The Diagnostic and Statistical Manual (DSM), version 5, is finally out after years of debate and posturing. This book is considered the “Bible” of psychiatry. It is the one used by all clinicians and doctors to give diagnoses so insurance companies will pay for mental health benefits and so treatment can be directed. It is part science and part art and that can be a problem. For example, in 1968, the DSM voted out Narcissistic Personality Disorder, then in 1980, it was voted back in–not something you see with disease. For example, does bronchitis get voted in and out of disease?
The 947 page manual contains revisions that have been controversial. So much so that The National Institute of Mental Health has turned its back on the DSMV and is working on its own diagnostic system for 2020, claiming to bring more precision to biological markers of mental illness. But DSM V has already attempted that and found it to be more challenging than anticipated. Still, NIMH feels the DSM-V lacks validity and won’t use it in its funded studies.
Even though psychiatry is moving to a more neurobiological model, there is still so much we don’t know. And while we know psychotherapy is effective in so many cases, psychotherapy would be marginalized in a more neurobiological model. Already, it is tough getting reimbursement for helpful therapies like marital and family.
Part of the controversy includes dropping Asperger’s syndrome and child disintegrative disorder. They are included under the blanket autism diagnosis.
Bereavement will now be excluded, making it difficult to distinguish between “normal” grief and depression.
Binge Eating Disorder becomes a full fledge diagnosis that most of us would probably qualify for at some point!
And on it goes…
The reason this manual is so important is because it affects who gets treatment.
What most therapists do is find a diagnosis that seems to fit so people can use the code to pay for their treatment. Then a therapist goes about the business of working with people to solve problems and help them live better. Most therapists will reluctantly embrace the DSMV because of its necessity to service provision. But that doesn’t mean we are excited about the changes.
Exodus 20: Remember the Sabbath day, to keep it holy. Six days you shall labor and do all your work, but the seventh day is the Sabbath of the Lord your God. In it you shall do no work: you, nor your son, nor your daughter, nor your manservant, nor your maidservant, nor your cattle, nor your stranger who is within your gates. For in six days the Lord made the heavens and the earth, the sea, and all that is in them, and rested the seventh day. Therefore the Lord blessed the Sabbath day and hallowed it.
Rest…a commandment given, but not often followed in today’s culture. For me, I tend not to rest because I always have so much to do, but I heard a sermon Sunday that challenged me to rethink rest on Sunday.
I felt convicted, not because I wasn’t following the rule of the law, but because I didn’t really grasp the reason for rest. So after the sermon, I was intentional about resting, changing my perspective and trusting God to redeem my time.
My pastor talked about rest in the context of self-sufficiency. Our inability to rest is often motivated by our self-sufficiency. If we don’t keep working, the work won’t get done. It all depends on us.Yes, we must be diligent in all we do, but even God rested on the seventh day from His work of creation.
Rest is more than an Old Testament law difficult to follow. It points to something spiritual.
We rest because we believe God is working for us, or in the case of salvation, the work is already done. Rest points to the work of Jesus. Jesus, our warrior King, has already won the battle and provides us rest in Him. He goes before us, He leads us, He provides and gives us rest.
The pastor went on to explain how the day of rest shifted from the Sabbath to Sunday because of Jesus. Jesus took our sin to the cross and gave us freedom from sin and eternal life.
“Thank you oh my father, For giving us your son,
And leaving your spirit, ’til the work on earth is done” (Keith Green).
Rest begins on our first day of the week, rather than the last as was the case in the Old Testament. Jesus represents the new beginning. He was raised from the dead on a Sunday and so we begin our week with worship and resting in Him. The first thing we do in the week is to worship Him because the work is already done. We rest in Him, completely depending on Him, knowing that He works on our behalf. I can rest knowing that my life is directed, led and in the hands of my Savior. It is not all about me!
The sermon changed my perspective. Rather than wondering what I should or should not do on the day of rest in order to keep the commandment, I realized that Sunday, the beginning of my week, is my day to rest and worship God in all I do. I don’t work my way to God, He has already completed the work for me.
Rest is a spiritual act. It declares the glory of God, His powerful sacrifice on our behalf and His Son who goes before us each day, working all things for our good.
Can you rest in that truth?
The pastor ended the sermon with a challenge, “Think of ways you can worship God on the day of rest.” Rather than trying to keep some legalistic law, worship!
Rest is an act of worship!
Marital fidelity is still the norm even though Hollywood depicts it as a dying possibility. Survey data suggests that 15% of women and 25% of men confess to straying. While these numbers are still too high, they don’t suggest that everyone is being unfaithful.
Myth #2 – Affairs help a marriage.
This is absurd. An affair is a break of covenant and does damage. But all you have to do is read Cosmopolitan or Playboy (I am not suggesting you do!) and you will be given the idea that affairs can rev up a dying relationship. I’ve even heard some marriage therapists suggest an affair to an unhappy spouse. This is ridiculous and harmful.
Myth #3 – Affairs are a result of lost love.
Usually it is the other way around–affairs bring on feelings of lost love. Affairs have more to do with the person who has the affair. It is a choice usually related to issues of identity and values. Friendship, not love, can be a primary motivator.
The reasons for affairs vary tremendously but the bottom line spiritually is a spouse who has strayed from his/her intimate relationship with God.
Myth #4-The affair is about sex.
Obviously affairs involve sex although 20% of people have what are called “emotional affairs” in which they admit to limited sexual intimacy. It is not that affair partners are better looking, more accomplished or sexually more impressive. It is a connection based on some fantasy or emotional tie that has overstepped its limit.
Myth #5-It’s best not to know about an affair.
Because this behavior is a breaking of the covenant, it must be confessed to the betrayed. Lies and deceit will produce problems. Spouses often fear that if they confess, their partners will leave. This does happen. But when the betrayer is sincerely remorseful, has stopped the affair and confessed to God and you, then reconciliation should be tried.
Myth #6- Affairs are caused by the spouse.
An affair is a choice that is made by one partner. You cannot blame the other person for this behavior. Marital dissatisfaction may be a joint or loner feeling. But the decision of how to deal with unhappiness or dissatisfaction is made by one person. If there is any hope of repair, the affair must stop. Whatever the marital issues, the betrayed is not responsible for the betrayer’s behavior.
Myth #7-An affair leads to divorce.
It can. An affair is a marital crisis and brings a set of problems that may intensify and change the landscape of the marriage. Certainly those in repeated affairs who cannot tolerate intimacy have more serious problems that make marriage difficult to sustain. But those who want to work on the marriage and feel guilty for the betrayal, have stopped and want to return to marital commitment should be given the chance. Affairs are sin. Sin can be forgiven and because of that forgiveness, we are to forgive one another. Once forgiveness begins, it is imperative for the betrayer to figure out what motivated the choice to act out and how to prevent it from ever occurring again. The power of the Holy Spirit in someone makes it possible to change and be faithful to vows.