Biblical Counseling and Post Traumatic Stress Disorder (PTSD)
What is PTSD?
“Traumatized people have alterations in their brains,” so says Christian counselor H. Norman Wright. He contends that the neurological evidence is best summed up with, “Trauma can create PTSD. This is not just an emotional response to troubling events; it’s the expression of a persistent deregulation of body and brain chemistry. And brain chemistry can be altered for decades. With this change arousing events can trigger flashbacks. Trauma creates chaos in our brain. Trauma causes an emotional as well as a cognitive concussion.” On his website he does an excellent job of describing this traumatic process and appropriate treatments (Trauma and the Brain, Suggested Steps in Helping Those in Trauma).
Is PTSD Consistent with Biblical Doctrine?
Is this description of trauma’s negative impact on the brain biblically viable? Well, theologically it seems fitting to admit that Wright’s description is very probable because we live in a fallen world that is deformed in sin, which means that ectopias (that is abnormalities in the brain) most likely could and do develop (2 Corinthians 4:16). While many evangelical Christians do not endorse wholesale evolution, there is little doubt in Scripture that devolution is happening, that humankind—both in soul and body— has fallen and continues to move further and further away from the glory of God that we were intended to fulfill (Romans 8:18-23). Biblically, Philippians 3:21 calls our earthly bodies a “lowly body” (Greek: the body of our humiliation), which certainly highlights the fragility of our bodies. Therefore, it seems reasonable to conclude that “brain weaknesses do influence the person” as Dr. Edward T. Welch observed (M.Div. degree at Biblical Theological Seminary, Ph.D. counseling psychology with an emphasis on neuropsychology from the University of Utah).
How Do We Biblically Help People with PTSD?
What does the Bible guide us into doing for people who’s brain suffers from Post Traumatic Stress Disorder (please see my blog article on this topic for more information; A Biblical Counseling View of Posttraumatic Stress Disorder (PTSD) and Posttraumatic Growth Development (PTGD) as it is presented in the Life of the Apostle Paul)? Perhaps, Philippians 3:6a can serve as a starting point to construct a treatment approach to PTSD that is conducive to the biblical record and is empirically provable. Paul writes that he was “a persecutor of the church.” New Testament exegete Ralph P. Martin writes, “Paul seems never to have been able to forget his persecuting activity, based on that misdirected zeal for God (Acts 22:2, Romans 10:2) and His cause, of which he speaks here. The memory of it continually haunts him; so much so that he uses the present participle of the verb, diokon, persecuting, as if the action were before his eyes at the time of writing.” (emphasis added) Here Paul vividly—like experiencing a flashback or an extremely active imagination—possibly relives that dreadful day of the stoning of Stephen (Acts 7:54-8:3), which would have been the inglorious capstone of all his persecuting activity. Paul was a supportive witness of the ghastly and cruel execution of a beautiful deacon of the Lord’s. Such memories must have been hard indeed to live with, even after he was saved by Christ the Lord (1 Timothy 1:13). Thus, this autobiographical account by Paul leads me to ask: 1) How does current neurological research help us to understand such vividly haunting memories?, 2) What did the Apostle Paul do about his reoccurring disturbing memories?, and 3) How would this Pauline approach assist someone enduring PTSD today? We will discuss them in the order presented:
A) How does current neurological research help us to understand such vividly haunting memories today?
Wright says that “Trauma freezes thinking.” He describes it this way, “The Amygdala is a small, almond shaped portion of the brain. It’s the emotional part. It’s the alarm portion of the brain. It becomes highly active during and while remembering a traumatic incident. It controls our behavior. When you’ve been in trauma it’s hypersensitive and overreacts to normal stimuli . . . Another part of the brain (hippocampus) is analytical and calms down the emotional part of the brain: It analyzes things and puts things in perspective.” Meanwhile, “The hippocampus is reduced in size”, which means your memory is affected and your “frontal cortex ability is decreased” and this limits your capacity to analyze events and to put into words how you feel. Therefore, it is apparent that biblically derived theological reasoning (Romans 12:1-2) surely will help the traumatized Christian endure, work through, and overcome as is witnessed in the life of the Apostle Paul and his example is intended to help us all (Philippians 3:17, 4;9). Such Scriptural theo-logic will stir the brain to better analyze personal traumas and put them into a perspective that brings hope because “we know that for those who love God all things work together for good, for those who are called according to his purpose.”
B) What did the Apostle Paul do about his reoccurring disturbing memories?
Saint Paul trained himself (Philippians 4:12-13) to say, “Brothers, I do not consider that I have made it my own. But one thing I do: forgetting what lies behind and straining forward to what lies ahead, I press on toward the goal for the prize of the upward call of God in Christ Jesus (Philippians 3:13-14).” (emphasis added) And he gives us a brilliant example of such eschatological thinking when he concludes chapter 3 of Philippians with, “But our citizenship is in heaven, and from it we await a Savior, the Lord Jesus Christ, who will transform our lowly body to be like his glorious body, by the power that enables him even to subject all things to himself.” Notice how this statement is Christ-centered (Savior, Lord, his glorious body) and emphasizes the sovereignty of God in Christ (to subject all things to himself). Meditating on the sovereign Lord Jesus Christ who controls today, yesterday and forever is always illuminating, healing, and exhilarating to the Christian’s soul.
C) How would this Pauline approach assist someone enduring PTSD today?
