Should Christians get Therapy?

The role of therapy is by far the most controversial topic for Christians in regards to the field of psychology. There are mounds of books devoted to the integration of therapy into Christian theology and the different views on it. Thankfully, I think there's a way to cut through all the rhetoric, at least in regards to the question of whether Christians should seek therapy for mental health concerns.

In order to think clearly about this issue, we need a very basic understanding of the brain and the mind, which is sometimes referred to as the soul. There are two main views: dualism and materialism. Dualism says that brain and mind are different things, the brain being physical matter and the mind being immaterial (the soul). Materialism says the brain and mind are both just physical matter and that consciousness is a function of the brain. Christians can be either one and often fall somewhere in the middle, often disagreeing just on minute details.

As for our brains, they are composed of glial cells and neurons. The neurons are what do all the works and they have three main parts: a cell body (nucleus), dendrites, and an axon. The synapse is the open space between the axon of one neuron and the dendrite of another neuron. We have nearly 100 billion neurons in our brains and between 100 and 1,000 trillion synapses. This is because one axon can connect to several dendrites. As we learn and develop, our dendrites grow so that our neurons become more interconnected.

Solution
Regardless of what position a person takes on whether the mind is material or immaterial, everyone agrees that the brain plays an important role in who we are and how we make decisions. Materialists say it's all in the brain while dualists say that the mind interacts with the brain in some unknown way. What this means is the people on both sides essentially agree that changing the physical structure of the brain will change a person's thoughts and behaviors.

If you've ever driven a car, you understand what this is like. Think of the windshield as your brain and your eyes as your mind. If your eyes work perfectly, but the windshield is covered in dirt, bugs, or rain, you cannot see well. No matter what you do to fix your eyes, you still won't be able to see better through the dirty windshield. Instead, you have to clean the windshield so your eyes can see to their full potential. In the case of mental health concerns, physical structures or chemicals in the brain are almost always, if not always, part of the cause. There may or may not also an issue with the mind or soul, but we simply cannot know without first addressing the physical aspects of the brain.

Therapy, whether done by a Christian or an atheist, attempts to heal the physical structure of the brain. It works by strengthening good connections in the brain and weakening undesirable ones. By healing the brain, the mind has a clear window through which it can see or work. God can and occasionally does heal people instantly of mental health issues, but just like with a broken bone, we are not guaranteed that He will. If you have a mental health issue, or are just going through a hard time, there's no shame in seeking therapy. It doesn't make you a worse Christian or less of one.

Precautions
I do want to offer a warning though. There is secular counseling, Christian counseling, pastoral counseling, biblical counseling, and other non-Christian religious counseling. I would strongly advise you to avoid that last two. Non-Christian religious counseling should be obvious to avoid and most secular counseling methods do not conflict with with a Christian worldview so there's no reason to avoid it. The one secular practice that I hear criticized most often for not being Christian is meditation or mindfulness practices because of their association with eastern religious practices. However, as a secular practice that is removed from mythic practices, meditation or mindfulness is simply a state of relaxation and attunement to one's surroundings.

But what about biblical counseling? The issue with biblical counseling is that the people who do it are not well qualified. They're not required to have a degree in psychology or theology, which is problematic since they explicitly reject secular psychological science in favor of their own interpretation of scripture and lack the training to even know if the two contradict. Their healing techniques are fairly limited to what most people would consider spiritual practices such as memorizing scripture. While this can certainly be helpful, it's unlikely to completely resolve major issues. Here's a quick article on the differences and agreements between Christian counseling (a qualified therapist who is also a Christian) and biblical counseling.

Conclusion
There's no reason to hold on to mythical, pre-scientific views of the brain. Mental health problems are just as much of a physical issue as cancer or a broken bone. If you're having a tough time, seek help for it. Talk to someone, and if they're not able to help you, seek more qualified assistance. I'd be more than happy to talk with you if you send me a message. If someone you know if having a hard time, listen to them without being judgmental. You likely have no idea the depth of their suffering. Even if you know the cause, you probably don't know how it feels, so have some humility before thinking you'll be able fix them with a few superficial words.

