Written by: Pastor Mike Schill Psy.D
Recently, I read an excellent article by Michael Gerson who suffers terribly from depression. I would like to combine this article with another article by Dr. Peter Kinderman on, “Why we need to abandon the disease model of mental health care.”
In the first article, Mr. Gerson called his depression “an illness.” Undoubtedly, because this is what his mental health practioners told him. And everything in his journey as he explained so well is very similar with the experiences of many others I have counseled.
The Bigger Picture
From the symptoms one often feels – sadness, emptiness, anxiousness, helplessness, irritableness, worthlessness, guilt, hopelessness, and quite often pessimistic and suicidal thoughts – these feelings are real, and they need to be validated and accepted as such. However, in accepting these emotions and the terrible patterns of behavior that come with them, we cannot, we must not, fail to look at the larger picture and provide a “fuller” diagnosis than just the medical disease model mental health currently employs.
The idea that distressing emotions such as grief, anger, depression or anxiety can best be understood as symptoms of illnesses is pervasive today in our culture, and why shouldn’t it be as this is taught and held to be sacrosanct by the mental health system.
But mainstream medical authorities have recently begun to question the creeping medicalization of normal life experiences like the emotions one suffers due to the death of a loved one, or any tangible loss, being categorized now as a mental illness in the DSM-V (Diagnostic and Statistics Manual of mental disorders).
It is important to be able to categorize and provide proper diagnosis to the disorders treated, but we muddy the waters rather than help when we use the language of medical disease to describe the understandable and normal responses of people who encounter traumatic or distressing circumstances.
Diagnosing and Making Assumptions
In the DSM-V, what is often referred to as the psychiatrist’s bible, it can be quite difficult to differentiate between one disorder and another, even for seasoned clinicians. Dr. Thomas Insel, a past director of the National Institute of Mental Health suggested that traditional psychiatric diagnosis may have outlived its usefulness. He goes on to state a new diagnostic system, referred to as RDoC or The Research Domain Criteria, could eventually replace the DSM. But Insel is not the only psychiatrist or psychologist who has over the years reached this conclusion.
Larry Crabb, a Christian psychologist had this to say about our current mental health system, "What we think of as diagnosable psychological problems, if they are not rooted in a medical condition, are better understood to be relational problems, and are better dealt with by relational love than by professional techniques."
It’s all too easy to assume that mental health problems — especially the more difficult to diagnose like bipolar disorder, ADHD, or personality disorders — must be mysterious biological illnesses, being random and essentially unconnected to a person’s life except through biology. But when we start asking questions about this traditional disease-model way of thinking, diagnosing and treating those who are our clients, patients or congregants, those assumptions begin to crumble.
Many people also assume that serious problems such as hallucinations and delusional beliefs are essentially biological in origin, but there is now considerable evidence referenced by Dr. Kinderman, that traumatic childhood experiences (i.e. poverty, abuse, TBI’s, griefs etc.) are associated with later in life psychotic experiences.
For instance, Kinderman asserts, “there has become an almost knee-jerk assumption that suicide (described by Mr. Gerson and attributed to his depression/suicidal ideation) “is a consequence of an underlying illness state, explainable only in biological terms.”
But this contrasts with direct observation coupled with an understanding of Biblical truths, that economic problems, life trauma’s, social/environmental issues, relational factors, and also spiritual bondage (giving a demon control through sin and then choosing to live under their control) can also have a direct impact on suicide rates.
This last factor is the one we as pastors need to look at more closely. For if we are to truly search for all factors contributing to good mental health, we need to identify and assess this third part of mankind – his spirituality.
When Spirituality is Excluded from Diagnosing and Treatment
St. Augustine, attributed by some to be the Father of Christian psychology, is purported to have said, “There is no psychological problem that is also not a spiritual problem.” For just because we can’t see, hear or measure aspects of this spiritual part of man doesn’t mean it doesn’t exist, or that we should toss out any causations that may be attributed to it.
Haven’t archaeologists determined that there has never been a culture recorded in human history which has not practiced some form of religion, spirituality, or god worship? Man is inextricably tied to his spirituality whether science and psychology can explain it or want to admit it or not. In fact, it is this very point that has contributed to medical science and mental health’s unwillingness to look at other options in diagnosing causes for mental illness states.
For when God and the spirit world are excluded from diagnosing and then the treatment of a mental health issue, is it any wonder why there are so many well-intentioned attempts to treat disorders that end in partial, if not total failure?
When clinicians have myriads of medications that often do little if anything to address the root issues, alleviating the patient/client from their pain and suffering, but oftentimes do much harm through the side effects they cause; or the 250+ differing talk therapies or methodologies now being employed by therapists, which are all based on a relativistic/humanistic foundation with only partial truth, providing coping mechanisms and only helping up to a point, is there any astonishment here that there is something missing?
A Different Model of Mental Health Care
It is therefore my belief that we must move away from this fully embraced disease model of diagnosis and treatment, which assumes that emotional distress is only symptomatic of a biological illness or psychological/environmental trauma, and in its place embrace a model of mental health and well-being that in addition to the aforementioned causes, recognizes our total humanity which includes our spirituality.
We need to realize and accept that our mental health is largely dependent on a correct understanding of our world view, our thoughts about ourselves, our identity, others in our lives, and the recognition of our spirituality.
Biology, psychology, social/relational, and spiritual factors are all intertwined to form our total human experience, and all these taken together affect the processes that help us understand and make proper application of our sense of who we are and the way the world works.
I believe it is time for a different model of mental health care today that incorporates our spirituality and the truth that God and the spirit world do in fact play an active part in our lives.
Crabb, L.J. (1977) “Effective Biblical Counseling” Zondervan publishers
Gerson, M. (2019). Article adapted from a sermon delivered at Washington National Cathedral
Insel, T.R. (2013). “Mental Health researchers reject psychiatry’s new diagnostic Bible” Healthland.time.com
Kinderman, P. ((2015). “Why we need to abandon the disease modal of mental health care.” Published in Scientific American