There aren’t many books that walk you through the question: What should I do when I am planning to sin again? All Scripture, of course, is about this question because we all know we will sin again, but there are two patterns that are especially precarious.

1. Confess—then ignore. A couple indulges in premarital sex and feels guilty. They confess it to the Lord, and promise God and each other, never to do it again. But it happens again, and then again. By the third time they are not quite sure how to proceed. They still might feel a little horrible, but why bother confessing something that you know you will do again? They know that making guilty promises doesn’t work and, by this point, they admit that such promises are lies anyway. They expect to do it again. Better just to let this phase run its course, they conclude. Marriage might come soon, or maybe the sin will gradually die out. Then they can re-engage with God.

2. Confess—try—feel really bad—be hopeless—try to ignore. This is a slight variation on the first and takes a little longer to spiritually quarantine the recurring sin so that no one messes with it anymore. For example, someone might not be planning his next descent into porn, but he has done little to interrupt that descent such as share his internet activity with an accountability partner. He can confess his next nine falls (leaps?) into porn, but once it gets to double digits he starts to wonder, what’s the use? Then this sector of life gradually closes to divine activity, though those bad feelings never quite go away.

Either way, God is marginalized, sin wins by way of our denial and complacency.

Ask for Help

These patterns demand action. They kill our souls and our souls will not heal themselves over time. To the contrary, we need spiritual intervention. The most obvious intervention is to go public. Sin is like mushrooms and other things that flourish in the dark. So bring it to the light and confess it to another person. If we can confess something to the Lord but not to a mere human, our confession is suspect. Go public.

There are risks. Perhaps the person we tell will then tell others, or much worse, do nothing at all. But we must not talk ourselves out of a wise course of action because there may be unwanted consequences.

Two Approaches: Grace or Law

When we ask for help with these patterns, we will likely hear one of two approaches: grace or law. A trusted pastor told me to preach grace until a person took sin lightly, then preach the law.

Grace proclaims the kindness, forgiveness and forbearance of the Lord. It invites and accepts. It asks: “How can you continue to sin in light of God’s love now revealed in Jesus Christ? You must not know he loves you. How can you be either hopeless or committed to sin when the Holy Spirit has been given to you?”

The grace of God woos us. It is Christ’s love that compels us into godly action (2 Cor. 5:14). It is his grace that teaches us to say “no” to ungodliness (Titus 2:12).

The law takes the many pieces of the character of God and reassembles them in the form of commands: “Thou shalt . . .” and “thou shalt not . . .” Without them, we are clueless about how to imitate him. Without them, we forget that everyday life is lived before God and our instincts are treasonous.

The law has urgency—“today” (Heb. 3:15). It warns. It asks, “Is there no fear of the Lord? Is following Jesus reserved only for those times when there is a coincidental meeting between your desires and his?” It is the fear of the Lord that compels us to live righteously. We belong to him. He has all authority.

Which Way Do You Lean?

As we have opportunities to apply these two approaches to our own recalcitrance and offer them to others, how do we lean? Toward grace or law?

Words and meanings matter on this one. There are many different uses of the law: the law reveals the character of God, restrains sin, exposes sin—showing us our need for Jesus—and teaches how to live. None of these are opposed to grace but are expressions of it. Yet another use of the law is found in Romans and Galatians where the law is short-hand for a Spirit-less system that looks to our own actions for personal righteousness. This use of the law—called works-righteousness or legalism—is opposed to grace and the gospel.

With one use of the law, grace and law are companions. With the other, they are enemies. I am using the law as a companion of grace. Instead of opting for either grace or law, we could say that the law is embedded in the larger grace of God.

So what we are really asking is this: As a result of God’s manifold grace to us, do we woo or warn? The matter of intentional and planned sin does not force us to choose grace or law. Instead, both grace and law reveal the character of God, and we want access to the range of God’s character as we woo or warn. With all the persuasive love we can possibly offer, with pleading, we consider both the kindness and sternness of God (Rom. 11:22).

