Dale Johnson: Today, I am delighted to have with us Dr. John Street. Every time I’m around this guy I laugh until my belly hurts. I love being with Dr. John Street. Let me tell you a little bit about him. He is an elder at Grace Community Church and has been for a number of years. He’s a longtime board member at ACBC. He serves now as our board chairman, which I’m delighted to work with him on a consistent basis. He’s also the chair of the Department of Biblical Counseling at The Master’s University and Seminary. He serves there as a professor. I love Dr. John Street, and I appreciate him being here with us today to talk about what is often considered a very difficult subject—the subject of schizophrenia.
Where I want to start, if I can Dr. Street, is just asking about this idea, this term of schizophrenia. So many people are confused by it, so many people don’t understand it. We understand it sort of from a cultural perspective and what we think when we hear that term, but there’s a lot of confusion. That goes without saying. How do we define this idea of schizophrenia? I mean, what are we talking about here?
John Street: Wow, that’s a good question. I think one of the things that’s most helpful for people is to put this within historic setting, because historically, down through many centuries people didn’t have any idea of the term schizophrenia. By the early 20th century, the old concept of insanity or madness became fragmented into diseases or psychosis, but soon the term schizophrenia was being used and it was actually coined by a Swiss psychiatrist in 1908. His name was Eugene Buehler.
He coined it from two Greek terms. One is schizo, which means split. And the other one phren, which is the Greek term for mind. It gave the impression, from at least the Greek terminology that was used there, that a person was suffering from a split mind. There’s a split type of reality to it. I think one of the key things that helped people to understand is that up to this particular point, usually a person like this was described as being insane or sometimes even mad, depending on how serious the symptomatology was there. It’s only been recently in terms of history that people have called this cluster of symptoms schizophrenia.
In fact, there are five major symptom domains that are usually used to describe this term. One is that a person is experiencing delusions, that is, believing something that is not true or a false belief. That’s a very broad description that’s used in the DSM-5. The other symptomatology is hallucinations, where a person is hearing or even seeing things that others do not hear and see. Another has to do with disorganized speech, where a person is incoherent or sometimes nonsensical in terms of their talk. A fourth one is disorganized or catatonic type of behavior. In other words, it’s usually behavior that’s very inappropriate for the situation that person is in. The last set of characteristics is sometimes what is referred to as negative symptomology, which is not directly related, but it’s indirectly related to the symptoms of schizophrenia. And that is depression is usually a side effect, anxiety, sleep problems, usually a person has pretty serious social withdraw from people, there’s a lack of motivation in their life, or just a difficulty in normal functioning (what we would consider to be normal functioning for everyday life).
Dale Johnson: Now, that definition is helpful. Especially, what’s interesting to me is that you just described the criteria as it’s even laid out in the DSM-5, and for us to consider that I think is really critical because the DSM-5 gives these categories for this label as a cluster symptom. That’s the language that you use and that’s exactly the language that’s used in the introduction of the DSM to describe this type of diagnosis.
But oftentimes we know very clearly that this idea schizophrenia comes with what we would know as physical symptoms—symptoms that are expressed in some sort of bodily form. Oftentimes because of that we categorize this as a problem that’s outside of the purview of biblical counselors. Now, I want us to talk specifically about these physical symptoms because we are body and soul, that’s certainly true. But most people would describe that we have these types of experiences—those diagnosed with schizophrenia because of some sort of physical ailment that now leads to these symptoms. Talk a little bit about what we know about the physical symptoms related to schizophrenia.
John Street: There are numerous physical symptoms, so this is a really great question. We could almost go on all day just talking about these issues, but whether or not this is caused by some organic causality, whether or not that’s really going on—the jury is still out at best on this. I think we have to be very careful about professionals who want to label this only as a physical disease. Now, we’re not opposed in biblical counseling to recognize genuine physical diseases and that there are complex component parts of the physical body that affect the spiritual conditioning of a person. We’re not opposed to that at all, but there are well-qualified professionals in the medical community that disagree about this, and that really don’t have anything to do with biblical counseling (so it’s not some kind of agenda that we’re writing here).
