Dale Johnson: This is Mental Health Awareness month, the month of May. And as it has become our custom, the last few years, we are addressing several different topics regarding the issue of mental health. Today, we’re going to entertain a topic related to biological psychiatry. We’ve talked about biological psychiatry in the past (episode 258), this was last May we talked specifically about biological psychiatry, we don’t want to rehash all of that. I would recommend that you go back and listen to that podcast. It gives you some information about the history of it, what biological psychiatry is.
Let me just summarize, the idea of biological psychiatry is trying to explain the psychological productions of man from some sort of reduced biological explanation, David Powlison in a Journal of Biblical Counseling editorial back in 1999, wrote this as he summarized biological psychiatry or bio-psychiatry. He said: “It’s an explanation that your psyche becomes a byproduct of your body.” That’s the way that a lot of research in the modern, particularly since 1955, really began to amp up, became prominent in 1980 and today it’s the primary way that we think about the idea of mental disorders. Again, I’ll give you the back and forth year relative to the history of biological psychiatry where biological psychiatry sort of ebbed and flowed in its emphasis in history. It’s certainly more recent, the last several hundred years between what’s called romantic psychiatry, and that’s more of your moral therapy or your talk therapy, this would be Freudian psychoanalysis, this would be your humanistic talk therapy approaches. And those two things have been sort of at odds and what’s happening now even in the current literature is those two things are rising as two opposing views and I think people don’t often recognize that.
Today, Sam Stephens is here with me to discuss some of these issues. You guys are familiar with Sam. He is our Director of Training Center Certification. He also teaches here at Midwestern Baptist Theological Seminary in our Biblical Counseling department. Sam and I love to read about this subject. We love to discuss this subject. It’s very interesting to us. As we think about biological psychiatry and really what’s happened particularly since 2013, we’ve seen an increase in concern, as it relates to the model of the Diagnostic and Statistical Manual of Mental Disorders and the way we think about mental disorders from primarily a biological perspective. But what’s happening even right now is an increase in literature that’s questioning this narrative of biological psychiatry and calling it reductionistic. We’ll explain that as we move forward.
We want to interact today, if we can, with an article that was presented last year in 2020, and it comes from the Harvard Review of Psychiatry and this is the title of that: “Messaging in Biological Psychiatry: Misrepresentations, Their Causes and Potential Consequences.” It’s really interesting to see this literature as it continues to unfold, questioning the narrative of the last several decades of biological psychiatry being propped up as some sort of scientific pinnacle of explaining psychiatric disorders or psychological disorders. So, Sam, I want us to sort of dive into this if we can because some of the things that we’re going to talk about today may be shocking to some of the people that we’re going to introduce this idea to. I want to make sure that we explain it carefully, we explain it well. This podcast will probably extend into at least two, so I want to make sure we slow down, we explain this as good as possible. What I want to do is to start off with just assessing some of the literature, that’s what these guys are doing here in the Harvard Review of Psychiatry. They’re assessing some of the scientific literature and some of the various problems that they see, some of what we’ve called the misrepresentations of biological psychiatry. So I want you just to introduce our listeners to this idea about some of the literature, where it’s leading, what some of the things that are being said even now.
Sam Stephens: I think it’s fascinating to consider that actually this is coming from within the field of psychiatry itself and even broader scientific research and studies on psychiatry, its impact on medicine in general. Many of our listeners, who are our members or just interested in this topic, may not be aware of that because that does not come across in mass media. It doesn’t come across in the general parlance of discussing mental health, mental illness, which is very common in our culture and society here at least in the West.
So, with this particular article there are two major thrusts that the researchers are getting at. One is that we’ve already talked about the biopsychosocial model or what they also identify as the multi-causal explanation of mental disorders. Let me talk about that for a moment, that is basically, there are multiple factors, not just one that is the cause or explanation of mental illness, mental disorders. The thrust of this article is that the biopsychosocial model should be considered as important or at least as important as the biological model or the monocausal model of psychiatry.
Dale Johnson: Let’s break that down for a second. The biopsychosocial, you can hear the language that is there and some integrationist Christian psychologists even use this phrase biopsychosocial and sometimes add spirituality in relation to that. What they’re trying to do is to explain man to some degree. They are pushing against, in some ways, the exclusionary or reductionistic view of biological psychiatry saying, “No, we can’t reduce all of our emotions down to just some sort of neurological problem.” They would acknowledge that there are probably issues of chemical imbalance in the brain, but there’s also spiritual explanation. They look at those things as different buckets, if you will, of man and that there are different ways to deal with some of the problems of man depending upon the category that it’s defined by.
