Now (this is continuation of previous posts on mental illness) we are faced with questions like:

  • What does God require and the gospel offer in the change process for biological, environmental, and volition struggles?
  • How moral are struggles commonly called mental illness?
  • How much (i.e., percentages of the problem) can we change when our struggle is rooted in each of these areas?
  • What type of change (e.g., eliminate struggle, change perspective, redeemed only in heaven, etc…) is possible?
  • How much should becoming a Christian or living out Christian teaching impact mental illness?
  • Is mental illness divine punishment, outside God’s control / concern?
  • Is it a sign of weak faith or idolatry (e.g., replacing God) to seek help for these struggles from secular sources?

If we seek to answer these questions with a one-size-fits-all answer we will help some people but hurt many others. This is where I believe my beginning assumption – that there are as many people who need to de-stigmatize mental illness as there are who need to de-gospelize psychology and medication – is most important. That is why as we seek to answer these questions, we need to locate the individual in at least two ways:

  1. What kind of struggle is an individual facing (i.e., sin-based, suffering-based, or identity-based)?
  2. What beliefs does this person hold about how faith, medicine, therapy, friends, or their choices should be able to fix it?

Let’s engage the first question by asking, “What are the three types of struggle an individual can face?” From a biblical perspective, I believe it is most helpful to delineate three types of struggle.[1]

  1. Sin Struggles – challenges we face because of our immoral choices or mis-prioritized allegiances.
  2. Suffering Struggles – challenges we face because of living in a world marred by sin that is inhabited by other sinners.
  3. Identity Struggles – challenges we face because we define ourselves by the wrong things or lack a sense of identity.

These do not directly correlate with the previous categories of biology, environment, and volition.

  • Substance abuse (volition cause) is the result of personal, sinful choices, often is a self-medicating reaction to suffering, and has a strong tendency to become an identity – “Hello, my name is [blank] and I’m an alcoholic.”
  • Struggles of same sex attraction (often biological cause) are often an unwanted form of suffering, always a struggle of personal identity, and acting on these desires is biblically prohibited.
  • Post-traumatic stress (environmental cause) is a reaction to intense suffering, often results in many sinful-destructive choices, and carries a stigma that can alter one’s identity.

Let’s take a look at each of the potential causes of mental illness and consider how the gospel speaks to each. This is where we will engage a counselee’s expectations of self, others, and God in the change process.


[1] I am borrowing these categories from Michael Emlet, M.Div., M.D. in CrossTalk: Where Life & Scripture Meet (particularly chapter 5) New Growth Press (2009).