References

Sleeping for Christ

A few weeks ago, a friend of mine asked me what spiritual disciplines I was participating in. If I asked you the same question, what would you say? One of my answers was sleep, which seemed a bit odd to my friend until I explained the way sleep affects our lives. Most people, if they've ever even considered sleep as part of their spiritual life, probably think they should be doing less of it, not more. I'm going to gives some reasons why Christians might start considering sleep a spiritual practice and why we should probably be doing more of it.

This is from 1 Kings 19:5-7, and Elijah did nap, but God didn't tell him to.

The science of sleep might just be the single topic that is most susceptible to pop-psychology bunk or pseudoscience. The myths about sleep in popular culture are extremely pervasive and overshadow real science. Thankfully, sleep is not a very controversial topic so hopefully, that means I won't offend anyone and people might actually be open willing to follow my suggestions!

I say this without exaggeration, but if you think of all the things we do on a regular basis, sleep is probably the single more important one (obviously assuming that eating and drinking are done to a degree that avoids death). This is because sleep affects how well we can do all of the other activities. It can help us drive safer, memorize scripture better, stay focused at work, and even eat better.

 A person who is sleep-deprived will have all kinds of side effects, some of which are obvious, but some are not. For instance, sleep deprivation makes people cranky. We all know this, but there's more to it than that. It also makes you more likely to get angry even when you're in a good mood. Having a morning coffee or feeling alert may make you feel alert, but it won't necessarily improve your performance very much. Sleep deprivation negatively affects memory, emotion regulation, alertness, mood, physical performance, concentration, mental and physical health, self-control, and even our diets (we crave fatty and sugary foods when sleep-deprived, which is especially bad when our self-control is already exhausted). How we sleep affects every aspect of our lives.


Scientists who study sleep are mostly concerned with two variables: quality and quantity. Both variables affect how a person feels and functions during the day. Poor sleep or not enough sleep can be equally negative. If a person doesn't get enough high-quality sleep, they start to accrue sleep debt, which is a term to describe how sleep-deprived a person is. Moreover, the effects of sleep debt are cumulative from day to day so we accrue more and more sleep debt every night we don't get enough sleep.

Quantity
Everyone knows we're supposed to get 7-8 hours of sleep per night; right? Wrong. For most adults, a full 8 hours is necessary to avoid sleep debt (although there is some variability). One of the most pervasive myths about sleep is that we can adapt to less sleep than we need. We might be able to adapt to a schedule, but this will not improve our cognitive, emotional, and physical performance. The amount of sleep you need is biologically determined and you cannot change it.

Kids need more sleep than adults and women tend to need a little more than men. Adults under the age of 25 or so likely need a little over 9 hours of sleep per day to avoid sleep debt. I say 'day' because the ideal would be to sleep mostly at night and then nap in the early afternoon, but since most people in our culture are unable to nap, sleeping only at night works just fine.

There is the rare person who needs less than 8 hours a day, but most adults really need the full 8 hours to avoid sleep debt. If you need 8 hours per night and only get 7 hours, you may still feel fine and perform fine the next day, but if you only get 7 hours per night throughout the week, you will feel and perform progressively worse throughout the week until you are able to get a full night's worth of sleep (and maybe more) to get rid of your sleep debt. Also, just like there are people who need less than 8 hours per night, there are also people who need more, so don't necessarily be worried if you need more than 8 hours per night (although sleeping too much can be a sign of depression or other problems so it might be something to discuss with a doctor).

The easiest way to know if you're not getting enough sleep is whether you need an alarm to wake up and if you sleep in on the weekends. A person who is getting enough sleep will not need an alarm nor will they sleep in on weekends. It still might be a good idea to set an alarm clock just in case, but if the alarm is waking you up regularly or you feel groggy when it goes off, you probably need more or better sleep. Also, don't use the snooze button. They're bad for your quality of sleep. Just set the alarm later.

Quality
Most people tend to think they have limited control over the quality of their sleep. This too is far from true. The most important thing a person can do to ensure they get high-quality sleep is to get on a set schedule, even on the weekends. Our circadian rhythm governs our sleep cycle and alertness throughout the entire day, even when we're awake. It is because of our circadian rhythm that you probably feel overwhelmed by tiredness every day shortly after lunch and start to feel tired around bedtime.

