The following series of five blog posts is meant to build anticipation for my upcoming book, “After Psychosis: How Biblical Counseling Can Help.” They are each almost completely cut and pasted from the Book and placed in the following as excerpts.
Chapter One: The Clinical and Cultural Context
“The wisdom of God is seen in making the most desperate evils turn to the good of his children. As several poisonable ingredients, wisely tempered by the skill of the artist, make a sovereign medicine, so God makes the most deadly afflictions co-operate for the good of his children. He purifies them, and prepares them for heaven. These hard frosts hasten the spring flowers of glory.”
― Thomas Watson, A Body of Divinity
It is interesting to observe that the media has for years adopted the slogan, “If it bleeds, it leads.” There is no motivation to chase positivity. Basically, if it’s sensational, it’s the headline. For so many people, the first thing that comes to mind when they hear “schizophrenia” is the kid who had that diagnosis and shot up the school or the shopping mall. Maybe it’s the guy who got acquitted in court of horrendous crimes on the basis of “mental insanity.” The reason that people have such negative thoughts about this illness and about mentally ill people with related illnesses is because those are the images that come to mind.
The late psychiatrist Thomas Szasz, who sadly ended his own life in 2012, did nothing to stem the tide of those fears in his theory that mental illness is just society’s made up excuse for evil. But these terrifying cases are the select few cases that we see the most of in the headlines. The praiseworthy news about the guy who does the best he can with a similar diagnosis and lives in peace is never the headline because “If it bleeds, it leads,” and consequently, most of the hurting people who are sincerely trying just suffer the consequences.
The State of Mental Health in America
In 2023, the State of Mental Health in America Report indicated that 21% of Americans or about 50 Million of us suffer with a mental illness of some sort at this time.[1] That is up from the reporting of 2019 (before COVID) saying that 19.86% of Americans experienced a mental illness in that year.[2] Suicides and suicidal thoughts are up as well. One of the things I think we need to see is biblical hope as found scripturally.
The Bible is the real and most direct way that we can connect with God because He reveals Himself in His word. I address biblical hope in this book, essentially the how and why of hope and meaning and purpose. But it is equally troubling that a lot of people cannot afford medical treatment for themselves or their loved ones. Schizophrenia can be particularly devastating all the more for this reason alone, due to this simple but very difficult hardship.
Equally troubling is the related question of how mental illness is so much on the rise after COVID and perhaps what some would suggest are the ever expanding parameters of what some would call the new and more widely encompassing definitions of these illnesses in the supposed expansions of the DSM-V. My goal in this book is not to comment on these issues at all. The focus of this book is that there are very real and serious mental illnesses, and I happen to be diagnosed with the most troubling of those. I have fought it my whole adult life, and previous writing testifies to that.
Psychosis
A suffix for certain medical terms is “-osis.” It signals a condition, status, or process. It can denote a disease process or disorder of the body. Hematosis basically means “blood disease.” Coniosis refers to any disease caused by the inhalation of dust. Tuberculosis is a bacterial disease that mainly affects the lungs. Psychosis is like a disease of the mind, but it is technically a set of symptoms that may dissipate before there is ever a diagnosis made. However, because it seemingly affects a person’s soul, or their rational mind, so severely and directly, it is shrouded in some degree of mystery or even skepticism.
Essentially, it seems incredulous to some that other people can apparently sin so badly and yet blame it on a disease of the brain. And truly, these people are more in line with Thomas Szasz than with mainline medicine. And yes, some people have appeared psychotic and have been known to recover almost as randomly as they succumb. All of this adds to the mystery of this disorder.
At the same time, while my first book focused on the medical condition that causes psychosis, this book centers on the symptoms of that underlying cause. If someone recovers fully and permanently from a psychotic episode or chronic condition, then they never had the underlying disease. Psychosis can be caused by the underlying diseases I outline below, but this book shifts focus from these to the spiritual and biblical issues that can be addressed in the symptoms that are involved with psychosis or the spiritual issues alongside this which these people also face.
