The “Roughage” of Life

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I wanted to write a follow-up to my blog titled How Counseling is Discipleship_Personal Experience.

In that blog I made reference to an article by psychologist Mark Tyrrell titled, How to avoid the damage caused by psychological labelling. Here is the lengthily quote I want to deal with.

…although modern society has made some attempts to de-stigmatise conditions such as clinical depression and anxiety, in a way these conditions have actually become more daunting for sufferers through being ‘medicalized’ – they are seen as pathological chemical disorders rather than what Milton Erickson described as ‘the normal roughage of life’.

Having a ‘disorder’ can seem a lot more of a problem than ‘feeling depressed’. So

  • ‘feeling blue’ has become ‘clinical depression’
  • ‘having cold feet’ about undertaking something difficult is now ‘avoidant personality disorder’

and, as a psychologist friend of mine likes to joke:

  • ‘normal childhood’ is now called ‘attention deficit hyperactivity disorder’

I’m not suggesting that these diagnostic labels have no relevance or value, and for some people having a so-called ‘proper diagnosis’ can be reassuring in an “Ahhh! Now at least I know what is wrong with me!” kind of way. And I respect that when I am treating people who have been diagnosed in these ways.

But the danger is that if we come to believe we have a ‘disease’ or a ‘genetic condition’ when in fact we are just experiencing part of life’s rich pattern, then we may:

  • feel we’ve lost control over our lives, leading to a deepening of depression and a worsening of anxiety or addiction (after all, if my problems are a ‘disease’, the best I can do is live with it – it isn’t something I can resolve)
  • start to feel we are fundamentally different and weird, instead of just a regular human being struggling with life.

How to avoid the damage caused by psychological labeling

Tyrrell recognizes a number of things common in his profession.

He points to fact that just about everything that ails us has been “medicalized” (he invented the word, not me) and that medicalization has led to the disease model of just about everything that troubles human beings.

Prior to the virtual take over of the culture by psychology a disease was a pathological condition that affected our bodies. The pathology was measurable via medical testing and therefore had an objective basis for attaching a label to a disease.

This is not so with many of the psychological labels handed out now. Today many labels are handed out not on an objective basis but on a subjective basis based on how a person feels and what symptoms they exhibit or report to their doctor. Blood tests and other medical testing that do not show tissue damage do not prevent the handing out of a label suggesting a disease hence the medicalizing of the subjective.

Dr. Charles D. Hodges, M.D. and a certified biblical counselor reports in his excellent book, Good Mood Bad Mood-Help and Hope for Depression and Bipolar Disorder that he helped a young woman who had the label of Bipolar Disorder. The doctors treating the young woman based the diagnosis on the “chemical imbalance theory” an idea that basically says one or more chemicals in the brain is out of whack thus causing a chemical imbalance and in the young woman’s case Bipolar Disorder. The young woman was treated with various meds to no effect in an effort to correct the supposed imbalance.

The problem is no one knows what a normal balance would look like so they end up experimenting with various drugs none of which worked with the young woman. Hodges turned to the gospel for solutions and helped the young woman see that she was reacting to life’s circumstances in habitual ways that led to bouts of good moods, bad moods. He helped her see her “disease” through the lens of Scripture to the point she recognized she didn’t have a disease at all. She now leads a normal life.

This is the type of thing Tyrrell is talking about without the solution of a gospel orientation to life.

Tyrrell illustrates the point in a humorous way by pointing out that “having cold feet” is now having the “disease” of avoidant personality disorder and that “normal childhood” is a prescription for ADHD.

Tyrrell turns a bit serious when he notes that if our problems are all diseases the best we can do is live with it.. In other words if all we can do is “live with it does not offer much hope and as Tyrrell notes may lead to further depression.

I want to commend Tyrrell for recognizing the problem and while I may disagree as to how he would offer hope I certainly appreciate his willingness to try to slow down the idiotic trend to treat everything that ails us as if it were a genuine disease.

Tyrrell cites Milton Erickson who describes some of the problems common to man as the normal “roughage of life.” That’s a great phrase that translated biblically means life in a fallen world-life in a fallen world that is rough at times.

Later Tyrrell notes most of us are not “weird” meaning we have some “weird disease” but are instead normal human beings struggling with the normal ups and downs of life.

I think it is great that secular people helpers are starting to see the danger of medicalizing all the problems that are common to man. They may not have the best solution but at least some see the danger of labeling things as diseases that are really just part of normal life.

