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As U.S. Corporations Face Reckoning Over Prescription Opioids, CEOs Keep Cashing In

March 28, 20217:00 AM ET
BRIAN MANN
Source: NPR

Source: NPR
Shidonna Raven Garden and Cook

Steve Collis, president and chief executive officer of AmerisourceBergen Corp., testifies during a House Energy and Commerce Subcommittee hearing on May 8, 2018.Bloomberg/Getty Images

Imagine you’re part of a project that goes horribly wrong at work, causing a scandal, costing your company a ton of money, maybe even putting people at risk. Now imagine after that kind of performance your company rewards you with a raise and a bonus.

Critics say that’s happening right now with CEOs at big drug and health care companies tangled up in the opioid crisis.

“When leadership fails … the board of directors have to be willing to hold their executives accountable,” said Shawn Wooden, Connecticut’s state treasurer.

His job includes investing state pension funds and other taxpayer money in firms that include some of the nation’s biggest drug makers and health corporations.

Wooden believes executives at some of those companies made risky decisions, leading their firms deep into the opioid business.

More than 450,000 Americans have died from opioid overdoses since drug companies began making, distributing and selling large quantities of prescription painkillers.

Now many firms face a tsunami of opioid lawsuits, have filed for bankruptcy, or find themselves on the hook for billions of dollars in settlements.

But Wooden says CEOs and other top executives keep getting rewarded.

A company loses $6.6 billion, a CEO is rewarded

Wooden points to a recent shareholder fight over compensation for Steve Collis, CEO of AmerisourceBergen since 2011.Article continues after sponsor message

The health services giant agreed to pay Collis $14.3 million for his work in 2020, a 26% raise. In that same year his firm reached a tentative $6.6 billion opioid settlement with state and local governments.

Wooden said that one opioid loss “nearly wipes out a decade, a decade’s worth of the company’s profits.”

He argues when calculating Collis’s pay, the company’s board should have factored in the loss along with the “reputational harm and the societal harm” caused by AmerisourceBergen’s opioid business.

Amerisource Bergen has admitted no wrongdoing as part of its settlement talks.

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In a statement to NPR, a spokesperson for the company said Collis was compensated appropriately based on the “pay-for-performance principle that executives should be rewarded when they deliver targeted financial results.”

But the company acknowledges that when calculating Collis’s performance, its board first excluded “litigation-related expenses.” Which means the whole opioid mess, everything related to “legal or compliance costs” was wiped from the ledger.

Despite objections by Wooden and Rhode Island state treasurer Seth Magaziner, a narrow majority of the company’s shareholders voted earlier this month to approve Collis’s compensation.

Collis isn’t alone. CardinalHealth, also on the hook for an opioid settlement worth roughly $6.5 billion, gave CEO Michael Kaufman a $2.5 million bonus in 2020.

Source: NPR
Shidonna Raven Garden and Cook

Purdue Pharma CEO Craig Landau testifies via video to a House Oversight Committee hearing on Dec. 17, 2020. Members of the family that owns OxyContin maker Purdue Pharma have acknowledged the drug had a role in the opioid crisis but have stopped short of apologizing or admitting wrongdoing.AP

Purdue Pharma CEO sees bonus after company guilty plea

Critics in Congress say one of the most troubling cases of drug executive compensation involves Dr. Craig Landau, CEO of Purdue Pharma, maker of OxyContin.

Landau has been an executive with the firm since the late 1990s and stepped into the top job in 2017. While admitting no personal wrongdoing, he’s named in dozens of opioid lawsuits.

In 2019, Landau led Purdue into bankruptcy and then last year his company admitted committing federal crimes linked to opioid sales.

Despite that track record, Purdue Pharma’s board rewarded Landau with a bonus worth nearly $3 million, a decision approved by a federal bankruptcy judge.

In December, while appearing before a congressional oversight committee, Landau faced calls to give the money back so it could be distributed to creditors and people harmed by the opioid epidemic.

“Will you forego this $3 million bonus you’re taking out of the pockets of the people who should get that money from the bankruptcy court?” asked Rep. Raja Krishnamoorthi, D-Ill.

“I have already made — willingly made — significant monetary concessions in order to move the bankruptcy process forward,” Landau testified.

“So the answer is no,” Krishnamoorthi said. “You want those $3 million at the expense of those opioid victims. Shame on you, Dr. Landau, shame on you.”

Landau voiced regret for the harm caused by OxyContin and again said he had done nothing wrong personally.

In a statement to NPR, Purdue Pharma praised Landau’s leadership and said he was compensated appropriately.

“Despite unprecedented headwinds, Dr. Landau has led the company and delivered results for its many stakeholders,” the spokesperson said.

Shareholders hurt by opioid reckoning

Charles Elson, an expert on corporate governance and ethics at the University of Delaware, said this kind of executive compensation at companies embroiled in a public health crisis leaves a bad taste.

“No matter how thick you slice it, it’s still the same old baloney,” Elson said, noting it is common for American corporations to reward executives with hefty bonuses even when things go wrong.

According to Elson, the financial pain for losses, like these billion dollar opioid settlements, typically gets passed along instead to average Americans who own stock in these companies.

“The shareholders are not simply a group of people on Wall Street, the shareholders are in fact all of us who were damaged as well,” Elson said. “I think that’s why it’s galling to see [executives] rewarded.”

