# Why do people always assume nouthetic counseling is against depression medicine?



## RamistThomist (Jul 9, 2015)

Whenever discussions about nouthetic counseling come up, people always throw the charge that the Jay Adams school is against using medicine to treat depression. Or said another way, "Depression is caused by sin."

I have been told by students of this school that is a straw man. Perhaps it is, but why is this a recurring criticism? Is there some earlier basis of fact?


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## Pergamum (Jul 9, 2015)

Here is Jay Adams from his book _Competent to Counsel_:



> Sometimes, instead of speaking of mental illness, people talk about “emotional problems.” But this language is as confusing as the former. When a client is depressed or high, or anxious or hostile, there really is no problem with his emotions. His emotions are working only too well. It is true that his emotions are not pleasant, but the real problem is not emotional, it is behavioral. Solutions aimed at relieving the emotions directly (as, e.g., chemical methods like pills or alcohol), therefore, must be considered to be nothing more than relief of symptoms.


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## Pergamum (Jul 9, 2015)

...and again:



> In nouthetic counseling, the stress falls upon the “what” as opposed to the “why” because the “why” is already known before counseling begins. The reason why is already known before counseling begins. The reason why people get into trouble in their relationships to God and others is because of their sinful natures. Men are born sinners.


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## Pergamum (Jul 9, 2015)

From The Christian Counselor’s Manual…



> Biblically, there is no warrant for acknowledging the existence of a separate and distinct discipline called psychiatry. There are, in the Scriptures, only three specified sources of personal problems in living: demonic activity (principally possession), personal sin and organic illness. These three are interrelated. All options are covered under these heads, leaving no room for a fourth: non-organic mental illness. There is, therefore, no place in a biblical scheme for the psychiatrist as a separate practitioner. This self-appointed caste came into existence with the broadening of the medical umbrella to exclude inorganic illness (whatever that means). A new practitioner, part-physician (a very small part) and part secular priest (a very large part), came into being to serve the host of persons who previously were counseled by ministers but now had been snatched away from them and placed beneath the broad umbrella of “mental illness.


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## RamistThomist (Jul 9, 2015)

Thanks. Would you happen to have page numbers?


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## Pergamum (Jul 10, 2015)

Sorry. Not sure.


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## Ask Mr. Religion (Jul 10, 2015)

ReformedReidian said:


> Thanks. Would you happen to have page numbers?


First and second quotes from pages 93 and 48, respectively.
Third quote from page 9.


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## psycheives (Jul 10, 2015)

Excellent question and quotes and page numbers. Good job, guys. This is helpful.

I understand CCEF and Westminster Theological Seminary Philadelphia's classes to have moved away from such a strict view and they hold a more positive view on medicine. Also see David Murray's views in his Christians Get Depressed Too book. They leave room for physical causes of depression (like issues with the Thyroid) due to the fall, acknowledging that our bodies are broken in may ways that they originally were not.

I understand Association of Certified Biblical Counselors (formerly NANC) and many of my previous MacArthurite/Baptist churches (who generally endorse/teach and are part of NANC) to take a middle road between Jay Adams' view and CCEF. They require certified counselors to read Adams but take a softer approach in supplementing him with CCEF materials and admitting he was a bit strict.


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## SolaScriptura (Jul 10, 2015)

I agree that medicines are "mere" relievers of symptoms. I liken it to putting a man in a straight jacket: his ability to flail and harm himself or others is inhibited, but nothing about his heart or mind that led to the situation has been affected. Thus as soon as the straight jacket (medicines) are removed, he's back in the same old mess. This is why treatment of emotional/behavioral problems with medicines is deficient. Please don't read me as saying controlling symptoms is bad. Not at all. But what is bad is the all too common idea that equates symptom management with having fixed the problem.


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## Pergamum (Jul 10, 2015)

Ben,

Agreed. But you're not willing to discourage all medication and denounce all of psychology as bunk, right? You see that a temporary back brace may help until the patient builds up the muscles of his back, right? And that psychology may have some usefulness. 

I think Jay Adams saw all the abuses of psychology and reacted very strongly.


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## RamistThomist (Jul 10, 2015)

Pergamum said:


> I think Jay Adams saw all the abuses of psychology and reacted very strongly.



Right--and few secularists today take Freud seriously. Once medical and chemical diagnoses came onto the scene, Freud's psychoanalysis became laughable.


