Resisting Therapy Culture — with Matthew Loftus

[00:00:00] You're listening to Thatll Preach. We've got Matthew Loftus on our show today to talk about his book, Resisting Therapy Culture. And Matthew, he lives in Kenya with his family. He's a family medicine physician. He works at a hospital that was founded by Christians in Kenya, and he's serving there. And we're really excited to have you on the show. Thanks for coming on, Matthew. Thanks so much. Glad to be here.

[00:00:25] Well, we really enjoyed this book. Paul and I were talking about this off the mic. We appreciated how well-researched it was, and also a lot of the nuances you brought to it. And this idea of therapy culture, that is an attention-grabbing title. Maybe explain to us what is therapy culture, and what got you interested in this topic?

[00:00:55] Yeah. Thanks, Brian. So therapy culture is, it can be described in a lot of different ways, but I think the three most important things are, number one, it's medicalizing normal human experiences.

[00:01:11] So it's taking the grief that, you know, people experience normally in their life and calling it depression. It's taking our thoughts about, you know, just sort of normal worry, the things that we all experience and calling that anxiety disorder and kind of magnifying all of these things and medicalizing them.

[00:01:37] And then another big component I think that we see in both churches and schools is judging institutions by their perceived mental health impact. And so the idea there is, well, if it makes someone more anxious, then it can't be good. So you can't hold people to certain standards anymore. And then finally, when you have these different components in place and people think of themselves as sick, excuse me,

[00:02:03] then they start to act sicker and become sicker. And so people become, they're weaker. They're less able to do things. They have less agency in their own lives. And that can just be really catastrophic for people and how I got interested in this. I mean, I have a lot of different interests in mental health. I love practicing mental health and taking care of sick people,

[00:02:31] both in the U S and here in my practice in Kenya. I personally experienced different mental health issues over the years and just more and more what I was hearing from friends, from pastors, seeing in patients and even learners working with is just this ever growing sense of, you know, more and more mental health diagnoses without people necessarily getting better.

[00:02:58] And just watching the proliferation of well, therapy culture and seeing that it was starting to have some really negative effects. So it seems like there's two aspects of this where one, like you're saying there's a medicalization of normal experiences in, in, in human life, grief, sorrow, anxiety, fear, all these types of things.

[00:03:23] And added to that is that recategorization of these things actually ends up harming the person and making things worse. Okay. Yeah. Interesting. Yeah. Yeah. And even you see like in schools, for example, there's a lot of, um, push to have, you know, school mental health screening programs and identifying conditions.

[00:03:49] And now more and more evidence is coming out that actually the more that you ask teenagers, you know, do you feel depressed? Do you feel depressed? Do you feel depressed? Eventually they're going to start saying, well, well, gosh, you know, I don't feel like I'm fully living up to potential. So maybe I am depressed. And then, you know, they start to inhabit that, that diagnosis. And it even seems like people are noticing this across sort of the political spectrum,

[00:04:17] so to speak. It's something that people who, whether they identify as more progressive or liberal or conservative, whatever it is, it seems to be a universal observation that in a time of the most resources for mental health, you're seeing the highest rates of mental health issues and how to, how to untangle that. Absolutely. Why don't you talk a little bit about the history of therapy and, and, uh,

[00:04:47] and just some of the historical roots of this. And cause you go about, uh, you talk about that a little bit in the book, which kind of helps give a context to what we're talking about. Can you give a brief overview?

[00:04:59] Sure. I mean, uh, you know, it kind of depends on where you choose to start. Um, you could go back to, um, ancient history really. And, and think about, uh, you know, there's kind of this argument that you have, um, even from the earliest philosophers, right? That philosophers were interested in the same source of questions that people bring to therapy today, which is, you know, how do I live a good life? How do I deal with that?

[00:05:28] How do I deal with the difficulties within myself? Uh, how do I, you know, stop myself from doing bad things? Uh, you, you definitely see, I think within like the early church and in particular, Augustine, um, this looking inside of yourself.

[00:05:49] Now, you know, this is a little bit outside of my pay grade, but certainly, um, you, you can see threads, um, even from within the earliest church fathers, like Augustine, right. Of, of seeing an, an, an inward turn.

[00:06:05] And for Augustine, that was obviously like learning about himself and within ourselves. So that way we can discern what it is that God created us for and glorify him and whatnot. Um, and then the other aspects of this are more, um, kind of develop over the years.

[00:06:29] And then with, um, uh, the scientific revolution, you start to see more psychology as a discipline in and of itself and how that becomes, um, uh, more scientific, more categorized, more of people trying to, um, you know, study.

[00:06:57] Okay. How do people respond in certain circumstances as they, um, encounter different phenomena and things like that? We, uh, then moved to Freud, uh, you know, Sigmund Freud, who is, um, just revolutionary in a way that a hundred years later is hard to appreciate just because so many of the things that he wrote about for the first time were, you know, now feel very commonplace, especially in a very therapeutic culture.

[00:07:27] Um, you know, but we can't, you know, as, as much as we may not like the fact that he was anti-Christian in many ways. And he saw, um, in particular sexual morality as really psychologically harmful to people. Like there's still things that we talk about and think and take for granted now, like for example, the idea that one, you know, someone's childhood trauma might affect their behavior as a grownup.

[00:07:55] Right. We take that for granted now, but that was a pretty revolutionary idea, uh, pretty big, important insight. Right. And it's, and it's the power of insights like that. I think that gave psychology and therapy, it's sticking power within our culture.