When we have a consistent schedule of going to bed at the same time and waking up at the same time, our circadian rhythm becomes more stable and we sleep better. Just because you're an adult doesn't mean you're immune to the negative side-effects of a poor schedule. The more consistent you are, even on the weekends, the better your sleep quality will be, which means you may actually need less sleep. Seven hours of high-quality sleep could be as good or better than 8 hours of poor sleep, depending on several other factors.

There are plenty of other things you can do to improve the quality of your sleep, even if you believe some pop-psychology or anecdotal myth about sleep! 😉 The one I hear most often is "I need background noise to sleep." That may be true, but that's probably only because you've been conditioned to need it. Your sleep quality will likely improve if you create a habit of sleeping without background noise, but it might take some time to adapt. On the other hand, if there are noises you cannot control, white noise might be better than erratic noise. In other words, the sound of a fan or rolling ocean sounds are probably better than random train noises sporadically throughout the night.

Other factors to consider are your level of physical activity during the day, what you do before bed, the temperature of your bedroom, and the level of darkness. A cool, dark room is ideal. Obviously, you don't want it too cold, but a little on the colder side with a warmer blanket is better than being too warm. If you must have a light somewhere, a red light is best because it has less impact on your melatonin production. Additionally, reading, working, or watching TV in bed also negatively affects our sleep quality. If we limit the use of our bed to sleep (and sex), our brains learn to associate our beds with sleep so that we will fall asleep easier and stay asleep better.

One final myth to dispel is that alcohol helps you sleep better. This is false in two ways. It is true that when you drink alcohol, you feel like you've slept better, but this is because we don't remember all the times we woke up and tossed and turned throughout the night. Additionally, alcohol causes us to have less REM sleep, which may sound great, but our brains need the right balance between the different levels of sleep. As a result, too much deep sleep one night will cause us to have to catch up on REM sleep the next night. In other words, drinking too much or too close to when we go to bed on a Friday night will cause us to sleep like crap on Saturday night.

Conclusion
It's actually pretty hard to sleep too much. This is because we wake up naturally once we get enough sleep. If you are sleeping too much, it could be a sign of mental or physical health issues, in which case, it's probably a good idea to see a doctor. It's possible to be from laziness, but this is unlikely because, in order to sleep too much without a health issue, you basically have to just lay around for extended periods of time to fall back asleep.

As Christians, we should view sleep as a spiritual discipline. God designed us to require sleep and determined how much sleep we need. There are lots of reasons to stay up late from time to time, some good and some bad. Whether your reason is reading, watching Netflix, "doing work for the kingdom," or something else, you cannot avoid the negative effects of sleep deprivation. In fact, there is a correlation and possibly a causal link between sleep deprivation and Alzheimer's.


Getting enough high-quality sleep probably won't cure all your problems, but it might help some of your issues or play a role in doing so. It can help you drive safer, be a better spouse and parent, improve your attitude, help you learn better, be a better evangelist, and be more motivated to do whatever God might be calling you to do. All of this is especially important for apologists who are often engaged in intellectually and emotionally challenging activities.


References
Cappuccio, F. P., D'elia, L., Strazzullo, P., & Miller, M. A. (2010). Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes care, 33(2), 414-420.

Ju, Y. E. S., Lucey, B. P., & Holtzman, D. M. (2014). Sleep and Alzheimer disease pathology—a bidirectional relationship. Nature reviews Neurology, 10(2), 115.

Lim, J., & Dinges, D. F. (2010). A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychological bulletin, 136(3), 375.

Koslowsky, M., & Babkoff, H. (1992). Meta-analysis of the relationship between total sleep deprivation and performance. Chronobiology international, 9(2), 132-136.

Pilcher, J. J., & Huffcutt, A. I. (1996). Effects of sleep deprivation on performance: a meta-analysis. Sleep, 19(4), 318-326.

Van Dongen, H., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26(2), 117-126.

Wickens, C. D., Hutchins, S. D., Laux, L., & Sebok, A. (2015). The impact of sleep disruption on complex cognitive tasks: a meta-analysis. Human factors, 57(6), 930-946.

Vaccines and Apologetics

I've been meaning to write about vaccines for a while now but just haven't gotten around to it. However, in the past year or so, I've heard several Christians question their safety (mostly about autism), there have been several outbreaks, and there is a proposed bill in Colorado (the state I live in) that would require kids to get vaccinated, so I thought now would be a good time to discuss them from an apologetics point of view. There are certainly more lessons to be learned, but for now I want to focus on just three lessons we can learn from the vaccination debate.

