Dr Caroline Leaf – Increasing the stigma of mental illness again

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Let me tell you a story.

A couple of years ago, one of my patients was an elderly gentleman in his late seventies.  He was living in a nursing home at the time, but because of his history of psychosis, he remained on a treatment order – a requirement by law that if he was to remain outside of a mental facility, he had to have regular anti-psychotic medication every few weeks.

This man was on a treatment order because his disease caused him to have delusions.  He misinterpreted what was going on around him, and would not consider that he could be wrong.  In his particular case, he was convinced that his next-door neighbour was a paedophile, and he was planning to ambush his neighbour and castrate him.  Luckily the police had taken my patient into custody before he got the opportunity.  With treatment, my patient had clear thoughts, although needed close supervision.  Without his medication, he became confused and violent.

According to a post on the blog Mad in America and promoted by Dr Caroline Leaf, my patient’s diagnosis was spurious, and he was denied his basic human rights by being forced to take medications.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She is also a self-declared expert in mental health, despite not having any professional training in medicine, psychiatry, psychology or even cognitive neuroscience for that matter.

Indeed, if she had any experience or expertise in mental health, she would have recognised the basic factual errors and logical fallacies that riddled the post she quoted from.

Take the quote that Dr Leaf posted on social media.  The full quote from the Mad in America post is:

“Despite the fact that no one in history, not even the omnipotent American Psychiatric Association – which produces and profits mightily from the ‘Bible’ of mental disorders — has come up with a halfway good definition of “mental illness,” and despite the fact that the process of creating and applying the labels of mental illness is unscientific, any of those labels can be used to deprive the person so labeled of their human rights. This is terrifying. It ought to terrify those who are so labeled and those who are not, because deprivation of human rights on totally arbitrary grounds is inhumane and immoral.”

This is the same tired, emotionally laden and misleading rhetoric that’s so often barked in fervent paroxysms through the foaming lips of those opposed to modern psychiatric practice:

  1. There is no good definition of ‘mental illness’
  2. The American Psychiatric Association is just a profit-driven cabal
  3. The DSM5 (which the author alludes to as the ‘Bible’ of mental disorders) is unscientific
  4. Psychiatric diagnoses are unscientific
  5. Any psychiatric diagnosis can be used as a trigger to force people into unwanted treatments or incarceration
  6. Therefore psychiatric diagnosis and treatment is against basic humans rights and is inhumane and immoral.

Inhumane and immoral hey?  Tell that to my patients neighbour who almost became a eunuch except for that “inhumane and immoral treatment” of my former patient.

Caplan claims just don’t stand up to any rational scrutiny.

  1. There are lots of good definitions of mental illness … modern psychiatry critics just don’t like them. But take the definition used by the CDC, “Mental illness is defined as … ‘health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.’” There’s nothing wrong with this definition. It describes mental illness and helps differentiate mental illness from variations of mood, thought and behaviour that are part of the everyday human experience.
  1. The American Psychiatric Association isn’t the only group to have created a classification of psychiatric illnesses. The World Health Organisation publishes the International Classification of Diseases, or the ICD, which is also used for psychiatric diagnosis. Is the WHO an evil profit-driven junta too?
  1. The DSM, the ICD, and any other system of diagnosis, are simply different classification systems. Over the last century, clinicians have noted clusters of symptoms and have tried to classify them into common groups. How is that unscientific?  It’s no different to scientists looking at the different characteristics of various animals and creating a taxonomy, to provide a common system and language for clinicians and researchers across disciplines and across countries.The DSM system isn’t perfect, but what system ever is?  As knowledge of neuroscience grows, the classifications are reviewed and tightened in an ongoing process of improvement.  If those who oppose the DSM want to come up with something better, they’re welcome to put something forward.
  1. The old saying goes that medicine is an art and a science. Human beings, as nuanced as we are, often don’t fit into diagnostic criteria as easily as we would like. That doesn’t invalidate the diagnostic criteria or make the process unscientific as critics of modern psychiatry would have us believe, just like an unusual and hard-to-classify form of cancer doesn’t invalidate the other cancer classifications that are well defined.  Psychiatry, by it’s nature, relies on verbal report from patients rather than a clean-cut blood test or piece of tissue under a microscope, so at this stage in history, it seems imprecise.  That doesn’t make it any less scientific.
  1. The allegation that any psychiatric diagnosis can any be used to deprive the person so labeled of their human rights is utter nonsense. It’s a giant scarecrow – it seems really scary, but on closer inspection, it’s just a tarted-up mound of straw.People are never forced into treatments unless they really are “dangerous to themselves and/or others”.  This rule can’t be invoked willy-nilly.  There are multiple checks and balances, and a whole school of civil rights lawyers expectantly circling, ready for the whiff of blood in the water (http://www.mhrt.qld.gov.au/?page_id=2 is an example of the process in my home state, but each jurisdiction has their own version).

Caplan rightly pointed out that those with mental illness were less likely to be the perpetrators of violence and more likely to be the victims, but that doesn’t negate the need for protection of the community from those with mental illness who have shown violent intent and no capacity to control their behaviour.

If you want to find a group that really are suffering from inhumane and immoral deprivations of their human rights, then that would be Christians.  Around the globe, millions of Christians are oppressed, imprisoned, tortured, raped, and murdered every year.

