Dear Editors,

As a result of reading the articles regarding IRBC in the Dec.1, 2020, and Jan.15, 2021, Sword and Shield issues, as a psych (related to mental health) nurse, I reflected on treatment of mental illness in general. Christian counseling is very important for depressed and anxious patients that are functioning well enough to process thoughts, or those seeking to deal with life circumstances in a Godly way, following the only Truth, the Bible. Hopefully, counselees would not be further discouraged by incorrectly being told they are not feeling better because they are not doing enough or aren’t spiritual enough. In more complex cases, Christian counselors, especially those that are lay people trained briefly, may not have the depth of training needed. I feel so strongly the Bible has the answers to life but that certain aspects of psychiatry can be very helpful in some cases. I realize carefulness is needed in that, and if necessary a pastor or elders may have oversight.

As an example, I have seen, where a particularly gifted, non-Christian therapist saved a marriage when spiritual counseling, well-meaning as it was, did harm. This therapist, with a keen and unusual understanding of early childhood development and how that impacted the current relationship, worked expertly and diligently within the framework of the couple’s beliefs regarding divorce and remarriage. That excellent outcome is not saying I don’t understand the importance of Christian counseling, but there are exceptions. Mental illness and its treatment can be incredibly complex.

Another non-Christian therapist, in passing told me, “You are seeing that in a codependent way and it is affecting your ability to see accurately.” These were words that were helpful then and have been ever since in various situations. If I were to see a Christian counselor, I would hope for this level and type of insight.

Ideally, we would have Christian therapists available that are trained with a strong background in God’s science of psychology (which the world has distorted), and who also have had past experience working on a psych unit. It is incredibly helpful to work with and know different types and levels of depression, bipolar illness, OCD, mania, psychosis, PTSD, anorexia, schizophrenia, multiple personalities, and more. Also, it helps to learn to recognize and how to work with personality disorders. The area of special concern though is the world’s twist on psychology in social and behavior studies. This should be worked through carefully and with Christian support depending on the specific class.

Just after leaving med-surg to work psych, I asked our director, a Christian psychiatrist, Dr. Mulder, if most of our patients were there because in some way they had a sin problem. A man of few words, he looked at me, paused at length, looking like it suddenly was becoming a very long day and said,” That is greatly oversimplifying it,” and turned back to his charts. How right he was, but it was something I’d have to see for myself over time.

I am curious how it works for spiritual counselors when patients may not really be ready for any counseling until they have had medication to clear distorted, fixed, incredibly anxious thinking, or have lost the ability to stay on track mentally. Psych meds are not “happy pills” or a cop out. There is a class of meds called “benzos” (Valium, Xanax, and Ativan) that help anxiety. These are typically used until the meds that actually help restore the brain biochemistry start to work. Because these meds can be addictive with long term use, prescriptions are watched closely. There sometimes is a lot of trial and error in med management and it can be a very frustrating and long process.

The psych meds that actually help the altered brain chemistry usually have side effects and it is not patients’ first preference to be on them. They often go off these meds when they shouldn’t, sometimes with much regression. And meds should usually be tapered when going off of them. It was particularly frustrating when ministers would come in and tell patients they aren’t better because they do not trust God alone to heal them, and that they shouldn’t take psych meds.

As an aside there are many possible causes of depression like stroke and coronary bypass surgery; and depression can be a precursory sign to things like Alzheimer’s and Parkinson’s. It’s also possible there are not external causes to the brain’s pathology in depression; in the same way not all with hypertension are overweight, smoke, don’t exercise, or watch their diet.

In regard to spousal abuse, a related subject, some Christian counseling denies it exists or shouldn’t be called such because it should be called and dealt with as sin. It is sin…murder. The wife, who is usually the abused one, can be confused and unable to even put the pieces together of her situation, while her husband in private does things like repeated undermining, gas lighting, crazy making, and / or physical abuse. She often carries the fear for years of not being really sure people understand or believe what she went through. After a marital session, retribution can come to the wife in a variety of ways. The abuser wants control at any cost. It’s important to see the couple separately. It should not ultimately be marital therapy but therapy for the abused first of all, and abuser secondly. Most severe abusers are either narcissists or sociopaths. In the psych field, severe abusers are considered so cunning they often dupe the therapist, so it is recommended the therapist work under a supervising therapist.

I haven’t understood, sadly, until recent years, how, as a last resort, separation may need to happen. First of all, to bring strength of mind and body back to the abused person and to the children if there are any. This can take months, and children, often silent sufferers, also are incredibly destroyed by abusive marital relationships. Secondly, separating can bring stark reality to the abuser. In a later case, bringing reality by separation caused a complete turnaround in the abuse, and then reconciliation. This would not have happened without that last extreme step. In regard to abuse, two very helpful books that all counselors and consistories should be well versed on are, Why Does He Do That by Lundy Bancroft and The Unholy Charade by Jeff Crippen and Rebecca Davis. The latter is in regard to churches.

In closing, there is not always one easy answer in treating mental illness. As I’ve struggled for years with exactly where to land in the spiritual counseling alone view—versus also the use of psychotherapists and psychiatrists (who prescribe meds)—I’m open to more thoughts on this subject.

Sincerely,