Friday, November 18, 2022

Part I

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1 Out of 8 Americans Have Been Given Prescriptions for Antidepressants — Are We Really at the Point Where the Modern Age Just Equals Depression?

We’re going to get to questions in just a moment. I want to start out by raising an issue and then a related issue. I don’t think you’re going to see the related issue coming.

The first issue has to do with the rise in the use of antidepressants in the United States. There’s a stunning report out indicating that one out of eight Americans either has or has had a prescription for some form of pharmaceutical antidepressant. Now, that’s depressing, and I mean that with full force.

It’s depressing because it tells us that what is now defined, perhaps even medically and clinically as depression is becoming something so widespread, and the use of antidepressants have become so widespread that something like one out of eight people in the United States right now, and we’re talking here primarily about adults, either have or have had a prescription for an antidepressant, but actually some of the most interesting research coming out, tells us something else, and that is, that no one actually knows how they work anyway.

Now, when it comes to medication, you would often think that causality would have to be the defining issue. That would work this way, the maker of some kind of pharmaceutical, some kind of drug or product would have to prove, not only that it works, but that it works like this. But actually, when it comes to a great many pharmaceuticals, a great many of the prescriptions that are written, no one, including the companies who make the drugs, knows exactly how they work.

Now, sometimes they do, with drugs such as statins or something as simple as aspirin. But on the other hand, even when it comes to statins and aspirin, the makers and the users don’t know exactly how they work. In every case, they just know that they do work and have proved to work, therefore, they’re considered acceptable and to use one of the words in the industry, efficacious or effective.

In other words, the test for most pharmaceuticals is correlation, not causation. If you know the difference between the two of those, causation means you have to know how it works, with correlation, all you have to know is that in X number of cases, it does work, even if you don’t know how it works. This is where I was surprised in recent days to know that when it comes to antidepressants, the most commonly prescribed to these antidepressants, it turns out that it’s being publicly acknowledged. No one knows exactly how they work.

The article by Dana G. Smith in The New York Times in recent days is the special science section of that newspaper by the way, it starts out this way, “Over the course of the COVID-19 pandemic rates of depression and anxiety soared, and many Americans turned to antidepressant medication to help them cope. Even before the emergence of COVID, one in eight American adults was taking an antidepressant drug. According to one estimate, that number rose by 18.6% during 2020. Zoloft,” one of those drugs “is now the 12th most commonly prescribed medication in the United States.”

We’re going to come back to that in just a moment. It’s the next paragraph that’s particularly interesting, “Given this, you might assume that the question of how and how well these drugs work has been clearly answered. And yet recent papers have challenged their efficacy and actions in the brain. For psychiatrists,” we are told, “this debate is nothing new.” The first medical authority cited in the article, Dr. David Hellerstein, a professor of clinical psychiatry, the Columbia University Irving Medical Center, said the question is, do antidepressants work? He says, “I think they do. The best clinical trials in meta-analyses, most of them indicate that there’s some medication effect. I would say that it’s less than we would like it to be.”

Later in the article, there’s something else that’s really interesting and that is, that even as so many who are prescribing these drugs, don’t know how they work or if they even in terms of a chemical or medical response do work, they say that combined with a placebo effect, the medications evidently do work because people taking them, at least a significant number of the people taking them, say that the drugs do help them or that taking the drugs helps them.

One of the doctors pointed out that even the action of taking the drug, well, it might indicate a sense of self-satisfaction that one is doing something to deal with one’s depression or anxiety. But all of that just points out how much every one of us is a mind game in operation.

Now, I’m going to leave the antidepressant medications as an issue. I’m not a medical authority. I don’t pose as one. I want to look at it in moral and worldview terms. I want to look at the number even before COVID-19 of one out of every eight Americans being prescribed an antidepressant. Is this who we have become as a people?

Now, one of the questions to be raised here has been raised even by secular authority, such as the late Philip Rieff. In his book, the Triumph of the Therapeutic, he asked the question, “Are we really at the point where the modern age just equals mental illness? Is this where we are?” Now, from a Christian theological perspective, we also have the reality, that human beings experience what can be described and perhaps even diagnosed as depression. Perhaps it’s episodic, perhaps it’s momentary, perhaps it’s lasting.

