Onward Christian Soldiers (Part 2) - Theism in Philosophy and Science

Stanford Memorial Church at the dead center of campus (the symbolism of which Daniel Dennett complained about when he was here a few years ago). Inside are inscribed Jane Stanford's words: "There is no narrowing so deadly as the narrowing of man’s horizon of spiritual things. No worse evil could befall him on his course on earth than to lose sight of Heaven; no widening of science, no possession of abstract truths can indemnify for an enfeebled hold on the highest and central truths of humanity."

In the field of Philosophy, there has been a revolution. The best description of it is by Atheist philosopher Quentin Smith. He writes in the professional journal Philo an Atheist call-to-arms and describes the “problem”:

The secularization of mainstream academia began to quickly unravel upon the publication of [Alvin] Plantinga’s influential book, God and Other Minds, in 1967. It became apparent to the philosophical profession that this book displayed that realist theists were not outmatched by naturalists… theists in other fields tend to compartmentalize their theistic beliefs from their scholarly work; they rarely assume and never argue for theism in their scholarly work. If they did, they would be committing academic suicide or, more exactly, their articles would quickly be rejected. . . . But in philosophy, it became, almost overnight, “academically respectable” to argue for theism… God is not “dead” in academia; he returned to life in the late 1960s and is now alive and well in his last academic stronghold, philosophy departments [1]

Smith estimates up to half of the thinkers in philosophy are theistic. Though, in William Lane Craig’s opinion, this may be the “Gideon effect” (Bible story about Gideon and Craig article about it in Philosophy) of startling an unsuspecting enemy into overestimation, it shows considerable advancement of theistic ideas in philosophy. And philosophy is the foundation of every discipline, be it science or math. Of all the disciplines to win, philosophy is the most strategic. Indeed, Craig describes it as a “beachhead” for Theists to be able to enter other fields as well.

Perhaps the “north campus” [2] “fuzzies” in the non-sciences are falling into the silliness of Theism. But what about the hard sciences? My impression after spending my entire adult life listening to lecturers was that all (or at least a vast majority) of my professors were Atheists. I knew only three of my professors who said or did anything even vaguely religious: a Jewish professor once had a guest lecturer “because of Rosh Hashanah,” and two others I discovered outside of class attended a local church. I must have had on the order of 200 professors and lecturers over the course of my schooling, and I only ever knew about 3 who did anything religious. Over almost a decade of schooling, that’s it. And that is generally the experience of most of my peers. The only problem with this experience is that it is an illusion.

According to the only data on the subject for since about when we landed on the moon (this hasn’t been a terribly well-researched question), among research scientists in the physical and social sciences, only a meager 34% do not believe in God [3]. That’s it. Of course this is much higher than the national average (2%). But it’s far lower than the perception that it is something like 99%. Furthermore, of all scientists pipetting early Monday mornings (or, as the case may be, writing grants to keep other people pipetting), one in five was at church the morning before [4].To my professional lecture-sitter-through-er ears, those numbers are absolutely astonishing.

It seems that a revolution has occurred in philosophy that is abrupt and apparent. But, assuming scientists were ever majority Atheist, there has been a quiet revolution in the sciences. And though Theism is not yet a valid framework for scientific hypotheses as it is for philosophic ones, it seems that there is an invisible majority.

So be heartened, my brothers in the Academy[5]! For though you feel alone, you are not!

[1] Quentin Smith, “The Metaphilosophy of Naturalism”  Philo 4/2(2001):  3-4
[2] GO BRUINS!!
[3] http://www.patheos.com/blogs/blackwhiteandgray/2011/11/moving-forward-the-science-religion-debate/
[4]… or synagogue the day before, or mosque the day before that. And it’s not just biotech scientists. Come on, people! It's a metaphor!! :). Fine. Here it is in concrete terms: 18% of scientists attend weekly religious services.
[5] Yup. Another metaphor for "higher education" ;) Though I must admit, I had to Google what it was called: metonym.



Part 1 - Introduction
Part 2 - Theism in Philosophy and Science
Part 3 - Onward!

