Pastor Jones was perplexed. For the fourth time this month Cynthia, a 24-year-old single woman, had come to see him, each visit more puzzling than the last.
Cynthia had grown up in his church, where her parents were long-standing members. Cynthia had professed faith at a youth meeting when she was 14 and had been a leader in the youth group before going away to college. Now she was home again, looking for a job.
At her first session with Pastor Jones, Cynthia explained that two years earlier she had started dating a young man. They became serious but fought often and frequently broke up.
"A year ago, I discovered I was pregnant," she finally said. "And against my better judgment, I had an abortion."
Troubled by both the relationship and the abortion, she felt "locked in," unable to extricate herself from either the relationship or her past behavior.
"What can I do?" she wailed. "Where can I go to get away from all of this? What's wrong with me that I can't break off this sick relationship?"
Pastor Jones listened with deep sympathy to Cynthia. He reasoned with her and then prayed for her. She felt better.
But a few days later she was back again. He listened to her repeat her anxieties and guilt. She seems worse, maybe even depressed, Pastor Jones thought. Why isn't she experiencing forgiveness and freedom? Has she really experienced conversion? Is perhaps some demonic power at work in her?
Not that he had had much experience in spiritual warfare, but so many groups were talking about it he couldn't help but consider it.
Still, he repeated his standard counseling format: he helped her confess her sins and pray for forgiveness. Then he hoped God would work a miracle.
Twice more she came back, even more troubled still. Pastor Jones was baffled and even a little irritated. He wondered, Could she have some deep-seated emotional problem? Has something snapped in her mind, or is there something bad from her childhood coming back to haunt her?
He felt inadequate. But he hesitated to refer her to someone else for fear Cynthia and others would think him incompetent. This seemed a spiritual problem. Why couldn't he just do his job as a pastor? He stewed about what to do.
Pastor Jones is not alone here. I have heard this story, with minor variations, over and over from pastors. No pastor can become an expert in every aspect of the human condition.
And yet every pastor has to diagnose, if only at a rudimentary level, a troubled person's problem: Does this person need to be pointed toward making a commitment to Christ and thereby experience the new life of regeneration? Does this person need some supernatural intervention? Or is this a case for psychotherapy or counseling?
Before I set out some guidelines for diagnosing people who come to see pastors, first let me discuss two factors that complicate a diagnosis: (1) how psychological factors, especially childhood experiences, can impact or impede spiritual healing; (2) the difference between demon possession and its most popular imitator, schizophrenia.
Psychological Scars
Hardly anyone reaches adulthood without collecting a few psychological scars on the way. Even Christian homes can be severely dysfunctional and anxiety producing. Abuse can take many forms. The worst is not physical but emotional.
Divorce is increasingly common even in Christian circles, wreaking havoc on the social and emotional lives of children. Or psychological damage can be caused by bad parenting-neglectful, overly permissive, or overly repressive.
In later life these scars can interfere with a person's spiritual development and prevent a free, unhindered experience of Christ.
For example, our understanding of God is very much shaped by childhood experiences of people significant to us. When a father, for instance, is abusive, demanding, cold, or unforgiving, we are likely to assume that most authority figures, even God, are that way.
One woman told me, "I can't approach God without confusing him with my father. I can't pray with my eyes closed because if I do, I see images of my father towering over me and making threats. I can't even pray the Lord's Prayer because saying 'Our Father' sends fears flashing through my body. God and my father seem to be the same-emotionally I can't tell the difference. When someone speaks of God's love, I don't have the slightest idea what they are talking about. It's all very confusing to me."
This woman will have great difficulty in developing a healthy and balanced spiritual life. Scores of people in most churches suffer from such distorted images of God. When such people are in emotional pain, these distortions will hinder their ability to appropriate God's help.
A pastor counseling such a person will need much wisdom in correcting these distortions. Merely educating people in the "attributes of God," teaching them about who God really is, is only part of the counseling task.
The psychological damage needs to be healed, and while God does sometimes intervene in wonderful ways to erase these scars, other times such supernatural intervention does not occur. (God does not always short-circuit the healing process, I believe, because in the long run we are better off having "worked through" these problems by God's grace rather than experiencing instantaneous cures.)
