Did you see the obituary notice for Thomas Szasz, a 92-year-old psychiatrist who made it his life’s work to attack his own profession? If not, read the NYT’s article here. Szasz’ beef with psychiatry centered on two complaints: the diagnostic system treated individuals as having “things” rather than describing what they do (thus making it seem like people have diseases AND the coercive nature of treatments (forced treatment and meds for psychotic individuals.
What makes Szasz important to Christian counseling is that many biblical counselors and nouthetic counselors touted Szasz in their criticism of secular psychology and psychiatry. The Bobgans and Jay Adams used Szasz quotes to bolster their own criticisms.
How he was right AND wrong about diagnoses
Szasz was right in that DSM diagnoses tend to treat problems as discrete disease states when in fact they are descriptions of clusters of symptoms. More Venn diagram than discrete thing. Yet, Szasz and his ilk often used examples of diagnoses that he thought were not disease states. Well, some of these diagnoses have turned out more disease than not disease. Take ADHD for example. Many critics complained that there wasn’t anything that could be seen under a telescope…thus ADHD isn’t a real disease. Well, we can see significant differences in brain activity in the frontal lobes of those carrying the diagnosis. While we can’t yet point to a specific cellular structure or gene (and we likely never will since it is more complex than just biology), we are understanding the biological aspects of a number of mental health diagnoses.
Szasz was right that some portions of psychiatry treated those diagnosed as victims and ignored responsibility. Interestingly, as our understanding of genes and brain functioning have improved, the victim mentality has decreased. We are doing better in identifying responsibility even as we are more articulate about the effects of the Fall on the body.
We should thank critics like Szasz for pointing out serious flaws in the foundation of mental health philosophy and practice. And yet we should avoid the all/nothing approach that Szasz and his opponents took in criticizing or defending psychiatry. One common human reaction is to either (a) always look to be the critic, or (b) always look to explain away criticism. Both responses are normal but disastrous to helping others.
Want to learn more about counseling this summer? Are you in ministry and want to sharpen your skills? Already a licensed mental health provider and need CEUs*? Want to explore…
- How to counsel people diagnosed with Borderline Personality Disorder?
- How to help those diagnosed with a chronic condition?
- How to use the Old Testament better in counseling?
- How to better understand and evaluate the major models of counseling?
Just a reminder that this summer Biblical is offering 4 electives for students, alum and any auditors who might find the topics of interest. The first three of the four courses are only one credit and delivered in a weekend formats(Friday night and Saturday) with some pre-class reading/assignments. The fourth is a two credit course delivered in a completely on-line format.
For information about each of these course, the professors, the costs, and how to apply, click this link. It will take you to the Biblical website and a PDF of our flyer.
* Note: For those seeking CEUs, there are two ways you may be able to count them as fulfillment of your licensure requirements. Biblical Seminary is an accredited graduate institution and these courses are offered as graduate education in counseling and psychology. Most mental health licensure bodies accept graduate courses (shown on a transcript) as meeting the requirements for approved CE providers. You will need to check with your board to see if that applies to you. Second, we have applied for CE provider status for my class (Borderline Personality Disorder) from the State Board of Social Work, Marriage & Family Therapy, & Professional Counseling. If approved, we will be able to provide licensed attendees with 9 clock hours at the cost of ONLY $175.
Christians tend to have some strong feelings about counseling, psychology, psychiatry and similar terms. Come to think of it, most people, regardless of faith, have strong feelings about these topics. Experiences dictate much of these reactions. Experiences, such as:
- experiencing or hearing of a mental health representative (mhp) belittling Christianity
- experiencing or hearing of an arrogant, controlling, or completely incompetent mhp
- experiencing or hearing of a positive experience where someone found relief or change or insight
- feeling either helped or stigmatized by a received diagnosis or a use of medication
In psychopathology class tonight, we will explore the background behind psychiatric classifications. How did we get the Diagnostic and Statistical Manual? What are its underpinnings? There are a couple of common concerns about the DSM
- It purports to be atheoretical and descriptive only
- Diagnoses suggest objective and distinct “things”
- It medicalizes problems in living
- Under one diagnosis (e.g., depression) you can have such wide variety of symptoms
- Therapists have sizeable disagreements on diagnoses so are they all that helpful?