Why Psychiatry is Awesome

A butterfly, the source of the Greek root "psyche"

I love psychiatry. I’m on it now and have a week to go. But I really really love it. There are several reasons why, and I’m going to list them. In no particular order:

1) Patient Relationship
I love psychiatry because it, above all other fields, requires and encourages relationship with patients. There are no physical diagnostic tools in Psychiatry. There are no objective measures, “signs” of depression. It is perhaps the purest field of medicine because there is no technology to aid or hinder the psychiatrist in diagnosis. It is one mind evaluating another. To get to the diagnosis, a psychiatrist must know a patient. In therapy, a psychiatrist uses his mind as a surgeon uses his knife.

I love getting to know my patients, and I love Psychiatry because this is both encouraged and required.

2) Philosophy
I have many interest, and it is always my goal to integrate them as much as possible. I have a long and sustained interest in philosophy, and I had previously given up any serious integration with medicine and philosophy. But when I started considering Psychiatry, I realize that it, perhaps alone among medical subspecialties, has profound philosophical implications. Of course ethics and a general philosophy of medicine might apply everywhere. But seriously, what other field gets to play with Ontology (what actually exists)?

Cardiology is pretty clear: the heart (cardia) is a pump, and we should keep it pumping. But what is soul (psyche) that soul-doctors (psyche-iatros) are trying to fix? Does it exist, or is it a useful fiction? How can it get diseased? What is the best way to heal it? It may well be that practice in psychiatry will yield insight into these questions, or that philosophical insight on these question will suggest changes to psychiatric practice.

3) Interesting Problems
The patients in Psychiatry are downright interesting. This is in contrast to most medical specialties where it is largely the diseases that are interesting. An unusual tumor is interesting, but the patient may be anyone. In psychiatry, there is a relatively limited number of disorders, but an infinite difference in the patient. The disease of schizophrenia may include delusions, but the patient will always have a different and intriguing story. One may think it’s the CIA that is out to get them, another may think it’s the County of Santa Clara. Perhaps it is because of an invention they have, or out of vengeance. What makes a mind do this?

Then there is the who “somatiform” cluster. People go blind, get migraines, feel pain, lose the ability to urinate, get paralyzed from the waist down, all by the power of their mind. As in the Matrix, “Your brain makes it real.” Emotional pain transformed into the physical world. How does that happen?

I love stories and there’s one thing psych patients have it’s stories. For depressed patients, all of them have a different trail of tears, a different Shakespearian tragedy that led them to the psychiatrist.  It is an intriguing thing to get into the mind of a patient, empathizing with a tragic tale (in depression) or suspending disbelief on an assumption or two (in schizophrenia).


4) “New” Field (Lots Left To Do)
There is nothing psychiatrists like to do more than talk about how Psychiatry is a new field. A century or so ago (i.e. when it really was new), Wilhelm Wundt (1832-1920) launched it as an experimental science at about the same time as many physical sciences. But, as Daniel Robinson in “An Intellectual History of Psychology” Modern psychology is in a state of perpetual youth because there hasn’t been dramatic progress like we’ve seen in biology or physics.

It’s a wide open field. On the physical side, we are just beginning to be able to watch a functioning brain with fMRI and PET scans; we have psychoactive drugs that can actually change brain processes that are more recent than antibiotics. On the cognitive side, we have new treatments and paradigms that, for the first time in history (thanks to modern experimental design, statistics, and computing power), can be experimentally verified. From the faith perspective, I know of no one who has successfully wrestled with these concepts and figured out how to fully understand them as a Christian.

Young or old, there’s lots of work to be done. I like the pioneer narrative, and so an ‘unexplored’ field like Psychiatry fits in nicely with the story I’m trying to tell (that is, my life).

5) Lifestyle
One of the totally awesome things about Psychiatry is that you can be a Psychiatrist and you can be other things too. This is not true for surgeons. I suppose some of them sometimes do things outside of surgery. But thanks to Halstead, going into surgery residency is pretty much like going into a monastery. Psychiatrists, on the other hand, seem to have lives. They are married, and make dinner (yes, dinner) plans with their spouses. Surgeons tend not to be able to do this.