We will all sin again, of that we can be sure. When we do, we ask forgiveness of both the Lord and those who were wronged. Then some hand-to-hand combat against sin is probably in order along with some public planning to either stand firm or run when there is another assault. All of this is both preceded and followed by our rest in forgiveness of sin secured by Jesus. Rest is spiritual, complacency sinful. 

Usually counseling skills are talked about from the counselor's perspective. But what is it like from the point of view of the one seeking help? For counseling to be fruitful, what must happen in the counsel-seeker’s relationship with the counsel-giver? This workshop will discuss four key ingredients that make a decisive difference in the effectiveness of pastoral counseling

The Gospel Coalition is providing David Powlison's session from this year's conference for free. Click here to listen to the audio.

It’s the year 2063. A New Yorker article titled “The Last Normal Person in the United States” highlights the life of a certain E. Piphany. As far as experts know, she is the last living person not found to be diagnosable by the recently released DSM-9. Amazingly, she alone does not fall into one of the 5,146 conditions currently described in the DSM[1]. Which, ironically, makes her quite abnormal . . .

OK, I admit I’m being a bit snarky. No one, least of all thoughtful and caring psychiatrists, wants the trend of multiplying diagnoses to continue to this hypothetical endpoint. In fact, the fifth edition of the DSM unveiled last week contains a few less diagnoses than its predecessor. But the release of the DSM-5 after more than a decade of debates and revisions still pushes us to ask hard questions.

·      Why are more and more people receiving psychiatric diagnoses?

·      What is the best way to understand and classify disordered thoughts, emotions, and behaviors?  

·      Does having a diagnosis equate to a malfunctioning brain?

·      How can we wisely and compassionately care for those who are truly suffering?

Even insiders within the psychiatric community have raised concerns about over-diagnosis and the way we classify mental disorders. See for example the recently released Saving Normal, by Dr. Allen Frances, who chaired the Task Force that created the DSM-IV. The subtitle says it all: “an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life.”

What I hope to do in this post is to briefly orient readers on how to think about  psychiatric diagnoses and what role they should, and should not play, in biblical counseling.

DSM categories are descriptions not explanations

It’s important to remember that psychiatric diagnoses are descriptions of a struggling person’s thoughts, emotions, and behaviors; they are not explanations for them. They tell you what but not why. The DSM admits that. So what’s the problem? What’s wrong with giving a name to a set of symptoms? Isn’t that generally how the diagnostic system has historically evolved?

The problem is this: giving a summary label to a set of symptoms gives the appearance of explanation, particularly in our medicalized culture. It suggests that each diagnosis is a discrete and largely brain-determined entity, and there is simply little evidence for that except in the major psychiatric categories of schizophrenia, bipolar disorder, and severe depression. Even in these entities, we must realize the complex interaction of multiple factors.

Knowing that these categories are primarily descriptive (and not definitive explanations) should reduce any intimidation biblical counselors might feel about them. Don’t be scared off by a diagnosis! Don’t assume that you can’t provide what the person really needs. It may be important in certain cases to involve others, including psychiatrists, in the care of your counselees. But you can do the hard work of pressing beyond the symptoms to explore a variety of potential contributors to the person’s struggle. Spiritual, physical, relational, situational, and cultural factors are all important to probe and address. Doing so will help prevent the uniqueness of individuals from being swallowed up by a clinical description.

Descriptions can be helpful

On the other hand, do not simply dismiss the diagnostic entities in the DSM as invalid. Realize that they describe a subset of people who are struggling in real ways. Don’t allow a critique of the DSM to become a critique of the suffering people described in its pages! Rather, listen and learn—from your counselees—and from those in the psychiatric community who are “case-wise” and have devoted their lives to helping people who struggle in very particular ways.

But then, prayerfully seek to interpret people’s lives through the pages of Scripture. If it’s true that Jesus comes to make his blessings known “far as the curse is found,” then we need to wrestle with what the outworking of redemption looks like in concrete ways in the lives of those who struggle with psychiatric problems.