Time and space preclude a full analysis of Caplan’s post, but what’s really important is that both the American Psychiatric Association and the U.S. Department of Health and Human Services’s Office of Civil Rights, an independent ombudsman, dismissed formal appeals by Caplan relating to her hysterical claims of inhumane forced psychiatric treatment.  Dr Leaf conveniently left that out of her social media post.

Instead, Dr Leaf chose to publish one of the most alarming quotes from an article heavy on scaremongering, from a disaffected author on an extremist blog.  If Dr Leaf was a real expert on mental health instead of being a self-declared one, she would have easily seen how nonsensical Caplan’s post was.

By posting this quote on social media today, it’s highly likely that Dr Leaf has caused harm to thousands of vulnerable Christians by unnecessarily increasing the stigma and fear of a mental health diagnosis.  This, in turn, is likely to lead to these same vulnerable Christians missing out on (drug and non-drug) treatment which would help them rise to their true potential in God and in life, leaving them trapped and suffering in their mental destitution.

Dr Leaf has a track record of misinformation when it comes to mental health.  Christians suffering mental illness need more support, not more stigma.  It’s time Dr Leaf stepped aside, and stopped making things worse.

Christian male modelling

Zoolander

Some love him.  Some hate him.  It doesn’t change the fact that he was still “ridiculously good looking”.

Zoolander was one of those cult movies that polarised people into “absolutely love it” or “absolutely loathe it” camps.  I admit, I’m one of the former.  (“Moisture is the essence of wetness, and wetness is the essence of beauty”  … It still cracks me up!)

For those who aren’t familiar with the story, Derek Zoolander was a top male model who was famous for his different looks: “Blue Steel”, “Ferrari”, “Le Tigre” and the famous “Magnum”. They were all the same pose, of course, but everyone thought they were different. Except for evil fashion designer, Mugatu, who in a burst of rage at the climax of the movie, yells, “Who cares about Derek Zoolander anyway? The man has only one look … Blue Steel? Ferrari? Le Tigra? They’re the same face! Doesn’t anybody notice this? I feel like I’m taking crazy pills!”

There are times when I read Dr Leaf’s social media posts, and I feel the same as Mugatu.

“Dr Leaf isn’t a scientific expert … ‘When we think, we learn because we are changing our genes and creating new ones’ … That’s not scientifically possible! Doesn’t anybody notice this? I feel like I’m taking crazy pills!”

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Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  If Dr Leaf was a legitimate scientist, she would know that our genes do not change when we process new information. Our genes are stable. They do not change unless there’s a mutation, which occurs in one out of every 30 million or so genes. We do not make new genes at will. Last year, scientists at MIT were reported to have shown that DNA breaks when new things are learnt, but in a normal nerve cell, these breaks are quickly repaired. That’s certainly interesting, but that’s not changing the DNA or making new genes. Making claims that we make new genes to hold new information is like saying that pigs fly.

Dr Leaf’s supporters would likely make a counter-argument that she probably didn’t mean that genes really change, or we make new genes, she’s just not worded her meme properly. Well, there are two responses to that, neither of which are any better for Dr Leaf. Because scientists who really are experts don’t make errors so large that you can spelunk through them. And, this isn’t the first time that Dr Leaf has made claims about how our genes fluctuate. She made a similar claim back in September 2014. Saying the same thing several times isn’t a mistake, it shows she really believes that we change our DNA code by the power of our thoughts.

Whether someone thinks DNA is changeable isn’t likely to cause any great harm to that person, but what is concerning is that Dr Leaf has been given her own show on the Christian cable TV network TBN to discuss mental health. She’s already proven that her knowledge of psychiatric medications is dangerously flawed. If Dr Leaf doesn’t know the basics of DNA, then giving her a platform to preach something that can effect whether a person might live or die is particularly perilous.

Dr Leaf’s rise is also a worrying symptom of a Christian church that is intellectually imploding. In a 2013 blog for the Huffington Post, Charles Reid wrote,

“Christians must provide effective witness against both extremes. But before Christianity can engage atheism it must first address the scientific illiteracy in its own house. For the greatest danger Christianity confronts at the present moment is not incipient persecution, but increasing marginalization and irrelevance. If Christians cannot engage reasonably and responsibly with science, there will be no place for them in the public life of advanced societies.”

Reid was paying particular attention to Ken Ham in this blog, but the principle remains the same. Scientifically illiterate Christians quickly lose credibility with people. We can’t meaningfully engage with a person who has a rudimentary understanding of biology by proudly tell them that we create new genes with the power of thought. That makes us sound like a male model.

For the sake of other Christians health and well-being, and for the sake of our credibility and our witness, we need to critically assess Dr Leaf’s work, not promote it as another gospel.

The Prospering Soul – Christians and Anxiety

When you say the word “anxiety”, it can mean different things to different people. To a lot of people, anxiety is the same as being a little frightened. To others, it’s being really scared, but with good reason (like if you have to give a speech and you’re afraid of public speaking).

Medically speaking, anxiety isn’t just being frightened or stressed. After all, it’s normal to be frightened or stressed. God made us so that we could experience fear, because a little bit of fear is actually protective. There are dangers all around us, and if we had no fear at all, we’d end up becoming lunch for a wild animal, or road-kill. So there’s nothing wrong with a little bit of anxiety – in the right amount, for the right reason.

But anxiety in the wrong amount or for the wrong reason, can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. That’s the anxiety that we’ll be talking about today.

