Friday, September 15, 2017

Q&A with Mike Emlet on "Descriptions and Prescriptions"

The folks from New Growth Press asked Michael Emlet some good questions about Descriptions and Prescriptions, the new release which I've been featuring on the blog this week.

His answers give a flavor of the contents of this helpful little book:

Why did you write Descriptions and Prescriptions?

When it comes to issues of psychiatric diagnoses and medications it is too easy for Christians to go to one extreme or the other. That is, to either grant too much authority to psychiatric classifications and solutions for people’s problems as though Scripture is irrelevant for issues of mental distress. Or to dismiss them altogether as though medical science is irrelevant for issues of mental suffering in Christians. I wrote this book to present a nuanced “third way” between those two extremes that is grounded in Scripture, does justice to human beings as embodied souls, respects the role of scientific inquiry, and suggests compassionate and wise ways to minister to those who are struggling with mental illness in our churches.

How do you think your medical background and ministry training/experience contribute to the shape of this book?

My training and experience in both medicine and gospel ministry means that the book is first and foremost grounded in Scripture while also giving careful consideration to the medical research that contributes to the discussion. The book is marked by both biblical and scientific inquiry.

Who is your target audience?

My primary audience includes helpers and leaders in the church--pastors, vocational counselors working in a church setting, lay counselors, elders, deacons, small group leaders, and others involved in one another ministry. I trust the book will be helpful also for Christian psychiatrists, Christian psychologists, and Christian professional counselors.

What are the takeaways of your book?

For readers who come skewed to one extreme or the other regarding psychiatric classification and psychoactive medications, I hope they leave with a more balanced and nuanced approach. For readers who already have a more balanced approach, I hope they leave more clearly informed and equipped with biblical and scientific perspectives to undergird their ministry. Ultimately I want the perspectives of the book to provide helpers with guidelines for compassionate, wise, gospel-saturated care to those who are struggling with issues of mental health.

What imbalances have you seen in the way Christians think about psychiatric diagnoses and medications?

Regarding psychiatric diagnoses, I have encountered people who embrace a psychiatric label as an all-encompassing explanation for their struggles. Their diagnosis becomes the identity around which their lives orbit. They may seek only medical means of help and believe that biblical and pastoral realities are irrelevant to their problems. On the other hand I have seen people who resist a particular diagnosis when it might provide a helpful way to bring some clarity and order to their experience. These people may over-spiritualize their problems and resist appropriate medical interventions. Since God has made us both body and spirit creatures, it is important to consider both aspects of our personhood as we seek to understand the struggles of others.

What are some limitations and benefits of a psychiatric classification of people’s struggles?

The main limitation of a psychiatric classification is this: it is a description of the person’s experience but it is not an explanation for it. A diagnosis describes the person’s disordered thinking, emotion, and behavior but doesn’t tell you why the person is struggling in this particular way. The Diagnostic and Statistical Manual of Mental Disorders (the DSM) acknowledges this limitation. This means that a diagnosis becomes a starting point (not an endpoint) for careful inquiry, biblical understanding of this person as a body-soul image bearer, and ongoing pastoral ministry. At the same time, certain psychiatric diagnoses (for example, schizophrenia or bipolar disorder) alert us to patterns of severe suffering that may well require additional intervention, including medication.

How does Scripture give us a framework for understanding various forms of mental suffering?

Our starting point is Scripture because we cannot understand ourselves apart from God’s revelation to us. God created us as body-spirit image bearers who perfectly reflected His design for abundant and fruitful life (Gen 1:26-28; Gen 2:7). Body and soul worked seamlessly to honor and glorify God. The fall of Adam and Eve into sin affects us holistically—we are fallen, body and soul. Sin and suffering (physical and mental) become two ever-present realities for us as a result (Gen 3:16-19; Gen 6:3-7; Rom 5:12-21; Rom 8:22-23; 2 Cor 4:7-12).

