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Going the Distance: Resources for Preventing Burnout and Compassion Fatigue in Caregivers

[The following is a presentation I gave at a conference sponsored by the Center for Faith and Health at Samford University, November 2017.]

Introduction

Burnout and compassion fatigue are known occupational hazards for caregivers.  The causes of these conditions are more complex that mere physical exhaustion.  In this presentation, I suggest three ideas that can provide assistance to caregivers for the prevention of burnout and compassion fatigue: a sense of vocation, sufficient margin, and positive social networks.

I spent much of my career in campus ministry, working as a college chaplain on six different university campuses.  My first such job was in 1990. I would wager that my professional experience is similar to many of yours in several key ways.  Chaplains are typically generalists, not specialists, because we often work with a small staff (or no staff) and limited resources.  Chaplains wear many hats.  In 25 years, I have worn many hats: pastor, preacher, teacher, professor, lecturer, counselor, advisor, mentor, supervisor, manager, administrator, coordinator, event planner, travel agent, cook, caterer, editor, chauffeur, sound technician, stage lighting engineer, web designer, graphic artist, photographer, videographer, historian, accountant, DJ, mechanic, pop culture expert, etc. The skills required to continue this work year after year include a willingness to learn quickly, to change readily, and to grow continually.  But maybe more importantly, the job requires determination, endurance, and grit.  We spend long hours, nights, and weekends, dealing with student crises, emotional meltdowns, financial burdens, family dysfunctions, addictions, mental illnesses, academic struggles, and relationship drama.  And honestly, we don’t get paid that well, yet we still love our work and the people at the center of it.  Caregiving in my field requires 10% intelligence and 90% endurance; a little bit of inspiration, a whole lot of perspiration.

I suspect that this sounds familiar to most caregivers, so I also suspect that it comes as no surprise that among the most common occupational hazards of caregiving are burnout and compassion fatigue.  A survey published in 2014 on the prevalence of depression found that over 14% of professionals working in the social services and health care sector suffered from episodes of major depression, the third worst rate of any of the 55 occupations studied. [1]  Frequent interaction with distressed clients and patients, high levels of stress, and low levels of physical activity were found to correlate with depression rates among professionals.  Rates of burnout and compassion fatigue in the healthcare sector could be as high as 60%, further pointing to the costs associated with caregiving.[2]  Additionally, a 2009 study found that nearly 66 million Americans were providing unpaid care for at least one family member.[3]  The emotional, psychological, and spiritual costs of caregiving represent significant personal and professional challenges to many. In my experience, we pay close attention to the details of caregiving, but far less attention to caring for the caregivers.

Burnout and Compassion Fatigue

The concept of burnout was first identified in the mid 1970s by the German-born Jewish-American psychologist Herbert J. Freudenberger.  He identified burnout as consisting of (1) feelings of overwhelming exhaustion, including physical and/or emotional depletion, (2) interpersonal detachment or cynicism characterized by intense negative feelings toward aspects of one’s job, and (3) a sense of ineffectiveness or lack of achievement and productivity at work.[4]  Compassion fatigue, also know at Secondary Traumatic Stress (STS), is a condition similar to but distinct from burnout.  STS is described as a state of extreme stress, tension, or preoccupation with the suffering of others to a degree that is traumatizing for the caregiver.  The key factor distinguishing STS from burnout is the presence of trauma in those for whom one is providing care, although burnout is frequently a symptom of STS, along with frustration, anger, depression, sleep difficulties, fear, intrusive thoughts, debilitating anxiety, and decreased feelings of compassion and empathy over time.  Caregivers at high risk of STS include those who are regularly involved in emotionally charged or traumatic situations, such as first responders, trauma unit workers, oncology caregivers, hospice nurses, public defense attorneys, and military chaplains.[5]

Some of the research on the prevalence of burnout and STS may shed some light on its causes.  Studies indicate, for example, that in many caregiving professions, young caregivers are at significantly greater risk of burnout than older ones. This seems counter-intuitive, does it not?  Female and unmarried caregivers are also at greater risk than male or married ones, suggesting that a sense of control over one’s life and work plays a role in preventing burnout and STS.[6]  Additionally, caregivers who report being “quite a bit” to “extremely” religious had lower levels of diminished empathy and emotional exhaustion than those who were less religious.[7] 

The key point here is that burnout and STS involve more than mere physical exhaustion. These conditions result from an absence of meaning, the lack of belief that one’s work is important or significant, and a sense of hopelessness in the face of life’s demands.[8]  These conditions are emotional, psychological, and spiritual as much as physiological, and so a holistic approach to their prevention and treatment seems clinically advisable and arguably unavoidable.

I think you agree that solutions to the problems of burnout and STS involve more than mere rest from caregiving, otherwise I would simply recommend that you go somewhere and take a nap!  But that’s not my recommendation, so it seems to me that my task as a presenter is to help provide you with some emotional, psychological, and even theological resources to help you who are caregivers for people in crisis stay in this profession and remain effective over the long-term.

