Stetzer: "Mental illness is not a subject Christians should run from."

[Aaron Blumer]

jimcarwest wrote:

So would anyone like to provide a proper definition of “mental illness”? Is the term intended to define a pathology of the central nervous system? Or does it intend to refer to the multitudes of emotional problems that people have developed as a result of poor parenting, enslaving habits, deviant behavior, drug abuse, sexual abuse, and a host of other expressions of the sin nature and its consequences? If the brain is injured, undeveloped from birth, or damaged by accident or through repeated mal-nutrition, then we are dealing with a real physical malady. In such cases, medication and surgery and diet may offer some promise of treatment to alleviate the resulting suffering. If we are applying the term “mental illness” to the multitudes of bad behaviors that are the result of sin against God and against others, it is mal-practice to attempt to remedy these character flaws and deficiencies in a way that does not deal with the divine/human relationship. The early tendency among Christian psychologists was to defer to the medical model, but experience showed that real healing of spiritual problems was not actually possible in this way. It was like applying a skin salve to an internal illness. This is not to deny that there is a spiritual/physical interaction that is going on in all of us. Attitudes affect physical responses, and physical illnesses may influence spiritual attitudes. It is essential to delineate, however, between the two. The secular social sciences and medicine have generally discounted the role of the spiritual. The field of biblical counseling has brought some balance to this study.

I don’t have a good answer for that.

I was thinking I probably need to qualify or contradict something I said earlier on the definition of mental illness. I described it as ‘ever expanding’ but I’m not sure that’s fair. What the Diagnostic and Statistical Manual of Mental Disorders (DSM) has increasingly done is expand the number of named “disorders.” But it’s probably popular misunderstanding that equates these with “mental illness.” It might be fairer to say it’s a capitulation to their inability to define mental illness. Rather than classifying these as “illnesses” they prefer to term them “disorders.”

Which is fair enough.

They may be on the right track. Through a biblical lens, we know everybody is messed up spiritually due to sinful nature, the Fall, etc. We also know that being sinners and living among sinners results in all sorts of collateral damage, so to speak. Or, shall we say, collateral “disorder.”

The social/psychological/psychiatric world is limited by its nature to categories like healthy vs. unhealthy, constructive vs. destructive, and the like. As Christians we are more interested in the category of right vs. wrong and true vs. false. But these categories overlap a good bit more than we often seem to recognize. Shouldn’t we expect, given what is revealed in Scripture, that people who do wrong or have a lot of wrong done to them (and deal with it as sinners do), also behave in ways that correlate strongly with the categories of “unhealthy” and “destructive”?

The twist is that a social science world that is mostly godless and lacking any transcendent moral authority will frequently err in its view of what is “healthy” and “constructive.” But not always, by a long shot. Because they are committed to observation and fact gathering, reality has a way of often butting in on faulty views of what’s healthy/constructive. The data, though ultimately not enough to penetrate fallen minds and force truth on those hostile to it, does provide checks and balances on the whole system.

I mean, you don’t have to be a Bible believing Christian to understand that behavior that gets you rejected by everybody you try to make friends with is unhealthy…. or behavior that makes you unemployable, unable to sustain a marriage, unable to raise stable and independent children, etc…. We would expect that the kinds of thought processes and behaviors that are destructive/unhealthy in these ways also correlate strongly with what the Bible reveals to be sinful attitudes and actions.

So, no, the social sciences are not going to start talking about sin (LOL). But they know a lot about what doesn’t work and it’s no coincidence that sinful patterns also don’t work too well. A good bit of the time, a person who learn to relate to people in “more healthy” ways, would also, if born again, be relating to people in ways that are less sinful.

Back to the definition question: Maybe we should give up on that entirely. I mean, as a thought experiment, what if we just imagine that everybody is “disordered” in varying degrees and ways and people need help to deal with it in morally right as well as “healthy” and “constructive” ways?

So maybe I agree with the “mental illness is a myth” folks more than I thought, but for entirely different reasons.

All I know for sure at this point is that I’m (1) not equipped to precisely define mental illness and (2) I can’t really see any way it would help if I could.