And if there’s one thing I have it’s other interests. Research, reading, religion. Global health, philosophy, history. Photography, music, walking. There are a million things that I like to do that are not “my job” and I’d prefer a field where I could continue to do them. Psychiatry seems like it’s chill with all this.

Onward Christian Soldiers - The God Debate (Part 1)

Soldier, from Arc de Triomphe

Onward, Christian soldiers, marching as to war,

with the cross of Jesus going on before.

Like a mighty army moves the church of God;

brothers, we are treading where the saints have trod.

We are not divided, all one body we,

one in hope and doctrine, one in charity.

-"ONWARD, CHRISTIAN SOLDIERS" by Sabine Baring-Gould,

It is a wonderful thing to catch a glimpse of the Kingdom of Heaven. There are, of course, many different sides to it and it never quite looks the way you’d expect. It’s better than that. But I’ve recently been thrilled by a series of recent Christian and Theist victories in the battlefield of ideas. It is at times like this that the church can truly be seen “spread out through all time and space and rooted in eternity, terrible as an army with banners” [1]. The old Catholic phrase “The Church Militant,” technically describing the Christians alive today, seems to be an apropos metaphor.

Now before we begin, I’ll need to take care of another bit of metaphor housekeeping. I will be using martial metaphors throughout this essay. I think that when it comes to ideas, we are all in a battle (and if you disagree with me on this point, I’ll fight you :). Thought it is a battle, I think it ought to be a knightly battle, where both sides gain honor when they fight nobly. My celebration of Christian victories does not mean that I hate Atheists any more than my celebrating a Dodgers’ victory means I actually hate the Giants. I love a good game, or as the case is here, a good debate. Of course, I think these matters more serious than ballgames, but the mutual respect of ballplayers for each other captures a bit of the chivalry that I think we need to bring to all our differences of opinion, trivial or grave.

There have been a number of developments recently that bode well for Theists and Christians in the field of ideas. Over the next few posts, I’d like to explore a few of them. I hope you’ll join me! The first part is the story of a debate.


The Showdown
Recently, the world’s leading Atheist champion was challenged by the world’s leading Christian champion to a debate at Oxford, the Atheist’s home institution. A battle to end all battles! I wish I could describe their meeting. I wish I had the words to tell a modern day epic, one that would be remembered for decades or centuries to come. I wish I had the wisdom to understand and discuss it with theist and atheist alike, and to present my opinions here on this blog. But I can do none of these things. I cannot tell you what happened, because the Atheist never showed up. Citing the immorality of the otherwise well-respected Christian, he declined. A chair was left empty for him should he change his mind. But he never did. The Christian dismantled the Atheist’s written arguments with efficiency, and spent a few minutes discussing how groundless the accusations of his immorality were [lecture video].

Over the past few years, the self-titled “Four Horsemen” of the New Atheism (Richard Dawkins, Sam Harris, Daniel Dennot and Christopher Hitchens) had been gaining fame by beating some of the smartest Theists, pastors, scientists and philosophers. They believed that Atheism was more rational, and so accepted debates with most anyone in the spirit of free thinking. Their books were New York Times bestsellers (most notably “The God Delusion” by Dawkins ~2.5 million copies and “God is not Great” by Hitchens). And then a Christian champion arose, William Lane Craig [2]. He debated dozens of atheists before getting noticed by the Four Horsemen. Of them, he first he challenged Hitchens to debate in 2009. And, though there’s no official judge in these debates, it is clear that he won (Hitchens conceded his closing statement; debate video). Then he challenged Harris and won (rarely are you ever able to show that your opponent’s view is not just wrong in its premises, but is logically false; debate video). Most recently, he planned a trip to Oxford, and everybody was waiting with nervous anticipation: how would he do against Dawkins? But the question was never answered. On October 25, 2011, Richard Dawkins refused to debate William Lane Craig. On October 25, 2011, we entered a new phase of the debate on God’s existence. Up until that day, there was some question as to which side was winning.

