Warren Kinghorn, MD, ThD, had nearly finished his medical education when he first grappled with one of the most fundamental questions in medicine. After four years at Harvard Medical School and nearly three years of psychiatry residency at Duke, he faced the query, “What is health?” Or, more specifically, “What is mental health and what does it mean to live with suffering?”
“I went through years of training before anyone ever asked me in a formal teaching context to answer these questions,” said Kinghorn, associate professor of psychiatry and behavioral sciences. “It’s always struck me that I was already a physician—and had been for two years—before anyone posed that question. These are big questions that often aren’t asked inside the medical curriculum.”
It was then that Kinghorn, who also serves as the co-director of the Theology, Medicine, and Culture Initiative at Duke Divinity School, began to question whether patients were receiving mental health care that addresses their needs at the most personal level. These reflections led him to write Wayfaring: A Christian Approach to Mental Health Care.
In the book, he examines ways that modern medicine shapes mental health care and contrasts them with a more holistic approach championed by Saint Thomas Aquinas, the 13th-century philosopher, theologian, teacher, priest, and Dominican friar. By spotlighting this more person-centered approach to mental health care, Kinghorn challenges mental health clinicians to look beyond merely diagnosing and treating symptoms to healing the patient as a whole.
Where the Journey Began
Kinghorn’s journey to explore a more individualized focus in mental health care started when he took a break during medical school. He traded one type of training for another and earned a two-year degree from Duke Divinity School. This part of his education reshaped the way he practices medicine.
“With my divinity degree, I really immersed myself in the Christian theological tradition,” he said. “It was those years of theological training that led me into psychiatry, because I began to realize how deep and rich the conversations in the specialty were. It’s a field where the big questions around life and health are more likely to be addressed.”
As a specialty, psychiatry attends to concerns around a person’s community, their relationships, and their stories. Providing care for someone’s entire being is the goal. But the discipline can still do more, Kinghorn said, because there are forces even within the specialty that make it more difficult to embrace a humanistic model.
“This book emerged from my own rootedness and grounding in Christian tradition. It also comes from the awareness that, for a lot of our patients and clinicians, faith and spiritual traditions are important ways to experience the world,” he said. “It’s how we find joy and strength and how we cope with challenges and suffering. It’s important for clinicians to be able to acknowledge that. So, this book explores the difference that Christian theology and practice might make for engaging the world of mental health care.”
“This book emerged from my own rootedness and grounding in Christian tradition. It also comes from the awareness that, for a lot of our patients and clinicians, faith and spiritual traditions are important ways to experience the world. It’s how we find joy and strength and how we cope with challenges and suffering. It’s important for clinicians to be able to acknowledge that.”
— Warren Kinghorn, MD, ThD
Machine vs. Wayfarer
In the book, Kinghorn makes a central comparison between two models of thought around mental health care — the machine model and the wayfarer model. These are two approaches to psychological care that are divergent in their understanding of what it means to be human, he explained.
The machine model is a more modern-day approach that views humans as highly sophisticated machines that must be fixed when they break or become ill. It’s not a view espoused by all clinicians, but it’s a common way of thinking.
“The machine model may work more subtly in psychiatry than it does in other disciplines, but it appears in our tendency to have patients come to us with unwanted or disvalued experiences or behaviors,” he said. “We listen and aggregate their symptoms into diagnoses that we can treat with techniques or technologies. Consequently, therapeutic success means we’ve been able to reduce those symptoms.”
But the result, he says, is that patients often feel dehumanized and unseen. They feel like their personhood, their stories, and their community experiences are overlooked.
The contrast is the wayfarer model. It promotes the idea that every person is on a continuous journey to find joy and hope in life. They are deeply impacted, molded, and shaped by encounters that must be considered during any mental health care treatment.
“In the book, I discuss the idea of humans as wayfarers who deserve to be attended. And we as clinicians ourselves are also wayfarers on our own journeys,” he said. “I explore the idea of what it means for us, as clinicians, to come alongside wayfarers and ask what is needed on their journey right now. That is the central question of our clinical care.”
“I explore the idea of what it means for us, as clinicians, to come alongside wayfarers and ask what is needed on their journey right now. That is the central question of our clinical care.”
— Warren Kinghorn, MD, ThD
The Potential of the Wayfarer Model
If implemented by and for individuals who embrace Christian or faith-based ideologies, the wayfarer model can open the door to remarkable possibilities for patients experiencing mental health problems, Kinghorn said.
“Our patients may need secure housing or help to escape a violent relationship. Or it could be that they do need transcranial magnetic stimulation or medication to address a specific clinical disorder,” he said. “The wayfarer approach helps us keep a broad view in mind of what’s needed on every person’s journey. It empowers us to collaborate with our patients to provide their mental health care in a humane and dignified way.”
Ultimately, Kinghorn said, the book is intended to help interested clinicians evaluate their approach to mental health care and reframe their goals for treatment.
“Symptom reduction is certainly important,” he said. “But, beyond that, what mental health clinicians should hope for—and what many do pursue for their patients—isn’t just symptom reduction. It’s agency,” he said. “It’s about securing the capacity to act as whole beings toward purposes and goals in the world and to develop healthy, secure, life-giving relationships.”
Wayfaring: A Christian Approach to Mental Health Care is available through Wm. B. Eerdmans Publishing Co. Kinghorn also published Prescribing Together: A Relational Guide to Psychopharmacology in 2021.