(Photo: Volker Mohrke)

In March 1979, a 24-year-old Californian named Kenneth Nally took an overdose of his antidepressant medication, Elavil, and waited to die. Unconscious, he was found by his parents and rushed to a San Fernando Valley hospital, where he had his stomach pumped. A doctor recommended to Kenneth’s parents, Walter and Maria Nally, that they commit their son to a mental institution, but Kenneth and his father balked at the idea. Instead, Kenneth accepted an invitation to stay at the home of his pastor.

For many religious families, such a development might have been a relief. But Walter and Maria were Roman Catholic, and Kenneth no longer was. While an undergraduate at the University of California-Los Angeles, Kenneth had begun to attend Grace Community Church, the largest Protestant congregation in Los Angeles. Its founder was John MacArthur, who remains a titan in American conservative Christianity—famous for prolific writings, a radio program, and a fierce commitment to Calvinism, the austere branch of Protestantism that emphasizes predestination and salvation by grace alone.

Kenneth ended up spending six days at MacArthur’s house. During that time, he read the Bible, listened to tapes of MacArthur’s sermons, and helped to take care of the MacArthur family’s children. Then he returned to his parents’ home. A week later, Kenneth and his parents got into an argument about religion, and Kenneth left for a friend’s apartment in Burbank. There, he entered a closet, put a shotgun to his head, and pulled the trigger. All he left by way of a suicide note was a piece of paper with verses of scripture written on it.

In their grief, the Nallys began looking into the sort of help Kenneth had been receiving at Grace. It was a form of Christian therapy known as biblical counseling. Developed in the 1960s, biblical counseling rejects conventional approaches to mental health and holds that the Bible is sufficient as a guide to treatment. Many of its adherents think of it as a strict but hopeful alternative to what they view as the permissive and guilt-absolving premises of psychology. In biblical counseling, most psychological distress is rooted in sin, and the path to healing lies in confession and repentance.

The Nallys learned that Kenneth’s counselors had received no training outside of Grace; one was, by profession, a fireman. They learned that Kenneth’s counselors had told him to repent of his sinful attitudes toward his family and girlfriend. They also learned, or at least came to believe, that Grace counselors had discouraged Kenneth from taking medication or going to psychiatrists, even reassuring Kenneth that those who commit suicide can still go to heaven.

On March 31, 1980—almost a year to the day after Kenneth was found dead—the Nallys filed a $1 million wrongful death lawsuit against Grace Community Church, MacArthur, and three other Grace pastors, arguing that their counseling had “exacerbated [Kenneth’s] preexisting feelings of guilt, anxiety and depression.”

Over the next nine years, the case wound its way through the legal system—dismissed twice in superior court, reinstated by a court of appeal, then rejected by the California Supreme Court. It was hard to prove malpractice where there was no clear practice; biblical counseling fell into a gray area between religious teaching and therapy. By the time the Nallys took their claim to the U.S. Supreme Court, in 1989, the case had become a national cause for Christians, with thousands of churches and religious organizations expressing support for Grace. But the high court declined to hear the case. The lawsuit had run its course.

Biblical counseling had overcome its first great challenge. Now it was freer to expand without worry—and so it did. Today, it is a major force among conservative American Protestants. It is so popular, and so widespread, that in 2005 the Southern Baptist Convention’s theological seminaries—the pastoral schools of the largest Protestant denomination in the country—announced a “wholesale change of emphasis” in favor of biblical counseling over an earlier “pastoral care” model that had drawn in part on the behavioral sciences.

But biblical counseling also faces serious difficulties, ones as great as those faced by Grace Community Church over 30 years ago. It has been confronted with mounting external criticisms and widening internal divisions, and the result, among its practitioners, is a looming crisis of principle. How Christians address this crisis will shape the mental health choices of millions of Americans.

FROM THE PERSPECTIVE OF most mental health professionals, biblical counseling is at best a murky phenomenon. Among many conservative evangelical and fundamentalist Christians, though, it is central. Since the mid-1960s, when Presbyterian pastor Jay Adams first laid out its principles, biblical counseling has become dominant in conservative Christian denominations that follow Reformed (or Calvinist) theology. It is relied upon by conservative Presbyterians, Calvinists, Baptists, and thousands of non-denominational Christians, including those who fall under the category of Independent Fundamentalist Baptists. For mil`lions of Americans suffering from anxiety, depression, bulimia, anorexia, bipolar or obsessive-compulsive disorder, or even schizophrenia, biblical counseling is the sole form of treatment they are likely to receive.