 

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How Counseling is Discipleship_Personal Experience

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Is it true that if you “feel blue” you must be sick?

Allow me to explain.

I recently had  knee replacement surgery and will have to have at some point the other knee replaced.

The surgery involved a two-day hospital stay and follow-up visits to the surgeon’s office. In each case I’ve been asked questions regarding my mental health.

“Are you depressed?”

“Do you feel threatened in any way at home?”

“Are you having trouble sleeping?” (a question that usually relates to anxiety)

“How is your stress level?”

The questions are certainly well-meaning since one’s mental state can have an effect on the healing process. The question regarding depression is especially revealing.

If I were to answer in the affirmative that I was depressed the chances are the surgeon would have prescribed an anti-depressant to go along with my handful of post-op meds.

I knew what they were trying to do (help me) so I answered that I was fine which is not true; yet not a lie.

When medical people ask if you are depressed they tend to equate “feeling blue” with clinical depression.  In other words, if you exhibit or confess to “x” number of symptoms you are awarded a depression label.

What I have experienced is what I’ll call “normal discouragement.”

And what would I be discouraged about?

The therapy associated with knee replacement surgery is painful-real painful. The patient, for his or her own good is forced to bend and extend muscles that are in rebellion to the process. When forced, they scream out in pain and I confess to being brought to tears on more than one occasion.

The cycle of therapy and rest is repeated each and every day more than once per day and each day you feel like you are starting over. That is discouraging since progress seems slow.

What else is discouraging is that my wife has to help me dress. It’s minor but never-the-less discouraging to need help in such a simple task.

I’m also useless around the house. My wife works full-time so the division of labor between us has always been fair and not holding up my end discourages me.

The same is true regarding my ministry. Between therapy and doses of pain killers one is not inclined to produce anything useful much less coherent. Hopefully this blog is the exception!

The total of these circumstances and more, result in feelings of discouragement since I am anxious to recover and get back to normal.

I believe that my reaction of discouragement is a “normal” response to the circumstance of major surgery. I further believe to call normal discouragement “depression” medicalizes something that does not need a prescription to cope with. Yet, that is exactly where the process could have ended up had I confessed to depression.

Since I am a Bible-believing Christian, my prescription for my discouragement is different.

There is a battle for my mind going on. One side of the battle says lay in bed, take my pain pills, avoid the more hurtful therapy, and if push comes to shove, settle for a disability.

The other side of the battle says follow the doctor’s therapeutic instructions, press on regardless of the pain because in the long run it will help, and do whatever I can to help around the house as I recover.

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Biblically speaking, in my current state, my job is recovery and the side of the battle that says “these are the things you can do to do your job, do them as onto the Lord (Col. 3:23).

This is not always easy but battles rarely are.

Furthermore, there is prayer. There are a great many people who remember me in prayer. My small group leader asked me Sunday how I was doing with discouragement. He used the right word and so my small group prays not only for healing which is important but  more importantly that I remain faithful to the battle for my mind and that I grow in Christ through the trial of recovery.

Third, there is the recognition that my wife wishes to serve me. and As she helps me struggle we make jokes and walk down this path together as we’ve had for the past 40 years through thick and thin. Her assists help me with my pride because there simply are times we need help.

And finally there is an attitude of gratitude that I must fight for.

My church is incredibly supportive including my friend and Sr. Pastor. There is no pressure, just encouragement to press on in recovery.

There is gratitude for having the insurance for the surgery. There is gratitude for having a top-notch surgeon and hospital staff.

There is gratitude that our sovereign God has providentially arranged all these things for my good (Rom. 8:28-29).

In other words, I do not need meds or psychological counseling; I need discipleship. I need to use biblical tools to fight “normal discouragement” as I recover.

What I’ve said here is nothing new to biblical counselors.

It is interesting to see that even secular psychologists and therapists are recognizing the danger in medicalizing normal responses to unpleasant circumstances.

The below link to How to Avoid the Damage caused by Psychological Labeling by Mark Tyrrell is helpful. While I do not agree with every point, it is refreshing to see therapists and psychologists saying something about the over medicalizing of the downers that occur in all of our lives.

It isn’t true that if you “feel blue” then you must be sick.

http://www.uncommon-knowledge.co.uk/articles/uncommon-hypnosis/avoid-damage-caused-by-psychological-labelling.html

How did depression lead to theft?

