It is the Spirit of Power who sanctifies us, so we would expect sanctification to feel like strength. But usually it feels like weakness — visceral, physical weakness. It felt that way for the apostle Paul, as 2 Corinthians 12 shows, and we expect that there are times it will feel that way for us.

No one likes physical weakness. It is, at least, a nuisance. At worst, it is a chronic and intrusive pain that leaves people imagining how death is better than life. But it is a frequent accompaniment to spiritual growth. When you generate a list of wise people — Joni Eareckson Tada comes to mind — most of them have been familiar with physical weakness.

It makes sense. Sanctification is for the needy, and physical disabilities certainly remind us that we are needy. Notice how much more we pray and ask for prayer when we have a physical weakness. That alone shows how the Spirit uses weakness in our sanctification. As a general rule, we expect that among God’s people, the more broken the vessel, the more obvious the sanctification.

When we consider examples of physical weakness, the normal suspects come to mind: cancer, any upcoming surgeries, disabilities from accidents, headaches and other chronic pains. These and many other physical struggles are too common among us. There is another category of weakness, however, that is especially relevant in our modern era, and these weaknesses are particularly confusing and sometimes marginalized in our churches. They are the ones identified by today’s psychiatry and psychiatric diagnoses.

“Sanctification is for the needy.”

Psychiatric diagnoses can be hard to understand, and ministry to those who have been labeled with a diagnosis tends to be either too cautious or too confident at a time when wise pastoral care is most needed. With this wise pastoral care in mind, this chapter will introduce psychiatric diagnoses, identify the basic theological tools to help those who identify themselves in psychiatric terms, and then illustrate what sanctification can look like in the midst of weakness.

Be Alert to Psychiatric Diagnoses

In only a few decades, psychiatrists have gone from being the lampooned stewards of asylums to being our great hope for emotional peace. The word on the street is that they have pharmacological answers for everything from the blitzes of mania to the weariness of boredom, and we hear rumors that new designer drugs might make us all a little better.

These hopes have led to a bifurcated world. In one, Scripture speaks about the eternal condition of our soul. In the other, psychiatry offers answers to our most pressing day-to-day struggles. Given this perceived division, psychiatry has become the de facto expert.

Psychiatry, of course, is not to be chastened for intruding into matters that were once the purview of Scripture. The problem is that we are unskilled at turning Scripture’s gaze onto these diagnoses in such a way that Scripture continues to meaningfully interpret all things. When you hear, “I am bipolar,” or “I am ADD,” you hear people who feel more understood by a label than by Scripture. When Scripture seems silent on such important human experiences, self-understanding becomes secular and pastoral care suffers. A goal, therefore, is to biblically interpret psychiatric diagnoses so that those who adopt such diagnoses are meaningfully known by Scripture, wisely loved by the church community, and grow in Christ.

What Is a Psychiatric Diagnosis?

Psychiatry has gradually expanded its girth to include most things in life that are hard: the emotional lows of depression and highs of mania, addictions, fears and anxieties, disordered or chaotic thought, learning disabilities, autism and Asperger’s disorder, anorexia and bulimia, cutting and self-injurious behaviors, and post-traumatic stress disorder, to name a few. Descriptions of these experiences appear in the Diagnostic and Statistical Manual (DSM-IVR) of the American Psychiatric Association (APA), and they can be found in print or on the APA website.

These descriptions aim to demarcate problems from each other and identify them rather than provide explanations. The DSM-IVR does not focus on alleged causes, and there are no clearly understood biological markers for most psychiatric problems. Those who adopt a diagnosis, however, usually assume that there are biological causes and, as a result, medicines are the premiere treatments. Given that assumption, we can understand even more why psychiatric diagnoses have become partitioned from Scripture. Scripture and pastoral care do not claim jurisdiction over medical conditions. When medical problems appear, we are content to leave them with the medical experts. As a result, sanctification becomes functionally irrelevant, and symptom relief becomes the order of the day.

Yet, even if there is a medical contribution to psychiatric diagnoses, that is not the end of Scripture’s oversight or the church’s oversight. The church must be more active when someone has a physical affliction. In the face of potentially life-dominating chronic diseases, afflicted people need a bounty of service, prayer, encouragement, and spiritual clarity. The church moves toward people who are struggling. We never simply leave them to the experts. Therefore, a rule is necessary: if someone is taking psychiatric medication, then help that person. Pastoral care should be an automatic accompaniment of medication, whether that medication is chemotherapy or Prozac.

