From behind pulpit to beside the couch

On its sprawling campus on the outskirts of town, City Church of Chattanooga offers its members a range of novel programs -- an in-house Christian rock band called Beckon, gym nights for singles and Wee Nation, a weekly religious service-with-sermonette for 2- to 5-year-olds.

For the last year, members of this conservative Pentecostal church have also had this opportunity: Outside the sanctuary, in Mark Carpenter’s office, they can be treated for mental illness.

With a box of Kleenex placed next to a carefully angled chair, Carpenter’s office looks like any other psychotherapist’s. Beside his desk are three editions of the Diagnostic and Statistical Manual, the guide to modern psychiatry, which he has used to diagnose a steady stream of clients with anxiety disorders, clinical depression and personality disorders.

In some ways, though, his practice is unusual. Most of Carpenter’s patients arrange their lives around ideas not found in the DSM-IV -- ideas such as sin and the devil and hell.

Practices like Carpenter’s mark the end of a long enmity. In psychiatry’s early days, many of its luminaries looked with contempt on religion, blaming its leaders for loading their followers with guilt and fear. Their antipathy was more than matched by Southern pastors, who saw psychologists tempting their parishioners into a fallen culture that no longer recognized the notions of good and evil.

That’s changed over the last two decades as evangelical Protestant churches have waded ever further into the field of mental health. Initially, the churches recommended psychologists who identified themselves as Christians. But a growing number of evangelical churches in the South are embarking on experiments like Carpenter’s, in which they open their own clinics, staffed by licensed professionals from within their ranks. The American Assn. of Christian Counselors, an organization of evangelical Christian mental health professionals, has grown from 700 members in 1991 to a present roster of 50,000, said Tim Clinton, the organization’s president. Half of those are licensed.

As it grows, the evangelical mental health trend promises to make treatment available to a large swath of Americans who have been reluctant to seek it. But there are also tensions, as therapists work to keep their treatment in line with their churches’ strict beliefs. If evangelical leaders no longer fear the mental health professions, said one scholar, it is partly because they have control over them.

Psychology is “no longer seen as a wolf in sheep’s clothing,” says Nancy L. Eiesland, an Emory University sociologist who has studied suburban megachurches. “It’s been domesticated.”

Carpenter, 42, sits in the calm of an office with framed diplomas on his wall, but he didn’t always.

Before he began attending City Church of Chattanooga, he spent nine years managing a McDonald’s. As recently as five years ago he was taking classes toward his bachelor’s degree and working the night shift at UPS.

His venture into mental health began right here, at City Church, after Pastor Mike Chapman asked him to teach a class on codependency for church members. Carpenter, who had no training, based the curriculum on his own family dynamics.

The pastor was pleased.

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Mental health turf wars

Over recent years, Chapman had run into difficulty with secular mental health professionals, occasionally clashing so dramatically that it felt like a tug of war over someone’s soul. Once, he says, he performed an exorcism on a woman who had been treated without much success by psychiatrists. Another time, he marched into a psychiatric hospital and confronted a clinician over treatment that challenged his church’s teachings.

Eventually, Chapman attempted to secure release forms from church members who entered psychiatric treatment, so he could participate in decision-making. It should be perfectly clear to mental health professionals, he said: In the inner lives of worshipers, the church remains the foremost authority.

“My feeling is, you’re on our turf now,” says Chapman.

An in-house licensed professional would do two things for City Church: First, it would help the pastor avoid those clashes. The second benefit was pragmatic: In the highly competitive atmosphere of Chattanooga megachurches, where new members are drawn away from smaller and more traditional churches, people were beginning to demand such services.

It was Pastor Mike who encouraged Carpenter to attend the Psychological Studies Institute, a newly accredited graduate school based in Atlanta and Chattanooga that specializes in Christian counseling.

For Carpenter, the son and grandson of strict Baptist preachers, graduate school in psychology (he earned a master’s in professional counseling) opened up a new world.

The people around him sprang into new focus. He peered at them as if they were puzzles to be worked: Looking harder at his own painful history of sexual abuse, he has untangled the roots of his hostility toward male authority figures, something that dogged him for years.

Examining more deeply the jittery, irritable behavior his wife, Debbie, displayed in shopping malls, Carpenter traced it to a traumatic episode from her early childhood, when as a bewildered 5-year-old she was separated from her family. He encourages client after client to look for reasons for their behavior, something a church upbringing does not teach.

Debbie Carpenter, raised by a conservative Pentecostal family, is admiring when she relates this breakthrough: In the world where she grew up, anxiety was written off as nervousness; depression went unmentioned.

“People would have been scared” if anyone sought help for mental health, she says. “My parents’ generation swept it all under the rug.”

Once word got around that City Church had a therapist, referrals flowed in, in part because Carpenter charges only $30 an hour -- less than half the going rate for psychotherapy in Chattanooga -- and patients can avoid the restrictions of managed care. He will receive his state license in August.

