Psychiatric Disorders & the Church

Transcript:

Alasdair Groves:

Some people live day in and day out caring for family members who have really severe issues in living. If you’re one of those people, you know what I’m talking about. But most of us don’t know and therefore, we probably don’t do the best job of thinking about how to help the families of those who struggle. So please join me and David Powlison as we talk about how can you help the families of those who struggle with severe issues in living.

You are listening to CCEF on the Go, a podcast of the Christian Counseling and Educational Foundation. Here at CCEF, we are committed to restoring Christ to counseling and counseling to the church. You can find our podcasts, books, articles, videos, and more resources for Christ-centered pastoral care at our website, ccef.org.

Alasdair Groves:

Welcome to CCEF on the Go. I’m Alasdair Groves, a faculty member here at CCEF. Today I’m speaking with David Powlison, our executive director and faculty member here as well. David, how are you?

David Powlison:

I am doing well. Doing better talking to you Alasdair. It’s always a pleasure.

Alasdair Groves:

You’re too kind. You’re too kind. I wanted to get some thoughts from you on one of those challenging issues that could be a 12 hour class rather than a 20 minute podcast. But psychiatric disorders and the church and particularly the focus actually that I want to go with is not what are psychiatric disorders so much as how can the church help? What’s our focus as a church? How can we be moving toward those with psychiatric disorders in wisdom and love? You’ve been thinking about this a lot longer than I have. What’s your take?

David Powlison:

Yeah, yeah, great question. Maybe I’ll take say a bit of personal history. Part of why I’ve been thinking about it for a long time is I came to faith in the context of working in a psychiatric hospital, locked ward. Worked in psychiatric hospitals for a total of four years. So knew, I would say over those years, probably between a thousand, 1,500 people who had been institutionalized, whose lives had been disrupted enough that they were put behind a door with a lock for their own protection or the protection of others.

And one of the things that actually played a very significant role in my own conversion, and I count this, one of these mercies of God that you’re not even a Christian, you’d have no awareness of God, but he’s running before to work in your life in such ways that you become, you start to see the points of contact with the gospel. I was spared by God’s mercy putting psychiatric patients into this category that made an us and them that I am one of the well and they are the sick. I have keys, I get to go home. They are somehow this other kind of human being. But even in the most disturbed people I could see, take this the right way, but I could see myself, I could see-

Alasdair Groves:

I find that easy to do with you as well, David.

David Powlison:

Yes, it’s not far away, but in someone who was in extreme blinding panic, I could see that there were in a sense normal anxieties and fears just running wild. And someone who is in the blackest pit of despair, I could see there’s something in here that’s an understandable human experience of hopelessness and it’s taken on a quality that is, or a quantity maybe we should say that’s extreme, that’s beyond normal. But I can understand something of the experience. And one of the things that was very significant in working day in, day out with patients in the hospital is I don’t think there was a single patient that I didn’t connect with human to human at some point or other. And it didn’t mean there weren’t times where the person was very weird or unresponsive or bizarre or hallucinating or their talk made no sense. But then you’d talk to somebody and you’d find out that they were very lonely, very immature, very depressed about how life went, very frustrated with themselves, angry at what people had done.

They were people in other words. And I think that when… I’m glad the way you phrased the opening question, okay, let’s not try to figure it all out cause I think there are mysteries, there are things you can take a stab at or posit, but the fact that you’re dealing with another human being means that there’s a human point of contact and that humanizing and in a certain sense, not minimizing the oddity or distressingness or destructiveness of what’s going on, but at the same time saying this is a person and that means we can relate to each other. And that’s just hugely significant because that starts to open all sorts of practical ways that you can debunk what’s frightening or intimidating or weird. And you can start to pursue, okay, there’s a person here, how do I connect, how do I care? Really basic things of human relationships.

