Dale Johnson: I’m joined by Dr. Sam Stephens. Dr. Stephens is the Director of Training Center Certification and he’s going to join me this week to talk about a very important topic, at least in the month of May. During the month of May, it’s been known since 1949 as Mental Health Awareness Month, and so we wanted to get together to discuss this idea of mental health this month. Many people are celebrating the ideas of mental health, wanting to make other folks aware of the idea of mental health, and Dr. Stephens and I wanted to get together to discuss this concept. It seems to have become a dominant way of thinking in the modern world, so we wanted to try and bring some clarity, some biblical thought as we think about this concept that’s thrown around quite regularly.
Sam Stephens: The term mental health carries several different connotations that work against the aims of biblical counseling, and we want to help our listeners to see that there are actually several problems that lie behind a label like this. Before we discuss some of the history and philosophy behind this concept of mental health, could you break down the concept for our listeners?
Dale Johnson: The idea of mental health is somewhat ambiguous, and even when you look at the definitions that people offer, historically, it has a wide range of definitions and even expressions in the modern age. Is it something different and distinct from psychiatry? Is this something different and distinct from psychology? What is the aim of mental health? As we approach it and we think about these terms, we look at the two definitions. Think about the idea of “mental.” What does that mean? Are we talking about something that’s non-biological, because that’s interesting when we also join that with the idea of health. Most of the time when we speak about health, we’re thinking about something that is biological, physiological. We’re thinking about something that has an ideal type of function. When we mix the two, we’re talking about the importance of biblical anthropology relative to the immaterial and the material and those two things work together.
When we put these ideas together, mental health becomes quite confusing. In mental, are we talking about the brain? Are we talking about the mind? Those two things can become quite confusing, especially when we’re referring to mental health as a state of being. To conjoin that with the idea of health becomes quite confusing, because how do we measure that? Do we measure that in the same way that we would measure physiological health or sickness? That becomes the difficult way for us to think about that; it becomes very subjective.
One of the things that we have to understand is that the idea of mental health has evolved quite a lot over time. It’s something that has been built upon a philosophical narrative that’s existed for a couple of hundred years at least. It’s important that we understand the subjective nature of it and what it is that those who push mental health awareness are trying to accomplish by utilizing these types of terms.
Sam Stephens: It’s really important that you mention that just like any other term, mental health doesn’t just develop in a vacuum; it carries with it a lot of weight. Our listeners might appreciate a little historical background, going through some major points in history where this term did develop, evolve into something different, and how it’s popularly understood today.
Dale Johnson: We’ve always, to some degree or another, been concerned about the state of a person’s mind, how we handle and interact with life that goes on around us. But what we began to see in the middle part of the 19th century is a joining of forces or ideas. This idea or concept was built upon this framework of what they referred to, Clifford Beers particularly referred to, as “mental hygiene.” It’s important that we understand how this developed, because the idea of mental hygiene was a reaction to psychiatric medicine at the time.
If you understand about the history of psychiatry and the history of psychiatric medicine, during that era in the early part of the 19th century and heavily into the 20th century, you began to see psychiatry utilizing all kinds of different methods in the asylum medication that were quite barbaric. Even many today would argue that they were barbaric in the way in which they treated human beings, and it was built upon an evolutionary narrative. It was built upon this idea that something was wrong with the biological person, the genomic structure, or the hereditary aspects of a person’s being. They would put them aside into an asylum and they would do all kinds of different types of barbaric psychiatric techniques to try and heal a person from this madness that they were experiencing.
To be fair to mental hygiene, it was really an attempt to treat the patient’s humanely. There was this concept that, “Man, these people are really sick, something is wrong with them, and we’re not even treating them with humane sense.” This idea of mental hygiene really took off, particularly in the US, and then in the world at large. The World Health Organization actually recognized this term “mental hygiene” and began the ideas of mental health. One of their primary goals and roles was to utilize this concept of mental hygiene to protect those who had been so mistreated with psychiatric techniques. When we think about the difference between mental hygiene and mental health, mental hygiene was basically this attempt to include all types of measures in order to promote what they believed to be a mentally healthy state.
