Against the Moral vs. Medical Divide

An interesting read. The author is a psychiatrist.

Christians who live with mental health challenges deserve better than pastors and clinicians who embrace the medical-moral divide and who use that divide to stake out their professional turf. Rather, the church needs pastors and clinicians who are willing to exercise their office faithfully, who will use their wisdom and skill to encourage and edify those who are struggling, and who will remember that those in their care are not malfunctioning machines but rather wayfarers who are on a journey to God. Pastors and biblical counselors have an important role to play, but so do psychiatrists and other mental health clinicians.

He seems to be overly optimistic about “on a journey to God.” I’m not sure what his theological commitments are. He also seems unclear on “the church” vs. “the professions/vocations.”

His argument that Christian psychiatrists working faithfully are the church helping people seems off target. I’ve written before about “the church as the church” vs. “the church as individual believers.” The difference can be hard to articulate. Maybe its simpler and more relevant to focus on a category we’re overlooking: humans being faithful as humans.

Before there was “the church,” there was such a thing as “humans doing good.” There is still such a thing. Using Jesus’ summary of creature faithfulness as loving God and loving neighbor (Matt 22:37-40), roughly half of what the professions/vocations are about is being humans who work to love their neighbors as themselves. It does not have to be “the church” to be true, beautiful, and good.

(Maybe the author narrowed his focus in there somewhere to Christian medical professionals helping fellow believers through their local churches and I missed it.)

Aaron, for theological commitments, he's at Duke, which is generally liberal, but he published through Eerdmans, which is of course at least moderately evangelical. So I would bet a shiny new nickel on "moderately evangelical".

Regarding his hypothesis, I think it's great. Thankfully a lot of people, both pastors and psychologists/psychiatrists, try to cross it, but there are an awful lot of people doing counseling who tend to exclude one or the other. Think of people who will tell you that their depression is an organic thing, nothing they can do about it with behavior, and that sort of thing on the one side, and then on the other side, you've got people who will tell you that postpartum blues is an obvious sign of the sin of the mother. There's a lot of middle ground that too many people are abandoning, IMO.

And to the point by the author that it's "disturbingly easy" to "treat" patients without ever getting to know them, ABSOLUTELY. I can run through a string of cases where precisely this was done, starting with a time when I was in the care of a therapist (probably psychologist, no drugs were involved) who decided that my troubles were not because my parents' marriage was blowing up, but because I was feeling guilty about "self-pleasuring", which I'd never done.

I can point to other cases where the "standard hypothesis" was applied even though the data didn't fit. Thank God in my case that the standard hypothesis wasn't "gender disphoria"!

Sounds like that therapist had absorbed a bit too much Freud.

The question of “the divide” is what interested me most in this one, because I think I see a lot of manifestations of it among my fellow Bible-believers. The essence of the divide is the feeling that there is something inherently incompatible about faith and reason or, to narrow down, faith and the sciences. Some talk as though they see a fundamental clash between faith and all ordinary cause and effect. So, if you can identify an observable cause, you’ve somehow moved away from faith, the Holy Spirit, and so on.

To an extent, I get it. I mean, if you can explain it in terms of observable causes, it’s not miraculous, right?

But isn’t it better to see that God is present and active in everything, not just the unexplainable? Isn’t that really a more comprehensively Christian way to think?

As long as we keep acting like God is limited to the unexplainable, we’re going to try to actively avoid explaining things. It feels like a Christian duty. It’s not. It’s just obscurantism. Seeking to understand how things work is seeking to understand the world God has made and also the One who made it.

I’m reminded of Col 1.17, Acts 17.27-28, Psalm 19.1-2.

I would say the domain of their work is both church and common grace.

Common grace is good (agathos), but not saving. It’s a physical rescue, not a spiritual one.

I struggle with making the distinction between physical and spiritual work in a practical way. For humans, everything spiritual has a physical dimension and everything physical has a spiritual dimension. Looking at creation as a whole, God’s omnipresence and immanence mean He is active in everything He has made. Is He active spiritually or physically? I don’t know how to tell where one ends and the other begins in reference to Him. He is incorporeal, but nothing corporeal exists separate from His presence (Psalm 139).

So, while the categories of physical and spiritual are often useful in limited ways in various contexts, the distinction seems to quickly become more theoretical than practical. What we observe is physical, but we know there is much more, always, going on. So it seems to me, anyway.

I am also concerned with the idea that we as pastors are expected to be experts in everything. Unfortunately, after a having a counseling minor, too many pastors actually think they are experts in counseling. Why not just admit that there are certain areas that pastors should refer to others about and then focus on the word and prayer. That is not to say that pastors cannot benefit with some training in counseling, but we must be humble enough to realize that there are some problems we cannot solve. The reality is there are some problems no man can solve, but that doesn't mean we should just give up on getting help from others either. Further training in counseling and training in the physical aspects of mental issues are two vastly different fields.

I’m often comforted by the NT use of blindness both literally and metaphorically. Bartimaeus receives sight physically but spiritually he was already seeing (Mark 10:47).

Saul (later Paul) can see physically, but he is blind spiritually (Acts 9:1-2). Then also blinded physically (Acts 9:9), then gains sight both spiritually and physically (Acts 9:17)! Really love that one.

(Someone should write a song.)

For me, the comfort is this: Only God gives sight to the blind. I don’t have that power. No counselor does, biblical or otherwise. We might be the ones to put some mud on (John 9:15) but it’s not our job to make anyone see. There is some peace in knowing that.

Yes, my particular example might be linkable to old "Siggy", but there is a broader pattern I've observed about the "diagnosis of the month" replacing actual diagnosis based on evidence. Making it still more complicated is that you have several levels of mental health care, including psychiatrists, psychologists, social workers, and more. Now I'm sure you've got great people at all levels, but there are also "hirelings" who seem to be mostly interested in the paycheck.

Scarier yet is that there's a proposal out there to create a level of "mental health technician" with less training than the existing categories, and my hunch is that this level--along, sadly, with "family practice" and "general practice" MDs--might be even more prone to the "diagnosis of the month."

And given that the "diagnosis of the month" seems to be "gender dysphoria" in many circles these days, the damage that can be done could be immense.

One thing that comes to mind as well is a very simple question; "do you understand people?". There is, IMO, a somewhat special ability that some people have, and others don't, or at least suppress, to suss out what the likely motivations of a given person are. Right now, my wife's family is dealing with that as my mother-in-law is having a really tough time dealing with her husband's stroke. She's had some weird behaviors that may be attributable to dementia, stress, loss, and possibly even a traffic accident that gave her a severe head injury 60 years ago.