Hope is powerful; so powerful it can radically alter the course of life, just like it did for Steven.^[1] Currently in his sixties, Steven lived with anxiety and depression ever since his teen years. Over the decades, he has interacted with numerous doctors who prescribed him numerous medications that seemed to work for a little while, but he soon found himself battling the same feelings of sadness and worry. Although Steven claimed to be a believer, church was not much of a priority for him, and he rarely read his Bible.

One of the issues that caused his anxiety to increase dramatically is the fact that he was hiding a significant sinful lifestyle from his wife for years. She thought his bouts with depression and anxiety were due to his mental illness and an imbalance with his medication. His struggles brought about a racing heart, sleepless nights, and constant nausea as he continued to live in secret sin.

That all changed one Sunday as Steven sat in church and heard about the amazing grace of Jesus that can rescue a sinner who struggles with his specific sin. Steven came to the realization that he was lost and needed Christ for salvation. He also knew right then and there that he must confess his sin to the Lord and to his wife and get help from his church. I had the joy of working with Steven, who realized that his current battle with anxiety and depression was connected to his unconfessed sin and how the gospel brings the freedom he was looking for.

Steven is now a devoted follower of Jesus Christ who reads his Bible every day. As a faithful church member, he sits with his family each Sunday, and he leads his wife and children in family worship at home. In the past, anxiety and depression ruled his life, but now there is indescribable joy that has come because his hope is in Jesus Christ alone!

In this essay, I want to explore mental illness as the negative backdrop that fuels the search for the misguided hope in the world of mental health. More than that, I want to show broken people that real hope is found in the Bible because that’s where Jesus, our living hope, is found. Finally, we will critique the confusion of hope found in the book A Christian’s Guide to Mental Illness.^[2]

The Source of True Hope

In the search for real, lasting hope, one key passage is 2 Corinthians 4:16, “so we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day.” Here, Paul identifies the dual nature of man, that humans are composed of a body and a soul, the union of the physical and the spiritual.^[3] There is massive biblical evidence that shows the interaction of these two natures as they work together, as well as impact and are impacted by each other.^[4] Second Corinthians 4:16 highlights the reality that while the physical body is wasting away (i.e., gets sick, damaged, and will eventually die), for the Christian, the spiritual is constantly improving.

The Bible uses numerous terms for this inner, immaterial nature of man. The most frequent term used is that of “heart.” Proverbs 4:23 says, “Keep your heart with all vigilance for from it flow the springs of life,” and in Matthew 12:34, Jesus says, “For out of the abundance of the heart the mouth speaks.” The basic understanding of these verses is that the immaterial gives motivation to and direction for the material nature of life. In other words, humans live out of their hearts. Another term the Bible often uses to refer to the inner man is “mind.” These two words are equated when Jesus says, “You shall love the Lord your God with all your heart and with all your soul and with all your mind” (Matthew 22:37). Jesus is not identifying three different aspects of man. Instead he is stacking synonymous terms on top of each other to make a point. Using the most common biblical terms to refer to the immaterial, spiritual nature of humans, Jesus teaches that from the core of our being, man is to live to the glory of God with comprehensive love and devotion, and this is to be the driving force behind everything we do (c.f. 1 Corinthians 10:31).

However, because of sin, man no longer desires to live to the glory of God. Instead, Romans 1 and 2 say that humans, by their unrighteousness, suppress the truth about God, even though he has made himself known to them in what he has created and has written his law on their hearts. Thus, fundamentally every person possesses an internal knowledge of God along with irrefutable external evidence of his existence. Yet because of sin, humans in their unrighteousness suppress that truth. It is in this foolish, darkened state of mind that unrighteous humans then begin to live in rebellion against God and in opposition to the purposes for which man was created, which opens the door to countless negative consequences.

These consequences are seen in 2 Timothy 3, where Paul writes that the last days will be described as times of difficulty and then proceeds to give a litany of sins that characterize those difficult days: issues like abuse, rebellious children, slanderous lies, and brutal violence (2 Timothy 3:1-5).^[5] Just a cursory reading of these verses will lead one to realize that those days are upon us! Paul continues by mentioning individuals who will be burdened with sin and led astray by various passions, who are always learning and never able to arrive at a knowledge of the truth (3:6-7).^[6] Then he says, “Evil people and impostors will go from bad to worse, deceiving and being deceived” (3:13). In short, the last days will be defined by sin and deception, a horrible situation that will only get increasingly worse.

