Dale Johnson: You guessed it, it’s the month of May and we are talking about Mental Health Awareness Month. As part of that, we are going to discuss several topics that are hot-button issues right now in the world of mental health and which certainly impact us in the biblical counseling world. Today, I have with me Dr. Sam Stephens, who’s a professor of biblical counseling at Midwestern Baptist Theological Seminary. He serves full-time at ACBC as the Director of Membership and Certification. I’m so grateful for this, brother.
Today, our task is to talk about a very popular book that was released at the end of 2023. We want to be gracious, but we also want to be wise in how we talk about this particular subject. The title of today’s podcast is actually the title of the book, A Christians Guide to Mental Illness, put out by David Murray and Tom Karel. Sam, we’re going to talk about that today and this is going to be more of a discussion, but I’m looking forward to the things that we can glean from this today and hopefully give some of our listeners some wisdom in how we’re to distinguish this idea of mental illness as a concept.
Let me start just by acknowledging several things that I can appreciate. You don’t start out by writing a book or wanting to address a topic that’s popular in our culture, like mental illness, if you don’t appreciate or like people, and so I appreciate that intentionality from Mr. Murray and Mr. Karel. They acknowledge the difficulties of this idea and the concept of mental illness. For example, he says on page 2 that there’s a mystery in talking about mental illness at times which science has never fully understood or explained. He recognizes some of the complexities of this concept of mental illness. And this is something that we’ve talked about on the podcast at length before. Another thing that he describes in talking about humanity is that we suffer in so many different ways, such as despair and defeatism, in part because, as he describes it, mental illness is something that’s hard to understand. He’s assuming the term mental illness, and I don’t want to give him that quite yet, but he’s at least acknowledging that some of these things are difficult to understand. Another thing I can say that I appreciate about the book and a little bit about their approach is that they want to assure readers that God is our hope and help, and if they were able to accomplish that then I would certainly affirm that, but I don’t know that I would say that they did accomplish that. I do believe that God is our hope, and He is our help. So, with that, Sam, I want to bring you in and I want us to talk about some of the possible problems that we would see with this particular construct; the way the whole book is framed, assuming that mental illness is an appropriate category or categorical structure.
Where I want to start, Sam, is in talking about definition. You would assume that in A Christians Guide to Mental Illness, one of the first things that needs to happen is a definition of mental illness, and in my reading of this book, and I want to be as fair as possible, I genuinely did not see an outright definition. There’s a description of symptoms that we would say seem like, at least in our culture at a popular level, would be problems or issues or things that people suffer from with lack of function. I think on page sixteen, they use the definition from the National Alliance on mental illness, and this is the definition that he offers: “medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning, and it often results in a diminished capacity for coping with the ordinary demands of life.” I think he’s using that as the primary definition that he refers to, and what you can see there is we’re assuming a category based on a deficit in functioning as opposed to describing it in terms of causality and things like that. I want to get your thoughts just specifically on definition and how he tries to build this in the beginning of the book he appeals to this idea but there’s a lot lacking in clearly offering definition here.
Sam Stephens: Now, I think you point to something that’s really important for all of our readers to keep in mind when they read resources like this. Even early on, and I think you mentioned this from page 2, he says that there’s no test to confirm the existence of mental illness, but yet what is very clear in his holistic Christian approach to mental illness, as he puts it, is his belief in the legitimacy behind the term and concept. He very much defines it using medical language, and he opens up into chapter 1, which, I believe, is supposed to be the chapter that grounds the reader in what mental illness is. I think you and I would agree, however, that he does not accomplish that. It’s just chalked full of various assumptions. Some of them are implicit. Some of them are very explicit. To one of his points that, again, I would probably agree with not using the term. The problems that people face in life, the things that he would align with the concept of mental illness, are post-fall problems. In that type of avenue, I would be in agreement, right? He’s trying to put things in a biblical worldview, where we see the nature of sin, we see the impacts of sin on individuals, relationships, and all those types of things. But he then almost seamlessly moves into the assumption that mental illness is a legitimate medical category. And this includes a lot of things. I mean, you mentioned that definition —talk about moving goalposts. That’s very broad. It encompasses pretty much every type of experience that someone would encounter. He includes anxiety, depression, PTSD, and personality disorders, which is a pretty wide gamut. So, I think that makes it much more difficult for the reader to figure out where exactly the starting point is, and where it all ends.
