Alright, back into mental illnesses, diagnoses, and medication from a biblical perspective. Remember this is part two, so if it feels like we're just jumping into some stuff with no background, it's because we already had a part one. So anybody listening online, there is a part one, and anybody here that wants to hear some of the groundwork that we laid last time, that is available online. to listen to. I'll try to give you a quick rundown of what we're doing. First of all, I wanted to tell you that we have lots of MP3s and books. If you're interested, those resources available to dig in more because we're only doing this once a month, obviously. So if you want to get to more of it faster, we're starting with Michael Imlett, Descriptions and Prescriptions, A Biblical Perspective on Psychiatric Diagnoses and Medications. So I'm drawing from this heavily. So just know that I'm not making up a lot of the stuff that I'm saying that is outside of my realm of expertise, but trying to distill information that is from experts and that have the degrees and the experience and that sort of thing. In addition, I'm adding to it, obviously, but that's where a lot of this is coming from. Let us, let me give you a rundown. And remember, this is going to be a shorter... Oh, please don't tell me this tablet is frozen. Hmm. Well. This tablet is very old. I need to edit all this out of MP3. Come on now. OK, here we go. So let me give you a rundown of some of what we talked about. We're not going to make any claims about the rightness and wrongness of ever taking psychotropic medications. We're not going to say that you should never do it or that it's never appropriate. We do want to warn about what might be some unknown, maybe some areas that people are ignorant of in terms of the seriousness of it and the symptoms of it and how casually it is sometimes done. If that is something in your life, you've got to talk to a doctor. They're going to know some of the medical stuff obviously better than any of us here. There are key differences in the way that the The psychological world, the secular world, deals with man and how we deal with man, and that's something we're calling attention to. The differences between, they don't have a category of sin being a major thing. When we talk about psychotropic medication, it's anything that's capable of affecting the minds and emotions and therefore having an influence on behavior. So when we cite that, that's what we're talking about. Let's see, we gave a little bit of history about. psychology, we talked about God's design, about the interaction between mind and body, and how complicated that actually is, and the point about everything that you put in or on your body can have an impact on hormones or potential body chemistry. It can be essentially viewed as a medication, everything that you take in or put on yourself. can have potential effects to these balances in your body and the way that you think or the way that you feel and there's an interaction between your mind and body. We wanted to call attention to a lot of that. We talked about the placebo a little bit, the placebo effect. Let's see, what else did we talk about? The divergent views in the world about these things. We talked about sin producing misery, and not all misery can just be treated as if it's a brain disorder, but that there are ramifications from sin, and some of those should be dealt with as if it's merely an incorrect way of thinking or something like that. We talked about what diagnosis is, what actual diagnosis is. It's a form of classification, a grouping of symptoms that are gathered together, recognized, and then given a label. That's all diagnosis is. It doesn't talk about the cause. It doesn't talk about the solution. It just says, this is a group of symptoms that we recognize that go together, and we call it this thing. We give it a name. So it classifies symptoms, gives them a label. And some of those labels we talked about can be like oppressor, victim, addict, adulterer, narcissist, antisocial, bipolar, OCD, PTSD, ADD, ADHD, stuff like that. Those are some of the labels that can apply to groups of symptoms. We haven't gotten into any specific things yet. We'll eventually get there, but we haven't talked about necessarily any specific diagnoses. We said that all psychiatric diagnoses, everything that is come up with and given a label, needs to be submitted to biblical diagnoses. So we don't just take what they say and not put it through our worldview, that sort of thing. Then we talked about the history a little bit. We talked about the DSM, which is the Diagnostic and Statistical Manual of Mental Disorders. So this is like the psychiatrist's bible. And I think on their fifth edition, and it has changed over time, things that weren't in there before are now in there. It's expanded quite rapidly, and some things that are politically incorrect have been taken out. We said psychiatric diagnoses are descriptions, not explanations. They tell us what, but not why. I'm skipping ahead here so we can get to our new material. Okay, so we're going to start tonight talking about how psychiatric diagnoses have the potential to abnormalize the normal through over-diagnosis. And over-diagnosis is a legitimate problem. It's happening a lot. Basically, it's thought of this way. If it can be