“First do no harm” reads the famous first line of the Hypocritic Oath which is to govern the practice of all medical professionals. Now, I wish to ask a rather difficult question and draw from it rather difficult conclusions. You see there is a growing epidemic in our land which strikes indiscriminately at all people. I believe this can be stopped, but drastic action is required. The impetuous for that action is an uncomfortable truth. I have tried for several months now to come up with some gentle way of exposing the truth, but I am not sure I can succeed in that. Nevertheless, I must press forward in writing and hope my readers will understand if I appear too rash. If you are reading this while dealing with mental illness please understand that this article is not meant as direct help for your condition, but rather as dialogue on the general science and practice of mental health in our day. My question is this: If we leave someone in a state where they are not well and unaware that they are not well, have we done them harm? Now, on the one hand, the question might hinge on what is ailing the patient and prognoses. If they have a small scratch, the chance of noticeable harm arising is small, but what if they have brain cancer? Even the smallest cut could become infected and lead to something far worse. Also didn’t we best consider if there is potential for the patient to get better? If we deny someone the potential of a higher quality of functioning, greater ease, or increased ability, have we not harmed them? It seems to me we have kept them being as well as they might have been. Again, by not making them better we might also open the door for them to get worse.
First Do No Harm & the Role of Christian Counseling
These considerations are quite plain when we think about physical health. We have established baselines of what is and is not conducive to the normal functioning of our bodies. When it comes to mental health, however, the baselines are quite blurred. The trouble stems from the foundation of modern psychology in the subjective reporting and interpretation of subjects. I think, therefore it is.
How else can we get into someone’s head by listening to them talk about it? Well, there really isn’t any other way.
However, this does not mean that our thoughts dictate our reality. “I think therefore it is,” is as hopeless a thought as “I created that which I speak.” Much of contemporary psychology has lost sight of the objective nature of reality in the subjective worlds of people’s minds. This is reflected in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM5) which removed the sexual identity disorders of the early DSM4.
Why was this done? I am sure political pressures and financial expediencies played some role, but there is also surely a shift in the supporting science.
The issue is that psychology cannot change the facts. A man will always be a man no matter what mutilation is performed on his body. His masculinity is encoded not only in his DNA but also in his soul. The same is true of women, they will always be women no matter how we try to make them into men.
These people are suffering not from being in the wrong physical form, but from confusion about what it means to be a man or woman; and likely from issues of self-image. The same sort of danger is arising in aspects of the body-positive movement which wants to affirm morbid obesity as a normal, healthy human condition. Any time we set people in opposition to an unchangeable reality we are setting them up for painful failure. It is no different than convincing some poor soul to punch through a mountain of granite.
God created this world to run in one particular way, He said it shall be so, and the Bible says of God’s decrees. See Psalm 119:89: “For ever, O LORD, thy word is settled in heaven.”
We creatures have no right nor ability, either individually or collectively, to overturn what God has enacted. We cannot shift our chromosomes, re-engineer our bodies to function differently, revoke gravity, or cause the Sun to revolve around the Earth. When we keep trying to do those things we are fitting ourselves into the definition of insanity.
Surely, it is better to accept the things we cannot change and to deal with the thoughts and feelings that prevent us from accepting them. That is a task we might succeed in. Now the patient is not likely to enjoy the initial phases of such a treatment, just like no patient enjoys being cut open and exposed. It is a lot easier to just go on living with the illness than to undergo treatment when you do not perceive any ill effects from the illness.
Psychology can play a cruel trick on its patients here by telling them the ill effects are not from mental illness, but from other outside factors. The patient is healthy, everyone else is sick, and that is the source of their pain. In some dystopian future, one might find the sane locked away in institutions while the mentally ill run the world. I do not think that situation would arise due to any evil intentions from psychologists, but rather it would come about from good intentions which are misguided.
If there is an area of ill-intent I would locate behind the second fault in our psychology, which is that often presents illnesses as uncurable. The diagnosis of a mental illness has become something of a badge of identification to be worn throughout life. We suffer from depression, as one who suffers from a missing eye.
The condition can be treated, but it cannot be fully removed. To be fair there are clear examples even of mature Christians who never did overcome depression or anxiety fully. There are also many mature believers who never recovered from cancer.
Those cases are justifications for presenting a patient with a more or less hopeless prognosis. If there is no cure, why not get comfortable with this disease and fit our lives to the condition? Now, that sort of thinking is the foundation for a truly miserable life of things like, “I can not do that because I have anxiety,” or “I wish I could go there but my depression prevents it.” The incurable illness becomes to many a chain and anchor to keep them living a diminished life.
Not all schools of psychology or psychologists fall into this hurtful practice, many are still working for a true cure with their patients. However, perpetually treating symptoms is a means to financial security so there is a temptation. There are also many schools of psychology that by their very nature render cure doubtful, and in some cases truly impossible.
With man some things are impossible, only with God do all things become possible. Secular psychology has some answers to our problems, but only the Gospel of Jesus Christ has the full, definitive answer to our entire mental/spiritual health.
