Dale Johnson: I am joined by Dan and Pam Gannon. Dan is a retired orthopedic surgeon and Pam is an RN. She worked as an ICU nurse for quite some time and she spoke at our 2018 Annual Conference. They live in Bozeman, Montana where they attend Grace Bible Church. They’re both ACBC certified members and Dan is an elder at Grace Bible Church. I’m so thankful for you both and your work, for the way that you think about medical issues and biblical counseling, and for your love. You are practitioners. You do biblical counseling. You’ve seen it work in the counseling room.
Today’s topic is a serious and difficult topic, and we acknowledge that it’s very rigid on several different sides. It can be very sharp and people often are not really sure how to take conversation about the issue of psychotropic medication. We want to be cautious and sensitive, but we want to be honest about all that we can relative to psychotropic medication through a biblical perspective. The term “medical diagnosis” often gets conflated and confused in terms of the medical model of science and medication with a psychological diagnosis. Could you help us to distinguish a medical diagnosis versus a psychological diagnosis?
Dan Gannon: In a medical diagnosis a physician may take a history, do a physical exam, or take your blood pressure. They may do blood tests, take X-rays, or take a biopsy of your cells and then have a pathologist look at it. If I may go on a bit of a rabbit trail, we know there are standard X-ray scans, CT scans, MRIs, and so forth, but a whole field study that I think biblical counselors need to be aware of is the area of functional scans—neuroradiographic scans.
Instead of just looking at the structure of the brain, they are looking at the activity of different parts of the brain. There was a study at UCLA where they looked at OCD, obsessive-compulsive behavior. They did a PET scan on that group of people and they had abnormal PET scans. They could have stopped the study right there and come to the conclusion, “Aha! It’s a brain disorder and a medical diagnosis.” But they counseled them through various therapies such as Cognitive Behavioral Therapy and then they repeated the PET scan after a number of months.
An interesting thing was found: their scans became normalized. They became much more normal after months of counseling without drugs, radiation, or surgery. So does a brain disorder cause OCD? Then why did they get better? The chicken or the egg question comes into play. In other words, our thoughts, feelings, and behaviors can change our brains. All that to say, a medical diagnosis is made based upon an identifiable pathology. You can measure it in some way. There are abnormal labs or cells or scans. That’s how a medical diagnosis is made.
Pam Gannon: That’s very different than a psychological diagnosis, because a psychological diagnosis is actually based on the descriptors or the labels that are in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Those labels are descriptive, but they’re not actually diagnostic or prescriptive. They describe thoughts, feelings, and behaviors and they label them as disease or as mental disorders.
That leads to the medical model of psychiatric problems. The medical model simply means that thoughts, feelings, and behaviors are presumed to be due to a biological cause of some kind. With that presumption, there’s a biological treatment such as drugs that must be prescribed by specialists. Thoughts, behavior, and emotions are thought to be due to brain physiology, genetic inheritance, or perhaps a combination of the two. They’re thought to be outer man issues. In the medical model, there really is no inner man to bother with. They don’t believe in that aspect of people. It’s a materialistic theory that man is just an outer man. Everything that goes wrong with man has to come from some kind of medical, biological issue. That’s basically how the medical model works—mood problems are seen as brain malfunction. In that way of thinking we are actually subject to our emotions and not responsible for them. They happen to us physically, chemically, or genetically and we become a victim in this system. Belief in that theory also promotes research to seek a chemical fix as the way to emotional health. Now we have a generation of people who believe that the only answer to troubling emotions is found in medicine.
Dale Johnson: That helps to draw a line of distinction. It’s helpful for biblical counselors to say, “We’re not denying medicine. We’re not denying the medical world. We’re not denying medical diagnosis, but we’re distinguishing.” There’s a difference in the way these things are diagnosed from medical pathological problems into the world of psychological diagnosis. Practically speaking, as a physician, somebody walks into your office and they’re looking to be diagnosed. There are some symptoms that could be medically or pathologically caused. What would be some of the differences that a doctor is going to look at in order to come to a true medical diagnosis versus how a doctor would approach diagnosing a psychological disorder.
