Session 2: Ministry and Mental Health

Now we're going to go into the mental health world.

Yesterday we went to the Valley of Vision.

! It's a book of Puritan prayers.

This is one of the prayers in Valley of Vision.

!

Interestingly, he uses the word mentally ill,

the concept mentally ill,

and this is probably 1630 or 40

when this is written.

So this idea of mental illness is not new.

What it means, how it's understood,

has changed dramatically.

But it's not new.

If you're ministering to people in this culture,

in some way you're going to engage

what I would call the mental health world.

Whether you're ministering to people

who are taking psychiatric medications,

sorting through mental health diagnoses,

struggling with issues that raise question

about whether they might need inpatient care,

it can be a confusing world.

So what we're trying to do is we're trying to look at

the experience of people in the mental health world

and how we relate to it

and how we can minister within it.

When we looked at the previous world,

the worldview areas,

what really was required, I think,

was theological discernment.

You need to be in theological discernment,

biblically informed,

gospel-oriented theological discernment

into understanding those worldviews.

When you're in this world,

you'd be more of the category of biblical wisdom.

How do we understand how to relate to this?

Because this is a stream-level reality

for a lot of people.

You may have had your own experiences

or people in your family.

I've had members of my family

committed to institutional care.

I've had issues in my family

with other kind of mental health disorders.

So it's not hard to see.

The big picture,

how do we come into contact with this world?

Just some ways.

You might have parents who are told

they have a child with learning

or behavioral disorder

like Asperger's or ADD or ADHD.

People struggling with depression

and anxiety attacks.

You have teens

who are self-destructive behaviors

or relationships

or unable to control emotional responses.

Suicidal people.

People who are susceptible to delusions.

Addictions requiring inpatient treatment.

A legal situation

requiring a psychiatric evaluation

or assessment.

A mental breakdown

non-necessicating interventions

or hospitalizations.

Self-destructive bipolar behavior.

Postpartum depression.

Profound grief and loss.

PTSD.

Early onset Alzheimer's.

You'll find this all around you.

This idea that we live in a world

where understanding

what is the mental health issue related.

And I would see that,

well I think,

you can tell I'm not a huge fan

of Western materialistic culture.

I am very grateful

in this affluent culture

that we have a mental health system.

I'm very grateful

that people don't just simply suffer

without help.

Because it is profound suffering.

So things considered

in the area of mental health,

we need to be able to interact

with the world of psychology

without integrating.

We talked about that before.

Same goes here.

psychiatric pharmacology

is a common go-to option

when other things

don't seem to be working.

But it can't change

all that needs to be changed

to resolve complex problems.

I like to compare

the mental health,

social services field

with the legal

or law enforcement world

as a system

of dealing with people

in their troubles.

They're both systems

that are social responses

to life in a sense that

you don't enter those systems

if everything is going okay.

At their very best,

they extend common grace,

but they'll never have

redemptive impact

apart from the intervening mercy

and saving grace of God.

They are limited.

They're both complex

and bewildering to people

who find themselves

having to engage in them.

If you've ever walked

with somebody through a trial,

a legal trial,

you will find that it is

a very unsatisfying

experience.

The system itself

makes it unsatisfying.

And it's bewildering.

Why is this?

What are all these terms?

What does this mean?

Who do I talk to?

Who do I go to?

Who's in charge?

It's very similar.

These systems,

the mental health system

and the legal system,

are full of gaps

in quality of service.

Competence in those fields

can vary tremendously.

So you might end up

with a wonderful attorney

or a terrible attorney.

You might end up

with a wonderful therapist

or a wonderful psychologist

or a terrible psychologist.

I'll give you a quick story.

I had a man

who was attending our church

and he wasn't really involved,

but he had a work-related accident

where a propane tank

blew up in his face

and it burned his face off.

And so he needed...

So I got involved

and I ended up going over there

once a week

for about a year.

He just all banged up.

I didn't know what he looked like

because he was banged up.

The fascinating thing about it

is that he had had

this lifelong skin condition

which meant his skin

was constantly flaking.

And it actually created

a regenerative experience

of his face returning.

So that was amazing.

