MADNESS: MYTH AND REALITY
Many Christians are uninformed and confused about madness. Does it really exist, or is it a smoke screen to evade responsibility under God? Is some insanity due to demonic activity? Does at least some madness or insanity have identifiable organic causes? Is mental illness on a continuum with mental health so that no distinction exists in principle between the "sane" and the insane? Does the Bible speak clearly on the issue? In short, what is the myth and what the reality of madness?
The biblically informed Christian does not exclude the real existence of insanity or madness because he knows from Scripture that man is now far removed from his original perfection before the fall due to the ravages of sin. Madness can occur suddenly in later life: King Nebuchadnezzar was insane for seven years when he ate grass like an animal (Daniel 4). There was a real difference between his sane and his insane estate; however, his insanity was due to his pride and disregard of God and hence not "innocent." Scripture also shows that madness can be simulated: when fleeing from Saul, David pretended madness before Achish the king of Gath, scratching on the doors of the gate and letting his spittle fall down on his beard (1 Samuel 21:10-14).
Demons may also cause madness. We know this because Jesus cast out many demons. After He cast the legion of demons out of the wild man among the tombs of Gadara, the man sat at His feet, clothed and "in his right mind" (Mark 5:15, Luke 8:35). This Scripture also shows that there is a real dividing line between the insane and the sane, the mad and the normal. Demonically caused madness may well be initially due to the oppressed person's disobedience to God, as in the case of King Saul (1 Samuel 16:14-23). However, we must be extremely cautious in "diagnosing" demon possession! Dr. Alfred Lechler, an experienced Christian psychiatrist who does not deny demon possession, points out that Jesus clearly distinguished between disease and possession, revealed in the way He dealt with the deaf mute in Mark 7 and the deaf and dumb boy in Mark 9, and in His command to "heal the sick" and "cast out demons" (Matthew 10:1-8). Dr. Lechler rightly adds that "we are duty bound, when dealing with the mentally and emotionally disturbed, to stress the need to differentiate between disease and the demonic."1
Madness can be caused by willful indulgence in drugs. Though the drug taker is initially responsible for his suffering, the resultant madness is not imaginary or a myth; we deal with real physical changes and disabilities. "Psychoactive drugs" can pierce the brain's barrier designed to block harmful compounds (the handiwork of our loving Creator). They then penetrate to the limbic system deep within the brain which controls our emotions, instincts essential for survival, and brain areas generating feelings of pleasure. Experts now believe that cocaine, for example, interferes with the normal production and/or functioning of dopamine, an essential neurotransmitter in the brain: "Disturbances in the dopamine supply are involved in serious mental illness such as schizophrenia and in movement disorders such as Parkinson 's disease, which results from abnormally low levels of the neurotransmitter."2 In insanity due to drug addiction both personal responsibility and physical factors are thus involved, and both must be addressed for lasting relief.
