The Heart of Mental Health
The relationship between religious belief and mental health is negatively portrayed in modern Western culture. The most accessible historical facts about how systems of belief have shaped societal understandings of mental health phenomena tend to be accounts of witch hunts and demon possessions, contemporarily construed as the Christian church’s hostile misinterpretation of common mental illnesses. While there is certainly truth to these accounts, taking them in isolation creates a myopic portrait of how the Christian faith both perceives and interacts with notions of mental health. Restricting the evidence to a narrow set of historical moments, during which mental illness had not yet emerged as a scientific or cultural category and its manifestations were shrouded in uncertainty for both religious and secular populations, encourages the belief that Christianity has always existed in conflict with the science of psychiatry and the pursuit of mental well-being. This is not only historically inaccurate, as the church largely accepted proposed natural causes to mental disorders prior to a post-Middle Ages emphasis on demonology, but it also obscures the capacity of the Christian worldview to uniquely locate, enrich, and deepen how the concept of mental health is understood.[i]
Before clarifying what constitutes this unique understanding, it is important to establish some parameters for the following discussion, the first concerning terminology. There is no simple definition of mental illness, which is why the term is often associated with diagnosable psychological abnormalities that clearly impair regular human functioning, such as schizophrenia, bipolar disorder, or depression. Moreover, the range of factors that can underlie a mental disorder is broad, encompassing the neurological (brain structure and function), psychological (thoughts, feelings, and behaviors), and social (interactions between subject and environment). As the science of psychology and psychiatry developed, the models that arose by the late 1970s primarily treated these factors as independent of one another, but more recent research has given rise to an integrated neuropsychosocial model that casts them as “usually involved simultaneously and constantly interacting […] through feedback loops.”[ii] Given the complex etiology of many mental disorders, it follows that the Christian worldview makes few universal claims on sources of causality across the wide spectrum of psychological dysfunction. The crucial exception is the foundational Christian tenet that the world has been ravaged by the presence of sin in the created order, which has adversely affected all elements of the human person—mind, body, and spirit.[iii] The specific ways that mankind is affected by this core brokenness, mentally and otherwise, are innumerable.
The Christian worldview also provides hope for restoration through the death and resurrection of Christ, through which all sin is defeated. This redemptive work, and the healing it offers to the mind, manifests with the same diversity and particularity as the brokenness that prompted Christ’s sacrifice— numerous tools exist to facilitate the process of recovery from mental illness, from medicine to many forms of psychotherapy. The Christian worldview provides a framework that contextualizes the meaning of these interventions; it does not lay out exactly how they should be implemented in every case, save for the command to show love and respect to the sufferer as a fellow bearer of the image of God. Thus, the discussion that follows is not an exhaustive consideration of how Christianity explains mankind’s understanding of every unique manifestation of mental disorder that is observable in our world. Rather, it seeks to provide a glimpse of what the Christian framework claims as mental wholeness, the goal that all mental health care (secular and spiritual) is oriented towards. Finally, it is intended to show that this framework, undergirded by the sufficiency of Christ’s restorative work, expands our understanding of the role that human care providers play and what is considered healing practice for mental health challenges. This will be explored by comparing the underpinnings and aims of two forms of mental health care: cognitive-behavioral therapy (CBT) and biblical counseling (BC). The goal of the comparison is not to claim which one “works better” (indeed, many Christian counselors blend the two approaches), but to reveal the differences in how each practice constructs the ultimate end of mental health care writ large and how this shapes the management of uncertainty for the care provider.
