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Cornerstone Bible Church – Equipping Hour January 18, 2015 Discipleship Counseling & Godly Living: Introduction to Biblical Counseling Part 2 Last Week: Intro to Biblical Counseling Part 1 I. The Need for Biblical Counseling II. The Definition of Biblical Counseling: Discipleship -- Seven Distinctives of Biblical Counseling III. Theological Basis of Biblical Counseling IV. Fundamental and Irrecoverable Errors of Psychology V. The Call to Biblical Counseling VI. Christ’s Example of Biblical Counseling This Week: Intro to Biblical Counseling Part 2 I. Secular Perspective: Mental Health Disorders A. Intro to DSM IV B. Generalized Anxiety Disorder C. Panic Disorder D. Major Depression E. Bipolar I Disorder F. Schizophrenia G. Psychotropic meds H. Advertising I. Science II. God’s Perspective III. The Mind Body Connection IV. Biblical Perspective V. Biblical Principles VI. Biblical Perspective on: A. B. C. D. E. Generalized Anxiety Disorder Panic Disorder Depression Bipolar Disorder Schizophrenia VII. We are not fighting “mental health disorders” I. Secular Perspective: Mental Health Disorders A. Intro to DSM IV 1. DSM IV stands for the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition. 2. The Fourth Edition was first published in 1994 and then revised in 2000. 3. The Fifth Edition was published in May 2013 4. The First Edition was published in 1952 by the American Psychiatric Association. The Third Edition (DSM III) was published in 1980 and was considered to be a landmark transformation for the field of psychiatry. 4. “each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome”. B. Generalized Anxiety Disorder (DSM IV) 1. 2. 3. 4. 5. Chronic excessive anxiety & worry about a number of life events & activities lasting ≥ 6 months Difficulty controlling the worry Worries or anxieties associated with 3 (or more) of the following: • Restlessness or feeling keyed up/on edge • Becoming easily fatigued • Difficulty concentrating or mind going blank • Irritability • Muscle tension • Sleep disturbance; early insomnia or restless sleep Worries or anxieties interfere with social or occupational functioning or cause the person clinically significant distress Not due to the physiological effects of a substance, or general medical condition C. Panic Disorder (DSM IV) 1. A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: • Palpitations, pounding heart, or accelerated heart rate • Sweating • Trembling or shaking • Sensations of shortness of breath or smothering • Feeling of choking • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, unsteady, lightheaded, or faint • Derealization (feelings of unreality) or depersonalization (being detached from oneself) • Fear of losing control or going crazy • Fear of dying • Paresthesias (numbness or tingling sensations) • Chills or hot flushes D. Major Depression (DSM IV) Lifetime prevalence is 7-12% men and 20-25% for women A patient with major depression will experience at least one of the symptoms from Category 1 and three or more symptoms from Category 2 for a total of at least 5 out of 9 symptoms. These symptoms must be present for most of the day, nearly every day for at least TWO weeks. Category 1: • Persistent depressed mood • Pervasive anhedonia (loss of interest/pleasure) Category 2: • Sleep disorder • Change in weight or appetite • Fatigue/loss of energy • Psychomotor retardation/agitation • Difficulty concentrating/indecisiveness • Guilt/low self-esteem • Recurrent thoughts of death or suicide E. Bipolar I Disorder (Manic Depressive) 1. At least one Manic Episode (next slide) 2. There has previously been at least one Major Depressive Episode, Manic Episode, or Mixed Episode. 3. The mood episodes are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. Manic Episode: (DSM IV) 1. 2. • • • • • • • • • A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week 2. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: inflated self-esteem or grandiosity decreased need for sleep more talkative than usual or pressure to keep talking insomnia or hypersomnia nearly every day psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) flight of ideas or subjective experience that thoughts are racing distractibility increase in goal-directed activity or psychomotor agitation excessive involvement in pleasurable activities that have a high potential for painful consequences 3. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). F. Schizophrenia (DSM IV) 1. Characteristic symptoms: two or more of the following, each present for a significant portion of time during a 1-month period: • Delusions • Hallucinations • Disorganized speech (e.g. frequent derailment or incoherence) • Grossly disorganized or catatonic behavior • Negative symptoms, i.e. affective flattening, alogia or avolition (lack of speech, will) 2. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations or self-care are markedly below the level achieved prior to the onset. 