The official description of anxiety reflects this idea of the wrong amount of anxiety about the wrong things: “… marked symptoms of anxiety accompanied by either general apprehension (i.e. ‘free-floating anxiety’) or worry focused on multiple everyday events, most often concerning family, health, finances, and school or work, together with additional symptoms such as muscular tension or motor restlessness, sympathetic autonomic over-activity, subjective experience of nervousness, difficulty maintaining concentration, irritability, or sleep disturbance. The symptoms are present more days than not for at least several months and result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.” (This is taken from the beta-version of the latest WHO diagnostic guidelines, the ICD-11, but has yet to be formally ratified).

There are six main disorders that come under the “anxiety disorders” umbrella, reflecting either an abnormal focus of anxiety or an abnormal intensity:
1. Panic Disorder (abnormally intense anxiety episodes)
2. Social Anxiety Disorder (abnormal anxiety of social interactions)
3. Post-traumatic Stress Disorder (abnormally intense episodes of anxiety following trauma)
4. Obsessive-Compulsive Disorder (abnormally intense and abnormally focussed anxiety resulting in compulsive behaviours)
5. Specific phobias (abnormally focussed anxiety on one particular trigger), and
6. Generalised Anxiety Disorder (abnormal anxiety of everything)

The common underlying theme of anxiety is uncertainty. Grupe and Nitschke wrote, “Anxiety is a future-orientated emotion, and anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain.” [1]

The dysfunctional approach to uncertainty that underlies anxiety is in turn related to genetic changes which affect the structure and function of the brain, primarily in the regions of the amygdala and the pre-frontal cortex, which then alters the processing of our brain in five different areas:
> Inflated estimates of threat cost and probability
> Hypervigilance
> Deficient safety learning
> Behavioural and cognitive avoidance
> Heightened reactivity to threat uncertainty

In simpler language:
> the brain thinks that threats are more likely and will be worse than they are
> the brain spends more time looking for possible threats
> the brain fails to learn what conditions are safe, which is aggravated by
> the brain over-using avoidance as a coping mechanism, and
> the brain assumes that unavoidable uncertainty is more likely to be bad.

It’s important to understand at this point that anxiety disorders aren’t the result of poor personal choices. They are the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [2].

The other way of looking at it is that some people are blessed with amazing tools for resilience [3, 4].

It’s not to say that our choices have no impact at all, but we need to be realistic about this. Everyone will experience stressful situations at some point in their lives, and everyone will also make dumb choices in their lives. Some people are naturally better equipped to handle this, whereas some people have genes that make them more vulnerable. It’s wrong to blame yourself, or allow other people to blame you, for experiencing anxiety, just as it’s wrong for other people to assume that if one person can cope with the same level of stress, then everyone else should too.

It’s not to say that you shouldn’t fight back though. Just because your facing a mountain doesn’t mean to say you can’t climb it. It will be hard work, and you’ll need good training and support, but you can still climb that mountain.

Managing anxiety is very similar to managing depression like we discussed in a previous post. Following the tap model, there’s overflow when there is too much going into the system, the system is too small to handle it, and the processing of the input is too slow. So managing anxiety involves reducing the amount of stress going into the system, increasing the systems capacity through learning resilience and coping skills, and sometimes by improving the systems processing power with medications.

Reducing the input – stress management

Sometimes the best way of coping with anxiety is to reduce the stress that’s fanning the flames. It mightn’t seem to come naturally, but as we discussed in the last chapter, there are a few basic skills that are common to all stress management techniques that can form the platform of ongoing better skills in this area.

Engaging the “vagal brake” as proposed by the “Polyvagal Theory” [5] is as important in anxiety as it is in depression. By performing these techniques, the activity of the vagus nerve on the heart via the parasympathetic “rest-and-digest” nervous system is increased, which not only slows down the heart, but enhances the activity of other automatic parts of our metabolism. Some of the techniques allow a relaxed body to have a relaxed brain which can cope better with whatever is confronting it. The full list will be a blog for another time, but the simplest technique is to breathe!

It’s really simple. Sit in a comfortable position. Take slow, deep breaths, right to the bottom of your lungs and expanding your chest forward through the central “heart” area. Count to five as you breathe in (five seconds, not one to five as quickly as possible) and then count to five as you breathe out. Keep doing this, slowly, deeply and rhythmically, in and out. Pretty simple! This will help to improve the efficiency of your heart and lungs, and reduce your stress levels.

Remember, B.R.E.A.T.H.E. = Breathe Rhythmically Evenly And Through the Heart Everyday.

Increasing capacity – coping and resilience

Like with depression, anxiety responds well to psychological therapies which help to increase coping skills and enhance our innate capacity for resilience. And like depression, anxiety improves with CBT and ACT [6, 7], which enhance the activity of the pre-frontal regions of the brain [8]. For anxiety, CBT teaches new skills to handle uncertain situations, and to re-evaluate the chances of bad things happening and what would happen if they do. ACT puts the train of anxious thoughts and feelings in their place, and teaches engagement with the present moment, and a future focusing on values, and accepting the discomfort of uncertainty by removing the distress associated with it.

Practicing each of these skill sets is like practicing any other skill. Eventually, with enough practice, they start to become more like a reflex, and we start to cope with stress and anxiety better automatically.