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My wife works for a major healthcare provider in our area. Recently, her employer received some unwelcome publicity.

A high level female employee was convicted of embezzling $1,000,000 from the employer as well as one count of identity theft although she messed with the records of 848 fellow employees. She faces 15 years in prison.

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It’s an interesting story on a number of levels including how this obviously intelligent woman was able, over a period of many years, steal so much money and effectively cover her tracks. She was caught because the company made a procedural change and not because the company had effective audit practices. That’s embarrassing.

As a biblical counselor the thing that interested me the most was the woman’s motive or reasons for the theft. Her’s was a position of some responsibility and while I do not know what her salary was I am assuming it was considerable and quite adequate for a comfortable lifestyle, yet she chose to steal $1,000,000. The question is why?

According to the print version of the  Milwaukee Journal-Sentinel she started to gamble after she had lost a prior job some 15 years past. Her stated reason was the gambling helped her deal with the depression resulting from the job loss.

She quickly became addicted to gambling and would frequently lose $10,000 per night on slot machines. I am not familiar with slot machines but that must represent some serious time being spent in order to lose that amount of money! When she felt the need to feed her gambling habit she began to steal more and more.

Since she was convicted it does seem that a measure of justice is being administered but having said that I’d be curious as to what the defense had to say given some of terminology used as to why she did what she did.

The first word is “depression.” She was depressed because she lost a job. To alleviate the sadness she began to gamble. The more she gambled the more she became addicted which is the second word used that sets off alarm bells to me.

In the world of psychology both terms, depression and addiction, are loaded terms. There are numerous labels attached to depression but basically they fall into two basic categories, 1) minor depressive disorder and 2) major depressive disorder. The difference is the number of symptoms observed or expressed.

A working definition of depression is: Depression is a persistent mood that is characterized by intense feelings of inadequacy, sadness, hopelessness, pessimism, apprehension, and a decreased interest in or ability to enjoy normal activity. This mood must last at least two weeks to be diagnosed as clinical depression.

I have no idea if the woman had been diagnosed as being clinically depressed after she lost that first job. If she was, then it probably worked to her favor in her trial because she would have had a medical label attached to her depression or in other words, a major depressive disorder.

The defense could postulate that the woman was sick with something when she was motivated to gamble and then to steal funds from her employer and co-workers, thus alleviating at least some of the personal responsibility.

The second word, “addiction” adds to the perception of sickness or disease.

A working definition of addiction is: Being given over to an undesirable habit to the point of dependence. Psychologists make a distinction between psychological and physical addiction. The most popular theory of addiction is the medical model which views the addiction as an illness with genetic or physical causes. Some psychologists reject this theory. They believe that addictions are psychological in origin.

The so-called medical model of addiction, that is, “an undesirable habit to the point of dependence” also tends to relieve the addict of some if not all responsibility for their actions. In the case of this woman had the defense tried this tactic they clearly failed because she was convicted and given a substantial sentence. However, this is often not the case because the medical model can be persuasive to an unsuspecting and sympathetic jury (which is why I’ll never be selected for a trial like this given my profession).

In other words what often happens is the perpetrator becomes the victim because they have a disease or sickness that explains their undesirable behavior.

The Scriptures would see the situation rather differently.  Scripturally speaking, an addiction is slavery to sin, a habit of the heart which is something a bit more than an undesirable behavior.

To become an addict a person pursues their selfish desires to the point of being enslaved by them. It may feel like they cannot help it but actually it is a decision or a series of decisions that add up to pursuing what they desire most. Whatever the addiction, there is a selfish desire of the heart at work. In the case of the woman she pursued the pleasure given to her by gambling, probably the emotional high given when one wins and the adrenalin rush one gets when risking something in a game of chance.

The Bible calls such behavior idolatry. It is the worship of self but self is not the controlling idol. In the woman’s case the controlling idol was pleasure and to get her pleasure she resorted to theft which in turn contributed to the further worship of the idol.

I suppose that this woman will get some kind of therapy in prison, something to convince her that theft is wrong to feed one’s bad habits. But that kind of therapy does not get to the root of her problem. Only Christ and the sufficiency found in him and his word can change the human heart and cure the worship disorder that she has.

And that’s the way I see it.

Christ can break the addiction cycle and set a person free from the slavery.

Christ can break the addiction cycle and set a person free from the slavery.

Definitions used in this blog post are from The Christian’s Guide to Psychological Terms by Marshall and Mary Asher

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