American Christian Engagement With Mental Health and Mental Illness

Although scholars commonly describe a “troubled history between psychiatry and religion” (5), this tension has never been uniform within either psychiatry or American Christianity. Beginning in the early 20th century, many Christian clergy used psychiatry to inform their practices of “soul-care” (6). The emergence in the 1920s of clinical pastoral education, which brought seminarians into direct contact with psychiatric inpatients, accelerated this trend. Clergy often looked to psychiatry and psychology for pastoral insight, and there was some professional overlap—for example, psychotherapists Carl Rogers and Rollo May studied in Protestant seminaries before pursuing psychological training. By midcentury, many clergy pursued psychotherapeutic training to inform their pastoral work. These clergy were generally sympathetic to psychiatry and were supported by certain leaders in the mental health field. William C. Menninger (7), for example, noted in 1950 that “there is need for the co-operation of clergymen and psychiatrists. Pastors should learn to recognize when the persons who come to them for help are mentally ill and need psychiatric consultation. Psychiatrists should recognize the powerful emotional support that many individuals derive from their religious faith. . . . Despite a few irrationally prejudiced remarks and articles written by those who would stir up antipathies, psychiatrists and clergy are working together, and understanding and borrowing support from each other.”

The pastoral care and counseling movement has spawned numerous movements relevant for modern health care. Health care chaplains provide spiritual care and support in many contemporary health care settings and are supported by organizations, such as the Association of Professional Chaplains (www.professionalchaplains.org) and the Association for Clinical Pastoral Education (www.acpe.edu), and by journals, such as the Journal of Pastoral Care and Counseling. Pastoral counselors, who may be chaplains or ordained clergy, are often licensed professional counselors (L.P.C.s) and may be certified by the American Association of Pastoral Counselors (www.aapc.org). The pastoral care and counseling movement has also influenced the development of interfaith mental health advocacy organizations such as NAMI FaithNet (www.nami.org/NAMIFaithnet) and Pathways to Promise (www.pathways2promise.org), which in turn have informed the advocacy and lobbying efforts of many Christian organizations (8).

The congenial approach to psychiatry in modern pastoral care and counseling, however, has not been shared by all Christian pastors and churches. Protestant Christianity in the United States was sharply divided in the 20th century between more “liberal” theologies that interpreted Christian concepts within modern approaches to science and reason and more “fundamentalist” or “evangelical” theologies that were more guarded about these approaches. This division manifested itself with respect to psychiatry most visibly in the movement now known as “biblical counseling.” Biblical counseling originated with Jay Adams, a pastor who rejected the psychoanalytic teaching he received in seminary and, influenced by Thomas Szasz and the behavioral psychologist O. Hobart Mowrer, founded a new movement that he came to call “nouthetic counseling.” Nouthetic counseling was marked by four distinctive commitments: emphasis on personal responsibility and, correlatively, on personal sin as the core human problem; strong affirmation that the Bible should be the primary text used in pastoral counseling; marked distrust of psychology and psychiatry; and promotion of pastors, and not mental health clinicians, as preferred counselors. Nouthetic counseling was, and is, directive and sometimes confrontational, with frequent and authoritative references to Christian scripture (9).

Although nouthetic counseling continues to exist within Adams’ own Institute for Nouthetic Studies (www.nouthetic.org) and the Association of Certified Biblical Counselors (www.biblicalcounseling.com), the movement is now more broadly known as “biblical counseling” and incorporates the Christian Counseling and Educational Foundation (www.ccef.org), the Association for Biblical Counselors (www.christiancounseling.com), and the Journal of Biblical Counseling, which display Adams’ influence but often display more openness to modern psychology and especially to modern biological psychiatry (because mental disorders, if proved to be organic, are properly the domain of medicine) (10). Biblical counseling plays an influential role in the way that many clergy are trained and in the way that many conservative Protestant congregations respond to mental illness; for example, it is currently the dominant model of pastoral training within several of the seminaries of the Southern Baptist Convention, the nation’s largest Protestant religious body. Biblical counselors, some of whom are credentialed as licensed professional counselors, usually work within churches or faith-based organizations (including addiction treatment centers).

Biblical counseling, however, is not the only approach to contemporary psychology and psychiatry within American evangelical Christianity. Other midcentury American evangelicals, more sympathetic to psychological science and practice, formed training programs and organizations that are now often referred to as “integrationist” because of their commitment to integrate clinical psychology with Christian doctrine (11). This commitment has over time led the integrationist movement into closer alignment with clinical psychology than its “pastoral care and counseling” counterpart. Integrationist doctoral training programs, such as Fuller School of Psychology (www.fuller.edu/sop) and Rosemead School of Psychology (www.rosemead.edu), maintain American Psychological Association accreditation, and graduates are board eligible for licensure in clinical psychology. Integrationist organizations publish the Journal of Psychology and Theology and the Journal of Psychology and Christianity and are professionally linked within the Christian Association for Psychological Studies (www.caps.net). More broadly and variably, integrationist thought informs institutions such as the Meier Clinics (www.meierclinics.com) and Pine Rest Christian Mental Health Services (www.pinerest.org), as well as numerous master’s-level counseling programs and the American Association of Christian Counselors (www.aacc.net). Like the pastoral care movement, integrationism has given rise to support and advocacy movements for persons with mental illness within Christian congregations and denominational bodies (for example, Mental Health Grace Alliance [www.gracealliance.org]) that are generally accepting of medical models of mental illness (12). Integrationist thought also informs psychiatric professional networks such as the Psychiatry Section of the Christian Medical Association (www.cmda.org/ministry/detail/psychiatry). While not all graduates of integrationist training programs advertise themselves as faith-based clinicians or work in faith-based care settings, many self-identify as “Christian psychologists” (Ph.D. and Psy.D.) or “Christian counselors” (M.S.W., L.P.C., and others).

Two additional movements, although younger and less institutionally mature, are nonetheless noteworthy within the diverse terrain of American Christian engagement with mental health and mental illness. The first, which self-identifies as “Christian psychology,” is linked through the Society of Christian Psychology (www.christianpsych.org) and the journal Christian Psychology (formerly Edification). Christian psychology so far is primarily a scholarly movement in which clinicians, philosophers, and theologians explore ways that the Christian theological tradition might shape distinctively Christian models of mental health care and inform empirical research (13).

The second movement is centered primarily on the Institute for the Psychological Sciences (IPS [www.ipsciences.edu]), an accredited Psy.D. training program in Arlington, Virginia, and displays a specifically Catholic form of engagement with modern psychology. Although many American Catholic institutions sponsor clinical training programs indistinguishable from those at non-Catholic universities, IPS describes itself as pursuing a distinctively Catholic vision of psychology and mental health, rooted in church teaching. Scholars and clinicians associated with IPS have published numerous articles and monographs interpreting mental health and mental illness through Catholic traditions of philosophy and moral theology (14).

Although the movements described above are often unfamiliar to mental health clinicians and policy makers, each is relevant to the way that mental health care is delivered and received in the United States, particularly among highly religious populations. I close by suggesting four appropriate responses to these movements.