How do Churches Handle Difficult Mental Health Cases, Biblical Counseling, and the Law?

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A friend sent me a tragic story this morning.   It is an older story from 1979 involving John MacArthur’s church, Grace Community Church, and a young man, Kenneth Nally, who at the age of 24 shot himself and died.   He suffered from depression and sought counsel from church leaders/counselors.  The counseling provided at Grace Community is biblical counseling.  They do not claim to be trained mental health professionals.

Kenneth’s father, Walter Nally, later filed a $1 million lawsuit against Grace Community Church and four leaders for malpractice and negligence in their son’s death.

I was thinking back on my former church experience and the many e-mails I received from people who had been there before me regarding the topic of mental health.  My former pastor thought he knew how to handle a sex offender better than professionally trained civil authorities.  He also thought he knew how to handle counseling cases better than anyone outside the church.  He was not keen on anyone attending any support groups or private counseling.  People were rebuked for getting outside help. We’ve read similar stories at Sovereign Grace Ministries and IFBs as well.  What is the deal about pastors presuming to know what is best for people and their personal lives and dictating whether or not they can seek medical/mental help.  This is inappropriate behavior for a pastor. This is beyond the scope of pastoral responsibilities.  Do we need their permission to go see doctors?  No we do not.

I’ve spent several hours reading about this case. It is important to note that in the court documents and interviews, it appears that Grace Community did not dissuade Nally from keeping his appointments with his psychiatrist or doctors, yet they did continue to counsel him at church.  This story did, however, made national news because of its broad implications in church responsibility:

The allegations of clergy malpractice prompted more than 7,000 churches and religious organizations to join in court papers arguing against the Nallys and the precedent their case could set if ruled in their favor.

The case, which was followed by the New York Times, the Los Angeles Times and other national news media, was dismissed twice by Superior Court judges, reinstated by the state Court of Appeal, then ultimately rejected by the state Supreme Court in 1988. The U.S. Supreme Court denied a request to hear the case. (Source)

This case was so big, a book was written on it, Clergy Malpractice in America: Nally V. Grace Community Church of the Valley (Landmark Law Cases and American Society), by Mark A. Weitz.

Here is a brief summary of the book and case taken from a review by Susan E. Grogan, Department of Political Science, St. Mary’s College of Maryland:

Ordinarily, the term “clergy malpractice” brings to mind clergy who seduce adult church members or sexually abuse children under their pastoral care. Indeed, a quick review of the law review literature using “clergy” and “malpractice” as the search keywords shows that seduction and sexual abuse are what most authors have as their topics. The NALLY case, however, concerns the extent to which pastoral counselors, who have received no professional training in psychological counseling and locate their therapeutic approaches in religious precepts, can be held to a “secular standard of care” (p. 69). At the heart of the Church’s and pastors’ defense in this case was their claim that the suit against them necessarily implicated the First Amendment’s Free Exercise and Establishment Clauses, a claim that curiously disappears in the final ruling on the case.

As a college student, and already experiencing emotional difficulties, Ken Nally left the Roman Catholic Church in which he had been raised and joined the independent, fundamentalist Grace Community Church in 1974. Grace, with some 20,000 members, was then the “largest Protestant church in Los Angeles County” (NALLY v. GRACE CHURCH 1988: 950). A significant part of Grace’s ministry-“perhaps the most important aspect of [its] services” (p. 16)-was the church’s pastoral counseling program, which was directed by biblical principles, in particular the belief that unresolved sin lay at the base of psychological problems. In 1978, suffering from continuing depression, Ken Nally engaged in formal and informal counseling with three of Grace’s biblical counselors. Nally’s emotional state continued to deteriorate and, in February 1979, his mother took him to a psychiatrist who prescribed an antidepressant medication. The next month, Ken attempted suicide by taking an overdose of the antidepressant and was hospitalized. Although the counselors from Grace Church were aware that this was not Nally’s first suicide attempt and although he told them, during his hospitalization, that he was determined to succeed in a future attempt, they did not share this information with his parents, physicians, or the hospital staff. Nally’s parents did not support having their son involuntarily committed and Ken was released from the hospital. About a week later, Nally used a shotgun to take his own life.

