099 Reframing Mental Health: From Fixing a Machine to Fellow Wayfarers (with Dr. Warren Kinghorn)

While modern psychiatry has improved many patients’ quality of life, it falls short in addressing their relational and spiritual needs? Can we draw on theological wisdom and scientific evidence to reframe our understanding of mental health care? 

Dr. Warren Kinghorn is a psychiatrist and theological ethicist whose work centers on the role of religious communities in caring for persons with mental health problems. He is jointly appointed to the faculties of Duke Divinity School and the Department of Psychiatry and Behavioral Sciences of Duke University Medical Center, and practices psychiatry at the Durham VA Medical Center.

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Transcript

Warren Kinghorn

Introduction to the Podcast

[00:00:14] Geoff Holsclaw: While modern psychiatry has improved many patients quality of life, sometimes it might fall short in addressing their relational and spiritual needs. Can we draw on ancient theological wisdom as well as scientific evidence to reframe our understanding of mental health care? That's what we're talking today about.

On the Attaching to God podcast. I'm Jeff Holzkloss. Sid is not joining us today, but we're, this is an interview podcast and here we are seeking to explore a neuroscience informed spiritual formation today. 

Meet Dr. Warren Kinghorn

[00:00:46] Geoff Holsclaw: I'm excited to have Dr. Warren Kinghorn. He is a psychiatrist and a theological ethicist who works at the center of the role of religious communities in caring for persons with mental health care.

Problems. He is jointly appointed to the faculty of Duke divinity school, as well as the department of psychiatry and behavioral scientists of Duke university medical center. And he is a practicing psychiatrist at the Durham VA medical center. Dr. King or thank you so much for being on today.

[00:01:17] Dr. Warren Kinghorn: Thanks so much, Jeff. And please call me Warren. Thank you so

[00:01:19] Geoff Holsclaw: Warren, absolutely. Yes. 

Warren's Journey into Psychiatry

[00:01:22] Geoff Holsclaw: Well, um, I was really excited to kind of come across your book. Um, and we're going to jump into that, uh, in a second, which is called wayfaring. Uh, but how did you, um, let's start with the field of psychiatry. Uh, how did you become, you know, for, I was raised at evangelical. So I'd say something like, how were you called into the field of psychiatry?

Can you give us the, the, the origin story a little bit there?

[00:01:46] Dr. Warren Kinghorn: Yeah. Actually, it has very much to do with my being a Christian. I was also raised in a evangelical Southern Baptist context, and I didn't have any direct direct serious mental illness in my family, as many clinicians do, and have really powerful family stories. But I was part of a church where people really struggled, and I had really up close experience of people who were depressed, or who were struggling with substance use, or who were closely affected by suicide, and that made me really just attended, the way that people live and what people engage and what they go through.

Um, I kind of was also raised in a tradition of evangelicalism that saw psychology as a good thing. And so I grew to think, oh, psychologists are doing good and important work. And so I went to college and I eventually went to medical school thinking I'd become a psychiatrist. And, and then I was turned off to the field of psychiatry as I was exposed to it in my first and second year of medical school.

It was, um, It was, it was like, it was taught in a way that was well intentioned, but it was pretty rote. I had to, we had to memorize diagnostic criteria from the DSM, our Diagnostic Manual. We had to do very structured interviews. It felt very kind of impersonal and not what I was used to in my other experiences of medicine.

So I thought, well, I guess I'm not going to I'm going to be a psychiatrist. I guess I'll be a primary care physician or palliative care doctor or something else. Um, but I wanted to understand medicine more as a Christian and so I left medical school for a couple of years after my third year of med school.

I came to seminary here at Duke and I did a two year theology degree to try to understand like what am I doing in the world of medicine and how do I make sense of this? And it was actually that time when I got more interested in psychiatry in in part because I got I got interested in medicine in a different way.

It wasn't just that I saw myself as a medical student and physician who had this personal faith who could inform things, but I grew to see that as a Christian I was part of this long, deep tradition of thought and practice that is our faith. It's, you know, 2000 plus years old. And in comparison, modern psychology and medicine are maybe 200 years old, and they're much newer and more modern ways of thinking.

