The Modern Evangelical Church and Mental Illness

I think that for a long time it’s been a hard sell to say much about mental illness in the modern evangelical church. Mental illness has a way of challenging some of our evangelical tropes and the exaggerated conclusions we may draw form them:

  • “Jesus brings us joy”; therefore we should not feel sadness or grief, and if we do, something is wrong with us. Even more, whatever that is that may be wrong with us, I cannot speak truthfully about it because, my fellow believers will neither understand nor accept me because of it.
  • “Jesus brings us peace”; therefore we should not feel anxiety or fear, even though Jesus told us that in the world you will have tribulation.
  • “Jesus brings us love”; therefore if we are rejected and experience heartbreak, there’s something wrong with us – even though Jesus said that the world would hate us because of him.
  • “Jesus changes our lives”; therefore there is something wrong with us if something goes wrong with our thinking processes, even though Jesus told us that we will enter into the kingdom of heaven through many afflictions.

Over the years pastors and churches themselves have often followed the trends of the psychiatric and psychological community, and pastors have often seen themselves as or acted like a kind of junior varsity mental health worker. So they have often enough followed the trend of the psychiatric and psychological community in pathologizing problems of the ‘worried well’  — which we could easily call life adjustment problems –as in the same category as true brain and cognitive disabilities such as the many varieties of schizophrenia and manic depressive illness. Then, too, the casual use of much psychological terminology among proud, intrusive and ignorant people in our churches has often led to real travesties of those who try to play medical doctor or psychiatrist with second hand bits of knowledge and labels. Then again, there has often been real ignorance and actual cooperation of well meaning and compassionate believers with abusive people in the abusive practice of gaslighting.  Then again, any ministry to the poor and homeless will come to an awareness of the role of mental illness in poverty and homelessness – estimates are that in the USA 1/3 of the homeless have severe mental illness and that many of those in our prisons and jails have treatable mental illnesses, and much of this has been attributed to the desinstitutionalization of the mentally ill that took place since the 1960s. Even more, the causes of the kinds of brain diseases and cognitive impairments which are now called mental illness are not certainly known, but much of the current medical community believes that many of those who currently have twill be found to have either an environmental, bacterial, viral or other physiological origin.

I think that the first thing to do is for many to get a handle on where the current state of research is. It is now generally conceded that Sigmund Freud and Carl Rogers, among others who dealt in talk therapy and investigating what they thought was happening in the subconscious or as a result of a person’s past were wrong. And it’s unfortunate that many, many pastors, who may not have had much in the way of counseling courses since the 1970s or 1980s, may be attempting to minister with now discredited or superseded theories and understanding of mental illness.In addition, the consensus is growing that there are a number of problems which cause people deep grief, sadness and anguish which are not related to brain dysfunction. Furthermore, when I consider the experience of Jesus himself in the Garden of Gethsemane, I can only think that our understanding of the prevalence of the experience of sorrow and grief in a godly and holy person in our sinful and broken world has been sadly underestimated and often misdiagnosed. So, I offer the following links only as a starting point to get information.

******************

On a personal note, I’ve had contact over the past decade with many others who qualify as intellectually gifted in terms of IQ. One common theme in the stories of so many is the misdiagnosis of giftedness as a mental disorder even with trained medical professionals. Here’s some more information about this tendency.

Advertisements

Fashionable Compassion and Making a Real Difference

Back in the 1980s, a young boy who lived in the Philadelphia area, Trevor Ferrell, felt a great deal of compassion for the homeless people that he saw in the various streets and parks in which they lived. He persuaded his family to take them some food and blankets. Some others joined in, and there was for a while a ministry to the homeless, Trevor Cares, that was featured on local television stations, and the center was Trevor. Eventually, though, he and his family left that ministry, which still solicits donations through a website. The last news on Trevor is that as an adult he runs a thrift store in the Philadelphia area.

Trevor and his family were evangelical Christians, and certainly they and many others believed that they were following Christ when they were handing out food and blankets to the homeless. I think that that kind of ministry became kind of fashionable back in the 1980s, and tended to die off in the 1990s. First, it became apparent that a number of people who were claiming to be homeless and soliciting funds were actually not homeless. In fact, in a number of cities investigative reporters traced many of them back to fairly well to do homes. Second, it became clear also that many of the genuinely homeless were suffering from much deeper problems than a lack of food and shelter: namely, severe addictions to drugs and alcohol and severe mental illness or a severe combination of the two. Certainly it was compassionate to give them food and blankets but it was evident that they needed much, much more.

