Bad Therapy

Bad Therapy, Abigail Shrier (Penguin House, 2024)

There is always value in looking at something from a different perspective. For the last 4+ years I have studied counselling. Therefore, I am reasonably educated in therapeutic approaches, being trauma-informed and attachment-based, understanding the influence of one’s childhood, and ways to consider mental health challenges.

In addition, like anyone who has parented (or taught) children over the last 2 decades, I have observed the ever-rising rates of anxiety and depression, the ballooning well-being spaces in schools, the common usage of psychological terminology, the increased use of medication and therapy, and the plethora of diagnostic labels applied to more and more children.

In Bad Therapy, Shrier explores why. She first poses some key questions. 

[We believed that we] “would cultivate the happiest, most well-adjusted kids. Instead, with unprecedented help from mental health experts, we have raised the loneliest, most anxious, depressed, pessimistic, helpless, and fearful generation on record. Why?”

How did the first generation to raise kids without spanking produce the first generation to declare they never wanted kids of their own? How did kids raised so gently come to believe that they had experienced debilitating childhood trauma? How did kids who received far more psychotherapy than any previous generation plunge into a bottomless well of despair?” (xvii)

Shrier posits that this over-parented, over-counselled, over-pathologised generation of children and young adults would mostly be fine if allowed to experience failures and challenges, develop resilience and perseverance, and be expected to mature. (She acknowledges some children do need professional help). 

She proposes that some of the main issues are: 

• A model of parenting designed to produce happy children. 

“We adopted a therapeutic approach to parenting… Successful parenting became a function with a single coefficient: our kids’ happiness at any given instant. An ideal childhood meant no pain, no discomfort, no fights, no failure – and absolutely no hint of “trauma”.” (xvi)

• Schools that are over-involved in children’s mental health, often without the skills to do so (and often to manage classroom behaviour better) 

• The damage of smartphones 

“If mental health experts wanted to do what was best for adolescents, advising parents against giving young teens smartphones would be a no-brainer.” (24)

• Constantly asking children how they are feeling can lead to rumination and an inward, self-absorbed focus.

• A lack of values and overarching worldview. Everyone is looking in at themselves, rather than outwards, and what it means to be connected to a wider community. There is some interesting data about the mental health of those with liberal political views, and the high numbers of kids who get caught up with extremist views and in cults: 

“In so many liberal American families today… parents disavow their authority, give children endless choices, and constantly solicit kids’ opinions on major life decisions. But the hunger for authority and boundaries is profoundly connected to a child’s sense of self and well-being. It does not dissipate simply because parents fail to supply it.” (194)

It is a bit of a diatribe, but it also offers a well-argued alternative view to some current theory. Shrier clearly enunciates and explains some concerns that had already been floating through my mind. In her opinion, adults (as parents, educators, and mental health professionals) have misstepped - and in doing so, have created an over-psychoanalysed, over-diagnosed and over-medicated generation of young people, very few of whom are happy.

What is her solution?

She strongly encourages parents to back themselves, suggesting they know their children best and should stop handing authority to mental health professionals, school counsellors, parenting books and internet forums. 

“When you mute the expert advice, when you log off Slate Parenting, when you lay down the rules according to your values, and insist your kids abide by them – you will be surprised by just how much you like your kids.” (240)

“The purpose of childhood is to allow kids to take risks – things that involve all kinds of hurt – and to practice the skills they will need while they are still safely under their parents' roofs. Childhood exists to allow kids to hazard an unpredictable friend, lose a ball game, stand up to a bully, pick themselves up, offer another kid a hand. We want them to venture out and get their hearts broken, try and fail, and at last succeed – all while we're still in the next bedroom.” (241)

“Remove… the technology, the hovering, the monitoring, the constant doubt. The diagnosing of ordinary behaviours as pathological. The psychiatric medication you aren’t convinced your child needs. The expert evaluations. Banish from their lives everyone with the tendency to treat your children as disordered.” (250)

An interesting read for a timely concern.

Down, Not Out

Down, Not Out: Depression, anxiety, and the difference Jesus makes, Chris Cipollone (The Good Book Company, 2018) 

Lots of books about depression and anxiety are about understanding it, or helping those around us who are struggling, which are very helpful and needed. However, this offering by Chris Cipollone is much more for the person living with depression and anxiety. It’s gentle, loving and honest as he shares his own journey, and guides the reader through the gospel truth that God loves them and is with them through it all.