And, and that my, my faith not only could provide personal resources and spiritual resources, but intellectual and institutional resources for thinking about what we're doing and and that made me appreciate even more the experience that of mental illness and the challenges that people go through and I thought like how as a Christian, uh, can I engage helpfully in this world and so I went back to medical school, did more work in psychiatry, actually realized that I could love it if I could get beyond the impersonal diagnosis focused approach to it and, um, and I never looked back.

It's been, it's been a really, really

[00:04:34] Geoff Holsclaw: That is, that is not the journey that most people take on these kind of, uh, issues and questions. So you went from, If I got this right, a conservative Baptist background that still had a positive view of psychology,

[00:04:50] Dr. Warren Kinghorn: Yeah.

[00:04:51] Geoff Holsclaw: was not my case, I was raised independent Bible Baptist who had a negative view of psychology, all those atheists, they're explaining faith away.

It's really like idolatry. Uh, and then you went to medical school and instead of. Like the scientific model, like feeling fulfilling, it actually was dissatisfying to you and sort of fill the dissatisfaction in the medical psychiatric kind of model. You went back to faith, which is usually the opposite of people who get diss, diss, like satisfied with faith when they're in school and then they have to go to some other discipline to fix their life.

So you're like, go, you're like tacking, like, you know, the opposite currents here, like the whole way. That's really interesting.

[00:05:32] Dr. Warren Kinghorn: Yeah, there's a lot of twists and turns there, but that's, that's basically right. Yeah.

[00:05:37] Geoff Holsclaw: Oh, that's super interesting. Okay. 

The Evolution of Modern Psychiatry

[00:05:39] Geoff Holsclaw: Well, so you mentioned just briefly that you were kind of dissatisfied in your actual training. Um, could you give, cause you do this in, uh, early on, uh, in your book, wayfaring, uh, you kind of talk about, well, there has been these kind of transformations in the, in modern psychiatry, uh, the mental health field.

So can you. And I don't know if you could do it briefly, but just kind of talk about kind of this machine model or the machine metaphor that a lot of mental health care kind of operates in and maybe a little bit how we got there.

[00:06:09] Dr. Warren Kinghorn: Yeah. Well, first of all, how we got there, I mean, you're right over the last 50 to 75 years, there have been huge transformations in what we now consider mental health care. So we kind of think of the world that we have is the world that we've always had, but that's not the case. Before World War II, there wasn't a lot of outpatient like psychiatry or psychology there.

There were large psychiatric institutions. Uh, after World War II, you began to see the explosion of what's often called kind of a therapeutic culture. People got more interested in personal counseling. And often, um, the, the therapy of the mid 20th century, it often engaged kind of existential questions, questions about like, what does it mean to live well?

What do humans need? What does it mean to kind of live wholly and fully? You have the humanistic psychologists and existential therapists. Uh, and that, that I think is kind of a tide that's passed for the most part. Uh, for the last 40 or 45 years since the modern DSM, which is Psychiatrist Diagnostic Manual, has come into focus, there's been much more of a focus on, like specific categories of mental illness or mental disorder.

Words like PTSD, major depressive disorder, generalized anxiety disorder, and people tend to seek care for particular disorders or particular problems and psychotherapies and also other kinds of treatments are kind of focused on treating particular disorders. And so modern psychiatry, psychology, Other counseling and therapy disciplines have become like less focused on kind of broader questions of what does it mean to live a well lit human life and more like how can we bring specific things to bear on specific disorders.

And that, that, and there's a lot of other, other currents in modern mental health care, too. Things have become much more industrialized, much more focused on business models, much more focused on efficiency, on payment. Uh, there's a lot of things we could talk about. 

The Machine Model of Mental Health Care

[00:08:00] Dr. Warren Kinghorn: But all of that kind of co, uh, coalesces in what in the book I call the machine model of mental health care.

And I think this is more true in my own field of psychiatry than it is in other therapy disciplines. And so I'm not trying to, you know, generalize broadly. But in

[00:08:15] Geoff Holsclaw: and just, just a pause there really quick. And sometimes people, this is kind of a comment for the general listeners. Sometimes like the fields of psychiatry and then being a psychologist and a therapist and a counselor are thought to be all the same thing. Uh, but they're not like, they are kind of on different.