If Dawkins showed up and lost, I would say that it was just one debate. The question as to “who’s winning?” would still be open. Both Atheism and Theism are contending valiantly in the arena of ideas, sometimes winning and sometimes losing. But Dawkins didn’t lose. He fled [3]. And, to be sure, many other brave Atheists in Britain did debate Craig, showing that the debate has not been finally settled. But their leader left the field. And so we enter a new era where Atheists now have to explain to Theists that, unlike their leader, they really are intellectually serious.

This is one battle in the war of ideas. It is important in itself, but in part is part of a larger movement in higher thought back to God. Next post, I'll talk about the most important discipline and it's return to God.

[1] Lewis, CS. “The Screwtape Letters”

[2] Technically, he’s been “arising” for a few decades. But he really started to get notoriety more recently.
[3] Of course, he has plenty of reasons why he wasn’t there, ranging from “I’m busy” to “This Christian 'philosopher' is an apologist for genocide.” In his UK Guardian article he writes, “Would you shake hands with a man who could write stuff like that? Would you share a platform with him? I wouldn't, and I won't.” By one count, Dawkins has given 12 different excuses as to why he won't debate with Craig. 



Part 1 - Introduction
Part 2 - Theism in Philosophy and Science
Part 3 - Onward!

Dialogue on Suffering

[Begin full fiction mode. This was based on nothing but my imagination. To pretend to be not totally arrogant, I’m going to put my arguments in the mouth of the character Paul. But even that’s pretty presumptuous. I suppose that’s an inherent problem with dialogue. It’s like playing chess with yourself. Of course you’re going to win. So watch as one figment of my imagination totally works another. So here goes another attempt at this medium:]

I was walking with my good friend Paul (he’s from a place called Tarsus, right off I-5, if you know where that is). We were enjoying the crisp January air when we saw our mutual friend, Job.

“Good day, Job!” said I.

“What is good about it?” he asked.

“Light and life and breath, to begin with,” said Paul. “We live in a wonderfully ordered world under an astonishing heaven ruled by a Good God.”

“Good God?” asked Job sarcastically. “How can you dare to say that? And to me, of all people? Don’t you know that He killed my ten children? Don’t you know that this has been my daily torture for these long years?”

“Dear Job,” said Paul, “I have wept with you about your children. And I have walked with you through those valleys. But this attitude is unbecoming. What alchemy has transmuted your sadness into anger? What has made the pure cold gold of mourning into the boiling lead of rage?”

“It is only rational,” Job retorted. “Rage is the only proper response to so blatant an offense. What have I done to deserve this? What possible good is it accomplishing? And even if there is some good, could it not be accomplished with less suffering?”

“These are all excellent questions,” said Paul. “To answer them, I will need to tell a story and you will need to do a bit of imagining. Would you like me to answer your questions?”

“Though I know it is a dangerous thing to do with you, I will play your game.”

“Wonderful!” exclaimed Paul. “Imagine a woman is pregnant. The pregnancy is complicated and the woman dies in childbirth. The woman’s husband and now father of the child names him Jamal. Jamal’s doctors notice that he looks blue. He is worked up and diagnosed with Tetralogy of Fallot, a birth defect of the heart. Untreated, Jamal has slightly better than even odds that he’ll make it to his fourth birthday and almost no chance of seeing adulthood. The doctors tell Jamal’s father that there is a cure, but it will require multiple, painful heart surgeries. What should Jamal’s father do?”

“He should get the surgeries.”

“But wait,” said Paul. “He is causing terrible pain to his own son. He’ll have to spend countless days in a nightmarish hospital, away from the sounds and sights and smells of home. It will involve a hundred needle sticks that Jamal will not understand, tape and tubes, beeping and buzzing. For his first few years of life, Jamal will several times be thrown into a whirlpool of confusion and pain.”

“Yes. But it will be for his own good. Several short years of pain will lead to a tenfold longer life.”

