What then is psychiatry?
Psychiatry is quite simply the diagnosis and management of mental disorder. This covers a vast array of conditions from dementia and delirium to depression. Because of the emphasis on physical medicine in medical training, diagnoses like depression may sound rather vague and unscientific. However, with recognised international classifications, the reliability of psychiatric diagnosis has been shown to exceed that, say, of a speciality with 'hard' facts such as radiology. Moreover, with modern drugs, the success of treatment has improved for conditions like depression. Psychological treatment for phobias has again been shown to alleviate much suffering. There are nevertheless problems with certain disorders. Sometimes the profession risks bringing itself into disrepute by listing as diagnoses such conditions as paedophilia and kleptomania.
Doesn't the treatment of disorders of the mind only mask the real problem?
This begs the question: what is the mind? It is the way we think, our thought processes, the way we see ourselves, the world, others and God. It is also our emotions, our mood and our feelings. In this sense it may be difficult to distinguish it from the heart or even the body. Physical pain can lead to crying or to 'depression'. So, mental disorders can be one of the presenting symptoms of physical diseases.
What then of spiritual conditions? When we became Christians our spirits were made alive by God's Holy Spirit; until then we were dead in our sins (Rom 6). Generally speaking spiritual problems need to be dealt with by spiritual means – repentance, forgiveness and salvation. Of course, sometimes there is a connection between the physical, the mental and the spiritual. Sometimes physical diseases were used by God for the punishment of spiritual conditions (sin) as in the example of Herod (Acts 12:23). Just as Christians fall physically ill – because we are all subject to the consequences of the Fall – so also we fall prey to mental distress and disorder. It may sometimes be because of sin or its direct consequences, such as a guilty conscience after wrongdoing, leading to depression. But often genetic and constitutional or personality factors predispose to mental illness. The common disorders schizophrenia and manic-depression have now been shown to occur more frequently in the families of sufferers, even after environmental factors have been eliminated. These conditions need to be treated with the best available means – medical, psychological and social – whether we are Christians or not.
For Christians who suffer with mental disorder there is also the opportunity to benefit from adjuvant 'spiritual' treatment such as fellowship, practical support, prayer and Bible study. One schizophrenic patient I know has managed his own illness very effectively with the help of his church, his family and health professionals. There are also organisations which help patients such as the Association for the Pastoral Care of the Mentally Ill. However, one of the messages I have been trying to convey to my own church is that people suffering with major mental illness should not have spiritual treatment on its own. This is also one of the tenets that the Association of Christian Psychiatrists (with over 200 members) have as a priority. Another tenet is that for most conditions Christians are quite adequately served by consulting a non-Christian professional.
Does God have to be involved before healing is complete?
Most mental conditions can be dealt with in the same basic way that physical conditions would be approached by a non-Christian surgeon or physician. Nowadays mental health professionals are trained to take into account, and be sensitive to, the religious beliefs of their patients and not to impose their own beliefs on vulnerable people. In my experience there may be certain problems which do require spiritual input. These include situations where forgiveness is needed for a wrong committed against the patient. If a Christian has become depressed in this situation they will need the help of a pastor or fellow Christian. However, sometimes even here, it may be necessary to help the person out of a severe depression with drugs or electro-convulsive therapy (as John White asserts in The Masks of Melancholy). Only then can the spiritual issues be addressed by a person in command of their faculties.
Isn't the work of the psychiatrist and the pastor often the same?
The scene may be the same – in the outpatient clinic or in the church. The person gives a story of distress, failure and depression. It is the job of the psychiatrist to understand the reasons for the distress and to point these out in a way that the patient can attempt to deal with. The task is also to relieve the distress, to improve the level of functioning and to enable the patient to use their own resources.
In some ways the aims of psychiatry are similar to those of the Gospel: to help, to heal and to restore. Psychiatry attempts to do this by trying to iron out the distorted mental processes and then to help the person to help themself as well. It is not the job of the professional psychiatrist then, to share the Gospel unless the patient explicitly asks the professional for their personal view. When a patient is very ill, in my experience it is not productive to talk about spiritual things because the person's appreciation of reality is so damaged. Once their balance of mind has been restored it can be very helpful to pass the patient over to a pastor if he is willing.
