BCC Staff Note: In addition to this robust post, Colin has also provided the BCC with an even more robust PDF resource that you can download at A Guide to Counseling the Chronically Ill.
“If you live long enough, you will suffer.” I remember hearing D.A. Carson open his talk entitled “A Pastoral Theology of Suffering and Evil” with this declaration. His comment stuck with me and caused me to think a lot about suffering in the months that followed. Hearing and thinking about this was a good thing, because in the case of my wife and me, we didn’t need to live much longer before our suffering began.
In January 2011, my wife, Marianne, began to experience chronic fatigue. Before long the fatigue was accompanied by chronic itching all over her body. As the weeks progressed, the fatigue remained, but the itching turned into chronic skin pain. Soon she began to feel pain in her upper abdomen around her liver, which radiated throughout the right side of her abdomen, shoulder, and side. As months went by, numerous other symptoms also presented. I watched my wife, who had been a perfectly healthy woman in her late 20s, become confined to bed and continue to worsen until she became jaundiced and passed out from pain around her liver. Something was obviously very wrong.
Throughout this process we had made numerous trips to urgent care and the emergency room with no help, no diagnosis, and no treatment from the physicians we saw. We were told that there was nothing to be done until we could meet with a Gastroenterologist, a specialist who would hopefully have more answers. After waiting for over two months, we met with a specialist who was able to give an initial diagnosis of auto-immune hepatitis and auto-immune cholangitis.
These two diseases are auto-immune diseases, meaning they result from the body’s own immune system overfunctioning and attacking the body in a way that makes it sick. In the case of my wife, her immune system attacks her liver. She has been treated with numerous drugs, including the steroid Prednisone, a drug that has kept her body from destroying her liver, but also has caused serious side effects in the process, some that are more challenging than the symptoms of the disease itself. Now at the two year mark, we are still waiting and hoping to see her disease enter remission. While the disease could enter remission, my wife will not be cured and will live the rest of her life suffering from chronic illness.
Looking for Biblical Counseling Resources
Once Marianne was diagnosed with her two illnesses, I began to look for resources by biblical counselors that could help us think through our struggle theologically, practically, and emotionally. Unfortunately, I found next to nothing specifically addressing chronic illness. I found extremely helpful resources on suffering in general, disability, grief/bereavement, and chronic pain. However, I could not find any resources by biblical counselors that addressed chronic illness.
Thankfully Marianne and I both hold Master’s Degrees in Divinity from Western Seminary, so we relied heavily on our theological training to make sense of our experience of suffering. We also relied heavily on communion with God and our church for help during this season. I kept feeling troubled though by the lack of resources available. I wondered what resources biblical counselors, pastors, and the chronically ill were using as resources to deal with the suffering that comes with chronic illness.
Take a minute to ask yourself these questions:
- How is the Gospel good news for us as we cope with chronic illness?
- If we were to turn to you for counseling as we struggle with chronic illness, with what unique challenges do you think we would need your help?
- What resources would you turn to for help in order to counsel us well?
- How many individuals in your church currently suffer from a chronic illness?
- How well are you counseling these individuals in their struggle with illness?
- Are you asking God to give you more opportunities to evangelize and edify individuals with chronic illness?
Each pastor, counselor, and Christian needs to wrestle with these questions because God cares deeply about individuals suffering from chronic illness. God’s care and compassion for the sick is made plain throughout the Bible. One example of this is the multitude of stories we find in the Gospels that show Jesus healing the sick. I completely affirm that the primary point of these stories, and the point of each Gospel, is to show that Jesus is God by demonstrating His authority and power. While affirming this, these narratives are meant to show us more than just this singular truth. The healing narratives are also meant to show us the love and compassion Jesus has for the sick.
Consider Mark 1:41 where Jesus has pity on the man who was chronically ill. Consider Mark 3:1-6 and Luke 13:10-17 where we read that Jesus is angered at the hard heartedness of the Pharisees because they care more about observing Sabbath law than healing the ill and disabled. Jesus has compassion for, and ministers to, the chronically ill. The question for us is do we also have compassion for, and minister to, the chronically ill?
If you honestly evaluate your current ministry, I anticipate many readers would answer “No.” If that is you, you are not alone. One cannot deny that the biblical counseling movement has made great progress recently in developing resources to help sufferers. However, chronic illness is one area that the biblical counseling movement still needs to address. It is not an abstract or impersonal need. Your church likely has members who suffer from chronic illness. Your community has individuals suffering from chronic illness who do not know Jesus and do not have the hope of God needed to combat the despair of a failing body. All Christians, but especially pastors and counselors, need to think hard about how to counsel individuals suffering from chronic illnesses. The biblical counseling movement needs to develop resources that help pastors and counselors care well for this population.