[00:08:11] And, um, and so, but the more that those, you know, when people took those, those insights and those ideas and sort of ran with them and, and let them, you know, in many ways kind of metastasize beyond their original purview.

[00:08:29] That's when I think, um, you know, therapy as a culture started to really germinate and, and become more, uh, more powerful than it ought to be.

[00:08:43] Um, so in 1968, um, so in 1968, you have, uh, Philip Reif writing Triumph of the Therapeutic, which is, um, uh, a book that sort of, I think signals sort of this point at which, um, therapeutic culture, uh, is now becoming more dominant in American society or really in, in, in most Western societies, I should say.

[00:09:09] And then, uh, from that point on, you know, there's kind of been this back and forth. I was just talking with, um, a pastor not too long ago who, you know, said, well, you know, in the, in the nineties, we had, you know, the pastor as CEO. And then in the eighties, we had pastors therapist.

[00:09:28] So like there's, you know, there's been these cycles, um, but really in the last decade or so, um, I think things have really accelerated to the point now where you have now this real institutionalization of therapy, like with, um, mental health screening programs in schools and things like that. Um, so, um, yeah, that's kind of the brief contours. And I hope that's helpful. No, that was, that was really helpful.

[00:09:57] I mean, I think you can see, and this is why I think your book is really insightful because I think even in the church and maybe the past 10 or 15 years, there's sort of been a reaction to a complete denial of any kind of mental disorders, uh, a complete sort of shutting out maybe of, of any kind of psychological insights.

[00:10:19] It's the point where now people are so infused with therapy language that you wonder if it's what not, you wonder it, all these things happen like pendulum slings and you swing the other direction to where you can't even make moral judgments anymore. Or, you know, or at least, you know, you're very, you're very afraid of sort of, uh, there, there, there becomes in a sense, a new set of commandments that you can violate that are ever shifting, you know, when it comes and you're trying to help people.

[00:10:47] But even, and I think there's definitely some overtones of that. And so, but you don't want to throw the baby out with the bathwater. And I think a lot of it is philosophical in some ways on the nature of human agency and things like that. I know, Paul, we talked about that a little bit. Do you want to chime in on that?

[00:11:05] Yeah, Matthew, one thing that I found really helpful in the book is that you're trying to, to carve a middle way between the two extremes of maybe in the sixties, seventies, I don't know the exact history, but the church. And you still get voices like this today. I think you were talking about maybe in certain parts of the African church, a kind of like instinctual kicking against the idea of mental illness.

[00:11:28] It's all directly under our control or indirectly in our control, um, or it's all spiritual oppression. Um, and there's nothing actually happening in the brain. There's nothing actually happening neurobiologically. So that's, that's one extreme. And the other is the extreme that you're taking on explicitly in the book, which is the over therapeuticization. I'm not even sure if that's over medicalization of, of, um, very everyday normal phenomena of human experience.

[00:11:57] Um, and I really appreciated that you were trying to say, okay, well, let's try to avoid both errors here. And there there's serious, there's PTSD, there's depression as a technical term. There's trauma in a technical sense. Let's preserve these categories and see how to, um, how can the church like think about these issues? And then you say at the end, the church is not meant to fix PTSD.

[00:12:19] It's not meant to be a medical professional, but how can the church come alongside these individuals without labeling everything trauma or everything, depression or everything? Um, but one question I did have, and this is Brian. I were talking about this earlier. How do we, what's, what's the strategy here for thinking about when something is like in our control versus it's being a pathology.

[00:12:43] And as, as someone who's a Christian, as someone who, um, a medical practitioner, uh, maybe, you know, you've got your own personal experiences that you've mentioned. Um, yeah. Yeah. How, how does it, how does a Christian know if this is what I'm dealing with, um, what I'm thinking about and struggling with, is this something that's like an issue of agency? Is this about virtue vice character or is this pathology?

[00:13:09] Whether, I mean, and you could think about that in terms of trauma, you can think about in terms of addiction or depression. Um, is there, yeah. Do you have any thoughts on how do we think about agency versus pathology? How do I know? Like, let's say I'm thinking about this personally. How do I know if what I'm going through is pathological or this is a character issue? Yeah, that's, um, that's a really good question. Thank you.

[00:13:32] Um, I mean, I think the, my, my first response is to say that there is always, there's always some agency. Um, right. That by the time, if, if someone has zero agency, then we're dealing with, I think, um, you know, a whole different category. Right. And it's, and it's tricky, right?

[00:14:00] Because, you know, if you've ever had a loved one who suffered from dementia or, um, experience, you know, seen someone who, uh, completely lost agency, uh, right. That they were dealing with severe psychosis or something like that. Um, there are people who, uh, just, just cannot be held accountable for any of their actions.

[00:14:28] And so they require the community, you know, we, as a community, we have to help and support and love them. Um, but also, you know, especially with certain neurodegenerative disorders, right? Like there's a point at which someone goes from impaired agency to lost agency. Um, and I think it is really valuable to kind of hold onto a sense of agency whenever possible because, right.

[00:14:56] Because that's a, that's a privilege of being in the human community, right. Of being able to be held accountable for your actions. So there's always some agency. Um, and the tricky part is, right. That these psychological disorders, these mental illnesses, right. They, they impair agency. They take it away from us, but it's always a matter of, well, now I'm, now I'm offering it 90% of my capacity down to, you know, 70, 80, uh, 20. Right.

