"What About People on Meds?"

Dear Readers,

Recently, a friend of mine from church e-mailed me the following question:

Hey Marie,


I was wondering if in your NANC training you ever get to the point when you have to encourage someone to stop taking drugs. How do you do that? I know it is probably a long answer but I would love to know!

I thought it was a good question, and quite possibly one which some of you readers are wondering about, as well, so I am posting my entire answer to her below. Anti-depressant medications are routinely prescribed in the treatment of eating disorders, so this is an ethical question related to my ministry. Since writing this reply, I've gotten much deeper into my current course of "Medical Issues in Counseling" and find that I've portrayed the position accurately.

My response:

"Well, first I should clarify that I am not under NANC, but rather INS (Institute for Nouthetic Studies). It's the same exact position, theology & theory, though...but the difference is if you want to get the NANC certification (after completing the INS' 185 hours of coursework), you still have to then take the NANC exam and do your 50 hours of supervised counseling under your local church. I would expect that question then becomes a big one, because so many peeps are on so many meds. (Interestingly, my next course, which should arrive any day now, is Medical Issues - and I am SURE that question will be covered in much more depth!)


From what I understand, a NANC counselor does not/cannot advise a counselee to stop taking her physician prescribed meds. They have to qualify counsel with "I am not a physician", and if you think about it, it would be a HUGE liability risk to come out and tell a counselee to stop taking them. Some actions are described as "painting a big bulls-eye on the door of the church" (lawsuits). Also, as you know yourself, going off psychotropics and SSRI meds cold-turkey can be dangerous; the body grows physically dependent on them. I am honestly not sure if a NANC counselor can even encourage the counselee to "wean" herself off of them, and while it's great if they do, that MUST always be done under a doctor's supervision.


Now, that said, suppose a person were asking the NANC counselor hypothetically about the usefullness of drugs for what is assumed to be a "chemical imbalance". Depression is the usual issue....did you know, that after marriage problems, depression is the biggest thing you see in nouthetic counseling? It's also the hardest to counsel - because peeps come in armed to the teeth with "information" they've "learned" about depression. When working on my book, I discovered that now top-flight psychiatrists and researchers are admitting the chemical imbalance theory is unproven. It was a myth all along.


If asked, I imagine a NANC counselor could certainly point these facts out (having the research info right there in front of you doesn't hurt - "The Christian Counselor's Medical Desk Reference" is required reading for my course, and I also recommend Tyler & Grady's "When Sin is Called Sickness"). But making the argument that depresion etc. is not an organic disease (and therefore meds don't work; they ONLY TREAT THE SYMPTOMS) is one thing; telling someone they should stop a Rx they are already on is quite another.


As you know, the "counseling" I do is infomal - generally women seek me out after finding me online. I have never shied away from telling them straight-up that drugs are totally ineffective at treating eating disorders; that's a pretty easy one to prove. If they've contacted me, they've already read at leasts ome of my writing and know where I stand on that issue, anyway. However, what I have found is that (in the case of eating disorders), women prefer to take meds because they want to convince themselves it is still a "disease". If they realize the drugs don't help, on some level they are admitting it's not a physical disease that they have...but a spiritual one (sin). Many Christians just don't want to go there. (Which is probably most of the attacks I've gotten on my blog are from professing Christians -- NOT atheists).


It's a hard thing to face that you are in sin, and as long as you hang on to the meds and the illusion that you are "suffering from a 'mental illness'", you can deny to yourself that bulimia (or whatever) is a sin against a holy God. It takes time for the Holy Spirit to gently lead someone to that realization. Once they get there, though, NOW real change can begin. I have never seen a truly repentant women want to keep on claiming it's a "mental illness" card - so the drugs become a non-issue (although withdrawal may be another story).


So basically, my approach would not be first and foremost to focus on "stopping the drugs". It would be to help the person understand what God's Word says, and what it implies about her behavior (or depression). Once she is open to let God work in her heart and she is renewing her mind, the drugs can be seen for what they are -- a chemical answer to a spiritual solution. Then it's up to her. But to directly tell a counselee she should stop whatever she's on would be dangerous - for the counselor; for the church; and possibly for the counselee. I would not hesitate to advise against STARTING them, though. And from what I've seen just in my work as a medical interpreter, doctors push antidepressants like lemon drops. It's crazy!!! An elderly woman having a melancholy day? "I'm going to recommmend a psych consult...I think you should take something." An immigrant with an unemployed husband and health problems? "I'm going to increase your Celexa dosage." I could go on all day....but the point is, doctors will deliberately put patients on antidepressants to make them dependent; now the healthcare system is getting $$ for the rest of his/her life. (Nearly half of the $$ supporting the pharmecuetical industry is from antidepressants, according to one instructor). So there is a definite agenda there...and while I wouldn't think twice about explaining this to a counselee, you can't overstep your bounds by advising them against what their doctor is doing. Although I don't think a NANC counselor would agree to counsel someone who's also seeing a psychiatrist."

