Big Pharma and Flourishing

Listen to it here!

So, you may or may not have heard about the bombshell research about antidepressants. Everybody’s talking about it, and it’s clearly touched a nerve. People have an AWFUL lot of medical expert fatigue these days, and this research may be yet another straw placed upon the back of a camel with several herniated discs. Before we begin today, however, I want to preface my comments with a few preliminary qualifiers. First, my own personal goal as a pastor-theologian is the help people flourish. I want people to live the best, most fulfilling, most joy-filled, productive, Christ-honoring lives they can. I want people to be happy and healthy. So everything I do, as a pastor and as a theologian is to help people experience the fullness of flourishing that God has for them.

Second, I have nothing but compassion for people who are suffering from major depression. I want them to not suffer. I want them to flourish. Whatever my beliefs on the causes of major or clinical depression, my beliefs on the effects are simple: depression is bad and doesn’t promote the Christ-life.

Third, I’m not a psychologist or psychiatrist. So, please don’t take anything I say as psychotherapeutic or medical advice. I have not had the training. So, I’m no expert.

However, the problem with expertise, as all of us are learning right now, is that expertise is never a guarantee of being correct, and often expertise hinders someone’s ability to change their own mind. People who are experts often lack the ability to take criticism, especially criticism that comes from a common-sense critique to their views. Experts often, when challenged by other experts, get into a very illogical and very unacademic posture where what really matters is who has more academic prestige. And worse, if you aren’t an expert in the field you’ll just be laughed at. And there are complex reasons for this. First is pride. Top scholars, in any field, do not ever want to see their own reputations tarnished or their future prospects diminished. Second is confirmation bias. When a scholar or researcher has been looking at the same data and working with the same presuppositions for so long, anything that challenges their paradigm is a threat to be rejected – those guys don’t know what I know, is the attitude. Third is money. The dirty little secret about science, all disciplines but particularly science, is that it’s a zero-sum game. There is only so much research money out there and you gotta get as much of that sweet-sweet green pie as you can, cause nobody’s gonna share theirs with you. And so if something is threatening your research, they’re threatening your livelihood.

So, don’t be surprised when scientific experts are just wrong, and painfully, obviously wrong. Again, the past 2 years ought to have demonstrated, conclusively, that going to a fancy law-school and having lots of fancy friends, and knowing all the technical lingo and jargon doesn’t make you right. You can have an econ degree from Chicago and a law degree from Harvard and still be an idiot and fail to see something that any trucker or plumber or fry-cook can see.

Experts are often blinded by their own expertise.

And this is something that Dr. Joanna Moncreiff has a long history of writing about. She’s been banging the drum for years, trying to get people’s attention about the lack of evidence to support the serotonin-theory of depression. Because, according to her, there is no real evidence that depression is cause by an imbalance in the serotonergic system. And right now, you’re thinking, OK, Lukey-Poo, you read a few articles by one scholar. One swallow does not a summer make! She’s just one lady. Except no.

This is not a secret. The doubts about the serotonin theory of depression have been around for a very long time. Back in 1987 Healy had shown, pretty convincingly, that there was not scientific evidence that depression was caused by a serotonin imbalance. And, there were doubts before that, mind you. And, in fact, things got so bad for Big Pharma, that Ronald Pies, one of America’s most respected Psychiatrists said that the serotonin theory was never taken seriously by psychiatrists, who always know that blaming a chemical imbalance was a gross, but useful, oversimplification – that it was a metaphor.

Yes. Because when being prescribed drugs that will alter our mental state, we want to be reassured that it is safe and effective through metaphor. That’s what I call informed consent, eh chaps!

The problem for Pies was that that was simply untrue. As Moncrieff, Horowitz, and Ang show, the Psychiatric community in its most cited articles and most influential textbooks often did, in fact, tout the serotonin-theory as gospel truth, with unequivocal acceptance.

The problem is that as the public we have a lot of competing voices. We have some, including the pharmaceutical industry saying, nothing to see here, keep taking your antidepressants ; we have guys like Pies saying, nobody is saying antidepressants correct a chemical imbalance, nobody at all; then you have people overtly saying, yes antidepressants totally correct imbalances in the serotonergic system; then you have people like Healy and Moncrieff – and others – who are saying that the data show that not only is there no link between serotonin and depression, there are a lot of negative side-effects associated with SSRI anti-depressants, and these drugs do only marginally better than placebo – except placebos don’t have severe withdrawal symptoms.

