THERE BUT FOR THE GRACE OF GOD

A recent episode of the Unbelievable? podcast features a frank and respectful discussion between two psychiatrists and colleagues, Dr. Claire Brickell and Dr. Brandon Unruh, both of whom specialize in treatment of severe personality disorders such as Narcissistic Personality Disorder (NPD) and Borderline Personality Disorder (BPD). Dr. Brickell is a secular materialist who sees no need or room for God in life or therapy; Dr. Unruh is a Christian who brings that worldview to his therapy, not necessarily overtly, but as the foundation of his own understanding of meaning and health. Theirs is an interesting collaboration and it is an interesting conversation.

At one point the discussion turned to the humility of recognizing that the patient-doctor roles could have easily been reversed, that the doctor might well have been the one suffering from a mental health issue. The following dialogue is from the podcast transcript. It begins with Dr. Unruh, who introduces the notion of grace, and alternates thereafter between Drs. Brickell and Unruh.

“Because of course, I really, hopefully, I mean, I pray that I really share your humility and the sense of the power in, well, the sense of there but for the grace of God go I is how I would say it. You know, I both know it just could be us at any time on the other side of the couch, so to speak.”

“But why would God grace you and not them?”

“That’s a deep question.”

“Because I feel better about it being just luck. Because then there isn’t like an entity, a supposedly all-powerful and all-knowing and all-loving entity that is gracing some more than others.”

“That’s where I think it’s a little dicey, because from my perspective, I don’t think I can say who God has graced more than anyone else, actually. And this goes to the problem of ego. Difficult to say sort of how much blessing or grace is there for one person at any one particular moment in their lives. What’s God doing through suffering and tragedy? So, that maybe is a whole other conversation, but I agree, it’s not a question that’s answered easily. I take the point.”

The phrase “there but for the grace of God go I” caught my attention. Christians — all people, but I am particularly interested in Christians at this moment — use cliches rather thoughtlessly. I appreciate that Dr. Brickell did not let this one pass without challenge: “But why would God grace you and not them?”

It seems that both Drs. Unruh and Brickell, while having very different views on God, share a common notion of grace, specifically that the patient has been denied it to a significant degree and that the doctor has received it in abundance. Now, to be fair, Dr. Brickell does not believe in grace; she sees it simply as lucky. The patient has been unlucky; she has been luckier. So, the issue of why God would grace one more than another is not really her issue, except, perhaps, as an argument against the Christian concept of a good, fair, and just God. It simply is not a question that a materialist has to answer as does a Christian.

Dr. Unruh makes a good move toward an answer but doesn’t have the time to develop it, particularly since it is tangential to the topic of the podcast. So, I would like to take it a bit further.

First, we must move beyond a simplistic and false notion of grace as tangible blessings as the conversation seemed to imply: mental and physical health, economic security, satisfying emotional relationships. These are great blessings, yes, but they are not synonymous with grace. Grace is God present and active in the life of a person to sanctify that person, to make that person God’s very own, and to bring that person to the fullness of salvation. Grace is an inner working that is not always visibly manifested. To assume that the patient struggling with a personality disorder has been “less graced” by God than the doctor who is not similarly struggling is not humility — in fact, in can mask pride — but rather a deep misunderstanding of grace. I am simply not given to know what God is doing in the heart — used in the patristic sense — of another, of how grace abounds there. That is true not just in the case of psychiatric patients but also of those with dementia or those in a coma. It is true for us all, though from time to time God may grant us glimpses of his presence in the life of another.

The other issue is the very limited, temporal nature of our understanding. The fact is that, in the age to come, the patient struggling now may well be revealed as a great and glorious saint whose brightness outshines ten thousand like me who considered themselves more graced in the days of our mortal life. God makes saints as he will, but there seems to be a correlation between suffering and purification. Jesus did, after all, tell us to take up a cross and follow him.

There is something in this discussion that puts me in mind of the Holy Fools for Christ seen frequently in the Russian Orthodox tradition, men and women whose behavior and lives are so bizarre, so countercultural, so apparently poor and disordered, that they are rejected by polite society as hopeless cases. And yet, these are the saints in the making, saints in disguise, men and women who looking at the rest of us merely normal people might be thinking, “There but for the grace of God go I.”

From Unbelievable?: Can therapy alone heal the soul? Two Psychiatrists Treating BPD & NPD Explore the Search for Meaning, Jun 6, 2025
https://podcasts.apple.com/us/podcast/unbelievable/id267142101?i=1000711867410
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