SOURCE: Brad Hambrick
When engaging a difficult and highly personal subject, it is better to start with good questions than a list of answers. The better our questions are, the more responsibly we will utilize the answers of which we are confidant, the more humbly we will approach areas of uncertainty, and the more we will honor one another in the process of learning.
As I’ve read, counseled, and thought about the subject of mental illness, here are some of the questions that have emerged.
The purpose of these questions is to expand our thinking about mental illness. We all bring a “theory of mental illness” to this discussion. This theory, whether we can articulate it or not, shapes the questions we ask. Exposing ourselves to important questions from other perspectives is the first step in becoming more holistic in our approach.
Don’t allow these questions to overwhelm you. All of these questions existed before you read them. Speaking them didn’t create them. Actually, an appropriate response to this list would be the generation of more questions. Take a moment to write down the additional questions you have.
- Is mental illness a flaw in character or chemistry? Is this the best way to frame the question? What do we lose when we fall into the trap of either-or thinking?
- Why do we think of genetic influences as if they negate the role of the will or personal choice? Substance abuse can have a clear genetic predisposition, but every addiction program – even those most committed to a disease model – appeal to the will as a key component to sobriety.
- In the modern psychological proverb, “The genes load the gun, and the environment pulls the trigger,” where is the person? How do we best understand the interplay of predisposition (genetics), influences (environment), and the individual making choices (person)?
- What percent of those who struggle with “normal sorrow” are labeled as clinically depressed? What percentage of those who think their sorrow is normal are actually clinically depressed? How do we communicate effectively when the same word – depression – has both a clinical and popular usage?
- Would we want to eradicate all anxiety and depression if we were medically capable of doing so? What would we lose, that was good about life and relationships, if these unpleasant emotions were eradicated from human experience? Would that be heaven-on-earth or have unintended consequences that are greater than our current dilemma?
- Can we have a “weak” brain—one given to problematic emotions or difficulty discerning reality—and a “strong” soul—one with a deep and genuine love for God? If we say “yes” to this question in areas like intelligence (e.g., low IQ and strong faith), would there be any reason to say “no” about those things described as mental illness? C.S. Lewis in Mere Christianity says, “Most of the man’s psychological makeup is probably due to his body: when his body dies all that will fall off him, and the real central man, the thing that chose, that made the best or the worst of this raw material, will stand naked. All sorts of nice things we thought our own, but which were really due to a good digestion, will fall off some of us; all sorts of nasty things which were due to complexes or bad health will fall off others. We shall then, for the first time, see every one as he really was. There will be surprises (p. 91-92).”
- When do labels serve well (i.e., offering a sense of hope by breaking the sense of isolation and shame that comes with believing “my struggle is completely unique”) and when do labels serve poorly (i.e., diminishing hope by creating a sense of determinism and stigma)? How free should a counselor be to choose whether to use or not to use labels based upon these potential benefits and detriments for a given individual?
- What is happening when we “think” and “feel”? Are these experiences merely random neurological fireworks, the soul talking to itself using the physical organ of the brain like an internal telephone, or something else? Ed Welch in Blame It on the Brain? says, “It is as if the heart always leaves its footprints in the brain… The Bible predicts that what goes on in the heart is represented physically. But the Bible would clarify that such differences do not prove that the brain caused the thoughts and actions. It may very well be the opposite. Brain changes may be caused by these behaviors (p. 48).”
- Is mental illness a physical event with spiritual side effects or a spiritual event with physical side effects; do choices-emotions trigger biology or biology trigger choices-emotions?
- How do we best assess when the relief of medication would decrease the motivation to change versus when that same relief would increase the possibility of change? Pain can both motivate and overwhelm; is this simply about personal thresholds or should mental anguish be evaluated by a different set of criteria?
- Are our emotions more than the alarm system of the soul (moral) and the chemicals of our brain (biological)? Do these two categories tell us everything we need to know about emotions? Are these categories complimentary or competitive with one another?
- Can we have a collective disease? Is mental illness always personal or can it be cultural? Cultural changes necessarily add to or detract from the kind of stresses that influence mental illness. How should we understand this influence and when might an “epidemic” require a collective solution as much as personal choices?
- Why are we, culturally, more open about almost everything in our lives than we were a generation ago except mental illness? Why does this stigma / prejudice maintain its socially-accepted status when most others have been rejected? Kathryn Greene-McCreight in Darkness Is My Only Companion says, “The mentally ill are one group of handicapped people against whom it still seems to be socially acceptable to hold prejudice (p. 36).”
- Are we trying to medically create an idyllic sanguine personality?Is “normal” becoming too emotionally narrow? If not in the medical establishment, then are societal norms pushing people in this direction and the service-oriented medical profession trying to accommodate its well-intended, but misguided clientele? Joel Shuman and Brian Volck, M.D. in Reclaiming the Body: Christians and the Faithful Use of Modern Medicine say, “The consumer model to which medicine seems to be uncritically adopting pursuance is providing what the patient wants—that is, customer satisfaction in matters of health—is the measure of success (p. 26).”
- Does the alleviation of symptoms with medication always mean we are curing a disease? We medically treat the symptoms of many diseases and non-diseases to provide relief. This is good. Why have we allowed the debate over the disease model for mental illness to polarize the conversation about the roles of medication can play in mental health?
- How should we understand the effects of the Fall on the mind and brain? We know our bodies age and die. We know all of our organs are susceptible to disease and deterioration. We have “norms” for the frequency, duration, onset, and prognosis of these effects of the Fall; what are the equivalent expectations for the mind and brain?
- How do we understand the tension between “already” and “not yet” with regards to the health, development, and preservation of the mind? How much should we expect to be able to remedy the effects of the Fall upon the mind prior to the ultimate redemption that will occur when Christ returns (Revelation 21:4)?
- How much should we expect conversion and normal sanctification (spiritual maturity) to impact mental illness? Outside of medical interventions, most secular treatments for mental illness focus on healthy-thinking, healthy-choices, and healthy-relationships; so how much should Christians expect sound-doctrine, righteous-living, and biblical-community to impact their struggle with mental illness?
What do we gain from asking good questions? Humility. Humility may be more vital for this conversation than most other conversations we have. Why? Because the neurological, genetic, and medical research that have prompted many of these questions is still in its infancy. What we “know” in these areas will likely seem as outdated as a VHS tape 10 years from now.
“It is very likely that in the future, with increased research into depression and also increased understanding of the Bible’s teaching, much of the current confident certainty, which presently masquerades as biblical or medical expertise, will also look ridiculous, cruel, and even horrifying (p. 12).” David Murray in Christians Get Depressed Too
But if the Bible is timeless, do research developments in these areas matter? Yes. Not because new scientific discoveries will change what the Bible means, but those discoveries will likely change our application of the Bible. Did the discovery of epileptic seizures change the truthfulness of the Bible? No. But it did help Christians understand that these were not demonic events. It is likely, if God should tarry, that many similar discoveries will emerge in the area of mental illness.