The reality of the pharmecuitical industry is that it is a big business who has been paying fines for some time. How much of these fines are written into the cost of creating a drug and bring it to market? How much are these companies willing to pay and how many lives are they willing to see loss. How much can you afford to pay: drug management, disease management or death? Which one will you pay?

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Disease mongering and drug marketing

Shidonna Raven Garden and Cook

Howard Wolinsky
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This article has been cited by other articles in PMC.Go to:
Source: US National Library of Medicine – National Institutes of Health
Featured Photo Source: Unsplash, National Cancer Institute

Summary

Does the pharmaceutical industry manufacture diseases as well as drugs?

Most people may not have heard of metabolic syndrome, but that is likely to change. Once known mysteriously as Syndrome X, the condition, a precursor to heart disease and type 2 diabetes, is about to be transformed into a household name by the US pharmaceutical industry and its partners in the medical profession. A society dedicated to addressing the condition has been organized, a journal has been started, and an education campaign launched. Patients are already being tested for metabolic syndrome. As the trade publication Pharmaceutical Executive said in its January 2004 issue: “A new disease is being born” (Breitstein, 2004).

…industry has found itself under fire from detractors who contend that, in the pursuit of profits, companies are in league with medical doctors and patient advocacy groups to ‘disease monger’…

The situation is reminiscent of the attitude towards cholesterol. Twenty years ago, physicians were not concerned about the effects it might have on heart disease. Today, thanks to efforts by pharmaceutical companies, high cholesterol levels are now recognized as a major health problem. In fact, IMS Health, a global healthcare information company, reports that the two best-selling drugs in 2004 were statins: Lipitor® (atorvastatin calcium) from Pfizer (New York, NY, USA)—valued at US$10.6 billion with growth of 13.9% over the previous year—and Zocor® (simvastatin) from Merck (Whitehouse Station, NJ, USA). Pharmaceutical Executive noted: “The emergence of cholesterol reduction as a market was a major event for pharma. Metabolic syndrome promises to be as big or bigger” (Breitstein, 2004).

However, critics note that not every new disease for which the pharmaceutical business provides a drug is necessarily a major public health problem, but rather a venue for drug companies to increase revenues. Pharmaceutical companies research, develop and exploit drugs to prevent, control and cure diseases and treat symptoms. Companies then market these medications to recoup their investments and reward shareholders. It would seem to serve the interests of society, but some critics characterize it as a vicious circle in which businesses invent new diseases to match their existing drugs. Increasingly, industry has found itself under fire from detractors who contend that, in the pursuit of profits, companies are in league with medical doctors and patient advocacy groups to ‘disease monger’: convince people that their usually mild ailment urgently needs drug treatment.

The late medical journalist Lynn Payer addressed the issue in the early 1990s in her book Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick. She wrote: “Disease-mongering—trying to convince essentially well people that they are sick, or slightly sick people that they are very ill—is big business…. Disease mongering is the most insidious of the various forms that medical advertising, so-called medical education, and information and medical diagnosis can take.” Similarly, Arthur Caplan, Professor of Bioethics at the University of Pennsylvania, Philadelphia, USA, last December told the popular American TV programme 60 Minutes, “If you want to stir up worry in the public, and you’ve got the advertising dollars to do it, you can turn almost anything into a disease.” The focus of the 60 Minutes report was the recent emergence of a market for adult attention deficit disorder (ADD)—the traditional view was that ADD afflicted only children who would eventually outgrow it.

Critics such as Payer and Caplan maintain that the routine human condition…is increasingly being re-defined as disease…

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Critics such as Payer and Caplan maintain that the routine human condition—unhappiness, bone thinning, stomach aches and boredom—is increasingly being re-defined as disease: depression in its milder forms, osteoporosis, irritable bowel syndrome and attention deficit disorder. Likewise, risks factors, such as high cholesterol and high blood pressure, are declared diseases in their own right—hyper-cholesterolaemia and hypertension—with falling thresholds resulting in more people considered to be sick. In other cases, drugs approved for devastating illness, such as clinical depression, are indicated for milder conditions, such as shyness, which is now dubbed ‘social phobia’.

One such example is Strattera® (atomoxetine hydrochloride), developed by Eli Lilly & Co. (Indianapolis, IN, USA) and approved in November 2002 by the US Food and Drug Administration (FDA) for treating ADD in children, teens and, for the first time, adults. One Lilly advertisement shows a series of photographs of an uptight-looking model, and asks in the headline: “Distracted? Disorganized? Frustrated? Modern Life or Adult ADD?” The advertisement notes that adult ADD can go undiagnosed because “its symptoms are often mistaken for a stressful life.” The commercial suggests that readers get checked out by their physician, because Strattera®, the first approved medication for adult ADD, can help “you stay focused, so you can get things done at work and at home.”

“I certainly have watched adult attention deficit disorder start to spread out from the first grade/kindergarten crowd right up to adulthood. I am suspicious because I think that this expansion is fuelled by Lilly and Strattera®,” Caplan commented. “I don’t like the way their website [suggests that] people go pester their doctor if they have problems waiting in lines or get frustrated being put on hold on the phone.” Lilly did not respond to a request for comment.