Related, they're all dealing with kind of the inner life of the person, uh, and reducing symptoms, but they're not all the same. And so there is kind of a specific trajectory of, uh, the S maybe a slightly older field of psychiatry, uh, of which you do have to be a medical doctor, um, and then the somewhat younger.

Um, not necessarily, but, uh, a tangent of psychologists and certainly research psychologists and then, uh, counselors and therapists, um, of which is somewhat of a newer field coming up a little bit with this, uh, uh, World War II kind of explosion of mental health professionals as well as, and you bring this up in the book as well as the closing of mental health institutions.

So we have this climbing of mental health professionals while this following of inpatient. Institutions, and this is all kind of part of the mix. So anyways, just wanted to jump in there that, uh, yes. So you're not speaking for the whole world of all therapists therapy, but you're speaking of your particular profession, but I think there is some, uh, crossover to some of these

[00:09:33] Dr. Warren Kinghorn: Yeah. I can speak mostly about my experience as a psychiatrist, and then others who are trained in other disciplines, I invite them to kind of think about, does, do you see this reflected in your own training and practice? And I think that's going to show up in different ways in psychology and license marriage and family therapy and social work and counseling and other, other disciplines too.

Yeah. Yeah. Yeah.

[00:09:57] Geoff Holsclaw: toward kind of treating us as machines to be fixed, like, what does that mean? And, uh, how did that kind of show itself up?

[00:10:04] Dr. Warren Kinghorn: Well, the way that it works in my training and my own, even the way that I practice psychiatry now is, there's this kind of way in which we're encouraged to, to address our patients and their issues. So people come to me with what we might consider broadly unwanted experience or behavior. They're feeling ways they don't want to feel, they're acting ways they don't want to act.

And I'm trained as a psychiatrist to say, Oh, I recognize what those are. 

[00:10:29] Geoff Holsclaw: Mm hmm.

[00:10:30] Dr. Warren Kinghorn: so that's immediately a way of, like, narrating something, of labeling something. So, somebody might feel generally bad, or, and I say, oh, that's a symptom. It's a symptom of anxiety. And then we, we categorize, or we cluster those symptoms into categories of symptoms.

diagnosis or disorder. And so I say, well, based on this collection of symptoms, I'm going to diagnose you with major depressive disorder or generalized anxiety disorder or obsessive compulsive disorder or whatever the diagnosis is. And then once I have the diagnosis, then I can reach into my toolbox of evidence based treatments, and I can say, well, this is the treatment that I can match to this disorder.

So as a psychiatrist, I might say, here's a medication that is effective for this disorder, or I'm going to refer you for a kind of individual psychotherapy that's specifically effective for this disorder, or I'm going to refer you for transcranial magnetic stimulation or something else that's effective for the disorder.

And so, so, so what we do is we can match like treatments to disorder categories, and then if If those treatments work to reduce the symptoms of the disorder and especially if that can be shown in clinical trials to be the case consistently, we say, oh great, these are evidence based treatments. And so, and so we go about our work like naming symptoms into disorders, treating the symptoms of disorders where the goal of treatment is ultimately symptom reduction.

And of course, if you can develop a treatment that works, then you can buy it and can sell it, whether that's a unit of time or whether that's a medication or a device. And that fuels our. mental health care economy in some ways, you know, so as a psychiatrist, I, I benefit from that. I think there's, there's, there's advantages to that way of thinking.

I mean, I certainly believe in the scientific method as it comes to understanding what we're doing therapeutically. I think that way of thinking has led to a lot of really interesting treatments being developed and tested, and so there's many gifts to that. But I think there's some problems to it as well, that that machine model of thinking about mental health care.

I call it the machine model because people can end up being feeling like they're being treated as these collections of symptoms that need to be just either medicated or, or taken away. People feel like it's this industrial process that people are going through. I think one problem is that it encourages us to see mental health problems things that are inside a person.

