Biblical Counseling, a Clarification

Dr. David Powlison — author of the "Sane Faith" series on Boundless (part 1, part 2 and part 3) — appreciates the comments you've written on a blog post I wrote yesterday. This morning he sent me an e-mail responding to some of them.

Among other things, he writes that "faith actually changes how you perceive [someone] and respond to [them]." Later he adds, "How you're relating to God and how you're relating to [others] are not controlled by your body, but by your heart."

I find his clarifications helpful as I wrestle with the principles laid out in "Sane Faith."

* * *

I so appreciate the honesty of blog responders. Life is not easy street, but a hard road. Contrary to the glib self-confidence and easy answers that define our culture's style, the Bible respects that our lives are fundamentally fragile, vulnerable to coming unglued. The psalms are the voice of honest strugglers, which is why Psalm 23 (and the anti-psalm) play such a key role in the lead article I wrote.

I want to make sure that the purpose of those articles is not lost. Ted Slater's blog comments are right in saying that these articles are not about medications at all. They are about affirming our humanness. They seek to shine a light on our common bond in the human struggles. We're all in this together, and God comes to take us in hand. I'd hate to have the main point obscured by the discussion getting swallowed up in the medication issue. That is an important issue in its own right. Here are some thoughts to put in the mix in thinking about medications. But I hope that readers will also go back and ponder my original articles further.

About 10 years ago I watched a PBS special on the state of psychiatry in America. The head of the National Institutes for Mental Health (NIMH) was interviewed. He can fairly be called America's "top psychiatrist." He sits at the top of the pyramid that funds medication research, sets standards for care, and so forth. He knows his field. His comments were insightful and fascinating.

He said that society has given psychiatrists an impossible job. They are charged with trying to help people solve all their woes and struggles. Then he said that psychiatric medications can sometimes take the edge off symptoms, but they can't give people what they really need. People need meaning and relationships. Psychiatry can't give that. Medication can't give that.

You might want to reread that last paragraph. It contains a philosophy of medication that is sane and realistic, as well as knowledgeable. It's so different from what our culture tells us.

This psychiatrist was also seeing something about people that I believe can only be truly addressed by Christian faith. People need to find personal meaning and meaningful relationships. My articles are about what people really need.

I fully agree with the head of NIMH that medications can "sometimes take the edge off symptoms." He credits medication with possibly doing some modest good, not all the time, but sometimes. Modest good does not mean no good, or all bad, or useless. Nor does it mean the best good. People most need meaning and relationships. And "sometimes" does not mean always, or without the possibility of negative side effects. It means what it says, sometimes.

Most people who've tried medications would say that their experience mirrors what the head of the NIMH said. He knows the literature. He knows people. He knows that people might be helped a bit, but that they need more help and deeper help. In my 30 years of counseling, I've seen the same thing countless times. I've also seen that when people find more help and deeper help they often drop the meds and don't go back. They don't need the symptomatic relief, because they've found more significant change. (That's not always, but in my counseling experience it's more often than not.)

More help and deeper help is what my articles are about.

Here's an analogy you might find helpful. Let's say you go to visit your mother for lunch. The relationship can be a bit strained. She can be "difficult." When you are with her, and things take a wrong turn, you get tense. You feel a bit edgy, anxious, and irritable. You can get sarcastic. Later you might vent to your friends, "She's impossible!"

Let's say you've also learned that your relationship with God makes a huge difference. You love this promise and response:

He himself has said, "I will never leave you or forsake you." So we can confidently say, "The Lord is my helper. I will not fear. What can man do to me?" (Hebrews 13:5-6)

When you remember that, live it, take it to heart, you're calmer. You don't take your mom so personally. You're more constructive. You're able to forgive her. You pray for her rather than vent negative gossip. You're able to get on with the rest of your day in a positive frame of mind. You say to your friends, "I've got to say, it's hard to relate to my mom. But I'm very thankful to God for helping me not to return evil for evil." That passage of Scripture speaks sweet promises to you, in God's own voice: He himself says it! It also portrays how your faith comes to life: I can confidently say. Your thinking changes. What you say changes. How you feel changes. It doesn't mean your mom changes. But your faith actually changes how you perceive her and respond to her.

Now here's where our little analogy get interesting. Let's also say that when you drink three cups of coffee on an empty stomach and don't eat a good breakfast, you go into your day feeling tense. You get a bit edgy, anxious, and irritable. (Sound familiar?) Eating a good breakfast and laying off the caffeine makes you feel better. Similarly you find that healthy exercise and a good nights sleep also make you feel better, less prone to that tense frame of mind.

Here's the million dollar question. Will eating a healthy breakfast, taking a brisk walk and being well rested make your relationship with your mother tension-free and happy?

No, it won't. It might help you go into that lunch visit a bit less keyed up. It might help you not cancel because you can't face her. Maybe you won't be quite so reactive. But your relationship with your mother is a matter of "meaning and relationships." How you're relating to God and how you're relating to her are not controlled by your body, but by your heart.

Jesus puts all this in His usual pithy way. "Man does not live by bread alone, but by every word that proceeds from the mouth of God." Bread means bodily sustenance: breakfast, exercise, sleep. But bread alone can't bring energy and light, hope and love, to the meaning of your life and to your relationships. Whenever we make the connection, life makes much more sense. It's a connection to make every day, like eating a healthy breakfast.

The same sort of thing is true with medications. When they help, they tweak your body to feel and function better. But they can't touch your need for the things that Hebrew 13:5-6 touches. Perhaps this paraphrase catches the right sense of proportion: "Man does not live by meds alone, but by every word that comes from the mouth of God."

Our society attaches such inordinate hopes to medication. Pharmaceutical advertising makes such grandiose promises (not just about psychoactive drugs, but about many classes of meds). We want to say, things that help your body are good: healthy diet, exercise, and sleep, always; medications, sometimes. But they aren't the best. See these things for what they are and aren't, and you'll keep your life struggles in proper perspective.

The human touch that the articles seek to elicit and portray is always the most important. Those articles are about the YOU on the inside of who you are. They are about the YOU in your relationships.

I'd encourage readers to go back and read the lead articles again. As Ted Slater mentioned, Boundless and I have been working on this project for a year. In a culture of online information, people are not used to reading something more than once. But anything worth thinking about carefully is worth reading a second time. Print it out. Take it slowly. Underline. Write in the margins. Ponder what it means. Take it to heart.