3. Duration: Continuous signs of the disturbance persist for at least 6 months. 4. Schizoaffective disorder and Mood Disorder with Psychotic Features have been ruled out. 5. The disturbance is not due to the direct physiological effects of a substance or a general medical condition. This Week: Intro to Biblical Counseling Part 2 I. Secular Perspective: Mental Health Disorders A. Intro to DSM IV B. Generalized Anxiety Disorder C. Panic Disorder D. Major Depression E. Bipolar I Disorder F. Schizophrenia G. Psychotropic meds H. Advertising I. Science II. God’s Perspective III. The Mind Body Connection IV. Biblical Perspective V. Biblical Principles VI. Biblical Perspective on: A. B. C. D. E. Generalized Anxiety Disorder Panic Disorder Depression Bipolar Disorder Schizophrenia VII. We are not fighting “mental health disorders” G. Psychotropic medications: Definition: Psychotropic medication: Any medication capable of affecting the mind, emotions, and behavior. From the Greek psycho-, the mind + trop, a turning = (capable of) turning the mind. -- Merriam Webster’s Medical Dictionary Psychotropic 1. adj. -- affecting mental activity, behavior, or perception, as a moodaltering drug. 2. noun -- a psychotropic drug, as a tranquilizer, sedative, or antidepressant. Random House Unabridged Dictionary, © Random House, Inc. 2006. Psychotropic drugs are those that affect the function, behavior, or experience of the mind. While their exact mechanism of action is not known, psychotropic drugs are thought to act upon the biochemistry of the brain and positively affect thinking mechanisms, emotional control, mood, and other behavioral processes. -- Ayd F. Lexicon of Psychiatry, Neurology, and the Neurosciences. 1995. Baltimore:Williams & Wilkins. H. Advertising A. B. in 1997, the FDA loosened regulations for marketing of drugs to consumers “1997 change [in DTCA laws] unleashed an unprecedented onslaught of commercials. By 1999, the average American was exposed to nine prescription drug advertisements on television every day. The number of television ads increased 40-fold between 1994 and 2000.“ Dr. John Abramson, Overdosed America: The Broken Promise of American Medicine, HarperCollins, September 2004, p. 152. C. D. E. Advertisements can give drug name, name condition without disclosing all risks Ads must mention important risks and provide a statement explaining that additional information is available Advertising makes you feel a certain way I. Science: A. “science” would have us believe that we feel a certain way because of the chemical levels in our brains. B. lots of scientific theories about neurotransmitters C. Serotonin, Dopamine, GABA (Gamma-aminobutyric acid) • currently, the most popular class of medications is the SSRI (selective serotonin reuptake inhibitors) Dopamine & GABA Neurotransmitter Theory GABA = Gamma-aminobutyric acid GABA-A Receptor Model Norepinephrine Neurotransmitter Theory Serotonin Neurotransmitter Theory Video: Zoloft Commercial 2004 E. Science refuting “science” • “Although it is often stated with great confidence that depressed people have a serotonin or norepinephrine deficiency, the evidence actually contradicts these claims”. Professor Emeritus of Neuroscience, Elliot Valenstein, in Blaming the Brain (1998), which reviews the evidence for the serotonin hypothesis. Valenstein ES (1998) Blaming the brain: The truth about drugs and mental health. New York: Free Press. 292 p. • “A serotonin deficiency for depression has not been found”. Psychiatrist Joseph Glenmullen, clinical instructor of psychiatry at Harvard Medical School, in Prozac Backlash (2000). Glenmullen J (2001) Prozac backlash: Overcoming the dangers of prozac, zoloft, paxil and other antidepressants with safe, effective alternatives. New York: Simon and Schuster. 384 p. E. Science refuting “science” (continued) • “I spent the first several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin. In fact, we cannot measure brain serotonin levels in living human beings so there is no way to test this theory. Some neuroscientists would question whether the theory is even viable, since the brain does not function in this way, as a hydraulic system”. Stanford psychiatrist David Burns, winner of the A.E. Bennett Award given by the Society for Biological Psychiatry for his research on serotonin metabolism, when asked about the scientific status of the serotonin theory in 2003. Lacasse JR, Gomory T (2003) Is graduate social work education promoting a critical approach to mental health practice? J Soc Work Educ 39: 383–408. “Indeed, no abnormality of serotonin in depression has ever been demonstrated”. Psychiatrist David Healy, former secretary of the British Association for Psychopharmacology and historian of the SSRIs, in Let Them Eat Prozac (2004). Healy D (2004) Let them eat prozac: The unhealthy relationship between the pharmaceutical companies and depression. New York: New York University. 