With 15 very short chapters, it’s very readable in small chunks, purposefully designed for the person who doesn’t have a long concentration span. Again and again, there were messages of hope and encouragement:

“I still live with depression. But life has seasons, and in God’s grace it is possible to press on. Your life has dignity because God gave it to you.” (p.13)

“We are beloved children of God, and this, more than any other truth, must impact how we navigate mental illness.” (p.15)

“You may live with mental illness for a while, or for the rest of your life. However, the extent to which this affects your daily life will fluctuate. When you are having a good day, praise God for this mercy. When you are having a bad day, know that God is still for you and not against you. His love never changes, and salvation is not dependent on our ability to function how we would like.” (p. 23)

While the chapters are short, they are not light. He addresses feelings (which do not change our reality in Christ), sin (how mental illness is the result of sin in the general sense but not necessarily specifically), and how Satan could be at work in this space (yet God is always more powerful). He encourages the pursuit of maturity rather than happiness, and warns us to be aware of idols that underlie our struggles. 

“It could be that your depression or anxiety reveal something about the ways in which you become dissatisfied with God. If so, your gospel identity tells you that you can bring your heart to him with honesty, and rest in the grace the he has shown you in Christ.” (p.73)

He openly addresses suicide: “It may not look impressive but the act of not succumbing to suicidal thoughts is in itself a reliance on God’s strength” (p.79)

He encourages seeking wise help, both Christian and secular, and utilising what is helpful and available in terms of medication and therapy. Our prayers can speak our pain and longing honestly to God - we can groan, mourn and wail, but we hold back from cursing God. We continue to be involved in our Christian communities, despite the challenges.

“However, we who wrestle with mental illness must also remember to be gracious to ourselves for we have a Lord who is wonderfully gracious with us. We may find that in our darkest moments worship simply looks like getting through each day that God has given us.” (p.66-67)

He finishes with the encouragement to carers and supporters to just keep patiently loving - when people are struggling and when they are not.

In the end - the framework to persevere is found in Jesus:

“Your identity is in Christ, and you’re loved by God, who you worship each and every day” (p.134)

If you are struggling with anxiety or depression (or someone close to you is), and you want to explore it through a compassionate and understanding Christian lens, this is an excellent choice.

Mental Health and Your Church

Mental Health and Your Church: A Handbook for Biblical Care, Helen Thorne & Dr Steve Midgley (The Good Book Company, 2023)

I had the privilege of attending a day conference recently where Steve Midgley spoke about mental health and the church. It was excellent - biblical, psychologically informed, thoughtful, and nuanced. So, I was pleased to get a copy of this new book he has written with Helen Thorne.

This book is for everyone in churches who wants to care for those with mental health challenges - yet sometimes feel unsure of how to do so and what role the church could have in this space. As they say, the aim is “not to turn you into mental health professionals, but to equip you with knowledge and wisdom, and to help grow that attitude of love and compassion towards those who struggle” (p.17).

The goal is to help everyone to see that caring for one another is what we are called to, especially for those who bear more burdens in life. While mental illness is hard, it is normality for many in our church, and “despite the hardships of those struggling and the complexity for those trying to care, one thing is certain: when the local church is acting as a local church can, the results for all involved can be a delight and not a burden.” (p.14)

The first section is about understanding mental illness. Firstly, diagnosis - and the qualifier that a mental health diagnosis is more a description than an explanation. And God speaks to these situations:

“What we want to resist is the idea that mental-health disorders place people into such a distinct category that Scripture no longer has a voice there.” (p.29)

They present a biblical understanding of humanity: where our hearts (from which come our thoughts, emotions, decisions, etc) are embodied in a physical frame, located in the world (the place we are, our circumstances, society, etc).

“An understanding of mental health and mental illness that seeks to do justice to the Bible’s understanding of people must make room for all these factors: our physical bodies, our cultural and personal circumstances and the activity of our hearts.” (p.39)

They discuss medication and talking therapies, providing sensible and balanced perspectives on each (both positive and negative) and how faith intersects with them:

“If we can redeem the wisdom found is psychology and learn to apply the grace of the gospel and the power of Scripture to one another’s lives, we will have a talking therapy that surpasses all other talking therapies. We will profit from the ultimate psychotherapy - God’s own gospel plan for the healing of our souls.” (p.64)

The second section explores what a church can do. In the end - it’s neither nothing nor everything, there are a range of options and opportunities which include just loving people well in their complexity. This section focuses on what is achievable for most churches:

• helping people feel welcomed by raising awareness - talk about mental health challenges in a way that shows it’s part of normal human experience. 
• helping people feel loved 
• helping people remember their identity - both in God (forgiven, secure and free) and as part of God’s people. “Understanding truth about God and themselves won’t erase mental illness, but it will provide a beacon of hope within it.” (p. 100) 
• helping people be refined to be more like Jesus 
• helping people persevere - including ways to practically resource 

Throughout, they also acknowledge the need to support carers and those who walk alongside those who struggle.