described then you can have it. It can be a thing. If you give it a label, then it can be a thing that you have. It can be diagnosed, in other words. So some have called this the medicalization of ordinary life, because you can always group symptoms that people feel, and you can give it a name, and people then tend to think of it medically. And then overdiagnoses is exasperated by the fact that most diagnosis and treatment is actually carried out by primary care physicians. These are basically the doctors you see for a common cold or for aches and pains, and then maybe they'll refer you on to a specialist, but most of the time these are the people that are giving out the prescriptions, and they do not have the time or the training to do it properly. But they are also under this pressure to medicate their patients. Because patients are coming in and they're saying, I have this problem, and they're under pressure then to medicate them, to avoid any malpractice lawsuit, to give insurance a legitimate reason to bill. Because if they come in, they say, well, I've got this thing. Can I have a prescription for it? Because they often come in with a prescription in mind. doctor is then under pressure to do something about that thing because if anything goes wrong it can come back on the doctor of like well I told him and he did nothing therefore he bears responsibility so or they could say well I went to the doctor for this thing he said he didn't know what to do with it or whatever so he doesn't have anything to write on the prescription for the insurance so the insurance doesn't know how to bill so it won't get paid and then it goes back to the person so it can be a big issue with that. There's a pressure to diagnose and prescribe because of those things. They're scared. Doctors are often scared not to follow the AMA, that's the American Medical Association, and the DSM, the guidelines in there. So there's pressure to follow exactly what gets put in there. They don't want to get sued. Sometimes they'll put something down just for the sake of the billing. And then we also want to recognize that there's this symbiotic relationship between psychiatric diagnoses and the pharmaceutical industry. And that's true of other branches of medicine as well. But in other words, the presence of a drug to supposedly treat a problem will increase the amount of diagnosis that happens for that problem. So if a drug company comes out with, we have a drug that solves these symptoms, then there's going to be far more people saying, I have those symptoms and I want that drug, and the doctors will then prescribe that drug more. And it looks like there's this huge increase in the, well, there is a huge increase in the diagnosis of whatever this drug is meant to solve. So as the drugs are created, there's more diagnosis of what the drugs are made to solve, which is a bit like the tail wagging the dog. It's a little bit reverse of the process that's supposed to happen. An example here, erectile dysfunction. It can be caused by things like blood pressure and heart issues, and it can also be caused by the use of pornography. They're finding a rise in people that are perfectly healthy that have this problem. And so that diagnosis comes up more and more as this drug is made available for it. And the causes aren't dealt with at all, even though they're very wide arrays of why that can be. So as Viagra, after it got created, the diagnosis for that skyrocketed, unsurprisingly. But the cause is still being ignored, because that's not really what they do. Also adding to this is the direct-to-consumer advertising by drug companies, which a lot of other countries apparently do not allow, like it's actually illegal. So this increases patient self-diagnosis and pressure on the physician then to prescribe the medications unnecessarily, because patients can often just go to different doctors and say, I want this drug. I have this thing. I saw this commercial. I want this drug. And they can just get a doctor to do it, because all you have to do is just try again, and they come in saying, this is the thing I have, I already know it. And they ask for the specific drug by name. Which kind of takes the doctor out of the medical field. He's not practicing medicine anymore, he's just a guy writing prescriptions. We already talked a little bit about the danger of an arbitrary standard of normal. Added with the constant over-diagnosis, we can extrapolate to the logical conclusions This seems extreme, but it's not too hard to imagine a place like China, for instance, doing this. But you could diagnose religious extremism and call it a mental disorder, and you can use a drug that can mute those things in the brain, the feelings in the brain. And it could be categorized that way. It could be medicated away. So you could group symptoms like opposition to modern sexual ethics and transgenderism. You could say, well, this group of people shows these tendencies. They have the symptoms to not be accepting of them. And then, you know what? That is called sexual liberation opposition disorder. And they need this drug. And then you start drugging the people that are opposed to... I mean, it seems crazy, but it can happen. It can get there. as you could see how normal things can be grouped together, categorized, labeled, and then opposed, or categorized