[00:15:25] Um, and that is, so, you know, what I really encourage my, my patients that I'm working with is to start is to try to help them find, okay, what is the one, what is the thing you do have control over? What is the thing you can do, uh, to, to do right by yourself, to help yourself.

[00:15:49] And for some patients, it is like the, the one thing that they can do is like take their medication every day so that they can, um, function and not slip into, you know, go over into the, to the zero zone. Um, and then for other people, I think for, for most of the rest of us, it is, it's also, it's finding, okay, what are those things that I can choose? What are the things I am capable of?

[00:16:20] For someone who finds themselves constantly like bumping up against like, well, like this is the most that I can do. Like if I, I've really, really tried to do what I can in this situation.

[00:16:37] And I just, you know, I just feel like there is when, when I, no matter how much I apply myself in the situation and pray and ask for accountability and help from others. Like I, I constantly feel like I am hitting that wall. I think that's a really good sign that there's a pathology that's impairing, um, you there.

[00:17:02] And then, you know, and then having professional help in that context of whether it's, um, uh, therapy or medication or whatever to kind of break that wall that you're hitting. Um, and so again, it is, you know, a lot of these things that we do are, are about extending the reach a little bit.

[00:17:28] Um, not so much getting you from zero to a hundred, but about getting you from 50 to 80. And then you got, you still got to do the rest of the work, um, to get better. I like that. Like assuming, assuming that you've got agency and trying to do what you can within your control. Until you, that's a helpful phrasing, like butt up against, or, you know, feel pressure feedback from, I just can't get past the ceiling. I can't get past this wall.

[00:17:57] And if that's a recurring theme, then maybe that's an indicator that there's something that's outside of your control going on here. Maybe something pathological, but starting first with this idea that I've got agency. I'm going to try what I can within my own, whether that's going out and taking walks, whether it's taking my medication, whether it's whatever, um, there are things that I can do. And even thinking of myself as an agent is really, really helpful. Right. So I'm not just seeing myself immediately as a victim, as a victim of circumstance, but a human being, someone made an image of God.

[00:18:27] I've got agency and that kind of self messaging is important, right? Like I've got this ability to do something, um, and I should treat myself that way until I've got really, really, really good reason to think that actually my agency is diminished. And then even then, um, it's about categorizing just how much agency has been lost and that's going to acquire medical professional, um, assistance. But yeah, I really liked that. That's great. Yeah. Yeah.

[00:18:51] No, there's a, um, uh, a book by a guy named Alan Noble called on getting out of bed. That is really profound and really helpful on this particular, it's my favorite book on this particular topic. Um, where he just writes about like, sometimes it is so much work. It is so hard to get out of bed. Um, but here's how you do it.

[00:19:13] Even when you do have a really profound mental illness, I think it was helpful in your book when you, you talked about how pop psychology, things you find on social media, the sort of therapy culture propagators, uh, they're very different from actual, you know, professional clinicians who are working people where, where a lot of clinicians you talk about, you know, the best ones.

[00:19:41] They're really focused on reclaiming some sense of agency for their patients because they know how important that is for their healing. And, you know, you mentioned some guys, uh, uh, Gabor Mate or Mate, you know, I remember reading his book on ADHD and I remember reading it being like, at one point I'm like, is he kind of saying like, you need to just do mushrooms or something? Like, he's got some odd ideas. Yeah.

[00:20:05] And, uh, but I left reading it and being like, yeah, as somebody who I think, you know, I've got a little, you know, ADHDness in myself, uh, before it was popular, but, uh, I felt discouraged. I'm like, oh my gosh, I've got to like, I've got to go on like a nature walk and seclude myself for months. And I don't know, like, I'm like, what, what, what are these? It just, it almost seems so therapeutic that it felt hopeless. Like you couldn't really change.

[00:20:30] And, and, uh, you know, I'd read, um, you mentioned Johan, I forget his last name. Hari. Yeah. Hari. Yeah. Who wrote a book on depression and, you know, there were some good things in the book, but I remember reading it and it's just like, he's just saying you probably need friends and you need to eat and sleep. And I don't know. I mean, it just felt, uh, I didn't know how helpful some of these things were. Um, but it was interesting to see that the centrality of agency of thinking that, um, you know, there's a way to do that. That's ham fisted.

[00:20:58] Maybe that's, I can see if somebody is struggling with, you know, mental health pathologies that they're trying their hardest. You can, it can be really hurtful for the, for you basically to say to them, try even harder. And they're like, I'm, I'm pouring everything I have in this and I just can't break through. And it's like, okay, well maybe you need something more to help you through that. Um, but that idea of agency I think is, is helpful.

[00:21:22] Now this idea of therapy, you know, what is, what is good therapy? You know, if we're, if we're talking about, we know online, you don't want to, you don't want TikTok or Facebook or, or Instagram, you know, being your therapist. Um, but what's the positive angle? What does therapy contribute and how do you know you're getting good therapy? Hmm. Yeah, good question.

[00:21:49] Um, good therapy is focused on, I would say helping someone to identify their own internal barriers to living, um, a good life, a flourishing life. And I think in a Christian perspective that often includes making, you know, good decisions, making wise, moral decisions.

[00:22:14] Um, there are some, I think some therapists who, who would push back against that particular aspect of it. But I think when you really, you know, pin, you know, when you try to really pin people down, they're like, well, yes, of course there are, you know, uh, goods that people have to choose. Right.

