Mere Fidelity
Mere Fidelity
Resisting Therapy Culture, with Matthew Loftus
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Therapy culture (not therapy itself) has gotten way out of hand. Too many of life's normal vicissitudes are treated as mental illnesses. How do we avoid the extremes of medicalizing morality or moralizing medicine? How's a pastor to navigate this issue? Matthew Loftus, M.D., joins Derek, James, and Brad to discuss this sticky, hot-topic issue.
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Part of the Problem
Derek RishmawyMy name is Derek Kushmalli. I'll be your host for today. I'm joined by regular cast and crew members Brad East and James Wood. Good to see you guys. Howdy. Good to be here. And uh we also have a special returning guest, uh, an it's it's been a while since he's been a returning guest, but we want to invite on Dr. Matthew Loftus, the recent author of Resisting Therapy Culture, The Dangers of Pop Psychology, and How the Church Can Respond. And so we're happy to have you on to the show today. Good to see you. Uh good to see you too, Derek. So glad to be back. For this show, we've all read the book. We've all loved the book. I think you guys should everybody should pick it up, read it, hand it to your pastor, that sort of thing. But we actually I actually wanted to hand the show over to Brad, who's who's just been rare and to go for this discussion for a while now. So, Brad, why don't you just lead us off, take us into the into the weeds with Matthew here.
SPEAKER_05This is just my play for your throne, Derek.
Derek RishmawyI'm just I'm just gonna I had to come back to to to secure it. Uh, you know, I was supplanted but once before.
SPEAKER_05But you know, have me do it, you know, multiple times in a row. I love it. Matthew, it's great to have you on. I imagine some of our listeners will have already uh seen uh the book online or uh even have purchased or started to read it. But give us give us the thesis. Give us the give us the over. I'd say give us the brief TLDR, but then I'd actually love to know before we de delve into the meat of the book, what led you to write it?
SPEAKER_02So the TLDR is that therapy culture, which is distinct from therapy as a practice, makes people psychologically sicker by medicalizing normal life experiences. So when people think about their um normal grief as a uh symptom of depression, their everyday anxiety as a symptom of anxiety, as anything bad that happens to them as like a trauma, those all uh contribute to people thinking of themselves as patients with a disease. And then the more that they interpret their life through that frame, the sicker they become, the more their agency is drained. Um, and then people are judging institutions by their perceived mental health impact. I wrote it because I just started to see this stuff pop up everywhere um in church. I think it was, I mean, it was uh obviously I I don't live in America, um, but I was visiting one church one time in the US, and um the sermon was 20 minutes of therapy speak with a Bible verse at the end. That's kind of like I that's not what I went to church for. I come to church for the Bible. Um if I want therapy speak, I can go on TikTok. And then also I I read Abigail Schreier's book, Bad Therapy, and I was just frustrated because it was such an important topic, and the book was so close in so many ways, uh, but didn't quite get it and obviously didn't have the the the church side of things. So that's what really got me off my butt into gear to write.
SPEAKER_01Matthew, can I can I ask a quick clarifying question there?
SPEAKER_02Yeah.
SPEAKER_01Because I
Threading the Needle
SPEAKER_01I think you and I see a lot of these things very similarly. I think we we interacted even when there was a a a viral video going out by a a big uh kind of biblicist pastor uh kind of attacking therapy culture. And I think you and I both shared reservations about that because there seems like there's two ditches you're you're trying to attack, right? Which is the on the one side over medicalizing every kind of mundane problem that's just part and parcel of human existence in a fallen world. And on the other side, kind of denigrating medicine or therapy and and thereby kind of moralizing uh every issue. Would you s would you say that those are two big ditches you're also you know really trying to navigate between?
SPEAKER_02Yeah, I think that's a great way of putting it. Um I obviously spend more time in the book focusing on the the dangers of therapy culture, but absolutely I want to avoid that ditch on the other side of saying, well, you know, uh mental illness isn't real, you just need to pray harder. Um, you know, those kinds of things that take away from the truths that we've learned from how God made us with psychology and the way that like, you know, psychiatry and therapy can really save people's lives.
SPEAKER_05Matt Matthew, I'm curious about the um intersection of your expertise, but also your non-expertise here. So this is a this is a you know, in the same way that Schreier wrote her book as a journalist, and you said she she came close. I read that book as well. I I friends that I recommended it to who maybe kind of sort of needed to hear it, I would tell them, like, like, you'll agree with 80%. You need to hear 80% of this, but but the remaining 20, it's okay for it to make you a little bit mad. But um to cor correct me where I'm wrong, but also let our listeners know. On one hand, you're a medical doctor, so you're not a counselor or therapist, unless I'm mistaken about that. And on the other hand, um, you're not per se a pastor or theologian, though of course, like you've been writing and and working in that area in all kinds of ways, and and a medical missionary is itself um itself, right? An intersection of many things. So I I guess maybe speak for for listeners who again for whom like you know they don't know you from Adam, but but also like to say a little bit about where you're coming from. But then also what was it like what was it like? You know, this is a this is a tough endeavor to write about something so hot in our culture, so hot to handle.
Derek RishmawyYeah.
SPEAKER_05And I've already seen, I'm just not very like online in in these, in these ways, but I have friends who have shared with me pushback. And we'll get to pushback later. So don't touch that yet. But just you you knew you were gonna, you were, you were gonna stoke the ire of folks who are like, ah, you know, as a dot dot dot expert, I know that you're wrong already. So tell us where you're coming from and and a little bit about that experience.