Adult ADD has been a favourite target of the critics. But psychiatrist Peter Jensen, a mental health researcher at Columbia University (New York City, NY, USA), concedes there is a dearth of epidemiological research on adult ADD, which can be a real condition that impairs and disables people. “Pharmaceutical companies are businesses that are out there to make money and sell things. But saying that diseases are invented seems a little over the top. [Companies] certainly spread information and increase awareness, but you can’t sell it to the FDA that way,” said Jensen, who serves on the governing board of Children and Adults with Attention–Deficit/Hyperactivity Disorder (CHADD; Landover, MD, USA), a non-profit patient support group. “Illness is defined in a social context. Value systems are inherent in medicine. With adult attention deficit disorder, some people whose brains are easily distracted are [annoyed] at being labelled [and] will say that they are just high energy and creative; others will be thankful they were diagnosed, treated and had their attention span restored to almost normal.”

…it is not only companies who are to blame, but also physicians who diagnose a disorder and prescribe a drug, as well as patients who feel that they have a serious disease that needs treatment

Not surprisingly, the pharmaceutical industry does not buy the ‘disease mongering’ critique. “Our [industry’s] job is to look for cures, not to create disease. It’s up to the medical community to develop new diagnostic tools and ways to evaluate patient response,” said Alan Goldhammer, Associate Vice President for Regulatory Affairs for Pharmaceutical Research and Manufacturers of America (PhRMA), an industry trade group based in Washington, DC, USA. He maintains that drug regulators, such as the FDA, approve drug therapies on the basis of clinical trials. “One can argue you can’t do a clinical trial because if it’s not a disease, it’s unethical to treat people with a drug if you’re not going to come up with any potential benefits. There are a number of checks and balances throughout the development process that are totally external to the pharmaceutical companies.”

Critics maintain that it is not only the pharmaceutical industry that has a role in the creation of new diseases, although they certainly fuel the process. For this reason, Australian journalist Ray Moynihan, a visiting editor at the British Medical Journal and co-author of the forthcoming book Selling Disease: How Drug Companies are Turning Us All into Patients, describes the process as ‘corporate-sponsored drug creation’ because it also involves physicians and patient groups. “There are informal alliances of doctors, drug companies and increasingly patient groups that help to widen the boundaries of illness in order to widen markets for those selling treatments. Often this process is driven by the medical profession, but it’s driven with fuel provided by the drug companies,” he said. Nevertheless, drug companies have an important role in the process. “The meetings where these disorders are defined and expanded are all drug-company funded,” Moynihan said. “Drug company activity lubricates this process, but it’s often not corporate executives in the driving seat. Often it’s the so-called thought leaders at the top of the tree in their profession and in their specialties.”

Furthermore, it is not always obvious where the border should be defined between a mild symptom and a disorder that needs medical attention. “I wouldn’t draw such a clean line between manufactured and real diseases,” said Joe Dumit, Associate Professor of the Anthropology and Science-technology Studies’ Programme at the Massachusetts Institute of Technology (Cambridge, MA, USA). He has been studying the topic of disease creation as part of his work on how patients with controversial sociomedical conditions, such as chronic fatigue syndrome, Gulf War syndrome and multiple chemical sensitivity, organized themselves to obtain research funding from the US National Institutes of Health. Dumit found that when patient groups were backed by pharmaceutical companies, such as patients with ADD and post-traumatic stress disorder (PTSD), the character of the debate changed entirely. “When Zoloft [®; sertraline hydrochloride] was approved [in 1999 for PTSD], almost every article that came out about PTSD now more or less no longer questioned the existence of the disease, but instead talked about the treatment and whether [PTSD is] underdiagnosed or overmedicated,” he said. In addition to forming alliances with patient groups, drug companies also attempt to “maximize the detectable prevalence of conditions as part of the economic rationale for growing the market for the medications,” said Dumit. “Once you decide on a threshold like a cholesterol level or an amount of irritation in your bowels, and once you decide there’s a drug that could reduce that in a population, they have a strong incentive to market to that whole population.”

One such example is social anxiety disorder, better known as shyness. GlaxoSmithKline (Uxbridge, UK) had the indications for its antidepressant Paxil® (paroxetine hydrochloride) extended to treat social anxiety disorder, an extreme form of shyness marked by fear of public speaking, eating in front of others or using public bathrooms. The FDA approved this new indication in October 2003. However, “shyness is a new disease invented by Glaxo,” said Sidney Wolfe, executive director of the Public Citizen’s Health Research Group (Washington, DC, USA). “In a pathological way I’m sure that people are so shy it can be a disease. It can be a real downside for people. A lot of these people are depressed. A number of these people are shy because they have been physically or sexually abused when they were younger. Shyness is generally a symptom of something else and to gloss over finding the cause and to just throw a drug at someone is doing a disservice.” GlaxoSmithKline did not respond to a request for an interview.

In the end, it is not only companies who are to blame, but also physicians who diagnose a disorder and prescribe a drug, as well as patients who feel that they have a serious disease that needs treatment. “What you have in social anxiety disorder is senior clinicians who are often connected with [several] different drug companies promoting this almost as a horrifying psychiatric disease,” Moynihan explained. He therefore lays some blame on the medical profession if they are not forthcoming about these connections. “I just don’t think you can be credible when you’re taking money from drug companies. And often when these [experts] are communicating with the public, the public does not know of those ties,” Moynihan said. “This is the marketing of fear. This is not a healthy way to run a society. It’s putting disease at the centre of human life.”