Let me give a quick history of this. Biological psychiatry was gaining ground as I said, from the 1950s into the 60s, 70s, 80s, and beyond. There was a physician by the name of Engel who basically constructed this model. He saw where things were going and I think rightfully so, he began to raise some caution. He saw that we’re trying to explain humanity from a biological only perspective. Now, we have to pause and acknowledge we are biological beings, we are physical beings, but that’s not all that we are if the Bible is true, and I believe that it is. As we look at where biological psychiatry is going and where it has been, that’s a concern for us. It should be biblically because it’s explaining man in different ways that in the Bible explains man and those things can’t be true if the Bible is true. I think he was right to raise concern. Now, the way he responded, I think raises caution into this biopsychosocial model and what’s happening. Maybe we’ll talk about this in a future podcast, but there are major questions being asked in the last decade about this biopsychosocial model. Is it an appropriate way to categorize psychiatric or psychological problems that people are facing? And this is not religious fanatics, crazy people like me asking this question (or Sam), right? This is people in the field. One of the leading guys who’s critiquing the biopsychosocial model is from Tufts University in Boston, one of the leading institutions of higher education relative to psychiatry in the country. We’re talking some major discussion that’s happening now. I understand this is a little bit deeper than we normally go, but these things are important if we’re going to understand that worldview and approach of mental health, okay? Sam, I interrupted you very rudely. I want you to get back into describing some of the terms here and then some of the literature that we’re seeing mass media just explode and build a narrative that’s not an accurate scientific expression, but is so dominant in the culture that we live in.
Sam Stephens: We talked about that first thrust and so I’m glad you clarified that the researchers and this article at least implicitly are definitely in favor of that multi-causal explanation, right? They even identified that biological psychiatry, that monocausal is one explanation that’s purely naturalistic and biological, all mental disorders come from this. They’re pushing back on that and saying listen, the main message delivered to laypeople is that mental disorders are brain diseases. That there’s no difference between mental disorders, as we would find specifically laid out in the DSM with biomedical diseases and that this messaging, at least what they put down very cautiously, is misleading. This gets to the second thrust of the article, that media represents psychiatric studies and research broadly as fact—a scientific fact—and consensus.
Many of our listeners, I would say probably even more so our counselees, are getting their information, their understanding of mental disorders, the psychiatric complex, mental health broadly speaking, not from these studies that we are referencing that comes from research and these types of things, but they’re getting them from a secondhand source, they’re getting them from mass media, newspapers, from news stories that you hear. I mean, I don’t know about most of our listeners but when you turn on the news in the morning, I want you to listen in the next few mornings. Listen for stories that come out about these studies that come out regarding mental health and how different activities and different ways of thinking improve our lives in various ways. This is again, it underlies in a big way, the way that we think as a society. These are two major thrusts in this article. One that we should consider or that the field should consider biopsychosocial explanations as just as important, if not maybe more important, than the biological model and that secondly, the media generally represents biological psychiatry in a very favorable way, but that’s problematic because there’s not a lot of consensus behind that approach.
Dale Johnson: I want to go a little bit further into that but I think it’s fascinating. I’m just going to read you the first few sentences of the abstract where they’re explaining in this article what they’re getting at. Then Sam, what I want you to do is talk about some of those problems that they’re identifying in the scientific literature because I think that’s really, really critical here. This is what they say: “Most experts in the field of psychiatry recognize that neuroscience advances have yet to be translated into clinical practice.” And I think that’s interesting, even from our perspective, because we’re seeing that explode even in the biblical counseling movement. Some people are entertaining these ideas of neurological advances, neuroscientific advances, and these things are important, I’m not dismissing that, absolutely not. But there’s an assumption that when you have some sort of neurological explanation for this or that, it gives scientific fervor to it. And that’s not what they’re saying. What they’re saying is that people are trying to build their scientific, you know, vigor on the back of neurology, but it’s not translated into clinical practice at this point. They continue to say the main message delivered to lay people—this is people in the culture broadly—however, is that mental disorders are brain diseases, cured by scientifically designed medications. Wow. This isn’t me saying this, these are researchers from Harvard, making this statement, both PhDs who are writing this, they go on to say, “Here [in the article] we describe how this misleading message is generated. We summarize the academic studies describing how biomedical observations are often misrepresented in the scientific literature through various forms of data embellishment, publication biases favoring initial and positive studies, improper interpretations, and exaggerated conclusions.” That is a massive indictment on the literature that’s often used to propagate these ideas and quite frankly, it’s often used to squelch biblical counseling as an approach. As if it’s too simplistic, it’s not complex enough, you guys aren’t understanding science. We have to clarify here. What are some of the things that we’re seeing in the literature?