These difficult days produce people who are weighed down by sin. Not only do they commit sin, but they also have sin committed against them. People know that this world is broken, and they have a desire (i.e., a passion) to be freed from those burdens. Paul makes it clear that this passion leads them to try and find answers to their problems, to learn how to escape the difficulty of this world. However, because their thinking is futile and their foolish hearts are darkened, as seen in Romans 1, their learning does not lead them to a knowledge of the truth. In other words, they are trying to solve the problems of life without looking to the Giver of Life (c.f. Jeremiah 2:13).

Yet in the face of the increase of sin, deception, and the resulting heavy burdens, Paul points Timothy back to the truth, the God-breathed Scripture that makes one wise for salvation through Christ Jesus and equipped for every good work (3:15-17). Thus, in the face of horrible things like abuse, broken family relationships, and the vast wickedness that results from the love of money (c.f. 1 Timothy 6:10), Paul says the way to deal with those who commit these sins and minister to those weighed down by the effects of sin is through the Word, because only in the Word do we have the true source of hope found in Jesus.

Wayne Mack says it well: “In clear and unmistakable words, Paul tells us that the resources we need for ministering to people who live in a 2 Timothy 3:1-13 society are found in the Scripture…Paul extols the Bible’s total adequacy for ministering to people whose lives are characterized or affected by the things mentioned in verses 1-13.”^[7] The Bible is the true source of hope because the Bible alone gives us what we need to be reconciled with God and equipped to live life in the way God intended us to live (c.f. Ephesians 2:10).

The Source of False Hope

Now, we turn our attention to the subject of mental health and mental illness. When we look at the secular world of mental health, we see the conflation of the inner and outer man. This is the result of an evolutionary understanding of man, which does not see humans as possessing two natures but one: that man is nothing more than a physical body, and that human functioning is nothing more than chemical reactions and electronic impulses. Going one step further, this seems to be evidence of what Paul refers to as those who are always learning yet never arriving at a knowledge of the truth (2 Timothy 3:7). Broadly speaking, the mental health industry represents an attempt to help people who are burdened by this world find answers to the problems of life apart from the Giver of Life. But before we go any further, some history and definitions will be beneficial.

Terms like “mental illness,” “mental disorder,” and “mental health” find their origins in the early 1900s through the work of Clifford Whittingham Beers and his focus on “mental hygiene.” Beers is thought to be the father of modern psychiatry in America and thus responsible for the movement that started to see problems of the mind as objective physical diseases.^[8]

According to the American Psychiatric Association (APA), “mental illness” is a term that refers collectively to all diagnosable mental disorders that involve significant changes in thinking, emotion, and behavior and can also include distress and/or problems functioning in social, work, or family activities.^[9] The APA defines a mental disorder as “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.”^[10] In general, “mental illness” is the broad term for which “mental disorders” are individual categories.

The National Alliance on Mental Illness (NAMI) describes mental illnesses as “medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.”^[11]

In each of these definitions, there are some keywords and phrases: “diagnosable disorders,” “syndrome,” “clinically significant,” “biological,” “mental functioning,” and “medical conditions.” All of these phrases are a referent to the Diagnostic and Statistical Manual of Mental Disorders, with the most recent iteration being the fifth edition (DSM-5). This manual is owned, published, and maintained by the APA and can be viewed as an encyclopedia of mental disorders, which includes the diagnostic criteria used to identify each disorder. It has become the standard by which the medical community in America understands, diagnoses, and researches mental illness, as well as the mechanism used by doctors and mental health professionals for medical coding and insurance purposes.

These phrases give the impression that mental disorders can be viewed as or are similar to physical illnesses. The NAMI even seeks to establish mental illness as a brain disorder, much like diabetes is the result of a disordered pancreas. The DSM-IV, the precursor to the DSM-5, provides further insight into this when it says, “the term mental disorder unfortunately implies a distinction between ‘mental’ disorders and ‘physical’ disorders that is a reductionistic anachronism of mind/body dualism. A compelling literature documents that there is much ‘physical’ in ‘mental’ disorders and much ‘mental’ in ‘physical’ disorders.”^[12] In other words, we are meant to see mental disorders largely as physical disorders.