Increased processing – Medications

Sometimes, to achieve long-term successful management of anxiety, a little extras help is needed in the form of medication. Like depression, the main group of medications used are the Selective Serotonin Reuptake Inhibitors (or SSRI’s for short). Medications appear to reduce the over-activity of a number of brain regions collectively called the limbic system [8], which are involved with many innate and automatic functions, but in its simplest form, the limbic system controls many of our emotions and motivations, including fear, anger and certain aspects of pleasure-seeking [9]. So essentially, SSRI’s help the anxious brain to make better sense of the incoming signals.

There are other medications commonly used for anxiety treatment, collectively called benzodiazepines. Most people wouldn’t have heard that term before, but would have heard of the most famous member of the benzo family, Valium. Benzos are like having a bit too much alcohol – they slow down the activity of the brain, and induce a feeling of relaxation. When used appropriately (i.e.: in low doses and in the short term), they can be helpful in taking the edge off quite distressing feelings of anxiety or panic. But benzos are not a cure, and after a while, the body builds a tolerance to them, where a higher dose is required to achieve the same effect. Continued long term use eventually creates dependence where a person finds it difficult to cope without them.

The final way to help manage anxiety is prayer. Like for depression, there is limited scientific information on the effects of prayer on, although a small randomised controlled trial did show that prayer with a prayer counsellor over a period of a number of weeks was more effective than no treatment [10].

Though given that anxiety is a future orientated emotion, excessively anticipating possible unwelcome scenarios and consequences, it’s easy to see why prayer should work well for anxiety. Trusting that God has the future in hand and knowing “that in all things God works for the good of those who love him, who have been called according to his purpose” (Romans 8:28) means that the future is less uncertain. The Bible also encourages us, “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.” (Philippians 4:6-7) When we give the future to God, he will give us peace in return.

Again, like in the case of depression, it’s sometimes hard for Christians to understand how strong Christians can suffer from anxiety in the first place. After all, we’ve just read how God gives us peace. And the Bible says that the fruit of the Spirit is peace (Galatians 5:22).

So when you’re filled with the opposite, when all you feel is overwhelming fear, it makes you feel like a faithless failure. Christians without anxiety assume that Christians with anxiety aren’t living in the Spirit. And it’s the logical conclusion to draw after all – if the fruit of the Spirit is peace, and you’re not filled with peace, then you mustn’t be full of the Spirit.

But like depression, when you look through the greatest heroes in the Bible, you see a pattern where at one point or another in their lives, they went through physical and emotional destitution, including mind-numbing fear … Moses argued with God about how weak and timid he was (Exodus 3 and 4), Elijah ran for his life in panic and asked God to kill him, twice, over the period of a couple of months after Queen Jezebel threatened him (1 Kings 18 and 19). Peter had spent three years with Jesus, the Messiah himself, hearing him speak and watching him perform miracle after miracle after miracle. But Peter denied his Messiah three times when he was confronted with possible arrest (John 18).

For the same pattern is also seen in King David, Gideon, and a number of other great leaders through the Bible. The take home message is this: it’s human nature to suffer from disease and dysfunction. Sometimes it’s physical dysfunction. Sometimes it’s emotional dysfunction. It’s not a personal or spiritual failure to have a physical illness. Why should mental illness be treated any different?

As the stories of Moses, Elijah and Peter testify, being a strong Christian doesn’t make you impervious to fear and anxiety. Hey, we’re all broken in some way, otherwise why would we need God’s strength and salvation? Having anxiety simply changes your capacity to experience God’s peace. As I said in the last chapter, closing your eyes doesn’t stop the light, it just stops you experiencing the light. Being anxious doesn’t stop God’s peace, it just makes it harder to experience God’s peace.

In summary some anxiety, at the right time and at the right intensity, is normal. It’s not unhealthy or sinful to experience some anxiety. Anxiety at the wrong time or at the wrong intensity, can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. Anxiety related to a dysfunctional approach to uncertainty, and is a future-orientated emotion because anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain. Anxiety disorders can be debilitating.

Like depression, anxiety disorders can be managed in four main ways, by reducing the amount of stress coming in with stress management techniques, by increasing capacity to cope with psychological therapies like CBT and ACT, and sometimes by using medications, which help the brain to process the uncertainty of each situation more effectively. Prayer is can also useful to helping to manage anxiety.

Christians are not immune from anxiety disorders, and it’s important for the church to understand that Christians who suffer from anxiety are not weak, backsliding or faith-deficient. Having anxiety is not because of making poor choices. Though if you have anxiety, trust in the promises of the Bible, that God has the future under control.

References

[1]        Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews Neuroscience 2013 Jul;14(7):488-501.
[2]        Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2.
[3]        Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10.
[4]        Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84.
[5]        Porges SW. The polyvagal perspective. Biological psychology 2007 Feb;74(2):116-43.
[6]        James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. The Cochrane database of systematic reviews 2013;6:CD004690.
[7]        Swain J, Hancock K, Hainsworth C, Bowman J. Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clinical psychology review 2013 Dec;33(8):965-78.
[8]        Quide Y, Witteveen AB, El-Hage W, Veltman DJ, Olff M. Differences between effects of psychological versus pharmacological treatments on functional and morphological brain alterations in anxiety disorders and major depressive disorder: a systematic review. Neuroscience and biobehavioral reviews 2012 Jan;36(1):626-44.
[9]        Sokolowski K, Corbin JG. Wired for behaviors: from development to function of innate limbic system circuitry. Frontiers in molecular neuroscience 2012;5:55.
[10]      Boelens PA, Reeves RR, Replogle WH, Koenig HG. A randomized trial of the effect of prayer on depression and anxiety. Int J Psychiatry Med 2009;39(4):377-92.

