Fear of Man

By Brianna Klassen

I. Definition: 

Fear of man is defined as an epidemic of the soul that can be characterized by peer-pressure, worry, and codependency. It is the act of placing others before God in one’s life.

II. Biblical perspective

Fear of man is expressed biblically as a “snare” in Proverbs 29:25. In the book When People Are Big and God Is Small, Edward Welch best describes fear of man as, “Fear in the biblical sense…includes being afraid of someone, but it extends to holding someone in awe, being controlled or mastered by people, worshipping other people, putting your trust in people, or needing people.” This problem is severe and must be combatted with the truth of God’s Word. All throughout Scripture we are commanded to fear God and not man. Scripture is sufficient and superior than any other form of help and comfort. It is the only means by which biblical change comes about.

We are given two clear examples of fear of man in the Bible. The most well-known case of this is one of Jesus’ beloved, Peter. After Christ had been taken and questioned, Peter repeatedly denies Christ three times. This was the fear of man inside Peter that caused him to fear others instead of his Savior. This trial later leads Peter to write to encourage others in 1 Peter 3:14, “…have no fear of them, nor be troubled, but in your hearts honor Christ the Lord as holy, always prepared to make a defense to anyone who asks you for a reason for the hope that is in you.” Another example of fear of man in God’s Word is the story of the Pharisee named Nicodemus. John 3:1-2, “Now there was a man of the Pharisees named Nicodemus, a ruler of the Jews. 2 This man came to Jesus by night and said to him, “Rabbi, we know that you are a teacher come from God, for no one can do these signs that you do unless God is with him.” Nicodemus was a powerful ruler that met Jesus under the cover of night in order to prevent anyone to know he was there. Nicodemus and Peter were both ruled by the fear of man and it manifested in both of their actions and thinking.

Secular perspective

 

  1. The term “fear of man” does not exist in the secular world and culture. Based upon the physical and emotional symptoms that fear of man can have on a person, the most commonly probable diagnosis would be a Borderline Personality Disorder, specifically the Avoidant Personality Disorder or Dependent Personality Disorder.
  2. The Cleveland Clinic characterizes the Avoidant Personality Disorder as being a condition included in the anxious personality disorder group. This group, they claim, includes disorders marked by feelings of nervousness and fear. People with avoidant personality disorder have poor self-esteem. They also have an intense fear of rejection and being negatively judged by others.

The Cleveland Clinic describes the Dependent personality disorder as the need to be cared for by others. This condition results in submissive and clingy behavior, a fear of separation, and difficulty making decisions without reassurance from others.

Diagnostic criteria for Avoidant Personality Disorder and Dependent Personality Disorder based on DSM-IV:

  1. avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
  2. is unwilling to get involved with people unless certain of being liked
  3. shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  4. is preoccupied with being criticized or rejected in social situations
  5. is inhibited in new interpersonal situations because of feelings of inadequacy
  6. views self as socially inept, personally unappealing, or inferior to others
  7. is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
  8. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  9. Has difficulty expressing disagreement with others because of fear of loss of support or approval.
  10. Has difficulty initiating projects or doing things on their own (because of a lack of self confidence in judgment or abilities rather than a lack of motivation or energy).
  11. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

 

Symptoms according to DSM-IV:

  1. Feelings of inadequacy
  2. Feelings of consistent anxiety
  3. Fear of rejection
  4. Easily hurt by criticism
  5. Lack of close friends
  6. Reluctance to become involved with people
  7. Avoidance of activities or occupations that involve contact with others
  8. Shyness in social situations out of fear of doing something wrong
  9. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
  10. Needs others to assume responsibility for most major areas of their life.

 

The Avoidant and Dependent Personality disorders, in the secular world, are sometimes characterized as “incurable” and those who are diagnosed with it are encouraged to pursue ways of keeping it maintained and manageable.

  • Therapies recommended to those with avoidant or dependent personality disorder:
  • Psychotherapy
  • Cognitive-Behavioral therapy
  • Desensitization
  • Medications recommended to those with avoidant or dependent personality disorder:

Sedative

Selective Serotonin Reuptake Inhibitor (SSRI)

Fluoxetine

  • Recommended specialists:
  1. Clinical psychologist
  2. Psychiatrist
  3. Primary care provider
  4. Emergency medicine doctor

III. History  

 The phrase “fear of man” is a term that was first mentioned in Proverbs 29:25, “The fear of man lays a snare, but whoever trusts in the Lord is safe.” This sin often goes unnoticed in most because it is a sin that all are tempted in. This issue hasn’t been widely covered and there are not many resources that are directed to this exact problem. The research on this history of this phrase is not very evident. One of the first books that has directly covered fear of man is Edward Welch’s book, When People Are Big and God Is Small: Overcoming Peer Pressure, Codependency, and the Fear of Man. This book provides a very clear and beneficial perspective on fear of man. It has been significantly helpful in laying out the theology behind this struggle and promoting growth and change.

IV. Evidence of the Problem

Fear of man is evident in everyone’s life in some way or another. The extent of this struggle will appear different in most. We all struggle with how we view ourselves in compared to others. We base our choices and decisions on whether or not others will think highly of us. Welch describes this perfectly as, “We are more concerned about looking stupid (a fear of people) than we are about acting sinfully (a fear of God).”  We become consumed with how others view us, and we forget how we look in front of the One who created us. The fear of man is captivating and controlling and will run our lives if we do not fight it. Galatians 1:10 declares, “For am I now seeking the approval of man, or of God? Or am I trying to please man? If I were still trying to please man, I would not be a servant of Christ.”

V. Etiology

Fear of man is integrated into every person because of our sinful nature. Everyone will struggle with fear of man at different times and in different ways, both spiritually and physically. This sin has definite consequences that can represent itself in both physical and spiritual symptoms. Spiritual causes of fear of man will come from an inner sinful attitude or thinking. Physical symptoms of fear of man will represent itself in the outward actions that flow from the heart.

Spiritual symptoms

  1. Discouragement
  2. Lack of peace
  3. Ungratefulness
  4. Anxiety
  5. Envy

 Physical symptoms

  • Unclear of shifting self-image
  • Impulsive behavior
  • Emotional mood swings
  • Ingenuine behavior
  • Fickle
  • Insomnia
  • Insecure
  • People-pleasing
  • Discontentment
  • Lack of self esteem

 

VI. Examining the Heart

  1. Heart themes
    1. Incorrect view of the sovereignty of God
    2. Incorrect view of self
    3. Fear of others
    4. Lack of understanding of Scripture
    5. Lack of love for others
  2. Idols of the heart
    1. Self-image
    2. Pride
    3. Others’ opinions
    4. Control
    5. Envy

VII. Biblical Solutions

 Counseling Agenda

Fear of man is the most common struggle that we all face. We ache to feel connected to others and to feel a sense of belonging. In order to feel that way we do everything we can to please those around us, even at the cost of ourselves and God. In order to face this inner battle of worship we must turn to God’s Word. Scripture will remain as the only way to be truly renewed and changed by the Holy Spirit. Therapies and medications can be helpful and can erase some of the physical symptoms of fear of man, but it will never get to the heart of a person, only Jesus Christ is capable. There is a reason and a purpose for the struggle of the fear of man. As Edward Welch states the truth that, “Jesus did not die to increase our self-esteem. Rather, Jesus died to bring glory to the Father by redeeming people from the curse of sin.”  In order to be changed and renewed from our desire to please man instead of our Creator, we must turn to Christ and Scripture.