“Alright. But shouldn’t we get the consent of someone before performing a procedure on them?” asked Paul.

“If it is possible. But here, it’s not possible.”

“Why not?”

“Because Jamal cannot understand,” said Job. “He doesn’t understand about the genetic inheritance patterns, ventral septal defects, the failure to adequately oxygenate blood. He can’t even know about adequate hydration and the need for a needle stick and IV fluids, let alone the complexities of cardiothoracic surgery. ‘Informed consent,’ requires that a person understand at least the very basics of their condition and the procedure. Jamal, being a newborn, cannot understand these things. His father must make the decision for him.”

“So you think that when someone cannot give informed consent, the decision should fall to another?”

“Yes. In this case, the father is clearly the one who has the responsibility to care for him and to make decisions on his behalf until he is old enough to make his own decisions.”

“So now imagine,” said Paul, “that it’s four years down the road, and though he should be cured, Jamal’s case is complicated and he needs one final surgery. He’s now old enough to fear hospitals and hate doctors. Jamal’s father tells him, ‘Jamal, we need to go to the hospital again to get you healthy.’ This time Jamal pleads, ‘No! I won’t go! It hurts! Why are you hurting me, Daddy?’ What could the father reply? After the reply, what should he do?”

“There isn’t much he could say that would satisfy Jamal. He could say, ‘Jamal, I know it hurts, but it is what is best for you. Do not worry, because I will be there with you, and I will suffer with you.’ And then, whether Jamal likes this answer or not, he should still take him for the surgery.”

“So even in this case when Jamal has clearly against the idea, his father should do his best to explain it, promise to be with him, and do it anyways.”

“Yes.”

“So,” said Paul, “We have established that because a child lacks understanding, certain decisions should be made on his behalf. Now what if Jamal asked, ‘Daddy, if I have to go, can you ask the doctors to make it hurt less?’”

“The father should reply, “Jamal, they are already doing everything they can to make it hurt less. The cure for your sickness requires a lot of pain. If there were a better cure, don’t you think I would have chosen it?’”

“So long as the father is minimizing pain in his attempt to reach a good end for his son, he is justified in causing it. Is Jamal capable of knowing if a given needle stick is a required part of his medical care?”

“Of course not,” said Job.

“What about the number of surgeries? Can he know by the apparently gratuitous number of his surgeries that his father is actually not loving?”

“It would be impossible. Such a question is difficult for health policy experts, let alone for four-year-old children.”

“It this is impossible, wouldn’t it also be impossible for him to then to know that his father loves him?” Paul asked.

“No. Jamal can see it. He can feel it. Most of all, when he sees his father suffer with him. When he cries at a prick, his father’s face looks as if it were hurt. The promise I put in the father’s mouth at the beginning, that he would always be with Jamal, is perhaps the greatest proof of love when it is fulfilled.”

“But can he prove that his father loves him?”

“Love is not the sort of thing that can be demonstrated by mathematical or scientific proof. It is something that is sensed on a deeper level. Jamal can know it, but he cannot prove it.”

“So,” said Paul, “We’ve established that the father should act in Jamal’s best interest, regardless of how painful it might be.”

“Yes.”

“And we’ve agreed that Jamal would have no adequate understanding of his condition to make any judgments.”

“Yes.”

“And finally, we’ve shown that even though he lacks understanding, he can still know that his father loves him through his pain.”

“Yes.”

“Now allow me to tell the story in a different way,” said Paul. “What if instead of a newborn named ‘Jamal’ we were talking about an adult named ‘Job.’ And instead of an earthly father, we were talking about God. A physical birth defect in the heart becomes a spiritual one. Jamal suffers for four years to gain 70 of life; Job suffers for 80 years to gain a millennium of life and more. Job, how is your position any different from Jamal’s?”

Job was silent for several minutes. His eyes darted to and fro, searching for an escape but finding none. Finally, with a reluctant tone, Job said, “I see your point: I am Jamal. I will have to reflect on this.” 

The three of us walked along the road together, enjoying the warm sun and bright blue sky.

