In the world of biblical counseling, a phrase you often hear is “organic disorders.” These are the types of problems that are biologically based and may require medical treatment, and Jay Adams (founder of the biblical counseling movement) expressed from the start that organic disorders are to be treated differently from other types of emotional problems. In Competent to Counsel Jay Adams notes, “Organic malfunctions affecting the brain that are caused by brain damage, tumors, gene inheritance, glandular or chemical disorders validly may be termed mental illnesses. But at the same time a vast number of other human problems have been classified as mental illnesses for which there is no evidence that they have been engendered by disease or illness at all” (Grand Rapids, MI: Baker Book House, 1970. p. 28).
Adams was and still is making a great point that the term “mental illness” has become so broad that almost anyone can qualify for one. Surely, any counselor or psychiatrist who uses the Diagnostic and Statistical Manual of Mental Disorders (DSM) must approach its use ethically and responsibly. There are many ways in which the mental health field has been too quick to turn to medication or labels to solve problems. In addition to Adams, there are many secular psychiatrists and mental health professionals who sound the same alarm (for example, Saving Normal by Allen Frances, M.D.).
So let us begin this dialogue with a few clarifications. First, it is my position the DSM-V (or any previous version) does an imperfect job at presenting various disorders but its classification of symptoms when carefully researched and used responsibly is useful to the counselor in identifying organic disorders. Secondly, the very nature of Church Therapy promotes counseling by a Christian professional in the church context for people who are already Christians or seeking to be so. Third, Christians experience organic disorders related to brain dysfunction as do non-Christians.
With these specific guidelines in mind, how does one define an “organic disorder”? Is it only organic if it is a physical problem that can be verified by a medical test? Or is it possible that organic disorders are often diagnosed even by physicians through observation of behaviors or self-report? Do medical tests alone validate a disease, or are our medical and scientific capabilities limited in some ways? Thinking back in history, there have been many (wrong) theories about physical problems. We probably all remember learning about the body “humors” and flawed medical practices like leeching. These medical theories were unscientific and wrong, but they pointed to something right: there is a physical problem going on in the body. In early medical times, they may not have been able to measure various diseases and disorders but that does not mean these disorders were not real. Certainly no one would argue that diabetes suddenly came into being upon the discovery of the blood sugar test.
If organic disorders may be present even when we have not developed an adequate medical test to diagnose them, how do we assess these disorders? We live in a time that is perhaps past the infancy stage in our true medical knowledge and testing of the brain, but we are not far past toddlerhood in how much more we have to learn. Some brain imaging tests, like PET scans and even more advanced measures, are providing new understandings but are unlikely at this point to be used on a regular basis to diagnose things like depression. At our present scientific capabilities, dysfunctions of the brain (certainly a critical bodily organ) are not particularly measurable beyond brain damage, blunt trauma, or certain forms of dementia.
If after a careful and well-researched look at the DSM we agree that at least in some cases there is such a thing as clinical depression, for example, who should assess and treat this organic disorder? How do we determine when depression symptoms are organic and when they are not? Is it possible to make that distinction? It is here that I find the role of the church therapist critical, and it is why I insist that a church therapist must be a professionally trained and licensed provider with a biblical view of persons. If one is not trained in psychopathology, human development, or evidence-based cognitive therapies I do not believe one will assess organic disorders accurately. You will either dismiss all mental illnesses as non-organic or you will leave all the power of assessment in the hands of primary care physicians and psychiatrists who are likely not Christians.
Theory is wonderful to create and study, but we also must look at actual practice to guide our thinking. In reality, a biblical counselor who is untrained in psychopathology will not have enough information to accurately assess organic disorders when they see them. Let’s assume, for a moment, that a biblical counselor does feel he or she has encountered a true organic disorder. To whom does the biblical counselor refer? If they send the person to a primary care doctor, it is most likely that the doctor (also not highly trained in the specialty of psychiatric diagnosing and medication) will have a medical view and not a biblical one and will write a prescription for a medication. If the biblical counselor sends the person to a psychiatrist, again they will be treated by someone who is not likely to share a biblical view of persons and will prescribe medications. Either way, the person will have about 7-10 minutes with the medical professional treating him or her. It is unlikely that any medical tests will be performed, since as mentioned earlier these types of measures either do not exist yet or are too costly. In these scenarios, we abdicate our role with the client and leave assessment and treatment of organic disorders to someone likely to medicate and unlikely to agree with the Bible. Or, perhaps more likely in biblical counseling situations, disorders such as Bipolar Disorder, ADHD, Major Depression, PTSD, or Generalized Anxiety Disorder will not be viewed or treated as organic.
A licensed mental health professional at the Master’s or doctoral level working in a church setting has a unique role to play in assessment and treatment. This church therapist will have received training on how various disorders and symptoms present themselves, and with training and experience he or she gains an ability to diagnose disorders such as those mentioned above. Because the church therapist is a mental health professional but not a medical professional, he or she has the ability to maintain a biblical view of persons and use many additional techniques to help organic disorders that do not require medication. Just as exercise and diet can be an effective treatment for someone with heart problems, so too can various therapeutic strategies be applied before medication is deemed necessary. Organic disorders do not mandate medication. If medication is necessary, the church therapist can communicate with the psychiatrist or doctor and maintain an active role to ensure that over-prescribing is minimized.
The team approach in church therapy allows the right treatment for parishioners. When everyday life problems are getting a person down, they can receive biblical or pastoral counseling from their pastor. They can participate in mentoring and discipleship by a pastor or lay person, learning how to understand and apply the Bible to their lives. And in cases in which the pastors feel that a person may have a more complex problem or organic disorder, their first referral is to the church therapist, not to an outside provider. In this way, pastors, biblical counselors, and church therapists can all work together addressing needs according to a biblical worldview and with a goal of healing.
The point of diagnosing is not to give someone a label or a free pass on an area of sin. Just the opposite! With proper diagnosis and treatment by a professional who has studied the varying presentation of disorders, a person can be effectively helped and can move forward emotionally and spiritually. The church therapy model is a call for professionals to enter the church setting to provide a full complement of care based on the needs of the individual. Some Christians have organic disorders; should we not offer the best possible care in the context of the church?