Drugs Are NOT the Only Answer for Mental Illness

Marcia Angell, Senior Lecturer in Social Medicine at Harvard Medical School, in her article “The Illusions of Psychiatry” in The New York Review of Books concludes:

The books by Irving Kirsch, Robert Whitaker, and Daniel Carlat are powerful indictments of the way psychiatry is now practiced. They document the “frenzy” of diagnosis, the overuse of drugs with sometimes devastating side effects, and widespread conflicts of interest. Critics of these books might argue, as Nancy Andreasen implied in her paper on the loss of brain tissue with long-term antipsychotic treatment, that the side effects are the price that must be paid to relieve the suffering caused by mental illness. If we knew that the benefits of psychoactive drugs outweighed their harms, that would be a strong argument, since there is no doubt that many people suffer grievously from mental illness. But as Kirsch, Whitaker, and Carlat argue convincingly, that expectation may be wrong.

Above all, we should remember the time-honored medical dictum: first, do no harm.

At the very least, we need to stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness or emotional distress. Both psychotherapy and exercise have been shown to be as effective as drugs for depression, and their effects are longer-lasting, but unfortunately, there is no industry to push these alternatives and Americans have come to believe that pills must be more potent. More research is needed to study alternatives to psychoactive drugs, and the results should be included in medical education.

In particular, we need to rethink the care of troubled children. Here the problem is often troubled families in troubled circumstances. Treatment directed at these environmental conditions—such as one-on-one tutoring to help parents cope or after-school centers for the children—should be studied and compared with drug treatment. In the long run, such alternatives would probably be less expensive. Our reliance on psychoactive drugs, seemingly for all of life’s discontents, tends to close off other options. In view of the risks and questionable long-term effectiveness of drugs, we need to do better. Above all, we should remember the time-honored medical dictum: first, do no harm. [Emphasis mine]

Answering Condemnation

Terry Virgo in his book The Spirit-Filled Church writes,

Sadly, many a Christian is more aware of a sense of failure and condemnation than of reigning and rejoicing…

The problem for many Christians is that they always feel condemned. But the answer to condemnation is never simply to improve our performance. It is to reckon on our position through grace. God has justified us freely as a gift. Condemnation is to do with guilt, not with feelings or improved performance. If we, through grace, are declared “not guilty” by God, then we cannot be condemned. Only the guilty man stands condemned. It is God who justifies, and if God has declared us “not guilty”, Satan cannot take us to a higher court. There is none. There is no more condemnation for us, not because we have been doing well lately, or because we have set ourselves a new standard, but because we are in Christ Jesus. He has carried our guilt on the cross. The more we come to enjoy that truth, the more we will know how to refuse Satan’s constant barrage of accusations aimed at getting us down. (Oxford, UK: Monarch Books, 2011) 56, 60

Interview with Dane Ortlund

Dane Ortlund is the Senior Editor in Bible Division at Crossway. He holds an M.Div. and Th.M. from Covenant Theological Seminary and a Ph.D. in New Testament from Wheaton College Graduate School. He blogs regularly at Strawberry-Rhubarb Theology and is featured at The Gospel Coalition and the Resurgence. He has also written a book titled A New Inner Relish: Christian Motivation in the Thought of Jonathan Edwards. Dane will be teaching at the Immanuel Theology Group put on by Immanuel Church in Nashville, Tennessee, where his dad, Ray Ortlund, serves as lead pastor. The following interview with Dane revolves around the theme “The Gospel in All of the Bible” which he will take up at the Immanuel Theology Group on August 13 of this year.

1. What is the gospel of Jesus?

The gospel is the startling proclamation that anyone can be right with God—acquitted, forgiven, restored, adopted—through trusting faith in Jesus, who lived the life we cannot live and died the death we deserve to die.

If I had to pick one place in Scripture where the gospel is laid out, I’d go with 1 Corinthians 15: “Christ died for our sins . . . was buried, and was raised” (vv. 3-4). The opening verses of Romans 1 give another helpful summary of the gospel message, though there in more story-like terms.

2. Why is it important to see the gospel of Jesus in all of Scripture?

For at least two reasons, one about the Bible and one about us.