Dialogue on God’s Hair Color

I was recently having a discussion with a friend about God and he objected, “But what about God being a man? Surely you don’t think he’s sitting on some throne up in the sky, do you?” The following is inspired by a real conversation, but as I have the personal memory of a goldfish, I’m going to kinda have to make up most of it. And in attempting to remember a real dialogue I’ll probably end up like Eric Cartman) and/or Plato in making my position sound totally awesome and my discussant a total fool. But this is not reality, and my apologies to my real-life discussant. I might try this style more often, especially as I have other real life events to inspire them.

So as I was saying, my friend asked me “But what about God being a man? Surely you don’t think he’s some bearded man sitting on a throne up in the sky, do you?”

I thought about it for a minute, noting how my discussant intentionally tried to make it sound as ridiculous an idea as possible. And I said with confidence, “Yes. As a matter of fact, I do.”

And then there was a wonderful silence. I’m beginning to see why Jesus said shocking things all the time. It really bothered me at one point. I used to think, “Why don’t you just answer them straight? Really, Jesus? I could have given a clearer answer in line with Christian Orthodoxy than you just did.” And perhaps I could have. But what I’m beginning to realize is that it’s not all about true information. Presentation matters.

After the silence, he asked a real question. Or rather, he asked a question whose answer he was going to pay attention to: “Why?”

I asked him, “Do you think the idea of God is something easy or hard to understand?”

“It’s very hard. Maybe even impossible.”

“Harder than physics?”

“Much harder.”

“I agree,” I said. “When we try to understand physics, we have to use symbols and metaphors. Gravity works like a bowling ball resting on a rubber sheet; a marble will ‘fall’ into its divot. Relativity can be understood by imagining twin astronauts. And so on.”

“OK. But what does that have to do with God?”

“Because,” I said, “If we think God is harder to understand than physics, then wouldn’t it be reasonable to try to understand what we can of Him using similar tools?”

“Sure.”

“So could I say, ‘Imagine God has a white beard’?”

“Yes, but he or she or it doesn’t. It’s above that.”

“And gravity isn’t a rubber sheet. I said, ‘imagine’.”

“OK. God has a white beard.”

“What does a white beard mean?”

“Male. Unshaven.”

“Think literary. What attributes might an author be communicating if he gives a character a white beard, as opposed to, say, a black beard, or a clean chin?”

“Age. Maybe wisdom.”

“Good,” I said, “So the visual image communicates something about Him.”

“And that’s another thing. Why do you keep saying ‘Him’. The concept is above such crude biological concepts. God is not a man.”

“Isn’t He?” I asked. “Does manhood communicate anything? Would the image be different if it were a woman sitting on the throne?”

“Well, I suppose.”

“What if it were not a man or a woman, but energy. Would that image be more or less relatable?”

“Less.”

“So,” I said, “The image of God as a white-haired old man sitting on a throne says to the reader, ‘God is like a wise old king,’ which we can imagine, even if God’s true nature is unimaginable.”

“I envision God genderless. Why does God have to be a man?”

“He doesn’t have to be anything.” I said, “The hero of a story could have black hair or brown hair. It’s a story. The writer may give him black hair to go along with his mysterious nature, or brown hair to match his boots and ground him. God doesn’t have to be white-haired. But in Daniel 7, He is. It’s less useful to complain, “Why does he have to be white-haired?” and more useful to ask, “Why is he white-haired?” Perhaps we need to think of God less like grown-ups arguing theology and more like kids reading a story. And a kid reading that God is a man might think, ‘God is a man like Dad! He must be strong and smart and brave, and good at keeping the bad guys away and making sure there’s no monsters under the bed.’ In fact, on this attribute, God was not just pictured as a man, but took on the flesh of a first-century Jewish man.”

“But it seems so provincial! How can God just pick one race? Isn’t he more universal?”

“It’s a suit. We can’t see God in heaven, so he ‘clothes’ Himself with humanity. He puts on a suit so that we can better understand him, so that we can talk to Him face-to-face.”

