Friday, March 8, 2019

Part I

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Why the push for confidential medical advice for adolescents is actually a bigger deal than the Wall Street Journal suggests

Yesterday, the Wall Street Journal ran an interesting article about the redefinition of medical practice when it comes to children, especially teenagers and adolescents. Brianna Abbott writes about the fact that, “adolescent health experts and doctors are stepping up efforts to increase teenagers’ access to confidential health care, and help them develop skills to navigate their own care.”

She continues, “Groups such as the American Academy of Family Physicians, the American Academy of Pediatrics, and others, have long pushed for adolescents to have individual time with their doctors, but these recommendations are unevenly practiced, pediatricians and adolescent medicine specialists say.”

Now Abbott’s article is just another alarm of sorts, telling us about the redefinition of medical ethics and medical care in our age. In particular, we are looking at the fact that so many moral issues are now packaged as health issues. That emerges in this article when we are told about one mother, who does allow her teenage daughters to have confidential time with a physician, but we are told, “She says she understands why some parents might be nervous, especially when it comes to topics like sexual health, or substance use.”

She said, “Parents like to think their kids listen to them, and would come to them if they need anything. I could easily see a parent being overprotective, and just wanting to be in control.” Now, there’s a lot to unpack in just a few words there, but for one thing, you saw the phrase, “sexual health”. Now, let’s just be honest. Sexual health in this case really refers to, or at least includes, sex. Now we might understand that there would be a different conversation if the doctor is talking to the teenager in private, that might happen if there is a parent in the room.

But before even looking at the redefinition of parental right, we need to look at the moral transformation that takes place with the redefinition of health, moral issues as health. For instance, just look at the category of sexual health in this article, or reproductive health as we see in other contexts. Reproductive health, being an intentional effort to try to remove the moral dimension of abortion … Sexual health in this case … attempting to do the very same thing when it comes to teenagers and sex.

We also have to look, as we’re thinking about moral transformation, with the fact that groups cited as authorities here, the American Academy of Family Physicians, in particular the American Academy of Pediatrics, these are groups that are hardly neutral in the moral revolution. The American Academy of Pediatrics appears to be falling all over itself to come to terms with celebrating every dimension of the LGBTQ revolution. And of course they are also involved in trying to redefine the appropriate relationships between a doctor and a minor; in many ways, intentionally trying to remove the parent from the entire context.

But that’s the issue that might get prime attention here, is the redefinition of parental rights and parental responsibilities. Removing a parent from the room in this kind of conversation, is not just a spatial … That is, time, place, and space … reality. It is also a big moral reality. It removes the parent from the equation.

Now, the article makes clear that in most states, parents have a right to the medical records of their children, right up to age 18. And furthermore, parental consent is also required, for even rather minimal medical treatments, or even drugs given to children and teenagers. So there appears to be something of an intellectual double-mindedness, a moral or politically correct double-mindedness on the part of much of the society.

Are these teenagers and adolescents to be treated as autonomous adults, or not? Well, of course, we’re looking at a larger society that is quite confused about how to answer that question. It wants to answer the question on way when it comes to even some issues in sex, but another way when it comes to other issues in sex.

When it comes to the transgender revolution, the cultural authorities are telling us, that even if parents do not accept, or find even faulty the medical advice given to an adolescent, or even a young child, concerning gender identity, then the parent is to be excised from the picture. Now let’s also be clear. There would be many doctors who would handle this kind of situation with great care, and would not take advantage, nor seek to further some kind of liberal moral argument.

But there are at least a couple of other big dimensions we need to note here. For one thing, medical practitioners and professionals, including doctors, are increasingly bound by professional expectations, standards of care, and professional guidelines, even when it comes to sexuality and gender identity issues. We’re also looking at the fact that many in politics and in the larger culture want to put in every school a so-called comprehensive sex education center, that would offer not only what might be considered to be rather traditional biological advice, but would also encourage the moral revolution, encourage LGBTQ identity and issues and encourage sexual relationships and development of sexual behaviors.

And here again, we come back to the issue of sex, reminding ourselves that even by the 1980s, this revolution in morality in the name of health had already taken the form of assurances that the basic distinction is between sex that might be dangerous, and so-called safe sex. The moral context was entirely removed. Safe sex was simple a matter of using some kind of physical protection, as if sex outside of God’s instituted norm, which is marriage between a man and a woman, could ever be in any sense safe.

