Dale Johnson: This week once again, I’m joined by Dr. Sam Stephens, our Director of Training Center Certification and we are here to talk about mental disorders. This week we’re going to talk about anxiety and depression specifically. Certainly we could separate these out but we wanted to try and tackle these because there’s a similar narrative that runs throughout both of these types of disorders as they’re defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM).
I want us to be aware of some of the things that are undergirding the idea behind mental health as it relates to these particular categories of anxiety and depression. We’re in the month of May, this is Mental Health Awareness Month. We want to raise these issues so that you can be more aware of the language that’s used out there.
Sam, there are several ways that we could address this and I think it’s important for us to consider the time that we’re currently in. We’ve been dealing with the idea of a pandemic now for four or five months. We are wrestling with the realities that we’re seeing unfold before us. One of the things that I keep reading is a constant increase in mental health talk. Our public health officials were once talking about how we need to flatten the curve and make sure that the hospitals are okay. Some of that has transitioned to think about the impact of the pandemic moving now toward a third or fourth stage, which incorporates a fear of the flood of “mental health” problems. Now we have to worry about how the psychiatric industry and the psychological industry are going to be flooded with people who are affected by the pandemic, which has nothing to do with an underlying true virus or disease at all.
Back at the end of March, one article stated that there was a 34.1 percent increase in prescriptions for anti-anxiety medications. Now, that’s incredible. The whole narrative builds itself into saying that anxiety and depression medical and classified as diseases that need medical treatment in order for people to overcome it or manage it and to be cared for. I want us to discuss this because so many, even in the biblical counseling movement, seem to be okay with just leaving those classifications sort of on the side. They say, “We can use those as proper classifications and then use biblical language to describe.” Part of my concern is as we buy into that narrative, we’re not just buying into the criteria that’s expressed. We also buy into the baggage that’s with it.
Help our listeners to understand, what’s the problem if we were to adopt these types of categories (all the listing of diagnoses that fall under the headings of depression, depressive moods, and anxiety moods)?
Sam Stephens: Before I can speak to that, I want to note in addition to what you said, in a recent article that was published through the Journal of the American Medical Association, they talked about this very thing. They were communicating that we’re reaching the back end of the pandemic, but now the discussion is turning to focus on suicide rates, which have been rising in the United States for two decades now, so it’s not limited to just the coronavirus. But now we’re having more and more discussions about adverse mental health concerns to social distancing. This article specifically focused on suicide risk. The problems included in this article were about decreased community support, social isolation, exposure to national anxiety (the news), and then of course barriers to mental health services, which you discussed. The solutions proposed in this article would be the same kind of answers: increased mental health services, tele-mental health screenings. The article conflated physical health interventions with mental health interventions, saying they’re one in the same.
Back to your question and answering what we should be concerned about here. As we’ve talked the last three weeks about psychiatry as a field and its approach, we cannot ignore the philosophical underpinnings that the entire field has. As we noted last week, it’s not just Christians that are pointing this out. A plethora of psychiatrists—well-known, well-credentialed psychiatrists—understand this about their own field. We should be concerned about utilizing the categories, terminologies, and frameworks that the American Psychiatric Association purports through the DSM. They are essentially redefining human nature.
Philip Rieff, a well-known sociologist, talks about this idea of the therapeutic in one of his books The Feeling Intellect. I think it’s a really important framework that we cannot ignore. He said this in his book The Feeling Intellect, “The therapeutic is the most revolutionary of all modern movements, basically towards a new world of nothing sacred. There is a therapy where theology once was. Religious man was born to be saved, the psychological man is born to be pleased.” We see this a shift away from seeing man in relation to God, where we understand humanity best when we understand our Creator. Now that’s being removed, God has been removed, and it’s man in relation to himself. It’s a therapeutic understanding of man.
So what do we see happen? Well, this is the common logical follow of that shift in anthropology. We are essentially reconfiguring misery, sadness, and fear. We’re reconfiguring that misery of life into an illness. This is all in an effort to address these problems, that can’t be ignored, without objective morality or objective truth. The psychiatric industry at large, definitely clinical psychology and psychotherapeutic approaches, are all about assuaging guilt, removing the concept of disease and replacing that with dis-ease—discomfort and anything that would cause us pain.