In my last article, Biblical Counseling and Mental Health Crises: Does it Always Work?, we discussed whether the Bible has all of the answers to life’s mental health crises.  The folks at Southern Baptist Theological Seminary (SBTS) apparently believe it does.  In that article I linked to a 2-day course offered by Drs. Stuart Scott and Heath Lambert who claim that even the most difficult issues of life can be dealt with by using scripture.  Their belief that the Bible has all of the answers is a not just isolated at SBTS.  We also find it at Grace Community, my former church, Sovereign Grace Ministries, etc.  Here is a quote I found from the court documents describing a church publication which depicts the counseling climate at Grace Community (I bolded key points):

This asserted capacity to handle severe psychological disorders was also reflected in a Church publication entitled “Guide For Biblical Counselors” (Guide). Pastor Thomson was the author of the Guide, which served as a basic text for aspiring biblical counselors and was required reading in Thomson’s class on biblical counseling. According to Pastor Thomson, absent a gross physiological cause such as a brain tumor, “every emotional problem” was within the competence of the pastoral counselor to handle. Among the symptoms or disorders the Guide listed as falling within the pastoral counselor’s domain were “drug abuse, alcoholism, phobias, deep depression, suicide, mania, nervous breakdown, manic-depressive [disorder] and schizophrenia.” The Guide devoted separate sections to a number of these disorders, including suicide, with hypothetical questions and answers interspersed throughout the text. One such exchange read as follows: {Page 47 Cal.3d 307} “[Question]: You mean I could counsel with an extreme problem like a suicidal tendency or nervous breakdown or something like that? [¶] [Answer]: With the proper understanding of God’s Word to diagnose and treat the problems, this could not only be done occasionally but could become the rule.” fn. 2

Nally was well aware of defendants’ self-proclaimed proficiency at treating severe depression and suicidal symptoms. Nally was a student in Pastor Thomson’s course on biblical counseling, which used the Guide as a text, and affirmatively sought out formal or informal pastoral counseling from defendants during each of his several suicidal crises. (Source)

Betty Rollin of Religion & Ethics Newsweekly (PBS) covered this story in her article (bolded by Rollin):

ROLLIN: Grace Community Church is still thriving with the same pastor in charge, Reverend John MacArthur, still holding only to the strict biblical interpretation of human problems.

Reverend JOHN MACARTHUR (Pastor, Grace Community Church): We live in a fallen world, and sin is pervasive in this world and sin is the reason anything goes wrong.

ROLLIN (To Rev. MacAuthur): Where do you think you went wrong with Ken Nally?

Rev. MACARTHUR: I don’t think we went wrong at all. We have absolutely no regrets. My regret is that Ken Nally took his life.

ROLLIN (To Rev. MacAuthur): Do you think the counseling he received was appropriate and good?

Rev. MACARTHUR: Yes, I think it was exactly the kind of counseling we always do. We’ve done it with thousands upon thousands of people.

ROLLIN (To Rev. MacAuthur): But what if a person is mentally ill?

Rev. MACARTHUR: We simply approach the issues spiritually. We don’t refer them to psychologists or psychiatrists or whatever. We don’t attempt to deal with them in those terms. The only real transforming, life-changing guidance is that which God provides through his word to his people. Anything else is going to be the wisdom of man, not the wisdom of God.

