John H Armstrong

The Problem of Teen Suicide

Boy Interrupted is an HBO documentary film that raises powerful and troubling questions. It asks how a boy can threaten to end his life at 6 and 7 years of age and then actually do it at the age of 15. This documentary, produced by parents who are gifted film artists themselves, struggles to find answers about what kind of family this troubled boy really had. By its very nature, it is a raw and revealing display of personal life at its most disturbing level. How can a mother, we may ask, make a film about the death of her own son? What defines this film as a remarkably unique and truth-telling achievement is the way it explores how filmmaking can create closure for its creators as well as its audience.

Dana Perry gathered home movies, photographs, and a variety of different documents to tell the story of her son, Evan. Dana deals with Evan’s bipolar illness, his short and extremely troubled life, and his awful death. She shows the impact these events had on those who loved Evan the most. She interviews his siblings and friends, his doctors and his teachers. The camera provides insight and revelation, and yet Boy Interrupted is a film that is full of profound despair. Evan’s short life leaves so many unanswered questions that any feeling person will be moved by it very deeply. It is an essentially human story, and a parent’s worst nightmare.

In the last few minutes of the film the suicide note that Evan left behind is put on the screen. Evan listed six things to die for and six things to live for. His list is both chilling and revealing.

Six Things to Die For:

1.    Fear of failing
2.    Lack of trust in friends
3.    Working hard for what?
4.    Never being able to fit in
5.    Knowing all the bad things are true; being lazy, loser, ugly, untalented and stupid
6.    What’s the point?

Six Things to Live For:

1.    Potential for being something great
2.    Love of the people I trust
3.    The future
4.    Finding trusted friends
5.    Sadness brought to family
6.    Feeling better later

He concluded his note by writing: “So, six things to live for and six things to die for.” When you consider it these words seem almost clinical.

There is so much on both these lists that is true for many teenagers today. The statistics tell us that teen suicide is the number two killer among young people in America. If you want to get a sense of this tragedy Boy Interrupted provides it in large doses.

Mental disease is quite real. Christians who think otherwise should see this dark and powerful documentary. It refuses to provide simplistic answers.

The Connection Between Medication and Counseling

In the common goodness and grace of God the twentieth century brought real advance in the area of psychiatry. New drugs were discovered and various schools of counseling were developed as knowledge increased regarding the human body and how the mind actually works. But a recent trend does not bode well for patients with psychotic and emotional needs. Health insurance plans show an increasing unwillingness to pay for real counseling. The result is that more psychiatrists are prescribing medications without therapy.

A recent study showed that in more than 14,000 sessions, the percentage of visits that involved actual therapy fell to 28.9% in 2005, down from 44.4% in 1996. The use of medication rose to 83.8% of all cases, up from the earlier number of 68.6%. Authors of a recent study based on these numbers suggest there is no hard evidence yet that this has harmed patients, but they are generally agreed that drugs and therapy should be kept together. The two approaches work “synergistically,” noted one physician.

The problem is in the health plans themselves. Some plans make it much more lucrative for doctors to prescribe medications, and alternative practices and methods are always slow to get coverage. This I have found out first hand in dealing with a chronic illness that the medical community took  many years to even recognize.

More and more psychiatrists are majoring in medication management, not in counseling. This could be a good news and bad news story. Some therapies are questionable for sure, but prescribing drugs without working on very real human psycho-social problems is not the answer either.

Can We Develop a Truly Christian Psychology?

No subject is more divisive, at least in many conservative churches in America, than Christian psychology, or better stated, Christian counseling. One reason for this problem is that Christians who engage the social science of psychology often do a very poor job of submitting their reflections to biblical authority. The result is that there are many Christians doing psychology and counseling who are not actively submitting their practices to the types of biblical patterns and principles that offer real solutions.

Because of this confusion a virtual “war” has broken out, over the past ten years in particular, between the various types of counseling done by Christians. One side we have what has been called “biblical counseling” while on the other we have what is often referred to as “integrationist counseling,” or, to some who are very critical, non-Christian counseling.

A recent reader of this blog, who is himself a Christian counselor (Rev. Rick Sholette of Norman, Oklahoma), recently sent me a link to his site, Paraclete Ministries. I find myself agreeing with Rick's approach completely, or at least in so far as I have read his excellent work up to this point. I think he articulates clearly and succinctly what I have been trying to say (far more poorly I might add) for about twenty years now. If you are a pastor I suggest you look into this man and his work and if you are not you will still benefit by reading all that he writes on his site.

