[This is the first in a two part series about mental illness. This post will be about religion and mental health and the second post will be about mental health and public policy.]
The longstanding antagonism between many religious groups and professionals in behavioral health fields is a significant but inadequately discussed conflict. As a member of a religious community that has not always had an entirely positive relationships with mental health practitioners (especially psychiatrists) who also happens to live with a significant mental illness (bipolar disorder), I find this issue very much worth talking about. There is a growing recognition, on the part of religious people—including those in my own Latter-day Saint tradition—that psychotherapy and psychiatric treatment can valuable complements to religious counseling for mentally ill adherents. Likewise, mental health professionals (who have long viewed certain religious behaviors as pathological and have often expended little effort in trying to understand the role that religious faith can play in the lives and coping strategies of practitioners) have—in recent decades—realized the advantages of treating the religious faiths of clients with respect. Now, many professionals even view religious practices and counseling as useful adjuncts to secular psychotherapy. The bad news, as I see it, is that this rapprochement is happening far too slowly and many adherents to conservative and high-investment religious traditions who are also mentally ill are still not benefiting as much as they could. For example, (looking only at one side) there are many dysfunctional beliefs that are common in religious groups and are obstacles to better mental health for adherents with a mental illness. In this post, I would like to address a few of the unhelpful things religious people (and especially Christian people) are likely to hear if they have a mental illness.
You're Not Praying Hard Enough
In many religious communities, people dealing with mental illness, especially mood disorders, are informed by helpful bystanders that their problems could be solved by simply praying more intently. I will be the first to acknowledge that prayer can play an important role in living through episodes of depressed or manic mood. However, the belief that prayer—unaided by any other action of the part of a mentally ill person—can bring about recovery, is contrary to the experience of every mentally ill person with whom I have ever discussed the matter. Certainly, most Christians have heard the saying of Jesus from Matthew 21:22: “Whatever you ask for in prayer with faith, you will receive.” If faith is understood to mean nothing but intellectual assent or wishing very hard, and the assertion is that you get whatever strikes your fancy just because you ask for it, the resulting theology is one of what I like to call “Jesus Christ, Vending Machine.” If mental health problems, and any health problems, disappeared in response to fervent prayer, the American South would not be approximately the least healthy place in the developed world. Certainly, if it is consistent with your beliefs, pray. Pray hard. Also, find the best medical treatment and therapy that is available to you and work to get as much from this treatment as you can. It may be that your prayers will be answered though (to name but one example) a selective serotonin reuptake inhibitor and cognitive-behavioral therapy. Just because it is not magic, does not mean it is not divine.
You Just Need to Repent
If it is not praying, it is repentance. I once heard an account of a Mormon Bishop (a sort of lay pastor) who had provoked the ire of the mental health professionals in his community. He was putting them out of business. When this simple man—a farmer, if I remember correctly—was asked what he was doing to alleviate the behavioral health problems of the people in his ward (congregation), he responded that he just told them to repent. In fact, when I was told this story, I was in the midst of a depressive episode. The person who told it to me was helpfully informing me that all I needed to do was cast my sins away. Of what I was to repent, I am not sure—it was neither specified in the story nor explained by its teller.
I will be the last person to speak negatively of repentance. I believe that life is about approaching God. For me, this entails perpetual reorientation and inner transformation. I would also accept that behavioral changes, which could be characterized as “repentance,” can play an important role in mitigating mental illness. However, I have never encountered a situation, either in my own life or the life of a friend or family member, when simply discontinuing a “sinful” behavior cured a psychological disorder. Furthermore, telling people with mental illnesses that the cure to all their problems is repentance places the full responsibility for their illnesses upon them. This is bad psychology as well as bad theology. People who suffer from depression and anxiety often have highly perfectionistic personalities; these people find it very easy to identify sins in every aspect of their lives and are eager to flagellate themselves for these shortcomings in ways that compound their symptoms. At the same time, the idea that one can draw a straight line between sin and suffering (or righteousness and prosperity) contradicts the most superficial observation of the human condition. While some biblical literature (like the Deuteronomistic History—Joshua, Judges, 1 Samuel, 2 Samuel, 1 Kings, and 2 Kings as well as Proverbs) supports this idea, it is powerfully critiqued in books like Job and Ecclesiastes (Qoheleth). Eccliastes 9:11 famously states (NRSV):
Again I saw that under the sun the race is not to the swift, nor the battle to the strong, nor bread to the wise, nor riches to the intelligent, nor favor to the skillful; but time and chance happen to them all.
That is to say, much of the good or bad that happens to us has no deterministic relationship to our own choices or attributes. Mental illness is like that too. Though different disorders have different etiologies, many have a genetic component. You do not chose your chromosomes and having particular sequences in your DNA could hardly be a consequence of your sin (unless your religion allows you to sin before conception). You also have no agency in most of the developmental insults that can contribute to mental illness. I suppose a person could make the tenuous claim that it is your fault you have PTSD, since you joined the US military or dated an abusive man, but such explanations seem deeply twisted to me. And this is not about playing the victim—it is valuable and admirable to take charge of your mental health and seek the best possible treatment for it. Perhaps putting an end to certain destructive behaviors will be part of this process, but repentance is almost never sufficient, by itself, to address mental illness. Pretending otherwise is a flawless way to hurt yourself and others.