 

Bibliography

 

  • Bloom, Jon. “Lay Aside the Fear of Man.” Desiring God, September 16, 2016. https://www.desiringgod.org/articles/lay-aside-the-fear-of-man
  • Mack, Wayne A., et al. Courage: Fighting Fear with Fear. P&R Publishing, 2014.
  • Welch, Edward T. When People Are Big and God Is Small: Overcoming Peer Pressure, Codependency, and the Fear of Man. P & R Pub., 1997.

 

 

Recommended Resources:

 

Books:

Adams, Jay E. What Do You Do When Fear Overcomes You? Nutley, NJ: Presbyterian & Reformed Pub., 1975.

 

Fitzpatrick, Elyse. Overcoming Fear, Worry and Anxiety: Becoming a Woman of Faith & Confidence. Vereeniging: Christian Art, 2002.

 

Fitzpatrick, Elyse. Idols of the Heart: Learning to Long for God Alone. Phillipsburg, NJ: P&R Publishing, 2016.

 

MacArthur, John F. David C Cook, 2012.

 

Mack, Wayne A., and Joshua Mack. The Fear Factor: What Satan Doesn’t Want You to Know. Tulsa, OK: Hensley Publishing, 2002.

 

Mack, Wayne A., Joshua Mack, and Jerry Bridges. Courage: Fighting Fear with Fear. Phillipsburg, NJ: P&R Publishing, 2014.

 

Mellinger, Jared. A Bright Tomorrow: How to Face the Future without Fear. Greensboro, NC: New Growth Press, 2018.

 

Smith, William Paul. Living in a Dangerous World: Moving from Fear to Faith. Greensboro, NC: New Growth Press, 2011.

 

Welch, Edward T. When People Are Big and God Is Small: Overcoming Peer Pressure, Codependency, and the Fear of Man. Phillipsburg, NJ: P & R Pub., 1997.

 

Welch, Edward T. Running Scared: Fear, Worry, and the God of Rest. Greensboro, NC: New Growth Press, 2007.

 

Welch, Edward T. When I Am Afraid: A Step-by-step Guide Away from Fear and Anxiety. Greensboro, NC: New Growth Press, 2010.

 

 

 

Articles

  • Bloom, Jon. “Lay Aside the Fear of Man.” Desiring God, September 16, 2016. https://www.desiringgod.org/articles/lay-aside-the-fear-of-man
  • Jones, Robert D. “Getting to the Heart of Your Worry.” The Journal of Biblical Counseling 17, no. 3 (1999): 21-24.
  • Andrew H. Selle, “The Bridge over Troubled Waters: Overcoming Crippling Fear by Faith and Love,” Journal of Biblical Counseling.

 

 

 

Recommended homework resources

 

Edward Welch recommends completing various homework assignments that can accurately assess where one lies spiritually.

 

Sample

(taken from Edward Welch’s book, When People Are Big and God Is Small: Overcoming Peer Pressure, Codependency, and the Fear of Man.)

 

Example 1:

 

  1. In your own words, what is fear of man?
  2. If the fear of others is as prevalent in our lives as the Bible suggests, make a list of the ways it is expressed in your life.
  3. Answer these questions to uncover a fear of man,
    • What thoughts or actions do you prefer to keep in the dark?
    • Have you noticed times when you cover up with lies, justifications, blaming, avoiding, or changing the subject?
    • Do you show favoritism?
  4. What are some word pictures that describe you?
  5. Try to interpret the descriptions of codependency and see the idols that lie behind them.

 

Another beneficial homework assignment to combat the fear of man with a godly fear would be as follows,

 

Example 2:

 

David’s psalms are not illustrations of the fear of man. His fear was within godly parameters. In his fear he consistently turned to his King. He is an illustration that ad experiences don’t have to provoke the sinful fear of people. But notice what David did. He was constantly reminding himself that he stood at the crossroads between faith in god and fear of people. He was always alert to his vulnerability to the fear of people. It is a slippery slope between normal fear and an idolatrous fear of man. To stay on track and to keep yourself accountable, meditate on the Psalms with faith and follow David’s example. Try to align your heart’s desire with Psalm 27

 

The Lord is my light and my salvation;
whom shall I fear?
The Lord is the stronghold of my life;
of whom shall I be afraid?

When evildoers assail me
to eat up my flesh,
my adversaries and foes,
it is they who stumble and fall.

Though an army encamp against me,
my heart shall not fear;
though war arise against me,
yet I will be confident.

One thing have I asked of the Lord,
that will I seek after:
that I may dwell in the house of the Lord
all the days of my life,
to gaze upon the beauty of the Lord
and to inquire in his temple.

 

 

Example 3:

 

A simple but effective homework assignment is writing down these verses on notecards and placing them in areas that you see often, (ex. mirror, car, etc.)

 

  1. 2 Timothy 1:7, “For God gave us a spirit not of fear but of power and love and self-control.”
  2. Galatians 1:10, “For am I now seeking the approval of man, or of God? Or am I trying to please man? If I were still trying to please man, I would not be a servant of Christ.”
  3. Isaiah 51:12, “I, I am he who comforts you; who are you that you are afraid of man who dies, of the son of man who is made like grass”

 

 

 

 

Other useful resources for homework

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Anorexia

By Hannah Walsh

I. Definition:

Eating Disorder: the habitual misuse of food, characterized by severe disturbances in eating behaviors and related thoughts and emotions. Anorexia Nervosa: an eating disorder characterized by extreme weight loss.

Biblical Perspective

A person ought to bring glory to God in all that they do, including eating and drinking (1 Corinthians 10:31). Eating disorders are a misuse of God’s gift of food, and are contrary to God’s design for human beings. God created food to be enjoyable and nourishing. Unfortunately, sin affects the proper use and enjoyment of food. A person may misuse food by overeating, undereating, or having the wrong attitude about food. This is a result of being controlled or enslaved by wrong desires (1 Corinthians 6:12-13). Indwelling heart idols such as control, pride, or vanity may lead an individual to develop an eating disorder. Actions are sinful when one does them primarily to satisfy one’s own desires instead of to please God.[1] 1 Corinthians 6:19-20 says that one ought to honor God with one’s body. A person’s body does not belong to themselves, but to God (Romans 14:7–8). It is clear that someone with an eating disorder is not glorifying the Lord in the way that they are treating their body and the provisions that He has provided, nor with the desires that initially brought on the eating disorder.