If you’re suffering from anxiety or any other mental health difficulties and if you want help, see your GP or a psychologist, or if you’re in Australia, 24 hour telephone counselling is available through:

 Lifeline = 13 11 14 – or – Beyond Blue = 1300 22 4636

The Prospering Soul – Christians and Depression Part 1

In the average charismatic church, from the time you park your car in the parking lot, to the time the music starts at the beginning of the service, the smiles of at least a hundred people beam at you, and at least one third of those smiles are also attached to enthusiastic handshakes and exhortations like, “Isn’t it great to be in church this morning!”

When you’re a Christian, especially at the happy-clappy end of the church spectrum, you’re supposed to be constantly full of the Holy Spirit and experiencing the joy of the Lord.

Which is why for most church-goers, putting the terms “Christian” and “depression” in the same sentence just doesn’t seem natural, even though depression affects a lot more of the church than the church is aware of.

So, how much of the church is affected by depression? The lifetime prevalence (how likely you are to suffer from depression at one stage through your life) is about twenty-five percent, or about one in four people. The point prevalence (those who are suffering from clinical depression at any particular time) is about six percent.

I used to attend a church which had a regular congregation of about 2500 people. So statistically, one hundred and fifty people in that congregation are suffering from depression every Sunday, and more than 600 will experience depression in their lifetime.

And by ‘depression’, we’re not talking about feeling a little sad … that Bill Shorten might become Prime Minister one day, or Ben Hunt can’t catch, or that One Direction isn’t the same without Zayn. Sadness for genuine reasons … you broke up with a long term partner, someone stole your purse out of your bag, or there’s the threat of redundancies at your office … also doesn’t mean you’re depressed.

The DSM5 is the current standard for psychiatric diagnoses around the world. I’ve included the full definition of depression at the end of this blog, but suffice to say, depression is more than just unhappiness. Proper depression symptoms “cause clinically significant distress or impairment in social, occupational or other important areas of functioning.” In other words, you’re so low that your social life or work is affected, and for more than two whole weeks. It’s also important to know that depression isn’t just low mood but can also be experienced as “Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day”.

Depression has a number of causes and correlations. People who are chronically unwell, be that from chronic pain, long term illness such as cancer or autoimmune disease, or life threatening illnesses such as those who’ve suffered from heart attacks or meningitis, have a higher rate of depression. People who have experienced significant physical or psychological trauma also have a higher rate of depression. In fact, stress of any form is highly correlated with depression (that is, people who suffer from any severe stress are more likely to develop depression).

This observation led to a theory about the development of depression, called the Stress Exposure Model of depression [1] – You develop depression because you’ve suffered from stress. This is one of the most common assumptions about depression in our society, and there are some important consequences from this line of thinking. Like, if being stressed is the cause of depression then the cure for depression is simply reducing stress. This is probably why most people assume that depression is a choice, or a simple weakness, and why depressed people are often told just to snap out of it.

But there’s more to depression than just better dealing with stress. Fundamentally, I understand depression as the end result of the brains capacity to deal with the demands of life. Too many demands or not enough resources overwhelms the brain and low mood is the end result.

Some depression is predominantly biological. People with biological depression can’t effectively deal with even a normal amount of demand on their system, because their brain doesn’t have the resources to process the incoming signals correctly or efficiently. The main biological cause is a deficiency of a growth factor called BDNF, which is needed for the nerve cells to grow new branches, which enable the brain to process new information. This theory is called the Neurotrophic Hypothesis of Depression [2] (‘neuro’ = nerve and ‘trophic’ = growth). BDNF isn’t the only critical factor in the biological story of depression. There are many others, including the stress hormone system [3], the serotonin system [4] and the dopamine/rewards system [5].

Some depression is predominantly psychological. There are certain situations in which there’s so much going on and so much change and adaptation is required, and the brains coping systems simply can’t cope. So, severe and sudden stressors would fit into this category. For example, people trying to cope with natural disasters, or a tragedy like a massive house fire.

Most of the time, depression is a combination of both biological and psychological. Genetic factors change our capacity to handle the incoming. The nerve cells don’t have enough BDNF and are slow to grow new branches. Genetics are also important in determining other mechanisms of resilience, and people with poor resilience are also more prone to depression [6-8]. Genetic factors also determine other factors involved in the way we process the incoming stream of sensory input – our personality. People with the neurotic personality type, the classical introverts/pessimists, are more prone to depression, because of the way their brain naturally biases the flavour of the incoming information [9]. What’s also very interesting is that these tendencies to depression also tend to create more stress [1, 10]. So stress is important to the risk of depression, but ironically, it is the risk of depression which influences the risk of stress.

The risk of depression is related to an increased tendency towards stress, and poor processing of that stress because of personality factors and a reduced capacity to cope. All three of these factors are influenced by a broad array of genetic factors.

What’s also important to see here is that being depressed isn’t because of “toxic thinking” or because of “negative confessions”. What we say and what we think are signs of what is going on underneath, not the cause of it. And more importantly, you can make as many faith-filled confessions as you like, but if they don’t help you to change your capacity to cope, then they’re just hot air.

In the next instalment, we’ll look at ways to handle depression, and what the Bible says about being depressed.

