Category: Psychology

Person centred care

(You can listen to the podcast here)

Olivia was sixteen years old and wouldn’t go to school. It began a couple of years before when she started feeling anxious and those feelings grew until they ruled her life. Everyone feels anxious some of the time, Olivia struggled all the time. Her fear had a savage intensity that only subsided when she shut herself away in her room.

The most recent Adult Psychiatric Morbidity Survey (APMS) shows that she is not alone. One in four people between the ages of sixteen to twenty-four report feeling anxious or depressed. Among the rest of the population, the survey shows that Generalised Anxiety Disorder (GAD) is now present in one adult in twelve.

Studies like this are incredibly useful to Christians. If there are a hundred people in your church twelve of them are likely to have a diagnosis of GAD. Preachers, small group leaders, and mentors should reflect on this. How can our bible teaching heal the wounded and grow confidence in the worried? How might our outreach address these needs in our not-yet-Christian friends? How would you help Olivia?

Jesus can teach us if we watch him in action. The first time we meet him he is listening and asking questions (Luke 2:46), then we see him taking time to get on the wavelength of the weak and vulnerable (e.g. Mark 7:31-37). He doesn’t nag or bully people, he listens and supports them, Isaiah predicted that “He will not crush the weakest reed or put out a flickering candle” (Matthew 12:20 NLT).

In modern jargon this is called person-centred care; understanding that individual and supporting them while they navigate life. Supporting Olivia will take time, prayer, and patience. Jesus is our example.

The heart of the gospel is the offer of ‘peace’ (John 14:27, Romans 5:1-5). That little English word sits on the shoulders of a much bigger Old Testament concept, ‘shalom’. Our word means the absence of conflict, Jesus’ word means ‘wellbeing’, or ‘completeness’. For sure, the gospel meets our need to be reconciled to God, but it also addresses the human longing for physical and mental wellbeing. All our preaching, group leading, and counselling should reflect this.

“Find me a faithful pastor in some old village” said Francis Schaeffer, “And I will show you a man who is dealing with psychological problems on the basis of the word of God, even if he has never heard the word ‘psychology’ and doesn’t even know what it means.”[1]

It is hugely helpful if we do know some things though. It will help if we have a working knowledge of mental health from a medical perspective and have reflected on it carefully from a biblical one. We need a personal understanding too. I once asked people in my church to get in touch if they had a diagnosis of anxiety or depression and were willing to have a conversation with me about their experience. Twenty people offered and the resulting conversations changed my life and my pastoral ministry.

And here’s a hint for your preaching or small group work, don’t crush with mighty words that overwhelm the vulnerable, encourage with Christian hope that feeds oxygen to the guttering candle in the heart of the weak. Be gentle (Philippians 4:7).

Olivia’s parents were beside themselves when I saw them. Young people’s mental health services had helped a little. We prayed together. I suggested that they don’t drag her to church, “If she doesn’t believe, you must believe for her. She will get through this”.

We looked at an online directory of counsellors. This would cost money, but the church could help them with that. “Look at the options with your daughter”, I said, “And let her choose the one she likes the look of”. The key to talking therapy is the relationship with the counsellor, Olivia’s intuition would be a better guide than her parents’.

The path to peace may take time and involve as many set-backs as there is progress. But she recently went to France with her school and is looking at university. People recover; with patient and godly support they can recover well.

[1] Quoted in ‘Five Evangelical Leaders’, Christopher Catherwood, p 124.

Are doctors over-diagnosing mental health problems?

Read this article or listen to the podcast here

In 2018 back pain ceased to be the main reason people were taking days off work. The number one spot is now occupied by the stress-anxiety-depression family of mental health problems. Some used to say that people with back pain were malingering, now we reserve that accusation for people with mental health issues.

Wes Streeting, the health secretary, added fuel to this fire recently by suggesting that doctors were ‘over-diagnosing’ mental health problems. The cynics are having a field day.

As a Christian, what do I make of this? It is an important question because the answer has a bearing on pastoral care for those who suffer from mental health challenges. I think that three things are important to consider.

Here’s the first, scripture recognises mental health struggles, sometimes in surprising places. Just think of three ‘difficult’ Psalms. Psalm 6 where David’s feelings look very much like what we might call depression. Psalm 88 where the song writer feels immersed in inescapable darkness. In Psalm 137 where, traumatised by the destruction of his people, the writer asks God to bless those who kill little Babylonian children.

These Psalms show us that depression exists, that anxiety is real, that trauma makes godly people ask for ungodly things. Even Paul, in the months before he wrote his second letter to the Corinthians, experienced stresses so great that he says that he ‘despaired of life’ (2 Corinthians 1:9). Sometimes the bible is more real than we would like it to be!

The great Victorian preacher, C.H. Spurgeon, knew about this. Expounding Psalm 88 he says, “It is all very well for those who are in robust health and full of spirits to blame those whose lives are sicklied o’er with the pale cast of melancholy, but the evil is as real as a gaping wound… Reader, never ridicule the nervous and hypocondriacal, their pain is real; though much of the evil lies in the imagination, it is not imaginary.

Christians who brush aside the reality of mental ill health really need to think again.

Second, we should not be too sceptical about diagnosis itself. Even though mental illness is all about feelings such as low mood, anxiety, or feeling disconnected from reality, psychiatrists are trained to assess people’s feelings objectively. If a doctor has made a reasonably objective assessment, I need compelling reasons, and some expertise, to question it. A diagnosis can be helpful in itself for someone who is confused about their feelings, convinced that they are alone and that there is no hope.

Third, medical professionals are our partners when we support people who are experiencing mental health challenges. I encourage Christians I support to see a doctor because it opens the door to a variety of therapies within the NHS. Alongside the church’s ministry, these interventions can be effective in the journey to wellness.

The hair-raising experience Paul records in 2 Corinthians 1:9 had a purpose; Paul tells us that it both sensitised him to the struggles others face (equipping him to be pastorally effective) and it helped him to trust God more than he did before (read the whole chapter). The gospel changes the meaning of suffering. While others see it as random hardship a Christian sees it as a means to growing resilience, character and hope (Romans 5:1-5). Preaching the gospel should offer this to those who suffer but it should not exclude God’s goodness to us through medicine and other helpful therapies. Cynicism is not a Christian virtue.