Many Christians are suffering from the ravages of life and are unnecessarily caught up in the psychological counseling system. When people are suffering from problems of living related to feeling, thinking and behaving, the usual response is to refer the person to psychological counseling. Referrals need to be reversed: away from psychological counseling and back to the church for spiritual guidance, encouragement, and help and over to medical specialties when necessary. If pastors and other church leaders would pay attention to the research that has been in place for the last forty years, they would discontinue referring their people to psychological counseling, they would prepare their people to minister God’s grace to one another, and, if a physical problem is suspected, they would advise the person to see a medical doctor.
Misdiagnosis
Misdiagnosis is a serious problem that not only prevents possible healing, but may lead to death when the underlying disease is life-threatening. Talk therapy will in no way take care of a subdural hematoma (bleeding underneath the skull, possibly putting pressure on the brain) or any number of other diseases that may present themselves as depression, anxiety, or psychosis. As the talk goes on and the disease worsens, there can be much discouragement, frustration, added agony, a worsening of the disease, and even death. Psychiatrists and psychotherapists need to be well-informed in regard to diagnosis outside and beyond the Diagnostic and Statistical Manual of Mental Disorders (DSM). Perhaps in the future there will be more knowledge about the way the brain works in response to physical diseases in other parts of the body. In fact, the day may come when knowledgeable psychiatrists and psychologists will be referring their patients to other specialties, in contrast to the way doctors currently refer patients to psychiatry or psychology when they can’t figure out what’s wrong.
Serious misdiagnoses can be made when psychiatrists and psychological counselors depend on the DSM to diagnose patients and clients suffering from mental-emotional-behavioral symptoms, without considering the possibility of a physical illness causing those symptoms. A major flaw of the DSM is its diagnostic difficulties with its lists of symptoms and diagnostic categories. In fact, only one DSM diagnosis relies on clear organic markers. 1 The University of California Berkeley Wellness Letter reports:
Mental illness is both extremely common—one in five Americans will experience a mental disorder in any given year—and extremely hard to diagnose in some cases, since no simple biological tests exist to detect them. There’s no blood test for, say, depression or a personality disorder; no scan that can reveal attention-deficit hyperactivity disorder (ADHD). Instead, a clinician must rely solely on a patient’s symptoms and observation of his or her behavior to reach a diagnosis.2
Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University and president of the American Psychiatric Association, said: “With rare exceptions such as narcolepsy, which can be diagnosed by testing cerebrospinal fluid, there are no objective biological measures for mental illness.”3 (Bold added.)
Psychiatrist Barbara Schildkrout sees the shortcomings of simply diagnosing according to the DSM. She has written two books to encourage her fellow practitioners to look beyond psychological symptoms. They are titled Unmasking Psychological Symptoms: How Therapists Can Learn to Recognize the Psychological Presentation of Medical Disorders4 and Masquerading Symptoms: Uncovering Physical Illnesses That Present as Psychological Problems.5 At the beginning of Masquerading Symptoms she quotes E. K. Koranyi:
Non-specific behavioral and mood alterations often represent the very first and, occasionally for prolonged periods of time, the one single and exclusive sign of an undetected physical illness. Flagrantly and convincingly “psychological” in nature on presentation, such masked physical conditions frequently mislead the examiner and obliterate any further medical consideration, resulting in misdiagnosis and thus, inevitably, in treatment gone astray.6
Schildkrout then says:
Many medical conditions can produce mental symptoms as their dominant clinical feature. This creates a diagnostic problem. How is one to know whether an underlying medical disease might be the cause of a patient’s presenting psychological symptoms? This question is a serious one for all mental healthcare practitioners, indeed for all clinicians.7
In her book, Schildkrout describes seventy different illnesses that may have psychological symptoms and may therefore elicit a misdiagnosis based on the categories of symptoms in the DSM, rather than a diagnosis associated with the actual illness. With many of the disease descriptions, she lists “Possible Presenting Mental Signs and Symptoms,” and in another section she lists diseases “that may present with anxiety,” a “depressed mood,” “episodes of fear,” and so on.8
Such misdiagnosis has been a long-standing concern with us. In our first book, The Psychological Way/The Spiritual Way, published in 1979, we have a brief section titled “Body/Mind: Misdiagnosis and Mistreatment,” in which we describe cases in which people were misdiagnosed as having a mental problem when they were actually suffering from debilitating physical diseases. Schildkrout’s book is a step in the right direction, and we hope many psychotherapists and medical doctors, particularly psychiatrists, internists, and family practice physicians, who are often the first to see a patient who is suffering mental distress, will read it.
