Mental Illness and Compassion

May 15, 2013

Mental Illness and Compassion
Charles Hodges

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Charles Hodges

Mental Illness and Compassion

BCC Staff Note: We describe the BCC’s Grace & Truth blog as “Voices from the Biblical Counseling Community.” The modern biblical counseling movement spans a diverse spectrum of people and organizations committed to a view of people helping summarized by the Biblical Counseling Coalition’s Confessional Statement. It is with this diversity in mind that we have run a series of posts addressing the important issue of biblical counseling and mental illness. In addition to today’s post by Dr. Charles Hodges, we’d encourage you to read:

Compassion and Labels

It has been over a month since I heard the sad news that the son of a well-known pastor had chosen to take his own life. I have had little to say about it other than that I continue to pray for the pastor and his family. Sometimes that is best thing I can do when it is hard to ask questions and the answers don’t seem adequate. The pastor said it best. “In the first shock of an unspeakable tragedy, don’t speak. Hug them! Weep with them! Just be there. Use touch, not words.”

As a medical doctor and biblical counselor, there is something I do need to talk about. A lot of questions have been raised about the relationship between terrible outcomes for struggling individuals and the attitude of the church toward the concept of mental illness. Some of what I have read has been constructive. Some of it has muddied the water.
The central thought is that the church as a whole stigmatizes those who have been diagnosed or labeled with mental illness as defined by the Diagnostic Statistical Manual of Mental Disorders (DSM). We are told that a smaller part of the church wants to ascribe all such labels to the sin of the struggler.

World Magazine took aim at “Christians (who) still don’t know how to offer grace and mercy to people suffering from mental illness and suicidal thoughts” in their April 16 article “Condemnation Trumps Compassion in Suicide Response.” At the start, it is off by just a couple of degrees which in golf means it will be yards away from the green on landing. The problem, as I see it, is not so much with the church, and if you aim the argument there you will miss the point.

The problem often can be with the undefined term mental illness.
In order to be compassionate, the church does not need to agree to a concept whose definition is in dispute. The current definition of mental illness is the DSM and the 5th revision is due to be published in May. It comes with controversy because many believe it takes normal human behavior and redefines it as disease. This is not a view held by a small segment of biblical counselors; it is the view of a significant number of those in psychology and other counseling disciplines.[i]

Recently, Ed Stetzer said in his blog[ii], “If I’m struggling with grief, with sin, or with any host of issues, having people who can encourage me or even counselors in the Christian tradition are wonderful. But there is a difference between that and mental illness, which is a physiological reality. We wouldn’t shame someone for getting a virus. Why do we shame someone for having a chemical imbalance that leads him or her to a lifelong struggle with depression?”

I know that it is hard to communicate complicated subjects in 500 word blogs and Stetzer has done a good job with it. However, his effort illustrates what I think is the struggle. As long as we speak of speak of “psycho-biological disease” in undefined terms such as mental illness and then leave the definition of it to those who control the DSM, we will be faced with deciding how to help people based mostly on their labels.

I do not think it is wise or helpful to concede to the idea that compassion does not include a careful scientific and theological examination of the diseases and disorders that we are asked to accept. In fact, I believe we are obligated. Otherwise we will find ourselves saying “disruptive mood dysregulation disorder” when we mean tantrum.

We will also be held captive to the idea that all those labeled with depression are ill. It is likely that 90% of those labeled as depressed today are struggling with normal sadness due to loss.[iii] It is not necessarily compassionate to tell them they are ill. As one struggling friend who had suffered a huge permanent loss in life said, “it gave me hope to know…I am not sick, I’m just sad.” It is also not compassionate to tell the other 10% who cannot express why they struggle, that they are not sad and that their problem is not real.

What Compassion Requires

Being compassionate is not connected to what we think about counseling or terms like mental illness. We can stand on both sides of the divide and be kind to one another. We can show compassion to the pastor who lost a son. We can withhold judgment and show mercy. We can do all of these things and never agree about the cause or care for those who struggle. We can do them because the Lord who loves us demands that we do so.