One final observation on the story by Brianna Abbott. It is at the bottom of the page in yesterday’s print edition of the Wall Street Journal on page A11 in the Life and Arts section. This is not even really a news story. It’s in a newspaper, but it’s not a news story. Instead, it’s something of a feature story under the headline of Health and Wellness. But Christians, and Christian parents in particular, must recognize this really is a bigger story, than might appear as merely a feature article on page A11 of a newspaper.

The transformation of the relationship between parents and their own children, including teenage children, in the context even of the specific issue of a visit to the doctor, it’s no small thing.

Part II

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The therapy generation: What the trend of millennials seeking out therapeutic help communicates about a generation starving for meaningful community

But next, I want to turn to yet another article that appeared in the Wall Street Journal just a few days ago. It’s by Peggy Drexler. The headline: “Millennials are the Therapy Generation.” The subhead: “People in their 20s and 30s seek medical health help more often, as new habits and technologies change the nature of treatment.”

Drexler tells us about Christina, a 27-year-old publicist living in Manhattan, who has been in and out of therapy since she was nine, when her parents got divorced. Back then, she says, “I had a pretty pragmatic view of what was happening. And so did my parents. Going to therapy was just something you make kids of divorce do.” But then as the article continues, the young woman tells us that she had thought back then that the therapy was something that she would get through, it would be done, she would deal with her trauma, and it would be over.

But she says, “I eventually learned that’s not really how it works.” And then we are told, she’s had four or five different therapists since then. So have most of her friends. Then here’s the big statement, “The stigma traditionally attached to psychotherapy has largely dissolved in the new generation of patients seeking treatment, raised by parents who openly went to therapy themselves and who sent their children as well, today’s twenty- and thirty-somethings, turn to therapy sooner and with fewer reservations than young people did in previous eras.”

Again, the headline of the article is, “Millennials are the Therapy Generation.” Drexler gives us a great deal of detail about this, telling us that there has been a huge shift in the culture, and millennials are the leading edge. For millennials, we are told, going to therapy is just a part of the adult experience. And furthermore, the article’s pretty sad because we are told, “Many younger people pursue therapy as another form of self-improvement and personal growth, not unlike yoga, meditation, or preventative Botox.”

We are also told that mental health problems are becoming increasingly pervasive, or at least more pervasively diagnosed amongst millennials, but far beyond the diagnoses, there is very clearly in this article, and in the culture around us, affirmation of the fact that therapy is replacing something in the lives of millennials. We need to ask the question, what would be therapy be replacing? One argument would be, replacing what otherwise would be a function served by parents.

It’s no accident that this article begins with a child who first experienced therapy in the context of the breakup of her parent’s marriage. A huge cultural shift is also indicated in a paragraph like this, “Many of my clients joked that they and their coworkers often start conversations with, ‘My therapist thinks.'” That according to Elizabeth Cohen, a clinical psychologist in Manhattan. She said further, “The shame of needing help has been transformed into a pride in getting outside advice.”

But this is a particular kind of outside advice. It is therapeutic advice. The article by Drexler also tells us that another reason for the shift among millennials is the fact that so many celebrities very publicly depend upon therapy. Many of them speak openly of their own struggles. The huge shift here might be the fact that for many people, having a therapist is something of a badge of authenticity.

Looking further at the article, we come to discover that many of these millennials are seeking therapy for what really doesn’t amount to any kind of deep depression or psychological problem at all. One young woman quoted in the article said, “My life coaching and my therapy work really well together. It’s about forming habits and behaviors that lead to a fuller life.” Drexler tells us beyond, “Young people are struggling to find such balance.”

A 2018 study of 40,000 American, Canadian, and British college students, we’re told, published in the journal Psychological Bulletin, found that millennials are suffering from what was described as multidimensional perfectionism in many areas of their lives. “Setting unrealistically high expectations, and feeling hurt when they fall short.” This propensity, says Drexler, “Can motivate them to seek assistance when something goes wrong, but it also sometimes drives them to turn that assistance into dependence.”

Even later in the article, we are told that young couples are sometimes going to therapy together before, they not only get married, but even decide to cohabitate. But the Wall Street Journal article ends with this, “For many, such self-care doesn’t feel like a chore.” One young woman said, “I just enjoy therapy. I don’t enjoy getting blood drawn. I’d be looking for ways to stop having to do something like that, but I like my therapist. I have a good relationship with him. It’s not like I’m trying to figure out at what point can I stop doing this?”

Well, again, you don’t have to read between the lines there to understand that therapy is really replacing something else. What’s it replacing? I mentioned parents. It is also, in many ways, replacing friends. It is, from a Christian perspective, also reflecting the fact that many young millennials don’t have any older adult friends. They just don’t relationships so they have to go out and pay someone to be involved in this kind of conversation about their lives and meaning, organization and habits.