Dr. Girgis gives a brief definition of psychosis which can characterize the big three: schizophrenia, bipolar, and major depressive disorder, of which major depressive disorder (MDD) is much less likely to actually occur with psychosis than schizophrenia, and Bipolar is somewhat in the middle of the two. Schizophrenia consists of psychotic episodes throughout the patient’s life either recurring or chronic. Psychosis can also occur with dementia and drug use. In chapter two of his very interesting book, “On Satan, Demons, and Psychiatry: Exploring Mental Illness in the Bible.” Dr. Girgis writes,
Psychosis is defined as a disconnection from reality and is one source of commonality among serious mental illness. Psychotic symptoms include delusions, hallucinations, disorganized speech and disorganized behavior. Delusions are beliefs that are false. Delusions may be plausible (such as thinking that one is being monitored by the FBI, or that a famous movie star is in love with oneself) or completely implausible (e.g., thinking that one’s boss is actually an alien from another planet made to look like a human).
Hallucinations are perceptual phenomena, such as hearing, seeing, tasting, smelling or feeling something that is not actually present. These are most frequently auditory, such as hearing derogatory voices, but can be very bizarre and unusual (e.g., feeling as if an alien is crawling under one’s skin).
Disorganized speech is an abnormal thought process. There are many types of disorganized speech. Often, people with disorganized speech jump quickly from one thought to another with little to no association between the two thoughts. Other times someone with disorganized speech may be thought blocking (when a person stops speaking suddenly due to loss of a thought) or have complete “word salad,” in which there is no connection between the words being spoken.
Disorganized behavior is characterized by behavior that is inappropriate and gets in the way of normal functioning. An example of bizarre behavior is purposeless behavior. For example, especially before the advent of psychiatric medications, patients would hold abnormal postures for hours at a time, such as standing on one leg, or holding one’s arms out as if catching something, for no reason. Another example of disorganized behavior is very impulsive, disinhibited behavior, including impulsively assaulting people.
Negative symptoms are another type of psychotic symptom that are somewhat different than the four so-called “positive symptoms” described above. Negative symptoms involve a “loss” of functioning, such as anhedonia (the inability to experience pleasure), alogia (not talking), apathy, loss of motivation, loss of social interest, etc. People with substantial negative symptoms often appear flat, allow their level of hygiene to substantially deteriorate, and become isolated.[3]
Psychosis exists in these and other mental illnesses if only at times. They can also involve tendencies towards obsessive compulsive disorder and narcissistic personality disorder among other things. Schizophrenia is such that psychosis comes and goes throughout the course of the illness or it can be continuous but medication can also be preventative if taken at a constant rate. Yet, in cases with major depressive disorder and bipolar, psychosis can also be present. There are other mental illnesses that do sometimes involve psychosis, but these three are the most feared and predominantly associated with the dreaded psychotic symptoms.
- Schizophrenia
When a person looks at something complex it can be very confusing. An Amoeba is an example of something in nature that is protean or tends to change frequently or easily. Sunlight is another example where light particles can either present themselves as waves or particles. The character, Mystique, of the X-Men franchise is a villian whose superpowers are protean in nature because she can assume the form of any person she comes in contact with in the movies. An actor can be said to be protean because he can play any role. Schizophrenia is sort of protean in an actually far more negative sense because its presentation is vastly different in each person as it has been for years of medical research. Symptoms can vary too and in intensity. It is a multi-faceted and confusing medical and psychological issue which doesn’t necessarily present any overt biological basis, which happens to be the case with persons like me.
Many authors who are schizophrenic and choose to write about their experiences are very caught up in the drama of it. They wax on and on about its profundity and their own incredible insights due to being inspired by their own dark mental prisons. And yet they are very vain and childlike. There is a profound depth to their lack of awareness that cannot be expunged no matter how you treat them. And of course, people naturally distance themselves from such people because it is awkward and honestly kind of frustrating to interact with them. It can be pretty draining in a sense. Certainly, there is a self-infatuation and love for the bizarre that is dark and sinful. They simply cannot switch these or related things off.
Psychotics can feel deeply that someone has or is controlling them. Yet they are simply victims of their own biology. I believe this to be the case even though some persons in general would present a lack of evidence for the hard facts of this – both religious and not. There may actually never be a cure for schizophrenia, while at the same time, there may be something appealing to some individuals about the supposed romance of their own version of insanity. One must grant this only to a limited extent and with the very real understanding that the brain is so complex and intricate that it makes sense that we simply can’t detect a lot of the things that could go wrong and still do.
