Friday, April 11, 2008

Barber on Biopsychiatry: Thoughts from Powlison

Charles Barber (lecturer in psychiatry at Yale) is the author of a new book entitled, Comfortably Numb: How Psychiatry Is Medicating a Nation, described as “an unprecedented account of the impact of psychiatric medications on American culture and on Americans themselves.”

The Winter 2008 issue of the Wilson Quarterly ran an excerpt of it, entitled, The Brain: A Mindless Obsession? It’s a fascinating look at the rise and now full embrace of biological or scientific psychiatry, and along with it, psychoactive drugs.

Here are the closing paragraphs, which summarize Barber’s argument:

If there’s any lesson to be gleaned from the recent history of psychiatry, it is, in the anthropologist Tanya Luhrmann’s words, “how complex mental illness is, how difficult to treat, and how, in the face of this complexity, people cling to coherent explanations like poor swimmers to a raft.”

We don’t know much, but we should know just enough to recognize how primitive and crude our understanding of psychiatric drugs is, and how limited our understanding of the biology of mental disorder. The unfortunate fact remains that the ills of this world have a tantalizing way of eluding simple explanation. Our only hope is to be resolute and careful, not faddish, in assessing new developments as they arise, and to adopt them judiciously within a tradition of a gradually but steadily growing arsenal in the fight against genuine human ­suffering.

David Powlison writes in with some thoughts on the column:

Charles Barber offers a thoughtful, high-end critique of one of our contemporary world's most potent obsessions. Biopsychiatric claims distract countless people (inside and outside the church) from getting first things first. Barber’s article contains some real keepers, of which I’ll mention and comment on two.

[1]. Even at the high end of medical science, an understanding of grave human troubles remains elusive. “If anything has been gleaned from the last two decades of work in the genetics of psychiatric disorders, it is that the origins of these maladies are terribly complex. No individual gene for a psychiatric disorder has been found, and none likely will ever be. Psychiatric disorders are almost certainly the product of an infinitely complex dialogue between genes and the environment.” And, saying the same thing in a different way, psychiatric troubles are "incredibly complicated and poorly understood . . . an intricate, infinite, dialectical dance between experience and biology."

This observation comports with a Christian understanding of human life. But I'd add three important facts.

First, the intricate motives of the human heart always play lead in what is actually a three-way dance. And the motives of hearts are unsearchable. Do they express aspirations of the remnant image of God and common grace? Do they express intricate, self-blinding assertions and falsities of the fallen human heart? Do they express the dynamics of renewed wisdom, as the redemptive image of Jesus progressively infiltrates who we are? Do they express one, or some, or all of the above? The dance and dialogue between nature and nurture, between social context and physical body – does not occur in a moral vacuum.

So the dance is more complicated than Barber sees – in fact, it is infinitely more complicated than the infinite complications which rightly humble him. The human dialectic actually has three partners, and this third one is the most complex and the most decisive. (This underlying moral reality is in fact why merely talking with people – the psychotherapies Barber mentions, which variously mimic and substitute for Christian wisdom and Christian ministry – help and work to the limited extent they do. This moral reality is also why Christian wisdom will produce the only truly constructive “psychotherapy.” As we learn to speak the truth in love, as our words become constructive, timely, and grace-giving, people will grow wise in Christ, and life will triumph over death.)

Second, the renewing and redirecting power of Jesus Christ – the Word made flesh, tempted in all ways as we are yet without sin – rewrites the dance and rescripts the dialogue. He initiates fundamental, qualitative changes in the human heart. He continually changes us, awakening us to love God and neighbor more clearly. He will finally complete what he has begun. Whether we live amid the happiest social and biological conditions, or amid the most “normal” mixed conditions, or amid the most grievous conditions, Christ makes a decisive difference.

Third, God himself is creating exactly this intricate, infinite dance and dialogue as the stage on which he reveals himself to us, in us, and through us. It is in the actual conditions of life – our complex physical embodiment, our complex social embedment, and our complex (and renewable) moral center – that he shows himself as the creator, sustainer, king, judge, and redeemer.

[2]. Barber writes: "The unfortunate fact remains that the ills of this world have a tantalizing way of eluding simple explanation. Our only hope is to be resolute and careful” as we acquire a growing arsenal of scientific, medical, and psychotherapeutic knowledge and skill “in the fight against genuine human suffering."

Barber is right on target in his description of the unfortunate fact: “The ills of the world have a tantalizing way of eluding” human efforts at explanation and solution. Of course, given his premises, what he sees as "our only hope" does not in fact include our only hope! And his vision fails to see the endemic sinfulness intertwining all through our suffering. Barber offers an argument for sanity in a culture of psychiatric hype; but there is a deeper fight than he can imagine, a deeper sanity than he can envision, and a deeper, more substantial hope.