Vocation

The first helpful resource that I would like to discuss is vocation.  An oft-quoted passage from the American Presbyterian writer and theologian Friedrick Beuchner serves as an effective introduction to the concept of vocation:

“Vocation comes from the Latin vocare (to call) and means the work a person is called to by God. There are all different kinds of voices calling you to all different kinds of work, and the problem is to find out which is the voice of God rather than of society, say, or the superego, or self-interest. The kind of work God usually calls you to is the kind of work (a) that you need to do and (b) that the world needs to have done. If you find your work rewarding, you have presumably met requirement (a), but if your work does not benefit others, the chances are you have missed requirement (b). On the other hand, if your work does benefit others, you have probably met requirement (b), but if most of the time you are unhappy with it, the chances are you have not only bypassed (a) but probably aren’t helping your customers much either. The place God calls you to is the place where your deep gladness and the world’s deep hunger meet.”[9]

The concept of vocation is rooted in the claim that you are the happiest and most energized when you are doing the work that bring you joy and meets a genuine need.  [e.g. cigarette sales and cardiology]  No doubt, the world needs caregivers, but if Beuchner is correct, you are not going to last very long at it unless you find some level of gladness in it.  Vocation frees you to think about your work as a calling rather than merely a job.  Your vocation and your job need not be the same thing identically.  St. Paul, the missionary who authored a considerable portion of the New Testament, was a tentmaker by trade, a job that allowed him to pursue his missionary vocation.  A job is meaningful only to the degree that it allows you to pursue your calling, and can be stifling if it does not.  A series of jobs strung together over a lifetime we call a career, and careers typically follow the paths of ambition and upward mobility.[10]  But they need not do so. 

Henri Nouwen and Albert Schweitzer provide two examples of people who forsook the enticements of career for the rewards of vocation. Nouwen was a Dutch-born Catholic Priest who left a successful academic career that included two decades of teaching at prestigious universities such as Notre Dame, Yale, and Harvard.  He left the academy at the age of 53 to live and work with physically and mentally handicapped people in a small community in Richmond Hill, Ontario, Canada. Schweitzer, a German organist, theologian, and medical doctor left behind a brilliant music career in Paris at the age of 30 and became a medical missionary in what is now Gabon, Africa.  During his first 9 months on the continent, he treated thousands of patients and performed hundreds of surgical procedures with the help of his wife, a trained anesthetist, in a hospital that he built on his own out of corrugated iron.

These men left behind prestigious careers to become caregivers.  They traded ambition for vocation.  Their work was not easy and they were not perfect – Nouwen struggled with depression and Schweitzer with exhaustion – but their stories illustrate the powerful pull of a call.  Are you called?  Do you think that you have merely inherited your work by accidental necessity?  Or do you believe that there is a divine providence that organizes our universe by matching others’ necessity with your ability?  Vocation reminds you that you are here for a reason, created for a purpose, and equipped for that purpose.

Margin

I first encountered the concept of margin in a 1995 book by that title, written by the physician Richard A. Swenson. Swenson describes margin as “the space that exists between ourselves and our limits.”[11]  Swenson observes that the stresses of modern life devour margin. Technological progress helps us do things faster, but simultaneously gives us more to do and increases the pace of life. Every space is filled with clutter.  Every moment is filled with noise.  Every dollar is spent, and probably a few more.  We have not a minute to spare.  Our relationships with family and friends weaken, we limp through life physically exhausted, sleep deprived, and emotionally drained.  We lack the time to practice genuine reflection and build true virtue.  So although scientific progress benefits us in many ways, it may also make us less likely to experience lives of meaning and purpose.  As a medical doctor who restructured his own life and practice in order to create margin, Swenson’s prescription for what he calls “overload syndrome” is fairly predictable: work less, earn less, spend less, accumulate less, exercise more, sleep more, rest more, etc. (That actually sounds like vacation to me.)  In other words, we regain margin not by making a few small behavioral changes, but by transforming the way we live entirely.

Good caregiving requires margin, doesn’t it?  We need margin for emergencies, for unexpected or unwelcomed interruptions, for serendipitous opportunities to show kindness, and for timely conversations.  Genuine compassion is difficult to schedule because caregiving is the ministry of interruptions.  Add to that the fact that many of us in this room chose our professions for reasons other than earning potential, so we are particularly subject to the economic pressure to spend more than we earn, and the resulting pressure to work harder and longer in order to earn more.  So in a profession in which margin is sorely needed, the evidence suggests that it is sorely lacking.  We need change, individually, institutionally, and culturally. 

What Swenson is suggesting, and what I am suggesting, is not unlike what Christian theologians have commended for centuries.  In the Christian classic Celebration of Discipline, Richard Foster notes that “superficiality is the curse of our age.”  By contrast, “the classical disciplines of the spiritual life call us to move beyond surface living into the depths so that we have the capacity to “be the answer to a hollow world.”[12]  Foster’s prescription for the shallow life consists of three sets of practices: the inward disciplines (meditation, prayer, fasting, and study), the outward disciplines (simplicity, solitude, submission, service), and the corporate disciplines (confession, worship, guidance, celebration).  But who has the time, or the discipline, for all of these disciplines?  Just glancing at this list of disciplines makes me tired.  And here is the irony: how many of us seek to reclaim some margin by avoiding the practice of margin-giving disciplines?  We have become very much like the proverbial woodchopper who has little time to sharpen his axe.  We know we could work more efficiently with a short break, but we feel as if we will fall hopelessly behind if we take one.  And so we continue to chop, with decreasing effectiveness, until exhaustion overtakes us, and the blade becomes almost irreparably dull.  All the while the disciplines of religious faith call to us, or more accurately, God calls to us.  “Come to me, all who are weary and heavy burdened, and I will give you rest.”  If we cannot claim the time to respond to that call, to care for our own souls, then we will not likely care well for others for very long.

