Evangelicals have a significant stake in the decision-making nature of human beings. Terms like belief and unbelief, obedience and disobedience, are part of a biblical grammar of responsibility. Accountability and culpability are essential concepts in relation to the bad news about sin, the good news of the divine gift of salvation, and the expectation of final judgment. Typically, only extreme cases of mental disability find exemption from this understanding of willful human agency and accountability.

With this longstanding view of human responsibility, it should not be too surprising that evangelicals—-particularly in the fields of counseling—-have been reticent to accept the relatively recent findings of medical research that attribute moods and behaviors to neuro-physiological conditions. As neuro-chemical deficiencies became an established social narrative for explaining a host of personal problems ranging from depression and anxiety to learning deficiencies, suspicion of these findings has grown. Some evangelical leaders worry that the findings of neuroscience assault biblically based theological conclusions about humanity, sin, and even salvation.

But counselors should acknowledge that sometimes life is not easily reduced to choosing. If we treat people only as volitional beings, we fail to relate to them based on the full theological narrative of the imago Dei and the fall from grace. We must consider matters related to nurture and nature when addressing complex issues of life in this world.

Sociology: the Context of Nurture

I think about these factors often when I read our local newspaper. Almost daily I learn about what seems like an endless stream of young people convicted and sentenced for crimes. In many cases, I sense there are important stories behind their stories that never reach the paper. Long before these young people landed in the legal system, irresponsible adults carved a path the path that helped lead them toward a life of crime. I don’t say this to excuse them from taking responsibility for their actions, but to recognize a reality that caring people cannot ignore.

I realize that we must take responsibility for our lives and that playing the victim (even when there is truth to the claim) only binds us to destructive patterns of life. Yet when counseling others, it would be naively simplistic to overlook or to minimize the effects of a troubled upbringing. There is guilt to be shared when those intended (by God’s plan) to be lovingly nurtured and brought to maturity under the responsible oversight of committed parents are instead abused and neglected. How do we talk about the outcomes in the lives of such children? How do we teach them to process the culpability of negligent parents? Does the behavior from children who come from such neglect and abuse always warrant the label of sin?

The intended design for individuals in community was clearly stated when God said that it was not good for the first man to be alone. Our story is not meant to be one formed, for better for for worse, in isolation but in a social context. Those who refuse to acknowledge how one’s sociology (relationships and life circumstances) plays a major role in shaping one’s life disrespect the Creator’s design. Compassionate counselors must consider the whole person holistically when guiding people into truth.

Physiology: the Context of Nature

Similar consideration must be given to the effects of physiology. Just as we are social beings formed in community, we are also physical beings with bodily needs. We are complex, and our fall from God’s will only complicated our existence with brokenness on every level of life. Our original fall from God’s will corrupted both our social and physical existence in powerful and painful ways. This is where spiritual considerations must enter the picture for those who counsel the whole person based on truth. We are equally spiritual beings with a God-directed need for living in and under the will of our Creator.

Part of human complexity involves the brokenness of our bodies and minds. The brain is the most complicated organ in the body, and it is marred with dysfunctions to varying degrees in the same way as other human organs. Medicines that treat neurological conditions should be understood along similar lines as medicinal aids for dysfunctions of hearts, lungs, and other bodily organs. Consequently, those who benefit from depression medications should never be made to feel embarrassed about their need. Our bodies are fearfully and wonderfully made but woefully and tragically fallen.

Yet we need to exercise special caution in assigning moods and behaviors to neurologically based deficiencies. When counseling the whole person holistically, we should not allow counselees or patients to reduce their problems to medically based solutions. Perhaps the medicines are essential to their health, but other considerations are just as important. People must look at their social context and their spiritual needs along with bodily deficiencies. I’ve worked with counselees who have benefited from depression or anxiety medication while working through circumstances and relationships to bring more stability to their lives. Once their lives reached greater levels of health and stability, they were able to progressively move away from the medicinal supports.

We must understand that our brains can become physically altered by our circumstances. These changes are typically chemical in nature. This should not be too surprising, as the same truth applies to other organs of the human body. Stress, for example, is proven to be bad for the heart.

But this is not to say that everyone can expect physical changes with changes in their circumstances. Some people must accept medicinal aids as a permanent part of their lives. But even in more severe cases, we must guard against simplistic reductions of persons to a single dimension of personhood.

Avoiding Reductionism

It is naive and potentially harmful to those seeking help to treat them one-dimensionally. It also disrespects the way God made humans and the pervasive effects of our fallen condition. Along similar lines, the need for medicinal aids for behavior or moods should not preclude responsibility and accountability. It should temper our approach with compassion and mercy, but only in a context that preserves the dignity of exercising as much responsibility as possible.

In summary, counselors and doctors should never think one-dimensionally concerning medicinal aids for neurologically based needs. We are more than bodies with physical needs. Other dimensions of our being (spiritual, emotional, social) must receive equal consideration in the battle for health. A biblically based holistic approach to counseling respects all dimensions of personhood created by God in the full context of creation, fall, redemption, and final restoration.

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