I'd describe medication questions as a riff off from those articles — an important question in its own right, but a sidelight, even a distraction. You've probably seen how easily that happens in blogs. A riff carries the discussion far afield from the original topic.

I hope that what really sticks in your mind is Psalm 23. Verse 4 brings a true perspective on all our woes, including a body that gets out of sync and mothers who can sometimes be difficult.

* * *

P.S. Here are some further thoughts, and something for further study for those so minded. Joseph Glenmullen, a research psychiatrist at Harvard, summarized hundreds of studies on the effects of psychiatric medications for anxiety and depression (Prozac Backlash, Simon & Schuster, 2000). He takes a balanced view, similar to the director of NIMH. He simply gives the research data. Research shows that most of the positive effect comes from placebo effect, not psychoactive ingredients. Perhaps two-thirds of those who take medications feel better because they expect the medication to make them feel better. In other words, even with a pill, the issue of one's faith plays a significant part.

How can you know whether you're getting a psychoactive bump in mood or a placebo bump? You can't. That's part of why paying primary attention to meaning and relationships puts medications in their proper place as second-tier items. A person getting a placebo bump will continue to feel better when off medications because the meaning and relationships in his or her life improve.

Glenmullen also gives details on the negative side effects that frequently arise and the frequency of drug ineffectiveness. People in these categories need not despair. Fruitful dealing with meaning and relationship issues always makes a difference in a person's life, even if they must live with lifelong tendencies towards depression and anxiety — which many wise and godly people in history have done. Even if there's no medication to make the tense-and-anxious reaction in your body go away, if the tense-and-anxious reactions in your relationships improve, then your life improves.

Comments

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1. Christina said the following at 1:04 PM on Aug 29:

I will ask a question my discipler once raised that may help shed some logical light on the issue.

When people have a chemical imbalance in their brain, why does that always lead them into the sin of despair and melancholy? Why don't chemical imbalances make them more susceptible to cheerfulness and joy? It seems that these chemical imbalances people are always speaking of lead to actions, attitudes and words that do not exalt Christ.

In a counseling class, we went over a chapter in our book that was geared towards depression and I found the author's set of rules to be a little intimidating and without compassion. When it finally came to discussing the chapter in our group, my pastor's wife (with great wisdom) said that we wouldn't be studying that chapter in the group setting. Instead, we spent the evening studying the power of God.

I'd be more than willing to email anyone that power of God study. It is filled with the hope of the gospel.

2. Rachael said the following at 1:42 PM on Aug 29:

As an adult daughter of a Christian woman who has been diagnosed with everything from schizophrenia to bipolar disorder to, at the age of 66, ADHD, I am crying tears of both thankfulness and sadness as I read this. I am thankful because it expresses so clearly what I have been unable to say to my mom each time she announces she has been "healed" by yet another drug with all its awful (unadvertised) side effect, and then watched her inevitably spiral downwards. I am sad because in the past I really was one of those who, because of what my mom was like on meds, rejected all of it and was one of those "just take five Bible verses and call me in the morning" people. I am not that way now, but my harsh, prideful attitude helped little and harmed much. And I am saddest of all still for my mom, who will listen only to "white coats" with Harvard degrees, and especially the Christian ones who have so totally rolled over and worshipped secular science, which denies even the existence of the sould, instead of the God who created both science and the soul. My prayer over the last few years has been that God would reenergize the Christian medical community and renew their commitment to the study and care for the whole person. Maybe this article, coming from an institution that hasn't always in the past expressed ideas in this area this way, is the begnning of that answer.

3. connie said the following at 2:41 PM on Aug 29:

"When people have a chemical imbalance in their brain, why does that always lead them into the sin of despair and melancholy? Why don't chemical imbalances make them more susceptible to cheerfulness and joy?"

Guess what? When I was suffering from bipolar type two I DID have both. The highs were wonderful. I was joyous, full of energy, talkative, better than best. The problem with that was that what goes up must come down, and the lows were horrible.

Thankfully for a period of time medication did help me. But I don't miss the point that good relationships with other believers and with the Lord Himself was a vital part of keeping me as well as possible.

Thankfully, a year and a half ago the Lord totally healed my brain and I no longer have the high highs nor the low lows. My doctor released me from treatment since even he saw there was no need.

But let me make it perfectly plain-for a time there was a need, and a very big need. I was on meds in obedience to God, while waiting for His timing to heal me.

Treating true chemical imbalances-and the soul and spirit issues that result from them-is a complicated matter, and there are no quick and easy answers. It is wrong and cruel to say meds are never needed but it is equally incorrect to say they are ever the total answer either.

4. BDB said the following at 2:50 PM on Aug 29:

Christina (#1) wrote:

>>Why don't chemical imbalances make them more susceptible to cheerfulness and joy? <<

I think it can, but the other people around them are OK with that. They can be fun to be around, but they might not be able to focus enough to manage their affairs. It's easier for friends and family to be willing keep them organized if they're fun to be around.

Similarly, there are drunks who become violent and dangerous. There are also alcoholics who become funny and cheerful. The latter is still using a chemical to deal with their life. That's still not healthy. But it doesn't frighten the people around them.

I do know a few people on lithium, and it does seem to moderate their bipolar tendencies.

At the same time, I've read a lot of biographies of giants of the faith. Pretty much all of them grow their faith through suffering. Much of the therapeutic community seems to believe that all suffering is bad. It's not. Suffering is sometimes necessary to the development of godly character. Why else would books like Lamentations and Ecclesiastes be included in the Bible?

I remain deeply concerned that antidepressants are being heavily over-prescribed in North America. I do know people who've been on Paxil and other drugs. One of the side effects with a few of them is that it seemed to erase their conscience. The things they would do...a normal person would be ashamed of. It didn't bother them at all. No sense of urgency to get their work done.

I think there's a lot we don't understand about antidepressants, and that scares me as much or more than mental illness.

5. Hoyt Roberson said the following at 3:02 PM on Aug 29:

Christina,

Most people with chemical imbalances are not "right," and usually when our bodies aren't functioning properly, we don't become happier. Does cancer make someone brighter? Why should a brain imbalance?

But it isn't true that chemical imbalances always make people depressed. Sometimes it makes them irritable (much like having the flu might), or in some cases, it makes them manic.

Unfortunately, even if they are manic, the "better feeling" isn't usually productive in its effects.