Accreditation organizations like the Association of Certified Biblical Counselors have certified just over 1,000 counselors to date—but biblical counseling does not require accreditation. One leader in the field, Donn Arms, estimates that if you include local pastors who use biblical counseling in their own churches, “there are tens of thousands of us.”

In 2013, 48 percent of self-identified evangelical, born-again, or fundamentalist Christians said they believe that conditions like bipolar disorder and schizophrenia can be treated with prayer alone.

Indirectly, the influence of biblical counseling is wider still, and echoes of it can be heard across conservative culture. In 2012, when Adam Lanza slaughtered a school full of children in Connecticut, Fox News host and onetime GOP presidential hopeful Mike Huckabee, a former Southern Baptist pastor himself, slipped into biblical counseling territory when he laid blame for the killings in part on a society in which we “stop saying things are sinful and we call them disorders.” And when Southern Baptist research organization LifeWay Research conducted a survey of evangelical Christians in 2013, 48 percent of self-identified evangelical, born-again, or fundamentalist Christians said they believe that conditions like bipolar disorder and schizophrenia can be treated with prayer alone.

MYSTERIOUS AS BIBLICAL COUNSELING may be to those outside of Reformed Christianity, nothing about it is furtive. Its literature is extensive, its practitioners approachable. Anyone interested in learning more about it firsthand, as I was, can attend meetings like the annual conference of the American Academy of Biblical Counselors. This year, it was held in April at the Gateway Biblical Counseling and Training Center, a long, flat complex of buildings—including the Edgemont Bible Church and Berean Christian School—off a suburban miracle mile in Fairview Heights, Illinois. A sign near the exit of the complex reminds departing visitors of their duty to spread the word: “You are now entering the mission field.”

The opening session took place on a Thursday night, and, even before everyone had arrived, an overflowing crowd of more than 40 attendees had gathered in a small space called the Glory Room. One long wall was painted with a spectacular six-foot-high mural divided into seven panels and spanning six millennia: a depiction of the Young Earth creationist history. From left to right were the cosmic void, Adam and Eve (standing next to a lion), the pyramids, the birth of Christ, the smoking towers of 9/11, and a final narrow black panel starkly titled Tribulation (a phase of the apocalyptic end times prophesied in the Book of Revelation).*

At the front of the room stood Kurt Grady, a cheerful, heavyset man with a Vandyke beard and a yellow button-down shirt. Grady teaches biblical counseling at Gateway and other schools around the country. However, on his LinkedIn profile, he lists himself as “Senior Medical Science Liaison” for a biopharmaceutical company called Avanir. This gives him a measure of scientific authority and makes him a popular figure in biblical counseling, a movement keenly aware of being viewed as simplistic and anti-science.

“Mental illness is real in the sense that people and families suffer,” Grady explained to the crowd, and the response of biblical counselors shouldn’t be “‘Just take two scriptures and call me in the morning.’”

There were appreciative chuckles.

“But,” he continued, “if you spend time talking to people with labels [of mental illness], you see that their lives are full of the problems of living.”

These problems of living don’t originate in brain chemistry, Grady said, but in men’s hearts. He repeated a biblical counseling mantra: “The problem isn’t the problem; the problem is the heart.”

Grady handed out a worksheet depicting the various branches of mainstream psychology, illustrated with clipart cartoons. The schools of Sigmund Freud, B.F. Skinner, and Cognitive Behavioral Therapy were summarized, respectively, as “feeling” (represented by the smiling, angry, and fearful faces of a young boy), “behaving” (two siblings wrestling over a blue teddy bear), and “thinking” (a silhouetted girl whose brain was labeled “Brain!”). These, Grady said, were the world’s inadequate answers to people’s problems. A thick dark line separated the worksheet from a full-color illustration of the body electric—a dynamic female form suspended in a blue sky, with bolts of lightning radiating off her body—representing the soul. Typed in repeating block letters across the bottom of the page was the treatment for the soul: APPLIED SCRIPTURE, APPLIED SCRIPTURE, APPLIED SCRIPTURE.