False guilt is another example of psychological damage that can hinder spiritual growth. Many children raised in devout Christian homes are traumatized by excessive and unrelenting guilt. Sometimes parents, yearning to raise "God-fearing" children, impose rigid discipline and practice severe punishment.
For instance, one Christian family, who lived in a house next to us when we first arrived in the United States, had strict rules about whom their three daughters could talk to. The parents were so scared that their girls would become "contaminated by the world" that they told them: "You may not have any conversation with a non-Christian child. If we catch you talking to such a person, we will punish you."
These children developed intense guilt about talking to non-Christians. My daughters (who were allowed to be their friends) would listen for hours to their fears. Our neighbor's daughters grew up to be excessively guilt ridden; one now suffers from a major emotional disorder.
This sort of guilt is often referred to as "neurotic" or "false" guilt, as opposed to true or healthy guilt. Although many psychologists see all guilt as false, I do not. We need healthy guilt. We need to develop a clear sense of right or wrong. But when we feel condemned by arbitrary rules, or when the guilt we feel is far in excess of what is appropriate, then it becomes neurotic.
Why is it neurotic? For one important reason: such guilt does not respond to forgiveness, whether it is offered by human beings or God. It only knows punishment. It demands to be punished. It won't let up even when all is fully restored.
This was the problem with Cynthia (the person Pastor Jones was counseling). Her upbringing made her conscience oversensitive and out of control. She could find no way out of the prison of guilt brought on by her wayward behavior. Having strayed, she could not find her way back to the peace of mind that forgiveness from God should have provided.
Is this purely a spiritual problem? Obviously not. Can God not miraculously cure such a problem? Yes, but often he doesn't. God's wisdom is far greater than ours, and his concern is much more for our sanctification than our comfort. Cynthia needed to replace her neurotic guilt with a healthy sense of guilt. She also needed to experience forgiveness-the deep and profound forgiveness that God offers her, conditional upon her repentance-so that she can come to live with her imperfections.
Schizophrenia and Demon Possession
If psychological trauma, especially in childhood, can impede spiritual growth, what about spiritual powers? How do these impact psychological or spiritual problems?
I encounter scores of emotionally troubled people every year who at one time or another have been told they have an "evil spirit" or a "demon" possessing them. But demon possession is not always the problem.
Not every person who has a sexual addiction is under the control of a "lust demon." Lustful thoughts and behavior can be the consequence of poor self-control, inappropriate exposure to sexual activity as a child, sexual abuse, or ordinary sin. We don't need to jump to exotic explanations.
In addition, it can be harmful to assume demon possession too readily. No doubt Satan appreciates the extra publicity, but even worse, the hopelessness that such a label, especially when untrue, engenders in the victim (especially after exorcisms fail to cure the problem) can often do more harm than the original problem.
Falsely attributing emotional problems to demons has several dangers: It removes the victim from responsibility for recognizing and confessing human sinfulness. It enhances Satan's power inappropriately. But most importantly, it delays the introduction of effective treatment.
And delaying treatment for a problem like schizophrenia can significantly decrease the likelihood of the sufferer's return to normality.
Schizophrenia is a physical disease. Because it exhibits bizarre symptoms, it is frequently labeled as demon possession. But just as we learned with epilepsy (another disease formerly labeled as demon possession), we now know that schizophrenia is the result of a defect in brain chemistry. Medication can cure people of it.
And any delay in starting the right medication for treating schizophrenia can impact the sufferer's long-term recovery. Misdiagnosis here can have serious consequences. This is especially true for a form of schizophrenia that starts in late adolescence.
Every pastor, therefore, should be able to recognize the basic symptoms of schizophrenia. Frankly, those who cannot should not be counseling. Some basic symptoms include:
Marked social isolation or withdrawal;
Marked inability to function as wage-earner, student, or homemaker;
Markedly peculiar behavior (collecting garbage, talking to self in public, hoarding food);
Marked impairment in personal hygiene and grooming;
Digressive, vague, over-elaborate conversation, or lack of conversation, or lack of content in conversation;
Odd beliefs or magical thinking that affect the person's behavior (superstitiousness, belief in clairvoyance, telepathy, "others can feel my feelings");
Unusual experiences (recurrent illusions, sensing the presence of a force or person not actually present);
Marked lack of initiative or energy.
