I am a counselor. I spend most of my day working with others to evaluate their problems, strategize for change, and seek wisdom from God’s Word. I love what I do, but what I do is different from many of the dominant models of counseling. Biblical counseling’s emphasis is on the first of those two words: the Bible. This emphasis has led many to draw all kinds of reductionist conclusions about this model of care and make all kinds of accusations against it. In this series it is my hope to communicate a more detailed picture of biblical counseling by pushing back against some of those criticisms.
The accusation that biblical counseling is anti-medicine arises from its belief in the sufficiency of Scripture. Every counseling approach has an organizing center that establishes the framework for how it will look at the human experience. For the biblical counselor that organizing center is the Bible. It is assumed then, that because we believe in the sufficiency of Scripture we are therefore anti-science and anti-medicine.
This is a strange accusation and it creates a false dichotomy. The Bible actually has a lot to say about the body and taking care of the body. No counselor who reads the Scriptures should come away with the conclusion that taking care of our physical body is sinful. Biblical counseling’s belief in the sufficiency of Scripture does not necessitate a disapproval of the use of medicine and science. Furthermore, that’s not what actual Biblical Counselors believe. Heath Lambert, Executive Director of the Association of Certified Biblical Counselors, explains:
From the very beginning of the biblical counseling movement, leaders have made clear their belief in the legitimacy of sources of information outside of Scripture. Biblical counselors do not ignore or outright reject extra-biblical sources or counseling insights. In fact, I would argue that biblical counselors have demonstrated a high level of theological sophistication about the use of extra-biblical data, often greater than our brothers to the theological left. The biblical counseling position is that there is much true information that exists outside the Bible – that found in the sciences for example. (A Theology of Biblical Counseling, 53-54)
The movement as a whole has a long history of respecting the insights of science. In fact, many of its respected counselors, speakers, authors, and leaders are also trained physicians (see Bob Smith, Michael Emlet, Charles Hodges, and Laura Hendrickson, just to name a few). Many books and articles from within the movement attest to its support of medical science and the appropriate use of medicine.
The point of disagreement between Biblical Counseling and other approaches to counseling comes with regard to the “appropriate use” of medicine. Our culture in America has increasingly sought to medicalize everything. Sorrow and suffering of any kind have been attributed to biological causation and are to be treated with medication. Within this climate, then, if you do not treat all mood disorders, for example, with medication then you are failing to help people because, after all, mood disorders have a biochemical cause. There are many, however, from within even the secular counseling world who believe that we have over-medicalized our problems. The diagnosis of depression can serve as a good example.
Over the past several decades American culture in particular has seen a steady, sometimes dramatic, increase in the number of diagnosed cases of major depression. Between 1987 and 1997 there was an increase of 300%. Between 1980 and early 2000 researchers saw an increase in treatment for depression of 76%. That’s a 76% increase in just 20 years. And the rates continue to go up. At present we see nearly 10% of adults in the U.S. each year are afflicted by Major Depression, and roughly a fifth of the whole population at some point in their lives experiences it as well. These are staggering statistics that cannot simply be explained by a better method of diagnosis in modern psychiatry. Allan Horwitz and Jerome Wakefield explain that the real rise in diagnosis stems largely from ignoring the distinction between normal and disordered sadness. They write:
We argue that the recent explosion of putative depressive disorder, in fact, does not stem primarily from a real rise in this condition. Instead, it is largely a product of conflating the two conceptually distinct categories of normal sadness and depressive disorder and thus classifying many instances of normal sadness as mental disorders. The current “epidemic,” although the result of many social factors, has been made possible by a changed psychiatric definition of depressive disorder that often allows the classification of sadness as disease, even when it is not. (The Loss of Sadness, 6)
We’ve turned normal, healthy, human sadness into a disorder. Robert Spitzer, editor of the DSM III agrees. After he oversaw the publication of this diagnostic manual he stated later that it “effectively medicalized normal human sadness.”
Many others have joined the cacophony of voices decrying the way we think about emotional health in this country. Writing in the New York Times, Julie Holland has observed how we often shame women in particular, as it relates to their emotions. She writes:
Women’s emotionality is a sign of health, not disease; it is a source of power. But we are under constant pressure to restrain our emotional lives. We have been taught to apologize for our tears, to suppress our anger and to fear being called hysterical. (“Medicating Women’s Feelings”)
This is not emotional health. Still others are recognizing the importance of therapy not just medication in the treatment of mental health. So, Richard Freidman, a professor of Clinical Psychiatry, actually argues that there are limitations to what medication can do and more intensive counseling is needed to really help people change (see “Psychiatry’s Identity Crisis”). Even the effectiveness of medicine itself is being challenged, as increasing studies find that medications do not make a lasting difference in overcoming many problems. Thus, the biblical counselor’s hesitancy to ascribe every issue to a medical cause is no less anti-medicine than the many other voices from outside the movement. Our view is increasingly a common view.
There are, of course, many cases where medicine is the right course of action. There are also real mental disorders that require medical attention. I see a man who struggles with manic episodes; it is of utmost importance that he remains on his medication. I also saw a woman who had such crippling anxiety that she couldn’t leave her home. It was important for her to go on medication in order to come and get formal counseling. There are many other examples where the relationship between our bodies, minds, emotions, and spiritual lives necessitates considering medical treatment. Biblical counselors are not anti-medicine.
The larger point of contention relates to our refusal to accept, wholesale, the medical model of counseling. There is great value in the insights coming from the psychological community and medical science. But these must all be interpreted through the lens of Scripture. In other words, biblical counseling lets God’s Word prioritize how we think about human experience. Jeremy Pierre describes the difference between prioritizing God’s Word and prioritizing psychological insights. The following two sentences describe the same problem, but do so from two different perspectives:
While it’s true that developmental and psychosocial realities have shaped who you are today, Scripture addresses you as a moral agent who actively responds to life in covenantal ways
While it’s true that Scripture addresses you as a moral agent actively responding in covenantal ways, developmental and psychosocial realities have shaped who you are today. (“Scripture is sufficient, but to do what?” in Kellemen and Carson eds., Scripture & Counseling, 107)
The difference in emphasis is the reason biblical counseling is often accused of being anti-medicine. The accusation, however, does not hold up. Biblical counselors are not anti-medicine, we are just careful with it.