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Psychiatric Labels and Human Sanctification
QUESTION: I just graduated with a BA in Psychology. We were taught that people with Paranoid Schizophrenia must first be medicated to break past the delusions, odd speech patterns, etc., before they can talk with a counselor. So I have two questions. Was John medicated?* Do you think what I was taught is true?
John was on cocktail of three or four medications. Over the years he had tried many different medications and combinations. Sometimes symptoms softened. But nothing had worked well enough, or worked for long enough, or actually changed him enough, or worked without negative side effects. He was obviously delusional, disjointed, and despairing when he and I talked.
One beauty of a Christian approach to people, including extremely disturbed people, is that you can always talk with anyone. No guarantees that they’ll listen, of course—just as there are no guarantees that “normal, undisturbed” people (who also have madness in their hearts: Ecclesiastes 9:3) will listen.
Yes, no guarantees ever when we seek to love a fellow human being. But I think that your teachers would have better served their students if they had firmly noted, “No guarantees with meds, of course.” When meds take the edge off symptoms, that is a plus. And if the benefits outweigh the negatives, that is also a plus. But if counselors and/or strugglers put their prime hopes in medicine, that’s a big negative. And if counselors and/or strugglers think that becoming a higher functioning sinful human being is a good enough goal, that’s a big negative. One effect of making John primarily into a victim of a medical condition is that very important things about him get lost. John is a creature of God. He is an image-bearer with gifts and potentials. He is a sinner whose sins are unfathomably complex (Jeremiah 17:9). Operating in behind his certifiable delusions, we discovered unbelief, murderous hatred, perverse sexuality, laziness, deceitfulness, entitlement, pride, lovelessness, self-righteousness, hypocrisy… just in the first two hours! He is a member of the human race. And he is also a sufferer in multiple dimensions—whatever things are going on in the relational-social-cultural sphere and in the physiological sphere are unfathomably intricate. And John is redeemable by the mercies of Jesus. He will either perish forever or he will live forever—just like every other person.
My next comment might seem like a nuance, but it significantly affects our attitudes to people like John. I do not think of John as “someone with Paranoid Schizophrenia.” I think of him as a person who is living life paranoidally, i.e., living in delusions of grandeur and of terror, as if he were the center of the world, gripped by suspicions that others are out to get him. There may be a dense web of reasons and contributing factors, some real, some imaginary. But when a description of his problems is made into a “thing that he has” (technical term: “reifying the diagnostic label”), it scares us off from humanizing him. It keeps us from being able to identify with him. It intimidates us from making humane efforts to connect with him, from seeking to normalize, to humanize, and to interact constructively with thoughts, emotions, and actions that seem bizarre and abnormal.
*John was a person who was diagnosed with the psychiatric label "Paranoid Schizophrenia," which Powlison used in class to illustrate how to think about psychiatric labels in general.
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