In the cities and towns in which I ministered as a pastor, usually the churches developed some policies to deal with those in need of ministries of compassion. Usually there was some kind of partnership with local rescue missions and food pantries. In the last small town in which I served as a pastor, the churches had in fact joined together to sponsor a food pantry. There were some limits placed on the handouts. While there would be emergency help, usually churches would sponsor families if they were known to the pastor, or, if the family had no church connection, someone from that family would need to come to a church building (not necessarily a church service) to receive their monthly food basket. There was the hope that this would give that person or family some kind of awareness of the possibility of a church connection through which they could receive more than simply a handout of a food basket. There was never the expectation, though, that anyone would ever need to sit through any kind of spiel to receive a food basket when that person came to a church building for a food basket.

There was one church, though, that scorned this kind of ministry, and said that they were going to put up their own food pantry with no limitations on who could come, how often they could come, or how much they could carry away. In two days their pantry was cleaned out and had nothing left to give anyone. So they then learned the lessons that the other churches had learned and joined together in the sponsorship of the food pantry to which the other churches were giving both money and people.

During the month in which my church had its turn to hand out the food baskets, there was one woman who insisted that no one from her family could come to the church building to pick up the food basket. So I drove to her house to deliver the basket. It was obvious when I came there that she was suffering from some kind of mental illness, and that her family was also suffering because of that, since every inch of the floor was covered with her children’s toys. It was pretty difficult even to find a path to a place where I could set down the bags of food which I brought.

So, these stories are to show some of what may happen when someone tries to take the commands of Jesus seriously in ministries of compassion to the poor. There may be, though, too much of a misperception among people who have grown up in the evangelical church that their churches and denominations have not really done very much to show compassion to the poor. Much of this may be due to personal ignorance – perhaps their own experience has been lacking in actual exposure to and understanding of these ministries. Or, if they have come through the secular university experience, they may have been exposed to and may be giving far too much credence to the ignorant claims of the hostile critics of academia and left wing, antiChristian organizations that evangelical churches and denominations have been doing nothing. In fact, though, local churches and local church joint ventures have often doing much more than is known even among people who regularly attend evangelical churches.

The truth is that evangelical denominations and churches do have centuries of a strong and often ignored track record in dealing with actual problems that plague society, and often what is done is quiet and unheralded. Compassion for the poor? World Vision, Compassion International, World Relief, Samaritans Purse …and church food pantries in almost every city and town. Dealing with addicts (the real cause of much poverty and abuse)? The Salvation Army, Teen Challenge, and rescue missions in almost every city and town. Prison ministry? Prison Fellowship and many other prison ministries. Could more be done by Christians and churches? Probably — and I personally think that there could be more done with the severely mentally ill. Have the churches delivered a utopia? No, but that was never their mission – and there is no other ideology or religion that will deliver any kind of utopia until Jesus returns. Is there any truth to any charge that little to nothing being done by Christians in North America and around the world to address the ills of society? Absolutely not!

So here are the kinds of questions that need to be asked if we are to move beyond fashionable compassion to making a real consistent difference in the lives of others.

  • What is being done now in the body of Christ locally, nationally and internationally?
  • What can be done locally, nationally and internationally?
  • What are the lessons of experience that others involved in ministries of compassion have learned and from which I can learn?s
  • What are my expectations of what the end result of ministries of compassion will be?
  • Am I willing to participate in ministries of compassion even if I receive no earthly recognition or, even worse, no earthly financial recompense myself for this ministry?
  • What are the possible root causes of the problems that I see?
  • What is the most reasonable understanding of the teaching of the Old and New Testaments regarding poverty and social justice and what are the most reasonable applications of this teaching in our culture?
  • Do I understand that ministries of compassion can and should be kept in balance with ministries of evangelism and disciplemaking?

