Dale Johnson: Sam, here we are once again. Our Director of Training Center Certification, professor of Biblical Counseling at Midwestern Baptist Theological Seminary and we’re glad that you’ve joined us again this week. We are continuing a conversation that we had to rudely interrupt because of time and so much that we need to say about this. So we’ll call this a part 2.
We were looking last time at a Harvard Review of Psychiatry article that came out in 2020 discussing the issues of misrepresentations of biological psychiatry, particularly in mass media. They do a really good job of helping us to see some of the problems that have been revealed about “scientific research” relative to psychiatric illnesses, or mental disorders, mental health issues. I want to remind you that may is mental health month, which is why we intentionally focus in this direction. I do hope that you’re not put off by this being a little bit more academic. It certainly is. But I see it as important translated down to the church that this becomes a blockade from so many pastors wanting to engage in biblical counseling. They leave this category that science has this curb on biological psychiatry, we don’t want to pit ourselves against science, as people of faith have done in the past, and so it keeps them from exploring the beauty of the sufficiency of Scripture to deal with the problems that we struggle with in life. It diminishes our Christian worldview, it diminishes the idea that Christ is supreme and holds all things in His hand, including the cells that hold us together of which, by the way that God says He will fully restore at that time when Jesus returns in glorifies us who believe. So it really begins to erode that Christian narrative. That’s our big concern I think, Sam, as we talk about this.
Brief recap, we talked about the various problems of scientific literature. I think it’s important that you guys go back and listen to last week to understand where we’re going this week. But I want to jump in because we have a lot of stuff to cover. We talked last week about this idea of monocausal versus multicausal. Let’s just explained very quickly. Monocausal is what biological psychiatry attempts to do. It attempts to explain, in a reductionistic way, that the psychological problems that we have are because of something that’s gone awry in our body. Now, can we say that they’re influential? Of course, but to reduce it to simply say that they’re the primary cause and that’s the corridor that we look down in order to explain all of these emotional problems that we all have to some degree or another, that’s reductionistic. That’s monocausal. It’s trying to describe a singular cause of the problems that we have.
On the other side, you have the multicausal, which is exactly what it says. There are differing factors that contribute to some degree. That’s most famously recognized in what’s been called the biopsychosocial model of mental disorders or of psychiatry. What I want us to do is to explore the way these guys in the Harvard Review of Psychiatry talk about the lack of support that’s revealed by the scientific literature. Many meta-analyses that have happened to look at some of the scientific research, the psychiatric research, if you will, that’s a demonstrated the lack of validity in so much of the research that’s become prominent and most understood by our culture, to explain biological psychiatry is the answer to all of our problems, but there’s lack of support for it. Sam, I want you to get us kicked off into helping us to understand how these guys reveal to us some of that lack of support for a monocausal explanation of mental disorders.
Sam Stephens: Well, just the note that you ended our podcast on last week should be re-emphasized. That this article is in response to one that was published in 2019 from the New England Journal of Medicine that spoke about that there is still to this day, even after several decades, a lack of “a comprehensive biological understanding of either the causes or even the treatments of psychiatric disorders.” This article is not an oddball in the literature. As you mentioned, there are more and more articles being published all the time. They’re not getting the air time, they’re not being promoted on mass media but from within the field itself people are saying, “Listen, psychiatry at large is grounded in this monocausal explanation that has no scientific basis whatsoever.” Even if you want to expand that into pharmacology at large, that also is grounded in this monocausal explanation. Why is that? Because it’s extremely lucrative, okay? And I don’t want to sound like a conspiracy theorist here but money drives many many things. When you can market and promote life issues as biological causes, you can also market and promote medications that will resolve messy life issues. This is very common to our listeners. This is not something that should sound foreign to you at all. This is the common way that we think about it. In fact, we’ve talked about this, Dale, and you may want to expound on this more, when it comes to direct-to-consumer advertising for things like psychotropic medications, medications that are marketed and promoted and even designed to basically alter reality, to alter mood and these types of things, the US is one of the only couple countries in the world that we can have direct-to-consumer advertising for these types of medications.
Dale Johnson: We should find that interesting. I don’t watch a lot of TV, but one of the things that I enjoy watching is sports. It’s really interesting to see the amount of commercials that come on that are what’s known as direct-to-consumer marketing or direct-to-consumer advertising. Did you know that the US is one of only two countries in the world, along with New Zealand, that allow legally direct-to-consumer advertising? That’s interesting, particularly as it relates to psychopharmaceuticals. If the narrative is true that we are describing—and the research is demonstrating that it is—there is no biological explanation, there are zero biomarkers in psychiatry at this point. There are theories, that’s true, about biomarkers and what’s caused and all that. But the literature has not demonstrated that yet, nor the research. It’s really critical when we see how these commercials are proposed, I’m sitting there watching it, right? And the only ramification that is given in places like the US or New Zealand is legally you have to give the side effects. You know how that happens, right? You do this flowery commercial and at the very ends, you got the Micro Machine Man. You guys remember, if you’re my age, you remember the Micro Machine Man who speaks rapidly to where you can barely understand him. That’s how you hear all the side effects and the possibilities of this and that. It really becomes this risk-reward thing?
