Diagnose before You Treat

I worked as a physical therapist for 10 years, and so I still get asked today, “What exercises can I do to help my back pain?” It’s a troubling question. I wish I could suggest a few back bends or stretches to make their pain go away. Instead, my answer always disappoints them. “I can’t say what treatment plan will help unless I know your diagnosis first.” They probably think to themselves, No wonder he doesn’t practice physical therapy anymore. He can’t help anyone!

The reality is that it’s very difficult to solve back pain unless you know what’s causing it. It could be a muscle, a bone, a nerve, a ligament, a disc, or a combination of them. Even if you know, for example, that the pain is caused by a disc pinching a nerve, you still can’t know which direction to move your back to reduce the pain. Extension exercises might alleviate the pain, or they might aggravate it. It all depends on the type and location of the problem. That’s why I can’t offer a treatment plan unless a doctor (or someone else) provides a diagnosis. That was the procedure when I worked at the hospital.

It’s equally challenging to help someone who asks me, “What should I say to my non-Christian friend who refuses to believe in Christianity?” Again, that’s a tough question. I need to have a “diagnosis” before I can provide a “treatment.” I can’t offer something to say until I have more information about their unbelief. What are they thinking? Are they raising objections, and if so, what are they? Are they angry with Christians? Did they grow up with a religious background? If so, what happened? There’s a lot to be explored before one can know how to respond.

John Coe, director of the Institute of Spiritual Formation at Biola University, provides a helpful distinction. He says there are reasons for unbelief and causes for unbelief. Reasons for unbelief are intellectual objections. For example, one might claim there’s no evidence for God, that miracles are impossible, that the Bible is wrong about sexuality, or that the soul doesn’t exist. These objections can be genuine obstacles to the gospel and can be addressed by apologetics.

But there can also be causes for unbelief, which are based in emotional thinking. When emotion is driving the will, reason can take a back seat. This type of unbelief can be a greater or more complex obstacle to the gospel than an intellectual objection. Often, causes of unbelief stem from dysfunctional relationships, childhood experiences, betrayal by a loved one, or other traumatic emotional events. Attempting to address a cause for unbelief by treating it as a reason for unbelief will fail.

I remember attending California State University in Long Beach and talking to a student who was unwilling to follow Christ. I asked her to read an apologetics book with me. After we read and discussed each chapter together, I asked what her position was on the central tenets of Christianity: God, Jesus, the resurrection, etc. Her answers all sounded great. God? He exists. Jesus? He’s the son of God. The resurrection? It happened. Soul? We have one. Great, I thought, She must be ready to trust Christ! “Absolutely not,” she replied. I was confused. Why wouldn’t she follow Jesus? All her intellectual questions had been answered.

While it’s true she didn’t have reasons for unbelief, it turned out she had causes for unbelief. She was in an illicit sexual relationship she didn’t want to give up, she was doing drugs with her friends, and she was drinking heavily on the weekends. She was living life for herself, and it felt good to be in control. Why would she want to give up all that “fun?” Addressing her intellectual questions about Christianity didn’t move her closer to God because that wasn’t what was holding her back. She was emotionally addicted to the vices in her life and her belief that she controlled it all. Had I been mindful of the distinction between reasons and causes for unbelief, I may have been more productive.

That’s why you need to diagnose before you treat. Before we can offer advice to someone struggling with what to say to a non-Christian friend, we need to understand what’s going on in their life. Is there a reason for unbelief or a cause for unbelief? The best way to understand that about a person is to start with a loving and trustful relationship. Then be intentional about spending time with them, asking them questions, and learning about their life. Francis Schaeffer once noted, “If I have only an hour with someone, I will spend the first 55 minutes asking questions and finding out what is troubling their heart and mind, and then in the last 5 minutes I will share something of the truth.” Notice Schaeffer’s order and emphasis. First, he takes (a lot of) time to diagnose. He asks questions and finds out what is troubling their heart and mind. Then he can offer a treatment. He can say something significant that will help them only because he’s taken the time to know them and understand their unbelief.

Whether you’re involved in healthcare or spiritual care, you need to diagnose before you treat. I often suggest to people who have a friend that is reluctant to become a Christian to begin by spending an evening with them at a coffee shop. Sit down and ask them questions, listen to them unfold the story of their life, and find out what is troubling their heart and mind. Don’t plan to respond that evening. Your only motive should be to understand them. Finally, pray and ask God to help you discover their diagnosis. Then you can know the treatment plan and how the Great Physician can provide healing.

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Alan Shlemon

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