There is no doubt that our cognition, our affections, and our will to act must and do reference the living God—we are by nature worshippers, according to Paul in Romans 1. The human heart is always active (Gen 6:5; Exod 25:2; Lev 19:17; Deut 6:5; Prov 13:12; Prov 14:13; Ezek 36:26-27; Matt 15:10-20; Luke 6:43-45; Eph 6:6; Heb 4:12). So while mental illness is suffering, it is also demonstrative of an active posture before the Lord—we remain image-bearers, after all! Our thoughts, emotions, and actions reveal an orientation toward or away from him, moment by moment. To ask, as Scripture urges us, “What does the call to love God and others look like in the midst of your suffering?” is a profoundly humanizing question.

At the same time we must recognize the mystery involved in the interface of body (brain) and spirit. Scripture doesn’t slice and dice people into bodies and spirits per se, but approaches God’s people holistically as saints who need confirmation of their identity in Christ, sufferers who need the consolation of God, and sinners who need loving correction of their wayward ways. Ministry to anyone with a psychiatric diagnosis always involves these elements in various measures (1 Cor 1:1-9; 1 Thess 5:14).

How does Scripture guide our thinking about the use or non-use of psychoactive medications?

Clearly, Scripture does not provide explicit instruction about the use or non-use of medication. However it provides a wise and balanced framework for considering such questions. For example, here are several biblical perspectives that offer guidance: (1) Relief of suffering and growth in Christian character in the midst of suffering are both important; (2) Medications are a gift of God’s common grace and medications (like any gift of God) can be used idolatrously; (3) Motives are important—a person can have wrong motives for wanting to take medication and a person can have wrong motives for not wanting to take medication; (4) Attention to the interplay between the spiritual and somatic aspects of the person’s experience is important. In the end, the use or non-use of medications is not a “right or wrong” issue but a “wisdom” issue. We ask, “What seems wisest for this particular person with this particular constellation of struggles and strengths at this particular time?”

If the local church embraced the ideas in your book, what would change?

My hope is that leaders in the church would have increasing confidence to pursue those in their congregations who are struggling with mental health issues. And that they would do so in a balanced way, being attentive to both spiritual and bodily aspects of these struggles. I want them to have a growing conviction that Scripture speaks broadly and deeply to the disordered thoughts, emotions, and behaviors associated with psychiatric diagnostic categories, and that Scripture provides fundamental ways of understanding people that are much more full-orbed than a diagnosis can capture. At the end of the day my goal would be a restoration of the local church as the central locus of care for those who are troubled, while recognizing there are times when we must wisely partner with those in the medical community.

How can leaders in the church become better equipped to minister wisely to those diagnosed with psychiatric disorders?

The most fundamental starting point is to listen deeply to people and to Scripture. Both are critical. Listening to people’s stories without an accompanying biblical perspective will result in truncated, imbalanced ministry. Listening to Scripture without listening to people’s experiences will also result in short-sighted and imbalanced ministry. Always ask, “How does Scripture provide clarity and coherence to this person’s struggle as a body-soul image bearer?” But do so, making sure that you have sought to understand the struggler’s experience as well as possible.

In addition, the Christian Counseling and Educational Foundation ( provides a wealth of resources to equip leaders in the church, including blogs, podcasts, videos, conference talks, mini-books, books, online classes, and The Journal of Biblical Counseling, to name a few.

Can you tell a story that illustrates the balanced approach you are advocating in the book?

I knew a man in my former church who struggled with paranoid schizophrenia. Despite the use of multiple medications, he continued to have bouts where accusatory voices filled his head, telling him that he was worthless and that he ought to kill himself. What did he need? Fine-tuning of his medications? Certainly that was something important to pursue, given the complexity of his psychoactive medical treatment. But I think what he also (and perhaps especially) needed at those times was a friend. A friend who would listen with compassion and patience. A friend who would take seriously the impact of those demeaning and frightening voices in his head. A friend to remind him of God’s favor, care, and presence in his experience of isolation, confusion, and loneliness. A friend who would pray for him and read the Psalms with him. A friend who would highlight that, in Jesus, nothing could separate him from the love of the Father (Romans 8:38-39). A friend who expected both personal and corporate benefit from having this man as a part of the body (1 Corinthians 12:21-26). You can be that friend. I can be that friend. And that’s apart from having any particular medical expertise with schizophrenia (which of course he needs as well). There’s the balance: by all means seek psychiatric input/medication when it seems justified but approach the person with biblical categories in mind, confident that God speaks into the experience of suffering.