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With our "No pastoral advice" policy, we usually see these kinds of questions quickly, close them, and urge the user to find help in the real world from a real and trusted spiritual adviser. I greatly applaud our steadfast holding to this policy.

Not wanting to tromp on this wise and sound policy, I have a concern.

Recently, we've received a few questions that may indicate the asker is suffering from a medical condition. In this particular example, the asker claims to see and hear dead people and is not necessarily concerned with the fact that they may be hallucinations and not real, and much more so concerned with whether this is okay for a Christian to engage in. Hence, they asked a pastoral advice question. But I shudder at the suggestion that we'd send them to a pastor when they may very well need a doctor!

In light of obvious medical implications, I believe we should strongly urge the asker to see a doctor first, then a spiritual adviser. The possibility of real medical conditions seem to me to be a far more immediate issue for the safety and health of the asker.

And of course, we are not doctors! Therefore, the advice ends with "Go see a doctor."

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    Part of me agrees with you. But part of me says that recommending a doctor, particularly to only some of the people asking for advice, is saying one thing. Are we equipped to make that determination? Wouldn't a spiritual adviser, meeting in person, be more equipped to judge if medical help is necessary? – Nathaniel is protesting Jul 28 '16 at 21:18
  • @Nathaniel I think it's obvious that you should consult a doctor if you see and hear things that others can't. We know as a scientific fact that hallucinations exist; it's common knowledge. If they said they were seeing purple unicorns and waffle houses instead of something religious, you'd quickly agree, I think. In the least, it will rule out a medical cause. In the worst, they hurt themselves or someone else because whatever it is, it went untreated. This is one thing that we cause little harm by saying, but can cause much harm by not saying. – 3961 Jul 28 '16 at 21:43
  • That's fair. I imagine that a good answer to this question will have to deal with the inevitable difficulty of who needs to be told that they should see a doctor. Just people who apparently see hallucinations? Or everyone, including a spouse asking for marriage advice? – Nathaniel is protesting Jul 29 '16 at 2:00
  • @Nathaniel I feel like it will be obvious when those occasions arise. Need for marriage advise doesn't usually imply someone may have a medical condition. – 3961 Jul 29 '16 at 4:20
  • @Nathaniel On marriage advice, I don't really forsee suggesting a doctor in any circumstance. Maybe things like "uncontrollably violent", or "can't remember anything" indicate uses, but the context of the question tells us, not individual phrases. I'm just trying to point out that legitimate medical issues are more immediate concerns than spiritual ones. We should embrace this fact and suggest doctors when warranted. – 3961 Jul 31 '16 at 17:18
  • I agree that medical advice in such situations is normally unecessary.. My concern echos that of those answering – when is it "warranted," and who decides? You may believe alcoholism is a disease, while someone else doesn't. Or that some particular mental issue is a disease, while someone else thinks it's a demon. I'm concerned that there's no clear line when to recommend a doctor and when not to. – Nathaniel is protesting Jul 31 '16 at 17:27
  • I believe the situations are self evident, as it was with the seeing dead people question. I'm advocating we say "You should see a doctor to rule out any medical conditions, then see a pastor." The reason we have the no pastoral advice policy is to prevent harm (unintentionally giving harmful advice). Suggesting a doctor surely will cause no harm, but neglecting it may. – 3961 Jul 31 '16 at 19:07
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    I don't even agree that "seeing things that others don't see" is a clear sign of a medical problem, as opposed to a spiritual problem. The Bible is full of stories of people who saw things that others didn't see. Jesus' biological mother and adopted father come to mind as prime examples. So I don't agree with your criteria--but even if I did, there are others who don't, which means this proposal is based on a premise which violates the site's own definition of "Truth". – Flimzy Jul 31 '16 at 20:20
  • If, for example, a Catholic claims in a question on this website to be seeing Marian apparitions, they might be hallucinating or they might be seeing visions. I'm not willing to assign a probability to either without in person evidence. Referral to a doctor will almost certainly deal with only the first possibility, whereas referral to a Catholic priest would evaluate both. – Matt Gutting Jul 31 '16 at 21:37
  • @Flimzy We know hallucinations exist as a scientific fact. We also know they can be extremely dangerous. Seeing things others can't is an hallucination whether occurring entirely in the brain or actually being external. I never denied spiritual implications as a reality. I denied that those concerns are more immediate than health concerns. Even Elijah was offered bread and water multiple times before God would speak to him. – 3961 Aug 1 '16 at 0:30
  • @Matt I'm not suggesting either-or. I'm suggesting both. – 3961 Aug 1 '16 at 1:13
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    And I'm suggesting that we can't say both without saying both in all pastoral advice situations, including "should I marry someone of denomination X?" I don't think that the cases in which medical attention is not required are at all clear. – Matt Gutting Aug 1 '16 at 1:16
  • @Matt If that's what it'll take for you all to be on board with this, the pastoral advice meta past should include a section on medical concerns. – 3961 Aug 1 '16 at 3:59
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    That's not unreasonable. Sure. I don't know how is come up with a good section though. – Matt Gutting Aug 1 '16 at 4:18
  • christianity.stackexchange.com/questions/52025/… This new question for example the op should be directed to a doctor for depression – Kris Aug 4 '16 at 14:20
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I'm going to disagree with this — not because I think you are wrong about many problems needing medical attention but because I think it's better to grab the stick from the side the people with the issue think their problem is on and redirect from there than it is to try to diagnose issues online.