And so, chemical imbalances cause various reactions in people because their bodies aren't functioning properly. And when we're sick, the illness seldom makes us productively feel better.

6. Jo said the following at 3:27 PM on Aug 29:

A clarification from me too: There's a lot I agree with in the articles, and in this post too. I still think there are important issues that haven't been addressed, and there are places where I disagree or would be cautious at least, but perhaps those things weren't the point of this series. Topics for another time, maybe.

To Christina, though:

"Why don't chemical imbalances make them more susceptible to cheerfulness and joy?"

Actually, mania leads to extremely elevated mood, hyperactivity, high energy etc - virtually the opposite of depression. That's not 'cheerfulness and joy' in the positive sense, but as you say:

"It seems that these chemical imbalances people are always speaking of lead to actions, attitudes and words that do not exalt Christ."

Obviously an imbalance is not a good thing. The balance is what God intended, therefore an imbalance of any kind will not exalt Christ. It doesn't mean these conditions aren't real, in fact it can be clearly shown on brain scans that they are.

7. Leeandra said the following at 3:55 PM on Aug 29:

@Christina--chemical imbalances in the brain CAN produce definite feelings of inordinate cheerfulness and joy just as they can produce feelings of despondency. The former is called mania, the latter is called depression, and people can (and do) continue to exult Christ in BOTH these states. See Christopher Smart's poem "Jubliate Agno," written while confined to a madhouse for what we'd now call bipolar mania, or the "terrible sonnets" of Gerard Manley Hopkins, who spent most of his adult life suffering from what we'd now call clinical depression.

The thing people must remember is the difference between depression and despair. Depression can often lead to despair, but it's not a given.

Good books on this exact subject (I'm surprised no one has mentioned them yet) are Viktor Frankl's "Man's Search for Meaning," "The Will to Meaning," "Man's Search for Ultimate Meaning," and "The Doctor and the Soul."

8. Jethro said the following at 4:41 PM on Aug 29:

Dr Powlison cites a few studies in his response and then heads straight to his predetermined conclusion - which he is refreshingly honest about.

Conspicuously absent however is a three way outcome comparison between regular counseling, biblical counseling and no counseling across the medication/no medication/placebo sub-groups.

I'm not sure if there is such a study or not, but perhaps Dr Powlison can address this and let us know the relative success of the different counseling models both alone and combined with medication?

9. Lynne said the following at 9:55 PM on Aug 29:

Ted,
Thanks so much for including research and the NIMH director's words about medication.
When I work with parents and adults, I often tell them the purpose of medication is to control or minimize the symptoms, we review common side effects, then we talk about how the medications help us regulate the emotionality so we can work on the thoughts and behaviors we picked up along the way, things meds don't fix.

For example, a child can take a stimulant for ADHD. This will likely help them sustain attention longer. It will not fix the other symptoms that often come with ADHD (poor social skills, poor study habits, poor organizational skills). Nor will they suddenly recall the information they did not pay attention to and learn.

Research also shows that for mild to moderate depression, Cognitive-behavioral therapy works a little slower the anti-depressant meds initially, but the gains hold up far longer. This is because you're working with peoples thoughts and behaviors.

Rachel,
I appreciate you sharing your story and the impact your mom's mental illness has had on her and you. My prayers are with you. I have so much respect you sharing how your opinions have shifted over time and some of the events that have shaped them.

10. Amir Larijani said the following at 8:46 AM on Aug 30:

I fully agree with Powlison.

Medications are useful in terms of taking the edge off symptoms. That can be helpful to both counselor and client.

If you are dealing with someone who is bipolar, medications can mean the difference between having a client you can work with, versus someone who is too irrational to reason with, or--worse--commits suicide.

If you are dealing with a nasty depression, medications can help blunt the symptoms enough to help you see reality more clearly.

Meds aren't everything, but they certainly can augment the process.

Some people would contend that mental illness is the result of sin, and it may be in many cases. I know some friends who are bipolar, and a lot of their woes stem from post-abortion guilt. (Note: All bipolar sufferers do not fall into this category, but some do.)

I would also contend that some people have predispositions to mood swings that can become exacerbated by hormonal factors, substantial life events, and--yes--even sin.

For them, meds are hardly a panacea. Not by a long shot. But they can help blunt the damage and make it more possible to deal with a more rational client/patient.

11. Anna said the following at 9:14 AM on Aug 30:

"How you're relating to God and how you're relating to [others] are not controlled by your body, but by your heart."

My experience, and that of many other depressed people I know, is in direct contradiction to this statement. From my response to the first blog post:

'When I'm in a deep depression, I can't focus long enough to read the Bible. Irrational guilt and self-condemnation make me feel unworthy to pray. Memorizing comforting Scriptures is impossible when my mind is so foggy I literally can't remember what I ate for breakfast. Fellowship with other Christians can be a source of deep comfort, but only if I can force myself to leave the house and seek out people to spend time with.

I can (and do) pray for strength to withstand the compulsion to pull out my hair and pick holes in my skin -- but it falls short when the fixation begins, because the disease is by definition COMPULSIVE. All of my attention is focused on this behavior and I can't even remember that I'm supposed to pray, much less follow through. The symptoms of these diseases can themselves block the "cures" some Christians recommend.'

I have spent hundreds if not thousands of hours in the past decade praying for forgiveness, strength, the fruits of the spirit, more love for my neighbor, and healing from my depression and trich. I've read the Bible cover-to-cover twice and studied large portions of it in-depth. I've participated in a number of Bible studies and Christian ministries. I've served my church and community as much as I am able. I pray and worship daily, even when tears are pouring down my face and I can't even get out of bed. I certainly don't lack in self-discipline; I graduated from college a year early, summa cum laude, while battling this disease without medical or psychological help because I was convinced that it was my own fault and I just needed to pray harder.

I'm still depressed, but now I'm medicated and functioning. Would anyone like to tell me what I'm doing wrong or where my faith is lacking?

12. Charles H. said the following at 9:46 AM on Aug 30:

I think we need to draw a line between admitting that medication has been overused, and discarding it wholesale. It has legitimate purposes. On the other hand, it's overused -- particularly amphetamines (Ritalin, etc) and SSRI's (Prozac).

Just as it's appropriate to use exercise and a low-fat diet as a first step against high cholesterol, and limiting sodium as a way of decreasing blood pressure, it's also true that much childhood "hyperactivity" has to do with sugar and caffeine intake. How many kids *could* sit still after washing down a bowl of Frosted Sugar Bombs with a nice, cold Coke?

