Parenting and Mental Health

Michael Emlet. Descriptions and Prescriptions

What is a mental health diagnosis?

Symptomatic Diagnosis

The DSM-5 offers a descriptive model of mental health diagnosis

It unites a group of symptoms together into a meaningful description. There are no laboratory tests for psychological disorders (with a few small exceptions: substance abuse addictions and narcolepsy) So what is someone saying when they say, “I’m bipolar.”

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospi­talization is necessary).

During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a sig­nificant degree and represent a noticeable change from usual behavior.

Inflated self-esteem or grandiosity.

Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

More talkative than usual or pressure to keep talking.

Flight of ideas or subjective experience that thoughts are racing.

Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.

Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).

Excessive involvement in activities that have a high potential for painful conse­quences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. Note: A full manic episode that emerges during antidepressant treatment (e.g., medi­cation, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis.

A psychiatric term, like depression, is just a shorthand description of thoughts, feelings, and actions. It is always an occasion to pursue and hear this person’s specific descriptions and experiences that are summarized by the diagnosis. Once you understand those descriptions, you will typically be able to identify a number of potentially fruitful ways to help. (Welch)

How can a diagnosis help?

It helps organize and categorize information

We can learn many things with wisdom and experience, but sometimes it’s nice to learn from others’ wisdom and experience

A diagnosis can help us categorize and find patterns in someone’s struggle.

A diagnosis can help us be on guard against other associated issues.

A diagnosis helps us see how someone else’s experience is different from mine.

A diagnosis can help us understand underlying biological factors which are better classified as suffering than sin.

How can a diagnosis hurt?

Descriptions not explanations

Descriptions are not explanations

Our capacity to think correctly is compromised by all sorts of things

Most significantly: Sin

Substances

Diet

Rest

Ignorance

Health issues

Mental illness

Mental illness describes symptoms not causes

When we fall into an exclusively diagnostic model, we tend to flatten a diverse set of causes and isolate one “easy to fix” cause.

If there is a magic pill that fixes my mental struggle, I want that instead of the hard work of dealing with all these other potential causes.

Example

What do these physical reactions describe?

Shortness of breath

Racing heart

Wide eyes

Pale face

Body tension

Fight or flight

With this information about these symptoms and a neat category to describe them all together, are you able to help the person?

Did a bird cause the symptoms?

Did an onrushing train cause the symptoms?

This does not mean that mental illnesses are not real, but when my struggle or the struggle of my friend fits into the categories of a mental illness, we should not stop correcting other likely causes of that struggle.

Over-diagnosis

Some of the illnesses in the DSM-5 are overly broad and lead us to diagnose common shared human problems as unique diseases.

The simple fact is that ordinary human life is a struggle.

Every struggle does not need a diagnosis.

Mental health diagnoses by definition operate on a scale of normal to abnormal. Life is hard and you’re not weird if you think so.

Misdiagnosis

A mental health diagnosis can confuse our common sin problem with a biological problem.

It is possible to be simultaneously sinner and sufferer. Your body can make you suffer, but it can’t make you sin. Your body can’t stop you from growing spiritually.

Ecclesiastes 12:14 “14 For God will bring every deed into judgment, including every hidden thing, whether it is good or evil.”

Romans 14:12 “12 So then, each of us will give an account of

How do we care for those with mental illness?

Ed Welch. Ten Ways Ordinary People Can Help Those with Psychiatric Problems. JBC 28:2 (2014)

1. Move toward them

Don’t let a diagnosis scare you away

If someone is beset by intrusive and harmful thoughts, it would be nice if you could make the thoughts stop, but since you can’t, love them instead by reminding them of the truth when they believe a lie. You may not have experienced X (manic episode, depression, schizophrenia), but you do understand hardship. Jesus speaks to suffering.

4. Be a student of the person

Learn about them

Symptoms

Needs

Confusions

5. Treat them like you treat others

It’s not natural to be normal with the abnormal

They are still a person

Their sin can be confronted

Their suffering can be comforted

Even in the case of more extraordinary struggles, there are common struggles under the surface. If you are helping someone who believes that the government is listening to his every thought, you can still encourage him to be a loving son, without ever understanding or repairing the delusion.

6. Prioritize ways to help

Encourage them towards godliness and health in simple matters.

Start by making your bed.

Set small achievable goals

The practical often has a spiritual component.

7. Acknowledge what you don’t know rest in what you do

A diagnosis is not a treatment plan

Do not make medical recommendations you are unqualified to offer

You may not be a psychiatrist, but you can be competent with the Word – encouraging obedience in daily living

8. Avoid sinful responses in yourself

Anger

Fear

Apathy

9. Keep Christ at the center

2 Peter 1:3 “3 His divine power has given us everything we need for a godly life through our knowledge of him who called us by his own glory and goodness.”

The only eternal hope the mentally ill person has is Christ

10. Ask for help

Professional help (go along for doctor visits)

Help from others with more experience/wisdom (pastors, friends, books, other sufferers)