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Biblical Counseling Coalition: Grace & Truth

Psychiatric Medication and the Image of God

Psychiatric Medication and the Image of God

BCC Staff Note: This blog was first posted at The Gospel Coalition. You can read the original post there at Psychiatric Medication and the Image of God. We are re-posting it here at the BCC’s Grace & Truth blog site with the permission of Jeremy Pierre and TGC.

Watch any daytime talk show with an expert medical guest or flip through Time magazine’s colorful diagrams, and you’ll see that the latest emphasis in neurology, the brain’s causal influence on human behavior, has leaked down to the popular level. Many of these experts consider the human being primarily as a physical creature whose actions, feelings, and thoughts for the most part simply manifest neurological activity. Undesirable feelings or behavior, then, should be addressed by ever-more-precise medical methods.

Many Christians have correctly seen the incredible danger such an understanding poses to a biblical worldview, which involves realities beyond what can be seen, touched, or medicated. In other words, we know that a human being involves more than the body. But we also know that the body is a vital aspect of our being as designed by God. So we begin to answer this question—How should Christians think about psychiatric medication?—by considering at least two aspects of what it means for people to be made as the image of God.

1. The Image of God as Union Between Soul and Body

The immaterial soul does not function independently of the material body. The soul is not a “ghost in the machine” whose function is autonomous of corporeal mechanisms. God intentionally designed humankind to represent himself in the physical world—a psychosomatic unity comprising both a soul that reflects the immaterial God and also a body that grounds him in material creation.

The keystone passage introducing the image of God is Genesis 1:26. “Then God said, ‘Let us make man in our image, after our likeness.’” Biblical scholar, D. J. A. Clines has pointed out that this phrase is better translated, “Let us make man as our image” for grammatical reasons as well as for historical-contextual reasons. Man, as the image of God, is the physical representation of God’s presence in creation.

This is the case in the New Testament as well. For instance, Paul’s use of soma demonstrates a complex anthropology where “all spiritual relations must be in and through his somatic existence (Romans 6:12),” according to Clines. “The body is the coordinate of the spirit in that it provides the spirit its agency of expression.” So, amazingly, the brains God constructed out of dirt are the necessary vessel of the spirit He put in them. We could say that physical brain function and spiritual soul function are necessarily correlative in the present age. And, instructively, this is the ideal for all of eternity, since this psychosomatic unity does not disappear with the new creation. Rather, this unity will be rather brilliantly enhanced when people receive imperishable physical bodies like the one Jesus had (1 Corinthians 15, John 20-21).

2. The Image of God and Dominion

But man as psychosomatic unity is not the only aspect of the imago Dei pertinent to our question of psychiatric medication. God gives all of us made in his image a function: to have dominion over the created order (Genesis 1:26). We rule over “all things,” which implies the larger horizon of the entire animate world, having been crowned with glory and honor, only a “little lower than God” so as to have “all things under his feet” (Psalm 8).

Thus, we rule over the created order, arranging it in ways that honor the Creator and promote His kingdom. We strategize, organize, invent, implement, and construct in an attempt to bring order to disorder. In this way, we reflect the character of God in the physical world (Genesis 1:1-25). Human beings did not lose the dominion function at the Fall. We are still responsible to rule over the world as God’s agents obedient to His commands. We show dominion over sin and its corruption primarily by preaching the Gospel of the kingdom; but we also show dominion by mitigating sin’s physical effects on the created world. For instance, people can make a cursed ground yield more fruit by overcoming it with the latest farming technology.

The mitigation of the effects of the Fall can apply to the corrupted physical body, including the brain. Thus, in principle, human means of alleviating the effects of sin on the brain, in terms of injury, disease, and dysfunction, are sanctioned by God as a legitimate function of man, His image. Let’s think about these principles specifically in regard to psychiatric medication.

First, psychiatric medication does not address the main dilemma in human trouble: sin.

We must not mix up addressing sin’s effects with addressing sin itself. Medication cannot produce the obedience of faith. As Clines eloquently reminds us, “The image is fully realized only through obedience to Christ; this is how man, the image of God, who is already man, already the image of God, can become fully man, fully the image of God.” Psychiatric medication should never been used in hopes of producing behavior that Scripture calls obedience, because obedience flows from faith.

The dominion function must be understood in a redemptive/historical framework, specifically under the great theme of the coming of the kingdom of God, from Adam’s failure to rule righteously to Christ’s righteous rule over all things. Christ said the kingdom of God is not of this world, nor would it be ushered in by human means (John 18:36ff). Linking Christ’s redemptive work with man’s technological advancement ignores the ultimate intention of the dominion theme. Thus, dominion with regard to the human brain and psychiatric medication is not bringing about the coming of the kingdom through chemically perfected people.

Second, psychosomatic unity means that problems are never merely physical, but always involve a spiritual response.