Alasdair Groves:

It’s interesting, I mean I’m just actually processing this through my own life. I had a conversation with a pastor today about a situation he’s involved in where I’ve had the chance to be involved as well. And he was just sort of saying, “Hey, what do think?” And it was just a helpful reminder that for most people around anything that’s at all severe or anyone who’s quite troubled in their experience of life and their mind and their emotions and their perceptions, whatever the case might be, you feel helpless and it feels utterly mysterious and you feel like you haven’t got a clue how to move towards someone. And a lot of that can be warranted and there may be many options that aren’t on the table. You know, have very little ability sometimes to affect someone’s-

David Powlison:

Yeah, you may not be able to have some rich, meaningful personal heart to heart conversation.

Alasdair Groves:

Or their meds may not be doing much for them right now. And hopefully a different set of meds is going to possibly do something different in a week or a month or we’ll see. And maybe a hospital stay can be kind of a reset or who knows. But just the experience as I would assume for most pastors, for most people in the church is something like this. I just feel very unable to do much that feels meaningful. And what you’re saying is don’t lose sight of there is a person and how powerful of an avenue of help it is simply to treat a person as a person and think of them as, okay, what is this person in need of? This person may be in very serious, seriously disturbed and in serious trouble, but I still want to see them as a person first.

David Powlison:

Yeah. And let me, there’s a lot of ways we could take it, but let me focus on one. In every single extreme disabling condition of life that gets a label of a psychiatric disorder, every single one is characterized by a profound aloneness and loneliness. There’s no love, these aren’t ways to connect to people. These are disconnects. These are, whether it’s in extreme darkness or weirdness or a high in a bizarreness…

Alasdair Groves:

Sure, delusion.

David Powlison:

Or something more mild like an eating disorder. These are not ways that people are connecting to other people. So there’s a loneliness and an isolation. And so there are things that are very elemental human responses that simply to welcome someone and to know their name and to, depending on the situation, to give them a hug and a warm hello of some sort. Things that… To include them in a dinner. Things that actually you might say operate on the assumption of shared humanness that what are the things we would do as someone who’s lonely and isolated? We seek to include them. We seek to make them part of our lives and us part of them.

One of the most interesting sociological studies I read of psychiatric disorders was a comment on the way in which I think it was, it might have been Zimbabwe, it was some sub-Saharan African country where they have the same bizarre behaviors and such that we would have that people get put into psychiatric labels and institutions. But there’s certainly no resources, there’s no social resources or no hospitals or… So they’re in families. And there’s something about just being included in family life that actually makes… It modifies symptoms. Having offering somebody an opportunity to be helpful, dry the dishes, take a walk, look at God’s creation, pray for them, the express faith, in one sense it’s an intensification of what’s so in every kind of ministry and you actually don’t know what’s going to happen. There’s something, an adventure that, there’s something intriguing that we are particularly aware that we don’t control it. When you’re with someone who’s really struggling deeply.

But the doing of normal things you never know. And you can have that, you can have some enthusiastic adventure in that. Let me wade in and see what happens. One of the things in the psychiatric hospital that played a role in my coming to faith was pondering the single most effective staff member. He was the only member of our staff who had not been to college. He was not just doing mental health work like I was as a experienced stepping stone before going to grad school for a career. This was his life, working on this in the psych hospital. He treated people like people he had this knack for, he had a good sense of humor.

If somebody was… I mean it was, it’s things that you might take you back at first, but if somebody was talking nonsense, word salad, dementing, he might say to them, “Stuart, what’s really going on with you? What you’re saying is making no sense. What’s going on?” Didn’t always quote work, it’s not a technique. It’s not like applying a wrench to a carburetor. But was what was so interesting and working side by side with this man for a number of years was when people were in trouble and wanted to talk, he was the one that they most often wanted to talk with. He just dealt straight with people so he could laugh with people, he would include people. He was very involved in activities on the floor and he would be blunt with people where bluntness was called for, and he wasn’t a Christian, but he was somebody who humanized the psychiatrist who tend to be viewed through a dehumanizing lens.

And I would describe him as the single most effective staff member in a common grace way. And think how much more that we as Christians can not only do all the everyday practical caring, including things that common grace can do, but we can pray for people, we can talk to them about the living God who has free access into the heart and mind. God is hindered by any kind of mental illness or disability. There may be a very limited degree to which someone’s growth potential is, and that’s by God’s creation and providence. But if faith, just as there’s great isolation, there’s also no faith in any of the psychiatric disorders, in the disorder part of that person’s life.