Wow.

You couldn't tell today

that he had any...

Wow.

But he was living.

His ears were burning off

and everything sort of returned.

But what happened

is because of this,

it was such a trauma for him

that he had a psychiatrist

who prescribed medication

to deal with the trauma.

So long after he started getting

physically better

and everything came off,

he still was just this kind of shell.

And we were talking about,

well, maybe you need to talk

to the psychiatrist

about your medication.

And so finally he called

the psychiatrist

and the guy had left.

He just quit.

He never told his patients

that he needed anything.

He just quit.

And so he had to scramble

to find another psychiatrist.

That psychiatrist said,

this guy was medicating

you into a living.

Wow.

He changed his medication

and within two weeks

he was coherent and fine.

Wow.

I'm not blaming the system for that.

I'm just saying

in complex systems

you have,

you have,

not everything works

the way it's meant to work.

Laws that govern these systems

can be difficult to navigate.

There are federal, state, county,

and municipal laws

that make where you live

crucial to what you receive.

One of the biggest examples of that

is whether you live in a city

or outside of the city.

The services you're able

to get in Philadelphia

are not nearly as good

as the services you're able

to get in the surrounding counties

which are more affluent.

And the overwhelming nature

of the services,

of the need in most urban areas

mean that they're stretched

far more than if you go

to a suburban facility.

Money matters significantly

in the quality of what we receive.

That may mean cash

or may mean just insurance.

You have good insurance or not.

It can matter significantly.

People who have access,

have to access these systems

are profoundly discouraged

by their experience.

Often they're,

they may be their help ultimately.

you have somebody

who's in a civil suit.

They sue an insurance company.

They sue somebody.

For years it drags out.

At the end they get,

they get a,

they get some kind of settlement.

But it's very unsatisfying

for them.

The system itself

they felt was broken.

Same can happen

with the medical field.

I have so many people,

a lot of the people we get,

we have what we call

the bridge program

which is our,

our,

it's an outreach program

where people commonly do,

it's evangelism.

So many people are coming

and they've,

they're burnt out

on the mental health system.

I just don't have confidence anymore

and I'm looking for something different.

And that drives them to the church.

And whether somebody's been involved

in the legal system

as a victim,

as a perpetrator,

or in the mental health system,

they need care,

humility,

and support

when they engage them.

So if you know somebody

who is involved

in some sense

in treatment

in the mental health system

and we'll kind of broaden

that out what that means,

just recognize

they don't need

your critique.

It's hard.

It's difficult.

And it's very difficult

to know

how I get done.

What is,

how does this end?

How do I get out of this?

And so,

so we want to have that in mind.

So,

these are reflections

of components

of the mental health world.

Causality.

One of the popular

Christian critiques

of psychological diagnosis

is that

this really isn't

about a disease.

We talked about,

you know,

everything that seems

to be a disease

in the mental health world.

And so,

Christians will often critique

because there's no

biological cause.

How can there be a disease

if there's no

biological cause?

We have to be very careful

when we talk about causes.

Be careful

not to make statements

like if you can't find

an underlying

biological cause,

then it can't be

considered a disease.

It's scientifically

short-sighted.

Just because

there is an identifiable

underlying biology

or condition

known now

does not mean

there won't be one

discovered in the future.

It's also historically

dubious.

Medicine has always

had a problem

with disease,

cause,

cure concepts.

Even today,

there are a lot

of medical conditions

where there isn't

a clear understanding

of cause.

Migraine headaches,

fibromyalgia,

Alzheimer's,

chronic fatigue syndrome.

Ultimately,

a full biblical

understanding

of personhood

is not confused

by the lack

of clarity

on whether

disease categories

are appropriate

for psychiatric

mental health

type problems.

I don't think

this is going to be

a big issue,

you guys,

but in certain parts

of the country,

this is a huge issue

because there's

a tendency

to make this

about,

well,

it's clearly

not medical

because you can't

find a cause,

so therefore,

it's all sin.

We just don't

go there.

We don't go there.

Is sin involved?

Certainly,

sin involved

in everything we do

and everything we experience,

but we don't speak

in terms of causality

when we're dealing

with this.