Positive Social Networks

Let us turn our attention now to the network of people that you need to survive as a caregiver long-term.  In a 2012 book entitled When Our Leaders Do Bad Things, social worker and clinical psychologist Mangal Dipty argues that people fall into three categories in terms of their impact on us. There are positive, negative, and neutral people.  Positive people are those who, on the whole, contribute more to us relationally than they cost us.  Every relationship costs you something, but positive people make a net contribution to your coping resources and your margin.  Negative people, on the other hand, cost more than they contribute.  Neutral people cost about what they contribute, for zero net gain or loss relationally.  Admittedly, you cannot quantify relationships with exact precision, and relationships change such that people who were once positive can become negative and vice versa.  That said, I still find this idea persuasive, that you need a critical mass of positive and neutral people in your life so that you can help negative people.  We cannot and arguably should not spend all of our time with positive people.  Most healthy adults consider helping others an essential part of life, so we should spend some time with negative people.  The key strategy is to balance the negative people with positive to maintain balance.

The problem for us caregivers is that we are particularly at risk of spending much of our time with relationally negative people.  Notice that I am not necessarily talking about the attitude of the people who need care.  Some may have quite positive attitudes, but relationally they likely require more of us than they can give to us.  And if we surround ourselves with mostly negative people most of the time, then we will eventually be of little help to anyone.  Excessive relational negativity can lead to what University of Washington psychologist John Gottman refers to as “negative sentiment override,” a condition in which a relationship becomes conflicted to the degree that even positive messages are interpreted negatively.[13]  When you reach this state, your environment has become toxic and your physiological response to that environment changes biochemically.  Your blood pressure and heart rate increase, your brain’s ability to process information is reduced, hormones trigger your body’s most basic fight or flight instinct, and compassionate care becomes almost impossible.  Emotionally, physically, and spiritually you cannot sustain critical levels of relational negativity.  They have the power to taint your vocation and ruin your career. 

The bottom line is that we need relationships that nourish us.  All caregivers need caregivers.  We are incapable of surviving long-term in these demanding fields without resources that we simply cannot get on our own.  We are fallible and dependent creatures.  Until we admit this, we are in trouble.  When we admit this, then we are free to seek in humility what can save and sustain.  The Christian tradition calls this grace.  And I know that other religious traditions provide comparable resources. The forgiveness and compassion that was hard earned by Christ is offered to us freely, so that we in turn can offer it to others.  Grace is the relational resource that feeds our vocation, giving us the margin to run with endurance the race set before us.

Conclusion

Three years ago I took up trail running.  I have been a runner and cyclist for many years, but with age I have slowed.  So, when the Red Mountain trail system opened just seven minutes from my home here in Birmingham, I found a new hobby.  Trail running requires of me physically what my vocation requires of me spiritually.  Many trail races are longer than marathons (usually 50k or longer) and as a result, trail running is less about raw speed and more about steady progress.  Trail runners must carefully balance nutritional intake with the strategic expenditure of energy for long hours over difficult terrain.  Even the best trail runners walk or fast hike up steep inclines in the mountains.  At mile 30, every runner wants to quit and every runner needs a good reason to keep going, a calling to continue.  Slow and steady wins the race, or at least finishes it.  Strangely enough, trail running energizes me.  A weekend without a few hours on the trail seems empty, almost wasted.  The physical depletion that accompanies a dozen miles in the July heat also includes for me a reconnection with God’s creation, a time for reflection, and a rejuvenation of the soul.  Everyone needs his or her version of a good trail run.

For the surgeon and author Richard Seltzer, it is the library.  And now I’d like to quote a brief excerpt from an essay that appears in Seltzer’s book entitled Letters to a Young Doctor that will conclude and I think captures the heart of my talk today.  The essay that I abridge here is called “Toenails.”

It is the custom of many doctors to withdraw from the practice of medicine every Wednesday afternoon.  Some doctors spend Wednesday afternoon on the golf course.  Others go fishing.  I go to the library where I join that subculture of elderly men and women who gather in the Main Reading Room to read or sleep beneath the world’s newspapers, and thump through magazines and periodicals, educating themselves or just keeping up.

How brave, how reliable they are!  So unbroken is their attendance that, were one of them to be missing, it would arouse the direst suspicions of others.  And of me.  For I have, furtively at first, then with increasing recklessness, begun to love them.  Either out of loyalty to certain beloved articles of clothing, or from scantiness of wardrobe, they wear the same things every day.  For the first year, this is how I identified them.  Old Stovepipe, Mrs. Fringes, Neckerchief, Galoshes – that sort of thing.

Neckerchief is my favorite. He is a man well into his eighties with the kind of pink face that even in July looks as though it has just been brought in out of the cold. A single drop of watery discharge, like a crystal bead, hands at the tip of his nose. His gait is stiff-legged, with tin, quick, shuffling steps accompanied by rather wild arm swinging in what seems an effort to gain momentum or maintain balance.  One day, as I held the door to the Men’s Room for him, he pointed to his knees and announced, by way of explanation for his slowness: “The Hinges is rusty.”  From that day, Neckerchief and I were friends.  I learned that he lives alone in a rooming house eight blocks away, that he lives on his Social Security check, that his wife died a long time ago, and the he has no children.