I think the main point of this series of posts stemmed from the subject of “mental illness” and how to address it. If we move to the larger sphere of “the social sciences,” we include counseling, sociology, psychology, and psychiatric therapy. Generally, for quite some time now these modalities have pursued a philosophy that ignored God, diminished personal responsibility and denied guilt, practiced blame-shifting, and rejected the biblical view of man.

It has always been the practice of wise, spiritual counselors to rule out physical causes for aberrant behavior. Every good counselor addresses the possible physiological causes that might explain these behaviors or disorders, often requiring a medical examination to inform the counselor of the current state of health of the counselee. These physiological causes fall within the term “mental health” in a constructive manner. It is when no physiological reason for wrong behavior can be found that biblical counselors examine the individual with regard to wrong, sinful, and/or misguided conduct, i.e. a sin issue. The counselee may be suffering from the hurt/damage caused by the sinful behavior of others, but it may also include sinful responses found in the counselee that, when addressed, hold promise for healing and restoration. It is wrong to denominate such sinful behavior with the term “mental illness.” If that is the case, then all of use are a little bit sick. In reality, we are all sinful, and that is a different thing.

The so-called social sciences tend to discount the spiritual element in behavioral disorders because they do not accept the biblical view of man. For them, disorders have primarily a physiological or a sociological cause which therapy and medical treatment (psycho-tropic drugs, shock treatment, hospital internment, and other therapies/modalities offer the best hope of treatment.

Given the historic development of psycho-therapy and the social sciences in the secular world, it appears that never the twain shall meet between biblical counseling and the social sciences.

God never asks us to do what we are wholly incapable of doing. But for anyone to assume that a normally functioning individual cannot deal with his own responsibility for wrongdoing or for sinful responses to wrongdoing would be to let a person “off the hook” spiritually. It would exempt him from the need for repentance, for forgiving, for trusting God for strength to overcome hurts, etc. A person who has received damage to his central nervous system that produces a corresponding physical impairment could not be held responsible to take the biblical actions for healing. These examples, however, are rare. In most cases of counseling, the individual possesses the ability to follow counsel if he so chooses. In these cases, it is his own sinful heart that refuses to accept God’s remedy for healing.

I think I would agree that we can’t assume specifics like “This person is incapable of overcoming this specific problem.” I wouldn’t take the assumption of damage that direction. Rather, my inclination has been to assume that everybody is broken in some ways that are not going to be fixed this side of glory, and I don’t really know what those ways are.

So the assumption is that a person can change/adapt/ajdust/grow, but also that we don’t know what barriers are insurmountable and what ones aren’t. So assume each barrier is a conquerable one until it proves otherwise… and even then, we only shift our efforts in a direction that seems more fruitful.

To me, it’s just like raising kids. I don’t know much of what I see is a hard wired limitation vs. how much is “just haven’t grown yet” in that area. We often (usually? always?) can’t really tell. So what do you do as a parent? You prioritize a bit, and you encourage progress where you can and when you run into something seemingly unmovable, you redirect efforts in some other direction and maybe try again later.

Maybe that helps a bit with the spirit of what I’m trying to say.

But I do think that we who want to be as biblical as we possibly can in helping people do also need to get over our aversion to solving practical life problems. I have more thinking to do about this topic and then maybe put something organized together, but many in the Biblical Counseling movement have taken up a manner of speaking about problems that suggests we should all just be sort of sanctification generalists. That is, just generally help people move forward in their walk with God but not specifically try to help them fix their marriage or have more friends or perform better at work, etc.

Why are we so determined not to be practical? I’m generalizing and maybe not fairly, but I’ve sure seen a boatload of it. Maybe it’s an overreaction to the practical focus of the social sciences. My take on that is that practical is really all they can do (to the extent they can do that much) and there is a good bit of useful stuff there. I am just not in the tribe of lofty minded folks who think there is something wrong with useful, practical, duct tape type truth.

As I understand DSM—a meager understanding at best—it more or less refers to cases where the mind is incapable of understanding reality as we see it, where the mind does understand reality but the person does not care (especially in a way that wants to hurt others), where the mind is less than able to perform certain tasks (e.g. ADHD), or where the mental state leads to undesireable outcomes—e.g. depression, etc..