The problem with non-biblical models of treatment, Grady said, is that they never address the real issues that cause mental illness. “If you give someone anti-anxiety drugs, and they’re less fearful, that’s not because you’ve helped their heart, but you’ve anesthetized their sense,” he said. “Until the pharmacy is closed on Sunday and it all comes back. Scripture says ‘Fear not, fear not.’ If we ignore that—if you deal with the fear problem and the meds run out, what happens?” He paused. “Maybe that God thing will work after all.”

It was a friendly crowd. One woman rose to say that biblical counseling had helped her overcome her lifelong diagnosis of serious depression, which had lifted only when her thinking aligned with God’s.

Over the next couple of days, nearly 100 biblical counselors from around the country would pass through Gateway for workshops, speeches, and networking to learn the latest in biblical counseling’s methods of addressing family problems—from addiction and grief, to depressed mothers and angry teenagers, to ADHD diagnoses. Uniting everyone was the conviction that psychology and psychiatry aren’t the sciences they claim to be but, rather, a messy gang of competing theories, as unproven and internally divided as sectarian religion.

THE FOUNDER: Jay Adams sought to reclaim for pastors and church leaders a role that he felt had been usurped by psychologists. (Photo: Institute for Nouthetic Studies)

IN THE MID-1960S, Jay Adams, a pastor who had spent his college years studying the Greek Bible, started a job as a professor at Westminster Theological Seminary, a conservative Presbyterian institution outside of Philadelphia. One of his assignments was to lead a class in pastoral counseling, which involved training seminarians in how to shepherd their future flocks. Working his way through his predecessor’s notes, Adams was dismayed to find them imbued with the morally neutral language of non-directive therapy, as laid out by leading psychologists of the era, and woefully light on references to old-fashioned sin.

This was consistent with the times. In 1950s postwar America, Freudian psychoanalysis and its many offshoots permeated popular culture, and terms like ego, neurosis, and complex had woven their way into everyday speech, even among those unaware of their etymology. As far as Adams was concerned, most of this thinking was nonsensical and spiritually harmful, and the competing approaches to psychiatry were little better. A steady stream of psychoactive drugs was appearing on the market, from anti-psychotics and anti-depressants to stimulants and anxiolytics, all promising to alleviate psychic pains by chemical means. (The 1966 Rolling Stones song “Mother’s Little Helper” famously mocked the popularity of Valium.) And then there were the behaviorists, like Joseph Wolpe in South Africa, Hans Eysenck in England, and B.F. Skinner in the United States, who seemed to view man less as a moral agent than as another animal that could be manipulated and conditioned according to various stimuli.

As Adams saw it, psychology had attempted to master the soul and wound up generating as many puzzles and contradictions as it purported to solve. How can “science” tell you where to draw the line between bad behavior and sickness? If a therapist is to remain neutral in values, then why should one state of mind be considered preferable to another? If guilt is sometimes a misguided neurosis and at other times a proper response to wrongdoing, who decides, and by what authority? To Adams, psychology seemed like a religion of its own, complete with feuding high priests.

Such doubts were not confined to those of religious faith. In 1961, Thomas Szasz, a State University of New York psychiatrist and professor who had fled Hungary and Nazi Europe as a young man in 1938, published a seminal book titled The Myth of Mental Illness. Keenly aware of society’s potential for oppression, Szasz stressed the arbitrary nature of determining what behavior was considered normal or socially deviant. The “mind,” Szasz argued, was just a metaphor, an idea—and ideas don’t get sick.

While Adams appreciated the questions raised by Szasz, what changed the course of his life was coming upon the work of O. Hobart Mowrer, a psychology researcher at the University of Illinois. Mowrer was a contrarian, an on-again, off-again Christian who declared Freudianism a failure that absolved patients of responsibility for their own lives, and he warned evangelicals that they had “sold [their] birthright for a mess of psychological pottage.” Mowrer believed that the guilt many patients felt wasn’t neurosis but a proper reaction to genuine wrongdoing compounded by self-deception. To treat such conditions, Mowrer created what he called Integrity Groups, group-therapy sessions designed to challenge patients to own up to their misdeeds, admit their guilt, and make an attempt at restitution.