as a mental disorder, or the people with that sexual liberalization, what did I make up the name, opposition disorder, people that have that, they're unfit to serve in such and such roles. Or they can't get jobs because they have this mental disorder that causes them to be mean to people. They're bigoted because they have this disorder. So, you know, they'll ask you in a job interview. That's the sort of thing that can happen. They could abnormalize the normal. That's a normal thing to oppose those ethics. But they can abnormalize it by calling it a mental disorder just by categorizing the symptoms and labeling it. Or you could do the same thing with caring more about pleasing God than preserving your own life. If you look at the first century martyrs, they could all be grouped together with some label like, these people are crazy, they're willing to be burned at the stake instead of, you know, offering a pinch of incense to Caesar. That's clearly a mental disorder. You know, you move that to our modern day, give it a name, group those symptoms, and you abnormalize the normal. So overdiagnosis has a tendency, it can do that. If it can be diagnosed as abnormal behavior, it can be called a mental disorder. And then who determines what's normal? Because there's stuff in the DSM that's pretty normal. It's just things that happen to people. It's just life sometimes. And some of it's extremely abnormal, but some of it's normal. There's this danger. Another thing that we want to talk about. Some psychiatric diagnoses redefine behavior that Scripture would characterize as sin. And this one should be obvious to us. So let me give you a case study. In 1999, An orthodontist lost his license because he admitted to, he was accused of and admitted to molesting hundreds of sedated patients. So he'd put them under and he would molest them. And he argued that he had something called froterism. And that's in the DSM. It's a disorder in their manual. And this is defined as recurrent sexual urges and fantasies involving touching and rubbing against a non-consenting person, oddly specific. But they call it a disorder. That's what froterism is. And he says, I had froterism. So he didn't go to jail. He went to a hospital for sex offenders. I think he spent about a month there before he was released. And then he sued his insurance company for a million dollars because he said his disorder caused him to lose his practice. Because he has a disorder, he's a victim of this disorder that he has. It's not his fault, he has a medical issue. It medicalizes something that scripture would categorize as sexual sin, but they medicalize it and he says, I'm disabled, I'm entitled to my disability insurance. Because of my froterism, I can't practice as an orthodontist because I can't handle being around these sedated people. Because of my froterism. So that's a case study. And based on their logic, he's got a case. I couldn't find the conclusion of his case. I looked for it. I couldn't find it. It was mostly just cited of how outlandish it was, but at the same time, it's like, but is it? I mean, if he has froterism, he has froterism, right? It's a mental disorder according to you. We call it sin. We recognize that this is just a pervert. Well, they don't really have that avenue. So that's a good example. The DSM cannot distinguish between moral and legal issues when it categorizes them all as mental illness issues. It can't say what's sin and what's not. It just says, there's a group of symptoms, and here's what we call it. They don't have the category of sin, and that's a great example of why that's a problem. They also have diagnoses, and these are in the DSM, voyeurism, exhibitionism, pedophilia, Masochism, these are all gross sexual sins that they give a name to and call a disorder or a mental illness. And it has stuff outside of the sexual realm too, like oppositional defiant disorder. Yeah, I'm guessing some of your kids might exhibit oppositional defiant disorder. Yeah, and it sounds ridiculous, but they group the symptoms, give it a name, hey, we'll come up with a drug, we'll solve that problem. Now everybody's kids are obedient. Conduct disorders, pyromania, kleptomania, intermittent explosive disorder, which is categorized as, or described as recurrent verbal or physical aggression. So I'm not just a huge jerk, I just have intermittent explosive disorder. See, I'm not doing it right now, it's only intermittent. We recognize that as sin. They categorize it. Suddenly it's a mental illness. Suddenly that person isn't guilty of sin they need to repent of. Suddenly they're out from under the law because the law is not condemning them anymore. They're a victim of a disorder. And that's a huge problem. That doesn't mean that every disorder is not a thing that happens to somebody or something going wrong in the brain, but it means this DSM and this secular world and how they think of these things can't do it completely. There's a big disconnect. So are these just disorders making them victims or are these people in sin? Are these moral? The DSM is amoral in its diagnosis. It can't say this is right or wrong. They just say it is. So secular anthropology, I think we pointed this out last time, is at odds with biblical anthropology. It's thus incapable of a full understanding of man's problems and the correct solutions