Mental Defect vs Responsibility Part 2

Mental Defect v. Responsibility 1. Question: Can one who has been diagnosed as mentally sick be held responsible for his behavior? 2. This entire issue comes down to a fundamental difference between Christianity and the modern medical model. A. When these two schools of thought come into conflict, we must yield to God's school: Scripture. PSA 119:128; ROM 3:4. B. The medical model reduces all behavior to biological factors. Mental problems should be treated in the same way the body is treated. C. By contrast, Christianity affirms that man is more than a biochemical machine. (1) Man has a center that initiates moral choices. It is called the soul and spirit or the heart or the mind. JOB 7:15; EXO 35:21; MAT 15:18-20; ROM 7:25; 2CO 9:7. (2) There is more involved in man’s choices and behavior than simply his material brain. D. The body gives the heart access to the physical world. (1) Compared to a computer, the body is the hardware and the heart is the software. (2) The heart has the executive role whereas the body has the mediating role. E. There are organic problems that originate in the body or brain as in strokes, brain injuries, brain tumors, and Alzheimer’s disease. (1) These organic problems can obviously limit the expression of one’s heart and hinder one’s ability to perform. (2) One would not be held accountable for being unable to perform a function rendered impossible because of an organic problem. F. “Psychological” refers to functions of the immaterial inward man. (1) Common psychological problems are anxiety, depression, fears, phobias, compulsions, and obsessions. (2) Biological changes that accompany psychological problems are not pathological changes such as occur with a brain tumor. (3) The Scriptures address such problems as moral and spiritual issues. (4) Of believers, 2TI 1:7 says: “For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind.” 3. Consider some relevant definitions. A. madness: The quality or condition of being mad. Mental disease, insanity; now applied esp. to insanity characterized by wild excitement or extravagant delusions; mania. B. mad: Suffering from mental disease; beside oneself, out of one’s mind; insane, lunatic. (1) insane: Of persons: Not of sound mind, mad, mentally deranged. Also of the mind: Unsound. (2) lunatic: adj. Originally, affected with the kind of insanity that was supposed to have recurring periods dependent on the changes of the moon. In mod. use, synonymous with INSANE; current in popular legal language, but now employed technically by physicians. (3) lunatic: sb. A lunatic person; a person of unsound mind; a madman. C. mania: Mental derangement characterized by great excitement, extravagant delusions and hallucinations, and, in its acute stage, by great violence. (1) The bipolar disorder is also called mania. (2) “Bipolar disorder is a ‘condition’ in which the patient has periods in life which swing from major depression to mania. Mania is defined as times when the patient has increased motor activity, a pressure to keep talking, a reduced need for sleep, Mental Defect v. Responsibility 8-8-15 Page 1 and a ‘flight of ideas.’ These times may be marked by grandiose thinking, impaired or poor judgment, impulsiveness, aggressiveness, and hostility. They may spend large amounts of money they do not have and make personally destructive decisions in business and in sexual/moral matters. May also include thoughts of suicide, and hallucinations.” (Dr. Charles Hodges) D. folly: The quality or state of being foolish or deficient in understanding; want of good sense, weakness or derangement of mind; also, unwise conduct. (1) foolish: Fool-like, wanting in sense or judgment. Befitting a fool. (2) fool: One deficient in judgment or sense, one who acts or behaves stupidly, a silly person, a simpleton. (In Biblical use applied to vicious or impious persons.) (3) derangement: Disturbance of the functions of the mind; mental disorder; insanity. (4) Scripture defines folly thus: “...the foolishness of fools is folly” (PRO 14:24). 4. The teaching of Scripture with respect to responsibility must be weighed in determining whether those diagnosed as mentally ill can be held responsible for their behavior. A. One can be held accountable for doing wrong even if he does not know he is doing wrong. (1) (LEV 5:17-19) And if a soul sin, and commit any of these things which are forbidden to be done by the commandments of the LORD; though he wist (knew) it not, yet is he guilty, and shall bear his iniquity. (18) And he shall bring a ram without blemish out of the flock, with thy estimation, for a trespass offering, unto the priest: and the priest shall make an atonement for him concerning his ignorance wherein he erred and wist it not, and it shall be forgiven him. (19) It is a trespass