What about mental illness?

Question 11100

Mental illness is one of the areas where the church has too often made things worse, and I say that as a pastor who has watched it happen. A believer with depression or an anxiety disorder is told to pray harder, to confess the hidden sin, or to stop being so introspective, and they leave feeling both unwell and guilty.

I want to set out a better way of thinking. It begins with what Scripture actually shows us about the inner life of God’s people, and it involves taking the body seriously in a way that a good deal of popular Christian teaching does not.

The Bible does not hide this

Consider Elijah. Fresh from the greatest public victory of his ministry, he runs into the wilderness, sits under a broom tree and asks God to take his life. Read what God does in 1 Kings 19. There is no rebuke. An angel feeds him, twice, and lets him sleep. The first prescription for the greatest prophet of his age was food and rest.

Consider the psalmist asking his own soul why it is cast down and in turmoil within him, and having to preach hope to himself repeatedly because he cannot feel it. Consider Job wishing he had never been born. Consider Paul in 2 Corinthians 1, saying he was so utterly burdened beyond his strength that he despaired of life itself. Consider Jeremiah, whose whole book is a study in anguish.

Scripture is not embarrassed by any of this. It records the mental and emotional collapse of its greatest figures without treating it as evidence of spiritual failure. That alone should make us cautious about the confident diagnoses we hand out to people struggling with mental illness today.

We are body, soul and spirit

Much of the confusion here comes from a flattened view of the human person. If a believer is only a soul with a body attached, then everything that happens inside must be spiritual, and mental illness has to be either sin or demonic. Neither conclusion follows once we take the whole person seriously.

I hold that we are body, soul and spirit, genuinely distinguishable as Paul indicates in 1 Thessalonians 5:23. The soul, the Hebrew nephesh, is the seat of individual life, appetite, emotion and identity, and it is bound up with the body at every point. Damage the body and the soul feels it. That is not a defect in the design, it is the design.

Which means mental illness can have physical causes in exactly the way heart disease does. Thyroid disorders produce depression. Brain injury changes personality. Sleep deprivation produces hallucinations in perfectly healthy people. None of that is spiritual failure, and treating it as such is a category error with cruel consequences.

Mental illness is not automatically sin

Let me be plain, because plainness helps here. Clinical depression is not the sin of ingratitude. An anxiety disorder is not the sin of failing to trust God. Obsessive compulsive disorder is not a lack of faith, and the intrusive thoughts that come with it are not confessions of a wicked heart. Psychosis is not rebellion.

The New Testament commands to rejoice and not to be anxious are real commands, and I am not setting them aside. But a command addressed to the will is not automatically applicable to a condition of the body. We would not tell a diabetic to command his pancreas, and telling a depressed believer to command his serotonin is the same mistake wearing more spiritual clothes.

That said, I am not saying sin never features. It can. Bitterness held for years does damage. Guilt over something unconfessed produces real distress, and the remedy there is confession and the assurance of forgiveness. The pastoral skill lies in telling the difference, which takes time, patience and a willingness to be wrong. See my answer on whether depression is a sin or a spiritual problem.

What about the demonic?

Some Christians treat every mental illness as demonic, and others deny the demonic exists at all. Both are wrong. The Gospels distinguish between the two: Matthew 4:24 lists those oppressed by demons alongside those afflicted with various diseases and epileptics, treating them as different sorts of case.

Spiritual opposition is real, and a believer under sustained attack may well feel it in their mind. But leaping to that explanation first is dangerous. It delays treatment, it makes the sufferer feel unclean, and when the deliverance ministry does not work they are left believing they are beyond help. I have written more on this in my answer to whether demons can cause mental illness.

The wise approach is to treat the ordinary explanations first, since the ordinary explanations are ordinary precisely because they are common. Pray, certainly, and pray seriously. Just do not stop the medication in order to prove something.

What the church should actually do

Start by believing people. A congregation where someone can say aloud that they are struggling with mental illness and be met with warmth rather than alarm has already done most of the work. Silence is what does the damage, and silence is usually the result of people fearing what will be said back to them.

Then be practical in ways that are unglamorous. Meals. Lifts to appointments. A walk. Sitting with someone without needing to fix them. Elijah got food and sleep before he got a conversation, and there is a pattern in that worth copying. Do not underestimate what a phone call on a Tuesday does for someone whose week is otherwise empty.

Encourage proper treatment rather than treating it as a last resort. That means doctors, and where appropriate it means therapy and counselling and medication. And keep offering the ordinary means of grace gently, without making attendance a test. Someone who cannot face a crowded building is not backsliding.

If you are the one struggling

You are not a second-class Christian. Your mental illness is not a verdict on your standing before God, and the feelings that tell you otherwise are symptoms rather than testimony. Feelings are real, but they are not always reliable witnesses, and this is precisely the situation the psalmist is in when he addresses his own soul rather than believing it.

Do the practical things even when they feel pointless. Tell somebody. See your doctor. Keep sleeping and eating as regularly as you can manage. Lower the bar for what counts as a good day. And let other people carry things for you for a while, which is harder than it sounds for those of us who prefer to be the ones helping.

If your thoughts have turned to ending your life, please tell someone today: your doctor, or in the United Kingdom the Samaritans on 116 123, who will listen at any hour. That is not a spiritual failure either. It is a signal that you need more help than you currently have, and asking for it is the right thing to do.

Hope that does not depend on how you feel

The gospel does not promise that believers will always feel well. Some of the most faithful people I have known have lived with mental illness for decades and served the Lord throughout, quietly, without ever being free of it. Their usefulness was not delayed until they were better. It promises that our standing with God rests on what Jesus did rather than on our emotional condition, which is precisely why it holds when everything inside has gone dark.

Psalm 103:14 says he knows our frame and remembers that we are dust. That is not a criticism, it is tenderness. God is not surprised by human fragility, and he does not require you to be robust before he will have anything to do with you.

And there is an end in view. Mental illness belongs to this age and not to the next one. The day is coming when God wipes away every tear, and the mind that has fought itself for decades will finally be at rest. That is worth holding on to on the days when nothing else will stay in your hands.

So, now what?

If you lead a church, take an honest look at your own vocabulary before you look at anyone else’s. Ask yourself whether anyone in your congregation could actually say the words out loud on a Sunday. If you are not sure, that is your answer, and the fix begins with how mental illness gets spoken about from the front.

If you know someone who is unwell, contact them this week and do not wait for them to ask. They will not ask. And if you are the one in the dark at the moment, will you tell one person before Sunday?

Why are you cast down, O my soul, and why are you in turmoil within me? Hope in God; for I shall again praise him, my salvation and my God. (Psalm 42:5, ESV)