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If one read only the first two chapters of Unholy Madness: The Church's Surrender to Psychiatry, one might get the impression that the entire book is a discussion of the philosophical foundations of our current conception of mental illness and the dangerous implications of that (flawed) conception. Drawing heavily on the work of well-known critics of modern psychiatry Thomas Szasz and R.D. Laing, Seth Farber questions the dominant understanding of severe mental illness--major depression, manic-depressive disorder, and particularly schizophrenia--as a chronic condition of primary biological origins that requires a lifetime of pharmacological therapy. Farber sees the mental health profession as an agent of an oppressive social regime, deliberately inflicting needless pain and suffering on healthy but vulnerable members of society in order to satisfy its own selfish motives, portrayed as either social control or simple greed. Judging from the title, one might even expect some discussion of the neglected, if not actively avoided, role of spirituality in the lives of those deemed mentally ill.
But this is not such a book. The reader will not find a discussion of how neglecting humans' spiritual dimension may handicap psychiatry, nor practical suggestions for mental health practitioners for integrating spirituality into their daily practice. This is a book that argues for the fundamental illegitimacy of the modern secular world order based on its sinfulness, and demands that Christians live the life of Christ rather than accept or accommodate such an order. Farber, himself a Christian, argues that Christians have a particularly strong duty to minister to the mentally ill, to reverse the Christian church's alleged abandonment of them to the clutches of the "new religion," psychiatry. For a priest to refer a parishioner who has emotional problems or is hearing voices to a mental health practitioner is an ultimate betrayal, Farber says; these are problems of a primarily social and/or spiritual dimension which can and should be solved by ordinary Christians.
The book jacket and Farber's opening chapter appeal to his credentials as a practicing Ph.D. psychotherapist for sixteen years, but this should not be taken to mean (as the author suggests) that the author was once in the mainstream of psychology and has now been converted to the other side. Farber was familiar with the work of Szasz and Laing (who were in their heyday at the time) before he ever entered graduate school, and he spent only two years practicing from a Freudian psychoanalytic perspective. He then converted to the family therapy movement, which he describes as holding that the cause of mental illness lies "not within the individual but between individuals, usually within the family" (21, emphasis in original). He also cites Peter Breggin as an admired critic of the current system.
Farber is clearly familiar with contemporary philosophical work. As a psychotherapist, he incorporated narrative into his therapy, replacing the typical story of the mental patient as chronically ill, permanently disabled, and less than fully human with a new story of an individual on a quest, descending into madness only to emerge stronger for the experience of spiritual growth and self-discovery. He also focuses on the power dynamics of the current mental health system; a declaration of mental illness, he says, removes all control from the patient and puts it in the hands of the system. Every word, every behavior is taken as an expression of illness. And the slow creep of medicalization shows that the industry is seeking to gain power over a larger and larger proportion of society, including children (inventing attention deficit/hyperactivity and oppositional defiant disorders).
Finally, Farber accuses proponents of the medical model of mental illness of having epistemological problems; in his words, they "consistently conflate description and interpretation" (55). They refuse to see that their concept of mental illness is an interpretation of data, a construct, rather than an objective, ontologically real phenomenon. Mental health professionals just cannot see or acknowledge their own bias. But Farber never turns the same critical lens on himself; he presents himself and his sources--Laing, Szasz, Breggin, and others--as crusaders for truth unencumbered by economic and political considerations. He never acknowledges that his view is as biased and subjective as any other; his epistemological concerns apply equally to himself.
But again, Farber's main focus is religious, not philosophical; he only uses philosophy insofar as it reinforces his larger theological mission. As an Anabaptist, he argues that the church irredeemably compromised itself when it accepted the patronage of the emperor Constantine in the fourth century A.D. Jesus was a social critic and revolutionary who expressed his opposition to the dominant social order by dining with prostitutes, tax collectors, women, and other social untouchables. Farber sees the mentally ill as the contemporary successors of those stigmatized social groups; they should therefore be supported and listened to, not demeaned and debilitated with powerful medicines. If mental illness can be conceived of as an inability to function within the current social order, Farber argues that since contemporary secular society is corrupt, this inability to adapt may be a strength, not a weakness. Molding persons to function well in a depraved world is in no way virtuous.
Farber's book is a call to fellow Christians to live their lives so as to serve as beacons to the non-believing masses; specifically, Christian communities should establish asylums for those labeled "mentally ill" by an actively predatory, selfish mental health system. On Farber's growth model of mental illness, which sees altered states of consciousness as opportunities for spiritual development and emergence within a romantic narrative, the identity crisis signified by so-called "psychotic" symptoms is "an optimal time for [individuals] to be initiated into new identities as disciples of Christ" (138). He immediately goes on to emphasize that this opportunity should be "offered," not "coerced," but it is difficult to see how a distinction could be reliably maintained at a time of extreme vulnerability for the suffering person.
It also remains unclear, even if one accepts his criticisms of the contemporary mental health solution, why an Anabaptist Christian solution is the answer. That this solution is the correct one is simply assumed, never argued for. One can even accept the idea that altered states of consciousness are spiritual crises which provide opportunities for growth without cramming the opportunity into a Christian framework. John Nelson, for example, a practicing psychiatrist who argues for acknowledging the role of spirituality in mental health treatment, might see the opportunity as one for personal transcendence using a Hindu chakra model. (Nelson, unlike Farber, also admits that there are some cases for which traditional drug therapies are appropriate.) This may not be a particularly compelling issue for the Christian audience for which Farber is writing, however. Farber's main goal in this book is to call Christians to take back the mental/spiritual turf ceded to the new science in the 20th century; the mental health practitioners claims of expertise are both false and harmful, Farber argues, and Christians have a duty to challenge them.
Lara Winner is a graduate student in philosophy with a concentration in medical ethics at the University of Tennessee, Knoxville. She is interested in mental health/mental health ethics both because it is a traditionally underserved area of medical ethics and because it can provide valuable insights into the interrelationship of mind, body, and spirit.