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  "path": "/2026/06/02/indwelling-sin-soul-sickness/",
  "publishedAt": "2026-06-02T14:27:18.000Z",
  "site": "https://juicyecumenism.com",
  "tags": [
    "Culture",
    "Competent to Council",
    "nouthetic counseling",
    "Whatever Became of Sin",
    "every part of creation",
    "Dan. 4:29-37",
    "Troubled Minds",
    "Jn. 9:3",
    "been shown",
    "Indwelling Sin and the Sickness of the Soul",
    "Juicy Ecumenism"
  ],
  "textContent": "For many conservative Christians, the topic of mental illness has been controversial. In the latter part of the twentieth century, American Reformed theologian and author Jay E. Adams (1929–2020) advanced a sweeping claim that psychology is wrong to see mental distress as an illness. Instead, Adams argued, it should be viewed as a consequence of personal sin. In fact, Adams insisted, modern psychology transgresses on the domain of pastoral counseling and prophetic ministry. Hans Madueme, Professor of Theological Studies at the Presbyterian Church in America (PCA)-affiliated Covenant College spoke on how Christians should sort out the relative claims of theology and psychology at the annual L’Abri conference in Rochester, Minnesota on February 14.\n\n**The Debate on the Reality of Mental Illness**\n\nMadueme observed that for many people, “mental illness is a fact of life. About one in four adults in the U.S. has a mental disorder, usually an anxiety or mood disorder. And research suggests that almost half the population will experience at least one psychiatric episode in their lifetime.” Mental illness is common even in developing nations, according to the World Health Organization. In 2010, the global costs of mental illness were estimated at $2.5 trillion. This is project to increase to $6 trillion by 2030.\n\nRegarding the debate among American Evangelicals, however, Madueme said that there are “mental illness maximizers” and “sin maximizers.” He defined mental illness maximizers as people who believe that “the brain suffers from underlying disease,” and thus “the brain fails to process thoughts and emotions” as it should. On the other hand, sin maximizers “are Biblical counselors who often skeptical about the reality of mental illness … They are jealous to guard Biblical notions like sin, and redemption, and salvation.” Emotionally distressed Christians in churches where this latter viewpoint is prevalent may find it harsh and finally turn for help to secular counselors.\n\nThe “illness/sin” controversy in American Evangelicalism stems from the 1960s and 1970s, and particularly the publication of Competent to Council, by the late Adams, in 1970. Adams rejected both secular and Christian psychology as incompatible with Christianity. Psychology, he held, replaces the theological category of sin with the medical category of illness. Instead of providing therapy according to various current psychological theories, Christians should provide counseling based on the Bible, with sin and sanctification as key doctrines. This method he called “nouthetic counseling.” The action of the Holy Spirit is needed for both salvation and sanctification, and the cooperation of the sinner in mortifying sin. Today’s Biblical counselors are less confrontational than nouthetic counseling as Adams proposed it, yet the focus on sin remains crucial for them.\n\nMadueme proposed “the sufficiency of Scripture and the doctrine of sin” as the lens through which Christians should address mental distress. He noted that even secular observers are concerned about the increasing degree to which human problems and issues are being medicalized. Such secular scholars as Thomas Szasz, R.D. Laing, Karl Menninger (famous for his own book, Whatever Became of Sin), and others maintain that the category of mental illness is largely a social construct projected on normal life and behavior (which includes problems and unhappiness), and “has had a negative effect on how people engage the struggles of life.” From this background, one can easily understand Adams’ Christian assertion that psychology and psychiatry distract people from seeing themselves “as sinners, in need of the grace of God.”\n\n**Background of the Debate in Protestant History**\n\nBut what this Biblical commitment often leads to is people relying on “their own Biblical intuitions … and what ends up happening in our churches is that people with depression, or schizophrenia, or other mental disorders have been marginalized as perhaps weaker Christians.” They are considered to be “people struggling with sin, or perhaps even demonic oppression.” Madueme observed that from “the seventeenth century onwards … people blamed insanity on personal sin or demonic influence.” He, however, noted that many Puritans recognized melancholy as a simple mental distress, not necessarily the result of moral turpitude. In the nineteenth century liberal Protestants came to view mental distress as a kind of physical illness, and looked to psychiatry, which was then just emerging, for answers. Conservative Protestants, however, stuck to the older view of the connection between sin and insanity, “because that seemed to fit the Biblical picture of the world.” Indeed, alternate explanations for insanity were feared as attacks on Christianity itself. Madueme said that when modern Christians doubt the value of psychology, “they are harking back to this older way of thinking.” It is held that the Bible is “all we need for our knowledge of God and for the Christian life.” The various secular psychologies are rival doctrines to Christianity about how life should be lived.