A Pastoral Counseling Approach
for Those With Chronic Illness and Pain
By Doug Wiegand
Of the countless needs brought to a pastor by church members, few are as complex and difficult to address as those of chronic illness and pain. Chronic illness and pain (CI/CP) have a tremendous impact on the quality of an individual’s life. Just knowing the likelihood that they will live their entire lives (except for a healing miracle) having to cope with the ravages of disease or pain is an enormous burden to carry. Thus, the worldview of those with CI/CP, even the Spirit-filled believer, is vastly different from that of a healthy person. Those with CI/CP belong to a unique population that sets them apart from most other people.
The twin scourges of CI/CP exist in epidemic proportions in the United States. According to the Center for Disease Control and the National Center for Chronic Disease Prevention and Health Promotion, the number of individuals suffering from chronic illness ranges between 54 million (1 in 5 Americans) to 90 million (1 in 3 Americans). Chronic illness is defined as any physical, psychiatric, or cognitive disability that significantly interferes with daily living. Therefore, chronic illness takes in a huge number of diseases, including: heart disease, diabetes, multiple sclerosis, muscular dystrophy, Parkinson’s disease, blindness, traumatic brain injury, birth defects, and a large number of mental illnesses.
According to the American Chronic Pain Association, an estimated 50 million Americans live with chronic pain. Chronic pain is defined as ongoing physical discomfort that is severe enough to significantly interfere with the normal activities of life. Chronic pain can include: back injury, rheumatoid arthritis, neuropathy, cancer, gastro-intestinal disorders, and migraine headaches. Two thirds of the 50 million Americans living with chronic pain have done so for more than 5 years. Since our perception of time is relative, imagine how long 5 years of constant pain must seem.
Many who suffer from CI/CP shy away from discussing their problems with anyone. Fear of not being understood, embarrassment, and feelings of failure are the most common reasons for not seeking help. However, a compassionate pastor who is willing to address the overwhelming problems faced by someone suffering from CI/CP, has a unique opportunity to minister hope to the hopeless.
Chronic pain adds to the torment experienced by those with chronic illness. Whether it is moderate or agonizing, ongoing pain can wear down the most faithful Christian. The following quote from one of my clients demonstrates the enormous toll taken by his chronic neuropathy. “Some days I don’t think I can stand it anymore. Day after day the pain just wears me out. It’s always there. It tears at me. Some days it’s worse than others, but it’s always there. At times, the pain is a dull throb like a toothache. I say to myself, This isn’t too bad. You can handle it. But at any moment, that dull ache can flare up without warning and a stab of pain, like a razor sharp knife, cuts through me. I try not to cry out, but sometimes I gasp in surprise and grab for my leg. Worse than the pain is seeing the look of sadness in my wife’s face.”1
Based on the statistics quoted above, the chances are good that you will be called on to care for an individual who suffers from CI/CP. This person’s chronic illness may have severely limited his mobility. Perhaps chronic pain has taken away his ability to work. As you face the thorny problems of helping a church member with CI/CP, you will certainly need Holy Spirit wisdom and insight to be effective.
It is difficult for those in relatively good health to understand the unique life experiences of those with CI/CP. But there is a pattern of common attitudes, beliefs, and behaviors present in the chronically ill or pain-filled person. By understanding the common themes, the pastoral counselor will be better prepared to assist those with CI/CP.
The anguish of trying to endure unrelenting pain is damaging to a human being. I have divided the human personality into three fundamental dimensions that are negatively impacted by CI/CP.
The Spiritual Dimension
The spiritual dimension contains the supernatural strivings and yearnings of the human soul. Those with CI/CP often have serious doubts about the nature or even the reality of God. It is vital, therefore, that early in the counseling process the pastor respectfully opens the door to discuss the counselee’s spiritual beliefs and his relationship with Jesus. As counseling progresses, the pastor will have set the stage to minister salvation or to bolster the faith of a believer. Only by allowing Jesus to be our burden bearer, can anyone find the strength to endure unending pain or suffering.
A pastoral counselor will likely be asked to address the why questions. Specifically, “Why must I suffer this pain and illness?” There are many other why questions that are often asked: “Why am I not healed?” “Why does a loving God allow pain and suffering?” These questions are among the most significant in all of Christianity. I cover these questions in detail in my book, Struck Down But Not Destroyed!: A Christian Response to Chronic Illness and Pain.
The following are three Scriptural explanations for why CI/CP is present in the world.
First, we live in a world tainted by sin. The perfect, earthly paradise God created (the Garden of Eden) was lost. Paul explained that “sin entered the world through one man (Adam), and death through sin, and in this way death came to all men” (Romans 5:12). All people in the world, to one extent or another, face illness, pain, aging, and death because of Adam and Eve’s original sin.
Second, having CI/CP is not an indication of God’s punishment of individual sin. As stated in Paul’s letter to the church in Rome, “For all have sinned and fall short of the glory of God” (Romans 3:23). If CI/CP were punishment for individual sin, then every person would have equal opportunity to be struck down.
The Bible does describe circumstances in which a person’s sin has brought about his illness. It is essential, however, that this possibility be considered only after much prayer and Holy Spirit confirmation. Job comforters can do great harm to the already alienated individual with CI/CP.
