Dale Johnson: As promised, this week we are bringing back Dr. Jenn Chen. She’s ACBC certified, and she’s taught biblical counseling at seminaries, universities and conferences. She’s also been featured on biblical counseling observation videos, and recently published Biblical Counseling and Mental Disorders. Jenn was previously licensed as a clinical psychologist in 2002, after earning a doctorate in clinical psychology and a master’s degree in marriage and family therapy from Christian institutions. She was formerly trained in evidence-based practices in psychotherapy.
However, midway through her psychology career, Jenn ended up receiving biblical counseling, after which she returned to school for a master’s in biblical counseling. She left the secular world of mental health to practice biblical counseling, and one of the reasons she’s here today is she’s become a dear friend, and she’s written this book that I’m so excited to talk to you about. This was released back October 2024, Biblical Counseling and Mental Disorders. One of the reasons I was saving it for now is the Mental Health Awareness Month. Last week, we had an opportunity, Jenn, to talk about: What is the DSM? So, if you need to catch up on that, make sure you go back to last week and catch up. What it is, what it is not, distinction between descriptions that it’s providing versus most people interpret it to be a diagnosis of some biomedical problem. But that’s not what the DSM really is about.
That’s not what mental disorder diagnoses are about either. But people have culturally a strong misconception. I think in your book, Jenn, you’re helpfully addressing what the DSM is, what the secular world was trying to do, but now what it’s become. And It’s become something that is spoken negatively about among secularists. I was just reading this past week, knowing, man, we have to do something to change the way that we look at these problems because we’ve created a very bad thing for the West. I appreciate that you’re addressing this from a biblical perspective. You’re helping us to think biblically about these concepts that we’re so easily deceived in.
As we sort of pick back up the conversation, what I want you to do, if you can, is there are a lot of things that you described last week, that this is what the DSM is, while not trying to be too critical. This is just what they’re trying to do. Also offer why this might not be the best approach, but there are some weaknesses and those are things that we have to address. And that’s kind of where I want us to start this week, in your book. Just talk about some of the ways that you see this concept of mental disorder, mental diagnosis, the setup of the DSM and the construct of it. It’s not neutral. It has a weakness. It actually leads people in certain directions to have certain effects, the way they think about themselves and so on. So, just address some of those weaknesses to help us think biblically about it.
Jenn Chen: Yeah. When you even think about the word diagnosis, and it’s original meaning: dia is through and gnosis is like gnosis in the Bible, to know someone intimately. So, we’re supposed to be able to know somebody better through these labels. But unfortunately, because of what I talked about, there are inconsistencies within the disorder labels. And because again, there’s overlap of symptoms in the different disorder labels—that you could have panic attacks in all different types of labels. You could have a depressed mood and all kinds of different labels. And we talked about generalized anxiety disorder and major depressive disorder where there’s 80% overlap of symptoms. So, how it makes it very complicated to separate out is this, again, one label, different things, the same thing, presenting different ways. And so just that inconsistency. And then we talked about the lack of consistency or reliability of different people giving the same person the same label.
And then also, does the person look different six months later? And then does that mean they have a different label or is it the same thing? And then is it the person giving them the label? So, it’s very hard to consistently get the same label—to the point where I’ve had patients that I would look at the last six years and they would have had 10, 15, 20 different diagnoses. What that gave me was just a picture of is just that this person is very distressed. They have all these different symptoms, but did it help me to know them better through a diagnosis? It just made me more aware of the difficulties in diagnosing. So that is, again, a bigger picture of just the reliability.
And then, you know, it is a man-made thing. And with man can come total depravity. And we know with total depravity, that doesn’t mean people are as depraved as possible. But there are temptations in this world to make a name for yourself, to make money, etc. And with the last DSM-5, there are so many social, political and economic influences. And actually, one study found that 70% of the people serving on the committees to define specific diagnoses have financial ties to the pharmaceutical companies. So, we’re talking millions and millions of dollars here that are tucked into, “how are we going to decide that this is a diagnosis in the DSM, and this is not?”
Dale Johnson: And this is becoming a known part of the story, historically. Robert Whitaker, who used to be a Harvard medical journalist, has now been writing on this social topic for quite some time. He wrote a book called Psychiatry Under the Influence, and this was even before the DSM-5 came out. And he gave similar statistics and connections where he talks about, you know, not everybody in psychiatry is doing bad things or whatever, not evil actors. But there are some of those things taking place that we would have to say have jaded the story of psychiatry and the development of something like the DSM. It is a huge weakness that raises, at least to a level of compromise, scientific validity. And as you mentioned, on a practical level, it certainly doesn’t play out to demonstrate consistency and reliability that you would expect from something that should be scientifically rigorous. And it’s certainly not accomplishing that. So, talk a little bit more. There are several other weaknesses that I think could be helpful to at least mention as far as efficacy; you mentioned long-term.
