Here’s the second installment in our current series, Sin, Mental Illness and the Church. Today, we look at the work of Jay Adams and his conceptualizations that are foundational to the development of the Biblical Counseling movement.
If Sigmund Freud had an outsized role in the growth of modern psychiatry, Jay Adams has had a similarly outsized role in the growth and influence of the Biblical Counseling movement.
It’s important for our readers to understand how central Adams has been in impacting how pastors from evangelical and reformed traditions think about mental illness and pastoral counseling. Now in his mid 80s, Adams continues to teach and to write. Other leaders of influence within Biblical or Christian counseling circles have either written in response to Adams’ foundational work or sought to build upon his work. We’ll look at this phenomena in a subsequent post in which we’ll examine the perspectives of the leaders following in Adams’ footsteps.
As a young pastor fresh out of seminary in the early ’60s, Adams felt ill-prepared to respond to the needs of those who approached him for counseling. He was critical of the practice of referring out to secular professionals who would impart “non-Christian counsel.” Ironically, Adams was to be influenced in his thinking by O. Hobart Mowrer, a prominent psychologist and behavior therapy researcher from the University of Illinois (a former President of the American Psychological Association, and a non-Christian) who was a vicious critic of the field of psychiatry and the medical model of understanding mental illness. Adams served a summer internship with Mowrer at two state-run psychiatric hospitals in Illinois in 1965…paid for by a foundation established by Eli Lilly!
In Adams’ landmark book, Competent to Counsel he established the foundation for the Biblical Counseling movement.
The thesis of this book is that qualified Christian counselors properly trained in the Scriptures are competent to counsel-more competent than psychiatrists or anyone else.
In the book, Adams lays out his construct of mental illness. In reading what he has to say, I have to remind myself that the book was written in 1970, that it’s one of approximately 100 books that he has written, and much of his subsequent writing has served to modify, expand upon or tone down criticisms (a little bit) issued in Competent to Counsel. Heath Lambert, a modern leader in the Biblical Counseling movement, wrote that “for Adams, bombast was a conscious tactic.” With that said, Adams (as the founder of the Biblical Counseling movement) rejected the modern concept of mental illness…
To put the issue simply: the Scriptures plainly speak of both organically based problems as well as those problems that stem from sinful action and behavior; but where, in all of God’s Word, is there so much as a trace of any third source of problems which might approximate the modern concept of mental illness.”
Adams was also very blunt in his assessment of persons with mental illness…
What then, is wrong with the “mentally ill”? Their problem is autogenic; it is in themselves. The fundamental bent of human nature is away from God. Man is born in sin, goes astray “from his mother’s womb speaking lies” (Psalm 58:3) and will therefore naturally (by nature) attempt various sinful dodges in an attempt to avoid facing up to his sin. He will fall into varying styles of sin according to the short-term successes and failures of the particular sinful responses he makes to life’s problems. Apart from organically generated difficulties, the mentally ill are really people with unsolved personal problems.
“I do not wish to disregard science, but rather I welcome it as a useful adjunct for the purposes of illustrating, filling in generalizations with specifics, and challenging wrong human interpretations of Scripture, thereby forcing the student to restudy the Scriptures. However, in the field of psychiatry, science largely has given way to humanistic philosophy and gross speculation.”
Sometimes, instead of speaking of mental illness, people talk about “emotional problems.” But this language is as confusing as the former. When a client is depressed or high, or anxious or hostile, there really is no problem with his emotions. His emotions are working only too well. It is true that his emotions are not pleasant, but the real problem is not emotional, it is behavioral. Solutions aimed at relieving the emotions directly (as, e.g., chemical methods like pills or alcohol), therefore, must be considered to be nothing more than relief of symptoms.
Adams was resolute in his initial insistence that sin is the cause of the problems that lead people to seek counseling…
“In nouthetic counseling, the stress falls upon the “what” as opposed to the “why” because the “why” is already known before counseling begins. The reason why is already known before counseling begins. The reason why people get into trouble in their relationships to God and others is because of their sinful natures. Men are born sinners.”
Adams’ approach is described as nouthetic counseling. Nouthesis and nouthesio are the Greek noun and verb forms of the word translated as “admonishing” in the ESV translation of Colossians 3:16…
Let the word of Christ dwell in you richly, teaching and admonishing one another in all wisdom, singing psalms and hymns and spiritual songs, with thankfulness in your hearts to God.