Dale Johnson: When we look at the DSM categories, you and I are not saying that people who do not have the Spirit of God, who are seculars in their mind, cannot describe certain things. That’s not what we’re saying. The problem is that the DSM system in-and-of-itself, really lends itself to carrying along a lot of baggage with the categories it provides. Even in the introduction, it describes that the whole point of the criterion system is to build a fully-informed treatment plan, which is interesting because in the whole DSM, they say there’s no etiology. The DSM is not just a simplicity of descriptions. Yes, a lot of the criterion descriptions that are given are accurate in their expression to say, “Yes, people are sad. People struggle with this. This is something that’s sometimes very deep in it’s degree.”
However, we have to be cautious to think that those systems, those diagnostic criteria, are not value-free. They come with ideas of prescription. And that’s the problem with the baggage. When we talk about the 34.1 percent increase in prescriptions and anti-anxiety medication and the increase of suicide during this pandemic, it demonstrates something that at least all of us should have a question about. The whole narrative has been pushing us to say that depression and anxieties are biological, and yet we’re seeing the impact of a pandemic on depression and anxiety. Our physical health is under scrutiny, we lose control, we feel pressure from an emotional standpoint, and that’s what’s increasing the fear and the concern. We ought to question: Is this really coming from some sort of biological background?
Sam Stephens: To further what you just said, let’s not forget the DSM is a diagnostic manual. This is primarily used for clinicians. These are people that are trained to use these categories to make observations. But of course, they are ascribing value. All of our listeners have presuppositions about their world. We all have assumptions that we bring to the table. Of course clinicians trained this way will have a worldview that’s going to be based in the biological psychiatry framework that we talked about.
When you look at the DSM, for example, let’s use for instance depressive disorders. Even the manual itself speaks to the fact that it’s not value-free. We’re coming with these observations, but we’re bringing with it assumptions. In its attempt to make itself more scientific, they’re trying to come across as being objective, but it’s impossible to be that way. Let’s just read what it says here for a moment under depressive disorders. The DSM says, “The common feature of all of these disorders [that’s over 20 when you look at types and subtypes just in this one category, which is continuing to grow] is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. What differs among them are issues of duration, timing, or presumed etiology.”
It’s presumed. Even all of those aspects listed are very subjective: timing, duration, sadness. Who hasn’t felt sadness? Who adjudicates what the basis is? As we talked about the last three weeks, it’s not hard science, but committees that decide these criterion.
Dale Johnson: They also consider what’s called clinical utility—what they’re seeing in their experiences in their offices. I think this is important for us to consider. A question we should consider is, are we medicalizing normal? I don’t know about you, Sam, and maybe some of our listeners—but I’ve experienced anxiety before. I’m not minimizing the fact that there aren’t degrees of the way that we experience these emotional issues. Or with depression—the Scriptures tell us that in this world, we will have trouble. So why do we think it’s strange? Why do we feel like we have to categorically place this now under some sort of medical jurisdiction? Are we medicalizing normal?
I’m looking at an article here that I’ve read. It’s entitled this: Almost Everyone Meets Criteria for Mental Illness. Now, I find that interesting because it’s claiming that there’s an increase in recognition that almost everybody (from between 85 to 90 percent of people) sometime in their lifetime will have met the criteria that’s found in the DSM for something like an anxiety disorder or depressive disorder. What are we doing? Are we taking what is really normal life in a fallen, broken, sin-cursed world and trying to make that medical by our own philosophy?
Sam Stephens: The short answer to that is yes. Normal has been medicalized. It’s continuing to be, and I don’t see that’s going to stop anytime soon. In her book the Myth of the Chemical Cure, Joanna Moncrieff traces the history of and criticizes psychiatric drug treatments. In her chapter dealing with antidepressants, she discusses that really since the late 1950s, antidepressants came onto the scene pushed by the psychiatric industry. She says, “The very concept of an ‘antidepressant’ is an inherently disease-centered notion, as expressed in the word itself. It consists of the idea that a drug can improve symptoms of depression, not just through drug-induced effects, but by reversing the process of depression, at least temporarily. Implicit in this idea is that depression is caused by a physiological mechanism that drugs can act upon.”
This is what’s known widely as the monoamine hypothesis of depression, and Moncrieff goes on to say it was actually formulated upon assumptions in psychiatry. That’s not how traditional medicine works. You have a hypothesis for the cause of a problem that’s actually come about because of the use of drugs. She says here that this monoamine hypothesis suggests that symptoms of depression are caused by a deficiency of brain monoamines—basically neurotransmitters. She says, “According to this theory antidepressant drugs are thought to exert their therapeutic action by increasing brain monoamine levels.” But of course even since the beginnings of that hypothesis, and many others that have followed and continue to be born, there’s been no scientific (and definitely no conclusive) evidence to show that that’s actually validated.
