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The goal of research is to discover information through the application of scientific procedures. (Claire Selltiz, et al., Research Methods in Social Relations [New York: Henry Holt, 1959] , pp. 1-5.) Research begins with a problem or a question, to which techniques of observation or experimentation may be applied. The question may be either intellectual (simply the desire to know) or practical (for the sake of being able to do something better or more efficiently) Both would seem appropriate reasons for research on the churches and mental health.

Research into the role of the churches in community mental health may take two directions: (1) statistical studies, empirically designed, as to the effect of religious beliefs, membership in, and activities of, members of churches and synagogues, and (2) the effects of training in mental health principles and skills of clergymen and laymen in improving their effectiveness in religious behavior.

Since research in confined to "empirical" data mainly, any person carrying out research in this area of experience should keep in mind that scientific research "can tell us nothing about the truth, validity or usefulness of religious phenomena" though it may be very enlightening and useful when it furnishes "information about the conditions under which people become religious . . . the influence of religion itself on other dimensions of behavior: . . . and the empirical laws governing religious behavior may help in understanding phenomena which are the causes of undue concern."( Michael Argyle, Religious Behavior (London: Routledge & Kegan Paul, 1958) , p. 3.)

Gordon W. Allport reinforces this concept when he writes that "neither religion nor mental health . . . (is) a discrete, measurable thing. Each has many factors and aspects, and one must . . . talk about things that are related to essential trust or things related to constructiveness of personality or other concepts into which one might be able to break down religion and mental health."( Academy of Religion and Mental Health, Research in Religion and Health, 1961 [Bronx: Fordham University Press, 1963] , p. 32.)

The goals of research on mental health and the churches are, necessarily, at this point vague and indistinct, mainly because of problems of definition and instrumentation. Many studies (some to be referred to later) have relative and situational validity, but few useful instruments or techniques have as yet been developed.

One report summarizes general goals which are usable for direction:

A major research direction, then, might well develop a design for research in which pastors would develop psychological skills in aiding parishioners in the development of wholesome (as part of "holy"), mature personalities, and in assisting persons in developing meaning and purpose in their lives, as well as dealing therapeutically with specific emotional problems which cripple their functioning. The design would include pastors’ application of psychological insights in the total range of pastoral activities and relationships, with training presented through classroom teaching; clinical supervised involvement; and personal counseling and/or psychotherapy to prepare them better to use their theology, the formal rituals of the church, and the religious faith they transmit in living relationship with their people.

In the definition of any goals, the theologian and clergyman must have first priority in formulation. The psychiatrist’s preoccupation, arising out of his professional training, with the causes and treatment of mental illness; (Richard V. McCann, The Churches and Mental Health[New York: Basic Books, 1962] , pp. 133-34.) the preoccupation of the psychologist with purely human behavior, its description, and development; the preoccupation of the sociologist and cultural anthropologist with the forms and development of society, make these mental health professionals unable to define the function of the churchman, though their professions may well be of immense importance in providing information when the clergyman thinks through his unique and necessary role as pastor to persons.

Practically, psychologists, statisticians, and the rest of the research teams must be involved in these research designs, but the hidden goals and preconceptions of both clergymen and psychologically trained professionals must be articulated before the designs are firmed up. In designing studies, for instance, which would seek information on how the religious community could produce a "healing fellowship" for the emotionally disturbed and a healthy atmosphere for developing children, the scientist and the religious leader must both keep in mind that "that which frees man from moral evil is not mental health but God’s grace." (Robert G. Gassert, SJ., and Bernard H. Hall, Psychiatry and Religious Faith [New York: Viking Press, 1964] , p. 43.)

This section will select individual research designs which seem productive of further research implementation. Selected studies are suggestive of the general field and not representative of all potential research.

1. The National Institute of Mental Health, Religion and Mental Health Project

Three related projects were funded by the NIMH in 1956 to construct extended programs for training seminarians in mental health skills. The programs were designed to bring together professionals and materials in psychiatry, psychology, anthropology, medicine, and sociology and to relate mental health information to the theology of the three major religious traditions. (Vincent Herr, S.J.: "Mental Health Training in Catholic Seminaries," Journal of Religion and Health, January 1962, p. 127.) The Academy of Religion and Mental Health, under the direction of the Rev. George Christian Anderson, as well as the churches involved, encouraged this research in improving their pastors’ and rabbis’ mental health skills. The curriculum developed from this project is available to other seminaries.

A. Loyola University of Chicago was chosen to develop a curriculum for Roman Catholic priests. Under Father Vincent Herr’s direction, materials were prepared to cover (1) the psychodynamics of normal personality and religious development; (2) "small group" dynamics, particularly of the family; (3) problems of personality maladjustments; and (4) interviewing and counseling techniques. At the time of the first report by Kobler, et al.,( F. J. Kohler, et al., "Loyola University NIMH Project on Religion and Mental Health," Pastoral Psychology, Feb., 1959, pp. 14-46.) some 740 seminarians and priests from five seminaries had participated.

B. Rabbi I. Fred Hollander of Yeshiva University directed the development of training courses for rabbis. Not simply to enlarge the clergyman’s store of secular knowledge, he declared, and not to train him to be a professional psychotherapist, the project was rather "to prepare him for the practical task of fulfilling his pastoral responsibilities more effectively" (I. F. Hollander, ‘Mental Health Teaching Materials for the Clergy," Journal of Religion and Health, April, 1962, P. 273.) and to increase his ability to help people who turn to him as rabbi in their time of need. This ability is an integral part of his function as a minister of religion. While religion’s importance to people transcends its healing value, Rabbi Hollander reports, its primary value lies in defining every phase of man’s existence -- describing his condition, his place in the universe, and his role in the shape of things.

C. Hans Hofmann at Harvard Divinity School probed the literature of the world for instances of "religious behavior." Believing that "the rigidity inherent in orthodox theories has fostered mere shadow boxing between ministers and psychiatrists," (Hans Hofmann, Religion and Mental Health [New York: Harper, 1961, p. xv.) he deliberately sought human experiences which (1) in their complexity were "true to life," (2) that touched directly on problems of religion and mental health, and (3) that encouraged free and independent thinking. He encouraged experimentation with pastoral counseling which went beyond an exclusively supportive conception of counseling, because he believed that "within the Christian tradition in which we believe [is] the power of the Holy Spirit to regenerate people through merciful judgment and a loving challenge to grow through suffering into a stronger and deeper faith." (Ibid., p. 15.) So he suggests that studying historical expressions of religious awareness should suggest challenging hypotheses which may well find that mental health in the Western "Christian" civilization cannot be achieved without the confrontation of the religious aspects of culture.

2. Institutional Experiments in the Churches and Mental Health.

A. The Church of the Savior, Washington, D.C.

In addition to orthodox research design composed of experimental controls and statistical analyses of the data, an experiment set in a parish began when the Rev. Gordon Cosby returned from military service to involve a small band of persons (seventy) in total commitment to a disciples’ way of existence. Intense training prepares the members for "ministry" in a mission group, each strengthened by spiritual discipline. "Dayspring" is a 175-acre farm in Maryland within which a retreat was built as a renewal center for the emotionally and spiritually disturbed. The Rev. Joseph W. Knowles describes the goals of the Renewal Center Mission as (1) developing the Life Renewal Center through small "groups," (2) giving attention to the use of present structures to focus the whole life of the church as a healing community, (3) developing a program of supervised clinical pastoral education for theological students, and (4) maintaining a Residential Center halfway house for twenty men and women who have been previously hospitalized for mental illness.( Elizabeth O’Connor, Call to Commitment[New York: Harper, 1963] , pp. 135-44. Also, personal communications with the Rev. Joseph W. Knowles, 70CT68.) Continuous therapy groups are carried on as well as individual counseling and Adult Intereducational Mission Groups, which combine sensitivity training and the development of skills in writing devotional materials. Research with such churches as this will clarify the general role of religious institutions in developing the mental health of involved persons.

B. The American Foundation of Religion and Psychiatry.

This center for the training of clergymen in counseling was founded in 1937 as the Religio-Psychiatric Clinic in Marble Collegiate Church in New York City. Its purpose, as described by Paul E. Johnson is to enable persons to "come for psychiatric help where ethical and religious values will not be overlooked and religion thus aids in the acceptance of psychiatry." In this center, clergymen and psychiatrists are joined in treating psychiatric patients and in carrying on research on healing on cooperative levels by the two professions.(Samuel Z. Klausner, Psychology and Religion [New York: Free Press, 1964], pp. 197-255.)

C. Pastoral Counselors Serving in Psychiatric Settings.

In 1964, the federal government, in developing comprehensive community mental health centers, insisted that:

Centers already involving clergymen are as widespread as Fort Logan Mental Health Center in Denver, Colorado, where ministers serve as therapists in the Division of Alcoholism, and the Oaklawn Psychiatric Center, Elkhart, Indiana, and San Mateo County Mental Health Center in the San Francisco area which employ pastoral counselors.

D. Cooperation Among Psychiatric Personnel and Clergymen in Referral and Training.

While Becker probably overstates the case when he claims that the unity of aim of religion and psychology has brought clergymen and psychiatrists "into a contiguity and interlacing of work where it is no longer possible to distinguish neatly the psychologist from his religious colleague," (Russell J. Becker, "Links Between Psychology and Religion," American Psychologist, 1958, 13, pp. 566-68.) it certainly seems accurate to say that cooperation is increasing, and many persons turn to clergymen for help in emotional disorders. One study revealed that in a representative sample of 2,460 Americans, persons with more education were more likely to seek out a clergyman, and regular church members were also quicker to call on their pastor (54 percent among Protestants and 52 percent among Catholics) (Gerald Gurin, Americans View Their Mental Health, p. 335.) The same study indicated that church attenders were somewhat happier and had less worry, and infrequent church-goers and non-goers had a more negative evaluation of their overall adjustment. In short, "low church attendance is associated with a somewhat higher level of distress in the general adjustment measures, a more negative self-percept, less happiness on the job, and strikingly less marital happiness." (Ibid., p. 245.)

