Across the world millions of people struggle with the pain of a mental illness diagnosis. I am a biblical counselor and have walked with many people down the dark, hard road of responding to these problems. From dysthymia to panic disorder there are few difficulties in human experience as painful, isolating, and complex as the ones our culture calls mental illness.

I, along with many others, am trying to devote my life to helping people overcome the pain of these diagnoses. There are many challenges involved in overcoming them. One of those challenges is that when we use the term “mental illness” nobody really understands what we are talking about.

Most Christians simply do not have a clear understanding about the nature of mental illness. I think when most Christians use the term they are talking about hard and complicated problems that produce significant debilitating effects. When they see these problems they find them to be so extreme and troubling that they believe they must require some type of medication to correct a perceived physical problem.

Christians are right to want to provide all the help possible for these kinds of problems. If we want to provide real help, however, it will be important to know what we’re talking about when we use the term.

What Is Mental Illness?

Defining mental illness is a hard thing to do. The Diagnostic and Statistic Manual of Mental Disorders (DSM), the catalogue of mental illnesses created by the American Psychiatric Association, regularly changes the definition of mental illness. Their changing definitions are meant to keep up with the changing opinions in psychology about mental illness. But they're often at odds with the definitions provided by other entities like The National Alliance of Mental Illness. Writing in Psychology Today, secular psychologist Eric Maisel points to the failure of psychologists to define mental illness as proof that the phenomenon doesn’t even exist.  

Everybody knows that people with a mental illness diagnosis have genuine problems. The question concerns the nature of the problem. The DSM was first published in 1952 to create a system of language for new kinds of problems. Psychologists had a good desire to provide categories for serious issues that overwhelmed people with difficulty, but for which they could find no evidence of pathology.  

Pathology is what physicians look for when they diagnose disease. It is a physical abnormality that is the cause of illness. For example, people receive a diagnosis of cancer when they have a mass of cells in their body that divides and multiplies at a rapid and uncontrollable rate. Scientists know about this pathology because of repeated testing and observation of normal cell growth compared to abnormal cell growth. Physicians perform medical exams and determine objective results against a clear standard. They render a medical diagnosis of diseases by doing tests that demonstrate concrete evidence of pathology.

Most people wrongly assume that mental illnesses in the DSM are characterized by this same level of medical precision. They are not. Unfortunately, there are no medical tests to determine the existence of most of the disorders in DSM. In general the disorders listed in the DSM have several characteristics that separate them from the diseases in the rest of medicine. Below I list three of them.

1. Not pathology, but committee votes

Unlike diseases in medicine, diseases in psychology are created by committee votes. One reason there are so many different versions of the DSM is because different committees keep voting to add, subtract, and modify the various disorders. There are many examples of this practice in the history of DSM. One glaring example is homosexuality.

In the early editions of the DSM homosexuality was listed as a mental disorder. In 1974, the APA removed homosexuality from the DSM-II. Homosexuality was declared to be normal by the vote of a 15-member committee. This committee was not responding to any new scientific information, but rather to political pressures supplied by gay-rights activists. 

Not all the DSM disorders are as politically volatile as homosexuality, but all of them are characterized by the fact that they are created, removed, and modified by committee votes. Votes like this are altogether different from the medical science behind diseases like cancer, diabetes, and Alzheimer’s.

2. Not pathology, but subjective behavior descriptions

The objective science of medicine determines disease through biopsies, blood work, X-rays and other tests, which discover pathology. Psychology determines mental illnesses differently. The same committees that vote on which problems are normal and which ones are not also vote on the descriptive behaviors that determine the illnesses. Depression is just one example.

The committee working on DSM-IV agreed that people would be considered mentally ill with a diagnosis of major depression if they had a depressed mood for two weeks and manifested five out of nine criteria including changes in sleep, changes in activity, and feelings of guilt. The committee on DSM-V voted to make significant changes to these criteria so that now, a woman grieving the death of her husband can receive this diagnosis.

People who meet these criteria in the DSM have a problem for which they need help. Christians ought to be eager to help them. But it is not typically the work of medicine, seeking pathology, to make a medical diagnosis from a changing list of subjective behavior descriptions.

3. Not pathology, but moral behaviors

Many of the behaviors that the DSM describes are moral categories that God describes. I previously mentioned homosexuality. But consider Gender Identity Disorder (GID), which is described in the DSM as a mental disorder.

GID is trans-sexualism. The DSM defines it as a strong, persistent feeling of identification with the opposite gender and discomfort with one's own assigned sex. People with GID desire to live as members of the opposite sex and often dress and use mannerisms associated with the other gender. Psychologists recommend several different kinds of treatments for GID, from counseling to deal with the pain over being assigned the “wrong” gender, to gender-reassignment surgery.

It is characteristic of the DSM to medicalize moral problems—from GID to worry—addressed by God in his Word.

What This Does and Does Not Mean

None of this description diminishes the significant suffering going on in the lives of people diagnosed with mental illness. People struggling with these problems need complex and multi-faceted help. People with a mental illness often have a physical pathology for which they need medical interventions.  

But this understanding means we need to admit that these problems are typically different from mere medical problems. If we want to help people with mental illnesses we need to have an accurate understanding of what we are talking about. When we conclude that mental illnesses are equivalent to something like Non-Hodgkin’s Lymphoma in their level of pathology we are saying more than even the secular psychologists who write DSM.

Biblical Anthropology

As Christians we believe that human beings have both a body and a soul. This is something that the Bible teaches clearly and repeatedly (Gen 2:7; Matt 10:28; 2 Cor 5:1; 1 Tim 4:8). The Bible affirms both physical and spiritual problems because God created mankind to consist in each of these realities.

This biblical teaching, called dichotomy, means that it is just as biblical to take a Tylenol for a headache as it is to fight to depend on the Lord in times of financial stress. The biblical teaching on dichotomy is also a warning to Christians. Because humans are both soul and body, it is sinful and ignorant to reduce all problems to the spiritual. The inverse is also true: it is wrong to reduce all problems to being physical in nature.  

As I mentioned previously, I think Christians look at the problems represented in mental illness diagnoses and think that they are so extreme in nature that they must be physical problems. A biblical understanding of humanity and the importance of the soul demonstrates that problems do not have to be medical to be serious. Job’s overwhelming grief, Saul’s murderous rampages, Nebuchadnezzer’s deranged behavior, and the ravings of demoniacs in the New Testament are all examples of extreme spiritual problems that medical intervention will never help. Christians must not assume that all serious problems are medical problems.

We like extremes. We feel comfortable when problems are all one thing and none of something else. The biblical teaching on dichotomy teaches that problems can be physical, spiritual, or any combination of the two. Caring for people means being alert to physical problems that require medical treatments and spiritual problems that require Christ and his Word. The designation of mental illness by the DSM is not as helpful in determining the difference between these matters as I wish it were.

I’m praying for a revival of uniquely Christian concern with troubled people. When Christians look at folks diagnosed with depression, anxiety disorder, and gender identity disorder we are not allowed to see merely medical problems. Medical issues may be on the table, but where are the Christians who will do more than encourage medication? Where are the Christians who will plead with those locked in a mighty struggle with everything from depression to GID to draw near to Jesus Christ, the comforter of their souls? 

When we look at mental illnesses and only find medical categories, we do not understand the term, and we dishonor Jesus Christ. In doing so we will also keep troubled people from the fullness of help they need. Yes, people with severe problems often need medication. But even when medication is necessary no medical doctor can prescribe what the Great Physician alone can provide.