Renowned Christian counselor Jay E. Adams states that prior to the advent of Sigmund Freud and his "medical model" of behavior disorders," 'mentally ill' persons were viewed as malingerers rather than as patients."3 Was there truth in that historical perception? Adams cites the case of "Steve", diagnosed as a "catatonic schizophrenic," who turned out to have faked all his symptoms to avoid facing his parents with failure in his college studies due to his own neglect.4 Dr. Franklin E. Payne, Jr. reports that "Mrs. Jones," a Christian widow in her sixties who was deeply depressed and about to undergo electroshock treatment, overcame her depression simply by resuming her daily responsibilities from which her well-meaning family had sought to relieve her.5 Finally, the ability of psychiatrists to diagnose genuine mental illness may well be questioned in view of the famous Rosenhan experiment of 1973. In this experiment David L. Rosenhan, a professor of psychology at Stanford University. had eight sane people apply for admittance to five psychiatric hospitals to try to pass as "mentally ill." They did, and neither psychiatrists nor other staff saw through their deception, though the other, real, patients did. Rosenhan then advised another hospital that he would send them some pseudo-patients, and among 193 patients admitted for treatment 23 were considered suspect by the staff. In fact, all 193 were genuine patients; Rosenhan had sent no pseudo-patients to that hospital at all.6 The Rosenhan experiment gave support to those who denied the existence of any psychiatric illness whatever, Nevertheless Christians in the field like Adams and Payne, while adamantly opposed to Freudian approaches and emphasizing the client's own responsibility for his problems under God, are careful to state that there are cases requiring medical treatment.7 Modern research involving brain scans of monozygotic twins seems to show beyond doubt that schizophrenia, the most common psychiatric disorder is indeed physically and genetically based.8
Until the nineteenth century the insane roamed the roads and subsisted on alms. Alternately they were confined in prisons or poor houses together with the mentally retarded, criminals, drug and alcohol abusers, physically disabled elderly, mothers with young children, and so on. They might be put in cages, chained to walls, or even exhibited for money. At London's notorious "Bedlam" (its real name was St. Mary's of Bethlehem Hospital) spectators "would jeer at the fenced-off wretches from a distance, provoking them to ever more crazed behavior." Until set free in 1794 by Philippe Pinel, the inmates at the Bicetre Hospital for the insane in Paris "presented pictures of complete neglect."9
In the United States Dorothea Lynde Dix (1802-1887), a New England school teacher and social reformer, brought about the transfer of the insane to separate state hospitals or asylums in restful countryside settings in the 1840s. Here inmates could work in housekeeping, gardening, food preparation, laundry and the like, The therapeutic value of meaningful work is in full accord with Scripture and has been well established in the treatment of the insane, most recently in successful halfway houses for former asylum inmates established in the 1980s. But all was not well in the asylums. There was lack of staff and overcrowding as the number of inmates grew to a peak of 559,000 in 1955, at which time half of ail hospital beds in the United States were occupied by those classified as mentally ill.10
Until the late 1940s treatment for violent mental patients was essentially limited to physical restraint. It consisted of isolation cells, straitjackets, immersion in freezing water or being packed in wet sheets. After Freud there was also psychotherapy by talk, an essentially useless method as we shall see.
In the late 1930s electroconvulsive therapy (ECT) was introduced. It was effective with chronic patients and in acute episodes of suicidal and aggressive character. Early problems with ECT were gradually overcome, and by the 1970s the one major remaining side effect was permanent spotty memory loss in a significant number of patients. ECT and another radical medical approach, psychosurgery, have fallen into general disfavor largely due to the organized efforts of former mental patients. Psychosurgery was "the first and easiest target of those opposed to all psychiatric treatments" because "The crude early operations had a significant mortality rate" and might indeed produce a " 'vegetable personality'--people who were left without awareness or initiative, and would vegetate on the back wards of hospitals for the rest of their lives."11 However, Isaac and Armat believe that ECT and psychosurgery are now much more sophisticated, citing testimonies of former patients who greatly benefited from them. They point out that "it has long been known that in its first stages schizophrenia-- particularly where there is acute, rapid onset of illness--responds well to ECT."12