\n\nMany Christian psychologists today, however, would appeal to general revelation to argue for mental illness as a real category. Madueme pointed out that the Calvinist doctrine of common grace allows believers to learn from unbelievers truths about the world at large disclosed by general revelation, and hence secular psychologies may have something valuable to say about happiness and mental distress. Secular research should be received both “with gratitude, and with critical discernment.”\n\nMadueme believes that both sides in the controversy need “more nuance.” He said that he agrees with the “sin maximizers” that “we’re not just physical creatures, we’re body and soul.” Everyone has a “non-physical dimension.” The sin and salvation drama basically occurs in this non-physical dimension. Doctors have their proper role in treating the body (including the brain), but psychology is trespassing on the domain of clergy and Biblical counselors by ignoring sin as a possible factor in mental distress. In contrast, he quoted Jay Adams: “Biblically, there is no warrant for acknowledging the existence of a separate and distinct discipline called psychiatry. There are in the Scriptures only three specified sources of personal problems and living: demonic activity (principally possession), personal sin, and organic illness. These three are inter-related. All options are covered under these heads, leaving no room for a fourth, non-organic mental illness.”\n\nBut Madueme said that this is too simple. The human body is intimately connected with the soul and can “affect the soul in ways that impact our mental and spiritual functioning.” Psychologists and psychiatrists can discern mental malfunctioning which has natural causes without undermining the sufficiency of Scripture. Scripture tells us that sin has affected every part of creation, and this includes our bodies as well as our souls. Indwelling sin “is our deepest psychopathology.”\n\n**Another Christian Alternative**\n\nAs an alternative to Adams’ claims, Madueme cited the Christian psychologist Everett Johnson, and his identification of another pathology Johnson calls “biopsychosocial damage.” This is “a disorder of the soul in which our cognitive, emotional, and psychological capacities can be broken or damaged.” He quoted Johnson: “people can have genetic defects, their bodies and brains can malfunction, they can experience catastrophic or chronic trauma which can alter brain function, their thinking and emotions can be consistently distorted, they can have difficulties connecting with others, and as with suffering, such biopsychosocial damage is massively unevenly distributed.”\n\nThis biopsychosocial damage “comes in degrees. At its most severe, we see genuine mental illnesses, like bipolar disorder and schizophrenia.” Madueme said that “theologically … all human beings suffer from psychopathology, disorders of the soul. Our deepest psychopathology is sin, and for that we need Jesus. But there are other psychopathologies that people suffer from that we can broadly call biopsychosocial damage. And here the soul is disordered, or the connection between the soul and the brain is damaged in some way, and the result is sickness of the soul.”\n\nMadueme said that “unlike sin” the illnesses that we suffer from as a result of “biopsychosocial damage are weaknesses that we suffer from but are not necessarily culpable for. They are consequences of living in a fallen world … Saying that Scripture is sufficient is gloriously true. But that confession doesn’t shed much light on whether we experience biopsychosocial damage, and the extent to which we experience that.” Scripture, in fact, “largely assumes biopsychosocial health.” Human sin and flourishing are spoken of in Scripture under that assumption. A notable exception is Nebuchadnezzar’s madness (Dan. 4:29-37) (although this was ultimately divine judgment for his pride).\n\nBut Madueme believes that “the reality is even more complex.” Sin is our deepest problem, and we are culpable for that. Biopsychosocial damage can also be a problem, and we are not culpable for it. He believes that “in most instances, people with mental illness are two things at the same time. They’re guilty of being sinners, and they also suffer from biopsychosocial weakness.” This, he believes, “should temper the attitude of the ‘sin maximizers’ … who are just saying it’s all sin.”\n\nRegarding the “mental illness maximizers,” Madueme said that they must “take the authority of Scripture very seriously.” They must recognize that what is called in Reformed Christianity “the noetic effects of sin” (original sin’s corruption of the human intellect). The possibilities of sin’s corruption are greater, however, in disciplines that deal more with the human world (psychology, social sciences, and humanities) than in the natural world (physics, chemistry, and even biology). What in psychology can be attributed to sin and what attributed to genuine scientific discovery (made possible by common grace) will be a point of controversy with Christians, Madueme believes. But Christians must never allow psychology to speak uncorrected, because it does not recognize the important Biblical categories of sin and sanctification. These secular disciplines are attempting to comprehensively analyze distressed people, and Christians, taking a very different standpoint of human depravity, must be critical.