The USA is the epicentre for both drug and drug-marketing innovation. In addition, it is the only developed country apart from New Zealand that allows direct-to-consumer advertising for medications. According to Moynihan, consumers are exposed to an average of ten drug advertisements per day on news programmes, sitcoms and soap operas, which has a major impact on their view of disease. “The drug ads are changing perceptions of human ailments and conditions and experiences,” he said. Referring to the process in which disease prevalence is maximized, Moynihan cited GlaxoSmithKline’s campaign to market Paxil in the late 1990s, when pamphlets were distributed suggesting that one in eight Americans had social anxiety disorder. “One in eight Americans! This is clearly an absurd fiction. The point of that is to try and make ordinary people feel sick,” Moynihan said.

It’s not healthy for children or adults to sit in front of a wall of drug-company promotion every day that tells healthy people they’re sick.

Although other developed countries may not have direct-to-consumer advertising, they are not immune to the influence of marketing campaigns. “This is a global phenomenon,” Moynihan said. “In other countries, you can’t advertise drugs direct to the public, but you can run and sponsor disease awareness campaigns and that’s what they see in Europe and Australia.” In fact, in the autumn of 2003, Germany’s largest weekly news magazine Der Spiegel devoted a cover story on the topic, based on German science journalist Jörg Blech’s book Die Krankheitserfinder (The inventors of disease), which analyses how the pharmaceutical industry invents new diseases to increase sales of their drugs.

Jerry Avorn, a medical professor at Harvard University and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at the Brigham and Women’s Hospital (Boston, MA, USA), is a long-time critic of the drug industry’s marketing practices. However, he is also sceptical of the social critics: “The reason we’re not still using leeches is we base our decisions about drugs on well done clinical trials of what works and what doesn’t. Nothing that comes out of the realms of anthropology or philosophy matters much if the science isn’t taken into account.” According to Avorn, there are two extremes in the discussion: those who overpromote the pill-for-every-ill philosophy and nihilists who view diseases as being invented. “The truth is somewhere in the middle,” he said.

Faced with increasing costs for healthcare services to cover drug prescriptions, politicians have also begun to investigate the issue of disease mongering. In 2004 and 2005, the British House of Commons held hearings on practices of the pharmaceutical industry, including disease mongering. In March 2005, the House of Commons Health Committee published a report, The Influence of the Pharmaceutical Industry, in which it expressed concerns about the effects of “medicalisation of our society—the pill for every problem.” The committee did not blame this trend solely on the pharmaceutical industry, but rather said the industry has encouraged it by acting as a “’disease monger’, with the aim of categorising an increasing number of individuals as ‘abnormal’ and thereby requiring (drug) treatment. This process has lead to an unhealthy over-reliance on, and an overuse of, medicines. It also diverts resources and priorities from more significant disease and health problems” (House of Commons, 2005).

To increase people’s awareness of disease mongering, Moynihan called for “a more robust conversation” on regulation. “The disease-awareness campaigns need to be seriously regulated. It’s not healthy for children or adults to sit in front of a wall of drug-company promotion every day that tells healthy people they’re sick,” he said. “I actually think quite strongly that there must be a conversation about how or if to regulate this. I think that’s extremely unlikely [in the USA] in the near future. I think the Europeans are a little more civilized about this stuff. And in fact the Europeans recently rejected loosening the rules on advertising.” As governments and public healthcare systems are increasingly confronted with the high cost of medications, no doubt the issue of medicalization and disease mongering will become even more important in future debates.Go to:

References

  • Breitstein J (2004) The making of a new disease. Pharma Exec 1 Jan, www.pharmexec.com [Google Scholar]
  • House of Commons (2005) The Influence of the Pharmaceutical Industry. Fourth Report of Session 2004–2005, HC 42-I. London, UK: The Stationery Office Limited [Google Scholar]

This interesting article from the health care industry discusses the huge push of the pharmaceutical industry to create disease and prescribe drugs motivated by profit. What medicines / drugs do you take? Why? How did you obtain the disease to require the medication?

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The Misuse of a Biblical Doctrine

Shidonna Raven Garden and Cook

The History of Christian Counseling and General Revelation

Samuel Stephens
Feb 23, 2018
Source: Biblical Counseling
Features Photo Source: Shidonna Raven Garden & Cook

Introduction

A movement cannot be rightly understood unless it is placed in the context in which it began and how it progressed – what we call history. History allows us to trace threads of ideas and themes through time. Within the movement and practice of Christian Counseling, a line of division surfaces as we look at sources of authority upon which counselors have depended through the years. This division occurs between biblical conviction and counseling practice. In this essay, I suggest that the integrative model of counseling, namely Christian Counseling, misses the mark concerning the search and identification of truth by abusing the biblical doctrine of general revelation. The field of Christian Counseling has consistently demonstrated a historical misrepresentation and biblical misapplication of this doctrine in an effort to provide a justification for the utilization of secular psychology.

What is Christian Counseling?

