Franchising Hope

In March 1907, Sigmund Freud took on God, presenting a paper before the Vienna Psychoanalytic Society in which he concluded that religion was a “universal obsessional neurosis.” Ever after, psychiatrists have seen religion as a symptom of problems, not a source of healing. No field has been more resolutely irreligious.

Today’s scene, though, would make Freud twitch. Psychiatry’s realm of final authority—the mental hospital—has been invaded by outspokenly Christian inpatient clinics. Most are run by fast-growing, Christian-owned companies working by contract with local hospitals, but at least one secular corporation has jumped on the trend.

Charter Hospitals, among the nation’s largest providers of inpatient psychiatric care, last year launched “Kairos,” a pilot program in Sugar Land, Texas. Those entering the program are greeted with a “belief statement,” signed by all its therapists, proclaiming among other things, “The Bible is the uniquely inspired book that possesses the authority of God,” and, “Through the work of Jesus Christ, God redeemed humanity.” Program administrator Stuart Palmer, a graduate of Asbury and Wheaton colleges and Princeton seminary, says the program has been an outstanding success, and he gets calls regularly from other Charter hospitals eager to know how they can duplicate it.

Profit Motive

Palmer calls Kairos a miracle program, but the miracle has a lot to do with money. In Palmer’s Houston area, a Christian corporation named Rapha (Hebrew for “heal”) has grown into a major provider of inpatient psychiatric care. “Rapha and Minirth-Meier [another Christian provider] have really got the attention of these big hospital corporations,” Palmer says.

Launched in 1986 by therapist Robert McGee, Rapha has grown with the hustle and free-enterprise spirit of a Texas oilfield. Last year Rapha operated 32 psychiatric inpatient programs in 17 hospitals, taking in nearly 4,000 patients for stays averaging about three weeks. Hospitals welcome Rapha, because Rapha fills beds. Since a day in a psychiatric ward can cost anywhere from $600 to $1,200 a day, a single patient can make the difference between profit and loss for a small hospital.

The three “big boys” of Christian care are Rapha, Minirth-Meier, and New Life—all operate as privately owned, for-profit corporations. In addition, many smaller, local Christian companies maintain a single hospital unit. Christian providers are still a tiny slice of the total—there are over 2,000 mental hospitals or units in the country—but they are a growth niche in a struggling industry.

Times are tough for psychiatric hospitals. Insurance companies, which pay for most psychiatric care, have been squeezing mental hospitals to discharge patients as early as possible. Hospitals that used to keep patients 30 to 60 days now discharge adults after an average of 20 days. That means empty beds. Typically, Christian companies contract to fill one wing of a hospital—15 to 30 beds—and run the unit for a fee. The hospitals supply the nursing staff, but the therapists and administrators are evangelical Christians.

So are their patients, who might never enter a psychiatric ward if it did not call itself Christian. Many come through the companies’ toll-free telephone numbers. By advertising these numbers on Christian radio stations and in Christian periodicals, Christian providers can by-pass the traditional referral system and go straight to consumers.

New Life, for example, logs 6,000 calls monthly; about 300 of these people will be treated, they say. The rest are referred to outpatient counselors or other resources deemed appropriate. The ability to pay is a key ingredient: If your insurance won’t cover the costs, you won’t be admitted (see “Money Matters,” p. 25).

Naturally, this profit-motivated, market-driven growth troubles some people. They wonder whether patients are admitted inappropriately, or whether the care is truly professional. Some say they have heard of groups calling their care “Christian” strictly as a marketing ploy. Southern Californian psychologist Dave Smith says, “Christianity is a great thing to market these days. I’ve seen so many programs that call themselves Christian, and there isn’t anything Christian there.”

These concerns, while real, should not be overdrawn. The Big Three, who probably comprise more than half the Christian care, appear to be thoroughly evangelical in their staffing and in their philosophy. As for professionalism and inappropriate admissions, insurance companies watch these closely. Dan Holwerda of Pine Rest in Grand Rapids, Michigan, one of the few Christian mental hospitals that predates this trend, says, “You can abuse the system, but you’d have to work on it real hard.” The fear of lawsuits also motivates Christian companies to professionalize their staffs.

There is a positive side to the market-driven growth. Nearly everyone in the field of psychiatric care agrees that conservative Christians have underused the mental-health system. Doubts about psychology’s legitimacy, and fears that their faith would be attacked, have kept some from getting the help they need. That is changing fast.

More “Church” Than Anywhere Else

The sign outside the Western Medical Center in Anaheim, California, has peeling paint, as befits the small, aging, sixties-era hospital. Underneath the original sign, however, is a bright new one: New Hope Treatment Center—one of the programs run by Southern California-based New Life.