Certainly mercy ministries and giving in the name of Jesus are good things. But certainly also those who encourage, follow and labor in those ministries will always need to grow in wisdom, particularly if they pursue these ministries in their youth. There will still be many, many lesson that they all can learn over the years, especially when they may pursue these ministries with naiveté of personal and spiritual immaturity and arrogance of inexperience. Again, the compassion of Jesus is more than a pure emotion of pity for those in difficult and harmful circumstances but it is a compassion which is tempered with wisdom. The compassion of Jesus for this world is a love with wisdom. And more and more this will mean a wise redirection of starry eyed youthful enthusiasm – the wholly commendable drive to ‘change the world’ – away from any kind of magical thinking and naïve utopianism into actual ministry. And the growth of experience will, I think, bring about the realization that compassionate handouts need to be accompanied with lifechanging ministries that address and deal with the long term patterns that contribute to long term poverty. This will mean that there should be more mobilizing of the effort from fashionable compassion to more long term ministry involvement. And that will mean understanding that sharing the life changing gospel of Jesus, his healing power and ability to deliver from the following long term patterns will always be part of a compassionate ministry to the poor:

  • Addictions
  • Financial and moral irresponsibility
  • Mental illness
  • Abusive and broken families

In these circumstances then, by the command of Jesus himself, the mission of his church remains the same:

  • Evangelism
  • Discipleship
  • Compassionate and generous interventions

Salvation Army: Amazing Grace

Some Things for Consideration

My generation was told that there were no long term consequences to smoking marijuana. Here is something that recently appeared that says otherwise:

Samuel T. Wilkinson: Pot-Smoking And the Schizophrenia Connection: Medical research shows a clear link between marijuana use and mental illness.

In other words, the movie Reefer Madness was partially right. The consequences would be neither immediate nor inevitable, but any activity that has a possible long term consequence that 10% of smokers would develop mental illnesses as serious as schizophrenia is definitely to be avoided.

Another common but not inevitable consequence is amotivational syndrome: “Amotivational syndrome is common amongst long term marijuana smokers. Some symptoms include: increased levels of apathy, difficulty in starting new tasks, not accomplishing or not setting goals, decreased concentration, and a tendency toward introversion.” (http://karen-stephenson.suite101.com/weed-out-marijuana-use-a6461, http://www.getsmartaboutdrugs.com/drugs/marijuana.html) So for those who may manage to avoid schizophrenia may find themselves checked out and unable to cope with life anymore. Again, it is quite reasonable to avoid any activity that may result in this kind of life.

I’ve often said that drug abuse – chemical dependency — needs to be recognized as a work of the flesh similar to alcoholism but which is not specifically named in Galatians 5:19-21. The language clearly leaves open that there are other unnamed activities which are similar to the other works of the flesh which can be included: “ . . . drunkenness, partying and other such similar things, which I warn you in advance just as I already warned you that those who continue to participate in such activities will not inherit the kingdom of God.” Marijuana use was known in the ancient world, since Herodotus mentions its use among the Scythians, but it does not appear to have been an issue among the Jews or the parts of the Roman empire in which Paul ministered. So was opium, but it seems to have been used more for medicine. The religious and ritual use of marijuana and opium would seem to be covered under the word translated ‘sorcery,’ (Greek pharmakeia). It seems that the apostle Paul would have mentioned them more explicitly, though, if they were issues that he had encountered alongside the sexual immorality, drunkenness and partying that was endemic throughout all classes of society in the eastern Roman empire in which he ministered. But this does provide more hope for the chemically dependent: that Jesus Christ can set them free and enable them to live a life of victory in sobriety.

For more information:

Good News for the Chemically Dependent and Those Who Love Them

The Lighthouse Network

Teen Challenge USA

The National Association for Christian Recovery

Offical Alcoholics Victorious Headquarters Website

What Is a ‘Nervous Breakdown,’ Really?

I once worked with someone some years ago who had several times in her life which she described as ‘nervous breakdowns.’ In one of them she described times when she would go catatonic: she would go to her room, wrap herself in a blanket, and remain motionless and expressionless for hours. From what I know of what was happening in her family and marriage at the time, it’s no wonder that she felt overwhelmed and unable to cope. I was reminded of her experience through my recent reading through a biographical account of F. Scott and Zelda Fitzgerald by an English professor, and it’s noteworthy that Zelda was institutionalized several times when she became delusional and dysfunctional, and sometimes these are called mental breakdowns.

