Powlison on the Darkness of Depression

David Powlison of the Christian Counseling and Educational Foundation spoke with guest host Russell Moore about depression on the July 23rd edition of the Albert Mohler Program. (HT: Greg Linscott)

A President's Depression

Over at MercatorNet, psychiatrist Theron Bowers compares two different looks at Abraham Lincoln's depression. The first is from CBS Television which is running 30-second public service announcements this month featuring Lincoln and other historic sufferers of depression. The segments, part of a campaign called CBS Cares, are intended to destigmatize mental illness. Bowers explains the rationale for such campaigns and why he thinks they're of minimal help:

Current dogma assumes that depression is under-treated because people are too embarrassed to ask for help. Therefore, pinning mental illness on the coattails of giants should remove the shame attached to a condition and draw sufferers into treatment....

No helpful information is contained in the CBS commercials. Tagging room-temperature heroic figures with various human ailments yields zero insight into that person or the “illness”. Would Prozac have made Poe less creepy? Would a happier Sherman have not burned down Atlanta? You won’t find the answer at CBS Cares. Our passion for diagnosing the dead is another skin-deep facet of the diversity movement.

Bowers points to what he believes is a far more informative glimpse into Lincoln's depression and how he lived with it:

Fortunately, we can have a deeper understanding of this brilliant man and his “illness”. In 2005 Joshua Wolf Shenk provided an analysis of Lincoln and depression in his book, Lincoln’s Melancholy. Shenk goes beyond the usual agenda of the troubled genius exposé. The book doesn’t settle for simply emboldening sufferers. Shenk moves the questions about Lincoln’s mood disorder from the realm of pop history and posters for Mental Health Awareness Month to the level of serious scholarship. He proclaims his ambitious goal in the subtitle of the book: How Depression Challenged a President and Fueled his Greatness

In the course of his review (which is worth reading in its entirety and caused me to add the volume to my wish list), Bowers rightly criticizes the biological reductionism that so pervades popular assumptions about the nature of depression:

Shenk elevates Lincoln from modern poster child for mental health to iconoclast against the modern biological conception of depression. Psychiatry built the medical tower of mental disorders by equating emotional suffering with disease. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) identifies distress as a hallmark of mental disorder. The focus on distress is so entrenched that many perversions such as bestiality, sado-masochism and transvestitism are no longer classified as mental disorders unless the practitioner is “distressed” over the behavior.
Emotional suffering is only evidence of a mental disorder in the way that physical pain is evidence of disease. All aspects of depression -- brief versus chronic, mild versus severe -- have labels attached in the DSM. Sadness has no more meaning than a rash. Certain cognitive habits associated with depression are also deemed unhealthy. Hopelessness and low self esteem have acquired mythological powers for explaining our social problems.

Shenk’s Lincoln restores sanity and hope to our present notions about depression. The story of Lincoln and his troubled mind doesn’t follow any script, treatment algorithm or predictable outcomes. Lincoln’s Melancholy provides both surprising answers and true inspiration.

Related: Covenant Seminary's Zack Eswine, who describes himself as one who "wrestle[s] with a melancholy temperament and bear[s] the scars of tragic circumstances," reflects on how Lincoln and C. H. Spurgeon persevered "while suffering varying degrees of gloom." (HT: Justin Taylor)

Materialism, Materialism

When people use the word "materialism" they usually have one of two definitions in mind. Philosophically speaking, materialism is the belief that everything that exists is either composed of matter or dependent upon it for its existence. "Naturalism" is an equivalent term. Atheist and evolutionary biologist Richard Dawkins notes in his book The God Delusion that philosophers use "naturalist" as the opposite of "supernaturalist" and approvingly cites the following description of naturalistic philosophy offered by Julian Baggini in Atheism: A Very Short Introduction:

What most atheists do believe is that although there is only one kind of stuff in the universe and it is physical, out of this stuff comes minds, beauty, emotions, moral values - in short the full gamut of phenomena that gives richness to human life (13,14).

Dawkins goes on to elaborate on the implications of this philosophy for our attempt to make sense of human cognition and affect:

Human thoughts and emotions emerge from exceedingly complex interconnections of physical entities within the brain. An atheist in this sense of philosophical naturalist is nothing beyond the natural, physical world, no supernatural creative intelligence lurking behind the observable universe, no soul that outlasts the body and no miracles - except in the sense of natural phenomena that we don't yet understand it and embrace it within the natural (14).