Adams traveled to Illinois to observe and learn from Mowrer’s work. “Apart from those who had organic problems, like brain damage, the people I met in the two institutions in Illinois were there because of their own failure to meet life’s problems,” Adams later wrote of his time with Mowrer. “To put it simply, they were there because of their unforgiven and unaltered sinful behavior.”

Adams came to believe that, aside from a limited range of organic problems like brain tumors or head injury, the problem with mentally ill people was their inability or refusal to meet life’s challenges. Christians should accept that scripture holds all the tools needed for pastors to become “competent to counsel.” And Competent to Counsel became the title of his manifesto, a 270-page text published in 1970, that laid out the tenets for a new form of Christian pastoral counseling, something he named “nouthetic counseling,” from the Greek nouthesis, translated roughly as “to admonish,” or, as Adams would suggest, “to counsel.”

Competent to Counsel was both a guide and a polemic. “The Christian pastor is called to be a paraclete, not a parakeet,” Adams wrote with typical bite. “Judgments of moral value in counseling are precisely what the Scriptures everywhere commend.” As if to fight Freud with Freud, he filled the book with his own case studies—of people like “Steve,” a lazy college student who faked nervous breakdowns to avoid final exams, and “Mary,” an adulteress habituated into manic-depressive behavior by counselors who indulged her. (Mary, Adams wrote, started to be cured the moment Mowrer’s counselors stopped her in mid-hysterics with a stern reprimand: “O be quiet! Unless you stop this kind of nonsense and get down to business, we simply can’t help you.”)

Among conservative pastors already skeptical about referring their congregants to outside experts, Competent to Counsel struck a resounding chord. “They embraced him and they rose up and called him blessed,” says Donn Arms, who is executive director of the Institute for Nouthetic Studies, an organization he co-founded with Adams 15 years ago. Arms says Competent to Counsel has sold some 800,000 copies.

A BIBLICAL COUNSELING SESSION can look like traditional therapy. When counselees arrive—whether at a counseling center like Gateway or their pastor’s study; singly or with their spouses; to meet with one biblical counselor or a team—counseling typically begins with an intensive recounting of personal history. Diagnoses that counselees may previously have received from secular psychology or psychiatry—depression, bipolar disorder, or schizophrenia—are disregarded in favor of a nearly blank slate. No confidentiality is assumed, and counselors are often committed to working with the clients’ pastors and church leaders. At some facilities, like the Christian Counseling and Education Foundation in Pennsylvania, fees are around $95 per meeting. At many other places, including local churches, sessions are free.

In practice, despite its rejection of secular psychology, biblical counseling draws both on psychoanalysis, with its focus on getting to the root of problems, and on behaviorism, with its stress on correcting habits. A constant refrain in biblical counseling is the command for counselees to “put off” bad and sinful thoughts, and to “put on” biblical, God-pleasing thoughts instead.

"These problems of living don't originate in brain chemistry," he said, "but in men's hearts."

Donn Arms cites the example of a widow whose grief over the death of a spouse has led her to a months-long standstill, unable to care for her kids or do other work. “I’m not going to come down on them and hit them on the head with the Bible,” he says. He might, however, eventually suggest that she is “living a life that says God is not sufficient for my problems.” Biblical counselors might assign her “homework”: a mix of scripture readings and practical modeling of appropriate behavior, such as getting up to get her children breakfast every morning, as she works her way back to her full domestic load. It sounds like tough love, but the difference, says Arms, is that biblical counselors believe the Holy Spirit will bring about change—a conviction he expects will sound strange to secular ears.

Some of the best-case scenarios of biblical counseling are laid out in a book called Counseling the Hard Cases. It features 10 case studies, each penned by a different author, of people who have been given secular diagnoses for serious mental health issues—from post-partum depression to dissociative identity disorder—which are then broken down until the biblical counselors find their spiritual roots. One man finds that a compulsive need to drive on only even-numbered streets springs from his lusting after girls he sees in church; an anorexic college girl discovers she is struggling with the sin of vanity; a bipolar church ministry leader who had a violent breakdown in front of his wife is at root driven ragged by a sinful focus on appearing successful to others.

