Is there any point in talking to a person with paranoid schizophrenia?

QUESTION: I just graduated with a BA in Psychology. We were taught that people with paranoid schizophrenia must first be medicated to break past the delusions, odd speech patterns, etc., before they can talk with a counselor. Do you think what I was taught is true?

One beauty of a Christian approach to people, including extremely disturbed people, is that you can always talk with anyone. No guarantees that they’ll listen, of course—just as there are no guarantees that “normal, undisturbed” people (who also have madness in their hearts: Ecclesiastes 9:3) will listen.

Indeed, there are no guarantees ever when we seek to love a fellow human being. But I think that your teachers would have better served their students if they had firmly noted, “No guarantees with meds, of course.” When meds take the edge off symptoms, that is a plus. And if the benefits outweigh the negatives, that is also a plus. But if counselors and/or strugglers put their prime hopes in medicine, that’s a big negative. And if counselors and/or strugglers think that becoming a higher functioning sinful human being is a good enough goal, that’s a big negative.

We also run the risk of making those who psychiatric diagnoses into victims of their medical condition. If that happens, then important things about the individual get lost. This person is a creature of God. He is an image-bearer with gifts and potentials. He is a sinner whose sins are unfathomably complex (Jer 17:9). He is a member of the human race. He is also a sufferer in multiple dimensions—whatever things are going on in the relational-social-cultural sphere and in the physiological sphere are unfathomably intricate. And this person is redeemable by the mercies of Jesus. He will either perish forever or he will live forever—just like every other person.


My next comment might seem like a nuance, but it significantly affects our attitudes toward people with a diagnosis. I do not think of these individuals as “those with paranoid schizophrenia.” When a description of a person’s problems is made into a “thing that the person has” (technical term: “reifying the diagnostic label”), it scares us off from humanizing the individuals. It keeps us from being able to identify with the person. It intimidates us from making humane efforts to connect, from seeking to normalize, to humanize, and to interact constructively with thoughts, emotions, and actions that seem bizarre and abnormal.

To read yesterday's Q & A with David Powlison click here