At Rick’s Web site he brings out a very interesting historical observation that I had no knowledge about until I read his comments last week. He believes that there needs to be a distinctive and carefully developed “Christian psychology.” This counseling should be developed by biblical theologians and Christian psychologists seeking to do this as partners. Rick writes: “Christian psychology initiatives predate focused Christian integrationism efforts by decades. In 1912 Oswald Chambers’ wife published verbatim notes from lectures Chambers gave in 1911 at the Bible Training College, London. The book title: Biblical Psychology.” I knew that Chambers wrote this book but I didn’t understand its importance until Rick pointed it our. This may well be a case where going back to an older thinker, who wrote long before our current battles, will help us immensely. We seem, at least the moment, to be locked into a state of impasse and this results in more warfare in the Church about this matter.

Rick captures the very essence of the present struggle when he writes:

"All of these turbulent streams of difficulties are combining to create a torrential river of crisis for Christian counselors, as manifest by the recent decision of the flagship school of the Southern Baptist Convention, Southern Baptist Theological Seminary (SBTS) in Louisville, Kentucky, to jettison its clinical pastoral counseling program and adopt a Nouthetic/Biblical counseling program in its place (David Winfrey. Christian Century, 1/23/2007, Vol. 124, Issue 2, pp. 24-27). The implications of this change for professional Christian counseling is significant, for in doing so, SBTS has essentially rejected secular standards and sanctions for professional Christian counselors, preparing their counseling students only for professional work in churches or para-church contexts. Southeastern Baptist Theological Seminary in North Carolina has done the same (Ibid), reflecting a June 2002 resolution by the Southern Baptist Convention to ‘affirm Christian counseling that relies upon the Word of God rather than theories that are rooted in a defective understanding of human nature.’”   

Rick concludes, again very wisely I believe, “Every conservative Christian school that currently provides secular-controlled clinical counseling programs will eventually have to address this growing disillusionment with clinical psychology and psychotherapy among Bible-believing, spiritually sensitive Christians.”

It is Rick’s judgment, and I deeply share this view, that the best understanding of "Christian psychology" is to be truly found in a careful effort to understand people from within a Christian worldview. The results of that activity, including the development of models, methods, and materials (from within a Christian worldview) that are then made genuinely useful for further research, teaching, and counseling.

John Frame has written an incredibly important article titled: “Machen’s Warrior Children.” In it he cites a number of issues that have divided the Reformed children of the late Presbyterian conservative, J. Gresham Machen. One of the major items on his list is counseling. I think we would all do well to pay more attention to this issue with an eye on solving the crisis it has created in the churches. It is literally ripping apart churches, families and ministries. There are likely hundreds, or even thousands, of my readers who have experienced this pain and division firsthand. This issue will not go away since dogmatic ministers and lay people have made their view of counseling synonymous with faithfulness to the authority of Scripture.

Did Jeanette Sliwinski Get Justice?

Some court cases strike me as particularly intriguing. Not because they make Court TV, though they might for all I know, but because they involve complex factors in decision making and punishment. One such case in Illinois involved the sentencing of Jeanette Sliwinski yesterday to eight years in prison. Jeanette's crime was fairly straightforward. She, now 25 years old, got into her auto in July of 2005 after a verbal fight with her mom, and then decided to take her own life. She ran into a stopped car and in the process killed all three occupants, young men on lunch break who were 29, 35 and 39 years-of-age.

Jeanette was initially going to be tried for first-degree murder but the charge could not stick so a lesser degree was sought by the state. She was tried, not by jury but by the bench, and found guilty by Judge Garritt Howard. Most critics testify that this judge is both fair and tough at the same time.

The families of the deceased victims are most unhappy with the verdict. Jeanette has already served two years in a Cook County jail and after two more years she will be able to complete her eight year sentence with good behavior. (She has been a model inmate so far.) Prosecutors wanted a ten-year sentence, the maximum.  The judge took into consideration her lack of a criminal record and what has been called "her diminished mental health." Since being in prison Jeanette has been placed on two psychiatric medications that have helped her immensely according to court records.

This case raises two issues. First, Jeanette suffered from a bipolar disorder that led to psychotic episodes. Her doctors had not treated the condition correctly and thus she was very vulnerable to shifts in personality that went untreated medically. For many in America, and in many churches, this means nothing. I disagree. Bipolar conditions are medically proven and regardless of what you think of mental illness the evidence is strong that such a condition impairs reasoning and behavioral responses directly. Accordingly, I believe Jeanette should be shown compassion. Part of the argument for this is established by the fact that she has made great progress in jail while being properly treated medically. In addition she expressed deep remorse at her sentencing. (The family of the victims felt she was "insincere."  How can such be judged when you have lost your loved ones in such a tragedy?)