that should accompany those problems. So some guy that has intermittent explosive disorder, they'll just What can they do? We can diagnose it as sin, something that needs to be repented of, and we can say why it happens, because that man is a fallen sinner, and he has either remaining sin in his life that he needs to overcome and be battling, or he's unregenerate and not seeking to do it. We have those categories, they don't. So they're severely handicapped in diagnosing man and finding correct solutions. Psychiatric categories and medications have fundamental limitations because of this. Secular worldview does not even operate with category of sin, thus it cannot even begin to evaluate the suffering, the anguish, the depression, and the emotions that are caused by sin. That doesn't mean no emotions or no depression, but the ones that are caused or a direct result of sin, they don't have the ability to evaluate. And that's a problem, again, a huge problem. They might be able to recognize it at times, they might be able to see it just from self-reporting of a patient, and they can give it a name, but they can't solve it. Even if they have a drug that they say will make you not feel it, they can't solve it. And by the way, those drugs that make you not feel it have some pretty serious side effects that people tend to ignore. Again, we're not saying there's no biological factor. We talked about this last time. There can still be biological factors that impact these things. I've got another case study for you, and this is a pretty crazy one, but there was a school teacher, and this is a true story, a school teacher began collecting, for the first time in his life, never had the feelings, never had the desires, but he began collecting child pornography and utilizing prostitutes. Just kind of out of nowhere, he had these feelings. He started pursuing sexual relationship with his stepdaughter and then got reported and he had to enter into a program to deal with it. When he was in the program he got kicked out for some further sexual deviancy with other people in the program and then he eventually went to the doctor like an emergency room he was reporting headaches and And he had trouble walking, but he also said, I have this extreme fear that I'm going to sexually assault my landlady. And these feelings are, you know, I'm feeling them and I don't know why, but I am worried that I'm going to get myself in trouble. Well, the hospital found a huge brain tumor in his brain. And when they removed that brain tumor, all that sexual deviancy, all those compulsive feelings that he had, that compulsiveness, it all returned to normal. He didn't have any of those feelings anymore. Now he was still guilty of the things that he did and had to deal with those legally, but the brain tumor seemed to have been causing the desires. So there was this big biological factor. And then he started noticing that those compulsions were returning. And so he went to the hospital again and they noticed again that tumor is back, they cut it out again, and again those compulsions decreased and went away. Clearly a biological factor was creating some compulsions that were very abnormal for this person. But at the same time, it didn't make him do it. It made him have the feelings. It didn't make him give in to the feelings. You could have a brain tumor that makes you really, really hungry. and your stomach might be totally full, and you would know it, you've eaten your fill, but that feeling, you just keep eating because you feel it, well, that feeling doesn't make you choose to eat, it makes you want to eat. And that's a big difference between having a feeling of wanting something and doing it. And that difference is your will, and you're responsible for that. So this is an example where A biological factor doesn't make him do it. He has a physical problem, but he also gave in to those compulsions, so he has a spiritual problem. That would be hard to deal with, admittedly, and he's a victim of that. But at the same time, he's an oppressor, or he's guilty. He's a perpetrator of giving in to these compulsions that came from this brain tumor. Obviously, an extremely rare case. We can see how there are desires and symptoms that might be experienced. For example, with transgender people, a man might really feel like a woman. He might really feel it. It doesn't mean that he should go through with the feeling or follow through with the feeling. Someone might truly feel perverted or some criminal sexual urge. They might really feel those urges. It doesn't justify it. You can't just say, but I really felt it, therefore I'm not guilty of it. When the person gives in to them, it's a spiritual problem. It's something that they're dealing with, and their will is not conforming to God's will. They're doing immoral activity, and it's their fault. It's not their fault they're feeling it. It's their fault they're doing what they feel. Because we don't do what we feel, we do what we know is right. We talked about this on Sunday, actually. So again, a person experiencing psychosis, for instance, Might hear voices, like, oh, well, this guy's crazy. He has voices in his head telling him to kill. Okay, yeah, pretty crazy, pretty weird, right? Can those voices make him kill? Who's deciding to listen to the voices in his head? The crazy