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

Part of the struggle is discerning the extent of the spiritual issue with mental health. How much is physiological and how much is spiritual ? Is mental illness a punishment for sin or a natural illness?

The first question is a very very good one. The second one is simultaneously a false choice and a false disjunction. There are many other ways for sin to be involved other than “a punishment”… but on that point, there is no reason why a particular case couldn’t be both “natural illness” and some sort of punishment.

Some subtle strawmanning there? He doesn’t mention the biblical counseling movement, but it seems to be in the crosshairs. While not agreeing entirely, I can sympathize. I have encountered a fair amount unhelpful oversimplification in the movement… but the alternatives I’ve seen are certainly not reliably better!

The kernel of truth is that there is generally not a culture of openness about problems in churches, in what I’ve been able to observe directly and indirectly. How to fix that I really don’t know … though I have been blessed to be in congregations where it does not seem to be a problem. I’m just not sure how that was achieved.

I’ve got multiple relatives who’ve been on various drugs from Lithium to Prozac, and we’ve seen quite a bit. The brother in law who was basically in a vegetative state while his mania was controlled, but always gave a clear sign he was going manic that the counselors always missed. Millions in care for him and nobody figured out his cue was buying and selling cars. The sister in law (his wife) who was also bipolar and the best the same basic group of helpers could do was to keep things in check. The helper from her church whose help managed to get him into divorce court, and others who “helped” themselves to her possessions. The counselor who did destroy my stepdad’s first marriage and nearly destroyed his relationship with his daughter. The counselor who, while counseling both my brother and I and our parents, missed the fact that what was bugging my brother and I was the state of our parents’ marriage at the time and tried to tell me that I was guilty over “self-pleasuring”—something I wasn’t aware of at the time, nor did I know the meaning of that big word.

Let’s just say that as far as I’m concerned, all parties have a LOT of improvement available, since my family’s experience parallels the treatment Santa got in “Miracle on 34th St.” And the article? Well, he’s obviously taken sides already and made some assumptions that he’s not totally open about, as Aaron notes.

Let’s say you wanted to preach a sermon on mental illness as the article suggests. What verse of Scripture would you start out with as a clear example of mental illness in the Bible?

What does that tell us?

Remember when David goes before Achish with drool in his beard? He wasn’t insane, but he knew how to play the part. Then you’ve got Acts 26:24, where Festus tells Paul his great learning has made him mad.

You could also make a case for Romans 1, where refusal to acknowledge God leads people to believe all kinds of things are normal and healthy. Probably a bunch more of that type—oh, and remember Nebuchadnezzar in the book of Daniel?

I don’t consider Festus’ comment having anything to do with mental illness.

David– he pretended to be insane. OK. How do take that and preach about mental illness?

As for Nebuchadnessar, that was spiritual, not mental. At least in my opinion.

So, nuts.

Mark—agreed fully that neither Paul nor David were actually mad. However, the way Festus and Achish talked does indicate that they were familiar with cases where the mind just wasn’t working right, just as Paul refers to in Romans 1, and just as is described in Daniel—and a bunch of other places.

Moreover, I’d suggest that you hit it right on the money when you comment that Nebuchadnezzar’s insanity was spiritual. Closer to today, a psychiatrist named Miriam Grossman became famous (or infamous if you’re on the left) by noting that most of the young ladies she was treating for depression at her employer—UCLA I believe—were ones who had not that long ago decided to become promiscuous. Now did these young ladies have a mental problem, or a sin/spiritual problem? My answer is “yes”. Remember that the root word of “psychology” is “psyche”, or….”soul”. So did Nebuchadnezzar have a mental problem or a spiritual problem? Again, yes. God in His goodness allowed Nebuchadnezzar’s sin of pride to be manifested as infirmity of mind.

Which is a long way of saying that you are entirely correct that it is not easy to figure out anything about mental illness from the Scriptures, but if we’re willing to do a little more work than just prooftexting, we’re likely to figure some things out.

We could start by correctly defining this term “mental illness.” It is a misnomer that has been created by psychologists and counselors who do not ascribe to the biblical viewpoint of man. So-called “mental illness” does not exist, unless one is referring to some physical anomaly in the central nervous system. If this is the correct definition, then as other illnesses, it should be treated as a medical pathology. The biblical view would be more aligned with the term “emotional problems or disturbances.” These find their explanation as spiritual problems, and to be healed, they respond primarily to spiritual therapies. Biblical counselors understand this and therefore provide the best treatment for long-term care and healing. Sorry to bust the bubble of those who may trace their roots to Sigmund Freud.

There have been a couple of unhelpful reactions to the Freudian revolution.

1. A generation of pastors (with exceptions of course) pretty much surrendered all the persistent personal problems/anything labled “mental illness” to the mental health professionals
2. A later generation decided that Freud and everyone associated with him must be wrong about absolutely everything

So I would agree that “mental illness” needs defining. This is the whole problem really. The biblical counseling movement, since early Jay Adams days, has upheld an “organic” escape clause, to avoid completely rejecting the mental illness concept. More recent iterations seem to be a bit more accommodating in tone, but last I knew, there was not really strong work out there on the boundary between sin issues/spiritual issues vs. what is in a more mental health professionals’ sort of category.