Second, the cry for "justice" from the victims is real and painful. How should the courts respond to such an act? Jeanette will be out of prison at age 27 and three people will never be brought back due to her reckless actions in July of 2005. These family members were deeply distressed yesterday by the verdict and said so to all who would listen to them. They were angry, upset and critical of the court system. Seeking vengeance seems to be the norm in America. I am not sure how a society responds to this problem when they have forgotten that the Judge of all the earth will repay evil for evil and vengeance belongs to God, not to us. I feel deeply for such people but one thing is for sure---harboring anger at Jeanette and the court system will not heal their pain.

The defense argued that this tragedy would never have happened had Jeanette's doctors done their job properly. Apparently the judge believed that part of the story and believes this young woman needs treatment and another chance at life. Punishing her unduly will not send any particularly positive signal to the culture in general and fostering anger seems to have become a major problem in our system of justice. That's my view. What do you think? 

Albert Ellis and the Birth of Rational Emotive Behavior Therapy

Albert Ellis (1913-2007) died a few days age. He was the father of a counseling method called Rational Emotive Behavior Therapy. When he was only 19 years old he devised a therapeutic technique to help him deal with his personal shyness. He sat on a park bench at the New York Botanical Gardens and decided to speak to every woman who sat down alone. Over the course of one month 30 women walked away but 100 stayed and chatted with him. This direct approach led him to believe that emotional hang-ups could be altered by discipline and rational choices. The National Institute of Mental Health says that today more than two-thirds of all therapists in the U.S. use this method in their counseling. When you consider where we were before Ellis, with the influence of Freudianism so strong, this is nothing less than a massive shift. It was Ellis who famously referred to Freud's doctrines as "horseshit." He got that right.

No matter what a person had suffered or struggled with in the past Ellis argued that "Neurosis is a high-class name for whining." This response: "Stop complaining and deal with it." His approach was rejected by most until about the 1980s. When I went to seminary he was not taken seriously, even by most Christians. By 1982 he was ranked by his peers as the second most influential person in their field, after Freud of course. (To be influential does not mean you are right or even that your peers think that you are right.) Ellis authored more than 75 books, many of them best-sellers.

Ellis has his detractors for sure. He was once called "the Lenny Bruce of psychology." What he lacked in human empathy he made up for in showing counselors that people had to take personal responsibility for their present and future actions. Christians can surely celebrate this advance in the field of therapy, one needed now as much as ever. Ellis was very often rude and always provocative but he was never boring. He helped pull back his profession from some very silly and dangerous developments. I would guess that he will still be remembered for some time to come. When Christian counselors argue for their own innovations in this field they should at least give some credit to this non-Christian for their own approach to getting patients out of Freud and back into personal responsibility for human choice.

Depression Still Not Understood

Former U. S. Senator Thomas Eagleton (D.MO) died last Sunday, at the age of 77. Some older readers will recall that it was Tom Eagleton who was placed on the Democratic ticket as a vice presidential running mate to Senator George McGovern at the nominating convention in 1972. Only two weeks after the national party convention nominated Eagleton he was removed from that ticket because of an earlier psychiatric hospitalization for depression that was revealed through the press.

Eagleton was tapped, according the McGovern’s campaign director, the future Colorado senator Gary Hart, because he was “Catholic, urban and an unknown from a border state.” The McGovern campaign knew of Eagleton’s previous hospitalization(s) but felt that they could present Eagleton as a man of vitality and hard work who had been hospitalized because of his aggresive campaigning style that drained him.

What finally brought Eagleton down was intense media questioning brought about through, as is almost always the case, anonymous tips. Eagleton admitted he was “voluntarily hospitalized for nervous exhaustion and depression three times in the previous twelve years.” These depressions generally followed a campaign season and his treatments included counseling, medical treatment and electrical shock therapy, common procedures in those days. Senator McGovern initially stood by Eagleton but as influential newspapers questioned his suitability for the job Thomas Eagleton withdrew from the national ticket. (McGovern, clearly the most politically liberal major national candidate of the 20th century, went on to loose the election in a massive landslide to Richard Nixon.)

Tom Eagleton was re-elected to the U. S. Senate from Missouri in 1974 by a wide margin, showing Missourians trusted him. He was re-elected again six years later. When he finally left politics he practiced law in St. Louis and later helped bring the L. A. Rams football team to the city.

