Saturday, June 25, 2011

Therapy and the Christian

Discussions about the relationship between general and special revelation don't just affect the age of the earth. Here is a different spin on the issue.

Last Tuesday, Dr. Albert Mohler, president of the Southern Baptist Theological Seminary, posted some comments about therapy on his blog. I am hopeful that his post does not represent a complete picture of his thoughts on the subject. Even so, I would like to offer some general thoughts on the attitudes reflected in his blog post as I think they represent a common view many pastors have toward counseling. I will also tie this into a broader discussion about general and special revelation and a possible connection to young-earth creationism.

Before you read my commentary, however, I urge you to read Mohler's original entry. That way you'll see his comments in context and can judge more adequately whether I'm being fair.
"Theology, Therapy, Twitter, and the Scandal of the Gospel"
Mohler begins by commenting on the recent scandal surrounding Anthony Weiner and his announcement “to seek professional treatment to focus on becoming a better husband and healthier person.” Mohler apparently tweeted a comment about Weiner prior to writing the blog post:
"Dear Congressman Weiner: There is no effective ‘treatment’ for sin. Only atonement, found only in Jesus Christ." 
Mohler's tweet seems to be an expression of his belief about therapy in general.
That is a course now familiar to us all. As a matter of fact, it is now almost a reflex that people caught in moral trouble (especially related to sex) announce that they are seeking “treatment” for the problem.
On the one hand, this just points to the fact that the “Triumph of the Therapeutic” heralded by sociologist Philip Rieff in 1966 is now so ingrained in our culture that therapy appears to be the answer to every problem, including a moral crisis.
Sadly, many Christians have accepted this worldview as their own, believing that their own deepest problems are therapeutic rather than theological in nature. To our shame, many books written by and for evangelical Christians reflect the therapeutic impulse, rather than the appropriate biblical and spiritual concerns.
Mohler states quite clearly that his Weiner tweet was actually intended for Christians.
"My message was mostly directed at my fellow Christians as a reminder of this very concern — that the American impulse is to seek treatment when our real need is for redemption."
He also made this comment:
This is a basic and central Christian belief. The Bible reveals that our need is not to find a way to make ourselves well — which we can never do — but to realize that we are sinners in need of a Savior. The Christian Gospel is the message of redemption accomplished by the Lord Jesus Christ and the salvation that is found in him and in him alone.
Based solely on these remarks, I would like to suggest that Mohler engages in at least one informal fallacy about the nature of psychotherapy: the false dilemma. Mohler seems to be promoting the idea that we either believe in the power of therapy or we believe in the power of the Gospel. At its best, this view of pastoral counseling is imbalanced. Taken to an extreme, it's potentially dangerous.

Let me begin by arguing from analogy. If someone is dealing with cancer, no responsible pastor tells a parishioner to merely go home and pray about it or repent of his/her sins. A good pastor will pray with that person and urge him/her to seek professional medical help as well.

I would like to suggest that a similar principle applies to brain disorders, including such conditions as schizophrenia, bipolar disorder, obsessive-compulsive disorder, autism, and addictions. These conditions are widely understood by medical professionals to have a physiological component, which need professional medical attention. It's also understood, however, some people with these disorders frequently engage in harmful and destructive behaviors, sometimes including abuse, toward their loved ones. This doesn't excuse their behavior, but it does need to be understood within its proper context: this person's brain may not be functioning properly. All the best research indicates that treatment needs to include both psychiatric treatment as well as on-going psychotherapy. Research also indicates that spiritual guidance can also be incredibly helpful.

I'm not a mental health professional, but I don't think it's a stretch to speculate it's quite likely Rep. Weiner has a fairly serious problem with sexual addiction, possibly some kind of obsessive-compulsive disorder and a personality disorder (narcissism?). If he does have some kind OCD, his brain might look something like this (scroll down to see the images of the pathological gambler). Although these problems have a behavioral component to them, they may also have a medical and/or psychological component. All of these aspects of the problem must be dealt with appropriately.

Do people who engage in sinful behaviors have a sin problem? Yes, they do. Do they need to repent? Yes, they do. But some people also need to seek treatment from mental health professionals. The church needs to do a much better job of seeing people with brain disorders as having a multi-dimensional problem in need of multi-disciplinary treatment. It's not merely a spiritual problem. Neither is it merely a physiological nor psychological problem. It's all of these things and probably more. Treatment for brain disorders requires a multi-faceted approach, which can (and ideally should) include spiritual guidance and repentance. None of these treatment options should be done in isolation or to the exclusion of the others. Just as cancer is a complex disease, so is the nature of its treatment. But when Christian leaders continue to act in unsophisticated ways concerning mental health issues, it makes us look incredibly foolish and ignorant.

So, let's make this practical. Here are three test cases from my personal life that I think highlight the problems with Mohler's approach.

Case #1
One of my family members refuses to seek treatment for extreme paranoia and aural hallucinations. (This isn't a professional diagnosis; it's simply based on our family's collective observations over a period of several years.) He has engaged in many hurtful and sinful behaviors toward others, including having children out of wedlock, neglecting his children, being in jail, threatening former girlfriends, disrespecting his mother, being chronically unemployed and just plain difficult to deal with.

