We begin this review of Christ or Therapy? For Depression & Life’s Troubles 1 by Dr. E. S. Williams by saying that much of the book is well written and some of the material covered is excellent. We are in agreement with Williams that there has been a huge over-medicalization of mental problems, such as depression and anxiety, and that there are many available biblical means of dealing with such problems. Much of his book contains material with which we are in agreement. However, in contrast to its excellence, there are serious problems with Williams’ book. Prior to the publication of his former book, The Dark Side of Christian Counselling,2 Williams sent us a manuscript to examine and respond to, which we did. That manuscript was actually the forerunner of both The Dark Side of Christian Counselling and Christ or Therapy? The very same criticisms we have of his current book were problems with his original manuscript, which we pointed out to him at the time.
Our prime reason for writing this book review is to confront a false conclusion that many Christians have reached regarding mental disorders. Because mental disorders often have no biological markers to reveal their cause, these Christians, including Williams, conclude that both the cause and cure of such disorders must be spiritual. We once more discredit that view in this review.
One reviewer of Christ or Therapy? accurately sums up Williams’ position as follows: “His argument is that unless there is some objective evidence of brain disease that could account for the troublesome thoughts, feelings and behaviors, then we must assume that the root cause (and cure) is spiritual.” While some people, such as Mary Baker Eddy, avoid a dualism of “spirit versus matter” and reduce all things to the spiritual, Williams avoids a dualism when it comes to most mental disorders that lack “objective evidence of brain disease” and thus attributes such disorders to having spiritually caused roots and spiritual cures.
Williams is in denial of the psychiatric history of treating mental disorders that later turned out to be true bodily disorders which result in “troublesome thoughts, feelings and behaviors,” such as general paresis, caused by the spirochete of syphilis invading the brain, and pellagrous psychosis, caused by a dietary deficiency of nicotinic acid. And, apparently Williams is in denial about medical history where various physical diseases in their emerging state or actual existence have not been shown to have biological markers, but nonetheless result in mental, emotional, and behavioral symptoms. For Williams, no bodily markers for brain disorders in most cases means their “root cause (and cure) is spiritual.” While the brain is more than molecules in motion, Williams denies the fact that the brain is not less than molecules in motion when it comes to those many mental disorders that lack “objective evidence of brain disease.”
One additional reason for writing this review is that Christ or Therapy? is being offered and is “Strongly Recommended” by the Metropolitan Tabernacle in London. The Metropolitan Tabernacle is the bastion of conservatism in the UK and carries on the tradition of Charles Haddon Spurgeon. We demonstrate in this review that Christ or Therapy? is in serious error in a number of respects and does not deserve the “Strongly Recommended” stamp of approval by the Metropolitan Tabernacle.
Before beginning this section, we need to say that we have been long-time critics of the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, we are concerned about Williams’ criticisms of the DSM. A major and central teaching of Williams’ book relates to the DSM in his description of what he calls “The Psycho-Secular Model of Depression.” He says:
We are now in a position to identify two essential characteristics of the model of depression constructed by the DSM. First, the model is secular in approach, in that it ignores the spiritual dimension of life. There is no recognition that man has a living soul, and is created in the image of God. There is no acknowledgement of man’s sinful nature, or that sin has consequences (italics his, 25-26).
It is strange that Williams would make so much of the DSM model being secular. Isn’t every model in medicine secular and don’t all medical models ignore “the spiritual dimension of life”? And, yes all models in the field of medicine are guilty of Williams’ description of having “no recognition that man has a living soul, and is created in the image of God” and “no acknowledgement of man’s sinful nature, or that sin has consequences.” As a medical doctor Williams must know that.
Next Williams says:
Second, the model is psychological in orientation in that it is based on the wisdom of psychiatrists and counsellors steeped in the psychological theories that have come from the giants of psychotherapy, such as Freud, Adler, Maslow, Rogers and Ellis among others. As a secular, psychological model it describes depression as a mental disease that affects our feelings, thoughts and actions. Depressed people need to be treated with drugs and psychotherapy (italics his, 26).