Unfortunately, the term ‘nervous breakdown’ or ‘mental breakdown’ really isn’t a term of clinical psychology or psychiatry. It’s more a popular term and colloquial description, and it seems to have its roots back into the earlier half of the 20th century, when the term ‘nerves’ was used to describe ‘anxiety’. It isn’t used that much any more; panic attack nowadays is used much more accurately of some of these incidents. In other words, ‘nervous breakdown’ is not a professional diagnosis from either a qualified psychiatrist or psychologist, and probably has not been anything close to one for many years. It’s been for a long time a sign of amateur psychobabble and of amateur misdiagnosis. In the case of Zelda Fitzgerald, I think that the historical record might be well enriched by a forensic analysis by a professional psychiatrist in the light of more contemporary diagnoses and treatment.

Here are some online sources, some from professional psychologists and psychiatrists, which describe more of what people have meant by the term:

It’s valuable for pastors and Christian leaders to read over these descriptions, since it can help them to avoid jumping to wrong conclusions about what people are going through in their lives. Deep and overwhelming panic, hurt, disappointment and grief can often provoke a strong outward reaction in the people who are experiencing those emotions, and pastors and Christian leaders are often the closest person to be able to minister to those people. For instance, in some communities, someone experiencing the grief at the loss of a loved one may break out in loud crying and wailing. Most of the people going forward do not become dysfunctional in their lives nor do they show signs of delusions, mania, or catatonia, and are not living afterwards ‘on the verge of a nervous breakdown,’ as the cliché goes. They may live in sadness for a while, and may need to make some significant adjustments, but they may not need any kind of medication and certainly not need to be institutionalized, since their reaction is necessarily not the sign of something organically wrong with that person. I personally would not even call it ‘mental illness.’ Rather, I would call it a sign of deep psychological injury, along with those who are seeking to change the terminology to distinguish between organically based mental illnesses such as some forms of schizophrenia, developmental and character disorders such as narcissism, and psychological injury such as post traumatic stress disorder. These outward signs of psychic pain would thus correspond to the same signs of crying and screaming as when someone receives a very painful physical injury.

Usually in the Christian community, when someone tries to market a psychological condition such as depression or burnout, that person points to the dejected Elijah sitting under the broom tree (I Kings 19:4). Rather, the most perfect, sane and sinless person who ever lived once went through a brief period of extraordinarily deep sorrow and distress – measured in an hour or two — and prayed himself through it. That person was Jesus, and he went through this kind of great torment in the Garden of Gethsemane — he was overwhelmed. This is how he described his emotional experience: “My soul is extremely sorrowful, even unto death” (Mark 14:34). And this is how his praying is described: “And while he was in agony he prayed fervently, and it happened that his sweat became like drops of blood which fell upon the ground” (Luke 22:44). I would never, ever, though, apply this term of ‘nervous breakdown’ to the experience of Jesus in the Garden of Gethsemane, because that term also has implications from the past that for someone experiencing a ‘nervous breakdown’ the next step is an institution, and I would never want to put anything close to that implication on Jesus. Rather, I think that we miss the reality of how deep that experience was for Jesus, because throughout the trial and crucifixion we see the same sane, calm, compassionate and truthful Jesus that we see throughout the gospels. But even more, for anyone going through  deep waters, the truth is that Jesus understands what you’re going through, and he is able to help you more than anyone else: “ . . . [he] in the days of his earthly life offered prayers and supplications with strong cries and tears to him who was able to save him from death, and he was heard because of his reverent submission . . .  for we do not have a high priest who is unable to sympathize with our weaknesses, but who was tried in every way like us – apart from sin. Therefore let us approach the throne of grace with boldness, so that we may receive mercy and that we may find grace in times of our need . . .  since he is able to save to the uttermost those who come to God through him, since he always lives to intercede for them” (Hebrews 5:8, 4:15-16, 7:25).

‘Weird’ People, Christlike Love And Pastoral Care

Updated AGAIN!!!

Corrie ten Boom once told a story about an elderly couple who attended her meetings in post World War II Germany. They were from an isolated rural area of Germany, and their unkempt appearance and lack of physical hygiene put off some of the people at the meetings. The more spiritually mature Christians who attended the meetings encouraged the group to accept them and demonstrate the love of Christ to them. Before long, they both made professions of faith in Christ, and without anyone saying anything to them, they began to make use of the washing facilities, laundered their clothes and combed their hair.