Dan Gannon: We are looking for an identifiable pathology. We are looking for something wrong with our body that is the obvious cause for the symptoms. People come to us and they describe symptoms, and as a physician I want to find the actual cause. In the psychological world, there’s not an identifiable pathology as far as cells or lab tests, so they have to rely upon thoughts, feelings, and behavior.
Dale Johnson: As an example, you’re going to draw blood, you’re going to do labs as you mentioned, and you’re going to be able to measure those to see if they’re in some sort of range of normal or whether this could explain where the symptoms are coming from in a medical sense. However, in the psychological diagnosis, you take the DSM, and if you read the introduction they make it very clear that they do not know the etiology. What that means is that they don’t know the cause. A person goes to a doctor looking for a psychological diagnosis. No one is denying that they have symptoms. When they approach a doctor, the doctor is not going to ask for labs. They’re not going to do those types of pathological testing.
Pam Gannon: We don’t see any particular pathology at all in any of the descriptors that the DSM describes. It’s not a pathological thing. It’s based on how I feel, for example, “I’ve been sad, I’ve been thinking these thoughts.” They’re talking about inner man issues, but they’re trying to medicalize those and make them seem as if they come from a biological etiology.
Dan Gannon: The neurotransmitter theory as far as mental disorders is an example of the medical model. They’re theorizing that there’s an abnormal level of Serotonin or other neurotransmitters at the synapse and they say that’s the reason why we have mental disorders. There’s an abnormal neurotransmitter. This gets to be very confusing because we know we have abnormal endocrine problems and abnormal electrolyte problems. Those are very identifiable, but we cannot measure neurotransmitter level at the synapse. Yet, we are told that it’s a Serotonin deficiency and you need this medication to enhance your Serotonin.
Dale Johnson: Interesting research is coming out relative to those things such as the monoamine hypothesis—the understanding that Serotonin deficiency in your body is the cause of some sort of depressive feelings. The research is demonstrating that these things as they were proposed in theory form are actually demonstrated by science as untrue. We could go read the DSM and see that they’re not saying anything that we’re not saying, they’re saying that we don’t know the etiology. We don’t know the cause. When we think about psychotropic medication, what is the theorized purpose of psychotropic medication?
Pam Gannon: They are proposed to treat a medical problem, a biological problem. They’re meant to treat those problems in the DSM as mental disorders, as if they are outer man issues. We define thoughts, feelings, and behaviors as inner man or heart issues according to Scripture. They’re proposing that psychotropic medications treat something that we would see biblically as inner man issues. That’s the conundrum we have with psychotropic medication treatment.
Dale Johnson: It has a very strong stated purpose and in its purpose, there are several assumptions. If you’re on psychotropic medication, no one is suggesting here that you get off of those medications cold turkey. That can actually be harmful, and it should be something that you consult with your doctor. Please, do not think we’re suggesting or describing that as a helpful thing for you. We want you to make sure that you’re in consultation with your doctor. With that being said, we’ve talked about the stated purpose of psychotropic medication. In America we’re definitely pragmatists. We think about what works. Do antidepressants work?
Dan Gannon: From a medical point of view, there’s an assumption that they work. If you ask most practitioners who prescribe them, they would say they work about 75 percent of the time. There are some significant questions in secular literature noticing that they don’t really work as well as we thought they would. They’re saying that the placebo effect, thinking that it’s going to work because it’s a pill, is very strong. Dr. Irving Kirsch has studied this a lot and he’s saying that the placebo effect can be 75 percent of the effect. We have to question whether they really work from a medical point of view.
You could use the tack analogy as far as psychotropic drugs or antidepressants. If you sit on a tack, it hurts and you are suffering. Acetaminophen, Tylenol, Ibuprofen, and Oxycodone may help. If you sit on that tack long enough and you get an infection, then an antibiotic will help. Then the question is, “What’s the real answer?” That would be to stand up, identify the tack, and pull it out.
Dale Johnson: It doesn’t necessarily mean there’s an Acetaminophen deficiency.
Dan Gannon: Exactly, there’s not a deficiency of Tylenol, Ibuprofen, or Oxycodone. Those things may address peripheral symptomatology, but the tack, the heart issue, still has to be identified and addressed. Sometimes it’s not easy. Sometimes it’s very clear that someone who comes in with depression is going through grief and loss, and in that case its fairly easy to identify the tack. But often people have very difficult, hidden, or veiled issues of the heart that they are struggling with that only later come out as feelings of despair or depression.