offering: he hath certainly trespassed against the LORD. (2) (LUK 12:47-48) And that servant, which knew his lord's will, and prepared not himself, neither did according to his will, shall be beaten with many stripes. (48) But he that knew not, and did commit things worthy of stripes, shall be beaten with few stripes. B. Psychological problems may impose difficulties upon our ability to understand and to resist temptation and they may provide occasion to sin, but they do not cancel our moral responsibility. (1) For example, depression is not an excuse for giving up on doing what is right. GAL 6:9; JOS 7:6-10; HEB 12:3. (2) Fear does not exempt one from serving the Lord. MAT 25:24-28. C. We (1) One who kills another is not guilty of murder where there is no malice are responsible according to the purposes of our hearts. aforethought. DEU 19:4-6. (2) A woman was not guilty of fornication who was raped and whose cry for help could not be heard. DEU 22:23-27. (3) However, one must be held accountable for a sinful action if it results from foolish choices whether the specific action was intended or not. a. For example, a man could be charged for not providing for his family if he gambled everything away on games of chance, even though he did not specifically intend not to provide for his own. 1TI 5:8. b. For example, a woman could be charged with being without natural affection if she injures her child by chronic intoxication during pregnancy. ROM 1:31. (4) We are responsible according to our ability. MAT 25:14-30; LUK 12:48; 1PE 4:11; 2CO 8:12. a. A man who has lost consciousness because of a brain injury would not be Mental Defect v. Responsibility 8-8-15 Page 2 held responsible for not supporting his family. He supported them while he could. b. But a depressed or fearful man is not unable to perform. c. A man who loses his ability to perform through his own sin, as a drunk who is comatose from an automobile accident, must be held accountable for his condition. d. Brain injuries can cause negative psychological changes but evidence shows that the post-injury behavior is an aggravated form of pre-injury character: “Most families who observe the results of head injuries remark that the same old behaviors are present, but in an intensified, exaggerated form. Someone who struggles with lust will either do it more openly or act on it. Someone who was angry on the inside but apparently pleasant on the outside might become more openly hostile, demanding, and critical. As such, it is not surprising that one of the best predictors of postinjury problems is preinjury character. The cognitive impairments of persons committed to biblical living will rarely lead to the same frustrating changes that are obvious in others. Secular research and case studies, even though they use different language and descriptions, support this conclusion.” (Edward T. Welch, Counselor’s Guide to the Brain and Its Disorders, pp.151-152) 5. Bearing in mind that folly is defined as derangement of the mind, consider what the Scripture says about folly. A. Scripture calls sinful behavior folly. (1) GEN 34:7; DEU 22:21. Fornication. (2) JOS 7:15. Covetousness. (3) JDG 19:23. Sodomy. (4) 2SAM 13:12. Rape. (5) PRO 14:8; JER 23:13. Deceit. (6) 2CO 11:1, 16-17. Confident boasting. B. Fools are characterized by their lack of knowledge (PRO 9:13; 13:16; 18:2; JER 5:4). Yet this does not excuse them. C. ECC 7:25 defines the wickedness of folly as foolishness and madness. This derangement of the mind definitely has a moral dimension in that it is called “the wickedness of folly.” D. To sin against a holy and almighty God is foolishness and madness. E. (PRO 14:16) A wise man feareth, and departeth from evil: but the fool rageth, and is confident. (1) rage: v. To go mad; to be mad; to act madly or foolishly. To show signs of madness or frenzy; to rave in madness or fury; to act or speak wildly or furiously; to storm. (2) rage: sb. Madness; insanity; a fit or access of mania. (3) This man is not a fool because he is manic. Rather he is manic because he is a fool. F. Note this description of a fool in ECC 10:12-15. (1) His lips swallow up himself. He is self-destructive. (2) His words begin with foolishness and end in mischievous (harmful) madness. His talk is insane. (3) He is unpredictable. (4) His work wears him out because he lacks good judgment. (5) How many people matching this description would be diagnosed as mentally ill and treated with medication without regard to a moral dimension? Mental Defect v. Responsibility 8-8-15 Page 3  G. Consider the description of one diagnosed with bipolar disorder and compare it with the description of a fool given in Scripture. (1) Pressure to keep talking: a. “...a prating fool shall fall” (PRO 10:8, 10). b. prate: To talk, to chatter: usually dyslogistic (expressing censure or