Part 3: Who Is Normal, Who is Not, and A Biblical Orientation of What Ails Troubled People
What is Wrong with the Mentally Ill?
What is wrong with people diagnosed as mentally ill? What state of pathology or lack of health earns the label illness? Psychiatry does not render a diagnosis of illness the way other medical practitioners do. There is no blood test for “clinical depression,” no biopsy detects bipolar disorder, a CT scan cannot detect borderline personality disorder.
A diagnosis of mental illness is not usually a medical diagnosis at all. It is an evaluation of behavior based off a subjective standard of what actions and attitudes are considered to be normal or abnormal. People are considered mentally ill when they think, feel, and do things outside the range of what normal people do.
Normality and AbnormalityIn his book, Saving Normal, Dr. Allen Frances has an interesting discussion about what makes someone normal and what makes someone abnormal. Dr. Frances is the former chairman of the department of psychiatry at Duke University and served as the chairman of The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). Writing as a leading psychiatrist with decades of experience in his field, Dr. Frances is concerned about the sliding scale of normalcy, psychiatry’s institutionalization of which behaviors are normal and which ones are not, and the assignment of “mental illness” to those who are different.
Frances spends an entire chapter of his book explaining just how challenging it is to define normal. Then he describes, from his experiences leading DSM-IV, how hard it is to define mental illness and abnormality. On page 16 of his book he writes:
I have reviewed dozens of definitions of mental disorder (and have written one myself in DSM-IV) and find none of them the slightest bit helpful either in determining which conditions should be considered mental disorders and which not, or in deciding who is sick and who is not.
This is a stunning admission from one of the world’s foremost psychiatrists and the leader of the most influential guidebook on mental illness in the world. Frances believes that our efforts at defining mental illness, normality, and abnormality are not the slightest bit helpful in determining who is sick and who is not.
Is Normal the Standard?
Though he is a significant leader, Frances’ statement is controversial. There are doubtless many other psychiatrists who would disagree with him. Fine. But Frances got me thinking: What is normal? Is normal a biblical standard for what ails troubled people?
In fact it is not. When you read the Bible you discover that what is normal or typical—what surrounds the mean—is not the standard. Lying is normal, but it isn’t legitimate. Faithless sex is ordinary, but it is no benchmark. Pride is as commonplace as the air, and yet is a terrible standard. All sorts of things are normal, and yet terrible.
The Bible’s standard isn’t normalcy. It is righteousness. Listen to the Apostle Paul:
For the sake of Christ I have suffered the loss of all things and count them as rubbish, in order that I may gain Christ and be found in him, not having a righteousness of my own that comes from the law, but that which comes through faith in Christ, the righteousness from God that depends on faith (Philippians 3:8-9).
Paul’s driving passion is not to become normal. It is to be found in Christ and his righteousness.
One of the reasons psychiatrists argue so much about what is wrong with troubled people is that they are measuring against the wrong standard of normalcy. The Bible calls us to the righteousness of Christ. People’s problems do not concern any problem with abnormality. We are all born sinners and continue in that state apart from grace. People aren’t messed up because they are abnormal. They are messed up because they are wrong. Sin is the defining standard of normalcy for all of us.
This means that the most significant problem people face is that they are far too normal. What people need is not more normalcy, but more righteousness. The Bible teaches that this righteousness comes by faith. It is in understanding this that you will come to know that the most troubled people among us need the gospel, embraced by faith, far more than they need to be normal.