And it is a world of inhibitions, or feelings that make them tense and unable to relax especially in social contexts. Without reason, they fight to expose those inhibitions with what they feel to be a sense of the somewhat troubled complexity of it. In the worst cases, they provide rather disjointed lines of thought and random statements. They are fighting against their own faulty chemistry, whose minds routinely make demands on their attention so that they struggle with basic social skills. And the weirder they feel, and the weirder their receptions in public, the harder their attempts to make sense of it all, hence deepening delusions in an effort to account for it. Honestly, there is often little anyone can do.
All that being said, this “mania” is found up and down the strata of common and somewhat famous people alike. For many persons, schizophrenia itself is such a debilitating disease that it renders them unable to function, and yet, Vincent Van Gogh was schizophrenic, as well as John Forbes Nash, Jr. of the movie, “A Beautiful Mind.” Carrie Fisher of “Star Wars” was schizophrenic. Eduard Einstein who was the son of the great Albert Einstein was diagnosed with schizophrenia while studying medicine at the age of 20. I have heard of people studying things like Nuclear Physics in the Military who simply came to a point and “snapped,” in the words of my acquaintance. But certainly the majority of schizophrenic people who struggle hard with psychosis and its symptoms, like paranoia, mood instability, suspicion, fear and the like are not super intelligent. That is a common myth that needs to be dispelled.
Schizophrenia is a psychiatric disorder involving chronic or recurrent psychosis. It is commonly associated with impairments in social and occupational functioning. It is among the most disabling and economically catastrophic medical disorders, ranked by the World Health Organization as one of the top ten illnesses contributing to the global burden of disease.
Characteristics of Schizophrenia typically include positive symptoms such as hallucinations or delusions, disorganized speech, negative symptoms such as a flat affect or poverty of speech, and impairments in cognition including attention, memory and executive functions. A diagnosis of Schizophrenia is based on the presence of such symptoms, coupled with social or occupational dysfunction for at least six months in the absence of another diagnoses that would better account for the presentation.[4]
But I have wanted to focus on broader issues rather than to talk specifically about schizophrenia. There are other disorders that can exhibit psychosis or psychotic episodes. Several of these I have not researched, but those more often associated with psychosis are bipolar and MDD.
- Bipolar
According to the National Institute of Mental Health, bipolar disorder can manifest itself in more than a couple ways:
“Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks.
There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
Bipolar I disorder is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called “rapid cycling.”
Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.
Cyclothymic disorder (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.
Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as ‘other specified and unspecified bipolar and related disorders.’”[5]
- Major Depressive Disorder
MDD can be a very devastating and difficult condition. Some people have it very severely, while others might only deal with less extreme forms of difficulty. Many people deal with it once in their lives, receive treatment and counseling, and are able to move on, but that is certainly not always the case. The Cleveland Clinic defines it as follows:
Clinical depression, also known as major depressive disorder (MDD), is a mental health condition that causes a persistently low or depressed mood and a loss of interest in activities that once brought joy. Clinical depression can also affect how you sleep, your appetite and your ability to think clearly. These symptoms must be present for at least two weeks for a diagnosis.
Clinical depression is a chronic condition, but it usually occurs in episodes, which can last several weeks or months. You’ll likely have more than one episode in your lifetime. This is different from persistent depressive disorder, which is mild or moderate depression that lasts for at least two years….
Clinical depression (major depressive disorder) is common. It’s one of the most common mental health conditions. It affects 5% to 17% of people at some point in their lives.[6]
The article from Cleveland Clinic goes on to show that there are in fact a few different subcategories of this illness that are related but different. They consist of the following:
- Seasonal affective disorder (seasonal depression).
- Prenatal depression and postpartum depression.
- Atypical depression.
People who have some degree or form of clinical depression can also have some other mental health conditions or problems, such as:
- Substance use disorder (dual diagnosis).
- Panic disorder.
- Social anxiety disorder.
- Obsessive-compulsive disorder.