What’s happened over time is mental hygiene as a term has rescinded and gone away, and it’s been replaced with this idea of mental health. Along with this, essentially what’s happened is it’s put forward our naturalistic worldviews. The idea of mental health is trying to utilize, “Okay, what is a healthy state of being?” The definition of mental health is basically just regarding some sort of condition that an individual has that gives them some healthy state of being. The idea is that we’re to look at the social environment, we’re to look at the context of a person and what it is in the environment that provides for them a way to live healthily from a mental standpoint. What we must be careful of there is, “What do we mean when we talk about the term ‘healthy?’” That’s the question. Is the culture defining that? Is the individual defining that? What is healthy?
Certainly in our Western culture, we would see that what defines human health is, does a person feel good about themselves? Do they feel like they fit in with the culture at large? Do they feel like they are able to live their best life in this particular moment? Do they feel good about themselves relative to self-esteem? That’s how mental health is often defined. Are we building environments around ourselves, pursuing these as mediums of hope to make us feel better about the things that are going on in and around us? As we think about that, it becomes problematic because now we’re looking to environment to shape the possibility of us even being healthy.
Sam Stephens: If I hear you right, we understand modern psychology and mental health, mental hygiene, as a reaction to modern psychology in the sense that modern psychology did away with the soul, dehumanized people, and especially the practice of psychiatry specifically.
Dale Johnson: Yeah, I would definitely say that, and we would say not psychology at large, but psychiatry and the practice of it in the particular framework. That was moving into the bigger portion and bigger discussion that we could talk about: Biological Psychiatry, that type of psychiatry which was based on explaining a person and what comes from a person from what was going on in their physiological being. So yes, mental hygiene was definitely a reaction to the extremities that were reached during the latter part of the 19th century.
Sam Stephens: At least at face value, we can look at the purposes and the reasons behind mental hygiene as a good thing. We want to bring humanity back to the human, in a sense. But what’s important for us to understand as the church, and what our listeners need to understand is that, again, like every other concept, mental hygiene, mental health carries a lot of weight. It’s not a neutral term. What’s problematic? You mentioned how some of it is already built on a naturalistic understanding, but bring it back down to us as listeners as we practice biblical counseling in the church, as we seek to bring Scripture to bear upon the problems that people face. What is the caution behind using the idea of mental health?
Dale Johnson: The caution is the worldview that it’s built on, and what it forces us to aim at. What it forces us to begin to aim at is that environment is what creates the state of being that we want, and we are the one choosing the state of being that we want to pursue. That’s contrary to Scripture and that’s not what Scripture portrays with us. What mental health has built is a therapeutic culture, a culture in which we try to pursue everything that we think “heals” us or “makes us feel better.” While that sounds religious and healthy, the problem about that is that it begins to breed the question of, “What does it mean to be healthy?” From a Christian narrative, we would define that very differently. This is an example that I use quite a bit in my teaching when we ask the question, “What does it mean to be healthy?” and I think the idea of mental health really is not reaching far enough. It is only concerned about that which is temporal and how it defines that which is healthy.
For example, let’s say that we have a 65-year-old who has been diagnosed with cancer, but they’ve been a faithful believer and follower of the Lord Jesus. They’ve served very well in the church, they’ve grown in their faith and the exaltation of Christ in their life, they’ve been conformed to the image of the Lord, but they’re dying and they’ve been given months to live. They’re laying on their deathbed in hospice care, and the world would look at that person and say, “Man, they’re not very healthy.”
Let’s compare that person from a biblical worldview with someone who’s, let’s say 25, they just graduated from somewhere like MIT and they’re working up the corporate ladder and things are going well for them. Physically, they seem to be in good order, but they don’t know the Lord Jesus. If we take the Scriptures and we begin to dive in on who’s more healthy, the person lying on their death bed or the person who’s climbing the corporate ladder and to all appearances, looks to be “healthy,” it begins to beg the question for us as to how we define that which is healthy.
I would argue, biblically speaking, the person who’s laying on their deathbed who’s secure in the promises of the Lord Jesus is much more healthy. Why? Because the Bible says life is a vapor and that all could end for the 25-year-old at a moment’s notice. The way the Bible describes him as he will be, he will be spending an eternity in darkness forever. That’s the ultimate sickness, to die the second death, to be separated from God forever.
It begins to beg the question of what we’re looking at. Is it that which is temporal to fill us up with what we feel like is something that’s healthy, that our feelings feel good and that sort of thing? I think about Jesus in the High Priestly Prayer He’s not so worried about the environment that the disciples and those who would come after the disciples would be involved in, He actually requests of the Father to sanctify them in the truth, “Your word is truth,” and He doesn’t ask for the disciples to be taken out of the world but to help them to walk through the world.