“But why can’t it be another color?”

“Which would you prefer?”

“I don’t know. Don’t you think it’s a little arbitrary?”

“Definitely,” I said. “But He just as well might have picked another color suit and you could justly ask why He hadn’t put on the one He did. Keeping on the suit analogy, if He chose to mix all dyes, it would be a black suit; if He left it undyed, it would be a white suit. Even if we could understand “every color” or “no color,” black and white are both still colors. Perhaps He could’ve picked a transparent suit, but then we’re back where we started: an incomprehensible, invisible God. He’s gotta wear something. And He happened to wear the First-Century-Jewish-Man-In-Palestine suit.”

“So you’re saying that we can learn something from a first century Jewish man in Palestine?”

“Yes. Yes I do.”

Renewing of the Mind (Part 1) Phil 4:5-7

I've recently been more and more interested in Psychiatry and specifically in Cognitive Behavioral Therapy (CBT). I’ve had several intriguing conversations with Jeffrey Schwarz (who showed the brain changes that occur with CBT) and I’ve studied under David Burns (most famously of Feeling Good) and his TEAM therapy. CBT as I understand it, essentially focuses on intentionally practicing certain thoughts. The idea is that many mental illnesses are at their core an irrational belief which leads to a habit of bad thinking. If this irrational belief can be identified, confronted with rationality, and then finally ousted through practice of right thinking, there will be some healing. Essentially, the theory asserts that you can choose your thoughts, and so by indirect consequence, you can choose your moods. If you think depressing thoughts, you will wind up depressed. If you think pleasant thoughts, you won’t. The role of the therapist is to help teach a person to identify the irrational thoughts and practice rational ones.

[Now please note: this is what I have learned from two specific thinkers in CBT. CBT doesn’t strike me as a standardized orthodoxy, so these observations might not be true elsewhere, and as I am only a neophyte, it might not even be true here.]

I was reading in Philippians yesterday and chapter 4 really jumped out at me because it seemed that Paul in the First Century had figured out CBT. This will begin a long-running series on Psychotherapy in the Bible. I’ve had the thought before, but decided “here” was as good a place as any to start. If you have other passages that speak to this question, please let me know and I’ll (eventually) write about them. I’d be interested to collect these from other traditions, literature and philosophy. So if you’re a Shakespeare scholar, send some passages my way. Or if you know about parallel passages in the Koran, please let me know.

5 Let your reasonableness be known to everyone. The Lord is at hand; 6 do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. 7 And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. (Philippians 4, ESV)

The sections starts off with “reasonableness,” and moves immediately to anxiety. The alternative to anxiety is prayer with thanksgiving. The immediate consequence of this thankful prayer is the peace of God. And this peace itself becomes a defense of both the heart and the mind.

One of the major ‘irrationalities’ that cause anxiety is the desire to control. What if I fail that test? It’s Friday night and I’m out of town; what is she doing right now? I don’t know everyone at the party; what if they don’t like me? I’m speaking in five minutes; what if I say something stupid? What if the plane crashes? Everyone has the temptation to fall into these anxious thoughts. What does Paul advise? Pray. Give it to God.

What does that do? It helps you realize that it’s in God’s hands, anyways (everything is, after all). Kneeling before the Throne Room of the Universe, one feels humble; not the big shot who has something to prove. And then when one rises from prayer, and walks out of the Throne Room, one realizes that one was just in the THRONE ROOM OF THE UNIVERSE. What problem could possibly concern Heaven? And what problem could possibly concern one of its citizens?

Also, we can’t forget the thankfulness. No matter how bad things get, every Christian can open his prayer with: “Thank you Father, for life and breath and salvation.” Though every once in a while you get a man like Job, most can go a lot further than that prayer. Most can be thankful for family, health and even wealth. Most have some hint of nature (sun or stars or sky if nothing else) that they can be thankful for.

Paul tells us to pray a lot. He tells us to practice this set of thoughts and attitudes. And when we do this, we’ll be armored from further assault to both heart (emotions) and mind. Exactly in agreement with CBT, Paul says that something you practice by conscious effort (prayer) will be a guard against future perturbation of mood (“heart”) and thought (“mind”).

