Terms like belief and unbelief; obedience and disobedience are part of a Biblical grammar of responsibility. Culpability and accountability are essential in relation to the bad news about sin; the good news of the divine gift of salvation, and the expectation of final judgment. Typically, only extreme cases of mental disability find exemption from this understanding of willful human agency.
With this view of human responsibility, it should not be too surprising that evangelicals (particularly in the fields of counseling) have been reticent to accept the findings of medical research that attribute moods and behaviors to neuro-physiological conditions. As neurochemical deficiencies became a widely accepted cause for a host of personal problems ranging from depression and anxiety, to learning deficiencies, suspicion of these findings only increased. Some evangelical leaders felt that the findings of neuroscience conflicted with Biblically based theological conclusions about humanity, sin and perhaps even salvation.
The alarming increase in depression diagnoses and prescriptions of medications for alleviating them serves as primary example of the pervasive influence of neuroscience. Toward the end of the 20th century, treatment for depression in outpatient services increased by 300%. Antidepressant medications are the largest selling prescription drugs in America. During the 1990s, spending increased by 600% (exceeding 7 billion dollars annually). Estimates now indicate that major depression afflicts 10-12% of Americans. These numbers invite suspicion as to the accuracy of the diagnoses.
Before addressing this concern, it’s worth noting that evangelicals are not alone in their emphasis on the importance of the human will. Legal and judicial systems serve as clear examples of the way social order itself depends on positive assumptions about human responsibility. Convictions and punishments involve conclusions inseparable from willful human agency. Before reaching verdicts of guilt or innocence, juries assume that those charged with a crime are both rational and culpable. Claims to insanity, as exemptions to willful responsibility, are rare and demand exceptional evidence. All levels of social life (e.g. parenting, education, athletics, employment, etc…) involve assumptions about the accountability of the human will.
“One of the most enduring and cherished elements of our experience of being human is our presumed capacity to decide. …this sense of self-determination—and with it, self-responsibility—is irrepressible. …. For many, a distinguishing characteristic of humanity is the capacity to decide. Earthworms, goldfish, and jaguars do not leaf through a register of options before acting; they simply do what they are genetically programmed and neurobiologically hardwired to do. They act on instinct. They are possessed by ‘animal desires.’ Humans, on the other hand, possess the capacity to step back from the precipice of innate desires or inborn patterns of behavior in order to elect for or against them, so that even when human action follows the path of instinct this is nonetheless the product of a decidedly human reasonableness” (Body, Soul, and Human, Life: The Nature of Humanity in the Bible, Joel B. Green).
Counseling and the human will
In the context of counseling, it seems best initially to treat counselees as if they have a full line of moral credit. We should treat people as individuals who can accept and pay for their debts. Out of respect for human dignity, based on the image of God, counselors should relate to counselees as those who are responsible, capable, culpable and accountable.
“After all, what could be more arrogant than treating other persons as if they were no more responsible than tiny children or the mentally maimed? What could be more patronizing than the refusal to blame people for their wrongdoing and to praise them for their right doing and to ground this refusal in our assumption that these people have not caused their own acts or had a hand in forming their own character?” (Not the Way It’s Supposed to Be, Cornelius Plantinga Jr.)
But sometimes life is not easily reduced to raw choosing. If we treat people only as volitional beings, we fail to relate to them based on the Imago Dei and the human fall from it. One must consider matters related to nurture and nature when addressing complex issues of life in this world.
Sociology: the context of nurture
I think about this often when I read our local newspaper. Almost daily I learn about what seems like an endless stream of young people being convicted and sentenced for crimes. In many cases, I sense that there are important stories behind their stories that never reach the paper. Long before these young people landed in the legal system, the damage done in their lives by irresponsible adults played a huge role in carving the path that led them to a life of crime. I don’t say this to excuse them from taking responsibility for their actions, but to recognize a reality that caring people cannot ignore.
I realize that we must take responsibility for our lives and that playing the victim (even when there is truth to the claim) only binds us to destructive patterns of life. Yet when counseling others, it would be naively simplistic to overlook or to minimize the effects of a troubled upbringing. There is guilt to be shared when those intended (by God’s plan) to be lovingly nurtured and brought to maturity under the responsible oversight of committed parents are instead objects of abuse and neglect. How do we talk about the outcomes in the lives of such children? How do we teach them to process the culpability of negligent parents? Does the behavior from children who come from such neglect and abuse warrant the label of sin?