So like people often think, well, I'm struggling because something's wrong with my own brain circuits or my neural circuits, or something's wrong with me deep inside my own personality. And it, it takes away the understanding of mental health struggles as Um, it is challenges that we're facing and the world around us and that are often challenges in relationship and in community.

And that gets to, I think, your work, Geoff. It also tends to focus on the body and the brain When the body and the brain may be the site of where the problem is, but it might not be. It might be that the problem is more in the communities in which we live or in the relationships in which we find ourselves.

and our body and brain is just responding and reacting to those. those settings that are outside of us. Um, I think it sends the message also that successful treatment is a matter of reducing symptoms rather than like living well in the world. I think we know intuitively that someone can like not be anxious or not be depressed.

That doesn't mean that they're living a whole, fulfilling human life, but, but if we focus only on symptom reduction, that's, that's typically where we get. And I think it also doesn't, this machine model doesn't really get to the kind of core questions of who we are as human beings, and the core questions that we are asking ourselves, like, who am I, and what does it mean to live in this world, and do I matter, and do I belong, and am I loved?

These are questions that, that I think this kind of symptom focused approach to treatment just can't really fully answer. 

[00:14:21] Geoff Holsclaw: Yeah. Well, while you've been talking, like what keeps jumping into my mind is, uh, the spiritual formation category of sin management. And it just seems like there's actually some large congruence to certain kinds of spiritual formation, which is really just like, you just need to sin less and we manage our sin.

And then what you're saying of like, well, we just need to reduce symptoms and that'll fix everything. Uh, I don't know if there is a lot of congruence, but that what, that's kind of what kept jumping into my mind, uh,

[00:14:46] Dr. Warren Kinghorn: I mean, reducing symptoms is a good thing, like, if I'm, you know, if I'm

[00:14:50] Geoff Holsclaw: And reducing, managing sin is a good thing

[00:14:52] Dr. Warren Kinghorn: Yeah.

[00:14:52] Geoff Holsclaw: right?

[00:14:53] Dr. Warren Kinghorn: Yeah. But it doesn't get to

[00:14:55] Geoff Holsclaw: the

[00:14:56] Dr. Warren Kinghorn: of the problem.

[00:14:57] Geoff Holsclaw: the core of the problem. Right. 

Integrating Faith and Mental Health

[00:14:58] Geoff Holsclaw: So, well, let's kind of shift then because, um, Like many pastors and theologians like myself are kind of tacking toward like psychology and therapy as a way of understanding themselves or maybe their ministries, you know, I've been moving a lot toward attachment theory, but you.

As a psychiatrist, you know, it seems like you sat down one day and you're like, you know what, what I really need more of is the medieval theology of Thomas Aquinas. So how is it, and maybe it's just a Duke thing, right? I understand that Aquinas is

[00:15:29] Dr. Warren Kinghorn: Not the most popular choice. Yeah.

[00:15:31] Geoff Holsclaw: Yeah. Yeah. Yeah. Like, where did that, how did you get to Aquinas?

And then also like, not just how, but the, the, why do you feel like bringing on this medieval, uh, theologian has been helpful for you and I loved the way you, you brought him throughout your whole book.

[00:15:45] Dr. Warren Kinghorn: Yeah. Well, it's a great question that I ask myself sometimes Like why if you're want to think as a Christian about modern mental health care, would you turn to this 13th century? Theologian and philosopher who lived, you know before the advent of modern science And I think for me that's part of the why for me Aquinas who I deal with throughout the book is actually a great resource Because he's an example of a of a Christian thinker who lived at a time where we didn't have our modern categories of, like, science versus religion, or mind versus body, or, you know, mechanism versus the spirit.

He lived in a world where all of that was much more integrated and unified than it is now. I think part of what draws me to Aquinas is that he has this amazing personal story. Like, he was, um, now he's kind of known as a staid, you know, theologian, who's known for his kind of density of his writing. But, but in his time, he was the He was a talented son, but not the firstborn son, of a pretty wealthy family in Italy.

