Let the Shepherd Lead

• You might ask, “what if the person who comes to me for counsel has a medical or a psychological diagnosis?”
  • First, make sure to understand and affirm that God created us with both a body and a soul, thus it is wise for shepherds to encourage regular medical care.
    • The “two aspects of our nature [body and soul] interrelate in mysterious and wonderful ways” that sin and suffering corrupt and complicate with among other problems, disease.[1]
    • Pursuing appropriate medical care is stewarding the body God gave us in the same way pursuing biblical counseling is stewarding the soul God gave to us.[2]
    • Thus “medicine is just one tool in the overall biblical approach to care for embodied people, and this tool must never be used in a way that undermines engagement with God through His Word.”[3]
  • Then, be honest with that person.
    • Most of us are not medical doctors. A medical doctor’s focus is on tracking symptoms and discovering the biological signs and underlying causes for disease.[4]
      • Symptoms are subjective feelings/conditions reported by a patient (ex. It feels like my heart is racing).
      • Signs are objective, observable changes in the person’s physiology that MAY indicate disease. (ex. a pulse check reveals an elevated pulse rate).
      • Causes are the root problem leading to a physical ailment (like an elevate pulse due to an infection) or a spiritual ailment (like anxiety about a loved one).
    • We are biblical counselors. Our focus is on telling people how they can trust and please God.
    • Each of us is a whole person knitted together by God (Psalm 139:13-16).
      • Thus, disease in our bodies can affect the condition of our soul. Similarly, spiritual ailments can affect the function of our bodies.[5] 
      • For this reason, a believer will seek both medical treatment and biblical counseling.

• This will likely lead to basic discussion about medical diagnoses (including psychological diagnoses).
  • • Medical diagnoses describe certain set of observable, verifiable, objective phenomena in a person’s body that indicate disease. This is called a pathology, or a study of causes.[6]
      • This means that when we come to a MD with a symptom, they do not immediately prescribe a treatment.
      • They verify their suspected diagnosis by testing for the presence of an objective sign.
      • Then they seek to understand the underlying cause for that sign.
    • With psychological diagnoses, these are merely labels that describe certain sets of observable behavior and connected, but subjective symptoms.
      • Properly most of the diagnoses in the DSM are called syndromes or disorders.
      • A syndrome or disorder indicates that we are dealing with a physical problem with an unidentified cause.[7]
      • In Ed Welch’s book, Blame it On the Brain (1998), he offers a helpful way of thinking about most mental diagnoses based on presence or absence of pathological causes for the physical symptoms.
        • The Brain Did It (Alzheimer’s, Dementia, Head Injury)
        • Maybe the Brain Did it (Depression, ADD, other related Psychiatric disorders).
        • And The Brain Didn’t Do it (Homosexuality, Alcoholism & Addiction).
  • Finally, let me say that no diagnosis should scare us away from addressing a person’s heart condition.
    • No matter if it is a medical or psychological diagnosis, the person we counsel must choose out of his heart how to respond (1 Cor. 10:13).
    • As shepherds we can become informed as to what habits and challenges any diagnosis presents.
    • Even so, our goal must be to guide each person to respond biblically to each situation.
    • As Rita Jamison says in addressing ADHD, “Problems are a part of every child’s life. Deuteronomy 6 instructs parents to be continuously teaching and training their children…” even that is more difficult with “an impulsive easily distracted child.” Further she says, “just like every other human being, children with an ADHD diagnosis have sinful hearts that need a Savior.”[8]
    • Most importantly, we offer counsel and support by…[9]
      • Refraining from making the person feel shame for seeking medical treatment.
      • Making sure the person realizes that they can still trust the Lord and address their spiritual issues while they are being treated medically.
      • Advising the person to find the right doctor who will get to know the entire situation of their patient. Further you want a doctor who recognizes that medical treatment has limits and will not hesitate to see the spiritual care of the church and pastor as an ally.
      • Crucially, as a shepherd we should maintain a spiritual oversight over this sheep.
        • We should ask them how their appointments and treatments are proceeding.
        • We should help them to think through their doctor’s advice and treatment options.
        • We should endeavor to help each person keep Jesus Christ central to their treatment plan.

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[1] Reju & Pierre, 125.

[2] James Halla, MD. A Bibilical Approach to Receiving Medical Care, 4-5.

[3] Reju & Pierre, 125-126

[4] James Halla, MD. True Competence in Medicine,

[5] It is therefore misleading to discuss our mental health, emotional health, physical health, and spiritual health as if they are all separate entities rather than interconnected parts of a whole person. Halla, Competence, 24.

[6] See Charles Hodges, Good Mood Bad Mood, Chapter 2-3 especially pg. 39-40.

[7] Hodges, 40

[8] Rita Jamison, Parenting Your ADHD Child, 3-5

[9] Drawn from Reju and Pierre, 118-127.