区分属灵问题与生理问题
编者的话：
迈克•艾姆雷特弟兄曾经是一名医生，后来顺服神的呼召读神学，成为全职的圣经辅导人员。本文以问答的形式介绍了他关于辅导服侍的经历和经验，希望其中的内容能够帮助我们认识和思考基于圣经的辅导，从而牧养和辅导那些需要帮助的灵魂。
【医疗背景和训练】
Q1 九标志事工：您曾经是名医生，然后转型成为一名全职的教师和辅导员，您的医学背景是否对您后来的辅导工作有帮助？
迈克•艾姆雷特：这是个漫长的过程，而且完全出乎我的预期。因为我参与地方教会，并且常常和病人有接触，这使我开始思考牧养的事工。这个想法通过在教会的服事得到了外部的印证，我自己也感受到日益强烈的内在呼召。在一年左右的时间里，我与这个呼召不断较力，最后我决定去读神学。我当时不认为我一定要成为全职的辅导人员。我希望既从事牧养事工，又能继续兼职作医生。比方说，我就好像看见自己是一位在城市里从事两份工作的牧师。最后我因为基督教辅导和教育协会(本文简称CCEF)去了威斯敏斯特神学院。我知道作为一名牧师将参与许多辅导的工作，所以希望得到更好的装备。
Q2 九标志事工：您为什么会参加基督教辅导和教育协会（CCEF）？
迈克•艾姆雷特：我第一次接触圣经辅导是我在南卡罗来纳行医的时候。当时有个负担，就是在全美范围内，将圣经辅导老师与基督徒家庭医生结合在一起。这是个很棒的主意。在基础护理中，有许多人是带着心理－社会灵性等各种问题来看医生的。作为医生，我们有很好的牧养他人的机会，但是医生却常常没有足够的时间来进行辅导。作为尝试，我们几个人和组织方以及其他几位受过训练的人士见面。这看上去是不错的配搭，但是分配给我们的辅导人士并不适合作辅导。他非常唐突、生硬，并且不太能与人建立私人关系。几个月之后，我觉得不再适合把病人介绍给他了。我接触到有些人受罪的捆绑以至于引发健康问题。但他给出的方法却千篇一律，“把这句经文写在卡上，当你受试探的时候，把这张卡片拿出来。” 这样并没有什么以福音为中心的内容。有一段时间，我决定再也不去接触圣经辅导了。
后来我们遇到另一位辅导员，他和被辅导者有很深的联接。我深受鼓励，但是过了一阵子，我开始怀疑真的能产生长效的改变吗？我知道直接的圣经辅导方式似乎不能与人建立关系。现在这个新的方式似乎与人有联接，但是我不能确定它是否可以解决更深层次的问题。当时我和一个正在参加圣经辅导课程的学生有交流，他不断提起基督教辅导和教育协会(CCEF)的名字，我开始对圣经辅导有了些不同的感受。
Q3 九标志事工：在医疗领域有没有一些世界观的假设，是普通基督徒或牧师看家庭医生时应该注意的吗？
迈克•艾姆雷特：一般而言，一个非基督徒医师的世界观是把人当作简单的物质来对待。他们倾向于用生理或生物医药等原因来解释遇到的问题，特别是针对情绪或智力方面的问题，精神层面的问题更是如此。当然，无论基督徒还是非基督徒医生都会把脚踝骨折作为物理问题，但是当涉及情绪和智力，你就能看到世界观的影响力。有意思的是，即使是基督徒医师，我受到的所有生物医学和生理训练，都使我有意无意地将这两者区别开来。在我看来，圣经是某一领域的权威，但在生物－医药领域，知识则是权威。不过，通过圣经辅导的训练，我开始认识到圣经对生活中的任何问题，都有提纲挈领的解决方法。
【区分属灵与身体】
Q4 九标志事工：如果有人来到基督教辅导和教育协会(CCEF)寻求辅导，他们的问题可能是身体的，也可能是心理的，您会鼓励他们在进行圣经辅导的同时寻求医生的帮助吗？
迈克•艾姆雷特：是的，有些时候我会。有些焦虑或抑郁的症状是身体原因造成的。甲状腺功能降低可能造成抑郁。甲状腺功能亢奋可能引发焦虑。因为我的医师背景，我倾向于对人进行综合考量。我会思考——我看到的问题更偏向于属灵问题、人心的问题？还是与身体的关系更密切呢？我希望把这两者都考虑进去。
Q5 九标志事工：牧师常常发现和自己对话的人会使用“严重抑郁”、“精神分裂”或“创伤后应激障碍”等术语。牧师应该如何看待这些标签？这些术语有价值吗？还是会产生误导？
迈克•艾姆雷特：我认为这些术语有意义但是也可能引起误解。只要我们了解这些标签意味着什么，认识到它们的益处与风险，这些术语还是会有帮助的。换而言之，我们必须意识到心理学诊断系统的问题与缺陷。有意思的是，即使在精神病学中，对如何区分情绪和智力的反常也有不同的争议。现在使用的精神失常诊断和数据分析手册是第四版，而第五版正在准备中。第五版还没出版的原因是，精神病学的专家们从根本上不清楚如何对这些问题进行分类。
针对这些诊断依据最重要的是，承认这些术语对描述思想、行为、情绪等方面的失常还是有用的，但是它们不是解释。埃德·韦尔奇在《归咎大脑》（Blame It on the Brain）一书中讲到过这些。
有些人在看病时，描述他们的感受、经历和看到的。医生把这些结合起来作为诊断依据。
类似地，精神疾病的诊断依据是一系列症状，但问题在于并没有可推荐的客观身体检查可以进行——就像脑部扫描或血液检查。越来越多的人有意对患有强迫症或深度抑郁的人进行大脑模式检查，但是没有人能对抑郁进行特殊的血液检查，或对强迫症患者进行脑部扫描。我们需要意识到这些描述是很好的，但它们却不能告诉你为什么一个人会抑郁——他们只是达到了这个程度。它总结了症状是什么，但是却不能告诉你为什么。
