A response to Dr. John MacArthur’s statement on mental health

I was working on a presentation titled, “Medicine and the Christian Worldview” when a counselor colleague sent a clip of Dr. John MacArthur making a statement at a “For the Valley” Conference about mental health. Here’s a transcription:

“I was reading a book, an interesting book, called A Profession Without Reason. It’s a book that shows basically- this is pretty shocking to some of you- that psychiatry and psychology is finally admitting the noble lies that they’ve been telling for the last hundred years. And the major noble lie is there is such a thing as mental illness.

Now this isn’t new. You have Thomas Szasz back in the 1950s writing a book (who was a psychiatrist) on the myth of mental illness. There’s no such thing as PTSD,  there’s no such thing as OCD,  there’s no such thing as ADHD. Those are noble lies to basically give the excuse to, in the end of the day, to medicate people. And Big Pharma is in charge of a lot of that.  

If you understand, take PTSD for example, what that really is is grief. You were fighting a war, you lost your buddies, you have a certain amount of survival guilt because you made it back (and) they didn’t. How do you deal with grief? Grief is a real thing. But grief is part of life.

And if you can’t navigate grief,  you can’t live life. But if you clinically define that, you can give them a pill, a series of medications, and they end up in LA homeless on the sidewalk.

In regard to children, it’s the most deadly thing that's been unleashed on children, medication. We are trying to make it clear to parents that behavior is essentially the result of choices that kids make and if you parent them properly they will make right choices. But if you blame it on something other than their choices and you identify them as having something they can’t do anything about but medicate it you literally are turning your child into not only a potential drug addict, but a potential criminal, because they never learn how to navigate life in a socially acceptable way.”

To be clear, this article is not an attack on the person or character of Dr. MacArthur, a Christian brother for whom I have much respect and who has been a bulwark of solid reformed theology for many decades. Nevertheless, there are several things within the statement that, as a professional working in Christian psychiatry I would like to address:

First, that mental health diagnoses are “noble lies” is a statement of opinion, not fact. Psychiatry is a field that attempts to describe observable phenomena within human thought and behavior, though imperfectly as any science is, through terminology. Unlike other fields of medicine, psychiatrists cannot examine the “organ” they treat. The mind is nonphysical. Despite this, its manifestations (ie behavior and thoughts reported by patients) are visible. Is it any wonder the field is named after the Greek root psyche meaning soul or spirit, and spirit is often depicted in Hebrew as wind? You can’t see wind, but you see it in what it affects. This approach to understanding disease (literally dis-ease) has been debated. Dr. MacArthur made mention of a fellow colleague in the field of psychiatry, Dr. Thomas Szasz. Szasz followed the work of German pathologist Rudolf Virchow who defined disease at the cellular level (eg if we couldn’t examine it in tissue, it wasn’t disease).

Szasz was especially concerned with attempts to use the definition of disease employed by psychiatry to coerce or control (and psychiatry does have a dubious and at times outright unethical history). Szasz went so far as to say of schizophrenia, “…[Schizophrenia is] a social construct created by the therapeutic state to control and remove offensive persons from society”.

Szasz philosophy might be applied with dire consequences to the Christian concept of our diseased spiritual state apart from Christ. We understand this to be our greatest need for healing, a fact Jesus regularly showed in healing the physically disabled by first forgiving sin. How would Szasz have viewed this concept of spiritual disease which is not rooted in cellular pathology but a totally depraved soul?

By my reading of Szasz it seems he was more concerned with fighting against involuntary commission, mental health courts, and attempts to restrict patient autonomy. In a manner internally consistent with his ideological and philosophical beliefs Szasz ended his life in 2012.

Debate regarding how to define disease will continue and it is appropriate that MacArthur would make mention of the continued discussions but “noble lies” is a mischaracterization of that ongoing debate.

Second, psychiatric diagnoses are not an excuse to prescribe. Following observation and classification of thought and behavior under the psychiatric model attempts to heal patients take a variety of forms that are not exclusively, or even in some cases primarily, pharmaceutical. From counseling and therapy styles to supplements and medications mental health providers attempt to help patients live more effective lives. At my Christian psychiatry practice, we define that not as the absence of mental health problems alone but as the presence of a God-glorifying purposeful living (growing in the knowledge of God, conformity into the likeness of Christ, and increasing effectiveness for the Kingdom). We use medications on occasion because we see them as part of the arsenal of good gifts God has given us as we walk this fallen world and see them contributing to the God-glorifying aims listed above.

In the case of “which came first,” in pharmaceutical development, it is disorder identification followed by the medication. Many of the pharmaceuticals used in psychiatry were discovered by accident. “Big pharma” is an easy boogeyman and we can conjure stories of greedy businessmen making drugs and then creating diseases to which they could be applied. The idea that diseases are invented so that drugs may be prescribed is refuted by the fact that there are many mental health conditions for which we have no viable medication options. We pray God advances medical technology so that relief can be offered to those who suffer from these conditions. 

I appreciate MacArthur’s concern regarding competing interests (ie financial gain and patient care) however, these competing interests do not necessarily lead to nefarious or malicious intent. There are many problems with medicine in the United States, this is to be expected anytime sinful humans gather together for a common goal, yet, what cannot be denied is the influence of the American pharmaceutical industry to export globally some of the most innovative medications to cure both common and obscure diseases. The fallen, but redeemable, machine of capitalism keeps turning and medicine has benefited as a result.