Conversely, the distinction between sadness and depression is often blurred by general practitioners forced to hurry by poorly conceived insurance systems. "I am feeling downbeat because my loved ones have abandoned me and I am stuck in a dreary nursing home" is not equivalent to "I have a nice life, but I am sad to the point of contemplating self-harm." One may reasonably be treated with talk therapy and (if possible) a change of environment; the other, probably not.

13. Alex C. said the following at 1:18 PM on Aug 30:

Maybe they do. Its just that being cheerful and joyful are positive qualities, so no one ever thinks about needing to correct that particular type of brain imbalance ^^.

14. f-jen said the following at 10:36 PM on Aug 30:

I've just read over all three articles, and all the blog posts as well. (At least, up to #2 here.)
And I keep thinking of several different things - probably not entirely related.

First - the three articles seem to circle around a common theme, of "quasi-diagnoses." And, I would agree, those are a real problem. Every real psychological ailment does seem to enter the common parlance as synonym for sin or weaknesses. (eg, "I'm a little bit OCD" instead of a "I have a bad habit I haven't yet broken," or, "oh I'm so depressed!" instead of "Gee I'm having a bad day today.")

But - on the other hand - the diagnoses were developed to describe Real problems. Real chemical or physical glitches - just as physical as a broken leg or torn meniscus - that really do show up and cause real problems. Sure, a person with the particular glitch may be suffering with sin in their life. And, sin complicates - makes the glitches worse!

But, give them Jesus -- even, get rid of all the problematic sin -- and, still (sans miracle or medicine, that is) the real, physical glitches will really remain.

And, when that's the case, when there is a glitch in the operating system (aka brain, aka neural connections, etc), then an accurate diagnosis can be of great value.

For myself -- I know that I have tendencies toward depression. Also I know this is genetic. So when a cousin mentioned to me the monthly nature of her own struggles, I made the connection. Now, at certain times, I resist depression by the knowledge that, at that moment, my feelings are not reliable. Without the label "depression," I might be overwhelmed at those times when even prayer, even psalms, just lead me to tears. Instead, with the label, I can know that "this too will pass" (in about a week or so). ;)

(And, by the way - I suffered from depression also before I became a Christian - and, it's a thousand times easier to deal with, knowing Jesus. However, it's still there.)

But - as an alternate example: I have had bad habits from time to time. (Yeah okay lets be honest - I have plenty of bad habits!)

And at times it might have been convenient to call some of my bad habits, "OCD."

But, they're not.

A best friend of mine since childhood does has OCD. The real thing. It's not due to particular sins in her own life. (Although, attempting to deal with it has led her into various dsturggles.) It's a mental glitch. There was a time she worked hard with a counselor, to root out the compulsions. And, together they did root out some. But the moment one compusion went away, another, totally unrelated would appear. (She was not immediately aware of them, but I spent a lot of time with her, and I could see them.) They weren't mere expressions of sin, of character flaws or selfishness. They were expressions of her mental glitch. (BTW she is Christian.)

And then, I saw her when she was finally prescribed medication that helped some. She couldn't actually afford the medicine, so she would take it only sometimes. And the difference was like night and day. It wasn't a placebo affect. (Before getting something that worked, previously she did get a placebo-type medicine. It lifted her mood, a bit, to believe that something was helping. But it was clear to observe, that it didn't do much.) But the medicine that worked -- on the days she took it, it was like having my friend back. We could have real conversations, her intellect no longer disrupted by the need to check every bush in case she had dropped something two days ago. (From pockets that she KNEW were empty!)

But - I also knew someone, more recently, who claimed to have OCD. She claimed to have been diagnosed with it. (It's possible. A lot of psych diagnoses depend on self-reported symptoms - doctors can't follow their patients around 24-7 to verify the truth of their claims.) But, every compulsion she displayed was a form of greed, indulged when it suited her and when she could manipulate others to do what she wanted. Was that really OCD? Maybe, one form of it. But I'm personally certain that, at most, it was a symptom of something else. Perhaps something else that needed investigated - or perhaps not. Perhaps just sin that needed confessed and changed.

But in any case, her form of OCD was Not it's own glitch. In her case, it was just an excuse, just a diagnosis to set herself apart. And, there's a good chance that diagnosis, of a symptom not a cause, and which she wielded as an excuse, may have helped obscure the real problem.

To me, the problem with diagnoses that simply describe, is just that. A doctor does not typically, nowadays, have lots of time with a patient. (Even in an inpatient setting!) So a doctor goes by what is described, and doesn't always have time to perceive whether what is being described is the Real problem, or whether it's a secondary, or even a false problem covering up something else.

15. composer girl said the following at 9:36 AM on Sep 1:

Thank you for the clarification in this post. I almost think that Dr. Powlison's response in this post was made with more clarity and straightforwardness than the original articles. The point was made clearly, without getting lost in parables and analogies.

16. Leah said the following at 7:01 PM on Sep 1:

Christina asked When people have a chemical imbalance in their brain, why does that always lead them into the sin of despair and melancholy? Why don't chemical imbalances make them more susceptible to cheerfulness and joy? It seems that these chemical imbalances people are always speaking of lead to actions, attitudes and words that do not exalt Christ.

Um, no. These chemical imbalances *can* make them more susceptible to cheerfulness and joy- that's part of bipolar. Extreme highs and extreme lows.

It's also very unfair to say that someone with depression (for example) demonstrates "actions, attitudes and words that do not exalt Christ" anymore than you do. Yes, a depressed person may do these things, but so do you. I think you'll find that generally depressed people have these horrible, saddening, confusing thoughts and are saddened and confused by them even more because they know they
a) shouldn't be having them
b) don't want to have them
Just because it's all very unhappy doesn't mean it can't be used to Christ's exaltation (and that the sufferer themselves doesn't).

17. Christina said the following at 8:26 AM on Sep 2:

Clarification:

First, I must apologize, my first comment was written in haste and not much thought went into how I could have been misunderstood.

Second, my question wasn't said out of ignorance for the real, serious issues that some of us struggle with. One of my best friends struggles with depression and my sister is bipolar. I was merely stating a question that was once raised to me.

I suppose my thought process in all was that there is hope outside of medication. If depression causes us to sin, we (as Christians) have the power of the Holy Spirit working within us so that we might not sin. Jesus came to set the captives free, so that we may no longer live in bondage to sin.