On an ordinary morning in New Life’s locked wards, some patients are chatting in the hospital corridors, others are in class. The main difference in appearance between staff and patients at New Life is that the staff wear ties. Mental hospitals are no longer scary places. Thanks to improvements in medication, very few psychiatric patients hear voices or believe themselves to be Jesus. No one drools or mutters at New Life.

In a classroom, a therapist has written on the board 2 Corinthians 5:17 (“If anyone is in Christ, he is a new creation”) and John 8:32 (“You will know the truth, and the truth will make you free”). He is engaging a dozen men in a discussion of these verses. Drawing a rectangle, he writes “Bible” underneath, “history” on the left, and “honesty” on the right. An arrow up through the top of the rectangle he labels “freedom.” With unflagging energy he engages the men on these topics. This might be an adult Sunday-school class, except that on one wall is a list of the 12 steps of Alcoholics Anonymous.

Each day a patient at New Life participates in several groups, some like this one teaching biblical concepts, some discussing “what’s happening” in each other’s lives, some doing psychodrama, some processing the 12 steps together. Each patient will meet individually with a therapist for about an hour and will see—usually briefly—a psychiatrist. There is also time for exercise, for “occupational therapy”—generally some kind of craft activity—and for prayer meetings and Bible study. Patients pursue written exercises in their spare time. The atmosphere is more like a Christian school than a cuckoo’s nest, although most patients are on medication, and you need a key to get out.

In another room, patients have volunteered to tell a visitor why they have come to New Life and what they are gaining from it. They sit in a circle and, one after another, tell dreadful stories. One says she came because “I was suicidal. I didn’t want my little girl to wake up and find her mother in a pool of blood.” Another says she was so deeply depressed she couldn’t decide what to wear; every morning she would break down and cry uncontrollably. A man tells about his childhood experiences of sex abuse, his life as a sex addict, and his thoughts of suicide. Several tell of sexual abuse. A woman tells of a father who tried to hang her when she was two, of an older brother who repeatedly abused her sexually, and of her own sad history of five abusive marriages. As New Life founder Steve Arterburn says, “These people are not just in a bad mood. They really need help.”

Church is a central part of life for most of these patients, but they seem to feel that they have experienced more “church” at New Life than anywhere else. Several patients describe pastors urging them to use prayer and the Bible instead of turning to psychologists. “I would leave church and feel beaten up,” one woman says, explaining that she took everything “so literally and so personally.” When they speak of New Life, an evangelistic tone invades these patients’ speech. “You can be angry with God here,” one woman says. Another mentions the presence of the Holy Spirit and tells of patients who became Christians while in the program. “The staff are so caring.” Yet another says, “I’ve never had fellowship like I’ve had here.”

Arterburn, a popular Christian speaker and writer, expects that patients like these will change churches. “When they go back, they’re not going to take superficial answers,” he says. The church’s resistance to psychology will fade, he believes. “You can’t deny the results.”

For at least 30 years, evangelicals have been warming to psychology. Christian counselors like Clyde Narramore and Paul Tournier legitimatized psychological healing; James Dobson, Frank Minirth, and Paul Meier, among others, popularized it. Christian schools of psychology—Fuller, Rosemead, Denver, Wheaton, Regent, the list goes on—have been training therapists for at least two decades.

Not surprisingly, the use of psychological counseling has grown. A 1991 CHRISTIANITY TODAY survey found that 29 percent of readers have received counseling for themselves or a close family member within the past three years; they were three times more likely to receive it from a professional counselor or psychologist than from a pastor. For readers of TODAY’S CHRISTIAN WOMAN, the percentage was higher: 38 percent. Readers of both magazines turned to Christian professionals more than any other kind of care, and they rated their experience with Christian care, whether institutional or individual, far higher than they did non-Christian care.

Psychiatry Gets Religion

If the church is changing its attitude toward psychology, so is psychology changing its attitude toward religion. Increasingly, psychiatrists recognize that religion can be a positive force and that their own professional negativism toward religion has been bad psychology. Freudianism has faded, and Freud’s views on religion are widely viewed as mistaken.

Last September the New York Times headlined an article “Therapists See Religion as Aid, Not Illusion.” It quoted Stanford’s David Rosenhan, an atheist, as saying that religious beliefs can “improve your mental health, especially in resisting temptation and organizing your life in terms of what matters and what does not.” David Larson, a research psychiatrist with the National Institute of Mental Health, says that new data demonstrate not only that religion is beneficial, but that religious therapy helps. Patients feel safe when they are with people who share their basic commitments, and that enables them to trust their therapists and get down to the hard work of restructuring their lives.

In 1990, the American Psychiatic Association issued “Guidelines Regarding Possible Conflict Between Psychiatrists’ Religious Commitments and Psychiatric Practice.” The guidelines urge psychiatrists not to press their religious or antireligious views on their patients, to respect their patients’ beliefs and learn about them, rather than ignoring them. It is a sign of religion’s emerging profile that the guidelines were even considered necessary.

