A theologically and scientifically engaged exploration of modern mental health care The current model of mental health care doesn’t see it sees sets of symptoms that need fixing. While modern psychiatry has improved many patients’ quality of life, it falls short in addressing their relational and spiritual needs. As a theologian and practicing psychiatrist, Warren Kinghorn shares a Christian vision of accompanying those facing mental health challenges. Kinghorn reviews the successes and limitations of modern mental health care before offering an alternative paradigm of healing. Based in the theology of Thomas Aquinas, this model of personhood affirms four We are known and loved by God. We are creatures made of earth who are formed in community. We are wayfarers on a journey. We are called not to control, but to wonder, love, praise, and rest. Drawing on theological wisdom and scientific evidence, Kinghorn reframes our understanding of mental health care from fixing machines to attending fellow wayfarers on the way to the Lord’s feast. With gentle guidance and practical suggestions, Wayfaring is an essential resource for pastors and practitioners as well as for Christians who seek mental health care.
“Do mental health problems sometimes result from problems outside a person – problems in relationships, communities, and cultures – that then show up on the inside of a person’s body, brain, and personality?” (84)
In Wayfaring (viatores in latin), mental health care is reframed through a Christian vision that resists reductionism. The author, Warren Kinghorn, argues that contemporary models of psychiatry too often treat the human being as a machine to be fixed, when in reality “the human is not a machine to be fixed but a wayfarer to be attended and accompanied” (218). Grounded in the wisdom of Aquinas (with a Thomistic flare), the book emphasizes centering persons rather than disorders (74). This vision insists that mental health is inseparable from spiritual, relational, and environmental conditions: “We are created from the ground, we live on the ground, and we are profoundly affected by the ground conditions in which we live. The health of our bodies – including our mental health – is deeply connected to what we eat, what we breathe, polluted and diseased. Sleep-deprived and information overloaded in a world of artificial light that extracts and distances us from natural rhythms of light and day, we grow weary, inattentive, and anxious” (68). Mental health struggles are not merely internal, private problems, but are deeply shaped by social realities such as community, culture, and environment. This is why the authors highlight how relationships are “not an optional add-on to human existence.” They are a “basic necessity for our growth and security as creatures of dust” (78).
Suffering is interpreted not merely as a problem to be solved but as part of the journey, one that calls for companionship, faith, and patience: “Trust the rest to God, knowing that perfect participation in blessing is not possible in this life. When things remain hard, when life doesn’t make sense and negative thoughts and emotions outweigh the positive, don’t give up. This is how the journey goes sometimes, and you are not alone. But when things seem to be going well, when you experience your life as satisfying and rich in meaning, accept this as a gift” (171). Suffering, the book argues, can even become fertile soil for virtues such as patience, perseverance, and courage. In this light, mental health challenges are not roadblocks to flourishing but often conditions of the pilgrimage itself.
This theological vision also carries implications for how research funding and institutional priorities are structured— the author slyly highlights evidence of overspending on the inside-out model of healthcare. His goal is not to point blame at any clinician or even organization, which is likely why this information is tucked away in a footnote. If anything, I believe he could have spent more time in this area and brought forth some more data points. For example, I found it fascinating that in the year 2021, “NIMH allocated $847 million for basic and brain science research…compared to $185 million for mental health services and intervention research” (90). Thomas Insel, the former director of NIMH from 2002 to 2015 says that now, he has “come to think of mental illness as a medical problem that requires a social solution…..the three P’s, not “Prozac, Paxil, Prolixin” nor “psychotherapy, psychoeducation, psychoanalysis,” but rather “people, place, and purpose” (91).
The book is attentive to clinicians as well (again there is no blame or guilt to be placed in regards to this issue), acknowledging their limits and even their shame when patients do not improve as expected. “Unfortunately, patients do not always get better – at least not in the ways that we predict” (121). Instead of chasing unrealistic control, clinicians are reminded that they too are fellow wayfarers, called to walk alongside others with humility and compassion. This model reflects the multi-dimensional example of Jesus himself. In a chapter focused on the Gerasene man, Kinghorn writes that “Jesus’ healing was broader and deeper than the way that healing is often understood in modern healthcare. It was medical, spiritual, political, or liberatory, and relational. Jesus refuses any reductionistic approach to healing and calls us to a wider view” (227).
Drawing together theology, philosophy, psychology, medicine and clinical insight, the book critiques the dominance of purely biomedical approaches in favor of an integrative, hopeful model. It offers a countercultural vision in which love, community, and spiritual depth are understood as central to mental health care, challenging the modern world’s obsession with productivity and efficiency. This book is, undeniably, well done -- it is organized, succinct, and follows clear logic, and I found the argument both convincing and perspective shifting.
