Creation and human disorder
In the clinical seminar I am teaching this summer, we are exploring the nature of the DSM-IV-TR--the "bible" of psychiatric diagnosis--as a political document that constructs [and is used to construct] human "disorder" (and in the process privileges particular professional and economic interests) rather than to describe discrete, empirical illnesses with clear treatment protocols.One of the texts we are using, Constructions of Disorder, left students frustrated in its sometimes essentialist and intrapsychic approach to understanding mental illness, despite its foundation in constructivist, narrative, and social constructionist theories.
Students were particularly concerned with the ways in which the language of "disorder" contributes to the diffusion of deficit (to use Ken Gergen's memorable phrase) in our culture. While recognizing the need to speak the language of diagnostic codes in order to participate in the discourse of the mental-health industry (one aspect of a pastoral counselor's interprofessional role), they wondered about the positive and negative effects of reifying diagnoses such as "generalized anxiety," "depression," and even "schizophrenia" through conversation with counselees.
What is the pastoral counselor's responsibility, as a representative of divine reality (and, for Christians, a messenger of the good news of Christ), in such conversations? Should we honor the language of disorder as much (or more) than we honor the imago Dei (image of God) in each person?
This led us into a conversation about what "disorder" might be in human life . . . which led us into classic questions for pastoral theology: What is health, wholeness, salvation? What is brokenness? What is the meaning of suffering? and What does it take to heal/recover/become whole where mental illness is concerned? (Questions that James Lapsley dealt with admirably more than 30 years ago in Salvation and Health and that Don Browning addressed even earlier in Atonement and Psychotherapy.)
During the conversation, a not-very-original-but-perhaps-useful thought came to me:
In the first creation story in Genesis, chaos--that is, disorder--ruled in the form of darkness, formlessness, nothingness, and "the deep" until God placed constraints on it. The story does not say that God eliminated disorder, only that boundaries were placed upon it.
Disorder, then, still exists; at times, it might be understood to violate the boundaries God established to maintain order.
I wonder if this is a helpful way of thinking about mental disorders, drawing upon the doctrine of creation? It certainly externalizes the cause of disorder and perhaps creates hope that the person and the divine together (depending upon one's theology) can place boundaries on it and return to a more ordered way of being in the world.
Not, as I said, a very original exegesis of Genesis or understanding of mental illness . . . but a stab at creating a different sort of discourse about illness that is congruent first with some "takes" on Christian theology and second with constructionist approaches to helping people overcome their difficulties.
.: Posted by Duane Bidwell on Tuesday, July 26, 2005
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