I've followed with great interest Larry Crabb's movement toward a more intentionally and explicitly theological approach to understanding people and how to help them in distinctively Christian ways. I'm hopeful that he will be influential in provoking more of his professional peers, and the body of Christ at large, to give more serious thought to the conceptual frameworks functionally governing our evaluation of what is wrong with people as well as our efforts to help them change.
The latest issue of Edification, a publication of the Society for Christian Psychology, contains an interview with Crabb in which he offers the following thoughts concerning the role of the Bible in counseling:
...I think my essential contribution to the counseling discussion is in hermeneutics. You can't go to the Bible and find verses about anorexia. As a result, people who want to stay biblical -- and I do -- but who have a limited hermeneutic, become very narrow when they find some application of the Bible to deal with problems that the Bible doesn't seem to directly address. I think that if we have a rich anthropology [doctrine of man], a rich hamartiology [doctrine of sin], a rich pneumatology [doctrine of the Holy Spirit and His work], then we will know how to "hermeneut." We will know how to interpret scriptures so that we discover ways of thinking, and categories for understanding. When I deal with a homosexual, my concern is not only to say homosexuality is sinful, so stop it, and let me hold you accountable until you don't do it anymore. Certainly that must be said. It is a sin, so it shouldn't continue any more than adultery should, or pornography, or any thing else that is obviously sin. But these are not the root sin. So my concern is to say to the homosexual, "What did God have in mind when he created them man and female?" And, "Let's explore the essence of masculinity. Let's find where your terror of not feeling alive as a man has resulted in your clenched-fisted determination to find some kind of satisfaction as a man without taking the risk of manhood, which then makes you vulnerable to homosexuality." Let's explore these deeper issues, which in my mind are not "psychology," but are very biblical, because God made them male and female.
God wants us to unpack and to interpret scripture in a way that does not result in a proof text, and not in a bunch of principle - do this, and don't do that - but in an enriched, deep understanding of what is happening in the human soul that has gone profoundly wrong that leads to all these difficult and sinful problems. You can apply it to homosexuality, eating disorders, panic attacks, whatever else. What is going on in the human soul, and how does the Bible give us categories for understanding this? So I think my major contribution is a hermeneutic that allows me to develop categories for understanding that don't come across as proof-texting or merely exhortational, but as liberating and releasing.
Crabb goes on to describe the idolatry underlying homosexual (and all other sinful) behavior:
It [homosexual behavior] is sinful, but the core sin is turning to God and saying, "You are not the source of joy, you are not the essence of goodness. There's a greater good than you." This is the sin of Adam and Eve, who decided that there was a greater good than God. So we have to get down to the essential sin in dealing with all of these problems, and I think my hermeneutic, which is very nonlinear and categorical, allows for a richer understanding of the human condition. It remains biblical, but in the minds of some looks like it's forgetting the Bible and going towards psychology. But my understanding of homosexuality, of anorexia, or multiple personality, is dependent on biblical categories and not upon psychological research, even though I find secular research to be very analytic and the secular thinkers to be very provocative. They make me think and ask questions that I wouldn't otherwise ask, but never would I regard them as authoritative.
Crabb is right to point out the vital necessity of having our thinking about the nature of human problems and their resolution substantively formed by the doctrines and storyline of Scripture. I find it alarming how frequently the explanations offered by Christians about what motivates people to do what they do sounds virtually identical to secular accounts which have no category for the activity of the heart with reference to God. When pressed, we'll acknowledge in some vague, generic sense that "we're all sinners," so as not to be thought of as unorthodox. But listen carefully to how believers talk among themselves or read some of the bestselling Christian pop psychology (frequently marketed under the heading of "personal development") and you'll find that we don't really expect the Bible's teaching on sin to be of much practical value in helping us get to the meat of the matter of our intra- and interpersonal problems. Consequently, as I've stated before, the person and redemptive work of Jesus Christ is marginalized to that nebulous (not to mention, narrow) region of our lives designated as "spiritual." The gospel becomes icing on the cake of "real life" whose primary ingredients must be acquired at the mental health market.
I'm also glad to see Crabb drawing attention to the fact that how we answer the question "What is the Bible and how does God communicate through it?" has great consequence for the conclusions we draw concerning its relevance and the scope of that relevance for counseling issues. One of the main reasons that assertions about the Bible's sufficiency for understanding and addressing counseling issues is dismissed as being naive and simplistic is that people assume that the Bible is a compilation of atomistic verses (a view revealed by the frequently encountered request, "Show me a verse for....") rather than as a comprehensive lens through which all of life is to be interpreted. Crabb's reflection on this point resembles that of David Powlison who, in the current issue of the Journal of Biblical Counseling notes, "The writers of the Bible intend to provide eyeglasses that enable all seeing, not an encyclopedia that contains all facts."
Given the place of prominence that American evangelicalism has afforded psychologists, perhaps an affirmation of the Bible's sufficiency for counseling matters from someone like Crabb will persuade more believers to take it seriously.
The second in a series of articles the NY Times is doing about the increasing number of American children whose difficulties are diagnosed as serious mental disorders is entitled "What's Wrong with a Child? Psychiatrists Often Disagree." The piece could have been more accurately called "What's Wrong with Psychiatry?" for it dramatically illustrates the highly subjective nature of psychiatric diagnoses.