351 E. Science refuting “science” (continued) • if there is so much controversy, and no clear proof, then why do so many “scientists” (physicians, psychiatrists, psychologists) believe so strongly in the serotonin or neurotransmitter theory? • 2 Tim 4: 3-4 For the time will come when they will not endure sound doctrine; but wanting to have their ears tickled, they will accumulate for themselves teachers in accordance to their own desires, and will turn away their ears from the truth and will turn aside to myths. This Week: Intro to Biblical Counseling Part 2 I. Secular Perspective: Mental Health Disorders A. Intro to DSM IV B. Generalized Anxiety Disorder C. Panic Disorder D. Major Depression E. Bipolar I Disorder F. Schizophrenia G. Psychotropic meds H. Advertising I. Science II. God’s Perspective -- 1 Corinth 2:6-16 III. The Mind Body Connection IV. Biblical Perspective V. Biblical Principles VI. Biblical Perspective on: A. B. C. D. E. Generalized Anxiety Disorder Panic Disorder Depression Bipolar Disorder Schizophrenia VII. We are not fighting “mental health disorders” II. God’s Perspective -- 1 Corinth 2:6-16. Yet we do speak wisdom among those who are mature; a wisdom, however, not of this age nor of the rulers of this age, who are passing away; 7but we speak God's wisdom in a mystery, the hidden wisdom which God predestined before the ages to our glory; 8the wisdom which none of the rulers of this age has understood; for if they had understood it they would not have crucified the Lord of glory; 9but just as it is written, "THINGS WHICH EYE HAS NOT SEEN AND EAR HAS NOT HEARD, AND which HAVE NOT ENTERED THE HEART OF MAN, ALL THAT GOD HAS PREPARED FOR THOSE WHO LOVE HIM.“ 10For to us God revealed them through the Spirit; for the Spirit searches all things, even the depths of God. 11For who among men knows the thoughts of a man except the spirit of the man which is in him? Even so the thoughts of God no one knows except the Spirit of God. 12Now we have received, not the spirit of the world, but the Spirit who is from God, so that we may know the things freely given to us by God, 13which things we also speak, not in words taught by human wisdom, but in those taught by the Spirit, combining spiritual thoughts with spiritual words. 14But a natural man does not accept the things of the Spirit of God, for they are foolishness to him; and he cannot understand them, because they are spiritually appraised. 15But he who is spiritual appraises all things, yet he himself is appraised by no one. 16For WHO HAS KNOWN THE MIND OF THE LORD, THAT HE WILL INSTRUCT HIM? But we have the mind of Christ. II. God’s Perspective -- 1 Corinth 2:14-16. But a natural man does not accept the things of the Spirit of God, for they are foolishness to him; and he cannot understand them, because they are spiritually appraised. 15But he who is spiritual appraises all things, yet he himself is appraised by no one. 16For WHO HAS KNOWN THE MIND OF THE LORD, THAT HE WILL INSTRUCT HIM? But we have the mind of Christ. • • • • • Psychiatry and psychology are supposed to be the study of the mind and soul, but they are largely based on conjecture and theories that amount to a de facto religion masquerading as science. (Piaget, Jung, Erickson, Freud… believed…) The religion of psychiatry begins with wrong foundation and tenets, ends with wrong conclusions and principles. Don’t confuse scientific methods and scientific vocabulary for “true science” God’s Word is sufficient and supreme. You don’t need initials after your last name to counsel people effectively. Heb 4:12 For the word of God is living and active and sharper than any two-edged sword, and piercing as far as the division of soul and spirit, of both joints and marrow, and able to judge the thoughts and intentions of the heart. III. The Mind Body Connection A. • • Scripture corroborates and affirms the connection between the mind and body Psalm 32:3-4 When I kept silent about my sin, my body wasted away Through my groaning all day long. For day and night Your hand was heavy upon me; My vitality was drained away as with the fever heat of summer. Psalm 38:1-10, 17-18 O LORD, rebuke me not in Your wrath, And chasten me not in Your burning anger. 2For Your arrows have sunk deep into me, And Your hand has pressed down on me. 3There is no soundness in my flesh because of Your indignation; There is no health in my bones because of my sin. 4For my iniquities are gone over my head; As a heavy burden they weigh too much for me. 5My wounds grow foul and fester Because of my folly. 6I am bent over and greatly bowed down; I go mourning all day long. 7For my loins are filled with burning, And there is no soundness in my flesh. 8I am benumbed and badly crushed; I groan because of the agitation of my heart. 