Friday, June 28, 2024

Too Hot to Handle: Christians and Mental Health

In which our regular writers toss around subjects a little more volatile than usual.

Immanuel Can: Let me tell you a story, a true story. It’s about a Christian man. Unfortunately for this poor fellow, he was also a diagnosed schizophrenic. He was taking medication supplied by the government, and so long as he was on his meds he was functioning normally. But then his program was discontinued and his medication cut off. Without it he became delusional, and in that delusion he came to believe that his son could only be saved by being killed.

Operating in that mindset, he attacked and nearly killed his own child.

Go to Jail. Go Directly to Jail ...

Now, the child survived, but the man was jailed. In jail his medication was restored. Of course, you can imagine how horrified and ashamed he instantly became. He was cogent again, and fully capable of realizing his crime. But it was far too late. He was held to be a threat to the public and his family.

Tom: ... which genuinely appears to be the case.

IC: He has remained under the continuous counseling of a kind Christian who visits him in his incarceration, and is now as normal a fellow as one could wish ... but he is in “treatment” indefinitely, of course.

Tom: That’s a terrible story.

IC: My point in telling it is merely this. There is a new trend among some evangelicals today. Really, it’s the revival of an old idea, the idea that whenever something goes wrong in a person’s psychology or life, the remedy is what’s called “biblical counseling”, the sort of thing any kind-hearted, relatively knowledgeable and mature believer can handle. The idea is that resorting to extra-biblical expertise, such as the psychiatric profession, is somehow a betrayal of the all-sufficiency of scripture.

Problems with the Assumption

In cases like the one I’ve just detailed, there are significant problems with this assumption. Some problems are physical, biochemical, trauma-related, or products of the evils done by others, such as in abuse situations. Not all of these are addressable with exegesis and a smile. And people without experience and advanced understanding or expertise in such areas can easily produce disasters by forging ahead as if this were not the case.

Tom: Okay. Your story definitely packs a punch. It seems more than scripture was needed in this man’s case; he needed his meds.

IC: Brain chemistry affects spiritual perception. Imagine trying to counsel somebody who is high on drugs. The same is true of somebody whose inner body chemicals are out of whack, or who is sleep-deprived, or malnourished. The misbehavior of others can cause problems which are equally real and ongoing, particularly when, for example, they traumatize or victimize children. So it just does not follow that when somebody manifests strange or self-destructive behaviors, a good dose of quoting verses is going to set them back on their feet.

Tom: It should also be pointed out, though, that everybody failed this guy in your story. I’m a bit at a loss as to what the Christians he knew might have done for him when he was cut off from his medication. It’s not like 99.9% of us could write him a prescription, and that’s what was really needed.

IC: True enough. I’m not suggesting the church could treat him — it’s the opposite: that he had an issue that the church simply could not treat.

A Little Bit of Nuance

Tom: But this is what makes trying to help a mentally-ill Christian very complicated, and why so many Christians either turn tail and run from taxing and difficult relationships, or else find themselves offering simplistic and unhelpful remedies. For one thing, for diagnosis and the prescription of medical solutions, we are relying on a largely-secularized mental health profession, one that is far from spiritually neutral, and one that makes serious mistakes — like cutting thousands of people off needed medication to make the budget for the quarter.

Moreover, much of modern psychiatry and psychology are based on false underlying assumptions about human nature and sin. We are on very shaky ground looking for definitive answers or spiritual perception from men and women who have been trained to regard transgenderism and homosexuality as normal conditions which need positive reinforcement rather than a remedy. A relative of mine has jumped through all the hoops of the mental health profession and found very little help. The professionals were quick to diagnose, but the drugs they prescribed all did worse things than the problems they purported to fix, and the secular counseling was useless. Compounding the problem is the disproportionately small number of believers who are trained in psychology and psychiatry. It is understandable but regrettable. Finding help is tough.

IC: I wish I could refute that. I wish I could say that psychology was science, was an objective discipline, or was devoid of perverse secular agendas. But of course that’s just not at all true. Freud was about as atheistic and Jung was about as occultic as any two people you could name. But not every word they said were lies. Even the devil himself doesn’t tell lies 100% of the time. If he did, he’d be much easier to deal with.

Tom: No, but distinguishing truth from lies in a field in which you’re not an expert is no small problem. I don’t want to be discouraging, but I guess what I’m saying is that even when a problem like this is correctly diagnosed, treatment can be a bit of a minefield.