The First Steps of Pastoral Care

A simple way to bring psychiatric diagnoses back under Scripture’s purview is to move toward those who identify with a diagnosis and ask, “How can I pray for you?”

“The church moves towards people who are suffering.”

“I know that this [diagnosis and its symptoms] is probably hard for you, so you have been on my heart. How can I pray for you?”

If you are the one who identifies with a psychiatric description, ask for prayer.

This simple step is ordinary but revolutionary. With it, you break the partition between Scripture and psychiatry. Scripture is now brought close to these problems in living, and new questions suddenly appear.

How do we pray for this? What does Scripture say is relevant? What promises of God speak directly to the person?

Symptom relief is usually the first thought. “Pray that I wouldn’t be depressed.” That is a fine way to pray, but, with any problem that might be physical, we want to add, “May your inner person be renewed day by day” (see 2 Corinthians 4:16).

You or the afflicted person may be tempted to think that a psychiatric diagnosis can stand in the way of sanctification. But sanctification is possible — assured even — among those who profess faith in Jesus. In fact, we expect that sanctification would be more obvious in the midst of these trials. We also expect that the basic resources we have in Scripture are sufficient for spiritual growth.

His divine power has granted to us all things that pertain to life and godliness, through the knowledge of him who called us to his own glory and excellence, by which he has granted to us his precious and very great promises, so that through them you may become partakers of the divine nature. (2 Peter 1:3–4)

Remember Two Basic Theological Tools

Scripture is relatively easy to access for common struggles such as fear and anger. You simply find the dozens of relevant passages in a concordance. For the more complex and modern diagnoses of psychiatry, which rarely appear in any concordance, we need other strategies. Since at this point in church history we do not anticipate discovering a previously unearthed biblical teaching that has been overlooked by pastors and biblical scholars, we look to well-known and traditional biblical teaching for guidance. Our task is to discover new applications to old truths.

We Are Embodied Souls

The first basic truth that is crammed with potential applications is this: we are embodied souls. We are created of physical and material substance, body and soul. This is the essential and simple biblical teaching that we need. The Heidelberg Catechism begins, “That I with body and soul,” in which soul overlaps with words such as spirit, mind, heart, or inner person.

The Westminster Confession of Faith states, “The bodies of men, after death, return to dust, and see corruption, but their souls, which neither die nor sleep, having an immortal subsistence, immediately return to God who gave them” (32.1). There are alternatives to this position. Some believe that we are body, soul, and spirit; others that we are body alone. These alternatives are more cumbersome to apply, but they lead to similar applications.

Application, indeed, is always in view. What is it that body and soul do? How does each contribute to the whole person? Two passages send us in the right direction:

The spirit indeed is willing, but the flesh is weak. (Matthew 26:41; Mark 14:38)

Though our outer self is wasting away, our inner self is being renewed day by day. (2 Corinthians 4:16)

The body is referred to as “flesh” and “outer self,” the soul as “spirit” and “inner self,” as well as “heart” and “mind.”

The differences between body and soul can be summarized this way: the soul is the moral epicenter of the person. In our souls or hearts, we make allegiances to ourselves and our idols or to the true God. In our souls, we follow the Lord’s commands or turn from them. The soul is called righteous or unrighteous, obedient or disobedient, willing or unwilling.

The body is our means of service in a physical world. It is never described in moral terms. Instead, it is either strong or weak. This means that though the body cannot make us sin, its weaknesses can make our lives complicated, difficult, and painful.

The resulting principle is critical: we can spiritually grow even when the body is weakened. More specifically, we can spiritually grow even when the brain is weakened or just different. Depression, bipolar disorder, and attention deficit/hyperactivity disorder (ADHD) cannot make us sin. Instead, they can be occasions for more obvious spiritual growth. This principle brings psychiatric problems back into Scripture’s domain.

With this application in hand, the next task is to enlarge our understanding of physical weaknesses. When we help those who have strengths and weaknesses similar to our own, the category of the body is less prominent, and our understanding of the details of bodily weaknesses remain implicit. We know most people can read, write, remember, make plans, finish work they set out to do, and so on.