SPEAKER_02Yeah. So I am uh a generalist. I'm a family physician. So my training was very broad. Um I've always loved doing psychiatry mental health within the field of primary care, uh, even when I was in training in Baltimore. And then when I graduated, I worked at a clinic for the homeless in Baltimore City. And then here in Africa, I've been doing uh what you might call gorilla bush psychiatry and you know, providing psychiatric care, mostly medications, although I'm working very, you know, I work very closely with uh psychologists and counselors and pastors here. Um it's language is really the thing that hinders me from doing a lot of like therapy therapy with people. Um so yeah, I'm I'm a generalist when it when it comes to medicine, but obviously love practicing mental health and taking care of people with mental illness and teaching it, right? Like because in my context, a if someone sees a family doctor for their mental health problem, uh they're lucky. Many people just will never get to see a psychiatrist. And then as well, I think theologically, I'm a generalist. You know, I I I have um I've studied it in professional, you know, formal and non-formal contexts, and teach it to the residents. So uh that experience, I think it gives me a lot of different places where I've had this, uh, where it's touched in my career. Uh, and then also, of course, personally, like having um uh you know worked with uh or fought for many years through depression, porn addiction, and those kinds of things. Uh and I've so I've talked to lots of therapists and counselors, and then but at the same time, it's kind of like you just have to be a Christian who's talking to other Christians in the Anglosphere, I feel like, to have a sense that something is going on with therapy culture, right? Like uh friends who are talking about their relationships with other people that have, you know, have now gotten invaded by therapy speak, um, pastors who are like, what I'm what's going on with with people? What are they, you know, and I think one of the biggest things is just like people, um, yeah, parents, teachers, pastors, they have people in their life that are getting sucked into this stuff. And so they're hearing this stuff that's very authoritative sounding, very clinical sounding, and like, well, I want to love this person, I want to help this person. But this, this, what they're telling me, as authoritative as it sounds, still doesn't sit right with you know what I know about the world or whatever. And so that was really kind of the what I was trying to bring to the book and research it is be like, okay, here is this thing that's exploding in a lot of different contexts in a lot of different ways. And so what would somebody who um who isn't an expert, how would they what what what would be most helpful for them to know as they are loving and caring for people uh in their lives who are struggling with mental illness or who have gotten sucked into therapy culture?
Derek RishmawyI I thought, I thought just to chime in, I thought it was helpful knowing how often you clearly flagged you are a participant in and beneficiary of certain forms of therapy, and you are somebody who has, in the course of your daily, if not weekly, work, has had to had to medicate and prescribe uh medications for folks who you know that has potentially saved their lives or saved their mental health or helped them come back from the brink of severe uh mental illness. And so knowing that this is not just a, I'm gonna come from the outside hit job, this is somebody somebody who's like been in the world, benefited from it, benefits others with um especially the medical side of things, and then nevertheless has qualms, concerns, and all that really was helpful in in I think seeing some of the balance you were trying to strike. I actually thought uh I actually thought you were gonna come out swinging a little bit harder in a few chapters, given that, given that I I thought this was gonna be Matthew Loftus does f his best Freddie De Boeer minus the F-words, uh, or something like that. Um so this I was actually I was actually expecting some harder punches in certain places. And so I appreciated um I appreciated a lot of the balance on that. Uh so that was just a comment and reading. Thanks.
SPEAKER_05Matthew, if you you know, you might not remember Derek's more of a comment, not a question kind of guy.
Derek RishmawyYes. Uh this is a dialogue.
A Levelheaded Jeremiad
Derek RishmawyThis is a dialogue.
SPEAKER_05You could have written a polemic, you could have written a screed, you could have done the Christian version. We know all of the not all, there's a whole cottage industry of this kind of conservative or conservative Christian, throw out the baby with the bathwater approach, the Jeremiah. Um so yeah, talk about talk about your approach. Uh about you decided to be level-headed, you know?
SPEAKER_02Yeah, I mean, I like level-headed. Uh if if I have a brand, I suppose that's part of my brand. Um uh uh doggedly determined to represent all sides fairly. Uh yeah, and I'm a part of it is that I think in terms of the Jeremiah's, like there's there's plenty of that on the market already. Um, and so finding something with balance. Um but also, you know, I uh I really want to try to persuade people on the fence. Um and as I've been, you know, talking about the book and and going on podcasts and stuff, I've realized that someone needs to write a follow-up book called Escaping Therapy Culture, because the book that I wrote was, you know, for people that love people that are getting sucked into therapy culture. And uh we s we still need a book that is designed to kind of reach out to people who are stuck there and uh you know gradually, slowly walk them back into um uh a world of more sanity and balance. And yeah, I think I really it's so it was it was tough, I think, because uh, you know, in in terms of finding the way, because I I did think about like, okay, what if I just wrote like 10 lives of therapy culture and and how to respond to those. And I I think that there's a place for that approach and there's a place for stronger punches um and for getting uh getting people's attention. But also I think if you if you come out swinging too hard, then you know you you you will get more you will often get more applause from your own side, but then the people that actually need to hear the message um will get turned off. Um yeah.