Third, Post Traumatic Stress Disorder (PTSD), isn’t just “grief”. Grief is a painful thing and PTSD is a painful thing, sometimes they occur alongside one another, and other times they aren’t related. For those of us who have treated trauma disorders, we can see both physically and mentally the impact of a traumatic experience on a person. A body constantly hypervigilant, a view of the world as fundamentally unsafe, recurring nightmares and flashbacks that feel as real as the events themselves. For some, a loss that leads to grief may have been the catalyst for this response for others it could be a myriad of other causes.

Other diagnoses were mentioned by MacArthur in his statement such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) and I’ve written on these conditions separately. Suffice to say here, OCD is more than anxiety and ADHD more than distraction. Both in their genetic predispositions, neurological basis, and functional impact they represent clear clinical entities for which treatments have produced great results.

Fourth, pharmaceutical agents don’t lead others to end up “homeless on the sidewalk”. The truth is the opposite (see here, here, and here). The correlations between untreated mental health concerns and homelessness is well established. Proper access to mental health care is one of the most protective factors against joblessness, homelessness, addiction, suicide, and many other public health concerns. My time in Chicago and living in Center City Philadelphia made this fact abundantly clear to me, and now living near and attending church in the nation’s capitol has shown me how pervasive lack of access to mental health services spreads and its implications for violent crime, drug use, and homelessness. 

Fifth, difficult behavior in children is not de facto evidence of unbiblical parenting.

The family is the most important institution God has ordained this side of heaven. It is rooted in marriage, echoed in our fellowship as believers as we congregate for service, and is a shadow of that coming revelation of the people of God joined with the Lamb in marriage, eternally tied in a familial relationship with our Creator. Additionally, the rearing of children is the most important aspect for societal change and the breakdown of the family has resulted in catastrophic consequences for our society. 

Despite this, scripture is clear that right parenting does not always lead to right action by children and each is responsible for their actions. Ezekiel 18:19-23 proclaims that the son shall not be punished for the sins of the father, nor vice versa. As fallen humans, we are imperfect parents and we can expect that we will make mistakes in our child-rearing. God himself proclaims in Isaiah 1:2, “Hear, O heavens, and give ear, O earth; for the Lord has spoken: ‘Children have I reared and brought up, but they have rebelled against me.’” Our Heavenly Father, our perfect parent, is in no way culpable for our sinful behavior.

When we stand in judgment, each will be judged according to what they have been called to do: parents in their parenting and children in their obedience. Did earthly parents speak the truth in love (Ephesians 4:15)? Discipline appropriately (Proverbs 13:24)? Bring children up in the nurture and admonition of the Lord? (Ephesians 6:4).

I am not a father, myself. I speak not from experience but rather from what I know of the parents I have worked with and from Biblical exhortations on parenting. But if I can encourage parents of wayward children: do not lose heart, continue parenting, praying for your children, and entrusting them to their ultimate father, God. Know that your frustrations regarding disobedience are not unknown to God and continue to trust in his grace for your children, and for yourself.

With all this being said, I’d like to propose the following response for Christians who wish to love their brothers and sisters dealing with mental health concerns:

First, love like Jesus loved. Scripture is full of Jesus encountering those who suffered. How did he approach them? What did he say to them? If Jesus approached a man or woman suffering from symptoms of PTSD, depression, or anxiety, what would that interaction look like? 

I think this is one of the aspects that Dr. MacArthur was attempting to point to in his talk. The way we love others and the way we approach sickness and suffering should look different than the world. Jesus was radical in his approach to healing suffering and often worked to show others that their greatest need was spiritual rather than physical. This has not changed today. This, however, doesn’t mean we cannot pursue the healing of physical and mental maladies while also recognizing our dependence on Christ for all things. It is “in him that we live and move and have our being” (Acts 17:28). This is where we may differ from Dr. MacArthur’s statement.

Second, be okay with not knowing for certain. We seem obsessed with knowing “for certain” how everything works and why everything happens, mental health included. When someone tells us they are depressed we become not loving supports but critical detectives. Where is the hidden sin? How can we uncover the deficiency of faith? Instead, might we be okay sitting with someone anxious or depressed and simply saying “It’s okay that we don’t know the exact mechanisms of what is going on in your mind, brain, and heart but I’m content to sit here with you in it.”

Third, don’t view medications as a spiritual “throwing in the towel” in the fight for mental wellness. I see this so commonly in practice. Medicine somehow is viewed as giving up, as if one was saying, “I tried faith and it didn’t work, now let me try pills”. That’s not it at all. The truths of the gospel are healing balms to our broken, wounded spirits but these truths can be hard to grasp when we “sink in deep mire” (Psalm 69:2). 

I was saddened to hear the comments made by MacArthur and choose to believe the best about his intentions to speak the truth in love to fellow believers. I fear the harm done by his statement, not only to those who heard it in person but as it circulates the internet. As a church body, we need to see medication and psychiatry, not as oppositional to our walk with Christ, but as one of many potential good gifts God has given us as we walk this fallen world. 

I will conclude with a quote from C.H. Spurgeon, writing of his own depression and what he had seen in others, “I note that some whom I greatly love and esteem, who are, in my judgment, among the very choicest of God's people, nevertheless, travel most of the way to heaven by night.” 

Adam O’Neill, PA-C is a Psychiatric Physician Assistant and owner of Adam O’Neill & Associates, author of The Mind after Eden: Psychiatry in a Post-Fall World, The Patience of Hope: Encouragement for the Sufferer through the life and ministry of George Matheson, and The Mind for His Glory: A Theory of Applied Christian Psychiatry (forthcoming), and serves as executive director for the Faith and Medicine Foundation. He is a member of Capitol Hill Baptist Church in Washington, D.C.