- It is leveraged by insurance in ways that make it a liability
- It doesn’t address matters of the heart or spirit
- It has political overtones
- It treats most problems in an individualistic fashion without account for family systems
Every one of these concerns has merit. However, the biggest problem I have is not with the DSM itself but with many of its users. The complaints that are raised about the DSM usually come from someone mis-using the DSM.
Remember the simple explanation of a problem almost always distorts it. Thus, the simplistic use of diagnostic labels almost always does damage.
The latest issue of American Psychologist has a very interesting story about the search for John Watson’s baby Albert. Remember from your Psych 101 class that John Watson, a behaviorist at Johns Hopkins in the 1920s, attempted to condition the infant to be afraid of white rats by pairing scary sounds with the presentation of the rat. Most every history of psychology tells the story how his condition fear generalized to other furry objects.
For a couple of generations the story ended there. Myths held that the mother took the child away out of her anger; that Watson later deconditioned him. Neither are true. But these researchers decided to spend a great deal of time and energy seeing if they could discover who he was. With Watson burning his own notes before his death, they didn’t have much to go on.
I won’t relay all the details here but suffice it to say they likely discovered who Albert was (Douglas Merritte) and who his mother was (Arvilla, a wet nurse who lived/worked at the university as a wet nurse after becoming pregnant out-of-wedlock for the second time).
Sadly, the boy died before he turned seven (unclear but maybe due to meningitis). So, we haven’t any knowledge of the impact of Watson’s research on him.
What I find amazing is that it was considered ethical to seek and reveal this information in today’s American Psychologist. We are called to provide the highest standards in clinical and research settings, which include anonymity. Why was it okay to reveal this information now when the person in question isn’t able to determine whether he would want this information released. Maybe existing relatives helping with the search gave permission.
I posted this little item for my last guest blog at www.christianpsych.orgfor the month of July. In it I mention “Christian Counseling: An Introduction” by Malony and Augsburger (2007).
And no, I don’t say what it should look like–merely a comment that we still need to figure out how we handle the faith/science dichotomy that we’ve been handed all these years.
Those who have been around wisecounsel for a while will remember I blogged through each chapter. If you are interested in seeing those posts, just use the search engine on this page to find posts mentioning Malony.
Maybe it’s a stage of life, maybe I’m hallucinating, but it seems to me that the divisions withing Christian forms of counseling are exploding. And to that I can only say hurrah!!
Let me give you the clifnotes version of American Christian counseling history (minus many important details) starting with the 20th century:
- Fundamentalist/Modernist fallout after the turn of the century builds division between fundamentalist/evangelicals and academics, including psychology. Division over naturalism
- Christians authoring psychology related books (Boisen, Clinebell, Hiltner, Narramore) in 30s-50s
- Creation of Christian Association of Psychological Studies in 1956 by Dutch Reformed pastors but later broadened to include those wacky Californian evangelicals interested in psychology. Writings at this time were broadly evangelical but often contemporary psychology models with bible verses attached. Beginnings of the integrationof psychology and Christianity movement with creation of doctoral training programs by Fuller Seminary and others.
- Jay Adams counters in late 60s and early 1970 (Competent to Counsel) with nouthetic counseling model to return to the power of the Scripture to change people and to throw off the humanistic clutches of psychology. Numerous models of biblical counseling birthed. Most prominent: CCEF
- Divide between Biblical counseling models and professional Christian Psychology widens in the church. Much maligning of each other. To associate with one meant no possible association with the other. Biblical counseling avoids professional jargon; integrative psychology pushes for meeting state licensing standards
- Biblical Counseling moves in 1980s from predominantly deconstructive and critique oriented to more positive model building
- 1990s: some beginnings of dialogue between key thinkers/authors in biblical counseling and integration movement. Integrative clinicians see benefits of the biblical work done by biblical counselors, see problems with many superficial integrative models, and both sides seem to be less separatistic and more open to learning from each other
- Now in the 21st century: A new version of Christian Psychology willing to embrace biblical counselors, psychologists, theologians, etc. and desiring to build a robust, biblically founded understanding of people informed by psychological research.