Alasdair Groves:

Right.

David Powlison:

So by definition, for someone to grow in relationality and care and to be cared for and for someone to start to pray and to ask God for help and to believe, those things by definition are the opposites of every single one of the psychiatric disorders.

Alasdair Groves:

It strikes me, I think of one friend of mine who has dealt with some fairly severe mental sort of delusional issues and typically in the delusions that the place where things go for her is something like “You’re choosing hell. You’re choosing away from all things that are good in you’re damning yourself and you’re-“

David Powlison:

These are the thoughts in your mind, intrusive…

Alasdair Groves:

Exactly.

David Powlison:

Intrusive thoughts.

Alasdair Groves:

This is the, right, and suddenly the world around seems to be everything is my enemy. Everything must be pushed away and some at times fairly severe and problematic episodes for her as her mind just the very perceptions coming in are-

David Powlison:

Every channel is saying hostile, accusatory things.

Alasdair Groves:

Right. Exactly. And for her, probably one of the single most helpful, if you will, tools, I want to speak carefully in that language. But one of the most helpful things she has been able to do and some of those situations is to say, “No, Jesus loves me.” And that phrase, Jesus loves me. Those three words have had enormous comforting at times. It has actually snapped her out of psychotic episodes.

David Powlison:

Sure.

Alasdair Groves:

At times the phrase itself is not magic and it doesn’t snap her out. But that has been what she clings to as she comes out of the episode. Just something sweet about that.

David Powlison:

A lovely way… Yeah, because you’re not describing some magic spell or magic words or a technique in the technical meaning of that, something which has an automatic effect. But you’re describing a life that is going through extreme confusion, pain, struggle, delusion, falsehood. There’s lies running rampant. And so again, just as love is the opposite of loneliness and praying for help is the opposite of unbelief. Truth is the opposite of lies. And so we’re actually describing these very basic elements of Christian faith applied in a way that’s realistic, not magical. Applied in a way that is living within God’s world where people who have this depth of struggle are in God’s world and then God can reach them and no guarantees, no tricks, but we’re in each case talking about really normal things. I know when I was in the psychiatric hospital again before being a Christian, one of the things that just a common grace was it’s what gets called reality testing and someone is in delusions and to just calmly and persistently creatively talk about what’s true in the face of what’s false.

Well boy, coming to faith, you don’t abandon the truths that we would’ve reality tested. You just have a whole lot more and you’re able to frame the common grace truths as well, about what life really is and be able to have those candid conversations, caring, candid, constructive conversations, just like you would seek to have between you and me. One of us is struggling with feeling anxious or overwhelmed or really depressed. You’d want a caring, candid, constructive conversation. You’d want to listen. There might be times where you want to kind of say, “I really want you to listen to me because you’re not really taking this in. I think you need to take this in.” There’s every modality of human interaction that is helpful is in a sense an outgrowth of some aspect of Christian faith.

Alasdair Groves:

David, let me wrap this up here. Here’s my short summary of what I hear us saying. Number one, you treat people as people and that is profoundly living out the Christian faith that says, doesn’t matter how much the image of God and someone is currently under assault or injured or hurt, or doesn’t matter how many limbs they’ve lost or how many bizarre things they’ve said in the last 10 minutes. They’re a person. And when you treat them that way, that’s a powerful lack of love and faith. Secondly, prayer is just this incredibly, unbelievably-

David Powlison:

Significant thing to do.

Alasdair Groves:

Significant thing to do with and for somebody. Thirdly, just speak things that are true. And I’m saying it that way, rather than saying speak truth, speak truth tends to have the sense of confront. And of course it can and relative, but there’s something even, I mean something broader than that, speaking things that are true, bringing truth in contact with someone’s life, truths in contact with someone’s life is powerful.

David Powlison:

Yeah, let me… Could I take us a little bit different angle?

Alasdair Groves:

Of course.