Paul Washer on Depression ("What Have You Learned from Jay Adams?")

Paul Washer is a humble, godly, passionate steward of the Gospel whose preaching God has used repeatedly to convict and encourage me. In a brief clip here, he tells the truth about the biblical means of dealing with depression (a battle he has fought in his own life). HT: Puritan Fellowship

Why I Won't be Wearing a Ribbon this Week

A number of years ago, participants in medical support groups began wearing ribbons to show support for themselves and other sufferers of their illnesses. The pink ribbon representing breast cancer, for example, is instantly recognizable and has helped, by its association, to raise millions of dollars for cancer research. Not to be left behind, those with behavioral addictions and psycho-somatic conditions later got on the bandwagon and developed ribbons of their own. (How wearing a ribbon helps someone with a non-biological illness, by any vague definition of "support", I am not clear).

Apparently, several years ago an online eating disorder directory declared the week of February 20-26 "National Eating Disorder Awareness Week" and exhorts those with EDs, loved ones of those with EDs, or those who used to have EDs to wear a periwinkle ribbon. The goal of this is two-fold: 1) To increase public "awareness" of eating disorders; and 2) to "support" those suffering.

Why is this unnecessary, and counter-productive?

1) The public is already well aware of what eating disorders are. The average American woman born after 1970 can recite the statistics by heart. An event like this only causes the public at large to become more callous to EDs, which are already household words. I remember in the early 1980's, when bulimia became extremely common and over-exposed by the media, a journalist snapping, "If I hear one more word about eating disorders, I'm going to have a serious case of indigestion!"

2) "Supporting" someone who is in an unhealthy, dangerous and sinful lifestyle is actually the least loving and most unhelpful thing one can do. Eating disorder sufferers do not need "support" so much as they need godly counsel and accountability, with change and renewal of the mind as the ultimate goal. "Support" makes one comfortable and complacent in one's behavior; true counsel seeks to correct and help someone develop new patterns of godly discipline.

I realize this is a sensitive subject, and I do not wish to criticize anyone who chooses to participate in the "Awareness Week" or wear a ribbon for any reason. I am simply stating my reasons why I choose not to, and explaining why this type of activity (which inadvertently glorifies the eating disorder and makes "heroes" out of those practicing anorexia and bulimia) is an unbiblical approach to a spiritual problem.

According to the web page, NEDA's Mission Statement is as follows:

Our aim of NEDAwareness Week is to ultimately prevent eating disorders and body image issues while reducing the stigma surrounding eating disorders and improving access to treatment. Eating disorders are serious, life-threatening illnesses — not choices — and it’s important to recognize the pressures, attitudes and behaviors that shape the disorder.

I see both good and bad in this Mission Statement. Of course we want to "prevent" eating disorders (if such a thing were possible -- one can no more change another's behavior than regenerate another's soul). The logic completely breaks down, however, between the first and second sentence: while NEDA claims (erroneously) that eating disorders are "illnesses", and not choices, it nevertheless wishes to "reduce the stigma" surrounding them. The fallacy of this statement is obvious -- if eating disorders were, in fact, diseases or 'illnesses', (which by definition have an organic, physical cause), why is there a "stigma" surrounding them?

If I have the flu, am I "stigmatized" because I allowed the influenza virus to enter my body? Or suppose I am diagnosed with spinal muscular atrophy -- a genetic condition. Shall I be "stigmatized" because of my faulty gene pool? Of course not! The word "stigma" is used here as a stand-in for "shame".  If someone were suffering from an actual illness, why should he or she be ashamed? Could it just be....because intuitively the founders here realize, that on it's root level, anorexia and bulimia WAS a choice, and the behavior IS ungodly?

