Evangelicals and psychiatric services

The following is part of a talk I was invited to give to a group of psychiatric residents (doctors-in-training) here in the Twin Cities a few years ago. The talk was on “the evangelical tradition,” and was intended to give these medical practitioners a sense of the beliefs of evangelicals, possible impediments to serving this constituency, and ideas of how to serve them better.

I have already posted other portions of this talk here under the titles “Basic, basic Christianity” and “Evangelicalism–a basic summary,” part I, part II, and part III. What follows is the final portion of the talk, which outlines issues that may face a professional providing evangelicals with psychiatric services, and ideas on how to serve (some) evangelicals better:

Now I’d like to turn the corner and address more directly some of the challenges that may come up in serving evangelical Christians from within the field of mental health care.

The insights that follow mostly come from my Bethel colleague Steven J. Sandage, Associate Professor of Marriage and Family Studies, Bethel St. Paul. Steve has served as clinician, psychologist, and chaplain in a variety of settings (community mental health, correctional, university) and currently engages in part-time clinical practice. He taught at Virginia Commonwealth University and the Medical College of Virginia as an adjunct faculty prior to coming to Bethel.

As Steve has related it to me, some evangelicals have a tendency to over-spiritualize—they frame problems as spiritual, not being able to think in an integrative way about the interactions of their minds, emotions, spirits, and the material world. They may refuse medication, for example, because they think this would show a lack of faith in spiritual truth or spiritual reality.

In fact, this tendency does not reflect traditional Christianity. Rather, looks more like a set of teachings from the earliest centuries of the church that was rejected by the main body of the church, called Gnosticism. Gnostics believed, among other things, that the body and the material world were bad, and that salvation meant escaping from the down-drag of material things and bodies. We can, I think, accurately identify this small group of “super-spiritual” evangelicals as “more Gnostic than Christian.”

Such individuals tend to develop a “spiritually based defensive structure” for dealing with problems in their lives. They will use faith as a defense against something that feels foreign to them—including the advice of friends, non-believing family, or a therapist. Overall they are characterized by a lack of submissiveness and a love of autonomy that makes it difficult for them to accept a treatment.

The strength of such “super-spiritualizing” evangelical Christians is their loyalty to their religious tradition, but their weakness is a rigidity against trying things that they don’t recognize as sufficiently spiritual. In other words, they have trouble recognizing themselves holistically as embodied creatures, and seeing that this is a good thing (as indeed the Book of Genesis teaches). In therapy with people that have this tendency, Steve emphasizes the doctrine of the Incarnation—the teaching that Christ as the second person of the Trinity became an actual, physical human person, Jesus of Nazareth, thus affirming our embodiedness.

Problems may arise for this group with sexuality, as a facet of their embodiedness. Shame is a toxic emotion, and evangelicals can have dysfunctional beliefs and habits that crank up the level of shame they experience. There can be an implicit message in some evangelical circles that sexuality is not part of their spiritual life. Shame prevents them from considering the possibility that in fact their sexuality, too, is a spiritual matter. They may even come to associate some sexual sin in their past, or some ongoing sexual struggle, with a New Testament teaching that there is an “unpardonable sin.” Though that teaching seems to be talking about something like the complete, willful rejection of the Spirit of God in one’s life, some evangelicals may feel they have committed this sin by some sort of sexual misbehavior.

Often these folks are not even aware that their Bibles contain an Old Testament book called the Song of Songs, or sometimes Song of Solomon, which celebrates sexuality in frank and sometimes startling terms.

Another facet of this syndrome of the “spiritually based defensive structure” is that some evangelicals have trouble trusting those not from their faith tradition. There is a high level of guardedness and even a fear that a psychiatrist will think they are crazy because they are Christians.