First, the gospel is the main message of the Bible. When the last verse of the Bible says “the grace of the Lord Jesus be with all” (Rev. 22:21), that is an effective summary of the entire Bible—the grace of God in the Son of God for the people of God.

The gospel is the startling proclamation that anyone can be right with God.

Second, about us. We will be healthy, obedient Christians to the degree that we understand the Bible in all its many contours and flavors, including understanding the Bible’s main message. For example, if we view the Bible as mainly instruction, we will become either depressed when we fail to follow it or proud when we succeed. Both are self-focused. Neither is healthy. When we view the Bible as mainly—not only, but mainly—a message of grace, we will be freed from the emotional cowering before God that is so natural to us and will find fresh freedom to love God with real love, love that pours itself out in sacrifice and obedience to him.

3. Since this is so important, can you give a short summary of the gospel in the following books of the Bible:

• Where is the gospel in Proverbs?

Proverbs and James are the two easiest books to screw up. They are both heavy on advice/imperatives/instruction/exhortation. Divorced from God’s electing love in the gospel, Proverbs (or James, or any of the imperatives of the Bible) breeds self-despairing failure or self-exalting arrogance. Left in neutral, our hearts tend to slide into law-oxygenated living (tense, stuffy, despairing, burdened, relationally alienating) and away from grace-oxygenated living (relaxed, happy, calm, self-forgetful, liberated, relationally healing).

So—what is Proverbs? Wise help from an outside voice. Not all that different from the gospel! Proverbs is God coming to us and saying: ‘I love you so much, dear ones—here, let me help you live as the truly human being I wish you to be…’

There is no magic formula to ‘find’ the gospel in Proverbs. Rather, if we read Proverbs as wise words from a father who loves his children too much to let them ruin their lives through ignorant folly, we will receive it as God means us to, and be strengthened in a way that is grace-flavored.

And remember, from a macro-perspective, Jesus is the ultimate wise man. Paul said that Jesus ‘became for us wisdom’ (1 Cor. 1:30). Jesus is the wise man, and we fools, united to him by faith, share in that wisdom.

• Where is the gospel in Leviticus?

All over the place. Leviticus is an elaborate accounting of the sacrificial system that God mercifully instituted for Israel, to atone for their sins. It is virtually impossible to plunk down into a random place in Leviticus and not see God’s gracious provision of a way out for filthy people.

And Jesus himself brought that entire sacrificial system to fulfillment. The New Testament tells us Jesus was not only the priest who offered the sacrifice, he was also the sacrifice itself, the lamb—and he was even the temple in which the priest offered the sacrifice. As we read Leviticus as Christians, then, we can be ever mindful of what all those bloody sacrifices were anticipating.

From another angle: in Leviticus we see time and again that when the unclean touches the clean, both become unclean (see also Hag. 2:13). Jesus showed up and reversed this. He frequently touched lepers and others who were ‘unclean’ and in doing so both became clean (e.g., Mark 1:40-42). With Jesus we no longer see ourselves as basically clean in danger of defilement, but basically defiled in need of cleansing. And we can have it freely, because the one person who ever lived who was truly ‘clean’ went to a cross and was condemned as an ‘unclean’ person so that we unclean sinners can be freely treated as clean.

• Where is the gospel in Ecclesiastes?

Ecclesiastes insists that the good things of life—food, work, sex, wealth, honor—cannot serve as the ultimate things in life, and that if we make this mistake (as Solomon did) we will come to the end of life exhausted, frustrated, and disillusioned. Only God satisfies. And we human beings are so screwy that we will not believe God supremely satisfies unless God gets up in our face, through the voice of someone who actually had it all (Solomon), and tells us so.

As you look out on a congregation filled with broken marriages, hardened teens, bitterness, immorality, dishonesty, laziness, apathy, ask yourself: what has it been that has enabled you to conquer sin in your own life?

When Ecclesiastes speaks time and again of ‘fearing’ God, it does not mean being frightened of him but making him supremely central in your life so that everything funnels into that great loyalty. In telling us to fear God, we are given the key to contentment, to joy, to a meaningful life ‘under the sun.’ This is God’s kindness to us, is it not?