Key Concept: Iatrogenesis
Derek RishmawyYeah. In terms of in terms of the message, I want to talk about some of the key concepts in the book for a minute. You know, and I say this as somebody who I know uh a bunch of other RUF campus ministers, uh people working on college campuses, working with Zoomers and folks like that. What we've all noticed, we've all noticed that the last five years versus the five years prior and 15 years before that, the tendency for a student to come down, sit down, and just immediately start naming the four or five conditions they have in your first conversation has skyrocketed. And and and again, I'm someone who has referred out to therapy because there's been clear cases of like, hey, this is real. Uh as well as just but just seeing it skyrocket rocket for uh, you know, we could talk about online and phone usage and all those sorts of things. I wanted to hear you talk a little bit more about this key initial concept of iatrogenesis and kind of that that the way that shapes uh a lot of the uh initial onset of uh if we can talk about initial onset of of early stage therapy culture. Uh and and uh kind of getting somebody giving you an intro an interpretive grid and then suddenly everything getting sucked into that and the way that shapes or reshapes our experiences of the discomfort and the pain that we're uh living in. So I'd love for you to kind of unpack that a bit and see how that how that plays a role in in the foundation of all this.
SPEAKER_02Yeah. Um iatrogenesis is really foundational and it's a concept uh m kind of popularized by Ivan Illich in his book Medical Nemesis, which uh got toned down to be re-released as limits to medicine, um, a bit of a letdown. Um so iatrogenesis is just like the idea is any kind of problem or disease induced by the practice of medicine itself. Uh so it's it's not simply like medical error, but it's like it's it's things that you can only get by um med, you know, by by being a patient. And so, and you know, very often unintentional, done with best of intentions. The clearest example is you get a cold, it's caused by a virus, and then you go to the doctor and the doctor prescribes you an antibiotic, um, whether it's because you really want the antibiotic or the doctor mistakenly thinks that you should have an antibiotic, or there's just this cultural pressure to have whatever. Uh, and you don't need the antibiotic. And then you take the antibiotic and it gives you diarrhea, or you know, you have some other reaction to it. And so that was something that right, you were you were entering the medical system, and what you needed in that case was reassurance or maybe some other treatment, maybe just mitoprofen or whatever, but you got the wrong thing, and the wrong thing harmed you. And so there are ways in which this gets um, you know, really layered in in certain contexts. But within psychiatric context, it's like when someone comes in and they have the symptoms that uh are similar to depression, right? The same way that a cold might be similar to a bacterial sinus infection, uh, right, you get uh providers, uh, you know, that it kind of it starts from the providers and then works its way down into the social media and whatnot that mistake these problems that you're having that are just a normal reaction to stress in your life, or um, you know, there it's some other problem that kind of needs to be worked out um through some some method other than straight up uh therapy or uh medication. But then you get the medication, you get the diagnosis, right? And these things that were, these diagnoses and these ways of viewing the world that were really designed to describe people whose minds are broken in the way that like someone's leg is broken, as much as you can analogize those, right? Because the those and the analogies between medicine in the body and psychiatric medicine, it's never uh never perfect, right? Because there's uh there's so many differences in in what it is that we're describing and how we examine for whatnot. Um but when people uh take their an experience that is not um, you know, a severe mental illness and they think of it as symptoms of mental illness, then they start to interpret more and more of their life through the lens of, okay, so last night when I didn't sleep that well, that must mean my depression is really getting worse. Or, you know, I feel um really um anxious about this right now. That must mean my anxiety disorder, this thing uh that's uh defines me is now acting in a way that makes it harder for me to control my responses. Yeah. And so that just kind of builds up and builds up and builds up. And over time, people just sort of shrink more, you know, kind of collapse in on themselves. Yeah.
Derek RishmawyI I as an analogy, I when I was in my early 20s, I uh started having gait pattern issues with my walking. I had I had a total breakdown. Down, I tend to know this in both knees and started walking a little crooked. I went to the doctor. And I remember the doctor, uh, he said, Oh, you should go see um whatever, a foot doctor, a podiatrist. And I go to see the podiatrist. I was like, Hey, I'm kind of walking crooked now. What's going on? He's like, Oh. And he goes to measure and he's like, Oh, you actually have a leg length discrepancy. I was like, Really? I didn't walk crooked before. He said, Well, you know, you're getting older. Mind you, I was 25. Um, so he put me on some imbalanced uh uh medical grade foot inserts that locked in what was not an actual leg length discrepancy because those are actually extremely rare. It was rotated pelvis, but it locked it in for like a couple of years, which ended up cascading into shoulder issues. So total kinetic chain issues for a couple of years. I mean, so when I saw itrogenesis, I was like, I have lived this. I have experienced this. Yeah, that's a perfect example. This is so I just thought, oh, yeah, I've got a leg length. No, you have a rotated pelvis. Almost nobody, almost nobody has a leg length scope. But the guy had one trick, he prescribed something, and it made my life significantly worse for several years uh at the physical level. So I saw that. I'm like, I yeah, you give somebody a heuristic grid, you start to reinterpret all of your life in light of it, and suddenly it's everywhere. Um so that that was that was that was more of a comment than a question.
SPEAKER_02No, but that's that's a gr another great analogy.
unknownYeah.