References

[1]        Liu RT, Alloy LB. Stress generation in depression: A systematic review of the empirical literature and recommendations for future study. Clinical psychology review 2010 Jul;30(5):582-93.
[2]        Duman RS, Li N. A neurotrophic hypothesis of depression: role of synaptogenesis in the actions of NMDA receptor antagonists. Philosophical transactions of the Royal Society of London Series B, Biological sciences 2012 Sep 5;367(1601):2475-84.
[3]        Hauger RL, Risbrough V, Oakley RH, Olivares-Reyes JA, Dautzenberg FM. Role of CRF receptor signaling in stress vulnerability, anxiety, and depression. Annals of the New York Academy of Sciences 2009 Oct;1179:120-43.
[4]        Caspi A, Hariri AR, Holmes A, Uher R, Moffitt TE. Genetic sensitivity to the environment: the case of the serotonin transporter gene and its implications for studying complex diseases and traits. The American journal of psychiatry 2010 May;167(5):509-27.
[5]        Felten A, Montag C, Markett S, Walter NT, Reuter M. Genetically determined dopamine availability predicts disposition for depression. Brain and behavior 2011 Nov;1(2):109-18.
[6]        Karatsoreos IN, McEwen BS. Resilience and vulnerability: a neurobiological perspective. F1000prime reports 2013;5:13.
[7]        Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10.
[8]        Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84.
[9]        Hansell NK, Wright MJ, Medland SE, et al. Genetic co-morbidity between neuroticism, anxiety/depression and somatic distress in a population sample of adolescent and young adult twins. Psychological medicine 2012 Jun;42(6):1249-60.
[10]      Boardman JD, Alexander KB, Stallings MC. Stressful life events and depression among adolescent twin pairs. Biodemography and social biology 2011;57(1):53-66.

The DSM5 Formal Diagnostic Criteria for Depression

A. Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

(Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.)

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
  • 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).
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

I’ve got a brain, revisited.

Nearly three weeks ago, I published a post on critical thinking in the church. I briefly discussed what critical thinking was, and I posed a number of possible reasons why we didn’t see more critical thinking in the church.

Having thought some more about the issue of critical thinking in the church over the last three weeks, I wanted to devote one more blog post to it – to add some more to the discussion, and round it out a little.

But first, I want to offer an apology to the church. In the last three weeks, I’ve come across research where experts have looked at the issue of critical thinking across our society, and their conclusion is that critical thinking is hard, and is poorly done across the board. The church, therefore, isn’t necessarily worse than the rest of the community at large, so I may have been a little harsh on account of some unrealistic expectations.

Still, I would suggest that if the Christian church is to be salt and light, we shouldn’t rest on our laurels and think it’s ok to be as undiscerning as everyone else. Instead, we should be looking to lead our community, in our love for God, our love for people, and our love of the truth.

In the essay, “Teaching Critical Thinking: Lessons from Cognitive Science” [1], Tim van Gelder outlines a number of lessons from cognitive neuroscience on the nature of critical thinking, how we learn, and why we don’t learn critical thinking. These have important implications for critical thinking in the church.

  1. Critical thinking doesn’t come naturally to us

    “Humans are not naturally critical thinkers; indeed, like ballet, it is a highly contrived activity. Running is natural; nightclub ‘dancing’ is natural enough; but ballet is something people can only do well with many years of painful, expensive, dedicated training. Evolution didn’t intend us to walk on the ends of our toes, and whatever Aristotle (“Man is a rational animal”) might have said, we weren’t designed to be all that critical either. Evolution doesn’t waste effort making things better than they need to be, and homo sapiens evolved to be just logical enough to survive while competitors such as Neanderthals and mastodons died out.”

    Instead of thinking critically, humans tend to be “pattern-seeking, story telling”. Problems occur because we naturally tend to accept the first account that “seems right” and don’t challenge whether that account is actually true. The test of truth for most humans is not intellectual but intuitive.

  2. Practice makes perfect.
    Critical thinking is a higher order cognitive skill. If you don’t practice the skills, you won’t become good at them or eventually master them. So learning the theory of critical thinking won’t make someone better at critical thinking any more than watching a sport on TV will make you better at it. Though if you want to become really good at something, one needs to engage in deliberate practice of the skills of critical thinking on a regular basis, as well as broadly practicing critical thinking.
  3. Transfer.
    Transfer refers to the difficulty in transferring skills applied in one area and applying them broadly. This is an issue across all learning, not just critical thinking. The mind is a cluster of specialised independent capacities, and a skill learnt in one capacity isn’t easily transferred to the rest.
    Of course, if it were impossible to transfer skills across to our broader knowledge, there would be no point in teaching anything.   So it’s not impossible to broaden critical thinking skills, but this skill must also be learned. It’s unlikely to happen on its own.
  4. Practical theory.
    Australian is a nation of coffee drinkers. Even though we consume a lot of God’s wake-up juice, most coffee drinkers don’t know much about the coffee they consume. They have practical coffee knowledge (what they like), but little theoretical knowledge (why they like it). Improving in critical thinking mastery, just like increasing the depth of coffee enjoyment, involves learning a little more theory. Better theoretical knowledge improves your perception of what’s going on, which then improves insight enabling better self-monitoring and correction, as well as enabling better improvement from external coaching. Better understanding of critical thinking comes from better understanding some of the theory of critical thinking.
  5. Belief Preservation
    Sir Francis Bacon said,

    “The mind of man is far from the nature of a clear and equal glass, wherein the beams of things should reflect according to their true incidence; nay, it is rather like an enchanted glass, full of superstition and imposture, if it be not delivered and reduced.”