One day I watched as Neckerchief , having raided the magazine rack, journeyed back to his seat. As he passed, I saw that his usually placid expression was replaced by the look of someone in pain. Each step was a fresh onslaught of it. His lower lip was caught between his teeth. His forehead had been cut and stitched into lines of endurance. He was hissing. I waited for him to take his seat, which he did with a gasp of relief, then went up to him. “The Hinges,” I whispered. “Nope. The toes.” “What’s wrong with your toes?” “The toenails is too long. I can’t get at ‘em. I’m walkin’ on ‘em.”.

I left the library and went to my office. “I need the toenail cutters. I’ll bring them back tomorrow,” I said to my nurse. Neckerchief was right where I had left him. “Come down to the Men’s Room,” I said. “I want to cut your toenails.” I showed him my toenail clippers, the heavy-duty kind that you grip with the palm, and with jaws that could bite through bone. One of the handles is a rasp. I gave him a ten-minute head start, then followed him downstairs to the Men’s Room. “Sit here.” I pointed to one of the booths. He sat on the toilet. I knelt and began to take off his shoes. “Don’t untie ‘em,” he said. “I just slide ‘em on and off.” The two pairs of socks were another story, having to be peeled off. The underpair snagged on the toenails. Neckerchief winced. “How do you get these things on?” I asked. “A mess, ain’t they? I hope I don’t stink too bad for you.”

The nail of each big toe was the horn of a goat. Thick as a thumb and curved, it projected down over the tip of the toe to the underside. With each step, the nail would scrape painfully against the ground and be pressed into his flesh. There was dried blood on each big toe.  It took and hour to do each big toe. The nails were too thick even for my nail cutters. They had to be chewed away little by little, then flattened out with the rasp. Now and then a fragment of nail would fly up, striking me in the face. The other eight toes were easy. Now and then, the door opened. Someone came and went to the row of urinals. Twice, someone occupied the booth next to ours. They’ll just have to wonder, I thought.

I wet some toilet papers with warm water and soap, washed each toe, dried him off, and put his shoes and socks back on. He stood up and took a few steps, like someone who is testing the fit of a new pair of shoes. “How is it?” “It don’t hurt,” he said, and gave me a smile that I shall keep in my safety-deposit box at the bank until the day I die. “That’s a Cadillac of a toe job,” said Neckerchief. “How much do I owe ya?” “On the house,” I said.

The next week I did Stovepipe. He was an easy case. Then, Mrs. Fringes, who was a special problem. I had to do her in the Ladies’ Room, which tied up the place for half an hour. A lot of people opened the door, took one look, and left in a hurry. I never go to the library on Wednesday afternoon without my nail clippers in my briefcase. You just never know.

[1] Lawson Wulsin, Toni Alterman, et al, “Prevalance Rates for Depression by Industry,” Journal of Social Psychiatry and Psychiatric Epidemiology (2014): 49:1805-1821.

[2] Bernie Monegain, “Burnout Rampant in Healthcare,” Healthcare IT News (April 30, 2013) online at http://www.healthcareitnews.com/news/burnout-rampant-healthcare.  Accessed July 31, 2015.

[3] Lauren G. Collins and Kristine Swartz, “Caregiver Care,” American Family Physician (June 1, 2011): 83 (11): 1309-1317.

[4] H. J. Freudenberger, “Staff Burnout,” Journal of Social Issues (1974) 30:159-165.

[5] L. R. Simpson and D. S. Starkey (2006), “Secondary traumatic stress, compassion fatigue, and counselor spirituality: Implications for counselors working with trauma.” Retrieved July 2015, from http://www.counseling.org/resources/library/Selected%20Topics/Crisis/Simpson.htm.

[6] L.L. Emanuel, F.D. Ferris, C.F. von Gunten, and J. Von Roenn eds. Education in Palliative and End-of-life Care for Oncology (Module 15: Cancer Doctors and Burnout). Chicago, IL: The EPEC Project, 2005.  Retrieved July 2015, from http://www.medscape.org/viewarticle/754366.

[7] K.M. Kash, J.C. Holland, W. Breitbart, et al. “Stress and Burnout in Oncology,” Oncology (2000) 14:1621-1633.

[8] A. M. Pines, “Burnout: An Existential Perspective” in W. Schaufeli, C. Maslach, and T. Marek, eds. Professional Burnout: Recent Developments in Theory and Research. Washington, DC: Taylor and Francis, 1993.

[9] Friedrick Beuchner, Wishful Thinking: A Theological ABC, Harper & Row, 1973, page 95.

[10] Brian J. Mahan, Forgetting Ourselves on Purpose: Vocation and the Ethics of Ambition, San Francisco, CA: Jossey-Bass, 2002, pages 9-14.

[11] Richard A. Swenson, Margin: Restoring Emotional, Physical, Financial and Time Reserves to Overloaded Lives, Navpress, 1995. A newer edition of this book was published in 2004.

[12] Richard J. Foster, Celebration of Discipline: The Path to Spiritual Growth, San Francisco: Harper Collins, 1978.

[13] John Gottman, The Seven Principles for Making Marriage Work, New York: Three Rivers Press, 1999, page 21.