举例来说，你看到我脸色通红，跺着脚大喊大叫，眉头紧锁。你可能会说：“哦，你生气了。”然后你可能会问：“你为什么生气？”如果我回答说：“因为我眉头紧锁，脸色通红，四处跺脚。”这不会是个令人满意的答案。我只是用生气这个词描述了很多事——紧锁眉头、脸红和跺脚。
同样地，精神诊断依据也是用一个词，比方说严重抑郁症、强迫症、创伤后应激障碍来描述一系列症状。但是这个词还是没有告诉你为什么人会有这样的挣扎。我认为这些诊断依据会比它们的实际意义更具权威，但在另一方面，我也觉得这些描述是有帮助的。
我记得在自己行医过程中遇到一个病人患有阿斯伯格综合症。我从来没有听说过这个病。这是个比较新的诊断名称。这时候拿出医疗诊断手册来读一读、了解一下，会有帮助吗？当然，这帮助我预备一些问题，更好的了解这个病人。
Q6 九标志事工：您能给予牧师一些建议，如何区别病理和非病理的问题吗？他们可以如何帮助教会里的人呢？
迈克•艾姆雷特：我想第一是先看看有没有生理问题。我要提醒每一位从事教牧工作的人避免走极端。不要把所有的问题归结于属灵原因，也不要把所有问题归结于生理问题。常常问一问：“我看到的问题符合福音吗？还是与福音相悖？”如果有些事与福音不一致，那就要问“心理的层面上有什么问题吗？是什么驱使这个人呢？”
第二，牧师要思考这个挣扎潜在的生理问题是什么？我希望知道如果一个人发怒或抑郁，他们的家庭状况如何？是否在工作中受到不公的对待，是否家庭关系紧张，在我与他们交谈的时候，这些都是要考量的因素。同样的，我也需要考虑生理状态。人的两个方面——生理与心理——是互相作用的。我们需要在工作时充分考虑到这两者。
再次，如果你处理的问题是骨折，那你关注的焦点就是身体。如果你的辅导对象爱说闲话和抱怨，那就应该聚焦在属灵层面。但是我不想对此进行简单的分类。因为，我抱怨的时候不可能脱离大脑神经元的参与，所以这些都是互相交织的。
如果有人使用许多药物，很可能会对思想与情绪产生干扰。这些药物很可能有副作用。一个人服用越多的药物（并不仅仅是精神药物、抗抑郁药物等等，也包括抗高血压等简单药物），越有可能产生反应。可能产生睡眠问题，或者在日后产生剧烈症状——这些都可能是生理问题的表现。
很明显，福音更新了我们，但是如果我在之前的45年都是个内向的人，却突然变得非常外向；或者我一直十分节俭，但突然在信用卡上花费巨资。这时，作为牧者，需要考虑你的辅导对象是否身体出了问题。
【训练辅导人员和牧师】
Q7 九标志事工：您参与基督教辅导和教育协会(CCEF)的事工，请问贵机构如何训练实习生？
迈克•艾姆雷特：我们的实习生与我们机构的异象“恢复基督为中心的辅导，辅导教会”（Restore Christ to Counseling and Counseling to the Church）很吻合。我们希望装备弟兄姊妹使用与辅导有关的恩赐帮助地方教会与普世教会。实习生在这方面提供了一个可行的办法。无论是牧师、妇女事工的主任、员工辅导或是青少年主任，都可以获得实际训练，提高他们在事工中的辅导技巧。
Q8 九标志事工：你们如何把这些融入地方教会？实习生的角色是什么？
迈克•艾姆雷特：绝大部分的实习生在他们的辅导学硕士或神学硕士的最后一年，几乎都参与在他们教会的服事。有一些在实习的同时参与教会的服事。绝大部分参与带领工作。包括带领圣经学习，或者进行部分教导的工作。在申请的过程中，我们需要了解他们参与地方教会的程度，也需要有牧师的推荐信。我们需要从牧师那里知道这个人是可信赖的、受尊敬的，并且积极参与服事。
【倡导改变】
Q9 九标志事工：如果牧师和长老希望在教会倡导门徒造就，他们最需要考虑的事是什么？
迈克•艾姆雷特：我想第一件事（也应该是最重要的事）就是牧师或者执事是否活出了被基督恩典更新改变的生命。我之前的牧师常说：“要教会改变，我必须先改变。” 我觉得这太正确了。无论是在公开的事工、非正式的对话或是讲座中，如果教导的人员活出了以福音为中心，由心而出的改变，他们才能带领会众做到这些。
这也会在讲道中体现出来，我记得和我前牧师乔•诺弗森（Joe Novenson）聊到，讲更多饱含恩典信息的道，究竟是会增加或是减少辅导的工作量。我们觉得会增加，而且我的经历也是如此。如果一个牧者能够适当地敞开自己，并在日常生活中运用圣经，将会使人们更刚强，人们会上前来说：“我不需要全然完美，我可以敞开自己的挣扎和失败，我能在这里找到帮助。”
Sorting Out the Spiritual and the Physical
MEDICAL BACKGROUND AND TRAINING
9Marks: You began your career as a medical doctor and switched to full time teaching and counseling? How does your medical background benefit your counseling work?