Anyone out there who might streamline/correct that? I was thinking of trying to offer an alternative, but I’d figure that someone more skilled in DSM/etc.. than I might be able to refine this.

I really can’t say with any level of expertise what is behind the DSM, but with its inclusion of many new “disorders” each time a revision takes place, one might wonder if the health professionals aren’t attempting to include us all eventually so as to guarantee sufficient income in the future. I say this rather facetiously. However, according to statistical studies, fully 46% of all Americans now suffer from one of the disorders listed in the DSM, and the percentage rises with each new edition. http://www.slate.com/articles/health_and_science/medical_examiner/2013/…

Given enough time, we’ll all be deemed “crazy” or “abnormal” and in need of help, but since this number probably includes health professionals, we wonder who will be “sane” enough to treat us. Seriously, the field of Christian psychological ministry is burgeoning. The Bible gives us most everything we need to know about how to heal most psychological disorders. In tandem with a balanced health focus, the Church has what it needs to address the spiritual/emotional needs of everyone.

I think you should read the DSM a bit (I don’t recommend the whole thing. It’s a behemoth… and who has that much time?). I would think it wise to hesitate to make generalizations about it if you aren’t actually familiar with it.

As for what’s behind it… lots and lots and lots of research, clinical trials, peer reviewed journal articles, case studies… and on and on. And it’s not like the professionals all agree with eachother. If you dig a bit you’ll find that while there are fads that come and go and often a consensus forms for a while, there is lots of debate.

Also, as I’ve already noted, the trend is actually away from calling everybody crazy. Rather, the “disorders” language moves away from trying to make two big categories of “crazy” and “normal.” So the approach is to focus on observable patterns, catalog them, and study various ways of mitigating them. That’s really all it is.

It also doesn’t follow that only perfectly whole people can help partially broken people. If that were true, how could anybody ever help anybody?

“The Bible gives us most everything we need to know about how to heal most psychological disorders. In tandem with a balanced health focus, the Church has what it needs to address the spiritual/emotional needs of everyone.”

This is an interesting statement. “Most”? I can certainly accept that but, how do we determine which ones it can heal and which ones it can’t? And are “spiritual” and “emotional” the same thing? If not, how do we tell them apart?

But I’m mostly indulging my curiosity at this point.

Isn’t it really pretty obvious that we never know what is changeable and what is not in people, or what has to change first before something else can change, etc.? When something seems to not be responding to counseling/discipling/teaching/parenting/etc. efforts, you shift to something that seems to yield better progress. This is the case whether someone has a mental illness or disorder or whatever or not. Whatever damage a person has doesn’t alter whether they are responsible and capable of change, it just altars the way in which they are responsible and must change. But these vary a great deal from person to person whether some kind of illness/disorder is part of the mix or not.

Edit: I don’t want to sound overly rosy about the DSM. It’s just the product of a bunch of folks trying hard to help people but using a very limited (but still substantial) toolset. You just can only do so much with the tools of observation and inference, especially if you also don’t have your observation and inference process framed in an accurate worldview. Also, they do sometimes (often?) also classify “disorders” as “medical illnesses” and similar language. The APA et. al., are, on the whole, of the mindset that these problems should be dealt with as medical and health issues and funded by health insurance, the government, etc. …. which I personally think is not a helpful direction to go with it other than the extreme cases that are consistently responsive to medication. (It’s still true though that the trend is away from classifying people as either mentally ill or not. The trend is toward seeing mental illness as something that can happen to anybody for a while but some people permanently and severely, etc…. like the flu or cancer.)

….here’s an article on mental illness from wiki, where it’s defined as “A mental disorder (also called a mental illness or psychiatric disorder) is a diagnosis of a behavioral or mental pattern that can cause suffering or a poor ability to function in ordinary life.”

Looks pretty subjective to me, and like Christians have a lot of place to start taking part in the conversation.

I doubt if any of us has read the DSM, and then we have to ask “which edition?” because there are several. No one “reads” the DSM. It is an encyclopedia used for reference about what are called “mental disorders.” Things deemed mental behavior in one may be removed in another, depending upon the differing vote of those who agree to its content. Christians need to be on guard about the DSM definitions of homosexuality, trangenderism, etc., etc., which are decidedly anti-biblical.