We can adequately minister to them without knowing details of their strengths and weaknesses. The heart or soul is in the foreground, the body in the background. But there are times when we must understand the unique weaknesses and differences of others. Otherwise we will be impatient, without compassion, and miss Scripture that would be most relevant.

For example, if you plan to meet a friend at a local coffee shop in order to talk about a recent broken relationship, and the friend does not arrive on time, you could either get frustrated or remember that your friend is not able to drive because of poor vision and is dependent on the generosity of others to get to appointments. This would be an example of an obvious physical weakness. It is one that is easy to understand.

We can grow spiritually even when our bodies are afflicted.

Strengths and weaknesses of the brain are more difficult to understand. Some people are unable to judge the passing of time. Whereas most people know that it will take at least an hour to clean a kitchen, some think they can clean it before church, even though they have to leave the house in ten minutes in order to be on time. If we ignore the biblical category of strengths and weaknesses we will assume, by default, that the tardy but well-intentioned cleaner is immoral rather than a poor judge of time. One “diagnosis” will lead to frustration and conflict; the other will encourage patience and problem solving.

Consider depression. Is it possible that someone could feel emotionally down, if not emotionally dead, and that such despondency could be an expression of brain or body weaknesses? Is it sinful to feel emotionally lifeless? There are complexities to consider here.

For example, joy is commanded in the Christian life, and some might suggest that emotional deadness is in violation of that calling. Yet most Christians would agree that if someone were living with searing physical pain, we would not anticipate an exuberant display of joy. Instead, we would pray for grace in the midst of weakness, and that grace might be expressed in simply enduring pain, with few or no visible manifestations of joy, while still believing that God hears and is near.

Now add to the list. Weaknesses could include the physical experience of panic, hallucinations, disrupted sleep, poor memory, physical agitation, a mind that races from one thing to another, or an inability to make useful and practical plans.

Skillful parents are naturals at seeing their children as embodied souls. They do not excuse sin in their children, but they understand that each child has particular strengths and weaknesses, and the child who is always making a mess might be highly tactile and feels most comfortable when feeling certain textures. Such parents do not immediately identify personal inconveniences as disobedience. Instead, as careful students of children, they work to distinguish between immaturity (i.e., inability) and disobedience. With psychiatric problems, our aim is to bring these same skills to adult relationships.

We Experience Trouble and Hardship

The other theological tool needed to minister wisely and lovingly is a theology of hardships and suffering. The problems of life cluster around sin, suffering, or both. If there are brain or body weaknesses in psychiatric problems, then we need access to God’s good and comforting words to those who suffer.

We also need those words for their families and friends. Imagine having a gifted and engaging son who begins withdrawing in his late teens. As he begins to shed relationships, work, and education, he becomes increasingly eccentric, then bizarre, then incomprehensible. The parents feel like they are losing their relationship with their son, they have no idea how to help, they are watching his life fall apart, and they receive solicited and unsolicited advice that often implies their culpability in what is happening. A theology of suffering will extend to both the son and the family.

The Christian church has a burgeoning cache of good books on suffering, though we still have blatant shortcomings in our ministry to sufferers, as many sufferers can attest. Among the important teachings, three stand out.

1. God has revealed himself as the compassionate one (Exodus 34:6). He is moved by the suffering of his people.
2. After the death and resurrection of Jesus, we can no longer think that our suffering is a consequence of our personal sin (unless the link is obvious). Though Job’s story should have been all we needed to hear, the death and suffering of the perfect one suggests just the opposite: the best are the ones who suffer.
3. Suffering tends to turn us inward. Instead, the Psalms remind us that suffering is a time to speak openly from our hearts to the God who hears.

Understanding Complicated People

Equipped with these basic tools, along with a working knowledge of the doctrine of sanctification, we move toward those whose problems have been labeled in psychiatric categories and work to understand them. The simple purpose in knowing them is to encourage and help in their spiritual growth. The better we understand someone, the more appropriate and meaningful our help can be. But there is more.

With many people, knowing them helps them. To be known is helpful in itself. If you have felt misunderstood and marginalized for most of your life, and someone takes the time to know you and actually understand you, you will be blessed. Knowing and being known is a distinctive of the kingdom of heaven. It leads to unity, which is rightly prized and enjoyed by God’s people. In other words, the Spirit can use the simple act of knowing someone as a means of spiritual growth. But there is more.

