Responding to Mental Illness: the narrow path

Responding to Mental Illness: the narrow path June 18, 2013

I am in the middle of one of my long blog series.  Today there is a significant change in what I am addressing, however.  So far, I have essentially been saying “mental illnesses are real, you should not be afraid to seek medical help,” from today I will be arguing for the other side of the same coin, “the Bible has a lot to say that is relevant for those with mental illnesses, and can help all of us live a more mentally healthy life.

There are some who advocate strongly for a purely biological view of mental illnesses and essentially wash their hands of church members after referring them for expert help.  Others feel that the only valid form of counseling is done by secular professionals outside the church and put their trust in that.  A third group are probably quite annoyed with me so far: they would say that the Bible is entirely sufficient on its own to treat all conditions that are called mental illnesses.

I say that all three groups are wrong.

One thing I should be clear about, however, is that I am not really advocating what some would call an “integrationalist” approach.  I am not convinced that what is always needed is a form of counseling that combines secular and biblical approaches, although I am sure that is helpful at times.

Rather, I am saying, Church, be the Church and offer help that comes from the Bible and at the same time encourage people to get the complementary help they can only get from mental health professionals.

If you have access to trained professionals who are also Christians, wonderful.  If you feel called to develop and offer an “integrated approach,” fantastic.  But the needs are too great for us to wait till there are enough double-trained people. And the problems are too acute for us to assume that a church member can easily be trained in a Christian context to the level that secular counselors and psychiatrists are.

Why can’t we work together with secular services, each playing to our strengths?  I do hope over time some genuinely integrated approaches will emerge.  Lets not be so proud as to assume that we can convert our people, or even our pastors into psychiatrists overnight, nor should we even try.  Often people with very limited knowledge of mental illness can do a lot of harm if they stray from the one area where we have a good authority base.  What is that area? Well it is the Bible, and everything it has to say.

Long-time readers of this blog will know that I don’t follow the usual advice which is to make your blog very focused on a specific subject and grow a “niche” brand.  I haven’t tended to do that, but I have often focused on a subject for an extended period before moving on to another one.  (If you want to read about another subject than perhaps search my site in the sidebar for what I’ve said before or look at the menu above.)

If I was to develop a “tight brand” in my case, I suppose I would be a British Christian,  doctor, psychiatrist, medical researcher, church leader, author, long-time blogger, twitter enthusiast, evangelical, debator, champion of conservative theology, believer in hell, and penal substitution, moderate calvinist, charismatic, soft complementarian, enjoyer of modern worship, advocate of churches that are multicultural and unafraid to grow (in some cases very large), cheerleader for both multi-site churches, and traditional church plants, multi-faith dialoguer, sci-fi and action moviegoer, and Formula One fan. 

If all those things apply to you, welcome, if I put everyone who isn’t then you will probably be my only reader moving forward!  My approach, is not to just focus on one of these things, or my unique so-called “brand” but rather to blog about whatever interests me.  So the focus on psychiatry will remain for a while yet, but eventually I will no doubt shift my gaze onto something else, but even then, I will no doubt now and then come back to my passion for what has after all paid my bills for my entire adult life.

As I was saying, today marks a bit of a change of course, but don’t miss the fact that everything else I have written so far on mental health has been an important foundation on which we are now going to build.

There are two equal and opposite errors we fall into.  One is to assume that psychiatrists and therapists have nothing to offer the believer.  The second assumes that the Bible has nothing to offer the mentally ill.  Both these assumptions are really untrue and can paralyze us and prevent us from caring pastorally for the many that suffer with mental illnesses.  Frankly you don’t even have to actually have a diagnosed mental illness to struggle with sorrow, anxiety, and lack of hope.  It is the Bible that holds out the ultimate answer to all these ubiquitous problems facing mankind, even though our experience of them is often intensified by genuinely biological factors.

And so, I have previously clearly argued that Christians can and do get depressed, that we should seek medical help, medication, and even secular counseling at times. In summary we must adopt a “Four Pillar” approach to mental health.  I am now going to focus the rest of the series on what the Bible has to say to help all of us be more mentally healthy.  I look forward to sharing more of all this in the coming weeks.

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  • mbells

    Good series on a issue that is way too often overlooked / ignored in the church

    We are hosting a luncheon tomorrow for pastors in Orillia, with mental health workers, raising both awareness of the issue and making us aware of resources available.

    You are right, we need to work with those in the field who have expertise and experience.

    thanks again for a great series

    • Thanks for the encouragement. Let me know how your meeting goes!

  • Darryl Willis

    I have no problem with secular counseling…and I agree we should use all good tools available–but there is a growing movement among even secular psychiatrists who suggest that psychotropic meds cause more harm than good. Indeed anti-depressants have an effect–but according to Dr. Peter Breggin (Natl. Institute of Mental Health, Harvard grad) that effect is no greater than exercise–(and exercise is without major negative side effects). My father had a Doctorate in Pharmacy and his view of psychotropic meds was particularly negative. Breggin is joined by Drs. William Glasser, Bertram Karon, Loren Mosher and many others who share his view.

    As a minister I shouldn’t hold a simplistic view about mental illness as easily treated with a few Bible verses–but I don’t think we should ignore the growing weight of evidence against medications being touted today as a cure all. The medical model of mental health has the same problem as some ministers: it is overly simplistic.