The current description-based system of psychiatric classification seems to be here to stay, at least for the foreseeable future. The DSM-5 gives no epiphanies from the secular mental health community, which is still at loggerheads regarding how best to classify psychiatric problems. We Christians must remain intent on faithfully and creatively bringing the riches of redemption in Christ to the people before us, whether diagnosable or not.

[1] Diagnostic and Statistical Manual of Mental Disorders. This is the official diagnostic manual used by mental health professionals and published by the American Psychiatric Association.

A friend sent me a copy of Jon Ronson’s book, The Psychopath Test: A Journey through the Madness Industry. He just wanted my opinion of the book, I think. (But it did remind me of another friend who gave me a six-pack of Tic-Tacs for my birthday.)

The book is a very interesting journey. By page 97, you finally get to the 20 items of the psychopath test. By page 168, you are screening most of the people you know according to these items—I identified at least two, no active pastors (the one I considered had retired), no CCEF colleagues, but I was certainly looking forward to identifying many more with my new found knowledge. By page 211, I realized that I had just fallen prey to that diagnostic fever you get when you learn a new way to identify behavior and are suddenly on the prowl for it everywhere. By the end of the book I came back to sanity: there are some truly nasty people out there who are devoid of compassion, but there are not very many, and I do not have to keep looking for them.

Psychopaths

Psychopaths, also known as sociopaths, are described as charming, manipulative, and lacking conscience, empathy, guilt and remorse. The well-known ones are men. The checklist, which is not officially sanctioned in modern psychiatry, also includes need for stimulation and proneness to boredom, pathological lying, shallow emotions, promiscuous sexual behavior, unrealistic goals, inveterate blaming, and unstable relationships. Among the most eerie descriptions is that they have no warm emotions but study the emotional responses of others so they can use those emotions to their advantage. Now you are probably thinking about some people you know too.

No empathy and compassion

It is the matter of empathy and compassion that raises a question for biblical counselors. Psychopaths do register very little empathy and compassion as measured by amygdala functioning (the amygdala is an area of the brain that seems to be involved in emotions). Does this mean that someone can be neurologically wired to be unmoved by the pain and suffering of other people? And does this mean they are unable to change?

Here is a proposition to consider: compassion and empathy—the ability to enter into a person’s world and be moved by it—are unequally distributed throughout the population. Some people are good at it, others are not so good. I know people who are moved, even disrupted, by the day’s news stories and often pray for people they have never met. And I know others, who are barely moved, even by tearful pleas for engagement from loved ones. The range is broad, even in the non-psychopath population.

Is there hope?

Can those who, by nature, are less emotional, less empathic and less compassionate grow in such things? After all, some physical impairments never improve, and we do not expect them to. For example, we do not expect someone with a damaged spinal cord to be healed, even if the person has a growing relationship with Christ. But that’s okay because God does not say we must walk. He does, however, call us to grow in compassion (e.g., Col. 3:12) and with any calling he provides grace to fulfill it.

So the answer is clear: constitutionally passionless people can grow in compassion (though they might never be as proficient as some would like). They might never have strong emotional responses to the joys or miseries of others, but they can learn how to rejoice with those who rejoice and mourn with those who mourn. The criteria is not how brilliant they are in their compassion; it is their humility and willingness to grow that is important. If there are neurological predispositions, they set limitations but these limitations are malleable.

The “up side” of the fear of man

There is one other theme in the book that interests us. Ronson, at times, wonders if there is an inner psychopath in him, and leaves readers wondering about themselves. That is: Am I a psychopath? Ronson rejects the diagnosis for himself because he is so prone to anxiety. To be more specific, he cares what people think of him. This means that we have finally found something good about the fear of man! Though we want to do battle with it, be encouraged that, as long as the fear of man is palpable in our life, we are not closet psychopaths.