Originally Published By: Biblical Counseling Coalition by Garrett Higbee
Early in my career as a biblical counselor, it seemed that psychiatric labels were largely ignored. Mental health was seen as a secular term, and mental illness was often seen, at best, as a term latent with problems and, at worst, illegitimate to many biblical counselors. Lately, I have been encouraged to see that leaders in biblical counseling are approaching mental health more robustly based on Scripture and growing in the ability to address even severe mental issues. There has also been increasing interest from those in the biblical counseling movement in critically examining psychiatric diagnoses and the diagnostic paradigm they espouse. Having been trained in clinical psychology in the 1980s, I used the Diagnostic and Statistical Manual (DSM) version IV and then IV-TR (1994) extensively in my practice. After my conversion in 1993, I quickly saw many parallels between the categories that make up most of the clinical diagnoses and the main heart issues described in Scripture.
Seeing with New Eyes
In the mid-1990s, I had transitioned from secular private practice to full-time ministry, where my focus shifted from relieving symptoms (fruit issues) to targeting heart transformation and addressing root issues. That is when I began to write on the biblical equivalents to the DSM categories. In developing a more biblical diagnostic over 20 years, it has been rewarding to see counselees move from what seemed to be a secular label with a life sentence to understanding they are not stuck with a lifelong debilitating disease but can change (2 Cor. 5:16-21). We have trained thousands of disciple-makers and counselors to identify and reframe psychiatric diagnoses with biblical labels.
In the late nineties, I wrote an article called “Let Me Draw You a Picture.” I described the four most common heart attitudes that correspond to diagnostic categories. Understanding how to discern and counsel these four hearts is the core of the soul care training in our Transformed Equipping Series we use to teach small group leaders and soul care counselors. 
I believe we must continue to develop ways to reframe issues and guide our people to a biblical worldview of mental illness (Col. 2:8). While causality may vary, based on Scripture, we believe that every “mental illness” has a spiritual origin (Jer. 17:9; Rom. 1:20-24). Having a holistic and biblical perspective of man, we cannot let mental health assessment, standards, and care be abdicated to the secular therapeutic community as it has for over a century. Historically, soul care and the cure of souls were part of a pastoral care culture. In the last several decades, “well-being” has been measured by the Center for Disease Control and Prevention and insurance companies. They set the standard for what is “normal.” One might conclude that you can be mentally healthy without even considering spiritual health. Secular research has validated that prayer may reduce stress and church attendance may provide a meaningful community. Beyond that, what does the Bible have to do with mental health, or—maybe even more importantly—what does the Christian faith have to do with general well-being?
An Attempt at Defining Mental Health Biblically
Measuring mental health and well-being from a biblical worldview seems to require added dimensions, but how do we define them? First, I think it is important to note that our epistemology, anthropology, and etiology differ from our secular counterparts, who are measuring secular well-being. We see personal sin at the root of mental dysfunction and sin’s effects on this world causing tremendous suffering. We are not ignorant of human weakness and, in effect, mental illness as a result of the fall (Gen. 3), but we measure and treat it differently. Our truth as Christians is not simply based on objective and empirical evidence but also on the unseen (Eph. 6:10-12) and the authority of Scripture (2 Tim. 3:16-17).
Our view of man is not just naturalistic, although we know that man is subject to a fallen world and is in a fallen and decaying state of being (Rom. 8:18-15). Our study of causality and pathology is not limited to science, but it is not devoid of it either. So, we do not ignore the mental, physical, emotional, and behavioral factors that point to dysfunction and mental illness. However, we cannot overstate the resilience and power that allows us to overcome these factors in how we respond as we mature in Christ (Gal. 2:20; Col. 1:27-29). If the Bible informs our worldview, a popular ontological perspective is that man is an embodied soul. The soul is the immaterial part of man, often referred to as the mind, the will, and the emotions. For us, it would seem that mental health and well-being would relate to the wellness of the soul (Prov. 4:23) and, to some extent, how the soul and body interact.
We must acknowledge that it is impossible without God for a believer to really understand what it is to be healthy, happy, and well-balanced mentally (Eccles. 1:12-14). As created beings dependent on God, “wellness” then is directly related to our relationship with the Creator (Gen. 2:7; Rom. 1:20). If sin is the enemy of mental health, then any hope of wellness was lost in the fall of man (Gen. 3:22-24) and is only redeemed by being saved by grace through faith in Jesus Christ (Eph. 2:8-10). Secular scientists, while often well-meaning in their pursuit of mental health, are searching in vain without understanding the power of the Cross to redeem relationship and peace with our Creator. Thus, if we pursue mental health through means of addressing symptoms and focusing on self-esteem, self-help, and self-sufficiency, we too will reap misery in the end (Matt. 10:39).
