牧师如何处理恐惧、药物治疗以及各种上瘾问题

爱德华·韦尔契（以下简称“EW”）：当我们打开圣经，就能发现大量关于恐惧这一主题的讨论。正因为有那么多很好的资源能被用上，我们其实可以写许许多多这方面的书。这些素材紧紧地抓住了我。从一段经文不断引出一段又一段的经文，于是我开始相信上帝持续不断地在向那些与恐惧作斗争的人们诉说着美好信息。祂总是在对这些人说话。

EW：我认为牧师应该更加关注神的话，以及他牧养的会众。当牧师们仔细研究自己的会众，他们会发现人们充满着恐惧——来自别人的看法、财务的损失以及其他各种各样的事情。其实在圣经中有许多经文正是针对着这些情况。我希望牧师们对教会中正在与恐惧斗争的会众进行教导和劝勉。

EW：当人们想到恐惧的时候，确实会想到因性别的不同而产生的差异。大多数女人会马上联系到自己的生活、孩子、孤独带来的恐惧感之类。女人们的反应通常会很快。这是合理的，这种感觉紧紧抓住了她们。

另一方面，男人则会花更多的时间和精力来对付恐惧的问题。原因是多方面的，有些男人会认为“软弱的人才恐惧”或者“这种事情很娘娘腔”。私下而言，我希望我的妻子认为我是一个强者，凡事尽在掌握。当出现危机时，我依然希望自己看上去刚强，保持妻子能够依赖的样子。当我们谈及恐惧，其实违背了大多数男人天性。但是这是普遍存在的现象。当我们看圣经的前几章，我们会发现，其实女人的内心并没有什么恐惧感。

那么恐惧感对于男人而言在哪里呢？到处都是！恐惧造成了男人主要的问题。比如说，发怒是男人通常的问题。发怒是什么？是你有可能要失去一些东西了。一些对你而言非常重要的东西处于危险之中，并且让你产生了攻击性的反应，而非恐惧反应。但其实这是一样的：“我所爱的有了危险，我就应该做些什么。”

让我们看男人最热衷的事情和罪恶的行为：吸毒和性。今天，当我们和大多数男人聊及此事时，他们都害怕事情暴露、害怕被人厌弃、害怕不再被爱。你会发现，男人大多数的罪都被恐惧包裹着。我们随处都能发现恐惧和焦虑，但不同的性别会有不同方式的表达。

EW：身处我们这一代，有一件令人快乐的事，就是对整个现代精神治疗和药物治疗进行基于圣经的思考。我们很高兴有这个机会能够观察经文本身如何对人生中发生的问题说话，甚至这些问题在圣经作者撰写正典的时候不曾有过。

那么我们如何让经文来回应这些问题呢？让我们拿药物治疗为例。进行精神药物治疗是犯罪么？是明智的选择？还是错误的决定？当圣经中没有任何某个章节提及精神药物治疗，我们应该如何看待此事？如果我们说经文否定了现代药物治疗，我们不能使用，这会在解经上造成张力。现代药物治疗的目的在于缓解某些形式上的痛苦，我们显然不会拒绝缓解痛苦。当然，经文也常常会基于对上帝的敬畏，带领我们进入使用智慧的范畴。有时我们应该做出某种选择，另一种情形下，我们则应该换一种方法。

那么我们如何做决定呢？你会说，会有两种不同的解释。一种解释说，药物治疗是必须的，甚至每一位牧师都应该重视精神药物治疗。而另一种解释认为药物治疗是错误的，这会玷污基督的教会。

两种观点都存在，因为他们都有重要的论点。不使用药物治疗的论点是，当人们开始使用药物治疗，他们通常会接受当代精神病学的价值观。就会通过两种途径思考——一种精神病理途径以及属灵的途径。属灵的途径就是“主日的属灵供应如何影响我们”。精神病理途径就是“精神病理影响我们的情感，决定了我们的行为”。人们就会一直问：“我今天感觉如何？”如果他们感觉不舒服，而药物可以帮助缓解，那么他们就会把信心建立在药物之上。从这个意义上说，反药物治疗的观点表达了一个非常重要的观念。我们不能把我们的希望放在精神药物上，而应该放在基督里。

