Chapter 25: Training Church Laymen as Community Mental Workers by Charles W. Stewart
While I was serving as a parish pastor and mental hospital chaplain, a man came to the church office to see me. He told me of hearing voices and having some feelings of their religious significance. He was on the verge of a psychotic breakdown. That man went to a mental hospital, and I visited him there. He was deathly afraid of being there, for one of his brothers had died in such a place. He was afraid of what his neighbors would think of him when he returned and he was insecure about his wife and family when he was there. Six months later he returned to the community, and he came to church for the first time in years. How he was welcomed made a big difference in how he felt about himself. Fortunately there were some people who worked at that hospital and had prepared the others for his return. He was invited to the men’s club work night at the church. His family was made to feel welcome after their long absence from the church. That laymen’s group did many of the right things to help the returnee from the hospital. But they could just as easily have turned a cold shoulder to this man and his family. If he encounters such rejection a mental patient may not make it outside the protecting walls of the hospital.
Health, Salvation, and Community: The church is one of the institutions in our society manned mainly by volunteers, volunteers who have a working faith about health and community. They should be on the forefront of community mental health efforts. Unfortunately, parochial endeavors, lack of concern, and insufficient training have militated against laymen getting involved in this most important work. What I propose to do here is to set down the working faith which the Christian tradition has about health and community; to list some of the pioneer areas where church-related community mental health programs are operating; to outline one such project in order to illustrate the design and plan of such training; and finally to suggest action steps and resources for those interested in going further.
"The specific character of the Christian understanding of healing and health arises from its place in the whole Christian belief about God’s plan of salvation for mankind," wrote the draftsmen of the Tübingen conference on the Healing Church. Health is not the absence of illness or the simple adjustment of the individual to the pressures of his society; rather, health is the presence of new being -- physical, emotional, and spiritual -- which enables the individual to become the self his creator intended him to be. This is revealed in the "mature manhood" of Jesus Christ (his life, death, and resurrection) , since he overcame the confusion, anxiety, and division within man’s nature. The Kingdom of God is the community of those whose wholeness is found in Jesus Christ and who as his servants seek to hind up the brokenness of mankind.
Health is found in community, therefore, and the Christian community is the central agent of pastoral care with a specific healing ministry. It has certain characteristics which fit it for its role in Christian healing, says John Wilkinson. First of all, the congregation is the fellowship of love where mutual concern and interest are expressions of love of the brethren. This can lead to great incentive to recovery from sickness. Second, the congregation is a fellowship of worship. Here is an emphasis on the reality and presence of God, the physician of his people. Through the ministry of word and sacrament we are brought into healing contact with God. Third, it is a fellowship of reconciliation. Those who find forgiveness are restored to that fellowship with God and find the aim and completion of all Christian healing. Such reconciliation has a tremendous therapeutic force. Finally, the congregation is a fellowship of prayer. Prayer is one of the most potent forces in the world. Even if the congregation can do nothing else for the sick, it can pray for them.
Opportunities for Laymen: With such a dynamic understanding of health, salvation, and community, what may laymen do to move into the forefront of the community mental health revolution? The professionalizing of the pastoral counselor may cause some ministers to feel that this is their business and laymen had best remain behind to do the housework of running the parish. Laymen may have been intimidated by psychiatrists and mental health workers because of their frightening jargon, diagnostic skill, and therapeutic know-how. However, the new insights into mental illness, as recorded in this volume, show us that patients get well in the community and among the people they know best -- their family, co-workers, and friends. And it is this lay group which must provide the climate and the therapeutic milieu in which the restorative, and more importantly the preventative, work goes on. The community mental health effort is, therefore, a lay effort and requires committed Christian laymen at the center of the movement.
There are certain lay-led efforts which point the direction the church must take. Of longest duration are the groups organized in England for at least two decades -- the Marriage Guidance Council (For a description of the Marriage Guidance Council, see Chapter 35). and the Samaritans. The Samaritans, organized by Chad Varah in 1953, began as a suicide prevention center in the heart of London at St. Stephen’s church. It has spread to over ninety centers in England, Europe, Africa, and Asia. The organization begins with a telephone answering center manned for twenty-four hours a day, seven days a week. There are laymen who undergo certain basic training in guidance of potentially suicidal persons. Their work is one of befriending, walking with this person in his time of deepest depression and severest temptation to take his life. The group has a quasi-military setup with rigorous discipline and ultimate authority resting in the hands of the leaders.
In the United States the lay-led groups have the nature of therapeutic groups. Alcoholics Anonymous with its parallel organizations for mates and children, Alanon and Alateen; Parents Without Partners, the group for single parents; Recovery, the group for returned mental patients; and similar organizations which offer support and help for those who have specific problems are widely known. The impact of the human relations laboratory movement upon the church in encouraging the development of sharing group efforts to make the church more supportive has succeeded to a degree. People going through marital trouble, sickness, or vocational readjustment have found healing in discovery or personal enrichment groups. (First Community Church, Columbus, Ohio, and Church of the Saviour, Washington, D.C., are examples.) What has been lacking has been some concerted effort to train laymen in the pastoral care of souls, to enlist them in the mental health movement on a par with the clergy, and to use the church effectively as an arm of the community.