Stay Current
As a society, our knowledge is growing rapidly, especially our scientific knowledge. For this reason, it is important to reconsider our conclusions on various topics from time to time. The first time my wife was pregnant, I thoroughly researched the safety of vaccines, but that was almost 10 years ago. It is possible that new scientific discoveries have changed our understanding of the safety of vaccines since that time. People often like to quip that you can't trust science because it changes. This isn't entirely true. Scientific knowledge does change, but it almost always improves by becoming more nuanced. Very rarely does scientific knowledge completely change on a subject.

In the case of vaccines, I specifically looked to see if there was a link between any vaccine and autism. When I researched it 10 years ago, there was no published scientific data showing a link (more on this under the next heading); however, it is plausible that new scientific research has found a link between vaccines and autism, especially since newer research tends to be more specific.  Perhaps by testing specific vaccines given at specific times to specific populations of people, scientists have found that there is indeed a link.

I searched very thoroughly, and I found several scientific studies testing for a link between vaccines and autism, but none showed a relationship between the two. Even though the science on the subject has not changed and neither has my view, I'm glad I investigated it so that I will not embarrass myself and so that I can have stronger epistemic justification for my view.

Be Consistently Skeptical
As part of my investigation, I watched the documentary Vaxxed in order to understand why people think there is a link between vaccines and autism. One of the people featured in the documentary was part of a team investigating the MMR vaccine and he claims that he found a correlation between the vaccine and autism, but out of fear of losing his job, the leader of the team (DeStefano) covered it up and only published the analyses that showed no correlation. Most of the documentary is about the cover up, but it also includes several emotionally powerful stories of kids who developed autism shortly after receiving the vaccine.

The documentary is very well done and has a powerful emotional appeal, but ultimately, it should not be persuasive. At best, the producers of the documentary cast doubt on a single research study. From that same study, they present the "true" data to show there is a link; however, these analyses have not been subject to peer-review nor is the data available in enough detail to evaluate the reliability of the analyses. Just because the producers of the documentary present themselves as unbiased outsiders doesn't mean they are unbiased nor does it mean they are capable of performing the complex statistical calculations they claim to have done.

In searching the peer-reviewed scientific literature, I found 38 other studies that reported no link between autism and any vaccine. These studies were conducted by a ton of different scientists in several countries from multiple scientific disciplines using funding from all kinds of different sources so it's extremely unlikely that government or big pharma conspiracies can explain these results.

Moreover, there was not a single reputable scientific study showing a link between vaccines and autism. There have been three (two use the same data set) that found a link. The original study by Andrew Wakefield in 1998 that started the whole issue with vaccines and autism has been retracted and discredited due to methodological issues (small, biased sample). The two recent ones, funded by anti-vaxxers, also have sampling biases and weren't able to get published in a legitimate scientific journal so they were published in an open source journal (pay to publish journal). Despite all this, it's debatable whether they even show a link since they don't adjust statistical significance levels to account for multiple statistical tests (see notes in references below).

The point here is that we cannot trust someone simply because they claim to be an unbiased whistle-blower who has special knowledge. Likewise, we can't base conclusions off of the absence of evidence either (unless we have really good reasons for thinking the evidence should exist). We need to be just as skeptical of these people and claims as we are with mainstream claims. Ironically, I often see the same tactic used to support atheism. When sheltered Christians first learn about evolution, hear claims that the Bible has contradictions, or find out that there is limited non-Christian accounts of Jesus, they uncritically accept these as evidence against Christianity and leave the faith. Had they been skeptical of these objections and searched for Christian responses, they would realize these are non-issues.

Love Your Neighbor
Jesus sacrificed His life to save ours. As Christians, we are called to be like Christ. Not only are we to love our neighbors as ourselves (Mark 12:30), but we are to consider others as more important than ourselves (Philippians 2:3). Vaccines are a simple measure that improves quality of life and prevents death. Unfortunately, not everyone can get them. Infants, elderly, those who are allergic to some of the ingredients, cancer patients, and others are sometimes unable to receive vaccines. Thankfully, they can receive protection from illnesses when others get vaccinated. This is because when a greater number of people get vaccinated, fewer people will contract the disease and the few vaccinated people who get the disease will spread it to fewer people since they'll have it for a shorter period of time.

