Understanding Mental Health Diagnosis
By Pastor Scott Roberts
Is mental health diagnosis the same as medical diagnosis? In the eyes of many people, the two are identical – I go to a professional who is board certified, tell him my symptoms, and the professional in turn writes a prescription that ‘solves’ my problem. But there are some drastic differences in medical and mental health diagnosis.
Let me try to explain: Medical diagnosis is backed up by scientifically verifiable tests. Medical diagnosis is grounded in the core belief that the body’s physical tissue is damaged or under attack and needs remedy to be ‘normal.’ When a bone is broken, an x-ray is performed to see the nature of the break and based on those results a cast or operation is ordered and the bone is set and restored, i.e. ‘cured.’ When an infection occurs, the lab can examine some blood, or other fluid and via a culture determine the exact type of infection in order for an antibiotic to be prescribed to fight it. When a heart is faulty, stress tests, EKG’s and other tests can pinpoint the problem and the surgeon can determine if a new part is required to fix the issue. Each of these is objectively verifiable, and though mistakes are made, and our understanding of the human body is imperfect, a direct link between cause and effect is often understood.
This is not the case with mental health diagnosis. Unlike a medical diagnosis, people in this camp are given labels based on their thoughts, emotions, and behaviors. The DSM-4, which is the bible of the psychological/psychiatric world, clearly concedes this point with these words, “a diagnosis does not carry any necessary implications regarding the causes of the individual’s mental disorder or its associated impairments.” The admission that psychological labelling has nothing to do with causation but rather relates strictly to presentation of symptoms is fundamental in understanding the difference between medical and mental health diagnosis. In medicine the disease creates the symptom, but in mental health the symptom creates the disease.
So why does all this matter? As Christians seeking to provide sound biblical counsel to those around us, understanding this difference can be very useful in helping others. If our thoughts, emotions and behaviors can be changed, then according to the mental health world, our label disappears. (I want to be very careful here, never should a biblical counselor encourage someone to stop taking prescribed medicines. We must legally leave that to the doctor and the patient to determine, but we can work towards helping those with mental health diagnosis to find new patterns of life that will likely change and remove their diagnosis.) So, what must we do?
First, ask your counselee if he or she understands the process used to make the diagnosis. And then share the differences between medical and mental health diagnosis. Second, ask him or her if it is okay to use biblical terminology in place of secular words and labels. For example, anxiety is called fear and worry in the Scriptures, OCD would be called control, alcoholism is called drunkenness, etc. Third, ask this question – “If the medication works so well, why are you still seeking help?” Fourth, understand that the concept of ‘chemical imbalance’ is a new theory without any objectively verifiable way of proving it. Science knows very little about the brain and the known balance points of the chemicals at work in it. Science is able to measure levels of chemicals in the blood but not at the synapse and not on the other side of the blood-brain barrier where these chemicals are at work. We must understand that when chemical abnormalities in the body are able to be measured, then a medical disease/diagnosis replaces the mental health label. Fifth, ask, “What tests were run to prove a physical problem is present? How was it proven that the physical condition is the cause of the emotional/behavioral action? How can it be proven that the recommended medication corrects the physical problem?” All these steps are aimed and leading the person to this final place where we can speak about the counselee’s heart and life issues that are ushering forth in damaging actions, emotions and feelings. Help them to wrestle with the root causes and to find their hope primarily in the gospel; Why are they feeling afraid? What does the word of God say about overcoming fear? etc.
I know this is a very short and cursory treatment of the topic at hand, but I hope it helps as you seek to provide counsel and hope to those in your life.