I think that taking a stance to defend medication in this sense, is dangerously close to adding to the gospel. Just as the original post says, "Perhaps this paraphrase catches the right sense of proportion: "Man does not live by meds alone, but by every word that comes from the mouth of God."

By saying that we will never be able to function without the aid of medication, we are saying that Jesus' atoning work on the cross is not enough to sustain.

I also don't want to imply that because I don't struggle with depression, I don't sin. I often find myself sick with grief as the Lord reveals my wretchedness to me. My prayer is that I would learn to cling to the gospel and nothing else. It's a slow process, but God promises to bring to completion that which he started in me.

18. obewan said the following at 12:28 PM on Sep 2:

Depression is not only limited to feelings of sadness. Some people get severe insomnia and don't even know they are depressed. I have had periods of extreme insomnia during periods of extreme life stress. At one point, I went 21 days on 1-1/2 hrs of sleep a night. I was visibly shaking and had reactions to car horns honking and other sudden noises that were like a posttraumatic stress disorder victim.

My doctor claimed that if a person experiences sleep deprivation for a long enough period of time, brain damage might result. In cases like this, talk therapy does not do a whole lot over the short run.

The insurance companies play a role too. Many of them would rather pay $1 a day for a pill instead of $200 an hour for talk therapy.

19. Rosalie said the following at 1:03 PM on Sep 2:

I must confess I haven’t read all of the articles, or all the posts on the pervious thread. Mainly because I don’t have time and secondly because, although I’m sure they contain some good points, I suspect they would annoy me greatly. I’m sorry this has turned out so long.

As a final year medical student I’m used to readying articles written for medical professionals which use specific language to talk about specific issues and quote robust clinical trials. Obviously these articles are written for a much difference audience. Still certain terms (obsessive compulsive disorder, clinical depression, anorexia nervosa etc) mean specific things to medical professional who are treating people with significant problems and therefore I am very uneasy with them being used in the way they are in the first paragraphs of the first article. At least in the clinical settings I work in these are not easy “diagnoses” are not easy to collect. A medical doctor generally gives these diagnoses (and some, such as schizophrenia, generally need to be given by a psychiatrist) and perhaps a clinical psychologist in a few cases.

A few of my thoughts on the treatment of depression:

In the country that I practice in it is much easier for general practioners to access funded antidepressant medication (yes we are blessed with a public health system where I live) than funded cognitive behavioural therapy (which often has a 6-12 month waiting this) for their patients hence why many more people are treated with medication alone. Cognitive behavioural therapy (CBT), which is usually delivered by a clinical psychologist or another health professional specifically trained in its use, is pretty much of the only “talking therapies” shown (obviously this evidence is hard to get) to be affective in mild to moderate depression. Although I have no doubt that for some informal counselling is useful. But these people are generally not those who fit into a clinical diagnosis of depression. If you have a Biblical world view it would be very helpful that whoever is involved in “treating” / “helping” you shares this (your doctor, your psychologist and / or your counsellor. For Christians God must be part of the process. But there are other parts too. For some the chemistry in their brain is broken and needs to be reset.

I’m not familiar with the book /article Prozac Backlash. Although the placebo effect is significant in all medications (in pretty much all conditions) and the natural history (its clinical course if left untreated) of depression is that many people will have improvement of symptoms over time. However, many, many good quality trails exist that demonstrate the superiority of antidepressants over placebo in people with moderate to severe depression. The evidence is not quite as good for mild depression. Selective serotonin re-uptake inhibitors (SSRIs) such as Prozac are good but tricyclic antidepressants (TCAs) such as Amitryptyline are even better (however TCAs tend to have awful side effects in the doses uses to treat depression).Nothing is a magic bullet though.

Medication cannot fix broken relationship but it can help to deal with some of the symptoms that make it very difficult to fix those relationship.

Although the following example does not deal with depression, I hope it will help illustrate my point. For a person with a mental illness such as schizophrenia, having meaningful relationships and being able to talk care of themselves (at least in very basic ways) would be a big part of what I would define as success rather than simply the absence of symptoms. However florid psychotic symptoms make these two things extremely difficult it not impossible. The antipsychotics the doctor prescribes can help to deal with the symptoms but this will not necessarily mean that they do develop meaningful relationships etc. The social circumstance and many other thing play a huge role. I hope that none of you would suggest that it is the lack of meaningful relationships that is the entire aetiology behind the manifestation of schizophrenia symptoms (although there could be a loose link: loneliness leading to marijuana use in a person with a predisposition to schizophrenia ).

I do not live / work in the US. I am aware that antidepressants are prescribed at a much higher rate in the US than in many other “Western” countries and in some cases they may be over prescribed. However there are many people with moderate to severe clinical depression whom, without medication either would not get better or who would spend a very long time in the depths of disappear before recovering. Yes sometimes God does miraculously heal Christians from depression and other mental illness, just as he does with illnesses with a more “physical” presentation. However much of the time God chooses to walk with us in our suffering rather than remove us from it (as many people have written on this blog about their own personal experiences). This is not a sign of lack of faith. People can definitely glorify God in the midst of these times (I have seen this occur not only for depression but also for other mental illnesses such as bipolar disorder, or schizophrenia). Often when people become depressed they stop being themselves to some extent. Not that this is an excuse for sinful behaviour but things that previously have been routine habits such as reading the Bible regularly, spending meaningful time in prayer or enjoying socialising with friends and family can become huge efforts. We need to be careful to tease out the symptoms from the cause of the problem.

A few people get cancer primarily because they have smoked, however no one would suggest that everyone who has cancer smoked and therefore should be blamed for their cancer. Similar principles apply to depression: some people become depressed to a large extent because of the way they have lived their lives (many of these people still have an underlying genetic tendency, which predisposes them to depression). However there is also a group (which in my experience tend to be much larger) of people that have had awful experiences outside their control in addition to a underlying genetic tendency. All types of mental illness (including depression) already has huge stigma attached. Let’s not add to this by blaming people for their depression. In all areas of health people need to take some responsibility but there are many other factors at play as well.

On a side note: I’m also slightly annoyed by David Powlison using the title “Dr” in these articles. Although the side-bar gives a brief lists of some of the positions David Powlison has held (which I have no doubt are prestigious positions) it does not lists his formal qualifications so I am making a few assumptions here. I am sure David Powlison worked very hard on his PhD and has earned, therefore earning the right to use the “Dr” title. However much of the subject matter discussed in the articles do deal with things very relevant to medical professional including doctors. Therefore I feel using the “Dr” title when you do not hold a medical degree is confusing in this specific setting.