Psychiatrists’ personal attitudes often lag behind the literature, though. Stephen Post, who teaches medical ethics at Case Western Reserve University, says, “Most psychiatrists are very empathic and reasonably sensitive toward what you might call casual religious sensibilities. They recognize that people need to have meaning in their lives.… When you get to the level of evangelicalism and fundamentalism, at that point you move toward greater and greater misunderstanding in psychiatric circles. There is a definite bias against theological commitments that appear to be inflexible.”

Many Christian therapists say a patient’s faith often gets ignored by secular therapists, and occasionally it gets attacked. Researcher David Larson thinks that when psychiatrists realize they are losing patients—and dollars—to Christian programs, there will be a strong counterreaction.

To some extent, however, psychiatrists have lost control of the situation. Few would have voted for Christian inpatient centers, but hospital administrators already have. They are more interested in the bottom line than in the ideology of psychoanalysis. So long as the Christian programs make money, show effectiveness, and don’t get sued, they are likely to grow. Psychiatrists let God in the door when they began using AA’s 12 steps in their substance-abuse programs. They will find it hard to make the case that one form of religious treatment is okay, and another is not. The only major uncertainty about the Christian clinics’ future lies in the changing payment situation. Everyone expects national health insurance to come, and no one knows how it may affect mental health. It is conceivable that governmental controls could discriminate against Christian providers.

Money Matters

Inpatient psychiatric treatment is expensive, often costing more than $1,000 a day. Does that mean Christian providers are greedy? Not necessarily. Christian providers have little control over these costs, since most of them contract with local private hospitals that do the billing. Christian providers cannot even completely control who they accept as a patient: that is negotiated among the insurer, the hospital, and the Christian company. Consumers should know that all costs are negotiable, including the cost of transportation to the clinic if it is far from home. Cost comparisons over the phone are in order. Even those who are fully insured should look at costs, since some insurance policies include a lifetime cap on payments.

None of the Big Three take indigent or uninsured patients except on very rare occasions. They can’t. The private hospitals they contract with are not for charity. Only Christian hospitals like Michigan’s Pine Rest, an older-generation, not-for-profit facility, have the freedom to include poor people in their treatment. Says Pine Rest’s Dick Houskamp, “The marks of Christian servanthood ought to reflect a willingness to reach out to people who don’t have resources. If you’re too conservative about the bottom line, you lose sight of your mission.”

Robert McGee counters that Rapha’s profit status has enabled it to grow, serving 12,000 to 14,000 patients during their six-year history. “If I did this on some kind of nonprofit basis, I’m afraid we wouldn’t have seen one-tenth that number.”

While there are legitimate questions about the profit motive in Christian psychiatric care, they are bound up with national questions about health care. As costs have risen, so have the number of people who can’t pay. The gap between haves and have-nots grows larger, and no company can close it single-handedly.

By Tim Stafford.

Reforming The Church

The leaders of Christian psychiatric clinics want to be accepted by their professional peers, and they like telling stories about secular hospital staffs that once were suspicious and have come to respect Christian programs. From the church, though, they want more than acceptance. Some of them regard psychology’s influence as nothing less than a revival.

Paul Meier, cofounder of the Minirth-Meier clinics, tells of going on radio KKLA in Los Angeles to debate pastor John MacArthur, who is an outspoken critic of psychology. Meier made himself a sign to look at throughout the broadcast. The sign read, “Remember the Oppressed.” It is the last slogan you would expect from the tall, conservative, folksy Meier, who quotes voluminously from the Bible and says he spends 20 hours a week meditating on Scripture. But it represents a very common view among Christian therapists, who see the church through the lens of their clients. Meier wanted the sign to remind him that “in all these ultra-fundamentalist churches are people suffering pain because they are too embarrassed to ask for help.”

“Denial, resistance, unmet needs,” is how Arterburn answers when asked how the church is seen through the experiences of New Life patients. “Some of the characteristics of a dysfunctional family can be seen within the church,” adds Robert McGee, founder of Rapha. “For instance, the dysfunctional family teaches the person not to feel. We tell our people not to have feelings that are destructive: anger, impure sexual desires, hopelessness, depression. If I can’t have those feelings, then I have nothing to take to God to correct. I have to cram them down and not recognize them.”

Gregg Brannan is a counselor who takes calls on the 800 number for Fred Gross, a charismatic-oriented program recently acquired by New Life. He says, “I continually see Christian callers in different states of denial. ‘The Lord is going to deliver me,’ they say.… A recurring theme is, ‘I’m not that bad.’ ”

“If you aren’t in some kind of recovery group,” says Arterburn, “you’re denying the reality of who you are. We all need to be in groups where we can say anything and receive comfort and confrontation at the same time.”