Jenn Chen: Can I jump back a little bit too?
Dale Johnson: Yeah, let’s do that. Let’s jump back.
Jenn Chen: Let’s jump back to the financial issues, so that it’s not just happening in the diagnoses. One of the things that happens in a clinic is that they have drug reps. So, these are pharmaceutical drug reps, and they are usually very beautiful people, dressed well. And it’s interesting that there’s even an article called “Following the Script, How Drug Reps Make Friends and Influence Doctors.” It talks about different types of doctors and how you’re going to influence them. One wants to know data, so you give that person a lot of data. One person wants a friend, so you’re a friend to them. One person, you give them tickets to sports events and things like that. And so, there is actual thinking through, “how am I going to influence these doctors to prescribe these medications?”
Dale Johnson: And this is a part of the same story as what’s being debated actually right now. I was seeing questions float around on social media relative to, “Should we take away direct to consumer marketing,” right? And that plays into some of this financial issue that you’re raising here—where it starts to skew how we think about mental disorders and the treatments of them as well. So, those are certainly obvious weaknesses that we have to be cautious about. You do mention several others that I think would be helpful. You mentioned the concept of worldview and where the DSM is beginning. So, just describe a few of those weaknesses as well.
Jenn Chen: Yeah, the DSM worldview is not neutral. There are different presuppositions in them like naturalism—like everything is naturally caused. Or there can be a reductionism, where it is actually because of one specific thing like, “Oh, it is neurotransmitters.” Sometimes there’s an evolutionary model to it, of “Oh, this is how they developed because in order to survive.” And you’ll hear a lot of that, particularly in the trauma literature. So, it isn’t this neutral science of what we are seeing, but they’re really trying to describe why this is.
Another big concern is the efficacy. And that’s just a scientific word for how much a treatment brings about a desired outcome when it’s under expert hands, under ideal and controlled circumstances. The studies are about what happens in very controlled environments. They’re being very careful about who they choose to be in the study. They’re choosing very capable clinicians versus someone who might just bumble through it or read the book and then try to do it their own way. And even under those circumstances, they’re not picking people who are homeless or who have a lot of distress in their life. It limits the extent of the outcome.
So, the outcome may be their depression. So, they’ll measure their depression on a scale. And maybe before the treatment, their scale was like at a 32 and then now it is at a 12. So, the way they even measure outcome typically is how much do their symptoms decrease or how much does their functionality increase. For EMDR, it happens to be how much do they believe this thought anymore or how much distress do they have anymore.
So, efficacy, the extent of outcome is actually very limited both for therapy and for medication. And in fact, it isn’t mentioned that often that medication and therapy can actually cause harm. So, that is efficacy. Now there was a recent big study, an umbrella study, that reviewed studies. And here’s their conclusion, that evidence has emerged that their psychotherapy and psychopharmacology efficacy may be overestimated due to a variety of shortcomings in clinical trials of the main mental disorders in adults. So basically, they’re saying that the thinking that these were really helpful, that is overestimated because the way that they did the research was faulty.
And then they further concluded that after more than half a century of research, thousands of randomly controlled studies and millions of invested funds, the effect sizes, how much it helped of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect. That just means they can only go so high for treatment research as presently conducted.
Dale Johnson: You know, all that’s very helpful to really put in perspective what we’re talking about when we talk about effectiveness because I hear people all the time say, why would we even offer any critical analysis of medication because it seems to be effective or its efficacy. And what we actually see in some of the data is we’re looking at 35 to 45 percent people saying, “Oh, I think this was helpful.”
We’re not even considering some of the long-term effects and what you mentioned in terms of iatrogenic effects. And now we’re seeing not only people criticizing medication, long-term pharmaceutical, psychopharmaceutical approach long-term, but now we’re backing that off and looking at psychotherapeutic approaches and there are many studies right now that are raising concern and question about psychotherapeutic approaches, which seems to be harmless, right? It’s talk therapy. How much harm can you do to somebody in talk therapy? But they’re raising questions about the iatrogenic effects of even something like talk therapy because any type of counseling therapy is worldview laden.