[00:22:36] Um, we, we can say that there are moral absolutes or, or what have you that help people to, um, to guide in their decisions. Right. Um, so therapy helps people to identify, okay, what are those barriers? What are those internal barriers? What decisions am I making? What thoughts am I thinking? What behaviors am I engaging in that, um, make me sadder, make me more anxious?

[00:23:03] Um, uh, keep me locked into, um, these bad choices that I'm making, uh, over and over again, or these feelings that I'm feeling.

[00:23:14] Um, and finding ways to either, um, you know, replace those thoughts with a better line of thinking, uh, like in cognitive behavioral therapy or, um, in certain, certain kinds of trauma therapy are, are almost at like kind of, um, find helping the brain to reorganize itself.

[00:23:38] And to remember things differently, for example, like with EMDR that, uh, put, um, that allows someone to not be so hindered by their, um, traumatic flashbacks or whatever it else that they're experiencing. Uh, so, you know, this, this process can take longer for others than, or for some than others. I think most people generally need shorter courses of therapy.

[00:24:07] Um, uh, but you know, there are people that also need longer ones. Uh, but if over time you feel like you're getting, so, you know, there's a challenge, right? Because sometimes you do get, have to get a little bit worse before you get better. And sometimes a therapist, you know, having a therapist who challenges you, um, I think is really critical.

[00:24:30] One of the ways that therapy can go wrong is when a therapist just affirms, affirms, affirms without ever saying, well, how could you be making, what, what can you do to make the situation better? Um, and so, uh, having someone, uh, you know, having a therapist that challenges, uh, their patient is, I think critical.

[00:24:53] Um, but also knows when to, when to, when to push a little bit harder, when to let go. And, and it's, you know, there's an art to it. Um, I think with any kind of, of counseling, uh, but it, it's mostly about, okay, is it something, you know, good therapy helps to identify those barriers. And then come up with strategies to break those barriers down, to live a more healthy and flourishing life. Yeah. On, on that note, Matthew.

[00:25:22] Um, so can we also begin to think of good therapy or maybe some aspects of good therapy? You mentioned the inward turn earlier on. Um, could, yeah. Part of good therapy include moving away from the inward turn and having a kind of outward turn. And so here's, here's maybe just one, one example of what I'm thinking about.

[00:25:42] Um, a friend of mine, actually, she has a very rare form of cancer and she laments how early on in that process, after getting the diagnosis, um, a lot of well-meaning Christians. Wanting to maybe swing the pendulum away from the, well, God's going to be there for you. They wanted to create this atmosphere of like, well, well, how are you feeling? Like, it's okay to be sad. We want you to just be you. And she said at some points that got like just really frustrating.

[00:26:11] She said, I don't want to think about my feelings anymore. I don't want to think about the cancer. I don't want to think about the diagnosis, like point me to Christ, like remind me of the good things in my life. Um, and so the inward turn, while these people were really well-meaning and they wanted her to just, you know, you don't have to put on a front for us. And that's, you know, that's a good thing as friends where we can be transparent, but then also like help draw me out of myself, help me not focus on the things inside.

[00:26:37] Help me not stew, help me not, you know, um, point me to the good things. And so can, can a good therapist or even just good Christian friendships, what, what is it that the church is supposed to do in drawing us out of ourselves? Um, I'm thinking of like Tim Keller's, the freedom of self-forgetfulness. Um, how do we, how do we get transformed?

[00:26:58] Sometimes it's by avoiding the inward turn, forgetting about the self, not, not, not in the, in the, in the serious cases of, you know, there's actual PTSD, actual depression, the things that are actually like medical pathologies. But the sort of like the difficulties in life that maybe may not be aided by the inward turn, maybe the inward turn actually inhibits growth because you're, you're, we're prone to catastrophizing. We're prone to black and white thinking. We call bias. Maybe we're not even like building the narrative correctly.

[00:27:27] And so, you know, the song is saying, why are you downcast? You need to go to therapy. Open God. A lot of issues are coming out here for you. Um, I told, I totally don't have a dog in this fight. This is totally impartial. Yeah. I'm just, I'm just writing notes. I'm like, huh? This is rooted in Paul's childhood here. This is how I give therapy to Brian. It's a good question. It's a good question. Uh, yeah. Yeah. Yeah.

[00:27:53] I mean, that is one of the art of therapy things is, um, you know, you do have, you have some people. Um, I mean, I, I remember one, uh, particular, uh, you know, someone close to me was, was talking to their therapist and, and talking about their, their children and how they were just like, I wish it just had some way to it.

[00:28:20] You know, I wish I had like, uh, uh, an elixir or a medicine. I could give my child to let them know that they are loved and capable and, um, you know, not constantly plagued by self doubt. And, you know, therapist said, well, would, if you had that, wouldn't you take it for yourself? And she was like, oh, okay. Okay. All right. All right. All right.

[00:28:49] I see where you're going with this. Um, yeah. Yeah. So like there are those, those situations where you, uh, a little bit of self-reflection is, is needed, but I think you're absolutely right. That the, um, it's certainly the tendency nowadays is just to, um, collapse in on oneself and be constantly thinking about, you know, again, it's, you know, one of the odd things about mental health in general, right.

[00:29:18] Is that the more that we ruminate on our own internal condition, like, you know, from a, from a research perspective, the more that we do that actually the sicker that we get, which is why these school mental health programs are, um, bad. And, uh, I think the church, um, has a lot of really great potential to help draw people out of themselves because, well, I mean, number one at a good church, you're, you're worshiping God, right.

