For those who are counselors, pastors, or have gone through any kind of Christian leadership training, you may have come across any number of formal or informal articles about diagnosing people from the Bible with mental illness disorders. We see Job as depressed, Peter as anxious, or Saul as bipolar or schizophrenic. Some go blasphemous by diagnosing God as antisocial or narcissistic.
As a Christian, I have never felt comfortable with this. But from a professional standpoint, this is wrong on several levels. Here is why:
No Consent Given
The first rule of counseling is that you must be given consent to diagnose someone. We do not get to label people with a very formal diagnosis without their written and expressed permission. As mental health professionals, there is life impacting power in what we do.
It is generally understood that giving a diagnosis to someone changes a person’s response to themselves and must be followed up with proper clinical care. Some clients being diagnosed will fully change the way they act and behave based on our clinical formulation and recommendation. I’ve had clients transfer from another counseling agency that was told because of their personality disorder they’d never work again and they simply accepted it without seeing if there was more they could do. Others have lost custody of their children in court due to specific diagnoses.
So to diagnose someone without permission is not only unprofessional, its unethical and immoral.
No Differential Diagnosis
The standards in our profession require a review of medical, social, familial, and psychiatric history and records and a complete examination of mental status. Often collateral information from family members, primary care physicians, or individuals who know the person well is included, with permission from the patient.
We understand the person as a whole, knowing that someone having diabetes may lead to depressive symptoms, a traumatic brain injury could be an understanding of why they are anxiety and go into rages that feel like they blackout, or substance misuse that looks like someone is manic but is not the case.
The way I explain it to clients is when someone is vomiting, a doctor gives them anti-nausea medication. But the reason for nausea can be a wide range of things that are important to differentiate because it changes how you treat them. If they are anxious, you do counseling and psychiatric medication. If they have the flu, you give them medicine and rest. If they are pregnant, you connect them with an OBGYN. But it all looks like vomiting and without asking the person direct questions, you won’t know.
Per the American Psychiatric Association, here is the definition of the Goldwater Rule:
On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.
In 2018, they reiterate this and then note how it becomes armchair psychiatry, stating “Armchair psychiatry or the use of psychiatry as a political tool is the misuse of psychiatry and is unacceptable and unethical.” But the point that is most important from a professional standpoint is this: “Doing otherwise undermines the credibility and integrity of the profession and the physician-patient relationship.”
We see this with several professionals diagnosis one Bible character with something and then another with a different diagnosis, even though they are given the same information. This discredits the industry significantly. Ultimately, this can have significant ethical and legal ramifications. Therefore you should not do it.
One component to counseling that is often forgotten is the cultural context. We need to factor one’s culture into our diagnosis. When I talk with a client, I have my own perception of them, but only through my own experiences. They may not see symptoms with the same lens that I do and that’s important because it changes the diagnosis.
Native Americans use substances for spiritual practices that white Americans would say is substance misuse but would not be true for them. Black men and women are disproportionally diagnosed with anxiety and depression though with a cultural lens would not meet this criteria as what we would see as symptoms are simply ways of communicating and expressing ones self in a healthy manner.
So us trying to not only understand someone from a different continent, but also with a time gap of several millennia, and having to translate the language several times is simply irresponsible.
A Diagnosis Is A Snapshot, Not A Definition
You must understand that when we diagnose someone, we are not looking at their collective lives. Here are some durations of symptoms for diagnoses that must be met, any less time and we cannot give the diagnosis:
- Major Depressive Disorder: 2 week period per episode
- PTSD: 1 month
- Generalized Anxiety Disorder: 6 months
- Substance Use Disorders: Only in last 12 months.
When we see people diagnose Bible characters, they do not know any of this. They take one verse and generalize it to their life or they take one verse which could be months or years apart from another verse and throw them together to justify trying to label someone.
There is no debate with this, it is wrong, even from an educational standpoint to teach others. We must do better and not trivialize or profession or desecrate God’s holy word with our own personal agendas. I’d love to hear your thoughts in the comments below.