They also, we have to note, are often actually not very good conversationalists even with their own friends. A generation so dependent upon technology and addicted to social media is sometimes finding it very difficult to engage in conversation. Conversation appears to be awkward, but ultimately Christians must understand that the therapeutic worldview is more than anything else, explicitly a replacement, a stand in for a theological worldview.

That’s not an accident. Many of the first efforts in therapy in the late 19th and early 20th centuries, the very beginnings of psychotherapy and other therapeutic professions began in an explicit effort to try to ground human happiness and to fix human problems, to diagnose the most basic human issues in terms other than the theological terms that had been explicitly embraced by the Christian Church as taught in scripture.

It would be an exaggeration to say all of the founding fathers and mothers of psychotherapy were not Christian, but it’s not much of an exaggeration because as you look at the history of this entire worldview and the profession, the reality is that many of those who began the movement were explicitly identified as those who are unbelievers. To one degree or another, many of them had openly, if not energetically rejected the religion of their beginnings and they had embraced a fully secular worldview.

Therapy is the extension of that secular worldview into the attempted explanation of the self, of the human psyche, of the human problem and of some way of dealing with that problem. Back in the 1960s just as a therapeutic revolution was hitting warp speed, Philip Rieff, an interpreter of Sigmund Freud and a very skillful cultural observer, wrote a book entitled: The Triumph of the Therapeutic. The subhead of the article was: The uses of faith after Freud.

Now just notice the title: The Triumph of the Therapeutic and then the: uses of faith after Freud. Freud was such a revolution. Speaking of Sigmund Freud, he is also symbolic of a revolution that was larger than Freud. Rieff understood it. He understood the 20th century as the triumph of the therapeutic. In many modern western countries, the theological left behind the therapeutic put in its place.

The theological worldview begins with the existence and the authority of God. The therapeutic worldview begins with the existence and authority of the self. Again, by the 1960s, the psychotherapeutic worldview was so extensive that it became something of a motto that all persons honestly are either in therapy or in denial. Everyone was diagnosed as being sick and therapy was prescribed as the answer.

All issues were understood necessarily to revolve around the sovereign self as the ultimate unit of meaning, everyone therefore needs analysis and therapy. Rieff also understood that many people who think themselves not needing therapy they’re hardly immune from the therapeutic virus. Rieff, we should note, who was not a Christian in 2005 raised the question as to how many people who think that they are Christians are really holding to a therapeutic mentality and simply substituting some Christian categories.

Many bestselling Christian books amounted to nothing more than that, just the prevailing therapeutic worldview with some edited Bible verses put in, but the fundamental worldview was still that of humanistic psychology, not of biblical Christianity. Now, let’s be clear, there is an authentic discipline, medical profession known as psychiatry. There are legitimate psychiatric and psychological diagnoses.

I am not speaking as a medical doctor here, but as a theologian and cultural observer, it is really clear that in the larger culture therapy becomes the reflex. Humanistic forms of therapy become the norm, and once again we are back where we were in the 1960s, only in a worst situation than before. Now, we are either in therapy or in denial, but we’re also looking at a generation that has skipped denial and gone straight to therapy, but in so many cases therapy is now something of a badge of honor.

It’s not just a response to some kind of perceived brokenness, it’s now something of a rite of passage, only again, it’s a rite of passage that no one really intends even to outgrow. Fundamentally, we have to understand that Christianity, the Christian Gospel, is not a form of therapy. The millennials described in Peggy Drexler’s article are well understandable when we think about the culture that produced them, the culture that they have experienced.

A culture that overwhelmingly wants to communicate that if there is a problem in us, and everyone does really recognize there were some kind of problem in us, it is something that happened to us, it is something that can be alleviated by therapy, but you’ll also notice one of the most interesting aspects of Drexler’s article is how many millennials don’t expect for this really to resolve anything.

They intend to remain in therapy even if they don’t have any kind of deep distress, they want someone to talk to. That’s very sad. It’s actually a heartbreaking article when you consider how many of these millennials might not even seek this kind of therapy if they had a good relationship with their parents, especially when it comes to talking about basic fundamental issues, if they had deep friendships.

But this article also reminds me as a Christian of something that is one of the most important dimensions of the reality of being a part of a local church, a local gospel-believing, Bible-preaching Church. It’s a church. If it really is representing an authentic congregation, vibrant and Christian faith, it’s going to be made up of a multi-generational membership where you should find younger Christians, younger adult Christians, millennial Christians in very healthy relationships with older Christians, and I would simply ask the question, is that what you see in your church?