[00:29:45] You're, you're thinking about God, you're meditating on God, you're praying to God. Um, and these, you know, and God being the source of, of all goodness and life. Um, uh, unless you have a particularly, um, let's say, um, uh, diabolical, you know, demonic thought that's sort of poisoned, um, someone to, into thinking, you know, into meditating

[00:30:14] on their own sin to the point that they're just sort of self-flagellating in an unhealthy way. Right. That, that, that all of those things are good. Um, right. That, that taking, um, taking the body and blood of Christ together with other people, that can be a really powerful way of, um, connecting with God and, and being reminded of, of where we are and how we are loved.

[00:30:40] And then within the church itself, uh, there's so many opportunities, I think just to connect with other people in healthy ways to enjoy friendship and communion. There's opportunities to serve, um, in just about every church. You're, there's going to be someone who no matter how depressed or anxious or whatever you are, there's someone in your church who likes, you can still serve that person, um, in a, and

[00:31:09] usually in fairly simple and straightforward ways and, uh, serving others, um, is I think one of the most powerful ways, uh, to deal with any mental illness. And so I think there's just so many different ways that just participate, you know, again, like we, like we said, like it's, it's not the church's job to fix people's mental health,

[00:31:34] but being in the church provides opportunities, um, for people to heal. Actually, I want to keep going on that thread because for the people who are around people struggling these various ways, um, you know, a friend of mine was talking about how, uh, she noticed that a lot of people who probably wouldn't clinically classify for one of these

[00:32:00] pathologies that are clinically defined are going to therapy for normal things. And sometimes maybe it's even just a desire for friendship or something like that. And it seems that therapy is, is, is filling the gap that the church should be. So again, the church is not supposed to be a therapy center or to fix someone's PTSD.

[00:32:24] Um, but there is a role in maybe filling a gap that's been filled by therapy. Um, well, how, how does the church quote unquote reclaim the ground that maybe they do have, you know, uh, a way to participate in without overstepping its bounds and going into areas that are more clinical? Yeah, no, that's good. Good question. I think, yeah.

[00:32:52] So, I mean, a lot of, I think a lot of it has to do, I think you're absolutely right that people are going to therapy for things, you know, because therapy is in a therapeutic culture, therapy is pitched as the all purpose solution to any problem that you have in life. Um, there are people going to therapy because, um, they feel like their life is meaningless

[00:33:20] or they need a friend to talk to or what have you. Um, and I actually, uh, I mean, we probably should have done this, uh, at the beginning, but I am curious to hear your, um, your thoughts as, as an educator and a pastor about, you know, ways that you're seeing this show up, um, in your life and work.

[00:33:40] Uh, but I think for the, you know, for the church, um, you know, I, I, I, I don't like adding a lot of shoulds, especially onto a local church and a local pastor, right? In an individual church should be preaching the gospel, you know, serving the body and blood of Christ, worshiping God, um, discipling people, you know, very, I like having a very

[00:34:09] limited mission, but, um, and mandate for a local church. But also I think when a church is doing those things that it's supposed to do well, it creates, uh, a social environment where all of these other good things flourish. So it's, it's, it's not even so much as, you know, like churches should make people be friends

[00:34:37] with each other so much as a church that is healthy is, uh, is cultivating time and space where people want to be connected to each other, um, and are naturally, you know, spending time talking to each other, you know, so much of, I think where, um, where people are, are going

[00:35:03] to therapy when they really need something else is like all that, that time and space after church, uh, before Bible study starts, uh, when you're, you know, when you realize someone in your congregation needs help with something. And so you go over to their house and help them with that, that all of those things happen, um, just, I think as an overflow of, uh, the love of God

[00:35:31] working in people and a congregation where, uh, people who have had their hearts and minds formed by scripture and the Holy spirit will just naturally want to love each other. Yeah. I think that that's a helpful way to question. You can push, you can push back on that. If,

[00:35:58] if that's, if you feel like that's, that's not quite what you're looking for. No, no, no. I think that there's a lot of good in, in what you said. And I think that the church is like a space. I even think about that where hopefully a church can be a space where someone who's wrestling with major depressive disorder or, or, or, or, um, going through something

[00:36:25] difficult can find a place where that is not the primary narrative of their life. You know, when they go in and they're part of the people of God, they go through a liturgy, they're spoken of as, you know, God's son or daughter, they're a brother, they're a sister, whatever it is that it creates some breathing room. So it's not there to fix that problem. And I even think part of, I think the appeal of the therapeutic culture is

[00:36:49] the promise of present wholeness and healing and all these types of things. And I think what can make the Christian response through the ages and the great thinkers of the past, the great saints of the past difficult for us to stomach today is because their whole premise is, yeah, it's not this life. I mean, like you're just not going to get it. There will always be this ache in your heart. You know, there's, this is a pilgrimage. And I think that that doesn't sell. That doesn't sell

[00:37:19] to a world that is oriented to this age. Uh, and so in that, in that sense, I think the church can actually help orient people correctly and say, you know, this is why we have an, an eschatological hope. This is why we're looking forward to the vision of God. This is why we're looking forward to new heavens and earth. Um, you are not a weirdo for suffering in this life. You might, you may suffer in a different way,

[00:37:43] but we are all on this pilgrimage together. And I think the church can be a helpful horizon shifter for, for somebody who's suffering. And that, I think that helps you from over-promising or even trying to say to them that, um, if they're not completely fixed of this ailment in this life, they didn't, they didn't Christian hard enough or something like that, you know,

