Chapter 31: Training Clergymen in Mental Health by George C. Anderson
There is one overriding problem in training clergymen in mental health. Simply put, it is that no one has yet defined mental health in terms that will suit everyone. The fault lies in traditional concepts of mental health. People attempted to make these concepts too specific. They confined mental health to the health of the mind. But what is and where is the mind?
To the ancient Hindus and Chinese, the mind was seated mainly in the organs of the chest or abdomen. Aristotle conjectured that the heart and blood vessels were sources of thought. It was not until the time of Galen in the second century A.D. that the function of the mind was believed to be seated in the head. But why must the function of the mind be limited to the brain?
The late Harold G. Wolff, one of our most distinguished neurologists, pointed out that the function of nerve cells was not confined to the function of the brain. All the nerve cells of the body connect with one another. Furthermore, nerve cells have a relationship to all other types of living cells in the body. Dr. Wolff called attention to the fact that, in a sense, the "mind" resides in every cell of the body. Sinnott stated that mind is present in all of life. The term "mental health" has little meaning if it implies that mental health is something apart from other types of health and not related to the total health of the human organism. The psyche and the soma of the human being are not separate entities, but are inexorably interwoven.
Attempts to deal with mental health or to plan training programs in mental health without recognizing the interconnection between the mind and the body not only give a limited view of health and illness, but can hinder efforts of clergymen who counsel individuals with behavioral problems. For instance, we all know the influence of body chemistry on behavior. A sufficient amount of ingested alcohol can make a person act like a lunatic. Infection which creates high fevers also distorts behavior. Deterioration of nerve cells such as we see in advanced senility also has an effect on conduct. Trauma, such as in a concussion of the brain, can have a significant impact on the way we act. It is impossible to think of the function of the mind without recognizing these mind-body relationships. Those who would be specialists in mental health need to have an adequate understanding of all the body functions and activities that influence behavior. The interaction of psyche and soma is what makes human beings live and die.
Many courses offered to clergymen in pastoral counseling ignore this mind-body relationship. The psychoanalytic theories of Freud, Jung, and others who have laid the foundation for modern psychiatry provide merely one approach to the understanding of human behavior. Theories of psychoanalysis and training in psychoanalytic or counseling techniques provide only partial information for those who must deal with the behavioral problems of those they are counseling.
This is not to say, however, that clergymen who wish to become involved in the field of mental health must first be trained as physicians. It would be preferable if they had this training, but then the clergyman would be a clergyman-physician. It is important, however, that in training clergymen in mental health, opportunities be provided for some discussion of the physiological factors that enter into psychological behavior. I have known instances where a clergyman has attempted to counsel an individual with a behavioral problem using the insight and techniques of psychoanalysis, when what was really indicated was a physical checkup, since the behavioral pattern of the individual was being distorted by physiological factors. Clergymen who attempt to deal with deep-seated emotional problems in individuals should always make certain that such individuals have had a thorough physical checkup as part of the counseling process and program.
A serious problem, however, confronts most clergymen who desire to obtain sufficient knowledge of the physiological factors that influence behavior. Until recently, few medical schools permitted others than those pursuing a medical degree to attend their classes. At times I have heard psychiatrists condemn the pastoral counseling movement because pastoral counselors had inadequate knowledge of the various functions of the body. My reply to such criticism was: how could one expect clergymen to acquire this knowledge if medical schools were unwilling to open their classes to clergymen seeking this kind of information? Today, however, more opportunities are being provided in medical schools (particularly in the departments of psychiatry) for clergymen who are pursuing courses in pastoral counseling to participate in some of the courses offered to medical students.
For instance, the medical school of the University of Pennsylvania has an arrangement with the Marriage Council of Philadelphia whereby clergymen being trained in counseling under the auspices of the Marriage Council are permitted to attend classes in the medical school. This is a pioneering effort. More medical schools should make courses available for clergymen who are seeking training in mental health.
A few years ago a series of lectures and discussions was given in a pilot course in Psychotherapy in General Practice at the University of Minnesota. Some of the goals of the pilot course could well serve as a model for the objectives of mental health training for pastoral counselors. In retrospect, specific goals were defined as follows: (1) to give the doctor a feeling of dynamic qualities in the value of doctor-patient relationship, (2) to introduce him to broad patterns of human motivation and to the common causes of emotional disturbance, (3) to lead him to think in terms of the relation between emotional disturbance and illness, (4) to teach him easily understandable methods of therapy so that he can treat a share of such illness, (5) to give him some knowledge of more malignant conditions so that he may refer them to specialists.
If we were to substitute the term "pastoral counselor" for "doctor" in these goals, they would also serve as excellent guidelines on which courses in mental health for clergymen could be built. Obviously, it would not be possible to give such training in the limited time that clergymen can give to it. But at least these guidelines provide a broad outline and objectives for designing curricula in mental health.