Of course, the ever broadening definition of “mental illness” from that direction (DSM IV, DSM V) hasn’t helped the situation. But not all the professionals buy into that—by a long shot.

The fact of the matter is that we don’t really have a clear idea of how the spirit and body and brain and chemical physiology of the body interact. The mind-body question is a very, very old one. Scripture clearly indicates that they are linked in both directions. Body influences attitude/”emotions,” thoughts, and actions (e.g. Ps. 104:14-15, 1 Kings 19:3-7). And actions/thoughts/emotions influence the body (e.g. Prov. 16:24, 17:22, 15:30).

What we really need is a new collaboration between people with a high view of Scripture who will not surrender to the perceived authority of the social sciences but who will also not dismiss the social sciences from the equation. On the other end of the collaboration, we need a generation of Christian mental health professionals with a high view of Scripture who are determined to do everything possible spiritually to help clients and submit the findings of the social sciences to the authority of Scripture, but making use of what may be helpful.

It’s far to easy to be dismissive either of spiritual concerns or of the social sciences. But the right road in this matter is not an easy one.

By the way, Scripture does indicate that the heart can be “sick” and this is not a reference to an “organic” condition.

e.g.

Pr 13:12 NKJV 12 Hope deferred makes the heart sick, But when the desire comes, it is a tree of life.

Nonphysical illness of the mind is a biblical category and any anthropology that rejects this is defective.

So Jim, do you believe that schizophrenia or Bipolar disorder are physical anomalies in the central nervous system? In your opinion, is it ok for these people who have been diagnosed with mental illness to take psychotropic drugs to deal with these problems? I ask these questions because for several years I used to work for a Christian ministry called Servants Center that ministered to the mentally ill homeless. In my many encounters with this population of people, I met a guy that used to wash his hands with his own urine, another man who believed he received secret messages from the CIA through a cup that he would place against walls, another man who wore about 20 hats (even in the summer) because he felt that his brain would fall out of his head, another person who thought he could communicate telapathically with little people who lived in computers, and the list goes on. In most of these cases, once he were able to get them to trust us, provide some housing and get them on their proper medications for their mental illnesses, they stopped having these hallucinations and became much more stable. We were also dealing with other issues as well. A few of them were alcoholics and some had other sin issues in their lives, but the combination of discipleship and counseling along with connecting them to psychiatrist for their meds, and connecting them with housing was the best way to help them.

I think we who already have a high view of Scripture and a healthy skepticism for the social sciences have to start out with a presumptive respect for mental health professionals.

So how I see that working is case by case, but I think pastors can work more with these professionals than is often assumed. Navigating the privacy issues is a significant barrier, and I’m not a HIPAA expert. But there are ways for patients to authorize their “spiritual leaders/clergy/etc.” to have information about their cases and interact w/the professionals they’re working with to coordinate.

Your question makes some assumptions: that the categories represented by these diagnoses are valid. I’m not prepared to say they are or say they are not. But the DSM is a slowly evolving document, and not everybody thinks all that highly of it even in the professional world. So… I can’t answer the question because (a) I don’t have enough info about the specific cases and (b) I’m not sure the criteria for these diagnoses is entirely compatible with a biblical view of human nature…. and a few other reasons I’m sure I’ll think of later. :)

My attitude/experience though is that DSM & related perspectives don’t generally try to account for spiritual realities one way or the other. They just don’t go there. They are not actively denying them, but recognize that they have no tools for dealing with them or figuring out how they relate to where the observable stuff begins. The social sciences work with controlled studies, collected data, precedent, hypothesis and so on. And try to generalize from that.

I’m sure some of the pro’s are rabidly anti-Christian and anti-religion in general. I have talked with several (and read several others) who are not of that mindset at all. They want to help people, and usually welcome the participation of other leaders in the lives of “patients” to some degree.

I believe that in many cases medication is helpful. But even the pros, contrary to common stereotypes/strawmen, acknowledge that the efficacy of meds is widely disparate. Some seem to improve quite a bit, many only a little, many not all, and some get worse. This is all documented in the studies they publish. There may be some vocal (and ignorant …or extremely optimistic) zealots here and there who talk like the social sciences are going to fix everything, but this attitude is far more common among those outside the profession (media types and movie stars and pop lit. writers). The people who do research… well, making grandiose promises is not their style.

Also, the well informed acknowledge that success rates are …. not stellar.

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.

There is reason to believe that the disorders of Bipolar and schizophrenia may have a root in deficiencies in the central nervous system. Certain nutrients may be lacking that throw things into disarray. Sometimes a better diet may affect behavior. Eg. a study was done in prisons which divided the population between those who ate the normal diet, which was high in sugar, and a corresponding group that had sugar content reduced considerably. Definite behavioral and attitudinal differences were noticeable. In the same study, it was determined that criminal behavior was related to hypoglycemia — low blood sugar. In extreme cases, where returning the body to physical homeostasis, drugs have proven helpful. The tendency, however, is simply to prescribe drugs universally. My own experience stems from a family member who was diagnosed as Bipolar. Psychiatrists in different cities put him on a variety of psychotropic medications, some of which had suicide as a side effect. What was never addressed was the deep sorrow and shock that came from his mother’s suicide (who was also on the same drugs), and the sad result was his taking his own life after four or five years of these drugs. The problem he was dealing with was beyond the reach of medications.