Secular Perspective:

The National Eating Disorders Association states that there is a growing consensus that eating disorders are caused by a range of biological, psychological, and sociocultural factors.[2] More than merely a lifestyle choice, eating disorders are considered serious and often fatal illnesses.[3] Someone with an eating disorder is often described as having an abnormal eating pattern, stemming from mental or emotional issues. Signs of eating disorders may include an unhealthy obsession with food, body weight, and shape. The three general types of eating disorders are known as anorexia, bulimia, and binge-eating. [4] It is commonly accepted that eating disorders most often stem from incorrect thinking, and in particular an incorrect view of self.

Generally, people suffering from anorexia nervosa obsessively restrict calories and foods. Dorland’s Medical Dictionary for Health Consumers states that, most commonly occurring in young females, anorexia is characterized by a refusal to maintain normal body weight, a fear of gaining weight or becoming obese, a disturbance of body image, an unwarranted reliance on body weight or shape for self-evaluation, and amenorrhea.[5]

Secular treatments for eating disorders include nutritional rehabilitation, individual psychotherapy, reinforcement and cognition, inpatient and residential, group therapy, and family interventions, and medication.[6]

II. History

In the 19th century, a French psychiatrist named Charles Lasegue studied anorexia from a social and psychological standpoint.[7] In time physicians agreed that eating disorders were medical conditions and physical diseases, and later it was come to be accepted that they were not merely physical, but emotional and mental matters. In 1980, The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) added an eating disorders section for the first time.[8] Since that time, eating disorders have come to be considered serious issues stemming from mental illnesses.[9]

III. Etiology

Eating disorders are both spiritual and physical matters. It is important to understand both the spiritual and physical aspects.

Physical evidences of eating disorders depends upon the particular disorder. A person with anorexia nervosa will exhibit certain distinguishable behaviors The DSM-IV outlines four major criteria for diagnosis of anorexia nervosa, which include a refusal to maintain body weight at or above a minimally normal weight for their age and height , an experience of intense fear of gaining weight or becoming obese even though they are underweight, a misunderstanding of the seriousness of their weight loss provide and a demonstration of disturbances in the way their body weight and shape is experienced.[10] Obvious symptoms may include abnormal blood count, fatigue,  dizziness/fainting, anxiety and depression, insomnia, thinning hair, discoloration of skin, osteoporosis, or low blood pressure. A person with an eating disorders may isolate themselves from others or exhibit compulsive behavior.[11]

The spiritual side of the matter is of even more importance, as it is of eternal importance. Even secular psychologies state that eating disorders are not merely physical. The disorders stem from internal desires, and result in further spiritual issues. A person may, for example, desire to be in control of every aspect of their life, or desire to be beautiful or perfect. These desires, when desired above God, lead to sinful behavior. The eating disorder may lead to further sinful responses or attitudes, such as anger, depression, or anxiety.

IV. Examining the Heart

It is important that a believer thinks about the issues of eating disorders through the lens of Scripture. There are two emergency situations involved in eating disorders – the first is the physical life-threatening emergency, and the second is the spiritual eternal-soul threatening emergency.[12]  Both must be dealt with in the proper way. The goal in counseling an individual who is dealing from an eating disorder is not merely to help restore them to a place where they are physically healthy and out of danger, but ultimately that the individual would experience true biblical change that can only come from the truth of God’s Word and the work of the Spirit impacting their heart and mind. Ultimately, as in all matters, the goal is that Jesus Christ would be glorified.

A counselee should be led towards a better understanding of who God is and why He made man. This will lead into a better understanding of how one ought to live in response, and how that affects even the way that one eats.

Once determined, the heart issues need to be addresses. Common heart themes in regards to eating disorders are control and vanity.

Control: A person who idolizes control is not trusting in God’s sovereignty. There desire is, essentially, to try to be God instead of trusting and living in submission to God. This idol can lead to eating disorders, such as anorexia, because the person desires to control every calorie they intake or every pound they weigh to the point where is becomes unhealthy and obsessive. They may pride themselves in having control over their feelings of hunger. The desire to be in control can lead to obsessive behavior in regards to food.

Vanity: Vanity is another common root of eating disorders. Many secular counselors will tell their counselees that they need to think more highly of themselves, that there self-esteem is too low. This is not the case. On the contrary, a person is thinking too highly of themselves when they so strongly desire to look a certain way that they are willing to hurt themselves to get there.

V. Biblical Solutions

When it comes to eating disorders, many biblical counselors use what is sometimes called the Three-Pronged Approach to care for their counselee in the best possible way.[13] This refers to the team approach that should be taken, as eating disorders are both a physical emergency as well as a heart issue. The three-prongs are: Medical doctor, Nutritionist, and Biblical Counselor. A biblical counselor needs to care for the counselee’s soul and mind, while encouraging her to be heeding the instructions of her doctor and nutritionist. Eating disorders are unique counseling issues as the spiritual and the physical aspects of eating disorders correlate. As in any counseling issue, the goal is that a counselee would move towards Christlikeness. The purpose is promoting genuine, lasting change in the life of a counselee, for the glory of God. Ephesians 4 demonstrates that sin needs to be put off, and righteousness needs to be put on. In some cases, the sin of control or vanity needs to be put off, and trust in God and humility need to be put on. Sinful behaviors and actions, such as the misuse of food, need to be put off, and godly behaviors need to replace them. This can only be done through a work of the Holy Spirit in one’s heart. A counselee needs to be led to heart-altering truth of God’s Word in order to experience change.

 

Recommended Sources:

“How to Help People Change” by Jay Adams

“Love to Eat, Hate to Eat” by Elyse Fitzpatrick

“Redeemed From the Pit: Biblical Repentance And Restoration From The Bondage of Eating Disorders” by Marie Notcheva

“Counseling as if Life Depended on It” by Martha Peace (audio)

“Eating Disorders: Hope for Hungering Souls” by Mark Shaw

“Eating Disorders: The Quest for Thinness” by Ed Welch

 

 

Recommended Homework Sources:

“A Homework Manual for Biblical Living” by Wayne Mack

“More Than Bread: A Workbook for Women Who Struggle with Eating” by Elyse Fitzpatrick

Discovering Wonderful Things Worksheets

  • 1 Corinthians 10:13
  • 1 Corinthians 6:19-20
  • Matthew 6:33

Self-Talk Log Worksheet

Daily Prayer Journal

 

 

 

 

Works Cited

[1] Fitzpatrick, Elyse. More than Bread. 19.

[2] https://www.nationaleatingdisorders.org/what-are-eating-disorders

[3] https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml

[4]National Institute for Mental Health, Eating Disorders: About More Than Food.

[5] Dorland, W. A. Newman. Dorland’s Medical Dictionary for Health Consumers. 91.