CBT is widely touted as an evidence-based psychotherapy and is one of the most extensively researched mental health treatments of the past 30 years, with over 325 published studies on the impact of cognitive-behavioral interventions on various psychological disorders and 16 meta-analyses that collate and quantify CBT’s efficacy relative to other psychotherapies.[iv] CBT’s strong association with empirically-derived authority closely aligns it with the Western historical shift toward prizing knowledge produced through scientific epistemology; thus, CBT is validated by the mechanisms that have elevated general biomedicine to cultural authority. The foundational premise of CBT is that “emotions are difficult to change directly […] so emotions [are targeted] by changing thoughts and behaviors that are contributing to the distressing emotions.”[v] The treatment captures the modern idea of consciousness-raising in psychotherapy, which stipulates that “the content and process of our thinking is knowable” (as opposed to the Freudian school of thought that popularized the notion of the unconscious mind) and that thinking can be intentionally modified to produce new responses to external phenomena.[vi] This is accomplished through collaborative skill-building that empowers clients to “identify how situations, thoughts, and behaviors influence emotions and improve feelings by changing dysfunctional thoughts and behaviors.”[vii] The therapy is usually administered through “a 20-session treatment protocol” during which therapists work with clients on “observable, measurable, and achievable” goals for behavioral improvement.[viii] These goals include challenging and reforming maladaptive thoughts, adopting active behaviors that work against feelings of passivity and defeat, and creating problem-solving strategies.[ix] In-session work is complemented by homework assignments that a client completes to “integrate the concepts learned in sessions into daily life.”[x] Thus, CBT is structured from the outset with an endpoint in sight and tools designed to facilitate smooth re-entry into regular life with CBT’s imparted benefits in tow.
By contrast, the practice of BC is rooted in the theological tenets of Protestant Christianity over scientific validation, although counselors often affirm the contributions of biomedicine, psychology, and neuroscience to the body of knowledge on health and healing and find ways to integrate secular therapeutic techniques into their practice. Indeed, Sarah Rainer, a secularly trained PsyD and professing Christian, summarizes the push-and-pull between the two frameworks by noting:
The intricacies of the human brain, the environmental influences on our personality, and the social and cultural impact on our lives remind me that pathology cannot simply be reduced to issues of morality or sin […yet] due to the love of […] God, I also cannot reduce all pathology to a naturalistic model of humanity.[xi]
Many Christian counselors echo this statement, claiming that “there is a large body of tools that secular theorists have developed that are very useful” as aids in achieving the goals that emerge from the foundational premise of BC: “God’s answer to all needs is the sending of his son.”[xii] The death and resurrection of Christ is thus the precipitator for all processes of mental healing.
Dr. John Street, the Chief Strategy Officer for the Biblical Counseling and Discipleship Association of Southern California, describes the contours of the healing processes that occur in BC: “Biblical counseling discerns desires, thinking, and behavior that God wants to change.”[xiii] This change is enacted using “God’s Word, through the Holy Spirit” (referring to the Bible) for “the sanctification of the Christian (into Christ-likeness) for the glory of God.”[xiv] The treatment course that purports to realize these goals varies from practitioner to practitioner, but usually involves a client-centered approach that includes setting goals, addressing experiences through a biblical lens, and changing the “heart” by reforming thoughts and behavior. BC does not have a set length of treatment, but usually concludes when the client is equipped to manage their problem on a self-sustained, ongoing basis or when counseling does not appear efficacious.[xv]
The most central biblical counseling target is the “heart,” a therapeutic object that functions as a proxy for the whole individual. A presentation for an introductory BC course at the Master’s College renders the heart as the seat of habit, possessing the capacity to both love sacrificially and manipulate for selfish gain.[xvi] Accompanying course notes reference Old Testament lexical studies that identify the heart as “the richest biblical term for the totality of man’s inner being or immaterial nature.” Biblical counselor Alasdair Groves related a similar concept, claiming that his graduate training described the heart as “not just the seat of human emotion but also decision-making and desire.”[xvii] This de-physicalized concept of the heart allows for a moral reading of human instinct that stands in opposition to the portrait painted by secular psychologists. For instance, Abraham Maslow’s “Hierarchy of Needs” cognitive schematic paints human drives as “‘pre-moral,’ neither good nor evil.”xviii Yet a biblical anthropology paints the heart’s ultimate function as “worship,” an action that envelops processes of appraisal, valuation, and prioritization. The Christian worldview understands worship as the animating principle of human action; Groves states that “all of life is about worship […and] every single person comes through every single situation with some kind of worship disorder.”[xix] Mental health care, thus, is incomplete without recognizing this dimension of humanity and presenting a vision of what human worship is meant for.