Okay, that’s in broad brush strokes and I left out huge developments and individuals. But yesterday I received a survey about biblical counseling programs. It’s clear our old divisions and categories no longer work. Now, today I get an advertisement for a biblical counseling conference that includes a wide variety of speakers. We are truly crossing lines! I’m interested to see what comes of this in the next 5 years.
FYI, interested in a fuller history? Start with the 1st chapter in Eric Johnson and Stan Jones’ “Psychology and Christianity: 4 Views” book. Follow their reference list. Then check out David Powlison’s U Penn PhD dissertation on the history of Jay Adams. Neftali Serrano published his PsyD dissertation on the beginnings of CAPS. That will whet your appetite.
Biblical Seminary offers several completely on-line courses these days. Check out our homepage for short videos on each course: www.biblical.edu. Let me highlight one in particular. My colleague Bryan Maier is offering one this Spring entitled, Models of Counseling. Here’s his syllabus: http://www.biblical.edu/pages/equip/classes-course-syllabi-spring.htm
If you ever wanted to explore the key secular and Christian models of counseling from a Christian/biblical perspective, this course is for you. The good part is you don’t have to travel to Biblical to take it. Bryan is a great teacher with a good sense of humor. I think you would enjoy it.
I’ve been reviewing the history of psychology and Christians in psychology because I’m going to be presenting with a colleague on the topic next week at the National conference of the Christian Association of Psychological Studies (CAPS). Psychology is as broadly defined as the planet and what normally gets told is the celebration of theories and advances of “great men” from Rene Descartes to Darwin to Freud to Skinner to modern professional, clinical psychology. Modernist philosophies of science abound in the “story” of psychology and empiricism reigns as King. Faith and belief have little mention in the story other than science’s emancipation from theology that came during the enlightenment.
We people of faith have a tendency to look at the evils of secularization and the refusal to admit belief biases in the sciences. It would be easy to blame those bad unbelievers. Yet, as I look at the history of psychology, it seems to me that faithful people made most of the significant decisions to advance the field while protecting their private faith. That the effort to maintain faith in light of empiricism as the primary way of knowing, these individuals made significant decisions that still impact how we treat the mentally ill today. Continue reading
Several years ago I wrote an article on the Puritan “treatment” of despair and melancholia. But I despaired of ever finding a home for it. It was too theological for some psychological publications, too clinical for some theological/historical publications…and so it languished. But yesterday I got my copy of Edification (2:3, 2006), the newsletter about to be flagship journal of the Society for Christian Psychology–and my article is the lead article. See my links on the right side of this page for their homepage.
As a teaser, here are some points I make. The article has lots of delicious (to me at least) quotes. Next week, I’ll trot out a couple for you. Continue reading
Am reading Bryan Maier’s (my new colleague) recent dissertation-turned-book, The Separation of Psychology and Theology at Princeton, 1868-1903: The Intellectual Achievement of James McCosh and James Mark Baldwin. Don’t get put off by the long title (we like those in academic treatises because they really tell us what the book will be about).
In short, McCosh, the President of Princeton (1868-1888), was a man caught between the two worlds of science and evangelical faith. He held to the authority of Scripture and that the only way to have saving faith was the work of the Holy Spirit through the Scriptures. He also believed that inductive reasoning could uncover the nature and faculties of the human mind, apart from leaning on the Scriptures. In fact, he resisted appealing to Scripture as he felt (a) that he couldn’t rely on human interpretations of what God meant (too much possibility of distorting it for own purposes) and, (b) that he needed to use the philosophies of the day (materialism, realism, positivism) to have his views regarding metaphysics accepted by other scholars (but he failed to note the lack of objectivity within these forms of scientific inquiry). Maier’s conclusion is that McCosh, despite his evangelical faith, played a role in exiling God from psychology when he emphasized the powers of logical positivism to “find” facts over against the rigorous study of Scripture. By prioritizing scientific inquiry and marginalizing biblical theology, it was impossible for a true integration of psychology and faith—a problem he sees that has continued today in the integration movement. Continue reading