另一方面，牧师们应该了解精神药物。我们应该聆听那些精神药物所想要解决的问题。当我们聆听时，我们就能发现属灵层面和精神层面混乱造成的困扰了。

我们知道，那些使用精神药物的人正承受着痛苦。既然如此，我们必须帮助他们，因为圣经告诉我们务要每天彼此鼓励。这方面是毋庸置疑的。

这情形很复杂，但是我至少希望表达这两种观点的共同点。那些支持药物治疗的人认为在某种程度上帮助缓解病人的痛苦是必须的。如此说来，我们非常同意。

EW：我的回答分三部分。首先，我需要澄清思想和身体之间的关系。你应该已经听说许多关于化学失衡的讨论。事实上，基于当代精神病学，没有任何生理原因来支持这个观点。精神病专家希望按照传统药物治疗疾病的方式治疗这个病症，但是目前而言，并没有所谓的基因或化学失衡。这就是事实。

但是，这并不能解决我们关于药物治疗的所有疑问，不能因此简单得出一个结论说“不能用药”。我猜想，或许再过个100年，精神病专家们能够发现精神分裂患者和正常人之间化学性的不同。他们会发现他们的大脑不一样，甚至也会发现基因组合不一样。目前，他们不能断言诸如精神分裂症是简单的基因或精神现象。问题是多元的。当然，对于这个无与伦比复杂的大脑，总会不断出现更加有智慧的认知，有能力区分精神分裂症和正常的大脑。我很期待精神科专家的研究可以不断进步。

我的期待是基于合乎圣经的视角，因为圣经告诉我们人是有灵的活人。灵魂和肉体有独特的功用。当肉体刚强或软弱时，灵魂应当带来相应的忠心——属灵的忠心。灵魂和身体合在一起成为一个完整的人，但是他们是可以被区分开的。从圣经而言，我们因此可以期待，特定的刚强或软弱背后是有一定的生物化学机理存在的。

这就带来问题了，我们如何合神心意地回应此事呢？

其次，我们需要思考哪些是药物治疗可以做的事，哪些不是。药物治疗的工作领域是有限的。它不能改变我们的属灵状况。它不能帮助我们更爱上帝。它不能帮助我们减少罪性。充其量，它能够帮助我们缓解困扰我们的身体上的软弱。人心中的属灵状况依旧是我们生命中最重要的因素，所以，这也是牧师需要关注的。现在牧师们需要对我们所经历的刚强和软弱非常地敏感，并且对精神上的软弱特别地关怀。但是这些软弱并不构成我们的罪，上帝就是这么造了我们，这是生命的一部分。

我们对抑郁症了解多少？抑郁症对人而言至少是一种痛苦，这种痛苦常常可以用过药物来缓解。痛苦被缓解是件好事情。但是我们都知道，我们需要更加深入地学习，就是当我们在痛苦之中时，如何转向基督。

药物治疗确实存在危险，但是危险并不是精神科的范畴，而是源于人的天性。人们对不同事情产生兴趣，随之选择相信。问题就来了，我们如何迅速地彼此勉励，让身处困境的肢体转向上帝的恩典和怜悯。当我们思考抑郁症时，这才是从牧者的角度需要考虑的最重要的问题。

第三，我们需要思考药物治疗和罪之间的关系。一本关于百忧解（抗抑郁症药品）的畅销书提供了这么一个例证。一位男士因为轻度抑郁去找医生，同时表示他看色情图片。患者本人和医生都不会认为看色情图片是个问题，虽然他们都知悉此事。因为这位男士抑郁了，医生就开了百忧解给他。一个月后，这位男士回来复诊，检查完毕后，他告诉医生，他已经对色情图片失去兴趣了。呃，挺好啊。为啥要和色情图片作斗争呢？我们只需要吃点儿百忧解就好了。

在这个案例中，百忧解只是用另一个方式满足了这位先生的偶像。偶像就是：“我要有存在感。我希望有所感知，并且会尽我所能达成这个目标。”最终，他发现百忧解能够帮他达成这个目标，于是色情图片就不再占据他生活的中心地位。但是我们也知道，百忧解会走上色情图片的老路，他尝试，但这方法不久将失效，于是他会另寻新欢。所以从某种程度上看，药物治疗让人不去犯罪，但是我认为有其他更加合乎圣经的方法能够处理、解释所发生的事。