E. Influence of Religious Observance in the Home.

Fein reports that home observance of religious customs contributes to the mental health of persons involved,

3. Suggestions for Research.

Here follows a necessarily limited set of suggestions for further study:

A. Training of clergymen and laity in mental health skills:

Seminary training in special psychological skills for pastoral counseling, leader-trainer roles in groups

Identification of pastoral and psychological roles of hospital chaplains

In comprehensive community mental health centers, the role of the staff pastoral counselor, and his acceptance by staff colleagues and the community

Referral patterns among clergymen to and from psychiatric clinics

Changing attitudes toward the clergyman’s role and image, by clergymen and laymen

B. Pastoral situations, effects of congregational structures on persons:

Effects of denominational environment on mental health of constituents, including administrative structure and religious beliefs of the group

The place of the church as a therapeutic and redemptive community (a) on the mental health of the members, (b) as a referral source for post-treatment patients, (c) for persons under situational stress -- e.g. vocational, family, bereavement, etc.

Effects of "group belongingness" in religious experiences in worship services. Therapeutic and disruptive effects of small groups, study, Bible, prayer, etc.

"Binding" and "supporting" effects of congregational sharing in times of grief, life decisions, depressions, etc.

C. Types of individual religious experiences:

Ernest Bruder: "the distinctive contribution of religion is to present God adequately to the patient, using the basic, common resources of religion";( Quoted in 0. Hobart Mowrer, Morality and Mental Health [Chicago: Rand-McNally, 1967] , p. 351.) compare this with simple psychological counseling care of patients.

The effects of the Judeo-Christian faith, as expressed through church and synagogue, as a moderating factor in the competitive-ness of American culture

Effects of individual religious sacred acts -- e.g. confession and penance, conversation, communion in times of crisis, etc.

The "integrating effects" of personal religious experience, especially in adolescent years

Theoretically, there should be no competition between professionals trained in religion and those trained in psychotherapy, for "the hitherto existing chasm between religion and psychology is somewhat unusual because . . . both concern themselves with human nature and behavior." (Herman Feifel in ‘Symposium on Relationships between Religion and Mental Health: Introductory Remarks," American Psychologist, 1958, 13: 565, 566.) But there is a vital need for valid research into the effects of religious belief and behavior on individual and group mental health.

Much needed is research beyond that already completed which will develop guidelines for improving the church’s many roles in community health -- from meeting the existential crises of being human and belonging to social groups and facing anxiety and dread, to providing more efficiently the "learning atmosphere" for a religious style-of-life. The assumption is made in most congregations that these things do happen. Now we have the tools for investigating and improving these mental health functions of churches.

Even though we recognize and accept the fact that some of the most crucial problems of man and his existence (e.g., death, destiny, and divinity) are all but unresearchable by science’s tools, it is still true that well conceived and developed research designs are useful in the area of mental health and religion. They will sharpen the expectations by mental health professionals of the church’s proper role in community mental health, and they will increase the church’s and synagogue’s already considerable functional role in the mental health of the community.

For additional reading

Academy of Religion and Mental Health. Religion in the Developing Personality. New York: New York University Press, 1960.

--------- Religion, Science and Mental Health. New York University Press, 1959.

--------- Research in Religion and Health. Bronx: Fordham University Press, 1963.

Argyle, Michael. Religious Behavior. New York. Free Press, 1959.

Eister, Allan W. "Empirical Research on Religion and Society," Review of Religious Research, Spring, 1965, pp. 125-30.

Godin, A., S.J. "Belonging to a Church: What does It Mean Psychologically?" Scientific Study of Religion, Spring, 1964.

Gurin, Gerald, Veroff, Joseph, and Feld, Sheli. Americans View Their Mental Health: A Nationwide Interview Survey. New York: Basic Books, 1960.

Herr, Vincent V., S.J. "The Loyola National Institute of Mental Health Seminary Project: A Progress Report," American Catholic Sociological Review, Winter, 1960, pp. 331-36.

Hofmann, Hans., ed. The Ministry and Mental Health. New York: Association Press, 1960.

Hollander, I. Fred: "Mental Health Teaching Materials for the Clergy," Journal of Religion and Health, April, 1962, pp. 273-82.

Klausner, Samuel Z. Psychiatry and Religion. New York: Free Press, 1964.

Kobler, F. J.; Webb, N. J.; Herr, V. V.; Devlin, W. J. "Loyola University NIMH Project on Religion and Mental Health, Report on Research Procedures," Pastoral Psychology, Feb., 1959, pp. 44-46.

Lenski, Gerhard: The Religious Factor. Garden City, N.Y.: Doubleday, 1961.

Lowe, C. Marshall and Braaten, Roger O. "Differences in Religious Attitudes in Mental Illness," Journal of Scientific Study of Religion, Fall, 1966 5(3) , pp. 433-45.

McCann, Richard V. The Churches and Mental Health. New York: Basic Books, 1962.

Menges, Robert J. and Dittes, James E. Psychological Studies of Clergymen, Abstracts of Research. Camden, N.J.: Thomas Nelson, 1965.

Srole, Leo; Langner, Thomas S.; Michael, Stanley T.; Opler, Marvin K.; Rennie, Thomas A. C. Mental Health in the Metropolis: The Midtown Manhattan Study. New York: McGraw-Hill, 1962.

Planning and delivery of mental health services are both a public and a private responsibility. Federal, state, and local public agencies have statutory authority and public funds to carry out their tasks. Private groups and individuals participate through their agencies, organizations, and through philanthropy. Coordination and cooperation of effort between the public and private sectors are necessary for optimal functioning of the mental health care system. This chapter outlines the governmental structure for mental health which also provides for participation of private groups and individuals through various types of advisory councils.

Federal Level

The National Institute of Mental Health, part of the Public Health Service in the Department of Health, Education and Welfare, is the federal agency with major responsibility for development of mental health services, mental health research, training, and continuing education for all types of professional and subprofessional manpower. Federal funds are also granted to state public health programs ($66,000,000 in the fiscal year 1969) Community mental health receives a minimum of 15 percent of each state’s allotment, and 70 percent of the grant is available to support services in communities for which both public and private nonprofit groups may apply. Other federal programs also provide funds for mental health -- related purposes including Medicare, Medicaid, Vocational Rehabilitation, Office of Economic Opportunity, Office of Aging, and Office of Education. Recent legislation provides support for construction of community mental health centers and initial operation of new services in them.

A mental health staff is located in each of the nine regional DHEW offices to administer the NIMH program and to consult with public and private groups who desire assistance. (See list at the end of this chapter.)

State Level

Each state has designated a state-level agency called the Mental Health Authority to administer the federal community mental health grant. This Authority may be the same agency which administers the state mental hospitals. More than thirty states have passed community mental health service acts or other legislation which makes funds available on a continuing basis to match local public or private nonprofit expenditures for mental health services.

Local Level

State community mental health acts usually require that a local mental health board be established on a county or multi-county basis to serve as an administrative or policy-making board or as an advisory body. The board, usually appointed by the local government, in turn appoints an administrator of the local program.

Involvement by Clergymen

Clergymen and congregants have been involved in mental health programs for many years, the former usually in the role of pastoral counselor and therapist and the latter as volunteers in a variety of mental health and mental health -- related settings. Both serve as members of boards operating mental health facilities.

Each mental hospital, clinic, or other facility uses clergymen and volunteers in keeping with the philosophy and practice of the facility and staff. The newer community mental health programs are developing broad community-based programs which are expanding the traditional roles of pastors and citizens.

In the Far West, a mental health center has established a panel of fifty qualified community professionals who accept patients for individual and group psychotherapy after screening and evaluation at the mental health center The center pays a small fee to the panel members and retains responsibility for the patient’s total treatment program. Several qualified clergy are on the panel of therapists.

In a Midwestern city of 50,000, a marriage counseling center begun by a group of clergymen and based in a local general hospital which furnished secretarial service, is to be incorporated into the new mental health center established in the community. The clergymen will continue to provide counseling as part of the center’s activity.

An innovative school program carried out at a mental health center in New York uses parent-tutors to assist in remedial reading, which often is needed by children showing maladaptive behavior. The parent-tutors receive three preliminary training sessions in a special reading method followed by group supervision on a weekly basis. About seventy-five parents from public and parochial schools are involved.

In a ghetto of New York, an Interfaith Counseling Service has been organized with a membership of more than one hundred local clergymen who refer their troubled parishioners to the center for help for a broad variety of problems in living. The Council holds workshops for parents, couples, single people, and young people; helps to develop local community leaders; provides training in counseling for ministers and qualified laymen; and serves in an advisory capacity to the neighborhood educational system. The agency’s brochure states, "Our plans are geared toward providing alternatives to the use of destructive means to cope with feelings of frustration, isolation or helplessness. We aim to place appropriate responsibility on residents to create the kind of community atmosphere in which they will choose to live." The service, directed by a clergyman, employs two trained social workers, and a nearby mental health center provides part-time services of a psychiatrist to consult, teach, and supervise.

The Prairie View Mental Health Center in Newton, Kansas, whose roots were in a small mental hospital established under the sponsorship of the Mennonite Mental Health Service, has an administrator who is an ordained clergyman. This center won the top Mental Hospital Achievement Award of the American Psychiatric Association in 1968.