Even in the scriptures, there appear to be references to something like depression. And of course, we know that there have been massively important figures in world history who have been deeply affected by long bouts with depression. They would include President Abraham Lincoln and British Prime Minister Winston Churchill. Both of them suffered from very long struggles against depression.

In his own way, the same is true of Charles Spurgeon, the great evangelical preacher, the 19th century in London. And so as we look at this, we recognize that something like what would be defined as depression appears to be quite authentic and more common than we might want to think in the human condition.

Philip Rieff was raising the issue as to whether or not the modern age simply brings new complications that actually cause far greater rates of what might be defined or diagnosed as depression. There would actually seem to be very good evidence of something like that is true, and then you ask the question, “Well, what is it? Is it in the industrial revolution? Is it the alienation of the worker from the product of the work? Is it economic stress? Is it moral choice? Is it mass migrations and moving? Is it the transient of modern society? Is it higher education? Is it unbridled moral choice? Is it the fact that the self has become in the modern age a personal project?” Well, the answer is in biblical and theological terms that all of those things probably do make a contribution to modern anxiety.

But here’s where Christians also need to understand, that even as we don’t deny there can be a medical reality here. We do understand that there has to be a spiritual and theological component to this, at least in terms of our diagnosis and our understanding of a remedy. This is why we have seen the elaboration and the development of what is known as biblical counseling to make very clear, the biblical issues that are at stake.

But again, I am not speaking as anyone trained in the medical field. I’m not speaking as anyone with expertise in pharmacology or in psychiatry. I’m just speaking in biblical terms about the fact that this says something quite alarming about our society. It says something not good. Let’s just put it that way.

If one out of every eight American adults has a prescription for an antidepressant, something has gone horribly wrong. And as Christians, I think we have to say that whatever has gone that wrong, has to be at least largely explained in spiritual terms. That’s not to deny any kind of psychosomatic, any kind of physical reality, it’s just to say something has gone deeply wrong and it would seem to be the responsibility of Christians to try to know what that is and to put it right.

That is why by the way, Christians understand that depression can sometimes be an absolutely sane, rational, and reasonable response to something such as grief. And grief can be grounded in authentic loss. That is not some kind of depression that so much becomes a clinical concern. It’s just a reality that sometimes we are depressed because, well, to put it bluntly, there’s something to be depressed about.

But there’s also the reality that often we are a mystery to ourselves and we just don’t understand ourselves, even our current state of mind. And this is where our ultimate trust has to be in Christ. And our ultimate therapy has to be the preaching and teaching of the word of God and the application by the Holy Spirit of God’s revealed word to our hearts, our souls, our minds, our spirits, our emotions, our intuitions, our relationships, our feelings. So the big import of this news story is that the makers of these pharmaceutical products really don’t know how they work, but nonetheless, the therapeutic community believes that they work.

The bigger issue for me, is the number of American adults who are diagnosed with depression in the modern age and are clearly struggling with something.

Part II

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‘Puppies on Prozac and Cats on CBD’ : Evidently Our Pets Are Now as Anxious as We Are

But I told you just before turning to questions, there would be a second part of this and that you wouldn’t see it coming. I didn’t see it coming, and for that matter, I’m not sure the editors of The New York Times saw it coming, even though these two articles both appeared separately in the same science section, which is a weekly product of The New York Times this week. Both of them have to do with anxiety and depression. It’s the second one that’s truly shocking.

The headline in the article, by Melinda Wenner Moyer is this, “The cats taking Prozac, and the dogs on CBD.” The subhead, “Veterinarians say they’re seeing a higher number of pets having mental distress.” Ladies and gentlemen, our pets are now as anxious as we are.