And his family, as was the case, he wasn't going to inherit the estate, but his family actually wanted him to go to this, like, very kind of, um, wealthy Benedictine monastery and have a kind of life of, you know, of status there, which is something that would have been done in the 1200s. And instead he rebelled, and he, he, he got influenced by this, like, roving band of itinerant monks who were You know, going around from city to city collecting alms and they were preaching and they made vows to poverty, but they weren't living in a settled monastery.

This was the orders founded by St. Dominic and became the Dominican or was the Dominican order. But at the time they were kind of rogues and renegades and, and Aquinas joined them much to the consternation of his family. Um, he also was. Uh, was living and working at a time where the thought of Aristotle, which had been kind of known, but, um, but a lot of texts of Aristotle had been lost in the Latin speaking West and were mostly, uh, maintained in the, uh, in the Greek speaking world of the East and the Islamic world, and they began to make their way back into Europe.

And he began to read more of Aristotle, and he began to study, Aristotle, and the reason why that mattered for Aquinas was that Aristotle compared to Plato and, and the Neoplatonists was very focused on, like, close attention to the, to the world around us, like, immediate observation of the, the world that's right at our fingertips.

fingertips and, and, and being aware of what's in front of our senses. So Aquinas both drew this like amazing depth of theology, but he also was increasingly focused on what does it mean to closely attend to ourselves as human beings and to our bodies and to the natural world around us. And so in that way, he had the kind of sensibility that modern scientists and psychologists now have.

What does it mean to closely observe phenomena and to reflect on them? But he had this beautiful way of doing it as a Christian. And. And for Aquinas, he also lived at a time where pilgrimages were pretty common. Medieval pilgrimages sites were, you know, people would, would do this. He himself walked back and forth from Italy to France a number of times and, and so he grew to understand that the central image of what it meant to be human is to be God's good creature, but it was to be someone who's on a journey, to be a wayfarer.

And he had this, this beautiful image of humans that are God's good creatures, that are from God. on our way to God, and the end and goal of our lives is union with God, that we can only know for, only know finally in the life to come, but we can kind of know it in an anticipatory way in this life. And so we saw all of human life is this journey to God, and, and the sacraments and the graces being given to us to kind of aid us on the journey.

So when I think about the world of modern mental health, and how so many people feel alone, they feel like they don't know if they matter, They don't know if they belong and that image of what if we're not machines, what if we're not just like isolated people that are kind of making our way in the world, but what if, what if we centrally are those who are on a journey to God and that that's the goal and image of our lives, that we're, we're those who are on a journey and, and, and to me that's, that's been a metaphor that's been a way of making sense of.

The Wayfaring Approach

[00:19:58] Dr. Warren Kinghorn: What I do as a, as a psychiatrist, who I am as a Christian, who I am as a friend and parent, where the key question is not like, what's the problem that needs to be fixed, but what's needed right now for the journey that this person that's on, what's needed right now for my own journey, and how can we think about, about things in that context. 

[00:20:17] Geoff Holsclaw: Yeah. Well, again, I feel like there is so much like congruence between the journey that you're talking about with like. clients and patients, as well as how sometimes we talk about spiritual formation. Cause sometimes the spirit, like we talk about sin management, but it's often just like, here are the right things to do and here are the right things to believe.

And now you're a good Christian rather than the kind of journey kind of aspect of, well, we're all like in process as we journey together toward, you know, life in God, however you kind of think about that. Uh, And so you're kind of making, uh, using Aquinas, but also just kind of, you know, the other things that you're thinking is like, how do we shift from a machine kind of view to this wayfaring view where we're in process, we're on a journey.

So what are practically as like a clinician, how, how do, how do those shifts that kind of like show up kind of in your work then, or like, what's some, cause, cause it's not just the. The profession that kind of has this machine understanding. It's kind of our whole culture, right? So people come in with this even view of themselves as machines that need to be fixed.

So how do you kind of that work to help see this process as different and themselves as different as part of this journey?

[00:21:28] Dr. Warren Kinghorn: Yeah. I mean, one, one comment about what you just said about the way that we think, we so often think as, as modern Western people. And maybe as, maybe as Christians that, like, the goal of our lives is to think in a certain way. And it does matter what we think, but, I mean, God's hope and desire for us is not that we, just that we think in particular ways, but that we become deeper lovers.