That health begins with a clear and unyielding emphasis on our personal responsibility. Sigmund Freud, whose influence is still felt in psychology despite his thoughts being largely rejected but then accepted in popular psychology, established the notion that we are victims of outside forces.
Freud believed that those actions impacted below our consciousness in areas that shaped us, but which we could not easily reshape ourselves. While other schools give us more ability to influence our beliefs, behaviors, and actions, they all place an emphasis on forces beyond our control as the ones responsible for making us who we are. We are the way we are because someone else chose.
Being irresponsible is fun! No really, you can do anything and never feel guilty about it. It is nice when you are feeling low about something you struggling with to learn that it is someone else who is really was at the bottom of it all, and you were merely a hapless victim. No need to feel guilty or ashamed, it was not your fault after all.
It feels good yes, but if you are not responsible how can you have the power to change? Victims are not victors; they cannot be as they are helpless. A victim has no power. When a victim realizes power and acts with it, they cease to be victims and become something else. When we point fingers at everyone else, and never at the man in the mirror we create victims and we bind people in their current state.
Yes, other people do awful things to us, and it hurts us deeply. We never want to deny those realities. People can do a lot of harm, sometimes they can keep harming us for a long time. However, they cannot decide what we will do with the pain. They can suggest a course of action to us, but they cannot decide for us. Each of us decides what we do with our pain.
We can let it go on and on and remain victims, or like the writer in Psalm 42, we can choose to stop.
It is no different than battling a physical disease like cancer. You can resign yourself to death and let the cancer run its course, or you determine to do all in your power to live and seek treatment. Just as we diagnose a physical disease, we can diagnose a mental disease, find the root of it, and eradicate it. Sometimes, it just doesn’t seem believable.
Mental illness messes with our feelings, and we tend to let our feelings shape our perceptions, and our perceptions shape our beliefs. We might know there is hope for a better life when struck by cancer, or by depression, but that is not the way it feels to us and so we wallow in despair.
Is it harmful to let someone who feels life is over cease living? I am afraid the answer to the world is rapidly becoming yes. Romans 12:2 is perhaps the single-most relevant verse on mental health in all of scripture: “And be not conformed to this world: but be ye transformed by the renewing of your mind, that ye may prove what is that good, and acceptable, and perfect, will of God.”
It tells us not to conform to a vain way of thinking, but to be transformed by the renewing of our minds with truth. That is a recipe for mental well-being and a recipe for an effective form of mental health care.
Romans 12:2 tells us first that we are responsible for our mental state and capable of affecting it. We are told to renew our minds and so we must be able to do so. It does not say the process of renewal is quick easy, or perfect, but it is possible. That means that regardless of our past, whatever was done to us we can do something about it in the present.
The verse tells us that a cure is possible for damaged thinking. The mind that is broken can be renovated just as a broken body can be. So, there is good reason for hope. A hope that encourages and motivates the pursuit of life.
And this verse tells us that we do not want to be conformed to anything but the truth. Living in harmony with the ultimate reality is the state of mental health. When you can embrace who you are, what you are, and where you are in life you are living well.
Christianity has the cure for the ills of modern psychology. I do not wish to be overly hard on the field of psychology, but I do wish to see it doing better and less harm. It is not surprising that psychology would be missing a few key truths on mental wellness. After all, it has only been around for a century or so now. The Christian study and practice of mental health has been around for several thousand years. Any science that neglects such a rich tradition of insight and wisdom is bound to make mistakes. So, it has been with secular psychology.
Christianity too has made a mistake in allowing the Biblical counseling movement brought to the fore by Jay Adams to be portrayed as a response to secular psychology, rather than the recovery of a much older science. At this point, I feel the need to make a rather bold pronouncement.
Please understand dear readers I am saying not out of conceit, but out of earnest conviction: I think the best thing for everyone would be the establishment of the Christian tradition within the academic, and clinical arenas of contemporary psychological science as a valid, viable, and effective model for understanding and treating the human mind.
I do not say that our tradition is equal to other schools within psychology, but that it is vastly superior. Such a feat would require such gifts as only God can give. So, let us rest this desire with Him.
Right now, there are a lot of hurting people in need of real hope. There are also a lot of well-trained and fully qualified counselors who can bring the Word of God and the practical skills of counseling to bear on all that troubles the human mind.
Biblical counselors are not able to accept insurance in most cases so their services are often unavailable. Our churches can unite to fund clinics in our communities where people find sound mental and spiritual counsel without cost. We can also use our political and academic capital to bring Biblical counseling into the mainstream of the ongoing conversation on mental health. These projects are already underway and we have seen a lot of progress in recent years.
As individuals, we can be aware of the pitfalls of psychology, and seek for our own needs and the needs of our friends and family Biblically grounded counseling that offers hope and healing. Where Biblical counsel cannot be found, we can supplement secular psychology to provide whatever it might lack. And all of us can pray for God’s gracious help in every life afflicted with mental illness.
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- Views From the Branch: First Do No Harm & the Role of Christian Counseling - January 10, 2025
- Views From the Branch: The Holy Spirit Gift That Keeps on Giving - December 13, 2024
- Views From the Branch: On Using Your Testimony to Tell His Story - November 30, 2024
