A Mother's Concerns About The Schizophrenic Unicorn

A Thoughtful Appeal to ACBC

Photo by Kelly Sikkema on Unsplash

In the fall of 2024, while I was reaching out to the Association of Certified Biblical Counselors (ACBC) with my own concerns about the growing influence of Daniel Berger’s book The Schizophrenic Unicorn, another voice—unknown to me at the time—was doing the same.

Mrs. Michelle Johnson, a fellow Christian mother and caregiver to a son with schizophrenia, wrote the following letter to ACBC with clarity, humility, and conviction. Though we have never met, I was deeply moved by her careful research, personal experience, and unwavering commitment to both biblical truth and medical integrity. Her letter captures so many of the same concerns I have voiced and does so with both grace and strength.

With her permission, I am sharing her letter publicly because I believe her words reflect the heart of many Christian families who feel unseen in conversations about serious mental illness. This is a faithful appeal—not a critique rooted in hostility but one born from the love of a mother, biblical discernment, and concern for our Christian witness to the world.

Deborah Geesling Founder, P82 Project Restoration

September 10, 2024

Dear ACBC,

We are very thankful for your work over the years in training and equipping brothers and sisters in the Lord to provide biblical solutions to people’s problems. My husband, Dr. David Johnson, along with several Christian leaders from our church have attended your conferences and appreciate them.

I am writing to share my concerns about a book that ACBC appears to be endorsing and a workshop based on it scheduled for the October 2024 Annual Conference. The book in question is “The Schizophrenic Unicorn” by Daniel Berger.

I have just finished reading through its 648 pages and come away with many questions and concerns about the information presented and the conclusions drawn, more than I can share in this brief letter. I am concerned about how the thoughts shared in this book may influence Christian counselors, thus affecting both those suffering from schizophrenia and their families, as well as the testimony of Christ to the world. My prayer is that the information in this book will be reviewed and critiqued by Christian medical professionals with firsthand experience and knowledge of this topic who can bring much-needed light to Berger’s conclusions. I believe it is important to note that Dr. Daniel Berger is not a medical doctor.

I acknowledge that part of the confusion surrounding this topic is likely because many people suffering from psychosis are incorrectly diagnosed with schizophrenia. Not all psychosis is schizophrenia. “A recent study showed that up to 50 percent of those diagnosed as schizophrenic do not actually meet the criteria for the diagnosis.” (Dr. Charles Hodges) In the book, Berger tends to equate schizophrenia primarily with psychosis alone. What about all of the other symptoms of schizophrenia that people suffer through that define the illness, maybe even more so than psychosis? Namely, the negative and cognitive symptoms? Berger seems to minimize these symptoms for various reasons. Schizophrenia was initially named “dementia praecox” (premature dementia) because it was observed as a “progressive neurodegenerative disease which automatically resulted in irreversible loss of cognitive functions.”

Does the medical field have all the answers surrounding schizophrenia? Of course not. Is more research needed? Most definitely. Could there be more than one cause/illness for what is currently diagnosed as schizophrenia? Yes.

The book attributes a lack of sleep as a significant contributing factor to psychosis or schizophrenia. No one argues that sleep is essential, but to blame the severe symptoms of schizophrenia on a lack of sleep is quite a stretch! Schizophrenia often involves a prodromal stage where a person’s condition slowly deteriorates long before they experience psychosis or sleep issues. The prodromal symptoms often affect attention, perception, social withdrawal, speech production, motor functioning, thinking, memory, etc. Berger seems to dismiss these other hallmark symptoms of the illness. It makes me wonder how much time Berger has spent alongside those with schizophrenia and not just those who were inaccurately diagnosed with schizophrenia due to psychosis alone. That information is never explicitly shared in the book. Are Berger’s conclusions primarily from philosophical research or medical research and experience? Thankfully, he places a disclaimer at the beginning of the book: “The material contained in this book…is not intended in any way to be taken as medical advice. Rather, the views and material expressed in this book are philosophical, theological(?), scientific(?), historical… Ultimately, every individual must consider what is true and live accordingly.” The disclaimer may be the most critical information in the book.

Schizophrenia usually manifests at a specific stage in life, the late teens/early twenties in males and usually a bit later for females. Most would argue that there is a biological reason for this - a normal part of neurodevelopment is the removal of extraneous nervous tissue, termed “synaptic pruning.” Commonly, in those diagnosed with schizophrenia, over-pruning during this phase of life occurs. Berger’s explanation for the typical age of onset attributed to increased drug and alcohol use and then withdrawal, leading to sleep issues, resulting in psychosis, is feeble. This does not account for the typical age of onset by those who have never drunk alcohol or used drugs.