A World of Dragons

IC: Well, the world of psychology is full of dragons. But there’s also something else going on in it, and we need to recognize that. That is that spiritual problems can be caused or made much worse by issues that are not explicitly spiritual, or that are not even the fault of the person who’s suffering. So it’s just not at all wise to say, “We have biblical types of counseling, and that’s all we’ll ever need.” We need to pay attention to all the aspects of the problem. A secular diagnosis may actually help us target our spiritual efforts; a physiological treatment can sometimes help remove an impediment to spiritual responsiveness.

Tom: If it is a correct one, certainly. If not, it may provide the sufferer with a medical excuse to avoid looking more carefully at possible spiritual causes of his distress.

IC: We human beings are spirits in bodies; and what goes on in, and to, our bodies has a profound impact on our personal responses and our spiritual well-being. Inexperienced counselors who have not been taught the discipline of diagnosing and treating these problems are just not equipped to provide whole-person solutions. They may get the cognitive, spiritual part right, but that doesn’t suggest they have the means to treat the sociological or biochemical issues that feed into, and make intractable, things like obsessive-compulsive behaviors. So I’m afraid we have to — selectively, discerningly and very carefully — make use of the resources that psychology has discovered that can shed light on the total problem here. In other words, there are many bad psychologists and counselors; but find a good one, one who is at least respectful of the spiritual side of the issue, and eliminate any chemical, developmental or physiological complicators before doubling down on the biblical advice or writing off the sufferer as obstinate.

I recognize that saying a mental health professional may have something to contribute to the situation of a struggling Christian is probably going to be seen as a kind of sell-out by those who think that the sufficiency of scripture implies that quoting verses is all a mentally-ill person ever really needs. I can’t help that. I think that they don’t know what they don’t know about that.

’Tween Scylla and Charybdis

Tom: Well, scripture is absolutely sufficient in every area it addresses. That doesn’t mean a Bible makes a better splint than an orthotic or even a couple solid pieces of oak. The word of God wasn’t designed to deal with a broken ulna, and that’s not a deficiency. Christians who argue they can handle chemical imbalances with counseling are making what is called a category error. They are conflating two sources of evil which are distinct in nature. Even when the Lord Jesus was in this world personally, he didn’t do a lot of quoting scripture to demoniacs: he drove out their demons first, then engaged with those he had healed once they were in their right minds.

IC: Tom, I think we’ve got a problem here to which there is no easy solution. On the one side, we have the Scylla of secular psychiatry — with all its very serious and real dangers — and on the other side, the Charybdis of presuming to know too much ourselves. In my opinion both are very dangerous. This is a tightrope act, walking between two bad falls, not a simple matter to resolve on one side or the other.

Let’s suppose we have somebody with what appears to be a genuine psychological problem in our church. Not a mere attitude maladjustment. Not merely a matter of disobeying scripture. Something that appears to have elements of addiction, schizophrenia, delusion, compulsiveness, or other hallmarks of significant psychological malfunction. This person is suffering, their family is suffering, and the congregation is suffering. What can we do in such a case? What ought we to do?

Tom: There was a time when I might have said, “Consult a Christian psychologist.” Then I actually tried to find one, and discovered what rare birds they are. Never mind a good one; finding one at all is tough.

IC: Yes, it is. No question. It may be the best alternative, but for most of us, it’s also — sadly — an unrealistic one. There just aren’t many.

Love and Failure

Tom: In the absence of being able to find competent, Christian professional help for a struggling believer, I would say we have to be very realistic about what we attempt on their behalf, recognizing our own limitations. The story may end tragically no matter what we do. We can’t heal Christians who have cancer, and we can’t help Christian amputees regrow lost limbs. Why would we imagine we can fix a broken mind? Even really understanding what is going on in the heads of our suffering fellow Christians, and why it is happening, may be beyond us.

We can try to be kind to a person in that condition. Assuming they have a doctor they are seeing, we can try to support them in their efforts to stay on their meds ... again, assuming they have found a prescription or combination of prescriptions that actually helps. Sometimes that too is a work in progress.

IC: As I say, churches cannot treat biochemical problems or diagnose developmental dysfunctions or involve themselves safely in penetrating psychiatric counseling of abuse victims. And, at the end of the day, there are no easy solutions. That’s maybe the biggest takeaway: it takes every resource — spiritual, scientific, psychiatric, chemical, or whatever — even to help with some problems; and to solve them is sometimes beyond the capabilities of all men, short of a miracle and this side of heaven.