SPEAKER_05Yeah, I'd love to jump on that with with within with my own anecdote and then ask you a question about expertise, Matthew. My my anecdote will be a little bit vaguer because it's not uh I can't can't name who it's about, but a child. Um, we were dealing with one of our an issue, a mysterious issue with one of our children. Um and we we did eventually get to the bottom of it. Um, but in the middle of it, we met with our pediatrician, whom we trust and and whom we still go to and and really love. And at one point, when it was kind of like, so far we haven't found like an empirical material biological thing, he kind of like tested the waters about like, I could, and this was a very, very young child. Like, think early, early elementary. He was like, we could, it could be psychological, which could lead to medication. You know, he kind of like and and and and I was like, oh no, like we're not, we're not, like, we're we're not, we're not starting that at age seven because we can't figure out what's wrong, right? He was like, okay, great. I didn't want to do that, but I just I kind of have to. Like, you're the you're the one in charge, not me. And like that's one potential option. And I was just sitting there like, I'm someone, like, I read about this stuff. I'm educated. I I like I don't have limits. I I this is someone I actually have known for a decade. Like we we have friends in common. Like all of these things put me in a position to say, that doesn't like that would be that would be at the end of years of this, right? Not not in like the first three months of something weird. And he didn't, he clearly didn't want to either, but but he felt duty bound medically to say, well, this is one way some people treat something like this, and I and I need to give you the option, even if you're gonna reject it. I'm just I was just sitting there imagining
Who Can We Trust?
SPEAKER_05so many parents being like, well, I I mean, I love my child, and if that's what the doctor orders, like I I guess what what would you do, right? Um, and so okay, so this leads in that this leads into my question for you, because this does, this does connect to some of the stuff in Freddie's book next month. And actually, James, uh wait, which Mumford? Is it James Mumford? Yeah. He has he has a book on this, just I think coming out in January. Um, you know, my my impression from not Mumford, but at least from Freddie to some extent and from some others is what we need to return to is we need to get away from a lot of the TikTok self-diagnosis stuff. We need to get away from kind of the pop stuff, and we need to trust the experts. But sometimes, like the the rot is in the head, right? It is. It is, absolutely. And I will like who who can we who can we trust here?
SPEAKER_02Like, where do we go for help? I mean, yeah, no, and and it's uh it's a I I will 100% indict my own specialty, the generalist, the family medicine, the primary care people, because we are so way too we have been way too quick to just throw a pill at people who have uh, you know, who come to us with uh all sorts of problems, um, some fraction of which you, you know, could say are diagnoses of depression or anxiety or what have you, but you know, a lot of other things that need spiritual uh care, exercise, there's all those kinds of things. And yeah, I think it is it is challenging because you do have to find an expert that you trust. Um and hopefully, I think uh, you know, my my hope within you know the the counseling and therapy profession is that um, you know, they have as institutional exorcisms um to try to push out some of the people. And, you know, I think the the field right now, there's a book that just came out called Therapy Nation by Jonathan Shedler. Um, there's other, you know, Freddie's book that are about, you know, trying to push that process and get the experts who are um leading people astray, trying to push back on them. Um, but it is it is challenging. And so I think every every pastor should just, you know, get to know the people in his community who are practicing um therapy or counseling. So that way he can say, I, you know, it's uh I want you to go to this one, not that one. Um, you know, I think within uh, you know, when it comes to prescribing, uh that's I think it's even harder to find um someone who's balanced that you can trust. But uh I think that is it unfortunately, as with a lot of other aspects of modern life, um being able to read and understand, like having people that you know have done the research uh that you can look to to help kind of discern what which of the experts are are worth listening to uh is is uh yeah, it's a challenge.
SPEAKER_01So we're back to do your own research. That's I was gonna say, but this is this is so this back to it.
SPEAKER_03There's no way around it, guys.
Derek RishmawyThis is where I wanted to hear. So, Matthew, we've talked about we've talked about the iotrogenesis from from from experts and so on and so forth. But my students, some of them have been to actual therapists, but some of them have not.
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Trauma and Shame
Derek RishmawyJames, did you want to take that in direction? I was gonna ask him about TikTok.
SPEAKER_01Um I mean, it's a little different, but I mean, I do think this is kind of the part of the epistemological crisis that we're all in, right? I mean, yeah. Uh and I I just don't know if there's uh a complete way around, I mean, some of this, um, and you have to use judgment, and it's just very difficult. So I just I sympathize with people who are struggling with lots of these issues from lots of different directions. But I did want to um bring up a little bit of a curveball on this because we we've been talking a little bit about the the medicalizing part, um and you know, the medicine and the psychiatric part. But I wanted to bring up two other figures that one that you do directly address in the book that I I was really glad you did, and I really appreciated the nuanced way you you addressed it, which is the Vanderkoch, which is on my, you know, on my desk, The Body Keeps the School, a major work that's been, I think it's been on a New York Times bestseller's list for like what 15 years straight or something like this. Um, and there's been reaction to that reaction by some people that I love and respect that I don't fully agree with their reaction, uh, because I think I think they're throwing out his arguments based on certain aspects of his arguments that are highly disputable. But there's something to the bodies keeps the score argument that I think that you still retain. I think you, and so I I really appreciated your nuance there. So I want to discuss that, but I wanted before I forget, the other figure I wanted to bring up that I wanted to get your take on was I didn't see this name. And maybe because your the book doesn't have an index, which sorry, that drives me crazy, Matthew. There's no index here.
SPEAKER_02Yeah. I should have.