I would guess Dr. Mohler would characterize my family member's behaviors as sinful. And he would be right. But such a "diagnosis" is insufficient. My family member certainly needs to repent of his sins and find salvation in Jesus, but he also needs serious and sustained professional treatment for mental illness. (And quite frankly, if he were to start down the path of treatment with just one of those options, it would be a step in the right direction.)

I truly want to believe the best about Dr. Mohler. The problem is, the kind of anti-psychological rhetoric he engages in leaves the reader with the distinct impression that Christians should not seek professional treatment on any level because he offers no caveats or explanations. Is that really the position Mohler wants to promote to a family dealing with schizophrenia? Some schizophrenics suffer from homicidal delusions. Will prayer or the Gospel alone fix this? I doubt any responsible pastor would say yes. I doubt even Mohler would agree to this. Yet, the paradigm Mohler sets up by the remarks in his blog post, if taken to its logical conclusion, preclude treatment. This is why I call Mohler's view potentially dangerous.

Case #2
Perhaps Dr. Mohler would suggest that I am being too extreme in my presentation of his position. Fair enough. Let's consider another example. Some time ago, I became acquainted with someone with obsessive-compulsive disorder. Although I don't know the exact nature of this person's ritual, I do know that it did caused deep problems in the marriage. Although this person sought the counsel and prayers of their pastor, professional treatment was neither recommended by the clergy nor encouraged. Some psychiatric treatment was finally obtained for a limited time, but the problems persisted. Rather than the church leaders getting on board with a program of wholistic treatment, encouraging professional intervention, working alongside with mental health professionals, supporting the spouse with efforts of setting boundaries for behavioral and treatment accountability, this person continued to suffer because of a perception that the church was not in support of professional help. Meanwhile, the spouse and children continued to be hurt by a member of the family who wasn't fully functional.

I think this scenario represents an all-too-common situation of what happens when Christians seek the advice of their pastors or Christian friends when they are suddenly faced with a family member who is grappling with mental illness. They overly spiritualize a medical condition and pastors fail to engage themselves as a member of a team of professionals who can work together to support the family during a time of crisis and transition.

Case #3
I am going to come out of the closet here a bit and go public with something that I haven't before. I am doing this because it is the best way I can think of to highlight the inadequacy of Mohler's position. I am type 2 bipolar. Although I began experiencing symptoms of this when I was in my early teens, I wasn't diagnosed until six years ago. My chronic agitation and depression created a difficult environment for my family, my friends and my co-workers. Yet, I was a devout and mature Christian. I believed in the Gospel. I am a Calvinist and completely aware of the power and depth of the sinful human nature. The problem was, I could not stop my brain from being depressed or agitated. I couldn't talk or pray my way out of it. I couldn't listen to enough sermons or repent enough. The depression was still there. Why? Because being depressed and bipolar are brain disorders, not spiritual problems. If there was anyone who was in the unique position to have sound theology get me out of that mess, it was me. But it wasn't until I started going to psychotherapy, seeing a psychiatrist and taking medication that I began to make sustained changes in my behavior.

As I have reflected on Dr. Mohler's blog post for the past 12 days or so, I began to wonder whether Mohler's (and others like him) view on therapy stems from his broader theological position on the relationship between general and special revelation. Last year around this time Mohler shared his views on the age of the earth at a Ligonier conference. More specifically, he set out to address the question, Why does the universe look so old? "He said that there are really only two options for us to follow when we seek an answer: either the world is, indeed, old or the world looks old but is not as old as it appears." Mohler went on to affirm the "theological necessity" of young-earth creationism in order to preserve the "integrity of Scripture." In Mohler's view, general revelation isn't allowed to correct or augment our interpretation of the Bible (although I'm going to assume he'd make an exception for Galileo and Copernicus). Mohler seems to hold to the same biblicist framework that Answers in Genesis and other young-earth creationists promote: general revelation must be viewed through a young-earth interpretation of Scripture and made to adhere to that interpretation rather than being studied on its own merits.

In my view, psychology is part of general revelation. Are there unbiblical aspects of the wider academic discipline of psychology? Sure. But that reality shouldn't discredit the discipline as a whole. Was psychology originally founded by an atheist? Well, Freud was certainly no friend to Christianity. But to say this somehow disproves its validity entirely is to commit the genetic fallacy. In classical sense, general revelation says that wherever truth is found, it belongs to God. Psychology is not inherently in opposition to Christianity or the Gospel any more than mainstream science is. It's up to Christians and its leaders to be informed and carefully weigh its value and prudent implementation.

