Transgression or Disease?—The DSM and Sin

A timely word from the Kairos Journal vault on bringing a biblical worldview to bear upon our pastoral counseling:
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When English Puritan Richard Baxter penned his magnum opus of pastoral counseling, A Christian Directory, he appended a noteworthy subtitle: A Sum of Practical Theology, and Cases of Conscience. Directing Christians How to … Overcome Temptations, and to Escape or Mortify Every Sin. Though lengthy by modern conventions, it reflected his opinion that deviations from God’s standards of behavior are moral transgressions meriting judgment and correction. In contrast, today’s most popular reference work on behavioral deviance operates from a worldview that is decidedly less spiritual. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) never speaks of sin and hardly ever references moral categories of any sort. Instead, it often reclassifies as “disease” what humans have known simply as “immorality” for millennia, ignoring the moral aspect of human behavior.
Consider, for instance, how one could use the DSM-IV-TR to explain some of the traditional seven deadly sins without any reference to ethics.
Wrath could be a Manic Episode, “a distinct period during which there is an abnormally and persistently … irritable mood.” In children, one could classify it as symptomatic of a Major Depressive Episode.
Sloth, or laziness, could be written off as a depression problem rather than an affliction of the soul. One sign of a Major Depressive Episode, says the DSM, is “blaming oneself… for failing to meet occupational or interpersonal responsibilities.” Further, “The efficiency with which tasks are accomplished may be reduced.”
Pride could indicate a Narcissistic Personality Disorder. With that condition, according to the manual, “Individuals … have a grandiose sense of self-importance. They routinely overestimate their abilities and inflate their accomplishments, often appearing boastful and pretentious.”
The DSM’s section on “Sexual and Gender Identity Disorders” provides a plethora of options for explaining lust. Paraphilias, for example, “are characterized by recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations.”
Envy might be another sign of Narcissistic Personality Disorder, for, according to the DSM, “[t]hese individuals are often envious of others” and “may begrudge others their successes or possessions.”
Finally, gluttony need not enter the secularist’s vocabulary, for it can be replaced with Binge-Eating Disorder—a condition marked by “recurrent episodes . . . associated with … impaired control.”
Of course, mental disorders are real problems, not mere excuses for sinful behavior. Even so, the DSM leaves a patient’s most fundamental need untreated by isolating his psychological diagnosis from his fallen condition and the spiritual component of his being. Thus, it can lead well-meaning therapists to prescribe only medical care in cases where repentance is needed too. For instance, while children with Conduct Disorder may need clinical diagnosis, they need parental discipline too, a fact the DSM fails to mention. Similarly, Alcohol Intoxication is a moral defect to correct, not merely a mental disorder to diagnose, as the DSM suggests.
In contrast to the DSM’s amoral worldview, the Church must regard biblical instruction as the foundation of counseling. Indeed, the world needs more believers who deal compassionately with mental disorders but never abandon the call to repentance as their central theme.