20. Jo said the following at 3:36 PM on Sep 2:

In the UK, treatment for mental and psychological disorders is biopsychosocial - meaning that a multi-disciplinary team works together to treat a patient from three different angles: biological (medication and other medical treatments), psychological (therapies) and social (supporting the patient to find employment, manage finances better or whatever is needed in the specific situation). As Christians, we could add 'spiritual' as a very important fourth aspect. These kinds of illnesses are complex because there are physical, psychological and social elements to them, and the treatment model over here reflects that.

Incidentally, a Christian friend of mine has recently gone through a course of CBT on the NHS, and has found it extremely helpful, as well as Biblical - to address the facts, tell yourself the truth, control your thoughts and train your mind in healthy thinking are all scriptural concepts that have a huge amount of value in many cases.

21. Khalil said the following at 6:59 AM on Sep 3:

#19, Rosalie ...
very well said. When the original post came up I submitted a comment (probably too long) that shared many concerns with how quickly and dismissive the presented issues were "diagnosed".

#20 (Jo) and #19 (Rosalie) make some good point, esp. in the realm of treatment. A holistic (which by its very nature should involve spiritual issues) view with a combination of approaches (talk-therapy, medication, etc) covers a lot more ground and is more effective than being stuck in one particular modality.

22. Leah said the following at 6:56 PM on Sep 3:

How about this:

Mental disorders are very real, often with physical, chemical and biological causes. Some of these disorders may cause extra tendencies in a person to sin. BUT, they do NOT make the person unable to make the right decision, therefore they do NOT absolve the person of responsibility for their choices.

THEN you have the people who do NOT have a mental disorder, but really are just sinful and have been misdiagnosed for the sake of wanting to remove responsibility (as suggested in the articles).

23. David said the following at 1:50 PM on Sep 6:

Dear Dr. Powlison,

First, thank you for your hard work in helping all of us apply Scripture more fruitfully to our lives, and for your ministry and leadership through CCEF. Second, thank you for your wise and reasoned general response to the issue of Christians using medication for depression (see your blog entry http://www.boundlessline.org/2008/08/biblical-counse.html on 8.29.08). But like most responses to this issue, it does not go far enough, and can even be dangerous with what it does not affirm with respect to medication. I certainly don't claim your credentials, but I do have a B.A. from the University of Minnesota, a J.D. from the University of Minnesota, and a M.Div. from Gordon-Conwell Theological Seminary. I love and embrace reformed theology, am a member of Bethlehem Baptist Church (but do not represent BBC), and served as the pastor of a small congregation for three years. With this in mind, I would like to address medication for the treatment of depression. I do this from the perspective of those who do have Christian faith, have personal meaning in their lives and have meaningful personal relationships, but who need medication. My goal in writing this response is two-fold: First, I hope to help Christians who may benefit from the use of medication for depression do so without any fear from well-meaning Christian leaders who may not agree with such use, or who unintentionally make it seem like there is no legitimate place for its use. Second, I hope to make Christian leaders more aware of what their words are saying when they address the issue of medication for depression.

I have been seriously interested in the issue of medication for the treatment of depression and whether Christians may legitimately use them since February 2001, when my Christian physician told me I was a prime candidate for the use of anti-depressants. I had been struggling with depression since I was a little boy. I also struggled with it after I was saved at the age of 19 and continued to struggle with it into my 30's, no matter how strong my faith and life in Christ was. While certain forms of depression had ceased (e.g. lack of meaning!!!), I continued to struggle with “over-much sorrow,” despite having no apparent reason for such melancholic experiences.

In other words, my God-wrought Christian faith, the presence of objective personal meaning in my life formed through Scripture, the presence of wonderful Christian relationships, and the use of God-given Holy Scripture, simply did not drive away the symptoms of depression, which were at times very severe, even to the point of contemplating suicide. But by God's grace, it appeared that a door had opened for me to try the common grace of medication.

Whether to use medication was a painful and difficult decision. I did not think Christians – especially faithful ones – used medication for depression. Nor did I think “men” used medication to overcome problems. It took A LOT to get over this hurdle. But after much thought and prayer, I decided to try it. After three weeks, nothing happened (as I kind of expected). But the doctor said it can take some time until it works, so I kept on the prescribed regimen. Week four was it. It was like something just changed for me. The antidepressant I was prescribed alleviated the severity of the symptoms. It made life significantly more manageable. Yes, I graduated summa cum laude from college and cum laude from law school without it. Yes, I served as the President of my InterVarsity chapter, led small groups, and discipled others without it. Yes, I met my wife and we had our first child without it. But now I had the opportunity to enjoy life in Christ even more, without so many depressive symptoms, tendencies to isolate because I was so often depressed, and having thoughts that I hated and feared – thoughts that were even dangerous to my life. By God’s grace, I, a sinner, would not have to suffer so much any more.

The next significant event in my life regarding depression was understanding whether depressed people could be used by God in pastoral ministry. Thank God for the ministry of John Piper and his biography of Charles Spurgeon, and Spurgeon’s honest, transparent Lecture 9, “The Minister’s Fainting Fits,” in his Lecture’s to My Students. It opened my eyes, more than anything else I had read, that God can call people who struggle with depression into pastoral ministry. And, feeling that I would die should I not obey my call to ministry, and having it affirmed by my friends and elders, I was off to seminary. While this may be a little off topic, I hope it helps others.

When I went to seminary, I went off of my medication due to lack of health insurance. I was off of it for about six months. After the initial symptoms of the drug wearing off and its depressive symptoms and feeling that my brain was being "squeezed" (generally you should never "just quit" these drugs - go off of them slowly under a doctor’s supervision), the more serious symptoms of depression returned. Inter-punitive thoughts, self-isolation, over-much sorrow, suicidal thoughts, short-term memory loss: the undermining of the fullness of my joy in Christ was at stake.

However, by God's grace, the co-founder of the counseling department agreed to be my mentor and after meeting with me, reviewing my mental health history, my spiritual history, etc., he referred me to a very good Christian doctor who prescribed medication to me again. After working with me for a year, and being fairly "symptom free," I tried going off of the medication in a "controlled study" type of manner. I discovered that I am someone who needs these drugs in order to be free of the more severe symptoms of depression. God's common grace had made a way for me.