For a more personal review of the book, I read this book not as a current clinician but as merely a human. I have yet to begin medical school! However, I read this book as someone currently in therapy for grief, ADHD, OCD, MDD, GAD, etc. etc. The acronyms abound and admittedly they have made me feel like a machine in need of fixing. I have felt as though my brain is broken, that the only solution was a bootstraps mentality where my symptoms must be treated and cured both with therapy and medication. Dr. Kinghorn changed the way I think about my diagnoses. I am not my mental illness. There is a medical, physical component of my condition, but the solution to my condition will require care from all perspectives – medical, spiritual, political, relational, social, etc.
From an inside-out view, I am being treated for certain symptoms. An inside-out view can, at worst, convince me that I am the problem. It has done this, especially at my lowest moments. I have definitely felt a certain amount of shame for the current state of my grief and depression. HOWEVER, from an outside-in view, I think one of Kinghorn’s footnotes (footnote 9 on page 158, to be exact) spoke to my external situation where I am capable of mental health but not well-being. It is not to the same degree of seriousness to which he was speaking in this case, but I am in a situation where my mental health is ultimately on the mend. Therapy and medication are having an impact, both mentally and chemically. However, unless I get out of my current living situation and find somewhere that I can call home, I will not have well-being. Being able to put words to my current situation has been extremely eye-opening. I have learned a lot from this book, and it is exactly the kind of work I hope, one day, I will be capable of in whatever field of medicine I choose for my specialization.
“Both the inside-out view and the outside-in view are valid ways of understanding mental health problems. The inside-out view, however, dominates modern mental health care, overshadowing other ways of thinking” (84).
Here are all of the other quotes that I pulled out as “significant” from the Great Books pedagogy I was taught. They are not really in order, so, sorry, but get over it:
“There are times when it is useful, for a time and in a certain context, to frame symptoms as separate from the self, illness as lodged in the body, and medications and other technologies as ways to reduce symptoms. But it is dangerous for the machine metaphor to be made synonymous with care” (257)
When the two disciples’ eyes needed to be opened, “it happened because Jesus continued to walk with them, carefully and patiently talking with them about things that he would have already expected them to know. It happened because they invited him not just to walk with them but to stay (remain, abide) with them for the evening” (252)
“The contemplative life emphatically proclaims that a culture that values productivity, efficiency, and consumption above all else is ultimately self-consuming and does not have the last word. There is a “more” to our existence, beyond our productive labor. And this “more” has to do with the fact that above all, God is love, and that love, not productivity, is the most powerful force in the cosmos” (238)
“Mental health problems can be sites of blessing as well as challenge, fertile soil from which tenacious and deeply rooted virtues can grow. They are not so much constraints on the journey as possible conditions of the journey” (218)
“I have observed that people will do the best they can which what they have learned in order to get what they think they need in any given situation “ (218)
“The seven gifts of the Spirit – understanding, counsel, wisdom, knowledge, piety, fortitude, and fear – are dispositions given by God and infused by God into the soul that enable the soul to respond to the prompting of the Holy Spirit” (215)
“The effect of God’s love is to make us deeper and better lovers – the kind of lover that God is” (214)
On the Gerasene Man: “Jesus’ healing was broader and deeper than the way that healing is often understood in modern healthcare. It was medical, spiritual, political, or liberature, and relational. Jesus refuses any reductionistic approch to healing and calls us to a wider view” (227).
“The only way out of PTSD is to navigate through the post-traumatic memories, through some version of establishing safe ways to cope with intensely negative memories, remembering the felt experience of trauma, processing these experiences, and then finding new sources of life and connection” (207)
“Held in Jesus’s life, faith, hope, and love become possibilities that are attainable, though not by our own effort. We are able to display them only because God has adopted us as God’s children” (151)
“As we draw closer to Christ and therefore participate more fully in the life of the triune God, the image does not increase in us, but the glory of Christ’s life does” (143).
“If the image of God is associated with human dignity, it follows that people may be subjugated and mistreated who do not display these attributes or who in the light of histories of marginalization and exploitation are not thought to display these attributes. Indeed, mistreatment and oppression of women, colonized populations, people with disabilities (including in the thought of Adolf Hitler), and of Black Americans during and after the time of enslavement have often been correlated with claims that in some way these people fail to display capacities that are associated with God’s image…..attributing human dignity to capacities always places humans who do not display these capacities at risk of exclusion and dehumanization” (140)
On the shame of clinicians: “Unfortunately, patients do not always get better – at least not in the ways that we predict. Treatments do not always work. Patients and family members do not always like us” (121).