Moyer’s story begins this way, “When my dog Ozzy feels stressed, he emits loud rambly groans that are ridiculously cute, but also make me wonder if he’s having a stroke. After noticing that his anxiety swells quite frequently, our trainer recommended that we give him CBD,” Remember, that’s a derivative of cannabis treats, “to soothe his nerves. Shortly thereafter, our veterinarian prescribed him the antidepressant trazodone, for when he’s especially stressed, including before vet appointments. Ozzy appears to be in good company. In the process of reporting this article, I learned that two of my editors have cats on Prozac.”

Now, I’m going to stop right here and tell you that I’m going to make a moral claim that I believe just has to be right, and that is that the writers and editors of The New York Times, and their pets might actually be a special class separate from most Americans.

If you just happen to have an accidental conversation in your office and find out that a good number of your colleagues, well, they have pets who are on anti-anxiety or anti-depression medications, well you might be having a conversation. It’s actually not so much a conversation about the pets.

Evidently, this is becoming a widespread phenomenon. We’re told that in a 2021 survey of exactly 409 dog owners, the researchers reported that just over half of the respondents, remember just over half, said they had given CBD products to their dogs most commonly to treat fear, stress and anxiety. We’re talking about your dog, dude.

Now, by the way, in this article, there is speculation that given the COVID-19 pandemic and the shutdown, it might be that the pets have greater anxiety now because they got used to having their owners around and now their owners go to work, at least part of the time. Or there is speculation that maybe the anxiety on the part of the pets isn’t because we’re gone, but because you’re home.

Now, once again, let me be clear, I am not a veterinarian. I am no expert on pet anxiety, and furthermore, even as in the Mohler house we once had Baxter the Wonder Beagle, he clearly at times did get upset. Highly correlated, I might point out with fireworks displays. Baxter would simply look to me and to my wife and members of our family as if to say, “Do you not know that the world is coming to an end? Do you not see the fire in the sky and hear those booms?”

By the way, you’ll be fascinated to know that these medical authorities about pets, tell us that if in a situation of anxiety, the pet has an inappropriate accident in the house, either one or two, we are told this is not an indication that the pet is angry, but only that the pet is distressed, but then again, I’m going to argue that maybe the two are related as if the pet is saying, “Look, if I’m distressed buddy, guess what? You’re about to be distressed.”

I’m simply going to end this and turn to questions by saying that, as we’re thinking about much of this, I think you’re probably thinking what I’m thinking. That is, “Wow, we really are talking a first world set of problems here.”

Part III

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Why Is It Okay to Euthanize Our Sickly Pet But Never Right to Euthanize People? — Dr. Mohler Responds to a Letter from Young Listener of The Briefing

But next we are going to turn to questions, and you know where you find intelligent Christians, and sometimes in this sense, the most intelligent Christians are among the youngest of us, asking questions.

Honestly, sometimes one sign of adulthood is that we outgrow the ability to admit we have questions and sometimes need to ask them. One of the traits of childhood that is endearing, is the fact that children actually ask the questions that are on their mind.

Related to our discussion about pets. A listener named Heath wrote in to ask, “How do I talk to my child about euthanizing a sickly pet in this case a dog, when we are very adamantly opposed to any euthanasia when it comes to humans?”

Well, that’s a good fatherly question. It’s actually a smart question from a child, and it points out to us by the way, that being made in the image of God means that children are moral creatures from the get go. They don’t just develop a moral capacity. Being made in God’s image, they are born a moral capacity. It develops over time, but here’s just another sign of the fact that the Imago Dei shows up even in the questions asked by a child.

But in this case, the Imago Dei is also the answer to the question. What differentiates a human from any other animal species? Any animal species, cat, dog, you just go down the list. What makes human beings unique is the fact that we are made in God’s image, and this is where the creation account in scripture and Genesis 1, Genesis 2 just makes that abundantly clear. Most importantly in Genesis 1.

And this is why maybe it’s helpful to talk to a child in these terms, “This is why we eat ham, we eat beef, we eat meat. We eat the meat of animals.” And even as most children have the most immediate proximity to an animal in a pet, the reality is, that looking into the big eyes of a sweet calf is also something that just reminds us that, that too is an animal made for God’s glory and God’s glory is evident in that animal, but that is an animal that is not made in God’s image.