9Lord, all my desire is before You; And my sighing is not hidden from You. 10My heart throbs, my strength fails me; And the light of my eyes, even that has gone from me. 17For I am ready to fall, And my sorrow is continually before me. 18For I confess my iniquity; I am full of anxiety because of my sin. B. Case: 37 y/o man seen in the E.R. for chest pain. Came to my office one week later with the following complaints: cold sensation no appetite headaches insomnia numbness in ears and feet groin pain weakness in the hands Nausea, stomach aches feeling tired all the time back pain heaviness in his chest examination, labs and EKG were all normal Dx: Anxiety and Depression This Week: Intro to Biblical Counseling Part 2 I. Secular Perspective: Mental Health Disorders A. Intro to DSM IV B. Generalized Anxiety Disorder C. Panic Disorder D. Major Depression E. Bipolar I Disorder F. Schizophrenia G. Psychotropic meds H. Advertising I. Science II. God’s Perspective III. The Mind Body Connection IV. Biblical Perspective (Biblical Anthropology) V. Biblical Principles VI. Biblical Perspective on: A. B. C. D. E. Generalized Anxiety Disorder Panic Disorder Depression Bipolar Disorder Schizophrenia VII. We are not fighting “mental health disorders” IV. Biblical Perspective: Biblical Anthropology A. There are two types of people in the world: believers and unbelievers V. Biblical Principles: A. Sin is Sin – personal responsibility for sin • • • • • • • • Romans 6:23 For the wages of sin is death, but the free gift of God is eternal life in Christ Jesus our Lord. Ezek 18:4b The soul who sins will die Lev 5:17 “Now if a person sins and does any of the things which the Lord has commanded not to be done, though he was unaware, still he is guilty and shall bear his punishment. Rom 2:15 – the Law of God is written on our hearts “objection” – but God made me this way! first: God didn’t make us this way – sin did second: God would not command us to obey if He did not also provide the means by which we can obey. 1 Cor 10:13 No temptation has overtaken you but such as is common to man; and God is faithful, who will not allow you to be tempted beyond what you are able, but with the temptation will provide the way of escape also, so that you will be able to endure it. B. Symptoms are for a reason, suffering is for a reason • • • • • • • psychotropic medication can help to improve symptoms, but it does not fix the problem the problem is sin (either the proximate cause or the root cause) symptoms and suffering tell us that something is wrong! symptoms and suffering point us to Christ Matt 11:28-29 “Come to Me, all who are weary and heavyladen, and I will give you rest. “Take My yoke upon you and learn from Me, for I am gentle and humble in heart, and you will find rest for your souls. James 1: 2-4 Consider it all joy, my brethren, when you encounter various trials, knowing that the testing of your faith produces endurance. And let endurance have its perfect result, so that you may be perfect and complete, lacking in nothing. Romans 5: 3-5 And not only this, but we also exult in our tribulations, knowing that tribulation brings about perseverance; and perseverance, proven character; and proven character, hope; and hope does not disappoint, because the love of God has been poured out within our hearts through the Holy Spirit who was given to us. C. Case: Counseling a dying Christian man who was in chronic pain: o o o o § § § God is sovereign over symptoms, suffering and pain God could take away the pain if He wanted to right? God can bless us through suffering we can glorify God through our suffering and pain Caveat: we can never really know the degree of someone’s suffering and pain therefore we should be slow to judge someone who is taking medication to alleviate suffering (pain medication or psychotropics) in general, the alleviation of suffering is a good and compassionate thing the Bible does not prohibit the use of medications to alleviate pain and suffering – it is more concerned with motives and issues of the heart Prov 31:6-7 Give strong drink to him who is perishing, And wine to him whose life is bitter. Let him drink and forget his poverty And remember his trouble no more. D. “Is there any reason for a Christian to use a psychotropic medication?” • • • • • • • • • non-believers need the gospel of Jesus Christ believers need the gospel of Jesus Christ Sufficiency of Scripture – 2 Peter 1:3 mental health disorders are spiritual disorders, not chemical ones like Diabetes or an infection. Principle: Principle: God is sovereign over our circumstances Practice: biblical counseling first Practice: prayer, meditation, introspection, biblical counseling & discipleship last resort: medication – may help with symptoms, continue to address the heart issues. medication – not because of a failure of the Word of God, but more to help a weaker brother or sister with symptoms while we continue to address the heart. This Week: Intro to Biblical Counseling Part 2 I. Secular Perspective: Mental Health Disorders A. Intro to DSM IV B. Generalized Anxiety Disorder C. Panic Disorder D. Major Depression E. Bipolar I Disorder