If Scripture assumes the union between soul and body when addressing humanity, and its primary means of addressing human sorrows, weaknesses, and problems are the wealth of commands, directives, warnings, promises, narratives, poems, and prayers (all things addressing primarily the spiritual aspect of the unity), then Christians should understand these to be the regular means of ministry for whole persons, body and soul. This is not to say that knowledge of, or even obedience to, Scripture will necessarily yield physical health. To the contrary, it is clear in Scripture, history, and experience that everyone in Christ suffers spiritually and physically. My point, rather, is that God’s Word brings life to whole persons, body and soul.

So we should not approach human problems with the false dichotomy: Is this problem spiritual or physical? Rather, we should consider how the physical is affecting the spiritual, and vice versa. Thinking in this vein prevents the counselor from concluding that a problem is physical while ignoring spiritual influences, and vice versa.

Third, psychosomatic unity means sin’s effects are both spiritual and physical; therefore, Christians should acknowledge that brain dysfunction is a theologically tenable possibility and that such a condition would in some way hinder the soul’s operation.

Though some use the brain’s influence on the soul’s operation as a scapegoat for personal responsibility, we should not dismiss the concept itself. Taking the physical effects of sin seriously requires us to acknowledge the brain’s possible hindering effect on the soul. In a groaning creation, it makes sense that physical realities can frustrate spiritual ideals: brains don’t develop optimally, endocrine systems fail to regulate hormones, injury and disease strike. Because the operation of the brain and the soul are necessarily correlative, we should take seriously the influence physical difficulties have on whole-person response patterns.

Fourth, understanding dominion to include the mitigation of sin’s effects on the created order, Christians may affirm the responsible use of psychiatric medication to treat such conditions.

Since medication falls under dominion as an attempt to address the effects of the Fall, psychiatric drug use should seek to restore regular brain functioning. In cases of injury and underdevelopment, this could mean compensation for what is damaged or absent. In cases of uncontrollable excesses or deficiencies of neurotransmitters or hormones, it could mean stabilizing the brain’s regulatory functions.

One caution: psychiatric medication should not be used in a depletive fashion—for instance, to hinder an intrinsic capability or numb a proper neurological response. For example, numbing the effects of grief would be depletive. In grieving the loss of a loved one, medication could hinder proper functioning of the embodied soul. That circumstance often makes people most experientially aware of their beliefs and desires, and this is a key opportunity for strengthening faith. Medicating a person out of this opportunity could be a more sophisticated way of escaping from grief by getting drunk on alcohol.

Complex Navigation

Scripture is sufficient for solving man’s ultimate need for redemption in Christ, peace with God, and the future renewal of the entire created order. And proclaiming the Gospel is the primary way we exercise dominion. Psychiatric medication may be understood as a legitimate outworking of the dominion function, but merely as an imperfect attempt to mitigate sin’s effects on the present physical order. It cannot solve mankind’s primary problem of sin.

Applying this teaching practically is no simple matter. The psychiatric medication industry is largely driven by naturalistic assumptions and compelled by profit margins, and mental illness has been stigmatized in many of our churches. Thinking about how to navigate the process practically would require a discussion beyond the present one.

Join the Conversation (Added by the BCC Staff)

Without question, the use of psychiatric medication is a complex issue around which committed Christians have varying convictions. What are your thoughts on this robust, nuanced perspective on psychiatric medications? How should Christians think about psychiatric medication?

This entry was posted in Medication, People in Need of Care, People Who Offer Care, People Who Train Caregivers, Psychology and Christianity, Theology and tagged , , . Bookmark the permalink.
 
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  • Bill Francis

    Excellent article, and as described, robust yet carefully nuanced. “Applying this teaching practically is no simple matter.” Agree. The mental health system does not view psychiatric medication as “an imperfect attempt to mitigate sin’s effects on the present physical order,” but rather as the sharpest tool in their box of treatments. From psychiatrists to family physicians, the quick fix cure is to tinker with the medication. If Powlison is correct that the church is a different social system it would seem that at this stage in the game, we are quite dependent on their undestanding of how and what it means to restore regular brain functioning in persons. The heart of man is deep. How would we know when we where supplanting faith and peace for a pill?

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  • Adam Lambdin

    I was diagnosed with undifferentiated Schizophrenia in the Army and put on 4mg. of Rispiredone, which is essentially the minimal dosage that a Schizophrenic person should take. I am perfectly normal with the meds. Psychiatry has been very helpful to me. A Biblical Counseler with an M.A. in Biblical Counseling from a great school that I graduated from told me that my mental illness was because of relationship problems that had spirraled downard into worse thinking patterns that turned into Schizophrenia. He said I was just in sin, which of course is rediculous, though I respect Biblical Counseling very much in spite of this one person’s bad use of it.

    I think that Biblical Counseling is all that is needed to handle life’s problems unless it is a mental illness, in which case it may still be useful, of course for handling sin per se, but it won’t cure a mental illness like this guy was thinking. Clinical Psychology, that which deals with mental illness itself, is best at handling mental illness as mental illness.