One must always keep in mind that there is a significant difference in the treatment of the mentally ill between that provided by a physician and that offered by pastoral counselors. In the first place, the physician has a vast battery of diagnostic skills not available to clergymen. Secondly, in therapy he can prescribe drugs or even surgery. The limitations of the goal of psychotherapy as seen by the physician and the pastoral counselor are indeed different, as has been pointed out time and again by those involved in the field of pastoral counseling. Clergymen who attempt to manage severe emotional illness in individuals who come to them for help can be as guilty of malpractice as though they attempted to perform an operation or prescribe drugs. Yet there are many parallel goals of clergymen and others who engage in counseling. The important thing is to recognize one’s area of competency and not to attempt to invade a field of special knowledge without having been adequately trained in that particular field. Courses in health for clergymen must stress the limitations of the clerical role.
Most courses in counseling for clergymen are primarily confined to healing. This is all to the good. But I strongly believe that the primary function of the clergy in the health field is that of prevention. The opportunities are enormous. In the United States there are over 240,000 clergymen who are active in parish or synagogue work and dealing directly with congregations. This vast army of clergymen could make an effective contribution to the emotional health of the 125,000,000 Americans who are members of organized religions. We know that among many of the emotionally disturbed there is a crisis of morals, contradictory attitudes toward behavior, an uncertainty concerning a way of life, and often an unrealistic drive toward perfectionism. Organized religions have helped to keep moral values high, to provide high goals of living, to create dissatisfaction with anything less than almost a perfect human being. But many individuals cannot achieve this high level of behavior. In the attempt, many are plunged into emotional distress by excessive guilt and lack of self-esteem.
Some of this excessive guilt is nourished in religious groups. Many moral values become part of an individual’s ideals or style of life in early childhood. It is pertinent to note that over 55,000,000 children are exposed to moral training provided by religion and their clergymen. Because morals involve guilt, emotions are also involved. Clergymen with adequate knowledge of personality development could avoid those things that are likely to create difficulties for individuals as they grow up. For instance, most of the crises in adolescence, particularly in juvenile delinquency, are the result of inner conflicts between ideal behavior and those urges, many of them primitive, which the adolescent seeks to enjoy. Religion can lead an individual to mental health, but the wrong kind of religion can also help make an individual mentally ill.
It seems almost ridiculous for seminaries to train future clergymen to guide and influence people without giving them adequate knowledge concerning the factors that enter into human development and personality. Until recently, the vast majority of clergymen in the United States had little or no adequate training concerning these factors. Most of them were well versed in Scriptures, religious history, liturgy, church law, and other tools of their trade, but they knew very little about the human beings with whom they had to deal. It is only recently that courses in pastoral psychology have been introduced into the curricula of most forward-looking seminaries in this country.
A major contribution of organized religion is to enable clergymen to develop healthy emotional attitudes among those they serve. This is preventive mental health. But before this can happen, clergymen must understand much more than they do about all the ingredients that enter into the making of a human being. There are constitutional factors (both physiological and psychological) , environmental factors, sociological factors. Actually the training of clergymen in health concepts must begin much earlier than seminary days. Their college preparation must include more than the liberal arts. They need to know something about the medical, behavioral, and social sciences. Some training in clinical psychology is a must for anyone who hopes to lead individuals to the internalization of moral and spiritual values. Clergymen must understand that not all individuals can achieve total spiritual health — there will be cripples, some with distorted behavioral patterns, who must be accepted without hope of change. How to deal with such individuals is an important responsibility of clergymen. With adequate training, they can provide the kind of support that will prevent such an individual from being plunged into deeper despair. The preventive role of the clergyman in dealing with emotional health is an essential one.
Today, we are living in a new era in which the majority of physicians and others dealing with health seek the collaboration of clergymen. However, physicians, especially psychiatrists, rightly insist that the price of collaboration is the ability of the clergyman to function as an effective member of the healing team. Yet the collaboration must work well on both sides. Physicians and others must recognize that clergymen have a unique function and that religious resources can be valid. There are two sides of the coin of clergy-physician collaboration. On the one hand, the physician has his unique and specific resources. On the other hand, physicians should respect the unique and particular resources that are available for those with deep spiritual conviction and beliefs. There are rich resources in the treasure chest of religion; they must be made known to physicians and others who seek collaboration with clergymen.
Despite the fact that there is a growing desire for further collaboration between psychiatrists and clergymen, there is still a significant number of psychiatrists and other behavioral scientists who take a dim view of the invasion of the clergy into the health field. However, I have noticed as a result of my own experience with psychiatrists here and abroad that most of those who object to the involvement of clergy in the health field do so because of their own personal conflicts or ignorance about religion and its teachings. Many of them have little knowledge of the enormous changes that have taken place among theologians and clergymen over the past decade.
Generally speaking, today’s clergyman is a much different person from those of two decades ago. The modern preacher lives under a big umbrella; he is more liberal, more aware of contemporary life and its problems. This new-fashioned clergyman has helped to improve collaboration between the clergy and the physician. Today, the climate is right for medico-religio-psychological collaboration. The question still remains whether or not all those engaged in health and behavior realize how much they need one another.