Caring for Some Body: The Pursuit of Mental Health in the Health of the Body
Joshua Briscoe, Duke University School of Medicine
Of those who experience mental health challenges, some reach clinical attention, with approximately 23% of adults in the United States diagnosed with a mental illness. Describing the challenge, predicting how it will impact someone’s life in the future, and determining what is to be done about it are all fraught with challenges and each can be and are brought under medical authority. I contrast the medicalization of mental health challenges through diagnosis, prognosis, and intervention with the theological virtues of faith, hope, and love asserted by the apostle Paul and on display throughout the biblical narrative. Diagnosis can reduce a person to a category and cause them to lose rich language for describing their experience, whereas faith looks backward to what God has done in history, specifically in making a particular creature (from dirt and spirit), then a particular community (for life together), and then coming as the particular person of Jesus (to redeem the world from sin and death), shaping how we think of mental health challenges and their influence on one’s identity. Prognosis is a thin view of what might be expected in the future, speaking mostly to symptom reduction and the instrumentalization of the body (will this body burden me or others?), whereas hope looks forward to what God has promised to do in new creation, renewing everything in someone’s life in ways that are both experienced now and hidden for future fulfillment. Intervention submits a person with a mental health challenge to medical authority in a particularly neurocentric way, whereas love creates a context of connection that is humane and acknowledges shared existential concerns, meeting a person facing a mental health challenge as a fellow companion on their way toward greater things. While it is by no means easy to differentiate them, the biblical story accounts for vulnerabilities, dependencies, and limitations attributable to our creatureliness (which should be accepted with gratitude) as well as our fallenness (which should be resisted with means wisely chosen, sometimes medical, sometimes spiritual), but in either case inviting, even driving, us back to God.
The interaction between the biological, psychological, and social is best captured by the psychiatrist George Engel’s biopsychosocial model, which helps to elucidate what is inchoate in this biblical account. Engel argues we all exist in living systems, with each “level” connected to the others, and problems of any kind likely precipitated and perpetuated by factors at multiple levels. However, it remains no small challenge to discern what constitutes disease and falls within the rightful purview of medicalization. Rather than wade into these debates, I agree with Christopher Boorse that disease is the impairment of normal functioning of an individual human person (at the cellular level all the way up to the behavioral level), recognizing the added complication that mental health challenges will always be fraught with blurry boundaries because they belong to what the philosopher Peter Zachar call “imperfect communities,” clusters of properties which hang together reliably enough to say important things across cases and time. This means mental health challenges may be medicalized, moralized, or, perhaps most commonly, both, depending on the weighting of the burdens and benefits of each framing. Faith, hope, and love offer to better guide appropriate uses of medicalization and moralization in service to the restoration of the capacities of mental health.
The interaction between the biological, psychological, and social is best captured by the psychiatrist George Engel’s biopsychosocial model, which helps to elucidate what is inchoate in this biblical account. Engel argues we all exist in living systems, with each “level” connected to the others, and problems of any kind likely precipitated and perpetuated by factors at multiple levels. However, it remains no small challenge to discern what constitutes disease and falls within the rightful purview of medicalization. Rather than wade into these debates, I agree with Christopher Boorse that disease is the impairment of normal functioning of an individual human person (at the cellular level all the way up to the behavioral level), recognizing the added complication that mental health challenges will always be fraught with blurry boundaries because they belong to what the philosopher Peter Zachar call “imperfect communities,” clusters of properties which hang together reliably enough to say important things across cases and time. This means mental health challenges may be medicalized, moralized, or, perhaps most commonly, both, depending on the weighting of the burdens and benefits of each framing. Faith, hope, and love offer to better guide appropriate uses of medicalization and moralization in service to the restoration of the capacities of mental health.