Bob Smith


Of great importance in dealing with illness is one’s view of life and death. The Bible teaches that man is made up of a material, or physical part, and a non-material or spiritual part. The physical side provides senses of touching, tasting, seeing, hearing and smelling, by which the body evaluates itself and the environment around it.

The spiritual side of man may be thought of as having one or two components, depending on one’s basic view of man. Trichotomists think of these elements as part of the soul: (1) the mind, which is the source of thinking, reasoning, and remembering; (2) the will, with which choices and decisions are made; and (3) the emotions, which are the feelings and affections of the human being. The spirit is conceived of as the source of life. In the spirit is found the conscience, that part of us that knows right from wrong, God consciousness and the capacity to worship. On the other hand, dichotomists think that the spirit and the soul are non-material area of the human being. They often hold that the word “spirit” is used when thinking of the soul apart from the body, and the word “soul” is used when thinking of the spirit in relationship to the body. The exact description of the spirit and the soul, and a decision for trichotomy or dichotomy is not essential to this discussion.

The importance of the existence of the non-material part must be stressed. There is a definite vital relationship between our non-physical and physical being. For example, when we are physically ill, we may be sad. The physical illness may result in a change in the non-physical. By contrast and in the other direction, if someone slips up behind you unnoticed and startles you, the result will be a sudden increase in your heart rate. The non-material part of you has been stimulated and through your emotions a physical change has occurred. Or if I show you a thick juicy steak at 6:30 p.m., your salivary glands will begin to flow. Nothing has touched the body, but the mind prepares the body to eat. Accordingly, the saliva starts to flow in preparation for digestion. If in anger you blow up at someone, you will feel a sense of guilt. The sense of guilt is experienced because of a non-material, moral judgment that you make about your physical actions. If, on the other hand, the problem is not dealt with, and you clam up in bitterness, that bitterness, and the sense of guilt resulting from it, will produce physical symptoms. “It’s not what you eat, it’s what eats you.” [S. I. McMillan, None of These Diseases (Westwood, N. J.: Fleming H. Revell Company, 1963), pp. 65-69.]

What goes on in the body has a definite effect on the spiritual, just as what goes on in our spiritual being does affect us physically.

Let’s move more specifically into this. In John 13:17, Jesus said that fulfilling His commands with our body will bring happiness and blessing as the result. By contrast, in Psalms 32 and 38, David describes the sense of guilt that he experienced because of the sins he committed with his physical being. In this relationship we could show that the physical produces an effect upon the spiritual. The relationship that I wish to discuss in this article has to do, however, with the effect of the spiritual upon the physical. In the two psalms just mentioned, David vividly describes this effect. In verse three of Psalm 38, he describes the physical restlessness that is present in the body because of sin. He describes the weight of guilt upon him (vs. 4), and the lack of physical health that resulted. How this comes about will be described in a subsequent article on psychosomatic illness. The important thing to remember is that the relationship between a person and God does have a physical effect.

Let’s illustrate this a little more vividly. A non-Christian develops pain in his left chest. He has forgotten that two days before this he slipped on the snow and fell against his car, hitting his left chest. At the time it happened it seemed insignificant, but now he is developing pain in the left chest. It hurts when he takes a breath or moves his arms. When he becomes active, he breathes faster and he begins to wonder — “Is this heart pain?” When he gets more active he has more pain, and when he slows down the pain decreases. He recently read an article in a popular magazine on heart disease, and now he knows that this sounds like heart pain. He also knows that a heart pain might mean death. He becomes afraid. His fear is not only fear of death but of meeting God, whether he is aware of that or not. That fear may escalate into a panic state which could even lead to the hyperventilation syndrome (excessive breathing leading one to black out). When he consulted his physician, the examination revealed that there is no problem with his heart. Instead, he has bruised his chest, and after careful questioning the history of the fall is elicited.

Before a person is saved, he is totally oriented toward the physical. All of his life revolves around satisfying the desires of the physical. After he has been saved, God changes his life orientation. He becomes a new creature; all things have become new. As a result his basic orientation is turned from the physical to the spiritual. That does not mean a neglect of the physical, but a new, godly concern for it. Now what happens to the body is seen through spiritual eyes; the affections have been set on spiritual things rather than on physical things. The body is now cared for because God requires good care of the body, which he now considers the temple of the Holy Spirit. His basic concern has changed; it is no longer a dread fear of death or ill health.