However, the vast majority of the categories in the DSM cannot be proven to have a biological root. In fact, the DSM-5 itself gives room for this reality when it states, “Until incontrovertible etiological or pathophysiological mechanisms are identified to fully validate specific disorders or disorder spectra, the most important standard for the DSM-5 disorder criteria will be their clinical utility for the assessment of clinical course and treatment response of individuals grouped by a given set of diagnostic criteria.”^[13]

Three implications must be highlighted from this statement. First, the manual itself identifies disorders within the manual that do not have a physical cause or functional physical changes. Second, the statement presupposes–or at least implies–the hope that those physical aspects will one day be discovered. Third, the most important element of the DSM-5 is the clinical utility, namely that it should “help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their patients.”^[14] This exposes the worldview of the DSM-5, the belief that mental disorders are fundamentally physical in nature, even though for the vast majority of those disorders, no physical etiology has been discovered. This belief then becomes the framework from which clinicians diagnose and seek to treat their patients.

However, since no physical cause has been found, diagnosis is not based upon any physical test performed. There is no bloodwork, no sample taken, and no physical science practiced to diagnose mental disorders. Instead, in general, diagnoses consist of an interview with a doctor or mental health professional, including surveys and questionnaires filled out by the patient, and based upon the answers to those questions and the symptoms described by the patient, a diagnosis is given, and a treatment plan is prescribed. Referring back to the APA and the NAMI definitions, these symptoms include troubling thoughts, emotions, behaviors, and difficulty in coping with life situations, whether they be social, occupational, or familial relationships. This is what is known as symptom-based diagnosing.^[15] In short, a diagnosis is based upon the patient’s subjective explanations of their struggles that are then interpreted by the clinician using the DSM-5 criteria to assign a disorder, who then charts a course for treatment, which in America often includes the use of psychotropic medication.^[16]

The use of medication is an example of methodology flowing out of a worldview. If the problem is assumed to be physical in nature, then the solution must also be physical in nature. However, this process is not based on hard scientific discovery but rather upon a faulty view of anthropology and subjective interpretations of life. This approach has been critiqued by many within the field of psychiatry and mental health:

• Former Director of the National Institute of Mental Health, Thomas R. Insel, said, “The weakness is its lack of validity…the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”^[17]
• Professor Peter Kinderman, University of Liverpool, said: “The biomedical diagnostic approach in psychiatry is not fit for purpose…The diagnostic system wrongly assumes that all distress results from disorder and relies heavily on subjective judgments about what is normal.”^[18]
• Paul Minot, Professor of Psychiatry for Tufts University School of Medicine, writes, “The assumptions of the general public are that we psychiatrists have a good understanding of how the brain works; that we can diagnose distinct disease states, of which we have some pathophysiological knowledge; and that we can prescribe treatments, usually medications, with full awareness of how it is that they benefit us. But every one of these assumptions is unequivocally and demonstrably false.”^[19]

In other words, there are a lot of unknowns when it comes to mental illness, and the biological approach is very problematic. However, that does not mean it is all bad news. Here is where the element of hope comes into the equation. Even though most are not “cured” of mental illness and end up taking medication for life, it is true that some people are helped; lives are improved, symptoms are diminished, and suffering is relieved.^[20] However, when it comes to medication, the mental health industry does not know exactly how or why.^[21]

Part of the uncertainty is due to the placebo effect, which can be defined as “the measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered.”^[22] Placebos are used in drug trials to test the effectiveness of a certain medication. In general, volunteers are divided into two groups where one group receives the active drug while the second group receives an inactive pill, commonly known as sugar pills. Neither group knows if they are receiving the actual medication. Once the test is complete, the results are collected, and the differences between the two groups reveal how well the medication works.

However, medications used to treat mental illnesses often show no clinically significant difference in effectiveness over placebos. Dr. Irving Kirsch, a lecturer in medicine at the Harvard Medical School, says, “the analyses of the published and the unpublished clinical trial data are consistent in showing that most (if not all) of the benefits of antidepressants in the treatment of depression and anxiety are due to the placebo response, and the difference in improvement between drug and placebo is not clinically meaningful.” He goes on to cite a meta-analysis study that shows that the medically intended results for antidepressants used to treat depression and anxiety were also found in 75% of placebo groups.^[23] Even UCLAHealth says that placebos can bring about positive responses in patients even though the pills have no medical reason to be effective, especially when administered by a compassionate medical provider.^[24]

All of this raises questions about what is “working.” In short, the placebo effect is the belief that a drug will “work” because it is a pill given by a medical professional. There have been numerous studies that show the power of this type of thinking, ^[25] the hope that the medication will make things better. Yet, with reason to doubt the physical effectiveness of the medication, which comes from psychiatrists’ own testimony, an argument can be made that it is not the drug itself but the hope in the drug that brings about positive results. One thing that can be said about the placebo effect is that it shows how the power of hope has an amazing ability to bring about change, regardless of where that hope is placed.