Getting vaccinated is a simple and effective way to love your neighbor by decreasing the chances they will get sick. Yes, there are some risks. Here's the CDC's list of possible side-effects, most of which are rare and minor, although there a few major ones (on a side note, why are these major risks accepted by the scientific community but the link with autism isn't? 🤔) The risks associated with vaccines are smaller than the risk of not getting them, but if you're still not willing to get them for yourself or children, please consider doing it for the sake of others. Nobody is asking you to lay down your life or your kids' lives for others, but to simply take a small risk.

Conclusion
There is a lot of information in our world and very little time for us to really learn about and understand it all. Thankfully, we don't have to because we have experts who spend their lives studying topics in great depth. It is possible that the experts are wrong, but unless we have advanced knowledge in an area and very good reasons for rejecting what the experts say, it's probably best that we stick with the experts. If we, as non-experts, disagree with experts, we are likely the ones getting something wrong, not them.

Additionally, rejecting expert views calls into question our credibility and intelligence so that our ability to preach the gospel is greatly diminished. Again, this is worth doing, but only if we have strong reasons for doing so. In regards to vaccines, most people just aren't knowledgeable enough in the science and statistical methods used in order to take a rational stand against the experts.

Reasons to Believe (RTB), which is a ministry that focuses on science, has done some excellent work on this subject as well. Here's a couple of their articles and videos, which echo what I've said and goes into more detail in some ways. Here's their article on how vaccines are a way to love your neighbor, an article on vaccine safety, a video on vaccines from a Christian worldview, and a final video below by one of the RTB scholars, AJ Roberts who has done scientific work on vaccines.

The young-earth creationist ministry, Answers in Genesis, has also made favorable statements about vaccines in articles here and here. Likewise, the Discovery Institute, the other major ministry that focuses on science, has made favorable comments about vaccines here and here. My hope is not that people will get vaccinated, which is good for society, but that Christians will come to see that vaccines work because of our God-given design, and therefore, become proponents for them.

References
This first set of articles are all the ones that found no link between the MMR vaccine or those containing thimerosal and autism.

Andrews N, Miller E, Grant A, Stowe J, Osborne V, Taylor B. Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United Kingdom does not support a causal association. Pediatrics. 2004;114:584-591.

Davis RL, Kramarz P, Bohlke K, et al. Measles-mumps-rubella and other measles-containing vaccines do not increase the risk for inflammatory bowel disease: a case control study from the Vaccine Safety Datalink project. Arch Pediatr Adolesc Med. 2001;155:354-59

Demicheli, Vittorio, Tom Jefferson, Alessandro Rivetti, and Deirdre Price. "Vaccines for measles, mumps and rubella in children." Cochrane Database Syst Rev 4, no. 4 (2005).

DeStefano, Frank, Tanya Karapurkar Bhasin, William W. Thompson, Marshalyn Yeargin-Allsopp, and Coleen Boyle. "Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan Atlanta." Pediatrics 113, no. 2 (2004): 259-266. This is the article that is challenged in the documentary Vaxxed , yet there is no actual published evidence that the data were wrong. Even if we toss this one out, there are still all these other articles.

DeStefano F, Chen RT. Negative association between MMR and autism. Lancet. 1999;353:1986-1987.

DeStefano, F., & Shimabukuro, T. T. (2019). The MMR Vaccine and Autism. Annual review of virology, 6.

DeStefano, F., Bodenstab, H. M., & Offit, P. A. (2019). Principal Controversies in Vaccine Safety in the United States. Clinical Infectious Diseases, 69(4), 726–731.

Doja, Asif, and Wendy Roberts. "Immunizations and autism: a review of the literature.” Canadian Journal of Neurological Sciences 33, no. 4 (2006): 341-346.

Dudley, M. Z., Salmon, D. A., Halsey, N. A., Orenstein, W. A., Limaye, R. J., O’Leary, S. T., & Omer, S. B. (2018). Do Vaccines Cause Autism?. In The Clinician’s Vaccine Safety Resource Guide (pp. 197-204). Springer, Cham.