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Message to SouthLake Christian Faculty and Staff

As we began faculty in-service last week at SouthLake Christian Academy, I addressed our teachers with an annual State of the School update and some words of encouragement and motivation. I commended their unity as a faculty and their commitment to teaching our students in ever changing circumstances, and also acknowledged the challenges they face as our operations are turned upside down in every conceivable way. I offered the following devotional thought and challenge.

Matthew 14 and John 6 tell the story of Jesus walking on water, but they tell it a bit differently. In Matthew’s account, Jesus walks on water through a storm, gets into the boat with his disciples, and “the winds ceased.” In John’s account, Jesus gets into the boat and “immediately the boat was at the land to which they were going. If you are a contemporary historiographer, this may appear as a contradiction. Some argue that the two writers are telling two different stories. For Matthew and John, however, I believe the gospel genre in which they were writing was use for theological rather than purely historical purposes. Matthew tells us when Jesus arrived, the waters calmed. John says that when Jesus arrived, they were carried across the waters; the voyage ended. Sometimes God intervenes to calm our waters and we keep on rowing. At other times he carries us through the waters, the voyage ends, and the difficulty is over. How God chooses to intervene is his choice by providence, and I believe, for our greater good.

In that light, I challenged our faculty and staff to shift their thinking in the following ways:

  1. Shift from likes to needs. Rather than think about operational changes as things we like or don’t like, conceive of them as things we need to continue live instruction as safely as possible for as long as possible.
  2. Shift from opinions to facts. We may all have opinions about school opening, about CDC recommendations, about the politics of wearing masks, etc. but those matter far less right now than science and data. Opinions matter, but facts are actionable.
  3. Shift from feelings to strategies. As conditions change, and inevitably they will, how we may feel about changes is less relevant than the strategies we implement to cope as well as possible with whatever comes our way.

While I would prefer that God simply carry us through this storm, it appears that we still have some rowing to do. So I will hope for calm waters, trust God’s providence, and pray for endurance to give every stroke of the paddle my best.

Biblical Interpretation Leadership Theology
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Why Christian Education

Why Christian Education

[The following is a written summary of an address to the faculty of Westminster Catawba Christian School on August 5, 2019.]

At SouthLake Christian, we began a strategic planning process earlier this year to identify our main priorities as a school for the next chapter in our history. We spent a few months gathering data from our various constituents – teachers, students, parents, alumni, and members of the community – to clarify who we are and what next steps we should take, to select among all the good options the very best ones. Early and often, people identified two traits that characterize our school and must be preserved at all costs: our commitment to academic rigor and our identity as a Christian school. These conjoined twins represent the two main reasons our school was established and continues to exist, the reason parents hire us and pay us to do a job, the reason volunteers and donors give their time and money, and the reason that independent, public, and charter schools haven’t crowded us out. And yet, there are reasons for Christian education superior to those pragmatic considerations, important as they are. I propose that Christian education casts out fear[1], nourishes freedom, and tells a better story.

Bob Woodward’s 2018 book entitled Fear describes the inner workings of the White House with this phrase: “Real power is fear.” Machiavelli’s The Prince articulates a similar refrain: “It is better to be feared than loved.” Many leaders rise to power and maintain that power because they manage effectively to understand and articulate the underlying fears of their constituents. Some leaders maintain power by stoking that fear while promising to ameliorate it. These strategies work because fear plagues us all. It drives us to work and overwork, robs our sleep, wrecks our bodies, taints our relationships, and blinds us to life’s beauty. Fear. Cable news fuels it, social media feeds it, marketing firms monetize it. And the thing we have most to fear is fear itself. Yet we have a solution. Christians have always taught that the antidote to fear is love. The apostle John, for whom 4 books of the New Testament are named, writes that “God is love” and “perfect love casts out fear” and “greater love has no one than this: to lay down one’s life for a friend.” (1 John 4.8, 1 John 4.17, and John 15.13 – NIV). The love that led Jesus to lay down his life for us lives in us. As we love each other and our students and their families, we cast out fear. As we teach that love, and acknowledge explicitly its source and power, we smother the fires scorching our society. Christian education literally makes the world a better place, God’s kingdom come on earth as it is in heaven.

As we cast out fear, we nourish freedom. Years ago, I attended a conference of the American Academy of Religion, one session of which concerned academic freedom. The panel discussion was led by professors at various types of universities – state, private secular, and Christian. As they each described their context, something became blatantly obvious. Only Christian schools have any chance at true academic freedom! Public and secular private school teachers avoid religious conversations like the plague, by necessity. They can lose their jobs if they appear to advocate for any particular religious conviction. In the name of tolerance or open-mindedness or diversity, our society has pushed theological belief to the margins, treating nearly every other form of belief more amicably. A rather strange state of affairs now exists whereby religious belief, so important to so many, can barely be discussed by anyone in a secular classroom. And so, I ask, who is really free? The answer is YOU. You teach at a school that sees theological conviction not merely as a subject worthy of open discussion, but one foundational to all discussion because every belief of any kind begins with an unproven assumption. All learning requires faith. Your students attend a school where they can ask ANY question and get a straight answer. We can actually promote tolerance and open-mindedness and diversity not because these things are fashionable, but because they are beautiful, and good, and right, and true, and biblical. We have rich theological language by which to say that we should treat each other with respect and kindness because we are all created in God’s image, that we value people different from us because such is the Kingdom of God, that we seek community with people who do not look like us because heaven will be filled with people of “every tribe and tongue and nation” (Revelation 7.9 – ESV). We do not fear others because we love them. We love them because God first loved us. God’s love sets us free.