“The basic rule is to step toward those in need, but to do so with humility - asking them about their struggles and doing lots of listening rather than lots of advising.” (p. 131)

The final section explores through what this might look like in a church through extended examples. These consider someone struggling with depression, anxiety, addition, psychosis, and a carer.

In the end, Thorne and Midgley acknowledge that this book won’t make anyone an expert, “but we do hope it will encourage some of you who read it to turn toward those struggle when previously you might have moved away.” (187)

Highly recommended for all of us in churches - whether leaders or members - whether personally connected with mental health struggles or not. In the love of Christ and with his people, we can all walk this road better together.

I Have a Psychiatric Diagnosis

I Have a Psychiatric Diagnosis: What Does the Bible Say? Edward T. Welch (New Growth Press, 2022)

This very short book tries to address some very big topics, and overall does a pretty solid job of it. Welch is trying to bridge the divide between the reality of psychiatric diagnoses and what that means spiritually, so that we can understand:
- What God says, &
- How the bible speaks in ways that help you find wisdom, rest, and hope in Jesus, with a diagnosis

“Psychological categories help us see important human struggles. Spiritual categories include those struggles and help us see more. Spiritual indicates that God speaks in every detail of our lives, and we need him in every detail.”

He carefully balances the wisdom of learning from the world, medicine and health, with what we find in God’s word. 

“Careful observations, like those of the mental health sciences, help us to see important things; Scripture reveals what is most important. It opens our eyes to what is unseen and eternal.”

So, his approach is to:

• Listen to God and get help from his people. This including returning to the gospel and understanding that Jesus calls us to speak to him about our struggles, and to believe the gospel and how it practically impacts our lives with mental health struggles 
• Listen and learn from those who have experience. This includes medical specialists, those who understand and live with it, and exploring options such as medication. 

“These two approaches anchor the rhythm in what is ahead—listen to Scripture and God’s people, listen to those who have experience, listen to what God says. Back-and-forth. Listen, learn, ask for help. The cycle continues until you understand your struggles (or another’s struggles) better and have ways to help. What is important is that Scripture has the final words of hope.”

From this point, Welch explores four areas:

1. Anxiety and panic disorders. This is a helpful simple chapter, pointing to the wisdom of the world in recognising panic and anxiety and that all is not right, then turning us to God and how seeking him and the gospel speaks to our deepest anxieties and give us freedom to bring them to the Lord. 

“Faith simply acknowledges that you are desperate and needy, and only Jesus can give what you most deeply need. Your panic attacks have exposed the delusion that life is just fine—you can manage on your own—and it is good news when delusions are exposed. When we feel in control, we have no reason to turn to the Lord.”

2. Trauma. This is really a primer on trauma, helping the reader to understand its impacts and challenges. Turning to the gospel, we can see that God knows you and loves you, he has entered dark places to find you, he cleanses you from shame, and makes your future new. He encourages the person who has experienced trauma to find words to describe their experience, and speak them to God and to others. 

3. Depression. This chapter encouraged starting with listening to God and his people, and speaking our concerns, doubts, worries and melancholy to the Lord remembering that Christ is our faithful helper and friend. There is an encouragement to share your life with others, no matter how hard it feels.

4. Narcissism - this was a confusing chapter, for it was aimed at the person interacting with the narcissist, not the narcissist themselves. It does seek to find common ground for we are all sinful, we get to know their story, and assume they are normal human beings. But even this felt discordant with the rest of the book, and a little condescending.

“The narcissist has no problem, at least none that he or she feels. If there is any problem, it is you. Your disloyalty, your base ignorance and overt stupidity, your lessness. So you begin by finding words that help you understand someone else. You first go out and listen to what others are saying.”