People have cried when the DSM initially identified them. They found relief, even something close to joy, in finally having words for their struggle. They found comfort, though the instrument was only a definition on a website. We can understand how this could happen to a person who has long been misunderstood, but we might not foresee the consequences.

As a general rule, whoever understands you best will have the most influence. The person who cried at the definition of ADHD never cried in church but felt that she was a misfit among normal people. As such, she will still attend church, but psychiatric ways of thinking will guide her life, and psychiatric answers will gradually become her hope. The stakes in understanding people, indeed, are higher than we realize.

With many people, truly knowing them is a help in itself.

With this in mind, here are some complicated people we want to understand. All of them are also taking prescribed, psychiatric medications. Try to put yourself in the position of pastor or wise friend and consider what you would say as you encourage and guide them in their Christian growth.

Attention-Deficit/Hyperactivity Disorder

Do people even have a psychiatric disorder? Rather than thinking in terms of yes or no, it is more useful to think more or less.

Jane had more of a psychiatric disorder.

“I’ll be home in an hour.”

She was going to pick up some vegetables for dinner at a nearby store. Her husband usually made dinner, but she wanted to bless him and give him the night off. She was not certain what she would get, and she had not yet decided what else she would make for dinner. Just something simple. The children were grown. There was no need for anything elaborate. It was just her husband and herself.

Most people would budget about 20 minutes for the errand, but Jane knew she usually underestimated how long she took to accomplish anything, so she doubled a realistic estimate and rounded it off on the high side. That was an excellent start.

Five hours later she walked in the door, apologizing, berating herself before her husband did, sad that she had missed the impromptu dinner her husband had made and eaten, and mortified that she had done it all again.

She had left the house committed to a straight line — home to store and back. But she had left the house, noticed that an office supply store was having a great sale on Christmas cards, and, always wanting to be careful with money, even though it was August, she went and bought some cards. The cards reminded her that she needed to buy a birthday present for her niece’s upcoming party. Since she was already out, she drove to a toy store in a neighboring town and, after much deliberation, decided on three presents. She was now two and a half hours into her trip.

With rush hour bearing down, she took a detour that pointed her farther from home but in the general direction of her close friend’s house. This friend had recently shared how her life was overwhelming, so Jane stopped by to pray with her. While there, they cleaned up the kitchen until it started to get dark, when Jane suddenly realized that she needed to get home. After being ticketed for making an abrupt turn that disrupted traffic, she finally walked in the house, without the vegetables. Elapsed time: five hours, ten minutes. Ticket: $73.50.

With the exception of her husband, everyone loves Jane. She is selfless and never distracted when she is with you, as if you are the only person in the world. An indefatigable worker, she is an amazing deaconess. Everyone loves her, but they might not want to live with her, and they certainly would not hire her for anything that demands organization.

Her home is disheveled. Papers are everywhere. No one remembers the last time the dining room table was used for anything but piles.

Her husband just rolls his eyes. Between the occasional angry rants and condemning remarks, which friends and family rarely hear, he is civil but distant. Family members think he is a saint.

If we were to walk alongside Jane, the course of sanctification would begin with understanding her, which would mean seeing her through the lenses of Scripture. In some situations, ministry is straightforward. There is sin or suffering. When there are both, as there inevitably are, we make pastoral judgments about what is most prominent. But there are other situations in which our understanding might be blurred or myopic. This is not the fault of Scripture; the shortcomings are with us.

At first, we might see Jane through the lenses of “Let what you say be simply ‘Yes’ or ‘No’” (Matthew 5:37). Jane said one thing to her husband and did another. It is a form of lying. But lying is typically intentional, and Jane is not trying to deceive. Sadly, if the embodied soul is absent from our biblical lenses, we might not see anything else.

When considering her as embodied, we immediately become more patient, which suggests that we are on the right track.

“Jane, help me to understand what you were thinking when you left the house. These extended errands have happened before. You have left for one item and come back hours later with merchandise but not with what you planned to get.”

Jane cannot even answer through her sobs.

Planning and keeping multiple tasks in mind are abilities we take for granted, unless we are very poor planners and can be easily sidetracked. Jane is wretched at linear sequencing and can be distracted to the point where she barely remembers her original plan. Her distractions are good things — saving money, praying with a friend — but they make her life chaotic.

When my own daughters were young, we had a rule that they clean their room each Saturday. On most Saturdays my wife or I would check in on them after not hearing much for a few hours, and we usually found the room in its feral state.