So let’s imagine our first character, overwhelmed with feelings of anxiety for an upcoming exam. He is anxious probably because he’s grasping onto his pride and playing out the worst case-scenario in his mind, over and over again. He’s imagining getting the test back, with a big “F” on it, and his having to take the course again, and lose his scholarships, and be ridiculed by friends, and have to go home and tell his parents, and not get into medical school, and, and, and… Now let’s let him pray:

Father, I thank you for life and breath and salvation. I thank you that you have given me the opportunity to study at this wonderful school, that you’ve given me friends that believe in me and a family that loves me. Thank you for this beautiful day, the warm sun and calm green trees. I lift up this exam to you. I have been diligent in my preparation; I have studied what I have studied and done all that I can. And so now I pray that you give me success. Passing this exam will ultimately help me serve your children by entering medical school. Nevertheless, not my will but yours be done: I trust that you will be with me and will do what’s best for me, be it to fail this exam or to pass. Amen.

 If our young friend prays this prayer (or others like it) for 15 minutes a day, he’ll have a lot harder time stressing out about the exam. It’s in God’s hands. He’s accepted the possibility that he might fail, but he’s not worried about that either. On top of it all, he began with gratitude; even this alone will put him in a better mood than when he started.

The pattern of Philippians 4:5-7 is brilliant and powerful:
1. Begin with being reasonable.
2. Don’t worry.
3. Instead, pray and be thankful.
4. This will guard your heart and mind.

New-found Freedom to Think in Medical School

Last week I had a conversation with one of my attending physicians. His critique of my presentation was the only thing I would ever be praised for before: exhaustiveness. “What lab data do you want? What do you think is relevant?”

It’s a question I haven’t really had to answer before. I’m used to being asked, “What’s the bilirubin?” Or listing off all the values in the complete metabolic panel. But which to I think are presently relevant? Well, I’m not really sure. I’d have to think about it.

To think about it

That’s exactly what is finally being asked of me. Not “Memorize this” or “Learn this physiology” but finally, “Figure out this clinical problem.” Of course, all the memorizing and learning is necessary for there to be any problem solving. But there has been an abrupt change in the focus.

In our Practice of Medicine course, we would sometimes take 4 hours to go through a single case. Many of the exercises involved creating comically exhaustive differential diagnoses or similar tasks. Criticism would be mainly for being not exhaustive enough. Of course this exercise in recall is useful in helping us learn the common conditions associated with symptoms, but it’s still just recall. Now I have been asked to vet the list myself.

I have been waiting for two years to hear someone say “Think!” I’m no longer evaluated purely on conformity to a rubric, on my ability to list off everything that might possibly cause jaundice ever. It’s objective, to be sure. But it’s not all that doctors actually do. Doctors think. And when they tell other doctors what they’re thinking, they do not behave like patients with head trauma, with comatose brains, vomiting up (and possibly aspirating) undigested information.

For medical training, the beating heart of the medical student, with its passions and emotions, was put into arrest so that we could be “objective.” The medical student reports the information without passion or emotion (for these, of course, would “cloud” judgment). As a result, his verbal presentation is given in a monotone voice with exactly as much life as his heart has that is as flat as his EKG. But to become a real doctor, the student’s heart must be shocked back to life. He must take on bias, bias for his patient and for truth). He must start to care about what the diagnosis is. He must care enough to argue for his patient, to defend his view on the diagnosis, and to persuade others that he is right. No longer are patients presented as a list of facts; they are presented in a story.

And only human beings, alert and oriented with beating hearts, can tell stories. And they do tell stories. Doctors tell stories. And medical students should pay attention, for this will help them to emerge from the stasis that their first two years have put them into.

It’s never pleasant receiving criticism. But the criticism I got last week shocked me back to life. It was liberating! I could and I should behave like a real doctor now, not just a mindless, heartless medical student. I hope that my mind remains alert and my heart stays beating.