disapproval), implying speaking much or long to little purpose. c. (PRO 29:11) A fool uttereth all his mind: but a wise man keepeth it in till afterwards. d. (ECC 5:3) For a dream cometh through the multitude of business; and a fool's voice is known by multitude of words. (2) Grandiose thinking: a. (PRO 12:15) The way of a fool is right in his own eyes: but he that hearkeneth unto counsel is wise. b. (PRO 14:3) In the mouth of the foolish is a rod of pride: but the lips of the wise shall preserve them. (3) Poor judgment: a. This is the very definition of a fool. b. (PRO 13:16) Every prudent man dealeth with knowledge: but a fool layeth open his folly. c. (ECC 10:3) Yea also, when he that is a fool walketh by the way, his wisdom faileth him, and he saith to every one that he is a fool. (4) Impulsiveness: a. (PRO 12:16) A fool’s wrath is presently known. b. (PRO 14:29) He that is slow to wrath is of great understanding: but he that is hasty of spirit exalteth folly. (5) Aggressiveness (the disposition to attack others): “A fool’s lips enter into contention, and his mouth calleth for strokes” (PRO 18:6). (6) Hostility: “Let a bear robbed of her whelps meet a man, rather than a fool in his folly” (PRO 17:12). (7) Runaway spending: “There is treasure to be desired and oil in the dwelling of the wise; but a foolish man spendeth it up” (PRO 21:20). H. Nothing is settled when dealing with a fool. PRO 29:9. I. There can be no doubt that Scripture treats folly as a moral issue. J. God holds fools responsible for their condition, judges them Himself, and calls upon others to judge them. PRO 26:10; 19:29; 26:3; 14:7; 13:20. 6. Whereas the modern medical model of dealing with issues of the mind is not entirely without value, it does have a tendency of ignoring the moral and spiritual dimension and so erasing responsibility in areas where the Bible holds men responsible. A. “Certainly most medical professionals can agree on the meaning of cancer or heart disease, but words like abnormal, functional, and schizophrenia are much 'fuzzier.' They often come laden with covert assumptions, implications, and biases. And psychiatric diagnoses are often rooted in the shifting sands of cultural expectations rather than empirical facts.” (Edward T. Welch, Counselor’s Guide to the Brain and Its Disorders, p. 21) B. “The insidious part about the term abnormal is that, like other positions within the medical model, it sacrifices personal responsibility. It maintains that those with abnormal brains, because of diminished reasoning capacity, are not fully accountable for their actions. Instead, the culpable agents behind immoral behavior are genes, poverty, parental abuse, Mental Defect v. Responsibility 8-8-15 Page 4 biochemical compulsions, and even junk food.” (Ibid, p. 23) C. “The unique contribution of the body to the whole person is that it is the mediator of action rather than the initiator. As mediator, it is not the source of sin.” (Ibid, p. 39) D. “Are you a normal boy who doesn’t really like shutting up and sitting at a desk for six hours a day listening to some boring teacher? You may have 'attention deficit disorder.' Are you an angry volcano inside? Then you suffer from 'intermittent explosive disorder.' Do you get drunk to deal with your problems? That used to be considered a moral failing, a character weakness, a failure to face your problems with courage and honesty. Now, of course, it’s a disease called 'alcoholism.' “Today, everything is physiological and genetic and treated with drugs. Nothing is your fault. You’re an innocent victim. “Furthermore, many of us like it that way. We like the idea that whatever is wrong with us is an organic disorder, that there’s no sin, no weakness, no deficit of character on our part. Our egos love that, it comforts us.” (David Kupelian, Why So Many Americans Today are Mentally Ill, 8-14-2007) ( http://www.wnd.com/2007/08/43033/ ) E. “The possibility that psychiatric drugs could impair our conscience should not come as a shock. We know people do bad things under the influence of alcohol, crack and meth that they wouldn’t do otherwise. Is it so hard, then, to comprehend that some legal drugs can also obscure or eliminate our awareness of conscience? After all, what does “feeling better” often involve but the elimination of conflict? And what is conflict but the evidence inside us that we’ve done something wrong — something contrary to our conscience? Getting rid of conflict, then, often involves blotting out our conscience! “But the problem with that is, conscience is literally the presence of God in us, the friction between the way we are and the way He wants us to be. We experience this correcting and illuminating presence — which is actually our greatest friend (like Jiminy Cricket in Disney’s “Pinocchio”) — as a psychic pain when we deviate