“When one observes the rifts and scars of children whose parents took turns slapping, deriding, ignoring, bullying, or, sometimes worse, simply abandoning them; when one observes the wholesale life mismanagement of grown-ups who have lived for years in the shadow of their bereft childhood and who have attempted with one addictor after another to fill up those empty places where love should have settled, only to discover that their addictor keeps enlarging the very void it was meant to fill — when one knows people of this kind and observes their largely predictable character pathology, one hesitates to call all this chaos sin. The label sounds smug and impertinent. In such cases, we want to appeal to some broader category, perhaps the category of tragedy.”
“‘Tragedy’, however, “implies the fall of someone who is responsible and significant. It refers to someone whose significance has been ‘compromised and crushed by a mix of forces, including personal agency, that work together for evil in a way that seems simultaneously surprising and predictable, preventable and inevitable.’ A tragic figure is, in some intricate combination, both weak and willful, both foolish and guilty.” (Cornelius Plantinga Jr., Not the Way It’s Supposed to Be).
The God-intended design for humans as individuals in community was clearly stated when God said that it was not good for the first man to be alone. Our story is not meant to be formed in isolation but in a social context — for better or for worse. Those who refuse to acknowledge how one’s sociology (relationships and life circumstances) plays a major role in shaping one’s life are disrespectful of the Creator’s design. Compassionate counselors must consider the whole person holistically when guiding people into truth.
Physiology: the context of nature
A similar consideration must be given to the effects of one’s physiology. Just as we are social beings whose lives are formed in community, we are also physical beings with bodily needs. We are complex beings and our fall from God’s will only complicated our existence with brokenness on every level of life. Our original fall from God’s will corrupted both our social and physical existence in powerful and painful ways. This is where spiritual considerations must enter the picture for those who counsel the whole person based on truth. We are equally spiritual beings with a God-directed need for living in and under the will of our Creator.
Part of human complexity involves the brokenness of our bodies and minds. The brain is the most complicated organ in the body and it is marred with dysfunctions to varying degrees in the same way as other human organs. The fact that medicines have been discovered for neurological conditions should be understood along similar lines as medicinal aids for dysfunctions of hearts, lungs and other bodily organs. Consequently, those who benefit from depression medications should never be made to feel embarrassed about their need. They are no different from those who take medications for deficiencies in other bodily organs. Our bodies are fearfully and wonderfully made but woefully and tragically fallen.
Yet we need to exercise special caution in assigning moods and behaviors to neurologically based deficiencies. When counseling the whole person holistically, we should not allow counselees or patients to reduce their problems to medically based solutions. Perhaps the medicines are essential to their health, but other considerations are just as important. People must look at their social context and their spiritual needs along with bodily deficiencies. I’ve worked with counselees who have benefitted from depression or anxiety medication while working through circumstances and relationships to bring more stability to their lives. Once their lives reached better places of health and stability, they progressively moved away from the medicinal supports with great success.
We must understand that our brains can become physically altered by our circumstances. These changes are typically chemical in nature. One of the elders on my Church board is the Chairman of the Science Department of our local state University and specializes in neurophysiology. He confirmed for me that one’s actual physical neurology changes in relation to oppressive circumstances. This should not be too surprising as the same truth applies to other organs of the human body. Stress, for example, is proven to be bad for the heart.
But this is not to say that everyone will experience beneficial physical changes with changes in their circumstances. Some people must accept medicinal aids as a permanent part of their lives. But even in more severe cases, we must guard against simplistic reductions of persons to one dimension of personhood. It is naïve (and potentially harmful to those seeking help) when counselors or doctors treat them one-dimensionally. We must not treat people contrary to the way God made them or minimize the pervasive effects of our fallen condition.
Along similar lines, the conclusion that one needs medicinal aids for behavior or moods should not be used to preclude responsibility and accountability. It should sensitize our approach with compassion and mercy, but only in a context that preserves the dignity of exercising as much responsibility as possible.
In summary, counselors and doctors should never think one-dimensionally concerning medicinal aids for neurologically based needs. We are more than bodies with physical needs. Other dimensions of our being (spiritual, emotional, social) must receive balanced consideration in the battle for health. A Biblically based holistic approach to counseling respects all dimensions of personhood in the context of creation, fall, redemption and final restoration.