Four Problems and Pitfalls of Psychiatric Diagnoses

When it comes to psychiatric diagnoses and Christians, we are typically too warm or too cold. Michael Emlet, from the Christian Counseling and Educational Foundation (CCEF), calls this The Goldilocks Principle. Either we are too warm (too accepting) of diagnoses, or too cold (too highly suspicious). As a biblical counselor and former practicing physician, Mike encourages us to come to a more balanced understanding so that we may minister wisely in today’s over-diagnosed culture. His goal is “neither to vilify nor vindicate the psychiatric diagnostic system but to help those who struggle with disordered thoughts, emotions, and behaviors.”

Last month, at the ACBC conference in Jacksonville, I picked up a copy of Mike’s new book, Descriptions and Prescriptions: A Biblical Perspective on Psychiatric Diagnoses & Medications. After spending the first few chapters explaining how we got to where we are today, Chapters 4-7 describe four weaknesses and limitations of psychiatric diagnoses.

  1. Psychiatric diagnoses are descriptions, not explanations. In other words, a psychiatric diagnosis may describe for us a person’s thoughts, emotions, and behavior, but it cannot give us the reason behind them. In this way, it is deficient. The diagnosis cannot tell us the why behind the what. We need a Christ-centered worldview derived from Scripture to help us understand the causes of human behavior. We then counsel the heart behind the behavior. Emlet writes, “In our medicalized and pharmacologically-driven culture, the average person often assumes that each diagnostic entity is primarily caused by a clear and specific brain dysfunction. But there is very little evidence to support that assumption.”
  2. Psychiatric diagnoses have the potential to abnormalize the normal through over-diagnosis. “The proliferation of diagnostic categories mean that more people may be caught in a particular diagnostic net over time.” Emlet balances this with a warning to those of us who minister to others. “Putting someone in a diagnostic category who technically doesn’t meet the criteria doesn’t mean that the person isn’t struggling! Diagnosis or not, we need to listen well to people’s stories.” Amen! We need to learn to listen well.
  3. Some psychiatric diagnoses redefine behavior that Scripture would characterize primarily as sin. “Some psychiatric diagnoses ‘medicalize’ sinful behavior….We should take care that behaviors that are first and foremost violations of the first and second great commandments to love God and others (Matthew 22:34-40) are not neutralized, sanitized, or fully excused by a particular diagnosis.”
  4. Social-cultural values influence the inclusion or exclusion of specific diagnoses from the DSM and impact the prevalence of diagnosis. Emlet explains this pitfall with two illustrations: homosexuality and ADHD.

Emlet wraps up his discussion of these four pitfalls with the following summary: “The concerns with the diagnostic system when considered together suggest that psychiatric diagnoses have less functional authority than we might initially believe. The DSM may be the best secular classification system available, but it remains fraught with difficulties identified from within psychiatry itself.”

If you are a “people helper,” and are interested in learning more, I recommend this book to you. I am currently in my second read-through.

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