However, it is important that non-evangelical or non-Christian therapists be very careful in attempting to build a bridge to the evangelical patient by affirming their own connections to the patient’s faith. This can easily be a clumsy maneuver that will put the patient off even more. Saying, for example, that you are an Episcopalian may in fact make things worse. The therapist may think they are building rapport, but actually be distancing the patient from them. A parallel example would be some expression of “token” knowledge of African-American culture by a white therapist treating a black patient. A clumsy attempt like this may work against the therapist.

Another important facet of evangelical culture that may present a block to psychiatric service is that because evangelicals come from revivalist traditions, they may expect transformation to be rapid and dramatic. They may have a hard time with a gradual view of change over an extended period. They may themselves have become Christians through some sort of radical, rapid crisis experience. This may simply “feel” to them like “the way God does business,” and so they may be resistant to extended therapy.

Again, if these folks only knew it, there are resources in their own Bibles for a more extended, gradual model of healing. Examples include the Book of Job in the Old Testament and the Book of Hebrews in the New Testament. What these and other Bible books show the Christian is that the fact that we may be suffering does not indicate that God has abandoned us or is not helping us toward healing.

This is an important point: evangelicals are very strongly focused on relationship with a personal God. If, in a crisis situation or a time of suffering, they come to believe God has abandoned them, this may have a devastating impact. They may desperately need a sense of that relational presence to help them regain hope and trust in God. They may feel abandonment because of their condition and their troubles, but this is a false feeling.

Of course, it usually isn’t helpful simply to tell a patient, point blank, that they are not abandoned by God. But a therapist who shares the patient’s faith might point out that Jesus himself felt abandoned by God the father, in the experience of his crucifixion (the famous words from the cross are “My God, my God, why have you forsaken me?). They might also suggest that the patient read the so-called “Psalms of lament”—poems in the Old Testament in which the poet grieves openly at suffering or injustice and complains directly to God. This is part of a rich Jewish tradition of lament, still accessible to Christians today.

What the scriptural authors seem to be pointing toward in these books is that crises have the potential to help us grow spiritually. But this is an uncomfortable thought for some evangelicals caught up in the American tendency to need everyone to be happy all the time. This is what might be called the “happy clappy American church culture,” in which the only acceptable answer to the question “How are you doing, Brother,” or “Sister,” is . .  “I’m blessed! All of the time!”

It is also worth noting, although this may take some discernment on the therapist’s part, that some churches do better than others at emphasizing God’s constant, loving presence with his people, even in times of trouble. In some churches, there may be such a rules-and-regulations, “do this, don’t do that” emphasis, that it reinforces a person’s sense of their own failure and God’s abandonment of them.

In some churches, particularly in some corners of the Pentecostal or charismatic tradition—what we might call the “name it and claim it” or, technically, the “Word-faith” traditions—patients may be made to feel ashamed because they are not thriving as the preacher says they should. They are not enjoying perfect health, wealth, and happiness, and therefore they must be defective in their faith.

Other evangelical ministries—certainly most of the churches I have been involved with over the years—will be much more supportive of a troubled congregant. Nonetheless, there is a tendency among many evangelicals to not quite know how to deal with suffering in their midst. While some more mature church-members will know how to be pastorally present to someone going through suffering, others will feel their own faith and their own sense of the goodness of God challenged by other Christians’ suffering. They may go out of their way to avoid folks who are suffering, whether physically or psychologically, because they don’t know how to deal with the theological implications of this.

Of course, it’s tough to discern whether a particular individual’s church is of the helpful or the harmful variety, or some mixture of both. And people absorbed in dysfunctional church cultures may need to stay within those settings for the short term, for the sake of their comfort and stability. Nonetheless, it may be helpful for some patients in the “super-spiritualizing” category to realize that they need to challenge or deconstruct some aspects of their own faith and churches.

This can of course easily lead to a tremendous loyalty conflict. This is especially true because the patient may need to deconstruct their own family of origin as well as their church. They can end up feeling homeless and desolate.

