Modern Psychopathologies

A Comprehensive Christian Appraisal

Mark A. Yarhouse, Richard E. Butman, Barrett W. McRay

• Publisher: IVP Academic
• Year: 2016
• ISBN:
  9780830894321
• Edition: 2
• Topic: Psychology
• Subtopic: Psychopathology
• Index: Psychology

Modern Psychopathologies is addressed to students and mental health professionals who want to sort through contemporary secular understandings of psychopathology in relation to a Christian worldview. Written by well-known and respected scholars, this book provides an introduction to a set of disorders along with overviews of current research on etiology, treatment and prevention. Prior chapters explore the classification of disorders in historic pastoral care and contemporary mental health care. The authors explain the biological and sociocultural foundations of mental illness, and reflect on the relation between psychopathology and the Christian understanding of sin. Modern Psychopathologies is a unique and valuable resource for Christians studying psychology and counseling or providing counseling services, pastoral care, Christian healing ministries or spiritual direction. The revised second edition is fully updated according to DSM-5 and ICD-10. The authors have expanded the analysis to include problems associated with trauma, gender, addiction and more. Though fully capable of standing on its own, the book is a useful companion volume to Modern Psychotherapies by Stanton L. Jones and Richard E. Butman.Christian Association for Psychological Studies (CAPS) Books explore how Christianity relates to mental health and behavioral sciences including psychology, counseling, social work, and marriage and family therapy in order to equip Christian clinicians to support the well-being of their clients.

Part One

HISTORICAL AND CONTEMPORARY
CATEGORIZATION

1

CLASSIFICATION IN
HISTORICAL PASTORAL CARE

Why begin a book on modern psychopathologies with a chapter on historical pastoral care? Though the value of pastoral care for the life and ministry of the church may be obvious, what does it have to do with “modern psychopathologies”? What does historical pastoral care have to do with struggles people have with anxiety, depression or substance abuse? Pastoral care, also often referred to as the ministry of the “care” or “cure” of souls, has been described as “helping acts, done by representative Christian persons, directed toward the healing, sustaining, guiding, and reconciling of troubled persons whose troubles arise in the context of ultimate meanings and concerns” (Clebsch & Jaekle, 1964). Throughout Christian history, “representative Christian persons” have sought to understand the “troubles” of the persons under their care and respond with wise care and counsel. Those providing this care throughout the centuries have contributed to the development of ways of understanding human suffering and helpful responses to that suffering. This work of categorizing and responding is not dissimilar to the processes at work in the development of the contemporary field of psychopathology. Furthermore, those contributing to this developing nosology in pastoral care have most often interacted with contemporary understandings of human suffering accepted in the broader culture, thinking integratively about this task.

In every historic epoch, pastoring has utilized—and by utilizing has helped to advance and transform—the psychology or psychologies current in that epoch. . . . Nowhere in history has Christianity adumbrated solely from its own lore a distinct psychology, either theoretically or popularly understood. To appreciate traditional pastoring is to stand ready to adopt and adapt current psychological insights and applications without abdicating the distinctly pastoral role. (Clebsch & Jaekle, 1964, pp. 68-69)

We are committed to this ideal of integrative and collaborative study in the work of understanding the sufferings of persons. As we will explore in this chapter, Christian history has much to offer contemporary understandings of human suffering; however, the work of integration and collaboration has not always been well received by the broader culture. Ours is such a time, and our hope is that this book will contribute to changing that.

This book is about psychopathology, defined by the American Psychological Association as “the area of psychological investigation concerned with understanding the nature of individual pathologies of mind, mood, and behavior” (APA, 2015). The history of the mental health field, from its origins in Greek philosophy to the development of contemporary theories of psychotherapy, reveals an intensifying focus on systematic understandings and categorizations of the problems people experience in their psychological health (see Jones & Butman, 1991). This field of study provides the basis for the diagnostic categories and terminology used by contemporary health and mental health providers worldwide (accepted most widely in the DSM and ICD [International Classification of Diseases, World Health Organization] systems). These diagnostic categories have evolved through numerous iterations and revisions and continue to do so as theories mutate, societal values change, and continuing research offers a greater breadth of understanding. However, notably absent from these systems is any attention to spirituality or religious understandings of health and suffering.

The word “psychopathology” is a derivative of three Greek words: ψυχή (psychē), πάθος (pathos) and λόγος (logos)—which translated literally would be something like “soul suffering study.” Modern psychopathology, as defined above by the APA, has a more reductionistic focus limited to the study of “mind, mood and behavior.” It is our belief that the task of Christians in the mental health fields and pastoral ministry is to think more holistically about human suffering and to integrate the understandings of classic Christian literature with that of contemporary research and practice in psychopathology. We believe that the history of pastoral care provides us with insights into the human condition that predate contemporary psychology and specific theories of psychopathology. Further, we believe that Christians interested in the study of human experience, including various dysfunctions and psychopathologies, need to be informed by these insights and pastoral reflections on the experiences of “troubled persons” and the church’s concern for their everyday and ultimate needs.

Historical pastoral care and reflection was quite different from what we think of as modern psychology. It was based chiefly on reflection and deduction from principles derived from Scripture and pastoral experience, whereas the modern psychologies, while also indebted to reflection and theorizing, are grounded more in behavioral science investigation characterized by inductive, empirical study. In other words, the pastoral language, categories and methodologies for understanding human experiences are significantly different from those used by contemporary mental health professionals. These differences led to the neglect of historical pastoral care, in part out of disdain for premodern wisdom and its tendency to privilege reductionism, naturalism and empiricism (Oden, 1980). Although much has been gained through advances in the behavioral sciences, we wish to make connections that have been all but lost as Christians attempt to think as Christians about contemporary mental and spiritual health concerns. Toward that end we consider historical pastoral care and the insights of pastoral writers on the human condition.