In addition to known diseases, there may be excruciating mental-emotional symptoms for diseases not yet discovered. In fact there is a growing body of research indicating that mental, emotional, or behavioral symptoms may be caused by stealth germs in the body. For instance, people thought that ulcers were the result of worry and emotional stress until researchers discovered that they are actually caused by the bacterium Heliobacter pylori.9 Research is also bringing to light the possibility that OCD (obsessive compulsive disorder) has its pathogenesis in certain viral organisms. The authors of “Viral Antibodies in Blood in Obsessive Compulsive Disorder” say:
Obsessive Compulsive Disorder (OCD) is a relatively chronic disorder characterised by repeated thoughts, actions, impulses, ideas, images or actions, which are recognised as being irrational and are resisted. Although most of the earlier theorists regarded OCD to have a psychodynamic basis (Freud, 1909), recent work has focussed on its biological correlates (Jenike, 1984).10
Harvard Medical School posted a warning to parents of young children who suddenly develop strange behavior:
With evidence mounting about the connection between infection and sudden-onset OCD, as the executive director of the International OCD Foundation I helped coordinate two new public service announcements to help raise awareness that OCD and tic disorders can be triggered by infections in children. For many of these children, quick treatment with antibiotics can be the key to reversing OCD, tics, and other symptoms.
At the International OCD Foundation, we have heard heart-wrenching stories of well-adjusted children who develop sudden onset OCD. I have seen chilling before and after videos. One clip, with a time stamp of August 10, 2010, shows a typical, happy go lucky kid. The next clip, dated August 12, 2010, shows a screaming, terrified child and bewildered parents.11
This problem of misdiagnosis and maltreatment is not confined to medical doctors and psychotherapists. This serious problem has now ensconced itself in churches that refer their people to mental health systems and churches that do psychologically tainted biblical counseling. Unfortunately, it will be a long time before pastors and other church leaders quit referring their people out to psychotherapists and psychologically influenced “biblical counselors.” If any referral is to be made at all, it should be to the person’s own primary care doctor in case there is an underlying disease. Then, in addition to that referral, the body of Christ in the local fellowship should minister to the person, not with the assumption that the cause is spiritual, but rather to pray and bring biblical and practical help. When members of the body of Christ are suffering, others in the body need to encourage, comfort, pray, and respond through practical acts of mercy and help.
Human Complexity
King David, astounded by the amazing way God created us, exclaimed: “I will praise thee; for I am fearfully and wonderfully made: marvelous are thy works; and that my soul knoweth right well” (Ps. 139:14). By inspiration he wrote about our genetic make-up hidden within the coded language of the DNA:
My substance was not hid from thee, when I was made in secret, and curiously wrought in the lowest parts of the earth. Thine eyes did see my substance, yet being unperfect [unfulfilled]; and in thy book all my members were written, which in continuance were fashioned, when as yet there was none of them (Ps. 139: 15-16, bold added).
Every human being starts out with a complex set of DNA, which has been affected by the fall to the extent that individuals may be genetically vulnerable to certain diseases. Today scientists are finding certain patterns that may predict disease vulnerability. For instance, Huntington’s Disease often has mental symptoms of anxiety, apathy, depression, moodiness, irritability, aggression, and psychosis, some of which may precede the physical symptoms.12
Yes, we are “fearfully and wonderfully made” and scientists have just touched the surface! The brain itself is considered the “last frontier of medicine,” and the more that is discovered, the greater the realization that much remains a mystery. The brain interacts with every part of the body as well as with the external environment, and now scientists have revealed that it also interacts with the vast number of microbes in the intestine.