The Source of Confusing Hope

This brings us to a critique of A Christian’s Guide to Mental Illness: Answers to 30 Common Questions by David Murray and Tom Karel Jr. Murray is a pastor, counselor, speaker, and author of many books. Karel is a practicing psychologist at a Christian mental health center in Grand Rapids, MI, along with serving as an elder at his church. These men are ministers of the Gospel who love Jesus and want other people to know and follow him.

The goal of their book is “to replace confusion, error, and misunderstanding with clarity, truth, and education so that we all can be more effective in caring for the mentally ill” (7-8). Yet, the impression of the book reveals a desire to wed the clarity of God’s Word with the false hope of the mental health industry, thus diluting the true hope found in the Bible with the fraudulent hope found in the world. This is seen in the statement, “This word-directed, holistic approach is the most honoring to God and the most beneficial for sufferers and their families” (5). Even though their motives are genuine, there is much that raises concern.

The first concern is their acceptance of the physical root of mental illness. They acknowledge, “Apart from a few rare exceptions, there is no test to confirm the existence of mental illness, tell us what’s wrong, or show us how to put it right” (2). Yet they accept the NAMI definition of mental illness (mentioned above) and say that “‘Illness’ is helpful in that it points to a physical or biological problem requiring medical help…but, unlike many medical conditions, mental illness can rarely be identified with medical tests and is rarely cured with medical input alone” (16-17). In many places, there are comparisons between mental illness and medical issues such as cancer, diabetes, and the common cold. They also accept that there are chemical imbalances in the brain that can be corrected through medication (127), which is a theory abandoned in psychiatric medicine.^[26]

All of this is in line with Murray’s thinking, who has said elsewhere that mental illness can be viewed as a sickness in the brain like diseases in other parts of the body.^[27] The assumption is that the symptoms of mental illness provide evidence that something is wrong with the brain (82). However, this is to confuse the distinction between brain and mind; the inner man and the outer man. This confusion is seen when the authors write, “We cannot retreat from mental pain. It’s inside our body or brain. With a tortured mind, there’s nowhere to run or retreat to. Thoughts follow us and are with us wherever we go” (41). Here, the words mental, mind, body, and brain are used interchangeably.

The authors also say, “Despite its limitations, ‘mental illness’ is still the preferred label in the medical profession and in popular culture…Having weighed the pros and cons, we’ve reluctantly decided to retain the use of the label ‘mental illness’ in this book” (16-18). A charitable reading of this statement is that this shows a desire to use a common phrase to avoid the confusion and added explanation that may come from introducing a different term. But taken at face value, the authors are intentionally using a secular phrase that comes with massive worldview implications with almost no biblical counterbalance. These statements are made at the beginning of the book and thus inform the way in which “mental illness” is understood throughout.

A second concern for the book is the loose boundaries given to the term “mental illness.” One of the strongest criticisms leveled against the DSM-5 comes from Allen Frances, who was the Chairman of the DSM-IV Task Force. In his book Saving Normal, he includes a chapter entitled “Diagnostic Inflation,” where he claims that the current medical definition of mental illness is too loose and “the diagnostic labels have changed and are too elastic. Problems that used to be an expected and tolerated part of life are now diagnosed and treated as a mental disorder.”^[28]

Murray and Karel often allude to their acceptance of the DSM’s broad perspective on mental illness but make no attempt to draw a tighter circle around the term. They write, “Mental illness is also varied in terms of the nature and severity of symptoms. Each category of mental illness has a range of symptoms associated with it” (11). They identify that the term covers everything from schizophrenia to alcoholism, even to pedophilia (15), with no clear delineation between what is a mental illness and what are normal life experiences. Given their acceptance of the DSM’s expanding list of disorders and the lack of biblical evaluations, the danger is that the adherence to the ever-broadening categories of mental illness overshadows and sets aside the biblical approach to life in this world.

