Thinking Well about Mental Health

This is a difficult subject to address, because of its complexity and highly personal nature. Everyone is affected by mental illness; either personally or someone they love. People you care about have experienced depression, ADD, addiction, bipolar, or other mental health struggle. For you the phrase “mental illness” may be a safe haven of explanation, a label that carries stigma, or a mystery that is hard to understand.

This is why mental illness is a subject that must be discussed in the church; otherwise, our silence hurts people by leaving them to struggle in isolation. How does the mind relate to the body? How do our emotions relate to our faith? These are important questions that everyone grapples with and are essential to holistic discipleship.

For the moment, I will defer an attempt at defining mental illness. At this point, it is enough to say that it is a term on which even the experts disagree; that this is a large part of what makes this conversation difficult. When the central term in any discussion lacks a clear definition, the rest of the conversation will always be challenging.

Let me state one important assumption before we begin; an assumption that I anticipate most readers want to know in order to determine whose “team” I am on or what my “agenda” is in writing:

I am assuming there are a relatively equal number of people who avoid getting help (i.e., counseling or medication) because of the stigma of mental illness as there are people who use the labels of mental illness as a crutch to avoid taking responsibility for important choices in their life.

Whether the two groups divide into a neat 50-50 split in the culture at-large or in your specific circle of relationships, I believe it is generally agreed that there are a large number of people in both camps. Too often, discussions like this one are intended only to change the perspective of one side of the issue. This, I believe, biases those presentations.

A Starting Point – Good Questions

When engaging a difficult and highly personal subject, it is better to start with good questions than a list of answers. The better our questions are, the more responsibly we will utilize the answers of which we are confidant, the more humbly we will approach areas of uncertainty, and the more we will honor one another in the process of learning.

The purpose of these questions is to expand our thinking about mental illness. We all bring a “theory of mental illness” to this discussion. This theory, whether we can articulate it or not, shapes the questions we ask. Exposing ourselves to important questions from other perspectives is the first step in becoming more holistic in our approach.

• • Is mental illness a flaw in character or chemistry? Is this the best way to frame the question? What do we lose when we fall into the trap of either-or thinking?
  • In the modern psychological proverb, “The genes load the gun, and the environment pulls the trigger,” where is the person? How do we best understand the interplay of predisposition (genetics), influences (environment), and the individual making choices (person)?
  • What percent of those who struggle with “normal sorrow” are labeled as clinically depressed? What percentage of those who think their sorrow is normal are actually clinically depressed? How do we communicate effectively when the same word – depression – has both a clinical and popular usage?
  • Would we want to eradicate all anxiety and depression if we were medically capable of doing so? What would we lose, that was good about life and relationships, if these unpleasant emotions were eradicated from human experience?
  • Can we have a “weak” brain—one given to problematic emotions or difficulty discerning reality—and a “strong” soul—one with a deep and genuine love for God? If we say “yes” to this question in areas like intelligence (e.g., low IQ and strong faith), would there be any reason to say “no” about those things described as mental illness?
  • When do labels serve well (i.e., offering a sense of hope by breaking the sense of isolation and shame that comes with believing “my struggle is completely unique”) and when do they serve poorly (i.e., diminishing hope by creating a sense of determinism and stigma)?
  • Are our emotions more than the alarm system of the soul (moral) and the chemicals of our brain (biological)? Do these two categories tell us everything we need to know about emotions? Are these categories complimentary or competitive with one another?
  • How should we understand the effects of the Fall on the mind and brain? We know our bodies age and die. We know all of our organs are susceptible to disease and deterioration. We have “norms” for the frequency, duration, onset, and prognosis of these effects of the Fall; what are the equivalent expectations for the mind and brain?
  • How much should we expect conversion and normal sanctification (spiritual maturity) to impact mental illness? Outside of medical interventions, most secular treatments for mental illness focus on healthy-thinking, healthy-choices, and healthy-relationships; so how much should Christians expect sound-doctrine, righteous-living, and biblical-community to impact their struggle with mental illness?

What do we gain from asking good questions? Humility. Humility may be more vital for this conversation than most other conversations we have. Why? Because the neurological, genetic, and medical research that have prompted many of these questions is still in its infancy. What we “know” in these areas will likely seem as outdated as a VHS tape 10 years from now.

But if the Bible is timeless, do research developments in these areas matter? Yes. Not because new scientific discoveries will change what the Bible means, but those discoveries will likely change our application of the Bible. Did the discovery of epileptic seizures change the truthfulness of the Bible? No. But it did help Christians understand that these were not demonic events. It is likely, if God should tarry, that many similar discoveries will emerge in the area of mental illness.