But this brings up an important question. What is the cause of illness? If our body is the temple of the Holy Spirit, why does the body experience sickness. Well, there are two main reasons. The first reason is because of sin. Basically, this has to do with the general condition of mankind as a result of the fall of Adam. Romans 5:12 teaches because of his sin, we are all sinners and as sinners we do sinful things. Now sickness may be even part of God’s punishment. For example, take the man who contracts gonorrhea from illicit sex. This example shows a direct relationship between sin and sickness, which is a direct part of the punishment for violating God’s rules. The loss of health is a natural consequence and becomes part of the punishment. Smokers who develop incurable emphysema are literally punished in this life for their smoking. Not only does God punish in eternity for violating His rules in this life, but some punishments are administered during this life. In addition, the illness may be used to call to the non-Christian’s attention his need for Jesus Christ. It may be God’s way of getting him to hear the gospel or to obey it.

In a Christian’s life, the same principles are true. The illness may be a direct result of the sin and may be a part of his Father’s corrective punishment. Sickness, then, may be used by God to draw attention to areas of disobedience in his life. Over and over the Word of God teaches that one of the best means of good health is obedience to the commands of God. Many of these commands boil down to very simple matters: proper rest, correct eating, correct attitudes towards stress, etc. Failure to follow these commands destroys health. Poor health may thus be the result of disobedience of God. So, the first cause of illness has to do with the sin of Adam and the specific sins that come as a result.

The second reason for illness is described in John 9. Here the disciples came to Jesus asking Him to explain the reason for the blind man’s illness. They were going on the assumption that there is only one cause for illness: sin. Jesus’ answer gives us a totally new perspective on illness. The answer was that his blindness was not the direct result of someone’s sin, but that God might be glorified. He was blind so that the works of God might be made manifest in him. Jesus was teaching that illness, as such, is not all bad. God uses illness to glorify Himself. God wants sick Christians to glorify Him in illness. This same thought is found in Romans 8:28, 29. All things work together for good, and that good is that we might be made like Jesus Christ, that we might be conformed into the image of God’s Son. When this happens, God is glorified.

A Christian should look at all illness from two perspectives. First, he should ask: “Does God want to change something; is there some sin in my life that is producing this illness?” Once he has closely examined his life and found nothing there, then he can turn to the second principle. He may ask, “How does God want to glorify Himself through this illness?”

In either case he needs to follow the principle of I Thessalonians 5:18 and give thanks for the illness. He must thank God if He uses illness to point out some areas that need changed; or if God is blessing him with the unique ministry of glorifying Him through physical illness. His attitude toward illness will either glorify God or not. If he rejects the illness or rebels against God, he certainly will not glorify God. But his attitude toward illness is influenced by how he views life. If he recognizes that all of life is spiritual he knows that God allows nothing to befall His children that is not for their good, and that the steps of a good man are ordered by the Lord. He knows that God can glorify Himself through illness. But the only way for a Christian to affirm this is to see life as God sees it. He must be willing to set his affections on things above and not on things on earth. His primary concern must not be that he always enjoy good health, that he always feel good, and that he live a long life; it must be to obey God in all circumstances.

Now, the center of one’s attention in life many times will determine his response to illness. The one who sees life as both physical and spiritual, and recognizes the temporariness of physical life and the eternality of the spiritual, and orients his life to these principles, has a different attitude toward physical problems than the person who sees life only from the physical standpoint. The latter, under stress of illness, becomes gravely concerned for his life. Because he does not take into consideration the spiritual aspect of life, he can see only the three score and ten years of the human existence. Anything that threatens that existence, either by shortening or incapacitating it, is extremely dreadful to him. He may be a Christian who is still largely oriented to the things of the earth, as Paul states in Colossians 3:2. Such persons become very worried whenever they become seriously ill or whenever a member of the family becomes ill. In desperation they may seek to do anything (even running to quacks) to prolong life and prevent incapacity during life. This fearful and worried attitude may impede recovery.