The more spiritually mature Christians at those meetings got it exactly right. One of the most difficult human tendencies to deal with is the tendency to label people as ‘weird’ because of the ways that they may differ from others. And most certainly it can be extremely difficult for a person to deal with the dehumanization that may take place once others have given that person the ‘weird’ label. But the question then comes for the fellowship of believers: what are you doing to demonstrate the love of Christ to that person? And the question comes to those in leadership, as pastors and elders: what are you doing to lead the others in the fellowship of believers to show the love of Christ to that person?

The label of ‘weird’ can arise in several different ways. Sometimes it can come from the false expectations, stereotypes, prejudices, and preconceptions of others. For instance, one of my favorite coworkers told me that one of her friends called her, ‘weird,’ because she had minored in art history in college. I advised her that I found that to be quite the opposite of weird. This may well be from mere minor differences in upbringing, educational background, or region of origin. In addition, many times there can be highly exaggerated understandings of what ‘normal’ is, based on looks, popularity or athleticism. A person is not ‘weird’ if he or she is not the best looking person, most accomplished athlete, etc.  Just as much, this can even come from highly exaggerated and misunderstood observations on one time incidents and off hand remarks. For instance, if one encounters someone who has been up all night or who has just experienced the loss of a family member, it should go almost without saying not to make any snap judgments about that person, since one is not encountering that person in normal circumstances. And in all these situations the question remains: what are you doing to demonstrate the love of Christ in that situation?

I venture that the applicable passage of scripture in those more minor situations is Ephesians 4:1-3: “I therefore, the prisoner of the Lord, beseech you that ye walk worthy of the vocation wherewith ye are called, with all lowliness and meekness, with longsuffering, forbearing one another in love, endeavouring to keep the unity of the Spirit in the bond of peace.”

Even more, if there is an inclination to label a person as ‘weird’ because of these minor personal differences, preconceptions and expectations, there are two further questions to consider: what did you expect from that person? And what right do you have to put those expectations upon that person? So in this case, James 4:11-12 applies: “Speak not evil of one another, brethren. He that speaketh evil of his brother, speaketh evil of the law, and judgeth the law: but if thou judge the law, thou art not a doer of the law but a judge. There is one lawgiver, who is able to save and to destroy: who art thou that judgest another?”

Another way that someone may receive that label is because of social backwardness due to personal immaturity or having come from an addictive, neglectful or abusive family, or even a family with one or more members suffering from a mental illness such as depression. The truth is that neither of these situations is either permanent or spiritually crippling in themselves, and people who are in this situation may have received little more than avoidance, ridicule scorn or angry demands for change from others, and very little of the love of Christ. For instance, there was an episode of the TV series Wonder Years where there was a classmate who was trying desperately to be the friend of Kevin Arnold, the main character. She was socially inept, had a knack for saying the wrong thing at the wrong time and had a quirky hairdo, to say the least. The narrator said that his reaction was, “Why did she have to be so weird?” And at the end of the episode, he learned that she was part of a military family which had moved around the country several times a year, so that she never really had much of a chance to develop strong, lasting friendships.

The immature or socially backward person may actually find huge benefit in the stable environment of loving patience in Christ –a church which is living in Ephesians 4:11-16 rather than in I Corinthians 3:3. And for someone who is in the place of immaturity, the need is for growing in knowledge of, faith in and obedience to the Word of God, which “ . . . is sure, making wise the simple” (Psalm 19:7). So the questions then become, “What right do you have to treat that person with contempt or disdain for whom Christ has died due to an unloving, malicious, childish, prejudicial or pejorative label or stereotype? And if you have spread ridicule and tried to involved others in contempt for that person, shouldn’t you rather repent and seek to correct the false and disdainful impressions of another person you’re encouraging? Are you rather willing to sit back, pray, love and let that person grow in Christ?” In these cases the applicable scripture is I Thessalonians 5:14: “Now we exhort you, brethren, warn them that are unruly, comfort the feebleminded, support the weak, be patient toward all men.”