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I call heaven and earth to witness against you today, that I have set before you life and death, blessing and curse. Therefore choose life, that you and your offspring may live, 20 loving theLord your God, obeying his voice and holding fast to him, for he is your life and length of days, that you may dwell in the land that the Lord swore to your fathers, to Abraham, to Isaac, and to Jacob, to give them.”  Deuteronomy 30:19-20 

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In 2011, many years later, long after losing the court case,  Walter Nally (Kenneth’s father) died at the age of 79.  John MacArthur offered these comments on the occasion:

MacArthur expressed grief over Walter Nally’s death, and over Kenneth’s suicide, but also said the church felt vindicated over the final outcome of the lawsuit.

“We, the pastoral staff and flock of Grace Community Church, are deeply saddened to hear of the death of Walter Nally. Mr. Nally’s son, Kenneth, was a cherished friend to several of us before he tragically took his own life in 1979,” MacArthur wrote to Patch in an e-mail. “Walter Nally endeavored to find a court or a judge who would declare the church legally responsible for the suicide of his son. After a series of trials and appeals that spanned several years, the California Supreme Court upheld the decision of every lower court that had ever heard the case, ruling that the church had no culpability in Kenneth’s death. Though saddened by the circumstances that led to it, we remain grateful for the high court’s decision—one which set an important legal precedent for church ministries throughout the United States. We can only hope that, in the years since the concluding court case, Walter Nally was settled in his own heart over the issue.  We send our sincere condolences to the remaining members of the Nally family.”  (Source)

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45 comments on “How do Churches Handle Difficult Mental Health Cases, Biblical Counseling, and the Law?

  1. MacArthur is failing to make a very, VERY important distinction: that his church was not *legally* culpable for Nally’s suicide. That does not remove the spiritual culpability.

    Unfortunately, from a legal point of view, I don’t think you can hold a church accountable for failing to provide adequate counseling if they do not claim to be psychiatrists or mental health professionals. From an ethical standpoint, they are absolutely in the wrong for not encouraging him to keep his appointments. But from a legal standpoint, I don’t know that there’s any law holding clergy accountable for failing to refer to mental health professionals.

    Should there be legal consequences? I think probably yes, but I’m not sure that any sort of law is actually in place for this at the moment.

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  2. Thanks for highlighting these issues Julie Anne. One thing to keep in mind is that most church members will go to a pastor for help before going to a professional counselor. That’s why this is such an important topic. We pastors can do great good, but also great harm.

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  3. Shaney – I need to read over the article again to make sure this was clear. The GCC leaders did not interfere with his appointments.

    Ok, I just checked. Here it is:

    I’ve spent several hours reading about this case. It is important to note that in the court documents and interviews, it appears that Grace Community did not dissuade Nally from keeping his appointments with his psychiatrist or doctors, yet they did continue to counsel him at church.

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  4. Craig, you are right – – I also read those statistics. I should have jotted them down. Most people will go to a pastor before seeking mental health help. There is a higher level of trust with a pastor and in this kind of church climate, there would be a higher level of skepticism of mental health professionals, so that might prevent someone from even going at all – – – even if they were in a very bad state.

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  5. Hi Julie Anne, I understand that they didn’t interfere with his appointments, but they still failed to encourage him to go to them, as I said in my previous comment, which I think is still an ethical failing.

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  6. Julie Anne,

    Pastor’s taking on the role of mental counseling, drains an enormous amount of time, even if they have some counseling experience. In smaller churches of 150 or less, it would be difficult for churches to have on staff, a spirit led professional counselor.

    I would like to think large Churches would provide Spirit led Professional Counselors on staff that could offer real counseling while staying within the perimeters of scriptures.

    I don’t know what smaller and mid size churches could do other than co-op together the resources needed to have a Spirit led Professional Counselors available by appointment.

    I know of a situation that my former Pastor provided some “5 Point” counseling to somebody who has mental and physical problems who was seeking guidance to help his daughter deal with an abusive husband. The only only thing this person came away after that session, is the Pastor confidently had the impression this person was going to hell.

    When a Christian is going through problems, I can understand why it would be difficult pouring their heart out, for fear they may be exposing themselves to judgement, shame or feeling guilty for being “spiritually and mentally weak”.