From another perspective: Jesus really had it all, even more than Solomon. He had unbounded wealth, honor, etc., in heaven. He had everything Solomon chased after. To an infinite degree. And he emptied himself and gave it all up and came to earth and suffered and died. Why? So that you and I, wayward sinners, can have real wealth, real riches, real honor, in the new earth, forever.

4. What are some tools/practical tips you’d give to a person to help them see the gospel in their daily devotions?

1. Reflect deeply, in an unhurried way, on your own sin. Not misanthropic introspection, but healthy self-assessment, in the spirit of 2 Cor. 13:5. One reason the gospel does not feel real to us is that our sin does not feel real to us.

2. Get married, then have kids, adopting if need be. Nothing exposes your sins and need of the gospel like living with other people who see what you’re like when you’re not out in public, wearing various masks, trying your hardest to come across a certain way.

3. Discipline yourself to read Scripture every day. It’s hard to get in a spiritual rhythm of communing with the God of all grace if you only have fellowship with him sporadically.

4. Sing. Print out your favorite hymns and worship songs and sing amid your Bible reading. We are whole people, not brains only.

5. Belong to a church that loves the gospel and preaches the gospel so that you can learn from a wise pastor how to see the gospel all over the Bible.

6. Read every passage mindful of what Jesus himself says in John 5:39-46 and Luke 24:25-27, 44-47, and what Paul says in 2 Cor. 1:19-20. If that’s how Jesus and Paul read their Bibles, shouldn’t we?

7. Read books by Jerry Bridges, Bryan Chapell, C.J. Mahaney, and Mark Driscoll.

5. What are some tools/practical tips you’d give to a pastor to help them study and preach in such a way that they tether the gospel to every sermon?

1. At Covenant Seminary, Bryan Chapell taught us to ask of every passage you read: What do I learn here about (1) the God who provides redemption, or (2) people who need redemption? Every passage contributes something toward at least one of those two questions. These questions prevent us from reading the Bible in a moralistic, ‘be-like-David-cuz-he-was-so-brave’ kind of way.

2. If you do not feel yourself—not just know yourself, but feel yourself—to be a great sinner in need of a great Savior, then you will not be eager to preach such a Savior’s gospel.

3. Read stuff by Zack Eswine, Edmund Clowney, Tim Keller, Dennis Johnson, Graeme Goldsworthy, and T. Desmond Alexander. Follow the guys who blog at The Gospel Coalition. Get commentaries by Derek Kidner, Dale Ralph Davis, Don Carson, Doug Moo, and Peter O’Brien.

4. As you look out on a congregation filled with broken marriages, hardened teens, bitterness, immorality, dishonesty, laziness, apathy, ask yourself: what has it been that has enabled you to conquer sin in your own life? Not behavior alteration, but true transformation, way down deep at the core of who you are? Is not the answer—in a word—love? Grace? Kindness? And if so, then what can we expect will change our people? There is certainly a place for exhortation. The Bible makes that inescapable. Let’s preach the whole counsel of God. But must we not tell people, not only unbelievers but also believers, of God’s undeserved kindness to sinners in the gospel? Isn’t this what not only saves unbelievers but also changes believers? Didn’t Paul, in the very place where he spoke of preaching ‘the whole counsel of God,’ sum this up as ‘the gospel of the grace of God’? (Acts 20:24, 27).

—————–

Thank you Dane for not only taking the time to answer each question, but the way in which you answered each question so that they drip with the grace of Jesus!

Once Sinners…But

A quote regarding the identity of the Christian believer that you should wrestle with from Dietrich Bonhoeffer:

This is why Christians are no longer to be called sinners, in the sense of men who are still living under the dominion of sin (…–the only apparent exception is in I Tim. 1.15, but that is a personal confession). On the contrary, they were once sinners, ungodly, enemies (Rom. 5.8, 19; Gal. 2.15, 17), but now through Christ they are holy. As saints they are reminded and exhorted to be what they are. [The Cost of Discipleship (New York, NY: Touchstone, 1959), 281.]