Now, I’m not saying this to decry medicine, particularly. I’m saying what it communicates by mass media to our public that is not a true representation. It is, as we’re describing here, a misrepresentation and that is the key piece of this puzzle for me. It’s a misrepresentation of what the literature is actually demonstrating so that way the most of the culture just assumes: “Yes, I take this medicine because I have this and it’s curative.” And that is not the true message.
Sam Stephens: That’s right. And I think that’s one of the implications of this article, that mental disorders are being promoted as being exactly the same as what we would think of as traditional, classical, biomedical diseases. An interesting way to think about that is for most of these biomedical diseases, when it comes to diagnosis specifically, etiology is very important. What’s the organic cause? And how does that display and manifest through symptoms? But often a lot of these psychiatric diagnoses are done quite the opposite. An observer, a diagnostician, looks at symptoms and then comes to a conclusion from the DSM typically on a particular disorder.
Dale Johnson: Well, the distinction there is what’s called criteria-based medicine, okay? That’s just simply what psychiatry is. We see symptoms, we connect that to say, “Well, this medicine helps to squelch some of those symptoms.” People then begin to assume some sort of cause and effect. Then by deduction, they say, “Well, because this medicine alleviates these certain symptoms, then it must actually be chemically repairing something.” That’s a false narrative that we see propagated consistently in our culture. And that’s what we’re trying to explain here.
Sam Stephens: And to emphasize the human element in all this, we’ve got to bring it back down to the very basic component of counseling, which is relating to people. What’s really tragic—I use that word fully understanding its implications—about this monocausal explanation, this biological explanation of psychiatry, is what is prominent throughout this entire article (especially at the very end and Dale and I, both, have read in several books from people within the field) that all of these efforts, all of these promotions of this model and even medicinal approaches and things like this, there’s a lack of improved clinical care. One thing that they mention in the article is what they call this neuroessentialist, that’s the biological, psychiatric explanation of mental disorders, and problems of psychiatric disorders, it affects the care of patients in a negative way. People aren’t treated like people anymore. This is really the critique of psychiatry going back even into the Romantic Period in some sense because when people could not explain bizarre behavior, they were treated not like humans.
Dale Johnson: Yeah, that’s exactly right. I mean, you see psychiatry has a history of dehumanizing people. Especially in the modern era because it’s built upon a naturalistic perspective and so, therefore, it must in some way dehumanize, particularly, when you relate it to a Christian worldview of what humans are in our nature, it is dehumanizing. It deduces man in these particular ways. Now, you mentioned neuroessentialist. I need to break that down, right? The idea is essentially in biological psychiatry, neuro (as in neurological) essentialist, saying that neurology or the brain explains everything. All—our emotions and everything. They’re describing it as the cause of all of our responses. That’s where we have to pause.
You mentioned, and I think this is so insightful and helpful, think about what that says to the person who is depressed. Think about what that says to the person who exhibits schizophrenic symptoms. Think about what that says to the person who struggles immensely with anxiety. A neuroessentialist, or a biological approach to psychiatry, would essentially say, “Well, it’s something wrong with your brain. It’s something wrong biologically with you, whether that be your genetics, or your hereditary influence, or whatever. And this is what’s causing what’s going on with you. And now you’re going to take these medications.”
The percentages of those working across the board with people in alleviating symptoms is more minimal than what you would probably hope or wish based on the research. But what that communicates, then, to a person, think about the hopelessness that that person has, think about how others then respond to them. One study actually demonstrated that for caregivers, those who care for people who have been diagnosed with mental illnesses, or mental disorders, this neuroessentialist conceptualization actually dampens their empathy toward the patient or the client. I think that’s really an interesting and insightful perspective. Most people, when I talk about biblical counseling, may say, “Well, you guys aren’t empathetic. You don’t demonstrate sympathy. You don’t do these things to people.” What’s happening is they assume that the secular world is doing this so well, when in reality what we’re seeing is that reductionism is actually stripping our human natural response of empathy towards somebody that is hurting. It’s a false narrative that people are buying into and that’s an unintended consequence, right? We want to explain biological psychiatry, we want to do away with all the mystery of humanity here and it’s actually taking away our humanness in the way that we would relate to one another and the way that we would care for one another when we hurt.
One other thing that I want to mention here is the empowerment of biological psychiatry. You mentioned the lucrative nature of it and that’s certainly a negative effect and it’s a massive influence. I’ll repeat this one more time. I remember thinking the biggest lobbyists (I used to live in Texas) was the oil and gas industry, right? I’m not making a political statement at all, just recognizing that most people say, “Well, it’s the biggest influencer in Washington, for example.” Did you know that the psychopharmacological lobbyists in Washington are actually the largest body of lobbyists—to the tune of twice as much as the oil and gas industry. That is profound. The point that you’re making, Sam, is absolutely correct that it is lucrative, there is pressure there. But a second point that I think is equally important: Think of the power that biological psychiatry gives us. It gives us power because now we can reduce the problems that we have into our understanding. It gives us power of explanation. It gives us power of categories, it gives us power of labels in such a way that we think we can explain the problems that we have and we can fix them. That’s empowering to us and we like that explanation instead of enduring some of the mystery that we see in Scripture and our weaknesses being exposed, the lack of our intellectual understanding being exposed in relation to God, and our necessity to be constantly dependent on God for wisdom and all things.