People that end up on this site that clearly need personal help at least think their issues are spiritual. That's why they asked a question here in the first place and not on Health.SE. I have years of experience as both a pastor and an EMT (including at the same time) and have seen my fair share of people with assorted issues. I would say more often than not people don't fall neatly into one box or the other and need help from both directions. I've also seen a few cases where people start at what is clearly the wrong end of the stick. I've dealt with people who showed up at church bleeding from an accident or having ingested poison—these people need to be punted to medical attention immediately. I've also seen people with purely spiritual issues trying to seek help in the medical system.

Given the two scenarios, if there is any doubt what the issue is, I think people are more likely to end up with the right help in the long run if they start with a local church than they are a doctor. A good qualified pastor is more likely to know when to get somebody medical attention —and more likely to walk with them through the process— than a doctor is going to refer somebody to qualified spiritual help and walk them through their struggles.

Exceptions exist. Thankfully some doctors are wise enough to point people to the real source of their problems instead of just discharging them and sadly many pastors refuse to acknowledge physical ailments or that medical attention can in some cases set people up for healthier spiritual lives. But on the whole —and remembering what the subject matter is that brought people to this site in the first place— I think the best place to direct people is a trustworthy pastor who can be hands-on through the process of getting people the help they need. Unless the question is "I cut my hand off and am bleeding out, what should I do?", I think our go-to response should be in the direction of local churches.

  • I honestly believe that most pastors won't refer them to a doctor, assuming the situation is entirely spiritual. They will wait until something bad happens. I think we should at least seed the idea in their head that it may be a medical issue. – 3961 Jul 29 '16 at 16:09
  • I strongly disagree that this is Less likely to happen with pastors than with doctors. – Matt Gutting Jul 31 '16 at 1:03
  • @Matt What are you saying exactly? Are you saying that you disagree with Caleb or me? – 3961 Jul 31 '16 at 16:53
  • Of the pastors I've known, they'd suggest all kinds of stuff not medical, very likely delaying medical checkup. If medicine is mentioned, it's like an afterthought. It's already an afterthought to the asker, so why should we neglect this suggestion based on the assumption that a hypothetical pastor will act appropriately, and the assumption the asker will even seek them out in the first place? Truly, what is the harm here? – 3961 Jul 31 '16 at 17:25
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    @fredsbend You are claiming a pastor will reject nonspiritual causes or solutions and that this is a bad thing, resulting in further physical injury. One could also argue that a doctor will reject spiritual causes or solutions, leading to causing physical problems that weren't there ( trying to medicate a spiritual problem). I think a balance between the two is best and most pastors I know would agree, as well as most Christian counseling material I've read. So Caleb's solution of starting where the person thinks their problem is (spiritual) seems best. – Joshua Aug 22 '16 at 14:03
  • @fredsbend would you be equally worried about referring people posting about being unhappy and having feelings of guilt to a doctor rather than a pastor on a medical SE? Your answer to that may reveal some foundational suppositions that no one here is qualified to judge between. So let's stick to our own SE's realm. – Joshua Aug 22 '16 at 14:06
  • @Joshua I never once suggested either/or. It's everyone else here insisting that we don't even mention the possibility to the asker that they might need a doctor. I suggested we do both. – 3961 Aug 22 '16 at 15:10
  • @fredsbend You said "In light of obvious medical implications, I believe we should strongly urge the asker to see a doctor first, then a spiritual adviser." That is clearly placing one before the other. How and who decides what is obvious is the problem. If you simply want "doctor" to be included in the list of professionals as a truly equal possible "or" then I am confused by the purpose of your question since it already is in the accepted answer to the main meta on this topic. – Joshua Aug 22 '16 at 15:49
  • @Joshua I only think doctors should be stressed when a possible medical condition is a dangerous one. Hallucinations are extremely dangerous. People have harmed themselves and others because of hallucinations. – 3961 Aug 22 '16 at 15:54
  • This is beating a dead horse. No one here agrees with me even in the slightest, so I think we can just call this a dead proposal. I'm ready to move on. – 3961 Aug 22 '16 at 16:32
  • @Joshua that's interesting that the post already says refer them to doctors Etc. In that case I'll just keep doing what I've always done. On the last question I just commented and strongly urged them to see a doctor. But in light of the response here everyone seems to think that was wrong. Well they can just delete my comment, then at least my conscience would be clear. – 3961 Aug 22 '16 at 16:36
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I think referring people to pastors is better.