EW：一些神学院会这样教学生：“这些是你们的分内事儿，这些是你们应该交给别人做的。”而那些应该交给别人的事情包括了医药方面的和精神科方面的。精神方面的包括了生活中的焦虑、变化、麻烦以及困难的人际关系。那么还有什么是剩下给牧师的？只剩下犯罪、淫乱和谋杀了。

或许思考这些问题更好的方式应该这么说，当你以牧者的身份与人接触的时候，你知道你会发现挣扎；这些挣扎关于罪也关于病痛，常常是两者的混合。

当人们被抛在旷野，他们会想知道神在哪里。如果我们能知道和了解到那些旷野中人的情况，这就是他们需要从神子民而来的鼓励。他们需要重新定睛在基督身上，因为基督与痛苦中的人们同在。你会接近所有人，绝对是所有人，因为罪与痛苦围绕着所有人。

那么用药问题怎么办？你认识了一个癌症患者。他身处痛苦之中，而我们都知道我们应该说一些鼓励的话，让患者在病痛之中定睛基督。

精神问题是最难的。无论他们是精神问题还是属灵的问题，这没有区别。这都会涉及罪和病痛。我们亲近他们，去做我们向其他会众做过的一样的事，帮助他们转向基督，走有意义的路。我想圣经给了神学生和牧师一个简单的回答。有人在痛苦之中，有人深陷罪中，无论你面对的是哪一种，你都被呼召亲近他们。

EW：我已经写了一套材料，专门针对那些上瘾人群的，名字叫“十字路口”（Cross Roads）。在箴言中描述了这么一个画面，智慧走向了死荫幽谷。我们会在一个非常糟糕、非常困难的境遇。我希望能够写一套教材，让人们很快地找到经文，被经文吸引，并且能够让正在与上瘾斗争的人们被经文影响，这些人可以是生活在争战之中，甚至不一定是基督徒。在我们的文化中有这么一个好处，我不予评价，那就是大家把上瘾看作是属灵问题。属灵这个词被人们刻意地用许多方式赋予不同解释，但是至少意味着他们期待你谈论上帝。

我可以预见到这份材料能够向有信仰宣告的人说话，也可以向那些没有声称有信仰的人说话。他们只需要愿意听就够了。同时针对那些愿意陪伴的人，也有一份指南。

目标就是，表达清晰、便于适用、内容信服、文字漂亮、带出盼望并且让福音在其中发挥动力。

Ed Welch: As you look into the Bible on the subject of fear, the discussions are rich. There are dozens and dozens of books someone could write because it’s such beautiful material to access. That is ultimately, I think, the thing that gripped me with the material. One passage led to another to another to another, and I began to realize that God perseveres in speaking beautifully to people who struggle with fear. He speaks often to them.

EW: I think that pastors should give attention to the Word and to the people in their congregation. As they study people in their congregation, they are going to find that people are filled with fear about what other people will think of them, about financial loss, and about multiple other things. Now, there are many places in Scripture that speak to these issues. And I hope that pastors will speak to people in their congregations who wrestle with fear.

EW: There does seem to be a gender difference in the way people think about fear. Most women can immediately connect it to their own lives, their children, fears of aloneness, and so on. Women just seem to have that immediate response to it. It makes sense. It captures them.

On the other hand, it takes more work for men to reckon with the issue of fear. There are a number of different reasons for that. One is, “Fear is for wimps” or “It’s a womanly kind of thing.” Let me speak personally. I want my wife to think I’m a strong man who has everything under control. When there’s a crisis I want to look really strong; like someone she can rely on. To talk about fear goes against the grain of most male thoughts. But fear is a universal phenomenon. We know from reading the first couple pages of Scripture that women don’t have the corner of the market on fear.

Where is it with men? It’s everywhere. Fear plays a role in the main male problems. For instance, anger is a common problem among men. What is anger? It’s the possibility that you could lose something. Something precious to you is in jeopardy, and there’s an aggressive response rather than fear response. But it’s the same thing: “Something that I love is in danger. What am I going to do about that?”