When you label it a disease, then you begin to believe that change is possible only through some kind of drug regimen. Yet we know from experience and from what the Scriptures say that there can be significant change that goes beyond just a person’s biological problems that are going on, and that with schizophrenia (even if it did have a biological etiology or causation), you can still address spiritual issues the same way you would help a person with a terminal cancer. You can still address that, so I don’t think the biblical counselor should be afraid to help people in this situation.
Recognize that there may be a component of other professionals that will be able to come in and be able to help them as well, especially in the medical profession. On the other hand, I think it’d be just as dangerous to label this only as a spiritual problem too, because the interplay of the mind and body is very complicated. What happens in the soul within a sin-cursed body sometimes will result in somewhat bizarre and unusual interactions that a person may not fully and completely understand in their life.
But let me also mention the fact that I think one of the things that we have to be very careful about is that there are numerous actual physical problems that masquerade as as being schizophrenia. In fact those physical problems could be divided down into eight different categories with 28 different physical symptoms that can mimic schizophrenic-type characteristics. Now that’s significant. If you have a person that comes to you in terms of counseling, one of the first things you need to do is get them to have a very thorough medical check-up and exam. We’ve got to do the best that we can to rule out any of these physical problems.
For example, problems with the central nervous system of the body. We know that HIV can affect and have schizophrenic-like effects upon a person. Neurosyphilis can do the same thing. Encephalitis can do the same thing. Prion disease can do the same thing. All of those are central nervous system problems. Or there can be problems in terms of neoplasm in the body and that can manifest in sometimes real schizophrenic-like symptoms. Or the thyroid or the parathyroid or the adrenal glands sometimes can be directly affected. These are endocrine pathologies that can have schizophrenic-like symptoms. Now, the list is much longer than that. I’m just using this as an example. As biblical counselors, we believe what the Word of God says, we’re a complex component of body and spirit. We’ve got to take seriously what happens in the body, and we’ve got to make sure that there are no physiological problems masquerading as a kind of spiritual problem. That’s going to be critical for a good biblical counselor to do and to check out.
It’s really interesting because Solomon in Ecclesiastes 2:12 talks about the fact that for a period of time in his life Solomon lived a very materialistic lifestyle. He kind of devoted himself to that and he uses the phraseology (it’s a Hebraism in Ecclesiastes), which he called “living under the sun.” That means without any reference to God. He said during that particular time I turned to consider wisdom, madness, and folly for what will the man do who will come after the king except what has already been done. So in other words, living from purely an under the sun perspective, without God or any reference to God—there is a way that people live that can lead to madness and folly. It becomes a philosophy of life that tends to rule them or dominate their life. This is really critical.
In fact, the biblical view of delusion is that it is a highly desirable false view of reality that people have allowed themselves to believe and if maintained it will eventually end in madness. I want you to think about that for a little bit from a biblical perspective. In other words, can a person, by their philosophical approach to life, by what they believe (that is believing a falsehood) bring about madness in their own life? And they Bible says very clearly: Absolutely, yes. Then at this point the etiology is not some kind of biological origin, the etiology here (or the causation of it) is actually a spiritual causation.
The Bible also talks about fearful expectations. Fearful expectations can cause a person to deceitfully impersonate delusional madness. I mean, we can see this in first Samuel 21 with David. David feigned that he was mad. And why did he do it? Because fear was ruling and dominating his life for a time. Or Scripture tells us that sustained oppression, life crisis situations, and disobedience to the truth will often result in mental impairment (Deuteronomy 28:27-29; Ecclesiastes 4:1). The Bible also tells us that a mentally unstable person can be seen in disorganized and sometimes very harmful personal behavior, so we have to take that into account as well. All of these are illustrations of the fact that the Bible doesn’t say that necessarily this bizarre behavior, or this madness, or this folly is caused by some kind of biological abnormality that’s going on in the body or in the brain for that matter, even though we leave room for the fact that those kinds of things can exist as diseases that can bring about the same type of symptomology, but if you’re able to rule out those particular diseases then let’s approach this from a biblical point of view. And that’s one of the most compassionate things we can do.