In response to seeing the need for resources in this area I have written a booklet entitled “A Guide to Counseling the Chronically Ill.” I do not write as an expert or as someone who has it all figured out. Rather, I write as someone in the middle of the struggle hoping to help pastors, counselors, and those struggling with chronic illness. This booklet is still a work in process, and I am sure I will continue to revise it as the years go by and I continue to learn and grow. My hope is to offer you this booklet as a resource to help you understand the experience of chronic illness and to give you some ideas about how to counsel individuals suffering from chronic illness. In the rest of this post, I provide a framework for counseling the chronically ill. This framework is a condensed version of my booklet.
3 Groups We Need to Care for in Our Ministry
As we consider how to counsel individuals affected by chronic illness, we need to recognize there are at least three different groups we need to care for in our ministry:
- Individuals with a chronic illness who are seeking counsel.
- Yourself, if you are the person who has a chronic illness.
- The spouse (and other family members) of the person with a chronic illness.
When we assess how to counsel the chronically ill, we must begin with God’s desire for all Christians. God’s will for the chronically ill in the most basic sense is no different from His will for all Christians. God desires that all people repent, believe, and obey, living lives of worship for the glory of God. As Christians do this, they put off the old self and put on the new self. This process is called sanctification and is taught throughout the Bible in texts such as Romans 6:12-13. Sanctification is God’s will for all Christians, whether healthy or chronically ill.
All Christians are also called to help one another pursue sanctification by obeying Ephesians 4:15-16, which teaches, “Rather, speaking the truth in love, we are to grow up in every way into him who is the head, into Christ, from whom the whole body, joined and held together by every joint with which it is equipped, when each part is working properly, makes the body grow so that it builds itself up in love.” All Christians are called to speak the truth in love to one another to the end of sanctification.
Paul shows us how to speak the truth in love in 1 Thessalonians 5:14. “And we urge you, brothers, admonish the idle, encourage the fainthearted, help the weak, be patient with them all.” We speak the truth in love by encouraging, helping, and admonishing/rebuking, and by doing all three of these with patience. While Paul’s teaching helps us better understand how we should speak the truth in love to anyone we counsel, we will encounter some unique obstacles that make counseling the chronically ill challenging.
Encountering Unique Obstacles
First, chronic illness can be intimidating. The illness a person suffers from may be intimidating because it is hard to understand. We also may be intimidated because the ill person is experiencing profound suffering that frankly makes us uncomfortable and seems beyond our ability to help.
Second, chronic illness can seem overwhelming. The ill person may have many needs that make it hard to know where to begin when counseling. Chronic illness may involve a multiplicity of physical, emotional, spiritual, relational and financial needs. The sense of overwhelm arising from the illness may be worsened when you realize the illness may never go away.
Third, if we are honest it is probably more challenging to counsel sufferers than sinners. It is harder for us to know how to share the gospel as good news to individuals suffering from chronic illness than to individuals struggling with sin issues.
Let me encourage you if you struggle with any of these challenges. If you dedicate yourself to a few commitments you can overcome these obstacles and be well on your way to significantly helping the chronically ill.
First, listen. Commit yourself to being a good listener and student of the ill person. You may not know much about chronic illness or what struggles the chronically ill experience. However, if you keep asking questions, listen well, and work to understand their illness and the experience of the illness, this will not be a problem for long. When you are struggling to understand, tell the ill person, and keep asking questions.
Second, be present. Often one of the biggest pains in the life of a chronically ill person is isolation. Commit to spending time with the person regularly, and go to them if they have physical struggles getting out of the house. The gift of your presence is a blessing to someone struggling with isolation. Realistically, being consistently present may be challenging for the busy pastor or counselor, which leads us to the third task.
Third, commit to a group, not individual, approach to counseling and caring for the ill person. Enlisting the community group of the ill person as well as other counselors in training is essential. As Paul Tripp says, “Your walk with God is a community project.” Sometimes it can seem difficult to make counseling situations a community effort, especially in sinful situations like adultery. In these cases informing more people about the sin and involving them in the counseling sessions may be very unwise. However, caring well for the chronically ill likely requires taking the opposite approach. A community of individuals is essential, not harmful. One pastor or counselor cannot by him/herself combat the isolation a person with chronic illness will face.
As a general rule, the more individuals who know about, understand, and can counsel the ill person, the better. This rule has its limits, but enlisting a group of individuals to care for and counsel the ill person is the way to go. This also means that counseling situations involving the chronically ill have the potential to be ideal situations for training counselors. Keep in mind, involving a larger number of people will not be a good idea for every chronically ill person, especially if they are a private person.