F. Schizophrenia G. Psychotropic meds H. Advertising I. Science II. God’s Perspective III. The Mind Body Connection IV. Biblical Perspective V. Biblical Principles VI. Biblical Perspective on: A. B. C. D. E. Generalized Anxiety Disorder Panic Disorder Depression Bipolar Disorder Schizophrenia VII. We are not fighting “mental health disorders” VI. Biblical Perspective on: A. Generalized Anxiety Disorder 1. Natural fear 2. Sinful fear Prevents us from obeying God’s commands Causes us to disobey God’s commands Causes us to act selfishly Comes from unbiblical thinking Comes from unbelief or a lack of faith a. b. c. d. e. 3. Holy Fear (fear of the Lord) a. brings joy, peace, assurance, confidence 4. Fear (anxiety) and respect are inextricably linked and proportionate a. Idols of the heart VI. Biblical Perspective on: B. Panic DSO: 1. 2. 3. 4. Usually assoc with an intense overwhelming fear of death, loss of control, fear of panic attack, perceived threat, seek after quick relief or escape idol of safety, comfort, well-being, focus on feelings rather than God’s promises seek relief, comfort, and refuge from something other than God 5. Christians should have no fear of death -- Heb 2:14-15 Therefore, since the children share in flesh and blood, He Himself likewise also partook of the same, that through death He might render powerless him who had the power of death, that is, the devil, 15 and might free those who through fear of death were subject to slavery all their lives. 6. lack of trust in God’s protection -- Prov 3:25-26 Do not be afraid of sudden fear Nor of the onslaught of the wicked when it comes; 26 For the Lord will be your confidence And will keep your foot from being caught. VI. Biblical Perspective on: C. Depression: 1. 2. 3. 4. 5. 6. Usually a disparity in expectations discontent rooted in pride distrust of God’s promises and sovereignty Expectations not being met joy and pleasure from wrong things idols of the heart: Ezekiel 14:1-8 VI. Biblical Perspective on: D. Bipolar DSO: • • extreme lack of discipline of the mind prideful delusions of grandeur Phil 4:8 Finally, brethren, whatever is true, whatever is honorable, whatever is right, whatever is pure, whatever is lovely, whatever is of good repute, if there is any excellence and if anything worthy of praise, dwell on these things. VI. Biblical Perspective on: E. Schizophrenia: • • • extreme lack of discipline of the mind Nebuchadnezzar in Daniel Ch 4:27-37 his prideful and exalted view of himself was blasphemous and lead to his psychosis VII. We are not fighting “mental health disorders” We are engaged in a spiritual battle. • 1 Peter 5: 8-10 Be of sober spirit, be on the alert. Your adversary, the devil, prowls around like a roaring lion, seeking someone to devour. 9 But resist him, firm in your faith, knowing that the same experiences of suffering are being accomplished by your brethren who are in the world. 10 After you have suffered for a little while, the God of all grace, who called you to His eternal glory in Christ, will Himself perfect, confirm, strengthen and establish you. • Eph 6: 12 For our struggle is not against flesh and blood but against the rulers, against the powers, against the world forces of this darkness, against the spiritual forces of wickedness in the heavenly places. • Generalized Anxiety Disorder, Panic Disorder, Depression, Bipolar Disorder, Schizophrenia • • What do people with these disorders have in common? An intense inward focus – the Bible calls this selfishness and pride • Patterns of wrong and unbiblical thoughts that have become habitual 2 Corinth 10: 5-6 We are destroying speculations and every lofty thing raised up against the knowledge of God, and we are taking every thought captive to the obedience of Christ, and we are ready to punish all disobedience, whenever your obedience is complete. Rom 12:2 And do not be conformed to this world, but be transformed by the renewing of your mind, so that you may prove what the will of God is, that which is good and acceptable and perfect. Philipp 4:8 Finally, brethren, whatever is true, whatever is honorable, whatever is right, whatever is pure, whatever is lovely, whatever is of good repute, if there is any excellence and if anything worthy of praise, dwell on these things. This Week: Intro to Biblical Counseling Part 2 I. Secular Perspective: Mental Health Disorders A. Intro to DSM IV B. Generalized Anxiety Disorder C. Panic Disorder D. Major Depression E. Bipolar I Disorder F. Schizophrenia G. Psychotropic meds H. Advertising I. Science II. God’s Perspective III. The Mind Body Connection IV. Biblical Perspective V. Biblical Principles VI. Biblical Perspective on: A. B. C. D. E. Generalized Anxiety Disorder Panic Disorder Depression Bipolar Disorder Schizophrenia VII. We are not fighting “mental health disorders” Cornerstone Bible Church – Equipping Hour January 18, 2015 Discipleship Counseling & Godly Living: Introduction to Biblical Counseling Part 2