You Don't Have Enough Faith
In Matthew 17:20, Jesus is quoted as saying, “if you have faith the size of a mustard seed, you will say to this mountain, ‘Move from here to there,’ and it will move; and nothing will be impossible for you” (NRSV). Likewise, Luke 17:6 quotes Jesus as saying, ““If you had faith the size of a mustard seed, you could say to this mulberry tree, ‘Be uprooted and planted in the sea,’ and it would obey you” (NSRV). If a tiny bit of faith can lead to geologic catastrophes and anthropomorphic mulberry trees, surely it can cure a bout of depression or a wee psychotic episode! This way of looking at things is complicated by the fact mountains seem to move very slowly, even when believing Christians might benefit from swifter changes, and walking trees are seldom found outside of J.R.R. Tolkein books (I'm excluding the mediocre Peter Jackson films as non-canonical). It seems to me that the point of these sayings from Jesus is less that we can do great things through faith and more that humans are largely faithless. But that could just be depression speaking.
What I do know is that trying to encourage people struggling with mental illness by saying, “You just need to have more faith,” is usually counterproductive. Again, I am not trying to devalue faith. Trust in God has carried me through many times when bipolar disorder would otherwise have got the better of me. I believe faith is very healthy for humans, especially humans who suffer from mental illnesses. It may even be that God rewards faith with healing at times. However, relying on faith alone, to the exclusion of medical and psychological treatment, is equivalent in foolishness to trying to faith-heal sclerosis of the liver. I would suggest a more appropriate use of faith would be a trust in the best treatment that psychiatry and psychotherapy God has yet given humanity and further trust that, where these are lacking, God will make up the difference.
That's Just Satan Talking
And then, there is Satan. At one point in my life, when I was suffering from severe depression, a close family member tried to talk me out of depression by telling me, “That's just the Adversary talking.” Indeed, for many Christians, Satan is a very real and present part of everyday life. It is natural, from this perspective, to attribute idiosyncratic beliefs and a preoccupation with ending ones life to an external agent (e.g. demons or Satan). At one time, I also believed that this might be the case. What changed my mind was medication (lithium). I realized that when I was taking lithium at an appropriate dose, the suicidal thoughts and delusions were greatly reduced and my depressive episodes were less deep. Why, I asked, would the devil and his angels be affected by ions of a specific alkali metal? I asked my family member (roughly) the same question, and she could not give me a satisfactory answer. I concluded that Satan was not a significant cause of mental illness, any more than he is a significant cause of halitosis, and that problems with mood, anxiety, and so forth are best approached from a different perspective.
I recognize, of course, that the Gospels say Jesus cast demons out of people who acted like they might be mentally ill and that these people subsequently recovered. I am not entirely sure how to understand these episodes. Various readings have been proposed—literal, metaphorical, and otherwise. Perhaps demonic possession is real, but distinct from mental illness. Perhaps Jesus was reacting to a culturally specific psychological phenomenon. Perhaps the demons represented Roman occupiers to be cast out of a liberated Israel (explaining why one demonic collective identified itself as “Legion”). I cannot pretend to answer this question here. All I can say is that I am healthiest and happiest when I eschew a devil-centered life and worldview. I urge you to try the same approach and see if it works for you as well.
The Bottom Line
If you want to help someone close to you through mental illness (and are willing to acknowledge that sometimes mental illnesses provide a lifetime of excitement), or if you are grappling with mental illness yourself, focusing on prayer, repentance, or faith alone is unlikely to be the most effective strategy. While all of these things have value—indeed, deep value—when we propose simplistic formulae for “fixing” mental illness, we trivialize it in a way that would seem ridiculous if applied other medical conditions. I am writing in a exception for snake-handlers. Treatment for mental illnesses differs according to type and severity, but many common mental illness are most effectively treated by a combination of medication and therapy. Both types of treatment are steadily improving in effectiveness as new drugs come onto the market and practitioners modify their methods in light of new evidence. There is no good reason to believe that use of psychiatric medicine indicates a lack of faith or an unwillingness to repent and pray. I would suggest, on the contrary, that these pharmaceuticals are a gift from God (leaving aside their side-effects, which are clearly satanic). For someone who suffers from a psychotic disorder (like schizophrenia) or from psychotic depression or mania, appropriate drugs can spell the difference between inhabiting a world haunted by demons and inhabiting the mundane world where most people spend their time. I am not claiming that psychiatrists always get everything right, especially the first time, or that everything a therapist tells you will be helpful. These disciplines are, if not in their infancy, at least in their adolescence. But they help millions of people around the world and some day they may help you or a loved one as well.