The article opens with an introduction to Paul Williams, a 13-year-old who "has had almost as many psychiatric diagnoses as birthdays."
The first psychiatrist he saw, at age 7, decided after a 20-minute visit that the boy was suffering from depression.
A grave looking child, quiet and instinctively suspicious of others, he looked depressed, said his mother, Kasan Williams. Yet it soon became clear that the boy was too restless, too explosive, to be suffering from chronic depression.
Paul was a gifted reader, curious, independent. But in fourth grade, after a screaming match with a school counselor, he walked out of the building and disappeared, riding the F train for most of the night through Brooklyn, alone, while his family searched frantically.
It was the second time in two years that he had disappeared for the night, and his mother was determined to find some answers, some guidance. What followed was a string of office visits with psychologists, social workers and psychiatrists. Each had an idea about what was wrong, and a specific diagnosis: “Compulsive tendencies,” one said. “Oppositional defiant disorder,” another concluded. Others said “pervasive developmental disorder,” or some combination. Each diagnosis was accompanied by a different regimen of drug treatments. By the time the boy turned 11, Ms. Williams said, the medical record had taken still another turn — to bipolar disorder — and with it a whole new set of drug prescriptions.
“Basically, they keep throwing things at us,” she said, “and nothing is really sticking.”
A caption beneath a photograph of Williams reads "In his short life, Paul has taken antidepressants, antipsychotic drugs, sleeping pills and so-called mood stabilizers." One can only wonder what such a combination of drugs is doing to this young man's developing central nervous system, not to mention other organs. Consider the fact that despite use of terms like "disorder," "diagnosis," and "illness" there are no medical tests for any of the conditions listed in the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders and there is even further cause to question the wisdom of administering mind-altering drugs to children or, for that matter, adults to whom psychiatric diagnoses have been given.
According to Duke University professor of psychiatry and behavioral science, Dr. E. Jane Costello, psychiatry's system of diagnosis is "still 200 to 300 years behind other branches of medicine." This assumes, of course, that psychiatry is a legitimate medical practice, lagging behind its elder siblings. But other than the fact that its practitioners are licensed physicians with the authority to prescribe medication, what is it that biological psychiatry has in common with other fields of medicine which do not rely solely on emotional and behavioral symptoms to determine the existence of disease? To what extent is biological psychiatry a medical science? These are questions that even those within the profession have asked. In his letter of resignation from the American Psychiatric Association, the late Dr. Loren Mosher wrote:
"Biologically based brain diseases" are certainly convenient for families and practitioners alike. It is no-fault insurance against personal responsibility. We are all just helplessly caught up in a swirl of brain pathology for which no one, except DNA, is responsible. Now, to begin with, anything that has an anatomically defined specific brain pathology becomes the province of neurology (syphilis is an excellent example). So, to be consistent with this "brain disease" view, all the major psychiatric disorders would become the territory of our neurologic colleagues. Without having surveyed them I believe they would eschew responsibility for these problematic individuals. However, consistency would demand our giving over "biologic brain diseases" to them. The fact that there is no evidence confirming the brain disease attribution is, at this point, irrelevant. What we are dealing with here is fashion, politics and money. This level of intellectual /scientific dishonesty is just too egregious for me to continue to support by my membership (emphasis in the original).
I realize that to many, the idea of questioning the validity of biopsychiatry is tantamount to rejecting heliocentricity but that is just a testimony to how successfully pharmaceutical companies have indoctrinated the public (and in many cases, general practitioners) with their reductionistic philosophy of human nature. In his book Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression (chapters from which can be read here), Dr. David Healy, notes that the class of antidepressants known as SSRI's (selective serotonin reuptake inhibitors) has "given rise to a new language in which we understand ourselves - a biobabble to replace the psychobabble of Freudian terms that so coloured our identities during the 20th century."
To borrow terminology from the sociology of knowledge, the drug companies, in concert with the psychiatric community, have been highly effective shapers of America's plausibility structure. Leslie Newbigin, in The Gospel in a Pluralist Society defines and describes plausibility structures as:
...patterns of belief and practice accepted within a given society, which determine which beliefs are plausible to its members and which are not. These plausibility structures are of course different at different times and places. Thus when, in any society, a belief is held to be "reasonable," this is a judgment made on the basis of the reigning plausibility structure.
Biological psychiatry, like counseling, is an inescapably hermeneutic exercise. The individual seeking to assist another in resolving intra-and/or interpersonal problems inevitably makes assessments and judgments about what is going on in the individual's life. These judgments assume a system of values and beliefs about human nature, motivation, and behavior.
Multiple interpretations can be offered to account for whatever emotional and behavioral symptoms an individual reports. Likewise, multiple conceptions of what is in need of being changed and how that is to be accomplished exist. Counseling and biopsychiatry, therefore, involve placing the counselee or patient in some larger contextual framework of meaning. In other words, all approaches to counseling and/or psychiatry seek to make sense of a person and his or her situations in terms of a broad interpretive framework or worldview. Given this fact, as well as the serious health risks associated with psychiatric medications, I'm dismayed by the relative absence of Christian leaders sounding cautions against psychiatric labeling and medicating.