Sam Stephens: God becomes a second. He either becomes an afterthought or a nonentity.
Dale Johnson: Yeah, and I think these are some of the detriments that we see that keep us running back to these types of explanations. It’s a part of our sinful human nature to want to explain things in such a simplistic way.
Sam Stephens: The only other thing I would want to add to this. It is heartbreaking to think about this. We as counselors hear about this all the time, we have counselees that are on different psychoactive medications. We think about pharmacology in general and how it relates to this is biological psychiatric approach to understanding mental illnesses and we would agree that in some cases (and this is what the authors of the article say), that psychoactives generally, can alleviate reported symptoms. They do this, but it’s not how they are marketed to the public. As you mentioned in your direct-to-consumer advertising piece just earlier, that’s why they’re called antidepressants, anti-psychotics, anti-anxiety medications. They are proposing, they’re promoted as treating monocausal deficits. A low neurotransmitter in the brain that causes sadness. It’s a singular problem, it’s a biological problem. And again, if you want to talk about reductionism, that’s it right there. It makes it so ironic that many of our detractors would view our approaches being reductionistic, when all of psychiatry, people in the field who aren’t even believers (our cobelligerents) say: “We’re not treating people, this is inhumane.” They may not put it that way, but that’s the gist of what’s going on here. They’ve been writing about this for many, many decades. This is not some sort of peripheral conversation anymore. I think this is a main conversation within the entire field of psychiatry. It’s been and has remained to be a field in search of a science to support its new theories of human problems.
Dale Johnson: Yeah, I think that’s an interesting conclusion. Again, we’re running out of time and we have a few more points actually that we want to make. What I want to do, Sam, if we can, is maybe push this to our final week in the Mental Health Awareness Month and continue discussion of this article because I think this is a profound issue. But before we push to next week and focus on some of the implications (what are the implications of a study like this?), what I want to do is let’s take the academia and bring it down just in a few final thoughts today. We’ll do some more of this maybe next week but a few final thoughts for today: Why is this so important? If you’re sitting there as a pastor. If you’re sitting there as a church leader, an elder of some sort in your church, why is this such a critical subject? Why should we want to know about this? Why is this important to us? Give me just a couple of thoughts of why this might be important.
Sam Stephens: I think the first one is one that our predecessor and ACBC founder, Jay Adams, made extremely well and very often. Pastors don’t have to feel like they have to cede any ground in the care of souls. The care of souls is a direct responsibility, a privilege, of pastors. It is something that all believers can engage in and even if down the road there is any scientific validation of any of these theories, it doesn’t change our mission one bit. Don’t be intimidated by the language. Don’t be intimidated by the frameworks and the hypotheses and the worldviews, just remain faithful. Trust the Holy Spirit, trust that the Word of God truly is sufficient. I think what the temptation is to do is to either say, “Well, there’s a certain level of problem that is out of my hands and my control. I can’t speak to it. It has to go to this realm.” When the truth is, regardless of the severity of the problem, there is always a place for the minister to speak. Always, because we are people made in the image of God. Let me encourage our listeners, our biblical counselors, our lay people, especially our pastors, keep being faithful, minister the Word, don’t cede that ground.
Dale Johnson: And trust the power of the Word and the supernatural ability of God to do His Work. We can’t minimize that. And that doesn’t translate into a “scientific world” very well. I’m going to leave you with one thought as we conclude this particular podcast on biological psychiatry. David Powlison wrote an article back in 1999 in the Journal of Biblical Counseling. I want to just use him to answer the question that I posed to Sam. He’s talking about biological psychiatry and he’s talking about how prominent it had become in the latter part of the 20th century and basically what he tries to do is to say this is deeply affecting the church already, so let me give a couple of responses. I want you to listen to the wisdom of Powlison as to why this is such an important issue. He gives a couple of arguments. I’ll just give you his first.
This is what he says. “First, what God has said about human nature, our problems, and the only redeemer is true. It is true truth. His truth is reliable. What the Bible says about people will never be destroyed by any neurological or genetic finding. The Bible is an anvil that has worn out a thousand hammers. Neurology and genetics are finding lots of interesting facts. New findings will enable good doctors to cure a few diseases, which is a genuine good. More power to them, and we will all be the beneficiaries. But biopsychiatry cannot explain, nor will it ever explain, what we actually are. All people are in the image of God and depend on God body and soul.”
I don’t know that there’s anything I can add other than Amen. Thank you, Dr. Powlison, for giving such clarity early on. I want us to return to his clear thinking in how we discern and think wisely about some of these philosophies that are impacting and even fear-mongering us who believe by faith. I want to encourage you with that. Don’t forget to be with us next week as we conclude this discussion on biological psychiatry and some of the misrepresentations that we see propagated consistently to the culture at large.