Why? They found a treasured toy under the mess or perhaps a good book, and they became engrossed in what they found.

Sinful? Certainly not. We gave them no deadlines for finishing their cleaning. We were usually amused by how easily they were distracted; sometimes we would help them with the job because they had difficulty knowing where to start.

With children we expect such things, but, with adults, we expect them to be just like us. If we could get to the store and back in an hour, so can everyone else. If we can clean a bedroom without stopping every minute to enjoy a rediscovered friend, so can everyone else. And we will get frustrated with those who violate our standards.

“Jane, it must be so difficult to feel like you fail at everything. With each new incident you probably feel more and more hopeless. Do you have any ideas on how I could help?”

Then Jane cries because someone understands.

Depression

Susan, married with two boys, has been depressed for twenty-three of her forty years. Depression is rarely constant, unending misery. Susan has had times when she was less depressed and times when she was more, and the fluctuations loosely followed a yearly pattern, but she is hard-pressed to identify a day that has been depression-free.

She describes depression as both internal death and massive agitation, as if she will explode if she does not escape or do something. Failure, hopelessness, and suicidal thoughts are daily companions.

She speaks at least weekly with a fine counselor who is compassionate and, as far as you know, directs her attention to Scripture and Jesus. Susan considers the counselor’s help to be a lifeline. She thinks she would be dead without her. She also sees a psychiatrist and has tried most every variation of anti-depressant medication possible.

Let’s say you have a friendly relationship with Susan. You know she struggles with depression, and you sometimes pray with her, but you usually leave ministry to the experts. You have become more involved recently because of an emergency call she made to the church, and the church staff alerted you to Susan’s recent downturn.

“Be patient with them all” (1 Thessalonians 5:14). You listen and discover that she is, indeed, in extremis. Since there are others who also know her and would make decisions on hospitalization, you are free from those challenges and can focus your attention on understanding her, praying for her, and searching for encouraging words to give her.

She is agitated. She does not know what she wants or needs. When you move toward Scripture, she ignores you. When you do it again she gets frustrated.

“Can’t you see what’s happening? I don’t want to hear the Bible!”

You ask her if you have misunderstood her pain or said anything offensive, and she calms down momentarily, but it becomes clear that she gets more agitated when you offer biblical truth.

As you try to understand her with the category of the embodied soul, you believe that depression could be a hard suffering that can appear for no apparent reason. Spurgeon said from personal experience, “You may be surrounded with all the comforts of life, and yet be in wretchedness more gloomy than death if the spirits be depressed. You may have no outward cause whatever for sorrow, and yet in the mind be dejected, the brightest sunshine will not relieve your gloom” (Elizabeth R. Skoglund, Bright Days, Dark Nights with Charles Spurgeon in Triumph over Emotional Pain [Baker, 2000], 69). Depression can come from disordered bodies. The feeling of depression does not violate the commands of God.

Disordered bodies, however, are not powerful enough to make us indifferent or antagonistic to Scripture. Our response to God’s Word is a spiritual matter. But now is not the time to press this issue with Susan. Your relationship has been stretched, and you do not want it to break. So you listen and consider deeds that might encourage her, such as simply spending time with her when she feels most vulnerable and helping her around the house. You will revisit the spiritual matters when you think she can hear them.

Panic Attacks

Steve always had a tendency toward anxiety. He preferred routines and, at forty-five and single, with the same job for twenty years, he was able to maintain a relatively predictable life. When faced with situations in which he was unprepared or that were simply new, he would sometimes notice physical symptoms such as sweating and increased heart rate, but he would endure through them with only close friends noticing his tension.

About seven years ago, he was challenged to spiritually grapple with his anxieties rather than manage them, and he took that counsel seriously. He studied Scripture on anxiety and fear and read good books on both a biblical way of handling anxiety and general Christian growth. He shared his struggles with good friends and church elders and was quick to ask for prayer.

His growth was obvious. We all have our areas of struggle, and Steve would always have to keep an eye out for encroaching anxieties, but anxiety was instrumental in his sanctification. That’s why he was shocked when he had his first panic attack.