A final distinguishing marker of BC involves its connection with the Christian practice of discipleship, in which believers are personally directed by spiritual mentors on how to build character reflective of the person of Jesus Christ. Street claims that counseling is targeted discipleship that exerts work on problems that people have tried to fix themselves but could not, implicitly defining a goal of BC as changing a client’s response patterns to be emblematic of the behavioral schematic offered by the character of Christ as glimpsed in the Bible.[xx] This reveals a picture of mental wholeness that recognizes the human inability to independently intuit what it fully means to live well, which contrasts strongly with Western values that idealize the self-determined individual.
Indeed, secular conversation around mental wellness is deeply rooted in capability; it paints the ideal world as one where individuals are equipped with the knowledge necessary to make preventative decisions that steer them away from lapses into mental illness, implicitly rendering counseling itself obsolete. In this world, the onus rests on the individual to optimize mental health, which often appeals to purely mechanistic framings of the body and mind. If the operations of the human machine are discernible, then improving those operations is simply a matter of willpower and potentially pharmacological resources. This is inherent in CBT’s assertion that one’s own thoughts can be known and influenced. By targeting agency, CBT and similar treatments claim to empower humans to exert control over their own functionality through intimate knowledge of that functionality. Wholeness, thus, emerges from such self-sufficiency. Yet the Christian worldview uniquely portrays mental wholeness as deeply other-centered. The goals of BC are not inseparable from notions of optimal human functionality; rather, proper operation of the human machine is a beginning rather than an end. Street’s definition of BC indicates that God has the ultimate authority to define the problems that require healing, but the end goal of all healing practice through which God works is the glorious restoration of humanity to a thriving relationship with himself. This is the apex of human flourishing that BC is concerned with.
Indeed, according to Street, the end goal of counseling is a mature and “complete” heart that is “more like Christ.”[xxi] If the heart is oriented toward God, whom it was designed to worship, then it begins to be molded in God’s image and achieves true flourishing. Moreover, Street claims that the “changed heart” is fixed as the dividing line “between pre-counseling and counseling.”[xxii] A change in heart can be viewed as the patient’s reorientation in stance on the nature of their problem; this newfound recognition equips the patient with receptivity to a narrative that promises to reveal what living well looks like. This state of living well is intentionally encouraged by the therapist because it brings glory for God; the therapist’s motivation is other-centered in a multi-modal sense, connecting the betterment of the patient to honoring God.
Moreover, the healing process itself is understood as ultimately directed and mediated by God, not the therapist. This creates an entirely different set of expectations about where the causality of change in mental health care is located, removing the weight of the human therapist’s limitations from encounters with uncertainty in therapeutic practice. Such weight is apparent in the experience of Daniel Mackler, a secularly trained psychotherapist who describes how his education did not prepare him to manage uncertainty well: “I feel that a lot of my mental health training made me arrogant […] it taught me to feel that I should know the answers, that I should be a foundation of wisdom and maturity and confidence. Well, what about all those times when I had no clue what to say?”[xxiii] Repeatedly experiencing the limits of his knowledge taught him that a principal part of his job was to “shut up and listen,” a conclusion that implicitly condemns attempting to construct an artifice of authority that will eventually be revealed hollow by human error.
