‘I’ve got something deeper, something psychological going on…’ … ‘It’s my mental health that’s the issue…’.
Hearing such statements can lead us to think that a person’s struggle is beyond the reach of pastoral care. Discernment is needed, and referral to a qualified professional may be necessary, particularly with medical problems and struggles that involve risk. But are psychological problems outside the scope and understanding of Scripture itself?
Take the example of obsessive-compulsive disorder (OCD) experienced by Tom. When we describe it as a psychological issue, it says a number of things. It can mean that Tom’s struggle is harder, more complicated than ordinary anxiety. It expresses that the struggle isn’t going away and that normal means of help – encouragement, prayer, the Bible, time – don’t seem to be working. We may also be saying that the problem is more life-dominating. For all these reasons it feels like a struggle that is sectioned off from Tom’s spiritual life and the pastoral care available.
More depth, width and length
Why might a problem become so big and so hard? It may mean, firstly, that there is more depth to Tom’s struggle. His anxiety is more than just feeling nervous and worried. It involves obsessional thoughts that seem to get stuck, feelings of anxiety and guilt that won’t easily go away, and unusual compulsive behaviours that are frustrating and distressing to him. What’s more, all of this may just be the surface expression of deeper fears, desires and beliefs in Tom’s heart.
To describe the problem as ‘psychological’ also means that there is more width to Tom’s struggle. There are other factors at play. The body is involved, for example. He feels the anxiety and guilt of OCD physically – sometimes out of the blue – and these feelings cannot be just willed or prayed away. Circumstances are also involved. He knows by now that current pressures and tiredness make it worse. His past is relevant: it all started when Tom saw an explicit image on TV as a boy, and then ran to ‘cleanse’ himself of the bad thoughts by washing his hands. As he grew up it was heightened by the excessively strict standards his parents laid down for him.
We could also add that for Tom, the significance of this struggle is its length: it doesn’t seem to go away completely, relapsing then remitting – but always hanging over him.
Deeper, wider, longer ministry
The Bible doesn’t recognise a separate category for complex struggles. The Psalms are full of troubles that don’t easily go away (how long, O Lord?), where help doesn’t seem to be immediately present (why are you so far from helping me?), where the problem seems to be life-dominating (all your waves and billows have gone over me). But such hard and complex problems are a call to better ministry.
A note of caution: ‘psychological’ often means complex, and complexity requires experience, wisdom and humility. Going deeper might bring us out of our depth – we may need help! But we grow in pastoral care: we have the Spirit who searches everything (1 Cor. 2), and a man of understanding will draw out the heart (Prov. 20:5).
So there should be more depth to knowing the person. We listen harder to Tom, with better questions that probe the fears and beliefs of his heart. We come to know the guilt, the standards, the fears and how these connect to his unusual behaviours. We go wider in our understanding of him – asking about his physical struggles, hearing about a hard past and asking about his spiritual life. We go wider still, and listen with spiritual discernment to the secular psychological wisdom crying out in the streets. We walk longer with him within God’s family, not giving up when things don’t seem to get better.
But we also go deeper into God’s word, to understand Tom’s story within the words and story of Scripture. How will promises of ‘fear not, I am with you’ help him to resist compulsions? How will the grace of God teach him that he isn’t sinning with an anxiety that doesn’t go away? We speak words of relevant truth, addressing his struggle in ways that invite Tom to his Saviour for true Refuge.
Andrew has spent many years working as a consultant psychiatrist in Belfast alongside part-time work providing Biblical counselling. He is an elder at his church in Portadown, Northern Ireland.