In many of the cases, a sense of compassion is obvious. In co-editor Heath Lambert’s treatment of a young mother with severe post-partum depression, sin is de-emphasized in favor of practical ideas. Rather than placing the mother, who has had a momentary ideation of killing her child, on powerful medications, Lambert tells the woman’s husband to start helping with the baby and ensure that his wife gets some sleep, and he rallies a team of church service volunteers to assist the family around the clock until they adjust to parenthood. In other accounts, counselors come across as equally sympathetic, softly urging counselees to recognize that they have developed a pattern of letting themselves lose control of their emotions when they really have more control than they admit. Even in the case of the counselor “treating” a man’s homosexuality, the author stresses to his readers that the man’s “condition” must not be viewed as any more sinful than the reader’s—or the counselor’s—own faults. “No temptation has overtaken you except what is common to humanity,” he writes, quoting a verse of scripture—1 Corinthians 10:13—repeated in almost every chapter of the book.

At times, biblical counseling can seem little different from a Bible-inflected form of talk therapy—a willing ear and a gentle prod for people who are stuck in unhealthy patterns. Many of its tenets have the ring of common sense and would probably resonate with those who worry about over-medicating children with diagnoses like ADHD or who roll their eyes at seemingly exculpatory diagnoses for bad behavior—sex addiction for cads, or oppositional defiant disorder for brats.

For many mild cases of depression, biblical counseling is undoubtedly also beneficial. This is because it resembles conventional psychology in one important respect: One human being is getting a generous amount of sympathetic personal attention from another. As psychotherapist and author Gary Greenberg has pointed out, psychologists have been wrestling for nearly 80 years with a phenomenon called the Dodo Bird Verdict. That is the nickname for the discovery by American psychologist Saul Rosenzweig in 1936 that patients receiving one form of psychological counseling had rates of success just as high as those receiving another form of psychological counseling. Simply put, one form of treatment seemed to be as effective as any other. While the Dodo Bird Verdict—which takes its name from Alice in Wonderland and the character of the dodo, who announces, “Everybody has won and all must have prizes”—has been repeatedly challenged and questioned, it remains robust enough to be a continuing subject of debate among psychologists.

That is surely one reason why there is no lack of testimonials in favor of biblical counseling. One woman who sought guidance after her husband had committed adultery told me about the comfort of “being able to talk to people who are able to speak truth and encouragement and to love on you.” She also recalled that she sensed a gratifying lack of judgment from her counselor—perhaps an ironic observation, given that judgment is supposedly central to biblical counseling, but also a testament to the simple power of a sympathetic ear.

BUT BIBLICAL COUNSELING BECOMES far more dubious when it disregards evidence of traits that are beyond a person’s control. One of the most troubling stories in Counseling the Hard Cases concerns a bipolar mother of three who appears to be stuck in an abusive and controlling marriage. Her husband wants her to go off her medications, to have more children, and to homeschool them. Going off medication leads the wife to episodes of uncontrollable mania, and she starts drinking.

The author of the account, Robert Jones, a biblical counseling professor at Southeastern Baptist Theological Seminary in Wake Forest, North Carolina, declares that the mother’s issues aren’t mental illness but addiction and adultery, rebellion and unbelief. He approves the husband’s decision to take away the counselee’s car keys during the day, to commit her to a residential detox facility, and to tell her children that their mother “is not following Jesus or obeying God right now.”

The story of this mother also makes clear how hard it is to separate biblical counseling as an approach to therapy from biblical counseling as an approach to quelling any beliefs or behaviors at odds with an exacting church doctrine. Many biblical counseling case studies focus on stay-at-home mothers, for instance, faulting them for poor housekeeping skills or an inability to keep up with the demands of their husbands and children. To an outsider, what the church sees as sinful often looks like a desire for a less circumscribed way of life—a desire for freedoms many Americans take for granted.

One person who has thought extensively about such issues is John Weaver, a 34-year-old English lecturer at SUNY Binghamton. Weaver comes from an upstate New York family with such a startling incidence of mental illness—six of his father’s 13 siblings were diagnosed with conditions like bipolar disorder—that it has been studied by the National Institute of Mental Health. He has also experienced biblical counseling firsthand, although the episode was short-lived.