 And here’s where I want to interject my own thoughts, and where I think that the Bible and Christian theology are extremely relevant. Whatever the experts say, it’s well for Christians to remember that the experts are very rarely experts for long. It’s wise to take anything said by an expert with a very large grain of salt. Much that is published under the aegis of “science” is not scientific – not in the sense of inductive, experimental, controlled, repeated attempts to falsify hypotheses. Scientific, often means, that which endorses the worldview of people in the Cult of Science. So, Christians oughtn’t to be intimidated by things that have received the Mark of Science on their right hands or foreheads. That doesn’t mean that we oughta be arrogant, or dismissive, it means we shouldn’t be gullible chumps.

Christians always should have been, and still should be skeptical, of the idea that a chemical imbalance is the cause of every single instance of depression. We SHOULD be skeptical. Why? Because despair is so often described as sinful. The Bible, God, commands us to have hope. Depression, real depression, not simply feeling sad, is having no hope.

Now, I want to be clear, I’m not saying that there is no neurochemical imbalance that happens when people are depressed – in fact, I would be surprised if the brains of depressed people were functioning normally. But that doesn’t make something the cause. It may just be part of the effect. Imagine, a house burning down, and you looked at the burning house and you said, man, look at that smoke – that must be the cause for all that heat! Everyone would laugh at you because you’d confused a cause with an effect. Or if you thought that all you needed to do to hit a homerun was to make contact with the baseball (because all homeruns involve contact with the baseball) you would be making a serious error of confusing a necessary condition with a complete explanation.

In the same way, claiming that all depression is caused by a chemical imbalance is even more dubious than the claim that all you have to do to hit a homerun is to make contact. The reason it’s more dubious is that we know, in fact, that you have to make contact to hit a homerun. We don’t have any evidence that chemical imbalances are the cause of depression.

And this matters an awful lot. It matters because, while there may, indeed, be people with brain injuries, or congenital pathologies, whose depression really is beyond their control, that cannot be the sole explanation in a significant portion of the population. And this matters. It matters because if the cause is not biological, then it’s behavioral.

And, truth be told, that’s kinda what most non-experts believe anyways. Most non-experts believe that depression, whatever biological factors exist, can be solved through therapy and other behavior changes. But this doesn’t get to the root.

WHY are people depressed? And why are rates of depression and suicidality rising? Why are so many so sad and so willing to end their own lives, sometimes the lives of others as well?

I would argue that the reason for most people, not all, but the vast majority, is because we are failing to live as God would have us to live. We are failing to experience the blessings of living the Christ-life.

Consider a 25-year-old man 200 years ago. Life was hard. But that 25-year-old, along with 90% of other Americans lived in a rural setting. He got plenty of sunshine, plenty of sleep, ate few processed foods and no real junkfood, and the sweets he ate he burnt off with manual labor. He had a wife and probably at least one child. He worked with his hands, seeing the results of his labor, and there was broad optimism about the future of this country and that he and his children’s prospects would only go up. He lived in a community where people knew eachother and were forced to rely on eachother. He went to church and his whole life was built around the idea that there is a loving God to Whom we must give an account. He may or may not have truly believed in Christ, but he believed in enough religion for it to affect his entire outlook on life.

Compare that with the average 25-year-old man today. He likely lives in a city or suburb with his parents. He’s unmarried. He has no children. He does not have a career that he’ll stick to his whole life. He gets less sunshine, less sleep, eats worse, gets less exercise, has lower testosterone. He doesn’t live in a community built around mutual trust and obligations; he doesn’t know his neighbors; he views children as hindrances to be murdered if necessary; he has no conception of the Biblical God.

Which person sounds like he’ll be happier? Which person sounds like he’s more prone to despair?

Friends, flourishing comes from living God’s way. Yes, Christians, too, can despair. It’s a sin. It’s built on not trusting God or His promises. We can lose our sense of hope and purpose. And sure, maybe antidepressants can help. But as believers, we ought to recognize that the overwhelmingly high numbers of people suffering from depression cannot simply be a matter of chemical imbalances – especially as we look at it in age cohorts. Rather depression, largely speaking, is a theological issue.

I’m not claiming that Godliness is the cure for ALL depression. But I am saying, I believe it to be the cure for most, if not the vast majority. And even if it isn’t the cure – godliness is beneficial in all things, anyways. I know for many, if not most, loving and finding fulfillment in Christ and the Christlife is the cure for despair and depression. I know it was for me.

And I hope that we as a Church can share the life and hope-giving message of Christ with a society that needs Him.