ECT has also been beneficial in conjunction with the modern neuroleptic drugs developed after World War II and now the mainstay of psychiatric treatment. Among them are chlorpromazine (Thorazine) for schizophrenia, lithium for manic-depressive illness, antidepressant medication such as amitriptyline, minor tranquilizers such as diazepam to relieve clinical anxiety- and so on. Some medications have severe adverse side effects requiring remedial medication of their own.l3
The most famous opponent of the "medical model" in psychiatry in the United States is Thomas Szasz, author of the extremely influential The Myth of Mental Illness, published in 1961 just as the anti-establishment drug culture was about to get under way. Szasz completely denies the existence of any genuine mental illness whatsoever in the name of full autonomy for one's choice of lifestyle, a claim the drug culture rebels fully shared. According to them, "madness" was just a label put on people who would not conform to the "establishment." Norman O. Brown, one of their gurus, expressed their typical stance that madness is actually desirable because it helps us overcome the "reality principle"!14 Similar to Szasz but less radical is British psychiatrist Garth Wood's very instructive book The Myth of Neurosis, published 1983 in England and 1986 in the United States. Its subtitle is, significantly, "Overcoming the Illness Excuse." Wood militates most of all against Freudian psychoanalysis, but also urges a restriction of the field of psychiatry to ''genuine psychiatric illnesses," namely, schizophrenia, disorders of mood and emotion, obsessive-compulsive states, and eating disorders such as anorexia nervosa. He offers an excellent layman's guide to the diagnosis and prognosis of these illnesses, He argues that abnormal personality or personality disorder, abnormal personality reactions, psychopathy/sociopathy, hysteria, drug abuse and alcoholism, and sexual dysfunction and deviation are not "true psychological illnesses" and should therefore be excluded from psychiatric treatment.15 Wood recommends "Moral Therapy" which consists of following the voice of one's conscience and
will seek to show people that in their own interest their goals must never be luxury and ease, but rather activity and difficulty. ... As (the client) begins to see life in a different and more realistic way he will begin to like and admire himself ... because, in the brave confrontation of his problems, he will realize that he is genuinely worthy of self-admiration.16
A libertarian humanist measuring self-worth by self-effort, Wood believes that "It is then immaterial to Moral Therapy whether or not the individual is a Catholic or a Jew, a Communist or a Humanist, a Protestant or a Buddhist, for as long as he has his own value system his mental health can be secured by the observation of its dictates."17 Similarly, psychiatrist O. Hobart Mowrer proposed a "Moral Model" of psychiatry, in which a patient's problems are seen as stemming from his own real guilt for past poor behavior and are solved by confession of sin (not biblically defined). The famous "Reality Therapy" of William Glasser parallels Mowrer's work, Certainly these therapies, emphasizing the client's responsibility for overcoming his problems and therefore closer to the biblical Christian perspective, are more successful than Freudian approaches. However, as Adams rightly points out,
neither Mowrer nor Glasser has solved the problem of responsibility. The responsibility they advocate is a relative, changing human responsibility; it is a non-Christian responsibility which must be rejected as fully as the irresponsibility of Freud and Rogers. ... there is no standard apart from God's divinely imposed objective Standard, the Bible.18 Freudian psychoanalysis has been enormously popular in the United States in mental hospitals and private counseling for the last sixty years. It is heavily preoccupied with hang-ups about sex and consists of lengthy, costly talk sessions about the counselee's past, dreams and the "subconscious," shifting responsibility and blame for one's problems to others, above all one's mother. As everyone knows, Freudian psychotherapy under various names is still going on today, much of it unfortunately in the name of Christian counseling.19 This is so despite the fact that already in 1952 H. J. Eysenck of the prestigious British Institute of Psychiatry examined the evidence relating to the actual effects of psychotherapy. He found that people without any treatment at all or with other forms of treatment did at least as well and usually better than people receiving Freudian psychotherapy. Other significant studies have confirmed Eysenck's work.20 At the present time, careful, scientifically controlled research studies are underway seeking to provide evidence as to what types of psychotherapy approaches, if any, are effective and with what specific types of complaints. The goal of such research is to make psychotherapy practitioners publicly accountable along the same lines as physicians in the dispensing of drugs for physical complaints. In general, Freudian related, "mental dynamics" therapies do not fare well under research scrutiny. On the other hand, therapy approaches that emphasize appropriate, personal responsibility, common logic, and problem-solving skills have been shown to work well in helping troubled individuals improve their everyday coping and adjustment.21