In his book The Mind-Gut Connection, University of California, Los Angeles professor and researcher Dr. Emeran Mayer tells us that “there are 100,000 times more microbes in your gut alone as there are people on earth.”13 Throughout his book Mayer describes how this huge population can influence the brain in various ways. He describes how the gut and brain interact and how the gut microbe population can influence health and, if disturbed, “may even play a role in autism spectrum disorders and neuro-degenerative brain disorders like Parkinson’s disease.”14 He says:
Your gut microbes are engaged in ongoing conversations with your GI tract, your immune system, your enteric nervous system, and your brain—and as with any cooperative relationship, healthy communication is essential. Recent research reveals that the disturbance of these conversations can lead to GI diseases, including inflammatory bowel disease and antibiotic-associated diarrhea, and obesity, with all its deleterious consequences, and may be involved in development of many serious brain diseases, including depression, Alzheimer’s disease, and autism.15
Numerous articles can be found on government and educational websites on the “Gut-Brain Axis.” The Abstract for one article, in giving an overview of the influence of the gut on feelings and behavior, says:
The gut-brain axis (GBA) consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions. Recent advances in research have described the importance of gut microbiota in influencing these interactions.16
In an article from Trends in Neuroscience titled “Gut-brain axis: how the microbiome influences anxiety and depression,” Jane A. Foster and Karen-Anne McVey Neufeld say:
Going forward, there is a significant opportunity to consider how the gut–brain axis and, in particular, new tools will allow researchers to understand how dysbiosis [imbalance] of the microbiome influences mental illness.17
This entire field of research into the Gut-Brain Axis is fairly new and much has yet to be discovered regarding how people can be helped. However, this is one more example of how complex we are and, therefore, why proper diagnosis is so very vital, particularly in how the gut affects the brain and how the brain affects the mind. In other words, instead of thinking “It’s all in your head,” perhaps it’s all in your gut. Or, instead of it being a psychological problem, it is a biological problem needing a biological solution. Or, instead of it being solely a spiritual problem, it is indeed a biological problem affecting the brain and thereby affecting the mind, will, and emotions. Or, instead of it being a psychological or biological problem, it may be a spiritual problem after all.
Context of Symptoms
Symptoms of fear and depression are often simply normal responses to life’s challenges. Therefore, one also must add context to the confusing mixture of influences on the mind and issues of the soul. Not everything is biological and not everything is abnormal. The context in which symptoms occur is extremely important, particularly when it comes to fear, anxiety, and depression. For instance, fear is a natural response when confronting a bear or a rabid dog or even if there is an unusual noise in the house. Sadness is an appropriate and normal response to disappointment or loss. Frustration can be entirely normal under many circumstances. Anxiety is also a normal response to fearful events, such as public speaking. There is often too hasty a diagnosis when a behavior should be recognized as normal within the surrounding circumstances.
In the forward to a book titled Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, Robert Spitzer says:
The Loss of Sadness represents the most cogent and compelling “inside” challenge to date to the diagnostic revolution that began almost 30 years ago in the field of psychiatry. The authors begin by arguing for the existence of a universal intuitive understanding that to be human means to naturally react with feelings of sadness to negative events in one’s life. Incontrast, when the symptoms of sadness (e.g., sad feelings, difficulty sleeping, inability to concentrate, reduced appetite) have no apparent cause or are grossly disproportionate to the apparent cause, the intuitive understanding is that something important in human functioning has gone wrong, indicating the presence of a depressive disorder. Horwitz and Wakefield then persuasively argue, as the book’s central thesis, that contemporary psychiatry confuses normal sadness with depressive mental disorder because it ignores the relationship of symptoms to the context in which they emerge. The psychiatric diagnosis of Major Depression is based on the assumption that symptoms alone can indicate that there is a disorder; this assumption allows normal responses to stressors to be mischaracterized as symptoms of disorder. The authors demonstrate that this confusion has important implications not only for psychiatry and its patients but also for society in general.18
This foreword by Spitzer is especially telling since he was involved in creating the third edition of the DSM in 1980. Since then he has been concerned about clinicians diagnosing according to symptoms alone without considering the context in which emotional or behavioral symptoms occur.
After all is said about diseases, the relationship between the mind and the gut, and the context of symptoms, we must remember that God created humans with a soul and a conscience. Therefore, within the context of the Bible and all that is included in the spiritual life, we must consider God’s involvement in every aspect of our being. Fear may originate in the conscience; sadness may come from the consciousness of sin in oneself and others. God created people with emotions and the Bible has much to say about emotional issues. In fact, some symptoms may come from alienation from God. Christ calls individuals to come to Him to find rest and peace:
Come unto me, all ye that labour and are heavy laden, and I will give you rest. Take my yoke upon you, and learn of me; for I am meek and lowly in heart: and ye shall find rest unto your souls. For my yoke is easy, and my burden is light (Matt. 11:28-30).