Dale Johnson: In fact, the literature actually demonstrates the lack of efficacy with the medical treatment. We’re not saying that people don’t have some sort of feelings of feeling better, maybe their emotional highs are not as high, and their lows are not as low. These are psychoactive medications, which means that they have substances that have impact on the brain. The issue that I think is important for us is to ask, “Are they curing it?” The literature is demonstrating right now that the increase of diagnostic inflation—more opportunities for this type of medicine to be prescribed—gives us more samples that are being researched and studied, that are beginning to question the efficacy of this medication to do what it says it will do.
In fact, not only are we seeing a question of the efficacy, we’re also seeing a detriment in some of the major side effects that are happening with these very potent drugs. These are important questions for us to ask. As we run this philosophical narrative, trying to medicalize what are very normal experiences in life, we ostracize people. We ostracize them, pushing them aside and acting as if there’s something wrong with you. In that narrative, we begin to stigmatize people in a certain way—when in reality part of what they’re experiencing is quite normal if we understand life from a Christian disposition and know that this is a broken world. I think we need to awaken our mind to pay attention to what’s happening in the secular, scientific literature that’s questioning this narrative that our culture—even church and Christian culture—has bought into very deeply.
I do think we see that, not just among people like you and me who would maybe be called religious fanatics, but we’re seeing this among the establishment in psychiatry and in psychology, who are raising these questions about very common experiences like anxiety and depression.
Now I want to do something very quickly if we can. We could do this if we had time for both depression and anxiety. I’m going to read the criteria for generalized anxiety disorder, and I want you to hear the way its described. I think it’s important. Here’s the first criteria: “Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities (such as work or school).”
The second criteria is, “The individual finds it difficult to control the worry.”
The third: “The anxiety and worry are associated with three or more of the following six symptoms:
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
5. Muscle tension
6. Sleep disturbance”
The fourth criteria: “The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas.” The fifth: “The disturbance is not attributable to the physiological effects of a substance.” The sixth: “The disturbance is not better explained by another mental disorder.”
When I read those types of things, I don’t read something that’s clinically definable as a medical disorder. What I read are common experiences that you probably had last month, and that I probably had last month—things that we experience to some degree or another. Now, I fully acknowledge that there are higher degrees of intensity in these emotional experiences. We’re not removing the idea of those experiences, we’re just saying that maybe we shouldn’t put this in a category of medicalization. Maybe we should acknowledge this as being a part of the normal, cursed world that we live in.
Not only are we medicalizing normal, but I think it’s important especially during this month (Mental Health Awareness Month) as we look at all of the DSM, its criteria, the aim of the psychiatric system, the aim of psychologist in their talk therapy, to ask: What is the goal? If we look at mental health, what is it that they’re actually trying to accomplish that makes their means and their way superior to any other and so believable to the common culture? What is it that they’re aiming at?
Sam Stephens: According to Mental Health America, which is the nation’s oldest and largest mental health advocacy group, it’s about living mentally healthy. So what does that look like? According to their website that looks like “avoiding stress, because stress hurts. Staying positive. Seeking professional health.” They’re encouraging us to turn right back to the mental health industry for answers and guidance on these things.
I think this is one of the most dangerous aspects about this: They advocate for spiritual health. Why would our listeners think that’s dangerous? Because they are emphasizing the utilitarian value of religion. They say, “focus on your own or universal wisdom,” or “trust in a greater force.” We see the same thing in the addiction recovery industry as well. They point to general spirituality, but they don’t get specific. They’re not talking about going to God in the Bible, because then we have to deal with sin and that’s messy. Unlike physical diseases, psychiatric disorders and mental illness brings a great weight—it distorts identity, it distorts responsibility, and it essentially takes our eyes off of our purpose.
Dale Johnson: It’s in critical for us to see that we’re allowing them to define what is healthy, as opposed to allowing the Scriptures to define what it means to to walk in peace, to walk in purity, and to walk in health before the Lord. We’re not allowing the Scriptures to define what normalcy really is and what normalcy really means. We’re stripping Jesus as the pinnacle for how it is that we are restored—by His grace, by His work, by His power, by His Word, by the Spirit. We are stripping the power that God has given in His sufficient Word to restore us and we’re looking to something else.