Sam Stephens: Well, and even on a personal note, I’ve mentioned this to our listeners before. When I began to engage in a lot of this literature, I was very intimidated because I’m not a scientific researcher. You read some of these studies and you come at the end of them and you think, “Well, I mean, it sounds pretty reasonable to me. It sounds pretty founded.” What I really think is fascinating about this particular article, this particular study demonstrates that not even just in psychiatric scientific research and studies, but even broadly that these elements are found quite often. Let’s dig in a little bit deeper for our listeners to kind of explain what are some of these issues, these problems, in the psychiatric scientific literature that we find quite often.
The first thing that you mentioned was data embellishments. What is that? That can come in several different forms and they cite all of these studies, by the way, at the end of the article. I would encourage our listeners to take a look at the article, we’re going to provide it in the show notes for you, and you can find these studies, many of them are open source so there’s not a paywall. Some of these are examples of deletion of data, what actually should be included in the study to give the most accurate picture of how the study was conducted in the outcomes, just simply is not included to give the final result. I mean, you can stop right there. That’s very problematic. That really is a problem in just how science generally should be conducted in the first place. The entire scientific method really is at risk when you don’t include the full, accurate picture data.
Also, there’s the issue of ending data collection once desired outcomes are reached. Now, this kind of bleeds into another issue that is found quite often, and this is in particular in the social science as scientific literature, regarding positive outcomes. What that means is generally in scientific research, the scientist has a hypothesis, they test the hypothesis and then the results are measured up against that hypothesis. I put it very simplistically for all of us to understand how that generally works. What one interesting article found, and again, these researchers cite this study, this is from a few years ago, but the study looked at scientific studies from across all the different types of sciences. We generally would think of sciences as the hard sciences and then the soft sciences, which are going to be sociology, psychology, psychiatry. They looked at this broad spectrum, everything from astrophysics to physics to chemistry to, you know, more of the social sciences, political science, and psychiatry and they looked at the positive outcomes of these studies. Do you know which of these categories by far yielded the most positive outcomes? It wasn’t the hard sciences, it was psychiatry. What these authors put forward in this particular article that we’re referencing is that that demonstrates some of the embellishment of data. How interesting that over 80 percent, leading up to a few years ago, of the outcomes of these studies were positive—the hypothesis perfectly matched the outcomes of the study. When you look at what this one referenced article brings up is when you look at how these often go, that’s very, very abnormal. You don’t typically find that—especially, again, when you’re trying to (and what good science does) is it tries to explore as far as it can the implications of the study and the research and the outcomes. They really want to test the hypothesis. Is it accurate or not? So that they’re finding that these hypotheses from researchers come out positive at this high rate is very interesting. Again, they tie this into the media output that generally, the mass media is very favorable to these types of studies. Again, you see them everywhere and so when there’s at least an initial positive outcome from a study or again, the data is embellished or somehow collection of data is ended to promote a desired outcome. These things are often pushed by the media and there are several examples included in this one article.
Another thing that they bring up is exaggerated conclusions. Now, I find this to be really interesting as well. Along with the social sciences having a very high positivity rate in a lot of these studies is that the conclusions are broadly applied. Typically, when you read these types of studies you get two major aspects. One is the data and an explanation of the data. What was the sample size? What were the different stipulations of the study? And then you have some sort of summary. And again, if you’re not used to reading these types of articles, it may feel kind of strange reading it, but these are the two elements that you’ll find.
One thing that I found interesting that this article brought up was that oftentimes the data presented, if it’s accurately presented, and the summary of the data don’t match. The summary is much more glowing, if you will, it’s much more positive than the data actually translates into clinical practice, clinical reality. They’re saying that you’re not seeing a really realistic matchup between these two things. Again, there are many reasons behind that but one is, when you think about just the whole effort of publishing in scientific or academic journals and then even just the research context, there’s a lot of need to obtain funding for ongoing research. Well, what gets funding? Positive studies or at least promising studies. You’ve got to put this factor into play and they include that here in this article as well.