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  7. Test Everything. 1 Thessalonians 5:21. A tree is known by its fruit. Matthew 12:33. It may be observed that, in the case of Kenneth Nally, the fruit of a spiritual-only approach to counseling was death. This may be observed without assessing legal or moral blame. Yet surely this is an instance in which “They have healed the brokenness of My people superficially, Saying, ‘Peace, peace,’ But there is no peace.” Jer. 6:14, NAS95. See also Jer. 8:11. Inasmuch as the word shalom has made its way into English, this verse may be translated “They have healed the brokenness of My people superficially, Saying, ‘Shalom, shalom,’ But there is no shalom.” Shalom includes the ideas of well-being and wholeness. See Wikipedia entry for shalom.

    I submit that it is indisputable that mental illness can be rooted in physical pathologies, including but not necessarily limited to pathologies involving the brain and its functioning. Medical science has made great strides in this area. Yet it seems that so many who would serve as “spiritual” counselors ignore and even reject medical knowledge. In how many cases is it still the case that continuing despair and even death are result?

    These counselors, in holding to their principles, reject knowledge. “My people are destroyed for lack of knowledge.” Hosea 4:6, see about any translation. Hosea continues, “Because you have rejected knowledge, I also will reject you from being My priest.” May the world be warned. May we mark and avoid these false counselors. May our Lord soon intervene, though to correct and redeem, and not to destroy.

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  8. “Rev. MACARTHUR: We simply approach the issues spiritually. We don’t refer them to psychologists or psychiatrists or whatever. We don’t attempt to deal with them in those terms. The only real transforming, life-changing guidance is that which God provides through his word to his people. Anything else is going to be the wisdom of man, not the wisdom of God.”

    I am sorry but he (Rev. Mac) is a seriously misguided buffoon… “The only real transforming, life changing guidance is that which God provides through his word.”
    That depends on how the Word is being taught, a lot of damage is done when the sheep are whipped with it, or shamed into submission with it.

    As I mentioned before my X pastor was mentored by MacArthur. X- Pastor lacked compassion or a willingness to even try to understand the depths of the wound inside a person in agony. All their hurt-anger- got swept under the Word. People were rebuked for their humanity, because woe to you if you were in process, the expectation was be ye perfect. My question is why counsel hurting people at all when you have a mindset like this. It doesn’t help the wounded.

    I wept when I first read this quote by Henri Nouwen:

    “Who can save a child from a burning house without taking the risk of being hurt by the flames? Who can listen to a story of loneliness and despair without taking the risk of experiencing similar pains in his own heart and even losing his precious peace of mind? In short: “Who can take away suffering without entering it?”

    FWIW I don’t think anyone can take away suffering, that is Jesus’ work. But first, it does help if one has entered their own suffering, even if it seems miniscule, because empathy & good listening skills can be a place to start. You know weep with those who weep, bear one another burdens… Be real, be a human being…
    A lot of these leaders, pastors, want to scrub the humanity right out of people and they use the Word as their soap.

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  9. Gail, this is quite profound: “A lot of these leaders, pastors, want to scrub the humanity right out of people and they use the Word as their soap.” And yet there are pastors who would say you were blasphemous for saying such a thing. I was talking to a friend the other day and she said, “When I’m around a Pharisee, it makes me Sad U See.” I think Kenneth Nally was sad hanging around all of the black/white legalism.

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  10. That little ditty just popped into my head as I read about Kenneth Nally, so if I was called blasphemous by these guys, I would consider it a compliment! Damn Julie, all of the hurt that is perpetrated by these men is so disheartening. My hat is off to you for shining the light on them, I am new to this world, I knew what I went through, but it is staggering how many others have suffered at the hands of preachers. I pray that I will stay righteously bold & not succumb to the sorrow that hits my heart every time another story comes into the light… I only say that because depression has been a theme in my life. Sad U see, yes, I am with your buddy on that play on words. Lord Bless You my friend.