In 2001, when Weaver was attending a Christian college, he developed an obsession with working 100 hours a week. All too acquainted with mental illness, Weaver’s parents, while Evangelical in faith, had never rejected conventional treatment for their son (and had sought it out in the past). But Weaver wanted to experience biblical counseling at a Christian inpatient counseling program in rural New England. “I was ready for the tough-love part,” says Weaver, “but I thought it would be real help.”

Instead, Weaver recalls, on his first day of counseling, two college-age counselors took him into a room and asked him what he thought his problem was. When he suggested he might have a chemical imbalance, his counselors told him no, his problem was his pride. “They kept me in two rooms for six hours and kept telling me to repent, yelling at me and berating me,” Weaver says. Weaver called his father, who picked him up the next day. Weaver was so troubled by the episode that he did a deep investigation into biblical counseling and eventually authored a book, due out this November, The Failure of Evangelical Mental Health Care: Treatments That Harm Women, LGBT Persons and the Mentally Ill.

THE NEW GENERATION: Heath Lambert presents a less severe, more media-savvy face of biblical counseling, but he still adheres to the core notion of scriptural "sufficiency." (Photo: Baptist Press)

Weaver isn’t alone in his dismay. On Christian blogs and websites, complaints about biblical counseling are starting to accumulate: of abused women counseled to discover their role in their husband’s domestic violence; of molested children declared healed after a one-time, 45-minute counseling session. Biblical counseling has also been cited as a contributing factor to scandals at several prominent conservative Christian colleges—including Bob Jones University, Patrick Henry College, and Pensacola Christian College—currently under fire for allegedly treating rape or sex abuse victims by blaming them for their own assaults and asking them to look into their own sin. (Bob Jones University has now hired an independent investigator; Patrick Henry College and Pensacola Christian College deny the accusations.)

Often, the stories of failure concern counselors who are simply in over their heads—overly confident of scripture as a handbook and high-handed about applying it to complex cases. One woman, a 49-year-old Maryland public school teacher, told me about efforts by her church to apply biblical counseling to the problems of a volatile husband and a son on the autism spectrum. It was a disaster, she says, with counselors trying in vain to improve her husband’s behavior and asking her to seek out idols within her own heart. “They thought they could send someone to a six-week training with a white binder and that they’d be prepared to do counseling for people who are suicidal, anorexic, who are struggling with pedophilia,” she recalled. “Biblical counseling is really not designed to handle big-ticket items.”

BIBLICAL COUNSELING LEADERS RECOGNIZE the damage caused by such accounts, and most say that the unfavorable stories don’t resemble their approaches or methods. Heath Lambert, executive director of the Association of Certified Biblical Counselors, is an affable and press-savvy spokesperson for the organization who is quick to admit that there are bad practitioners out there. He doesn’t explicitly rule out the use of medication, and he urges biblical counselors and psychologists alike to proceed with an abundance of humility about things we don’t understand. He says stories like those emerging from evangelical sex abuse scandals upset him to the point of physical revulsion, and over the phone his voice breaks as he discusses the women he’s met who were raped or sexually abused as children.

But he is firm in defense of biblical counseling against secular skeptics. “If you pay attention to the debates that secular folks are having about mental illness, they have a very hard time defining it, too,” he notes. “Every time a new edition of the DSM comes out, they tweak the definition a little bit.” This is a point made by many biblical counselors: If our notions of what should and shouldn’t be considered mental illness are constantly shifting, then how can people have such faith in the professionals who define it? “The debate about mental illness isn’t just between smart secular people who understand problems and religious people who want to assign some sort of spiritual [root] to everything,” Lambert says.

Lambert also stresses that biblical counseling, like any other sort of therapy, succeeds on the merits of its practitioners. “Any counseling method can fail,” he says. Asked about accounts of women being blamed for their own sexual victimization, Lambert expresses disgust. If a counselor certified by his group were to suggest such a thing, Lambert vowed, “I would move to revoke their certification. That’s wicked. That person needs to be rebuked for their sin.”

