DISCUSSION ON MENTAL ILLNESS

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The Origins of Illness: How does it Matter?
As Christians, our biblical worldview sets us apart. It’s our foundation for living rightly. It is radical, controversial, and flies in the face of conventional secular belief. In mental health care, a biblical view of psychopathology refuses to get hung up on the psychological conditions themselves, but sees past the diagnosis and into the heart problem. As Christians, we believe that psychological disorders are the result of universal and individual sin, revealing humankinds need for a true Deliverer and refuge. Our worldview intimately affects every area of our live and should have an affect on our nursing practice. If this is true, then how does a biblical perspective of mental disorder make a difference in our patient care?
To answer this question, we must first understand the origins of disorder. The etiology of psychological disorders is hotly debated, with opposing and differing theories on all sides of the issue. Currently, the diathesis-stress model is the accepted view of mental disorder. This model explains behavior as both a result of biological and genetic factors ("nature"), and life experiences ("nurture"), and is supported by many traditional theories of psychology. Considered one of the inventers of psychology, Sigmund Freud’s view of mental disorder is one example of a traditional approach to mental disorder. Freud’s psychosexual theory states that there are five stages of a child’s development and one’s ability to deal successfully or unsuccessfully with life’s conflicts and challenges are the causes of adult psychological problems. In short, that “who you are” and “everything you become” is formed during these first few years of development. Each stage is characterized by confrontation of two forces, the id (representing privative drives for pleasure) and the superego (representing morals and principles). During the early years of life, a person’s sense or reality, or “ego”, begins to develop and serves as mediator between the id and the superego. Freud’s view of psychology and the procedure of psychoanalysis, which he developed, was the cornerstone of psychiatric care for many years. A quick glance at Freud’s theory will reveal that he left no room for God. His approach to treatment dealt with patients gaining a deeper understanding about themselves and their childhood, disregarding any higher power as a source of understanding. Another psychological theorist, Erik Erikson, proposed that social interactions are the driving source influencing development, formulating what is known as psychosocial theory. Interpersonal theory, developed by Harry Sullivan, highlights interpersonal behaviors and relationships as the central factor influencing development. The need to satisfy social attachment and the longing to meet biological and psychological needs are the two factors that influence interpersonal behaviors. Other theories include the cognitive theory developed by Jean Piaget, and various behavioral theories developed by psychologist such as Ivan Pavlov, B.F. Skinner, Julian Rotter, and Albert Bandura. All of these theories, from Freud on down to Skinner, conclude that psychological disorders are the result of some developmental or environmental problem.
While the above theories have traditionally been used to explain and treat psychological disorder, there is a rapidly growing trend to focus almost entirely on biological factors. This has been termed the biological model and today is one of the most popular models used by psychologist. This model states that psychological disorders are the result of chemical or neurological abnormalities in the brain. Consequently, treatment based on this model is heavily drug based. Chemically, these drugs affect neurotransmitters in the brain to alter the negative symptoms of disorder. As a result, many people see relief from their disorder and are able to live normal or close to normal lives. During my clinical experience at Green Memorial Hospital (GMH), I became very familiar with this approach to treatment. It was not uncommon for the patients at GMH to be on a dozen mediations, all of them used to treat an imbalance of chemicals in their brain. Unfortunately, all drugs have side effects, and in some cases these side effects can be very debilitating. Another obvious drawback to this model is the total lack of focus on environmental factors. When a person is suffering from depression, many of the psychologists today don’t consider the life issues or problems behind the depression. Their primary intervention given is drug therapy because drugs generally fix the chemical imbalance in the patients brain. This approach may reduce the symptoms of a disorder, but it fails in many other ways to address the problem.
Both of these approaches to treatment, weather it be traditional and biological theory, have one thing in common. Their interpretation of the problem is wrong. David Powlison, author of Seeing with New Eyes: Counseling and the Human Condition Through the Lens of Scripture, writes, “weather highbrow or lowbrow, the secular psychologies construct diagnoses of the human condition that suppress awareness of sin, and they offer cures that evade the necessity of Jesus Christ’s redeeming work.” Later in his book he states, “counseling that is faithful to Scripture must do justice to what God says about the whys and wherefores of the human heart.” Powison’s argument is that Scripture has something to say about psychological illness and we should pay attention to it. As Christians, we understand that the root cause of all evil is sin, a result of the fall. Consequently, the true etiology of psychological disorder is sin. However, there can easily, and historically have been, many misconceptions about this fact. To say that a person is suffering from schizophrenia or bipolar because of a sin in their life is unfair in the strongest sense of the word. These disorders appear to be solely caused by biological factors and are the result of universal sin, not individual sin. There are disorders that do have their roots in individual sin. Conditions such as eating disorder, substance abuse, or sexual disorder. These disorders and many others can greatly be helped with biblical counseling.
With a correct understanding of the cause of mental illness the question now becomes, “how should this change our care for psychiatric patients.” There are two extremes on the treatment scale that we would want to avoid. If we go too far to the left, we are practicing a pure biological model and only treating the chemical imbalances. If we go too far to the right, then we are practicing pure Nouthetic Counseling and only dealing with a persons sin problem, never giving the patient drugs that could be of substantial benefit to them. The difficulty for Christian psychologist is that different disorders fall in different places along this spectrum of treatment. For instance, a schizophrenic might benefit from biblical counseling, but they are much more likely to benefit from antipsychotic drugs used to treat schizophrenia. Eating disorder falls on the opposite end of the spectrum. There is debate about the cause of eating disorder, with evidence leaning towards genetics and biological causes. However, when a patient struggling with an eating disorder returns to normal functioning and eating habits, many of the biological similarities connecting that patient with others who have eating disorders vanish. This has led many to question the extent of the biological cause of this disorder. As seen through a Christian worldview, anorexia nervosa and bulimia nervosa are the result of an improper view of self and of food. People dealing with this can be treated effectively with biblical counseling. They might also respond to drug therapy as well, but drugs don’t get to the heart of the issue warring inside the patient. The balance is somewhere in the middle.
Understanding this spectrum of treatment is the fist step in biblically based patient care. Unfortunately, most nurses are not in a position to change the way patients are treated. For example, the nurses at GMH had very little decision over the treatment plans of the patients. So what difference does a biblical worldview have on psychiatric nursing if nurses cannot control patient care? In an effort to help me answer this question I took note as to how a Christian worldview played out under these limiting circumstances at GMH. To my surprise, I saw very little difference in the care from a Christian perspective then from a secularist perspective. In a psychiatric unit I would have expected a difference in communication at least, but I learned that all psychiatric nurses can use therapeutic communication techniques. It does not take a Christian to talk about the deeper problems a patient is experiencing. If this is true, and there really is little difference in patient care, then what is the point of my faith? I struggled with this question and how I could live out my faith at GMH during my clinical experience there. It was then that I realized the vast differences in motivation between Christians and secularist. Because of a Christian’s understanding of patients as created by God, nurses ruled by a Christian worldview assign infinite worth to each patient, treating them as such. Patients are not a means to a paycheck; they are actual people who need to be loved with the love of Christ. Christians show love to their patients because they are driven to love others in light of the great love that has been shown to them. Secularists come to the issue from a humanistic perspective that ultimately fails to provide a reason or motivation to love others. Christian nursing care disregards whether we like the person or not; it focuses on showing them Christ’s love through the nursing process. This is where the Christian faith plays out in most hospital settings: in the day-to-day monotony of patient care. The unit in which I will eventually work may not treat patients from a biblical viewpoint, but that should not keep me from doing my best to love my patients and show them Christ through me.