Being compassionate does not require that we agree with the idea that a chemical imbalance leads anyone to a life-long struggle with depression. Last summer the head of the National Institute of Mental Health said, “There is no biochemical imbalance that we have ever been able to demonstrate. What we think about are changes in circuitry and how the brain is processing information.” [iv] To say that we must agree with a theory whose scientific basis is unclear in order to be kind, tender-hearted, and love one another is simply not true. We can be compassionate and we must without regard to labels.

Biblical counselors can, in a kind, compassionate manner, address the suffering that comes with chronic medical illness. That includes the 10% of those who suffer and struggle with sadness, or depression for which there is no obvious cause. One case I remember[v] involved a patient who had struggled with headaches and sleeplessness for months and was diagnosed with depression. The young man had sought counseling and was eventually sent to see me by the counselor because no counseling problem seemed to exist and there was no significant loss that should have caused sadness or sorrow in his life.

Eventually, we found a solution to the young man’s problem that responded to medical care. In the process we reduced his medication list from nineteen prescriptions to one. Compassion in his case involved finding healthcare that was not fixed by the labels with which he came. It also involved a biblical counselor referring a counselee to a physician when he was convinced there was no underlying spiritual explanation for the problem.

So, I suggest we continue to pray for the pastor and his family who no doubt continue to suffer due to their loss. And, while we do it we should keep in mind James 2:12-13 remembering that mercy triumphs over judgment.

Join the Conversation

What does it look like for the church to show compassion to people struggling with deep, ongoing emotional distress? How can the church compassionately and intelligently address issues related to the diagnosis of mental illness?

[iii]This concept is discussed at length in Good Mood Bad Mood by Charles Hodges, and in The Loss of Sadness by Alan Horwitz and Jerome Wakefield.

[v]All case studies are composite and do not reveal unique patient information in respect of patient privacy.

6 thoughts on “Mental Illness and Compassion

  1. Pingback: The Church’s Mission and Psychiatric Disorders | Biblical Counseling Coalition Blogs

  2. Thanks Dr. Hodges! a balance view. Christians should be the most compassionate people around. Our landmark characteristic is our ‘Love for one-another.’ The term “mental illness” makes me wonder some, as I see books written by Thomas Szasz, one being “The Myth of Mental Illness.” Written from the secular view. Just something for us to contemplate.

  3. Quotation # iv is either a misquote or a wrong footnote. It does not appear as stated in the linked article. There is a similar though significantly different and longer quote in the article.

    “There is no biochemical imbalance that we have ever been able to demonstrate,” he said. “What we think about are changes in circuitry and how the brain is processing information.”

    Why does Hodges not go on to quote the whole statement and to explain its context? The whole quotation and the wider context has Insell supporting the idea of demonstrable physical changes in the brain.

    Hodges shortens and changes the quote to support his view of no physical changes.

    This does not reflect well on him or the BCC.

  4. Pingback: A Biblical Counseling Perspective on Mental Illness | Biblical Counseling Coalition Blogs

  5. Dear Dave, Thank you very much for your correcting comment. When I wrote the first draft of the blog, I did that quote from memory. When I did the final edit, I spent a day finding the original article that I put in the footnote, but neglected to compare my “remembered” form of the quote and the original. Please forgive me. I did not intentional substitute the word discovered for demonstrated in the quote, but the substitution does not change the intent of what Dr. Inman meant. His statement indicates that there has never been a chemical imbalance discovered. My attempt at the quote was meant to show that since chemical imbalances have not been shown to exist to substantiate the theory that we are not obligated to agree with them. Further, we do not need to agree with them to be compassionate towards people who struggle.

    I did not intend to imply that Dr. Inman does not think there are physical problems with the brain that cause depression because he clearly does. It is important to note that his views on brain circuitry are still in the realm of theory. I also did not say that no one’s depression is caused by some brain dysfunction, but instead noted that other authors think that perhaps 90% of people labeled with depression today do not have a disease but instead struggle with sadness over loss. That leaves the other 10% that I note in the blog.

    Thank you for your comment, the quote will be corrected.

    Charles Hodges MD

  6. David, Thank you for bringing this quotation issue to our attention. As you see, Dr. Hodges has responded to your comment. And the BCC Staff has corrected the quote.

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