The DSM in one hand and the Summa in the other

What does a 13th-century friar and theologian have to do with mental health care today? Quite a lot, according to Warren Kinghorn, for whom Thomas Aquinas’s thought both fuels a challenge to current approaches and plots a course for an alternative vision of mental health.

Kinghorn, a psychiatrist and ethicist who holds theological and medical faculty appointments at Duke University, begins Wayfaring by critiquing the way mental health is typically characterized in terms of data, diagnosis, and labeling. He points to the crisis of mental health in the United States—rises in suicide, drug overdoses, and depression. (About 46 percent of the population will meet the criteria for a mental disorder at some point in their lives.) Mental health care in the US is fragmented and inadequate due to inpatient facility closures, budget reductions, rising costs, industrialization of care, and the dominance of business models that create a wealth-driven consumer market for treatment. Not only do these conditions commodify care, they reduce it to technical fixes. When patients seek help with deep inner suffering, the dominant practice is to dissect and classify it into diagnoses that call for particular interventions. The belief that body and mind can be tinkered with and even fixed with pharmaceuticals and therapy—an approach which Kinghorn calls “the machine metaphor”—does a disservice to mental health care.

Kinghorn advocates replacing this model with the Christian image of the wayfarer on a journey of seeking and being sought by God. Humans, in this view, are not machines but creatures, image-bearers, knowers, and lovers. Such a perspective offers radical hope that modern psychology on its own terms cannot. Christianity affirms that we were created in and for relationship with God and that God is faithful to that relationship. God loves every creature, especially those who are unable to feel or reciprocate that love. Using biblical and christological rationales, Kinghorn shows how a shift from bare existence to beloved existence parallels the movement from shame to healing.