Tuesday, January 10, 2006

On the Internet Monk's "Christians and Mental Health"

Albert Mohler just wrote about the Reign of the Therapeutic which reminded me that I have yet to respond to Michael Spencer, the venerable Internet Monk, who recently did a whole series on The Christian and Mental Illness. Mr. Spencer's work is good reading and good thinking, as usual.

Spencer points out that Freud has done more than even Darwin to introduce tensions into Christendom. This is most certainly true. Freud's language and ideas have so saturated our culture that it's hard to think about what it would be like to talk about motivations and behavior without reference to the idea of the unconscious. We talk about someone being "anal retentive" and engaging in "repression" without any hesitation whatsoever.

However, I would again remind all: Freud is not the father of Psychology. That honor goes to Wilhelm Wundt in about 1879, when he founded the first laboratory for experimental psychology. Freud published his first major work The Interpretation of Dreams in 1900, and became the father of personality psychology. Modern applied psychology (Clinical, Counseling and Industrial/Organizational) in many ways has more to do with the former individual than the latter.

Despite this being a pet peeve, I understand the Freud=Psychology association that most people have (which is similar to the Schizophrenia=Multiple Personalities mistake). Freud was indeed extremely influential. I really enjoy Vitz's reinterpretation of Freud. He sees alot of Freud's work as a reaction against his strong attraction to Christianity. Vitz also talks about Freud's prototypical individual as the opposite of Christ - kills the father versus submits the the father, etc. Vitz's extremely interesting book on Freud is available for free here.

Spencer is absolutely correct that our culture calls on the psychologists when there is a crisis, as the sort of "secular chaplains of the American religous/cultural mileau." There is a movement within psychology to appreciate religion and even use spiritual interventions in counseling. In many ways, this is worse than an open animosity. At least when religion was pathologized, people were aware that the therapist was clueless and hostile to their beliefs. Now that some psychologists have a rudimentary knowledge of psychology and everything goes as "true for you," the therapist is actually more dangerous. Read some of this issue of the APA's Monitor on Psychology issue on Spirituality and Mental Health.

Regarding FBI profilers, everyone who watches Dangerous Minds should read these articles from the APA Monitor on Psychology - Psychological Seluths.

Another point that I would like to make concerns the Monk's battle with the concept of normal versus mental illness. There is actually a supposed failsafe for this problem built into the Diagnosic Manual of Mental Disorders (presently in is 4th - text revised edition, or DSM-IV-TR). Most diagnoses require subjective distress in order to be used. That means that theoretically, you, not society get to determine if you have a mental illness. If you're about to function adequately in the world even though you have obsessive rituals, you do not have a diagnosable condition. I don't remember where I heard it (see: source monitoring error) but I heard that there was a high-powered executive who had cleanliness obsessions and compulsions, but since he had a shower in the room off of his office, he was able to function quite well. Actually, there is controversy about the subjective distress criterion, particularly in the personality disorders which are characterological and tend not to cause distress. The best example is Antisocial Personality Disorder which is a "pervasive pattern of disregard for and violation of the rights of others" for which remorse is superficial or non-existant. Many have begun to talk in terms of a problem being "maladaptive" rather than "abnormal" or an "illness." This reflects more of a psychological understanding (the behavior was learned and can be changed) rather than a medical model (the patient is sick and needs to be fixed). But this shift is also inadequate to deal with personality disorders because Antisocial Personality Disorder can help a person achieve great power and fame becuase they become good at manipulating others and do not have qualms about doing so. This is true as long as the person also has a good bit of intelligence.

The medical model itself has its detractors, even from without the Christian community. The biggest problem with the medical model right now is that that it is used to restrict treatment goals. The APA has said that becuase homosexuality isn't a mental illness, treatment of homosexuality is a non sequitur. This argument doesn't seem to float because I could present to treatment for shyness and receive help, despite the fact that shyness isn't a mental disorder (but Social Anxiety is if it reaches the point that it interferes with my normal routine and there is "marked distress about having the phobia"). It actually made some sense when there was an Ego-Dystonic Homosexuality diagnosis (ego=I + dystonic=out of sync therefore "my sexual attractions are out of sync with my identity"). Now you would have to diagnose such a person as Sexual Disorder Not Otherwise Specified one example of which is "persistent and marked distress about sexual orientation."

Managed Care opperates from the standpoint of a medical model. If there is no diagnosable condition, then they won't cover it. The problem with this is that it discourages preventative care and doesn't cover things that lead to problems. Marital therapy is often covered differently or not at all. Vocational testing and counseling are often not covered either. One can easily see how work stress often follows a person home and affects well-being.

The good Monk also got me thinking about "mental illness" as a turning inward. Adler recognized that depressed people could become self-absorbed and would prescribe thinking about "how you can give another person pleasure." Now of course, I might change the task a little, but the idea of turning outward is interesting to me. I like Frankl's term - dereflection.

A couple more points and I swear I'm done.

Michael uses the terms Manic Depressive and mentally ill quite a bit. My training was of late so I am privy to the current thinking in psychology, especially Counseling Psychology wherein I would be excommunicated for calling someone a Manic Depressive. We would say, "a person with bipolar disorder" rather than "a Manic Depressive patient." Now I react just as strongly as you do to the idea that we are sugarcoating our language, but I do see where this is appropriate. First, a global label like Manic Depressive tends to be reifying - as a clinician you might start thinking of clients as diseases not people (rewatch Patch Adams). Also, it does no favors to the client, who can then blame all sorts of behavior on their being a Manic Depressive.

Finally, I just read a journal article that showed that psychologists who are trained in secular university are actually more dogmatic or conservative, presumably becuase they have had to defend their convictions throughout. Interesting that I am leaving graduate school as a Confessional Lutheran when I started as not much.


Blogger Kent Runge said...

Nice job analyzing iMonk ;)

I fully appreciate the point that you and Patch Adams make; and recently saw a client make a turn related to my correction of her statement 'I'm Borderline'. I told her "You are [insert name] and are suffering from borderline personality disorder."

It took a bit to sink in as there are developmental challenges as well, but our identity is not our disease/disorder.

8:31 AM  
Blogger Bob Waters said...

Good post.

Lest we be too hard on psychology and the tyranny of the theraputic mindset, however, it's worth considering another aspect.

I run a support group for Christians with Obsessive Compulsive Disorder. The single biggest obstacle Pentecostals particularly seem to face in dealing with the religious aspects of OCD is the virtually unshakable conviction that it is not a medical disorder at all, but is caused by evil spirits.

There are mindsets other than theraputic which can get in the way of dealing with one's inner struggles in a productive and God-pleasing way.

9:01 PM  
Blogger CPA said...

INteresting point about those in secular schools ending up more dogmatic or conservative. BUt do you think they mean "dogmatic about religious confessions" or "dogmatic about the religion of psychology"?

10:12 AM  

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