[00:38:09] that there is, there's like a built in sorrow. I think one thing, and I'd be curious your thoughts, and Paul, you can chime in too, is the thing I'm thinking about is the, the relation between pastors and ideally Christian therapists. You know, I could see one of the negatives is people sort of have their own private person talking to and there's confidentiality, which I don't think it's a bad thing, but it can make things tricky where you're not sure. Like, is this, does this therapist even

[00:38:36] worship God? I mean, that's a big thing, but also do they have, what are their convictions? What, what, what, you know, because inevitably therapy is going to bring in moral issues. And so I think what I hope that happens, and I think I've got great friends who are therapists and counselors who love the local church and they, they love to collaborate with pastors where we can mutually inform each other. And I think one that helps a pastor know where does my expertise stop? Where, you know, I need,

[00:39:05] I need a voice who knows this stuff to help inform me. But then the flip is, I think, um, you do need some theology and I think you do need some spiritual direction in a sense. So I think having more cooperation between pastors and counselors and therapists as allies, that's not doing the same thing, but doing, you know, uh, cooperative things is a big key because

[00:39:30] I think it gets, it gets really bad when things get really siloed. I think that can be, that can introduce a lot of complications. Yeah. And certainly, uh, I know that it, it can work the other way to where you have a therapist, therapists, a Christian or not, who are undermining the church. Uh, I think one of the more, uh, devious and dangerous lines that comes up as well, you know,

[00:40:00] uh, those pastors, they don't really understand this whole mental health thing. So, uh, they, you know, you can ignore whatever it is they are saying, um, about, you know, either, uh, moral imperatives or, or what have you. And yeah, I think one of the things that I think is just essential nowadays is for

[00:40:25] every pastor. Um, and I think also educational leaders as well, you know, if you're working in a school or what have you, um, to have a counselor, a therapist that you trust, um, that, you know, that, you know, when you have someone, you know, cause people, people still come to their pastors, right. With the, with lots of different issues. And I think one of the, one of the challenge,

[00:40:49] one of the, one of the pressure points where the silo hurts is when, um, it's, you know, if there's any hint of any mental health, anything, well then, okay, well now the pastor can't do or say anything. And I think that that's a, um, that's also a dangerous sentiment, right? That pastors are still capable of speaking a lot of wisdom into the lives of their congregation and the people that they love. Yeah. So yeah, having that connection

[00:41:20] is, is, is, is really important. Yeah. I mean, I, I think, um, you mentioned having, you know, trusted friends who are versed in this. And I, I think, you know, I have a friend who he's been a clinical therapist for many, many years dealt with a lot of tough cases. He's been a valuable resource. He's a member of our church. And just to ask him like, Hey, what, what's going on with this? What's going on with this? And what I love is a lot of times, you know, especially these veteran kind of therapists, they don't like therapy culture either. And they're just, and they're just

[00:41:50] like, man, you know, this is not, uh, not good at all. And I think also they're, they're worried that people with genuine pathologies are going to get overlooked if everything becomes trauma, if everything becomes this issue, a disorder or whatever, and the actual people need help, they don't get a fair hearing. Um, yeah, one of the things you talk about in your book is the topic of trauma. I think you have a chapter devoted to it. I just want to spend a couple of

[00:42:19] minutes there. Just how do we think about trauma? Like what is it clinically and what are some ways that we can think about it in a sober minded way? Yeah. Um, trauma is, it's interesting because we've, we've gotten a lot of good insights, I think, scientifically in the last, uh, 10, 15 years, but, uh, also it's the area where I think therapy culture is the most like out of control.

[00:42:49] Uh, and, and the definition of trauma scientifically, you know, is, is art is being still being discussed and argued about certainly, uh, uh, from the most basic perspective, a trauma is a, um, uh,

[00:43:11] life threatening or apparently, uh, life threatening or, or major, um, violation that, uh, happens to someone, uh, about 25 years ago, the definition was expanded to include, uh, people that, uh, or, you know, experiencing hearing about this happening to a loved one. Right. And even that was kind of like,

[00:43:39] oh, well, you know, we don't want to, we don't want to leave anyone out. So we're going to expand the definition a little bit. Uh, so the, uh, but it, it, I think that just illustrates that the, the borders are never perfectly clear. And I'll give an example. I was at an Airbnb and there was a guard dog and there was a, a sign about the guard dog that I did not see. And so I,

[00:44:09] I went out to my car to get something in the guard and these two dogs attacked me, um, and, uh, you know, bit, bit me. Um, you know, unfortunately I was, you know, only bitten in one place, but at one point I was on the ground trying to get up and, you know, it was, uh, the, the dogs really could have hurt me if they, um, had, you know, if I had not been able to get up.

