Chapter 10: The Therapeutic Opportunity of the Clergyman and the Congregation by James A. Knight
There is no institution more community-centered than the church. The church’s capacity to involve itself in every aspect of community life has served as a model for the development of certain aspects of the community mental health centers. There has been a growing awareness that the effective church has identified with the total culture of a community and all of its people. Her history has shown involvement and identification with poverty, discrimination, illness, loneliness, imprisonment, persecution, as well as with wholeness.
In the Judeo-Christian tradition, the church has never separated its message of salvation from its concern for concrete service to human beings, including the healing of sickness. At present, community mental health brings a new set of challenges and possibilities to the church. Cooperative efforts of the church and the community mental health center will bring about a better utilization of the new healing powers and methods available for dealing with human ills.
McNeill in A History of the Cure of Souls mentions that one of the difficulties in the effective correlation of "religious and scientific psychotherapy" has been the lack of the institutional means of cooperation. (John T. McNeill, A History of the Cure of Souls [New York, Harper, 1951] , p. 322). The comprehensive community mental health centers, to a large extent, may furnish the institutional means and thus provide a new pathway to cooperation.
Community mental health programs are being built on the concept of a necessity for an integrated fabric of mental health services in which all the available and appropriate resources of the community are mobilized for prevention, diagnosis, treatment, and rehabilitation of mental and emotional disorders. The focus is on the community where the individual, regardless of age or socioeconomic status, quickly and easily can obtain the services needed without transferring to institutions located in other communities.
In the development of the comprehensive mental health center, the entire community is being involved in identifying and taking action with respect to its own problems. The emphasis is on cooperative and collaborative work among the various groups in the community to the end that they may develop the capacity to work together in dealing with mental health problems. There is increasing attention to the concept that mental health and mental illness can be best understood when there is focus upon the relationship between the individual and the community in which he lives. The centers are not to be just central repositories of professional skills, waiting passively for patients to appear, but will reach out to identify illness in all its psychic and social variants and bring it within the centers’ therapeutic orbit through consultative, educational, and preventive efforts.
The clergyman is related to the field of community mental health primarily on three levels: promotional, supportive, and therapeutic. Through recreational, social, and family education programs, he helps promote and maintain mental health.
Through pastoral care and counseling, the clergyman functions in a supportive or sustaining role, and often a therapeutic one. Such a ministry is geared toward early help with minor emotional disturbances, crisis situations, parent-child relationships, and critical life experiences such as birth, death, illness, marriage, school, and work adjustment. Most of our population can be classified in the essentially well group. Often, however, even the healthy person may be in need of practical mental health information and assistance. If the person gets help during crisis periods in his life, a chronic disturbance may be avoided. Caplan has shown that the poor handling of a life crisis often sets the stage for a more inadequate handling of the next crisis by the individual.(James A. Knight and Winborn E. Davis, A Manual for the Comprehensive Mental Health Clinic[Springfield, Ill.: Charles C. Thomas, 1964]) Thus, the path of breakdown may begin with a poorly handled crisis.
In the configuration of mental health services in the community, efforts are made to identify the clergyman’s therapeutic skills. He can provide spiritual support to emotionally disturbed people in times of stress and crisis; counsel on religious matters, applying all the psychological insight at his disposal; listen and identify cases with problems outside the religious framework, and refer them to proper community resources; counsel on personal or interpersonal problems with little emotional content if his training in pastoral counseling is limited; counsel persons with more serious mental and emotional problems if he has had training in clinical practice under expert supervision.
A clergyman’s degree of effectiveness in counseling will depend, to a considerable extent, upon his ability to relate to people; his sensitivity and insight in recognizing the nature of the problem; his non-judgmental acceptance of the person in distress; and his knowledge of whether, when, and where to involve other helping resources.
The complex and flexible nature of the community mental health program calls for fully trained persons in all disciplines. Comparable competency among the professions helps dissolve artificial hierarchies and helps relate responsibility to talent. (Gerald Caplan, An Approach to Community Mental Health [New York: Grune & Stratton, 1961]) The diversity of local demands and problems underscores ability and accomplishment more than professional background. Particular abilities and talents do not necessarily follow professional stereotypes in hierarchical fashion, nor should functions in mental health programs be rigidly defined by profession. Commendably, there has been less strict division of rules and responsibilities among professions in this type of program because generalization is frequently required on the part of the staff.
The congregation is an instrument of therapy. The message in the Gospels discloses that an intimate relationship was taken for granted between physical, mental, moral, and religious health. Incidents are recorded in which a physical affliction was healed and sins were forgiven in one and the same act. Nobody attempted to split human health into a multiplicity of functions, and likewise nobody attempted to promote the welfare of one individual in abstraction from the salvation of the community. Each person saw and felt the spirit of God working through the religious community and knew himself to be a part of the priesthood of all believers.
In the Gospels of the New Testament more attention is devoted to the healing ministry of Jesus than to any other subject except the passion story of the last week of Jesus’ earthly life. One may ponder why the art and practice of healing, central to the biblical record, has until recent times been peripheral to theological education and to the central concerns of the organized church.