Again, we’ve talked about this in previous Mental Health Awareness Month podcasts; if we get the starting point wrong, if the paradigm of explanation is not grounded in a biblical worldview, it’s going to be that much harder to not just determine what the solution is, but the methodology that links those two things together is going to be warped as well. So I’m very concerned about that. He also mentions that it defies simplification, which, I guess I understand what he means —we don’t want to encounter any one person or any counselee in a reductionistic manner, but at the same time, the question I had that I’d like to get your thoughts on as well, would be that it seems like he is actually approaching this whole idea from a very simplified manner, so it’s very strange. They present it as though it’s very complex and there are these broad definitions from these associations and mental health organizations, and we don’t need to simplify something that’s complex. But then he goes throughout the entire book and just references mental illness as if we all know what he’s talking about, or something that can be scientifically, objectively, identified, measured, or traced through time and none of those things happen. So for me, it was just the moving goalposts which was very troubling and made it difficult to figure out where he was going.
Dale Johnson: Yeah. I appreciate how you articulated that, and I think one of the critical pieces is at the very beginning of chapter 1, which is called “What is Mental Illness?” He says, “Despite improved research and education, many of us are still confused, uncertain, or simply wrong about what we think mental illness is,” and I appreciate that he’s approaching it that way but there’s an assumption that mental illness actually is a factual category. Yet, it’s based on subjectivity in terms of a lack of function, and therefore we have to trace that lack of function back to something in particular. What I think he fails to recognize is that we’re talking about symptomatology. We’re describing what we would agree are symptoms that a person is experiencing and I’m not denying that. I think most people confuse biblical counseling’s perspective on mental illness or the whole mental health construct as if we don’t act as though those experiences are real because of the fact that we deny the concept of mental illness as a construct. That’s not a true statement.
The problem is in the definition, in how we describe what mental illness is. I think, as you were describing, there in his descriptions of mental illness, it defies simplification. I think that’s the way many are responding at this particular time regarding this issue of mental illness, in part because there’s so much pushback, and not from people like us. There’s so much pushback from people within the secular field on what it is that mental illness is trying to describe or capture. We can’t really define what mental illness really is, and part of the reason that there’s a struggle there is because what’s happened in the history of mental health is a reductionism in terms of the bio-psycho-social-sectarian tripartite sort of model.
So there’s been biological reductionism, or what some call biomedical reductionism. There’s been psychosocial reductionism. So, where we try to describe these types of psychological anomalies or problems in their severity in terms of something that’s reduced down to some sort of psychological problem, and this is where some of that confusion that I think Murray is indicating regarding mental illness comes from because the industry itself has not clearly defined these things. The industry itself has not clearly given causes, especially biological or even psychological causes of these particular things. So it leaves us quite wanting in what it is that we’re actually talking about in terms of mental illness. I want to get to one thing, Sam, that I think is pretty critical. One of the phrases he makes very early on where we always see this crossroads, if you will, is this point that comes up when we’re discussing mental illness in terms of whether it’s something that’s spiritual or whether it’s something that’s not. I want to read you a quote and just get your thoughts on this. He says, “While mental illness often has spiritual consequences, it is rarely only a spiritual problem that can be fixed simply with repentance and faith.”
Sam Stephens: There’s a lot to unpack there. I think I’ll begin by going about this in a little bit of a roundabout way. Again, I think it exposes where he places his, as I mentioned before, I use this term paradigm of explanation, his commitment to the legitimacy of the psychological sciences. One of the authors mentioned later in chapter 2 I believe, that they’ve reluctantly decided to retain the use of the concept –the label mental illness. They admit that mental illness doesn’t operate in many of the same ways as medical issues. Which again, is contradictory, this is just simply contradictory.
My take is that all this is an attempt to try, with the best motives, to communicate sympathy, but I think more of the focus of the book is actually focused on trying to destigmatize. So they focus on using this term in order to destigmatize so that people don’t feel like they’re ostracized because of any labels that they’re coming in with, but I think that’s an error, and I think that actually accomplishes the very opposite. When you get into what you just mentioned, this is what I think is very concerning. Mental illness becomes a category that is foreign to the Scriptures. It just does. There are consequences, but causation is rarely a spiritual problem? And when he mentioned specifically, even the way he worded it, fixed with repentance and faith? I frankly saw throughout this entire book as someone who is committed to biblical counseling and I don’t know David Murray or the co-author personally, and I don’t know if they would identify as biblical counselors or not, but let me be very clear and candid with our listeners, this is not a biblical counseling book. They mentioned biblical counselors later in the book as part of a helping team and we can get into that later if you want, but I think by stating something like this, it does seem to imply that maybe those of us that would find repentance and faith as biblical concepts that are very central to caring for people, that maybe we’re going about trying to fix people, and I don’t know if that was their motive, but that was my take by reading the book as someone who thinks repentance and faith are actually quite important.