Williams’ second characteristic of “the model of depression constructed by the DSM” is that it is “psychological in orientation” and “steeped in the psychological theories that have come from the giants of psychotherapy, such as Freud, Adler, Maslow, Rogers and Ellis among others.” Williams is in gross error here and is apparently unfamiliar with the origin and development of the DSM. The psychological theories and approaches of “Freud, Adler Maslow, Rogers and Ellis among others” are the antithesis of the current DSM.
The precursor to the current DSM is found in the work of Emil Kraepelin and NOT in the work of Freud et al. According to an encyclopedia, “Emil Kraepelin was a psychiatrist who attempted to create a synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of common patterns of symptoms, rather than by simple similarity of major symptoms in the manner of his predecessors.”3 In addition, Kraepelin’s “fundamental theories on the etiology and diagnosis of psychiatric disorders form the basis of all major diagnostic systems in use today, especially the American Psychiatric Association’s DSM-IV and the World Health Organization’s ICD system [International Statistical Classification of Diseases and Related Health Problems]” (bold added). 4
The authors of The Selling of DSM, a book critical of the DSM, say:
Freud’s dynamic theories of the substructures of mental disorders have been contrasted with Kraepelin’s approach, which is primarily descriptive…. Whereas Freud was primarily concerned with the etiological dynamics of mental disorders, Kraepelin throughout his career attempted to classify, categorize, and describe psychiatric disorders as discrete entities” (bold added).5
In discussing the contrast between the developers of the DSM and Freud, the authors say:
Their [the DSM developers] approach was a radical departure for American psychiatry, which had accepted as a first axiom that its task was to identify and treat causes, not symptoms. This oft-repeated homily led Freud and his followers to discount symptoms or to interpret them as symbolic clues to underlying psychological processes, which could be understood principally in terms of psychoanalytic theories (bold added).6
To put it simply, Freud and his followers were interested in underlying causes, whereas the developers of the DSM were interested in the signs and symptoms of mental disorders.
Common sense alone would discredit Williams’ accusation that “the psychological theories [that are involved in the DSM]…have come from the giants of psychotherapy, such as Freud, Adler, Maslow, Rogers and Ellis among others” (26). Freud and those psychotherapists who came after him are a mixed multitude of psychoanalytic, behavioristic, humanistic, and transpersonal theorists whose theoretical systems number up to 500 different approaches. How would the DSM assimilate these often-contradictory theories and techniques into the symptoms for the 297 disorders in the current DSM IV? Take depression, which is central to Williams’ book. There are nine symptoms listed with some caveats. The DSM material on depression is too long to list. However, we challenge Williams to read the nine symptoms with their cautions and relate each one from the list of mood, behavior, and belief symptoms to Freud and those who came after him. We repeat, we are critics of the DSM for more than the reasons listed in the book The Selling of DSM, but even that book, while critical, does not accuse the DSM of incorporating the psychoanalytic, behavioristic, humanistic, and transpersonal theories of various psychotheorists, as does Williams, and in fact teaches the opposite.
To compound his error, he says:
To distinguish between the two opposing views we use the term psycho-secular depression to describe the model constructed by the DSM, and terms used in the Bible, namely, downcast soul, deep despair or walking in darkness, to describe the biblical view (The Puritans used the term melancholia) (italics and parentheses his, 39).
Williams later says:
We have identified two views of depression that are fundamentally opposed to each other—the psycho-secular disease model of depression that has been constructed by the DSM, the bible of psychiatry, from its stance in secular humanism, and biblical view which is based on the wisdom of Scripture. According to the psycho-secular view, people with a label of depression are ill and in need of treatment (italics his, 58).