[6] Mental Health: American Addiction Centers, Inc: “Eating Disorder Professional Treatment

[7] https://www.mentalhelp.net/articles/historical-understandings/

[8] “DSM-IV-TR Classification.” Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)

[9] https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/symptoms-causes/syc-20353591

[10]https://www.psycom.net/anorexia-and-depression/

[11]https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/

[12]Peace, Martha. “Counseling as If a Life Depended on It (Anorexia).”IBCD Institute for Biblical

Counseling and Discipleship, 13 July 2017, ibcd.org/counseling-as-if-a-life-depended-on-

it-anorexia/.

[13]https://www.biblicalcounselingcoalition.org/2015/03/03/a-three-pronged-team-approach-when-caring-for-people-with-eating-disorders/

Bi-Polar Disorder

By Kelsey Trainor

I. Definition        

Secular Perspective

Those diagnosed with bipolar disorder are characterized by intense mood expressions that cycle from very up (manic) to very down (depressed). These moods typically last for weeks at a time. While there is great variation in secular approaches to treating and explaining bipolar disorder. There is overwhelming consensus that it is in fact a real physical disorder and not merely a habit pattern that the counselee falls into.

DSM-5: Bipolar is placed between Schizophrenia and depressive disorders, in DSM-5 because it is thought to relate to both and appears practically to be a cross between them. Since a bipolar diagnosis requires the counselee to experience both manic and depressive episodes, there must be criteria for qualifying these states, and that is what the DSM-5 tries to do.[1] Continue reading Bi-Polar Disorder

Persistent Depressive Disorder (Dysthymia)

By David Wong

I. Definition

  1. Biblical Perspective
    1. Persistent Depressive Disorder is “a continuous long-term (chronic) form of depression.”[1] Asher and Asher say that “the primary diagnostic feature is clinical depression (see Depression) that lasts more or less continuously for two years (one year in children and adolescents).”[2]
    2. Persistent Depressive Disorder is similar in nature to Major Depression, but Persistent Depressive Disorder “usually has fewer or less serious symptoms than major depression”[3]
      1. Major distinctive characteristic is the time frame and severity of the disorder.
  2. Secular Perspective
    1. DSM V
      1. “Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.”[4]
        1. 1 year for adolescents and children
      2. Treatments/Methodologies
        1. One of the significant treatments applicable to those diagnosed with Persistent Depressive Disorder through Psychology is Psychotherapy.
          1. Psychotherapy refers to therapeutic treatment of mental disorders without the use of medication.
          2. Some common therapies include[5]:
            1. Cognitive Behavioral Theory
            2. Interpersonal Therapy
            3. Dialectic Behavioral Therapy
            4. Psychodynamic Therapy
            5. Psychoanalytical Therapy
            6. Supportive Therapy
            7. Other Therapies include:
              1. Animal Assisted Therapy
              2. Creative Arts Therapy
              3. Play Therapy
              4. Yoga
              5. Psychotherapy does not necessarily have to be strict as to the type of psychotherapy being used. Psychologists may combine elements from several styles of psychotherapy, “they blend elements from different approaches and tailor their treatment according to each client’s needs.”[6]
        2. Medication
          1. Psychology also advocates for the use of anti-depressants as medication for depression as well. Some common medicines include[7]:
            1. Selective Serotonin reuptake inhibitors (SSRIs)
            2. Tricyclic Antidepressants (TCAs)
            3. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
            4. Other Types[8]
            5. Atypical Antidepressants
            6. Monoamine oxidase inhibitors (MAOIs)

II. History

  1. DSM III
    1. Categorized as Dysthymic Disorder (Depressive Neurosis) under 300.40 in Affective Disorders.
    2. Dysthymia was originally introduced in the DSM III[9]
    3. Dysthymia occurs when, during the last two years, the “individual has been bothered most or all of the time by symptoms characteristic of the depressive syndrome but that are not of sufficient severity and duration to meet the criteria for a major depressive episode.”[10]
      1. Duration of 2 years for adults
      2. Duration of 1 year for children and adolescents
    4. “The manifestations of the depressive syndrome may be relatively persistent or separated by periods of normal mood lasting a few days to a few weeks, but no more than a few months at a time”[11]
  2. DSM V
    1. Classified as Persistent Depressive Disorder (Dysthymia) under 300.4 (F34.1) as a Depressive Disorder.
    2. The major change from the DSM IV to the DSM V is that Dysthymia is gone, replaced with persistent depressive disorder
      1. This new condition includes both chronic major depression and dysthymia because of the “inability to find scientifically meaningful differences between these two conditions”[12]
    3. Evidence of the Problem
      1. The DSM V says that those experiencing two (or more) of the following are likely to have Persistent Depressive Disorder[13]:
        1. Poor appetite or overeating
        2. Insomnia or Hypersomnia
        3. Low energy or fatigue
        4. Low self-esteem
        5. Poor concentration or difficulty making decisions
        6. Feelings of hopelessness

III. Etiology

  1. Potential Causes of Persistent Depressive Disorder (Psychological View)
    1. The exact cause of Persistent Depressive Disorder is unknown. However, it could be a result of such causes as:
      1. Biological Differences or Brain Chemistry[14]
        1. Scientists have identified many different neurotransmitters that may play a role in depression, and this includes neurotransmitters like[15]
          1. Acetylcholine
          2. Serotonin
          3. Norepinephrine
          4. Dopamine
          5. Glutamate
          6. Gamma-aminobutyric acid (GABA)
  1. Inherited Traits
    1. “Depression does not have a clear pattern of inheritance in families.”[16]
    2. However, “people who have a first-degree relative with depression appear to have a two to three times greater risk of developing the condition than the general public”[17]
  2. Life Events
    1. “Traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people”[18]
  3. Potential Causes of Persistent Depressive Disorder (Spiritual)
    1. Biblical counselors must recognize that physical, physiological, and biological issues occurring with the counselee do have the ability to influence the response of the counselee.
      1. However, while physical, physiological, and biological issues can influence a person, they cannot force a person to respond with sin.
    2. “Depression unrelated to drugs or a physical illness are often indicative of wrong thinking or other spiritual problems”[19]
      1. The person must respond to their sin with confession to the Lord and repentance from their sin
        1. Persistent depressive disorder is not, in and of itself, a sin
          1. Sinful actions and habits may lead to persistent depressive disorder, and persistent depressive disorder may result in sinful actions and habits
          2. However, Persistent depressive disorder is not, in and of itself, a sin
        2. Spiritual Symptoms
          1. Guilt
          2. Anxiety
          3. Suffering
          4. Feelings of Inferiority
          5. Hopelessness
  4. Physical Symptoms
    1. Poor appetite or overeating
    2. Insomnia or Hypersomnia
    3. Low energy or fatigue