David Powlison:

Another interesting thing about how the Bible looks at life is you could say actually normal people are described in the Bible as insane. They’re under a strong delusion. So something like normal, everyday unbelief of your sister-in-law, that’s just an everyday who could care about Jesus. They are actually, she’s actually deluded now she registers as normal on the DSM and she registers as normal in her social interaction.

Alasdair Groves:

She’s highly functional in the system.

David Powlison:

She’s highly functional, but she’s crazy from the standpoint of we actually do live in God’s world. We are dependent on him for life. We are sinners against him and he has come in person to deal with our sins and to give us a new life and to walk with us. And she doesn’t believe any of that. In other words, she’s completely out of touch with reality and-

Alasdair Groves:

Which in a sense, so am I when I sin as a Christian because I am in touch with reality at the level of I know who has made me and what I’m made for, and so therefore when I act in a way that does not take that seriously or I’m runs against it, it’s insane.

David Powlison:

Then that is temporarily insane. No. Again, I’m not trying to push that and suggest there’s nothing there-

Alasdair Groves:

Sure.

David Powlison:

In these just extremely debilitating, destructive things that wreck people’s lives, that get the labels of psychiatric disorder. We’re not minimizing that, but relativizing it by, in a sense, questioning our idea of normal and that there’s something insane about it.

Alasdair Groves:

There’s in between normal and sane.

David Powlison:

And then elevating the people who are really troubled to never forget that they’re people more like us than different in certain essential ways.

Alasdair Groves:

So to finish the list, I’d say the one other thing I would highlight as just to, you’re almost always going to go right doing this in ministries, is thinking about the families of people. Just anything you can do on any of those three fronts again, but just how can you bring meals? How can you help? How can you have compassion for, how can you understand that to have a brother who is wrestling with some kind of psychiatric disorder or severe problem of living, whatever the case might be, is going to isolate the people around that person too. They’re going to feel a resulting shame to move toward them.

David Powlison:

Yeah. Your main ministry in some ways may be with a family member who it’s incredibly discouraging.

Alasdair Groves:

Right. Exhausting, overwhelming.

David Powlison:

When you’re working with someone who feels hopeless it’s catching, and family members, people who care, a spouse, parents, brother, sister, a child with a adult, with a parent who’s… You can, feel hopeless yourself. So I mean, there is a way where even as we’re talking together, Alasdair, we’re trying to cast a vision, where we ourselves would go into these relationships with hope, not hope that there is a magic answer or a quick fix, but hope that basic elements of faith and love and truth actually matter and I can persevere in them and to help the people who are maybe the more on scene caretakers to help them in the same way, to have a way to go forward without despair, anger, fear, all the things that can grip us.

Alasdair Groves:

And therefore, as churches, as local bodies of believers, we have really good reason to persevere. And that reason is not if we persevere hard enough and long enough, this person’s problems are all going to disappear. That reason is…

David Powlison:

Or that coming to Jesus is like an instant presto, everything’s fine.

Alasdair Groves:

Right. Or if they’ve been Christian for decades that somehow if they had a little more faith, they would just… But there’s something to us then of just being able say, “Yeah, we can continue to move toward people.” And there’s this patience in, and I think a high view of the very, very normal, mundane forms of ministry, realizing just how much it does mean to hang in there with somebody, move towards somebody, love somebody, pray with somebody that is an incredibly rich form of ministry that often feels very little and paltry because the problem seems that it takes all the air in the room, sucks all the oxygen out of the room.

Well, David, thank you so much. Appreciate…

David Powlison:

You are very welcome.

Alasdair Groves:

Appreciate the time and the conversation.

Obviously there’s a lot more we could say about the issues of psychiatric disorders and churches and how to help. One article you might find interesting is an article we’ve linked to as always on our webpage, which is ccef.org/podcast. It’s an article by Ed Welch, about 10 ways that you can help families of people with psychiatric disorders. It’ll be free on our website until the next episode goes up. And of course, if you have any questions or thoughts or comments for us, don’t hesitate to shoot me an email podcast@ccef.org. Till next time, blessings.