Finally, someone may receive this label due to demonstrations of irrational and immoral thinking patterns, words and behavior. Here I’m referring to persistent patterns which are markedly deceptive, malicious or even unimaginable for a person in touch with reality, and which cannot be charitably attributed to any of the reasons I’ve mentioned above. These may in fact be signs of an accelerating degenerative addiction or abusive lifestyle, mental illness or even demonic influence. I would counsel against any kind of snap judgment or superficial diagnosis by anyone in these areas, and attribution of any kind of addiction, abuse, mental illness or demonic without due consideration for the alternatives. This is one area where spiritual leaders need to stand strong in firmly rebuking what may turn out to be hateful and slanderous attributions by others and making extremely serious scriptural and sensible assessments if these kinds of patterns are evident. While I don’t have a great deal of experience in making these assessments, here are some things which I’ve learned from others and some situations.

First, do not be determined to find something wrong with someone, to find a label or diagnosis for a person, and, even more, be extremely diligent and cautious to protect each and every confidentiality in these cases. There can be strong legal sanctions in these cases where confidences are breached, particularly if there are violations of HIPPAA regulations in the United States. A spouse, an elder or a fellow pastor is not qualified to be a confidant in such a case, even if someone tries to justify breaking the confidence to request prayer. In addition, no referrals should ever be made without the explicit knowledge and probably written permission of the person being referred, and that person should always be aware of anyone attempting to refer him or her to any professional for anything.

Second, be ready and willing to consider that there may be physical problems which are contributing to the person’s behavior. D. Martyn LLoyd-Jones, whose background as a physician included assisting the leading diagnostician of his day (the Dr. Gregory House of Great Britain), counseled this in his book on healing, and he named some of the problems which could contribute to irrational and eccentric behaviors which might otherwise be labeled as mental illness. With this he agreed with Jay Adams, the originator of the nouthetic branch of pastoral counseling. It may take a thorough physical exam to find a physical cause, but it would certainly be in the path of Christian love and pastoral care to advise a physical exam. A pastor and a church could easily join together to pay doctor’s bills or to refer to a Christian doctor who might perform an exam pro bono for someone who might be in need of such an exam. For more on how physical ailments can be confused with ailments labeled as mental illness, see the Wall Street Journal blog entry on Confusing Medical Ailments With Mental Illness. In addition, an examination specifically for Post Traumatic Stress Disorder may be in order for people who have come through moderate to severe and protracted physical abuse, particularly if they show signs of heightened vigilance—a kind of unusual caution and jumpiness.

Third, where physical or organic causes, syndromes or illnesses are known, prayer for physical healing is easily an act of Christian compassion and love. Jesus healed those who were, as the King James Version put it, ‘lunatick’, or, in a more contemporary sense, suffering from physical afflictions that caused seizures and other abnormal behaviors. Compassion and faith in Christ to heal out of his own compassion for the physically afflicted are in order here, not fear, mere pity and avoidance.

Fourth, while the pastor, elders and other spiritual leaders need to avoid trying to play the part of amateur psychiatrists, the insights of psychiatrists can be quite helpful, especially when dealing with illnesses that carry perceptual and cognitive distortions such as schizophrenia. While I myself would prefer to offer prayer for healing as well as medication for people who have these kinds of afflictions, in these cases medication may in fact be the plan of God.

Finally, there may be demonic influence in some lives, and in some cases there may be an intertwining of the demonic, the psychological and the physical problems. These kind of problems are pretty rare, although Jesus dealt with cases, such as in Matthew 17:18, where he both took authority over the demonic and healed the person at the same time. Certainly none of those problems are necessarily mutually exclusive. But in the diagnosis of these kinds of problems, both Drs. Kurt Koch and Martyn Lloyd-Jones agree that someone who is truly under demonic influence will have a sense of spiritual darkness and show rejection and avoidance of the Word of God and the name of Jesus and resist prayer in the name of Jesus, sometimes with awful blasphemies and maybe even physical violence. It’s true that a rare few will believe that they are inhabited by demons and perhaps identify real physical symptoms that they are experiencing as demonic, yet remain calm while people are praying for them and honor the name of Jesus and his sovereignty and Lordship. This is most likely confused thinking that comes from an organic cause, and the only people that I’ve encountered like this had been institutionalized. In these cases the pastor may need to team with elders, medical doctors and mental health personnel to deliver wise, scriptural and compassionate treatment.