What is mental

illness?

Let's start with

terms.

I was just reading

about this fresh

last night.

Terms for mental

illness are very

fluid and there's

a number of

different terms

that are overlapping

conceptual meaning

and actually work

in different contexts.

I'll just say this.

Mental health,

the definition

of mental health,

this is Dale Johnson

who's ACBC.

I think this is good.

It's a long quote,

but I think it's good.

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

we're to look

at the social

environment,

we're to look

at the context

of a person

and what 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 this.

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?

What Josh is

getting at

in this

is something

you find

a lot of times

when you're

trying to relate

to this.

These terms

that are used

are not,

they're not

scientifically specific.

They're descriptive

terms.

And they're

relative

to other factors.

So healthy

is one of

those terms.

Certainly in

a Western culture

he says

we see that

what defines

human health

is does a

person feel

good about

themselves.

So he goes

on and talks

about that.

And so

whatever the

culture thinks

healthy is

is the way

we understand

mental health.

So different

cultures have

different

understanding

about what

healthy is

and wouldn't

necessarily use

those terms.

The point

I'm making,

the point he

tries to make

here is

the way

we understand

mental illness

is when

mental health

is somehow

impaired from

what we

generally in

the culture

will think

it should be.

The term

mental illness

is the

common language

to most

people.

American

Psychiatric

Association

says mental

illness

refers collectively

to all

diagnosable

mental disorders,

health conditions

involving

significant changes

in thinking,

emotion,

and or

behavior,

distress,

and or

problems

functioning in

social work

and family

activities.

So that's

how the

APA

defines

mental

illness.

Some things

from that

definition.

Note that

mental illness

is not a

have or

have not.

condition.

You don't

have it

or not

have it.

Mental

illness is

experienced

in changes

to a

typical state

of mental,

emotional,

cognitive,

or relational

function relative

to that

person's

experience.

So if

someone is

being assessed,

they're looking

at how

does this

person typically

function,

or how

do people

typically

function,

and where

is deviant

from that.

That may

be how

something is

assessed.

Though it's

technically

diagnosed this

way,

it's not

technically

diagnosed this

way,

mental health

is understood

as a

continuum.

How much

someone deviates

from what

would be

considered

typical

indicates

whether or

not they're

experiencing

a mental

health

illness.

mental

health

illness is

a health

condition

that

expresses

itself

in

thinking,

emotion,

or

behavior.

The

diagnosis

of mental

health

illness

is not

done

through

physiological

or

biological

testing.

There really

aren't

reliable

biological

or

physiological

tests

for most

mental

health

conditions.

But through

an assessment

of a

person's

reported

or

observable

behavior

or

mental

state.

We'll talk

about that

more below.

It doesn't

mean there

are not

physiological

factors

involved.

It just

means that

diagnosis,

at least

at this

time,

is not

based on

testing

or biology.

This is a

big issue

with National

Institute of

Mental Health.

We've

struggled

with the

fact that

most mental

health

diagnoses

are not

based on

any

objective

diagnosable

criteria.

they're

based on

self-reporting.

And so

NIH is

trying to

address

that.

So I

like to

talk about

mental

or emotional

disorders

than mental

illness.

I think

that's more

accurate.

So you'll

hear me

use both,

but I

like the

idea of

mental

disorder

as a

category

for talking

about this.

huge

question

is this.

Why

does it

seem so

many people

now struggle

with mental

disorders

to the

point that

some

researchers

believe that

over the

course of

a lifetime

everyone

will experience

some form

of diagnosable

mental

disorder?

Why is

that?

I think

there's

some reason

for it.

One is

there's

clearly

better

awareness

more

data

better

diagnosis

prevention

and

treatment.

Things

are

getting

picked

up

on

before.

This

progress

has led

to more

humane

understanding

of mental

illness.

The

stigma

associated

with mental

illness

is giving

way to

more

social

acceptance

so people

are willing

to talk

about it

and people

are willing

to be

open up

about it.

A lot

of times

in previous

generations

anybody

who had

a mental

disorder

was kind

of shuffled

away,

was hidden

away.

Now people

are getting

treatment

for it.