As scientific research reveals more and more about the mind-body connection within the context of living, we hope that more and more people will be helped. In the meantime, all of us need to take a humble look at ourselves and one another and not jump to conclusions about anyone’s emotional problems. We are indeed “fearfully and wonderfully made” and we live in varying circumstances, all in the context of a universe created by God. We pray that as medical knowledge increases, there will be less misdiagnosis in the realm of the mind and emotions. We also pray that Christians will not be too hasty in assuming that mental-emotional problems are solely spiritual. But, more than that, we pray that Christians will seek God for solace in all these things, for He is the one who made us. He is the One who knows exactly what’s going on in every individual and uses all for our spiritual good. We pray that referrals to psychological talk therapy will be replaced by mutual care among believers to help one another endure through trials and grow spiritually. Throughout every trial we are in our Father’s care and He uses various trials, including illness, to conform us to the image of Christ (Rom. 8:28-29), until that day when we are given glorified bodies and see Jesus face to face.
Because of the vast spiritual needs of most people who are enduring trials, medical doctors, psychiatrists, and psychotherapists would do well to refer their patients to the church for spiritual help and sustenance. As it is now, doctors and therapists refer patients to various religious practices in addition to the secular religion of psychotherapy. Patients are urged to participate in Yoga, Eastern forms of meditation, and guided imagery, but not Christianity.
Nearly 40 years ago one of the world’s best-known psychiatrists, Thomas Szasz, recommended taking mental health care away from the professionals, such as M.D.’s and Ph.D.’s, and giving “this whole business back to the ministers and priests and rabbis.”19 This also would have meant taking it away from the Christians who are psychological counselors. If this had been done, both the mental and spiritual health of the nation could have dramatically improved, that is, if the church had not already fallen in love with psychotherapeutic theories and therapies. However, having lost much of its birthright through worldliness, much of the church would have been ill prepared, because the seminaries were already including too many of the ideas and techniques from the world of counseling psychology.
After winning the Nally v. Grace Community Church of the Valley case for Grace Community Church, the first case of its kind, Samuel E. Ericsson wrote an article about the implications of the legal theory known as “clergyman malpractice.” 20 These implications reach into the very heart of what it means to be a Christian, and at one point he says:
It is inevitable that in making the courts the battleground for evaluating the content of the counseling, two inherently inconsistent world views will clash. The secular humanist proponents will echo the views set forth, for example, in the Humanist Manifesto…. The opposite world view, of course, is that of the religious community as seen in the Christian belief in a personal God, who cares and answers prayer and has spoken through His Word-the Holy Scripture.21
One of the issues of Nally’s lawsuit was that the church did not refer their son, who had committed suicide, out to psychotherapy. In response to that issue, Ericsson says:
The propriety of imposing on the clergy a duty to refer leads to the question of whether the courts should create a reciprocal legal duty on the part of mental health professionals, such as psychiatrists and psychologists, to refer to clergymen all spiritual cases—the simple as well as the serious—with a consequent liability for failing to refer their patients to the “proper” clergyman in the event of a suicide? Should the moral model take a backseat to the medical model in counseling?22 (Emphasis in original.)
It is time for Christians to reclaim and restore the cure of souls ministry and to do it now! In the book of Nehemiah, Tobiah was an opposer and ridiculer of the Israelites building a wall around Jerusalem. Yet, when the Temple was restored, Tobiah was given a room in the house of the Lord. When Nehemiah heard of it he came and threw him out. (Neh. 4:3; 6:1; 13:4-9; 1 Kings 11:2, 3.) This is what needs to be done with the Tobiah of psychotherapy in the church. Psychotherapy, with its facade of science needs to be purged from the church so that Christians will once more: “Bear ye one another’s burdens and so fulfill the law of Christ” (Gal. 6:2).
Even if the day never comes when psychiatrists and other medical doctors refer patients to the church, the body of Christ should take the lead and minister to its own and to others who desire to come. At the same time, believers would be wise to remember the complex relationship between the mind/soul and the brain/body. It’s time for a reversal of referrals away from psychotherapy: away from psychological talk therapy over to medical doctors when necessary, and especially away from psychological talk therapy and back to the church, where it existed as the cure of souls before the rise of the psychological counseling movement.
Martin Lloyd-Jones affirms the need to proclaim and trust the Word of God, when he says: “Nothing can substitute preaching—no psychological counseling or group therapy, or any one of the latest passing fads and crazes.”23 The largest of the four branches of psychotherapy is the humanistic one. The Association for Humanistic Psychology is the professional association of humanistic psychologists. Its president at the time, Dr. Lawrence LeShan, said, “Psychotherapy may be known in the future as the greatest hoax of the twentieth century.”24 It may also be known as one of the greatest heresies of modern-day Christianity.
A beginning step away from this fad of referring fellow believers to psychological counseling would be for pastors and all true believers to trust the sufficiency of Scripture, ministered by the Holy Spirit in the fellowship of the saints for dealing with the issues of life.