And, um, machines don't love, but humans do. I mean, creatures do. And so, and so what does it mean for us to be drawn more deeply into love, um, of God and love of, of others, love of ourselves, love of our bodies? Love of our own experience, even when that experience is not always welcome. Um, love of the natural world around us and of other creatures.

That's the goal of our lives, is to become deeper lovers. And so not to just draw things under control or even to think in certain ways, but to be drawn more deeply into love of God. And of course how we think matters for that, how we act matters for that, what we do matters for that. And that's I think the essence of a lot of the goods of spiritual formation.

My role as a clinician, as you mentioned, I'm a psychiatrist in the VA system, so I work in a government funded system, uh, working with veterans, and it's such a privilege to do so, but I'm not working in a, like, specifically Christian or specifically faith based practice where people come to me, like, because I'm a Christian psychiatrist, and I actually, I actually love that.

I mean, a lot of times people come to me just because I'm the guy that they're assigned to to see, you know, because they're struggling. So, with the patients that I see, uh, what I do is I am always wanting to know not just about their symptoms, but about their stories and about their history, so we take a lot of time in the first one or two sessions that I meet somebody to talk about, like, where are you from, um, what was it like for you, uh, in your home growing up, um, what do you care about, like what's the trajectory of your life, and that's a, that's beginning to help people to think of their lives as a kind of journey.

Um, I'll always ask people, again, I'm in this general government system, but I'll always ask people like, do you consider yourself a religious or spiritual person? Is faith important to you? And for a lot of my patients, the answer is yes. And then we talk in like open ended ways about that. And I kind of just ask questions and follow where they go, but we can often get into really, really interesting and rich conversations about their experience of God, their experience of church, their experience of another faith, if they're not Christian, although most of my patients are, are broadly Christian.

Um, and yeah, And I find that patients really welcome that, you know, they're like, Oh, I didn't realize I could ever talk with a psychiatrist about these questions, because I didn't think anybody cared, or it wasn't appropriate to talk about. But, uh, if, but I try to just welcome people to think about that.

And then when we think about, like, you know, treatment planning, I think a lot of times people think of psychiatrists as the medication managers. So if you get sent to a psychiatrist, you get sent four meds, the goal of the, of the therapy, of the treatment encounter is to come out with a prescription. And I do prescribe a lot of medication, and I think medication can be really helpful.

But, I mean, the goal of a encounter with a psychiatrist should not be, like, to get a prescription or to even, like, end up on the perfect medication regimen. It should be to sit with somebody who has experience listening and discerning and figuring out, like, what's the best path forward and to say, given where you are right now in your life, like, what's needed right now?

So, for a lot of my patients, I prescribe medications, but the answer might be other things, like, to get to access to secure housing. It might be to, um, get out of an abusive relationship. You know, it might be to join a therapy group. It might be to like, you know, really invest more in participating in the life of a church.

It might be to reconcile with a loved one, you know, with whom there's relational challenges. And all of those things are things that might be needed, sometimes along with medication and sometimes without medication. So I try to kind of keep an open frame for just like what's needed right now. How can I be helpful?

How can I walk alongside somebody? Again, thinking about the fact that I'm also on a journey. 

Inside-Out vs. Outside-In Perspectives

[00:25:33] Geoff Holsclaw: Well, in those last couple of points touch on a whole chapter that you have about, uh, how can we hold together an inside out kind of view to mental health as well as an outside in, uh, the inside out would be kind of like, well, I have these symptoms and problems and struggles and then medication might help me, you know, so that then my outward behavior is, is, is, uh, Or my life feels better or something like that.

But you talk about an inside out view and, uh, and you touched on some of those things as maybe we have to change our environment. Uh, our relationships could be causing our depression, not a chemical deficiency. Um, and so, um, like people and place and having a purpose, having these kind of broader things that are outside of us can then kind of, you know, Get into us, uh, and change what's happening.

Uh, is that kind of what you were, uh, getting at? You have a whole kind of list of these two different kind of, uh, outside in versus inside out. And I know there's a big, uh, Disney movie called inside out, you know, that talks about emotions.