A Layman’s Training Program: Let me report on a layman training program which was instigated and researched by John W. Ackerman at St. Elizabeth’s Hospital in Washington, D.C., in the fall of 1965. I believe it points out some of the values and the pitfalls of such training. St. Elizabeth’s conducts a course in the fall and spring in clinical experience for students at Wesley Seminary and for parish pastors. Ackerman and his supervisors, Dr. Bruder and Dr. Ward, decided that laymen should not have a different course but should be included in the same course and given all the training pastors receive. Sixteen laymen were recruited from the metropolitan Washington area, and divided for research purposes into two groups. Group I was given the lectures only; Group II was given the lectures and asked to make ward visits, submit written reports, and undergo group supervision. The research design -- to determine what changes took place as a result of clinical experience -- included pre-testing and post-testing and evaluation by trainer and supervisor at the end of the course.
The four orienting lectures were with psychiatrists who interviewed patients with certain mental illnesses, and also with chaplains who spoke on a panel about their knowledge of the patient and their particular ministry with them. Ward visits were made from the second session on, and the laymen were expected to write up their impressions of the visits and submit them for comments by the supervisor weekly. These written reports were discussed in group supervisory sessions at the end of the day, along with other impressions and feelings which emerged within the group. These groups remained on the supervisory level, however, and did not have a therapeutic goal. Ackerman reported that the laymen changed their perspective on mental illness through the twelve-week course. "The general dynamics of the group seemed to be movement from an original period where patients were seen as being ‘just like us’ through a period where the students identified with the helplessness and despair of the patients, to a final period where they began to find for themselves some individual methods of relating to the patients."
One student’s report of his change through the course is significant for our topic. He said, "The most significant information gleaned during the course has been the vital importance of the role of the church and religion in the community and the urgent need of the individual patient for spiritual food and better human relationships." Ackerman found his research results inconclusive, i.e., his pre-testing and post-testing did not turn up significant changes in the experimental group. His clinical hunches were, however, that the group which did the visiting did increase their skills in listening and their understanding of the mental patient. He writes that the laymen reported increased honesty with patients; increased ability to listen to the patients; increased ability to notice nonverbal behavior; lessening of the savior role; increased ability to help the patient face the facts as they are, and a lessening of the temptation to give false assurance; and finally, further realization that their being with another person was a tangible expression of God’s concern.
The weakness of the course was its lack of follow-through to the churches and the communities of the laymen involved. By being hospital based, it did not begin with the local community and the Christian congregation and return there. It had the strength, however, of tapping highly qualified professionals for the training, and of training laymen alongside clergymen for the work of hospital visitation and mental health aid.
Action Steps: One needs to develop with the responsible church body (official board, commission on Christian education) a workable plan for the total congregation in its responsibility for community mental health. One might well begin with a study group. The "Local Church Mental Health Study-Action Project," using Howard Clinebell’s Mental Health Through Christian Community and the Leader’s Guide by Paul E. Johnson, is a resource for such groups. The pastor may not be the one to lead this activity, although if he has training he may be the leader. A psychiatrist or social worker in the congregation may find this his particular stewardship. From the course there may be a selection and commissioning of pastoral aides. These persons should consider their visitation in a hospital, prison, or mental hospital a part of their training and should gather in groups to report their work and to discuss not only their growth in understanding of persons in distress, but the Christian resources available to these persons.
Those who show proficiency in such visitation might be asked to continue their training with a second course, like the one described above, in which they visited those with particular problems: the potential suicide, the alcoholic, the couple with marriage problems, the youth who has trouble with his parents, the lonely, and the aging person. Effective befriending of persons of this sort requires supervision -- and here the pastor or the committee chairman might draw on the professionals in his congregation who have supervisory skills to meet with the persons doing this more difficult work. The danger of going deeper into this kind of counseling work is that it arouses personal anxieties and the supervisor needs to be there to help. Referral of those who require professional help needs to be taught and the layman shown where the limits of his competence are.
Some laymen may do a job of befriending by taking certain people in trouble into their homes -- the unwed mother, the youth who is away from home and in need of certain boundaries, the mental hospital returnee. The homes need to be selected carefully, and the persons doing this kind of work should be mature enough to take the ups and downs of the emotionally distressed. I know instances, however, where providing a Christian home to persons of this sort has made the difference between life and death.
Finally those laymen who are in positions of power may work with community groups and agencies to do something about the disease-producing forces: poor housing, insufficient education, unemployment, lack of child care. It is one thing to work on the city council to shut down bars or to prosecute drug addicts or prostitutes; it is another to remove pathological conditions in which mental breakdown occurs. The church may have left an inner-city area, and so need to return to a storefront or support a Negro church in order to alleviate in a total push the kind of conditions which cause mental illness. Laymen who are concerned can do this. Such laymen are working at this in New York, Chicago, Los Angeles, and other large urban areas.
Laymen are not only capable of becoming mental health aides; they can serve as volunteers and do the housekeeping chores, so that their pastor might receive clinical training and become more professionally qualified. The challenge of our day, however, is for the pastor to see his job as enabler and to begin to train laymen for the more challenging task of community mental health workers. If the congregation sees its task as the pastoral care of its people, then health and wholeness can move out into the community, which will then become a leaven for the whole loaf.