It is important to note that as a label Christian Counseling can refer to a wide spectrum of counseling approaches.1 A unifying drive of this counseling approach, however, is the effort “to integrate psychology and Christian theology.”2Everett Worthington defined Christian Counseling as:

[An] explicit or implicit agreement between a counselor who is a Christian and a client for the provision of help for the client, in which the counselor not only has at heart the client’s psychological welfare but also the Christian spiritual welfare.3

As a formative influence in the Christian Counseling movement, Clyde Narramore noted that “wise counseling requires that evangelical faith be carefully integrated with the theories, therapeutic methods and professional roles of the modern psychologies [emphasis added].”4 In his book Psychology and Theology, Gary Collins added, “The Christian who wants to understand and help change human behavior must have a good understanding of psychological techniques and knowledge in areas such as biological, cognitive, affective, social, and individual bases of behavior [emphasis added].”5 A theme found throughout Christian Counseling literature is an emphasis on the importance of professional credentials, the reliance upon social science, and a focus on assisting clients in overcoming spiritual maladjustments on their own.6

Integration: An Idea and Process

Christian Counseling cannot be fully understood without highlighting the concept and method of integration. According to John Carter and Bruce Narramore, Christian social scientists who study human behavior through the scientific method use the term integration to show a correlation between professional and scientific fields with Christian theology. They stated, “Most of these efforts are based on one essential philosophical underpinning—the belief that all truth is God’s truth, wherever it is found. This proposition is frequently referred to as ‘the unity of truth.’”7

Collins defined truth as “an abstract idea, a universal reality that exists and can be grasped by analysis or experimentation.”8 In the inaugural edition of the Journal of Psychology and Theology, Bruce Narramore argued that “the minister and psychologist are not the only ones caught up in this conflict. The theologian, the physician and the student of psychology and scripture all share concerns for the whole man. They know they cannot minister effectively if they neglect the contributions of related disciplines.”9 Within Christian Counseling, integration provided a clear path to discovering truth in which psychological science, in conjunction with Scripture, could present a “cohesive approach to the problems that confront us.”10

The Doctrine of General Revelation

Within the context of the broader Christian Counseling movement, general revelation has been used in such a way as to make available “pieces of truth that cannot be found in the Bible.”11 According to Bruce Demarest, general revelation had traditionally been “mediated through nature, conscience, and the providential ordering of history” for the sole purpose of providing “a universal witness to God’s existence and character.”12 Demarest continued, “Through the modalities of general revelation, man at large knows both that there is a God and in broad outline what He is like” (14). In the first volume of his Systematic Theology, James Leo Garett clarified, “‘General’ revelation is that disclosure of God that is available to all human beings through the created universe (nature) and in the inner nature of human beings (conscience).”13

Christianity has been recognized as a revelatory religion and some have gone as far as to say that Christian faith necessitates revelation. The doctrine of revelation distinguishes Christianity from pseudo-religions which have more in common with pagan philosophies.14The very concept of revelation also assumes the sinfulness of man and the fact that man is in spiritual bondage apart from God’s activity and self-disclosure. In Revelation and Reason, his landmark treatment on this subject, Emil Brunner noted that biblical revelation, both general and special, did not disclose “facts” or “something” but it unveiled and disclosed God himself.15

A Brief Biblical Witness

Psalm 19 and Romans 1 demonstrate the doctrinal significance of general revelation.16 In Psalm 19, King David exclaimed, “The heavens are telling of the glory of God; And their expanse is declaring the work of his hands” (Psalm 19:1).17In his commentary on this psalm, John Calvin noted:

Scripture, indeed makes known to us the time and manner of the creation; but the heavens themselves, although God should say nothing on the subject, proclaim loudly and distinctly enough that they have been fashioned by his hands: and this of itself abundantly suffices to bear testimony to men of his glory.18

Not only did the heavens and sun address the glory of God, but each also revealed truth (Psalm 19:3). Peter Craigie noted that “as mankind reflects upon the vast expanse of heaven, with its light by day and its intimation of a greater universe by night, that reflection may open up an awareness and knowledge of God, the Creator, who by his hands created by glory beyond the comprehension of the human mind.”19

The New Testament contains a biblical witness to the doctrine of general revelation as well. Thomas Oden stated that a majority of theologians in the early years of Christianity agreed with the concept of general revelation as seen from the perspective of Paul in Romans 1­­–3 as the “universal revelation in the cosmos and human nature—along with a corresponding affirmation of human suppression of this revelation.”20 Romans 1:20 states that God’s divine characteristics “have been clearly seen, being understood through what has been made . . . .”21See W. E. Vine and F. F. Bruce, Vine’s Expository Dictionary of Old and New Testament Words (Old Tappan, New Jersey: Fleming H. Revell Company, 1971), 168. According to Vine, the Greek word translated understood (νοέω noeō) meant “to perceive with the mind, as distinct from perception by feeling.” The emphasis on understanding with the mind seems to demonstrate the clarity and purposefulness of God within the revelation of himself vis-à-vis creation.In his explanation of this verse, Dunn expounded upon the potential influences on Paul’s observations regarding revelation and truth:

[Paul] draws principally on influential Stoic ideas: that there is an innate rapport between the divine and the human because the divine logos immanent throughout the world is immanent also in man as the power of reason . . . however, it is Paul’s more Jewish perception of this divine relation which remains primary: what is known is an act of revelation personally willed by God (v.19b) in relation to a created order (v.20); and man is recognized as a responsible agent in face of this revelation . . . .22