I could go through life more severely depressed at times (and risk suicide), and mildly depressed at others, as nouthetic counselors such as Jay Adams would have it (they do not believe in medication for this brain illness – see www.nouthetic.org (there used to be a direct statement by him at this site stating that, but I was unable to find it now), but do for things like Parkinson's I presume), but to me, this was un-Scriptural. Furthermore, there is nothing romantic or “deep” about chronic depression that should induce outsiders to want to keep us there. See Peter Kramer’s (the author of Listening to Prozac) article in the New York Times Magazine, “There’s Nothing Deep About Depression,” http://www.nytimes.com/2005/04/17/magazine/17DEPRESSION.html?scp=1&sq=there's%20nothing%20deep%20about%20depression&st=cse.

Unfortunately, some years later, the peer-pressure of well-meaning Christian leaders with whom I desired to serve caused me to quit my medications a third time with disastrous effects. The results are that I am not serving in full-time ministry at this time, but hope to return to my true calling when I have fully recovered. But God used this to give me a new addition to my calling: to use my voice and education to stand up for those Christians who need medication (and who are benefitted by it), but who are in fear because of the harmful effects of well-meaning Christians – even Ph.D.s and Pastors – who, dangerously, either directly oppose the use of any medication for any reason, or who say they support its use, but who in practice do not.

Now, very briefly, a look at what I see as the facts regarding medication to be. Yes, there is a placebo effect, and it is growing with society's over-reliance on medication to solve its problems. But psychotropic medications, on average, in every study published between 1981 and 2000, have been shown to be about 20% more effective than placebo. (See Walsh, Seidman, Sysko & Gould, (2002). Placebo Response in Studies of Major Depression: Variable, Substantial, and Growing, JAMA, vol. 287, No. 14., pp. 1840-1847). Therefore, there is a legitimate, significant effectiveness to these drugs. And we should be supportive of their appropriate use, and not so cautionary and deflective that we make Christians afraid to use them or biased against commending them for depression (and while there is no way to truly tell if it’s biological at this time – we are generally not the ones to do the guessing, it should be the individual with the counsel of his/her doctor). For example, if we had a drug for Parkinson’s disease that would eliminate or seriously lessen the side effects, it would be negligence not to suggest its use, even though it only works 1/5 of the time. Unfortunately, what I hear mostly from well-meaning Christian Biblical Counselors is a heavy stress on the placebo effect. I also hear a heavy emphasis on Scripture in such a way as to indicate that the use of medication reflects a failure to use Scripture properly. At least that is what it sounds like. Scripture is provided in articles, in counseling sessions, but few are actually supported in their use of medication. And if you ask a Biblical Counselor about this, they will just say that their patients were already on medication before they arrived in their offices, or there are so many more important issues to address, and medication just gets relegated to the “unimportant” background of the conversation where it will most likely not be addressed. Finally, what I sense is a trivialization of the dramatic and positive effect on life that the alleviation of symptoms presents, as if "only" alleviating symptoms were not a massive benefit.

Why don’t these drugs always work? These drugs are not effective for everyone for various reasons such as: (1) the person does not suffer from biologically rooted depression, or (2) the person suffers from a biologically rooted depression whose etiology and treatment has not yet been discovered, or (3) a different medication the individual is taking is causing depression, such as Zantac or too much Ibuprofen, or (4) the person has spiritual issues that need to be addressed in the context of the local church (this could be the primary reason, but that is a matter of serious discernment, as are all of these, on a case-by case, fact-specific basis).

I would refer people genuinely interested in studying depression, and related studies, to peruse the true "industry standard" on depression, whether unipolar or bipolar, written by Fredrick Goodwin and Kay Redfield Jamison, the truly preeminent scholars when it comes to the broad spectrum of depressive disorders. In its second edition, the book Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, published by Oxford in 2007, is 1,262 pages with index, is the standard reference on depression, and does not include sound bites. I would also point out the dramatic “before and after” medication pictures of active brains that can be viewed on Dr. Amen’s website (some are offered without purchasing the Atlas): http://www.amenclinics.com/bp/atlas/.
Why is there such a bias against the use of medications among Biblical Counselors and other well-meaning Christians? For example, I consider Dr. Edward Welch to be the best Christian writer on the issue of depression. All of his books, from Blame it on the Brain to Depression: A Stubborn Darkness, appear to be support of the use of the discerning use of medication by Christians in careful consultation with their doctors. However, in his interview with Dr. Mark Dever (http://resources.christianity.com/archives/mrki.aspx), he admits that in all of his years of counseling, he has never – never – had a case where he believed medication should be used. I find this statistically improbable for someone who has counseled the depressed for so long and who claims to be supportive of the use of medication in his books. Nevertheless, I do believe he is growing in his willingness to understand, given his article on Bipolar in the Summer 2007 edition of the Journal of Biblical Counseling http://ccef.org/pdfs/JBC002503.pdf. My guess as to why there is such a negative view of psychotropic medications among some Christians, particularly in reformed circles, is at least five-fold:
1. There is probably significant over-prescribing of these drugs in society causing all of us to be wary of their being used in situations we become familiar with. But that doesn't mean throw the baby out with the bathwater. Over-prescribing does not go to efficacy, it goes to finding a good doctor.
2. For a very small minority of patients there are negative side effects, with some sensationalized by the media and others having seemingly large legal settlements. This is no reason for getting rid of these medications. Some people die eating shellfish and peanut butter. We don’t ban these – we give people choices. Similarly, the use of medication is a matter for the doctor-patient relationship where costs and benefits are discussed.
3. There is a placebo effect that is real and growing with respect to using pills for depression. However, there is a real and consistent benefit for a significant portion of the depressed community who benefit from the use of such drugs that can mean the difference between life and suicide, or a life of sorrow, and a life enjoying their children grow up. While emphasizing discernment in their use, we MUST NOT trivialize the beneficial use of these drugs for those who need them. They are part of God's common grace. If we could eliminate or seriously lessen the symptoms of 20% of patients with other brain ailments through medications – ailments such as Dementia, Alzheimer’s, Parkinson’s disease, through the use of medications, it would be negligence not to commend their use. So it is the case with depressive disorders that are potentially biological in nature.
4. An over-realized eschatology that fails to recognize 1 John 1 when prescribing Scripture for the healing of biologically caused depression. The effects of sin on the human brain and body will not leave us until we are finally glorified with Jesus Christ. To say that we just need to cancel out more sin through more faith is to believe that the power of the eschaton were already appropriated here on earth and it simply isn't.
5. An insidious works righteousness in the form of a name it, claim it mentality for depression and mental health issues that suggests we need only ramp up our faith in God, believe more firmly in Scripture, participate more meaningfully in our Small Groups, and our troubles will be gone. If they are not gone, don't look to medicine to help, because God's common grace through medicine in every other malady does not mean anything in the case of mental illness [sic]. Again, the logic simply isn’t there.
In conclusion, we as Christian leaders have a duty to be very, very careful with the way we talk about medication and depression. Failure to genuinely affirm the use of medication in our discourse can be the difference between life and death. And may God help us, especially, if that soul was not ready to meet his or her Creator.