And that’s another interesting point I’d love to hear, you know, if you have comments, maybe you don’t, on this perspective the DSM is very interesting because it promotes the idea that we don’t know the etiology of the labels that are in this book. Okay, It’s in the introduction. You can read it for yourself. And what’s interesting is they also follow that up to say, but what the use of this book is for a fully informed treatment plan. And you have to ask yourself, like, “How are we getting a fully informed treatment plan if we don’t know the cause of something,” right? It’s at least a fair question. And then we follow-up that fair question with saying that if you’re a psychiatrist, your fully informed treatment plan is based on a philosophy that there’s something wrong with a person’s brain. If you’re a psychologist, you think something very differently. Maybe there’s something influencing the brain, but I think talk therapy is the primary way to help a person.
Those are two different types of treatment plans, right? So, it’s very interesting that the DSM can have this information, but at least to a fully informed treatment plan relative to whoever’s doing the treatment. You see what I’m saying? Exactly. So even that concept in and of itself seems radically disjointed because it is philosophically appraised depending upon who’s taking the label and then how they think they can repair it. That’s all, you know, appraised by philosophy and then how they want to approach treatment. And what we’re seeing across the board, the psychopharmaceutical world, the psychotherapeutic world, people are questioning the efficacies just to your point, as you mentioned.
Now as you’ve talked about the efficacy, I think, and that’s very helpful. I want to kind of turn the attention a little bit to this concept. It’s comical. We hear this all the time. As Christians, we talk about the Bible and the authority and the sufficiency of the Bible, how important the Bible is to us, believing that it’s God’s word, how important it is to our lives, practically what we believe, the hope that we have, God has been so kind to give it to us… Many people culturally describe the DSM as psychiatry’s Bible. So, think about the metaphor that they’re using here. They’re describing something that’s so critical, so important to us, the Bible itself. They’re using the DSM in similar language, right, to describe this book as its usefulness for people. Is this psychiatry’s Bible?
Jenn Chen: Yes. Such a misnomer given that the Word is inerrant and Sufficient, but yeah, it is a misnomer. And in fact, Thomas Insel, again, a person who is a psychiatrist, a neuroscientist and a former director of the National Institute for Mental Health. He said, while the DSM has been described as a Bible for the field, it is at best—and this is at best—a dictionary, it’s creating a set of labels and defining each. So, each label has a definition. And then he stated, “as long as the research community takes the DSM to be a Bible, we’ll never make progress.” People think everything has to match DSM criteria, but you know what? Biology never read that book. So this is again, somebody, one of the top people in mental health is saying it’s not a Bible.
And then there’s the National Health Service of the United Kingdom, and they are basically the biggest government funded medical care system in the world. And they actually wrote that. Rather than seeing the DSM-5 as a psychiatric Bible, it may be better to think of it as a rudimentary travel guide. So very simple, rudimentary to a land we have barely begun to explore. So, a lot more humility of these are simply labels we have put together, but it is very rudimentary.
Dale Johnson: That’s very interesting considering the way most people revere and respect the label when it’s given, because many people do act as though the DSM is some Bible of sorts. It does give explanation to who we are and how we feel, when in reality, it’s just simply trying to describe. But to be fair, the common population has been led to believe that it is more than that. It is much more than that. Most people would say that, “Yes, this label actually now describes not just something I’m experiencing, but who I am and what I have.” This is the danger of this concept.
Final question that I think would be helpful is, any author who writes a book, they hope that the people who read it will walk away with maybe some intangibles. What are those things that you’re hoping somebody who picks up this book, maybe they could be informed and that they walk away with? What was your goal in that, Jenn?
Jenn Chen: My goal really was to help the biblical counselor not be intimidated by these labels, to know they sound professional and scientific and medical. Like I said, there are some caveats in there that some of them are, but once we’re starting to use that language, there’s a lot of baggage with it and a lot of assumptions of explanatory powers and then we think that we have nothing to offer as a biblical counselor.
So, I really wanted people to understand the DSM, even just from a secular point of view, but also be able to point to how the Bible has superior labels. When we use biblical language, then we’re more able to give biblical answers. And it’s not like, well, me personally will go and say, “No, you don’t have major depression. The Bible says you have this.” As much as open it up and say, “Look, this is where the Bible is speaking to your despair, your hopelessness, your lack of motivation. And when it’s open that way, you can see how God is there with you in it, and He has answers and hope.”
Dale Johnson: So profound. And I pray with you that’s what people are able to take away—that we start to remove some of the confusion, the ambiguity that we see in culture; the deception even that some try to implement. And then, they can see with clear eyes and think biblically about human experiences, the things that we legitimately walk through on a daily basis. Then we can deal with these human experiences from a biblical perspective.
Jenn, I think you certainly contributed and helped us to take a big step in the biblical counseling world with this book, with this contribution. I recommend it to you. I hope you’ll read it. So, thanks for joining me today and last week and for giving us some perspective on your book.
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