Look at men’s favorite compulsive and sinful behaviors. You have drugs and sex. Now, talk to most men and you’ll find people who are afraid they’re going to be found out. They are afraid they’re going to be left alone. They’re afraid they’re not going to be loved. I would suggest you can find fears wrapped around the majority of male sins. We can find fears and anxieties everywhere, but they do seem to have a particular gender expression.

EW: One of the enjoyable issues for us to consider biblically in this generation is the whole area of modern psychiatry and medications. There’s the delightful opportunity to see how the Scriptures speak to all the issues of life, even issues that weren’t anticipated by the biblical writers.

How do we bring the Scripture to bear? Let’s take the issue of medications. Are psychiatric medications sinful? Are they wise? Are they wrong? How should we view such things, especially when the Scripture doesn’t seem to speak about psychiatric medications in any particular chapter and verse? I think it’s an exegetical stretch to say that Scripture speaks against modern medication and that we cannot use it—period. Modern medication is trying to assuage some forms of suffering, and we certainly don’t oppose assuaging suffering. Rather, the Scriptures leave us in the category of wisdom—rooted in the fear of the Lord. Sometimes we might choose one thing, and sometimes we might choose another.

How do we make those kinds of decisions? You may say that there are two poles of thinking here. One pole says that medication is essential and that every pastor should be aware of psychiatric medications. The other is that medications are wrong and that they contaminate sanctification in the Christian church.

Both poles exist because they have important points to make. The important point on the no-medication side is that, when people take medication, they usually imbibe the worldview of modern psychiatry along with it. They begin to think in two tracks—a psychiatric track and a spiritual track. The spiritual track is the “stuff they get on Sunday.” The psychiatric track is “that’s where the action is because the psychiatric track owns our emotions.” People live their lives asking, “How do I feel today?” If they feel wretched and medication is able to help, then that’s where they will put their trust. The challenge for people taking medication is to think biblically and to not put their hope in medication. In that sense, the no-medication perspective is saying something very important. It is saying that we shouldn’t put our hope in psychiatric medication, but in Christ.

On the other hand, pastors really must know about psychiatric medications. We should listen to the problems that psychiatric medications are trying to address. When we do, we inevitably find a hybrid of spiritual and physical struggles.

We know that people taking psychiatric medications are suffering. If they are suffering, we must move towards them because Scripture says it’s imperative for us to encourage one another daily. There is no question about these things.

It is a complicated phenomenon, but I at least want to establish that both poles inevitably have a point. Those who speak for psychiatric medication have seen it alleviate (or at least lower the pitch) of certain kinds of sufferings in a person’s life. In that sense, we are very much for it.

EW: I’ll answer in three parts. First, we need to consider the relationship between mind and body. You hear all kinds of discussions about chemical imbalances. The reality is that no diagnosis in modern psychiatry has a known physiological cause behind it. Psychiatry wants its diagnoses to be treated as traditional medical diseases, but at this point there is no known gene or chemical imbalance. That’s just the way it is.

But that doesn’t answer all our questions about medications, as if to say we shouldn’t use them. I suspect that in another 100 years psychiatry will find that there are chemical differences between schizophrenics and non-schizophrenics. They will find brain differences, and they will probably find genetic differences. Now, they will not find that that something like schizophrenia is purely a genetic or a physiological phenomenon. It’s a combination of things. But certainly there will be a more sophisticated understanding of the incredibly complex organ of the brain, and they will be able to distinguish between a schizophrenic and a non-schizophrenic brain. I’m anticipating that that’s the way psychiatric research will go.

I anticipate these developments from a biblical perspective because we understand from the Bible that people are embodied souls. Both soul and body have a particular contribution. The body brings particular strengths and weaknesses, while the soul brings particular allegiances—spiritual allegiances. Soul and body work together to create a whole person, but they can be distinguished. Biblically, therefore, we can anticipate that there is some sort of biochemical substrate behind an individuals’ particular strength or weakness.

Now this raises the question, how do we respond to all this in a godly way?