Endnotes
1 “DSM-5: Psychiatrists’ ‘Bible’ Finally Unveiled,” Huffington Post, 05/16/2013, www.huffingtonpost.com.
2 “4 Controversial Mental Disorders,” Paula Derrow, Berkeley Wellness, 9/10/2015,www.berkeleywellness,com.
3 “DSM-5: Psychiatrists’ ‘Bible’ Finally Unveiled,” op. cit.
4 Barbara Schildkrout. Unmasking Psychological Symptoms: How Therapists Can Learn to Recognize the Psychological Presentation of Medical Disorders. Hoboken, NJ: John Wiley & Sons, Inc., 2011.
5 Barbara Schildkrout. Masquerading Symptoms: Uncovering Physical Illnesses That Present as Psychological Problems. Hoboken, NJ: John Wiley & Sons, Inc., 2014 (Kindle Edition).
6 E. K. Koranyi (1979), “Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population.” Archives of General Psychiatry, 36( 4), 414.
7 Schildkrout. Masquerading Symptoms, op. cit., p. xi.
8 Ibid., pp. 15ff.
9 Erno Daniel. Stealth Germs in Your Body: How Hidden Infectious Organisms Can Jeopardize Your Health. New York: Union Square Press, 2008, pp. 8-9.
10 Sumant Khanna, et al, “Viral Antibodies in Blood in Obsessive Compulsive Disorder,” Indian Journal of Psychiatry, 1997, Vol. 39, No. 3, pp. 190-195, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967113/pdf/IJPsy-39-190.pdf.
11 Jeff Sxymanski, Harvard Medical School blog posted 2/27/2012, http://www.health.harvard.edu/blog/can-an-infection-suddenly-cause-ocd-201202274417.
12 Schildkrout. Masquerading Symptoms, op. cit., p. 217.
13 Emeran Mayer, The Mind-Gut Connection. New York: HarperCollins Publishers, 2016, p. 14.
14 Ibid., p. 16.
15 Ibid., pp. 95-96.
16 Marilia Caraotti et al, “The Gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems,” Annals of Gastroenterology, Vol. 28, No. 2, April-June, 2015, pp. 203-209, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367209/.
17 Jane A. Foster and Karen-Anne McVey Neufeld, “Gut-brain axis: how the microbiome influences anxiety and depression,” Trends in Neuroscience, May 2013, Vol. 36, No. 5,pp 305-312, http://neuroscienceresearch.wustl.edu/userfiles/file/Gut_brain%20axis%20How%20the%20microbiome%20influences%20anxiety%20and%20depression_Tran%20%20%20.pdf.
18 Robert L. Spitzer, “Foreword.” Allan V, Horwitz and Jerome C. Wakefield. The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. New York: Oxford University Press, 2007, p. vii.
19 Thomas Szasz, “Nobody Should Decide Who Goes to the Mental Hospital,” CoEvolution Quarterly, Summer 1978, p. 60.
20 Samuel E. Ericsson, “Clergyman Malpractice: Ramifications of a New Theory,” Valparaiso University Law Review, Vol. 16, No. 1, p. 164, http://scholar.valpo.edu/cgi/viewcontent.cgi?article=1560&context=vulr. Footnote 3: Nally v. Grace Community Church of the Valley, No. NCC 18668-B (L. A. County Super. Ct., Cal., filed Mar. 31, 1980). On Oct. 2, 1981, summary judgment was granted as to all defendants on all counts by Judge Thomas J. Murphy, Superior Court of Los Angeles County, in Burbank, California. In addition, the court ordered the plaintiffs to reimburse the defendants for their costs. No appeal has been filed as of the time of this publication. Footnote 4: Sacramento Union, May 6, 1980, A7. Subsequent research has shown that it appears to be the first such case anywhere.
21 Ibid., pp. 172-173, http://scholar.valpo.edu/cgi/viewcontent.cgi?article=1560&context=vulr.
22 Ibid., p. 175..
23 Martin Lloyd-Jones’ quoted on the back cover of Majesty in Misery 3: Calvary’s Mournful Mountain: Select Sermons on the Passion of Christ by C. H. Spurgeon. Edinburgh, UK: Banner of Truth Trust, 2005.
24 Dr. Lawrence LeShan. Association for Humanistic Psychology, October 1984, p. 4.
PsychoHeresy Awareness Letter, September-October 2017, Vol. 25, No.5)