from its urgings. Thus, many of us foolishly come to regard conscience as a problem, even an enemy.” (Ibid) F. “The second problem is that sinful anger is an issue of the heart, not the body. The body can provide stumbling blocks for the heart, but it cannot force someone to sin. Furthermore, the biblical model isn't surprised when people report that they feel out of control with their sinful behavior. That is simply the nature of sin. People actually are out of control. They need help from another source, but they remain responsible for their behavior.” (Edward T. Welch, Counselor’s Guide to the Brain and Its Disorders, pp. 136-137) G. “The biblical position is this: the ravages of brain injury, disease, or dysfunction cannot rob us of spiritual vitality. At the core of our being we are moral creatures, image-bearers of the Most High. Certainly, this center can be defaced or suppressed, but the culprit is sin, not sickness.” (Ibid, p. 291) 7. Consider what the Scriptures have to say about madness. A. (ECC 9:3) This is an evil among all things that are done under the sun, that there is one event unto all: yea, also the heart of the sons of men is full of evil, and madness is in their heart while they live, and after that they go to the dead. (1) Evil and madness go together! Such is man by nature. (2) David associated his organic trouble and his turmoil with his sin. Mental Defect v. Responsibility 8-8-15 Page 5 PSA 38:3-8, 17-18. (3) Idolatry is a great evil and madness. JER 50:38. a. This is amply proved by the irrationality of the idolater. ISA 44:10-20. b. The madness which leads to idolatry is itself a judgment for vain imaginations. ROM 1:21-23. B. After he left home and wasted his substance with riotous living, the prodigal son came to himself and repented. LUK 15:11-19. (1) come to oneself (one’s senses): To recover consciousness; to become conscious again after sleep, a swoon, etc. To come to one’s right mind, recover from excitement, passion, or self-abandonment. (2) He was not in his right mind while he was engaged in riotous living. (3) Repentance is the first step toward recovering sanity. C. Naaman the Syrian was crazy when he walked away from Elisha’s prescription to heal his leprosy. 2KI 5:10-12. D. The enemies of Christ were filled with madness (LUK 6:11; ACT 4:25-27). They were certainly responsible for their madness and judged accordingly. E. Madness is sent upon men by God as a judgment for sin. (1) Israel was smitten with madness and psychological problems because they would not hearken to God’s commandments. DEU 28:15, 28, 65. (2) Nebuchadnezzar was smitten with madness because of his sins. DAN 4. a. His madness fell upon him in a moment of grandiose thinking. His pride brought about his mental destruction. PRO 16:18. b. Nebuchadnezzar was mad because of his behavior. c. When his reason returned to him, he worshipped God. F. Devil possession causes madness. MAR 5:2-5; 9:17-18, 22. (1) (2) G. Saul is Lord. (1) (2) (3) (4) Jesus is the cure for this. MAR 5:15. This can be cured through God giving one repentance to the acknowledging of the truth that he may recover himself out of Satan’s snare. 2TI 2:24-26. a classic example of one gone mad after he disobeyed the commandment of the An evil spirit came upon Saul and troubled him. Music was used as a therapy to make him well. 1SAM 16:14-15, 23. Studying Saul’s life, one finds mood swings, fear, grandiose thinking, poor judgment, impulsiveness, aggressiveness, hostility, fear, paranoia, depression, and in the end, suicide. Saul would doubtless have been diagnosed bipolar by the modern medical model and excused of responsibility owing to a lack of lithium in his system! Yet Saul was responsible for being in this condition because of his foolish behavior. 1SAM 13:13-14. H. The hireling prophet, Balaam, was mad. 2PE 2:15-16. (1) He was double-minded, claiming to serve the LORD while serving his lusts, and so was an unstable man. JAM 1:8. (2) He was obsessed with fortune, covetous, and therefore an idolater. COL 3:5. (3) He was mad upon his idol as much as a pagan with a graven image. JER 50:38. I. Ahithophel was given to grandiose thinking. (1) He was renowned for his wise counsel. 2SAM 16:23. (2) He believed his own PR so much that he couldn't bear to not be heard, and so killed himself. 2SAM 17:23. Mental Defect v. Responsibility 8-8-15 Page 6 (3) His irrational reaction was not owing to an organic problem of the body; it was owing rather to his “superiority complex.” (4) We are warned against being “over wise” (ECC 7:16) and “...not to think of ourselves more highly than we ought to think; but to think soberly...” (ROM 12:3). J. The word mad occurs three times in ACT 26. (1) In v. 11 Paul described himself before his conversion as having been exceedingly mad against the saints. (2) Bear in mind that Paul verily thought he was doing the right thing in doing many things contrary to Jesus’ name. v. 9. (3) What Paul did, he “...did it ignorantly in unbelief” (1TI 1:13). a. He did not realize that he was doing wrong but it was still wrong. b. What he did was based upon wrong thinking. How great a salvation is in processing life according to sound doctrine! 