I want to go to just a couple of verses that I was actually reflecting on just this morning to show the centrality of these two concepts, one being a very familiar verse to many of our listeners which is 1 John 1:9: “If we confess our sins, he is faithful and righteous to forgive us our sins and to cleanse us from all unrighteousness.” This is the initial beginning steps of what the Bible talks about is the doctrine of repentance, and that doctrine of repentance, according to what Paul says in the Scriptures and what many other authors in the Scriptures point to, is our purpose in life, is to live in a manner worthy of His name. We are to be pleasing to Him in all respects. That we actually make it our ambition, whether present in the body or absent with the Lord or wherever it may be, that our ambition is to please Him. Our effort in biblical counseling is not to fix people. Our effort in biblical counseling is to help them behold the Father in such a way that they live their lives, whether suffering or living life normally and enjoying all the joys of life, whatever it may be, before the face of God. So seeing repentance as something that we would just throw at people in order to fix their problems is just missing the entire point. Again, not setting on the spiritual is very troubling.
But to that second point, I just want to mention this as well: later on in First John at the end of the book in chapter 5 verse 4, John’s been walking us through the truth, then going back to chapter 2, pointing out that the world is passing away —the worldly lusts and worldly desires and these types of things will plague us, but the world is passing away and greater is He who is in us than he was in the world. Then we see in First John 5:4 that it says, “for whatever is born of God overcomes the world and this is the victory that has overcome the world, our faith.” He points specifically to our faith! As I’m reading this book, thinking the best about the authors and that they’re trying to help people that are in very difficult situations and scenarios, we may differ from them on how we would describe it, but I would like to think that one of their major goals would be to see this person have victory from whatever plagues them. I would think that strengthening their faith through a healthy exposure and dose of God’s Word through discipleship, life in the church, and walking with someone winsomely through the Scriptures, that would actually greatly spiritually benefit them. I think they really missed the mark here, and frankly, in a devastating way.
Dale Johnson: Yeah, and in a way that is not only trying to bolster a secular concept, but at the same time begins an unintended consequence as it diminishes the spiritual approach that the Scripture gives to all of human life. And I think that’s one of the things that’s missing, Sam, is he does address some of the concerns of the mental illness label, and I do appreciate that because I think that’s helpful for us to see that this label comes with all kinds of baggage that is a misappropriation and misunderstanding of human problems themselves, yet still, after acknowledging that, they are still wanting to carry on that tradition and seem as though they need to explain all these ideas and experiences away through this very vague approach in terms of mental illness.
One of the questions he asked in Chapter 2 was, “Is mental illness a helpful label?” And he starts to describe some of the limitations of the label. He starts by saying part of the difficulty that leads to both overuse and underuse of this label is the ambiguity in both the words mental and illness. We’ve talked about that at length, but the problem is furthered by trying to describe something that’s biological or that has a biomarker with something that’s mental. Mental is something that’s immaterial. So, how do we describe a biological marker over something that’s mental?
Sam Stephens: Dale, let me ask you this because this is just what I keep coming back to. This is a common refrain in a lot of integrated literature; if these terms are so chocked full of ambiguity and if the professional secularists can’t even define it, why in the world would we, as Christians, even seek to try and utilize it? Why don’t we try to go back to the Bible? I mean, this is one of the issues that, frankly, the early days of the modern biblical counseling movement with Jay Adams were focused on, which was very helpful because he pointed out that the language that we use in counseling to describe things is very important. It’s very important. If we don’t root our framework, our paradigm of explanation, using biblical concepts, with a biblical anthropology, looking at a biblical soteriology, understanding sin and its impact in all different types of forms, then we’re not going to lead people to real hope.
Here’s the issue that I see: there’s no hope for people with mental illness. There’s no telos, there’s no eschatological hope, there’s no real hope. It’s this world. Everything with mental illness anchors people to a broken world with broken systems that have done what in the last 80, 90, or 100 years? People are more depressed than ever. People are struggling more than ever. People are self-injuring. People are committing suicide. I mean, let’s get evidence-based for a moment, can we? It’s not working. It’s just not working. Biblical counselors, listen to me, why would we try to make and redeem a system that the secularists are even saying is not working? I just don’t understand it.