According to this perspective human beings are essentially physiological machines whose thoughts and behaviors are reducible to biochemical and electrical impulses. We are identical with our bodies. Consequently, if anything is wrong with us it must be biological for that is all we are. Imago Dei is a useless concept for making sense of ourselves. The images critical for interpreting our condition and what ails us are MRI's and PET scans.


"Materialism" is also used to refer to an approach to life that places premium value on the acquisition of material goods for the purpose of enhancing comfort, status, and/or pleasure. Gary DeLashmutt and Dennis McCallum define materialism as "...a subtle and sophisticated worldview that defines identity, fulfillment, significance, and security in terms of economics" (129). Obviously, one who is materialistic in this sense of the word may or may not be a materialist in the previously described sense. Both kinds of materialism are dehumanizing and destructive.

Because of my interest in counseling issues, I frequently consider how they converge in the pharmaceutical industry especially in that subset that manufactures psychoactive drugs. A naturalistic worldview prevails in contemporary approaches to enhancing mental health. It is a foregone conclusion that problems such as depression and social anxiety are the results of imbalanced brain chemicals despite the fact that there is a marked disparity between the evidence and claims made by the makers of the antidepressants marketed as treatments. This is where the second sense of materialism comes in. The drug companies have a vested interest in promoting and protecting a materialistic (the first sense) view of human nature to successfully market their products. Unfortunately, ample evidence exists to demonstrate that financial gain is often a greater priority for pharmaceutical companies than public health (see, for example, the following articles chronicling Eli Lilly's attempt to suppress links between its top-selling drug, Zyprexa, and diabetes: Eli Lilly Said to Play Down Risk of Top Pill, Playing Down the Risks of a Drug, Lilly Settles With 18,000 Over Zyprexa).


Despite the advances made in Christian worldview studies, it's frustrating that more is not being done in the area of mental health. I was heartened, therefore, when in a recent FRC briefing, Discovery Institute senior fellow Dr. John West made the connection between the materialist mindset and the treatment of children diagnosed with ADHD. While affirming that drugs might be a necessary part of treatment in some cases, he noted that the rush to administer them is an outworking of materialistic assumptions that may prove detrimental and unnecessary.

As we contend against the dehumanizing and culturally destructive consequences of naturalism with respect to such things as ethics, are we turning a blind eye to how we may have imbibed the very same philosophy in the garb of medical science?

The New Prozac Nation: Psychiatry Gone to the Dogs

From the L.A. Times:

THEY are the new "Prozac Nation": cats, dogs, birds, horses and an assortment of zoo animals whose behavior has been changed, whose anxieties and fears have been quelled and whose owners' furniture has been spared by the use of antidepressants. Over the last decade, Prozac, Buspar, Amitriptyline, Clomicalm — clomipromine that is marketed expressly for dogs — and other drugs have been used to treat inappropriate, destructive and self-injuring behavior in animals.


It's not a big nation yet. But "over the past five years, use has gone up quite a bit," said veterinarian Richard Martin of the Brentwood Pet Clinic in West Los Angeles. Half a decade ago, no more than 1% of his patients were on antidepressants. Now, Martin estimates that 5% of the 8,000 cats and dogs seen at the clinic are taking drugs for their behavior.

Speaking of canines, I can just see the pharmaceutical companies salivating like Pavlov's dog over this news. Americans have consistently proven that we'll spare no expense for the furry members of our families so the potential income from pet mental health is beyond imagination. I predict that Prozac Puppy Chow is on the horizon. What I want to know is if suicide rates increase among household pets, will PETA intervene?

I couldn't help noticing that the psychiatric treatment of four-legged creatures is superior to that of many of their human counterparts. The article cites one veterinarian who says that dogs are not intended to stay on antidepressants for life. "We don't have specific studies on long-term use." The article goes on to say that most vets prefer to taper their patients' use of the drugs. "We try to use these medications short-term," says another veterinarian, "because they are not without side-effects." If only more physicians exercised the same caution. I'm sure human physiology isn't any better suited to endure sustained treatment with brain-altering medication and, given the fact that the popular class of antidepressants known as selective seorotonin reuptake inhibitors only appeared on the scene in the late 1980's, we have yet to discover what adverse effects accompany long-term use.