[00:44:36] And that was a really terrifying moment. Um, you know, I certainly, if it was, the circumstances were a little different, the dogs were more aggressive or whatever. I, um, I couldn't have gotten up. Um, I could have been seriously injured. Um, and even now, whenever I'm out running or something like that, and I see a stray dog, there's just a little bit of

[00:45:01] fear reaction that's heightened compared to, I think before that incident happened. Um, it doesn't come anywhere near to meeting the clinical criteria for PTSD, which requires a wide variety of disruptions in, in someone's life and flashbacks and whatever. Um,

[00:45:24] um, you know, but it's, it's certainly a, it's a heightened fear response. Um, trauma is PTSD, post-traumatic stress disorder is a disorder of memory. So really from a clinical perspective, when we talk about PTSD, we talked about people who, when they, when their memory

[00:45:49] body of is somehow triggered, um, and it can be through, through very benign circumstances, like a scent or a sound or something like that, their brain is more or less kind of teleported back to whenever they were experiencing that particular, you know, life threatening, apparently life threatening, um, violating incident. Um, and then their body responds in the way that one normally would

[00:46:18] in that kind of circumstance. And so, you know, from a clinical perspective, that's, that's PTSD, right. And there are criteria about that, which again, you know, the scientists, the researchers are still trying to figure out what's the best way to characterize this. What are all the brain and body systems that are happening? Um, but there's a lot of, you know, I think expand if, if we keep

[00:46:46] expanding that criteria and we keep thinking, well, okay, so my, uh, my incident with, with the dogs is now like, that's, that's just my minor version of PTSD. And I like leaning into that, I think is really unhelpful because PTSD is one of the most, um, I would say agency, like sucking kind of diagnoses,

[00:47:14] because people really, um, you know, are, are, are, are physiologically, um, transformed in those moments. Right. And sometimes it can take hours or days to come back to, um, where they are in a safe place. And so, uh, and, and you have people that I think recognize that there is this

[00:47:39] continuum of stress and trauma. Um, and they're just leaning way, way, way over into the like, well, any kind of stressor can be the, the one word, the word I hate is micro trauma. Um, and I'm like, no, no, no, no, no, no, no, no. That's, that's not it. That's not, that's not the right direction we need to be going guys. So, well, you, you, you had a great line. This is from memory. I'm trying to remember the exact place it was, but you talked about how

[00:48:05] when people are being treated for trauma, legitimate kind of clinical trauma, that the goal is actually not to have them avoid all triggers, or at least not permanently, but it was something to the effect of trying to integrate into the narrative of their lives, the trauma in a healthy way. There's something to that respect. Yeah. That is,

[00:48:29] you could talk about that. Yeah. That is the goal of trauma, of all trauma therapy is to, uh, is, is the sense, right. If the, the idea is that there's this, there's this part of a patient's memory that is like catching. Um, and it's, it's, uh, I, I don't, I don't love computer or mechanical

[00:48:54] analogies for the human brain, but it's like, every time you open this program, uh, every time this picture comes up on your screensaver, the computer crashes. Right. Uh, and so it's like, you have to, to get to the point where you can open that program, you know, you can, you can, if that memory comes up, it doesn't totally disrupt, um, what you're feeling and thinking

[00:49:21] at that moment, it does, it's, you're not being teleported back, um, in that moment physiologically. And so, and that's, you know, that, that takes time. Um, that can be really difficult depending, especially if for very severe traumas or especially for complex and chronic, you know, someone who is victimized many different times, um, or experiences long periods of, of, of threat. Um, but it is, uh,

[00:49:51] that is the goal, right. To, to help someone feel safe and then to take those memories and then reintegrate them into the narrative of their life so that when they think about it, it's not, you know, it's still a bad thing that happened, but it's not destroying your present and your future. Where does, how does the church fit into helping people? I mean, again, I know you say,

[00:50:17] you know, it's not the job of the church to fix PTSD, but if somebody has something legitimate, legitimate trauma, you know, what are, what are some ways you think are helpful in terms of what the community can do for them and what that looks like? Yeah. Uh, it's gonna depend, it's gonna depend on that particular person and their particular needs. Um, you know, we in, in trauma therapy,

[00:50:45] uh, we say that there, there, there's two, two mistakes people make in trauma therapy. One is trying to get into the traumatic material too fast, too quick. Be like, okay, tell me everything bad that happened to you and let's process it. Um, that's one mistake. And then the other mistake is conspiring with the patient to avoid it forever. Um, and so I think that those are, you know,

[00:51:15] represent two different gutters that you want to avoid falling into of, um, um, I think providing a place and a space where like we were talking about earlier, where someone can dwell on the love of God, the goodness of God. Um, and just being a, being a place of safety and

[00:51:41] uh, care and love, uh, so much of life after PTSD for people is about living in a, in a healthy community and, and in many ways, right. Because the worst kinds of traumas are the, are interpersonal traumas. They're perpet, they're perpetrated by, uh, parents or guardians or teacher, you know,

[00:52:07] people that were supposed to protect and care for the victim, uh, rather than, um, abusing them or using them. And so being, uh, a place of, um, safety care, uh, kindness, um, but also I think encouragement and challenge to, um, you know, because when, when people have PTSD and other severe mental health

[00:52:36] disorders, their world shrinks and they, you know, going back to agency, one of the worst and most disabling symptoms of any mental illness is the constant lie that, um, you can't do anything, you can't get better. Um, and so giving people, uh, you know, giving people real, genuine, biblical hope,

[00:53:02] um, and, uh, I think expounding on how, uh, abundantly God loves us though. And, and then providing just, you know, good, solid, um, friendships and community. Those are, I think the most, um,

[00:53:26] um, some of the best things that can help, um, people with PTSD by just giving them those, these rich and beautiful areas in their life, um, to, uh, to enjoy and to feel safe and close in. But one of my favorite chapters was, uh, I think it's one of your last ones. I think it's called good enough church. Yes. Yeah. The good enough church. That's actually your conclusion. I'm looking at it now. Yeah. And, uh, I know you, one of the things you set out is that really talk about,