[Aaron Blumer]

I think we who already have a high view of Scripture and a healthy skepticism for the social sciences have to start out with a presumptive respect for mental health professionals.

So how I see that working is case by case, but I think pastors can work more with these professionals than is often assumed. Navigating the privacy issues is a significant barrier, and I’m not a HIPAA expert. But there are ways for patients to authorize their “spiritual leaders/clergy/etc.” to have information about their cases and interact w/the professionals they’re working with to coordinate.

Your question makes some assumptions: that the categories represented by these diagnoses are valid. I’m not prepared to say they are or say they are not. But the DSM is a slowly evolving document, and not everybody thinks all that highly of it even in the professional world. So… I can’t answer the question because (a) I don’t have enough info about the specific cases and (b) I’m not sure the criteria for these diagnoses is entirely compatible with a biblical view of human nature…. and a few other reasons I’m sure I’ll think of later.

Wouldn’t it be nice if some of those secular health professionals at least acknowledged the spiritual role in counseling also?

My attitude/experience though is that DSM & related perspectives don’t generally try to account for spiritual realities one way or the other. They just don’t go there. They are not actively denying them, but recognize that they have no tools for dealing with them or figuring out how they relate to where the observable stuff begins. The social sciences work with controlled studies, collected data, precedent, hypothesis and so on. And try to generalize from that.

I’m sure some of the pro’s are rabidly anti-Christian and anti-religion in general. I have talked with several (and read several others) who are not of that mindset at all. They want to help people, and usually welcome the participation of other leaders in the lives of “patients” to some degree.

I believe that in many cases medication is helpful. But even the pros, contrary to common stereotypes/strawmen, acknowledge that the efficacy of meds is widely disparate. Some seem to improve quite a bit, many only a little, many not all, and some get worse. This is all documented in the studies they publish. There may be some vocal (and ignorant …or extremely optimistic) zealots here and there who talk like the social sciences are going to fix everything, but this attitude is far more common among those outside the profession (media types and movie stars and pop lit. writers). The people who do research… well, making grandiose promises is not their style.

Also, the well informed acknowledge that success rates are …. not stellar.

[jimcarwest]

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’ll just throw this out there as an admittedly not-even-half baked idea….

If we suppose that we are generally not going to know if folks we’re helping are afflicted with chemical/brain or other sorts of damage, what if we strive to help with them with an assumption of damage/disease?

What I mean is, what does that really change? If so and so can’t seem to get along with his spouse or hold a job or stay away from drugs etc., how do I help him if he is “sick” vs. not?

What if I assume that he is damaged in various ways, maybe some of them physical and hereditary, maybe some of them “psychic” or whatever, and take it as biblically as possible from there?

It’s really not an extreme assumption, given what we know biblically: we live in a cursed world, body affects spirit and spirit affects body, tendencies toward particular failures can be multigenerational… and probably other truths that are relevant.

1. Where we run into trouble is with trying to think about how much blame/responsibility belongs to the individual and how much repentance is called for. I’m assuming a believer here, to simplify the issue for the time being.
2. The second issue we run into is ability: how capable is he of thinking and behaving differently?

Now I’ll hazard to say this much for the social sciences: they are not really interested in intentionally lifting responsibility from people for how they behave. The reason they’re not is that this has practical consequences: a person who blames his choices on incapacity or on other people is powerless to behave any better. He has put the solutions beyond his own grasp. To put it another way, responsibility and ability tend to correlate. (With exceptions.)

So, while the social sciences would tend to place less responsibility on people in general than a biblical view does, it’s not inherently anti-responsibility. It’s just pretty disadvantaged by not accepting revealed information as a starting point. But get this: to an extent, they have the same dilemma we do as biblical disciplers: they want to figure out what a person is capable of changing and make the most of that, while not really knowing what is unalterable or not their fault.

But back to my “what if”

What if we assume our counselees/friends/whatever are damaged in various ways, had alot of help getting as messed up as they are, and have at least some limitations that they cannot overcome? Where does that lead in how we biblically help them?

As an analogy, if a guy can’t run well because he has only one leg, all the counsel in the world won’t make him run better. What if he has an invisible emotional/mental missing limb? This is not as far fetched as some seem to suggest. We all know people have widely varying cognitive abilities/intelligence. We know some folks can’t ever in a million years learn to spell well—their brains are not wired that way. Some can’t see colors—or can’t perceive the differences between them. Some can’t remember the meaning of a multisyllabic word, no matter how motivated they are. In dealing with children who have not fully developed, we know they can’t abstract very well, no matter how hard they might try (though they really have no idea what abstracting even is). And we know that some never grow out of that.

People are damaged. And they are sinners. They are not one or the other. We have to deal with that reality in how we approach helping them.

(so I guess I don’t really think it’s half baked, as you can see!)