Pam Gannon: That reminds me of the Proverb that states that a wise man, or a man of counsel, can draw out the deepness of somebody’s heart. Often, it’s true that the heart issue is a deep thing that requires some good data gathering and good listening.
Dan Gannon: From a biblical point of view, do they work? Do they help us become more like Christ? If the goal of biblical counseling is sanctification, to become more like Christ, do antidepressant medications really do that?
Pam Gannon: Even from a secular perspective there’s a lot of research that shows that they’re not as effective as once thought. The question for us is if they work biblically. We have to define the goal when we talk about this. What do you mean by work? In other words, what is the goal of our lives? The goal is to become like Christ.
Has this person grown in their relationship with God and are they walking closer with Christ? They’re suppressing their emotions chemically, but are they growing in progressive sanctification? Are they showing more of the fruit of the Spirit? Are the medications dealing with heart issues, or are they just suppressing the outward manifestations of those issues? We would encourage people to turn to the Word of God because Jesus says in John 17:17 that we’re sanctified by the truth of the Word. Do psychotropic drugs work in the way that God desires people to change? That’s the question that Christians have to wrestle with.
Dan Gannon: Christians should not be afraid or intimidated by people who have a long list of psychotropic drugs. You have to remember that psychotropic drugs are not gospel blockers. We put blockers on our computer to keep out viruses and so forth. The psychotropic drugs should not hinder our counsel. I would not worry about that or make that the main focus of your counseling. Often people come in asking, “Should I take this drug? Is it a sin? Should I get off of it?” I tell them, “That’s between you and your doctor. Let’s address the heart issue.” Then with time take the layers of the onion away to get back to the real issue going on. That takes a lot of time and a skilled counselor to get to the bottom of this. Identify the tack, and whether they take the medications or not is up to them. As you mentioned earlier, we’re not going to encourage them to get off and we’re not going to be demeaning to them because they’re on them. They’re not second-rate Christians because they’re taking these drugs. They are our fellow sufferers. We want to have that love for them and empathy towards them as we draw them back into a purpose to honor God with their lives.
Pam Gannon: We don’t have to even talk about the medications beyond knowing that they’re on them and maybe knowing some of the side effects or the effects they’re having. Our job is the heart issues—they’re our primary focus. We don’t want to be distracted if somebody is on medication. Many of the gals that I counsel are on medication when they come in. We don’t talk about their medications a lot, we just go to the Word of God and we find out what’s going on. What are they struggling with? What are they suffering with? What are they sinning in? We use the Word of God to address their heart problems.
Dale Johnson: It’s encouraging to me knowing that you have a medical background because most of our counselors don’t have that background, and they would say, “They wouldn’t know how to handle these types of issues.” But that’s not something that is primary on your list of issues to address. We’re going to go at the heart issues and not allow that psychotropic medication to become some sort of facade as if it’s going to correct the problem. Even in its purpose statement, it’s simply trying to assuage a symptom. The Word of God goes deeper and can help begin to pull out the tack.
Dan Gannon: The point was well made by Dr. Bob Smith many years ago that you do not have to have medical experience to counsel somebody who has medical problems. You stick with what you know and lift up God’s Word. You do not have to be giving them a second medical opinion. That’s not your goal. As a biblical counselor, maybe you’re not trained in medicine. When somebody has a medical problem, don’t feel like you have to refer them to somebody else. Use God’s Word for their problem.
Dale Johnson: This is just the tip of the iceberg relative to discussion on psychotropic medication. I hope that you’ll take it for what it’s worth as we try to wrestle with some of the issues out there. Dan mentioned a book by Irving Kirsch that is part of the culmination of some of his work on this issue of anti-depressant medication. It’s called The Emperor’s New Drugs: Exploding the Antidepressant Myth. That’s one among several that are out there. Another one is by Joanna Moncrieff called The Myth of the Chemical Cure. She’s a British psychiatrist who’s addressing this issue historically and in the modern era relative to the new research that’s happening. There are so many more of those types of books as well. Thank you both for joining us today. It’s been a very helpful discussion in helping our counselors to distinguish and not be afraid of some of these issues that are pushed in our culture.