Counseling the pervasive doubts of those who experience chronic illness.
Pain hurts for a reason.
The normal, natural function of pain is to draw attention to something that needs to be fixed. Pain causes us to focus on the trouble in order to fix it: Set the broken bone, reduce stress to eliminate headaches, change diet to resolve stomach issues, exercise to increase energy levels.
But chronic pain is different. Those who deal with persistent pain or unresolved illness face several unique challenges.
- First, even after multiple doctor visits, specialist appointments, tests, prescriptions, and lifestyle changes, their body still constantly demands attention.
- Second, because their energy is limited, they miss out on activities and spend a lot of time alone.
- Third, because their body drains mental resources, and the medical community insists for years that there is nothing wrong, and friends don’t understand why they still don’t feel better, they often feel confused and doubtful about their own experience.
These realities—self-awareness, isolation, and brain fog—lead many who suffer from chronic conditions to be sensitive and introspective.
Sensitivity and introspection can be great gifts that lead them to be remarkably compassionate and encouraging to others who suffer. At the same time, these things can also press those with chronic conditions towards scrupulosity or a lack of assurance. I have seen both realities at work in my own life with loved ones who suffer from these things.
Archibald Hall’s chapter on “Ministerial Visitation of the Sick” from his magnum opus, Gospel Worship, targets these issues with biblical precision and pastoral insight. Originally published in 1770, this Puritan gem pinpoints—with unusual brevity—the most difficult spiritual questions asked by those who suffer physical sickness. Hall gives concise directions to those engaged in soul care in a way that is meant to be suggestive, but not exhaustive.
Below, I’ve rephrased Hall’s questions into a catechism form and used his answers as a starting point to address the most pressing doubts and fears faced by those with chronic illness. This is a useful prescription for those who suffer physically, and the passages cited can be used for deeper study, meditation, and memorization.
Yes, physical pain hurts for a reason. The same is true for the inner man: Spiritual pain draws attention to problems that only the promises of God can fix. So take these healing words to those who are hard-pressed by constant pain, that they may know the comfort and encouragement of the gospel.1
A Catechism for the Doubts Raised by Illness
Q: Am I beyond being saved?
A: This thinking is dangerous, because it contradicts God, who says, “Today, if you hear his voice, do not harden your hearts” (Psalm 95:7–8; Hebrews 3:7–8). I must meditate often on God’s mercy, particularly on this oft-repeated statement, “The Lord is merciful and gracious, slow to anger and abounding in steadfast love” (Psalm 103:8).
Q: Have I committed the unpardonable sin?
A: Because it is impossible to restore those to repentance who have become hardened, obstinate, and determined enemies of the gospel (Hebrews 6:4–6), my very fear of separating myself from God is clear proof that I have not committed the unpardonable sin.
Q: What if I am afraid of dying?
A: God has placed in mankind a sense of self-preservation, a natural fear of harm or death that causes us to protect ourselves (Psalm 34:11–14). My illness places me into a closer proximity to death and, necessarily, into a heightened state of natural fear. This is a sign that my body and mind are, in this respect, healthy and functioning normally. Yet the Scriptures call me to confide and rejoice in Christ, who by his cross has given me victory over death, removing its sting (1 Corinthians 15:55–57), and gives me his Spirit that I may enjoy life and peace (Romans 8:6). Sanctification means that I am to take courage in Christ, learn to walk by faith, and grow in my desire to be with the Lord so that whether I live or die, I make it my aim to please him (2 Corinthians 5:6–9).
Q: What if my sins are too great—even after becoming a Christian?
A: I must think about yourself the way the Bible describes me, and I must think about Christ the way the Bible describes him. I am a sinner (Romans 3:23). While I was still in my sin, Christ died for me, justified me by his blood, and saved me from the wrath of God (Romans 5:8–9). If I sin as a Christian, Christ is my advocate (1 John 2:1) and continues to plead with the Father on my behalf even now (Romans 8:34; Hebrews 7:25). If I confess my sins, he is faithful and just to forgive me and cleanse me from all unrighteousness—no matter how great (1 John 1:9). This is why Paul, who used the present tense to claim “I am the foremost” of sinners, said to trust and fully accept this saying: Christ Jesus came into the world to save sinners (1 Timothy 1:15). Therefore, I must continually entrust myself—no matter how I feel—to Jesus, the never-failing rock and surety of the New Covenant.
