By Janae Stout
- Biblical Perspective
- A person with schizophrenia has an inability to function normally in a society due to bizarre behavior as a result of organic/inorganic forces. This includes either internal or external forces that distort judgments and reality. The counselee dealing with Schizophrenia has physical implications that impairs their ability to perceive and function in a normal way, which is not necessarily sin, but the response of giving into the temptations to be self-focused, to fear, act in anger, laziness, and other manifestations are sinful. The heart theme that must be addressed in Schizophrenics is their response and deep-rooted fear, guilt/shame and selfishness.
- Secular Perspective
- Schizophrenia, literally meaning “fragmented mind” is a psychiatric disorder occurring in only one percent of the population involving chronic or recurrent psychosis and is commonly associated with impairments in social and occupational functioning. Schizophrenia is believed to comprise a ‘spectrum’ of related conditions with variable severity, course, and outcome.
- The term “schizophrenia” was first used as a diagnosis in 1910 by a Swiss psychiatrist named Paul Eugen Bleuler, which was first intended to refer to the dissociation or “loosening” of thoughts and feelings. Although there is a common misconception that schizophrenia refers to a ‘split personality’ or a form of multiple personality disorder, psychologists and medical professionals indicated that rather schizophrenia is dissociated thinking and bizarre behavior. Emil Kraepelin was the first to distinguish the disease in 1887 from other forms of psychosis and other mood disorders, specially his Compendium de Psychiatrie which classifies mental disorders. At that time, it was called ‘dementia praecox’, meaning dementia of early life. Sigmund Freud had his influence on schizophrenia as he believed that it was a result of unconscious conflicts that originated in childhood, but since then antipsychotics, advanced brain imaging, and genetic studies have shown the biological basis of the disease, according to psychologists.
III. Evidence of the Problem
- Schizophrenia is characterized by positive and negative symptoms, cognitive impairments, and mood and anxiety abnormalities. Positive symptoms are an exaggeration of normal processes, which include hallucinations, delusions, and disorganized thoughts and behaviors. Negative symptoms are the absence of normal processes which might include apathy, decreased expressiveness, flat affect, depression, paranoia, and lack of energy.  The Schizophrenic usually has a difficult time interacting with others and lives in isolation, which could largely influence their emotional responses like depression, anxiety, fear and paranoia.
- Schizophrenia is complex and necessitates the differentiation between the physical and spiritual components, since both are so heavily prevalent. It is important to note that the medical model ignores the fact that human beings are a unity of both body and soul, and although the medical model can reveal the implications that can directly have an influence on the soul, the body cannot cause a person to sin. In Schizophrenia, this is crucial, because as a biblical counselor, we must give hope in their situation that there is a way out (1 Corinthians 10:13) and they are not bound by their physical weaknesses. Living in a fallen world comes with the effect of sin that can be placed on the physical body, which can cause temptation to sin. For example, schizophrenics can experience hallucinations, delusions, and incoherence that are not necessarily sinful in and of itself, but they could be triggered by sin. All in all, these symptoms do not diminish moral responsibility. 
- Galatians 6:5-15 show that we are all responsible for our sin and that symptoms cannot keep us from following Christ in obedience. This is true of the schizophrenic as well, and although their mental processing or behavior is prone to acting bizarre, paranoid, fearful, anxious, guilty, etc., they have the ability to repent and live by the Sprit. Passages like Psalm 32:1-3; Proverbs 3, 4, and 15 reveal that God’s Word is healing to the flesh and bones, and that failure to follow His Word literally wastes the bones away. This gives hope in Schizophrenia because God’s Word has healing power in the midst of physical trials. 2 Corinthians 4:16-18 says that we do not need to lose heart because although our outer selves are wasting away in this fallen world, our inner self in sanctification is being renewed day by day and the suffering that is experienced on earth is preparing us for an eternal weight of glory beyond all comparison. The Schizophrenic, feeling trapped by their diagnosis, can feel hope in eternity and the Holy Spirit working in them to empower them to live Christ-like amidst their struggle with being prone to bizarre thinking and behavior.
V. Examining the Heart
- Common heart themes in the person labeled with Schizophrenia tends to be guilt/ shame that is either false or genuine (Romans 10:11; Dan. 9:7-13; Psalm 32:3-4); fear of man (Proverbs 29:35) and fear in general (1 John 4:18); and selfishness and pride (James 3:16; Proverbs 18:1). In all of these circumstances, the Schizophrenic is looking to themselves, rather than Christ, and they are holding to their own experiences rather than to God’s Word and His truth.
- There are also idols of the heart that are commonly prevalent in a person with schizophrenia, which includes a love of comfort, love of self, control, and fear of man. These idols must be replaced with love and worship of the Lord, with full dependence on Him rather than trust in their own thoughts, feelings, and emotions. 
