One of the central teachings of the Bible, especially emphasised in the letters of Paul, is the principle of the lordship of Christ over all of life. This principle received special attention by Christians fighting back against the modern secular dualism that divided spheres of reality between sacred and profane. This dogma proclaimed that faith should be lived exclusively as a private matter, leaving the public space as a neutral, scientific and rational sphere. From Kuyper to Schaeffer the idea that faith has to do with all dimensions of reality and life has challenged us to seek integration of our faith with our activity in the world. So, we are called to develop a Christian world view.
While for some, this idea might sound very familiar, the practice of integration is a very hard task. For instance, what would that mean, for the Christian psychiatrist? How should we integrate faith with the field of psychiatry, in a way that honours the lordship of Christ? Writing as a non-medic, my aim is to provide a framework for Christian medics to look at these questions, both to stir discussion, and lead to a transformative praxis (practice). An exploration of the meanings of the creation mandate of naming will form a framework for understanding what the nature of reality is, with application to psychiatric practice, a challenge to medics to reform their medical imagination in order to develop a Christian psychiatric imagination.
the naming mandate
We read in the creation narratives that 'in the beginning was the Word' (John 1:1), that when he created, 'God said…' (Genesis 1:3). Although, the meaning of 'the Word' in John is much larger, being connected to the divine logos, to the Son himself, it is clear that reality comes into existence through a creative act of speech, through a spoken word that creates and orders creation. In the same way, the Creator speaks man into being, creating him, according to the Genesis account, in his image and likeness. Therefore, man is imago Dei (in the image of God). Our anthropology — who we are — is derivative, which means that there is an external source to our identity. That is why the knowledge of God and the knowledge of the self, walk hand-in-hand; we need the revelation of God's word to shape our understanding of ourselves.
As imago Dei we reflect the Creator's attributes: in our rationality, emotions, relationality, moral capacity, and patterns of work and rest. However, another attribute is seen in our mandate to name things: 'Now the LORD God had formed out of the ground all the wild animals and all the birds in the sky. He brought them to the man to see what he would name them; and whatever the man called each living creature, that was its name.' (Genesis 2:19).
Even today biologists are still naming organisms. Every time a new one is discovered is up to us to name it. For instance, in 2008, in a popular diving site in Indonesia, a new species was found. Biologists named it psychedelic frogfish. 1 This is so not only within the biological realm; God gave us the mandate of naming reality. How can naming be defined though? Besides, what does it say about reality?
The attribute of naming expresses our calling as co-creators, as those that the Creator put in charge of the garden, to develop culture, and multiply. Naming could be defined as a creative discernment. It involves working with the given,but going beyond it. Only God creates ex-nihilo (out of nothing). We don't have this capacity. However, it doesn't mean we cannot create. We do and should create and through naming things, things come into existence and in this way we reflect God. Reality is facts plus meaning. It is both objective and subjective. Whatever the man called it that was its name. The subjective perception and choice create something which we inhabit, from a political system to a particular way of naming a pathological behaviour.
Naming is a way of being in the world. It feeds our imagination, both with words and images, giving meaning to reality and impacting everything we do. Think of the example of idolatry in Psalm 115. We are told that those who create idols will become like them. We do become what we imagine, because our imagination provides the categories through which we understand ourselves and reality. So, naming is a battle for meaning and ultimately for reality.
It is fundamental for us as Christians to understand that every single cultural artefact created by us, including tools, concepts, epistemologies, methods and techniques, is value laden and carries a worldview with it. That is the reason why the task of integration is so hard. In order to integrate our faith with medicine we cannot simply accept the tools of a particular science. For instance, thinking Christianly may require more than simply applying the accepted diagnostic criteria of psychiatry uncritically, and then applying what is thought of as a Christian answer. Most of the time using the correct terminology shapes the debate,and getting the naming right is a vital first step.
naming in psychiatry
Working with the apparatus produced in the modern world, it is necessary to develop Christian wisdom to discern how to navigate the concept and method of naming. Every single concept created by science is based on assumptions about what reality ultimately is — an ontology (beliefs about the nature of things). Applying that to the field of medicine, how can we identify psychiatric practices that might be completely based on a secular ontology? What do their categories look like? Are they big enough to capture the human condition? Can a Christian psychiatrist use these categories without compromising a Christian view of reality? I think these questions are big challenges for medical students who wish to integrate their faith with everything they do.
An example of naming reality within medical practice is the Diagnostic and Statistical Manual of Mental Disorders (DSM). It is crucial for psychiatrists to realise that naming is a battle for meaning, as we are called to describe and create. The methods and tools produced by the DSM are important and must be studied carefully. Nevertheless, we cannot forget that they are value-laden and carry a world view that in many cases distorts and reduces reality, in some way undermining human flourishing.
Every time a field of knowledge makes exclusive claims (based on its own assumptions) to explain one or more aspects of the human experience and reality, there is a risk of reductionism. Put in other words, when a field colonises another field, reality shrinks to fit within those categories. Think about a biologist who explains morality only in biological terms, or a historian who reduces the religious aspect of life to a mere sociological phenomenon. A similar risk can occur with medicine: the medicalisation of everything. If everything comes down to a 'mental health problem', for instance, how can we conceive human freedom? Is there such a thing, at all?
the need for a Christian imagination in psychiatry
If we lose the grasp of larger realities, reality will also be narrowed once we inhabit what we imagine. If within our horizon there is only an immanent frame (the here and now), as Charles Taylor puts it, categories such as sin and evil will make no sense. Besides, if these categories only make sense on Sunday and are not part of the picture in the clinic on Monday, we are already secularised, functional atheists.
So, there is a challenge posed for Christians working within this medical field. How can we develop a non-reductionist psychiatric practice that unfolds the task of naming in relationship with its Creator? I believe there is a need for a Christian psychiatric imagination to be developed. Remember, we inhabit our imagination. But our imagination derives from the categories we use to name the created order. If we are in rebellion against the Creator, we will name his creation very differently than if we are submitting our imagination to the Creator's revealed will and purposes. Psychiatrists have to remember that whatever man called it that was its name, without forgetting, however, that in the beginning was the Word.
Josué Reichow is a worker at UK L'Abri Fellowship
1. Pietsch TW, Arnold RJ, Hall DJ. A bizarre new species of frogfish of the genus Histiophryne (Lophiiformes: Antennariidae) from Ambon and Bali, Indonesia. Copeia 2009(1):37-45