Christian education casts out fear, nourishes freedom, and tells a better story. This summer I spent part of a day with Scott Dillon, Head of School at Westminster Catawba, and we talked at length about the why of Christian education. What sets us apart from other academically rigorous schools? Why do parents pay us to educate their kids? What do we offer that is distinctive? To approach an answer to those questions, play a game with me. Imagine your school is not a Christian school. A student asks, why do I need to learn this math? You could answer, because you will need it for next year’s math class. Why do I need next year’s math class? Because you will need it to graduate. And why do I care about graduation? Because you need a high school degree to go to college or vocational school. Why do I need college or vocational school? Because you need more education to find a job in a competitive global economy? Why do I need to a job? So that you can live, pay your bills, raise a family, enjoy the world. Why do I need to do these things? Because they contribute to the greater good. And why should I care about the greater good? And on, and on, and on. Eventually, every answer becomes depressingly utilitarian. We do these things because they have pragmatic value. BORING! As Christian educators, we have a better story to tell. We teach and we learn because all truth is God’s truth. Because every equation displays God’s handiwork, and every element on the periodic table gives evidence of God’s ingenuity, and every musical note sounds God’s beauty, and every star in the solar system declares the God’s glory, and every language expresses God’s love, and every event in history ultimately tells His story. And we are story tellers. And what an amazing story we get to tell.

[1] The idea that Christian education casts out fear I owe to Dr. Dennis Sansom, Professor of Philosophy at Samford University. He presented this idea in a Convocation address to the university sometime during the 2006-2007 academic year.

Biblical Interpretation Education Leadership Theology
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The Meaning of Christian Faith as Simply as I Know How to Explain It

God created all things and called the world that he created “very good.” Man and woman, happy and in perfect relationship with the creation and the Creator. Tempted by the desire to be like God, man and woman rebelled against God and sin entered the world. Every evil, every ounce of suffering, every war and death and disease and disaster originates from a good creation that is broken by sin. 

In response, God chooses the nation of Israel to use for his purposes to begin to restore the world. He taught Israel how to live as his chosen people, set them free from captivity, provided for their needs and gave them the law (10 Commandments, and a few others). But the law that was a gift was also a curse. The law exposes how truly broken we are. This was God’s plan all along, to teach us that we cannot be good enough to fix the world, to be genuinely happy again, or to restore a perfect relationship with God. The prophets, priests, and kings of Ancient Israel teach us that in the pages of the Old Testament.

Enter Jesus. He was an Israelite, the next step in God’s plan through Israel to remake the creation. He was born, lived, and died as a human being. But he was also God, the Son of God, the incarnation of God, the fullness of God in a human being. He was tempted like us, laughed like us, hurt like us, cried like us, bled like us, but without sin, without fault. So when he was executed he didn’t deserve it. He sacrificed himself for us, and in some mysterious way that I cannot fully understand, he took upon himself the sin and pain and misery of the world in order to fix it. There was a debt I owed that he paid. I was captive to an old life and he set me free. I deserved a punishment that he took in my place. The God of the universe is so just that he could not ignore sin, and so filled with love that he could not let it destroy us. So God sent Jesus to fix the problem. And Jesus did, and is continuing to do so, and will one day complete that task for good at the end of time, at the end of the world as we know it. In the words of Andrew Peterson, the world was good, the world is fallen, the world will be redeemed.

What does this mean for us? We cannot fix ourselves. We cannot manage our own spiritual lives. We cannot restore ourselves or the world to the good condition in which God created it. We need Jesus. And the good news is this, literally the Gospel is this, that Jesus invites us to follow him, to believe in him, to trust him with our lives. And if we do so, he saves us from all that is wrong with us and from all that is wrong with the world. He restores us to a right relationship with God and with other people, gives us companionship, meaning and purpose in the Church, and begins the process of fixing everything. We do nothing to earn what God gives – this is grace, all of God offered to us in Christ. We acknowledge our sin and accept God’s gift, with the faith that God is who the Bible says he is, and that Jesus did what the Bible says he did for us. We enter a new relationship with him. All things become new.

– Presented at Freshmen Retreat, Samford University, August 29, 2014 and Shades Mountain Baptist UMin, August 31, 2014

Bible Biblical Interpretation Theology
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How Should We Live? A Very Brief Introduction to Ethics

“Every pursuit aims at some good.” – Aristotle, Nicomachean Ethics

“Pride comes before a fall.” – Proverbs 16:18

Introduction
Students in both my graduate level Corporate Integrity class and my freshmen level Core Texts class read quite a bit of philosophy. Some consider philosophy boring or impractical, but in some ways philosophy is the most practical of academic disciplines because it helps us think about the things that matter most in life.  Philosophy deals with the good, the true, and the beautiful (ethics, epistemology, and aesthetics), the necessary components of a life well lived. Ethics helps us think about what a good life looks like.

From a Christian perspective, a good life comes by grace through faith in Christ, but the gift of grace is not the end of the Christian life. Instead, grace should motivate right behavior. The field of ethics helps us think carefully about right behavior. What is good? How should we live? The major of schools of ethical thought help us answer these questions. Let me list four, describe them, and discuss their strengths and limitations.