    I believe in Biblical Counseling, but I think that the medical doctors and psychologists of the world specialize in actual mental illness in a way that is essential for handling such problems. Where sin is involved, I believe in Biblical Counseling, but it is possible for the mind, just like any body part to be sick or damaged, and that requires a medical/theraputic approach rather than assuming that the Bible can be used as a textbook for handling mental sickness issues.

  • aprilshowers

    I have been diagnosed with schizophrenia and find that I fit many of the secular definitions of the symptoms ascribed to schizophrenia. My mother also has been diagnosed, so it is generational. I feel like the noetic effect of sin has a lot to do with my inability to remain focused on truth and perhaps my God given ability to have a very creative mind has been perverted and corrupted by sin in that I have some pretty creative thoughts which can produce in me the inability to discern what is real and what is not. Certainly the schizophrenic mind can be ruled by a type of pride in one’s view of oneself, even if it is illogical and quite a stretch of the imagination when one views themselves unrealistically as someone who is significant in the world or to the world (whether a character of extreme righteousness or unrighteousness). I find that there are specific Scriptures that I have found to defeat some of my chaotic dellusions such as the one that says “Who among men can know the thoughts of a man except the spirit of the man within him, even so, no one can know the thoughts of God except the Spirit od God.” Knowing that the bible is true, this scripture defeats the delusion that I sometimes experience that other’s can hear my thoughts and are reacting to them. Before knowing this scripture this delusion or belief in this lie has generated great fear in my mind. Certainly I wish that I could have a conversation with Jesus in which His words spoken to me would address some of the specific and bizarre lies that I have believed throughout the years. Certainly hearing Him address these issues with me would calm my fears and put to rest, once and for all, all the doubt. But I must rely upon the word of God to, even if only generally, to address fears and questions that I have. The concern that I have right now, is that I feel that I am potentially entering into a counseling situation, in which the biblical counselor is going to bring into question whether the psychotropic drugs that I am taking are a need or a hinderance. From the very beginning of my conversion to Christ, I was simultaneously put into a position where I had very little choice but to take meds, yet I found that they, along with reading through scripture were used hand in hand to lead me closer and closer to more sound thinking. Yet, there have been several times, both of my own accord and also other times as a result of a biblical counselor recommending it, where I was led to believe God was desiring me to get off the medication. And I found that while I had much energy and vitality and clarity of thinking and more emotion for a time, I found that after several months my mental state began to plummet into vexing delusions and was driven to the point of near suicide on several occasions, which brought great concern to my family, and so I eventually succumb to my need to again return to medication. While Risperdal 3 mg daily, does in fact help me to function in work and somewhat socially in a stable and ongoing fashion without dellusions of grandure or hearing voices or other dellusions, I find that it removes part of my personality to which I long for. During that period of time before the great plummet into darkness of psychosis, I can feel, I look at the sky and the colors seem vibrant, I find beauty in nature…I am moved to tears with compassion for others, I feel a depth of joy and excitement with life…I have a great deal more energy and my creative mind can be stimulated….but all this grows into a sort of hyperness which may be described as mania at times. While my emotions are set on a new height, the negative emotions such as fear, can similarly be heightened…and pride can slip in also as a result of my sense of self-importance as God seems to be greatly using me, which God most certainly humbles the prideful mind. I am unsure which comes first, the chicken or the egg. Perhaps there is some sort of physical malady in my brain, as I have read that scans of normal brains differ from that of the one with schizophrenia, I am unsure whether that is a result of one’s erratic undisciplined mind affecting physiology or if physiology causes this. It is hard to be on the fence about this, not knowing where I fall. I certainly see certain sinful thoughts in me that produce in my thinking a type of chaos as I fail to know how to deal with this, but even back to childhood, I can see many instances where I have viewed life quite differently than my peers…and have always been one to think deeply on the philosophy of life even before becoming a Christian. I do wish to tell you all that when off meds and I reach that place of plummeting into the darkness of the lies of schizophrenia, there is no place I have ever known that has ever been so bleak. I feel that God and humanity have abandoned me and that I am a wretch beyond the reach of salvation, becoming convinced that I am some evil character from biblical prophecy. There have been times, before knowing Christ as Lord of all, and my Lord, that I thought myself to be in the other ditch of pride; that I was in fact a type of savior for the world, hoping to achieve enlightenment so as deliver those enslaved by suffering into a place of peace…but after becoming greatly humbled, even to the extreme due to the lies I was still believing that since Christ was Messiah, then I must conclude that I was in fact the antichrist of sorts leading people astray by my witchcraft and false philosophy. But, with the medication, these thoughts are greatly and consistently subdued for the most part (being that the meds are considered a “major tranquilizer”, as other aspects of my personality are simultaneously subdued)…yet I still struggle with a passion for Christ, a sense of being on fire for Him, I experience still a lot of social anxiety and some illogical fixed phobias…as well as one of the most painful things that robs me of joy, namely a wavering assurance of salvation. Perhaps this will help someone learn from someone who is actually going through this and is a Christian open to learning about what Jesus would want to tell me about this struggle. Thanks for reading

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