Depression - It's Not Just for Grown-Ups Anymore

Mollie Murphy, a four-year-old girl in England, sad because she wasn't admitted to the same primary school as her friends from nursery, has been diagnosed by her family doctor as suffering from stress and depression and according to this Daily Mail opinion piece (HT: Psych Watch), her mother has been advised to put her on an antidepressant.

Jill Parkin, author of the Daily Mail article, expresses what I think is appropriate dismay over what little Mollie and children like her are learning and what it says about our culture:

...she's in danger of being taught a very dangerous lesson, before she can even read or write. It's a lesson that goes like this: Got a problem? Pop a pill. Finding life hard? Blame someone else.

Treating a little child with anti-depressants because she didn't get into the school she and her parents wanted is not just ridiculous and unnecessary, it is the most shocking example yet of a culture of dependency in which life's setbacks are not simply challenges to be confronted and overcome, but are medical conditions to be diagnosed and treated by 'professionals'.

I may not be a doctor, but this I can be sure of: little Mollie will get over her temporary sadness far faster without medical intervention. She needs a dose of good parenting and common sense, not Valium.

Mollie was alluded to this morning in a news segment Good Morning America ran on depression in infants (estimated as occurring in one in forty). ABC is also asking readers to vote on whether they would allow their baby to take antidepressants if doctors determined that he or she was depressed. After I voted a few minutes ago, 1,631 people had responded "Absolutely not. It's not safe," 315 replied "No. Babies can't be depressed," and 93 said "Yes. If the doctors thought it was safe then I'd be okay with it."

Two weeks ago I asked with tongue slightly in cheek, "Can fruit-flavored, infant-formula antidepressants be too far off?" In light of the above, I'd like to ask a different question. How long will it take?

Ed Welch on Biblical Counseling

Listen to Mark Dever talk with Ed Welch of the Christian Counseling & Educational Foundation about his testimony and a variety of topics including recovery groups, codependency, medicating depression, "integrationism" and "nouthetic" counseling, and the role of counseling in the local church. (HT: Greg Linscott)

Christians and the Psychiatric Culture

Last night I finished reading a book I mentioned here a few weeks ago, Will Medicine Stop the Pain?: Finding God’s Healing for Depression, Anxiety, and Other Troubling Emotions by Elyse Fitzpatrick and another biblical counselor, Laura Hendrickson, a physician who formerly practiced psychiatry. The book targets women since, according to the American Academy of Family Physicians, twice as many women as men will experience depression in their lifetime.Hendrickson not only prescribed antidepressants to her patients but for a period took them herself to treat diagnosed depression and bipolar disorder. She candidly relates her experiences with childhood rejection, subsequent emotional instability, and drug-induced confusion including suicidal and homicidal thoughts. Other first person accounts from Christian women who have struggled with depression appear throughout the book.

The authors explain how modern psychiatry frequently operates on the premise that human beings are reducible to our biochemical components. Intense emotional pain is therefore concluded to be the result of physical disease. They contrast this materialistic perspective with a biblical view of the person as consisting of the uniting of the outer man (the physical body including the brain) and the inner man which is referred to biblically by terms like the heart, mind, spirit, and/or soul. Fitzpatrick and Hendrickson acknowledge that the body can affect and influence the heart and vice versa. They also concede that there are real, empirically verifiable diseases of the brain (as well as brain injuries) that can have negative effects on one’s perception, cognition, and moods. However, they point out that there are no tests for so-called imbalances in brain chemistry for which antidepressants are said to be correctives. They also claim that emotional pain is intended to inform us what is going on in our hearts so that we might avail ourselves of the resources that are ours in Christ to experience heart transformation.

Fitzpatrick and Hendrickson take great pains to caution readers currently on antidepressants against deciding to go off them without medical supervision.  One of the medical professionals frequently cited is Joseph Glenmullen, a psychiatrist who teaches at Harvard Medical School and is also in private practice. I had seen him on ABC's Prime Time Live two years ago and had thought at the time of picking up one of his books but never got around to it. (Dr. Glenmullen's responses to Prime Time viewers' questions about antidepressant side effects and withdrawal are available here.) Glenmullen authored Prozac Backlash and more recently, The Antidepressant Solution which I’m in the midst of reading.