New roles for clergy and congregants in community organization and consumer participation are also developing. The establishment and maintenance of a community mental health program requires planning, organization, funding, interpretation to and support by the public, support by legislative bodies, and an ongoing dialogue between the provider (sources of funding and professional staff) and the consumer (user of therapeutic and preventive services)

Clergy have filled prominent roles as officers and board members of mental health agencies and associations; most boards include one or more clergymen. Their skills in community organization have been put to good use. They are also in key positions to channel information from the public into the mental health agency and vice versa. They are strong molders of public opinion. Congregants also are represented on boards and are in a position to provide a link between the agency and the community.

Recent federal legislation has given a prominent role to the consumer or user of health services. P.L. 89-749, Comprehensive Health Planning and Public Health Services Amendments of 1966, requires that a state health-planning council be established and that a majority of the membership shall consist of representatives of consumers of health services. Other health-related legislation also provides for consumer advisory representation and participation in shaping the services to be made available to individuals and their communities. Members of various governmental advisory councils are usually appointed by governing officials or bodies. Advisory councils are also often established to assist regional and local planning and service agencies.

Through membership on planning and other types of public and private councils and boards, clergy and congregants can fill key roles in shaping and furthering community mental health programs.

NIMH Regional Offices Mental Health Programs

Region I, Boston, Mass.

John F. Kennedy Fed. Bldg.

Boston, Mass. 02203

Phone: Code 617, 223-6824

Office Hours: 8:30-5:00

States

Conn., Maine, Mass,, N.H., R.I., Vermont

Region II, New York, N.Y.

26 Federal Plaza

New York, N.Y. 10007 Phone: Code 212, 264-2567

Office Hours: 8:30-5:00

States

Del., N.J., N.Y., Pa.

Region III, Charlottesville, Va.

220 7th Street, N.E.

Charlottesville, Va. 22001

Phone: Code 703, 296-5171

Office Hours: 8:00-4:30

States

D.C., Ky., Md., Puerto Rico, N.C., Virgin Is., Va., W. Va.

Region IV, Atlanta, Ga.

50 7th St., N.E.

Atlanta, Ga. 30323

Phone: Code 404, 526-5231 Office Hours: 8:00-4:30

States

Ala., Fla., Ga., Miss., S.C., Tenn.

Region V, Chicago, Ill.

New P.O. Bldg.

433 W. Van Buren Street

Chicago, Ill. 60607

Phone: Code 312, 353-5226

Office Hours: 8:15-4:45

States

Ind., Ill., Mich., Ohio, Wis.

Region VI, Kansas City, Mo.

601 East 12th Street

Kansas City, Mo. 64106

Phone: Code 816, FR 4-3791 Office Hours: 8:00-4:45

States

Iowa, Minn., Kansas, Mo., Neb., N. Dak., S. Dak.

Region VII, Dallas, Texas

1114 Commerce Street

Dallas, Texas 75202

Phone: Code 214, RI 9-3426

Office Hours: 8:15-4:45

States

Ark., La., N.M., Okla., Texas

Region VIII, Denver, Col..

Federal Off. Building 19th and Stout Streets

Denver, Colorado 80202

Phone: Code 303, 297-3177 Office Hours: 8:00-4:30

States

Colorado, Idaho, Montana, Utah, Wyoming

Region IX, San Francisco, Calif.

Federal Office Building

50 Fulton Street

San Francisco, Calif. 94102

Phone: Code 415, 556-2215

Office Hours:8:00-4:30

States

Alaska, Ariz., Calif., Guam, Hawaii, Nev., Oreg., Wash., Am. Samoa, Wake Island

The development of community mental health programs is predicated upon the development of interdependent working relationships between direct mental health treatment services and agencies, institutions, groups, and people in the community. Since the clergy and the churches are a major segment of the community there has been considerable interest in the development of effective working relationships between mental health professionals and the professional clergy.

During the 1940s and 1950s there was considerable interest in the so-called rapprochement of psychiatry and religion. During that time most of the problems of interprofessional cooperation centered around conceptual issues. By and large mental health professionals and clergy had their own domains of professional concern which did not significantly overlap. Both had concerns for the welfare and healing of distressed persons, but their respective approaches rarely crossed paths. During those two postwar decades there was an exploration of the conceptual issues that had seemed to loom so large in the debates of the earlier decades. The success of these conceptual explorations seemed to some a "fait accompli" after a time; for areas of agreement were reached by some, others felt that they had explored the ideas of the other professional group and finding them wanting had discarded them, while still others "bought" a psychological line or a spiritual line, so to speak. Thus the seeming conceptual rapprochement may have turned out to be an uneasy truce, without a clear exploration of the differences in points of view of mental health professionals and clergymen. Such conceptual issues included: naturalism vs. supernaturalism; monism vs. dualism; free will vs. determinism; whether man is morally good, bad, or neutral; how to eradicate mental distress and social problems; the values of the concept of unconscious motivation; absolute vs. relative moral codes; and the desirability of examining one’s religious beliefs.

Up until 1960, this pattern of relationship worked fairly well, for neither group of professionals had any great necessity to work intimately with the other. However the development of sophisticated chaplaincy training programs and pastoral counseling training among the clergy, and the development of community mental health programs by the mental health professionals, brought the two groups of professionals into a number of areas of professional overlap or mutual concern. This introduced problems of professional role conflict that were added to still unresolved, but more hidden, conceptual conflicts.

Although this chapter is concerned primarily with issues related to interprofessional cooperation in community mental health services, these cannot be discussed without calling attention to the fact that behind the issues of professional role allocation still lie conceptual disagreements that often play a major role in preventing effective collaboration and the working out of mutually satisfying professional roles. As we shall see, most problems in interprofessional relations involve combinations of both conceptual and role conflicts.

Cooperation in Referral. One of the major areas of community mental health where collaboration is most necessary is in the area of referral. Clergy are most frequently the first professionals in the community to whom people in emotional distress turn. Thus, community mental health services were planned to establish liaison with the clergy so that the emotionally ill could be quickly and effectively referred to the appropriate mental health services. Likewise the pastor, beset by many troubled persons, was looking for mental health resources to assist him. Theoretically the situation appeared ideal for mutual collaboration where both professional groups would profit.

However, after some five years’ experience with community mental health programs, it appears that such collaboration has not developed. It is estimated that over one-third of clergymen’s clients suffer from severe mental illness. Yet the clergy refer only 33 percent of such severe cases to mental health facilities, whereas general practitioners refer 88 percent of such clients. In terms of total case-contact, several recent surveys demonstrate that clergy refer less than 1 percent of their contacts to mental health resources. To look at the problem from the other side, data from community mental health services reveal that only from 1 to 8 percent of their referrals come from the clergy. Even in model community mental health centers, including several which are church-sponsored, the figures are minimal -- for example: 2 percent, 1 percent, 4 percent, "few."

These findings have stimulated a number of research studies to determine why the clergy -- community mental health center referral network has not developed as was envisioned. Several major reasons have been demonstrated.

First, there is a marked discrepancy between the role definitions and role functions of the clergy as defined by mental health professionals and as defined by the clergy. Mental health professionals tend to restrict and confine the role of the clergyman and even may voice grave warnings about the clergy assuming professional functions or encroaching on mental health domains. Hence the message is transmitted overtly or covertly to the clergy that liaison and referral is acceptable only within certain limited boundaries. Disagreement over those boundaries may lead both the mental health professionals and the clergy to withdraw from contact and collaboration as the easiest way to resolve the conflict.

Second, other studies have shown that mental health professionals engage in an asymetric relationship with professional clergy. That is, while mental health professionals usually acknowledge referrals from social agencies and physicians and will in turn refer patients back, with clergy referrals the referral is not acknowledged, nor is referral back to the clergyman made.

Third, some community mental health centers have established referral policies which accept referrals only from medical or social agency sources and exclude clergy referrals. This has certain screening advantages, but it also is a powerful deterrent to the clergy.

Fourth, effective clergy referral has been found to correlate with education, social status, and theological attitude. Clergy with little education have low referral rates, whereas clergy with the highest education have the highest referral rates. Clergy with low social status in the community have low referral rates. They indicate that communicating with high-status mental health professionals would "show them up" or "expose their inferiority." On the other hand, high-status clergy have high referral rates. Finally, several studies have revealed that clergy of the more conservative theologies tend to refer less, but also try to cope with the most severe problems. These clergymen tend to define all emotional problems as spiritual ones, and consequently deal with all problems in a spiritual manner with the least psychological sophistication. On the other hand, it has been shown that clergy of more liberal theology are apt to have exceedingly high rates of referral of all types of problems. They tend to define all problems as psychological and eschew any spiritual approach to human problems.

Fifth, many of the clergy trained in the decade of the 1960s have received basic, and at times advanced, training in pastoral care skills. Such pastors have redefined their role in relation to those seeking help in distress. These clergy consider that they have the knowledge, skill, and responsibility for the care of many of the problems they see. Thus these clergy have a lower referral rate because they elect not to refer as a professional decision.

Sixth, many clergy have not had the opportunity to acquire skills in pastoral care that will equip them to handle skillfully referrals, or to communicate easily and knowledgeably with mental health professionals.

Seventh, at least a few years ago many mental health professionals did not define the role of the pastor as including primary care, and only suggested that pastors refer all emotional problems. This was unrealistic, and many pastors have had no guidelines as to which type of problems might best be handled by the pastor, and which problems might best be referred to mental health services.

In summary, the area of referral illustrates both the conceptual and role problems that have interfered with successful development of referral cooperation. Yet this is an area in which both groups of professionals may indeed profit from establishing a working liaison with each other.