VI. Biblical Solutions
- Counseling Agenda
- As a biblical counselor who is working with a counselee with Schizophrenia, we want to follow the 8 I’s which is applicable to all counseling situations. It is essential to go into counseling with a focus of displaying Christ’s love and viewing the Schizophrenic counselee as an image bearer and ultimately pointing to the love of God for us (Romans 8:35-39). With that said, we want to take interest into the counselee’s life and walk with them in this trial. Right from the start, we want to give the counselee hope in their struggle with Schizophrenia from Romans 8:37, Romans 5:20, and 1 Corinthians 10:13. We also want to secure the right kind of information and truly listen as Proverbs 18:13 instructs us. We want to ask them medical questions to see if they have seen a doctor, if they have other illnesses, if they get enough sleep, eat the right kind of food, etc. before going right to the biblical instruction. In the case of Schizophrenia, it is essential that you urge your counselee to visit a doctor to ensure that there are not any underlying illnesses that could contribute. However, it is vital for the counselor to be prepared for the topic of antipsychotics. This could be a potential danger to become dependent on as well as be susceptible to side effects, but medication is not wrong biblically. It is important to use discernment and direct the counselee to the use of medications only in severe cases to get through a severely difficult time if this is in accordance with the medical professional. Medication must not be the “quick fix” but only used alongside of biblical instruction and counseling to get to the heart of the counselee. To show care and concern as a counselee, we also would want to ask questions that pertain to their emotions and how they are feeling and responding as well as what their relationships look like with friends, family, etc. With Schizophrenia, it is common that they do not have a close relationship with their family and rarely have friends. We must point them to the importance of biblical friendship and accountability, especially within the local church (Proverbs 27:6; John 15: 12-15). We also want to ask spiritual questions to get to the root heart issue and to find out more information about their personal relationship with the Lord and their time dedicated to reading God’s Word and prayer. After we gather information, we want to analyze and organize the information given by the counselee dealing with Schizophrenia. Help the counselee to understand their sin of selfishness, fear of man, and sinful guilt/shame that they are worshipping. We want to direct them to God’s Word for instruction and provide a way to change. Specifically, we would want to focus on the counselee trusting in the truth of God’s Word and that reality over experiences. I would go through 2 Peter 1:16-21 and extensively study this passage with them, as well as give it in the homework for them to meditate on and pray through. I would also go to 1 Corinthians 4:4 to reveal how we can be misguided, but God cannot. A schizophrenic is ready to change when they are ready to mistrust themselves and trust God’s truth instead (Proverbs 12:15; 16:2; 21:2; 30:12). In our agenda, we would also address the need for humility, how fear is a result of distrust in God and His goodness and faithfulness, and then how there is freedom and forgiveness found in Christ. We also want to induce the counselee towards repentance for sinful patterns and heart idols of comfort, control, selfishness, and fear. We cannot stop there, however, as we must implement the teaching and put on fruit of the spirit in their daily lives amidst their struggle in light of the gospel. I would assign homework that involves intentional prayer, specifically prayer through Philippians 4:4-9 to intentionally think on what is true and God-glorifying! Homework would also involve meditating and memorizing 2 Peter 1:16-21 as well as Proverbs 30:5-6 and Romans 7:13-25. This would not be all at once, but would be gradual throughout the course of the counseling sessions. I would also incorporate mandatory accountability to invest in relationships and get outside of their own comfort, as well as journaling to help organize their thoughts and work on self-discipline. On the more practical side, I would also assign mind puzzles and other brain-focused games to challenge their thinking and help to increase their cognition skills. Lastly, I would help the counselee to see the beauty of the local church and their responsibility to serve and use their gifts (1 Corinthians 13:6-7; Hebrews 10:24-25). This would help the schizophrenic grow immensely as well as get their eyes off themselves and find hope and help through the local body as God designed it!
- The Biblical Counseling Guide for Women by John Street
- Sin or Sickness: Biblical Counseling and the Medical Model,” The Journal of Pastoral Practice 10, no. 2 by Ed Welch
- Blame It on the Brain?: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience by Ed Welch
- Journal of Biblical Counseling 14, no 1, “The Christian Approach to Schizophrenia” by Jay Adams
- Schizophrenia: A Compassionate Approach by Todd Styrd
- Recommended homework resources
- The Biblical Counseling Guide for Women by John Street
- Schizophrenia, Psychosis, and Scripture? Finding certainty in Chaos by Todd Stryd
 Adams, Jay. “The Christian Approach to Schizophrenia.” The Journal of Biblical Counseling 14,no. 1 (Fall 1995).
 Snyder, Kurt, et al. Me, Myself, and Them : A Firsthand Account of One Young Person’s Experience with Schizophrenia. Oxford University Press, 2007.
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), (American Psychiatric Association, Arlington 2013).
 Tsuang, Ming T., et al. Schizophrenia. Vol. Third edition, OUP Oxford, 2011.
 Burton, Neel, M.D. ‘A Brief History of Schizophrenia: Schizophrenia Through the Ages.’ psychologytoday, last modified 11 September, 2017, https://www.psychologytoday.com/us/blog/hide-and-seek/201209/brief-history-schizophrenia
 Fischer, Bernard A. M.D., and Robert W. Buchanan M.D. “Schizophrenia in Adults: Clinical Manifestations, Course, Assessment, and Diagnosis.” UpToDate (January 2018). 1, 4.
 Carpenter WT Jr, Strauss JS, Bartko JJ. “The Diagnosis and Understanding of Schizophrenia, Part I-III. Use of Signs and Symptoms for the Identification of Schizophrenic Patients.” (Schizophr Bull 1974); 37-61.
 Ed Welch, “Sin or Sickness: Biblical Counseling and the Medical Model,” The Journal of Pastoral Practice 10, no. 2 (1990).
 Thomson, Rich. The Heart of Man and the Mental Disorders : How the Word of God Is Sufficient. Second Expanded ed. Alief, Texas: Biblical Counseling Ministries, 2012.
 Street, John D. and Janie Street. The Biblical Counseling Guide for Women. Eugene, Oregon: Harvest House Publishers, 2016.