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## DMcFadden (Jul 10, 2015)

With the rise of epigenetic science and proof that behavior can change our DNA, I wonder if chemical imbalance is always the cause of the depressive symptom or the depressive symptom is often the cause of the chemical imbalance.


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## R Harris (Jul 10, 2015)

What date or edition do you have for the "competent to counsel" book?

I heard from a nouthetic counselor here in OK a few years ago that Adams had somewhat softened his views - at least to the point that drugs should be a last resort, which I would wholeheartedly agree with.

It is a fact that sometimes physiological factors - such as hormone imbalance - can lead to depressive symptoms or behaviors. Treatment for this can help, but the vast majority of times it is not the definitive solution for the problems at hand, which is what the nouthetic counselors try and tell people.


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## Semper Fidelis (Jul 10, 2015)

Some things worth looking at:

http://archive.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all

http://www.albertmohler.com/2014/04...nversation-with-psychiatrist-e-fuller-torrey/

The Mohler interview is fascinating and the researcher's own conclusion that the mental health community has gone much further than it ought to have. He categorizes most mental illness as the "worried well" while acknowledging the existence of real psychiatric problems.

I think the things that have been added into mental health categories make it very difficult to sort out what, precisely, is mental illness.


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## Pergamum (Jul 10, 2015)

Here is a typical article on depression by those who follow Adams:
http://ids.org/pdf/applied/depression.pdf



> Depression is not an illness or a disease. “For something to be considered an illness
> there must be evidence of malfunction of or damage to some part of the body’s tissue.”5
> Although scientists have been studying depression for several decades, they have not
> been able to find any hard evidence that proves that depression is a disease or illness. A
> ...



Note that the author denies that depression is a disease or illness because a disease or sickness involves damage to some part of the body, whereas depression is merely a mood. Also, notice how the author is suspicious of any theory of depression which involves an imbalance of chemicals in the brain. His type of argumentation also usually includes studies showing the over-medication of antidepressants and studies which seem to disprove the current monoamine theory of depression.

The author goes further and states:


> The current medical practice of giving antidepressant medication to those dealing
> with depression is analogous to the ancient practice of blood-letting.



and also (in a step that some authors stop shy of) states:



> At its most basic level, depression is rebellion against God because of the way one feels.



In general, I think articles like this are both helpful and unhelpful. They are helpful in that they challenge the accepted notions of psychology, many of which cannot be proved through empirical research. But I also find articles such as this unhelpful in that they overstate their own case and go too far in the other direction, equate depression with sin, poo-poo all medications for depression, are overly suspicious of theories which factor in chemical influences over our mood, and often treat Christian counselors and psychologists who find merit in the secular field as if they were compromisers or inherently sub-biblical (i.e. there is only biblical way of practicing psychology). 

I believe that the bible shows us cases of depression that are not sinful and that chemical/physical/biological factors play a large role in our tendency towards depression (depression running in families, occurrence of depression in identical twin studies, post-partum depression or episodes where large health or hormonal changes coincide and seem to cause depression, etc), and I also believe that the verdict is still out on the monoamine theory of depression and that it seems like chemical deficiencies might play a role in mood.


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## Pergamum (Jul 10, 2015)

Here are also two relevant articles that seem to cover several perspectives:

http://biblicalcounselingcoalition.org/blogs/2013/07/09/mental-illness-psychiatric-drugs-and-counseling-education/

In that article is an AMA study, and it is interesting the conflicting ways in which both sides read that study:



> The Journal of the American Medical Association, to cite just one source, released a study showing that the actual pharmacological benefit of antidepressant medications for most people is basically non-existent and often worse than a placebo.





> I just read the study from the AMA you cited....with all do respect....can you read? The AMA study confirmed the effectiveness of antidepressants in moderate to severe presentations of depression. What medical training do you have? Oh, right, none.





> the AMA study states "The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms." - which Lambert is pressing, "the benefit for most people is non-existent", this would be the average. The AMA study goes on to state that medication helps in severe cases of depression but that level of depression has far more layers and issues at hand, but this was not pressed by Lambert.



Here is another article: http://www.psmag.com/health-and-behavior/evangelical-prayer-bible-religion-born-again-christianity-rise-biblical-counseling-89464


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## RamistThomist (Jul 10, 2015)

Semper Fidelis said:


> Some things worth looking at:
> 
> http://archive.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all
> 
> ...