Michael Emlet: It has been a lengthy journey and certainly not anything that I anticipated. Because of my involvement in a local church and the interactions I had with patients, I began to think about pastoral ministry. The movement toward ministry seemed to be confirmed externally through church involvement and internally with a growing sense of calling. Over the course of a year or so, I began to wrestle with that calling and finally decided I would go to seminary. I did not think that I would necessarily be counseling as a vocation. I anticipated that I would be in pastoral ministry, and possibly part time in medicine. For example, I saw myself working as a bi-vocational pastor in an urban setting. I ended up attending Westminster Seminary because of CCEF [Christian Counseling and Education Foundation]. I knew that as a pastor, I would be doing a lot of counseling, so I wanted to be better trained.
9M: Why did you want to go to CCEF?
ME: My first exposure to biblical counseling was when I went into practice in South Carolina. There was a real burden to match biblical counselors with Christian family practices throughout the state. It was a terrific idea. In primary care, there are many people that come to their physician with psycho-social-spiritual issues. It is a great opportunity to be able to minister as a physician, but there is just not enough time to be doing that kind of counseling. As a practice, a number of us met with the organizer as well as some of the people that had been trained. It seemed like a great fit, but the person that was assigned to our practice was not actually suited for counseling. He was very abrupt, abrasive and not very personal. After a few months, I did not feel comfortable referring people to him. I had experiences where people were entrenched in certain sin patterns to the point that it created health problems. He gave a cut-and-dried, “Write this verse on a card, and when you’re tempted, pull it out.” There wasn’t much about it that was gospel-centered. For a while, I said I would not go any place where biblical counseling was the norm!