IV. Examining the Heart

  1. Heart Themes
    1. Fear of Man
      1. “Instead of a biblically guided fear of the Lord, we fear others”[20]
      2. The most radical treatment for the fear of man is the fear of the Lord.
        1. The sufferer must first “know that God is awesome and glorious, not other people”[21]
      3. The action the counselee must take to remedy the fear of man is to “need them less and love them more”[22]
      4. Relevant Passages
        1. Proverbs 29:25
        2. Matthew 10:28
        3. Galatians 1:10
        4. Mark 12:30-31
      5. Control
        1. Wrong thinking and belief that control will bring us satisfaction or happiness.
        2. “We don’t know what’s best for us because we’re not the Creator.”[23]
        3. Show counselee that God is in control and that He is working for good
          1. God is Sovereignly in control
          2. God is Good and acts according to His goodness
          3. God is Faithful and always fulfills His promises for our good
  2. Comfort
    1. Obedience to God oftentimes means stepping outside of your comfort zone
      1. John 14:15
      2. 1 John 5:3
      3. Romans 12:1-2
    2. Chief end of man is to glorify God and enjoy Him forever.
  3. Biblical Solutions
    1. Counseling Agenda
      1. Involvement
        1. Seek to build a relationship with the counselee
          1. Enter the person’s world[24]
            1. Includes listening to the counselee to discern where they are struggling[25]
          2. Incarnate the love of Christ[26]
            1. “As Christ’s ambassadors, it’s not just what we say that God uses to encourage change in people; it’s also who we are and what we do”[27]
          3. Inspiration
            1. Provide hope to the counselee that Scripture has answers to their problems and that lasting change is possible
              1. “Hope is more than convincing people that things will get better, or helping them decide what to do”[28]
              2. Hope “helps people who are dealing with the unthinkable to view life from the perspective of God’s glory and grace and their identity as His children”[29]
                1. Romans 15:4
                2. 1 Corinthians 10:13
                3. Galatians 3:26
                4. John 1:12
    2. Inventory
      1. Gather physical data
        1. Sleep
        2. Diet
        3. Exercise
        4. Illness
        5. Medication
      2. Discern their heart through speaking and asking appropriate questions to better understand them
      3. Information the counselor wants to know[30]
        1. The situation
        2. The responses
        3. The thoughts
        4. The motives
    3. Interpretation
      1. Involves “accurately analyzing or conceptualizing the data and explaining it to the counselee” [31]
        1. Discern biblical categories that best describe the counselee [32]
          1. Saved or Unsaved?
          2. Spiritually mature or immature
          3. Unruly, fainthearted, weak?
            1. 1 Thessalonians 5:14
      2. Formulate a Working Interpretation[33]
      3. Determine possible reasons for the problem
      4. Consider the Counselee’s heart
      5. Test the Validity of Your Interpretation[34]
    4. Instruction
      1. Instruction should be biblically based[35]
        1. “Counseling that is faithful to the Bible effectively communicates the original meaning of the biblical text in a way that is relevant to the situation and heart of the person you are counseling”[36]
      2. Specific Instruction as to Depression
        1. Physical and Physiological Issues
          1. The counselor must provide biblical instruction as it relates to the physical or physiological aspects of their lives
            1. The extent of this counsel should be to counsel the counselee against unhealthy actions and habits as well as instructing the counselee to undertake healthy living (i.e. sleeping habits, eating habits, exercising, etc.)
              1. For issues that are medical, or may require more professional attention, the counselor should encourage the counselee to see their medical practitioner
            2. Instruct on the heart
              1. Potential heart themes for those struggling the Dysthymia
                1. Control
                2. Comfort
                3. Fear of Man
              2. The role of feelings
              3. Various problems and issues the counselee may be struggling with[37]
                1. Guilt
                2. Anxiety
          2. Suffering
            1. Inferiority
            2. Hopelessness
            3. Laziness
            4. Self-control
    5. Inducement[38]
      1. Fire up the counselee to make certain decisions and commitments that will facilitate change
      2. “Bring counselees to the realization that biblical change involves personal choice”[39]
      3. Promotes a concern about heart sins as well as behavioral sins[40]
        1. “Nothing less than heart repentance and heart change will please God and produce change that is genuine and lasting”
      4. “Secure a commitment from counselees to put off the desires, thoughts, and actions that hinder biblical change and to replace them with ones that promote biblical change”[41]
    6. Implementation
      1. Ephesians 4 Model
        1. Put off the Old
          1. Identify factors that hinder biblical change and take steps to eliminate them[42]
        2. Renewal of the Mind
          1. Provide practical action for the counselee to engage in, in the hopes that the counselee would be personally engaged with Scripture and contain a renewed perspective pertaining to their issues and problems as well as their heart
            1. Prayer
            2. Bible Reading
            3. Biblical instruction
          2. Put on the New[43]
            1. Should be specific as to the counselee according to the Ephesians 4 model
          3. Homework
            1. Homework should provide specific and practical action for the counselee to take
            2. Assigned Bible Reading for the counselee to do and meditate upon
              1. Ephesians 4
              2. 1 Corinthians 10:13
              3. Romans 15:4
            3. Homework should “assist the counselee to apply the truths learned about God, self, and others to the specifics of his living situation, making biblical corrections and instituting new biblical habits”[44]
    7. Integration
      1. Ensure that they are getting involved in their local Church
        1. Sunday Service
        2. Bible Studies
        3. Fellowship Groups
        4. Accountability
      2. At this point, the counselor would like their local church to be shepherding and guiding this person
        1. This includes ongoing discipleship and accountability within the Church
        2. Ensuring that the counselee is surrounded by strong believers that are devoted to the Word and are committed to discipling and keeping the counselee accountable in their living
      3. Recommended Books
        1. How to Help People Change by Jay E. Adams
        2. Counseling: How to Counsel Biblically by The Master’s College
        3. Instruments in the Redeemer’s Hands by Paul David Tripp
        4. When People are Big and God is Small by Edward T. Welch
        5. The Christian’s Guide to Psychological Terms by Marshall and Mary Asher
  1. Recommended Homework Resources
    1. A Homework Manual for Biblical Living by Wayne Mack
    2. Depression Homework Assignment Samples from IBCD
      1. https://ibcd.org/depression-homework-assignment-samples/

 

 

Bibliography

American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental       Disorders : Dsm-Iii-R. 3Rd edition, revised. Washington, DC: American Psychiatric      Association.

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental       Disorders : Dsm-Iv. 4th ed. Washington, DC: American Psychiatric Association.

American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders:             Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association.

“Antidepressants: Selecting One That’s Right for You.” Mayo Clinic. November 17, 2017.           Accessed April 16, 2019. https://www.mayoclinic.org/diseases-conditions/depression/in-       depth/antidepressants/art-20046273.

Daniel Wiswede, et al. 2014. “Tracking Functional Brain Changes in Patients with Depression     under Psychodynamic Psychotherapy Using Individualized Stimuli.”                     https://doi.org/10.1371/journal.pone.0109037.

“DSM5 Diagnostic Criteria Persistent Depressive Disorder.” 2013.

“Dysthymia – Harvard Health Publications.” 2010. January 6, 2010.                       https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/ Dysthymia.htm.

Edward T. Welch, 1997. When People Are Big and God Is Small : Overcoming Peer Pressure,     Codependency, and the Fear of Man. Resources for Changing Lives. Phillipsburg, N.J.: P      & R Pub.

Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub.,        2014.

Moore, Beverly. “The Illusion of Control.” Biblical Counseling Coalition. February 02, 2018.      Accessed April 18, 2019. https://www.biblicalcounselingcoalition.org/2018/02/02/the-           illusion-of-control/.

 “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic.           Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent- depressive-disorder/symptoms-causes/syc-20350929.

Publishing, Harvard Health. n.d. “What Causes Depression?” Harvard Health. Accessed   February 19, 2019. https://www.health.harvard.edu/mind-and-mood/what-causes-        depression.

Reference, Genetics Home. n.d. “Depression.” Genetics Home Reference. Accessed February      19, 2019. https://ghr.nlm.nih.gov/condition/depression.

Robin L. Cautin and Scott O. Lilienfeld, eds. 2014. The Encyclopedia of Clinical Psychology.     Hoboken, NJ, USA: John Wiley & Sons, Inc. https://doi.org/10.1002/9781118625392.

Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands : People in Need of Change          Helping People in Need of Change. Resources for Changing Lives. Phillipsburg, N.J.: P      & R Pub.

 “Understanding Psychotherapy and How It Works.” n.d. Https://Www.Apa.Org. Accessed          February 17, 2019. https://www.apa.org/helpcenter/understanding-psychotherapy

[1] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic. Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929.

[2] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 143.

[3] “Dysthymia – Harvard Health Publications.” 2010. January 6, 2010. https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/Dysthymia.htm.

[4] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association, 168.

[5] Daniel Wiswede, et al. 2014. “Tracking Functional Brain Changes in Patients with Depression under Psychodynamic Psychotherapy Using Individualized Stimuli.”  https://doi.org/10.1371/journal.pone.0109037.

[6] “Understanding Psychotherapy and How It Works.” n.d. Https://Www.Apa.Org. Accessed February 17, 2019. https://www.apa.org/helpcenter/understanding-psychotherapy.

[7] Robin L. Cautin and Scott O. Lilienfeld, eds. 2014. The Encyclopedia of Clinical Psychology. Hoboken, NJ, USA: John Wiley & Sons, Inc. https://doi.org/10.1002/9781118625392.

[8] “Antidepressants: Selecting One That’s Right for You.” Mayo Clinic. November 17, 2017. Accessed April 16, 2019. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273.

[9] American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iv. 4th ed. Washington, DC: American Psychiatric Association, 209.

[10] American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iii-R. 3Rd edition, revised. Washington, DC: American Psychiatric Association, 222.

[11] Ibid.

[12] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association, 168.

[13] “DSM5 Diagnostic Criteria Persistent Depressive Disorder.” 2013, 3.

[14] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic. Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929.

[15] Publishing, Harvard Health. n.d. “What Causes Depression?” Harvard Health. Accessed February 19, 2019. https://www.health.harvard.edu/mind-and-mood/what-causes-depression.

[16] Reference, Genetics Home. n.d. “Depression.” Genetics Home Reference. Accessed February 19, 2019. https://ghr.nlm.nih.gov/condition/depression.

[17] Ibid.

[18] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic.

[19] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 61.

[20] Edward T. Welch, 1997. When People Are Big and God Is Small : Overcoming Peer Pressure,   Codependency, and the Fear of Man. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 14.

[21] Ibid., 95.

[22] Ibid., 193.

[23] Moore, Beverly. “The Illusion of Control.” Biblical Counseling Coalition. February 02, 2018. Accessed April 18, 2019. https://www.biblicalcounselingcoalition.org/2018/02/02/the-illusion-of-control/.

[24] Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands : People in Need of Change Helping People in Need of Change. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 126.

[25] Ibid., 128.

[26] Ibid., 133.

[27] Ibid., 134.

[28] Ibid., 157.

[29] Ibid.

[30] Ibid., 189.

[31] Master’s College. 2005. Counseling : How to Counsel Biblically,147.

[32] Ibid., 150.

[33] Ibid., 157-160

[34] Ibid., 159-160.

[35] Ibid., 163.

[36] Street, John D. 2013. Men Counseling Men. Eugene, Or.: Harvest House, Chapter 2.

[37] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 61-62

[38] Master’s College. 2005. Counseling: How to Counsel Biblically, 176-177

[39] Ibid.

[40] Ibid.

[41] Ibid.

[42] Ibid., 190.

[43] Ibid., 193.

[44] Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands: People in Need of Change Helping People in Need of Change, 343.

Post-Partum Depression

By Andrea Johnson

I. Definition

Postpartum depression (PPD) refers to the intense sadness women sometimes experience after giving birth.[1] It must occur within the first four weeks of giving birth and last for a period of two weeks or longer.[2]

II. Secular Perspective

The DSM IV was the first resource to place postpartum depression under the category of major depression. Therefore, PPD is viewed/treated similarly to major depression, with the exception of the use of medication, because some anti-depressants are not recommended for mothers who are breastfeeding. PPD has a prevalence of 13% amongst new mothers[3], and it generally self-resolves within two weeks to three months. PPD often disrupts the mother’s interpersonal relationships, and can even harm child development.[4]

Those who are a part of the feminist camp do not approve of PPD being a specific category at all. PPD is offensive to them because they do not want women to have a specific disorder that does not pertain to men, as this would cause women to potentially appear weak. They argue that because men do not have a specific label for any hormonal or emotional imbalances, neither should women.

Secular treatment for PPD includes interpersonal psychotherapy, short-term cognitive behavioral therapy, pharmacotherapy, hormonal therapy, and in extreme cases, psychiatric hospitalization.

III. Biblical Perspective

Postpartum depression affects both the inner and outer man. Body and soul are distinguished, but they cannot be separated (2 Corinthians 4:16). PPD affects the woman as a whole – her physical body is experiencing hormonal changes, lack of sleep, shock to new motherhood, and physical pain due to childbearing, meanwhile her thinking, attitude, motivations, desires, and reactions are all being affected. Where there is a physical problem, there will also certainly be a spiritual problem.[5] Therefore, a woman who is experiencing PPD should care for both her physical body and her inner heart. 1 Corinthians 6:19-20 says that our bodies are the temple of the Holy Spirit. So the woman experiencing postpartum depression should be cared for as a whole person, both the physical outer man and the spiritual inner man.

Depression/anguish is not seen as a sin in and of itself in the Bible. We see this in the examples of David (Ps. 42, 2 Sam. 12:15-24), Job (Job 2:9, 4:9), and even Jesus (Isaiah 53:3, Luke 22:44). Postpartum depression means that a woman is experiencing real pain that is both physical and spiritual, and she should be cared for equally in both areas.