Cooperation in Consultation. As the churches have become involved in mental health activities there has been increasing need for consultative services with mental health professionals. Such consultation may occur at many levels: consultation to pastors concerning problem clients with whom they are working; consultation to a pastor and the church administration regarding human relation problems in the congregation; consultation to groups or programs in a congregation that are designed to assist people in the church; consultation to a local, regional, or denominational administration in regard to evaluation of religious candidates, human relations problems in the administration, or denominational programming related to mental health issues; consultation to a group of churches who sponsor a joint community program. Such joint consultation will benefit the mental health professionals in that it will foster the contributions of the churches, while it will benefit the clergy and churches in providing assistance in the achievement of their tasks.

There are several problems that may arise in such joint enterprises. First, there is the problem of reductionism. By this I mean the tendency to translate the concepts and ideas of the other professional into one’s own frame of reference. Thus the psychiatrist may reduce all the concerns of the clergy to psychological problems, or the clergy may reduce all the concerns of the psychiatrist to spiritual issues. A corollary to this is to implicitly or explicitly use the other professional for purposes other than what has been contracted in the consultation. For example, a psychiatrist may use a consultation to prove himself superior to the clergyman or expose the neuroticism of religion; or the clergyman may use a consultation either to seek a covert means of therapy or perhaps to gain power and prestige for an administrative maneuver. It is incumbent for effective consultation that both professionals have respect for their own professional discipline and role, and seek to use the help from the other for the purposes contracted, while avoiding aggrandizement of the other.

Another problem in consultation is that of syncretism, that is, conducting consultation in such a way that disagreement is avoided at all costs and the parties must stick together regardless of the means used or the goals set. If effective consultation is to occur both parties must feel free to see issues from their own point of view, yet respect other viewpoints that may suggest modifications. Frequently mental health professionals feel they cannot be of much assistance to clergy with whom they do not agree philosophically, while clergy may feel that a psychiatrist who shares no common theology cannot possibly be of value. It may prove fruitful to spell out carefully areas of disagreement in consultation so that differences can be respected and not interfere with the mutually agreed upon goals of consultation.

A final problem in consultation may be that of competition. Here either party may wish to win out and gain power over the other. This may be an intellectual competition, such as psychiatrist proving that the clergyman is dead wrong in his entire approach, or vice versa. Or the competition may be administrative or political, in terms of responsibility and power to make decisions or direct actions. Usually, openly competitive consultations quickly abort; however, subtle competitions may develop which can effectively sidetrack the consultation work from its intended goals. The end result, however, is a hollow victory.

In summary, there are many levels at which consultation may be part of the community mental health program. This is one of the potentially most fruitful areas of cooperation, for the benefits may accrue long after the completion of a consultation project. To be successful, however, consultation must be a collaborative enterprise between two professional who bring their own unique skills, knowledge, and concerns to the task at hand.

Cooperation in Treatment. Here we may consider opportunities for collaboration in the care of a patient who is receiving mental health treatment, either on an outpatient basis or on an inpatient basis.

In terms of outpatient care, patients in various types of psychotherapy were traditionally treated alone, and the problems were dealt with solely by the psychotherapist. More recently it has been found that the emotionally ill profoundly influence those around them and are influenced in return. Thus we have seen the development of joint treatment of married couples, family therapy, and treatment programs that enlist the aid and cooperation of relatives and friends. In instances where the pastor has a close and ongoing relationship with a parishioner who enters therapy, the pastor may play a role complementary to that of the psychotherapist. The therapist may inquire, question, observe, probe, interpret, and restructure in terms of the patient’s emotional dynamics; while the pastor may continue to provide support, guidance, and a continuing reality of the life of the congregation and the patient’s religious faith and practice. Some therapists have compared this to the needs of the child for both correction and instruction on the one hand, and love and nurture on the other hand.

In terms of inpatient care, we come more directly to specialized pastoral roles, in most instances a chaplaincy role. A number of recent studies indicate that there is considerable strain at the present time in the function of the chaplain. Mental health professionals tend to define the chaplain’s role solely in terms of traditional religious functions such as conducting worship services and administering the sacraments. However, chaplains with clinical training tend to define the bulk of their work in nontraditional areas such as pastoral visitation to patients, counseling patients, teaching in in-service programs, developing liaison with the community, conducting clergy training, performing administrative work, teaching religious classes, participating in research, working with volunteers, counseling employees, and doing religious group work. This list suggests many opportunities for vital contributions to a community mental health center program, but also represents unresolved role conflicts.

Other areas of cooperation include joint enterprises in community education projects such as those concerned with alcoholism, drug abuse, sex education, parent-child relations, marital relations, race relations, problems of poverty. Both groups of professionals may bring particular insights, knowledge, and skills to such educational programs.

Finally, mental health professionals and professional clergy may join forces in developing programs of social action in the community. Here they will probably work with other professionals and disciplines in the community who also have concern for social problems. In such programs both groups of professionals may be only part of larger community programs under the leadership of other citizens.

To sum up this chapter, it should be pointed out that there are many areas of joint concern to both groups of professionals. There are areas of conflict regarding conceptual issues and professional roles. These problems cannot be ignored. However, the fact that problems exist does not mean that inter-professional cooperation cannot be developed successfully. Indeed, the honest facing of areas of conflict may be an avenue toward the development of successful collaboration.

Action programs aimed at increasing interprofessional cooperation should focus on these needs:

1. The need for locally based in-service training programs for parish pastors. Such training should be geared not toward developing specialists, but toward enhancing and enlarging their pastoral care skills and providing them with skills and knowledge to collaborate with mental health professionals.

2. The need for education of mental health professionals in the structure, function, and role of the clergy and church institutions, and how to collaborate with them.

3. The need for establishing clear communication between local community mental health services and the clergy of the community, so that effective means of referral collaboration can be established.

For additional reading

Clinebell, H. J., Jr. Basic Types of Pastoral Counseling. Nashville: Abingdon Press, 1966.

Halmos, Paul. The Faith of the Counselors. New York: Schocken Books, 1966.

Hofmann, H., ed. The Ministry and Mental Health. New York: Association Press, 1960.

Klausner, S. Z. Psychiatry and Religion: A Sociological Study of the New Alliance of Ministers and Psychiatrists. New York: Free Press, 1964.

Linn, L, and Schwarz, L. W. Psychiatry and Religious Experience. New York: Random House, 1958.

Oglesby, W. B. Referral in Pastoral Counseling. Englewood Cliffs, N.J.: Prentice-Hall, 1968.

Pattison, E. M., ed. Clinical Psychiatry and Religion. Boston: Little, Brown, 1969.

Westberg, G. E., and Draper, E. Community Psychiatry and the Clergyman. Springfield, Ill.: C. C. Thomas, 1966.

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.

Advanced training is the training of clergymen to be specialists in pastoral counseling. These are men or women who have completed their college degrees, and who have also graduated from an accredited theological school with a Master of Divinity degree or its equivalent. This means a total of at least seven years of previous preparation. In college they may have had work in psychology, sociology, and anthropology. In the theological school they will have had some work in psychology, sociology, and counseling, along with the standard theological courses. The work described here leads to a Ph.D. or a Th.D. degree upon completion. This requires at least three years, usually longer. The average student entering advanced training is around thirty years of age, has had a period of clinical pastoral training in an accredited institution, and three years or more in a parish. Most are married and have a family.

Advanced training in pastoral counseling has three major aspects. They are, first, the development of the student’s emotional, intellectual, social, and professional life; second, knowledge and understanding of human behavior in breadth and depth; and third, the ability to relate to others therapeutically through an understanding of psychotherapeutic approaches and processes.

Most directors of such programs would consider the first of these goals as the most important, though they would also give full significance to the others. We believe it is more important to develop persons who can be therapeutic, in the broad sense of the term, than it is to develop some kind of pastoral technicians. This conviction is grounded both in our religious faith and in our understanding of the processes by which persons grow, become distorted, and find their way back to wholeness. We are concerned to help each student develop his own potentials and uniqueness, to become, as much as possible, a full human being, and to avoid creating some kind of stereotype of a pastoral counselor.

This concern is manifest in all aspects of the advanced training of pastoral counselors. One is in making it clear to the student that his own personal therapy is a requisite for training on this level. The student’s personal therapy is his responsibility and is obtained independently of the school, from psychotherapists in the community. The following statement in the requirements for accreditation by the American Association of Pastoral Counselors is taken as a guideline for this experience:

A second expression of this concern for the growth of the student as a person is in the teaching methods. There are few lecture courses in such a program. Most classes are based on the seminar-discussion method, and many revolve around actual case material presented by a student from his profession experience. The teaching staff is composed of men who are both practitioners and teachers, men who are concerned with both theory and practice. Most courses are team-taught by a pastoral counselor and a psychiatrist or a clinical psychologist, sharing in the teaching-learning process. Thus the clinical and theoretical material is integrated; psychological and theological understanding is related; and the student is helped to think critically about his own work, to benefit from the insights of his peers as well as those of his teachers, and to honestly face the problems involved in his relationships with others. These sessions often verge on a therapeutic experience for the student, and frequently provide material which he works through in his personal therapy. The educational process is intensified and deepened through supervision in counseling.

Supervision as a form of teaching is conducted both individually and in groups. It is supervision of individual and group counseling, including marriage counseling. The counseling takes place in a number of different settings, such as parish churches, schools, hospitals, and pastoral counseling centers. The supervision is given by consulting psychiatrists, psychologists, social workers, or pastoral counselors. The pastoral counselors doing supervision are accredited for membership in the American Association of Pastoral Counselors, Category III. By the time a student has completed the program he should have approximately four hundred hours of supervision.

The fulfillment of the second and third goals is achieved, not only through the educational methods, but also through the content of the curriculum. For a detailed description of the curriculum the reader is referred to the catalogue of any school offering such a program, and also to the statement of standards for membership in the American Association of Pastoral Counselors.