SPEAKER_01But but the name that I was waiting is because you talked about shame. So that's trauma. Yeah. There's the trauma side, uh, which that that's that framework has been very influential over the last 15 years. But the other framework that has was very influential, at least for a time, was Brene Brown's rejection basically of shame. I know her argument's more nuanced than that. But do you see those as um well, maybe can I start with shame? Maybe can we come back to the street? Yeah, let's start with shame. And and yeah, can we start with shame? Because I think for a time there was this understanding that look, to be really healthy psychologically, you need to unshackle yourself from shame. Um, and I I wonder if do you think is that still pr a predominant framework in churches and in the pop sphere? Or I wonder, is the the political moment changed that that message? That is there a return of shame that we want shame again? Because we've seen when we lose when people live completely shameless, that's they live in a way that we don't find healthy, but we're also maybe even seeing uh that living unshackled from shame is not helping people. Are you so give me your take on shame, the Brene Brown argument, that whole framework, and where are we now?
SPEAKER_02Yeah, so I think the the Brene Brown thing is uh uh I I have not read her books, I'll I'll admit that.
SPEAKER_01Well the name so she wasn't in there, I was right.
SPEAKER_02Yes, no, she's not and no, I don't I don't think I mentioned her name there. Um But uh it is I I do think that the her general the the general idea of like uh completely extirpating shame. Um and there, I mean there is another uh like Kurt Thompson, um, I think is is a person, his his book, The Soul of Shame, um, kind of takes a lot of that similar ideas and and relocates them within a Christian context. And so I do, and I think the church is honestly a couple years behind the general culture uh within with exactly the dynamic that you described of people realizing, okay, shame, uh shame serves a healthy social purpose, uh, right. And some of that is just kind of like being aware of other, you know, non-weird cultures where shame is a is a normal part of human society, um, a normal part of relational dynamics. And I think, you know, what what what helped me in thinking about shame was just sort of realizing that it is a it I mean it's it's sort of like gravity in that like it's going to occur, right? It is a natural consequence of sin. Um and so we can like look at the ways, you know, I think we can keep some of that some of the anti-shame messaging in sort of recognizing how uh shame when it is misused or shame when it when it hinders us from those loving relationships and honesty especially, right? Like I think that's that's still the the nub of truth to hold on to is that shame prevents people from being honest with each other when they need to be.
SPEAKER_01Thank you for that. Um and could you just I I thought your treatment of the Vanderkoek thesis, uh the body, which if people aren't familiar with that name, it's the famous book, The Body Keeps the Score, which is uh was helpful to talk about trauma and how trauma has kind of biological, physiological impact that uh and so it complicated just how we're dealing with how we have all these kind of subtle triggers that we might not even be conscious of that are shaping us in these these profound ways. And so it what when I first read that years ago, I I first of all it just helped me be a little bit more compassionate with myself and because uh having gone through certain things that you actually narrate as still legitimate suffering that still sticks with you, uh, I underwent in my own childhood that is still affecting me and I'm dealing with it. And I've and I think it just allowed me to that book was one of the first things that allowed me to be compassionate with myself, and then with others when they have different types of temptations. We do all have different types of temptations that are shaped from all these different influences. However, I didn't expect that book to have the life that it has, and then we have this kind of trauma maximalization where people are claiming that all sorts of things that are just like common experiences in life. And so can you just speak to the dance that you're trying to navigate, the the ways you're trying to navigate the conversation around that book?
SPEAKER_02Yeah. Uh what you're describing is I think similar to me, to my experience in uh more from the provider side of, you know, I I when I first read The Body Keeps a Score, I said to myself, wow, I wish that this book had come out five years ago when I was still in training, because it would have helped me understand what was going on in the lives of my patients, um, some of whom were very um frustrating to take care of because they were reacting to my attempts to help them in ways that, you know, were pushing me and other people trying to help them away and uh doing things that that didn't make sense to me. And, you know, I think that that that the book really did narrate a lot of things that are true about the way that trauma works in people's lives and the ways in which people can um, you know, the way that certain kinds of suffering can really stick with people. Uh and in in particular, you know, understanding PTSD as a disorder of memory um is just so helpful, I think, uh, when you're taking care of people to be like, okay, so when people have really have experienced profound trauma, sometimes what happens is their their way of remembering things really gets stuck. Um and and they're and that what happen, you know, and and those experiences that people feel in their body in that moment when they're ex you know, going through that that traumatic experience, like that can be reactivated um in uh otherwise innocuous seeming ways. And that's a a really helpful thing to keep in mind when you're help trying to help people. The problem is, like you said, the trauma maximalism, right? Of uh, you know, what the you know, the patients that Vanderkoel has worked with for the most part are people that have experienced really profound kinds of you know, things that uh crime almost always crimes, right, against them, uh, you know, of of severe physical, um, emotional, sexual abuse, neglect, those kinds of things. And that um there's a s you can kind of step that out like one standard deviation, you know, you know, if if people who are he's talking about um are, you know, at standard deviation five, you could step that out to like standard deviation four, maybe even three and a half. But then once you get within like the normal range of human experiences that we all, like the kinds of suffering we all go through, um, then that explanatory framework becomes less helpful. And the the iatrogenesis creeps in. And part of the challenge, right, is that there is this continuum of stress and and trauma. Um, there are ways in which human beings are designed to, you know, experience stressors and then um re and then manage those and process those. And so, and there's a lot of specifics about some of the research that Vanderkock cites that is, you know, he, you know, like I think a lot of people writing pop scientific people writing popular books do, they oversimplify um and they make it sound, you know, they they uh as much as they might try to find a balance of evidence to show both sides of an argument, they're gonna present the um the things that make their side sound the best. Uh, you know, there's already people that have pointed that out to me in my book. But in part because Vander Koelk's book was so popular, right? Now people think of it as like, oh, well, this is what the research on trauma says. And no, it is not. Um, there are a lot of ways in which uh, particularly, you know, his um anti-cognitive behavioral therapy stance um is just, you know, wrong. And it really helped me to read to read some of this other, some of the critiques and realize like, oh, so like Vanderkolk represents one side in a debate that's been going on for a while. And he his side got lucky because he wrote this mega bestseller.