IV. Evidence of the Problem

Common themes and patterns for women experiencing PPD are lack of sleep, transitional shock, hormonal withdrawal, and previous depression[6]. Common expressions of PPD are crying spells, insomnia, depressed mood, fatigue, anxiety, poor concentration, lack of interest in daily activities, increased or decreased appetite, hypersomnia, phychomotive behavior, feelings of worthlessness or inadequacy about being a mother, guilt about being depressed, and recurring thoughts of death regarding either her or the baby.[7] Women experience these expressions in varying degrees ranging from mild (i.e. the “baby blues”) to severe (i.e. postpartum psychosis). There are several risk factors that greatly contribute to a new mother’s chance of experiencing PPD[8]. These include previous depression, prenatal depression, prenatal anxiety, life stress, poor marital relationship, lack of social support, child care stress, and temperamental or sick infants.

There are consequences for both the mother and the infant that can arise from the presence of PPD, such as behavioral and cognitive development in the child[9], disrupted mother-infant bonding, disruption of interpersonal relationships for the mother, and disruption to the mother’s marriage[10].

V. Examining the Heart

It is important to investigate each scenario to find out what each woman is struggling with individually. PPD is looks different for different women, both physically and spiritually. Sinful heart themes that may be present are: pride in the unacceptance of physical weakness, a wrong view of motherhood, false expectations for motherhood, resistance to connecting with the local church/asking for help. Women who are new mothers may want to prove to themselves and others that they are a capable mother. In addition, their view of “capable/good motherhood” may not be biblical. This may contribute to a depressed state because women will never live up to an unrealistic and unbiblical standard of good motherhood. Motherhood must be learned, it is not simply known. Women experiencing PPD will often ignore their own physical pain in an attempt to focus on their child, when they should also be caring for themselves physically, and asking for necessary help. Sleep deprivation has been found to be one of the leading factors of depression[11], but women are often not aware of the implications of their sleep deprivation and other physical stress they are experiencing. This could be rooted in the pride of not wanting to accept their physical limitations, and not wanting to look like an incapable mother by asking for assistance.

VI. Biblical Solutions

A woman experiencing PPD must ensure she has a biblical perspective of motherhood, humbles herself to admit her physical weakness, and ask for help from the local church. She also needs to understand that it is good to take care of her physical body, as this will impact her inner soul as well. Heath Lambert and Stuart Scott recommend that a woman with PPD should seek help from her husband/friends/the local church, so that she is able to tend to her immediate physical needs of sleep and food. She should study Romans 5:1-5 to be encouraged that her suffering is not pointless, and she has the opportunity to see the Lord’s hand through her depression. She should confess sins of pride and any unrealistic expectations she has placed on herself. Finally, she should gain a biblical understanding of motherhood by learning from other women who have gone before her, as Titus 2:3-5 commands.

Homework would include prayer, studying Romans 5:1-5, meeting with an older woman from church, and setting a daily schedule. Setting a schedule will help the new mother ensure that she is getting rest, food, and daily tasks accomplished, and will help her to find out what areas she specifically needs help in (i.e. meal prep, laundry, house cleaning, etc.)

Recommended books include: Overcoming Fear, Worry, and Anxiety by Elise Fitzpatrick; Women Counseling Women by Elise Fitzpatrick; Depression: Looking Up from the Stubborn Darkness by Edward T. Welch; and Lies Women Believe by Nancy Lee DeMoss.

 

 

 

BIBLIOGRAPHY

Anderson, Gary R. 2017. Postpartum Depression: Prevalence, Risk Factors and Outcomes.         Health Psychology Research Focus. Hauppauge, New York: Nova        Biomedical. http://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=n  ebk&AN=1453453&site=ehost-live&scope=site&custid=s8898283.

Andrews-Fike, Christa. 1999. “A Review of Postpartum Depression.” Primary Care         Companion to The Journal of Clinical Psychiatry 1 (1):        914. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/.

Asher, Marshall and Mary. The Christian’s Guide to Psychological Terms, 2nd ed. 2004.

Bernard-Bonnin, Dr. Anne-Claude. “Maternal Depression and Child Development.” US National Library of Medicine. October 2004. Accessed April 13, 2019. https://www.ncbi.      nlm.nih.gov/pmc/articles/PMC2724169/.

Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC:    American Psychiatric Association, 2000.

“Interview with Charles Hodges & Jim Newheiser {Transcript}.” 2017. IBCD. March 24, 2017. https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

O’Hara, Michael W. 2009. “Postpartum Depression: What We Know.” Journal of Clinical           Psychology 65 (12): 1258–69. https://doi.org/10.1002/jclp.20644.

STUART, SCOTT, and MICHAEL W. O’HARA. 1995. “Interpersonal Psychotherapy for           Postpartum Depression.” The Journal of Psychotherapy Practice and Research 4 (1): 18        29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330386/.

 

[1] Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American

Psychiatric Association, 2000.

[2] Asher, Marshall and Mary, The Christian’s Guide to Psychological Terms, 2nd ed., 2004, 149.

[3] Anderson, Gary R. 2017, Postpartum Depression: Prevalence, Risk Factors and Outcomes, Health Psychology Research Focus, Hauppauge, New  York: NovaBiomedical, http://search.ebscohost.com/login.aspxdirect=true&AuthType=shib&db=nebk&AN=1453453&site=ehost-live&scope=site&custid=s8898283.

[4] O’Hara, Michael W. 2009, “Postpartum Depression: What We Know,” Journal of Clinical Psychology 65 (12): 1258–69, https://doi.org/10.1002/jclp.20644.

[5] “Interview with Charles Hodges & Jim Newheiser {Transcript},” 2017, IBCD, March 24, 2017, https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

[6] Asher, Marshall and Mary, The Christian’s Guide to Psychological Terms,

[7] Andrews-Fike, Christa, 1999, “A Review of Postpartum Depression,” Primary Care Companion to The Journal of Clinical Psychiatry 1 (1):914, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/

[8] O’Hara, Michael W. 2009, “Postpartum Depression: What We Know,” Journal of Clinical Psychology 65 (12): 1258–69, https://doi.org/10.1002/jclp.20644.

[9] Bernard-Bonnin, Dr. Anne-Claude, “Maternal Depression and Child Development,” US National Library of Medicine, October 2004, Accessed April 13, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724169/.

[10] STUART, SCOTT, and MICHAEL W. O’HARA, 1995, “Interpersonal Psychotherapy for Postpartum Depression,” The Journal of Psychotherapy Practice and Research 4 (1): 18 29, https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3330386/, 20.

[11] “Interview with Charles Hodges & Jim Newheiser {Transcript},” 2017, IBCD, March 24, 2017, https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

Social Anxiety

By Josiah Garber

Problem/Condition

I. Definition

Biblical perspective

Biblically, social anxiety comes from the underlying main issue of pride. That is to say that social anxiety is a sin that stems from a person focusing on themselves too much. The person with social anxiety sees the approval of man as the ultimate good in their lives. This means that they despair when they believe that they will not receive that approval that they feel they need. Therefore, social anxiety is a sinful self-centeredness that is the inverse of self-exaltation. This self-centeredness then replaces God with a love of oneself that manifests itself in either traditional prideful actions or, in the case of social anxiety, a despair that the one does not live up to the standard that they believe they should. Effectively, the god of the person who is struggling with social anxiety is himself. Social Anxiety manifests itself in people feeling inferior to those around them. Viewing ourselves as less than we are, less than God created us to be, stops us from loving others the way that we should.