A third concern is their use of Scripture, both in the lack of it in key areas and the misuse and misapplication of it in others. When it comes to the lack of Scripture, one glaring omission is that not once does the book ask, “What does the Bible say about mental illness?” or “How should we think about mental illness biblically?” The authors do use the Bible to provide comfort and encouragement but not for assessment and critique. Any Christian who embraces the authority and sufficiency of Scripture should be concerned to show God’s mind on such a consequential topic.

Scripture is also absent when it comes to the authors’ use of DSM-5 categories, labels, and criteria with little to no biblical interpretation. One example is the topic of sin and repentance, which plays a minor role when compared to the numerous uses of mental health diagnoses. They fail to acknowledge that much of the DSM has connections to the Bible, especially in regard to the moral nature apparent in the diagnostic criteria.^[29]

When it comes to the misapplication of Scripture, one example is that they read mental illness into the text of the Bible as they assign mental illness to biblical characters based upon the assumption that mental illness has been around since the fall, claiming, “When sin invaded the world, mental illness invaded our minds” (9). At numerous times, David is identified as having mental illness, with Psalms 32 and 51 used as evidence (42, 52, 92). They also say that the entire book of Psalms gives us biblical accounts of the struggles with mental illness (216). Nebuchadnezzar is said to have experienced mental illness, even though the authors acknowledge that his suffering was at the hand of God, which was clearly a spiritual issue that no amount of mental health efforts could cure (161, 194)! Another example is the authors’ identification of mental illness as a talent represented in the parable of the talents (Matthew 25:14-30). They write, “Mental illness is a talent that has to be used the right way to bring a return on investment that does good to us and brings glory to God” (231). What these examples represent is the mixing of true hope and false hope, which only brings about a confusion of where hope can be found.

Conclusion

Hope is a powerful force that can bring radical improvement in people’s well-being. With something so powerful, we must make sure that hope is grounded in something that is lasting and genuine. The mental health industry provides their version of hope, claiming to have found the way to address life’s problems, often found in a pill. However, that hope is always changing, for it is founded upon questionable science and a faulty view of anthropology. The Bible, however, offers the only source of true and lasting hope because the Bible tells us the truth about who we are, why we struggle, and how Jesus can make us right through the forgiveness of sins and the transformation that comes by his grace. Murray and Karel have written a book with genuine motives but end up providing a confusion of hope that mixes the truth of the Bible with the contestable claims of psychiatry. May we leave the shifting sand of mental health and return to the solid ground of the Word and to the Rock who is Christ.

^[1] The name and the details have been altered to protect his identity.

^[2] David Murray, Tom Karel Jr., A Christian’s Guide to Mental Illness: Answers to 30 Common Questions (Wheaton, IL: Crossway Books, 2023).

^[3]For a helpful discussion on the topic of inner man/outer man distinction when it comes to mental illness and the distinction between the mind and the brain, see Greg Gifford, “The Mind and the Brain, Parts 1-7,” https://transformed.org/podcast/the-mind-and-the-brain-part-1/.

^[4] Romans 12:1-2; 1 Kings 19; Psalm 51.

^[5] This passage has great significance for the sufficiency of scripture in biblical counseling, as indicated by Wayne Mack, “People need counseling either because they are personally experiencing and manifesting simple attitudes, desires, and behaviors; or they are personally suffering from the influence of people who manifest the simple patterns depicted in this passage.” Wayne Mack, “What is Biblical Counseling,” in Totally Sufficient: The Bible and Christian Counseling, ed. Ed Hindson and Howard Eyrich, (Ross-shore, Great Britain: Christian Focus Publications, 2004), 45.

^[6] When Paul talks about passions in this verse he’s talking about the inner person of the heart that motivates life. For a helpful treatment of the heart and its functions, especially as it pertains to thoughts and feelings, which are often the subject of mental illness, see Jeremy Pierre, The Dynamic Heart in Daily Life: Connecting Christ to Human Experience, (Greensboro, N.C.:New Growth Press, 2016).

^[7] Mack, “What is Biblical Counseling,” 46.

^[8] Jose Bertolote, “The Roots and Concept of Mental Health,” World Psychiatric Association, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408392/ (accessed April 27, 2024).

^[9] American Psychiatric Association, “What is Mental Illness?”  https://www.psychiatry.org/patients-families/what-is-mental-illness (accessed April 18, 2024).

