea and look at some examples here. For the one who embraces the philosophical view of naturalism, the brain is the final ultimate cause of behavior. We talked about that already. An article called Brain Atrophy and Alcohol shows a diagram with two sets of pictures. On the left, three pictures of a person’s brain, taken from different angles, showing black dark spots in that person’s brain. I’m not a medical doctor, but I’ve had three or four medical doctors help me know how to read those pictures, so hopefully I’m representing the pictures accurately. The three pictures on the left-hand side of the diagram are from a person who is abusing alcohol and the black spots are what is called brain atrophy. That’s the medical word. We would say that their brain is shrinking. There are holes. Cells are dying. Connections between cells are being lost, and there is actually less tissue in their brain. Then there are pictures of the control group on the right side of the diagram from a person with a normal brain who is not abusing alcohol. There is clearly a difference in the images. On the left-hand side, there’s less brain tissue because the brains of people who are abusing alcohol have this atrophy going on.

This is interesting. An article in Molecular Psychiatry, October 2013 discusses a study of video game players—young men who played video games. They discovered that brain gray matter increased in young men who played video games. What do you do with that? I don’t know, but their brains are different. You can read the article if you want to read their conclusions, but my point is, pictures of people’s brains that are in various sorts of addictions show that their brains are legitimately different.

Here’s another example that I just always can’t believe from PET scans from Baler and Volkow in their article “Drug addiction: the neurobiology of disruptive self-disrupted self-control” quoted in Trends in Molecular Medicine 2006. When they do PET scans, the colored part shows glucose metabolism—basically, the areas of the brain that are processing sugar, meaning that those cells are active at that moment. The article showed PET scans from the normal group and from a cocaine abuser 10 days after abstinence. Even after 10 days of abstinence, the brain of the cocaine abuser had not returned to normal functioning. Even after 100 days of abstinence, their brain had not returned to normal functioning.

Then, how do we understand addiction from a biblical point of view?

This is important. Do you counsel anyone with an addiction? This is very, very popular right now. We’re seeing lots of people struggle with alcohol and drugs. The way the psychological community is understanding it, they’re putting gambling and video games in that camp now. Our pastor who taught at our advanced track last year did a whole talk on what he called “technology addiction.” I don’t want to step on any toes here as I was convicted by the message personally, but you can end up being addicted to almost anything.

As biblical counselors with the Bible as our framework, how do we understand this medical data that says that the brains of individuals with addictions are different? How do we do that? Our model helps us to understand it this way: biblically, we must understand these changes as simply the physiological component of addiction. Remember that I told you that anything we do morally is going to show up in our body in some way. We expect a physiological change for anything that we do. Of course, addiction is no different. Since people are both body and spirit, we should expect that all moral behavior will be accompanied by corresponding physiological changes. This does not mean that the body causes the addiction or that addiction is a disease. Instead, body changes in addiction are one of two things according to the biblical view for understanding this medical data:

1. They are either a body influence rather than a cause; or

2. Perhaps they are the effect of the addictive behavior rather than the cause.

Those are your two options. It can be part of a person’s physiological makeup that doesn’t cause them to be an alcoholic, but it influences it and is part of the equation. Or, it’s the effect of the behavior and that’s what alcohol does. You know, “This is your brain on drugs.” I mean, that’s what it is. At this point, as best as I can tell, scientists are not able to determine conclusively if the changes in the brains of addicts are an influence prior to or the effect of their addictive behavior.

I have two medical articles here with me. The first one is from Journal Watch, which is a publication produced by The New England Journal of Medicine from April 1, 2012. In this publication, they review many important articles that come out in medicine in a particular field. I read the one in the field of psychiatry all the time because I’m interested in what’s going on in the psychological community. Here’s the headline: “Abnormal Brain Structure in Addicts: Cause not Effect.” This article is claiming that stimulant addiction may result from inherited abnormalities in brain structures that impair behavior. What they did is they imaged 50 series of sibling pairs. One sibling was addicted to a stimulant of some sort and the other was not addicted. Their conclusion at the end of it was that there were changes in the brain that led to the addiction. The conclusion of this research was that the brain had some changes in it, and that’s what caused the addiction. Now interestingly enough, listen to this: “Why the siblings of addicts with the same structural changes were not themselves addicted remains unclear.” That’s the comment by the physician that oversaw this article. Basically, you’ve got two siblings, and they both show changes in their brain. One becomes an addict, one doesn’t. The article concludes: “See, their brain made them do it, and by the way, we’re really puzzled why the sibling that had the same brain changes didn’t become addicted.” That tells us right away that there’s something more than just the brain causing these things. In fact, that fits much more in line with the biblical view of persons.