People

are willing

to live

and talk

about something

that was

considered

taboo.

This is

a good

thing.

The fact

that these

things are

being identified

in our

culture is

a good

thing.

It means

people aren't

suffering

in the same

way they

suffered

in the

past.

The

downside

however

studies

are also

showing

that as

a society

moves

away

from

values

like

character

and

community

and

faith

there are

mental

and

emotional

social

causes.

This is

showing up

in studies.

We're

embracing

a toxic

combination

going back

to what

we talked

about before

about

expressive

individualism.

We're

embracing

a toxic

combination

of demand

for uninhibited

fulfillment

and unbounded

personal rights

to have those

demands met.

You see

what's

happening

in our

culture

I have

this

imperial

sense

of self

that needs

to be

recognized

but I

can't

impose

that

recognition

on anyone

and so

I live

with various

kinds of

anxiety.

I have to

perform.

I have to

do things.

It doesn't

mean that

this underlies

every depression

or anxiety

but there's

a reason

why it's

depression

and anxiety

that are the

most prominently

diagnosed now

because we

live in a

culture

that is

going to

that is

driving

values

that when

people aren't

getting those

whether they're

a sense of

belonging

a sense of

connection

a sense of

validation

a sense of

affirming

a sense of

closeness

a sense of

self-agency

those are

natural

responses.

We're

psychologically

and emotionally

vulnerable to

a culture

that most

values

that things

at least

satisfy.

And I

think you

guys

you live

in a

hyper

productive

world

I think

this is

what you'll

see.

You'll see

people who

just assume

they need

to achieve

a certain

level

they assume

they need

to have

a certain

stance

in whatever

their field

is.

And they're

living with

anxiety

and depression

and that's

not happening.

You'll

promise things

that can't

be delivered.

If we

want to get

to the hard

unvarnished

truth it's

this.

We have

disorder

because we

are human

beings

and are

fundamentally

disordered.

You,

I,

we are all

fundamentally

disordered.

That's how

the Bible

describes it.

We were

created to

love and

glorify God

to find our

meaning and

joy in Him.

Sin is the

denial of

that fundamental

reality in

the vain

search for

self-worship

and self-glory.

So you see

what the

problem is.

If you

want to know

the foundation

of mental

illness,

don't read

Freud,

read Romans

Romans 1 · chapter mention

chapter 1

through 3.

the ugly

truth is

this.

To the

extent that

we seek

to live

life apart

from God,

we are

not sane.

It is in

fact the

most insane

thing anyone

can do

to live

this God

if we

don't stand

before God

and He's

not our

judge.

No matter

how well

adjusted we

may be in

this life,

that's the

fallacy.

Well

adjusted in

this life

can still be

damnation in

the life

to come.

The

fundamental

insanity of

human condition

is the

rejection of

the God

from whom

all life

and meaning

come.

The fact

that science

can identify

genetic

propensity

toward mental

illness and

observe it in

brain scans

doesn't challenge

the truth

of scripture.

It confirms

the pervasiveness

of sin at

the deepest

core of

who we

are.

So

whatever's

happening in

the world

of mental

health,

there's a

deeper reality

that needs

to be

factored in.

Even if

you're able

to help

somebody who

is disordered

become

functional

and live

more typically

apart from

Christ,

they have

no hope

for this

world or

for the

world to

come.

So that's

how we

need to

understand

mental

disorder.

It doesn't

exist,

it's a

fabrication.

No,

it exists

but it

exists at

a much

deeper

level than

even the

mental health

world wants

to acknowledge.

It doesn't

mean that

everything you

see in

somebody is

sin,

but sin

is the

ultimate

cause

out of

all our

disorder.

When someone

receives,

so any

questions about

that before

I move

on,

on the

concept of

mental

illness.

Great.

So what

happens in

the psychiatric

diagnosis?

When someone

receives a

legitimate

psychiatric

diagnosis,

it means that

someone qualified

to do mental

health diagnosis

has observed a

person's behavior

or descriptions

of behavior,

and based on

the predetermined

criteria of the

Diagnostic and

Tistical Manual,

DSM-5,

believe the

person fits a

sufficient number

of the

symptoms for

a particular

disorder to

warrant a

diagnosis.