    Or in other words, the human mind is prone to illusion, distortion and error, both because of innate hardwiring, and social learning. These cognitive beliefs and blind spots are many, and sometimes subtle. In this discussion, belief preservation is important. It is the tendency “to use evidence to preserve our opinions”. Humans seek out evidence which supports what we believe and avoid or ignore evidence which goes against it. We also rate evidence as good or bad depending on whether it supports or conflicts with our beliefs, and we tend to stick with our beliefs even in the face of overwhelming evidence against them, so long as there is a sliver of evidence in support.
    Critical thinking requires us to work against this bias, and doing so feels very unnatural, so while it might be challenging, it’s nevertheless, very important.

  6. Map it out
    The core of critical thinking is argument (the connected series of statements intended to establish a definite proposition, not an angry dispute).  We tend to handle arguments by expressing them in either writing or speaking. But there concept of an argument map in which the statements that make up the premises and the conclusion of the argument are drawn diagrammatically. Critical thinking skills improve faster when taught with argument mapping.

So how do we apply these lessons to critical thinking and the church?

  1. Critical thinking is hard but not impossible.

Critical thinking doesn’t come naturally to most people. Hence, why I apologised earlier in this essay – I was wrong to expect that critical thinking should come naturally to everyone.

But that doesn’t mean that the church should shy away from it either. At the very least, all Christians should be aware of the most fundamental basics of critical thinking – that we naturally tend to believe what’s intuitive, not necessarily what’s right. And, it’s ok to ask questions. No topic should be taboo.

  1. Those who can, should.

We’re all members of Christ’s body (Romans 12:3-8, 1 Corinthians 12:12-31). Some are more gifted in hospitality or leadership – the hands and feet. Some people are intercessors – the heart. So it’s not really a stretch to think that there are some members of the church whose gifts lie in the academic or the intellectual – the “brain”.

So those who want to think about God and their faith on a much deeper level should be encouraged to do so. If there aren’t any already, courses could be developed to teach the interested Christian how interpret Biblical Hebrew and Greek to increase the understanding of scripture. Courses in critical thinking can be added to every Bible college and seminary, and courses in critical thinking can be encouraged or taught by churches, along side courses in ministry and the supernatural.

At the end of my last post, I said that I would do an idiots guide to critical thinking so that we could all have the skills if we wanted them. Actually I don’t need to, since there are very good courses in critical thinking online already: http://philosophy.hku.hk/think/

  1. Be aware of our limitations

Lastly, pastors and leaders should be aware of their own limitations and their potential for cognitive biases.  Our pastors work hard, and do a very good job on the whole.  But they’re not all like Solomon.  Just because something seems right to them, doesn’t mean that it is. Sometimes there will be people who will legitimately question what they say, or a ministry or minister that they’ve endorsed.

Rather than taking this as an affront to their authority, they need to consider that the alternative view might be right. If they’re not in a position to weigh up the evidence for themselves, there’s no reason why they can’t ask for assistance from trusted elders who do have the knowledge.  If Moses can delegate, then so can they.

The same goes for Christian leaders all the way to the highest levels of church leadership. Our church leadership can’t plead ignorance when significant issues are raised. Burying your head in the sand just makes your arse a target.

Critical thinking is an important yet unrecognised major issue for the Christian church. If I have missed anything, or if you would like to further the conversation, I welcome your comments.

Happy thinking everyone.

References

[1]        van Gelder T. Teaching Critical Thinking: Lessons from Cognitive Science. College Teaching 2005;53(1):41-46.

I’ve got a brain, and I’m not afraid to use it!

I’ve got a brain, and I’m not afraid to use it! – The issue of critical thinking in the Christian church.

Mythbusters … I have watched a lot of Mythbusters.

For the last decade and a half, Adam Savage and Jamie Hyneman have been exposing various memes and myths to some TV-science scrutiny, to see if whether these culturally ingrained factoids have any element of truth. My sons love it, possibly because of their innate curiosity, though I’m sure the shows gratuitous use of guns and explosives helps.

Most of the time, the Mythbusters prove that the myths they test really are just myths like we expected.  Though occasionally, they come up with some really counter-intuitive results, like elephants really are afraid of mice, that bullets can’t penetrate water, and that a bull in a china shop doesn’t necessarily lead to lots of broken china.

What’s consistently good about Mythbusters is that it shows you can learn a lot by being open minded, and that failure is just as much of an opportunity to learn as success is (sometimes more so). It also demonstrates the value of critical thinking.

There are so many things in our lives that we accept just because other people accept them too. That’s partly because of the way we’re biologically wired, and then socially adapted. While this has its advantages, it’s also deleterious too. Sometimes we do things in ways that are actually wasteful, or accept second best because “that’s the way its always been”.

Because it consists of fallible humans, the church is not immune. If anything, the church is more prone to simply accept what we’re told rather than taking a different point of view and considering issues from alternative perspectives. For example, the push for same-sex marriage caught many conservatives and the church by surprise, partly because the church has been unwilling or unable to engage in public discussion on same-sex marriage without it degenerating into disgust and derision. This has left the arguments against same-sex marriage with holes big enough for spelunking, and has made opponents of same-sex marriage look like a laughing stock (https://www.youtube.com/watch?v=G-0u9Ad886M).

