Dale Johnson: This week, just like last week, I have with me Dr. Daniel Berger, the second. He’s a lead pastor at Faith Fellowship Church in Clarence, New York. He’s the founder and director of Alethia International Ministries and he serves as the director of Faith Biblical Counseling Center. He’s the author of 14 books on various topics, including biblical counseling and the history and philosophy behind the current mental health construct. That’s actually what we’re continuing our discussion on today — one of his books is called The Schizophrenic Unicorn. I would encourage you to go seek out that book. If you have not listened to last week’s podcast, I want to encourage you to start there and then join us as we talk this week and continue this discussion.
As I mentioned, Daniel, we finished discussing last week this issue of schizophrenia as either a biological disease or a construct. You were diving into describing this distinction, that it is in fact considered historically, according to what science has discovered up to this point, is a construct in how we approach this idea. I want you to give a brief sort of description of what you mean by construct, and then I want us to continue talking about this particular issue of schizophrenia further.
Daniel Berger: Yeah, the secular world does not believe in a biblical concept of dual nature. So, the idea of bio-reductionism, physicalism, naturalism, or materialism, whichever word we want to choose, requires them to explain everything within a medically sounding, or pseudo-scientific framework. Why I’m saying pseudo-scientific is because we as Christians embrace science, but if it’s an inorganic reality, especially if God speaks of it in Scripture extensively such as anxiety, sorrow, or even delusional thinking, then we’re talking about inorganic phenomena of the soul.
In my book, I have an entire chapter on phenomenology —Mildred Erickson— actually one of the common systematic theologies in most seminaries talks about the value of phenomenology as well for the believer because we’re talking about inorganic states that are not approachable in science. So, when I talk about a construct, they have to devise a medically sounding idea within their medically sounding apparatus to explain every human condition including those, again, which God says are soul issues that require either the Holy Spirit’s work, whether it’s self-control or giving wisdom that allows us to get through what we would call trauma or trials (James chapter 1). They have to divide something, and it’s interesting because if you think about the construct of schizophrenia, it doesn’t exist physically, but it’s being imposed on people as an explanation. It’s an interpretation, if you would, of psychosis. It’s a group of people’s agreed-upon interpretation of psychosis. And if you take an inorganic idea or construct and you insist that people treat it as if it organically exists like Bigfoot (there’s an article that just came out about how society needs Bigfoot; I think it was in Psychology Today) E. Fuller Torrey actually said that us chasing after schizophrenia is like chasing for the yeti, it doesn’t exist, but yet we keep insisting we’re going to find it, and that’s actually what led me to title my book The Schizophrenic Unicorn, because one of the most prominent psychiatrists, Nassir Ghaemi, who served at Novartis, one of the largest pharmaceutical companies in the world, teaches at Harvard and Tufts University’s medical schools, and says these constructs that we have are no different than a unicorn. We can define the unicorn, it’s in the dictionary, every culture in the world knows what a unicorn is, and yet no one’s ever seen a unicorn.
One of the illustrations that I give is that we can take hoofprints in the woods, especially if we’re in South Africa or somewhere on the African continent. We could take all these different elements that truly exist in nature and put them together and say, “You see! Unicorns must exist, and we will find them.” In doing so, we actually ignore what does exist. We ignore valid examples. So, if I can explain in just very short detail, if you take an inorganic concept and you pretend like it exists organically and insist that you will find it but insist that it be treated as if it exists already, that’s actually called reification. It’s reifying something that doesn’t exist. And that’s exactly what happens in psychiatric constructs. I’ll use another one: bipolar or attention deficit hyperactivity disorder. If you take someone who is struggling, and again, I just want to reiterate to someone whose jumping in here on this second session and not listening to the first, that psychosis is very real, but we’re saying schizophrenia is a really bad, and in fact, dangerous interpretation of psychosis. If someone’s in a psychotic break, their having behavioral issues, their emotional, or whatever, and they go to the clinician and that parent, or loved one, or friend describes what’s going on, all the clinician is doing is re-describing what was already known, and that is reified then into being the real problem instead of the descriptions. They’re missing what is actually going on and that’s the danger and really the deceit in all this —people walk away from the clinic thinking they just received an explanation. They think something wrong has actually been discovered with them, when in reality it’s just an interpretation through a humanistic hermeneutic.