As a biblical counselor, I have observed that the above is true and it is practical and productive for the traumatized Christian to hear and apply. However, there is one aspect of people’s pain that is often overlooked, even by competent pastoral counselors. Again, Wright’s explanations are indispensable descriptors for the biblical counselor as he writes, “The right section (right hemisphere of the brain), the alarm section, reacts too much . . . It’s like an alarm system of a car that keeps going off and staying on when there’s no danger. And the owner with the key isn’t around to turn it off. With a brain scan there is a lot of lighting up on the right side and very little on the left.” How do you help a Christian suffering from the incessant car alarm in the brain to actually turn it off? Well, using Wright’s words the Owner really is around—He is the Holy Spirit who is able to shut off the alarm (1 Corinthians 3:16). It is here where Reformed theology provides the answer in the doctrine of the illumination of Scripture, which is the inward illumination of the Spirit of God within the Christian believer. The Holy Spirit working by and with the Word in our hearts, which He Authored, turns off the internal alarm (Hebrews 4:12). Not the Holy Spirit apart from the Word; nor the Word without the Spirit; but the Spirit and the Word touching the deepest corridors of the Christian’s heart for we rest on this assurance that the Holy Spirit speaking in the Scripture (emphasis added) communicates to God’s people as the Westminster Confession of Faith teaches.
How Does the Holy Spirit Turn Off the Emergency Alarm?
Of course, the sovereign Spirit of God is free to work as He wills in this matter (John 3:8); nevertheless, in my exposition of the Scripture, the Holy Spirit often works through Scriptural Journaling. All one has to do is read the life of Paul to figure this one out. Paul is the pre-eminent Epistle writer of Scripture and of history. He not only wrote the most letters to be included in the New Testament but his book of Romans is one of the longest letters that has survived from antiquity. When he writes in 2 Corinthians about his overwhelming struggles he includes much emotional language (2 Corinthians 6:11) all the while incorporating the Old Testament Scriptures in his thinking (2 Corinthians 6:16-18). He overcomes His suffering by overwhelming them with his focus on the promises that find their yes in Jesus Christ the Lord (2 Corinthians 1:20). This is a positive and productive model for all those battling PTSD to emulate today. Such an approach is not unique to Paul because the Old Testament contains the Book of Psalms, which are essentially 150 prayer journal entries that bring forth hope and healing as Psalm 23 so famously bears witness to the power of the Psalter to assist the suffering. Furthermore, in the history of the Christian church such an approach was picked up by Augustine who wrote his Confessions and the Puritans whose pastoral counseling techniques relied heavily on providential journaling (see John Flavel’s Mystery of Providence). In order to underscore this important point about Scriptural Journaling, I will quote in length Dr. Donald S. Whitney’s article The Gospel & Journaling from the TableTalk magazine:
Keeping a spiritual journal has been a widespread practice among God’s people for millennia. As long a people have been able to write, it has been common for them to write about what is most important to them. Thus, the people of God have recorded their thoughts about the things of God, and they have done so in something akin to what is today referred to as journaling. King David poured out his soul to God in the scrolls of the Psalms. The prophet Jeremiah expressed the depth of his grief about the fall ofJerusalemin his Lamentations . . . Jonathan Edwards found the practice so useful for sharpening his thinking and deepening his devotion that he kept several different kinds of journals and notebooks.
As Whitney goes on to conclude, “Christians have been irrepressible chroniclers of their spiritual lives.” The bolstering usefulness of Scriptural Journaling is urgently needed today.
What is Scriptural Journaling?
Proper Scriptural Journaling contains at least the following components: 1) Writing about what is providentially happening to you (2 Corinthians 1:8-11, 4:7-12, 6:4-10, 11:23-33), 2) being transparent about your emotions and questions before the Lord (2 Corinthians 6:11), 3) incorporating Scripture, especially the promises of God, in your writings (2 Corinthians 1:19-22), 4) practicing Scriptural Journaling on a consistent basis (2 Corinthians 13:10), and 5) meditating on how the sovereignty of God is revealed in your particular set of circumstances (2 Corinthians 1:8-10, 12:8-10). As this is faithfully done, in my experience with those suffering from PTSD, the emergency alarm within the brain finally gets shut off— because the Holy Spirit gives the Christian’s mind as he or she mediates on the promises of God a confidence in God’s sovereign rule in Christ that seems to inform the physical brain “all is well with my soul.” As Dr. Welch once observed, “It is as if the heart always leaves its footprints on the brain.” I advise those I counsel to ask and answer these three questions:
- What is God developing in me because of my suffering?
- Where is God deploying me to minister to others because of my suffering?
- What is God delivering me from due to my suffering?
When such questions begin to be answered and recorded in written form by the sufferer that is holding a Christ-centered, Bible-based perspective—true healing emerges. Once Christians get a sense of God’s sovereign plan—even in the midst of their trauma—it turns off the emergency alarm within (interestingly, the internal physical alarm God created within us is turned on by the dangers we confront in the natural world as an effort to provide us protection whereas the power to turn it off-once it is firmly engaged by horrific events—is often a supernatural power provided by the Holy Spirit, which includes the peace that goes beyond our understanding).
More PTSD theological information is listed on this blog: A Biblical Counseling View of Posttraumatic Stress Disorder (PTSD) and Posttraumatic Growth Development (PTGD) as it is presented in the Life of the Apostle Paul; What Do We Do with the Disturbing Memories of September 11, 2001?: A Biblical Counselor Responds to the Question on Many Minds; Post Traumatic Stress Disorder & Paul’s Life: Finding Strength in Christ Alone; Serving Victims of Terrorism with a Gospel-centered Theodicy.