Q: How can I cling to Christ while the law denounces me and curses me as a transgressor?
A: I must learn to appeal to Christ, who bore the curse of the law for me, trusting in the word which says, “Christ redeemed us from the curse of the law by becoming a curse for us—for it is written, ‘Cursed is everyone who is hanged on a tree’” (Galatians 3:13).
Q: How can I enter heaven, knowing the shameful vileness of my sin and that “no unclean thing” shall enter?
A: I must remember that the blood of Jesus Christ cleanses me from all sin (1 John 1:7), and that the Lord has promised that though my sins be like scarlet, they shall, through the blood of Christ, be made white as snow (Isaiah 1:18).
Q: I feel that I can never do enough, and that even what little I can do is tainted with sin and failure. Are my good works, biblical duties, and religious performances enough?
A: These things are not my righteousness, for my righteousness is in Christ alone (Romans 1:17; 3:22; 4:3–5; 10:4; 1 Corinthians 1:30; 2 Corinthians 5:21; Philippians 3:9). Therefore I must renounce my attempts to do or be enough (Ephesians 2:8–9).
Q: I feel cursed and rejected by God. How do I know that God’s promises apply to me?
A: It is true that I have no claim on the promises of God, for these promises are made to Christ alone and he is the heir of all of God’s good promises. Yet Christ freely reveals all of his promises in Scripture and freely gives them to whoever will receive them:
- Whoever believes in him should not perish but have eternal life (John 3:16)
- Whoever believes in him is not condemned (John 3:18)
- Whoever believes in the Son has eternal life (John 3:36)
- Whoever drinks of the water that I will give him will never be thirsty again. The water that I will give him will become in him a spring of water welling up to eternal life (John 4:14)
- Whoever hears my word and believes him who sent me has eternal life (John 5:24)
- Whoever comes to me shall not hunger, and whoever believes in me shall never thirst (John 6:35)
- Whoever comes to me I will never cast out (John 6:37)
- Whoever feeds on my flesh and drinks my blood has eternal life, and I will raise him up on the last day (John 6:54)
- Whoever believes in me, as the Scripture has said, ‘Out of his heart will flow rivers of living water’ (John 7:38)
- Whoever follows me will not walk in darkness, but will have the light of life (John 8:12)
- Whoever believes in me, though he die, yet shall he live (John 11:25)
- Whoever abides in me and I in him, he it is that bears much fruit, for apart from me you can do nothing (John 15:5)
Q: How do I know that I believe?
A: Faith is a simple matter of where I look and who I trust. First, do I look to Christ for salvation? Then I believe. Do I look for salvation in something else, willfully rejecting Christ and consciously placing my hope in this other thing? Then I do not believe. Second, do I trust Christ when he says, “Whoever comes to me I will never cast out”? Then I believe, regardless of how I feel about myself or what I may fear. Do I believe that Christ is a liar, and will cast me out if I come to him? Then I do not believe. Finally, can I believe, while seeing the weakness of my heart and crying out, “Help my unbelief”? Yes.
Assignments
- Read through the entire catechism daily.
- Each day, look up at least five of the Scripture references until you have studied all the passages cited. As you do, carefully read through the catechism answer and ask yourself, Is this biblical? and, Do I believe that this is true?
- Write down any objections, arguments, or doubts and be ready to discuss with your counselor.
- Choose the question and answer that best reflects your worries, and commit it to memory. The answers are long, but your doubts are deep and require strong treatment.
- Note: Discussion of the additional doubts and objections noted in #3 will not take place until the hard work of #4 is put in.
- Adapted from Archibald Hall, Gospel Worship (Grand Rapids, MI: Reformation Heritage, 2024), 443–444. ↩︎