The radical absolute distinction between God’s image bearers and the other creatures that God has created, that’s absolutely fundamental to the Christian worldview. And this is where also we need to go back to Genesis 1, dad, and in this case point out the human beings are given a dominion assignment over the animals, but not over each other in the same sense.

There are governing authorities, there’s a set of responsibilities inside the household, inside the church, inside the community, but still we are not given the same dominion authority over fellow image bearers that we are given over the rest of creation. About that distinction, we should be abundantly clear. In any event, I deeply appreciate the question.

Part IV

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If the Fall Had Not Happened, How Could the Earth Have Provided for Population That Would Grow Exponentially And Never Die? — Dr. Mohler Responds to Letters from Listeners of The Briefing

Doug wrote in asking, “Look, if the world’s population is just reached 8 billion people and death is due to the fall, well, physical death is due to the fall and there would’ve been no physical death, but for the fall, then what would the human population be growing exponentially on a finite earth since creation?” And he goes on to mention animals and other issues related to death.

Well, the big issue here, Doug, is understanding that the multiplication, the reproduction mandate that is given to human beings in Genesis Chapter 1, well, it’s given to us and it continues after the fall, but before the fall, there would’ve been an abundance because remember, the abode that God made for human beings was a Garden of Eden, that was super abundant in terms of its provision for humanity.

I’ll simply say, Doug, that I’m absolutely confident that had sin not happened, the multiplication would have taken place in such a way that without physical death, human beings to the glory of God live with maximum indeed infinite flourishing and all our needs are met. There is no scarcity at all. Everything is simply abundance.

But after the fall, it’s just important to understand once sin enters the picture, the structures of creation do not become less important. They become more important. I love the language of the old Book of Common Prayer which says that, for instance, “Marriage now becomes important not just for human flourishing, for the natural affection of the one for the other,” Speaking of the husband and the wife, “and even merely for reproduction and the continuation of the human species, but it also says that it is as a remedy for sin.”

Now, that wouldn’t have been necessary in the Garden of Eden. It is necessary outside the Garden of Eden. And it’s just a reminder to us that everything we know about the world right now, is the world on the other side of human beings being cast out of Eden, or simply to put it another way, had sin not happened and the entire habitation of planet Earth was one giant Garden of Eden, then regardless of how many millions or billions or for that matter beyond that, human beings would exist, there would be enough for everyone an abundance.

Part V

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Why Did Georgia’s Senate Election Go to a Run-Off When the Republican Governor Won So Decisively? — Dr. Mohler Responds to Letters from Listeners of The Briefing

But next we go to a listener from Tennessee asking about the election, the midterm elections in the State of Georgia right across the border. And he writes about the confusion reflected in the fact that the incumbent Republican governor, Governor Brian Kemp won by a significant margin, but the senatorial election was so close, it went into a runoff. Now, what explains that?

Well, I’ll just say for one thing, Joe, you’re looking at what is often described as an overvote or an undervote. An overvote is a measure or a candidate getting votes that the candidate might not deserve, and undervote means not getting votes that you might have deserved. And that can happen either way on a ticket sometimes just because of the context.

Now, in the State of Georgia, you would’ve thought that Republicans voting for the Republican gubernatorial candidate would’ve at the same time voted for the Republican senatorial candidate. After all, you’re talking about a common platform, but that’s not what happened. There was a significant undervote for Herschel Walker, the Republican senatorial candidate. That’s why there’s a runoff. And that runoff, by the way, is very, very important, even as Democrats will have a majority in the United States Senate, this 51st seat or 50th seat, depending upon which way it goes, is still a vital importance, and voters in Georgia better remember that.

But in this case, Joe, I’ll simply say that what you see here is the fact that politics is not just about positions, it’s not just about parties. It really is at times about person, about personalities. And so if you’re looking at the differential between the gubernatorial vote and the senatorial vote in the State of Georgia, well right across your border there, I’m going to suggest it’s a reminder, that person really matters and that personality really matters. And all that’s involved with the human being really matters, because had the vote been the same, we would not be having this conversation. There would be nothing to ask about, but it’s the differential that does cause the very question you raise. That’s how it comes up.