Fourth, commit to the ongoing work of learning and becoming a better counselor to individuals suffering from chronic illness. This commitment is important for numerous reasons. People with different chronic illnesses will have very different struggles and levels of disability from their disease. The counseling you give to someone with Rheumatoid Arthritis may be completely different from the counseling needed by someone with Multiple Sclerosis (MS). Additionally, as stated earlier, counseling someone with a chronic illness may look very different from counseling someone with a sin issue. Brad Hambrick’s videos from the Summit Counseling Training (Session 3 and Session 4), which focus on counseling in sin and suffering respectively, as well as his paper titled “Gospel Driven Counseling for Suffering,” are helpful with this issue. These resources can be found at www.bradhambrick.com.
These four commitments will both help you to overcome any struggles you face with counseling the chronically ill, as well as equip you to counsel by speaking the truth in love through encouraging, helping, and admonishing/rebuking them and by doing so with patience.
While I cannot go into as much detail as the booklet contains, I will explore a few important points discussed in each section related to encouraging, helping, and admonishing/rebuking.
Section 1: How May Someone with Chronic Illness Need to Be Encouraged
- Remind them of what they already know is true. Speaking these truths to the person is powerful, comforting, and encouraging. Paul and the other apostles made a common practice of writing to remind the churches of things they already knew because they understood the power in encouraging one another with the truth (see Romans 15:14, 1 Corinthians 4:17, 15:1; 2 Timothy 1:6, 2 Timothy 2:14, Titus 3:1, 2 Peter 1:2, 1:13, 3:1-2, Jude 5). We should do likewise. An example would be reminding the ill person that God loves them and is for them, even as they struggle with illness.
- Remind the suffering ill person of what is real and what is not. The ill person needs to remember that future hypothetical possibilities are not reality. Often a person with chronic illness can experience great sadness, anxiety, anger, etc. over future life complications resulting from illness. While these complications may occur in the future, it is important to remind the ill person to focus on what is real right now in life.
- Encourage the sufferer by acknowledging that God may have given them more than they can handle. This statement may be a controversial point to some. The booklet explains this point at length (point 16 of section 1), and I encourage you to read the entire point for a clear explanation. For now, let me just say that I affirm that 1 Cor. 10:13 teaches no Christian can be tempted to sin beyond what he or she can bear, but that 2 Cor. 1:8-10 teaches Christians may face more suffering than they can handle. This may be comforting and relieving for the ill person to hear. If ill people think that God does not give them more than they can handle, but feels unable to handle their suffering, they may feel that they are a failure, not good enough, or like something is wrong with them. Freeing the ill person from the idea that God does not give more than someone can handle can relieve a significant burden and cause of shame.
- Encourage the sufferer to not be consumed with the “what if’s” and look to Jesus. Often chronic illness can lead a person to be consumed by “what if” questions like, “What if I need an organ transplant?”, “What if I can’t afford my medicine?”, “What if I cannot have children?”, etc. Hebrews 12 encourages the person with chronic illness to look to Jesus and lay aside these weights which cling so closely.
Section 2: How May Someone with Chronic Illness Need to Be Rebuked?
- Rebuke the person if they are dealing with a sinful anger toward God. Anger with God may flow from an entitlement mentality. The ill person may believe he or she deserves better in life. Anger with God may also flow from a desire not to suffer. The ill person may become angry with God because he or she wants a comfortable, fun, suffering-free life.
- Rebuke the person if they have become sinfully fearful. A person may become fearful of dying, losing financial stability, becoming physically dependent on others, or any number of other results of the illness.
- Rebuke the person if they have turned to sin for comfort. The ill person may seek comfort in any number of things. Comfort may be sought in things that are explicitly sinful, like pornography. Comfort may also be sought in things that are morally neutral but are sinfully used as a person seeks comfort in created things instead of God. An example would be becoming gluttonous with food or abusing prescription drugs used to treat pain.
Section 3: How May Someone with Chronic Illness Need to Be Helped?
- Help the person with financial difficulties. A person who develops a chronic illness may not be able to work, incur hundreds of dollars in prescription drug costs, and have other costs related to their illness that he or she cannot afford.
- Help the person with childcare: Sick individuals may need help watching their children if they suffer from fatigue, have to go to doctors’ appointments, or have side effects from their condition or the drugs they take.
- Help them by telling them they aren’t crazy. The ill person may feel crazy either from the disease or the drugs he or she is taking. People with a chronic illness may become extremely emotional due to the drugs they take, especially steroids, extreme fatigue, insomnia or several other factors. Telling the person that he or she is not crazy for being emotional is help that is regularly needed.
- Help the person deal with feeling isolated. Often people with chronic illness feel isolated. This feeling may be because they are actually physically isolated by their disease and unable to leave their home to engage with the world the way they used to do. This feeling also may be because while they are physically able to be out in the world, they feel few people really understand their illness or the experience of their illness. Help them by seeking to understand their illness and their experience of the illness and by physically being present with them regularly.
Join the Conversation
How could you apply these principles to your counseling ministry in helping those struggling with chronic illness?
If you are struggling with a chronic illness, what additional counsel would you give pastors, counselors, and friends regarding how they could minister to you?