At Garrett the qualifying examination which the student takes about the beginning of his third year (and which requires the equivalent of five days of writing, plus an oral examination) covers five major areas. These are: (1) theories of personality development in health and illness, including psychopathology, (2) theories of counseling and psychotherapy and their application in practice, (3) the psychology of religious experience, (4) the relationship between the theological and psychological understanding of man, and (5) research theory and practice. Included in the above would be such topics as marriage and family processes and counseling, group processes and group therapy, an understanding of the viewpoints and work of the other helping professions. For further elaboration, the reader is referred to the "Standards for Membership" of the American Association of Pastoral Counselors, which deals with requirements for education for clinical work under supervision, and for personal therapeutic experience.

Obviously such a program must be under the direction of a trained and experienced pastoral counselor, one who qualifies for the highest level of membership in the American Association of Pastoral Counselors. Depending on the size of the program he needs one or more associates who also are highly qualified pastoral counselors. Beyond this an interprofessional faculty is a necessity. This means teachers or supervisors who are psychoanalysts, psychiatrists, specialists in marriage therapy, clinical psychologists, research psychologists, social workers, and others. (Community resources such as psychiatrists, psychoanalysts, clinical psychologists, and social workers are used on a part-time basis as teachers and supervisors. In some instances they are given faculty appointments as "Adjunct Professors.") Thus the relationship between the pastoral counselor and other helping professions is a matter of continuing discussion. Through the interprofessional faculty, other disciplines make a very valuable contribution to the training of the pastoral counselor. In addition the entire faculty of the school is utilized in the program, as the student is expected to understand the relationship of his discipline to cognate disciplines. Where there is affiliation with a university, this faculty is also utilized. For example, in the combined Garrett-Northwestern University program, the student receives excellent training in modern research design and methodology through the psychology department of the University, and also guidance in adapting modern research methods to religious data.

There is a great deal in such a program which would also be found in the training programs of other helping professions. But there is a unique aspect to the training of pastoral counselors, and that is the pastoral or religious orientation. All the men accepted into such a program are committed to the religious ministry and are ordained by some faith group. Such student groups are ecumenical; Catholic priests and Jewish rabbis as well as Protestants of all theological persuasions are accepted. The goal of such training is to equip a man or woman for the work of counseling as a pastor or as a teacher in the field, and also as a competent research person in the field.

There is a continuing emphasis on the integration of scientific and philosophical material with the religious and theological point of view of the student. There is no attempt to indoctrinate the student in any particular theological point of view. Each student is helped to relate what he is learning to his own background and faith group. He is encouraged to examine his personal religious experiences and beliefs and to understand the purposes they serve in his life and ministry. This includes looking at the negative aspects of his religion as well as the positive. Students are encouraged to an understanding in depth of the personal, social, and historical-cultural processes in religion. Aesthetic, symbolic, and ritualistic aspects are studied. The ecumenical nature of the student group and faculty helps to broaden the understanding of the student. Religious issues which emerge in actual counseling experiences are discussed in individual and group supervision. Thus the religious dimension of such experiences as guilt and anxiety, love and hate, faith and fear, hope and despair, autonomy or control, insight or defensiveness -- to mention only a few -- receive attention. It is this concern to bring an understanding of the religious dimension to the therapeutic process which distinguishes pastoral counseling from other helping professions.

Perhaps this is the place to mention some of the unique contributions of pastoral counseling to community mental health. First, pastoral counseling maintains and develops the long tradition of the religious ministry in the care and cure of souls. Pastoral counseling is thus an essential part of total pastoral care and fulfills a necessary function in the total work of the pastor. Cooperation with members of other helping professions is both possible and necessary for the welfare of persons in a manner not possible in previous periods of human history.

Second, pastoral counseling provides the opportunity desired by many in our culture to receive personal help through the religious community and the pastor. Pastoral counseling thus becomes an extension of the basic pastoral relationship and expectancy, and is related to the other functions of the clergyman and of the religious community. Within the religious community there are resources of profound value to mental health, but they need to be used with skill and understanding. These resources may play a significant role in the mental health of the total community.

A third contribution lies in the unique meaning of the pastor and the pastoral relationship. To the various dimensions to be found in any therapeutic relationship there is the added religious symbolic meaning. The pastor represents, in addition to the religious community, the realities of his personal faith, culminating in the image of the God to whom he is devoted. The deeper meaning of the faith of the pastor is reflected unwittingly in his relationships, and becomes a source of identification within the religious dimension.

Fourth, because of his specialized training in religion, the pastor is able to understand and deal with religious elements within the intrapsychic, cultural, or relational aspects of the experience of the counselee. This means distinguishing between healthy and unhealthy aspects of a person’s religion; recognizing both the existential and pathological sources of anxiety, the significance of religious defenses, regression, and growth; and giving whatever encouragement he feels is indicated to positive religious directions. Many secular counselors are justifiably uncomfortable in dealing with religious aspects of a counselee’s experience.

In conclusion then, we would restate our main goal in this training as assisting the student to move toward the fulfillment of himself as a human being, with the additional understanding of those disciplines and the appropriation of those skills which are necessary to the pastor in the counseling process. We ask of our students a high level of excellence both academically and professionally. We seek to offer an educational and religious environment which encourages the development of breadth, depth, and wholeness within the student. We expect the student to develop the kind of religious understanding which quietly bears witness to its value and reality and hence does not have to be compulsively sold to others. To the extent that we succeed in this, the student then becomes the kind of pastor who can help others find a religious faith which is viable for them.

Theological seminaries began in the 1930s to involve both students and faculties in the actual life situations of the mentally ill as a way of educating clergymen in the ministry to the mentally ill and the prevention of mental illness. This was no new fad nor a departure from the basic claims of the Christian faith. The concern of the prophets and the Lord Jesus Christ for the epileptic, the demoniac, the anxious, and the fear-ridden provided both model and motivation for this effort to teach ministers about the contemporary ministry to people in mental illness. The anointing of rabbis and ministers to "heal the broken-hearted" in the tradition of Isaiah and Jesus is involved here. The minister or rabbi actualizes his own unique destiny as a minister or rabbi when he does this.

World War II threw clergymen of all faiths into the maelstrom of a world-wide catastrophe. Clergymen learned to work with other clergymen of all faiths. The lines between the other helping professions of medicine, psychiatry, social work, and psychology ceased to be walls. They became moving lines of creative collaboration between the clergy and men of other faiths and men of other professions. The training of clergy in mental health, which began after World War II, was an ecumenical and interprofessional endeavor. Human suffering knows no barrier, nor does the love of God. The work of the clergy is to communicate the love of God to people in times of developmental and emergency crises. Here they must not indulge in racial, denominational, national, and creedal conflicts. They are concerned with matters of life and death of persons, regardless of these differences.

Some specific guidelines for churches and temples in their efforts to train clergymen in mental health are as follows: first, intensive workshops in suicide prevention, the convalescent care of mental patients, mental retardation, personality disorders in children, and so forth, could be financed and provided by the church or synagogue. I recall being a part of such brief three-day workshops for clergymen of all faiths provided by the First Baptist Church of Greenville, South Carolina. Second, the churches and synagogues can participate together in the development of chapels and chaplaincies in public institutions. Sick people with "all manner of diseases" are cut off from the natural community. In our city, for example, the large charity hospital has a fine chaplaincy program, but worship is held in the medical school amphitheater or in a medical school classroom. The churches and synagogues have yet to do something about building a chapel, although they do supply the whole salary of two chaplains. Training the clergy in hospitals is made more distinctly pastoral if a chapel is available. Third, a synagogue or church can re-think what its youth needs. Our most common assumption is that the church should provide them with recreation and parties. The generation gap could be closed somewhat if the people over thirty would enter a planned collaboration with middle and late teen-agers in their interest in cars, in driver education, earning money for themselves, and in "consumer education." When a church asks a young theological student to be an assistant minister, a young rabbi to participate in the leadership of young people, these activities could be part of his assignments rather than "leading recreation."

The unique contributions of the theological schools and churches to the training of clergymen in mental health is reflected in the kinds of things we expect the minister, priest, or rabbi to know and to be able to do in this area. First, we expect him to know the basic evidences of psychopathology as it appears in religious garb. To do this, at our seminary we have an intensive twenty-four-hour-a-week course in psychiatric information for ministers and religious workers taught in another hospital where the students function as ministers alongside the chaplains. They are trained to deal with the specific distortions of religion that appear among the mentally ill. They are taught to collaborate with a psychiatrist in the care of the mentally ill in the hospital. They are taught what the convalescent mental patient needs from his parish clergymen and fellow parishioners when he returns home from the hospital. They are taught the principles of preventive psychiatry.

Another important contribution of the theological school to the training of the clergy in mental health is direct experience in small groups. Students themselves are being taught the dynamics of small groups by being members of small groups with one another. They are taught how to become effective leaders of groups of lay persons. More emphasis needs to be placed upon the difference between the function of the purely voluntary group, such as one finds in a church, and the controlled and not so voluntary group found in the classes of a theological school. For example, the motives of a theological student in a required course in school are very different from those of a person not being rewarded with professional status and a way of earning a living for participating in the group -- that is a lay person.

One of the most significant forms of education in mental health the minister, priest, or rabbi of today receives is in participating as a clergyman with mental health professionals. This involves the clergymen in seeing their own work as being both a profession and more than a profession. They are professionals in that (1) they are trained for their work, (2) they operate according to basic principles and not merely according to the ad hoc expectations of disturbed and anxious people, (3) they follow a specific and defined code of ethics in relation to other ministers, rabbis, or priests, as well as in relation to their communicants and to other professional persons, (4) they have a specific body of data or information in which they are informed authorities -- i.e., biblical knowledge; knowledge of the history of the churches and synagogues; knowledge of ethical and moral teachings; knowledge of theological beliefs in their variety, similarity, and unique contribution to mental health and well-being, and (5) they have a specific symbolic meaning to people as ministers, as representing God.