guy. He's still deciding to listen to it. Hearing voices doesn't make you do anything. Okay, another issue here. Social cultural values influence the inclusion or exclusion of specific diagnoses from the DSM and therefore impact the prevalence of a diagnosis. And you're probably going to be familiar with this. The DSM, that Diagnostic Manual, is a cultural document. It influences society and is itself influenced by society. So, for example, homosexuality and transgenderism, what they call gender dysphoria, used to both be included as mental disorders. And again, that's short-sighted because they don't have the category of sin, they just called them mental disorders, which it is, but it's also a spiritual disorder, and it's a moral spiritual sin. But under political pressure, and through the normalization of both of those, They have been removed, and now they're considered perfectly healthy and normal. They've normalized the abnormal, which is the opposite of what we talked about before. Abnormalizing the normal, they've now normalized the abnormal, something that is sin. They've normalized it, and now they say it's fine. It's totally fine. Alfred Kinsey was a researcher, an incredibly perverted man that did really inaccurate research. He was at Indiana University, and he led the way in normalizing a lot of sexual deviancy. ADHD is another one. Now there are real brain differences or weaknesses in some people's brains that make paying attention more difficult for some. There are biological differences that they found in people's brains that they think contribute to ADHD. But the large-scale diagnosis of ADHD in many kids is fueled by cultural factors involving academic standards at young ages, discipline, fatherlessness is huge, their home life is a huge factor, overcrowded schools with overwhelmed teachers, pharmaceutical promotion of ADHD drugs, excessive screen use, which promotes distraction, shifting attention, shortened attention spans, instant gratification, stuff like that. So there are a small portion of ADHD cases that they can see a difference in the way the brain works, like a biological factor that makes it harder for that person. Not impossible, but harder. But then we have this huge amount of diagnosis of it that is mostly cultural factors. For instance, Over 9% of American kids have been diagnosed with ADHD, which seems crazy high. And then you compare that to French kids, they only have 0.5%. It's an 18, what is that? Nine, two, two, 18%, right? Wait, no, 180? It's big, it's a big difference. I can't think on my feet. Big difference, right, between .5 and 9%. That's a huge difference. And that is because French psychiatrists view ADHD as a behavioral problem to be addressed primarily, not exclusively, but primarily with social and relational interventions, which I think most of us inherently know that a lot of kids with proper discipline seem to lose their ADHD. Not all of them, we're not saying that there's no biological factor, but All of this to say, and one of the things we want to realize is psychiatric diagnoses have less functional authority than we assume. It's not an exact science. It is an educated guessing game when it comes to diagnosis and corresponding medication. It is not some exact science that if somebody just comes in with a label, it's like, oh, well, that's a thing that's out of my realm. I can't handle it. It's like, they got this thing. So don't be overwhelmed by it. So I want to talk about some implications, and this goes for lay people too, some implications for ministry. So first of all, don't be scared off by somebody's diagnosis, of somebody that you talk to that says, well, I have such and such. Like, okay. Don't be scared off. Don't think, well, I can't talk to this person. We have covered this in the past few weeks. We have been given everything we need for life and godliness, 2 Peter 1.3. Don't think that you have nothing to offer somebody that has a label for a supposed diagnosis. You still have something to offer. Every Christian has something to offer. Even if you don't feel theologically competent, do not underestimate the power of being a friend, a listener, and speaking encouraging words and telling them and reminding them of God's promises, speaking law and gospel. You can do that. Everybody can do that. And those can have impacts, even if you don't feel super theologically competent or even familiar with whatever the medical thing is or diagnosis that they have submitted to you. Number two, the diagnosis is not the identity of the person. So don't let the diagnosis become the defining modifier of the person. It's not their identity. We don't identify, well, such and such a person is, he's an adulterer Christian, and that one over there, that's a gay Christian, and he's a depressed Christian, and that one is an angry Christian, and this one's got Intermittent Explosive Disorder. That's not how we identify, that's not the identifying, this is not the person's identity. It's not the sum of their personhood. So when somebody struggles with one of these symptoms, we don't use the label and apply it to the person as if that's what they are and who they are. They might deal with those symptoms, but that's not their identity. In terms of many of these symptoms that define many mental issues, we all actually have some degree of them. So