For the last twenty years "deinstitutionalization" of mental hospital inmates has been the rule. Many thousands of them were pushed out of state mental hospitals into the streets, sidewalks and parks of local communities without any treatment at all. The most trustworthy studies of this situation have found that at least 30 to 40% of America's homeless population of perhaps 4-600,000 are suffering from major genuine mental illnesses (schizophrenia, manic-depressive illness and clinical depression).22 The patients' desperate families are often forced to become their caretakers, mini-asylums and co-victims. They can defend their cohesion, functioning and physical safety only by legally barring the sick family member from the home after he or she actually commits violence against their persons. This victimization of the patients' families is due to the defense of the mad person's "right to refuse treatment." This "right" is preached by the disciples of Szasz, civil libertarians, and heirs of the rebellious 1960s in the name of personal autonomy which over-rides everyone else's right to comfort, safety and life itself. Of course personal autonomy is a travesty when people are unable to function in society on their own due to organically caused mental impairment. After years of cavalierly overriding the welfare of the sane in family and community, civil rights advocates and courts must face the fact that truly insane people exist and may endanger themselves as well as others unless properly restrained and/or medically treated. As psychiatrist Darold Treffert puts it, "what kind of twisted 'right' is it to stab or shoot to death yourself or some innocent bystander while in a psychotic frenzy, directed by terrifying voices from a disordered and disabled mind? ... enough family members have been exhausted in a fruitless effort to help, and enough patients have 'died with their rights on'."23
Several conclusions arise from the biblical Christian perspective. First, the diagnosis of organically caused mental disorientation or illness must be well established and then followed up by the best known medical treatment and/or hospitalization, involuntary if violence against self or others is threatened, Second, demon possession behind apparent symptoms of clinical insanity is a real possibility but should not be assumed hastily without prior careful exclusion of organic causes. Third, Freudian psychotherapies are anti-biblical, useless and must be replaced by strictly biblical counseling emphasizing the client's repentance, obedience to and responsibility under God. Fourth, the world as originally created by God and now subject to corruption through man's fall is the only reality there is. The counterculture of the 1960s warred not so much against the "establishment" but more deeply against God Himself and His creation order. Extreme denial of this reality through madness is not an "alternative life style" but a death style, it is a graphic picture of hell where all who worship themselves in would-be "autonomy" will spend eternity unless they repent. This picture of hell includes the mad wretches exhibited for money at Bedlam, the inmates of asylums feigning symptoms of insanity to avoid responsibility for their problems in a normal life, or the untreated insane due to substance abuse now haunting streets, parks and subway stations in our beleaguered communities. Alas, the picture also includes the innocent genuinely, organically mentally ill to whom our neighborly love and care is due just as much as to all innocent sufferers we meet. We must remember that all people, no matter how deeply disintegrated, bear traces of God's own image and likeness in which man was originally created. Furthermore, they also preserve to the last remnants of their God-given created identity or personality. After a discussion of various personality types Wood notes that "when genuine psychiatric illness manifests itself, the previous personality will be reflected in the symptoms."24
Finally, God in His sovereign grace may use both innocent, genuine organic mental illness and also madness and disintegration resulting from willful rebellion against Him and His created reality in conversion and sanctification of the sufferers themselves and those whose lives they touch. So it was with King Nebuchadnezzar. So it was with the madman of Gadara whom Jesus restored to his right mind by exorcising the legion of demons possessing him. Most truly therefore does Eve Lewis Perera speak of madness as a "tool of the New Creation."25 "For of him, and through him, and to him, are all things: to whom be glory for ever. Amen" (Romans 11:36).
Postscript: The following comments were received from Wayne Spencer, a friend and co-worker of the author's, upon reading this article in manuscript form;
Your article addresses a very important issue and I like it. It's not that I have a disagreement with anything you do say, but there are things you don't say that could be clarified. You address essentially two root causes of "mental illness"--physiological problems or willful sinful rebellion, I would say there is a third root cause: learned attitudes and behaviors.