We then had another counselor come along that had a great way with people and really bonded with them. I was encouraged, but after a while I began to be unsure that long-termchange was happening. I knew that theovertly biblical approach didn’t seem to connect with people. This new approach seemed to connect, but I wasn’t convinced of its ability to deal with deeper issues. I began to hear more about CCEF around this time by talking with a student who had been taking classes and began to get a different sense of biblical counseling.
9M: Are there any worldview assumptions in the medical field that the average Christian or pastor should be aware of as they visit the family doctor?
ME: Generally, a non-Christian physician is going to have a worldview that sees people as simply physical beings. They will be more likely to have a physical or bio-medical explanation for the problems at hand, particularly if there are problems in terms of mood or intellect. This is particularly true when you get into the psychiatric realm. Obviously both Christian and non-Christian physicians will treat something like a broken ankle as a physical problem. But when you get into the issues of mood and intellect, that’s where you really see the worldview assumptions coming to bear. Interestingly, even as a Christian physician, all the bio-medical and the physical training I had received caused me to unwittingly and artificially separate the two spheres. In my mind, there was one place where the Scriptures were authoritative, and there was another place where bio-medical knowledge was authoritative. But in my counseling training, I began to see that the Scriptures provide this overarching view to any problem of life.
SORTING OUT THE SPIRITUAL AND THE PHYSICAL
9M: If you had someone arrive at CCEF’s door for counseling, expressing some things that may be going on with them psychologically or physically, would you encourage them to also see a medical doctor in conjunction with their counseling?
ME: Yes, sometimes I do. There are some expressions of anxiety and depression that have physical causes. A low functioning thyroid might be associated with depression. An overactive thyroid might be associated with anxiety. Because of my medical background, I tend to approach people holistically. I tend to think—what do I see that is weighted towards the spiritual, towards the heart? What might I be seeing that may have a physical correlation? I try to keep both of these things in mind.
9M: Pastors will often find themselves talking with people who use terms like “major depression,” “schizophrenia,” or “post traumatic stress disorder.” How should pastors think through those labels? Is there any value in them or do they mislead?
ME: I think they have value and can also be misleading. They can be helpful as long as we understand what the labels signify and we are aware of the benefits as well as the risks. In other words, we must be aware of the problems and pitfalls with the psychiatric diagnostic system. Interestingly, even within psychiatry there is disagreement about how we should classify disorders of mood and intellect. The diagnostic and statistical manual of mental disorders is on its fourth edition and they are planning the fifth. It has been delayed because the leaders within psychiatry are fundamentally not sure how we should best classify these problems.
One of the most important things regarding these diagnoses is to realize that they are helpful descriptions of disorders (thinking, behavior, mood), but they are not explanations. Ed Welch talks about this in Blame It on the Brain [P&R, 1998].
Someone comes in (just as they would in any medical situation), describes what they are feeling, what they are experiencing, what they are seeing. Then the physician pulls it all together as a diagnosis.
Similarly, psychiatric diagnoses are a list of symptoms. The difference is that there are no recommended objective tests—physical tests like brain scans or blood tests. There is an increasing interest in examining the brain pattern of someone who has OCD [obsessive-compulsive disorder], or someone who is severely depressed. But no one has determined that to diagnose depression, you need to do a particular blood test; to diagnose OCD you need to do a particular brain scan. We need to recognize that these are good descriptions, but they do not tell you why a person may be depressed—only that they meet the criteria. It gives a helpful outline of what this experience is like, but it doesn’t tell you why.
For example, you see me and my face is red and I am stomping around, yelling and my brow is furrowed. You might say, “Oh, you’re angry.” Then you might ask, “Why are you angry?” What if I replied, “It’s because my brow is furrowed, my face is red, and I’m stomping around!” That wouldn’t be a very satisfactory answer. I am just using one word, anger, to describe many things—furrowed brow, red face, and stomping.
In a similar way, psychiatric diagnoses use one word (e.g. major depression, OCD, post traumatic stress disorder) to characterize a list of symptoms. It still does not tell you why a person might be struggling in a certain way. I think the diagnoses can come across as more authoritative than they really are. On the other hand, I think those descriptions can be really helpful.
I remember a prime example of this in my own practice. I had someone come in with the diagnosis of asperger syndrome. I never heard of asperger syndrome. It’s a relatively recent diagnosis. Was it helpful to me to pull out my DSM and read about it? Yes! It helped me craft questions and better understand the person’s experience.
9M: Can you give pastors any wisdom on how to distinguish between medical and non-medical problems? How can they help the people that are coming in the doors of their local church?