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  11. Gail – Yes – – I hear you on that depression thing. A lot of us have to go through that – sometimes temporary, sometimes longer. I’m still in the process of typing up my story. It’s getting longer than I expected, but I needed to take a break.

    And as far as being around sad stories and shining the light – – I wouldn’t be able to do this if I didn’t have support people behind the scenes that are my sounding board. I know who my friends are, let me tell you.

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  12. From the NT account of the life of Christ, we understand that the Word put on flesh to live as a human. He was filled with the Spirit, listened to the Father, and interacted with people who were just people. Jesus gave us a way to live that was full of hope and based on reality. It was beyond the stifling power of the Pharisees. Basically, God became man because he wanted to. His Kingdom is a new way to live that is liberating and real. There is so much to learn after we have ‘unlearned’ a lot of things.

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  13. I can only imagine how many times a day your heart breaks, how wonderful to have such support.

    Will you be publishing your story in a book? Look forward to reading it in whatever form it is delivered.

    I hope it wasn’t weird that I wrote: “bless you my friend” You don’t know me, I realize, however I consider you a friend, or better said yet, a friend & sister in our Lord.

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  14. That wasn’t weird at all, Gail. This last year I have met some amazing friends online, the majority of whom I have never met in person. I cry reading stories from strangers I have never met.

    No, I was going to post my story here 🙂 Still trying to figure out how to do that since the universal blogging rule is no more than 1,000 words per post. If my blog posts were graded on that rule, I’d be failing. lol

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  15. o, good. whew. you are a tender & yet strong woman.

    so, i hope we can expect a 6 part series. that actually might be kinda cool, because when i read a long blog post i get lost. and different parts of your story will resonate with some, and other parts of your story will speak to a whole different segment of readers.

    who makes up these rules? no need to respond. ( :

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  16. Julie Anne,

    Back in my early NeoCalvinist days, there was a very strong opposition to the use of modern psychology or any sort of counseling that wasn’t strictly “biblical.” A good friend of mine became a Christian after his junior year of college, and was converted through the college ministry of a well known church (many of your readers would know of this church). He completed his degree that year, in, of all things, psychology.

    He endured much criticism and judgment from other Christians for years for having a psychology degree, despite working in a completely different field.

    I don’t oppose “biblical” counseling – if in fact it is truly biblical (actually the bible should be used in much counseling) and I’ve heard some pretty lame junk from “Christian” psychologists on radio programs, etc. But to eliminate counseling simply because it doesn’t conform to certain conservative beliefs is a bit shortsighted, if I may say so.

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  17. MacArthur is failing to make a very, VERY important distinction: that his church was not *legally* culpable for Nally’s suicide. That does not remove the spiritual culpability.

    Sounds a lot like that law firm out where I am that got caught running a regulatory extortion racket. Their defense before the Bar Association? “But Everything We Did Was LEGAL!” (P.S. The entire firm got disbarred.)

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  18. But to eliminate counseling simply because it doesn’t conform to certain conservative beliefs is a bit shortsighted, if I may say so.

    Ees Party Line, Comrade.

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  19. As a survivor of spiritual abuse, I totally ‘get’ what you are saying. What you are saying is most pastors are not trained clinical psychologists or may only be trained in marriage counseling & not in treating mental illness.However there may be less than 1% of pastors like my brother who are trained clinical psychologists who go into ministry. Sadly there is still no guarantee that even if the minister is a trained psychologist abuse won’t still happen or that if a person gets refered by a minister to a psychologist or a psychiatrist that abuse won’t happen there. We live in a fallen world, see Genesis 1-3. Most pastors aren’t qualified to counsel the mentally ill though a few are even those few can still abuse people. There are no pat answers or safe havens from abuse except to wrap yourself in the Bible or go live on deserted island.

