Volume 44 - Issue 2

The Pastoral Handbook of Mental Illness: A Guide for Training and Reference

by Steve Bloem

Steve Bloem has written a fascinating handbook with the aim of resourcing pastors to be more sensitive and informed when caring for those living with mental illness. He writes from both a personal and professional perspective. Importantly, he describes his own experience of depression and suicidal thoughts. He refers to his work with Heartfelt Counseling Ministries and Christians Afflicted with Mental Illness (CAMI).

The book opens with a passionate appeal to pastors to approach people living with mental illness with compassion and not condemnation. He argues that illnesses of the brain are to be expected following the Fall and that one cannot assume that mental illness corresponds to spiritual immaturity or disobedience. He turns to the gentle ministry of the servant in the book of Isaiah and the image of a shepherd to indicate the attitude that one needs to bring to those with mental illness. He echoes the words of the apostle Paul: “encourage the fainthearted, help the weak, be patient with everyone” (1 Thess 5:14).

Among the tables of resources, Bloem provides a list of mental health professionals, explaining their role in treating illness and supporting people. This is useful but is situated exclusively within the North American health system. Some wider awareness of practices in other countries would give the handbook broader relevance.

The major substance of the book is an easy-to-read survey of major mental illnesses. Bloem provides helpful information on conditions such as Anorexia Nervosa, Borderline Personality Disorder, Obsessive-Compulsive Disorder, and Social Anxiety Disorder. There is also a discussion of suicide. For each disorder, the handbook offers medical perspectives and complements these with pastoral tips. For pastors who have had little exposure to mental illness in study or in life, there is real benefit in having lots of information in one handy reference work.

Bloem has also written a lengthy section (pp. 118–40) giving answers to 58 frequently asked questions about mental illness. The depth and scope of these questions is highly variable. Bloem tackles topics such as lack of insight in people with mental illness, treatment options for those living with depression, medication, the differences between professionals and their approaches to treatment and the experience of care givers. His answers are generally informative and would be valuable in many conversations in congregational life. He makes a point of noting the differences between secular and Christian thinking, sometimes with stark polarity. These comments would be enriched by a nuanced biblical theology of wisdom.

Finally, in a series of appendices, the book includes some useful reference tables. One of these is the life-events stress scale, which is often illuminating in helping people to make sense of the emotional impact of their experiences. Bloem includes extensive information about medications that may be used to treat various conditions. I suspect these medication tables offer details beyond the needs of most pastoral workers.

While the book’s goals are admirable and its marshalling of information is valuable, it occasionally evidences a naivety that diminishes its credibility. There are assertions that need to be stated with greater reserve (e.g., regarding the precise dating of the exodus and the composition of the book of Isaiah). There are appeals to Scripture that seem somewhat arbitrary, if not moralistic. Bloem claims, for example, that pastors should study carefully like the sons of Issachar who knew what Israel should do (1 Chron 12:23, 32), or like Ezra who set his heart on studying the law (Ezra 7:9–10). There are also hermeneutically questionable claims. For instance, he connects the darkness experienced by Abraham in the covenant cutting event of Genesis 15 to the experience of depression. However, the darkness is more likely a feature of the theophany than a symbol of Abraham’s mental state.

The topics covered in the book raise highly complex questions about the nature of humanity and how it is that body and mind relate to one’s relationship with God and spiritual forces. Bloem has stimulating suggestions that are worthy of consideration. Early in the book he provides a helpful glossary of psychiatric terms and then proposes an accompanying list of spiritual terms. He describes states such as demon possession, demoralization, and apparent desertion by God. He uses the emotional portraits offered in Job and the Psalms and the accounts of demon-possessed people in the Gospels to generate ways of differentiating between psychiatric and spiritual conditions. Appendix A (“Diagnostic Differentials”) develops this distinction with lists of symptoms or characteristics that may help in diagnosis. The spiritual categories have real potential to provide focus to pastoral conversations, but they also require fuller validation. This highlights another shortcoming of the handbook: it lacks a clear theological anthropology to provide the theoretical underpinnings for the presentation of potential spiritual states.

Bloem’s work also lacks sophistication in synthesizing biblical texts and psychiatric diagnoses. There is no clear discussion of how hard it is to generate a phenomenology of illness from an ancient text and to map this onto diagnostic labels taken from contemporary psychology and medicine. Bloem’s writing shows no evidence of interaction with the volumes of work currently attempting to integrate medical, scientific and theological anthropologies (e.g., John Swinton, Resurrecting the Person: Friendship and Care of People with Mental Health Problems [Nashville: Abingdon, 2000]; Eric L. Johnson, ed., Psychology and Christianity: Five Views [Downers Grove, IL: IVP, 2010]; Jennifer Anne Cox, Autism, Humanity and Personhood: A Christ-Centred Theological Anthropology [Newcastle upon Tyne: Cambridge Scholars, 2017]). There is also an absence of engagement with the critical theory that informs the work of disability theologians. Bloem does not interrogate accounts of mental illness that privilege medical diagnoses over social, political and ethical analysis.

Stylistically, the book has an uneven quality. The flow of ideas is not always clear, and there is frequent repetition. Several paragraphs seem to be in the wrong place. I was left with the impression that the text still needed the work of a careful editor. In the chapter on suicide, for example, the handbook reads more like an advertising brochure: “Pastor, do we have a seminar for you! We can train your staff and other groups in your church to be aware of this epidemic” (p. 113).

Bloem’s Pastoral Handbook is a warm-hearted volume that could serve as an accessible introduction to mental illness for pastoral workers. To that end, I commend it. However, it also needs to be supplemented by further reading of works offering greater biblical and theological depth.

Kirk R. Patston

Kirk R. Patston
Sydney Missionary and Bible College
Croydon, New South Wales, Australia

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