By the way, if you remember in Scripture, Jesus said that this world was to be filled with trouble of all sorts and all kinds, and if they treated Him with animosity, certainly the disciples would be treated the same way. Jesus didn’t say that their health or ability to live in life is dependent upon the environment that they walk in, but it’s actually dependent upon the promises and the eschatological hopes that they’re looking toward that are going to help sustain them in a healthy way, as they exemplify Christ and bear the image of God through the suffering and the difficulty of this world. It breeds a backwards paradigm that can be quite problematic that our church culture has adopted to a great degree.
Sam Stephens: In your own estimation, why do you think this has become such a novel idea? Why is it so common for us to be thinking in terms of mental health and mental hygiene? Why do we think in terms of that versus in terms of a more biblical paradigm regarding the long-term, eternal hope that we have?
Dale Johnson: In brief, what happens is it puts us in a position where we feel like we have some sort of authority and power over our state of being, rather than putting ourselves hopelessly on the work of the Lord Jesus and the promises that He’s granted, knowing that we can’t dictate our environment. We cannot determine what happens in and around us. We sit under the rule and reign of a sovereign God and we cannot manage all the things that go on around us. However, in that concept of mental health, if we can manage the environment around us, we feel somewhat in control of our state of being, of our mental state. To us, that’s enticing to the eye; it feels good that we might have some sort of control or we can manipulate the environment around us to build some sort of healthy mindset.
Sam Stevens: In addition to that, would you say that the concept of mental health also essentially replaces a biblical anthropology, a biblical view of man?
Dale Johnson: Absolutely, and it minimizes it to looking inward and then to the temporal world for help and hope. In that way, what happens is it really alters a true anthropology, what we would consider to be a Christian or a biblical anthropology.
Along with that, what happens is we began to redefine terms. Instead of looking from a Christian perspective toward being redeemed and being restored biblically speaking, or understanding what true sickness was all about, whether that be soul sickness or physical sickness. Notice in places like Mark 5, the woman who had an issue of blood. She had looked at all the temporal places for help. She could find none. Jesus was actually the answer even for the physical problems that she had, and we look at so many other places. Jesus is the answer for all the internal, soul problems that we deal with, as well from a biblical perspective. We need to reinstate a biblical anthropology and look toward not temporal hope, but that which is future hope which the gospel writers always tend toward.
Jesus is focusing toward that which is coming in the Kingdom. This’s what the writer of Hebrews describes in Hebrews 13, that Abraham was longing for a city which was to come. Paul in Titus 2:13 is looking specifically toward the blessed appearance of the Lord Jesus. Why? Because he knows this environment is not a place that is going to foster healthy thinking or healthy state of mind. It’s the promises of what is to come. We need to restore what the Bible describes as eschatological hope, the hope that is to come.
Our hope is not now, and I think the biggest danger about mental health and being aware of mental health is that we are looking at a façade thinking that hope is in the temporal, when what we should be looking at is the hope that will restore us once and for all. It’s really a replacement of God as being sovereign. It’s really a replacement of God sitting on His throne and thinking that there’s another way that we can manufacture a state of feeling, a state of being that operates as a shadow of hope. The real hope is that we long for and look forward to being satisfied with what’s to come, the environment that God is making even now, that Jesus is preparing even now for us to long for and to look forward to. The Bible claims that allows us to walk boldly and firmly planted, having Christ as the anchor of our soul through the difficulty of this world, longing for the next.
Sam Stephens: Thank you for bringing clarity to us and equipping us for further dialogue about what it looks like to interact with the idea of metal health, and for basically showing us that the pursuit of mental health is an attempt to merely preserve the ideal self, versus a true, biblical, sufficient hope in Jesus Christ. He redeems us, He justifies us and sanctifies us.
Dale Johnson: One clarification that we need to make is that I am not at all against someone pursuing what it means to be healthy in heart and mind. In fact, the Bible actually pushes us toward that. What I am saying is that the function, the way in which we go about doing that biblically speaking is very different than what is offered through the paradigm of modern mental health. We’re called to die to self so that we can live at peace with God in the world, no matter the environment that surrounds us. We need to understand we’re not against the idea of being healthy and being at peace. We’re just saying that God gives us the means by which to pursue what it means to be truly healthy and to be truly at peace as we walk through life.