When a person comes to a pastor the objective – whether acknowledged or not – is to find out what God has to say about the matter in hand. It is therefore preferable that pastors know a little about the warning signs of mental disorder and can pass patients with these over to a psychiatrist when appropriate. If the pastor believes the person is well enough then the problem can be brought into God's light for clarification and then be dealt with by prayer, forgiveness or other means.
Isn't it difficult to disentangle the signs of spiritual problems from those of mental disorders? It can be. Professor Sims (former President of the Royal College of Psychiatrists and Chair of the Association of Christian Psychiatrists) gives some helpful guidelines for indicators of psychiatric morbidity:
- The symptoms and signs are those which conform to those of mental illness, for instance the third person auditory hallucinations found in schizophrenia.
- There are other symptoms which are recognisable of mental disorder. A detailed history and a mental state examination are always taken and these should corroborate the signs.
- The post-conversion lifestyle is inconsistent with the development of Christian character and consistent with the natural history of mental disorder.
- The personality of the person is disordered in such a way that is consistent with the behaviour.
What then is behaviour which is consistent with religious experience – and is not symptomatic disorder?
This is an important question because Christians sometimes think that psychiatrists believe Christians must be crazy to believe the things we do. Firstly, psychiatrists have special training which should force them to take into consideration the patient's cultural background. Indeed, the definition of a key psychiatric concept – the delusion – is 'a belief that is fixed, unshakeable and out of keeping with the patient's cultural beliefs and background'.
How then can we differentiate depression, mania or schizophrenia from genuine religious experience?
Professor Sims lists five criteria which apply to a genuine religious experience:
- The person is reticent to discuss experiences, especially with those perceived as unsympathetic.
- The experience is described matter of factly.
- The person allows for the incredulity of others.
- The person understands that the experience makes demands on behaviour.
- The experience conforms to the religious culture.
What about demon possession?
For a start, I prefer the term 'demonisation' which is a better translation of the original Greek. Secondly, I believe that it does exist, albeit rarely in psychiatric practice. Thirdly, the discernment of demonisation is spiritually made and requires care. Fourthly, exorcism should only be performed by an experienced team.
The biblical example I find most helpful here is the one where Jesus meets the man amongst the tombs and casts out the legion of demons into a herd of pigs (Lk 8:26-39). John Wimber draws out nine characteristics of demonisation from this dramatic encounter: The demons opposed Jesus (28); the person had a new personality, shown by his asocial lifestyle (27-28); the demons had supernatural knowledge in that they knew Jesus was the Son of God who could cast them out of the person (29,31); the person had shown great physical strength by breaking his chains (29); he exhibited moral depravity by being naked (27); the person shouted at the top of his voice (28); the demons lived inside the person(30); the demons exerted episodic influence (28); but the person still had some control in that he went to meet Jesus (27).
These nine points should serve as useful distinctive qualities in discerning a true case of demonisation.
Moss contrasts the two different methods of dealing with demonised and mentally ill people. The mentally ill person is like a hurt child; the demon is a marauder who needs to be ejected. The mentally ill person needs safety, the healing of emotional hurts, Christian love, care with relationships, an acceptance of what cannot be changed, and also appropriate medical and psychological treatment. The demonised person requires the authority of Christ and his Word over him/her, prayer, and a life protected by spiritual discipline.
I do not think there is a contradiction between psychiatry and Christianity, just as there is no contradiction between other branches of medicine and Christianity. Jesus himself looked after people's minds. Of course, as in other branches of medicine, there may be times when there is a practice which is anti-Christian. The Nazis used psychiatrists to employ euthanasia on 300,000 mental patients. We must be alert to any abuse of psychiatry. As there will be many types of Christian practitioners in psychiatry; we must be watchful and not be afraid to put our own pet practices to the test of the usual scientific criteria.