Descriptions and Prescriptions

Descriptions and Prescriptions_Cover

Review of Michael R. Emlet. Descriptions and Prescriptions: A Biblical Perspective on Psychiatric Diagnoses & Medications. New Growth Press: Greensboro, NC, 2017.

Christians contemplating clinical mental health care are often unsure if they can safely give themselves over to it. Freud's antagonism towards religion still casts an ominous shadow over the profession. Aside from this historical tension between Christians and one of the great minds of the field, two worries derive from the two sides of medicine: one part is science, the other part humane care. Psychiatry is no exception.  On the side of science, the non-Freudian psychiatry based on neuroscience is suspected of reducing the human psyche to a biological machine, an unbiblical metaphysics of man. On the side of humane care, in psychiatry, attempts at behavioral reform--soul work in Christian terms--belongs to the pastor. Is his role being usurped by clinical psychiatric medicine? These are among the questions that often unsettle Christians about clinical mental health care. Michael Emlet successfully addresses a number of these concerns with an informed and balanced approach to a key feature of modern psychiatric practice: pharmacological therapy.

Emlet, both an MD, and a biblical and theological scholar, is well-placed to answer these questions. This is certainly a book for our times, which is both its chief strength and a minor weakness. Employing a non-confrontational stance (which makes this an eminently giftable book), the author attempts to affirm the genuine help one might receive from modern (secular) psychiatric medicine without reducing biblical counsel to a mere addendum. In Part I, he outlines the modern concept of psychiatric diagnoses, particularly with respect to the DSM (Diagnostic and Statistical Manual of Mental Disorders), constraining its value to its descriptive merits. He draws the line at the reification of diagnoses. Emlet warns against the temptation to take diagnoses as statements of one's nature, not merely a classification of behaviors. In all fairness, he might have noted that psychiatrists generally do not do this, even though it can be common among popular and lay interpretations of the DSM categories. Part II covers some basics of psychiatric medications--what is known about their actions in the brain and when their use might be appropriate within a Christian worldview.

In an age when Christians often react readily to perceived threats, this book is refreshingly moderate, careful to recognize the strengths and weaknesses of modern psychiatric care. And lest one fear that the author favors modern medicine over pastoral care, nowhere in the book will you find psychiatric care divorced from regular biblical counsel. I heartily recommend this to anyone who is newly delving into the subject, whether personally or as a pastor or family member.

The focus of the book, pharmacological therapy, is appropriate for the current medical scene where drugs dominate the medical portfolio of therapies. For those encountering mental health care in their 20s and 30s, the book is well placed. However, for an older generation, the book is lacking some key topics. Freudian psychoanalysis and psychotherapy ran strong through the 1980s and in some corners still lingers. Christians developed a justifiable suspicion of Freud-dominated psychiatric medicine. It was here that the Biblical Counseling movement found its voice. (See David Powlison, The Biblical Counseling Movement, 2010.) One side effect of Jay Adams' work, however, was an abiding suspicion of psychiatry in general. Emlet's plea for a fair assessment of a pharmacological therapy will fail to address the hesitations of this older generation who views psychiatry as hopelessly anti-Christian. Psychiatry has moved on from the "mind" world of psychiatry to a "brain" world, bringing with it different problems. The author addresses these, but latent concerns may be an obstacle to hearing him.

The classic couch therapy of the Freudian days may be gone, but talk therapy has found new life in CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), EMDR (Eye Movement Desensitization and Reprocessing), ERP (Exposure and Response Prevention), and yes, biblical counseling. Emlet concerns himself only with medications, and has a place for talk therapy only within a biblical context, such as with a pastor or trained counselor. This is only implied, not stated in the examples throughout the book. Nor does he comment on the value or liabilities of non-biblical (not necessarily anti-biblical) talk therapies. In many mental illnesses, the most effective treatment currently is talk, not pills. This raises additional questions for the Christian considering clinical mental health care: Might I use these alongside biblical counsel? In what situations? The balanced judgement he applied to medications would have been welcome here as well.

Emlet has not only provided a helpful sketch of the subject, but has set a good example for Christian discourse. Pastors, especially, those who are prone to cry down 'the evils of society' and the satanic host of '-isms' would do well to follow his example. Indeed, the world of modern mental health normalizes or pathologizes whatever is convenient to its social philosophy of life, and we must be clear when that is the case. Emlet shows that it is not necessary to burn down the house to deal with the cockroaches.