Dale Johnson: I think that this is so critical. I call this explanatory power. I mean, that’s what we as human beings created by God in the image of God do. We interpret things around us and we try to make sense of it using explanations. We often try to find the lowest common denominator of the things that we can see to give explanation. And I think that’s exactly what you’re describing, and it’s certainly what I would describe; we’re looking for explanatory power. So, as you mentioned, somebody walks out of the clinic sort of thinking, okay, now I feel known; like somebody explained to me what’s really going on. In some ways, that gives a level of comfort. When you read what psychiatrists say about this, they really have no idea what’s happening. Somebody might ask at this point, “Are we saying there’s no biology at all that is to be validated or that validates this particular construct? Or should we just throw out the whole idea of biology and our pursuit of trying to understand these experiences?” How would you answer something like that?
Daniel Berger: Yeah, I think it’s important to realize again that schizophrenia is not real, but psychosis is. So the question then becomes, what is causing psychosis? What all the science overwhelmingly shows, and what I love about Scripture and its sufficiency is that it also shows that psychosis goes through sleep problems. One of the most fascinating things in this study, if I can use Matthew Walker as an example who I mentioned is a neuroscientist at UC Berkeley and is considered to be the leading expert on sleep —you can watch Ted Talks by him, you can watch his Master Classes, he’s written several books and he’s widely acclaimed as the guru. I’ll just say that I encourage people to do this study because science agrees wholeheartedly with him that we go into this psychotic break every single night. So let that sink in for a second. In other words, we are actually experts at psychosis. This goes right back to that big fancy medical word called etiology. It essentially means causes and explanations. I would further add that it means theory of causation as well. If you’re studying etiology, you’re trying to discover what is causing something.
In medicine, this is an understandably massive issue. It’s important and vital. But I would argue that in theology, we have to go back to Genesis 3 for a lot of what we’re calling explanation or causation. Where did our deceived nature start? I want to be very clear on this. Sleep problems don’t cause us to be deceived, they expose our deceived nature. There’s a huge difference there in ideology. If I can point to Isaiah 9:9-10, it tells us that there are three metaphors given to show how deceived prophets were.
First of all, it speaks of drunkenness, then blindness, then deep sleep, and it’s a fascinating reality that Scripture presents this in the New Testament as well. In other words, we are so deceived to the point that when we are sleeping, when we don’t have that self-control, we’re going to find out who we really are. So our dreams reveal our fears, our anxieties, our desires, and our memories. They reveal all these different elements of what we’re holding dear and who we really are, and psychosis is no different. In fact, studies have been done where they wake people up in their dream state that are labeled as schizophrenic and it’s the exact same content as they have in their psychotic state. My personal belief, and what I’ve come to understand from all the science, is that every single physical thing that they’re trying to say is schizophrenic is perfectly explained through sleep problems, specifically insomnia and sleep dysregulation. There’s a disruption in the circadian rhythms. It’s fascinating when you start realizing that all these theories that they have, whether it’s atrophied brains, an increase in gray matter, enlarged ventricles, dopamine dysregulation or dysregulation in the pineal gland that produces melatonin, all these theories go back to the central issue of sleep problems.
Dale Johnson: Now, if you can, Daniel, I want you to describe a little bit why this is so significant, because I agree —I think we’re seeing this become a major issue. I think if we were to go back to how God created us and that He created the night for a specific reason, for our rest— it was one of the primary demonstrations that we are human beings, which meant that we’re not the creator. We’re not the one who is sovereign over everything. This difference was intended to be this mass distinction between us and who God is, because the Bible says that God doesn’t sleep. I remind my kids consistently that he’s the God who sings over us. He does not need sleep. The Scriptures teach us that He does not rest nor slumber, but that’s not true of man. God, in a good way, gave us the night for our rest because we needed to be rejuvenated. I want you to talk just a little bit about why these types of disturbances, these sleep disturbances, or disruptions in our sleep, are so central to this issue of psychosis.