The book abruptly ends after this chapter, with a list of further reading recommendations. I couldn’t figure out why more wasn’t included. The introduction mentions anorexia, obsessive-compulsive personality disorder, attention-deficit/hyperactivity disorder, substance abuse, bipolar disorder, schizophrenia. I was surprised that narcissism was included over some of the others, and would have appreciated a reason for choosing to address only those four. Each chapter finishes with questions, but they were so open ended as to almost be unhelpful, with each including: “What questions do you have?”. I’m not sure that helps anyone unless you provide a way for them to explore it further.

You can hear Welch’s care & compassion for people in his writing, but I felt this book fell a little short on what it was trying to offer.

I received a ecopy of this book in exchange for an honest review.

Burnout

Burnout: A Guide to Identifying Burnout and Pathways to Recovery, Gordon Parker, Gabriela Tavella and Kerrie Eyers (2021)

At times, burnout seems to be the buzzword. It’s used often, yet hard to define or quantify. Are you burnt out or burning out? Is it possibly depression? Or exhaustion? Or is there an underlying medical condition? This is a timely book for anyone impacted by burnout, whether personally, or for family and friends, employers or health professionals; with the aim to explain, advance awareness and enable ‘nuanced management recommendations’. It is peppered with personal stories that give meaning and expression to the research and concepts within.

Part 1: What is Burnout? 

They begin by considering the place of burnout in ancient literature (including possibly Moses and Elijah) and its more modern history. They interact with the generally accepted definition of burnout and it’s three factors: energy depletion or exhaustion, negative feeling or cynicism about one’s job, and reduced professional efficacy (this may be the definition you have heard, it’s the one I knew about).

Based on the authors’ research (referred to as the Sydney Studies), they expand the factors at play and propose that the main features include:

• exhaustion 
• loss of empathy or perhaps loss of joy 
• compromised work performance 
• impaired cognition 
• that it is different to depression, although there is overlap 
• that perfectionism heightens the risk (it’s identified as probably the key predisposing risk factor) 
• that it is a ‘diathesis stress’ condition meaning that some people are predisposed. 

This higher risk due to personality suggests that “escape from work or caregiving pressures may relieve some of the burnout symptoms, but failure to identify and modulate any personality contribution will not allow burnout to be so readily managed, while also increasing the risk of relapse”.

They consider other causes of burnout symptoms (what burnout is not: e.g. chronic fatigue syndrome, anxiety) with much time comparing the symptoms of depression. There is an extensive table comparing melancholic depression (that which arises from inside a person with no seeming trigger), non-melancholic (more responsive to a situation) and burnout. This could be very helpful for health professionals, as well as individuals seeking some clarification.

Part 2: Causes of Burnout

It seems universally acknowledged that a clear cause of burnout is work. But what work causes burnout? Certain professions are linked with high rates of burnout including doctors, nurses, police, lawyers, teachers, managers, and clergy. However, the high rate of burnout in caregivers is now also being more widely recognised.

Interestingly, there is a paradox relating burnout with how one views one’s job: “burnout rates appear lowest in those who work in simply a job, higher in those who view their work as a career and highest in those who whose work is at the level of a ‘calling’”. Let ministry workers have ears to hear.

Then attention is given to the predisposing factors that can increase the risk of burnout, the most prevailing being perfectionism. Others include: neuroticism, having an external (rather than internal) locus of control, a Type A personality, a low sense of self-efficacy and low EQ. They conclude that “the sad thing about burnout is that is more likely to afflict good people”.

Part 3: Overcoming Burnout and Rekindling the Flame

To resolve burnout, three approaches are helpful, with most benefit if all three are addressed:

• resolve work factors 
• learn and implement de-stressing techniques 
• identify and address personality contribution 

Following chapters focus on managers and improving workplace conditions and culture, workers and caregivers (e.g. when to speak up at work, and when to choose to leave), de-stressing techniques (e.g. mindfulness, meditation), and managing perfectionism (with a recommendation for the use of CBT).

They draw all the threads together at the end, with numerous suggestions about how to manage burnout, pointing out that “burnout resolves better with a self-management model” and therefore people can take control and manage it themselves perhaps with some assistance along the way.

Appendices

The appendices include:

• The Sydney Burnout measure - their proposed diagnostic tool to assess burnout which can be self applied. 
• A checklist of workplace triggers 
• A perfectionism scale 
• An extensive list of various resources (mainly apps and websites) 

All in all, this is a very helpful & relevant book, taking a concept that is widely talked about, but less widely comprehended or qualified, and provides a scaffolding for our understanding, assessment, and treatment of burnout.