And yet, despite such reassurances, the notion of revoking someone’s certification is inherently awkward. Since the sufficiency of scripture is central to the notion of being “competent to counsel,” biblical counselors are under no requirement to seek a degree or certification in the first place. Even “success” is an elusive term in biblical counseling, since many counselors judge their work primarily by how faithfully they have imparted God’s word—how well they’ve shared the gospel. By this reasoning, counselors need not be distraught if counselees do not feel better or conquer their issues. “It’s like the review of a play,” jokes Arms self-deprecatingly. “The play was a success. The audience was a failure.”

In Competent to Counsel, Jay Adams attacked psychoanalysis for its ineffectiveness, for patients “failing to recover after years of analysis and thousands of dollars.” But, in theory, biblical counseling allows for no similar complaint, since recovery is not the measure of success. And in many circumstances, the counseling can resemble what many advocates seek to dismiss as a crude stereotype: no more than declarations of sin and exhortations to repent.

IN THE SPRING OF 2013, Matthew Warren, the 27-year-old son of Rick and Kay Warren, two of the most influential evangelicals in the world, killed himself. That same year, former Southern Baptist Convention president Frank Page published a book about his daughter, Melissa Page Strange, who had committed suicide a few years earlier.

Although neither Matthew Warren nor Melissa Page Strange had received biblical counseling (and Warren, at least, had received extensive mental health treatment), their deaths nevertheless had the effect of placing biblical counselors on the defensive. In articles and sermons, religious luminaries challenged fellow Christians to show greater love to those with mental illness. Characteristic of the sentiment at the time was a blog post on CNN.com by Ed Stetzer, president of LifeWay Research (the Southern Baptist research organization), arguing in defense of medication. “Counseling will naturally be a part of treatment,” Stetzer averred. “But if we are not afraid to put a cast on a broken bone, then why are we ashamed of a balanced plan to treat mental illness that might include medication to stabilize possible chemical imbalances?”

In 2013, shortly after Matthew Warren’s suicide, the Southern Baptist Convention passed a resolution calling on member churches to demonstrate compassion to those with mental illness. Before it was passed, however, biblical counseling advocates within the SBC proposed amendments. One declared the “sufficiency of scripture,” but failed. Another encouraged pastors to provide “godly, biblical counsel,” and passed with what the Associated Baptist Press called “overwhelming support.” Some dissidents grumbled that the resolution now made Southern Baptists sound like the Christian Scientists of mental health.

“I think you’re going to see some extremely ugly denominational fights between people who take a more traditional psychological approach and biblical counselors, particularly in the Southern Baptist Convention,” predicts Matthew Stanford, a professor of psychology and neuroscience at Baylor University, a Christian school in Texas. Stanford represents a large but quieter faction among conservative Christians: those who believe that faith has a valuable place in therapy for believers, but who reject the notion that knowledge of the Bible alone makes people competent to counsel.

For millions of Americans suffering from anxiety, depression, bipolar or obsessive-compulsive disorder, bulimia, anorexia, or even schizophrenia, biblical counseling is the sole form of treatment they are likely to receive.

In March 2014, Stanford was a speaker at a large conference on evangelicals and mental illness hosted by Rick Warren in Orange County, California, at Warren’s church, Saddleback, which has 20,000 members. To Stanford, the conference was an opportunity for conservative Christians to reclaim Christian counseling from the legacy of Jay Adams. As he sees it, the major reason that biblical counseling gained so much influence is that, by the 1960s, most churches, even Reformed ones, had decided that mental health was solely a medical issue and had withdrawn from a historical commitment to caring for the mentally ill.

Adams rightly believed that “there was a role for the church to play,” Stanford says, but wrongly believed it required discounting nearly all psychology and psychiatry. In practice, according to Stanford, when churches began once again to address mental illness, the mindset that came to prevail among biblical counselors was that the mentally ill were simply “insufficient believers.” This had calamitous effects on severely troubled patients. “I can honestly tell you, as someone who’s been doing this for 20 years, that I’ve never seen someone who has a serious mental illness that went to a biblical counselor and didn’t actually get worse and get hurt,” Stanford says. “I’ve never seen them get better.”

Among biblical counselors, hardliners like David Tyler, director of the Gateway Biblical Counseling and Training Center in Fairview, Illinois, focus much of their ire precisely on Christian psychologists like Stanford and on “integrationists”—a loosely defined term that refers to any self-described “biblical” counselors who incorporate conventional psychology into their approach.