My closer? Be compassionate and spiritual. But just don’t casually mess about where you don’t have the expertise to know what you’re doing, because you could do more damage than good. Be open to the possibility that there may be something other than a lack of Bible knowledge at work, at least in some cases.

Tom: Amen to that. More to come on this subject ...


  1. 1 of 2. I read this article with satisfaction because you both have positions that well describe the positions Christians find themselves stuck between. The temptation is to cut one position loose and embrace the other position with certainty beyond reason.

    I think the church has an opportunity to apply complex thought to the complexities that psychology is discovering. People, secular or Christian, for a long time, have made discoveries that challenged church doctrine and dogma and the church needed to develop answers. Each time this happens it gives the church the opportunity to look closer, dig deeper, think wider, and judge better what we believe and why we believe it. To date, nothing has toppled biblical revelation into ruin or dealt the death blow to the faith so I don’t think the realm of psychology will be different.

    The field of psychology, to lump a whole bunch of disciplines together for the sake of time, is still rather new. This newness, I think, is one of the reasons that there are so many anecdotal experiences of bad experiences with counselling/therapy. In truth, there has been a lot of trial and error in the hopes of finding something helpful for patients. For a long time that was limited to a small number of theorists and clinicians who seemed to have a knack for helping patients with nobody understanding why they could help people and others could not. Only in the past 2 or 3 decades has valid research attempted to discover what actually works with reliable or transferable results.

    The relative newness of psychology has another implication I think is often unrecognized. The newness of the field means that the field itself is a long way from consensus on many things and that Christian thought about psychological discoveries is still minimal and inadequate. Consensus within the field and good Christian thought about the field will take decades to hammer out and integrate. It is a tempting mistake to grab for certainties when neither group can offer the certainties that would be nice to have. It will take a lot more time and discussion and ongoing discovery to get there, but what wonderful opportunity for discovery about how God has designed our selves and our bodies and how the integration of both is supposed to work. In the meantime, I think the task is to figure out what we can know but do so in the shadow of considerable uncertainty.

  2. 2 of 2. I the past decade or so I have seen the secular world take a step of humility that I wish I saw in the church. The secular approach to mental health today is best described as multi-disciplinary and eclectic (yes, there was a time when eclectic meant scattered and barely coherent, but that is far less the case now. Careful picking and choosing from good research and clinical practice is what eclectic has come to be). It is no longer only the domain of medical based psychiatry, or only the domain of clinical talk therapy. There is a recognition that the more complex the mental health issue the more professionals will need to be involved to address the full complexity to whatever degree is possible. The general idea is this: medication and talk therapy together lead to better outcomes than medication alone or talk therapy alone. Again, the more serious the mental health problem, the more this seems to be true.

    One thing I want to stress here is that finding the best professionals should be the goal. It is a mistake to limit the help someone might receive by limiting the helpers to Christians alone. We don’t do this with any other medical issue, so we should avoid this misstep with mental health issues too. Church leaders should ask around and find the best psychiatrists, psychologists, psychotherapists, social workers, general practitioners, nurses, and recovery groups in their area. Church leaders should take some time to build relationships with skilled professionals. This could work well for everyone involved. And, yes, if a professional is hostile to Christ and will actively undermine a patient’s faith in Christ, then quietly remove them from your referral list, but don’t stop looking for other professionals who will be helpful. I can tell you that these professionals also know that a healthy community (sadly all too often not found at church) will provide benefits to their patients in a way no professional ever can. People who are well integrated into a healthy community tend to do better.

    The church should be strong and vibrant in its ability to produce well balanced, mature adults who know how to love the Lord, one another, and their own selves well. For many, mental health recovery changes that order and begins with learning how to love one’s own self, then the Lord and then others. If those in church knew what proper adult maturity looked like they could spot problems sooner and more accurately. Perhaps people in a mental health struggle or starting to fall into one would be spotted sooner and helped sooner before destruction became undeniable to everyone. Earlier intervention tends to lead to better outcomes for the individual and those around them.

    I think helping those with mental health problems is best done with three overlapping domains: skilled medical professionals, skilled psychotherapeutic professionals, and a church that is rock solid in its maturity in Christ.

    1. Thank you for taking the time to share your thoughts on the subject, B. It's always helpful to hear from someone with experience in the field rather than just a strong opinion.