\n\nRegarding the effects of sin on those mental distressed, Madueme said that “it is deeply, deeply unfortunate, that too often in our history, too often even today, Christians have blamed mental illness on personal sin or demonic oppression. Many people, many Christians have been harmed in the process.” He quoted Amy Simpson in her book Troubled Minds, as saying that such blame “traps people into working harder and harder to achieve a level of righteousness that will justify their freedom from illness.” He noted that the Bible warns against blaming all suffering on sin, citing the examples of Job’s friends and Jesus’s assurance that neither the sin of the man born blind nor that of his parents had caused him to be born blind (Jn. 9:3). We can thus be confident that there is a distinction in the Bible “between ordinary sickness, and sickness that is a direct result of sin or demonic oppression.”\n\n**The Complex Role of Sin**\n\nEven with these caveats, Madueme believes that we may be failing to attribute enough of mental illness to sin. In particular, we need to avoid a “voluntarist” doctrine of sin. According to this doctrine, only the commission of a sin, or the conscious desire for commission of a sin is culpable. But involuntary impulses to sin are also culpable, Madueme said. He gave lust, sloth, and pride as examples. People are “culpable” for words or actions that “truly disclose” sinful attitudes in their hearts. Whether sin is a deliberate will to act, or an underlying attitude, treating it requires “theological and pastoral resources, and not just medical and psychiatric ones.”\n\nHe noted, as well, that the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) classifies mental disorders which are in fact crimes (voyeurism, exhibitionism, kleptomania, fetishism, etc.) in purely medical, not moral, or even legal terms. No “biological or neurological markers’ are indicated for the DSM’s disorders. Prior to the twentieth century, most Christians would have recognized them as sin. He believes that these diagnoses should be re-interpreted in terms of the Biblical doctrine of sin. The clinical language about whether or not the disorder is “recurrent, intense, causes distress,” etc. is not important, and really suggests that the disorder is an illness rather than sin. But what is important is that sinful conditions of the heart are being disclosed, which should be repented of. This is, in fact, the most compassionate approach, Madueme said, since it makes the grace of God available, and allows the sinner to repent, after which the Holy Spirit will work in his or her life for sanctification.\n\nAnother problem with purely psychiatric diagnoses is that they have “a looping effect.” It’s entirely reasonable that the patient’s condition is affected by the diagnosis. Thus, the condition of a person with ADHD or anorexia may worsen or otherwise interact “in complicated ways” on hearing the diagnosis.\n\n**Conclusion**\n\nMadueme summarized his conclusions as:\n\n  1. The mental illness maximizers are correct to an extent. “There is such a thing as mental illness.” This is “not a denial of Scripture … biopsychosocial damage is a result of the fall. And recognizing that allows us to be compassionate and to treat other people with the gentleness of Christ.”\n  2. Sin maximizers “are right in emphasizing the importance of the doctrine of sin.” Sin should not be medicalized in such a way that “we’re never morally culpable.” All people, even those with real mental illnesses “are sinners, who need God’s grace and mercy.”\n  3. “Taking psychiatric or psychotropic medication is not denying the gospel.” Humans are “a mysterious union of body and soul.” The body affects the soul, and the soul affects the body. Insomnia, he said, may have an impact on one’s ability to realize the Biblical virtues of longsuffering, kindness or gentleness.\n  4. Many people in churches need psychologically informed pastoral guidance to move into adulthood as faithful Christians. The old markers of adulthood (getting married, getting a job, having children, etc.) are not there for many people. Instead, young people are expected to “develop the self.” This puts enormous pressure on the self. “Depression, anxiety, suicidal ideation, self-harm, etc.” are some of the problems that result. Some have serious abuse in their background.\n  5. “Be wise in the present cultural context.” No one “wants to go back to the kind of cultic fundamentalism where we micro-manage everyone’s lives.” But with respect to social media, which have been shown to negatively affect mental health, many Christians today have “a grossly irresponsible lassiez-faire approach, where it’s almost like anything goes.” We need to better inform parents of the “sober realities” of the problems connected with social media. They can be “gateway drugs” to pornography addiction, transgenderism, or other destructive behaviors. So Christians need to be wiser in raising their children.\n\n\n\nOverall, while conceding the reality of mental illness (contra Adams), Madueme seemed to agree with secular critics of psychology that much of what psychology and psychiatry address as illnesses are simply unpleasant parts of normal human life (anxiety, depression, etc.) But where things that are clearly sinful can be discerned, as in the cases of lust, pride, greed, etc., specifically spiritual counseling according to Biblical teaching is needed by pastors, Christian counselors, or fellow Christians.\n\nThe post Indwelling Sin and the Sickness of the Soul appeared first on Juicy Ecumenism.",
  "title": "Indwelling Sin and the Sickness of the Soul"
}