    • Darryl, I think it’s important to acknowledge that for milder cases of depression there are many approaches that may be as (or more) effective as medication. But the more severe cases do often seem to only respond well to medication. Mental health is far from simple for sure.

      • Darryl Willis

        There is no question that severe cases do respond “well” to the treatments (your operative word is “seem”). No one questions that meds have an effect and many times they appear beneficial. However, the studies indicate that for severe depression physical exercise (and other options including traditional talk therapy) are equally effective without the side effects (which ironically can include suicidal thoughts, depression, and even psychotic behavior). I highly recommend you do some reading in the literature–there are more and more mental health professionals who are taking a second look at the medical model and the use of psychotropic drugs and opting out of the approach.

        • Darryl, the studies you are talking about are not involving the most severe cases. Feel free to direct us to specific published literature.

          • Darryl Willis

            I’ve editing this reply because of a couple of things: 1) Never answer a post late in the evening when you should have gone to bed! 2) Be willing to admit you have biases (I have enough for two people)! and 3) Always make a couple of disclaimers regarding discussion of anything relating to medicine:
            a) I’m not a doctor,
            b) my comments are in no way a suggestion for people on meds to take themselves off!!

            Here are some of the studies I’ve read in the past–granted it’s been three or four years. And they are written on popular level rather than scholarly level.

            Irving Kirsch, (Associate Director of the Program in Placebo Studies and a lecturer in medicine at the Harvard Medical School, a research psychologist). Author of The Emperor’s New Drugs: Exploding the Antidepressant Myth. The book is the result of his meta-analysis study completed in 2008.

            Toxic Psychiatry by Psychiatrist Dr. Peter Breggin is another off the top of my head.

            Also, statistician Dr. Timothy Scott examined the clinical studies provided by drug companies for psychotropic drugs–he chose an unfortunate title for his book (America Fooled: The Truth About Antidepressants, Antipsychotics And How We’ve Been Deceived). Sadly, it does sound like a title of some conspiracy theory which may turn people off from actually reading the book.

            Scott’s research into FDA practices is very disturbing.

            Let me also hasten to point out that this discussion is a spin off of your post–basic point of your post I completely agree with!

          • Darryl Willis

            And I hope I’m not coming off “snarky” here. I recognize I do not have the training you have as a psychiatrist.

            However, I also live in one of the states with the highest percentage of foster children on psychotropic meds (I have family in social work). I am very skeptical with the medical approach to mental health–there is an over zealousness in prescribing psychs. I have to be honest too and point out not all prescriptions are written by psychiatrists but by GP/Family Practice–which might be part of the problem.

          • Darryl, just to say that psychiatrists recognize the fact that the majority of our trials can only enroll people who are more mildly or moderately ill. This does mean that the relative effectiveness of the medications compared to placebo can seem quite small.

            However, this small difference is caused by a group of patients in these trials who do very well on medication, and improve dramatically (while some don’t improve and a few actually get worse). This group tends to be the more severely unwell of the patients in the trials. Accordingly. per such evidence and per their own clinical practice, most psychiatrists recognize that in general, the more severely ill someone is, the more likely they are to respond only to medication. The more mildly unwell can often be made better by CBT. One of the tragedies is that CBT is not more widely available. I really feel that is an area where churches could make a difference: supporting the provision of CBT in their area for church members and those outside.

          • I will just have to accept your word on this, because I can only refer to what I’ve read as a non-professional– which admittedly puts me at a disadvantage in this discussion.

            We certainly agree, re: CBT! At the risk of sounding over enamored with Glasser (and technically he is not self-identified as CBT–but many have observed, and he admits, there are a lot of similarities): I highly recommend his training for lay people (and I include ministers in the “lay” category).

            I was trained in his basic approach as a non-professional counselor a few years back (and separately–not through Glasser–in critical incident stress debriefing for first responders).

            For many of the problems ministers encounter, Glasser offers quite good training. It is intensive and there are opportunities for further depth training and even supervised counseling (through PsyD’s). For pastoral situations his training is excellent. I think we need more Christians at least familiar with the basic approaches to CBT.

            Actually, what would go a very long way for congregations would be interactive training in basic listening skills. I believe a man named Savage offers this in a How to Reach the Drop Out seminar. It is something like a three full weekend hands on seminar (two weekends intensive training utilizing triad groups with a weekend between to actually put skills in practice).

            Again, this is not to suggest the either/or attitude that says counseling should be done only by ministers and non-professionals or that all one needs are the right Bible verses to counsel. I am not a fan of Jay Adams’ (nouthetic counseling) disdain for psychologists or psychiatrists.

  • Jarrod, respectfully I disagree about secular therapy. Having said that there are so many different forms of counseling that it is vital someone finds the right sort. CBT seems to me to be one that very rarely if ever conflicts with a Christian worldview. Of course there are many who seem to get set free almost instantly via the gospel. But there are others who continue to struggle. Those are the ones who may need formal help.

  • Chad Ressler

    “I have yet to see one person get better after they have seen a psychologist.”

    I guess my question would be: does that mean it doesn’t happen? I’ve known many Christians that have been greatly helped by secular theories such as CBT. There is nothing in CBT that would conflict with theological orthodoxy. To assert that because person X developed theory Y that theory Y is bad commits the genetic fallacy.