Wayfaring: A Christian Approach to Mental Health Care
In his work Wayfaring: A Christian Approach to Mental Health Care, Warren Kinghorn explores a non-mechanistic approach to the understanding and treatment of mental illness, framing this view within a Thomistic account1 that explores transformation in the midst of suffering rather than human symptoms as problems to be fixed. Advancing his argument within a psychiatric perspective, Kinghorn critiques the epidemiological approach to understanding mental health care, which tends to underutilize narratives, case studies, and qualitative research. While Kinghorn’s critique of the “machine” metaphor in the psychological sciences is well-founded, it does not offer a complete view of contemporary trends, which have favored narrative psychiatry, with an ever-expanding interest in mixed methods research and qualitative design being shown in many academic psychological works. Likewise, it was surprising to see the omission of the work of Donald E. Polkinghorne, whose 1988 publication Narrative Knowing and the Human Sciences spurred a range of counter-movements in empirical psychological work.2
Nevertheless, Kinghorn’s critique of mental health care and research resonates well with the reader, revealing some of the problems associated with a technological approach to clinical work, which prizes not only the dissection that the author refers to in psychiatric diagnosis (which is philosophically paralleled in psychological assessment), but also the commodification of certifications that offer a convoluted suffix to the professional degree for many master’s prepared counselors. Such mechanistic affordances imply not only that psychotherapeutic techniques can be mastered, a dubious claim for a truly dynamic interpersonal matrix, but also that the counselor is a technician, rather than a fellow human being engaged in an existential quest that reflects the human condition.
Kinghorn frames mental health care within the metaphor of human being as wayfarer, or pilgrim in need of fortification and community in the midst of a powerful epic journey. This notion is meaningfully supported by the critique of modern mental health care, with awareness of the great loss of milieu services that were once flourishing during the social psychiatry of the 1960s.3 It is felt that Kinghorn could have spent more time exploring this period in psychiatric history in his account, for it seems more like a footnote to the central message. The author acknowledges that social psychiatry was diminished by reductions in public financial support, among many other factors worthy of deeper analysis. Although not a primary feature of Kinghorn’s argument, the devolution of mid-century social psychiatry was impacted by widespread usage of first-generation antipsychotic medications (and possibly excessive optimism regarding biological mechanism as an account of mental illness).
Wayfaring offers a complex and meaningful engagement with the work of Aquinas, focusing the reader’s attention on beatitudo as “participation in blessing,” with awareness of the “expansive vision of the soul’s rest in God” (22). The work of Aquinas is explored in terms of the passions; the active and contemplative life; the movement towards wonder, feast, and sabbath rest; and explorations of mind and knowledge. A potent feature of the book is the careful analysis of various perspectives of mind and body, dualism, and internal versus external constructions of mental illness. Kinghorn concludes that it is problematic to exclusively situate mental illness as essentially internal, for it resides in “forms of social, cultural, interpersonal, relational brokenness in the lived experience of an embodied creature” (107). However, this argument is well-aligned with longstanding and accepted views in developmental psychology of nature-nurture interactionism, epigenetic processes, and multi-directional, multi-trait dynamism.
The reader will likely appreciate Kinghorn’s attributional complexity; unlike some attempts to bring Christianity into dialogue with psychology, this work ascends well above the reductive dichotomies sometimes found in biblical counseling approaches. In contrast, this book offers a sophisticated analysis that considers many vantage points, offers synthesis in novel ways, and reveals the careful scholarship of a masterful thinker. Kinghorn critiques the conceptual weaknesses and harmful outcomes that spring from views of mental health that rest on a foundation of individualism, dualism, internalism, technicianism, or mechanism (110).
The account highlights the shame-reducing experience of being divinely known and loved; relationship as fundamental to mental health (111); the permeability of the self-system towards the environment (131); and Christ as the source of reconciliation (148). Kinghorn is wise to critique capacity-based accounts of the Imago Dei, applying the union with Christ in his understanding of love as the center of existence, for “your life is hidden with Christ in God” (Colossians 3:3; see 144, 152). The sense of being aware of communion with God, in the midst of suffering and loneliness, is offered not as a solution to the symptoms of mental illness, but rather as a way to navigate and persist on a journey that is often precarious, stigmatizing, terrifying, and lonely. Mental illness is recognized as an experience that has been labeled in a culture, rather than as a fundamental identifier or essentializing quality. In this way, Kinghorn speaks by implication into contemporary debates about the Possible Selves Theory,4 without addressing it directly. One might hope that he took this on more directly in exploring identity as related to his portrayal of God’s love as the ground of not only existence, but also loving awareness of the self.
In considering a Thomistic account of human flourishing, Kinghorn examines a view of freedom that extends beyond the definition of non-restraint; rather, such liberty involves the capacity for moving towards a teleology of the good (166, 169, 170). Embodied love is examined within the context of preparation for the wayfarer, which includes the guides of intellect, senses, agency, freedom, affections, and instincts (172, 177, 179). To be embodied is to exist as a sign of divine love, which stimulates delight (183–184). To engage in the practice of shaping one’s orientation (mind, emotions) towards the good, rather than the pursuit of the latest technology, offers a form of training that yields greater actualization, although not necessarily relief.