If you discern that something like this deconstruction is required in a patient’s therapeutic process, you can’t lead the patient in this direction without being prepared to help them through it. Otherwise the process could be very harmful for them.

Well, I have been emphasizing some of the potential dysfunction within evangelical settings. But to be fair, I should say that there is a growing body of empirical research from the past 10-15 years that shows that for most people, in most cases, religion and spirituality correlates positively with both good mental and good physical health. Key players in this research include Harold G. Koenig and David B. Larson. Not all of the researchers on these studies have been religious themselves—there has just been a growing curiosity about these correlations between religion and health.

For a review of some of this literature, see the Handbook of Religion and Health by Harold G. Koenig, Michael E. McCullough, and David B. Larson, published in, I think, 2001 by Oxford University Press. Duke University has recently instituted a Center for Spirituality, Theology, and Health to extend this research.

All of this means that there is a turning the tide against the anti-religious bias of the old Freudian and behaviorist traditions, which tended to assume that religion was neurotic. Instead, these studies are showing that the opposite is true—most religious involvements are good for people. This is still just correlation, not causality. But the old extreme bias against religion in the health fields is being shown to be ungrounded.

One or two more facets of evangelicalism could raise issues with mental health care. Part of the “super-spiritualizing” dynamic I’ve talked about this morning is a significant strain of anti-intellectualism among some evangelicals—especially those of more conservative or strict background, linked to the fundamentalism of the early 20^th century.

Among some of these folks, the ultimate authority on every question is the Bible. Once I find some Bible verse or passage—however oddly interpreted or out of context—that seems to solve a problem, I will not trust any other authority on that matter. Historically, this sort of anti-intellectualism has deep roots in the free-wheeling, egalitarian religious marketplace of the frontier period—that is, the early 1800s.

In that atmosphere, revivalistic evangelicals believed that any man (or often any woman) could take their Bible in hand and go out to preach the gospel. They distrusted the old-school, mainline Christians—Congregationalists, Episcopalians, some Presbyterians, and others—who believed that a person must receive years of training in theology and ancient languages before they were equipped to become pastors. This was what one scholar has called “the Democratization of American Christianity,” and it left evangelicals with a legacy of distrust of educated, professional ministers.

The usual evangelical critique was that such ministers got so caught up in the niceties of theology or the complications of biblical interpretation that their preaching lacked power or emotional force. And indeed, it was powerful, forceful, and often fairly uneducated preaching that grew such evangelical groups as the Baptists and the Methodists until they surpassed all other religious groups in America by the end of the 1800s.

This anti-intellectualism intensified in 20^th century fundamentalism—the movement reacting to Darwinism and higher biblical criticism that I described earlier.

Why point out this anti-intellectual strain among some (but by no means all) evangelicals? Simply to show you what may be behind some evangelicals’ deep suspicion of “the professional classes”—including all of you. Why should they believe that academia can create anything good and helpful, when it has often seemed at odds with their faith. (Indeed, I have to add, this evangelical attitude toward academia often extends to seminaries such as the one at which I work. The epithet sometimes hurled at seminaries by anti-intellectual evangelicals is that they are “cemeteries”—places of “death by a thousand intellectual complications.”)

One more point: within the Pentecostal and charismatic sub-traditions of evangelicalism, it is an accepted belief that one can hear the voice of God. This is usually not considered an audible voice, but rather a kind of spiritual direction or guidance. Of course, this sort of assertion may raise red flags in the mental health professions. And it may, once in a while, indicate a psychological problem. That is, such churches may in fact attract those feeling anxiety or battling dysfunction in their lives, and such people may in fact use “extreme” religious practices or beliefs in order to address these issues.

Even in these cases, however, you should know that there are good resources within such patients’ own traditions. There are checks and balances among charismatics—ways of telling if the things you think you are hearing from God fall into line with a healthy, biblical Christianity. So the patient may not need to abandon their tradition in order to get help in breaking out of unhealthy spiritual practices.