Many personal problems are related to upbringing and experience at school and such. They don't excuse the person's sin--but they can make it impossible for them to think or behave better--until they learn that there is something better. Attitudes and actions that are learned can be unlearned, especially in Christ, but many people live for years with various problems or personal sins just because they've learned to. Of course, people, all people, also have a conscience. But the conscience is affected by the learning process and by experience, so it too is fallen.
1. Dr. Kurt Koch, Occult Bondage and Deliverance (Grand Rapids, Ml: Kregel Publications, n.d.), p, 136.
2. Per Ola and Emily D'Aulaire. "Cocaine: The Devil Within," Reader's Digest. April 1991, p, 53.
3. Jay E. Adams, Competent to Counsel (Grand Rapids, Ml: Baker Book House, 1970, Third Printing 1973), p. 4.
4. ibid., pp. 31-33.
5. Franklin E. Payne, Jr., M.D,, Biblical/Medical Ethics (Milford, Ml: Mott Media, 1985), pp. 156, 161.
6. Rael Jean Isaac and Virginia C. Armat, Madness in the Streets (New York: The Free Press, A Division of Macmillan, Inc., 1990), pp. 54-55.
7. Adams exempts "organically generated difficulties" from personal problems people must solve (Competent to Counsel, p. 29). Payne reluctantly states that "In some rare instances medication or hospitalization may be necessary. Both the counselor and the counselee should be certain that... specifically identifiable physical causes have been investigated" (Biblical/Medical Ethics, p. 175).
8. Isaac and Armat, Madness in the Streets, pp, 164-167,
9. Isaac and Armat, Madness in the Streets, p. 1.
10. ibid., p. 20.
11. ibid., p. 177.
12. ibid., p. 219.
13. For a brief but very sobering look at some side effects of the neuroleptic drugs, see Isaac and Armat, Madness in the Streets, pp. 234-239. This warning is all the more convincing as Isaac and Armat generally welcome and defend these drugs as a great and indispensable advance in the treatment of clinical insanity.
14. See Ellen Myers, "Forerunner of New Age Madness: A Critique of Norman O. Brown" in Creation Social Science and Humanities Quarterly, Xlll:l (Fall 1990), pp, 7-16.
15. Garth Wood, The Myth of Neurosis (New York: Harper & Row, Publishers, 1986), pp.34-36; also Appendix 1, pp. 214-263.
16. ibid., p. 158.
17. Ibid., p, 146.
18. Adorns, Competent to Counsel, xix.
19. Payne warns that the danger of adding worldly concepts to Christian-biblical principles is a danger which "cannot be overemphasized. Most psychiatrists who profess Christianity are a serious hindrance, and even antithetical, to the cause of Christ because of their authoritative, but mistaken, influence in the name of Christ" (Payne, Medical/Biblical Ethics, p, 165).
20. Wood, The Myth of Neurosis, pp. 275-287, Wood points out that a significant number of patients are made worse by psychotherapy (pp.284-285), and that non-professionals often provide better help for emotionally troubled people than professionals (pp.286-287). Psychotherapy in all its forms is thus essentially worthless,
21. e.g. see I. Elkin, T. Shea, J. T. Watkins, 3. D. Imber, S. M. Sotsky, J. F. Collins, D. R. Glass, P. A. Pilkonis, W. R. Leber, J. P. Docherty, S. J. Fiester, & M. B. Parloff, "National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments," Archives of General Psychiatry. 46, (1989), pp. 971-982,
22. Isaac and Armat, Madness in the Streets, pp. 3-5,
23. Isaac and Armat, Madness in the Streets, p, 283. Also see ibid,. Chapter 12, "The Right to be Crazy" and Chapter 13, "The Specter of Violence," pp. 249-283 for case histories and other extensive documentation.
24. Wood, The Myth of Neurosis, p. 44.
25. Eve Lewis Perera," Madness as a Tool of the New Creation," originally published in Creation Social Science and Humanities Quarterly, 11:1 (Fall 1979), pp. 5-9, and reprinted nearby in this issue,