When the Engine Misfires: Biblical Counseling and Psychiatry
by Joe Leavell
Just two weeks into pastoring a small church at age 26, I had my first direct encounter with a serious mental crisis.
A faithful church member hadn’t been to services, so I called to check on him. He answered, but his speech was slurred and difficult to understand. Concerned, I asked if I could come by. He agreed.
When he opened the door, I was hit by the overwhelming smell of human waste. He looked disheveled, unshaven, unsteady on his feet, with bloodshot eyes. His speech was barely intelligible. I gently asked if he had been drinking or using drugs, but he insisted he hadn’t. Instead, he said God had told him he wasn’t saved, and that now he was terrified to die.
What was a young pastor to do? Was this man having a spiritual crisis of faith?
Something was deeply off about the whole thing.
I noticed dirty dishes were piled up and asked when he last ate or drank. He said it had been at least two days. He said he believed God told him food and water were sinful, and he was scared that if he drank anything, God would kill him.
Not yet understanding how time-sensitive these situations can be, I opened my Bible and shared how food and water are gifts from God, and that His love casts out fear. He stared ahead blankly and mumbled something about water being a sin.
As I asked more questions, it became clear he was suicidal and at risk of harming himself. I asked if I could call for help. He reluctantly agreed. Within minutes, first responders arrived, evaluated him briefly, and quickly took him to the hospital.
What had caused this man to hear voices telling him not to eat or drink and instilling fear into his heart? Was it a spiritual deception? Had he sinned in some way?
As it turns out, the man had suffered a stroke, was experiencing psychosis as a result, and would require long-term neurological and psychiatric care.
He didn’t need a conversation about God’s design for water. He needed immediate medical help. His brain had malfunctioned, not his spirit.
When Brains Break
That was my first encounter with a broken brain, but not my last. As a biblical counselor, I’ve worked with people whose thinking and behavior are so “off” that it becomes clear this is more than a heart issue.
Some have abused drugs. Others have endured trauma that fractured even strong minds. Some battle severe addictions, while others live with panic attacks or flashbacks rooted in betrayal, abuse, or tragedy.
Whether it’s from physical injury, birth defects, dementia, developmental issues (like autism or Down syndrome), or something else, the result is the same: the brain is no longer working as God designed.
While Scripture guides our every step, it does not always directly provide the solution to every problem. As biblical counselors, we are grounded in the belief that God’s Word is sufficient to guide us in life and godliness (2 Peter 1:3). Scripture does encourage medical treatment (1 Timothy 5:23). So when when someone’s brain is not functioning properly, they may not have the mental capacity to receive biblical truth and nourishment for their souls and need the care of a specialized physician.
Car Analogy
Using a car engine as an analogy for the brain, it’s important to understand that not every issue stems from poor driving decisions. It’s not always the driver’s fault. Sometimes the engine wears out, gets damaged in an accident, or simply starts to misfire. In those cases, it needs a skilled mechanic who knows how the engine functions.
At Biblical Counseling of Arizona, we believe God created us as both material and immaterial beings and has entrusted us with the stewardship of both our spirit and bodies, including our brains (1 Corinthians 6:19-20). Caring for our mental and physical well-being isn’t just wise; it’s an act of worship. That’s why we caution against practices or substances that harm the brain, body, and soul.
As Paul describes in 1 Thessalonians 5:23,
“Now may the God of peace himself sanctify you completely, and may your whole spirit and soul and body by kept blameless at the coming of our Lord.”
What If the Engine Isn’t Working?
At times, even when a godly believer has lived wisely and walked faithfully, their mind still struggles, whether because of past trauma, physical damage, or factors outside their control. In those moments, medical care can be a gracious provision from God to help bring stability and support. When it comes to caring for the brain, there are several options to consider.
1. The Doctor
Your general practitioner is like a quick-lube or tune-up shop, caring for the whole physical body that God has entrusted to us. They can often identify underlying physical issues affecting the brain, such as a thyroid imbalance or lack of nutrition that may contribute to depression or anxiety. When more complex care is needed, they will refer you to a specialist. Because our bodies and minds are closely connected, we encourage regular physical checkups for those struggling with emotional or mental challenges, so that any medical causes can be thoughtfully addressed alongside spiritual care.
2. The Neurologist
A neurologist is like a body-shop technician. They address structural damage like brain tumors, seizures, cancer, or dementia. They look for things that require direct medical intervention to restore proper brain function. Neurologists are highly trained specialists who can do much to help a damaged brain recover from head trauma, disease, etc.
3. The Psychiatrist
Even if the brain appears structurally sound, it may still not function as it’s designed. This is when a doctor usually refers to a psychiatrist, who is like a mechanic. Psychiatrists treat conditions like clinical depression, postpartum depression, schizophrenia, mania, and drug-induced psychosis. Psychiatrists are specialists in understanding medications of the brain that can be used to help stabilize brain chemistry.
To be sure, not all mechanics have the same level of skill or reputation, and the same is true in the world of brain health. Some people have, unfortunately, received poor or even harmful care. Many well-meaning doctors, neurologists, and psychiatrists can sometimes misdiagnose spiritual struggles as brain disorders, which can lead to further harm. This reality should not be ignored.
Additionally, with the rising demand for psychiatric care, many professionals are stretched thin and don’t always have the time to provide a thorough evaluation before prescribing medication. We understand and do not dismiss these valid concerns.