[00:26:30] Dr. Warren Kinghorn: That's right. Which is great, by the way.

[00:26:32] Geoff Holsclaw: Disney. So we're on record for that. That, no, I'm just kidding.

But, um,

[00:26:37] Dr. Warren Kinghorn: me there. Yeah.

[00:26:38] Geoff Holsclaw: yeah. Could you, uh, just kind of talk a little bit about that? How about how, uh, It's too often we could be on an inside out kind of perspective and what an outside in view might be.

[00:26:48] Dr. Warren Kinghorn: Yeah. Well, as Christians, we affirm that we're dust. That we're creatures of dust. And so we live as bodies. Our bodies get tired. They break down. They can get sick. And so, you know, And so how we live, how we feel, how we think, our bodies matter for that. So, so our bodies are relevant. And I think Christians have nothing to fear from like well conducted research into the biological, um, correlates and origins of various mental health problems and a lot of work going into that.

And Christians affirm that we're not just creatures of dust, but we, we, learn and we grow and we discover who we are in relationship. So, I mean from the very moment of conception, we're, we're constituted in relationship with our mothers, with our parents, with God, with others, and then, I mean, to the central good of attachment theory is making clear how, like, you know, from the very earliest times of our life, throughout it, throughout the the life course.

Like we're always like discovering who we are, we're finding ourselves, we're growing as selves in relationship with others. So Christians, I think, naturally should have like a bio social view of mental health problems, not just a biological view, but a bio social view. And when I talk with residents and students in the medical school at Duke, I, I challenge them to think about, like, two different models of thinking about mental health challenges.

So one, as you mentioned, would be what they call the inside out view. And this is the idea that, like, if, if I'm feeling in a way that I don't want to feel, then the problem must be somehow inside me, like in my, you know, in my brain. hormones in my brain circuits, maybe deepen my personality, and then that shows up on the outside.

So like a Duke undergraduate who's, you know, starting the semester and feeling overwhelmed, can go to the student counseling service and say, well, you know, the problem is that, um, there's something that's happening inside me. And, and, uh, and then the focus is either on an individual therapy that tries to help people.

Somebody addressed their innermost thoughts or it's, or it's like a medication that can help adjust, you know, neurotransmitters and that kind of thing. So the idea is that the problem starts on the inside and it shows up on the outside of relationship and community and culture. But what I encourage students to do is to turn that around and say, what if the, what if the locus of the problem, what if the problem starts not on the inside of someone's brain or body or innermost personality, but what if the problem is that, We live in communities that are sometimes fractured and we have relationships that are strained and we live in a culture that's incredibly challenged in different ways.

And so people can feel lonely. They can feel isolated. They can feel anxious. They can feel depressed. We feel a lot of things in response to like relationships and communities and cultures that are not And so, in that case, it's more of an outside in model, like, and so, it's not, it's not that things start on the inside and they show up in relationship and community and culture, but they start with problems of relationship, or communities, or culture, and then they show up on the inside of people's lives.

experience, and they show up in the brain, but that doesn't mean that the problem starts on the inside. So when Christians think about mental illness, we should think not only, like, how do we think about how things go on in the body, but also what's happening in the world around us, and maybe that's the place to focus and to start. 

[00:30:11] Geoff Holsclaw: And I think that there's a lot of congruence and you don't cover this a lot in the book. Although I'm sure you, you probably talk this way too, is, uh, we can think of sin that same way too. As soon as an inside out kind of problem, it's a behavior problem, problem of the will, sometimes a problem with, uh, what you believe that then causes you to, you know, act the wrong way.

Uh, but really scripture doesn't, it talks that way a little bit, right. Uh, that we're responsible for actions, but it also talks about how sin is like an environment that we're all. Uh, you know, enslaved to that. We've been captured by sin that sin has like a, or a kingdom, uh, you know, in Romans five. Um, and so it's like, yeah, like, you know, my struggles. Might not just be my fault. Although, you know, we're all contributing. It's all a two way environment, right? Um, so a lot of times when I'm preaching, I always balance it and say, well, you know, we, we sin, we put sin out in the world, but we are also sinned against and that sin gets into us. Uh, and it's like that outside in kind of movement.