In studying the biblical healing stories one discovers several basic conditions operative in almost all the cases described. Among these, none is more appropriate for emphasis in a discussion of community mental health than the observation that healing seems to have taken place almost invariably in some corporate context. An example of this is the story of the sick man who had to be let down through the roof into the room Jesus occupied because the door was blocked by large numbers of people (Mark 2:1-5) It is significant that apparently the friends and not the patient himself sought the healing and had the expectant trust. The group atmosphere in the New Testament healing episodes was a most significant factor in the preparation and support of the healing process. In the life of the early church, where healing became more and more associated with the corporate worship and the sacramental life of the believing community, the element of group atmosphere became a factor of major importance.
The implications of this are obvious for the pastor who opens channels of communication between his church and the mental health center. A neglected area of church activity is the use of the congregation as an instrument of therapy. The church as a therapeutic and redemptive community can have profound influence upon the health of the individual and the group. It would not be difficult to show how the congregation could function in a variety of healing capacities. Consider what a great force the congregation would be if it functioned with the devotion and dedication of Alcoholics Anonymous, for the group life in this organization is similar to the group life which the church could furnish to many people with a variety of problems and illnesses.
The mental patient is lonely and isolated, desperately needing to feel a sense of community with others. The congregation has within its very structure the ability to heal his isolation, to rescue the alcoholic, to answer the cry for help of the suicide candidate, to give direction and fellowship to the adolescent. The church also has a great opportunity with the "marginal" person who is living on the edge of life and who is in danger of dropping out of his family and out of society. By recognizing the "marginal" individual and including him in its group life, the church may well ‘‘rescue" him who lives on the borderline between sickness and health. Also, the church can function as one of the finest stabilizing forces for senior citizens, providing a sense of purpose and significance to their lives and incorporating them meaningfully and creatively into the religious group life of the church and community. And above all, as the individual in psychotherapy moves from an analysis of his condition to a synthesis regarding his value system, he runs head on into the religious question. He often turns to the church, especially if encouraged to do so, to explore fundamental questions related to the nature and destiny of man and his ever-present existential anxiety and guilt.
In the church one finds many people who have suffered severe adversities. Some have healed scars; others have open wounds. Often there is healing in these people as beautifully illustrated in Thornton Wilder’s one act play, The Angel That Troubled the Waters, based on the biblical story of John 5:1-4. The play tells of a physician who comes periodically to the pool of Bethesda, hoping to be the first in the water and healed of his remorse when the angel appears and troubles the water. Everybody at the pool also hopes to be the first in the water and thereby healed of his malady. The angel appears but blocks the physician at the moment he is ready to step into the pool and be healed.
Angel: "Draw back, physician, this moment is not for you."
Physician: "Angelic visitor, I pray thee, listen to my prayer.
Angel: "Healing is not for you."
Physician: "Surely, surely, the angels are wise. Surely, O Prince, you are not deceived by my apparent wholeness. Your eyes can see the nets in which my wings are caught; the sin into which all my endeavors sink half-performed cannot be concealed from you."
Angel: "I know."
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Physician: "Oh, in such an hour was I born, and doubly fearful to me is the flaw in my heart. Must I drag my shame, Prince and Singer, all my days more bowed than my neighbor?"
Angel: "Without your wound where would your power be? It is your very remorse that makes your low voice tremble into the hearts of men. The very angels themselves cannot persuade the wretched and blundering children on earth as can one human being broken on the wheels of living. In Love’s service only the wounded soldiers can serve. Draw back." (Thornton Wilder, The Angel That Troubled the Waters, and Other Plays [New York: Coward-McCann, 1928] , pp. 147 ff).
The person who was healed rejoiced in his good fortune and turned to the physician before leaving and said: "But come with me first, an hour only, to my home. My son is lost in dark thoughts. I — I do not understand him, and only you have ever lifted his mood. Only an hour . . . my daughter, since her child has died, sits in the shadow. She will not listen to us."(Ibid.,p. 149)
Since mental health planning authorities foresee every geographic area in the country being served by a comprehensive center, the opportunities for collaborative endeavor now exist. The pastor should get involved in the activities of the center and become a part of its leadership. He should spell out in some detail what he would like from the center, what the mental health needs of his people are, what training and educational experience he would like to receive, his ideas of cooperative projects between his church and the center, and the time and talents he has to offer. A clergy consultation service is already evolving as an important function of the mental health center, and such a program should not be overlooked in planning.
Remember that the pastor and the staff members of a center have something very much in common in that they are all submerged in the immediacy of caring for a host of broken or potentially broken people. The community center is not a theoretical ivory tower where hairs are split lovingly, but is primarily a clinical setting where the delivery of specific services takes place.
As for reading material, the Director of the National Institute of Mental Health will send on request a packet of the latest material on comprehensive centers. If particular areas of interest are pinpointed for the Director, an effort will be made to send material dealing specifically with one’s interests.