Farrington, C. Paddy, Elizabeth Miller, and Brent Taylor. "MMR and autism: further evidence against a causal association." Vaccine 19, no. 27 (2001): 3632-3635.

Fombonne E, Zakarian R, Bennett A, Meng L, McLean-Heywood D. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. Pediatrics. 2006;118:E139-150.

Fombonne E, Chakrabarti S. No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics. 2001;108:E58.

Fombonne E, Cook EH Jr. MMR and autistic enterocolitis: consistent epidemiological failure to find an association. Mol Psychiatry. 2003;8:133-134.

Heron J, Golding J. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United Kingdom does not support a causal association. Pediatrics. 2004;114:577-583.

Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism. JAMA. 2003;290:1763–6.

Hviid, A., Hansen, J. V., Frisch, M., & Melbye, M. (2019). Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Annals of internal medicine.

Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. J Child Psychol Psychiatry. 2005;46:572-579

Hornig, Mady, Thomas Briese, Timothy Buie, Margaret L. Bauman, Gregory Lauwers, Ulrike Siemetzki, Kimberly Hummel et al. "Lack of association between measles virus vaccine and autism with enteropathy: a case-control study." PloS one 3, no. 9 (2008): e3140.

Jain, Anjali, Jaclyn Marshall, Ami Buikema, Tim Bancroft, Jonathan P. Kelly, and Craig J. Newschaffer. "Autism occurrence by MMR vaccine status among US children with older siblings with and without autism." Jama 313, no. 15 (2015): 1534-1540.

Kaye, James A., Maria del Mar Melero-Montes, and Hershel Jick. "Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis." Bmj 322, no. 7284 (2001): 460-463.

Madsen, Kreesten Meldgaard, Anders Hviid, Mogens Vestergaard, Diana Schendel, Jan Wohlfahrt, Poul Thorsen, Jørn Olsen, and Mads Melbye. "A population-based study of measles, mumps, and rubella vaccination and autism." New England Journal of Medicine 347, no. 19 (2002): 1477-1482.

Madsen KM, Lauritsen MB, Pedersen CB, et al. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics. 2003;112:604-606.

Maglione, Margaret A., Lopamudra Das, Laura Raaen, Alexandria Smith, Ramya Chari, Sydne Newberry, Roberta Shanman, Tanja Perry, Matthew Bidwell Goetz, and Courtney Gidengil. "Safety of vaccines used for routine immunization of US children: a systematic review." Pediatrics 134, no. 2 (2014): 325-337.

Mandy, William, and Meng‐Chuan Lai. "Annual research review: the role of the environment in the developmental psychopathology of autism spectrum condition." Journal of Child Psychology and Psychiatry 57, no. 3 (2016): 271-292.

Mrozek-Budzyn D, Kiełtyka A, Majewska R. Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study. Pediatr Infect Dis J. 2010;29(5):397–400

Newschaffer, Craig J., Daniele Fallin, and Nora L. Lee. "Heritable and nonheritable risk factors for autism spectrum disorders." Epidemiologic Reviews 24, no. 2 (2002): 137-153.

Parker, Sarah K., Benjamin Schwartz, James Todd, and Larry K. Pickering. "Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data." Pediatrics 114, no. 3 (2004): 793-804.

Peltola H, Patja A, Leinikki P, Valle M, Davidkin I, Paunio M. No evidence for measles, mumps and rubella vaccine associated inflammatory bowel disease or autism in a 14-year prospective study. Lancet. 1998;351:1327-1328.

Picciotto IH, Green PG, Delwiche L, et. al. Blood mercury concentrations in CHARGE study children with and without autism. Environ Health Perspect. 2010;118(1):161-166.

Plotkin, Stanley, Jeffrey S. Gerber, and Paul A. Offit. "Vaccines and autism: a tale of shifting hypotheses." Clinical Infectious Diseases 48, no. 4 (2009): 456-461.

Price, Cristofer S., William W. Thompson, Barbara Goodson, Eric S. Weintraub, Lisa A. Croen, Virginia L. Hinrichsen, Michael Marcy et al. "Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism." Pediatrics (2010): peds-2010.