^[10] American Psychiatric Association, ed., Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed, (Washington D.C.: American Psychiatric Association, 2013), 20.

^[11] NAMI California, “About Mental Illness,” https://namica.org/what-is-mental-illness/ (accessed April 18, 2024). This is the definition of mental illness that Murray and Karel accept in their book, discussed below.

^[12] American Psychiatric Association, ed., Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed, (Washington D.C.: American Psychiatric Association, 1994), xxi.

^[13] APA, DSM-5, 20.

^[14] Ibid.

^[15] Gifford, “Mind and Brain, Part 4,” Transformed,  https://transformed.org/podcast/the-mind-and-the-brain-part-4/ (accessed April 21, 2024)

^[16] For an expanded discussion about medication and its overuse in America, see Charles Barber, Comfortably Numb: How Psychiatry is Medicating a Nation (New York: Vintage Books, 2009).

^[17] Thomas Insel, “Transforming Diagnosis,” National Institute of Mental Health,  https://psychrights.org/2013/130429NIMHTransformingDiagnosis.htm (accessed April 30, 2024)

^[18] University of Liverpool, “Psychiatric Diagnosis ‘Scientifically Meaningless,’”  https://www.sciencedaily.com/releases/2019/07/190708131152.htm (accessed April 30, 2024).

^[19] Paul Minot, “Many of the Public’s Assumptions About Psychiatry are False,”  https://www.paulminotmd.com/ (accessed April 20, 2024).

^[20] For a report of both negative and positive outcomes from the practice of psychiatry, see Alan Frances, Saving Normal: An Insider’s Revolt Against Out-Of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and The Medicalization of Ordinary Life (New York: HarperCollins, 2013), 242-278.

^[21] Betsy Reed, “The Drugs Don’t Work (And Other Mental Health Myths), The Guardian. Aug 7, 2022. https://www.theguardian.com/society/2022/aug/07/the-drugs-dont-work-and-other-mental-health-myths (accessed May 7, 2024).

^[22] Scientific Direct, “The Placebo Effect,”  https://www.sciencedirect.com/topics/psychology/placebo-effect#definition (accessed May 7, 2024).

^[23] Irving Kirsch, “Placebo Effect in the Treatment of Depression and Anxiety,” Frontiers in Psychiatry. May 22, 2019,  https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2019.00407/full (accessed May 7, 2024).

^[24] UCLAHealth, “Placebo Effect: Sugar Pills as Medicine?” March 14, 2019, https://www.uclahealth.org/news/article/placebo-effect-sugar-pills-as-medicine (accessed May 7, 2024).

^[25] Harvard Medical School, “The Power of the Placebo Effect,” Harvard Health Publishing. https://www.health.harvard.edu/mental-health/the-power-of-the-placebo-effect, and “The Placebo Effect: Amazing and Real,” Harvard Health Publishing.  https://www.health.harvard.edu/blog/the-placebo-effect-amazing-and-real-201511028544 (accessed April 17, 2024).

^[26] Christopher Lane, “A Decisive Blow to the Serotonin Hypothesis of Depression: An Exhaustive Review Debunks the ‘Chemical Imbalance Theory of Depression.” Psychology Today, July 19, 2022,  https://www.psychologytoday.com/us/blog/side-effects/202207/decisive-blow-the-serotonin-hypothesis-depression (accessed April 17, 2024).

^[27] This is one of Murray’s main arguments in Christians Get Depressed Too (Grand Rapids: Christian Heritage Books, 2021). He said in another location “We wouldn’t expect somebody with a broken body, a broken brain, a broken chemistry to have all the emotions and the thoughts they need to have joy and have fearlessness.” David Murray, “Podcast: Answering Common Questions About Mental Illness,” Crossway, September 23, 2023,  https://www.crossway.org/articles/podcast-answering-common-questions-about-mental-illness-david-murray/(accessed April 26, 2024).

^[28] Francis, Saving Normal, 84.

^[29] Charles Hodges, The Christian Counselor’s Medical Desk Reference, 2nd ed. (Greensboro, N.C.: New Growth Press, 2023), 11, provides some clarity on this issue when he says, “I will never call anything a disease that the Bible identifies as sin. This is an important divider of diagnosis. So much of what the DSM-5 calls disease is simply inconvenient or disagreeable behavior. And, in a good number of cases, that behavior is defined in the Bible as sin.”