From the church’s birth at Pentecost, its writings bear witness to the significance given the task of care for one another and especially for those in need. Recognition is given not only to the importance of this work but also to the knowledge and skill needed to provide care to those who are suffering. Christ and his apostles laid the foundation for a church committed to the care of each member and instructed believers to make this a central aspect of life within the body of Christ. The early church fathers taught about the need for “physicians of the soul” skilled in the care of those whose woundedness hindered their faithful obedience to Christ or deprived them of fullness of life in the community of faith (Clebsch & Jaekle, 1964). For example, Origen wrote in the third century that Christians should look carefully for a “physician” of souls to whom they could confess their sin and “lay bare the cause of [their] ailment, [one] who knows how to be infirm with the infirm” (quoted in Kemp, 1947, p. 27). Similarly, in the fourth century, John Chrysostom wrote, “So the shepherd needs great wisdom and a thousand eyes, to examine the soul’s condition from every angle . . . [and] must not overlook any of these considerations, but examine them all with care and apply all his remedies appropriately for fear his care should be in vain” (Chrysostom, 1977, chap. 2, sec. 4, p. 58). Throughout the history of the church, this ministry of soul care has been central to its life and mission.

In our day, pastors, elders, ministry leaders and Christian mental health professionals, in their desire to better understand how and why people hurt and ways to be helpful in response to their pain, have sought to understand the diagnostic categories of psychopathology and to appraise them in light of the truths of the Scriptures and the teachings of the Christian church. It is our hope that this book will serve as a resource to those who wish to better grasp this integrative endeavor and as a guide to those who wish to join in the ongoing task of understanding the nature of human suffering and responding to those in distress.

Western society’s growing fascination with popular psychological understandings of the person has catapulted concern about psychopathology and wounds of the soul into the mainstream. Many people when faced with emotional problems will turn to mental health professionals to sort out the complexities of their concerns. Symptoms are almost without exception organized and conceptualized with reference to contemporary diagnostic nosology (e.g., the Diagnostic and Statistical Manual of Mental Disorders, APA, 2013), and this may inform case conceptualization and treatment planning, though it may also foreclose prematurely on other resources, including those found within the historical pastoral care literature. As Oden observes, “It is time to listen intently to the scriptural text and early Christian writers. It is time to ask how classical Christianity itself might teach us to understand the providence of God in the midst of our broken and confused modern situation” (1991, p. 36).

It is toward this end of “listening intently” to the Scriptures and the voices of Christians who have gone before us and paved the way for our understanding of human experience that we consider the historical ministry of pastoral care and understandings of “soul suffering” that emerge from its literature. Unfortunately, contemporary societal trends toward reductionistic understandings of human experience, coupled with numerous other forces such as the advancement of the empirical study of human behavior, have led to the segregation of psychological and spiritual aspects of care and understandings of mental and emotional suffering. We will address this concern following a brief exploration of biblical foundations for soul care and an overview of the literature of pastoral care.

SCRIPTURAL FOUNDATIONS

The Scriptures, of course, do not use the language of contemporary psychopathology. Furthermore, it is not the intent of any of the biblical writers to offer a systematic categorization of psychological dysfunctions. Therefore we must be careful not to look to the Scriptures to find evidence of “God’s view” of psychopathology. It apparently was not the intent of the authors of the Scriptures to teach us the exact nature and breadth of our psychological functioning. However, in many places the Scriptures do offer instruction about the nature of our human condition before God and before one another. These truths have tremendous bearing on our understanding of issues related to psychopathology, and these teachings laid a foundation for the development of the church’s understanding and approach to human suffering and eventual categorizations of these experiences.

A number of theological truths emerging from the pages of the Scriptures have bearing on our understanding of these issues. These include the nature of humans as created beings and image bearers of God and the impact of sin on that nature. These truths also include teachings about the church’s response to the suffering that results from the evil that is now part of this world.

The nature of humans. It is beyond the scope of this book to offer a comprehensive theological anthropology. However, we affirm the Christian view that human beings are created by God, that they are “created persons,” to use Hoekema’s phrase (1986, p. 6). That is, human beings are dependent on God (created) while relatively independent and capable of making decisions and setting and meeting various goals (persons).

Also, to be human is to be created in the image of God (imago Dei). Numerous scholars have proposed various ways we image God—through reason, will, the soul, relationality and so on—but suffice it to say that there are many aspects of human nature and being that set us apart from other creatures and seem to reflect something of who God is. There may be many facets to human beings’ imaging of God, and we affirm that God intended from creation to set humanity apart for his purposes.

As created persons, as image bearers of God and in a number of other ways, human beings, whether or not they acknowledge it, are always in relation to God and to transcendent reality. We assume, then, that God created human beings to function in certain ways and that those functions include both “internal” thoughts, feelings and the experience of one’s conscience and “external” behaviors and ways of relating to others. When we are not functioning properly, we place ourselves at risk of spiritual, emotional and physical health concerns, and these domains are not discrete but interrelated and complex.

The impact of sin. Although we were created as image bearers of God and were made in relation to him, we exist in a fallen state. This fallen condition is referenced by Paul in Romans: “Sin entered the world through one man, and death through sin, and in this way death came to all people, because all sinn...