9Marks: You have written two books on the theme of fear, When People are Big and God is Small and Running Scared. Why is fear a theme you have focused on so much?

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.

9M: Should pastors give more thought to the topic of fear?

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.

9M: How do men and women experience fear differently?

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.

9M: You've also written a book called Blame It on the Brain, distinguishing chemical imbalances, brain disorders, and disobedience. Is there such a thing as chemical imbalances and brain disorders that require medical treatment, or are you opposed to medication for depression?

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.

9M: Are you opposed to medication for depression?

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.

9M: In seminary pastoral care classes, aspiring pastors are sometimes taught to distinguish between spiritual matters with which they are competent to deal and medical issues which they should refer to professionals. Is this good advice?

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.

9M: Can you talk about the materials that you have just written to facilitate a small of group around the problem of addictions?

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.

Edward T. Welch, M.Div., Ph.D., is a licensed psychologist and faculty member at CCEF. He has counseled for over twenty-six years and has written many articles, booklets, and books including When People Are Big and God Is Small; Addictions: A Banquet in the Grave; Blame It on the Brain?; Depression: A Stubborn Darkness; and Running Scared: Fear, Worry, and the God of Rest. Dr. Welch’s newest release is a curriculum entitled Crossroads: A Step-by-Step Guide Away from Addictions.

• November/December 2008 eJournal Editor's Note