Third, God may allow us to experience suffering for our spiritual growth and benefit. According to the Psalmist, “It was good for me to be afflicted so that I might learn your decrees” (Psalm 119:71). It is often only when we are struggling with a burden and have nowhere else to turn that we seek God in sincerity and faith.
When counseling those with CI/CP, it is important to emphasize the fact Jesus understands their pain and sympathizes with their suffering. He knew all manner of physical, emotional, and spiritual suffering. The prophet Isaiah described Jesus as “a man of sorrows, and familiar with suffering” (Isaiah 53:3). In spite of the feelings of alienation and loneliness the person with CI/CP experiences, there is comfort in the knowledge that Jesus “took up our infirmities and carried our sorrows” (Isaiah 53:4). Jesus is with the victim of CI/CP throughout his journey to ease his sorrows.
Feelings of inadequacy/lowered self-esteem
As a person with CI/CP tries to adjust to a life with tremendous limitations, it is typical that his self-esteem should suffer. We live in a society that prizes success and accomplishment. Our sense of value is often tied to our job or possessions. People who are confined to a wheelchair or use a guide dog no longer possess the same ability to perform or compete with the healthy person. Therefore, they are no longer part of the group.
It is essential that a pastoral counselor remind a person with CI/CP of the false value system that exists in the world. People need to be encouraged that their worth to God is unconditional and not performance based. Christians need to be empowered with the knowledge that our innate value is based on two facts. First, “God created man in his own image” (Genesis 1:27). Second, “The Spirit himself testifies with our spirit that we are God’s children” (Romans 8:16). Each Christian is an essential and unique part of the body of Christ, regardless of his limitations. Illness or pain does not diminish the importance of the role we play in God’s plan.
The Relational Dimension
There is a strong tendency for those with CI/CP to withdraw from friends, neighbors, coworkers, church members, and family. They also withdraw from activities in which they were regularly involved, including church attendance. Pastors need to be careful not to be offended or over react to their absences. Although they isolate themselves as protection, this only worsens their feelings of alienation and loneliness.
A person’s withdrawal often severely damages his relationships with his spouse. According to a recent National Health Interview Survey, the divorce rate for marriages with one partner who has CI/CP is more than 75 percent. Thus, the spouse is also a victim of CI/CP. Pastors counseling a married person with CI/CP need to strongly consider marriage and family counseling (depending on the age of children) in addition to individual sessions.
A person with CI/CP is hypersensitive to the slightest hint of disapproval or condescension. For example, few words will turn him away as quickly as when someone says, “I know exactly what you’re going through.” Even spoken by the most loving pastor, this statement cuts like a knife to the one with CI/CP. What is meant to be a word of comfort and empathy comes across as a glib remark. To the overly sensitive person struggling with CI/CP, it serves only to further alienate him from normal people. A spiritually mature pastoral counselor, however, can move in the compassion of Jesus. He can bridge the gap created by a thin-skinned individual. The pastor can demonstrate God’s love and acceptance. The Psalmist David rejoiced in God’s everlasting love for His children in these words: “For great is your love, reaching to the heavens; your faithfulness reaches to the skies” (Psalm 57:10).
The Emotional Dimension
Depression and anxiety
In almost all cases of CI/CP, the sufferer’s emotional life is negatively affected. As time passes, he is less able to handle stress. An estimated 25 percent of those with CI/CP meet the clinical criteria for chronic depression (dysthymia). Most people with clinical depression also suffer from some form of anxiety disorder. Together, they rob the person with CI/CP of the spiritual resources, emotional energy, and intellectual focus needed to combat their pain and illness.
People with chronic depression (dysthymia) go through life in slow motion. Their emotional reactions are blunted and a dark cloud of pessimism floats over their heads. Even the most basic activity seems beyond their ability to perform. Nothing brings them joy. They feel hopeless.
Now add anxiety symptoms to dysthymia. Anxiety causes people to feel nervous and ill at ease. They worry about everything. Their minds race from one negative thought to another. They might even experience an acute anxiety attack causing their heart rate to soar and their hands to tremble as adrenaline courses through their veins.
To combat depression and anxiety, a pastor must help those with CI/CP to realize that depression and anxiety are common reactions to their health crisis. The pastor must remind counselees that God is their ever-present strength and hope in times of discouragement. The Psalmist wrote, “Praise be to the Lord, to God our Savior, who daily bears our burdens” (Psalm 68:19).
This category of symptoms refers to the confusion and inactivity that floods over those suffering with CI/CP. Feeling overwhelmed and uncertain how to proceed, they freeze and do nothing. Sufferers become passive and unable to assist in their own recovery.
Typically, adjustment disorder hits during the initial occurrence of their disease or injury. This is when people must first face the many limitations and changes with which they must now live. It is important for a pastor to contact congregation members as soon as he learns of their debilitating disease or accident. At this early stage, groundwork can be laid that will help speed the process of adjustment to their condition. When the adjustment disorder becomes a long-term lifestyle, it is much harder to minister to them.
It is clear that the problems surrounding CI/CP are many and complex. In spite of the difficulties, if the Holy Spirit has gifted you with the ability and compassion to counsel, I urge you to reach out to the suffering and often isolated person with CI/CP.
1. Doug Wiegand, Struck Down But Not Destroyed!: A Christian Response to Chronic Illness and Pain (Rainbow’s End Publishing, 1996).