While I disagree with the earlier Adams School (assuming that they changed their views), it is true that there is a tendency to always prescribe something in terms of medicine. And there is such a way where Adams' Disciples and the medical community can be off. Sometimes depression is triggered by lack of sleep et al (my own case when my newborn was ill). Contra the hyper-nouthetics, I wasn't in carnal rebellion, but contra Big Pharma, I didn't need 200mg of Prozac. I just needed a week of sleep.


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## Pergamum (Jul 10, 2015)

ReformedReidian said:


> Semper Fidelis said:
> 
> 
> > Some things worth looking at:
> ...



You needed a physical change, albeit not meds. Not merely "take two Scriptures and call me in the morning" and "repent of your depression." Exercise, diet, outside walking, mental change and variety, good smells, and good health are all physical components which effect a mood change. Poor diet, poor surroundings, poor rest, and poor exercise patterns seem largely at the heart of many peoples' bad moods. I might even say that these things impact the chemicals in your body.


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## RamistThomist (Jul 10, 2015)

Pergamum said:


> ReformedReidian said:
> 
> 
> > Semper Fidelis said:
> ...



That's exactly what I did. I invested in kettlebells. I started systematically doing hand stand push ups, bent presses, one leg squats, back bridges, and the like. I literally felt new life coming into me. I might start a ministry and call it Judges14:5 Ministries.


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## Pergamum (Jul 10, 2015)

Ha. Yes. Sign me up for your ministry newsletters then. I prefer long hikes....I'll start a competing ministry and denounce yours as sub-biblical. I just need a bible verse for mine...


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## Ask Mr. Religion (Jul 10, 2015)

R Harris said:


> What date or edition do you have for the "competent to counsel" book?


The quoted page numbers I provided are from the Logos versions of the book.


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## MW (Jul 10, 2015)

Why is it assumed that counselling is therapeutic? The disobedient chooses death over life. It is a part of the perfection and righteousness of the providential order when people bear the consequences of their choices and actions. How else will they learn? How else will God's ways be vindicated. The counsellor must beware that he is not telling lies for God or working contrary to the providential order.

I think this is what Jay Adams was originally driving at. While the issue is understood to be moral it must be dealt with in terms of scriptural imperatives. If it is conceded that the issue is not moral, it really has nothing to do with the counsellor, and it falls to the sphere of the physician.


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## Pergamum (Jul 10, 2015)

Not sure I understand your point?



> Why is it assumed that counselling is therapeutic? The disobedient chooses death over life. It is a part of the perfection and righteousness of the providential order when people bear the consequences of their choices and actions.


What does this mean?

There are a great many issues where a physician may not be needed, but neither is the issue directly moral or spiritual. Weight loss strategies, sleeping problems, improving social skills, etc. A pastor may help somewhat, yet these areas being not always directly moral, there seems nothing amiss in getting advice from others as well.


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## MW (Jul 10, 2015)

Pergamum said:


> Weight loss strategies, sleeping problems, improving social skills, etc. A pastor may help somewhat, yet these areas being not always directly moral, there seems nothing amiss in getting advice from others as well.



The pastor is not a guru. Distinctively "Christian" counselling has nothing to do with these things. Consider what our Lord said to the man who asked Him to tell his brother to divide the inheritance with him.


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## OPC'n (Jul 11, 2015)

Low levels of serotonin is real and causes a multitude of illnesses not just depression. Levels of serotonin can be obtained via blood draws. Some of the effects of low serotonin are:

"Serotonin exerts its major effects on the parts of the brain responsible for controlling mood, appetite, sexual desire and performance, sleep, memory, learning, social interactions and temperature regulation.

However, outside the brain, serotonin also affects the cardiovascular system, the endocrine system and muscles. It has even been found to contribute to the regulation of milk production in the breast." Here is a link about low serotonin its effects and ways to increase the levels. 

There are a number of ways to increase your levels of serotonin which include diet and exercise, being in the sun, and medication. To ignore any symptoms of low levels of serotonin, is unwise. I say all this bc many times depression isn't a sign of a "bad" relationship with God. It's the least understood organ in the body. It's also the least testable. I've seen some of my patients who have had an injury to their brain become completely different people both in mood and behavior. The brain uses chemicals and electricity to function and help other organs function. We shouldn't treat it any differently than we would any other major organ.


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## Pergamum (Jul 11, 2015)

MW said:


> Pergamum said:
> 
> 
> > Weight loss strategies, sleeping problems, improving social skills, etc. A pastor may help somewhat, yet these areas being not always directly moral, there seems nothing amiss in getting advice from others as well.
> ...