What follows is a discussion on critical thinking within the Christian church. I don’t pretend to have all the answers. Actually, I hope that someone will be able to definitively disprove some of my later observations. Right or wrong, I hope to start an open dialogue on the way the church engages with critical thinking, because it’s a discussion that’s long overdue.

So first, just what is critical thinking? “Critical thinking is the ability to think clearly and rationally about what to do or what to believe. It includes the ability to engage in reflective and independent thinking.” (http://philosophy.hku.hk/think/critical/ct.php)

Is critical thinking Biblical? I propose it is. There’s no verse in the Bible that says, “Thou shalt be critical thinkers.” However, Acts 17:11 talked about those in Berea who searched the Scriptures daily, to see if what they were hearing was true to God’s Word. John and Peter both warned of false teachers, and Jesus said they may come to us in sheep’s clothing (Matthew 7:15; 1 John 4:1; 2 Peter 2:1). John said our duty is to “test the spirits.” Paul said: “Test everything. Hold on to the good.” (1 Thessalonians 5:21).

Is critical thinking being too self-reliant or denying the role of faith? I don’t think so. We don’t expect God to miraculously make us float around from place to place … we walk. God gave us legs, and using them does not deny our faith or God’s sovereignty. In fact, we’d look pretty silly if we sat still and prayed for God to move us around. It’s no different with our brain. God gave us a brain with the capacity for high-level thinking. Using our brain for high-level thinking doesn’t deny either faith or God their rightful place. The Holy Spirit guides us into all truth (John 16:13) and he will guide our thinking if we have the faith to believe.

Is critical thinking necessarily critical? “Critical thinking should not be confused with being argumentative or being critical of other people. Although critical thinking skills can be used in exposing fallacies and bad reasoning, critical thinking can also play an important role in cooperative reasoning and constructive tasks.” (http://philosophy.hku.hk/think/critical/ct.php)

So why don’t we engage in more critical thinking within the church? This is a simple question that requires a complex answer. I’m going to venture a few suggestions, but this list is far from comprehensive, and is more opinion than solid fact. If you disagree, or want to fill in some gaps, please leave a comment to add to the discussion.

1. People in general don’t have critical thinking skills

Critical thinking skills are sadly lacking, not just in the church, but across our society as a whole. Look no further than at the sheer volume of factoids and memes that go viral on social media. The average person accepts large numbers of baseless statements and passes them on to their friends in the mistaken belief that they hold some basis in truth.

There are probably lots of reasons for this, but I’d suggest that the main reason is that critical thinking is not taught in most schools, vocational training, or even at a lot of universities. Teaching critical thinking skills takes time away from teaching exam strategy, which is counter-productive for schools NAPLAN ranking. Since the world cares more about comparing themselves with others rather than actual intelligence, NAPLAN coaching is much more important than letting a child think for themselves.

Most work places actively discourage individual thinking too. Subservience to the system or to organizational rules makes for a much better workplace even if that means it’s full of mindless drones.

2. Christians don’t use critical thinking

The typical Sunday sermon, if it contains any scripture at all, is spoon-fed to the congregation without additional thinking required. It’s obviously difficult to have time for Q+A after a Sunday service, and for the vast majority of Christians, this is where their teaching for the week finishes.

There’s a small percentage of Christians that will go to small groups, but depending on the leadership of the small group, there may not be much opportunity to delve deeply into the text or subtext of the previous weeks sermon.

Then there’s a smaller number of Christians who have a habit of a daily devotional, though many of those will choose to be spoon-fed with a devotional text of some form.

Those who simply read the Bible think critically about the text and what it means will be a very small percentage of the Christian church.

3. Pastors don’t encourage critical thinking

When was the last time a you were at a church and the topic of the sermon was how to delve deeper into the Bible – how to understand the original Hebrew or Greek to enrich the meaning of the Biblical text? I’ve been in churches for more than 30 years, and I don’t recall a single sermon like that.

Perhaps it’s because pastors don’t think people would be able to understand. Or, perhaps it’s because they feel it would erode their position as experts? Perhaps they don’t understand themselves?

4. The church values the appearance of unity over critical thinking

In church-life, a high value is given to the concept of ‘unity’.   Discouraging critical thinking helps to maintain the appearance of ‘unity’. If someone did happen to have a thought of their own, they would tend to keep it to themselves since everyone seems happy when everyone’s in agreement.

When someone does speak out, it’s seen as ‘disunity’, even if their concern is legitimate. Continued non-conformity is treated as dissension. Sure, it’s couched in a thick layer of Christianese – that person’s taken offense / isolating themselves / is a troublemaker / out of God’s will / unteachable / unfaithful / has a critical spirit, etc

While that might very well be true, sadly, any non-conformity is treated the same, warranted or not. Either way, legitimate discussion is shut down, and homeostasis returns.

The solution is to use our brains. The church needs to openly accept and engage critical thinking rather than encourage diminutive homogeny and pretend they have unity.

Just because Jesus is our shepherd doesn’t mean that we should always behave like sheep, just mindlessly following the rest of the flock. God gave us a brain, we should not be afraid to use it.

—–

Post-script = In an upcoming blog, I’ll do an idiots guide to critical thinking. It’s all very well and good to say we should think critically, but that won’t happen if we don’t have the skills.