In contrast, biblical counselors are persistently made aware that they cannot be the authority in a healing process with a client; the only truly proficient knowledge in the therapeutic endeavor rests with God, an idea reflected in Street’s claim that BC “is not for experts.”[xxiv] Biblical counselor Ryan Thomas Neace argues that attempting to act outside the bounds of human knowledge’s proper role is dangerous, claiming that counselors make “themselves soothsayers at best and gods at worst” when they speak to clients without humility.[xxv] This sort of posture attempts to mimic the mind and authority of God. For Neace, a stance of therapeutic integrity in relation to the divine involves “embrac[ing] my weakness, unknowing, my lack of clarity […] my insensitivity to [the client’s] plight, my sinfulness, and ultimately, [the client themselves].”[xxvi] Being a suffering participant in a healing process that resists incisive penetration by the human mind, but can be trusted in the directive hands of a God understood to be good, captures the role uncertainty plays for the biblical counselor.
A key characteristic of this dynamic is that the management of uncertainty in BC is fundamentally socially situated, since God is understood to guide the therapist within murky situations and minimizes the ominous power of uncertainty. This engenders a persistence in treatment that is rooted in a fundamental sense of peace; commitment to action along an obscure pathway is made possible through the security provided by God’s presence in the endeavor. Moreover, the therapist’s own experience of guidance within his or her relationship with God expands the credible epistemological capacity afforded to intuitions that are uncovered through the therapist’s own experiences of living and being. As the therapist grows to see themselves as conduit of change over cause of change, the implications of belonging to the same category as the client (“human”) and possessing the same object of therapy (“heart”) involve the notion that ontological commonality provides the tools to sufficiently, though not completely, reduce uncertainty in constructing an accessible portrait of the client’s heart. Groves emphasizes the importance of being able to say “we” with counselees, since “if you can’t say, ‘Yes, I know something about this person’s struggle from my own life, my own experience of suffering and sin and temptation,’ then you haven’t listened well and you have to keep going until you can say that.”[xxvii] The therapist cannot walk alongside a client in a healing process that they, as a fellow human being categorically afflicted with worship disorder, have not begun to experience themselves.
Within a biblical anthropology, words are a therapeutic tool that carry mysterious efficacy to act upon the heart, and the authority to bring God’s words to bear on a patient’s situation is relationally bequeathed to the therapist from God. This is evident in the National Christian Counselors Association’s (NCCA) first article under the Statement of Faith in the Code of Ethics: “We believe the Bible is the inerrant, inspired Word of the Living God. The Bible is the final authority on all matters of life, faith, and practice.”[xxviii] The therapist’s job is to sketch out the connections between the core set of claims revealed to humanity through God’s Word and the unique context of the patient. The contours of concepts valued by biomedically-informed psychotherapy are altered by this set of claims; human agency is redefined as freedom within relationship, both the patient’s central relationship to God and the valuation of responsibility toward others that this relationship encourages. Since the Christian worldview articulates man’s ontological nature as both material and spiritual, the stakes in Christian counseling are inherently higher. Beyond learning new behavioral patterns, growing in relationship with God becomes the core epistemological unit for internalizing notions of what is good within the human heart, itself a force that resists unambiguous physical categorization, yet exerts a palpable influence on an observable mankind.
This, then, is the crux of the conception of mental health suggested by the Christian worldview: being mentally well is more than reducing a negative display of symptoms. It is the cultivation of a positive trajectory toward relationship with God, producing a way of living and being that fulfills the core design of humanity. Experiencing healing and freedom from mental illness is undoubtedly crucial to pursuing this way of living, but the deep interconnections between all elements of humanity—mind, body, spirit, and heart—imply that the roots of human brokenness continuously impact the whole person. A successful fight against mental illness, while reducing impairments to living and being that said illness produces, cannot inherently produce holistic mental well-being if the heart remains unreconciled with God. Repairing some domain of the human machine is not equivalent to ensuring that all components are working together according to design. True flourishing is existing in harmony with, rather than in opposition to, God’s goodness. Indeed, in the Christian worldview, this understanding of mental wellness is a pathway to infinite joy.
i. Alexander Moreira-Almeida, Francisco Lotufo Neto, and Harold G. Koenig, “Religiousness and Mental Health: A Review,” Revista Brasileira de Psiquiatria 28 (2006): 243.