SPEAKER_01Um that's interesting. You had punches. The the biggest punch I couldn't find the page again was you open one chapter, and I was just skimming back through a minute ago, where you say uh you resist the the kind of common mantra today that everybody needs to go to therapy. Yeah. Yes, that is a that's a spicy line at the opening of the chapter.
SPEAKER_02Yes. Yeah, no, well, uh, like I said, man, Iatogenesis.
Healing in Church
SPEAKER_05At the at the end of the book, you you have this um do you call it an epilogue or conclusion, a conclusion called the good enough church? And yeah, um the this was this was um you were speaking my language, this kind of deflationary approach to the church cannot be everything, the church can only be the church, and the church is full of sinners. Um and there's a certain kind of in one sense I I'm I'm all for a high ecclesiology, but it's gotta be a high ecclesiology of people like the guys on this podcast, like screwed up sinners who need God's grace. And so I I was I was here there for it, like preach the word, sacraments, let's get together, we'll screw it up, but like God's there. Um and I was talking about your book with um with a friend, theologically uh trained guy, uh himself a writer, and he was not moved by the deflated approach because uh and he had a number of comments, but I'll give you one because I want to hear what you think about it. He said, Isn't the gospel holistic? Like, isn't like isn't the ministry of Jesus in the gospels something that touches the soul, the mind, the heart, and the body? Isn't Jesus' ministry as well as the apostles' ministry one of healing? And if if I go to church expecting the gospel to have and and of course, this is not exactly what you're saying, it's why you get to reply, but I'm gonna sharpen it like. If I go to church expecting to like not be any better in the parts that are wrong with me, like that doesn't, that doesn't sound like it doesn't maybe sound like the ministry of Jesus, but it also doesn't sound like an omnipotent God. It's like, oh, you've suffered from years of clinical depression and you'll be depressed for the rest of your life, but when you die, you'll go to heaven, right? So how what what is the, you know, and and we can everyone on everyone in this conversation can can can look into one direction or the other and see the dangers of the prosperity gospel. I'm gonna take that as as red for this conversation. That's a given. Um nevertheless, like we've got a lot of biblical um data that suggests that that it's not unreasonable for like a a simple reader of the New Testament to think the things that afflict me might get taken away by the power of the Holy Spirit. So how how how how did you how do you thread this needle? How did you thread this needle? What's your what's your response to some of those concerns?
SPEAKER_02Yeah, uh that is a totally legitimate concern. And again, you know, it's uh obviously so hard to condense just uh so many things into one book. Uh I mean, just literally the other day I was um leading a Bible study on um Mark chapter five with uh my family with the family medicine residents that I teach. And we were talking about, right, like how Jesus healing of this woman uh with bleeding disorder, right, is not just a matter of like stopping this problem, right, but but restores her. And uh medical missionaries can't get enough of talk about holistic healing, um, right? Uh almost uh too much of it sometimes. And so I think it when a when you when a church is teaching the Bible and worshiping God and you know, studying Christian history, all these other things, right, the entirety of life is going to be affected. It it's just not possible to study the Bible and then walk away from it and you know, hear the gospel and not have that transformation um in your life. I think from a from a mental health perspective in particular, right, like I don't I would never want a pastor to stand up in the pulpit and tell me about um the differences between Lipitor and Crestor for uh, you know, lowering your cholesterol, right? Um and in the same way, I wouldn't want a pastor to get into some of the nitty-gritty about like mental health. Um, but also I think that it's just a it's a huge burden to lay on a pastor to say you have to help your people, um, your congregation have better mental health, um, particularly right in a in a therapy culture world where some people's expectations of what it means to have their mental health improved um are wildly unrealistic. And so uh, you know, I I think even though uh, you know, I I do push the deflationary language uh because I want uh pastors to feel like they are focused on um the things that are most important, right? The things that only uh pastors can do. I I also think that people, you know, there's so much um that the scripture calls us to that, you know, I think l every church is gonna do some the every church is gonna do other things, right? Um and so I think they should feel free, like if their big thing is, you know, uh street corner evangelism in their town, or supporting missionaries in other countries, or opening a counseling ministry, you know, running running a mental health ministry, that they're free to do that. And also just recognizing that like the the gospel is good news for everyone. And so people who are suffering from mental illness, uh when they encounter um the the words of Christ and their being being in church gives them an opportunity for the Holy Spirit to work more deeply in their life, like that is going to be good. And it may be that the mental illness, you know, it it may improve their mental illness, it may make it go away, you know, right? Um, like Eve Tushnett says, um I I've if I I would believe that uh I would if if someone tells me if I met five people on the bus that told me that they got healed of cancer by prayer, um, I would be much more sanguine about um cancer for prayer. I meet five people on the bus every day who tell me that their addiction or their depression got healed by prayer. And so uh I'm very sanguine about prayer for uh for those problems.