By contrast, the Christian who sees the whole perspective of life as God intends for him to see it, accepts illness as part of God’s sovereign plan for his life. He follows sound medical advice in the care of it, but does not panic at the thought of death or incapacity. He can delight in the fact that whatever God does for him is for his benefit; he knows that God wants to make him more like Jesus Christ. So when illness strikes, with Paul in II Corinthians 12:10 he finds strength in God’s promises and is pleased about whatever God does in his life. He follows sound medical advice in taking care of the body because the body is the Holy Spirit’s temple. But through it all, he trusts God’s sovereignty. His attitude toward illness will be a positive factor in recovery. If he has an incurable illness such as cancer, he is not panic stricken at the thought of what may happen. Contrasting life views lead to dramatically different contrasting physical results.

When counseling people with illness you must keep in mind their basic spiritual condition. God may be using the illness to show a non-Christian his need for Jesus Christ as Saviour. It should be obvious that illness can be used as an evangelistic opportunity. Jesus often did so. After a physician has examined a patient who has gone to him with chest pain and the physician has found no cause for the pain, a nouthetic counselor can point out the relationship between guilt and illness, and between guilt and symptoms, and suggest that the symptoms may be God’s way of calling attention to his need for Jesus Christ.

God may be using illness to call attention to specific sin in the Christian’s life. Or, He may be using the illness to glorify Himself. In either case, God wants to make the Christian more like Jesus Christ. The response to illness indicates where the orientation is. If a person accepts illness as part of God’s sovereign plan, and does what is necessary to see that the temple is properly taken care of, and is willing to glorify God by it, his life is oriented toward the spiritual. If he rebels against the illness, worries about its outcome, and may even become bitter toward God because of the pain and the inconvenience that it causes, he is not oriented toward the spiritual as he ought to be, and he needs to be confronted about this. Even this, as he is challenged with God’s commands, may result in further conforming him to the likeness of Jesus Christ.

One’s view of illness, response to illness, and recovery from it, are greatly influenced by his view of life and death. Every pastor must take this into account when counseling.


In his training, a physician is told that one of the first steps of a physical examination is inspection. This means to look at the patient and obtain what is called in nouthetic counseling “halo data.” The obvious things are very important in medicine and counseling. The word “looks” in the title of this series should be taken literally. Even though the various clues or halo data are obvious, they may be missed unless the counselor specifically makes it a point to look for them.

Depression is one of the conditions with much halo data. The first place to look is the most obvious — the counselee’s face. His face literally oozes a “what’s the use” attitude. His eyelids tend to droop, the corners of his mouth are turned down and seem to pull the entire facial expression down with them. His face is long, grim, and sad. He appears listless and generally expresses an air of helplessness or hopelessness. Written on his face is what is going on inside him.

All other visual and auditory clues or data follow the same pattern. His voice is quiet and his speech tends to be slow. His voice is a monotone with little or no expression. As he talks tears may come to his eyes. He may not look at the counselor but at the floor. He sits with a droop to his shoulders as though pushed down by the weight of the corners of his mouth. His hands rest limply in his lap. There is very little motion of his body as he talks. He walks slowly and at times almost shuffles. There is little life, spring, or bounce that shows some expenditure of energy. He is interested in doing what he does with as little effort as possible.

This describes the classic depression. All these things are not always present but there will be varying degrees of some of the signs present in most depressed people.

Occasionally a depressed person displays the exact opposite signs. He is overactive, fidgety, impatient, irritable, and talks fast but with disconnected speech. However, his physical symptoms are those of the classic depression.

The things a depressed person complains of and the physical changes that are present in his body are identical with what is observed on the outside. He complains of having no pep or energy but is always tired. He doesn’t sleep well because he has difficulty falling asleep or else awakens early. The latter is the most common complaint. Even when he does sleep, he awakens in the morning feeling as though he hasn’t slept all night. Then he drags through the day fighting the fatigue and sleep only to end up in bed that night again being unable to go to sleep. When he does, he spends the typical restless night and awakens early and tired the next day. He may have a sick headache in the morning and sore feet and a little backache in the evening. He has no appetite and food does not look good to him. He eats only because he knows it is necessary. He may have lost some weight. In association with this he complains of constipation. His mouth is dry and has a bad taste. He has lost interest in sex as well as other things that at one time were very interesting to him.