The article goes on to say that this condition can affect anyone at any age, but it most often begins to affect persons in their 20’s, which is very common. Again, the essence of the problem is that, though it can begin with life events, trauma, or times of stress and difficulty, it will persist without stopping for two weeks or more. Some people chose to simply call all of this “depression,” but that fails to accurately convey the nature of its many forms and onsets.
To Medicate or to Pray? – A False Dichotomy
The perhaps clinical, and inherent overshadowing of all this specific terminology, can have the negative effect of distracting some of these persons away from biblical solutions and even focusing on their identity as “sick.” Even with medication, biblical hope can alleviate their symptoms if not greatly help cases with regards to their perspective, or in their coping or proactive efforts to counter the sin in their hearts.
Regardless, as seen in a later chapter, the integration of prayer and spirituality with the personal God of scripture has a unique effect on neuroplasticity, where I cite neurobiologists to this effect, which also in this case, tends to directly impact a person’s ability to form and maintain relationships and to adapt.
In fact, I will state my conclusion at the outset and say that all psychotic people struggle with sin, and the Bible helps them. But psychotic people, being sinners, should not be presumed psychotic because they are sinning. We will look at the way the biblical worldview can also form a person’s moral and spiritual life in the final two chapters. It changes us from hopeless to hopeful. It fills an inner void that needs to be addressed with significant spiritual aid.
There is also a sense in which I am undecided about schizophrenia. It is too complicated an issue for me to ascertain what exactly it is, assuming it is one thing. My first book delved into more of that. I believe it is still prevalent to believe that schizophrenia is likely an autoimmune disorder that ravages different parts of an afflicted person’s brain.
Neither am I convinced about the issue of biblical counseling verses integrationist counseling per se. I will say that I want to agree with biblical counselors, but I cannot sometimes reconcile my experiences with some of the things that some biblical counselors say dismissively about this condition. I remain willing to learn, but so far, I am unable to see psychosis as something other than biologically affected or biologically based, or possibly even spiritual (though I know that it is not helpful to address psychotics as if they were demon oppressed). I address a gamut of these issues in this book, and I think that any of it can help, but again, the point is to find the most help in God’s word, which has the power to transform our thoughts, even if we are “chemically imbalanced.”
Neither would I suggest that psychotic people don’t need their meds, not even in the least! I am not a counselor. I am attempting to document my own navigation of these issues and to come alongside other people who are affected by these things directly or indirectly. I have even met some few people, and read about some others, who did come off of their meds (with the full knowledge and cooperation of their psychiatrist – which should always be the case) and were successful, but strictly speaking, perhaps one could say that the critics were right in their situation, but not with regards to countless others, for whom medication is more than a temporary crutch, as is the case with myself and so many more.
All the while, these critics fail to see that there is a lot more to modern psychiatry than medication and big pharma! I believe that having Christians in psychiatry is a huge blessing. This book is not about these issues, however. This book is a positive approach to how biblical counseling can really bless and encourage us who have been diagnosed with these conditions. The first few chapters following in this book deal with preliminary concerns and context.
[1] 2023 State of Mental Health in America Report. MHANational.Org. (Online) https://mhanational.org/sites/default/files/2023-State-of-Mental-Health-in-America-Report.pdf p. 8
[2] 2022 State of Mental Health in America Report. MHANational.Org. (Online) https://mhanational.org/sites/default/files/2022%20State%20of%20Mental%20Health%20in%20America.pdf p.8
[3] Ragy R. Girgis. On Satan, Demons, and Psychiatry: Exploring Mental Illness in the Bible. (Wipf and Stock Publishers: Eugene, OR) p.15
[4] Richard Hermann, “Schizophrenia: Clinical Manifestations, Course, Assessment, and Diagnosis,” UpToDate.Com, July 26, 2013, accessed Februrary 24, 2015, http://www.uptodate.com/contents/schizophrenia-clinical-manifestations-course-assessment-and-diagnosis.
[5] National Institute of Mental Health. “Bipolar Disorder.” NIMH.NIH.Gov. Accessed on 23 October 2023. https://www.nimh.nih.gov/health/topics/bipolar-disorder
[6]Cleveland Clinic. “Clinical Depression (Major Depressive Disorder).” Accessed 23 October 2023. https://my.clevelandclinic.org/health/diseases/24481-clinical-depression-major-depressive-disorder
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