So it's a

criteria that

trained people

are looking at.

Does this

description or

observation of

behavior or

thinking or

emotional response

warrant a

formal diagnosis?

A psychiatric

diagnosis is a

description of

behavior and

experience, not

an explanation.

It tells you

what.

It doesn't tell

you why.

The DSM-5

itself says,

a diagnosis

does not carry

any necessary

implications regarding

the causes of

the individual's

mental disorder

or the

individual's degree

of control over

behaviors that

may be associated

with this

disorder.

two things

that are not

addressed in

diagnosis that

often create

challenges for the

person or those

involved are

motivation and

morality.

Let's take, for

example, someone

who is bipolar

and they're in a

manic state.

And in that

manic state,

they do things,

they steal.

people, I've

had people in

manner states

do all kinds of

crazy things that

put other people

in peril.

And the

diagnosis doesn't

address the fact

that you did

these things and

other people are

now in peril.

It just addresses

what you did.

It can't address

the morality of

them.

One of the

great problems

with addictions

these days is

the drive to

make it entirely

a disease model

does not fit

what the

average addict

understands about

what they're

dealing with.

And they're

uncomfortable

calling it

disease.

You'll have to

hear some people

do it, but

they're almost

defiant because

they know the

amount of

deception and

lying and

selfishness that

goes into

pursuing an

addiction.

And they

don't, their

own souls are

struggling with

the idea that

you're just

calling this a

disease.

So, the

benefit of the

DSM, currently

the DSM 5,

fifth version,

is that it

standardizes

descriptions of

mental health

problems so

they can be

studied and

treated with

some level of

consistency,

apart from

this, it

really is just

the wild,

wild west in

terms of what

you're dealing

with.

And that's a

good thing for

our complex

culture.

So, I want to

say, first of

all, I'm

grateful for the

DSM 5.

I think, I

think, apart from

the Lord knows

what we're

going to have.

It's a

responsible act

on the part of

the mental

health community

to create some

sort of

standards to

draw from

some basis of

research to

have some

sort of

commonality and

understanding

particularly complex

issues.

The problem is

what gets in

and what gets

in and what

gets out is

always to

vote it on.

And it

depends on

culture, sometimes

it takes votes,

what's considered a

disorder, what's

not.

So it's not

scientifically

derived.

So from within

the psychological

community, I'm not

interested in

critiquing from the

outside.

From within the

psychological

community, here are

some critiques.

Psychiatric

diagnosis is

popularly understood

to have the

same basis as

medical research,

but it isn't

fundamentally based

on medical

research.

I could go

into, when you

talk about brain

scans, when you

talk about those

kind of things,

where is that

going?

Well, here's an

interesting fact.

Big, large

meta study.

The

understanding, the

data from

studies on

mental health

issues, where

do you think

that comes from?

Where does that

data come from?

Who is being

studied?

Well, it

used to be

who's being

studied was

prisoners.

because they

could be forced

to do the

studies.

There's

civil rights

being violated.

They changed

that.

Nobody can be

forced to be

in a study.

Who's being

studied now?

Those who

think that

there's...

Everybody

around here.

College

students.

70% of

all the

data that

creates the

categories of

mental health

and psychological

categories is

derived from

studying college

students in

American

universities.

Why?

Because you

get graded

for it.

Because you

get paid

for it.

So, when

you think

about what

is typical,

what is

understood as

typical,

think about

your average

college student

on these

campuses.

That's the

typical of

which everybody

is being

evaluated.

So, it's a

bit of a

skewed

approach.

But the fact

is, it's real

data.

And they try

to make

allowances for

that.

but it's

very difficult

to do

studies and

find another

population

significant

enough to

be able to

do voluntary

studies at

the level.

And where

are the

studies being

taking place?

At

universities.

Right?

So, the

system is

weighted, and

it's not even

what European

is.

It's American

college students.

Brainstance.

Similar.

They talk

about brain

scans.

Brain scans

show.

First of

all, brain

scans do

not show,

based on an

individual brain

scan, this

is how an

individual, this

indicates what

an individual

is dealing

with.