I realize that this web page, and most like it, was written from a secular, worldly perspective and not a biblical worldview. I also understand that as a Christian, I cannot hold unbelievers (particularly those in the psych fields) to biblical standards. Yet when I first began doing research in this field, one of the first things that struck me so sharply was the inconsistency (and hypocrisy) with which the "Medical Model" is applied to addictions (aka 'life-dominating sins'). If we are going to draw attention to the presumed heroism of those with eating disorders by wearing a ribbon, why are we not likewise celebrating those who struggle with shoplifting ('kleptomania')? After all, it's a "medical condition". And why not wear a ribbon to raise awareness of adultery ("sexual addiction") or pedophilia? Both of these perversions are classified as "illnesses" by the DSM-IV.

Does Wearing a Ribbon/Celebrating NEDA Awareness Week Glorify God?

As a Christian (who was actively anorexic and bulimic for nearly two decades), my answer to this is an unequivocal "No, it does not." Why not?

1.) NEDA Awareness Week glorifies eating disorders (however inadvertently) in the name of "raising awareness". Those of us who are in Christ are instructed to have one, central, driving purpose in life: to glorify God.

2) It also glorifies individuals with eating disorders. I spent only a few minutes on their site, but noticed the same tendency most similar sites have: making heroes out of those with (or recovered from) eating disorders. This is more dangerous than you may realize: turning anorexic or bulimic girls into suffering martyrs (as I have seen the media do) almost guarantees that they will not change their behavior. One young lady I know was featured on a television documentary for her struggle with anorexia, and thus procured many "fans". A professing strong Christian, several years later, she still claims to be "struggling against this disease", but the thousands of Facebook pictures she posts of herself tell another story. So much adulation has been poured on Kylie that her "disease" has become her "identity" -- she no longer sees it as wrong. Those leaving comments telling her how "beautiful" and "gorgeous" she looks in her emaciated Facebook photos are not helping matters. Whether we have repented of anorexia or bulimia or are still stuck in this lifestyle, we are not suffering heroes to be idolized, ladies. We are sinners in desperate need of a Savior.


3) WWJD? Would Jesus have you wear a periwinkle ribbon to call attention to your eating disorder battle? Or, is it just possible that He would put His arms around you, remind you of His great love, and offer you the gift of repentance once again? In the Bible we see a pattern - the Lord Jesus lovingly confronting individual sin; then pointing the person to His Father. We need more "God Awareness"; not "Eating Disorder Awareness". And we definitely don't need "Self Awareness" -- as much as the eating disordered woman craves attention, we've already seen our true selves, and it ain't pretty!

4) Wearing the ribbon perpetuates the myth that eating disorders are physical diseases. Neither anorexia nor bulimia meet any of the criteria of the medical definition of 'disease':

"When an organic cause is found, it is given a medical disease label or diagnosis. ...the diagnosis is based on some specific demonstrated problem in various bodily functions. This physical malfunction is found by examining the body and its functions by means of various objective laboratory tests. The conclusion that something is wrong with the body is based on information obtained from these tests. Specific diagnoses each describe a disease in the body. There is damage to some body tissue that can be demonstrated by objective laboratory tests. The tissue damage is producing the behavior in each diagnosis. People with organic causes for abnormal behavior are given a diagnosis based on changes in the body, rather than on descriptions of behavior."

("The Christian Counselor's Medical Desk Reference", Dr. Robert D. Smith, MD, pp. 80-81; emphasis mine).

5. It plays into the "victim" mentality already so prevalent in our society. Ladies, if you are stuck in the pit of an eating disorder, you need help. You need grace. You need forgiveness (so freely available through Christ's atoneing work on the Cross), and you need to repent. You need godly counsel and accountability; compassion and encouragement. And you need to be honest with yourself: you are not a victim. Nor are you a hero. When I interpret at the hospital for cancer patients receiving chemotherapy, I hope and pray that the money raised from pink-ribbon proceeds someday helps these victims of cancer. Please, please, out of love and respect for cancer victims and their families, let's not even attempt to put ourselves in the same category. An eating disorder is not something that you "contracted" or that just happened to you...as hard as it is to hear that. The first step in my own transformation (or 'recovery', if you prefer) was recognizing my own responsibility in becoming an out-of-control bulimic and shedding the "victim" identity. Only then can true change begin!

To anyone who may be participating in this "NEDA" event or feel it would be helpful to her, I do not wish to sound unduly harsh. However, I would encourage you to ask yourself this: "Who, or what, is glorified by this ribbon? Is the Name of Christ lifted up, or am I seeking vindication for my own lifestyle? Do I long to change my behavior, and walk free? Will NEDA help me to do that, or will Christ?"

I love you, and more importantly, so does God. He can and will set you free, if you turn to Him.