Yet at BCA, when asked for referrals, we have connections with some who are Christian psychiatrists who will not confuse a spiritual issue with a physical one or vice versa. As such, we recognize that there is a limited but legitimate role for medical psychiatric care when the brain is not functioning as it should. If someone can’t sleep, think clearly, or engage in meaningful spiritual care, medical support may be necessary.
As such, if you are receiving care from a doctor, neurologist, psychiatrist, etc, we will not dissuade you but will seek to stay in our lane of providing biblical care to help you know how to best faithfully drive and work to restore a damaged vehicle. We always defer medical concerns to qualified healthcare professionals. Our desire is not to see spiritual issues behind every medical malfunction.
To be clear, medical care does not replace biblical counseling nor does biblical counseling replace medical care. But they can support one another. In fact, some who have come for counseling have benefited from biblical care because a psychiatric intervention helped stabilize their mental capacities to understand and engage God’s Word and design. Others have received the medical treatment they needed because they went to a biblical counselor who shared God’s call for them to manage their body well.
What is Our Role?
While we’re not focused on diagnosing engine problems directly, we do pay close attention to how a person’s “driving habits”: life choices, thought patterns, and behaviors that may have contributed to the engine’s condition and the need for outside medical support.
At BCA, we speak to what the medical community cannot. We look at areas such as identity, purpose, despair, addictions, and more to see how the unchanging love of Christ impacts every aspect and circumstance in your life.
We also help you interpret your suffering in a sin-cursed world in light of the Gospel. We see suffering not just as a problem to be solved, but as a means through which God is shaping you into the image of His Son.
Even if you’re struggling with a damaged brain, our goal is to help you care for your “vehicle” with biblical wisdom and learn to function according to the Designer’s manual.
We want to walk alongside you, helping you understand how your driving habits were formed, grieve with you where others have caused harm, work through reckless choices that lead to engine strain or damage, and how you can now submit to the Manufacturer’s design for lasting restoration and direction.
For example, a car might be capable of hitting 120 MPH, but it wasn’t meant to run that fast constantly. Doing so will wear out the engine. Similarly, living at an unsustainable pace, sacrificing sleep, family time, and margin, goes against God’s design. Over time, it takes a toll on both body and mind.
Many people come to us looking for help to manage the stress of their hectic lives and practices that run well beyond what is healthy. We seek to caringly express biblical truth that mental and spiritual health means rest, a change of pace, a reordering of priorities, and time to heal body and soul.
When Might Psychiatry Be Helpful?
We don’t prescribe medication or make medical decisions. But here are some signs that psychiatric help may be beneficial:
Severe depression with suicidal thoughts
Psychosis, hallucinations, mania, or paranoia
Inability to function: no sleep, no appetite, overwhelming panic
Trauma that seems to have damaged mental function
Inability to receive biblical care due to impaired thinking
Unusual behaviors that do not appear rooted in spiritual struggles.
When Psychiatry Misses the Mark
In today’s culture, many are quick to seek a diagnosis rather than examine the heart. But not all struggles are brain-based. Heart issues are not brain malfunctions.
This is why many biblical counselors are cautious about psychiatry. Diagnosing heart issues as disorders and subsequently providing medication to dull the symptoms inevitably fail to address the root of sin or the need for repentance. As such, the issues persist.
For instance, a man addicted to pornography may feel depressed, or a woman angry with her husband for not living up to her expectations may blame her anxiety. But these are spiritual issues that require biblical solutions, not just pills.
Medication can numb the conscience, but only the Holy Spirit can renew the heart.
The Place for Godly Grief
Many Christians today also struggle to make space for healthy, biblical sorrow. Not all emotional distress is the result of personal sin.
Sometimes sadness is the right response to death, betrayal, loss, or injustice. These experiences often break our hearts and weigh heavily on our minds. Sorrow doesn’t always mean something is wrong with us. It often means that something is right and we are experiencing emotions that our Savior did in these situations.
In a culture that turns its face from pain, God trains the believer to rest in the One who took our pain as His own. In that way, brokenness becomes the soil where God grows deep spiritual maturity. In these moments, rather than medication, people need a caring community. They need presence, comfort, truth, and Gospel hope.
The Whole Picture
Psychiatry is not a substitute for biblical care and is often sought to avoid addressing soul-level issues. This will only mask and will not address the root issues. But when the brain “misfires,” it can be a helpful tool, especially when guided by wise, Christian medical professionals who will not undermine but reinforce God’s work in a person’s life, body and soul.
At Biblical Counseling of Arizona, we’re committed to discerning these differences with wisdom and humility. We’re not mechanics, but we care deeply about the whole person—body, mind, and soul. If you're struggling and don’t know where to turn, we invite you to reach out. We’d be honored to walk alongside you with wisdom, compassion, and hope rooted in Christ and His Word.
You aren’t meant to walk alone. If you would like to pursue counseling through BCA or have additional questions, please reach out today! You can register here or contact us at info@biblicalcounselingaz.org.
Biblical Counseling of Arizona is a 501 C3 non-profit counseling center that relies on the generosity of donors to provide affordable care for those in financial need. If you are interested in asking specific questions about our counseling, or are interested in financially partnering with BCA, please reach out to us at (480) 535-1800, write us at info@biblicalcounselingaz.org, or click here to donate.