More amazing is the number of sources Berger uses in an attempt to validate his claims that were either seemingly taken out of context or did not adequately reflect the position of the article quoted from. Someone reading Berger’s book would assume those quotes supported Berger’s suppositions, but upon further research, it is not always the case. (In particular, quotes from Dr. E. Fuller Torrey and articles by researchers, including Dr. Henry Nasrallah.) It’s one thing for researchers to question the root cause of schizophrenia and quite another to question whether it’s a physical/medical issue that requires treatment.

Throughout the book, Berger repeatedly fluctuates between quoting those who refer to schizophrenia specifically and those who refer to DSM-5 diagnoses in general. Is that fair? What may be true concerning other DSM-5 diagnoses does not necessarily apply to schizophrenia.

Berger’s suppositions lead to quite a few spiritual conclusions about those diagnosed with schizophrenia, especially regarding hallucinations and delusions. Berger refers to those with schizophrenia as “those struggling in the grip of deceitful thinking” as if they have a choice in the matter. Does the person suffering from delusions and hallucinations have a choice in the matter? Would we say the same about an Alzheimer’s patient suffering from similar issues? No, that would be cruel and add an unnecessary extra burden on those who are already suffering, along with adding an unfair burden on their family.

If counselors and counselees follow the ideas presented in this book, is it possible that those suffering from schizophrenia may not receive needed medical treatment? Untreated schizophrenia can lead to additional damage to the brain, not to mention death. Is ACBC confident that the information in “The Schizophrenic Unicorn” is accurate and medically sound, considering that Berger is not a medical doctor? Other ACBC medical doctors have differing opinions from Berger’s. Praise God for medical doctors who can help our loved ones who are suffering from illnesses such as schizophrenia! I am very thankful for Christian medical professionals such as Dr. Charles Hodges and Dr. Dan Dionne, whose writings and talks concerning schizophrenia are sound. Specifically, Dr. Hodge’s chapter on Schizophrenia: Medical Backgrounds and Biblical Principles in “The Christian Counselor’s Medical Desk Reference,” 2023, provides valuable insight.

If schizophrenia is indeed a brain-based illness requiring medical intervention, how does a book that questions its very existence affect the testimony of Christ to the world? Is ACBC confident that the material presented is biblical? Has anyone read through its entirety, along with the sources he’s quoting from? What is your response to all the families whose loved ones’ lives have greatly improved from the use of medication? Clozapine is the gold-standard medication for schizophrenia and is used at a much higher frequency in other countries around the world. It was not once mentioned in this book. If schizophrenia is not an illness, why have so many found dramatic, meaningful recovery with the use of medication?

Why do I care? My Christian grandmother suffered from a severe mental illness until she passed away at 85 years of age. My uncle suffered from schizophrenia until he died at 68. And four years ago, our wonderful Christian son, who was about to graduate from university with a bright future ahead of him, was diagnosed with schizophrenia. Our family has gone through unbelievable heartache watching our kind, gentle son suffer through this terrible illness. We witnessed what this illness looks like firsthand without medication for over a year, while unending prayers and counseling took place. Yet his condition continued to seriously deteriorate. At that time, I had little to no hope in psychiatrists or medication because I was uninformed. After much prayer, research, and reading books/information by some of the same doctors Berger quotes to purportedly substantiate his claims, we were led to medical/pharmacological solutions that actually helped our son. We praise God for His goodness in leading us to the underutilized medication of clozapine, on which our son eventually made tremendous improvements! He can now smile, speak, sing, and attend church again. None of this was possible just a few short years ago, prior to treatment with clozapine.

Many with schizophrenia don’t have a voice. God calls us to “open your mouth for the mute, for the rights of all the unfortunate. Open your mouth, judge righteously, and defend the rights of the afflicted and needy.” (Proverbs 31:8-9) How does Daniel Berger’s book, which questions the very existence of our loved one’s illness (and thus not treating it appropriately), help Christian families like mine? Unfortunately, it does not.

I appreciate your prayerful consideration of what I have shared.

A very concerned Christian mother,

Mrs. Michelle Johnson

PS – For the last four years, since our son’s diagnosis, I have searched for Christian materials to help educate, guide, and encourage a mother’s heart through this journey. They are very hard to find. Dr. Charles Hodge’s informative writings and talks through ACBC have been highly encouraging. But the book that speaks to a mother’s heart experiencing a child with severe mental illness, besides God’s Word, is Shelly Garlock Hamilton’s book “Always, Only Good,” produced by Majesty Music in 2021. She tells the story of her son with a mental illness and points the reader’s hearts to the goodness of God throughout the suffering. A resource worth looking into!