“Relationships are not an optional add-on to human existence. It is a basic necessity for our growth and security as creatures of dust” (78)
On Aquinas, specifically Aquinas’ difference between contemplation, meditation, and cogitation: “contemplation is the soul’s clear and free dwelling upon the object of its gaze; meditation is the survey of the mind while occupied in searching for the truth; and cogitation is the mind’s glance which is prone to wander” (240)
“Aquinas agreed with Aristotle that what we do shapes who we become: we become just by the doing of just actions, courageous by doing brave things, temperate by caring rightly for ourselves in the face of temptation, and so on. Virtue therefore requires action, and the active life is the seedbed and field of the moral virtues” (236)
“Aquinas would caution against pursuing short-term pleasures – whether academic or professional success, alcohol, exercise, sex, or relationships – that may be distracting from what is truly life-giving (luxuria). Second, Aquinas would encourage those with depression to examine their lives, preferably in relationship with wise counselors, to discern whether they might be stuck in ruts of joyless daily practice (acedia) and how to persevere in pursuit of what is good. Third, Aquinas would want clinicians and patients alike to be realistic about the external evils that are causing sorrow that leads to the experience of hopelessness” (213)
“While God alone can give these virtues, Aquinas holds that human interactions and relationships may be means that God uses. God may give faith, for example, by sending preachers” (212)
“And he [Aquinas] considers two virtues of pursuit that each require God’s grace and yet are central for living with mental health challenges: patience, the virtue of holding to what is good even in the face of sorrow caused especially by evils perpetrated on us; and perseverance, the virtue of staying with a difficult, good task even when it is hard and we want to give up” (207)
“Aquinas distinguishes the virtues of acting into three broad categories: virtues of relationship, of which the overarching virtue is justice; virtues of pursuit, of which the overarching virtue is courage; and virtues of self-regulation, of which the otherarching virtue is temperance” (203)
“Aquinas emphasizes that prudence requires a wholehearted open stance towards life as it is. Prudence, for example, entails the ability to remember the past while also being open to the present and attentive to the future; and openness to being taught; the ability to grasp subtle connections; and mindful awareness of one’s present context” (202)
“He [Aquinas] encourages us to interpret emotions as signs of whom or what we love – not only bodily feelings but also engagements with the world. Anxiety, depression, PTSD, cravings for addicting substances, cravings and aversions associated with disordered eating – all of these experiences are at least in part reflections of what, in the present, is loved, and there is much to learn from the exercise of tracing these loves to their source” (194)
“In Aquinas’s view, the living body is also attuned. Fearfully and wonderfully made, the body is not a machine and is vastly more complex than a Boy Scout compass. But informed by the soul, it is capable of aligning not with the earth’s magnetic field but with God, the object of its fulfillment, and with God’s ratio, God’s provincial ordering of the world” (176).
“God alone, that is, is the ultimate good capable of so satisfying human longing that there is nothing left to be desired. All other goods – including wealth, honor, fame, glory, physical health, mental health, positive emotion, pleasure, and anything else – are good insofar as they participate in God’s goodness. All of these things are good when properly oriented to God, but none of them is the highest good that is capable of grounding and constituting beatitudo. In Aquinas’s account, only God can do that” (164).
“The biblical wisdom literature celebrates the goodness of the quotidien, the joy of everyday, routine life before God, without assuming that this quotidian life should be denigrated in favor of some higher degree of actualization….there is deep grace in taking joy in being a caregiver, a friend, a spouse, a couch, a teacher, an encourager, a gardener, or any other good form of life. But Aquinas warns us that if any of these things are pursued for their own sake, as if the happiness of our lives depends on them, then sooner or later we will end up disappointed” (162).
“How is this person able to move toward the goals that help them to realize their potential? Aquinas���s embrace of final causation (or teleology, the study of a being’s telos or end) challenges modern reductionism, because it suggests that we can’t really understand a thing unless we understand the end towards which it is directed, either by its natural properties (as with inanimate objects), by natural properties and instinct (as with animals), or by natural properties, instinct, and free will (as with human beings)” (76).
“Aquinas holds that unlike rocks, living organisms are equipped with intrinsic tendencies to actualize their own fulfillment” (73).
A deeply thoughtful work approaching modern mental health care with a distinctively Christian lens. Not only is the premised critique of the machine metaphor in modern psychiatry juxtaposed with seeing patients as complex, embodied wayfarers on their journey towards wholeness and Christ a masterful one drawn from Thomas Aquinas and Christian traditions affirming individuals' dignity and belovedness, each individual chapter tangentially deepens this insight in their own unique discussions. I particularly took away much from the chapter on control to wonder.
This book is invaluable to those attending at the intersection of faith and mental health, carefully approaching it with deep love. It reflects the character in the professor I've seen in Dr. Kinghorn as a student, as well as the largely scholarly yet accessible language he employs.
🤯 Frames the soul in seamless unity with the body and mind, and unpacks embodiment and nonduality in a way that actually matches how life feels.
Recognizes that our burdens come not only from within but from the world pressing in on us. This book affirms that our suffering isn’t just biological or mechanical but shaped by the world we live in, why we are here, and our spiritual direction.