11 Ways the Book of Revelation is Relevant

New Testament scholar, Dr. Richard Bauckham, at the end of his book, The Theology of the Book of  Revelation lists eleven ways that the book of Revelation is relevant. In light of some of the recent shenanigans about the end of the world, I thought it important to post on how the book of Revelation is relevant in the here-and-now. What follows is my summary of his eleven relevant points and my attempt to make them a bit more brief. (It should be noted that particularly in #10 I add what I think to be some important clarification in light of recent one’s softening the reality of hell and judgment.)

1. It inspires, corrects, reforms, and ignites the Christian imagination. Because John’s Revelation is saturated with God’s transcendence it sparks a counter-cultural imagination that “resists any absolutizing of power or structures or ideals within this world” (159-160).

2. It drips with the truth of God. The plethora of images within the book are not used to deconstruct truth, but to reveal truth. It confronts relativism and consumerism and proclaims that the “church’s witness will be of value only if it knows truth worth dying for” (160).

3. It offers an alternative vision of the world which is God-centered at the very core. This theocentrism does not ignore humanity but “confront[s] oppression, injustice, and inhumanity” (160). A God-centered vision is ultimately for creation–humankind and the world–not against it. “In the end it is only a purified vision of the transcendence of God that can effectively resist the human tendency to idolatry which consists in absolutizing aspects of the world. The worship of the true God is the power of resitance to the deification of military and political power (the beast) and economic prosperity (Babylon)” (160).

4. It offers an “alternative future (the new creation and the New Jerusalem)” (160). God brings his kingdom to earth where righteousness alone will dwell. Man cannot and will not with money or power bring the perfected state for which it longs.

5. It brings perspective “from the victims of history” (161). “This is a standpoint taken in solidarity, rather than necessarily where John and his readers are by social and economic status” (161). Victims, of no matter what sort, matter.

6. It does not offer a theology of withdrawal and escapism from the world, but one “orientated to the coming of God’s kingdom in the whole world and calls Christians to active participation in this coming of the kingdom” (161). Christian worship is not “pietistic retreat from the public world” but “resist[ing] the idolatries of the public world” (161).

7. Its focus on the future (its eschatology) is grounded in the fact that Jesus Christ has already won, “but it cannot have reached its goal until all evil is abolished from God’s world and all the nations are gathered into the Messiah’s kingdom” (162). God’s kingdom has come and is still coming, which means that Christians are to remain “orientated towards God’s world and God’s future for the world” (162).

8. It critiques the church and not just the world. Idolatries of power and prosperity exist in the church as well as the world and must be repented of. The church is called to be a faithful witness to Christ, perpetually repenting of idolatry, and fixated on “the vision of the utterly Holy One, the sovereign Creator, who shares his throne with the slaughtered Lamb” (162-163).

9. It reveals that the church participates in establishing God’s kingdom primarily through verbal proclamation which is to be substantiated by its embodiment of the truth. Seeking power and influence as a means to bring the kingdom must always be in service to the reality that “God’s kingdom is not dependent on power and influence” (163). Christian witness “is consistent loyalty to God’s kingdom”, and “in this powerless witness the power of truth to defeat lies comes into its own” (163).

10. It is universal in the scope of God’s salvation for the world. God is reclaiming and renewing the whole world. Salvation is holistic and cosmic, not just individualistic and personal. This, of course, does not neglect the judgment that Revelation so clearly portrays. In fact, judgment serves salvation in that it eternally banishes wickedness and eternally punishes evildoers whether human or supernatural.

11. It upholds the universe’s greatest realities: the Triune God, the weighty transcendence of God which will at the consummation immanently dwell with the whole creation, the centrality of the glory of God, and sacrificial love seen by the presence of God in the world in the slaughtered Lamb and by the people of God laying their lives down in witness to the truth of God.

The greatest and “most urgent” contemporary need that the book of Revelation meets, according to Bauckham, is that “it can help to inspire the renewal of the doctrine of God” (164). In other words, what is unbelievably relevant to the church is that which the church tends to ignore and treat as irrelevant, namely, the knowledge of God.