While he prescribes antidepressants on a limited basis, Glenmullen has been a very outspoken critic of the pharmaceutical companies' campaign to market them to physicians and the general public. He believes that the majority of Americans currently taking them are doing so unnecessarily. He is also very concerned that many physicians, who are often reliant upon the drug companies for their information about the drugs and their effects, are ignorant about antidepressant dependence, withdrawal, and how to safely taper patients off them. It’s frightening to learn how misleading pharmaceutical companies have been in their pushing of various medications, many times suppressing evidence of ineffectiveness and/or harmful side effects. According to Glenmullen, ample evidence exists indicating that in some people, antidepressants can create the very symptoms they were prescribed to treat. And in some cases, such a dependence is built that serious symptoms can result from forgetting to take the pills at their proper time. When this happens, patients often think that they are having a relapse when, in actuality, the drug is responsible for their problems.

I can't recommend the above books highly enough to those taking antidepressants (whether male or female) and those who care about someone who is. Readers may also be interested in acquiring a Mars Hill Audio Journal interview with David Healy, a British psychiatrist and author of The Antidpressant Era and more recently Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression on antidepressants and the concept of disease.

When one takes into consideration that the disorders the psychiatric community labels people with, are not scientifically validated, there is much cause for both alarm and caution. I’m especially concerned because I know numerous Christians who have bought the well-publicized line that taking antidepressants is analogous to taking insulin or other medication designed to treat biologically detectable illnesses. In a chapter on biological psychiatry in his book Seeing With New Eyes: Counseling and the Human Condition Through the Lens of Scripture, David Powlison makes what I believe is an accurate observation:

The church typically lags a bit behind the culture's way of thinking. But the ethos and practice of biopsychiatry are deeply affecting the church already. If it's broken, or even just not working optimally, it can be fixed from the outside by a drug: better living through chemistry. In your ministry and in your church you are probably already facing the ethos and the practices. Many people in both pew and pulpit are on mind-, mood-, and behavior-altering drugs. We all increasingly face the ideas and knowledge claims, too. The cover story in Time magazine informs the everyday queries and choices of Christian people. Eventually such ideas make it into the educational system as the received wisdom of the culture with which to disciple the next generation (p. 243)

The more believers uncritically accept the therapeutic ethos that so permeates our culture, the less relevant and precious the gospel will seem.

Related Tags: depression, antidepressants, mental illness, psychiatry, Elyse Fitzpatrick, Laura Hendrickson, Joseph Glenmullen, David Powlison, David Healy, counseling, psychology, biblical counseling

Will Medicine Stop the Pain?

Today a good friend alerted me to a new book co-authored by Elyse Fitzpatrick and Laura Hendrickson called Will Medicine Stop the Pain?: Finding God's Healing for Depression, Anxiety and Other Troubling Emotions. Both authors are biblical counselors and Laura Hendrickson is a medical doctor who used to practice psychiatry. The following is from the back cover:

Where do my feelings come from?

Is emotional pain a disease?

Can I really change?

What is wrong with me?

Countless women struggle daily with depression, anxiety, out-of-control moods, and other troubling emotions. Will Medicine Stop the Pain? offers clear answers to help women handle emotional problems in a stable, God-honoring way.

The authors, both seasoned biblical counselors, include stories from real people and practical advice on issues like how to talk to your doctor. Read this book to learn:

• How your body and your emotions affect each other.

• Why drugs that help you feel better may end up making your emotional problems worse.

• How applying biblical principles can help you deal with the true sources of your pain.

• Why it is possible to respond to emotional pain in faith and hope.

“God is with you—no matter how you feel. His promises are stronger than all your feelings.”

I urge you to read this book all the way through—with a prayerful heart and an open mind. It may be one of the most important, helpful books you have read. It will likely challenge your thinking on many fronts. It will certainly give you a vision for how your suffering (and the suffering of others) can become a path to great blessing and growth and can result in the display of God’s glory in this fallen world.

From the foreword by NANCY LEIGH DEMOSS

I've had the pleasure of reading and speaking with Elyse Fitzpatrick and am extremely grateful for her commitment to helping Christian women look at life through scriptural lenses as opposed to the smudged spectacles of pop-psychology and biological reductionism. Hers is one of the all too few voices calling women to take theology seriously and see that the question of worship, whether of the true God or a substitute, is central in every relationship and situation. I'm sure this new title, like those before it, will stimulate thought, praise, and Christ-grounded hope.