[00:53:56] you know, pastors aren't supposed to be therapists. Therapists aren't supposed to be pastors. The church isn't supposed to be a therapy clinic and vice versa. Yeah. Really. You know, I mean, it sounds like the church is to help someone worship God, whether you have PTSD or not, whether you're dealing with something or not, it's helping you, you know, be in the presence of God and to keep the faith and all these types of things. Um, maybe Paul, do you have anything, any other questions on your end? Yeah. I, I was just going to ask, cause cause you've spent time

[00:54:25] in both American and East African church context, and maybe this is a nice way to dovetail with, uh, where I think Brian's going with the last chapter and we can wrap the conversation. Um, maybe you could comment a little bit or share with us what, um, you mentioned a little bit in the book, the differences between maybe how Americans and East African Christians think about mental health, the church, things like that. Um, do you have any, you know, anecdotal pieces of insight maybe, or,

[00:54:55] um, wisdom from the East African churches to, uh, to the churches in Tallahassee and Colorado Springs, uh, how to think about either church community or, um, mental health or, you know, worship generally. Um, are there things that instincts that they do better than we do or, um, just things you think maybe we could, uh, stand to gain from a different perspective on? Yeah, that's a really great question.

[00:55:25] Um, yeah, I mean, it's, it's, it's up and down a little bit. Certainly there's, yeah, there's church context here that I feel like are where we were in America 60 years ago, where things were maybe not, where there's still a little bit too much hostility to the idea of mental

[00:55:46] health. And, um, but I do think that here there is a much, um, richer sense of, of belonging and community. I think one of the, one of the reasons why I love practicing mental health here is that, um, by the time someone is sick enough to come to the hospital, like they're, they're really, really sick. And so, uh, they tend to

[00:56:12] respond very well to basic therapeutic interventions like, um, medication and psychotherapy and counseling and whatnot. Um, but I think there is also, um, a sense, uh, a very rich sense here of, um, of dependence on God and hope and really a trust that God is, is powerful, um, and able to, to work in people's

[00:56:42] lives in ways that in the West, we're often like, well, yeah, I guess I'll pray about that. But the, you know, we almost like say, well, yeah, it's like, well, yeah, I'll, I'll pray about that, but not necessarily really expecting God to, to do anything. Whereas I think here there's much more confidence and hope that like, yeah, God, God is going to show up in this situation. And we don't know what that's going to look like. Um, and, but, you know, just really, I think that sense of

[00:57:11] persevering, um, through faith, uh, because of God's goodness and God's character, uh, is, is a really potent thing here. So it's not just brute perseverance. It's perseverance because there's faith in a God who loves and acts and works in his people. And it's not just wishful thinking. It's grounded in a really deep sense of God and the church being the body of Christ. God works

[00:57:40] through that. That's, that's beautiful. It's really encouraging. Yeah. Yeah. Maybe to, you know, kind of wrap things up, but I, I'm kind of curious about your own personal experience. Where have you seen, uh, the church help you in terms of your own struggles? Where have you seen, you know, even, uh, a good counselor be a help to you? You know, what has that been like for you personally kind of walking through some of the things you talk about in the book?

[00:58:11] Yeah. Um, yeah, there's, I guess a lot of different stories I could tell. Um, I mean, I think one of the simplest ones is just, um, in dealing with, uh, uh, pornography addiction, Samson society is a really wonderful Christian community of men that are, uh, constantly encouraging

[00:58:33] each other, uh, to deal with our mental health, but also to push forward in, in, uh, that, you know, making that a positive, not, not a, a wallowing in shame or self pity, but like, okay, like we gotta, we gotta figure out what's gone wrong inside. So that way we can move forward and do well and

[00:58:56] stay sober and whatnot. Um, I think for me personally, some of the, the, the, the therapy that I've received, that's been most helpful has either, um, helped me to identify places in my life where I,

[00:59:14] um, um, was allowing myself to be, uh, crushed by, um, things that, that shouldn't have had that level of power over me. Um, especially like other people's expectations. Um, and then other times where

[00:59:41] there's this thing with, uh, counseling and therapy with people that are smart, that when, if you're smart enough or theologically reflective enough, like you get your mental illness starts to have this like Bible shaped sock puppet. Um, and that starts to tell you really devious lies in theological language. Um, at least that's, that's been my experience as a, as both as a provider and,

[01:00:11] and as a patient. And so, um, I think some of the most helpful things have been just for me, uh, having someone kind of ask me, no, but like, if you genuinely believed that God's grace was sufficient for you and that God's love for you was infinite, how, how would that change the way that you looked

[01:00:35] at yourself and responded to others and acted in your life? Like how, like, like if you, if you really took that as seriously as you say you do, um, how, how, what effect would that have? Um, and that has really been, been really life-giving to me. Well, Matthew, thank you so much for writing this book and for coming on the show and sharing some of your own experiences. I think, uh, this is a really

[01:01:00] got a lot of really great insights and, uh, looking forward to, to hearing more, more from you. Appreciate you coming on the show. Uh, thank you so much. It's been an honor and such a great conversation. Make sure you guys pick up, uh, the book. We'll have a link to it, uh, in our show notes and that we'll put a link to also, uh, Matthew's website. You can get more information about, uh, some things he's written, some stuff that he's up to make sure you

[01:01:25] subscribe and share this link and to help people get the word out. Appreciate you guys listening. Thanks.