Another New Testament scholar, Douglas Moo, generally agrees with Dunn’s assessment that general revelation was directed by God, revealed by God, and purposed to convey the glory and power of God. However, he viewed Paul’s presentation of truth in this passage, while derived from general revelation and accessible to both Jews and Gentiles alike, was still limited in scope. In itself, general revelation cannot provide salvation to sinners.23

Historical Perspective of General Revelation

The doctrine of general revelation has undergone scrutiny, served as the topic of debate, and has been used as a foundation for other church teachings.24Originating with Thomas Aquinas, theology came to be known as the queen of the sciences. Millard Erickson noted, “Until the thirteenth century, the term science was not applied to theology. Augustine preferred the term sapientia (wisdom) to scientia (knowledge).”25 As a scholastic theologian, Aquinas focused much of his philosophical musings on the idea of truth and knowledge, which included its definition, source, and purpose. He categorized truth in two realms one lower (nature) and one higher (grace). During the medieval period the church was in a unique dilemma where paganism and secularism, threatened the status of Christianity in the eyes of the common man. Instead of relying on Scripture as the authority of what is necessary for faith and practice, Aquinas chose instead to appeal to reason for an adequate defense of Christianity.26

From this effort, Aquinas formulated the concept of natural theology, which he later refined in his Summa Theologica. As defined, natural theology “is the attempt to attain an understanding of God and his relationship with the universe by means of rational reflection, without appealing to special revelation such as the self-revelation of God in Christ and in Scripture.”27Aquinas’ conclusion concerning natural theology was essentially a misguided attempt to create an apologetic from general revelation. This effect led the Catholic Church to place “Scripture and tradition next to each other” instead of recognizing the different natures, yet identical purposes, of special and general revelation.28Aquinas’ emphasis on the capability of man’s reason led theologians to view revelation as only necessary to explain “what is above reason.”29Therefore, Aquinas’ re-tooling of general revelation rested on two assumptions: first, that nature was wholly intact and yet only partially marred by the Fall of man (Genesis 3), and secondly that people had retained an integrity of reason and perception untouched by sin.

The Protestant Reformation of the sixteenth century brought more developments to the doctrine of general revelation. However, instead of the parameters of this doctrine being expanded, it was narrowed. There was general consensus among Protestant theologians that man’s reasoning abilities were tainted and skewed by sin and thus were susceptible to error.30As early at 1524 A.D., Balthasar Hubmaier, a German Anabaptist theologian, published Eighteen Dissertations in which he included a section refuting a widely accepted view of general revelation. He wrote, “All teachings that are not from God are in vain and shall be rooted up. Here perish the disciples of Aristotle, as well as the Thomists, the Scotists, Bonaventure, and Occam, and all teaching that does not proceed from God’s word.”31This bold representation of general revelation was echoed by another well-known reformer, John Calvin. Calvin’s doctrine of sin, like that of Hubmaier, was sophisticated and took “into account that sinful men corrupt the gifts of understanding and scholarship God gives.”32The rationalism of natural theology committed error in that it denied man’s “dependence in our present state of sin upon God’s past revelations of himself.”33

While the Protestant Reformation brought about many positive changes, the adverse impact of natural theology continued on through the nineteenth century. In 1870 the Catholic Church “announced that God could be known with certainty from that which had been created through the natural light of reason.”34 The modern era of theological deliberation, from the late eighteenth century through the mid-twentieth century, was characterized as having combined the man-centered philosophies of the previous century with a broad interpretation of general revelation.

Theological Implications of General Revelation

The first theological implication regarding general revelation is in the categorization of theology as a “spiritual science” as opposed to a man-centered social science. By the late nineteenth century, the definition of science began to shift from an orderly, systematic study of a particular topic to becoming almost synonymous with the discovery of truth. Writing prolifically on the topic of science and spirituality, Abraham Kuyper noted that due to man’s sinful nature, the scientific method imposed upon the study of theology would invariably lead to error. In his Principles of Sacred Theology, he wrote:

Science is entirely different from truth. If you imagine our human development without  sin, the impulse to know and understand the cosmos, and by knowledge to govern it, would have been the same; but there would have been no search after truth, simply because there could have been no danger of relying upon falsehood as a result of investigation.35

Kuyper defended an idea of truth that inherently pointed to non-truth, while modern science depicted a “thirst after knowledge” which attempted to know everything that existed.36 Commenting nearly a century later on this topic, Carl F.H. Henry noted that it is hypocritical for modern science to demand that religion fall in line when the hard and social sciences constantly re-evaluate and re-assess the veracity of previous conclusions. A consistent characteristic of modern science is that it was always “subject to ongoing revision of its judgments.”37 Erickson agreed with Henry that sciences not based on biblical revelation could indeed err. As such, general revelation can only be accurately understood when held in distinction from man-centered disciplines. Millard Erickson stated, “In an attempt to be regarded as scientific, disciplines dealing with humanity [e.g. psychology] have tended to become behavioristic, basing their method, objects, and conclusions upon what is observable, measurable, and testable, rather than on what can be known introspectively.”38