Now I'm going to get rather blunt so fasten your seatbelt. In my humble opinion, scientific advances in neuropsychology are leaving Christians behind. For example, in the book, Change Your Brain, Change Your Life, Dr. Daniel Amen (ironically, a graduate of ORU), one of the pioneers in neuropsychology makes a compelling case that brain malfunction stands behind many disorders. Once the brain's functioning is corrected through medication and therapy, bad behaviors often diminish as well. This medical reality has the potential to deeply undermine or alter the conventional understanding of several foundational Christian beliefs. If bad behavior can be boiled down to being the result of brain malfunction, and it can be "fixed" through treatment, then where does that leave the doctrines of sin, repentance and salvation? This is the question that I think Mohler is attempting to address in his blog entry, albeit in a rather unsophisticated way. His concern is to preserve key doctrines (special revelation). The problem is, he merely focuses on Weiner's behavior and doesn't make sense of a whole body of data about the nature of addiction, genetics and neuropsychology (general revelation). How should Christians bring together the data from general revelation (i.e., brain scan technology) with special revelation (sin and salvation) to form a coherent and accurate explanation of the world? Where is the line of moral culpability in a 21st century world of neuropsychology and genetics? To my knowledge, we have no qualified Christian apologists working in this area or working on models for how to understand this data within a Christian framework. In my opinion, this is a HUGE problem for Christian apologetics and potentially a crisis for Christianity in general within the next 5 years. And hand-waving, minimizing, preaching and ignoring will not make this problem go away. It will only continue to marginalize us from the broader culture.

Once again, I want to reiterate that I don't in any way mean for my comments to be a personal attack on Dr. Mohler. I don't know him personally, but I'm trusting in his reputation as a Christian leader and I likely agree with him on a great number of issues. But my hunch is, this is not one of them. As a theologian and as a Christian, I believe that there is a serious error in the view he represents.


Anonymous said...

I agree with you! There are many instances where a person's problems go beyond a clear cut issue of sin. Sometimes the problem might not be as simple as it seems. I know someone who was diagnosed as a sociopathic pediphyle. It looks like a clear case of wickedness. Several years after this diagnosis he had a brain incident. It was not a stroke in the usual sense. The medical team decided to open the skull and see what was going on. It turned out that his brain structures were abnormal. In all likelyhood, his behaviors were caused--at least in part--by a major brain malfunction. It doesn't mean that he is not a danger to society, etc. Of course the criminal justice system has to deal with him. But God's judgement might not be the condemnation we had all been expecting. Only God can determine the true culpability in this case.

Leigh said...

I have a great deal of respect for Dr. Mohler as a Christian and as an apologist, but I think he probably falls more in line with the nouthetic counseling philosophy with which I have some disagreement for some of the same reasons you've stated here.

I do think Mohler has somewhat of a point here, though. Rep. Weiner may have some sort of underlying psychiatric disorder. But I think there is somewhat of a sociatal trend toward calling sin anything but what it is. And as we have seen in falls of public figures, many people when caught rather than addressing the underlying sin issue sometimes resort to the method of seeking 'treatment.'

Which is not to say that psychiatric treatment is not helpful, or that Christians should not pursue such avenues. The brain is an organ like any other, and when things go wrong in the brain I don't see it any different as seeking help for type II diabetes or heart disease. But our spiritual self can impact our physical and mental selves as well. We worked closely with a young woman in our church who was undergoing treatment for bipolar disorder and schizophrenia. We encouraged her to see treatment and stay on her medications. But it wasn't until after she addressed an underlying spiritual issue of unforgiveness that she began to experience noted improvement. When my husband had his battle with depression a few years ago, counseling helped him take helpful steps. But he also had to address some things in his relationship with God that were contributing to the problem.

I would never encourage any beleiver not to seek psychiatric treatment or medication as needed. But I would also encourage that person not to see himself or herself as a label. We are not our disorders; as believers we are new creations and sons and daughters of Christ. In him we can triumph over sin and experience reconciliation. Both medical and mental treatments are tools best used in conjunction with the Great Physician.

Luke said...

It seems to me that the bigger issue that sparked this is the trend to pretend to seek help. "I was caught? How can we handle this from a PR standpoint? Get therapy? Sweet. Let's do it." This seems far more like a stunt than a genuine change of heart. ...which is why it is true: Repentance is key here.

Of course, you are right: If and when these situations are truly efforts to change, a multi-faceted approach is often incredibly helpful. For instance, going off wheat helped me tremendously with my response to negative stimuli. But my choices must come under the redemptive work of Christ (going off wheat was just one very helpful step).


Anonymous said...

I think much what you have said here is absolutely dead on. I can think of several examples from folks I know that received either little or destructive help from their church resources.

BUT, I think maybe you've missed understood what Mohler is getting at. I think he is getting at our culture's inability to recognize sin, name it as such, and repent from it. I read a good commentary from Susan Bauer addressing this:

Handmaiden Pat

Theology Mom said...

I certainly hope I have misunderstood Mohler. I WANT to have misunderstood him. Really, I do.

My problem is, Mohler doesn't make the key issue about our culture's inability to call out sin. (In fact, I'd probably totally agree with it.) What he does is pit sin/Gospel and treatment against each other. He's the one who brings therapy into the discussion, misdefines its nature and purpose, and the proceeds to knock it down in the name of the Gospel. THAT's my problem.

And again, even if I have completely misidentified his entire premise, his argument still reflects a general attitude among Christians about psychotherapy and as such deserves comment.