In theological school, the task of education is to enable the students to lay hold of the resources of the just-described professional identity and to overcome any major impediments that prevent them from assuming this identity with courage and dignity. Learning about mental health alongside other professionals in training has a way of helping to sharpen and clarify their own identity. The student is steadily pushed into a decision to function or not to function as a minister. In a hackneyed phrase attributed to Harry Truman, he is expected to get out of the kitchen if he can’t stand the heat. In a much less blunt statement, which nevertheless is not so clear, the student is encouraged to find the kind of profession to which he can give himself wholeheartedly from internal and not external motivation.

This points to probably the most important work going on in the training of the theological student in mental health. Real attention is being given in theological school to improving the student’s own mental health as a part of his education. This is being done through several different channels. For example, the Theological Student Inventory developed by the American Association of Theological Schools and the Educational Testing Service is being used more and more to enable students to assess and reappraise their motivations for entering the ministry. If they are responding to undue expectation of parents and home community, to the more intense religious zeal of a wife (in the case of minister or rabbi) , or to the opportunity for evasion of the military draft, these motives are being surfaced and dealt with positively more often now than formerly because of the teaching of mental health values in the curriculum. If the student himself has brought with him specific pathologies, a more therapeutic and less moralistic approach to them has been developed in the modern theological school. If the student simply comes to the conclusion that he is in the wrong calling, he can do so now with somewhat less social pressure, rejection, and isolation. He is more often encouraged to find the thing that he is "with" and that does have durable meaning for him.

Another example of the way in which the mental health of the minister is being fostered in theological school is the way in which Protestant seminaries are at last giving some ordered attention to the education and care of wife and children of the theological student. Prior to World War II, the theological student was ordinarily -- eight out of ten times -- a single man. The ratio now is just reversed. By the time they graduate, theological students are more often than not married, and many of them are parents of children. On our campus, for example, we began by starting an effective nursery-kindergarten program for the children of students. We moved toward a second objective of providing a "mini-curriculum" for the working wife. Thus she could become acquainted with a telescoped version of her husband’s education and meet personally some of the persons who teach him. We continued by developing pre-marital and post-marital counseling and guidance on a group basis for the husbands and wives together. At this time we are exerting an influence to encourage as many wives as possible to participate in the classes with their husbands at whatever level their own preparation and obligations permit. We are convinced that the best way to communicate mental health is through contagion. If these people whom we graduate are relatively healthy people, then maybe health, and not disease, will be "catching."

The most important thing we have discovered, however, was in a research project we conducted with a group of twenty-two students who were in a clinical pastoral education program. We learned many things about these students’ life situations that will enable us to help the succeeding student generations to be more effective ministers and to function as creative agents of mental health. Through intensive psychological testing, careful interviews, the writing of personal autobiographies, the use of interpersonal interaction groups, and other ways of getting to know them better, we discovered that the students tended to think in a continuum on a power-person scale. Some of them did their work on the predominant motivation of the political influence -- power, prestige, and so forth -- which would accrue to them. This was not their exclusive or conscious motivation. Others moved more in terms of personal values in relation to their involvement with the people to whom they ministered as persons. Like the other group, this was not their exclusive or conscious motivation. All twenty-two were strung out along this continuum.

We were not so concerned with this continuum as we were with where and how the men became this way. We discovered the key to this was that the persons who had first influenced them to think about entering the ministry had much to do with their concept of the ministry. Also, the persons with whom they continued to identify and like whom they most surely wanted to become were sources of these patterns of motivation. Consequently, the valuable thing here to suggest to synagogues and churches is that each synagogue or church should give systematic, ordered, and careful attention to persons planning to enter the clergy. These persons should be led by person-centered, not power-oriented, leaders. Projects could be developed in the preparation of candidates for ordination and in maintaining a durable and lasting relationship to the aspirant for the ministry throughout his education.

But the main thing we discovered about this group of students was a sort of built-in timidity and inarticulateness about their own religious life. The issues of effective prayer, creative religious fellowship as such, expression of religious concern, and implementation of religious resources -- these were available strengths and assets the student was reluctant to use. The most important function of theological education, then, would be to encourage and effectively reinforce the student’s confidence in the "gift of God" that is within him. As Goethe said, the truth that is his must be made his own.

Over a period of four years two groups of clergymen, in two separate cities, were given intensive, brief courses on how to deal with people under stress. The pattern for the approximately twenty clergy from Kokomo, Indiana, consisted of one intensive week at the University of Chicago, followed by six monthly meetings after which the men returned for a second intensive week of instruction at the University. This was to have been the end of the project, hut the clergymen continued to meet on a monthly basis, often with key groups of doctors, lawyers, nurses, and others in the town of Kokomo.

The clergy of the second community, La Grange, Illinois, following their one-week intensive program at the University, agreed to meet once each week for case conferences based on their own parish problems. After three months they returned to the University for a second intensive week and then continued to meet in La Grange on a weekly basis at the community hospital with one or more doctors present. Usually, the case presented was the patient of one of the doctors in attendance.

Both the Kokomo and La Grange projects grew out of one of the University of Chicago’s regular two-week seminars for parish pastors on the subject of pastoral counseling and the relation of ministers and doctors in their cooperative ministry to the sick. These seminars had been conducted each summer since 1945. Normally they drew clergymen from a variety of denominations who live in cities and towns in widely separate parts of the country.

At the conclusion of each seminar the students would attend an evaluation session where they were asked to comment on the course and offer ways to improve it. During the evaluation session in the summer of 1957, one of the students, a pastor from Kokomo, said, "This seminar has been tremendously helpful to me. I believe it will significantly change my perception of my responsibilities and opportunities of service to my people. But if I am to follow through on some of these necessary changes in myself, I will need the daily encouragement of fellow pastors who also feel as I do. As long as I have been surrounded by these men in the seminar, I have been doing quite well in my resolution to change. But when I get back to Kokomo, my enthusiasm will probably be dampened by the fact that I will have no one to talk to about these matters." He concluded by saying, "I wish that all you fellows were from Kokomo."

The pastor from Kokomo touched off an animated discussion. Every man present said approximately the same thing. Courses like this would have cumulative value if the students were all from the same community, for they could work together in implementing these newer concepts of clinical theology. During the next few months, we at the University did a good deal of thinking and planning of the possible development of such a project. With the help of the Lilly Endowment we finally decided to go to Kokomo and invite all full-time clergymen to attend such a seminar. We gave it the general title of "The Role of the Clergymen in Mental Health." Through the help of various groups in Kokomo, and particularly the Kokomo Tribune, we were able to explain the nature of the project to this community of some forty thousand people. There were approximately thirty-five full-time clergymen in Kokomo and surrounding Howard County. Of this number twenty-three responded to the invitation.

The Kokomo project was jointly sponsored by the Department of Religion and Health of the University of Chicago with the assistance of the Department of Psychiatry. Dr. Edgar Draper, a psychiatrist, gave full time to the project during each of the one-week sessions. The late Chaplain Carl E. Wenner, of the University of Chicago Clinics, and I acted as directors of the project.

It was not long after the arrival on our campus of the twenty-three Kokomo pastors that we were convinced of the value of inviting all the clergymen of a particular community to study the force of joint clergy action in the area of pastoral care and mental health. The Kokomo group consisted of a cross section of the major Protestant denominations as well as some less known denominations like Bible Baptist, Independent, and Mennonite. A Roman Catholic priest was in the group but there was no rabbi, for Kokomo had no resident rabbi at the time. We were fortunate that Dr. John Hoigt, a newly arrived psychiatrist in Kokomo, was able to participate in the entire project. He lived with the clergymen in the dormitory on the campus. This was his first experience in such a setting, and he said it afforded him an unusual opportunity to get to know the men informally.

By the end of about the third day, many of the clergymen began talking freely about their reactions to this experiment. Some of them admitted that they had not wanted to come to this seminar, but were practically forced to attend by members of their churches who, upon reading the newspaper articles, had insisted they take advantage of this unusual opportunity. These men had tried to beg off, pleading too much work, but their parishioners won out. They admitted that during the first day they had resisted becoming involved in the small group discussions of actual case situations. They said that as they gradually realized that the teachers held parish pastors in high regard they had found themselves more willing to enter into the discussions.

Then these pastors described bull sessions lasting far into the night in which they began to explore possible ways they might utilize some of the new insights for the good of Howard County. As they learned to appreciate one another in the neutral setting of the University campus, away from the arena of competition, they vowed no longer to compete against one another. These men were kept very busy from early morning until late at night, in large groups, in small groups, and in individual consultation. An attempt was made to cover certain areas and subjects which they could use as background for their clinical work in Kokomo during the six months before they would return to the campus for the second week of intensive study. Each pastor spent approximately two hours a day on the wards of the hospital seeing patients and writing up one of the interviews. These case write-ups became the meat of the seminars and forced each man to open himself up to his colleagues concerning his ways of dealing with people under stress.

In the teaching sessions considerable time was spent in describing the process of personality development and how pastors might detect early signs of mental illness. Also discussed were the family and ways in which the clergyman might assist in getting families off to a good start, particularly since he assumes this responsibility in agreeing to marry couples. The importance of the pastor’s conversation with his people was stressed. In the Kokomo group, as in previous groups, it was found that pastors felt very ineffective as counselors. All of them said that although increasing numbers of people were coming to them with their problems they felt there was little they could do for them. One of the aims of the first week of the course was to give these students a new appreciation of how helpful a pastor can be to people by carefully listening to them.