I’m afraid that in too many of our churches, churches that believed themselves to be very biblical and Gospel minded, the age groups simply hang around with one another. The millennials with millennials, older adults with older adults, children with children, teenagers with teenagers. There’s something fundamentally unhealthy about that. At least one thing intelligent Christians should consider is whether or not an article like this is a reminder to all of us in the Church of what we should be doing but might not be doing. That’s at the very least a question we know we ought to ask.

Part III

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The drug problem of American children: Why no pill can ever fully treat the deepest issues of the human heart

Now, staying in the Wall Street Journal. There was another article yesterday that falls on the same theme. Erica Komisar wrote an article with the headline: We’re Overmedicating Our Children. The second paragraph begins with the line: American children have a drug problem. But what’s the drug problem? It’s not in this case illicit drugs, but rather it’s drugs, psychiatric drugs to treat ADHD or malady such as depression and anxiety in children and in teens.

Komisar goes on to tell us what we already know really, and that is that the use of these drugs is both extensive and excessive. She writes, “A study published last year in the Journal of Clinical Child and adolescent psychology found that some 5% of American children were on stimulants like Ritalin and Adderall to treat ADHD and behavioral problems, and that was in 2016 that the study was based.”

“The Centers for Disease Control and Prevention,” she says, “Reported a nearly 400% increase and antidepressant use in patients between ages 12 and 19 just between the years 1988 and 2008.” 2008 shockingly enough, is the most recent year for which the data are available, but then shockingly enough, Komisar writes, “Yet many of these young people don’t actually have ADHD, clinical depression or anxiety.” She cites a 2000 study that found that, “The majority of children and adolescents who were being medicated for ADHD did not fully meet the diagnostic criteria for the condition.”

“Criteria,” she says, “That are so subjective,” that a 2018 study in the New England Journal of Medicine, “Showed that the younger a child is relative to his classmates, the likelier he is to be diagnosed with ADHD.” “That findings,” says Komisar, “Suggest the disruptive behavior is the result of immaturity, not illness.” When that study came out, I discussed it on The Briefing. Komisar’s latest article brings together a monumental amount of data demonstrating that the use of psychiatric drugs is excessive amongst American children and teenagers.

She points out, “Psychiatric drugs can often stop undesirable behaviors and silence the symptoms of emotional pain, but the use of drugs as a quick fix does not,” she says, “Help children become emotionally mature or resilient to stress. Instead, it teaches them to avoid painful or uncomfortable feelings. Medication,” she says, “Can also have significant side effects including addiction.” But this takes me back to Philip Rieff and the 1960s, his book: The Triumph of the Therapeutic because even then he pointed to the fact that increasingly Americans were looking for therapeutic salvation in some form of a pill.

Such efforts explicitly began to expand during the 1950s and the 1960s, but we’re now living in a time in which many Americans just assume that the answer to any problem, even immaturity or developmental issues, behavioral issues in their children or teenagers, they must be resolvable if not by therapy, then by a pill. Now again, I am not a medical doctor. I am not speaking about any specific psychiatric or medical situation.

I’m talking about as Erica Komisar is writing about, the overarching problem of overmedicating our children or believing that some kind of medication must be the answer to what really amounts to some of the normal traumas and developmental and behavioral issues of childhood and adolescence. Indeed, Komisar ends her article by saying, “This is not to say children should never be medicated. Psychiatric medication,” she writes. “Is an important tool in treating serious mental illness,” but she concludes, “It’s no substitute for attention, understanding and connection.”

Here, Christians would have to add, there’s something even more fundamental. It cannot be a replacement for love and understanding and patience and kindness and correction and discipline and instruction summarized in the Scripture as raising children in the nurture and admonition of the Lord, and furthermore, no medication, no pill, no therapy can provide what can only come by the gospel of Jesus Christ.

Most ultimately, we do not need mere healing. We do not need mere wholeness. The greatest need of our lives is not inner peace or even some kind of balance in our lives. What we need more than anything else is salvation. Now, that doesn’t imply that Christians do not sometimes struggle with some of these same issues, but it’s categorically different to understand that some may struggle with these issues and then on the other hand, to say that therapy is clearly the answer.

Looking at Erica Komisar’s article, it’s really important for us to recognize that it’s one thing, it’s bad enough for adults to be overmedicated and to look to the pill cabinet for some kind of deliverance, but there’s something even sadder, and even more ominous about the fact that we are now as a culture overmedicating our own children. Again, Komisar’s most graphic sentence begins her second paragraph when she tells us, “American children have a drug problem.” But this is where Christians have to understand if so, the culture has an even bigger problem.