Association of Certified Biblical Counselors executive director Heath Lambert, for his part, will be heading up a conference of biblical counselors to be held in Southern California this October—at John MacArthur’s Grace Community Church, just over an hour from Rick Warren’s Saddleback. The conference is an annual event, but this year’s meeting has a specific motivation. “We chose to do this conference not in response to the death of Matthew Warren, but in response to the church’s response,” Lambert explained to me. Noting that Matthew Warren had been seeing psychologists and taking medications, Lambert said it prompted the very questions biblical counseling addresses. “I’m concerned [that] if we say, ‘Oh my goodness, people with hard problems need physicians and need a drug,’ we’re going to lose much of what the Bible has to say about hard problems.”

JAY ADAMS, NOW 85, occasionally writes for the website of his Institute for Nouthetic Studies, but he no longer speaks regularly to the press, so his views on the current splits within the movement he started are not known. What has become clearer, though, is how many of those splits can be traced to the movement’s founding contradictions.

The most serious of these inconsistencies concern the role in biblical counseling of non-biblical knowledge, especially in the fields of medicine and science. Biblical counselors stress that they are not opposed to “descriptive” psychology, which makes observations about humanity, but only “prescriptive” therapy, which steps into an advisory role they view as the province of pastors. Most also claim to respect the role of science more broadly, something that Adams attempted to clarify over 40 years ago in Competent to Counsel, distinguishing between psychology, much of which he considered to be speculative and unproven, and proper hard science. The latter was welcome. “I do not wish to disregard science,” he wrote, “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.”

But teasing out the implications of such allowances makes clear why they put so many biblical counselors in an impossible position. The premise of biblical counseling is seductive in its simplicity: God has given you a guide to humanity’s most difficult problems, and the solutions are all in one place. But if you grant that non-biblical knowledge has any role to play—whether it is in “challenging wrong interpretations of Scripture,” as Adams suggests, or in parsing the line between which mental illnesses have biological roots and which do not—then the solutions stop being in one place. Scripture is no longer sufficient. And this upends the very premise of biblical counseling.

In trying to paper over this conflict, many biblical counselors have toyed with the notion of “sufficiency,” suggesting that there is no serious conflict between the notion that scripture is sufficient and the notion that outside knowledge is useful. As absolutists like David Tyler note, though, the ideas are inherently at odds. “I was at a conference a year ago and the workshop leader said, ‘Everyone has their definition of sufficiency,’” he says with dismay. “A lot of people believe [the Bible] is sufficient up to a point. But if it’s sufficient up to a point, it’s really not sufficient.”

While Tyler may have consistency on his side, plausibility is another matter. The sufficiency of scripture becomes less and less convincing as researchers uncover ever more about the brain. Even among Reformed Christians, a quiet but significant number tend to think that counselors who keep abreast of the findings of science are best equipped to help people—are most competent to counsel. And such thinking leads to the door of precisely those who most threaten biblical counseling and its legitimacy: people like Matt Stanford, devout believers who also understand clinical psychology. To hang together, biblical counseling requires absolutism. As goes an old saying popular in Reformed circles, “Lord of all, or not Lord at all.”

In their attempts to cast aside the many shortcomings and contradictions of psychiatry and psychology, Adams and his followers wound up creating many of their own. How can you decry the ineffectiveness of psychiatry in treating mental disorders, yet contend that effectiveness is beside the point in biblical counseling? How can you stress the moral agency of man, rejecting the determinism of Freud, and yet adhere to the predestination of Calvin? How can you deplore the “utter arrogance of any fallible man who attempts to speak authoritatively,” as Adams did in his book, and yet assure that same man that a grasp of scripture gives him precisely the tools with which to speak authoritatively?

And this may be the great irony: that Jay Adams and his followers gave birth to the very sort of person they were rebelling against, the “fallible man who attempts to speak authoritatively.” That man has always been with us, as both comforter and misleader, ever struggling to fit his rules around the oldest of mysteries—the one that Greeks called the psyche, cognitive scientists call the mind, and people of faith call the soul.

*UPDATE — September 11, 2014: We originally referenced a phase of the apocalyptic end times prophesied in the Book of Revelations. It is the Book of Revelation.

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