Carpenter’s faith makes him optimistic, even when he is grappling with psychiatry’s greatest challenges. He has particularly enjoyed working with patients who have borderline personality disorder, a group known for frequent self-mutilation and suicide attempts.

“Most people refer them away,” Carpenter says. “My internal perspective is that God gives me the opportunity to watch him go in there and turn the light on.”

His wife has noticed that he comes home more tired these days. Although he had done pastoral counseling for years, it was scripturally based and nowhere near as exhausting as clinical work. Now he finds himself faced with seriously mentally ill patients: “Every fiber of your being has to be alert.”

And every now and then, he finds that his desire to relieve psychic pain collides with the beliefs of the church.

Carpenter sighs when he describes the cases that bother him the most. It’s one thing, he says, to see a couple whose marriage has gone sour for a brief period. But sometimes he sees husbands and wives who have been hurting each other for years upon years. He knows what he’s got to do -- discourage them from divorcing. He warns new clients of his position on divorce. From time to time, though, those sessions trouble him.

“Which is going to be the greater sin? My faith says if I get this divorce it’s a sin. But what about continuing to live in the hell that [they are] living in?” he says. “Isn’t that a sin?”

At those times, Carpenter looks at two people, yoked miserably together, and realizes he is stuck. Sometimes he throws up his hands and sends them away.

“They’re extremely difficult for me,” he says.

The community standards, set by Pastor Mike Chapman, are unambiguous. A thousand people gather each week to watch Chapman preach, wearing a banker’s pinstriped suit, with a microphone clipped to his collar. City Church prohibits divorce except in cases of “sexual immorality” or desertion; remarriage is unlawful if there was intent to remarry at the time of the divorce. On rare occasions, Chapman has excommunicated members for failing to repent their violations.

He has little sympathy for people who give up on a marriage because it does not fulfill them. He tells a story: Years ago, one member sought out a secular psychologist, who advised her to divorce her husband and leave the church at the same time. Remembering that case, Chapman is still angry.

“Our perspective is, marriage is not to make you happy,” he says. “It’s to make you holy. Happiness comes later. If your goal is to be happy, go buy a bottle of Jack Daniel’s. It works quicker.”

When this line is quoted to him, Carpenter gives a little laugh. His practice falls under the confidentiality laws that govern all state-licensed psychotherapists, so he does not have to tell the pastor the advice he gives clients. “That’s where the confidentiality is almost more of a favor to me,” he said.

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Language barriers

Mark R. McMinn, a professor of psychology at Wheaton College, a Christian school near Chicago, describes Christian psychologists as envoys from one culture to another. While psychologists are trained in the “language of sickness,” the church has always employed “a language of sin and grace.” Clinicians like Chapman are “biculturally trained,” straddling two traditionally hostile camps.

Family matters still top the list of subjects that divide pastors from psychologists, said McMinn, whose new book is titled “Why Sin Matters: The Surprising Relationship Between Our Sin and God’s Grace.” The heart of their dispute is the balance between personal happiness and community standards.

Divorce brings those differences into high relief. Extremely fundamentalist pastors have maintained that divorce is unacceptable even in cases where a woman is being physically abused, while secular therapists may use neutral phrases like “she has outgrown her marriage,” he says. Routinely, pastors and therapists reach an impasse on these issues.

“If you talk with pastors, they all have stories like this, where the faith of the client has been disrespected,” McMinn says. “It also goes the other way.... Many psychologists have chosen to write off all religious folks.”

Carpenter finds himself in the narrow middle ground.

A good example came about a month ago: The borderlines had begun to exhaust him with their threats of self-harm, and so he decided to attend a training session in Nashville staffed by secular psychologists. Sitting there, listening to colleagues describe how they handle the clinical bind, he felt a wave of deep relief.

But when he approached the speaker afterward, she seemed befuddled by the things he said. In a long conversation, she questioned whether the church was a safe atmosphere for a borderline patient. She was from Wisconsin, Carpenter noted; the South, he said, “is a different place.”

“I’m so used to speaking in church terms, in Christianese, that when I’m with professionals I have to be careful,” he says. “It’s literally like I’m speaking a different language to them. Where I would ordinarily talk about ‘transformation,’ with them I say ‘cognitive behavioral change.’ ”

It disturbs him to feel isolated in a gathering of fellow clinicians. But what has turned out to be more painful is the rejection by fellow Christians. He compares himself to St. Paul, who presented the Gospel to Jews and Greeks in wholly different terms.

From the beginning, friends reacted harshly to his decision to study psychology. They fell into two categories, he says: “passively or aggressively negative.”

“They’d tell me, ‘You need to question everything that they say.’ That’s the passive. Or they’d say, ‘You need to pray about that decision.’ That’s the aggressive.”

The very worst is family. Both he and Debbie come from conservative Christian families. Some relatives have never spoken to him about his psychotherapy practice, although they comment in sharp terms to each other behind his back. Some drill him at family reunions. Others quietly disapprove.

Others -- the most conservative of his relatives -- don’t know about it yet. If he’s too worried about their reaction, Carpenter just tells them he’s a pastor.