Dale Johnson: See, that’s one of the critical points that we go back to quite often. The whole structure of the mental health world in the form of the DSM, the Diagnostic and Statistical Manual of Mental Disorders, does not even use this term: mental illness. I think that should be very telling to us because they describe all the labels given, nearly 500, in that particular book, which is a whole categorization of abnormalities. They describe the problem as a mental disorder, which is a collection of symptoms also known as a syndrome. They don’t even use the term mental illness. Why? Because as you mentioned, so many secularists are wanting to abandon that term that’s being propagated in pop psychology, in part because it’s misleading. It’s misleading to people and especially with the drug crisis that we’re having even now in psycho-pharmacology. We are seeing that this is coming to the forefront, and what’s misleading people regarding the effects of the drugs or the benefits of the drugs as people weigh the risk and benefit of those particular things, is that they’re being given misleading information.
And to your point, if we’ve had this narrative around for 90 almost 100 years now, we should see a story of massive progress, not just in the diagnoses of these types of labels and problems, but we should also begin to see alleviation of these things. But we’ve actually seen the opposite of that. There’s been no Western country that has demonstrated an alleviation of these diagnoses, only a massive increase, not just in the diagnosis of these types of labels but also in the medical treatment of these types of things. So we’ve not seen that narrative play out, and to your point, we want to talk about evidence-based. This is what the secularists are describing. I do find it lacking that in this book, they don’t address some of those very overt concerns from secular scientists regarding these types of labels from people like Nassir Ghaemi, who is a professor of psychiatry at Tufts University in Boston. People like Alan Francis, the task force chairman of the DSM-4, which means he helped to write the whole book. He’s not addressing some of those major concerns.
Sam Stephens: And this is what I see, again, if I look for common themes in books like this that tried to provide some sort of guide – there’s no serious engagement. Most of the research that’s suggested here is either outdated or it’s from parachurch organizations that are, frankly, already presupposing the legitimacy of the same concept. So it just feeds upon itself, but there’s no real serious engagement with the psychiatric community, and I would look at them as people that have a lot of authority and knowledge about the field and are extremely critical about its efficacy and its legitimacy in its current form. I want to ask how helpful of a guide it is that ignores half of the conversation?
Dale Johnson: Yeah, and I think that’s important for us to consider. We’re running short on time, which is what I always hate when we try to address these types of subjects because there’s so much to say. I do want to peek over into chapter 10, which is what causes mental illness, and I do appreciate their boldness to try and answer this question because that’s one of the ambiguous things about this term mental illness, because you’re trying to describe a pathological explanation of something that’s immaterial and that’s a difficult thing to do. Lots of people don’t even try, and at least they’re trying, and they give three basic categories, Sam, that I want you to think about here. Three main causes, they say, of mental illness.
Starting with first, what we are, meaning we have wrong biology. Number two, what we do, which is we have wrong lives. And number three, what others do to us, meaning ways in which we are wronged by others. Now, I do appreciate, as you mentioned earlier, that they place the setting of all these problems as a post-Genesis 3 problem. I appreciate that. Many people don’t try to fit all of our human problems within the context of Genesis 3, but I think that’s absolutely appropriate and very helpful. Part of the problem, I think, is even as we discuss problems with our biology, we act as though the curse of sin as it relates to our biology does not have a biblical answer. I can’t help but think of things like 2 Corinthians 4, where we are told even as our outward man and body is decaying, that our inner man can be renewed day by day. And what they’re presupposing there is the assumption that if we have a mental illness that’s bodily caused, then the Scriptures are powerless to help us at all. And that’s actually another category that we should refer to someone outside when, in reality, the Scripture acknowledges that the body can decay, yet the Scripture is not powerless to help us to overcome. Certainly, the idea is not that we’re saying you shouldn’t go see a physician. That’s not the point. The point is we shouldn’t diminish the value of the Scriptures even when that reality is true about our bodies decaying in whatever fashion that might be. What are your thoughts on some of these causes here?
Sam Stephens: One of them is a little personal story here, and I know some of our listeners will probably laugh at this, but I’m in my ripe old age of 37. And in the last few weeks, my leg’s been hurting, my back’s been hurting, I’ve got small kids, I’m thrown around. I’ve just become very aware of the fact that I’m not getting any younger and my body is going to start misfiring and not functioning correctly, but this is the natural way of things. Yet to your point, what hope is there in the fact that my spiritual life and my heart can be renewed day by day? As well as in thinking about the resurrection of our Lord and the great hope that we have with the resurrected body.