Adams describes nouthetic counseling as a strategy that seeks to correct sinful behavior patterns by personal confrontation and repentance. The three basic elements involve teaching by God’s Word, solving problems by verbal means through confrontation and the motivation of love and deep concern to help the counselee for their own good (an element that some may overlook in employing Adams’ techniques). Nouthetic counseling is a very directive, authoritative and confrontational approach.
He described the qualifications for nouthetic counselors…
Preeminently, a nouthetic counselor must be conversant with Scriptures. This is one reason why properly equipped ministers may make excellent counselors. A good seminary education rather than medical school or a degree in clinical psychology, is the most fitting background for a counselor.
Adams was also extremely critical of the secular professions that had commandeered the domain of counseling. From The Christian Counselor’s Manual…
Biblically, there is no warrant for acknowledging the existence of a separate and distinct discipline called psychiatry. There are, in the Scriptures, only three specified sources of personal problems in living: demonic activity (principally possession), personal sin and organic illness. These three are interrelated. All options are covered under these heads, leaving no room for a fourth: non-organic mental illness. There is, therefore, no place in a biblical scheme for the psychiatrist as a separate practitioner. This self-appointed caste came into existence with the broadening of the medical umbrella to exclude inorganic illness (whatever that means). A new practitioner, part-physician (a very small part) and part secular priest (a very large part), came into being to serve the host of persons who previously were counseled by ministers but now had been snatched away from them and placed beneath the broad umbrella of “mental illness.”
If I were to summarize the essentials of Jay Adams’ teaching that remain foundational to what we know today as Biblical or Christian Counseling, they would be as follows…
- Everything we need to be able to counsel people for emotional or behavioral problems that aren’t clearly organic in nature can be found in Scripture. The Bible is sufficient for counseling.
- Often, the underlying cause of the problems that lead people to seek help is sin, absent a clearly identified medical condition.
- If the underlying problem is sin, the solution is found in the person of Jesus Christ and his saving work of redemption as revealed through God’s Word. Positive change flows from the power of Christ through the transformative power of the Holy Spirit.
- Psychiatry and psychology all too frequently dissuade people from taking responsibility for their emotional states and patterns of behavior.
Dr. Adams is the founder of the Institute for Nouthetic Studies (INS), the National Association of Nouthetic Counselors (NANC), and the Christian Counseling and Educational Foundation (CCEF). INS offers training and a certificate program in Nouthetic Counseling. He maintains a current blog and has a page on the INS website featuring his answers to frequently asked questions.
Editor’s note: I presented Jay Adams’ work for the purpose of helping those within our growing movement of Christians seeking to welcome and include kids and families impacted by the full range of disabilities into the local church to understand how many leaders serving in churches most committed to evangelism and outreach gained their practical understanding of mental illness. While many of our readers will find Jay’s teaching “provocative” to say the least, you will find no criticism of his work here.
We need to keep in mind that if we’re going to change the perceptions that cause a majority of those who do not regularly attend church to disagree with the statement that those with mental health issues are welcome at church and engage church leaders from evangelical and reformed congregations to pursue intentional outreach to families impacted by mental illness, we’re going to need to find common ground with those in positions of influence within the Biblical Counseling movement and we’ll need to find a few courageous leaders in the field to take up the cause of inclusion.
Next, we’ll examine some unintended consequences of the movement Jay Adams launched.
Revised January 29, 2015.
Consider joining us this winter for Key Ministry’s online group study that will accompany our blog series…Sin, Mental Illness and the Church. This study will be a combination of Bible reading/study and supplemental readings/material to enlighten participants as we examine the following questions…
- How has the understanding of mental illness evolved in the evangelical movement in America over the past half-century?
- How do past and current attitudes in the church influence outreach efforts to families of children and teens impacted by mental illness?
- What can we learn from Scripture of God’s purposes in the lives of those impacted by mental illness?
- How can we help more kids and families impacted by mental illness to experience the love of Christ through involvement in a local church?
Anyone can join us, but a Facebook account is required. Click here to register!