I think we might agree. I never said the pastor should necessarily be involved in these issues. There are psychologists and other gurus who might help people with such problems, and such help is perfectly legit (i.e. all psychology and forms of counseling that are not pastoring/discipling is not bunk, but there are certain areas of help and benefit they can perform, even if from a non-religious perspective). Some coaches are great for increasing strength, losing weight, and some counselors are good at motivating people to eat right or sleep well or reducing fear of flying, etc. We need not discredit their legitimacy or claim that one must necessarily do all of these things in a "Christian way" for us to acknowledge some benefit from their services. 

Your statement seems to prove my own dismay that so many pastors spend so much time in "Biblical Counseling" and that so many seek out their NANC certifications and focus so highly on this area. It seems an area of overmuch focus in some circles. They are spending hours and hours in intimate counseling with fragile women and many fall, and some count this time counseling as "an evangelistic opportunity" such that they seem to equate biblical counseling with evangelism such that evangelism decreases. Pastors should preach, evangelize and disciple and i don't see counseling as synonymous with any of these key areas of focus pastors are charged with doing. Therefore, I remain very ambivalent about Jay Adams and the movement he started. Much of it was needed, but some of it became out-of-balance.


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## MW (Jul 11, 2015)

Pergamum said:


> Your statement seems to prove my own dismay that so many pastors spend so much time in "Biblical Counseling" and that so many seek out their NANC certifications and focus so highly on this area. It seems an area of overmuch focus in some circles. They are spending hours and hours in intimate counseling with fragile women and many fall, and some count this time counseling as "an evangelistic opportunity" such that they seem to equate biblical counseling with evangelism such that evangelism decreases. Pastors should preach, evangelize and disciple and i don't see counseling as synonymous with any of these key areas of focus pastors are charged with doing. Therefore, I remain very ambivalent about Jay Adams and the movement he started. Much of it was needed, but some of it became out-of-balance.



The minister has the charge to feed souls with Word and sacraments. He doesn't study for the ministry so that he can do brain surgery. He must leave these things to those who know what they are doing.

Dr. Adams' first concern was for the pastoral ministry. Psychology was negating moral norms and psychiatry was overtaking the roll of pastoral care. In this situation he carefully defined the sphere of service which the pastoral charge must defend if it is to remain effective. Without a knowledge of this sphere the minister will end up becoming a therapist without any moral authority. His clarifications were much needed, and well stated in the book on shepherding. I think once it extended beyond the pastor's office it started to move in on the territory of other professionals, and that is where it became problematic.


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## Reformed Covenanter (Jul 11, 2015)

ReformedReidian said:


> That's exactly what I did. I invested in kettlebells. I started systematically doing hand stand push ups, bent presses, one leg squats, back bridges, and the like. I literally felt new life coming into me. I might start a ministry and call it Judges14:5 Ministries.






Pergamum said:


> Ha. Yes. Sign me up for your ministry newsletters then. I prefer long hikes....I'll start a competing ministry and denounce yours as sub-biblical. I just need a bible verse for mine...


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## Pergamum (Jul 11, 2015)

MW said:


> Pergamum said:
> 
> 
> > Your statement seems to prove my own dismay that so many pastors spend so much time in "Biblical Counseling" and that so many seek out their NANC certifications and focus so highly on this area. It seems an area of overmuch focus in some circles. They are spending hours and hours in intimate counseling with fragile women and many fall, and some count this time counseling as "an evangelistic opportunity" such that they seem to equate biblical counseling with evangelism such that evangelism decreases. Pastors should preach, evangelize and disciple and i don't see counseling as synonymous with any of these key areas of focus pastors are charged with doing. Therefore, I remain very ambivalent about Jay Adams and the movement he started. Much of it was needed, but some of it became out-of-balance.
> ...



Thanks. Yes, I agree.


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## R Harris (Jul 11, 2015)

OPC'n said:


> Low levels of serotonin is real and causes a multitude of illnesses not just depression. Levels of serotonin can be obtained via blood draws. Some of the effects of low serotonin are:
> 
> "Serotonin exerts its major effects on the parts of the brain responsible for controlling mood, appetite, sexual desire and performance, sleep, memory, learning, social interactions and temperature regulation.
> 
> ...



I think what you have said here, combined with Matthew's comments, is the proper approach. The danger is swinging too far in either direction. It really takes a lot of experience and discernment to really be a strong, competent counselor to know what the proper remedy is in some complex situations.


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