1TIM 4:16. c. NOTE: Right thinking yields right processing which yields right reactions of emotion, speech and conduct. (4) In v. 24 Festus accused Paul that much learning was making him mad. (5) In v. 25 Paul defended himself saying that he was not mad, but spoke “...forth the words of truth and soberness.” (6) While Paul was persecuting Christ and Christians he was manic. a. After his conversion Paul confessed that what he had done was blasphemy, persecution, and injurious. 1TI 1:13. b. Even though he was insane and did not know he was doing wrong, Paul was guilty of sin and deserving of judgment. c. Only God’s mercy and grace rescued Paul. 1TI 1:13-16. d. Therefore, Paul was responsible for what he did and was liable to judgment had not God’s mercy and grace intervened. e. This is true of every believer with respect to his past sins. 8. In cases of madness other than loss of reason through deformity or injury, there is definitely a moral dimension. 9. Alcohol abuse (drunkenness) and drug abuse cause madness. A. drunkenness: The state of being drunk; intoxication; the habit of being drunken or addicted to excessive drinking. (1) drunk: That has drunk intoxicating liquor to an extent which affects steady self-control. (2) intoxicate: To poison; To stupefy, render unconscious or delirious, to madden or deprive of the ordinary use of the senses or reason, with a drug or alcoholic liquor. B. When one is drunken he is mad. JER 51:7. C. A drunkard loses control of himself. PSA 107:27. D. PRO 23:29-35 is a telling commentary on drunkenness. (1) In a state of drunkenness, one's moral inhibitions are broken down. LAM 4:21. (2) A drunk becomes insensitive to danger and pain. E. Drunkenness is not simply sickness; it is sin! F. Drug abuse has the same effects as drunkenness. In fact, drug abuse is included in the definition of intoxicate. G. When Paul listed the works of the flesh in GAL 5:19-21, he listed drunkenness “and such like.” Drug use to the point of intoxication is like drunkenness. 10. What about Paul's order to comfort the feebleminded (1TH 5:14)? A. feebleminded: Weak in mind; wanting firmness or inconstancy; irresolute. Mental Defect v. Responsibility 8-8-15 Page 7  B. This is weakness of mind in the sense of wavering and weak resolve. C. The order even here is not to placate or excuse but to comfort such. D. comfort: To strengthen (morally or spiritually); to encourage, hearten, inspirit, incite. 11. In conclusion, persons diagnosed with mental illness must be held accountable for their behavior unless there is brain damage rendering them incapable of performance providing that brain damage is not the result of sinful behavior. A. All come into this world in weakness. Hence, Christ's salvation. ROM 5:6. B. Some may have a genetic or organic weakness that will forbid soundness of mind. C. Some may have a genetic or organic weakness that will be a particular cross for them to bear which works against a sound mind. (1) Weakness can be a venue for God's grace for strength. 2CO 12:7-10. (2) “Finally, I realized that I couldn't go through life being a jerk one week out of every month. As much as PMS seemed to control me, it didn't. I couldn't let myself go into automatic drive. PMS didn't cause me to sin. I had a choice to make. I could give in and let it take over, or I could fight it. PMS is like my thorn in the flesh [2 Cor. 12:8, 9]. It's a weakness I have. I need to learn to view it as an opportunity for Christ's power to shine through me, and that is exactly what God is helping me do.” (Edward T. Welch, Counselor’s Guide to the Brain and Its Disorders, pp. 165-166) D. “The Bible's view of irrationality begins by immediately departing from traditional perspectives. It does not exalt rationality, IQ, or logical reasoning. Rather, its emphasis is on faith. True knowledge comes from looking at ourselves and others through the lens of faith. Anything that is not interpreted through the filter of the triune God as Creator, Sustainer, Redeemer and King---the Alpha and Omega---is insanity.” (Ibid, p. 233) E. (1PE 2:6) Wherefore also it is contained in the scripture, Behold, I lay in Sion a chief corner stone, elect, precious: and he that believeth on him shall not be confounded. (1) confounded: Discomfited, abashed, put to shame or mental confusion; confused, disordered, etc. (2) What is needed for many cases is not more drugs or excuses, but more faith. 1JO 5:4. Mental Defect v. Responsibility 8-8-15 Page 8