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  21. stevescottpew,

    I think having Biblical principles is an advantage that Church Counselors can utilize that secular Counselors don’t have, provided if the Church Counselor has a valid Degree in Psychology and can remember the Biblical principles of helping the distressed..

    Counseling requires enormous amounts of time and an understanding of how to develop trust so the patient can open up their heart without fear of being rebuked or shamed, while getting the guidance they really need.

    I really question how equipped most Churches are.

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  22. This is certainly a bit of a sticky issue. I have to say first that, based only on the details I read in this article, that it may have been a good idea for the case to have been dismissed. The only reason I say that is because of the risk that it would set a precendent that could greatly restrict the pastoral counseling that so many good pastors give. Cases like this do need to be handled carefully, we don’t want to unnecessarily restrict pastor’s from doing good work.

    That said, I do agree that there are issues which pastors probably are not well enough equipped to handle, and a professional therapist (one with a Christian worldview) would be much better. Sadly, there is still a perception amongst many Christians that psychology is evil and goes against the truths of the Bible. There certainly are some psychological theories that would be seen as destructive of bad from a Christian perspective, but this does not mean they are all so. I think many people still to strongly associate psychology with Freud. There are many psychologists and theories that fit in perfectly with a Biblical, Christian worldview, and Christian therapists can, do, and should incorporate the Bible into their therapy. My wife is studying to do just this infact.

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  26. I’m thinking and typing on the fly, so if my thoughts aren’t completely organized, you all have my apologies.

    The first issue from my point of view is that the nomenclature “biblical counseling” is far too broad. It can include everything from a licensed therapist who is counseling through a church, to the CCEF and Ed Welch, to Jay Adams, Jim Halla and the Nouthetic guys at the other end of the spectrum from the licensed therapist. This makes the title “biblical counselor” too broad for the purposes of taxonomy.

    Furthermore, I think MacArthur, et. al., made a fatal error when they said that every emotional problem is “within the competence of the pastoral counselor.” Given the wide range of gifts, that statement is just too much. It also seems that they are confusing the sufficiency of Scripture with the sufficiency of the pastor! Just because the Scriptures are a sufficient guide, it doesn’t follow necessarily that the pastor is competent to handle the problem he’s confronted with.

    Now I’ve got more stuff to ponder towards some posts at my own page…

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  27. Benjamin, I really appreciate this part of your comment: Just because the Scriptures are a sufficient guide, it doesn’t follow necessarily that the pastor is competent to handle the problem he’s confronted with.

    Imagine an unqualified pastor tending to someone whose life is facing life-threatening crisis. That puts the person needing help in a very compromising situation. Point well taken.

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  28. First, it’s late and I’m exhausted, so I might ramble a bit. If so, then you have my apologies.

    I’ll probably be posting more complete thoughts over at Southern Reformation at some point, but I have real misgivings about any issues surrounding pastoral competency.

    I was a pastor for 9 years before I went back to school because I realized that I need more education than I had with just a Bachelor of Theology under my belt, and because my theological convictions had changed a good bit–I moved from Lutheran theology to Old School Presbyterianism.

    I think that move and returning to grad school has deeply affected the way I see issues of competency. There are two competing pressures involved: the church on one side and the seminary/pastor himself on the other. Too often churches expect that their pastor be expert at everything, not realizing that every man’s gifts are very different. A seminary education can create a toxic arrogance wherein the prospective pastor thinks that because he has a M.Div he is now fully prepared for ministry. Until 80 or so years ago, the ministerial degree was a Bachelor of Divinity (not a Master’s) because the seminaries recognized that it gave you the initial tools to be successful, if you continued to labor in the learning you had acquired. It was only because of the confusion between an undergraduate Bachelor degree and the graduate level education in a seminary Bachelor of Divinity that the degree name changed.

    When you add these two things together, you either get a pastor who’s church is asking far too much of him, or a pastor that thinks far too highly of himself. In the end, either can be deadly.