A second theological implication behind general revelation is that it is distinct from the process and idea of scientific discovery. The Greek word ἀποκάλυψις (apokalypsis) is used throughout Scripture and is most often translated as revelation, which denotes “an ‘unveiling’ and hence a disclosure.”39 Despite this connection, general revelation has been consistently subsumed under the pursuits of modern scientific exploration. Regarding the use of general revelation by the Christian counselor and psychologist, Gary Collins stated, “He [God] has revealed this truth through the Bible, God’s written Word to human beings, but he also has permitted us to discover truth [emphasis added] through experience, through research investigation, and through the insights that come through reflection, observation, and the words of books and sermons.”40 David Penley disagrees with Collins’ conclusions citing that this is an inaccurate view of general revelation. Christians cannot justify utilizing the social sciences by claiming they fall under the category of general revelation. He noted, “General revelation is not God revealing new things to us. He is revealing things about Himself that He also has revealed through special revelation in the Scriptures.”41 A correct understanding of general revelation precludes that God is infinite and man is not. To know God, He must make himself known.42

Christian Counseling: Context and Ideology

In one of the most comprehensive texts in the field of Christian Counseling, Gary Collins mentioned that man’s discoveries of “truth” in general revelation must be consistent with the Bible as revealed truth; however, he did not concede that psychological theory and methodology were based on anti-biblical presuppositions. He further concluded that counseling becomes ineffective and limited when counselors “pretend that the discoveries of psychology, neuropsychology, psychobiology, human genetics, and related fields have nothing to contribute to the understanding and solutions of problems.”43In this final section of the essay, it will be demonstrated that Christian Counseling has adopted an unbiblical concept of general revelation in order to justify attempts at integrating secular psychological models with Christian theological approaches to soul care.

A Modern Approach to Soul Care

The endeavors of philosophy and psychology have, in many ways, intersected with theology and the Christian church regarding the dealings, purposes, nature, and solution to the “basic problems of human nature.”44The early integration of philosophy with theology culminated in pastoral counseling becoming dominated by a scientific and psychological model. Modern trends in pastoral counseling have set it apart from its foundation as the biblical care of souls. In 1956, William Hulme stated, “In former days, the pastor’s counseling was oriented in pastoral theology [anchored in Scripture]; today it centers on pastoral psychology. The impetus for this new movement has come more from the laboratories of the psychological sciences than from the scholarship of theologians.”45

Among Protestants, practical theology no longer covered matters related to soul care and counseling but focused only on topics including preaching, missions, evangelism, and church government. When faced with issues that practical theology did not answer, pastors referred their congregants to the “secular experts” for help and counsel.46Carter and Narramore noted that while liberal pastors functionally abandoned theology for psychology in this area of ministry, conservative pastoral counselors, who were in the minority, were unaware of “the contributions of psychology to the understanding of personality” and therefore lagged behind their counterparts.47 Soon a small number of Christian psychologists began calling all evangelical pastors and counselors to embrace one another’s methods, both biblical and psychological, in an effort to construct a holistic integrative approach to soul care that would be acceptable to clinical psychologists and psychiatrists, efficacious to patients who were emotionally, mentally, and spiritually ill, while still remaining unapologetically Christian.48 Eric Johnson considered the 1960s and 1970s the “golden age of integration” where many Christian psychologists, mental health workers, and counselors largely favored the integration of faith and psychology. The key figures at the forefront of the Christian counseling movement held to a strong conceptual view of integration. Johnson noted that the task of what he labeled as interdisciplinary integration “ostensibly involves reflection of the propositions of modern psychology and the propositions of theology (and the Bible) in order for Christians to end up with discourse that includes both theological and psychological propositions and that is logically consistent with Christian faith.”49In an attempt to integrate, those who held to this approach divided the “revelations” of the Christian faith into two distinct categories. Special revelation involved theology as disclosed in Scripture while general revelation allowed for the study of sociology and psychology by humans in order to “discover” truth.50. Others affirmed that psychology, as a “scientific discipline,” not only had more impact on the church than any other theory, except perhaps Darwinian evolution, but that as a human-centered field of study similar to theology, psychology could “offer a great deal toward an understanding of the human race.”51 In identifying the objective of Christian counseling, Collins stated, “As a counselor, you are a change specialist. Your job is to help people deal with the changes that come into their lives and make changes that will improve their lives.”52However, this change is inconsistent to the concept of “change” as presented within the Bible.

The Search for Truth

The question of the nature of truth serves as the impetus behind the psychologically-informed Christian Counseling movement. The goals and methods of Christian Counseling are concerned with both psychological and spiritual matters. Christian counselors and psychologists hold that the Bible, however useful for spiritual matters, never claims “to be a textbook on counseling” and “never was meant to be God’s sole revelation about people-healing.”53The logical conclusion of this claim on the nature and source of truth was expressed by Stanton Jones when he suggested that Christian counselors had a duty to their clients to share any knowledge of psychological theory they had in their possession. He also seemed to suggest that to withhold such knowledge would make the counselor not only irresponsible, but even negligent.54

Two related assumptions are shared by those who engage the integrationist approach to Christian Counseling. The first assumption is that God is the source of all truth. Carter and Narramore defend this assertion by stating that all disciplines share a basic unity of truth and this unity serves as the legitimate basis for all attempts at integrating the Christian faith with professional, clinical, and theoretical psychology. The view that Christian theology shares subject matter and philosophic jurisdiction with secular psychology leads them to conclude that God is the source of the truth found in these two often opposing sources. They claimed, “If we believe that God is the source of all truth, we assume that there is no inherent conflict between the facts of psychology and the data of Scripture [emphasis mine].”55