ME: I think the first thing is to have your radar up for the possibility that there could be something physical going on. I urge anyone in ministry to avoid the extremes. Do not put all your eggs into the spiritual basket or all your eggs into the physical basket. Always ask the question, “What do I see here that is either in line or is not in line with the gospel?” If something is not in line with the gospel, ask, “What might be going on at the level of the heart? What might be motivating this person?”
Secondly, a pastor should consider what the potential physical aspects of this struggle are? I want to know if I’m dealing with someone who is angry or depressed. What is going on at the home front? If they are being persecuted at work or if they are in a very contentious family situation, these contextual factors matter in terms of the way I approach them. In the same way, I want to be aware of the physical context. These two aspects of our personhood—physical and spiritual—are absolutely intertwined. We need a healthy awareness that both are at work.
Again, if you’re dealing with a broken ankle, you’re going to be focused on the physical. If you’re dealing with someone who is gossiping or complaining, you’re going to be focused more on the spiritual side of things. But I don’t want to create an artificial distinction. I can’t gossip without neurons firing in my brain, so I’m absolutely intertwined.
If someone is on a lot of medications, there is an increased likelihood of disturbances in thinking or mood. The medications may have side effects. The more medications a person is on, (not just psycho-active meds, anti-depressants, etc., but even simple blood pressure medications) there is potential interaction. There may also be sleep issues involved, or symptoms that occur later in life with an abrupt change—that is indication of something going on physically.
Obviously the gospel transforms us, but if I’ve been an introvert all of my life and, at age 45, I start being extremely extroverted; or I’ve been extremely thrifty and I suddenly begin spending thousands on a credit card, a pastor should start to wonder if something might be going on physically.
TRAINING COUNSELORS AND PASTORS
9M: You are involved with the counseling internship at CCEF. What does CCEF train interns to do?
ME: The internship falls right in line with CCEF’s vision to “Restore Christ to Counseling and Counseling to the Church.” We want to equip men and women to use counseling-related gifts to help the church both locally and globally. The internship provides a practical component. It is hands-on training to help people grow in their counseling skills for their field of ministry, whether it’s pastor, director of women’s ministry, counselor on staff, or the youth director.
9M: How do you integrate this into local churches? What roles do they play?
ME: Most if not all the interns are in their final year of an MA or the M.Div. in counseling and are involved in their local church. Some are serving in the church and participating in the internship simultaneously. Most of them are involved in leadership. Many are leading Bible studies, perhaps teaching in some capacity. During the application process, we inquire about their level of involvement with their local church and require a letter of reference from the pastor. We need a sense from the pastor that this person is trusted, respected, and actively involved.
PROMOTING CHANGE
9M: What are the most important things pastors and elders should think about as they seek to promote discipleship in their church?
ME: I think the first (and maybe the most important) thing is whether the pastor/elder is exhibiting a lifestyle of being transformed by the grace of Christ. One of my former pastors used to say, “For the church to change, I must change.” I think that’s right on the money. Whether it is in the context of public ministry, informal conversations, or session meetings, if the pastoral staff is exhibiting that kind of lifestyle (gospel-centered, heart-directed change), then they are essentially mentoring the congregation to do the same.
And this may show up in a man’s preaching. I am reminded of a conversation with my former pastor, Joe Novenson, where we discussed whether preaching more grace-saturated messages would decrease or increase your counseling load? We decided that it would increase them, and that has certainly been my experience. As the pastor self-discloses in an appropriate way and makes the Scriptures applicable to daily living, it emboldens people to come forward and say, “I don’t have to have my act together. I can be honest about my struggles and failures. I can find help here.”
作者：迈克•艾姆雷特
迈克•艾姆雷特，神学硕士、医学博士，在成为基督教辅导和教育协会（CCEF）咨询师和成员之前，从事家庭医生这一职业12年。他著有多篇辅导论文和两本书籍——《亚斯伯格症和强迫症：强迫中得自由》（Asperger Syndrome and OCD: Freedom for the Obsessive Compulsive）和《十字路口的对话——当生活与圣经相遇》（CrossTalk: Where Life and Scripture Meet），该书由新成长出版社（New Growth Press）在2009年出版。
翻译肢体：季方
用圣经视野和实用资源装备教会领袖
进而通过健康的教会向世界彰显神的荣耀
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