I think it’s unfortunate when leaders in the church make rigid connections between the Bible and their personal ideas. Dr. Adams, like many in various fields, has turned the Bible into a “key to everything” vs. what it is: a divinely inspired text that show us how to please God and how to live godly lives in relationship with Him. The Bible is not a science textbook (although it contains some scientific facts and an accurate historical narrative); it is not a counselling manual (although there are some really good principles in there); it is not even a cookbook (although I quite like Ezekiel bread… 😉 ) I think this is an instance of a person teaching as doctrine the precepts of men, based on a very limited human perspective. I also think too many people ignore the fact that our brains physically change as we go through life and any number of things–genetics, chemistry, trauma, stress–can alter the way we think and behave and create observable, physical differences in the brain. Spiritually-based counseling cannot erase a physical need (although I do think a truly loving, spiritual environment can promote or accelerate healing): Reminds me of James 2:15-16.
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I read Competent to Counsel in the mid-1970s, and my impression was that it was too “pat” to use in attempting to help people with serious mental illnesses, “emotional problems” etc. Some things in it were well-founded, but the expectations of recovery too rapid and idealistic. I think there is no question but what many mental illnesses start with sin, or failure to address a sinful thought pattern or life situation in a godly manner, or from suffering a sinful behavior perpetrated by someone else, but it can take **years** to help someone overcome the effects! Sometimes it can take a very detailed inventory of one’s actual honest thought processes to focus on where some irrational or sinful thinking is interfering with one’s life. Then you have to figure out what best helps the particular individual address the problem, and that can be different person to person. The import of Dr Adam’s approach is that “fixing” people is a 1,2,3 process — stop sinning and you’ll be better! It’s not that easy, particularly with people whose faith is poor, or plagued with poor theology they are convinced is truth, or a deep distrust in God, scripture or the Holy Spirit (no matter what they claim to “believe”). Many people who have been deeply hurt by others’ actions find it extremely difficult not to obsess about the incidents, or trust God’s goodness and sovereign purposes, etc. It may well be that pride, fear, resentment, revenge, and many other responses arise (against God as well as man), but something more than mere Bible verses and “commands to stop sinning” are needed to help such people find peace and follow Christ. Judging, condemning and Bible-whipping such people does no good, and may even make their recovery more difficult or impossible. Patience, understanding, sympathy and encouragement (dare we say love?) can go a long way to helping such people. I have found that meditation on particular Psalms and numerous scriptural accounts of God’s mercy to doubtful/weak people, promises of mercy and love, plus a real grip on the grace of God in the gospel can be a big antidote to depression; but it took me *years* to beat back nagging fears of failure drilled into me by youthful experiences in a non-Christian family. I think counselors also need to discern whether some people they attempt to help really are Christians! Many will say they are believers, but blatantly and stubbornly live in some open sin that they refuse to turn from, rationalizing it in ways reminiscent of the world’s philosophies and standards. The unconverted cannot turn their lives around on their own philosophies and “will power” while refusing to submit to Christ and scripture in the work of the Holy Spirit. The effects of hormones, damaged neurological structures, and so forth, whether caused by alcohol, drugs (even legal medications taken according to directions!), infections, accidents, war injuries, severe physical or psychological trauma need to be extremely carefully evaluated. It isn’t so simple as to say “Stop sinning and your problems are over.” If you believe as I do that everything we do as Christians has some sin in it no matter what we do, “mental illness” is a matter of degree, not “I’m either sick or I’m okay.” (Whitefield preached that everything he ever did were “so many spendid sins” — “I cannot preach to you but what I sin.” “My very repentance needs to be repented of” etc. — his only trust for righteousness was Jesus Christ, not his personal “spirituality.”) I think also that secular psychologists have come across a number of inter-related problems or “diagnoses” that Christian counselors would be foolish to ignore or avoid. Some anxiety disorders “cluster” for example — if you have one disorder, the chances are high you suffer to some degree from at least two others. I wouldn’t ignore my veterinarian’s prescriptions for my pet just because the vet is not a believer or has some “humanist philosophy of medicine.” Not everything non-believers come up with is useless or “godless nonsense.” Common grace is at work “out there” to some degree. One must use wisdom.