After one year the Kokomo project was technically over, except for the results of the psychological tests which over a period of two years sought to determine whether any changes were observable in the pastors who participated in this project. The results of testing seventeen out of twenty-three men from Kokomo caused the psychologist on the project, Dr. Andrew Mathis, to describe his findings in this way:

Before the year was over the ministers of Kokomo began an interesting experiment in education for marriage. Most of them asked couples who wished to be married by them to

participate in a course conducted several times each year on an all-county inter-church basis. Church bulletins carried an announcement that couples desiring to be married in the church were expected to get in touch with the pastor at least one month prior to the date of the wedding, so that he might get to know each couple personally. As a result of this tightening up of standards for Christian marriages, couples began calling the pastor as much as six months prior to the date of the ceremony to arrange for counseling and instruction.

The Kokomo project continued with some enthusiasm for a year or so, and then gradually the interest declined as men who were leaders in the project moved from Kokomo to other cities.

The La Grange project was similar to the Kokomo project except that the pastors came from a suburban community made up primarily of executives and junior executives. Several of the pastors in the group were now serving top churches in their denomination and had therefore reached the pinnacle of their professional mobility.

One of the most significant differences between the two projects was that a serious attempt was made to incorporate physicians, especially psychiatrists, into the La Grange project. It was one of the concerns of the leaders to get professional level conversations started between doctors and ministers. It was felt that some frame of reference needed to be developed so that each discipline could speak to and be understood by the other -- a need for a common language to bring about meaningful communication.

When the La Grange area pastors met for the first week at the University of Chicago, they had opportunities to meet perhaps a dozen different doctors in a variety of situations including lectures, ward rounds, and small discussion groups. Every effort was made to encourage the clergymen to talk with as many physicians as they could while they were there, so that they might learn to discuss constructively common problems concerning patients. While most of the pastors were reluctant to "bother" the doctors a few said they had more professional level conversations with doctors during that week than they had experienced in their entire ministry.

When the clergymen from La Grange completed their first week at the university and returned home to their local churches, they had some glowing hopes of more effective professional interchange with their local doctors on the staff of Community Memorial Hospital in La Grange. It was not long, however, before they discovered that these physicians were not prepared for this kind of conversation with clergy. This difficulty in communication showed up one of the weaknesses in the planning of the La Grange project. While a few doctors in the La Grange area were aware of the purpose of this special study of the role of the clergymen in community health, the majority of doctors had not been brought in on the early planning in any real way, and as a result they hesitated to enter into a project which to them had dubious value. In an attempt to explain to these doctors just what the La Grange project was, a committee of pastors sent the following letter to approximately one hundred physicians who were on the staff.

As a result of this invitation to physicians about a dozen different doctors sat in on two or more meetings over the two year period, four doctors sat in on more than ten meetings and two on more than twenty. In addition to the physicians, two clinical psychologists attended eight meetings each, a psychiatric social worker who is director of the Southwest Suburban Mental Health Clinic in La Grange attended many sessions, and a lawyer who participated in both weeks with the clergymen at the university attended faithfully.

The theme which perhaps recurred more often than any other was that of the difficulty of communication between ministers and doctors. This came out in many different ways. The following is an excerpt from a tape recording of one of the sessions. (All sessions were taped.)

Pastor A: "Oh I don’t have any trouble talking to the nurses about patients. Most of them belong to my church. It’s the doctors I don’t feel comfortable with because they haven’t asked for us as the nurses have."

Physician: "We don’t ask for you because we don’t know yet what you do. That’s why I’m coming to these meetings so that I can find out. But if, as Pastor B says, you ministers don’t know what it is you are trying to accomplish with a sick person, then I think probably you’ll want to back up and begin to define for yourselves what you think you can do for people."

We found then that modern clergy are generally uncertain of their ministry with respect to sickness. It was also clear that in their own theological education they had seldom been forced to relate their theological stance to a particular clinical situation. The method of these weekly seminars was to start with a clinical situation confronting the pastor. He would usually take fifteen to thirty minutes to make his presentation. Then for the next hour the group dealt with why this pastor responded in the particular ways he did to this person’s needs. His response was usually predicated on his particular religious stance, so his colleagues, and particularly the physicians and psychiatrists present, would ask him to spell out how this was related to his theological position. The case study method meant coming at the minister’s task in quite the reverse order from that to which he had been accustomed in his theological preparation.

This reverse approach to the examination of one’s doctrinal position was upsetting to some of the men, and one or two clergymen dropped out of the weekly seminars shortly after presenting cases on which they were questioned about their work with people. But those of us who led the group and who are accustomed to this clinical approach felt that there was more than the usual amount of kindness and charity demonstrated among the participants throughout the two years of weekly sessions. In fact we felt that there was never quite enough open criticism of one another. They treated each other with gloves on, perhaps, in part, because their own theological training had been conducted in dignified classroom settings. Most of them had never before had their own clinical work examined with any degree of candor and criticism.

The La Grange clergymen were quite open to frank criticism, provided it did not take the form of personal attack. While there was a good deal more self-searching than any of them had ever been subjected to before it did not go as deep as it might have.

As we worked with the men of these two projects we found ourselves listing ten goals toward which we were striving. We had to a degree --

1. Introduced parish clergy to the idea that they can take brief one- or two-week seminars which deal with subjects immediately applicable to their parish situation.

2. Succeeded in getting a medical school to offer a course for clergy in what might be called "clinical theology."

3. Helped clarify the minister’s role and responsibility in the search for underlying causes of mental illness.

4. Helped prepare parish clergy to recognize emotional problems which had their roots in religious conflict.

5. Demonstrated the importance of a cooperative attack on mental illness by fellowship and exchange among all the members of the clergy in a particular community.

6. Introduced clergymen to other professional people working in the area of health.

7. Encouraged pastors to promote an ongoing educational program in their own churches related to mental and spiritual health.

8. Gave impetus to an organized program of continuing postgraduate education for the parish pastor in a variety of subjects.

9. Discovered how a cross section of American clergy with traditional courses in theology would respond to a radically different manner of teaching.

10. Helped ministers obtain new insights for their own personal mental health.

Mental health is everybody’s business, for we live in one world open to one another. We breathe one atmosphere in which we live or die. And we are moved by the emotional waves and attitudes arising in our community life. Slowly and painfully we begin to comprehend how deeply we are involved in one another’s lives. Actually no one can live unto himself or hide within himself alone, no matter what defenses he may hold up to ward off the social currents sweeping through our common humanity. If one is mentally ill the whole family is caught up in the distress. And if one person is sound he may radiate healthy attitudes to bless many people around him.

Whatever we think of him as an individual person, the clergyman is an influential member of his community, who affects the emotional health of many persons for good or ill. A nationwide survey revealed that 42 percent of persons seeking help with emotional problems had gone first to a clergyman.(See Chapter 16 for a fuller description of this survey.) When they were asked why they chose a clergyman, they said, "Because we know and trust him." Consequently there is reason to be concerned for the mental health of the clergy, and how they prepare to assist persons who are wrestling, as we all do at one time or another, with emotional problems.

In Indiana several programs converge on developing the mental health potential of the clergy. In 1957 The Methodist Church, led by Bishop Richard C. Raines, began a program of pastoral care and counseling with a twofold aim: (1) to provide counseling for ministers and laymen, and (2) to offer pastors continuing education in this crucial ministry of pastoral care. District committees were formed, training institutes were held for one or more days in every part of the state, and pastoral counseling centers were opened in eight cities by the collaboration of pastors with several other professions. The Rev. James E. Doty, Ph.D., was the first area director, and after nine years he was succeeded by the Rev. Foster J. Williams, Ph.D., who is expanding these opportunities for pastors.

In 1965, the Indianapolis Pastoral Counseling Center (The more than 200 pastoral counseling centers in the U.S.A. and Canada represent significant new mental health treatment and training resources.) at North United Methodist Church received from the Lilly Endowment a three-year grant, which has been renewed for two additional years, to expand the education of pastors in pastoral care and counseling. This center has become ecumenical in the religious affiliations of the advisory board, the funding of the program, the pastors who serve as counselors, and the persons who come for counseling or education.

In 1967, 13 pastoral counselors provided 1,237 hours of counseling for 309 persons from 23 denominations. The counselors received individual supervision each week from 5 pastoral supervisors and group supervision in case conferences each week in which 18 consultants participated from medicine, psychiatry, psychology, and social work. Problems presented for counseling were: marital, 129; personality, 55; depression, 34; family, 34; divorce, 15; vocation, 14; sex, 8; religious, 5; juvenile, 4; psychotic, 4; finance, 3; premarital, 2; addiction, 1; and personal identity, 1.

This Pastoral Counseling Center was accredited by the American Association of Pastoral Counselors, provisionally in 1966 and fully in 1967. The first Director, from 1958, was the Rev. Kenneth E. Reed, Ph.D., who is Director of Chaplaincy Services at the Methodist Hospital of Indiana. There he has developed a program of clinical pastoral education, accredited by the American Association of Clinical Pastoral Education.

Clinical pastoral education brings another significant dimension to the education of the pastor for his vocation, and particularly his ministry to the emotional needs of persons. Here the pastor learns to be sensitive to feelings, to be aware of signals of stress, and to understand the motivations and responses of human behavior. With intensive supervision from a chaplain supervisor he learns how a pastor may minister to persons in face-to-face relationships with the potential resources of religious faith, hope, and love.