Naturally, schizophrenia is a complex disease. But if a pastor suspects it in a client, he or she should make the appropriate referral as quickly as possible.
If this is schizophrenia, though, what does demon possession look like? The characteristics of demon possession are not neat and simple to discern, but those with extensive experience with possession look for such things as:
The presentation of a new personality. The person's voice and expressions change, and he or she begins acting and speaking like a different person. However, this is also seen in "multiple personality disorders," a severe psychological problem associated with "splitting" and childhood abuse. It takes someone trained in psychopathology to tell the difference.
A striking lack of human warmth. The possessed seem barren and empty, and they lack empathy.
Marked revulsion to Christian symbols. The cross, Bible, and other Christian symbols make the possessed extremely uncomfortable. However, I also see many schizophrenics evidence this reaction. So this sign, by itself, is not evidence of possession.
Physical phenomena. Many describe an inexplicable stench, freezing temperatures, flying objects, and a "smooth, stretched skin" (see Malachi Martin's Hostage to the Devil).
Behavioral transformations. The victim has "possessed gravity," in other words, cannot be moved physically or can levitate or float.
Obviously, then, possession is not as common as is supposed, and many so-called possessions have more natural explanations. Diagnosis of demon possession is usually a matter of eliminating the obvious causes of the problem first.
How should the pastoral counselor set about making a diagnosis of possession? By ensuring that other professionals also examine the person to be certain that no obvious cause of the problem is being overlooked. If all natural explanations are exhausted and several of the above symptoms are present, then the pastor may wish to proceed with such a diagnosis.
The Law of Parsimony
In all matters of discernment the principle that should guide us is the "law of parsimony."
In essence, this law requires that we try to understand a problem at its most obvious and fundamental level. Simplicity is the rule. When diagnosing a problem, we must first try to find the most obvious and natural explanation before moving on to explain it in more complex or less obvious ways.
For instance, if I have a headache, I first try to see it as a result of stress or eyestrain (depending on the circumstances). If rest doesn't cure it, I may then need to consider whether I have a bad case of the flu. If that hypothesis doesn't pan out, I may need to go to a neurologist to check if I have a brain tumor.
But unless the symptoms obviously suggest a brain tumor, I don't immediately jump to the conclusion that every time my head hurts I have a tumor. All diagnostic processes follow this law.
Here's how we can apply that law to the pastoral counselor's task of determining the nature of a person's problem.
1. Take a careful history. This lesson we can borrow from other disciplines like medicine. Most pastors are not trained to take a thorough history, but it is vitally important if you are not going to miss an obvious cause of a problem. A history should include the following:
-Details of family background.
-History of dysfunctional patterns in the family.
-History of mental illness in the family.
-History of the presenting problem.
-When it first occurred.
-How often it occurs.
-The changes that have taken place in recent history.
-History of spiritual experience and practice.
-Experience of conversion-when, where, and how?
-Patterns of spiritual development since conversion.
A thorough history should provide a clear picture of what troubles the person, how it started, and the context of the problem.
2. Consider obvious causes first. Following the law of parsimony, you now try to explain the problem in the most obvious or natural terms.
For instance, if there is a history of mental illness in the family and the person you are counseling is experiencing bizarre behavior or emotions, the most obvious cause is likely the familial pattern of illness. Genetic factors strongly influence the severe mental disorders. Unless you are trained in psychopathology, however, the most responsible action you can take is to refer the troubled person to a psychologist or psychiatrist for diagnosis.
3. Intervene at the most obvious level first. It is helpful to think of counseling intervention in hierarchical terms. Not only does diagnosis work upwards from the obvious level of explanation, many interventions should also follow this approach. Treat the basic symptoms first, then move on to more complex symptoms.
For instance, a man may be behaving bizarrely and saying he sees things or hears voices that no one else sees or hears. The first intervention should be to refer the man to a competent professional who will treat these unusual behaviors and hallucinations.