1. Consequentialist Ethics. Sometimes called teleological ethics, consequentialism focuses on the outcome of a particular behavior. An action is good if it achieves a good end. There are two forms of consequentialism, egoism (act to maximize your own good) and utilitarianism (act to maximize the greatest good for the greatest number). Of course questions remain as to what goods should be maximized and for whom. Should we, for example, prioritize a growing economy or a clean environment? Should we sacrifice the needs of a wealthy minority for the needs of the poor majority? And how might we distinguish between needs and desires? Surely we desire many things that we do not genuinely need.

2. Rule or Duty Ethics. Sometimes called deontological ethics, rule or duty ethics focus on the obligations, rules, principles, laws, norms or duties that guide behavior. An action is good if it conforms to an accepted rule or duty. One classic expression of deontological ethics includes Immanuel Kant’s Categorical Imperative: treat people as ends not means, and act only on that principle that you would will to be a universal law. Another expression of deontology includes John Locke’s Social Contract Theory: if you choose to live in a society, you should respect the rights of others within that society. Deontology, however, raises obvious questions. How do we determine rules, duties, and rights? Are there ever exceptions to a rule? Can I tell a lie to save a life (as many did, for example, to hide Jews from the Nazis)?

3. Virtue Ethics. Sometimes called character ethics, this school of thought focuses on the development of virtue, the traits that lead to ethical decisions. An action is good if it embodies a virtue (integrity, trustworthiness, humility) and avoids a vice (greed, dishonesty, arrogance). Of course one might ask what virtues are most important, and whether or not it is possible for a vice sometimes to produce a good outcome.

4. Divine Command Theory. Here, an action is right if God commands it. There are two (mutually exclusive?) forms of divine command theory: (1) Plato – God only commands actions that are good, and (2) Ockham – Any action God commands is good. Plato’s view runs the risk of placing good over, God if it is something to which God is bound. Ockham’s view runs the risk of making good entirely arbitrary, such that humans could never know what was good apart from specific rules. Divine command theory raises some obvious questions. Which god’s command should be followed? How can one truly know God has commanded an action? Can God command something seemingly unethical (as when God commands Abraham to murder his son Isaac)?

Conclusion
No single school of ethical thought solves every moral dilemma. Some situations involve unavoidable moral complexity. Each school of thought contributes something to the conversation, but each has obvious limitations. Most people utilize a combination decision-making philosophies, but gravitate toward one in particular. It is wise to know one’s own ethical tendencies and to understand the strengths and weaknesses of that school of thought. To know what you don’t know requires humility, without which the good life (and God’s grace) will likely elude you.

Ethics Theology
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The Problem of Pain

If God were good, He would wish to make His creatures perfectly happy, and if God were almighty He would be able to do what He wished.  But the creatures are not happy.  Therefore God lacks either goodness, or power, or both.  This is the problem of pain, in its simplest form.

– C. S. Lewis

The problem of pain represents the most serious intellectual challenge to the rationality of Christian faith. Many have rejected or abandoned faith as a result of the failed attempt to reconcile God’s goodness with the realities of evil and suffering. Here I want to outline briefly how Christian theologians have answered this problem and offer a few suggestions for those suffering and those seeking to offer comfort. I make no claim to provide a complete solution to the problem. I do not think such a thing exists. Every answer includes insights and shortcomings. If we examine this issue long enough, we will likely be forced to admit that we have as many questions as answers. Along with the Old Testament character Job, whose suffering is legend, I must eventually confess: “I am of small account, what shall I answer? I lay my hand on my mouth. I have spoken once, and I will not answer; twice, but I will proceed no further.” (Job 40:4) Eventually we should all confess as much, but not before seeking answers as Job did. We may not get all of the answers we seek, but in the process we may get something better.

To begin, it would be helpful to define evil and to distinguish between natural evil and moral evil. Evil is often defined as anything without which the world would be a better place. By implication, some of what we might call evil might make the world a better place. Natural evil (disasters and diseases) results from features of the physical universe that are arguably necessary for survival. Gravity keeps me from floating off into space, but gravity also means that when I trip and fall I may get hurt. The cells in my body regenerate, divide, and mutate in order to keep me alive, but sometimes these characteristics of cells lead to the spread of disease. These examples of so-called natural evil lead to suffering, but the possibility of such suffering is unavoidable in a physical world that operates according to natural laws that keep us alive, making the world better on the whole. Moral evil, by contrast, occurs when people violate divine law, harming themselves and others in the process, rendering the world worse. Of course, there are ways that natural evil and moral evil mingle, such as when drought followed by monsoon rains cause mudslides in communities with substandard housing. Poverty, climate change, unscrupulous builders, and natural weather cycles coalesce to cause suffering. For someone with a biblical worldview, however, both moral evil and natural evil find their ultimate origins in Genesis 3; they result from sin that tainted human society and the natural world.

Now I’d like to review four historically prominent explanations for suffering in Christian history, and show some of their strengths and weaknesses. Theologians sometimes call these ideas theodicy, a term that means “defending the justice of God in light of evil.” These ides have a long history and for the sake of brevity I will avoid attributions, but if you’re curious, feel free to comment. The four ideas are as follows.