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  32. Hello Julie Anne,

    Is it your understanding that mental illnesses like depression are actually ‘illnesses’ like Diabetes or Cancer?

    Peter

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  33. Hi Peter,

    Welcome! I think some forms of mental illness are a result of trauma or biological issues going on. Ie, postpartum depression can be shown to occur because of a hormonal imbalance. Studies of the brain (mapping) show marked differences in those who have suffered abuse/trauma. This is evidenced by those suffering from PTSD. Those are a couple of examples that come to mind.

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  34. Hi Julie Anne,

    Thanks much for your response. Apologies for not replying sooner. Just wanted to offer a couple of quotes from respected mental health professionals in order to give you a view that you may not have considered.

    “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”
    – Thomas Insel, Director of The National Institute of Mental Health, in an article titled ‘ Transforming Diagnosis’, 29 April 2013, accessible at http://goo.gl/vv1Sj.

    “There are no objective tests in psychiatry; no X-ray, laboratory, or exam finding that says definitively that someone does or does not have a mental disorder.”
    – Allen J. Frances and Thomas Widiger; Pg 116, Psychiatric Diagnosis: Lessons from the DSM-IV Past and Cautions for the DSM-5 Future.

    “In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”
    – David Kupfer, MD, chair of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

    “Although it is often stated with great confidence that depressed people have a serotonin or norepinephrine deficiency, the evidence actually contradicts these claims”
    – Valenstein ES (1998) Blaming the brain: The truth about drugs and mental health. New York: Free Press. 292 p.

    “Some have argued that depression may be due to a deficiency of NE [norepinephrine] or 5-HT [serotonin] because the enhancement of noradrenergic or serotonergic neurotransmission improves the symptoms of depression. However, this is akin to saying that because a rash on one’s arm improves with the use of a steroid cream, the rash must be due to a steroid deficiency.”
    – Delgado P, Moreno F (2000) Role of norepinephrine in depression. J Clin Psychiatry 61 (Supple 1): 5–11.

    “No one is denying that people suffer very extreme forms of distress. What we are saying, and in fact what some of the world’s most senior psychiatrists are saying, is that there is no evidence that this kind of breakdown is best understood as an illness, with genetic or biochemical causes. … Obviously our brains and bodies are involved in mental distress. The question is, is there evidence that distress is mainly caused by changes in our bodies and brains? There is no evidence to support this – as senior psychiatrists themselves are admitting.”
    – Dr Lucy Johnstone, consultant clinical psychologist with the Division of Clinical Psychology of the British Psychological Society, in an article in MailOnline on 12 May 2013 (http://goo.gl/7oR3i)

    What do you reckon?

    Peter

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  35. Julie Anne, you’re right. But that’s because I never included any such quotes. And the reason for that is ––– environmental factors can indeed (and do) cause mental problems. Trauma such as mental/ physical/ sexual abuse (or some combination thereof), as well as war (as you mentioned) can have serious mental repercussions. So I’m not disputing that as a fact.

    What I’m disputing (hence the quotes from psychiatric professionals) is that mental disorders are illnesses (in the sense of diabetes or malaria) in that they are biologically caused; or caused via genetic transference or chemical imbalances.

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  36. Julie Anne, where am I going with this? I’d like to make the following point ––– the hypothesis that PPD is caused by hormonal imbalances is flawed.

    Please note that I’m not saying PPD doesn’t exist. I affirm that it exists.

    What I’m contesting is that the cause of PPD is hormonal imbalance.

    I could be wrong, of course. So am happy to consider any evidence you might have.

    Peter

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  37. I know this is an old thread, but I have recently had a bit of an exchange over at the Biblical Counseling Coalition blog, where the existence of most organic mental illness is questioned, if not denied. I’d like to link to the comment section so anyone searching this topic and finding Peter’s questions here will realize that there is a vast sea of emerging data about brain disorders.