While treatment for the bizarre behavior is underway, you may wish to counsel the person in the steps of Christian commitment, encouraging a "surrender" to the claims of Christ. (Your responsibility as pastor doesn't end when you make a referral.) Of course, the one intervention (professional treatment) may need to temporarily take precedence over the other (spiritual guidance) simply because the disease needs to be under control before the person can adequately comprehend spiritual matters.
4. Consider supernatural causes. At what point should one consider the possibility of supernatural or demonic causes for a problem and invoke deliverance as the remedy? Only when the more obvious causes have been eliminated.
If there is a history of schizophrenia in the immediate family of a troubled person, for instance, the treatment of schizophrenia must be given first consideration. I think it is gross negligence to move beyond this diagnosis without addressing the presenting issue.
But what about less bizarre behaviors? The same principle applies. Find the most obvious cause and treat this first. If you have eliminated the obvious, or if the symptoms are so strange as to rule out any natural cause, then you might want to consider moving directly to supernatural factors.
Some words of caution:
Never try to diagnose supernatural causes by yourself. Always seek corroboration from others, and hold yourself accountable to the corporate discernment.
Remember that many experts believe that possession doesn't usually manifest itself in bizarre behavior. Satan is more creative than that. We may need to look elsewhere for it.
Even when you think there is a state of possession, remember that psychological or psychosomatic problems accompany and complicate possession. These may also need treatment.
While Jesus instructed his followers to deal with demons (Luke 9:1-2), we find no injunction to seek them out. In other words, avoid preoccupation with these causes. Focus rather on the victory and protection we have in Christ.
5. Consider the need for regeneration. One of the great drawbacks of counseling or psychotherapy is that it does not deal directly with the core problem of human existence: our alienation from God.
Whatever the problem that a troubled parishioner presents, the question of regeneration is always a legitimate one. Without the regeneration that God works in the core of our being, all human endeavor to improve the quality of life (mental or physical) is limited. Pastoral diagnosis must always address the question of whether or not regeneration has occurred.
I am not saying that we judge people's salvation. But we have a right to call people to accountability for their souls. This is the work of evangelism.
During emotional turmoil people are more open to spiritual interventions. The caring pastor will carefully suggest ways the client can experience renewal by receiving God's grace. Regeneration literally means "rebirth," and only when the core (or "heart") is regenerated can counseling or psychotherapy make a significant difference.
As Christian counselors we can prepare a person to be receptive to God's work. We can help remove the obstacles of childhood traumas or distorted God images so that God's grace can be effective. Therapy or counseling does not do the work of grace; it merely aids it. It is nothing more than burden bearing as instructed by Galatians 6:2, 5 as well as Romans 15:1, helping others to rely upon the greatest burden bearer of all (Mt. 8:17).
6. Don't delay in referring. Whenever a problem is complicated or when you feel that it is beyond your training or expertise, refer the person to someone capable. Develop a relationship with a group of trusted professionals to whom you can make referrals.
Let me emphasize the word trust. Unless you know these professionals personally, you will not have complete trust in them. Cultivate a relationship. Go to lunch and talk to them so that they understand where you come from. Find out their orientation. If you are not satisfied, move on to someone else.
And even after you've made your referral, maintain ongoing contact so that you can evaluate progress and decide when and how you will intervene with spiritual direction.
While I suggest a parsimonious model of diagnosis, I cannot stress too strongly the importance of continuing education for pastors, especially in the area of understanding the human condition. Ignorance here is dangerous and can do much harm.
The misapplication of a spiritual solution may delay appropriate treatment of serious mental disorders. By the same token, the exclusive use of psychological treatments for spiritual problems is costly and dangerous to the soul.
Ultimately, calling people to respond to God's grace through regeneration has to be our primary focus. After all, "What good will it be for a man if he gains the whole world, yet forfeits his soul?" (Mt. 16:26).
For many, however, evangelism may mean helping them overcome the psychological obstacles to surrendering to this grace. This is where Christian counseling becomes a means of grace.
Copyright © 1991 by the author or Christianity Today/Leadership Journal.Click here for reprint information on Leadership Journal.