Second, we need to consider the question of what medications can do and cannot do. Medication has a certain limited field of work. It can never change our spiritual allegiances. It can’t make us love the Lord more. It can’t make us sin less. At best, it can alleviate some physical weaknesses that are especially bothersome. The spiritual allegiances of the human heart continue to be the most important issue in all of life, and it so happens that this is what pastors focus on. Now, pastors want to bring sensitivity to the strengths and weaknesses we all experience and to show compassion to psychiatric weaknesses in particular. But these weaknesses cannot make us sin, which is one of the really fine features of the way God has composed us.

What do we know about depression? Depression is at least a form of suffering, and medication in some people seems to alleviate the suffering. When it does, that’s a good thing. But we also know that there’s something deeper that all of us need to learn, which is learning to turn to Christ quickly in the midst of suffering.

There lies one of the dangers of medication, and the danger doesn’t arise out of psychiatry but out of the nature of the human heart. People latch onto different things to trust in. So the question is, how can we more quickly encourage one another to call out to the Lord for mercy and grace in the midst of trouble. That is what’s most important when we think about depression from a pastoral perspective.

Third, we need to consider the relationship between medication and sin. Here’s an illustration from a popular book on the medication Prozac. A man went to a physician for mild depression and also mentioned that he was involved in pornography. Neither the person nor the physician considered pornography to be a problem, but they both noted it. Since the man was depressed, the physician gave him Prozac. The guy came back in a month and, among other things, reported that was he wasn’t interested in pornography anymore. Well, that’s great, we say. Why battle pornography? We can just take a little Prozac.

Well, in that case, the Prozac was just another way of feeding this guy’s idol. The idol was, “I don’t want to feel lifeless. I want to feel a certain way, and I’m going to do everything I can to deal with that.” Finally, he found that Prozac could make him feel that way, so pornography no longer occupied the same central place. But we also know that Prozac will eventually follow the path of pornography, where he’ll try it, it won’t work, and he will move on to something else. So here’s a place where it looks like medication is helping someone to not sin. But I think there are other ways to interpret what has happened biblically.

EW: Some seminaries communicate to the students, “Here are the things that are yours, and here are the things you have to refer to other people.” The things that belong to other people include all things medical and all things psychiatric. And the psychiatric includes the angst of life, the challenges of life, the troubles of life, and the relational difficulties of life. What’s left for pastors? Guilt, adultery, and murder are what’s left.

Perhaps a better way to consider all this would be to say, as you move pastorally towards people, know that you will find struggles; and struggles will be about sin and about suffering—a combination of the two.

When people are out in the wilderness, they wonder where God is. If there’s anything we know from people out in the wilderness, it is that they need the encouragement of God’s people. They need to be able to fix their eyes on Christ who is with them in the midst of their suffering. You move toward everybody—absolutely everyone—because sin and suffering encompass all of this.

What about medical problems? You move towards someone who has cancer. It’s a form of suffering, and we all know that we want to speak words of encouragement and point them to Christ in the midst of their suffering.

Psychiatric problems are the murky middle. Whether they are physiological or spiritual does not matter. It will involve both sin and suffering. We move toward them and we do the same thing we do with everybody else in our congregation by helping them to turn to Christ in a true and meaningful way. I think the Scripture has a simpler answer for seminary students and pastors. Someone is hurting over there. Somebody’s stuck in sin. We are called to move toward them.

EW: I’ve written a curriculum for people struggling with an addiction that is entitled Cross Roads. There is a picture in Proverbs where wisdom goes into the urine-drenched alleys. It goes out into the bad places and the hard places. My desire was to write a curriculum that made Scripture quickly accessible, inviting, and persuasive for people who struggle with addiction, live in the trenches, and might not even be Christians. The nice thing about addiction in our culture is that, for better or for worse, people talk about addictions as a spiritual problem. The word spiritual can be defined by people in very different ways, but at least it means that they expect you to talk about God.

I foresee the curriculum as being able to speak to people who have a profession of faith and people who don’t have a profession of faith. They just have to be willing to hear; that’s all. There is also a guide for the people who walk along with that person.

The goal is that it would be clear, accessible, persuasive, beautiful, hopeful, and that the gospel would be vibrant in the middle of it all.