He was out for dinner with some dear friends. The food was good and the conversation edifying. Then he noticed a visceral sensation that seemed to start in his stomach and go to his chest. Within a few seconds he felt unable to breathe. He excused himself from the table, walked out of the restaurant and leaned against a nearby tree expecting to die from either not being able to breathe or a heart attack. The episode was so intense that he started vomiting, as if his body were mobilized for nuclear attack.

By the time one of his friends came out, the episode had subsided, but he asked his friend to drive him to a nearby emergency room. The physician ran a battery of tests and identified his experience as a panic attack. He wrote Steve a prescription for an antianxiety drug, which Steve has been taking.

If you have one panic attack, you often have more. Steve began having panic attacks about once a month, almost always at times when he was relaxed — watching a movie, running an errand on the weekend, getting ready for church. He assumed this meant that he had been a failure in dealing with his anxieties. His spiritual attentiveness must have been a sham. He wondered what the Lord was trying to say to him about deep sins to which he was blind. He asks you for help.

Your first question seeks details about these assaults.

“Tell me more about your recent panic attack. Help me to understand what it is like for you and what you are thinking.”

The story Steve tells could be imposed on almost all his episodes. It begins when he feels fine; sometimes he is with people and sometimes he is alone. He notices a rising discomfort, a sense of foreboding and being trapped. These give way to palpitations, which feel like his heart cannot withstand the force, and difficulty getting his breath. And his first thought is always the same.

“Jesus, help me. Rescue me.”

The attack usually subsides within 5 to 10 minutes and leaves him physically exhausted.

When you ask him if there are any particular pressures in his life, he identifies work as an ongoing challenge. He has good relationships with coworkers, but the job has deadlines and little margin for error, and he feels as though it is best suited to people younger and more ambitious than him.

We could easily leave the category of the embodied soul on the shelf with Steve. Anxiety seems to be solely a spiritual matter that is clearly addressed in Scripture. So we patiently pound away with verses he has already studied. Steve is open and willing to be taught, so he will appreciate what you give him. But you would be seeing him in only one dimension if that was your approach. A theology of the embodied soul will allow you to see him more clearly, and it will point him in encouraging directions.

Consider this: is it possible that the physical manifestations of panic are, in fact, physical? They could be triggered by spiritual anxieties, but is it possible that the body, at times, can have a mind of its own? Could Steve tell his body that all is well, there is rest in Jesus, but his body does not get the message? To opt for a careful interpretation, we could say that panic attacks are at least physical. They might have spiritual contributions.

When you zero in on matters of the heart with Steve, you find sheer beauty. Perhaps the pinnacle of Christian living is, “Jesus, help.” It is a resounding statement of both our need and the reigning of Jesus’s strength. If we assume that sanctification looks like strength, then we will miss Steve’s childlike and exemplary faith. If we look for strength in weakness, Steve becomes, along with tax collectors and the woman caught in sin, one of our heroes.

Helping Them Grow in Christ

One of the most difficult tasks in ministry is to accurately know another person. When the other person is similar to us, we can make assumptions. But the more complex the problems, the more our assumptions will miss the mark. We want to carefully understand the person, which means that we want the other person to feel understood. Then we can take the next steps of sanctification.

Attention-Deficit/Hyperactivity Disorder

“Jane, this is what I understand so far. You are an amazing servant. You love people and are quick to help. If I need someone to pray for me, you are one of the ones I would call. You bless people and are sincere in your desire to follow Jesus. But life is so hard for you, and it is hard for your husband too. Your best-laid plans are replaced by what attracts your attention at the moment. Life can feel random and chaotic.”

Notice how this summary identifies both spiritual and physical realities.

“Jane, the short version is that you feel like a complete failure. Everything you do seems to go wrong. You get jobs, people love your work, then lateness and distraction get you fired, even though most of your employers hate to fire you. Now you are starting to lose hope. With each new failure, you get more depressed, and there are probably times when you believe everyone would be better off without you.”

It turns out that Jane has had suicidal thoughts at times. When they come, she fights them off with faith.

Her marriage is, at best, two people living parallel lives. Her husband has withdrawn. He has had enough of her saying one thing and doing another. So you meet with them together.

He is calm and careful when you meet. He does not think anything will come of another person’s getting involved. He seems to be going through the motions. He has had enough of ADHD being blamed for everything.

“Perhaps the pinnacle of Christian living is, ‘Jesus help.’”