So, any biblical counselor that represents biblical counseling rightly sees both of those components. This is thrown around a lot by integrationists, but we are “embodied souls”, and that’s usually a euphemism for we need to be all about the secular therapies that really focus on the body. Well, I just reject that totally and say, yes, we’re embodied souls but the heart is always active, and it is out of the heart of man that the mouth speaks, from which the things of life flow, and that is what is redeemed by our Lord Jesus. I was born anew. Physically? No. Spiritually! He even mentioned earlier in the book that he’s tried to talk about the compartmentalization of man, such as the emotional and mental elements. Those are two different categories in David Murray’s mind. Listen, the inner man –let’s talk about the inner man. The things that I think both he and I would say are the problems that people struggle with in life are inner man issues that affect the outer man and the breakdown of the body that impacts our busy hearts and minds and how we interpret the fact that we are dying.
Dale Johnson: Yeah, and I think it’s critical that we’re saying that the body is not affected. I think people misinterpret that. What we’re doing is trying to present the emphasis according to the way the Scripture emphasizes things. This category that I brought up in the first cause (that we have wrong biology) is typically the category that most people say gives us permission for the whole adventure of mental illness when, in reality, what I’ve just described is that the inner man can be renewed day by day, no matter if the body is decaying.
Secondly, the Bible gives a perspective on how the body is to be redeemed. Can we pray and hope that the Lord heals us in an intermediate state? Yes. Can the Lord do that? 100%. But the fact of the matter is that we are all appointed to die and then face the judgment, and the fact that we have an eschatological hope that when our body ultimately decays, with whatever it is that we might have, that we long for something greater, is the perspective of Scripture that I think we’re missing when we adopt some of these categories.
The final thing I’ll say, and maybe we have to close here, is the other two causes, and I appreciate him saying this because this places some of the experiences that people have squarely within the realm of what the Scripture speaks to, and it’s the question of, “what do we do?” We have wrong lives, meaning, we sin. As people, we sin. Part of the consequence of that sin is we have disturbed emotional states. We have vexed souls, as the Scriptures describe. The other thing is, what do we do categorically when people mistreat us and sin against us? That’s his third category and I think he’s acknowledging from the Scriptures that we can have vexation from that, and my point is all three of those categories are clearly articulated in the Scriptures in how we would have genuine hope in a way that Paul describes in 1 Corinthians 2, that our hope would not rest in the wisdom of man but in the power of God. I think it’s really critical that we not miss that. So let me close out by giving a perspective from Hebrews 9 that I keep running back to, especially when we’re talking about disturbances and vexations of the soul that are very real in Scripture and certainly have bodily effects.
Listen to the words of the writer of Hebrews in Hebrews chapter 9. The reason I say this is important is because we’re talking about a purifying of the soul, and that the Bible, through God’s Word, gives us wisdom on how the soul is actually purified. We see this in Psalm 19:7 when it says, “The law of the Lord is perfect. It restores the soul.” But listen to Hebrews 9:11 and go down to verse 14. “But when Christ appeared as a high priest of the good things that have come, then through the greater and more perfect tent (not made with hands, that is, not of this creation) he entered once for all into holy places not by means of the blood of goats and calves but by means of his own blood, thus securing an eternal redemption. For if the blood of goats and bulls, and the sprinkling of defiled persons with the ashes of a heifer, sanctify for the purification of the flesh, how much more will the blood of Christ, who through the eternal spirit offered himself without blemish to God, to purify our conscience from dead works to serve the living God.” What we see is not just a reductionistic view of the Scriptures that it’s good for justification. We see an opening of the Scriptures. Yes, it is sufficient for justification, but it’s also sufficient for purification of our conscience, meaning that it’s sufficient for sanctification, the way we walk and live in life, which encompasses a holistic view of man, both body and soul and how we steward our bodies well and how we live with hearts devoted to the Lord, using every physical and material part of life that God gives us and steward it before the Lord for His honor and glory.
That’s a different paradigm than what’s being described here. When we give ourselves to these types of secular labels, that’s not their intention. I want to make that very clear. I’m not demonizing people, but the ideas lead to a place where we miss the depths of the value of Scripture in its application to truly satisfy the souls of men. It wrongfully categorizes human problems in ways that place us out of touch with the depths of Scripture to meet those demands in our hearts, in our lives, and even in our bodies. So, as we contemplate this, I would give the same caution that you gave earlier. A Christians Guide to Mental Illness, I would say, is not a biblical counseling book. I appreciate them trying to address a very difficult subject, but the concept of mental illness, I would argue, in the way it’s currently presented, and secularists would say this as well, is not helpful to advance the conversation and it actually brings much more confusion and ambiguity and it certainly doesn’t direct our hearts back to the Scriptures for help and hope.
Helpful Resources:
Mental Health Awareness Month Podcast Series
The Gospel and Mental Illness — ACBC 2014 Annual Conference