we're all on this spectrum, for instance, of narcissistic personality disorder. That's a thing in the DSM. Well, I can look at those symptoms and I can be like, yeah, I've got some of those sometimes. Maybe I don't have it enough to say that's what I am or I have that thing, but everybody's got a bit of narcissism in them, and some more and less than others, but we're all a little bit, some of us a lot, a bit narcissistic. It's part of our fallen nature. We're all a bit narcissist. Our goal is not always God's glory and other people's good. I mean, how often do we think about ourselves? What is that? How often do we think we're always the one in the right in every dispute? It's a bit of narcissism, right? We all have a little bit. We're all on these spectrums of these disorders. The anger disorder, like all of us have blown up at some point, right? How many times do you have to blow up before you qualify as intermittent explosive disorder? I don't know, but the symptoms are there in our life because we all have a degree of all of these sins, and I'm not talking like every mental illness, but some of these mental illnesses that are really just sins, we've pretty much all got some of it. So, those that point out that they have that label are not always necessarily radically different from those of us that don't have that label. Maybe they struggle with that sin more. Okay, maybe, but that doesn't mean that we're without it because we haven't been given that label. So all of us get depressed. All of us get angry. And that should lead to less stigma and feelings of isolation from the people that do have those labels. So that should be a good thing. It should make them less stigmatized in the church. Number three. Diagnosis is not an immutable destiny. And this one is good, this is a hopeful one. So I'm gonna read 2 Corinthians 4, 16 and 18. Therefore, we do not lose heart, but though our outer man is decaying, yet our inner man is being renewed day by day. For momentarily, light affliction is producing for us an eternal weight of glory far beyond all comparison, while we do not look at the things which are seen, but at the things which are not seen. For the things which are seen are temporal, but the things which are not seen are eternal. So diagnoses, if somebody has some of these symptoms to the point where they've been diagnosed, that is not the final word on that person. It should not give us tunnel vision when you talk to them. It's not like this is the only thing or like, well, that's it. They're going to deal with that the rest of their life and they're stuck forever. The Puritan, Timothy Rogers, that we mentioned last month, wrote Trouble of Mind and the Disease of Melancholy. We talked about that, how depression and some of these issues have, when it was called melancholy, have been dealt with for years in the church. And he wrote that book, Trouble of Mind and the Disease of Melancholy, because he himself suffered from melancholy, from depression. He had it very, very severely. But he was also delivered from it. It's not something that cannot be overcome. The vast majority of these, especially the sin ones, are not things that cannot be overcome. Do not, and this is the big point here, this is the hope, do not underestimate the power of regeneration and the power of the Holy Spirit's work to renew someone's mind. A narcissist can stop being a narcissist. An angry person can stop being an angry person. Jerks can stop being jerks. Perverts can stop being perverts. I've been all of those things at some point in my life. And by God's grace, I'm far less of them now. I'm not down to zero yet. but I'm working on it. People change because God changes people. And that applies to these mental illnesses, especially the sin ones. There is hope. So regeneration is massively important. The work of the Holy Spirit is massively important. And if we don't do that, we're discounting the power that God has to change and fix people. He loves to take broken people and fix them. He loves to take broken situations and redeem them. That's like one of his favorite things. So, we should all have hope, even if you've been diagnosed with something. It doesn't mean that you're guaranteed to never deal with it, but it can lessen, it can improve, and you can be renewed, because that's how God works. So, I know it's a little bit shorter and pretty quick, but we'll stop there, and let's go over this nursery policy stuff. Let's pray quick before we do that, too, though. Heavenly Father, thank you again for ways to think about these issues biblically. We pray for the narcissist and the angry and the perverts amongst us. All of us have that a little bit. All of us have some sin that may have a label and that some people think of themselves as a victim. We pray, Lord, that your Holy Spirit would change us and that when we deal with people that have these issues, we would have hope that the Holy Spirit would change them and we would not talk to them in hopeless ways, or reserve offering them the hope of the gospel because we think it needs to be dealt with by doctors instead of a spiritual issue in their soul. Give us that wisdom, give us that insight, and give us the words to speak helpful words into their lives to deal with these sin issues. And we pray all this for your glory and in Christ's name. Amen.