Upcoming "Hope for the Hurting" Conference - Lafayette, Indiana

Are you suffering? Need to make changes? Registration just opened for this year's "Hope for the Hurting" biblical counseling conference in July. Held on the grounds of Faith Baptist church, next to Vision of Hope's residential treatment center in Lafayette, Indiana, this conference speaks directly to the underlying pain and struggle that women with eating disorders encounter (as well as those with other life-dominating sin).

Since quite a few of my readers are studying (or are interested in) biblical counseling, I recommend this conference not only to those currently in the process of repenting from eating disorders, but also to those who would minister to them. The conference, which runs July 21-23, 2011, features Senior Pastor of Faith Baptist and NANC Fellow Steve Viars; Executive Director of Vision of Hope Jocelyn Wallace; author Amy Baker; and some of the Vision of Hope staff, among others. The conference info page mentions that a limited number of private, one-on-one counseling sessions will be available. The conference description says:

A Conference for Those Who Are Hurting



At one time or another every human being will endure periods of intense suffering. It is common to the human condition. However, something so common to each of us has the potential to completely derail us, devastate us, and potentially ruin us unless we understand how to Biblically respond to it. God’s word has so much to say about how we should think about and respond to pain.

See rest of information and registration page here.

If you are anywhere in the area or can avail yourself of this truly Christ-centered conference, I strongly recommend you do so. On a personal/ministry note, I have decided that if my book has been published by July, I will go myself (otherwise, it will be hard to justify the expense of travel). Currently, "Redeemed from the Pit: Biblical Repentance and Restoration from the Bondage of Eating Disorders" is in the capable hands of my publisher at Calvary Press. I received the foreward early last week; all endorsements are in and the final copy is edited and ready to go. Although I have not yet heard when the book will be released, the project is now out of my hands and I trust God to bring it to fruition in His perfect timing! When I have a date for publication, I will share.....but in the meantime, do avail yourself of this wonderful opportunity if you can!

P.S. The Indianapolis airport is incredibly easy to drive in and out of. It's right in the middle of a cornfield. So don't let the fear of driving in a new place put you off - they really couldn't have made it any easier.

Hope to see some of you in Indiana........

Disappointment in Course (or, At Least there's a Market for My Book!)

Nothing. In over 600 pages,
there's NOTHING HERE!

It was with great anticipation that I looked forward to the arrival of my current course in the biblical counseling tract I'm taking, "Medical Issues in Counseling 1 and 2". The course syllabus promised a 12-lecture course dealing with "specific medical issues i.e. anorexia, bulimia..."(sic) among other things.

Even though I have spent the last several years researching, writing and informally counseling women with eating disorders, according to biblical principles - to the best of my knowledge -naturally I was quite eager to see what the "experts" had written about this pervasive subject afflicting millions of Christian women. I was greatly looking forward to learning how top biblical counselors approach the whole subject of food addiction, bulimia in particular.

The 12 DVD set just arrived in the mail, along with the required text: "The Christian Counselor's Medical Desk Reference" (a $40 book, by the way). Including appendices, this tome is nearly 500 pages. IT DOES NOT CONTAIN ONE SINGLE WORD ABOUT ANOREXIA, BULIMIA, OR EATING DISORDERS. Neither do the more than 100-pages of lecture notes provided with the video lectures. (There is, however, an entire lecture devoted to "sleep disorders"). If anorexia and/or bulimia are even touched on at all in the lectures, the subject must have been so parenthetical as to not even warrant mention in the lecture outlines.

I am deeply disappointed, to say the least. My only explanation for this is that these books/lectures are written by men, and eating disorders tend to be a female-problem. (In biblical counseling, men counsel men and women counsel women, unlike in the psych fields). Broadly speaking, biblical counseling tends to be a very male-dominated field (and I say that as a complementarian...I strongly uphold male leadership in the Church); but more than half of Christian counselees are women. How could such a huge issue as eating disorders be so completely overlooked in a course like this? Especially when it is listed, on the course syllabus, as being included? If, after I have viewed all of the lectures it turns out that anorexia or bulimia was discussed, I'll write a retraction. But based on this (very expensive) material, there's nothing there.

I suppose there's one positive way of looking at this oversight: there's a definite market for my book! There is virtually nothing, written from a purely biblical perspective, on the subject of eating disorders.

Well...that's about to change. As soon as the publisher gives me an approximate publication date, I'll share and let you know how you can pre-order "Redeemed from the Pit".