Brain scans

show population.

They can

derive information

about population.

They can't

derive information

about individuals

from brain

scans.

Second of

all, most

brain scans,

about the

same number,

70%, are

done voluntarily

through college

students.

I want to

say that

we talk

about data,

the difficulty

in gathering

data upon

which to

develop theories

and diagnoses

is a profound

challenge in

the world of

psychology.

It's not

something you

have to deal

with.

also, in

terms of

critiques of

the DSM,

since the

DSM is used

to determine

insurance coverage

for treatment,

there's an

inherent tendency

to make

symptoms fit

the diagnosis.

I have a

number of

psychologists

and folks in

the church

who then do

diagnoses,

and they'll

say,

listen,

we know

that unless

we fill out

the box

with a

category,

we're not

getting paid.

That doesn't

mean they're

being irresponsible,

but they

approximate.

Nothing really

fits this here.

I'm not sure

they really,

if I really

diagnosed him,

would say,

yeah,

this really

does match

this,

or sufficiently

match this,

but they need

a category

for insurance

to work,

so they

put a

category in.

So,

what does it

mean when

someone receives

a diagnosis?

Psychiatric

diagnosis is

not the

answer to

problems we've

been unable

to address

through our

counseling and

discipleship.

It may

offer a

fresh category

of experience

and open up

options for

help,

but it's

not the

definitive

statement

on a

person's

life.

So,

you're going

to hear me

over and

over,

and the

tone you're

going to

get from

me is,

don't struggle

with someone's

diagnosis.

Don't fight

the battle

of should

you be

diagnosed

or not.

I don't

think it's

going to

help in

what we're

trying to

do to

help

somebody.

Diagnosis

can be a

helpful common

ground when

we begin to

talk about

complicated

feelings,

thoughts,

and behavior

patterns,

with mutually

understood

categories.

Ed Weld

said this,

people have

cried when

the DSM

initially

identified

them.

They found

relief,

even something

close to

joy,

in finally

having words

for their

struggle.

They found

comfort,

though the

instrument was

only a

definition in

a book.

We can

understand how

this could

happen to

a person

who has

long been

misunderstood,

but we

might not

foresee the

consequences.

As a

general rule,

whoever

understands

you best

will have

the most

influence.

One of my

struggles with

pastors who

go after

diagnostic

language is

they're not

going to be

as persuasive

as whoever's

diagnosing them.

And a

pastor's going

to lose

their voice

when their

voice should

really matter.

And so I

just don't,

when I teach

in the past,

do not be

confrontational

over diagnosis.

diagnosis.

It doesn't

do any

good.

Diagnosis can

be a helpful

doorway into

targeted treatment

and support

that's available

in the mental

health community.

So if you

have someone

who's diagnosed

bipolar,

it does

create a lane,

creates a

direction for

them to go

in so that

they can be,

so the

medical treatment

is helpful.

And actually

with bipolar,

medication can

be very important

for bipolar

tendencies.

It can be a

way to objectify

a problem so

that we can

begin to look

beyond it to

the deeper

issues of the

heart.

When someone

comes in and

says I've been

diagnosed with

this or this

or this,

it's part of

their story to me.

It's part of

their self

understanding.

It's not the

whole package.

It's not everything

about it.

It's not the

thing I focus

on.

This is part

of your package.

If you came

in and you

said I,

you know,

I start with

homosexual

thoughts and

tendencies or

past,

that's not

your whole

story.

It's part of

the story.

I live as a

minority in

a majority

culture.

That's part of

your story.

It's not

defining it.

I don't want

anything like

that to be

the thing that

sets up between

us in

relationship.

And

diagnosis can

allow us to

identify and

work with

risk factors

that are known

to be associated

with the

diagnosed

condition.

So if

somebody is

diagnosed with

something,

it might

help us

see that

they may

be vulnerable

to suicidal

tendencies in

a way that

didn't present

themselves before.

And it

gives us

ways to

extend

compassion.

When someone

talks about a

diagnosis,

Ed Welch

advocates,

we simply

ask,

how can I

pray for

you with