What is key here is to understand the philosophy that supports DSM. Is it secular? Is it anti-biblical? Is it primarily mechanistic, or does it value the approaches of Biblical counseling? Does it include as “mental illnesses” what the Bible calls sin?

I would recommend that readers consider the view expressed in the following article: https://www.thegospelcoalition.org/article/christian-reflections-on-men…

The article warns: “When we look at mental illnesses and only find medical categories, we do not understand the term, and we dishonor Jesus Christ. In doing so we will also keep troubled people from the fullness of help they need. Yes, people with severe problems often need medication. But even when medication is necessary no medical doctor can prescribe what the Great Physician alone can provide.”

Secular psychology tends to diminish and even despise the role of the biblical counselor in the same manner that modern medicine holds in contempt the role of natural healing.

Emotional/spiritual healing is a legitimate category of counseling. The Bible is a legitimate “DSM” when it comes to human problems and their solution.

I contend that we may have something to learn from each other, but in the present state of psychiatry, the atmosphere is not conducive where mutual respect is lacking.

[jimcarwest]

I doubt if any of us has read the DSM, and then we have to ask “which edition?” because there are several. No one “reads” the DSM. It is an encyclopedia used for reference about what are called “mental disorders.” Things deemed mental behavior in one may be removed in another, depending upon the differing vote of those who agree to its content. Christians need to be on guard about the DSM definitions of homosexuality, trangenderism, etc., etc., which are decidedly anti-biblical.

What is key here is to understand the philosophy that supports DSM. Is it secular? Is it anti-biblical? Is it primarily mechanistic, or does it value the approaches of Biblical counseling? Does it include as “mental illnesses” what the Bible calls sin?

I would recommend that readers consider the view expressed in the following article: https://www.thegospelcoalition.org/article/christian-reflections-on-ment…

The article warns: “When we look at mental illnesses and only find medical categories, we do not understand the term, and we dishonor Jesus Christ. In doing so we will also keep troubled people from the fullness of help they need. Yes, people with severe problems often need medication. But even when medication is necessary no medical doctor can prescribe what the Great Physician alone can provide.”

Secular psychology tends to diminish and even despise the role of the biblical counselor in the same manner that modern medicine holds in contempt the role of natural healing.

Emotional/spiritual healing is a legitimate category of counseling. The Bible is a legitimate “DSM” when it comes to human problems and their solution.

I contend that we may have something to learn from each other, but in the present state of psychiatry, the atmosphere is not conducive where mutual respect is lacking.

I am curious with your tendency to dismiss the DSM because of its secular nature, would you classify Autism, or a legitimate brain disease such as Schizophrenia, or Post-Traumatic Stress Disorder as something that only the Bible can heal? I am much more skeptical of your position to downplay the DSM because I have seen Christians with your worldview counsel mentally ill homeless who are Schizophrenic or Bipolar to stop taking their meds because Jesus and/or the Word of God will bring healing. In a few cases where there was a misdiagnosis, that actually did happen. However, the overwhelming majority of situations that I saw where Christians applied amateur counseling to legitimate mental illnesses made things worse. Several attempted suicides occurred with the homeless population that I worked with due to well-meaning Christians with a truncated Biblical worldview that did not know how to discern the good from the bad within general revelation and told them to stop taking their meds and trust in God. I understand your concern about mental illnesses and Christian Psychiatry where people ended up managing sin, rather than getting to the root causes of certain problems. However, just as dangerous is the mindset to dismiss and not take the time to discern the good from the bad within the DSM and attempt to apply the Bible to solve a mental illness like schizophrenia (which is equivalent to a mechanic turning to the proverbs as a guide to figure out how to fix an airplane engine).