How could you have a Republican candidate on this part of the ballot do so much better than a candidate from the same party with a similar kind of media exposure on the same ballot?

Now, whether voters should have made that distinction, well, that’s a matter for debate and ongoing moral conversation, but the fact is the results indicate they did make that distinction. And that’s a very important insight for anyone who cares about politics to note.

Part VI

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Why Is It So Hard to Share the Gospel? Does Loving People Mean That We Respect Their Choices Even When Bad? — Dr. Mohler Responds to a Letter from a 14-Year-Old Listener of The Briefing

But next to question from a 14-year-old listener, and the first question asked by this listener is this, “Why is it so hard to tell other people about the gospel?”

Well, that’s a question that doesn’t just fall to 14 year old believers. It falls to all of us regardless of age. There is a sense of awkwardness and sometimes an outright sense of reluctance. I think the scripture defines it sometimes as a spirit of fear as we are called to share the gospel. And I think one of the reasons for this is that we can’t talk about the gospel without talking an extremely personal terms.

And so one of the things I realized as a fairly young minister of the gospel, is the fact that we are actually a bit hesitant to talk about any number of things unless we have a deep relationship with someone. And sometimes even with those with whom we have a pretty deep relationship.

There’s some political issues that I think most families have just never discussed, or you might say cousin to cousin, there hasn’t been much discussion. Among adult siblings sometimes, there just isn’t much discussion about some of these issues because it might hit pretty close to the bone. But as you’re thinking about the reluctance in sharing the gospel, I think the other issue is we simply are up against the reality that people don’t want to be confronted in many ways with their own sin and their own need for Christ. But this is where we simply have to remember that the gospel is identified as the gospel because the word means good news. It is good news.

Now, the good news comes with the bad news of the fact that we’re sinners, but that just makes the good news of the salvation, the atonement accomplished by the Lord Jesus Christ, such infinitely better news. And so, I simply want to answer this 14 year old listener by saying, I don’t think you’re ever going to get over a certain hesitation because there is always the threat of rejection, but then again, we just have to remember that the one being rejected is not the human being sharing the gospel, but ultimately Christ himself.

And so as we think about this, perhaps we just need to remember, it is out of love of God and love for those who do not yet know Christ, that we are called indeed commanded to share the gospel. And the most important thing is to share the gospel with the people with whom we have the opportunity to share the gospel, and sometimes that is precisely what makes it most difficult, but here is where I also just want to remind you of the sovereignty of God. There is no conversation. You will be called to have or given the opportunity to have, that our sovereign God does not want you to have.

The same young listener then asked the question, “What about the argument that we should respect both the sinner and the sin?” And I actually have heard this argument in another sense coming from people who say, “If you reject what I do, then you’re rejecting me.” Well, this is where we have to understand that the scripture just is really, really clear that we are to love people, but we are never to love sin. And that doesn’t begin with not loving their sin.

It begins with hating our sin. And so it’s not just that we hate their sin and fail to respect their sin, we don’t have respect for sin. We do have a fearful respect of sin’s power.

Part VII

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Why Did God Refer to Himself as ‘We’ in the Old Testament? — Dr. Mohler Responds to Letters from Listeners of The Briefing

Finally, a question I think I can answer pretty quickly.

Mark writes sin to ask about the fact that in the Old Testament in particular, you hear God refer to himself as we read the scripture by using the pronoun we, and then the question comes, “How are we to understand that?”

Well, very quickly, I think this is easily answered in a conservative way, faithful to the integrity, in the truthfulness of scripture by saying that what we observe in that reference to we, is most importantly what is known as the plural of majesty and by the way, that means throne language.

The language of majesty is often in the plural, and by the way, it still is for example, in the British royal structure. The British monarch still makes first person reference as we, as in the often cited statement attributed to Queen Victoria, we are not amused. The plural of majesty is thus most importantly throne language, and when that comes to God on his heavenly throne, that is most appropriate.

Great questions. We’ll get to more next week. Send your questions to mail@albertmohler.com.