Now the second article I have here shows that the brain scans that we just talked about are actually the effect of the addictive behavior. The authors would say, “No, those changes are actually the result of them using the drug or using the alcohol.” You have some scientists saying that the brain changes led to the addiction, and you’ve got other scientists saying that the brain changes came from the addiction. They’re trying to figure out which one is which. Of course, biblically, it’s either an influence or an effect.

Now, in all addictions, there are chemicals—either foreign that are introduced in the body or natural manufactured by the body—that affect the body and contribute to the experience of addiction. If you put alcohol in your body, that affects your body, right? If you put a drug in your body, that affects your body. But did you know that when a person looks at pornography, engages in gambling, or plays video games, there are also physiological changes that happen in that person’s body? Some scientists believe that those physiological things that go on are very similar to putting something into your body. If we put a foreign substance into our body or maybe we have a natural chemical that is produced when a person gambles and they get that gambling high, those are going on in the brain. What does that do? It puts pressure on the heart through cravings, pleasurable experiences and feelings, and withdrawal. The reason that a guy who’s trying to stop gambling has withdrawal symptoms in the same way that a guy who is trying to get off alcohol is because some of those same chemical things are going on in his body.

What do we do with all this information?

Conclusion #2: It’s important that biblical counselors recognize addiction includes both heart and body components. That’s what you need to remember. If you’re dealing with somebody with addictions, you need to recognize that most certainly you need to address the heart, but you also need to remember that the addiction very often is manifesting itself in the person’s body. Now, we’re not saying the body did it. Our biblical conclusions don’t allow us to make that conclusion. But it may be prudent in some cases for biblical counselors to solicit the help of a physician to address some of the more severe body issues that are present with some types of addiction. I’ll give you one example. You definitely want to solicit the help of a physician if you’re trying to help a heroin addict get off heroin. The withdrawal symptoms of many drugs, including something as strong as heroin, produce such huge withdrawal physiological effects that you want a medical doctor there to watch over the body part and to oversee coming off any drug in a safe and effective way. I said it once and I’ll say it again. As biblical counselors, we don’t practice medicine. We don’t do that. We send counselees to appropriate medical professionals and we let the professionals address the medical problems, the medications that they’re on, and body issues.

3. Genetic determinism

One last area. This is pretty short and then we’ll wrap it up here. What about genetic determinism (that everything that’s wrong with you comes from your genes, basically)? Why do you do that? Well, it’s hereditary. It’s your genes. Your genes made you do it. We don’t blame the devil; we blame our genes. There’s a worldview that says: “Well, if you’re just a body, that makes sense, right?” That’s the naturalistic, materialistic worldview. Biblically-speaking, we know that can’t be true. Our genes are part of our body, but as we’ve seen, that’s not where moral behavior comes from. Moral behavior originates from the heart and we know that.

What’s interesting, and I’ll leave you with this, is that secular authorities are starting to realize this as well. Let me give you a quote from Stephen Stahl, who is the foremost expert on psychopharmacology (how drugs and the brain interact). Listen to what he says when talking about where mental disorders come from: “The new paradigm…”—meaning for understanding the relationship between genetics and psychiatry—”…conceptualizes genes not so much as the direct cause of mental illness, but as the direct cause of subtle molecular abnormalities that create risk for mental illness. Genes may thus act by biasing an individual’s brain circuits toward inefficient information processing and possible breakdown into psychiatric symptoms under certain environmental circumstances.” If you follow Dr. Stahl there, that is a huge admission. What he’s saying is: We don’t think it’s as simple as saying your genes made you do it. He’s saying that we know genes are in play, but there’s environmental factors, certain circumstances, and certain situations, maybe that’s it. As biblical counselors, we can say that we have a better model for understanding people because it’s God’s model. I would argue that it even explains the medical data better than the secular model does.