Just so you know, I am also familiar with misdiagnosis by certain health professionals that attempted to use the DSM and/or their experience in a psychiatric hospital to make a diagnosis. Three months ago, my 13 year old daughter had to be brought into the hospital because she had some physical as well as some emotional (anxiety) issues. Sadly, an influential pediatric doctor that only saw her for a few minutes was absolutely certain that she had childhood schizophrenia (which is extremely rare) because of her hallucinating and rapid eye-movement behaviors. However, one can gather from the updated DSM and other books about anxiety, is that the lack of sleep and anxiety will produce the same behaviors as schizophrenia. Thankfully, because my wife is finishing her degree to become a licensed therapist, she had studied this issue quite extensively and we were able to prevent a misdiagnosis that the hospital’s psychiatrist almost accepted.

I think you missed some of my doubts on the DSM, especially with reference to the secular mindset that seems to guide much of it. I do not necessarily doubt the research that might seem to support it in many cases, but my concerns are rather in the secular philosophy that is behind much of it. The tendency in secular psychology is to downgrade and berate the role of the Scriptures in spiritual healing. I would never rush to take medications away from anyone who is using them, but since medication tends to be the “go-to” solution for many of these anomalies, I would seek to use biblical counseling as an adjunct method of dealing with people who sometimes show symptoms of mental “disease,” when other issues are also involved. For your information, some suicides occur due to the use of the medications, which show “suicidal thoughts” as a side-effect on their labels. We have had two suicides in my family where this was unquestionably the case. They had no suicidal thoughts until they became dependent on the meds. A careful biblical counselor will exercise great caution when dealing with a person on psychotic medications. He will always look for root problems that may have led to dependency. The literature does recount examples of schizophrenics being “healed” and returned to normalcy through biblical counseling, demonstrating that this “disease” is not always organic in nature and may indeed include a spiritual element. So, while some avid spiritual counselors may exceed their expertise, and this may lead to other problems, it is only sensible to admit that secular counselors produce some of the same negative results but for other reasons. The fact is, spiritual-emotional disturbances have a variety of causes, and the fact that there are multitudes of people who have not been “cured” but who have rather become dependent on year after year of therapy, does not speak favorably of the secular approach. A great deal of the “mental” problems that present themselves today seem to be the result of modern living that creates stresses and strains that our forefathers did not deal with to the same degree. While being open to all the latest findings, I continue to believe that the Scriptures properly applied and believed go a long ways toward helping people to live sane and balanced lives, no matter the stresses we encounter.

Dr. Daniel Berger (BJU PhD) has just published Volume One of MENTAL ILLNESS: THE NECESSITY OF FAITH AND AUTHORITY. Extremely well-documented. Endorsed by Dr. Kevin Hurt, Executive VP of International Association of Biblical Counselors and by Ethan Stanley, Clinical Supervisor, National Counseling Group.

One of his emphases is that typical medications prescribed for bi-polar and schizophrenic behaviors are now being required by the FDA to list suicide as one of their side effects.

Available here: https://www.amazon.com/Mental-Illness-Necessity-Faith-Authority-ebook/d…

I fear that, as Bible believers who derive their approach ot life and its problems from the Scriptures, some may be looking too favorably on the field of psychology and mental disorders from the secular/atheistic viewpoint. To ignore that the trend is in that direction, even among believers, would be an error. I suggest more reading along these lines: “Biblical Counseling” by John MacArthur/Wayne Mack, “Psychobabble” by Richard Ganz, “Psycho-Heresy” by Martin/Deidre Bobgan, and “The Christian Counselor’s Manual” by Jay E. Adams. It’s alright to know what is in the DSM, but it’s good to recognize that in that manual, some so-called disorders are determined by ballot and not by solid research and experience. Just saying…

The Scriptures have been answering all sorts of these problems for thousands of years — depression, feelings of hopelessness, suicide, criminal behavior, self-pity, fear, anger, envy, drug abuse, sexual deviancy, etc., etc. It has not suddenly become deficient in dealing with modern man. It is the secular psychological therapy industry that keeps expanding the definitions and solutions, many of which rest upon blame-shifting, and most of which seek their solution in medications that have in some cases complicated the care of souls. Rather than finding solutions in many cases, what results is a new form of dependency of the counselee on the counselor. I’m not sure just what one hopes to gain by this trying to redirect attention towards more confidence in the DSM and secular counseling, but I feel sure someone will try to enlighten me.