You try to point out two things to him. First, there are praiseworthy qualities in his wife. She does the most important things very well: she loves God and loves others. Second, her life is, indeed, very disordered and hard to understand. If he is to grow in patience, he must know her even better. To this end, you ask her if she has access to an article or book that puts words on her inner world. You ask because you wonder if they could go through such material together.

Someone else already made that suggestion, and Jane has two books ready to go. She has had two books for the past four years, but her husband has never quite found the time to read them with her, and he does not seem to be motivated now either.

The marriage is tattered. Quick fixes will be meaningless. You soon realize that faithful encouragement and prayer will be what they need most. At some point, you hope to talk about forgiveness with the husband, but at this point, the more you say, the less he hears, so you leave it for another time.

You aim for small steps. Could they agree to focus on one task? It could be getting to small group on time, laundry, or making the dining room useable. You only want them to agree.

After some discussion, they settle on the dining room. Since she has tried and failed on that job so often, you ask what might help. She immediately says, “If I had someone who could work with me — who could help me decide what to do with some of the papers and clutter — that would keep me on task.” So you generate a list of names with her, and you call the women on the list. You fear that the process could take months if she makes the calls herself.

Two women are eager to help. So you set up a schedule for each to come once a week for a few hours. Every once in a while, the dining room table is in view, but it slowly reverts to its previous state if one of the women is unavailable.

After a few months, the marriage is essentially unchanged. Her husband has said he will read with her but has not. He seems angry, but it comes out in niceness without follow-through. (He has a profession of faith, though little involvement in church, which means you have no other appeal for help.)

So you focus on Jane, because she is eager for help, and you focus on those things that are most important. You try to distinguish between disability and sin. Her sin, of course, is the more important of the two.

She is quick to confess anger toward her husband (she acknowledges that some of her behavior is from both her distractibility and her anger), lack of love for being indifferent to how difficult her inconsistency has been for him, and even occasional turning away from the Lord when she blames him for her weaknesses. And her confession is with tears and a desire for the Spirit to search her heart. This is another way she blesses you in her weakness.

You try to think creatively with her. You set alarms, generate to-do lists, and place them in a place where she will actually walk into them. These and other ideas help, but they rarely initiate new habits.

Then you turn again to those things that are most important. You ask her what she is learning from Scripture, how she is loving her husband, how she is vigilant with anger, and you pray together. Her prayers are wonderful.

Meanwhile, the marriage sputters along, she is late as often as she is on time, and it might look as if little has changed. But she is, indeed, being sanctified. She is ashamed of her many weaknesses but sees them more and more as opportunities to rely on Jesus rather than on herself. She confesses her sin to her husband, even when he is distant and uninvolved. She prays without ceasing. She is finding rest in Jesus (Matthew 11:28–30). And, every once in a while, usually when she is serving someone else, you see joy.

It is not the transformation that some would like to see. It is endurance, which is arguably that most elegant expression of the Spirit’s power. God is the God of perseverance, endurance, and patience (e.g., Psalm 69:7; 2 Thessalonians 3:5), and when we see those character qualities in other people, we are seeing the holiness of God on display.

Depression

Susan’s depression is a mystery. Why has it stalked her for most of her life? What are its causes? Why has medication never really helped? With these and other questions, you have less reason to pursue her. If the experts do not have answers, you certainly will not.

New Testament ministry, however, is not dependent on in-depth knowledge of suffering and its causes. Both sin and suffering ultimately have reasons that are veiled to us, but we have all we need for sanctification even when questions remain.

The body cannot make us sin.

The body cannot separate us from Jesus and growing in him.

These can get us started.

When friends are taking psychiatric medication, we walk along with and care for them. They are saying that something is hard, and Scripture speaks clearly into those times of trials. So you continue to move toward Susan and love her wisely.

“Susan, sometimes depression seems like an invisible foe with whom it is impossible to fight. At those times, we know that God is doing something, and we probably don’t have to look too hard to see it. Notice how agitation comes out when your depression is intense. Agitation is akin to frustration and anger, and those are things we can do something about. Do you remember when you got angry with me for talking about Scripture? Your depression has anger in it, and sometimes that anger pushes God away.”

Depression can be so concerned with symptom relief that it misses larger spiritual realities. That is, any form of suffering is a test and trial that reveals our hearts (Deuteronomy 8:2–3; James 1:2–4). Will Susan trust the Lord even in great distress? Will Susan endure by faith when life is hard?