    The link is http://www.biblicalcounseling.com/blog/can-jesus-heal-mental-illness#comment-1304247926. The following is my response to the assertion that “mental illness” is mostly fabrication. Feel free to delete or abbreviate it.

    Michael, I apologize for my rude tone. You questioned the existence of any biological cause for mental illness, thereby relegating many sufferers to the default position of wallowing in sin or fabricating symptoms. I am also upset at those who place physical illness, poverty and suffering on the lack of faith chain.

    Here are some thoughts to consider:

    1. Premature birth increases the spectrum of psychosis, depressive and bipolar disorders in adulthood from 1.7 to 7.6 times in the general population. (Brain and Behavior, http://bbrfoundation.org/disco

    2. Increased ventricle-to-brain ratio (ie, larger fluid-filled or empty space in the brain) is seen in schizophrenia, bipolar disorder, and Alzheimer’s disease. (Van Horn, J.D., and McManus, I.C. (1992). Ventricular enlargement in schizophrenia. A meta-analysis of studies of the ventricle:brain ratio (VBR). British Journal of Psychiatry, 160, 687–97, and many other studies). Interestingly, in identical twins, the twin with schizophrenia has the abnormally large VBR while the unaffected twin does not. Clearly, something more than genetics is contributory, although in identical twins the chance that both will develop schizophrenia is 35-50%, indicating that genetics does indeed play a part. (E. Fuller Torrey, MD, Surviving Schizophrenia, 5th edition. NY: Collins Living, 2006)

    3. Obsessive compulsive disorder can have its roots in childhood strep throat, and may be triggered by subsequent infections. Evidence points to destruction of neurons in several area of the brain as a result.
    (This is a good overview: http://www.nimh.nih.gov/health

    OCD sufferers also have significantly less white matter (connection fibers) and markedly greater total cortex cell volume.

    4. The 40-90% loss of glial cells in post mortem studies of patients with depression or bipolar disorder suggest a complicated relationship with cortisol and glutamate metabolism. Loss of the glial “support” cells can lead to loss of neurons. I am not sure that even if the glial cells are able to regenerate, then new neurons can be recruited.

    5. Here is an example of an isolated DNA sequence contributing to both schizophrenia and autism. (http://sfari.org/news-and-opin

    6. These are just a few examples of a huge body of scientific literature. My impression is that imaging studies and DNA studies are still in the research phase, and data continues to accrue. Yes, one blood test or imaging study that would clinch the diagnosis would be helpful, but to be fair, a medical diagnosis is seldom made on the basis of a single test; the patient’s history and clinical presentation are still the foundation of diagnosis.

    7. Are people misdiagnosed? I’d say that’s the norm. It’s a long and winding road to an accurate diagnosis, and those without medical insurance and social support may find themselves in the prison system, never to be appropriately treated or diagnosed. Others remain on the fringes of society.

    I implore anyone, especially Christians, and most especially Christians who feel called to counsel this fragile population, first do no harm. If you are unable to communicate God’s grace without judgment, forgo this endeavor. To the others, be like a scientific Berean: know your stuff inside and out; people are regarding you as the experts. And never forget the compassion that has been lavished upon you.

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  38. I used to go to Grace Church in the 1990’s and know first hand how they handle those who are depressed. They instill fear into people who seek LOVE and help saying “you are in sin, so what I say, or else!” No wonder Kenneth blew his head off. I almost did the very same thing, after I went to the church for help when I found out EIGHTEEN YEARS after the fact of why my mother and sister died when I was only a BABY! It’s obvious that MacAurther twisted the truth and didnt tell the full story.

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  39. To those that think a pastor can’t provide help, then whats the use of reading the bible? Dont you uaed it as your authority? “scripture is profitable for ALL, reproof, teaching and correction.” The KEY is to intrerpriate it CORRECTLY!

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