Chapter 9: Clergymen in a Preventive Mental Health Program by John A. Snyder
Too often, pastoral counselors are like a group of men at the bottom of a cliff. People are stumbling off the cliff and getting hurt. Some come miraculously away from the fall without serious injury -- perhaps a sprained ankle -- and need a little assistance that can easily be given. Others, however, are more seriously injured and require a great deal of attention because of broken limbs. A few are quickly hustled away because of even more serious injuries. The whole scene is such a busy one, and the men so preoccupied with their healing tasks, that no one seems to be able to give any attention to what would seem a logical move: to build a fence at the top of the cliff to keep the people from falling off.
Until very recently, psychiatry has been concerned primarily with "bottom of the cliff" activity -- that is, treating the mentally ill and the emotionally crippled. Appropriately, then, much of the effort in psychiatry has been devoted toward elaborate description of the pathology and categorization of the problems to insure treatment in as systematic a fashion as possible. Psychiatrists, as physicians, have been specially trained to recognize, diagnose, and treat mental and emotional illness, and have made a major contribution with their skill.
What has happened in the 1960s is a rapid shift of attention from healing the brokenness at the bottom of the cliff to trying to build preventive fences at the top. The whole mental health movement is an example of this shift. However, all one need do is pay close attention to the precision with which a psychiatrist can define mental illness, and the fuzziness with which he defines mental health, and one becomes aware that our problems are not going to be solved entirely by that profession.
The real significance of this confusion is that psychiatrists have started acting like clergymen and clergymen have started acting more like psychiatrists. I am not one to get terribly upset by this. In many cases where the clergyman is specially trained or usually sensitive and perceptive, he may be able to provide healing in many cases of functional mental illness as well as, or better than, many psychiatrists. On the other hand, many psychiatrists with a religious desire to save men and nations can help us interpret what goes into the full, rich, and abundant life.
In our training programs for community clergymen at the Pennsylvania Hospital Community Mental Health Center we have been interested in mutual exchange: (1) We believe that psychiatry and its allied professions can help the clergyman do a better job with his healing ministry (at the bottom of the cliff) (2) We believe clergymen have something unique to contribute to psychiatry in the whole business of prevention (building fences at the top of the cliff)
It is widely accepted that psychiatry can contribute to the clergyman’s ministry to troubled people. The real question is, How can a community mental health center and community clergymen work together toward the prevention of emotional disturbances? Resistance comes from both sides -- from clergymen who would prefer to talk about schizophrenia than talk about how their Christian education program might be more effective from a mental health standpoint, and from some psychiatrists who have considerable difficulty in visualizing how religion could prevent any of the problems they deal with. In the latter case, the problem is not that these psychiatrists believe that religion is harmful; but rather having themselves grown up in a culture where religion was innocuous, they cannot see the significance of religion for good or ill. We have worked very hard over the last fifteen or twenty years to establish a good working relationship between clergy and psychiatrists in healing troubled people at the bottom of the cliff. If we think, however, that having solved the problem of cooperative effort at the bottom of the cliff we also have solved it at the top -- in prevention -- we are greatly mistaken.
The first step toward a good program of prevention is to establish a relationship of trust between the community mental health center staff and community clergy. Once some mutual sharing begins to occur, it is amazing what happens.
The clergyman may begin to realize that the mental health professional has a contribution to make to his total pastoral ministry. This may be more important than the mental health professional’s help in strengthening his pastoral counseling techniques, especially if the clergyman can realize his unique position of contact with people when problems are just beginning to become serious. We have discovered that the clergyman will often see only those problems for which he knows a solution. By broadening his knowledge of community resources, we broaden his vision. For example, in the beginning of the program one clergyman reported that he simply did not see people with problems. His visitation amounted to administering the sacraments and leaving as soon as possible. However, once he became aware of the help that he could receive from the mental health center for both consultation and referral, he started overwhelming us with calls about the troubled people he was visiting.
Second, the clergyman may find support and encouragement for his own unique style of intervention. In our program we had a black store-front clergyman from the ghetto who was viewed by our mental health staff with some suspicion because of his lack of credentials. He was self-educated and self-ordained. He lacked any formal clinical training, although many troubled people were turning to him for help. It was unexpected that he would become one of our best teachers. His lesson of how to prevent suicide in the ghetto is a classic. One of his lay leaders had made a serious suicidal attempt and had been hospitalized. The man was a puzzle to the hospital staff because of his depression; the staff was reluctant to discharge him or to move toward a long-term confinement. The usual approaches of individual and group psychotherapy seemed to be pointless with this man, who neither appreciated nor respected "all this talk-stuff." When allowed, the black clergyman moved in with some very direct intervention. He had discovered that the man’s two teen-age daughters were pregnant by him and that there was some community knowledge of this fact. He said his goal with the man was to give him a choice whether he would live or die. Right now, he said, the man will have to die. After having first arranged abortions for the two girls, he brought the layman in front of the congregation and asked the congregation: "Should he die?" The congregation responded in a booming voice: "No." The clergyman repeated the question, and the congregation echoed its response. The clergyman then directed the congregation toward a healing ministry to the man and his family but with a heavy emphasis on the man’s "sin." While we might question this clergyman’s techniques, it is obvious that he is able to use the resources available to him, and his style seems to be very effective with his people. It is with active intervention like this that some crises are contained rather than allowed to explode with more destructive consequences.
Finally, we have learned that prevention of mental and emotional problems must include concern for the economic, social, and environmental problems which trouble entire communities and form the foundation for specific instances of mental illness and breakdown. In terms of the figure of the cliff, we found that it was not enough to concern ourselves with building fences, even though in the beginning this was the way we defined our task. Far too many of the people who were ending up in the brokenness of life were being driven off the cliff by dogs yelping at their heels. An ideal program of prevention would imply cooperation between the mental health center staff and community clergy in attacking these wider community problems. In the long run this aspect of prevention is probably more important than all the rest.
Community clergymen can therefore move into action in the prevention of mental and emotional disturbances in each of these three areas: (1) by using the mental health center resources to make their total pastoral ministry more effective in the early detection of problems; (2) by becoming more comfortable in the use of their own style of helping troubled people so that some crisis situations can be contained; (3) by using the rich resources of social concern in the churches to attack the wider problems out of which so many individual cases of emotional disturbance arise.
For additional reading
Action for Mental Health (by the Joint Commission on Mental Illness and Health) gives the background for the development of mental health programs and suggests the importance of clergymen in the mental health field. For a more specific treatment of preventive programs, see Gerald Caplan, Principles of Preventive Psychiatry (New York: Basic Books, 1964) For the application of these principles of prevention to the role of the clergyman, see J. A. Snyder, "Clergymen and Widening Concepts of Mental Health," Journal of Religion and Health, July, 1968.