All these changes are the result of the effects of the unbiblical reactions to stress in life. To help us understand this, it is necessary to give a very brief and superficial explanation of the autonomic (or automatic) nervous system. The Lord made our bodies with automatic regulating systems controlling many of the functions. This system works somewhat like the thermostat in our homes. When the temperature is low, the thermostat tells the furnace to put out more heat and the house warms up. When the temperature is high, the thermostat tells the furnace to quit putting out heat and it stops. The thermostat for the autonomic nervous system (ANS) is in the brain and spinal cord. Certain needs within the body tell the ANS to make certain changes. Such things as the activity of the intestinal tract, the amount of saliva produced in the mouth, sweating, heart rate, and many, many others are controlled by the ANS. Even though all these functions are automatic, the brain can affect them. By brain is meant the reactions the human being has to the various experiences in his daily life. These reactions affect the ANS. For example, if a person suddenly hears a loud noise behind him, he may be startled by it with a resulting increase in his heart rate. If he sees a thick, juicy steak cooked just the way he likes, his salivary glands will start to pour out saliva. Through reactions to life situations the ANS is affected. This is what is happening in the depressed person. This is what is called a psychosomatic reaction. The word “psychosomatic” means the effects of the mind (psyche) upon the body (soma). The term is currently being changed to psychophysiologic with the same meaning. These terms are inadequate for the nouthetic counselor, for his concern is not just mental reactions but sinful reactions. The sinful responses of a person have a definite effect upon his body. Some of these are through the ANS. Thus spiritual problems and their effect on the body is the concern of the Christian counselor. A better term would be pneumosomatic or spiritual-physiological reaction.

This dynamic is what is going on in the depressed person. The weight of guilt for his failures is affecting his body through the ANS. The intestinal tract slows down, producing loss of appetite, some nausea, indigestion, and constipation. Decreased food intake and decreased digestion produce weight loss. Decreased production by the salivary glands produces a dry mouth, which contributes to the bad taste. The entire metabolism slows down, producing lack of pep and energy, a condition encouraged by the lack of sleep.

This tired, run-down feeling may also be caused by the failure to rest while sleeping. When the depressed counselee goes to bed, he takes his problems with him. He thinks about them, tries to solve them, and generally continues his daily activities in his mind. It is as though he is trying to sleep by a television set that is depicting his problems and activities. Even with the sound turned down or off, sleep is difficult and rest is impossible. The solution is to solve the problems during the day and turn off the mental TV at bedtime.

The cause of the depression has been vividly and accurately described elsewhere (Competent to Counsel, pp. 116ff., 126, 144, 148, and The Christian Counselor’s Manual, pp. 375-383). These causes are spiritual and are the result of sin in the counselee’s life or his reactions to stresses of life. This sin affects the body through the pneumosomatic process. The counselor’s responsibility is to work back through the physical responses to the sins and guide the counselee to biblical solutions.

There are some other potential causes for depression that must be kept in mind. Fatigue is one major cause of it. When fatigue is the result of a hard day of work, the depression must be handled as all depression. However, many times fatigue is the result of pushing the body beyond the limits God set for it. Then the depression that results is from a spiritual problem.

Depression many times accompanies diseases, especially those of a chronic nature. In these cases the depression is not caused by the disease but is the reaction of the counselee to the disease. This reaction is again an unbiblical one, especially when one deals with the spiritual reasons for disease.

Certain drugs may produce a feeling of depression. Included in these are certain of the tranquilizers. Withdrawal from amphetamines, barbiturates, or narcotics is many times associated with depression.

These other potential causes of depression make it very important to know the general health status of the counselee. A report from the counselee’s physician about diseases and medications affecting his behavior and producing depression is very helpful and even mandatory to the proper approach to the depression.

The most important thing to remember is that depression is no excuse for irresponsible behavior, no matter what the cause of the depression. Admittedly, depression makes responsible behavior more difficult, but it is not impossible. The counselee must respond to all of life in a biblical manner whether he feels like it or not. The goal of the nouthetic counseling is to help the depressed counselee see and understand this fact and then guide him in developing the correct behavior.