ii. Robin Rosenberg and Stephen Kosslyn, Abnormal Psychology (New York: Worth, 2011), 25.
iii. Matthew Stanford, Grace for the Afflicted: A Clinical and Biblical Perspective on Mental Illness (Downers Grove: InterVarsity, 2008), 12.
iv. A. Butler, J. Chapman, E. Forman, and A. Beck. “The Empirical Status of Cognitive-behavioral Therapy: A Review of Meta-Analyses,” Clinical Psychology Review 26.1 (2006): 18.
v. J.A. Cully & A.L. Teten, “A Therapist’s Guide to Brief Cognitive Behavioral Therapy,” Department of Veterans Affairs South Central MIRECC, 2008 <https://www.mirecc.va.gov/visn16/docs/Therapists_ Guide_to_Brief_CBTManual.pdf>.
vi. Deborah Dobson and Keith S. Dobson, Evidence- Based Practice of Cognitive-Behavioral Therapy (New York: Guilford, 2009): 4.
vii. Cully et al, “Guide to Brief Therapy,” 2008.
viii. Cully et al, “Guide to Brief Therapy,” 2008 and Dobson et al, Evidence-Based Practice, 6.
ix. Cully et al, “Guide to Brief Therapy,” 2008.
x. Cully et al, “Guide to Brief Therapy,” 2008.
xi. Sarah Rainer, “The Integration of Christianity and Psychology,” The Exchange | A Blog by Ed Stetzer for Christianity Today 25 September 2014 <http://www.christianitytoday.com/edstetzer/2014/ september/concerning-psychology-and-christianity-guest-post-by-sarah-.html>.
xii. Barney Armstrong, “How to Become a Christian Counselor,” Colleges & Degrees – Your Local College Guide, accessed 13 November 2016 <http:// www.collegesanddegrees.com/programs/christian-counseling>.
xiii. John Street, “An Introduction to Biblical Counseling,” Biblical Counseling and Discipleship Association of Southern California’s (BCDASoCal) 1st Annual Fall Basic Training Conference. Reseda, CA. 23 Sept. 2011.
xiv. Street, 2011.
xv. Deepak Reju, “When Do You Stop Counseling?” Biblical Counseling Coalition, 27 July 2016 <https://biblicalcounselingcoalition.org/2015/07/27/ when-do-you-stop-counseling/>.
xvi. Ernie Baker and Jeff Miller, “Understanding the Heart” BC 300: Introduction to Biblical Counseling, September 2015 <https://masters.instructure.com/ courses/308/assignments/syllabus>.
xvii. Alasdair Groves, interview, 15 November 2016.
xviii. Baker et al, “Understanding the Heart”, 2015.
xix. Groves, interview, 2016.
xx. Street, 2011.
xxi. Street, 2011.
xxii. Street, 2011.
xxiii. Mackler, Daniel, “Reflections on Being a Therapist,” Mad In America, 12 September 2013 <https://www.madinamerica.com/2013/09/ reflections-therapist/>.
xxiv. Street, 2011.
xxv. Ryan Thomas Neace, “But Aren’t You a Christian Counselor?” The Huffington Post, 28 June 2013 <http://www.huffingtonpost.com/ ryan-thomas-neace-/but-arent-you-a-christian-counselor_b_3176008.html>.
xxvi. Neace, 2013.
xxvii. Groves, interview, 2016.
xxviii. National Christian Counselors’ Association, “Code of Ethics,” 1 February 2014 <https://www. ncca.org/Members/CodeofEthics.pdf>.
Jake Casale ’17 is from Redmond, Washington. He is a Psychology major and a Geography minor.Tags: Abraham Maslow, Alasdair Groves, Daniel Mackler, emotions, healing, hope, John Street, joy, mental health, peace, psychology, Ryan Thomas Neace, Sarah Rainer, science, suffering