Schizophrenia, Mental Illness, and Pastoral Care

The bottom line is that we simply do not know where to divide sin from warped biology in mental illness. I am, however, not talking about alcoholism, which does not have very much support for being an illness, but about schizophrenia. What is brain disease? Science has so much to grow in and to learn about that we continue to develop all the time. The answers are coming slowly but surely. I greatly hope to know what causes schizophrenia in my own brain by the end of my lifetime.

There is a lot in the secular world that is excused as illness that shouldn’t be, on the one hand, and there is a lot that we are gradually learning about, especially in the traditional biblical counseling community, that does not need to be seen as sin, on the other hand. Mental illness is not a bad word. A pragmatic approach to the vast terminologies for each “mental illness” needs to be taken into consideration. Of course the term “mental illness” is overused, and sin is over-excused, but let’s not go too far in the other direction.

I believe that there is just too much about the human brain that we do not understand. I believe that because of that, we should take a less certain stance in whatever direction we lean. When dealing with people, already confused people, we could lead them to conclude any vast number of narratives regarding their suffering. They could adopt a number of our convictions and make them their own and fill in their newly adopted paradigm with all the events of their lives and make it convincing. My book is not about doing that. I am not writing to fit what I am saying into a perspective on mental illness. I am writing to share with you the basics of what we do know, what I have been through myself, and what we can do as ministers of the gospel.

This does not mean at all that sin is not present. We are never not sinful. We are always wrestling with this body of death just as Paul did in Romans 7. As biblical and pastoral counselors, we know that sin is there. There is just no reason to assume that sin is the cause of psychosis, or even a partial cause at whatever points. We simply do not know. I do not have a problem with individual sufferers coming to the conclusion that sin may have been the cause or a contributing factor in some way to their worsening delusional thinking patterns. That is certainly possible, but pastoral counselors should rid themselves of presumptions on this point and allow the counselee to come to this conclusion on their own, assuming that they are not delusional in these points as well.

Guilt is still guilt, and anxiety is still anxiety. Anger is still anger, but it may help to know that in a schizophrenic person, the anger that they might demonstrate may be void of emotion (called lack of affect) and they are simply interacting with their delusions and the way that they perceive other people. Voices could be telling them to act out, or Martians could be controlling them. That’s not an excuse. It’s a delusion. So deal with sin but make sure that, as such, you are not confusing sin with delusion. The difference is where the physical meets the spiritual, or where the body and the soul interact and depend on one another. You may not know where all to divide the issues of sin from the brain chemistry, but the soul is obviously in the works and needs guidance, not just correction.