Psychologist Henry Cloud says, “The recovery movement makes for a much more biblical church than we’ve seen so far.”

There remain traditional therapists who, as Rapha’s McGee puts it, “feel they are Christian psychologists [merely] because they have the love of Jesus in their hearts.” Alan Josephson, who teaches psychiatry at the University of Georgia medical school, sees himself that way. “What is Christian psychiatry?” he asks. “Is that different from a Christian practicing psychiatry? I’ve seen myself as a Christian psychiatrist, who is sensitive to Christian experience, but I don’t feel there is enough coherence to the field to call it Christian psychiatry.” Therapy is a craft, as he sees it, that can be practiced well by anyone of any faith. He does acknowledge that the empathy and understanding between a therapist and patient who share the same faith can aid the process. And, he says, a sense of respect and caring rooted in faith may be felt by patients in Christian units.

The therapist, in Josephson’s way of thinking, has a specialty that he ought not to expand too far. “I think everybody as a Christian needs the Lord,” says Josephson. “Everybody doesn’t need a psychologist or a psychiatrist.”

Many young therapists are challenging that separation, however. They want to integrate biblical and psychological insights, creating a continuum between the everyday healing work of the church and the more intense and specialized work of the psychotherapist. Minirth-Meier’s Cloud says, “People [from our clinic] go back to church and do their program, but it doesn’t feel spiritual as they understand spiritual. We want to tell them they are doing something biblical for the first time in their lives.” His colleague John Townsend adds, “The church is moving away from spiritual answers that don’t work to biblical answers that do.… We would like to see evangelicals make a paradigm shift.” Paul Meier proclaims that good psychology is just good pastoral theology.

While there is considerable variety in the way therapists integrate faith and psychology, many of their approaches seem linked to AA’s 12 steps, which are used in virtually every Christian program. They complain that the conservative church’s approach is entirely cognitive, telling people what to believe and expecting them to act on it. Instead, says Cloud, “We need a doctrine of inability.” Rather than seeing the sinner as a person who has deliberately made wrong choices, we ought to see him as a slave to sin, unable to do what is right. “Self-control is a fruit of the Spirit,” he points out. “Biblically, choice is a fruit, not a cause.” That is an exact parallel to AA’s first step: “We admitted we were powerless.”

There are other obvious links to AA: the emphasis on small, peer-accountability groups, the stress on honesty and vulnerability, and the insistence that someone claiming not to have problems is “in denial.” Only when denial breaks down, many emphasize, can God’s grace break in.

Interestingly, few if any emphasize exorcism or healing prayers—not even in the Fred Gross treatment center, which primarily markets to charismatics. Prayer is a part of what they do, but so is medication.

Shorter Stays, Greater Needs

In his debate with Meier, pastor John MacArthur asked, “Are we saying today in effect, that, yeah, we believe that all our sufficiency is in Christ, but that work can’t start until we go to psychology?” To which Meier replied, “I don’t think you have a right to limit Christ’s sufficiency” to traditional preaching, Bible study, and prayer.

Overwhelmed by people’s personal needs, evangelical churches are increasingly open to new forms of ministry. The CHRISTIANITY TODAY survey found that more than a third of readers’ churches offer groups dealing with “depression, eating disorders, character disorders, traumatic abuse, or substance abuse.” A survey of the readers of LEADERSHIP, a journal for pastors, found between a half and three-quarters were willing to have such groups in their churches. “Most pastors I know realize we’re spitting into a forest fire,” says therapist Dave Dillman, a former pastor. The situation is in flux, but psychology and the church look to be permanent partners.

That is exactly the development many young therapists long to see. They want closer ties to churches partly because they are evangelicals, instinctively regarding the church as the most important institution in the world. They also know that their own success depends on a good rapport with pastors, who can refer or scare off patients.

A more basic reason for churches and therapists to befriend each other has to do with the patient’s need. The driving force behind the Christian clinics’ growth—shorter hospital stays, which leave empty beds—also stymies the clinics’ effectiveness. Often doctors can only medicate and stabilize the patient, not get to root causes or even lasting solutions. Psychiatrists express frustration that they must release patients who are not ready to handle the stress of their old environment.

A growing network of Christian counselors helps. A supportive, healing community in the church would help even more. The leaders of the Christian inpatient clinics want the entire church to become a therapeutic community, with clinics being a parachurch specialty for people whose problems are so intense they need full-time attention.

Will psychology and the church set up housekeeping? A generation ago that would have seemed absurd. But so would the idea of evangelical Christians taking over wings of mental hospitals. A cadre of young, confident psychotherapists had the chutzpah to accomplish that. When they talk about reforming the church, some grow irate, but nobody laughs.

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