Free Will – God created humans with freedom and we may choose to use that freedom for good or ill. Implied in this explanation is a kind of retribution principle – evil behavior is punished, either passively or actively. If I operate an automobile while intoxicated and wreck my car, my injuries are the direct result of my behavior. Whether my suffering is God’s punishment or the result of natural law (or both), I deserve it and few will call it unfair. But what if, in my intoxicated state, I drive my car into a crowd of pedestrians? Free will explains well my pain, but not theirs, or that of their loved ones. Why didn’t God intervene to trump my free will to protect others? Turns out, free will is a helpful explanation for some instances of suffering, but a troubling response to others.

Soul Making – God intends pain to build character, to make our souls more nearly perfect. What doesn’t kill us makes us stronger, yes? Or as the New Testament epistle of James states, “Consider it joy when you encounter trials of various kinds, knowing that the testing of your faith produces endurance.” Indeed, some instances of pain instruct. Who will disagree? The question is whether God could sometimes teach by a less painful pedagogy. In other words, do the ends justify the means? What souls are improved, for example, by the holocaust? Couldn’t the same good be accomplished with less evil? Couldn’t an omnipotent God make it so? Soul making, while helpful in some ways, seems to fail as an explanation for the most horrific evils.

Best Possible World – An all-knowing God would be aware of all possible worlds. A benevolent God would create the best possible world. An all-powerful God is able to create the best world. In other words, our world could be either more evil or less free, either of which would be worse that our current state of affairs. The only way for God to eliminate the possibility of evil altogether would be to eliminate freedom entirely, or not create a world at all. A world without freedom is not a good world, but a morally neutral world, and surely our world is better than no world, or so the argument goes. Of course, someone with cancer might conclude that even if this is the best world possible, it’s still a pretty crappy world. Sometimes we’d all agree.

Divine Suffering – God did not exempt himself from the world’s pain. God suffers with us (in Christ, God feels what we feel). God suffers because of us (moral evil grieves God). And God suffers for us (in Christ, God took suffering upon himself that spares us). Perhaps divine suffering is less of a philosophical explanation for evil and more of a recognition that Christianity situates the solution to evil squarely in Christ. Jesus doesn’t so much explain evil as he experiences it, overcomes it, defeats it, swallows it, and ultimately renders it powerless. Exactly how this happens is a matter for another post; that it happens partially is a matter of experience; that it happens completely in the end is a matter of faith.

So what can Christians offer to a suffering world? Explanations, especially poorly timed ones, can certainly do harm. Theodicy isn’t for funerals. In the middle of Job’s pain God didn’t explain. In response to Job’s questions, God didn’t answer. Instead, God listened. God was present. Job’s final words to God affirm this: “I have heard of you by the hearing of the ear, but now my eye sees you.” The final solution to evil is to see God, and in Christ we see God most clearly and experience God most poignantly. In the final analysis, this is surely better than explanations.

Theology
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A Theology of Mental Illness

Sometimes when counseling students, I sense that there are some physiological things complicating the social, spiritual, and emotional issues we are discussing. I am not a counselor, but I have some training and experience in recognizing signs and symptoms of mental illness. One of my greatest challenges in these situations is convincing students to seek professional medical advice from a psychiatrist. The taboo associated with mental illness is clearly present, but there are also theological prejudices in place as well. If you develop a sinus infection (an issue with the biochemistry of your respiratory system) you go to the doctor, get an antibiotic, and get well. No worries. But if you develop anxiety and/or depression (an issue with the biochemistry of your brain), this feels like a fundamentally different thing to most people. Some say that anxiety and depression are a spiritual issue. I agree, but no more and no less so than an upper respiratory infection. Some say that anxiety and depression are the result of sin. No more and no less so that any other illnesses. We are broken people in a broken world.

I have a long and sordid history with respiratory infections and asthma. Sometimes they develop because I don’t get enough rest, and sometimes they just happen because I have allergies or because I’m a runner and the air quality is poor. I’ve learned that sometimes a respiratory infection will clear up on its own, and I can usually tell by my symptoms whether or not I need to see a doctor. Similarly, I’ve learned from my work with students and from pastors, counselors, psychologists and psychiatrists that anxiety and depression are sometimes episodic and will ease up without medication, but sometimes they are chronic and additional assistance is needed. Why do we place such theological weight on the decision to seek treatment for brain chemistry issues? Why do we classify respiratory infections as “physical illness” and anxiety and depression as “mental illness”?

The reality is that our understanding of brain science is relatively small compared to our knowledge of other bodily systems. We aren’t sure what everything in our brain does or how medications will affect it. It’s all scientifically hazy and so our thoughts about brain chemistry are theologically hazy. Some think that if people have faith or pray sufficiently, then their anxiety and depression will go away. Sometimes is does, in the same way that extra rest and proper diet can clear up the common cold. But sometimes that doesn’t do the trick, and there’s no shame or spiritual failure associated with getting help when help is needed, either for your body or your brain. After all, your brain is part of your body, and your soul and spirit are inextricably connected to all of it.

Are anti-depressants or anti-anxiety medications a crutch? Of course! So are antibiotics and antihistamines. And for that matter, so are crutches, and when my daughter broke her foot, I thanked God for the crutches. Can antidepressants and other psycho-trophic medications be misused, prescribed prematurely, and used to the inappropriate exclusion of other forms of treatment? Sure, but this is true of all medications. All good things can be misused. It shows no lack of faith or no deficit of prayer to take medication when medication is needed and other treatments alone won’t do the job adequately. Can God heal? Sure. And why do we tend to think that God’s healing and medical treatment are mutually exclusive?

 

Mental Illness Theology