SPEAKER_05Okay, let me let me do a quick follow-up and I want to hand it to James. Yeah, no, push you can feel like that. But I'm I'm team loftist, but you haven't convinced me. Uh this is what I mean. This is what I mean. You're absolutely right. And I think the analogy sh works in a very, in a strict sense, in a very good sense that no pastor should get up and pretend to be an MD and no pastor should get up, I mean, like in the pulpit and pretend, you know, dabble in pop psych speak because they're not a sci, they're not a they're not a licensed psychologist, psychiatrist, what have you. So let's grant that. I guess what I'm trying to to get at is not neither like like neither Peter nor Paul knew any of this stuff either, and yet they were vessels of the Holy Spirit's work. So it's it's I suppose one way of putting this is it might be easy for a cessationist, a non-charismatic, to read a book like this because it's just off the table. But if you're if you're not a cessationist, I mean the the the con the the the episode before you, Matthew, um, for the listener, listeners will already have access to it, is with Andrew talking about his book on joy. And he does address um things like depression and mental health. Um, but I'm I'm actually experiencing a little bit of cognitive dissonance here, theological incognitive dissonance, you know, because one is sort of like lift up your hands, lift up your voice to the Lord. The command of God is to rejoice in the Lord, to expect it to happen. And this is by a charismatic guy, you know, theologically charismatic. And then I've got the deflationary account over here, which is like, well, let the guys who have the degrees address the body and the other guys with the degrees address the mind, although PS, parentheses, you might not be able to trust them, do your own research. Um and then, but then like, and then it's like, well, what am I supposed to do with a Bible that from start to finish has signs and wonders? And a lot of Christians in the world, i.e., the supermajority, who think God does signs and wonders today. Is the mind cordoned off? Is the body cordoned off? That that's what I'm I'm trying to push you here to give me a give me a little bit more on this, and then I'll let Derek the cessationist jump in.
SPEAKER_02So yeah, I think um I I mean I'm I'm a sensationist at least three days a week. But I I think what you're saying is is absolutely correct that we expect you you when you have an encounter with the risen Christ, it will change your life. And every uh so there's two two sides here. One is um, you know, one message that therapy culture hates is fake it till you make it. Um and a lot of I think what's good about um going to church is that you, you know, when when you start off, you're just like, what, what is happening here? I'm maybe I'm you know, I'm I'm I'm singing these words, I'm praying these prayers, I don't feel it. Uh for I think especially for people who are experiencing, you know, profound mental illness, um, right, they're like, what what is it? Joy in the Lord? Like, how am I like I'm I'm trying, Lord, but it's it's not it's not happening for me today. Um and so by experiencing those things in a community and uh practicing them over and over, we do right, like that that softens us and opens avenues for the Holy Spirit to work a profound transformation. Um and and joy is one of those things. I think that you can fake it till you make it. Uh and then the other side is that um I do believe that in all right, so I'll use this uh analogy from from my own experience. Um you know, when I was really depressed, my one of the things my psychiatrist asked me was so if you really believe so you tell me that you believe in the grace of God, right? And that God loves you no matter what. If you really believe that, then how do you think that would affect your mood um and and your sense of yourself because you you also are saying that you know you feel worthless and guilty and all these other things. Um and that uh really annoyed me. Um we went back and forth. Uh, you know, some it it it psychiatry was you know, trying to treat smart people sometimes is really hard because mental illness is just constantly coming up with new intellectualized excuses um for feeling bad. But you know, that that really was such an important thing for me to hear. Um, and it had, you know, obviously like that was a very specific one-on-one conversation, right? But that was a truth that is at the heart of the gospel. And so when like those truths are are essential for everyone, but they are especially essential for people who are lost inside themselves, who, you know, have the demons telling them lies, who struggle to believe these promises. Um and so I think that there is um there is absolutely profound healing for um for mental illness within these truths of the gospel. Um, sometimes psychopharmacology um plays a role in in helping people to believe them. Uh, but like the truth is still the key thing um that you have to believe um to get better.
Psychological Prosperity Gospel
Derek RishmawySo I wanna, I wanna I want to come to Matthew's aid a little bit with less a question, more uh a jumble of thoughts. Uh one of the things that is helpful, I think, in this paradigm about resisting therapy culture and and and really just thinking about the way it shapes us. You know, everybody quotes Reef on on uh the rise of the triumph of the therapeutic. One of the things that therapeutic culture does is it reframes the be-all and end-all of human well-being and reduces it to psychological well-being defined in a certain way, right? And so if something's not producing psychological well-being it defined in a certain way, then it is failing, it is not working, it is not doing, it is not being enough. That's why I like the concept of the good enough uh church, you you know, kind of on analogy to the good enough parent, there's all the saying once you once you become a parent and you go on TikTok and you see all these, you see a lot of pop. I so I actually think there's a lot, a lot of good stuff in attachment theory overall, but you can you can freak yourself out that like, oh my gosh, there was that one time I was on my phone this one time and I wasn't, I didn't have shared attention enough and this or that, and you you're worried you're gonna massively screw up your kid. And then a bunch of the research is like, well, actually, if you're not doing like criminal levels of neglect, you love them, you you ask for forgiveness sometimes, you know, general levels of being okay enough as a parent, you're actually not going to radically change the outcomes. The one of the dangers that happens right now is you accept the therapeutic mindset, you think psychological well-being is the be-all and end-all of holistic wholeness. And then you go and you take that to church, and the church is not radically attuned to all of the ways that you expect it to be attuned to your mental health and well-being. And then you judge it in line of that. And I think that that that helpful reframe of realizing three or four things. One, the gospel is giving you something else. It is giving you it that has implications for your mental health. But if you objectively are not reconcile to God, that is an objective problem outside of the world in your head that like the gives you a gospel that actually reconciles you to God and then starts to have uh impact on your internal well-being in ways that are like sanctification. They're absolute and relative and growing and progressing, which is why I think Andrew, I think, would would agree. Like, I believe in, so I'm not I'm a soft cessationist in the sense of I think we've all seen, we've all heard of and seen miraculous healings. There are some people they get saved and they are like mentally better, right? There are some people who get saved and you hear about miracle healings. And there's some people in wheelchairs in your church, and there are some people in mental wheelchairs in your church. And I think about that that book we we had the interview with the guy, um A Quiet Mind to Live With.