Reading the symptoms of depression and its elaborations in the DSM will demonstrate that there are NOT “two opposing views” of the DSM and the Bible anymore than that of any other symptom-oriented medical model and the Bible. The DSM, according to Williams is “psychological in orientation” (p. 26), when in fact it is primarily symptomatic in orientation. A major problem with the DSM is not its symptomatic descriptions, but rather the psychotropic prescriptions that follow it. The problem is not the DSM but rather its use to way over prescribe psychotropic medications to way too many people who do not need them.
We want to make it clear that we do not recommend that individuals get on or off psychotropic medications. We generally do not write about psychotropic medications, but we do say that such medications are grossly over prescribed and greatly over used. Through the collaboration of psychiatrists and pharmaceutical companies, psychotropic drugs have been unnecessarily foisted upon millions of naïve individuals. Mental disorder labels are often recklessly applied by doctors to people who are undeserving of them. Moreover, based upon recommendations from friends and pharmaceutical advertising, consumers request such psych meds from their doctors, and doctors who are on tight timelines too readily prescribe them. Admittedly, psychotropic medications are way over-prescribed and greatly overused, being prescribed for anyone with any sort of unpleasant feeling state for whatever reason.
Just as we have been longtime critics of the DSM, we have also been longtime critics of the American Psychiatric Association (APA). There are many skeletons in the psychiatric closet that would compete with Pandora’s Box and “all the evils that could trouble humanity.”7 With respect to the APA and the DSM, it seems that Williams misrepresented the facts apparently because of his desire to discredit the APA as well as the DSM to promote his spiritual versus psycho-secular either/or view of mankind. However, Williams is in gross error again in his following statements:
Note that in the eyes of the [American Psychiatric] Association, depression is an illness that affects our feelings, thinking and actions. It follows that people suffering from depression, a serious medical illness, cannot necessarily be held responsible for the way they feel, think or act (bold added, 21).
Many people stand to benefit from a diagnosis of clinical depression, for they are then considered to be sick and therefore not responsible for their behavior (bold added, 22).
In effect, the DSM is asserting that those who lie, steal, rape and murder are mentally ill, and therefore not entirely responsible for their actions (bold added, 25).
It [the DSM] seeks to persuade society that the people it labels with ‘clinical depression,’ ‘conduct disorder’ or ‘oppositional defiant disorder’ are suffering with a disorder, and therefore are not altogether responsible for their actions and are in need of help from a psychiatrist or therapist (bold added, 25).
We know a lot about the American Psychiatric Association (APA) and the DSM and can find nothing official in the annuals of the APA or in the DSM itself to support Williams’ accusations in the above quotes. In researching we desire to be accurate and often go to original sources—in this case the APA. We sent the above quotes to the APA, which publishes the DSM, and their official response follows: “In reference to the quotes you sent—none of them accurately represent the position of the American Psychiatric Association and the Diagnostic and Statistical Manual of Mental Disorders.”8
Just by reading Williams’ above accusations, we suspected that the APA and its published DSM would not state that a diagnosis of major depression would lead to a conclusion that people “cannot necessarily be held responsible for the way they feel, think or act,” are “not responsible for their behavior,” are “not entirely responsible for their actions,” and are “not altogether responsible for their actions.” Common sense alone should prevent one from making such accusations as Williams does,especially when no footnotes to the original sources of information are provided.
Spiritual, Psychological, or Biological?
In this particular section we see how Williams deals with the spiritual, the psychological, and the biological facets of depression and other mental disorders and how he relates these to two classes of people, i.e., believers and unbelievers. Because of the manner in which Williams writes, it is necessary to add up what he says explicitly with what he only infers to conclude what he apparently means. Underneath what Williams says are important unanswered questions which lead one to conclude that, except for a small group, all mental illnesses are actually spiritual issues rather than possible diseases. Williams’ small group with mental illnesses does not include individuals without biological markers, such as brain tumors, unless there are severe symptoms, such as hallucinations and hearing voices.