Therefore, since we are surrounded by so great a cloud of witnesses, let us also lay aside every weight, and sin which clings so closely, and let us run with endurance the race that is set before us, looking to Jesus, the founder and perfecter of our faith, who for the joy that was set before him endured the cross, despising the shame, and is seated at the right hand of the throne of God. Consider him who endured from sinners such hostility against himself, so that you may not grow weary or fainthearted. In your struggle against sin you have not yet resisted to the point of shedding your blood. (Hebrews 12:1–4)

This text is rarely applied to depression, but when depression is interpreted as human suffering, which includes all types of causes, Susan is brought into Hebrews and so many other passages. Scripture is no longer silent. Her goal, along with like-minded sufferers in the history of the church, is to stand by faith. By faith Susan can hold on to the promises of God in the midst of hardship (Hebrews 11:4).

As with all of us, Susan’s clinging sins tend to be exposed in her suffering. We can believe that we are good Christians until suffering reveals that we are fair-weather friends. When God gives us what we want, we worship him. When he does not, we grumble, complain, and turn away, and all these reactions amount to holding God in contempt (Number 14:11). We are essentially saying, What have you done for me recently?

Susan took these words to heart and confessed her sin to the Lord. She confessed that she had stood over her Lord in judgment rather than under his love in humility. She confessed her entitlement — she thought she deserved relief. Confession is an unmistakable evidence of the work of the Spirit. Confession is power in weakness.

Susan’s depression did not suddenly disappear. It continued to wax and wane in her life, still reaching crescendos at certain times of the year. But during those darker times, she would ask others for prayer and encouragement from Scripture.

This is strength in weakness. This is Susan’s inner person being renewed even during hardships.

Panic Attacks

With Steve, your pastoral care is easy. You simply enjoy how he follows in the tradition of the psalmists.

In my distress I called upon the Lord; to my God I cried for help. (Psalm 18:6)

Hear, O Lord, and be merciful to me! O Lord, be my helper! (Psalm 30:10)

God is our refuge and strength, a very present help in trouble. (Psalm 46:1)

Your enjoyment will bless him. All Steve can see is his weakness, and he attributes those weaknesses to specific, yet-to-be-discovered sins. He is startled to find that his panic attacks have been occasions where he walked closely in the steps of the Suffering Servant.

“Confession is power in weakness.”

He also redoubles his efforts in resting in Jesus. He chooses Matthew 11:28–30 for meditation.

Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.

His previous work in Scripture focused on trust as fear’s opposite. Now he wants to learn how trust can be expressed in rest.

The most obvious change in him is how open he is with his panic attacks. Rather than being a source of shame, as they once were, they are now a way to be strengthened in weakness, and he wants others to know. In this, he continues in the tradition of the psalmists who were vocal about their hope in the Lord’s power and love.

O Israel, hope in the Lord! For with the Lord there is steadfast love, and with him is plentiful redemption. (Psalm 130:7)

As he was open about his own struggle, he was surprised to discover how many Christians also experienced panic attacks but were too ashamed to speak about them.

Steve has noticed that the panic attacks are now less frequent and less intense, but he mentions those things in passing. The change in his weakness is less important to him than the changes in his soul.

Acting the Miracle

We have come to expect certain things from Scripture. When confronted with complicated problems, Scripture will not minimize those complexities; it will provide insight that goes deeper than any approach that neglects its gaze, and it will respond with simple and clear direction. When considering psychiatric problems, Scripture delivers on those expectations. The primary tool that needs dusting off is teaching about the embodied soul.

The hard work is in the appropriate and skillful application of this teaching. Some parents are especially gifted at distinguishing morality and mental abilities, and they supplement those gifts with broad reading and humble questions. Some elementary school teachers intuitively understand that “bad” kids are sometimes different kids, and the differences reside in the child’s strengths and weaknesses. Talented teachers understand both the moral (good and bad) and physical (strengths and weaknesses). Many of us are clumsy in these matters. All of us can grow in more skillful application.

In this chapter we have followed three different adults, each with difficult though relatively common psychiatric diagnoses, and brought them back under Scripture’s domain. The result was not so much that psychiatric symptoms subsided but that sanctification became central.

The result was strength in weakness as inconspicuous saints were being prepared by their affliction for “an eternal weight of glory beyond all comparison” (2 Corinthians 4:17).