Uh, and we just have to be aware of those two. So it's not really an either or right. You're trying to just kind of, uh, offer these two things. So what would be the last kind of, as we kind of finished and conclude. 

Final Thoughts and Encouragement

[00:31:22] Geoff Holsclaw: Um, uh, what would be kind of like your last hope, not just for mental health professionals, but also people in the church, like this wayfaring kind of approach, uh, to life, what does it really kind of helped you or enriched you personally to kind of make some shifts or movements?

[00:31:38] Dr. Warren Kinghorn: One, just to echo what you said about sin, actually, I think we do need a really robust, strong theology of sin, but we need not to, to reduce it, you know, as, as is often the case. When I talk with students at Duke about, like, thinking about sin, you have these different models in the, in the, in Scripture of what sin is.

So sin is a, sin is described as a power, it's described as transgression, it's described as a breaking of relationship, and it's described in some ways as a wound. And so, And that leads to different things that we need. Uh, so, if sin is a power, we need liberation. If sin is a transgression, we need absolution and confession and forgiveness and reconciliation.

If sin is a relational sundering, we need restoration of relationship. If sin is a wound, we need healing. And I think that's a broader way to think about, like, how sin operates in our world and, and us. Um, so that's, that's just a comment on sin, but I think, uh, I think the bigger thing that, like, for listeners and readers of the book to, to come away with, is that, um, the deepest truth of who we are is not our sin, nor our suffering, nor our struggling, but it's that we as human beings are loved and known by God, and that, and that God delights in us, and that that's the deepest truth of who we are, and I would just encourage listeners and readers and anyone out there who is struggling.

First of all, to, to know that you're not alone in the world, that God knows you and loves you. And that's probably the most important thing that that, uh, that we could say. It's also that if you're struggling, that there's help out there for you, and so, like, seeking the counsel of people that you consider to be wise, uh, whether that's a psychiatrist, whether that's a counselor, whether that's a pastor, whether that's a spiritual director, whether that's a friend, but, uh, but, but don't keep your struggles alone.

Seek help. If you have any thoughts at all about, uh, harming yourself or about suicide, even more reason to immediately seek help, including calling the National Crisis Line 988 if, um, uh, and, and to reach out to others, but don't keep things alone because we need each other. And, and I think being aware that like whoever we are, whatever we are, when we struggle, it's not that we just need to be fixed, but it's that we need to be a company, we need to be loved, and we need to have people walk alongside us on, on a journey.

And we all need that, whether we're diagnosed or not diagnosed, whether we're struggling or not, whether we're in a helping role or not. We all need that as human beings.

[00:34:10] Geoff Holsclaw: Yeah, so much. So we need community, the, uh, companioning, uh, co laborers, uh, and the Co journeyers on the, on the, the pilgrimage, which is the wayfaring. It's the traveling on the way. Thank you so much for being on today. Uh, this is again, uh, Warren Kinghorn. He just wrote Wayfaring a Christian Approach to Mental health that just came out just a couple months ago.

Uh, are there any ways that people can kind of follow you or keep track of the other kind of work that you do?

[00:34:39] Dr. Warren Kinghorn: Yeah, thank you. Uh, well, I'm a co director of an initiative at Duke called the Theology, Medicine, and Culture Initiative and at Duke Divinity School, we're an initiative in the Divinity School that specifically exists to connect Christian faith to the world of health care, including mental health care.

People can easily find us online, but I would also say if there's people out there who are interested in exploring that connection more, we do offer some content. opportunities for clinicians especially to study with us in, in, in seminary, just like I did years ago to more deeply understand how does your faith matter for the world of health care and mental health care.

And if anybody's interested in more conversation, um, I'd welcome that. And I also just appreciate people's interest in the book and, uh, and welcome, uh, opportunities for conversation with people about that. 

[00:35:23] Geoff Holsclaw: Yeah. Well, thank you so much for taking a little time to be on with us.

[00:35:27] Dr. Warren Kinghorn: Thanks so much. 

Um,