Grace for the Afflicted

A Clinical and Biblical Perspective on Mental Illness

Matthew S. Stanford

• Publisher: IVP
• Year: 2017
• ISBN:
  9780830890804
• Topic: Theology & Religion
• Subtopic: Christian Ministry

Why has the church struggled in ministering to those with mental illnesses? Each day men and women diagnosed with mental disorders are told they need to pray more and turn from their sin. Mental illness is equated with demonic possession, weak faith, and generational sin. As both a church leader and a professor of psychology and behavioral sciences, Matthew S. Stanford has seen far too many mentally ill brothers and sisters damaged by well-meaning believers who respond to them out of fear or misinformation rather than grace. Grace for the Afflicted is written to educate Christians about mental illness from both biblical and scientific perspectives. Stanford presents insights into our physical and spiritual nature and discusses the appropriate role of psychology and psychiatry in the life of the believer. Describing common mental disorders, Stanford probes what science says and what the Bible says about each illness. Consistent with DSM-5 diagnoses, this revised and expanded edition is thoroughly updated with new material throughout, including eight new chapters that cover- bipolar disorders- trauma- and stressor-related disorders- dementia- cerebrovascular accidents (stroke)- traumatic brain injury- suicide- a holistic approach to recovery- mental health and the church

SECTION TWO

MENTAL
DISORDERS

5

A LOST MIND

SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDERS

I do not know what we would do without the Lord and his people. They have strengthened us and helped carry this incredible burden. They have made us see that our child can be used mightily by God to reach others that no one else without a mental illness could possibly reach.

JENNIFER, MOTHER OF A SON DIAGNOSED WITH SCHIZOPHRENIA

TO PEOPLE IN HER SMALL TEXAS TOWN, Jillian was the All-American girl everyone wished to be. Led to Christ by her grandfather at the age of six, she remembers always being involved in the church. A straight-A student who enjoyed competing in beauty pageants, she hoped to attend the same Christian college as her older sister. At home, however, not everything was as it appeared. Conflict in her parents’ marriage and the traumatic effects of childhood sexual abuse had set the stage for mental health difficulties to come. After graduating from high school, Jillian moved away from home for the first time to attend college. It wasn’t long before she recognized that something was wrong. She lacked motivation; everything was an effort. She was depressed and avoided people. In addition, her grades were not at her usual level of achievement. She started restricting when and what she ate, and became obsessed with exercise. Her college friends voiced their concerns to her. The second semester of her freshman year was even worse. Her depression deepened, her grades dropped further, and her problems with food increased. She says, “I felt like I was falling apart.” A hoped-for rest during the summer was replaced by a rollercoaster of emotional highs and lows. Her parents suggested that she transfer to the local college so she could live at home and go to school. The move changed nothing; she continued to struggle.

The voices started in the spring. By July she was sitting in her room at home motionless and unable to respond to questions from her family. That month she was hospitalized for the first time. Eight days in the psychiatric hospital brought a diagnosis of schizoaffective disorder. After being discharged, Jillian admits she wasn’t compliant with taking her medication over the next several months. “I didn’t think I really needed it.” By the fall, she had lost so much weight that she had to spend four months at a facility that specialized in eating disorders. After leaving the eating-disorder facility, she finally felt like things were on the right track. Her eating problems were under control, and she was not experiencing voices due to her daily medication. She moved back in with her parents, found a part-time job and began attending an intensive discipleship-training program at her church. It was several months later, just before she left on a short-term mission trip to Tunisia, that she noticed the voices starting to return. Several months passed; the voices intensified.

The stress of her first serious romantic relationship, the pain of working through her childhood sexual abuse in therapy, and not taking her medication regularly were the perfect storm that threw her into a delusional state. She found herself hospitalized once again. After two weeks she was discharged. The next few months were some of the most difficult as her psychiatrist worked to find the right mix of medication to manage her symptoms. The emotional highs and lows, suicidal thoughts, auditory hallucinations and delusions finally ended. That was three years ago.

Today Jillian is finishing up college and expects to graduate this year. She takes medication daily and receives regular psychotherapy. She told me her illness has strengthened her faith.