Price CS, Thompson WW, Goodson B, et. al. Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism. Pediatrics. 2010;126:656-664

Richler, J., Luyster, R., Risi, S., Hsu, W. L., Dawson, G., Bernier, R., ... & Goudie-Nice, J. (2006). Is there a ‘regressive phenotype’of autism spectrum disorder associated with the measles-mumps-rubella vaccine? A CPEA study. Journal of autism and developmental disorders, 36(3), 299-316.

Rutter, Michael. "Incidence of autism spectrum disorders: changes over time and their meaning." Acta paediatrica 94, no. 1 (2005): 2-15.

Schechter R, Grether JK. Continuing increases in autism reported to California’s developmental services system: Mercury in retrograde. Arch Gen Psychiatry. 2008;65:19-24.

Stehr-Green P, Tull P, Stellfeld M, Mortenson PB, Simpson D. Autism and thimerosal-containing vaccines: lack of consistent evidence for an association. Am J Prev Med. 2003;25:101-106.

Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014 June;32(29):3623–3629.

Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999;353(9169):2026–2029

Tozzi AE, Bisiacchi P, Tarantino V, et. al. Neuropsychological performance 10 years after immunization in infancy with thimerosal-containing vaccines. Pediatrics. 2009;123(2):475-482.

Uchiyama, T., Kurosawa, M., & Inaba, Y. (2007). MMR-vaccine and regression in autism spectrum disorders: negative results presented from Japan. Journal of autism and developmental disorders, 37(2), 210-217.

Uno Y, Uchiyama T, Kurosawa M, Aleksic B, Ozaki N. The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: the first case–control study in Asia. Vaccine. 2012;30(28):4292–4298

Verstraeten T, Davis RL, DeStefano F, et al. Study of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases. Pediatrics. 2003;112:1039- 1048.

Wilson, Kumanan, Ed Mills, Cory Ross, Jessie McGowan, and Alex Jadad. "Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence." Archives of Pediatrics & Adolescent Medicine 157, no. 7 (2003): 628-634.

This is a non-exhaustive list of articles that investigate the psychological factors of people who think there is a link between autism and vaccines, suggesting there might be a psychological explanation for why some people think there's a link.

Betsch, C., & Sachse, K. (2013). Debunking vaccination myths: Strong risk negations can increase perceived vaccination risks. Health psychology, 32(2), 146.

Browne, M., Thomson, P., Rockloff, M. J., & Pennycook, G. (2015). Going against the herd: psychological and cultural factors underlying the ‘vaccination confidence gap’. PLoS One, 10(9), e0132562.

Gulyn, L. M., & Diaz-Asper, C. (2018). Exploring Perceptions of Blame for Autism Spectrum Disorder. Journal of Developmental and Physical Disabilities, 30(5), 587-600.

Hornsey, M. J., Harris, E. A., & Fielding, K. S. (2018). The psychological roots of anti-vaccination attitudes: A 24-nation investigation. Health Psychology, 37(4), 307.

Jolley, D., & Douglas, K. M. (2017). Prevention is better than cure: Addressing anti‐vaccine conspiracy theories. Journal of Applied Social Psychology, 47(8), 459-469.

Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M., & Paterson, P. (2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. Vaccine, 32(19), 2150-2159.

Mitra, T., Counts, S., & Pennebaker, J. W. (2016, March). Understanding anti-vaccination attitudes in social media. In Tenth International AAAI Conference on Web and Social Media.

Pluviano, S., Watt, C., Ragazzini, G., & Della Sala, S. (2019). Parents’ beliefs in misinformation about vaccines are strengthened by pro-vaccine campaigns. Cognitive processing, 1-7.

Here are the only two peer-reviewed articles that have ever shown a link between vaccines and autism. Both of them have been retracted due to methodological issues such as biased sampling or poor controls. 

Wakefield, Andrew J., Simon H. Murch, Andrew Anthony, John Linnell, D. M. Casson, Mohsin Malik, Mark Berelowitz et al. "RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children." (1998): 637-641. Article has since been debunked and retracted due to methodological errors. This is the original article that started the controversy.