In 1959, the Rev. John A. Whitesel, Ph.D., came to the Indiana University Medical Center to develop a service to patients, faculty, and students; and to initiate a program of clinical pastoral education which is accredited by the Association of Clinical Pastoral Education. Other such programs have since been accredited at the Central State Hospital, the Larue Carter Memorial Hospital of Indianapolis, and the United States Penitentiary, Terre Haute, Indiana.

From 1964 to 1967, a demonstration program of continuing education for clergy and related professions in mental health was directed by John Whitesel, sponsored by the National Institute of Mental Health and the Lilly Endowment. During this program seventy-eight clergymen from twenty-three urban and rural communities participated with eighteen persons from medicine, psychiatry, social work, and psychology as co-participants. Six cities were selected as training centers where community resources were explored, clergymen and other professionals were enrolled, a local committee was formed to plan the curriculum, and a group organized for continuing education.

These persons came in the fall to the Indiana University Medical Center for one week of full-time clinical pastoral experience, and again in the spring. Before coming to the Medical Center and the related hospitals, each group had three orientation seminars with the supervisory staff. Following the first and second clinical weeks a series of tri-weekly seminars of four hours each was held in each city where case studies, theoretical concepts, and community resources were studied. The inductive method of learning was followed with a concluding evaluation to assess each person’s experience and growth.

Specific objectives were (1) to promote acceptance of the mentally ill in the community, (2) to develop inquiring and collaborative attitudes in the clergy, (3) to sustain a working relationship among clergy and the mental health professions, (4) to apply the theory and methods of clinical pastoral education to a community service program, and (5) to explore instruments for assessment and educational needs.

In 1958, the Rev. Lowell G. Colston, Ph.D., was called to be Professor of Pastoral Care at Christian Theological Seminary in Indianapolis where he has developed a graduate program. Through affiliations with the above centers of clinical pastoral education and the Indianapolis Pastoral Counseling Center, the opportunities for continuing education of pastors have been notably enriched. The new curriculum is emphasizing concurrent field engagement in the community where eventually the pastor will serve persons under the varied conditions of the secular society.

There is general recognition of the urgent need for continuing education of the pastor, if he is to keep abreast of the demands and expectations confronting him. The National Institute of Mental Health in 1968 awarded a five-year grant to Christian Theological Seminary for the continuing education of the clergy in reference to mental health needs and services. This grant acknowledges the potential resources of this community for designing a broadly based program of many dimensions for pastors in mental health.

To coordinate the expanding programs of continuing education for the pastor, the Indiana Pastoral Institute is being incorporated as an association of religious bodies and educational centers who desire to cooperate in stimulating and sharing potential resources for more effective education. Ministers, priests, and rabbis who receive the benefits of this continuing education will return to their communities to serve the emotional, social, and spiritual needs of their people with deepening understanding and responsiveness.

Forms of Continuing Education

The education of pastors is moving into action along these strategic lines representing opportunities to keep growing in the ability to serve human needs:

(1) Graduate studies in the various ministries of pastoral care are being enriched in a cluster of theological seminaries (The Catholic Seminary Foundation will draw together a cluster of Catholic seminaries adjacent to Christian Theological Seminary.) and universities, with academic credit leading to master’s and doctor’s degrees.

(2) Clinical pastoral education is available full-time for six or twelve weeks, or part-time four days a week, in accredited centers where pastors serve on a team with other professionals to meet the crucial needs of patients. Chaplain residencies are available for one or more years of full-time intensive training.

(3) Counselor education is offered pastors who may choose a parish setting, a seminary, or a hospital as the base for this supervised intensive learning in teamwork, referral, and consultation with other professions.

(4) Parish education is available in several formats, such as:

(5) Inner-city urban ministry either as a one-year resident or one day a week for thirty weeks to mingle with the people wherever they are, to engage the power structure of the community, to explore the economic and political strategies of community planning, to discover the potentialities for a ministry to total needs of persons who are deprived or in stress.

(6) Interagency participation to serve persons in special need, and staff the agencies of the community which seek to cope with crisis and despair, education and vocation, neighborhood associations and community organization. These services in Indianapolis may include the Community Mental Health Center, the family courts, the juvenile courts, the Suicide Prevention Center, child guidance centers, senior citizens programs, rehabilitative workshops such as the Goodwill Industries, schools for the blind or deaf, recreation and tutoring, housing and employment projects.

For additional reading

Accredited Training Centers and Member Seminaries 1968. Association for Clinical Pastoral Education, Room 450, 475 Riverside Drive, New York, N.Y. 10027.

The Journal of Pastoral Care, a quarterly publication. Association for Clinical Pastoral Education.

Manual and Directory 1966-1968. The American Association of Pastoral Counselors, Inc., 201 East 19th Street, New York, N.Y. 10003.

Ministry Studies, a quarterly publication. Ministry Studies Board, 1717 Massachusetts Avenue, NW., Washington. D.C. 20236.

Pastoral Psychology, a monthly publication. 400 Community Drive, Manhasset, N.Y. 11030.

Theological Education, a quarterly publication. The American Association of Theological Schools, 534 Third National Building, Dayton, Ohio 45402. See esp. Vol. IV, Spring and Summer, 1968.

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.

The second Vatican Council has, to put it mildly, generated a revolution within the structure of the Catholic Church. However, no phase of that revolution has been more dramatic than the emphasis that has been placed on the role of the parish council in parochial control. It is interesting to note that the loudest hue and cry for effective parish councils have been sounded by the parishioners of inner-city churches, and more specifically by those in black communities. There are many parishes whose parish councils are floundering because the pastor is giving only lip service to the need for relinquishing much of the administrative control of the parish to the parish council. Today, across the nation we are witnessing the formation of groups that are identifying themselves increasingly with community control. In every major city of our country there has been created, or there is in the process of formation, Afro-American patrolmen’s leagues, black lawyers guilds, black teachers’ associations, Afro-American firemen s leagues, black doctors’ societies, black ministers’ caucuses. I’m not sure -- there may even be a black psychiatrists’ group.

All these organizations are addressing themselves to the pressing need for community control, particularly among powerless people -- Mexican Americans, Blacks, Puerto Ricans, Appalachian whites. The current hassle I am involved in with my own church authorities in the Archdiocese of Chicago is largely a result of the phenomenon of community control. Sparked by St. Dorothy’s Parish Council, the black community demanded from church authorities the same recognition for our black community that is accorded, with no question, to the Polish, the Lithuanian, the Irish, and the German communities.

And now we are face to face with the potential of community control of community mental health. It would devoutly be hoped that professionals in the fields of mental health and, religion could learn from the mistakes that have been and are being made by other groups supposedly working for the betterment of our communities. Certainly the most obvious pitfall is that of reluctance to, and even hostility toward, listening to the vital components of the community, the residents themselves. Social agencies, welfare groups, religious organizations, commercial concerns, all have marched into our communities -- especially our inner-city communities -- with preconceived notions of superimposing their structures upon a community, of afflicting a community with a structure that was developed in some think tank without consulting any significant forces within the community itself. We would do well to ask ourselves how sincere are we in our concern for community mental health if we are unconcerned about consulting the community.

Another area of legitimate concern is that of actual involvement of the community in the administration of community mental health. It is so easy and so ridiculous for us to slap on a white collar or a white smock and assume that we have the trust of a community. Certainly in the black community nothing could be further from the truth. I am a black man, and yet I am automatically suspect in the black community. Recently a meeting was held in the basement of St. Dorothy’s Church in Chicago. Participating in the meeting were members of a young radical, activist, militaristic black group. After several hours of wrangling back and forth -- rapping is the term we use -- one of the young black men jumped up and yelled at me, "Father, what you are saying makes a lot of sense -- what does not make sense is that white man’s collar you have around your neck!" That incident has really made me stop and re-evaluate my position in the community. If that happens to me, a black man striving to be relevant, a fortiori it will happen to Caucasians -- excuse the expression -- in spades. It is the height of arrogance as well as folly for professionals in the field of mental health to ignore actual involvement of the community in the administration of community mental health.

Also we must be cognizant of the necessity that the community have reasonable control over allocation of funds for community mental health. For example, I really wonder how often community residents have been consulted prior to construction of community health facilities in a given neighborhood. Here are people who have lived in the community a great deal of their lives, and yet they are not considered qualified to state their opinions as to how much money should be spent in construction of a community mental health facility and where it should go. We who are professionals are very squeamish in furnishing information to the community about our financial affairs. Very few members of the community know how much money the pastor really receives or what the salary is of the professionals staffing our community mental health centers. We tend to shy away from letting the community get too close a look at us for fear that they might begin getting truly serious about this business of community control. Certainly if members of the community held the pursestrings and signed the salary checks of those working in the field of mental health in the community, we then would have a much more enlightened and much less patronizing behavior pattern displayed toward the community.

Furthermore, our efforts should be directed toward community participation in and sharing in the responsibility for mental health, not because of any ulterior motives but because this is just and right. There are skills that we professionals possess that are of immense value to our communities, especially our inner-city communities, but we are grossly derelict in responding professionally to our communities if we do not take the lead in giving them an effective measure of control in their own destiny. It is my hope and prayer that we will take heed and listen to our communities before we plunge headlong into them -- or we might find that we have plunged into a nest of hornets and will not have any communities left to diagnose. Finally, we ask ourselves possibly the most poignant question of all -- Should not the community have a say-so in the definition of terms of mental health? Just exactly what is mental health in the context of the community? Is one, for example, mentally healthy if he leaves his family because that family will fare better on ADC than they ever could on the meager unemployment compensation checks he receives?

If there is to be little or no effective community control of community mental health centers, then let us abandon the farce of the appellative designation, "community." Let us call them what they really substantially are -- federal, state, or county mental health centers. After all, these are the names given them by the people who actually live in the community.