God left us the key to true mental health in His Word, the gospel. The standard for wellness is a heart redeemed by and satisfied in Christ (Ezek. 11:19). A life where we are growing a Christ-like character, mindset, and demeanor is a believer’s “new normal” (2 Cor. 5:17; Gal. 2:20, Phil. 2:1-5) and the baseline for mental health in a biblical worldview. There is a paradigm shift from being conformed to a set of criteria that the world calls functional to being transformed through progressive sanctification (Rom. 12:1-2). But how? First, by abiding in Christ in deep dependency (John 15), second, by being mindful of Christ in all that we do (2 Cor. 3:18), and third, by being renewed in our thinking primarily through His Word (Eph. 4:22-24). Scripture does not mention mental health but does use words like shalom, joy, soul rest, contentment, and blessed to describe a person at peace in Christ (Ps. 4:8; 119:165; Prov. 3:17; Isa. 26:3; 32:17; John 20:21; Acts 10:36; Rom. 15:13; 1 Cor. 14:33; Gal. 5:22; Eph. 2:14; Phil. 4:7; Col. 1:20; James 3:18).
Implications for Counseling
If we believe from a biblical worldview that mental health starts with faith, we must help our counselees ask if they are right with God. Then we might ask, how are they staying right with God (Heb. 10:19-25)? Are they prayer-dependent (Rom. 12:12)? Is the Word of God their mirror for accurate biblical self-examination (James 1:22-25; Heb. 4:12)? Are they right with others (2 Cor. 5:14-20; 1 John 2:7-17)? Finally, is their mind set on eternity (Matt. 16:23; Rom. 8:5; Col. 3:1-2)? A mind filled with truth and set on eternal things will not be emotionally troubled or situationally disordered (James 3:14; 1 Pet. 1:22). Peter Scazzero, in his book Emotional Healthy Spirituality, makes a clear connection when he states that “emotional health and spiritual maturity are inseparable.” 
As we mature in Christ, we can expect to grow healthier emotionally, relationally, and mentally in some ways regardless, and in other ways because of trials, impairments, or circumstances (1 Pet. 1:3-9). We might carefully help our counselees see the inherent dangers of psychiatric labels. We might show sufferers how debilitating and hopeless a diagnosis that sets their identity in a victim stance can be: How it can lead to a poorly developed theology of suffering. How a clinical diagnosis can defer or distract taking responsibility for willful rebellion and self-inflicted suffering. A label based on an incomplete understanding of man can be confusing, and it can bring stigma and shame. As biblical counselors, we need to consider the labels our counselees have been diagnosed with, not so much to refute them but to help build a superior biblical diagnostic, leading to a more biblically informed care plan.
Biblical Mental Health Still Respects Weakness and Medical Complications
We are all aware that there are extreme consequences related to original sin. Our counselees come in with suffering that at times is so debilitating that their bodies, moods, and even their thinking become severely compromised. Dementia, Autism, Schizophrenia, and Bipolar symptomatology would be examples of some potentially genetic or biologically based weaknesses that warrant medical assessment and perhaps intervention. Extreme mental problems with physiological related complications create even more of a need for a holistic care plan. The more extreme the behavioral symptoms we encounter, the more we might consider the role of medication or acute care. But as embodied souls, we are not limited to the point where we can not obey. We are still deeply impacted by how we relate to God. In our new man, we have the ability to respond in a renewed way, and the battle with our flesh does not change how we are commanded to treat others (Rom. 12:10; 2 Cor. 13:11; Gal. 5:13; 1 Pet. 1:21; John 4:7).
I think of Hebrews chapter 4, where both the human high priest and then our heavenly High Priest showed mercy as they too understand human weakness. Certain neurological and physical issues can impact mental health and explain increased temptation, decreased self-control, and extreme behavior, but for most, they are not determinative of how we act (Eph. 4:17-24; Col. 3:5-11). In a biblical worldview, we understand these weaknesses are highly influential and necessitate a merciful and realistic approach to care. If we act in ignorance or indifference to the extremes, we risk losing all credibility with both our secular counterparts and those suffering in these ways.
Questions for Reflection
- How does a biblical worldview change your definition of mental health?
- Do you help your counselees to reframe their diagnoses biblically?
- When there seems to be a medical cause or contribution to the struggle, how do you develop a more holistic care plan?
 Garrett Higbee, Let Me Draw You a Picture, BCC blog, August 2011, https://www.biblicalcounselingcoalition.org/2011/08/18/let-me-draw-you-a-picture/.
 Garrett Higbee, Transformed Training Series, soulcareconsulting.com.
 Robert Kelleman, Soul Physicians: A Theology of Soul Care and Spiritual Direction, (BMH, 2007).
 Marc Cortez, Embodied Souls, Ensouled Bodies, (New York, NY: T&T Clark, 2008).
 Peter Scazzero, Emotionally Healthy Spirituality: Unleash a Revolution in Your Life in Christ (Nashville, TN: Thomas Nelson, 2006), 12.
 Chris Langer, Be Wary of Mental Health Labels, NHE, March/April 2016.