SPEAKER_03Right.
Derek RishmawyIt just talks about faith with severe mental health. And if you get in your mindset the gospel doesn't work because your OCD didn't magically disappear, or the gospel doesn't work because you still have to take meds for your bipolar disorder, or the guy, then we've taken that frame, made it the be all and end all, and judged everything in light of it in ways that help you, that that harm you seeing the goods that are in front of your face that are there, that if you accepted, would actually have knock-on positive effects. So it like almost prevents you from seeing the help that is there because you're judging it by a standard that um you're not meant to, and is actually ironically acting like a prophylac to prevent you from from benefiting from uh the ministry of the word. And and you know, it it it's like a mental health prosperity gospel in its own way.
SPEAKER_05Psychological prosperity gospel, yeah. Derek, that that's so good, man. Preach.
Derek RishmawyYeah. So that that that's pulling it all together, that is one of the things that I think is the overall benefit of that concept of the good enough church. It's not that like we deal with souls. We absolutely deal with souls, right? And I just as a side note, this is you had an article way back in the about this and talking about this is sometimes part of what we're dealing with is competing overlapping priesthoods of of of offering objective like gospels in certain ways. Like there's there's absolutely psychologists and therapists who uh like a nice hand-in-hand ministry for souls. Like I mean, my sister's a Christian therapist. That's how she's not trying to replace the church, any of those sorts of things. But then there's other there's other frames that are a little bit more like you, you keep over there, like we deal with minds, you deal with it. So I do overall, I think the the concepts are helpful in resisting that psychological um prosperity gospel, resisting the the the kind of absolutization of the priesthood of the therapist, and and and missing on some of that. So that was my that was my rant. That was my that was my defense of Matthew. Um James, I think.
SPEAKER_01Yeah, my defense of Matthew also, um, but also to defend maybe Brad's or Doinder.
SPEAKER_03Yeah.
SPEAKER_01So it's not just uh Brad argues with Brad argues with friends today instead of Derek. It's usually Derek argues with friends, but today it's been Brad, because he's all happy clappy, you know. Um and uh but um a couple points. One one quick point is another article that I I think is very similar to the argument you make in this book that when I was a campus ministry team leader in a ministry similar to Derek's, but not the same, um, was I would take our staff through uh David Pallison's article years ago, The Therapeutic Gospel, because he saw he foresaw these things, I think, pretty early and how it twists the gospel. And it's it's excellent. It's a night, it's free. I think it's on nine marks, very, very short and and and very helps us beware of the ways that we're twisting. But though um to to to uh thread the third-way needle here, uh, I thought another section of the book that very similar, it it anticipates the arguments you make at the end, but early on, it's on page 70, bottom of page 76 up to top of 77, where you you're basically arguing, look, churches can be very helpful in what you call the the rest of the work, uh things that are outside of all the medical, whatever. He said you say people with mental illness need the same thing every other person needs, usually in greater proportions, fellowship with others, prayer, daily and weekly rituals to help them take hold of joy, listening ear, a practical help with everything from hospitals, running errands. And I just thought that's kind of what you're getting at. And the way I read your conclusion is is the the the kind of medicinal nature of meat and potatoes Christianity. And that's one of the things that Christian, the church can really offer. It's not denigrating the other things, but saying, like, hey, just normal Christian life, normal church life is actually far more helpful than people realize. And it won't necessarily, it's not a prosperity gospel, but I think it's fix you, but it could it could do a lot of good. Do a lot of good. Normal diet, yes. Thank you for your book. I thought it was great, and I highly recommend it too. Yeah, truly. It's wonderful, guys.
Derek RishmawyI really appreciate it. Matthew, thanks for coming on. Thanks for staying up late in Kenya for us uh to to record this episode. There was this man endured suffering for the sake of you listeners to be able to hear what he had to say.
SPEAKER_01Um, but the other thing we didn't even get to talk about is how suffering talks about suffering. Oh good.
Derek RishmawyYeah, for real. That's that's another that's another time. But um, but for now, uh go pick up the book. All we're all good. Books are sold, so on and so forth. If you found this conversation beneficial, uh rate and review us on iTunes, on Spotify. Also, shout out to we're recording this today. Go poke around on the Mere Orthodoxy website. I'm sure there's like an ad that they're gonna splice in for this new resource called The Faith Received. Uh, that that it's a library, treasure trove of Christian resources. A little shout out ad for that. It's it's really remarkable. But for now, this has been another episode of Mere Fidelity.