The second assumption generally held within Christian Counseling is that man is able to know/discover all truth. According to Collins, science serves as the vehicle for studying and making sense of the natural world (via general revelation). In essence scientific methodology provides an illumination into the teachings and truths of Scripture in a way that man can grasp. A Christian psychologist must be a solid student of both general and special revelation and “continually test his scientifically derived facts against the revealed truth of the Bible.”56 Larry Crabb conceded this point by stating, “The Two-Book View (which is the implicit view behind much current thinking on integration) elevates the conclusions of empirical research to the same level of decisiveness as the conclusions of biblical study.”57

Historical Misrepresentation

Christian Counseling perpetuates the historical misrepresentation of general revelation by equating scientific studies and empirical data with God-given revelation. Concerning the use of general revelation in related literature, Deinhardt noted:

The importance and theological soundness of the stance taken on it is virtually ignored in the Christian counselling [sic] literature, in spite of the fact that it has a key role in determining what materials are to be included in theories of counselling [sic] and what methodologies will be employed in counselling [sic]. Moreover, to the extent it is mentioned, it is typically done so in a manner not representative of traditional evangelical theology. Instead, “all truth is God’s truth” is often used as a theological catch clause so-to-speak whereby one can uphold biblical authority, while in good conscience adding in whatever other “truths” one might deem worthy from other sources.58

In agreement with this assessment, Jim Owen stated, “Although ‘Christian’ psychology claims to integrate Scriptural truth with ‘discovered’ (i.e., scientific) truth, integration is not occurring; Integration is virtually impossible. ‘Christian’ psychology sets aside the historical-grammatical method of interpreting Scripture and replaces it with a hermeneutic centered on pathology.”59Jones views special revelation as an exalted gift; however, it is insufficient in providing what counselors need to fully understand human beings. Modern psychology, provided to man through general revelation, offers “legitimate and strategic” aid in helping the Christian therapist better understand human nature.60

Admitting that not all Christian Counselors and integrationists have adequately represented general revelation, Mark McMinn and Clark Campbell stated that this doctrine was “more authoritative on issues left unaddressed in the Bible” including examples given such as “constructing microprocessors or treating bacterial pneumonia.”61However, general revelation, as previously mentioned, is never referred to as an ambiguous truth that was to be discovered by “reasonable” men.62 General revelation was provided to man by God for the purpose of revealing man’s inherent sin, guilt, and need for reconciliation to His Creator. Scripture, as special revelation, brings explicit clarity to this relationship.63Henry, Revelation and the Bible: Contemporary Evangelical Thought, 19. See also, Packer, Ferguson, and Wright, New Dictionary of Theology. Pinnock stated, “The two species of revelation stand together in a complementary relationship. We should not forget that God is the source of revelation in both cases, and that two types of revelation work together to the same goal” (585).

Theological Misapplication

Collins reimagines not only the historical but the biblical definition of revelation. His model “begins with the assumption that God exists and is the source of all truth. This truth is revealed through the Bible (disclosed truth) and nature (discovered truth).”64The biblical definition of truth is re-framed by Collins and Crabb in the form of expanded empiricism. Collins noted, “I would agree with Crabb that the Bible is our primary source . . . But the Bible does not claim to be a textbook on psychology. We can and must draw from nonbiblical sources if we want to intervene to bring about maximum change through counseling.”65

In his book, Psychological Seduction, sociologist William Kirk Kilpatrick argues that the good intentions of Christian integrationists often leads to the secular overtaking the sacred. He stated, “True Christianity does not mix well with psychology. When you try to mix them, you often end up with a watered-down Christianity instead of a Christianized psychology.”66 In differentiating Christian counseling from biblical counselors, Ed Bulkley noted that the “controversy centers on the issues of authority and the source of truth.”67 As has been shown, the misapplication of general revelation in order to affirm extra-biblical sources of truth is not a new concept when the Christian counseling movement was first conceived; regardless, as a movement, this approach was widely applied.68 Years earlier, Abraham Kuyper noted that truth that is scientifically established has come to be known as universally valid. However, Scripture never presents truth as a force that depends upon corporate agreement in order to retain its validity.69

Conclusion

While it is a vitally important biblical doctrine, general revelation has been at the center of theological debate throughout church history. Unfortunately, this doctrine has been often misrepresented leading to error regarding the nature, source, and application of truth itself. Through this essay, I have argued that those adhering to an integrationist approach to Christian Counseling have perpetuated an incorrect understanding of general revelation in an effort to utilize both secular psychology and Christian Scripture. Ultimately, integrative counseling functionally identifies and utilizes two different types of wisdom: one found in the Bible and one found in secular psychology.70 At the same time, modern soul care practices pay lip-service to the sufficiency of Scripture while simultaneously denigrating the inherent authority of the Word of God. A proper historical and theological understanding of general revelation recognizes not only its place as subservient to special revelation, but also that revelation is not synonymous with empirical inquiry, incidental discovery, or truth-making but instead demonstrates an active and purposeful unveiling of God’s nature and plan to those who are made in His image.

<a href="https://biblicalcounseling.com/multi_author/samuel-stephens/">Samuel Stephens</a>
Samuel Stephens

Samuel Stephens serves as the Director of Training Center Certification at ACBC.

How does one achieve true healing? How is “medicine” / drugs apart of healing? Or are drugs apart of addiction cultivation?

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