Dale Johnson: That’s so critical because oftentimes people may think, “Well, that’s not very kind that we would engage in something like this. This is totally in the physical realm.” And the reality is we have to be cautious on both sides because to assume that something is physical when it’s not really physical becomes an issue. We should be engaging in some of these some of these problems. We have to be kind and cautious.
Now, a couple of takeaways from that that I want to highlight that are important. The first one is we have to make sure that we are ruling out organic issues that are there. That is consistent with biblical counseling in our history. The second thing is that sometimes biblical counselors seem intimidated or afraid to engage in something like this that is maybe a little bizarre, that is a little bit unknown. If you will, talk for a second Dr. Street about should biblical counselors engage in something like this, especially when we have so many thoughts that, “Oh, maybe this doesn’t fit in our domain as biblical counselors”?
John Street: That’s a great question. There was a well-known psychiatrist Thomas Szasz, who practiced for many many years at the State University of New York and I remember a comment he used to make about schizophrenia. Now here, this guy is not a Christian as we would understand Christianity, but he talks about the fact that psychiatrists look for twisted molecules and defective genes as the causes of schizophrenia, he says, because schizophrenia is the name of a disease. Then he goes on and says if Christianity or communism were called diseases, would they look for the chemical and genetic causes of the these conditions? Well, obviously nobody would do that kind of thing, but that shows you in a sense the kind of logic sometimes that goes on there.
Certainly one of the most compassionate things you can do is lovingly help the person in this condition with their suffering. You want to do that because it’s compelled, because you love the Lord as a biblical counselor first and foremost and the natural growth of that is going to be loving others as passionately as you already love yourself (Matthew 20). Counselees with schizophrenic characteristics are not used to that, at least in my experience. They’re oftentimes closed or guarded because they’re accustomed to hiding from the criticism of other people—and especially sometimes other Christians—because of their bizarre behavior. There’s feelings of shame and guilt that go along with that.
I think it’s vitally important that a biblical counselor begins very slowly. They build that person’s trust with very easy questions to help them understand that we care from the depths of our heart how well that person is faring and whether or not they’re really suffering. The other issue is as a biblical counselor you’ve got to begin with the gospel. You really do because that’s the most loving thing that can be done, and it’s the most hopeful thing that can be done. You begin with a gospel, no matter how well you think you know the person that you’re counseling. Because the overwhelming number of schizophrenics may say that they’re Christian, but they are really not believers. God’s Word must determine their view of reality—not their voices or not what they see in their visions. It’s God’s Word that’s got to determine that, and the only way that’s going to happen if they become a believer, they trust what the Word of God says. The Word of God’s got to frame their reality for them.
Dale Johnson: Dr. Street, listen, these are wonderful questions and we have tons of counselors I’m sure out there who are asking these very questions. What you’ve done today, I think in a very simple yet eloquent way, is you’ve helped us on some of the confusion that’s out there and really started with a biblical standard to say, “Okay guys. Listen, this is what the Bible says. This is what the Bible gives categories and possibilities for. Let’s begin there and then look at the data.” Not try and take everything that everyone else out there says and we have to accept their the cultural flow of it. I think that’s an important piece of how we think about schizophrenia and schizophrenic symptoms and our engagement with people who struggle in this direction.
I want to encourage you that obviously in 15-20 minutes we can’t discuss all the things that need to be discussed in such a deeply complex and often debated subject. As you mentioned, scientists are often on different sides and multi-theoried approaches to how we should think about this. So we want to be cautious about that, but we have to start talking about it somewhere. I think this is important. This is a biblical posture in how we would approach it in. Brother, thank you so much for engaging us with this topic and being willing to try and address such a complex topic in a short amount of time with biblical clarity. Thank you.
John Street: It’s been a pleasure to be here.