During the difficult times I did ask God, “Why do I have to go through this?” He simply told me, “I haven’t asked you to understand why, but I love you and I’m with you.” That’s when I really started believing God was with me in the struggle. This illness has taught me that I don’t have to have it all together for God. I can rely on him to get me through. My disorder drives me to God; it has caused me to be more dependent on him.

Characteristic Symptoms

The symptoms of the schizophrenia spectrum disorders fall into two broad categories: positive and negative. Positive symptoms are abnormal thoughts, perceptions, and behaviors that most individuals do not normally experience. These include delusions, hallucinations, disorganized thinking, and grossly disorganized behavior.

Delusions. Delusions are strongly held false beliefs despite evidence to the contrary. Several delusional themes are commonly seen in schizophrenia, including persecution (the belief that one is going to be harmed or harassed by another), reference (the belief that certain gestures, comments, or environmental cues are directed at you), grandiosity (the individual believes they have exceptional abilities, wealth, or fame), erotomania (the individual falsely believes that another person is in love with them), jealousy (the belief that the individual’s spouse or lover is unfaithful), nihilism (the belief that a major catastrophe will soon occur), and somatic issues (preoccupation with one’s health and organ function).

Hallucinations. Hallucinations are experiences involving the apparent perception of something not present. These experiences can occur in relation to any of the senses, but auditory hallucinations are the most common in the schizophrenia spectrum disorders. Auditory hallucinations are usually experienced as voices perceived as distinct from an individual’s own thoughts.

Disorganized thinking. Disorganized thinking is typically recognized in the speech of the individual with schizophrenia. They may show loose associations by switching from one topic to another. Answers to questions may be tangentially related or completely unrelated. In rare instances, speech may be so severely disorganized that it is incomprehensible.

Grossly disorganized behavior (including catatonia). Grossly disorganized behavior may manifest itself in a variety of ways, ranging from childlike silliness to unpredictable agitation. Individuals with schizophrenia often have difficulty formulating and producing goal-directed behavior. Catatonic behavior is a marked decrease in reactivity to the environment. Individuals exhibiting catatonia appear to be completely unaware of their environment, maintain a rigid posture, and resist efforts to be moved.

Negative symptoms. Negative symptoms are the loss or decrease of an ability that is normally present. Common negative symptoms seen in schizophrenia include diminished emotional expression, decreased motivation (avolition), lack of speech (alogia), lack of interest in social interactions (asociality), and a decreased ability to experience pleasure from enjoyable activities and experiences (anhedonia).

Diagnoses

The Swiss psychiatrist Eugen Bleuler introduced the term schizophrenia to the world of psychiatry in 1908.1 Schizophrenia means a “splitting of the mind” and was used by Bleuler to describe a group of patients who showed a “breaking up or splitting of psychic functioning,” including thoughts, feelings, and perceptions. Today individuals who show psychotic symptoms are diagnosed along a gradient, or spectrum, reflective of the duration and intensity of their disorder.2

Schizotypal personality disorder. Schizotypal personality disorder is a pervasive pattern of social and interpersonal deficits, including reduced capacity for close relationships, cognitive or perceptual distortions, and eccentric behavior. Abnormalities of beliefs, thinking, and perception are below the threshold for the diagnosis of a psychotic disorder. This is the lowest end of the schizophrenia spectrum.

Delusional disorder. Delusional disorder is characterized by at least one month of delusions but no other psychotic symptoms. If hallucinations are present, they are not prominent and are related to the delusion. Apart from the impact of the delusion or its ramifications, functioning is not markedly impaired, and the individual’s behavior is not obviously bizarre or odd.

Brief psychotic disorder. Brief psychotic disorder is characterized by the presence of one or more of the primary symptoms of psychosis (delusions, hallucinations, disorganized thinking, and grossly disorganized behavior). The duration of the disturbance is at least one day but less than one month, with an eventual return to a normal level of functioning.

Schizophreniform disorder. Schizophreniform disorder is characterized by the presence of two or more psychotic symptoms. The duration of the disturbance is at least one month but less than six months.

Schizophrenia. Schizophrenia is characterized by the presence of two or more psychotic symptoms, each present for a significant porti...