Daniel Berger: Yeah, let me start with biblical passages like Job 4:13 and Job 33:15. These passages talk specifically about how dreams and visions occur during the deep sleep state. It just lays this out. Science is just now catching up with that. They’re understanding that it’s during the deep REM state. God has made us to function properly when we are habitual in a good way. We certainly are good about being habitual in bad ways. Unfortunately, in biblical counseling, we deal with that almost on a daily basis. We are in need of set patterns that allow us to function properly, which points to how God has created this world, whether it’s the sun going up and going down, whether it’s the eventide, or whether it’s the menstrual cycle. All these things are in a habitual pattern that God has designed.
I will also say that my last chapter in the book is entirely application. How do we take all this information and help people? This isn’t just a neat little theory, I’m seeing it over and over again. We have had people in our church diagnosed in the past as bipolar, for years on psych meds as schizophrenic, and now they’re not only doing well, but one is off to seminary and another just got married. People just don’t understand that you were really once labeled as bipolar or schizophrenic. It’s getting back again to the root causes of these things and understanding what’s going on. So I want to start there, but I also want to say that if you or I, or anybody for that matter, goes two to three days without sleeping, you will enter into a psychotic state. If you go five days, the average person will die. That’s how vital sleep is to our physical, and what secularists would say, cognitive or mental health. So your memory can go, and some people become extremely hyper and manic. Some people become delusional and hallucinate; there’s just a variety of different things, but during our REM cycle, our brains clean themselves out. There’s a renewedness there, and if I can just go back to Psalm 127, there’s a parallel antithetical-ism there that talks about one person taking the bread of anxious toil and the other, God giving His beloved sleep. There’s a contrast there between anxiety that causes us not to sleep and the person to whom God gives His blessed sleep.
I think it’s interesting as we just briefly touched on, that anxiety in the heart is the number one cause of people not getting sleep. I think sleep in itself is an entire thing that we as biblical counselors really need to key in on because there’s always a cause to sleep problems. I think this is essential, Dale, as we talked about the centrality of sleep, it is not the underlying cause. There could be physical things like heart issues and post-stroke psychosis. Post-stroke psychosis is very common because people’s sleep is disrupted. Postpartum, even what we’re calling postpartum depression and bipolar, is because of disrupted sleep. Getting back to the question of, is there a spiritual issue here like guilt or anxiety? Or is it a physical cause, or some combination? Did somebody do something that they’re so guilty they’re turning to alcohol? Alcohol would be a whole other conversation because it is incredibly disruptive and destructive to natural sleep cycles. All of the experts, whether it’s Andrew Huberman or Matthew Walker, say that alcohol is the biggest impairment to healthy and natural sleep. It’s an interesting dynamic. So set aside morality —just alcohol in itself can destroy sleep. The last thing I’ll just say here again, but there’s so much more we could say, is there are just endless amounts of ways that people can go through what secularists would call a pathology or a pathway. Again, that central feature being sleep problems. It could be spiritual, and it could be physical, but the moment we start saying schizophrenia is the problem, we’re now saying that insomnia is just included as a symptom of schizophrenia, ironically.
They’re realizing there’s an association. In fact, some studies say 92%-95% of people diagnosed as schizophrenic have some major sleep disruption or severe sleep dysregulation, and yet they’re missing the big picture here. I want to make it clear to anyone counseling that the root cause is never sleep problems; it’s always something that is driving those sleep problems. It could be physical, or it could be spiritual, and so getting a like-minded physician to do a physical is key. Jay Adams and David Powlison were really big on this as the movement of biblical counseling began, and I think that’s really wise counsel on their part for us to continue as well. We really should look at physical weight and other physical elements, unless there’s actually known spiritual issues that come out from family members or friends as we’re meeting.
Dale Johnson: Well said. I would love for us to keep talking because there’s a lot more questions that I receive frequently that would be good for us to talk about. Let’s see if we can figure out a way to close this down as best as possible. Give some of your thoughts on the wisdom of using the language of schizophrenia. Is there anything wrong with us continuing to use this sort of label? With caveats, is it misleading? How do we think about using this language of schizophrenia?