The sum and substance of Williams’ argument is as follows: Unless there is some proven biological brain disease that can account for the usual symptoms of depression and other mental disorders, the ROOT CAUSE (AND CURE) IS SPIRITUAL. The only exceptions would be for “a small group of people with the most severe symptoms of depression” and “some people [who] may also experience alarming symptoms such as hallucinations and delusions” (42). Even the “small group” of people who suffer mental illness appears to be a reluctant admission on his part, as it did not appear in his original manuscript. In addition, it is doubtful that Williams would ever attribute a mental illness to a combination of underlying mental (thinking), emotional (feeling), behavioral, and undetected biological processes, except for “severe symptoms…such as hallucinations and delusions” (42), which is another major shortcoming of his book.
A repeated and revealing belief of Williams is found in the following:
Here we should remind ourselves yet again of the difference between psycho-secular depression and the biblical view of a downcast soul. Psycho-secular depression is the brainchild of psychiatry. It denies the spiritual nature of man; it denies the reality and consequences of the Fall; it treats depression with psychotherapy and drugs. The biblical concept of a downcast soul, by contrast, accepts the spiritual nature of man. It recognizes the effect of the spiritual Fall, and the oppressive consequences of sin. The answer to a downcast soul is always found in the Word of God (bold added, 43-44).
This repeated belief of Williams, along with his other writings, clarify that for him there are two opposing views of depression: one is the psycho-secular model based on the DSM and the other is of “a downcast soul,” which is based on the Bible. Adding up all that Williams has written and wading through the morass of unanswered questions related to the spiritual, psychological, and biological, we conclude that the only mental illness, in contrast to a downcast soul, that a true believer will have, according to Williams, will be one in which there are biological markers to reveal its source or obvious severe symptoms (hallucinations and delusions). Otherwise Williams would say that true believers do not suffer mental illness, but rather will suffer as a downcast soul.
Three Broad Categories
We take issue with Williams’ understanding of depression. Williams says, “We are told that Christians suffer with depression just like everybody else. That is, faith in Christ does not affect our tendency to become depressed” (54). Here and in other places Williams claims that believers and unbelievers do not suffer alike when it comes to what is called depression. He also claims that faith in Christ does affect our tendency to become depressed.
Instead of believers suffering depression “like everybody else,” Williams gives “examples in Scripture of men and women who experienced deep despair, misery, sadness, despondency and a downcast soul” (43). Williams then mentions “three broad groups of people who suffered from these symptoms” (43). He then describes the “three broad groups” and says:
The first are those downcast because of adverse circumstances, such as those experienced by Job and Hannah. The second are those who walk in darkness or gloom as a result of living in a fallen world. The third are in deep despair because of their personal sin, such as King Saul and Cain (43).
These are all examples of how believers do NOT suffer depression “like everybody else.” We agree that these are examples of how SOME believers suffer depression unlike everybody else. And this is where our disagreement with Williams begins. The examples he uses have led him to conclude erroneously that ALL Christians respond to depression like his examples. Williams’ three broad categories have to do with spiritual issues, and within his broad categories many Christians may indeed suffer depression unlike others. However, because he rejects dualism for mental disorders, he ignores or denies the possibility of another reason for depression for Christians, which would be biological, but without objective evidence.
(To be continued.)
1 E.S. Williams. Christ or Therapy? For Depression & Life’s Troubles. London: The Wakeman Trust & Belmont House Publishing, 2010. Hereafter references will be indicated with page numbers in parentheses.
2 E.S. Williams. The Dark Side of Christian Counselling. London: The Wakeman Trust & Belmont House Publishing, 2009.
5 Stuart A. Kirk and Herb Kutchins. The Selling of DSM. New York: Aldine de Gruyter, 1992, p. 5.
6 Ibid., p. 77.
7 Webster’s Dictionary, p. 1401.
8 Email from Erin Connors, Communications Specialist, American Psychiatric Association, 4/28/2011.
(PsychoHeresy Awareness Letter, September-October 2011, Vol. 19, No. 5)