Mawson, Anthony R., Azad Bhuiyan, Binu Jacob, and Brian D. Ray. (2017). "Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12-year old U.S. children."  Journal of Translational Science, 3(3), 1-12. Three results regarding autism and vaccines, two of them are significant at .05, but not .01. The other is significant at .01. 
Mawson, A. R., Bhuiyan, A., Jacob, B., & Ray, B. D. (2017). Preterm birth, vaccination and neurodevelopmental disorders: a cross-sectional study of 6-to 12-year-old vaccinated and unvaccinated children. J Transl Sci, 3(3), 1-8. These two "studies" are not published in reputable perr-reviewed journals and use a single data set. They also group all vaccinated children together, looking at neurodevelopmental disorders (not just autism) and all vaccines (not just MMR). The data comes from a "convenience sample" of homeschool children who are both more likely not to vaccinate and to have a neurodevelopmental disorder (which is why they homeschool). Here’s a more detailed response to these articles. https://sciencebasedmedicine.org/no-two-studies-purporting-to-show-that-vaccinated-children-are-sicker-than-unvaccinated-children-show-nothing-of-the-sort/ Here’s another critique of the study. https://www.snopes.com/2017/05/17/vaccine-study-autism/

Update: I was recently sent this article which appears to show a link between a different vaccine (Hep B) and autism. After reading it, it seems like a classic case of data fishing, which is when you have a large dataset and go digging for random correlations. In this case, out of 80,000 kids, they found a correlation with autism from on 9 kids who had autism and the vaccine and did no correction to control for type I error, which is they did, there would not be a significant correlation. Moreover, if we consider these results reliable, we must also accept that being a single-mother causes autism, which is what this study also reports.
Gallagher, C. M., & Goodman, M. S. (2010). Hepatitis B vaccination of male neonates and autism diagnosis, NHIS 1997–2002. Journal of Toxicology and Environmental Health, Part A, 73(24), 1665-1677.

Here are some sites that list additional studies showing no link between the MMR vaccine and autism. These are all probably listed above, but there might be a few extras that aren't.

https://www.cdc.gov/vaccinesafety/pdf/cdcstudiesonvaccinesandautism.pdf

https://www.historyofvaccines.org/content/articles/do-vaccines-cause-autism

Review: The Seven Principles for Making Marriage Work: A Practical Guide from the Country's Foremost Relationship Expert

The Seven Principles for Making Marriage Work: A Practical Guide from the Country's Foremost Relationship Expert by John M. Gottman
My rating: 5 of 5 stars

The author, John Gottman, is well known for his scientific research on marriages. Because of this, I have cited and read many of his academic and popular level works. This book may just be the best one so far, and certainly is the best marriage book I have ever read.

There are a lot of good marriage books out there, many of which I still recommend, but this one trumps them all, and does so for many reasons. First of all, most other marriage books probably cite Gottman at some point and refer to him as the expert, which he is. The principles laid out in this book are the basic framework that any other good marriage advice will fit into. This is because Gottman's advice comes from rigorous scientific study rather than anecdotal evidence from a small sample size. This is not to say any other marriage advice is irrelevant or bad, but if it does not seem to mesh with what Gottman says, it should be regarded highly suspiciously.

Another thing that makes this book so great is the excellent balance of intellectual advice, real-life examples, and practical solutions. This makes the book interesting, informative, and helpful all in one. The book explains many issues people run into with marriages and offers some solutions, but it also has exercises couples can use to help discover root issues and overcome the problems. It's also a surprisingly short book, at only 265 pages, many of which can be skipped or skimmed if you're not dealing with a specific issue or not actually doing the exercises. The exercises are to help diagnose problems in marriages, to help foster solutions, or to just simply build closeness between partners. Some are simple, one-minute questionnaires, others are longer exercises that couples can use to discuss and build intimacy over months, and some are in between.

A quick note of warning though. If your marriage is failing and you read this book, it might cause more difficulty, at least in the beginning. This is probably true of any marriage book because talking about personal issues, especially if they've been growing for years, is hard and painful for just about any circumstance. This book may simply increase that because it encourages couples to work on their issues instead of merely working around them. It can be hard in the short-term, but will have better long-term benefits.

Whether your marriage is good or bad, you've been married for 50 years or just starting in a relationship, this book can be tremendously helpful, especially if both partners read through it and do the exercises together. There really is something for everyone in this book. From now on, this book is at the top of my list as a recommendation for marital advice. Other books will certainly still be helpful, especially for very practical tips, but none that I know of can compare to the combination of practical advice and intellectual information in this book.

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