I had to wonder this week how the public would respond today to a national candidate who had been hospitalized for depression? We have made advances in accepting depression as an illness that is treatable and not that uncommon. Dick Cheney remained on the Republican ticket in 2004 even though we knew he had endured a series of pretty major heart issues for some years. But depression is still not understood in the wider society and is often treated in ways that are both unhelpful and lacking in solid medical understanding. Christians can be at their worst when it comes to this issue, often blaming depression on a lack of real faith and trust in God. I would like to think things have improved a great deal since 1972 but I frankly doubt it. Most of my friends who are pastors, and who have admitted their need for counseling and treatment for depression, have not been able to endure for long in conservative churches. The deep-seated misunderstanding and mistrust continues, especially in perfectionist settings. Eagleton’s obituary reminded me of this sad, sad fact. It also made me hope for better times in the future since I believe some progress has been made. For all who have suffered with depression, silently or otherwise, one can only hope that this will soon become the case since public rejection makes it all the harder to deal with this problem, especially when it comes from Christian brothers and sisters who should know both their Bibles, and the pains often associated with living well in a fallen world, much better. 

Biblical Counseling Pros and Cons

A few weeks ago (June 20, 2005) I wrote an article on Biblical Counseling that created considerable response, both pro and con. (See Weekly Messenger archives at www.reformationrevival.com.) I am always grateful for genuinely kind letters in response to my Weekly Messenger articles. Often the reality is that my readers have considerably different approaches, all of which would be worthy material for a respectful dialogue and serious public discourse. I can not respond to all of these replies as I would like. I do try. Sometimes this blog spot will allow this to happen.

One very good letter I did receive stated that the writer shared mutual concerns about biblical counseling. Since I was not sure what these concerns were it was very hard to respond to them point by point. I have found that most in the movement that bears the name, "biblical counseling," rarely cite their own concerns about their variously defined movement. An objective history that sees the good things this movement has done for the church (since about 1970), as well as some of the harmful things it has brought into churches, would be a welcome book or article in my view. I have seen the fruit, good and bad, of this movement in very conservative churches. The concerns that I raised were related to the pastoral and practical damage that I have seen firsthand. As with any movement it is always difficult for those who disagree with me to see their own strengths and weaknesses as I see them. (That is true in reverse for me just as well.)

A gracious and wonderful letter from David Powlison, sent to me with a massive stack of enclosures that I am currently reading, assured me that David did hear me and essentially agreed with several of my major points, at least as I read and understood his letter. (I am not surprised by this entirely, as my article did cite CCEF as moving in a far better direction than the narrow movement of counseling I know at the level of conservative local churches. I did not name NANC, as one example, on purpose but it seems clear to me that NANC, or at least the strong followers of NANC's heros and spokesmen, are now opposing CCEF in some fundamental and rather important ways. There is a clear divide here, at least to my mind, though some wish to deny it.)

My friend also wrote of my painting the story with "broad strokes." The nature of my article was to do exactly this, paint with broad strokes. I do not generally name names in these weekly pieces nor do I seek to do scholarly research in them. These pieces are painted in broad strokes precisely because this is what the people of God really need. God's people are generally filled with good will, godly wisdom, and good sense. I appeal to these basic qualities in what I write and how I write it.

Put very simply, I do not follow the present direction of Jay Adams, NANC, et al. I have spoken in these circles, read some materials, met both advocates and critics, etc. I know what I hear and what I feel and what I sense and there are important issues in all of this context that need profound discussion in the open. I am not the one to lead this discussion but hope some will and would be happy to promote it.

Most of all I am deeply and profoundly concerned that biblical counseling, broadly so-called, is tearing apart churches and making something other than core orthodoxy a test of faith and loyalty to Christ and his infallible written revelation of Holy Scripture. We evangelicals tend to destroy ourselves with every new insight and reformation we launch and this battle over the nature and role of counseling is just one example of my point. For thirty years I have watched "biblical counselors" disagree, attack the motives and positions of solid fellow Christians, and in general create further schism in the body. I have preached in several NANC settings and what I wrote is firsthand observation of what I have seen and heard. This was a major reason for my original article, plain and simple.

There is much room for me to learn from writers in this field and from the very good things several people have sent to me, most of which I was previously aware of and, in fact, have a great deal of sympathy for, especially those things written by men like David Powlison and Ed Welch, who are champions for a much better way forward in this whole field of pastoral ministry.