Psychopathology
July 16th, 2007[Ed. note: This is the 3rd blog entry by our July blogger, Mark Yarhouse of Regent University. Mark and two other colleagues at Wheaton College have authored a text, Modern Psychopathologies: A Comprehensive Christian Appraisal, published by IVP in 2005.]
This past week I have been thinking about what it means for something to be a psychopathology. There is a committee currently working on revisions that will eventually become DSM-V, with publication probably around 2011 or so. This is always an interesting time when various symptom clusters are given consideration and some current psychopathologies may end up being removed.
It is interesting to me to explore the question of psychopathology in a Christian psychology. As an intellectual exercise, it may be telling to consider what a diagnostic manual would look like if it were developed out of a distinctively Christian psychology. If there were no DSM and a group of thoughtful Christian psychologists, philosophers, and theologians were to have come up with a manual of some kind. In what ways would it have been different than the DSM? In what ways would it have been similar?
One of the many challenges in psychopathology is how to determine if a cluster of symptoms represent a condition that is pathological. The DSM tries to draw upon atypicality to some extent, but also maladjustment and distress are obviously considered. What we are left with is no real consensus on psychopathology today, and we see that the DSM has some disorders that are more clearly tied to sociocultural variables (e.g., eating disorders) while others (e.g., schizophrenia) are not.
It should also be pointed out that sociocultural variables are but one of several considerations in contemporary understandings of psychopathology. David Barlow is one of many authors who would also consider biological, emotional, learning, and cognitive factors.
So we are talking about more than what is in and what is out of a manual. We are talking about criteria for what constitutes psychopathology, as well as the many factors that are given consideration when determining what contributes to psychological problems.
July 16th, 2007 at 6:15 am
Mark, would you be willing to venture a few more thoughts as to what the DSM might look like if you were asked to frame it? What criteria would you want to include?
July 17th, 2007 at 6:39 am
I have been enjoying the SCP blog. Thanks to all the contributors!
For me, two thoughts immediately come to mind regarding a Christian view of diagnosing psychopathology.
First, I think any Christian view of psychopathology ought to take the reality of sin very seriously. To whatever extent possible, we ought to carefully consider what role sin is or is not playing in a person’s psychopathology. This is obviously missing from the DSM and would be extremely difficulty to do, even within a Christian context. One of my favorite quotes regarding sin is from Ted Peters,
“One item that has become clear. . . is this: sin is not clear. It cannot be. No matter how much effort we invest, sin and its accompanying evil will remain unexplainable. Why? Because of the lie. Because of the deceit. Inherent in sin is the denial of truth. We cover over our unwholesome motives and violent acts against others with a veneer of goodness. We sugarcoat our garbage. Everyone has a stake in hiding the truth of sin. This makes uncovering the mystery of how sin works difficult, because wherever we dig, lies rush in to fill the hole.”
Difficult as it is, however, sin would still have to be addressed in any explicitly Christian view of psychopathology.
Second, I think a Christian view of psychopathology ought to be characterized by a dimensional rather than categorical approach. The current DSM is a categorical manual. A person either has a disorder or he does not. He either fits the category or he does not. But I think the reality is that many of the disorders are better described in terms of varying degrees of severity.
Actually, there is one aspect of our faith that IS categorical – ‘justification.’ We are either saved or we are not. But after that, the reality of the Christian life is much more dimensional. The process of ’sanctification’ means we are involved in a lifelong process of always changing, growing, and maturing. We are at various times more or less like Christ. We are at various times more or less influenced by the Holy Spirit. We are at various times more or less spiritually, emotionally, and psychologically healthy.
Looking forward to more dialogue.
AN
July 17th, 2007 at 6:26 pm
Phil & Aaron:
I see the DSM as attempting to take the best from both categorical and dimensional approaches. Yes, there are categories, but there are also many ways a client can meet criteria for a disorder. There are core features and additional symptoms, which has made sense in my clinical work.
One of the most interesting observations to me is that the DSM has moved away from pretty much any discussion of etiology to focus almost exclusively on clinical presentation. I see this as reflecting the vast array of theoretical orientations and no one that is dominant among both academics and clinicians.
It seems to me that a Christian nosology would want to reflect on etiology out of a shared vision for human functioning and symptoms of conditions that reflect impairment in functioning. (There may be more criteria that impairment, but it is something that is commonly considered and I think it would be a part of the discussion.) A discussion of sin would enter in here, as Aaron suggests. There are of course many ways to conceptualize sin, so I think that would warrant fleshing out.
December 7th, 2007 at 9:59 pm
Mark,
It seems that you are moving in the right direction, but the biblical model for doing this work has not been established.
The biblical trichotomy model of the ontology of being in the creation account in Genesis 1:26 and 2:7 has not been developed as it runs throughout scripture. Nor has the biblical model of the ontology of the personality of being as its first label of “heart” appears in Genesis 6:5.
These two models must be developed first as they run throughout scripture. Then the physical models that God gave at the Mt. Sinai event become the means for developing the DSM.
The tabernacle is the focus of attention at Mt. Sinai and the trichotomy structure of the tabernacle must be viewed in light of the trichotomy structure of the individual in the creation account.
It appears that the NT writers developed their theology of the anthropology of the individual upon those two foundations for understanding the “wholeness, completeness, and perfection” of the believer as being established by Jesus Christ.
That wholeness takes in the scriptural reality that are lives are not complete until we recognize that God in Christ is in us and that we are meant to be in a fellowship and dialogue relationship with Him.
I would be very interested in working with a group to develop these two biblical models that would allow you to develop and build the DSM.