“Am I just imagining this pain?” “Do you think this pain is only in my head?” Such questions imply that there are symptoms that are not real but are just imaginary. By definition, a symptom is a subjective evidence of some physical disturbance or disease. It is something physical or emotional that a person experiences that is a departure from the usual or normal sensations or feelings occurring within his body. These symptoms may be the result of actual disease processes occurring in the body or they may be the result of the way a person handles stress. The pain from a blow to the head is very real. But the “tension headache” that one experiences from incorrectly dealing with stress is just as real. The cramping pain in the abdomen that is the result of a “nervous stomach” or a “spastic colon” is just as real as the cramping pain from the intestinal flu. In either case the symptom is a real problem. It is not an imaginary symptom. The difference is not the validity of the symptom but the cause of it.

The pain from a spastic colon is due to cramping in the colon. Anger, fear, worry, and other such responses to stress send a barrage of impulses from the brain to the colon. These impulses cause hard contractions of the muscles of the colon that are like the hard contractions of the leg that we call a “charley-horse.” The cramping pain from these contractions is just as real and painful as pain from diseases.

Another example of the reality of symptoms arising from the mishandling of stress is the hyperventilation syndrome or over-breathing. In the midst of an angry, tearful argument a person may breathe more rapidly than is necessary. The increased blowing off of carbon dioxide and increased intake of oxygen disturbs a very sensitive chemical balance in the blood. This is detected by the breathing center in the brain, which signals for a slowing down of the rate and depth of breathing in response, the breathing rate will slow down to less than the normal 16 to 20 times a minute in order to allow the balance to return to normal. Then the person notices he is not breathing as much and states, “I can’t get my breath!” The long pauses between breaths cause him to think something is wrong with his breathing mechanism. So he voluntarily overrides the automatic control center and begins breathing rapid and deep. The imbalance of too much oxygen and too little carbon dioxide continues to worsen, producing numbness and tingling of his mouth, fingers, and toes. These symptoms cause him an even greater fear that something serious or even threatening to his life is happening in his body. If the over-breathing continues, the chemical imbalance will produce spasms in certain muscles. The most noticeable are those of the extremities, where the fingers start drawing up in uncontrolled spasm. The arms and legs may also draw up. At this point the person thinks death is inevitable and panic reigns. The end result of continued over-breathing is shut off and the automatic mechanism takes over to restore the chemical balance to normal.

Thus the symptoms resulting from physical processes in the body are real and those resulting from the way a person deals with stress are also real. In addition, one’s response to stress may affect the symptoms from physical causes. The headache from the blow to the head may be aggravated and increased by the fact that the woman who was struck by her husband has great resentment toward him and a desire for revenge. She wants to frighten him by making him think she is more seriously hurt than she really is. Or she wants to make him feel sorry for her and for what he has done. Thus the medical findings do not account for the severity of her pain.

The symptoms from physical diseases may themselves be a source of stress. A person with a duodenal ulcer may have pain that is high in his abdomen and even in the lower chest. This pain is partially due to spasms in the duodenum. Before the ulcer is found, he may become very concerned as a result of where he hurts. Because it is in his chest he may become worried about his heart. He fears he is having a heart attack and thinks he might even die from it. This fear and worry produces an increase in the spasms already present in the duodenum and thus increases the pain. His worry and fear are responses to the stress of pain (that is due to a physical causes) and those responses cause further increases in the symptoms of pain he is experiencing.

“How does a counselor know which of these various causes of symptoms is affecting his counselee?” This is a question that is often difficult for the physician as well as the counselor. The best rule is to consider all symptoms as real. Then insist that the counselee have a thorough medical evaluation. The symptoms from disease states are treated by treating the disease and possibly giving medication for the symptoms (depending on the disease process and the symptoms). If no disease is found, it is possible that medication may have to be used to control the symptoms while the counselor is endeavoring to discover the dynamics of stress involved.

The counselor needs to obtain thorough data about stress in the life of the counselee and how he responds to it. It is important to look for unbiblical responses and ways in which these responses may have produced symptoms. The symptoms should be considered real and the result of sinful responses to stress. After obtaining the data and understanding the dynamics (being certain there is no medical problem present), the counselor’s goal is to help the counselee also understand and then make the changes necessary to reduce or relieve the symptoms. The solution is in dealing with the sinful responses (putting off) and replacing them with the correct biblical responses (putting on).


At the writing of this material, Bob Smith was a practicing physician in Lowell, Indiana, who also worked closely with the Christian Counseling Center at Lafayette, Indiana.

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