Dale Johnson: Just a quick aside relative to that, the specialization that’s happening in psychiatry and psychology broadly, I think is becoming more and more reductionistic into certain areas. I think it’s closing our mind to some degree in seeing the wholeness of humanity and what’s involved with us responding emotionally and, you know, as its termed secularly, from a psychological perspective. We have to be cautious and very careful too, even as these things become further specialized, that actually can be harmful to some of the scientific literature because you’re looking in a very narrow window for things not considering outside influence on some of your research.
Sam Stephens: I want to bring this point up to as well. Again, we’re throwing the word science around quite a bit, and we’ve talked about this, that not all science is science. We talked about the philosophy of scientism, so we’re really talking about more philosophical pursuits with scientific language or jargon. But I do want to mention this just to clarify or bring this to bear, I think in a more pointed way, about the initial studies that come out that seem positive and how the mass media really pursue this. I want to quote directly from the article that we are mentioning here: “Science is a cumulative process that evolves from promising but uncertain initial studies, toward a consensus based on a corpus of independent studies confirming, or not, the initial studies. Unfortunately, mass media do not take this process into account.” They take the initial studies and they run with them.
There are several examples in this one article that talk about this, them running away with this. Let me share this one with our listeners because this is really interesting regarding ADHD. Back in 2017, The Daily Telegraph, which is a very large newspaper with a broad circulation in the UK headlined this article “ADHD is a result of brain disorder, not bad parenting.” And so, inside the article, the journalist wrote this quote, “the scientists behind the study say that their findings prove for the first time that the condition has a physical cause.” Again, you hear that type of stuff pretty regularly here in the US, even in our news stations and programs. I mean, how many times have you heard about “This study proves X”? And then the next week you hear the exact opposite, “The study proves X.” This is clickbait, a lot of it is. What the writer in this article says, regarding this faulty way that The Daily Telegraph has interpreted the research, they said, “Yet, structural changes in certain brain areas are not necessarily the cause of mental disorders [as the authors in The Daily Telegraph have suggested]. For example, the most robust difference between the brains of depressed patients and those of healthy controls relates to the volume of the hippocampus. A large, international study showed that this volume reduction is modest (1.2%) and appears only after years of depression. It is not observed in patients diagnosed with a first depressive episode. Consequently, this minimal atrophy of the hippocampus might be the consequence of chronic depression rather than its cause.” This is a confusion between correlation and causation and how the mass media really works that in a very general way to promote the positivity of these types of studies.
Dale Johnson: Yeah, and I think that’s really helpful. Let me translate what he just said relative to the depression study. What he’s saying is that what is termed scientific neurobiological—those things are true, but what’s the part of the data that’s not given is that people describe this as a cause as if this appears early on and it’s causing our depression. Well, what studies are actually demonstrating is that our state of depression long-term is having a cause on our biology. Wow, that’s really interesting to think about. And, of course, more of that needs to be explored, but it’s really interesting how the mass media starts to promote this. Now, we got to shut this down. I was afraid this was going to happen, Sam, where we jump into this topic and there are so many things to talk about.
This is an important topic to me because and I’m going to continue to beat this drum. And the reason is, because this narrative that we’re seeing outside, and I would use Colossians 2:8 as one of our critical responsibilities, to stand for truth, to stand against false ideologies, empty philosophies, and vain deceptions. That it is one of the major hindrances of biblical counseling, people dismiss biblical counseling as if it’s not real, doesn’t exist, the Bible is not sufficient because they buy into these things. What we’re trying to say is that’s not what the secularists are saying. I’ll finish with this and then we’ll be done for today. This whole article from the Harvard Review of Psychiatry was actually a response to another article that was released in October 2019 from the New England Journal of Medicine. And these two gentlemen, researchers who published this article in the New England Journal of Medicine, and this is one of their primary claims, and what the Harvard Review of Psychiatry article is trying to do is to demonstrate how this happened. Why did this happen? Why did the culture, why did laypeople at large buy into this? This is what the New England Journal of Medicine said. Ironically, although these limitations of biological treatments are widely recognized by experts in the field, the prevailing message to the public and the rest of medicine remains that the solution to psychological problems involves matching the right diagnosis with the right medication. Consequently, psychiatric diagnosis and medications proliferate under the banner of scientific medicine. Though, there is no comprehensive biologic understanding of either the cause or the treatments of psychiatric disorders. That is a major claim. We’re going to try to revisit that in our next podcast next week as we’re dealing with these issues in Mental Health Awareness Month. I hope you’ll join us as we continue this conversation next week on the misrepresentations of literature that we see relative to biological psychiatry.