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This person realizes that you cannot even reason with a schizophrenic, psychotic or manic person, yes? No amount of biblical counseling can make a difference to a person who is hallucinating. Only meds. Once they are rational again, try counseling. In addition, it is important to realize that unless the patient is truly “converted”, truly a Christian (a nominal Christian), this type of counseling sadly won’t mean much to the person and won’t “stick”. Even more disappointing is the fact that if the person IS a converted Christian but has one of the “biggies”: Schizophrenia, Bipolar Disorder, Major Depression, or Psychosis they could receive tons of this type of counseling but without meds they won’t get better. This is not to say that the teenager who is down in the dumps and “going through stuff” can’t benefit from sound theology and biblical advice. But this person’s ideas are dangerous to the patients and to others. Unmedicated manic people are dangerous. I am bipolar. My parents refused to put me on meds, and even
after I was out of the house I figured they were right. At the age of 29 I had a severe manic episode and tried to set the house on fire. I don’t think biblical counseling would have helped. Once I was stabilized on meds in my mid-30’s, I became a Christian. After that biblical counseling became very beneficial because the spirit opened my eyes and ears (praise God!) to what the counselor said. I simultaneously attended (and still attend) sessions with a licensed psychologist who is also a Christian. He uses “head shrinking techniques” that help my disordered mind to simplify problems, or to see the nuances in situations. Now I balance those sessions by having sessions where I speak with an older Christian woman in my church who is biblically knowledgeable and helps me to think more biblically about issues. When you think of it, really, everyone needs that, not just bipolar people. The point is, all of these things are wonderful, but some were not accessible/helpful without meds (clinical psychology) and some were not accessible/helpful without salvation (biblical counseling). I feel very blessed to be where I am, balanced on meds and able to benefit from biblical and traditional counseling. But it is fool’s folly to shun medication.
I wanted to add to my previous comment that bipolar disorder is degenerative so even with meds it’s going to be difficult but without them you’re really up a creek. I’m glad Lithium is working! AND God has worked miracles in my life. He removed ALL of my major patterns of sin when I became a Christian. All of those patterns had been exacerbating my illness (and hurting my life in general) to a HUGE degree. The biblical counseling helped me to sort that out, but the Holy Spirit had already done the work!! Even after those miracles, sadly I still needed to take medication. Without it I become manic.
I have not read the book and have never heard of nouthetic counseling until I read this article. As a follower of Christ and a psychology student, I often struggle with these issues–church vs. science. I was raised to believe that mental illness was an attack of the devil and could be healed through fasting, praying, and studying the word. As a psych student, I look at the the teachings of Freud, Maslow, Ellis, and others and believe that there are some truths to their teachings.
But I often struggle with how to educate others on what I know to be true. There are some levels of mental illness that I believe can be treated with within the church with fasting, praying, studying, and counseling (If that person is a believer); but, I also believe there are some mental illnesses that require all of the above plus medication. The key is to figure out which is which; and, to not make that person feel less than because they have a mental illness or because they need medication to treat it.
I also believe that healing comes with time when dealing with mental illness. It can never be a cookie cutter situation. Everyone is different and therefore some my require more help, while others require less. No one should be attacked for their illness and in all cases should be treated individual with love, mercy, and grace.
Unless if I missed something, I am uncomfortable with this way of thinking. It mirrors those who believe that if you have a physical illness, then there is a sin in your life.
God set up perfect creation and yes, sin set things on a corrupted course. However, if we take that to the personal instead of the global, it is not welcoming to someone with mental illness in the church when we tell someone you are struggling because there is sin in your life (as if they have a hidden sin).
I have a young daughter with anxiety challenges. If I told her it’s because she sometimes lies or does not listen, what a burden and untrue statement. If I tell her we all have challenges due to man’s fall into sin, now we are in this together and welcoming. Than there are Biblical and yes sometimes….. medical things that can help this fallen world’s issue.
My name is Alan Roth, and I am a doctoral student at Masters International University of Divinity in Evansville, Indiana. I would like to invite you to participate in a research study I am conducting that will seek to identify Compassion Fatigue in Biblical Counselors and ascertain the mitigating effects, if any of spiritual well-being, religious coping and resilience. Particularly, I am searching for qualified experts in the fields of Christian and Biblical Counseling who have a working knowledge of biblical counseling. If you would like to participate in this voluntary survey, please click, and answer prayerfully. https://www.surveymonkey.com/r/8FG33XQ