May God use what is good here, and cause what is not to be quickly forgotten. Soli Deo Gloria.

24. rachel said the following at 5:26 PM on Sep 7:

As a Biola U. grad with a degree in psychology, I am partial to Drs. Cloud and Tounsend. Anyways, I really appreciate what they have to say about "Christian Counseling." Here is the link: http://www.cloudtownsend.com/library/christiantherapy.php

25. Khalil said the following at 6:42 AM on Sep 11:

I noticed there was another article about Biblical counseling. Can we please get some/a perspective from a person who is a practicing Christian psychologist or counselor as well, someone without a nouthetic leaning? There are other theories and approaches that take a well rounded and holistic approach towards psychological wellness, integrating faith nicely with mental health needs and accepted standards of care.

I have to admit that I haven't had time to read the new article yet, but I will when off work.

26. Ted Slater said the following at 9:40 AM on Sep 11:

Khalil -- this series is actually providing a perspective most of our readers have likely never considered. It's meant as a conversation starter, a provocative alternative to what most of our readers are likely heard before.

FWIW, the author has been a practicing counselor for over 30 years. Also, FWIW, while he draws from the writings of nouthetic counseling proponents, Dr. Powlison would not consider himself entirely within the traditional nouthetic camp associated with Jay Adams; Powlison would be either an integrationist or an adherent to a "neo-nouthetic" perspective. He has no problems "spoiling the Egyptians," for example: helpful counseling principles and techniques can be gleaned from "secular" psychology.

All that said, I do plan to publish articles on counseling from different camps within Christian counseling.

27. John said the following at 11:14 AM on Sep 11:

Could comment 23 go down as the longest ever?

28. David said the following at 9:44 AM on Sep 12:

Khalil,

I think if you'll read post 23 you will see that it is written by a Christian counselor (me) that does not have a nouthetic leaning.

Much grace to you,

David

29. khalil said the following at 1:22 PM on Sep 12:

#28, Dave,

I appreciate your thoughts and contribution to this discussion, by describing your personal journey with depression you have a special insight regarding a Christian's take on mental health issues. I mean no disrespect here but I am looking/hoping/wishing for a clinical approach from a licensed psychologist or therapist (with Christian leanings). I am not sure what state you're in but based on your listed credentials you don't meet the requirements for a licensed counselor or psychologist, at least in most of the states I know the requirements for such licensing. In Virginia almost anyone can hang out a shingle and say they're a counselor of some sort, but you just can't add LPC, LMFT, etc because there is a regulatory board over the professional area of counseling.

I would love to have a segment of this series be written by someone like Dr. Gary Sibcy, Dr. Naji Abi-Hashem, Dr. Mark Laaser, or Everett Worthington.

For what it is worth I have my Master's Degree in Marriage and Family Counseling, have 11 years of experience (9 work, 2 volunteer) with at-risk children and families (also involving J&D and G.D. Court mediation), 7 years experience in rape and trauma counseling (including specialized training in rape and violence prevention, women's rights, suicide intervention, and developing a positive masculinity), and almost 7 years of experience within a university setting of counseling and working with college students (3 out of the 7 are specifically with international students). Currently I am focusing on attachments and getting some additional training and supervision in play, narrative, and art therapies. Getting licensed has not been a priority of mine because of wanting to do work overseas (an LPC doesn't mean much in a country that has no licensing board).

I don't come to this discussion uninformed and without experience, which is why I am so adamant on wanting other professional views to be expressed and discussed. I also don't claim to know it all (though I might act like it in some posts) and realize there are others out in the trenches that are much more experienced and have a greater ability to serve in this field than I do. Some of the most effective "social workers" and "counselors" that I have seen are those that have been in the field for 20+ years that don't have an ounce of clinical experience or 18 degrees and initials behind their names.

30. Kristi Kohl said the following at 7:30 PM on Sep 14:

I am a family practice doctor in the US who often prescribes antidepressant meds for depression and anxiety. I appreciate the unique perspective brought here and feel that it is extremely helpful, more within our church than in my practice largely because of the ethics of patient autonomy. Rosalie, thank you also for your insightful commentary (which I agree with though we don't have the infrastructure that your country does).

There is a story about a guy on a roof in a flood. A raft comes by, then a motor boat, then a helicopter and his answer to their offers of help is "I have been praying to God and believe he will save me. Thanks anyway." then as he is about to be swept away cries to God "You said you would save me". God then replies "I gave you a raft, a motor boat, and a helicopter. What else do you want?" In other words, medicine can be a gift from God as well.

In short, I believe careful, prayerful consideration of all options including medicines as well as asking God to correct the sin in our life is an appropriate way to handle any situation including medical illness, mental illness, and... well, just about anything that arises. Also, as Christians we are called to obey God's plan for our lives, which may (and should not always) follow the world's thought of what is wise and what is not. I believe we should be as wise as we can but sometimes it is going against that popular wisdom that makes it clear our love for Him.

May He always be our guiding Light.

Kristi

31. Tay said the following at 9:39 AM on Aug 17:

ive been on medications for anxiety for 5+ years. I find that this article rings true in every way. I am most definitely not 'cured' of these demons. Sure, the medications have helped take the edge off & allowed me to live a semi-normal day to day life, but without support of family, friends and the good Lord above, I would be lost and in despair. The major downside of having ever started the medications are that I am unable to free myself of them. I have found myself absolutely positively dependent to the point that the doctors find it dangerous to remove them from the picture... Even if they were to try, it would be a horrifically scary battle. I hope that one day with some extra courage and strength and God's love surrounding me I will be able to be free of them, but until then... I trust in the Lord to guide me!

Peace & Love
Taylor