Here's why:

  • If we trust a random "local, trusted pastor" to help a person with spiritual problems, we should just as well trust the same pastor to refer the person to a doctor.
  • Suggesting to someone on the Internet that their problem is medical or psychological, rather than spiritual (which they believe) is a good way to turn them off entirely from listening to you. If what we really want is them to seek help, the best way is to get someone they trust to recommend medical/psychological help. This leads back to suggesting they seek out a trusted pastor or counselor.
  • I honestly believe that most pastors won't refer them to a doctor, assuming the situation is entirely spiritual. They will wait until something bad happens. I think we should at least seed the idea in their head that it may be a medical issue. – 3961 Jul 29 '16 at 16:08
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    If we have such a low opinion of pastors, neither should we refer people with spiritual issues to pastors. – Flimzy Jul 29 '16 at 20:12
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    Incidentally, I've honestly never had or met a pastor as incompetent as you suggest most are. I'm sure such incompetence does exist, but in my experience, it's not as rampant as you suggest. – Flimzy Jul 29 '16 at 20:15
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    Perhaps most important, why do you think a trained pastor would be less able to refer someone to a doctor, after a personal interview, than random strangers on the Internet? Forget pastors... Any random idiot in person is better qualified than we random strangers on the Internet, to make the proper referral. – Flimzy Jul 29 '16 at 20:17
  • It's not that I think pastors are morons. I just think they have a serious confirmation bias. They'll want to see spiritual implications before medical implications. They'll want to search that out first before ruling out medical issues. And during that time, the person may be going untreated for what is sometimes a dangerous condition. – 3961 Jul 29 '16 at 20:22
  • Likewise, doctors have a confirmation bias to see medical issues, but the threat to self and others if you are hallucinating is more immediate than any spiritual issues you may be having. Therefore, I suggest doctor first, then pastor. – 3961 Jul 29 '16 at 20:23
  • And of course, the ethos of the "No advice policy" is to prevent harm. Bad advice can be detrimentally harmful. So, to convince me, you'd have to argue there's more chance at detrimental harm by suggesting a doctor, than there is by not suggesting a doctor. – 3961 Jul 29 '16 at 20:25
  • You'd have to convince me that suggesting a doctor first, then a pastor is "bad advice". – 3961 Jul 29 '16 at 20:28
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    @fredsbend: If you think pastors have confirmation bias, wait until you meet a doctor. There's a much higher percentage of atheist doctors, who would never refer a patient to a spiritual adviser, than there are pastors who think everything is caused by a spiritual ailment. I really fail to even begin to understand our reasoning. – Flimzy Jul 30 '16 at 12:19
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    Do you have enough evidence to allow an unbiased judgment on the relative occurrence of confirmation bias in pastors vs that in medical professionals? My feeling is that, unless the asker is already inclined to consider their problem at least partly medical in origin, referring them to a doctor as well, or instead, is making something closer to a medical diagnosis than I feel comfortable with doing on line. – Matt Gutting Jul 31 '16 at 0:59
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    @MattGutting: If we want to include 'doctors' in our referral statements, we need to include them in every referral statement. If someone asks "Should I marry someone of another faith?" should we refer them to a doctor? I'd say clearly not. Therefore, we should not include it ever, otherwise it violates the can I say one thing principle. – Flimzy Jul 31 '16 at 10:14
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    To me, the common sense obvious answer is "Don't give medical advice over the Internet." And the proposal here amounts to doing just that. – Flimzy Jul 31 '16 at 20:15
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    @fredsbend: I've heard the suggestion that it could cause harm from at least two people (myself and Caleb). If you need it spelled out more clearly: Referring those who need medical help to pastors will still get their medical needs met in the vast majority of cases, as most pastors will refer them appropriately. Referring those who need spiritual help to doctors will not get their needs met in the vast majority of cases. That's called harm. – Flimzy Jul 31 '16 at 20:17
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    If the person had a trusted pastor they likley would not be scouring the web looking for advice. The "voices in the head" symptom is too be taken very seriously. So standard reply should perhaps encourage both medical and pastoral help for such a problem – Kris Aug 1 '16 at 17:47
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    @flimzy that's rather arrogant and dismissive. – Kris Aug 2 '16 at 14:53
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By the time someone appears on our site asking a question like this it is very likely that their friends and family have already expressed concern and told them to get medical help. If the OP won't listen to them then they certainly won't listen to us, but there is the slightest chance they might listen to a spiritual adviser they trust.

Yes they might turn to a spiritual adviser who does not help, but I think that chance is outweighed by the chance of them seeking some help rather than no help at all.

  • "By the time someone appears on our site asking a question like this it is very likely that their friends and family have already expressed concern and told them to get medical help." I don't think that's a valid assumption. In fact, the fact they're turning to the internet is evidence that they aren't receiving help in real life at all, or at least haven't begun to seek it out yet. – 3961 Jul 29 '16 at 22:32
  • "Yes they might turn to a spiritual adviser who does not help, but I think that chance is outweighed by the chance of them seeking some help rather than no help at all." That's an interesting point, but is it hinged on your previous (possibly erroneous) assumption? – 3961 Jul 29 '16 at 22:34

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