In recounting a Thomistic view of the movement towards freedom, virtue is examined in a range of manifestations and origins. These virtues can be related to action, pursuit, morality, or relationship (203–206), and there is recognition that some habits are divine gifts (212). Habits are examined as stable dispositions, with emotions representing the embodiment of love (196–197). The flourishing human will experience wonder, drawing attention towards the contemplative life (242) as one moves from “an economy of control” (249). Presenting Caravaggio’s painting Supper at Emmaus5 as a model for a eucharistic “knowledge-in-relation,” (254), which facilitates interpersonal communion, Kinghorn concludes his work with awareness that the destination is not the pilgrimage itself ( 252). Rather, the view espoused by Aquinas offers that the goal is to participate in the divine and eternal vision as a comprehensor rather than a wayfarer. For mental health care, this also implies attending to personhood rather than solutions, keeping a present-focused awareness of client needs, and pursuing the feast.
In sum, Kinghorn offers a stimulating integration of Thomistic theology with a broad-based understanding of psychiatry and psychological research and treatment, which is well-grounded in case study illustrations that are appropriate for the underlying narrative leaning. In some cases, there could be more tribute made to the many non-mechanistic revolutions in the field, as well as more dynamic views that incorporate some of the benefits of atomism for scientific progression. On the one hand, biogenic explanations are showing resurgence in mainstream views of mental illness in industrialized settings. Haslam and Kavaale point out that, while such etiological views precede a reduction in stigma, they can also prompt avoidance and views of mental illness as intractable and dangerous.6 A scoping review published in 2024 revealed not necessarily the primacy of mechanistic models, but rather a diversity of explanatory narratives inside of academic publications, with illness metaphors being common, but alternatives such as folk psychiatry, psychosocial explanations, and representational models also being prevalent.7 Furthermore, Kendler has argued for dynamic and iterative processes in understanding the interaction between biology and the mind, with awareness of the limitations of accounts that fail to consider both internal and external moderators.8 Although Kinghorn may favor his more selective critique of mental health research and treatment to yield support for his central arguments for the need for an alternative view, this limitation in scope is redeemed by his outstanding and deep work from primary source documents with Aquinas and others. By keeping the focus narrow, the support for his argument is self-evident. While I would have appreciated more discussion of the contributions of Maslow, Jung, Fromm, contemporary psychoanalysis, Carl Rogers, and the Gestalt revolution, because that would offer more acknowledgement to the long trajectory of non-mechanism, I found Wayfaring to be deeply engaging and reflective. I will return many times to this work as a resource, showing close attention to the sections on mind-body and internal-external dimensions of human experience
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Footnotes
- Kinghorn draws from a range of primary source documents from Thomas Aquinas, including the Summa Theologiae, his commentary on the Gospel of John, and collections of his prayers.
- Donald E. Polkinghorne, Narrative Knowing and the Human Sciences (State University of New York Press, 1988).
- Particularly notable is the development of milieu treatment based on the work of Daniel J. Levinson and his contemporaries. See Fred Pine and Daniel J. Levinson, “A sociopsychological conception of patienthood,” International Journal of Social Psychiatry 7, no. 2 (1961): 106–122; Daniel J. Levinson and Gerald L. Klerman, “The clinician-executive: some problematic issues for the psychiatrist in mental health organizations,” Psychiatry 30, no. 1 (1967): 3–15; R. Almond, K. Keniston, and S. Boltax, “Milieu therapeutic process,” Archives of General Psychiatry, 21, no. 4 (1969): 431–442; Gerald L. Klerman, “Assessing the influence of the hospital milieu upon the effectiveness of psychiatric drug therapy: Problems of conceptualization and of research methodology,” The Journal of Nervous and Mental Disease 137, no. 2 (1963): 143–154.
- See Hazel Markus and Paula Nurius, “Possible selves,” American Psychologist 41, no. 9 (1986): 954.
- Caravaggio, Supper at Emmaus, 1601, oil on canvas, 56 x 77.2 in (141 x 196.2 cm), The National Gallery, London, inventory no. NG172, https://www.nationalgallery.org.uk/paintings/michelangelo-merisi-da-caravaggio-the-supper-at-emmaus.
- See Nick Haslam and Erlend P. Kvaale, “Biogenetic explanations of mental disorder: The mixed-blessings model,” Current Directions in Psychological Science 24, no. 5 (2015): 399–404.
- Isaac L. Ahuvia, Ian Sotomayor, Kelly Kwong, Fiona W. Lam, Aqsa Mirza, and Jessica L. Schleider, “Causal beliefs about mental illness: A scoping review,” Social Science & Medicine (2024): 116670.
- Kenneth S. Kendler, “Explanatory models for psychiatric illness,” American Journal of Psychiatry 165, no. 6 (2008): 695–702.