Scripture calls social anxiety sin very clearly. This is seen first of all in Matthew 6:25-34 where Christ exhorts all not to worry. In this passage, we are called to not be anxious.  Anxiety is shown to be useless; it will not add a single day to our life. Instead, Christ calls us to focus on the struggles of today. It is a call to focus on what we are currently up against, not our fears of the future. This whole passage, through the analogy of the flowers and of the sparrows, emphasizes the sovereignty of God. He is the one who will provide for all of our needs.

A second passage that deals with this issue is Philippians 4:6-9. In these brief few verses, Paul commands the Philippians to “not be anxious about anything.” Social Anxiety, then would  be included. This is a clear demonstration that anxiety is sin. However, Paul gives the solution to anxiety in this passage. That is, he states that the one who is anxious is to give their requests to God in thanksgiving, prayer, and faith. Peace, he states, is the result of this. This means that faith is important as the believer must trust not that God will grant what they want, but that He will give what is best for them.

Secular perspective

Social Anxiety Disorder, also called Social Phobia, is defined as “an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune. The body often mobilizes itself to meet the perceived threat: Muscles become tense, breathing is faster, and the heart beats more rapidly.”[1] The secular view is purely physical, saying that it is simply an anticipatory fear of social situations. They distinguish fear and anxiety by saying that “Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat.”[2]

The treatment of social anxiety normally takes the form of one of two separate forms. The first is the use of psychiatric medications. These are usually similar to the ones used for depression, and they vary in their effectiveness at curbing symptoms from mildly successful to somewhat moderately successful. The second form of treatment is cognitive behavioral therapy. This will often take the form of exposure therapy or group therapy. It is also quite common for there to be a mixture of the two approaches in an attempt to cover the weaknesses of each approach. [3] In order for someone to be diagnosed with Social Anxiety they must have manifested symptoms for 6 months or longer.

 

II. History

Social Anxiety has existed for a very long time, with even general anxiety being directly addressed by both Jesus and Paul. The idea of social anxiety may have originated Hippocrates as early as 400 B.C. However, it wasn’t until 1968 in the DSM-II that Social Anxiety was specifically mentioned and defined. It was here that it was first classified, and the idea of it has only become more prevalent since.

III. Evidence of the Problem

Social Anxiety’s main theme is an avoidance of stressful social interactions. “The feared situation is most often avoided altogether or else it is endured with marked discomfort or dread.”[4] This often leads to isolation, where the person will distance themselves from their family or friends. Social Anxiety also manifests itself through a fear of judgement from others. It is a “fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.[5]

The person struggling with this will often fear that they will be rejected, unloved, or perceived as annoying, lame, stupid, weird, rude, boring, or a whole host of other undesirable outcomes.

IV. Etiology

While there is no known medical condition that causes Social Anxiety, there are several factors that may contribute to it. These factors are things such as abuse, internalization of fears, an unhealthy level of comparison of oneself to people one may see as ideal, and the perceived need to become the ideal form of oneself. Spiritually, Social Anxiety comes from a lack of trust in God, a propensity to not leave the worries of one’s life in the hands of God through faith and prayer. It may also come from valuing oneself as the most important thing, thus leading to that value having ultimate control over emotions and actions. [6]

Some physical symptoms of this issue are the avoidance of social situations, tremors, increased heart rate, tenseness, perspiration, and, in some more extreme cases, panic attacks. [7] Spiritual symptoms include a lack of trust in God, doubt in His promises to give  all that is needed, and a view of God’s love and provisions as not enough to satisfy social needs.

 

V. Examining the Heart

The possible heart themes behind Social Anxiety are a desire for control and a fear of man. The person with Social Anxiety will desire for the people in their lives to see them as they wish to be seen, of value, enjoyable to be around, and acceptable in their preferred social situations. Some idols that go along with this are a love of self, pride, and a love of comfort.

VI. Biblical Solutions 

In his Christian Counselor’s Manual, Jay Adams says “If the counselee’s fear fundamentally is a fear of men, then the answer lies in encouraging him to engage in loving ministry, in which he may give of himself to others. Granted, more may be involved, but ultimately, fear will vanish only when he has learned to live the life of loving concern for his neighbor.”[8] Adams also states that a constant and continuous prayer life will lead to peace. [9] Others mention that it is most important that one does not value himself primarily, as that will lead to worry. Valuing Christ first and other people before oneself will take the focus off of oneself, helping to get rid of anxiety. [10]

Recommended Books

“When People are Big and God is Small” by Edward T. Welch

“Overcoming Anxiety: Relief for Worried People” by David Powlison

“Anxiety Attacked: Applying Scripture to the Cares of the Soul” by John MacArthur

Recommended Homework Resources

“A Christian Growth and Discipleship Manual: A Homework Manual for Biblical Living Volume 3” by Wayne A. Mack and Wayne Erick Johnston

“For Further Thought” sections in “When People are Big and God is Small” by Edward T. Welch

 

 

 

[1] Gary R. VadenBos, APA Dictionary of Psychology (Washington, D.C.: American Psychiatric Association, 2015), 66.

[2] David J. Kupper et al., DSM-V (Washington, D.C.: American Psychiatric Association, 2013), 189.

[3] Vladin Staracevic, Anxiety Disorders in Adults: A Clinical Guide (Oxford, UK: Oxford University Press, 2010), 183.

[4] VadenBos, 999.

[5] Kupper et al, 202.

[6] Robert D. Jones, “Getting to the Heart of Your Worry,” The Journal of Biblical Counseling 17, no. 3 (Spring 1999), 22.

 

[7] James Morrison, DSM-IV Made Easy (New York, NY: The Guilford Publications, 1995), 262.

[8] Adams, 417.

[9]  Jay E. Adams, The Practical Encyclopedia of Christian Counseling (Heckettstown, NJ: Timeless Texts, 2003), 190-191.

[10] Jones, 22.

Schizophrenia

By Janae Stout

I. Definition

  1. Biblical Perspective
    1. A person with schizophrenia has an inability to function normally in a society due to bizarre behavior as a result of organic/inorganic forces. This includes either internal or external forces that distort judgments and reality.[1] The counselee dealing with Schizophrenia has physical implications that impairs their ability to perceive and function in a normal way, which is not necessarily sin, but the response of giving into the temptations to be self-focused, to fear, act in anger, laziness, and other manifestations are sinful. The heart theme that must be addressed in Schizophrenics is their response and deep-rooted fear, guilt/shame and selfishness.
  2. Secular Perspective
    1. Schizophrenia, literally meaning “fragmented mind”[2] is a psychiatric disorder occurring in only one percent of the population involving chronic or recurrent psychosis and is commonly associated with impairments in social and occupational functioning[3]. Schizophrenia is believed to comprise a ‘spectrum’ of related conditions with variable severity, course, and outcome.[4]

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