Daniel Berger: Yeah. I think people don’t realize the history of the label and its entirely eugenic basis. Francis Galton came up with the idea of premature dementia, or dementia praecox. And Kreplin, well he didn’t actually steal it necessarily, but it was widely understood that he took that concept and formed his. People may not know that Francis Galton is considered to be the father of the eugenic movement. I want to make it clear that most secularists have no idea where the label came from, let alone Christians. So please don’t feel badly if you’ve never heard this before, but the danger is that when you start accepting these constructs, you are also accepting the false teachings of bio reductionism and bio determinism. And in the process, you’re starting to look for these invisible, mystical constructs in nature, which they haven’t found, which we’re not going to find, and you’re also, then, not looking at the word of God and what we would call science or natural revelation, and interpreting it through that biblical lens.
My strong caution is, first, that if you’re going to use their language, and they do call schizophrenia their language, they say that this is their clinical language, but when we start talking in their language, we also subject ourselves to their theology, to their anthropology, epistemology, ontology, and on it goes. Willfully or ignorantly, we are still fitting into their worldview, and that’s the real danger. The vast majority of even secular psychiatrists that I’ve interacted with have a real heart to help people. I think it’s important that we don’t question anyone’s heart, especially even in biblical counseling. People are advocating that schizophrenia is a real thing, and I just graciously say it’s ignorance on their part. It’s not a lack of desire to love them, nor is it an affront to God, it’s just not understanding where this has come from and the danger. It certainly hasn’t helped anyone to use the word schizophrenia. In fact, I would advocate from all the science that it hurts. It’s incredibly destructive and, again, obstructs the ability to actually help people.
Dale Johnson: Really well said. I think that’s a really helpful caution. You even said at the end that you’re not trying to infuse motive to anyone. That’s not the idea at all, but it is important that we consider these ideas. You talked about the idea of construct, and that’s why the DSM was created —as a nosology. It was created for that purpose as a common language. It wasn’t really widely used even in the field until 1980 when we turned to this biological sort of ideal.
So, very important discussion. Again, I’ll encourage you, because this wasn’t our only discussion, to go back to last week’s podcast and listen to some of the things we talked about and then listen to this week’s again and process some of the things that Daniel’s describing here. This is consistent with the things that I’m researching and Daniel has written a book on this which I’ll remind you about, The Schizophrenic Unicorn. Get it and start wading through some of the concepts that he’s describing and you’ll see he’s quoting psychiatrists in the field, secular guys who are understanding some of these concepts and backing away from it knowing that the way we’re currently describing these things are destructive and unhelpful and we’re not finding answers. I think that’s really important for us to consider here, and this is indicative of what we’re seeing largely in mental health. There’s a crisis that’s happening within the mental health world right now in how we’re even supposed to explain these things. So, Daniel, I think you’re putting your finger on some of this in a really helpful way. Thanks for the discussion.
Daniel Berger: Yeah, could I just say one more thing? On page 25 of the new DSM, maybe people aren’t familiar with that, but it’s the Diagnostic and Statistical Manual where these constructs, ideas, and definitions actually exist. On page 25 of the new DSM, the text’s revised version, they actually boldly say they want people to think not in terms of dualism anymore. So they’re removing inorganic and organic disease concepts, and I think it’s really important that we understand that they want us to think outside of biblical dualism and think outside of a biblical framework to understand our human problems, and further, what the solution should be.
Dale Johnson: I think that’s important. I’ll finish by saying this: one of the greatest contributions of modern psychology was an intentional attempt to change our understanding of anthropology in lots of different ways throughout the different theories in the past, but that’s been one of the primary things that you’ve seen happen, and that had to happen post-Darwin, right? Because if you’re thinking about the closed system, now we have to explain man in that closed system, so therefore you’re going to have to theoretically describe the problems that he has in a closed system, and that’s not the anthropology that God describes to us in the Bible. So you’re going to see opposition there on a consistent basis if you study the history of mental health. That’s really helpful. Thanks for that clarification. I would encourage people to go get their copy of your book, The Schizophrenic Unicorn, and enjoy wading through it. I appreciate you writing it, Daniel.
Daniel Berger: Thank you, and thanks for this time, Dale.
Helpful Resources:
Listen to the Schizophrenic Unicorn episode Part 1 here.
ACBC’s Fall Fundamentals and Advanced Training Events
Mental Health Awareness Month Podcast Series
The Schizophrenic Unicorn book by Daniel Berger