What Is Mental Illness?

We can’t put this question off any longer. What are we talking about anyway? What is mental illness? As close as we can get to an accepted definition would be the one given in the Diagnostic and Statistical Manual: 5^th Edition (DSM-V) by the American Psychiatric Association (APA):

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”

But the accuracy and benefits of this definition are debated, even amongst various groups within secular psychology and psychiatry. That is why it is easy to find nuances of and alternatives to this definition. After the examples below, I will highlight the modifications each organization or author made to the DSM-V definition.

“A mental illness is a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning.” National Alliance on Mental Illness

• • Notice the narrowed declaration that mental illness is a medical condition.

“Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior… Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.” The Mayo Clinic

• • Notice the desire to differentiate normal emotional struggles from those that are clinically significant.

“A disorder of the brain resulting in the disruption of a person’s thoughts, feelings, moods, and ability to relate to others that is severe enough to require psychological or psychiatric intervention (p. 43-44).” Matthew Stanford in Grace for the Afflicted: A Clinical and Biblical Perspective on Mental Illness

• • Notice the desire to locate the problem only in the physical organ of the brain.

Where do these definitions agree? There is one main point of agreement. In order to qualify as a mental illness the life-struggle must “impair life functioning.” This reveals that the struggles known as mental illness exist on a spectrum; almost everyone will struggle with these challenges to some degree. However, there comes a point on the spectrum where life is impaired to a degree that it seems wise to classify this struggle differently.

Mental illness means that a common struggle has crossed a threshold and become “clinically significant.” The term is an assessment that outside help is needed; that (a) the passing of time and (b) continuing in the same life pattern will not result in the desired relief from these struggles.

Where do these definitions differ? We will consider two key points of difference.

First, some definitions seem very concerned to identify the location of mental illness in the physical organ of the brain. Other definitions seem less concerned with defining one single location for the struggle. The latter seems wise:

• • Many instances of depression are rooted in the glandular system more than the brain.
  • When attention is exclusively given to brain chemistry to the neglect of neural pathways; which are not treated with psychotropic medications and have more to do with habituation.
  • A brain-only focus can reduce our “humanity,” and inadvertently our value, to the strength of our frontal lobe – the aspect of human neural anatomy that is most distinct from other creatures.
  • A brain-only focus can distract us from the beneficial influence of exercise, sleep, diet, and other healthy practices.

Yes, we want to continue to grow in our understanding of the brain’s role in our emotions. But we must realize there is a modern temptation to reduce people to their brains, which parallels the historic temptation of the church to reduce people to their souls. Whenever we allow one facet of our humanity to trump all others, we become blind to other important factors. We become excellent in the things we do well, but dangerous because of the things we fail to consider or give their full weight.

Second, some definitions seem content with the broader term “syndrome” while others want to use the more narrow term “disease.” Consider the difference in these two definitions.

1. 1. Syndrome: “a group of signs and symptoms that occur together and characterize a particular abnormality or condition.”
   2. Disease: “an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors.”

Disease implies a known and verifiable cause. Syndrome is merely a group of recognizable symptoms. With the multitude of factors that can result in depression, anxiety, inattention, addiction, and other experiences commonly called mental illness, it is seems wiser to call mental illness a syndrome rather than a disease.

So, after this discussion, how are we defining “mental illness” in this presentation?

Mental illness is a life struggle, which is common to all people to some degree, that significantly (degree of impact) and persistently (duration of influence) impairs an individual’s mental-social-emotional ability to function. With the exception of responses to trauma, this impairment is beyond a normal response to their life circumstances. The strengths and weaknesses associated with particular personality qualities and aptitudes are not mental illness.

Mental illness may have its cause in the physical body (i.e., brain chemistry, habituated neural pathways, genetics, glandular system, viral or bacterial infection, etc…), environmental causes (i.e., trauma, poor socialization, abusive-neglectful home life, etc…), personal choices (i.e., the consequences of sinful or foolish decisions on a spectrum from isolated bad choices with significant emotional-relational implication to addiction), or a combination of these causes.

The primary declaration made by the term mental illness is outside help is needed because the passing of time is unlikely to produce the desired decrease of symptoms. Based on this definition of mental illness any number of soul-body physician-counselors may be relevant and effective in assisting the process of change. A mental illness may be a true disease, a syndrome, or a consequence of life choices / circumstances.

The bullet points below clarify key points in this definition.

• • Common to all people – emotional regulation, reality testing, and social awareness are struggles all people face
  • Degree of impact – in order to qualify as a mental illness a struggle must impair someone’s ability to function
  • Duration of influence – in order to qualify as mental illness a struggle must last longer than is normal for its trigger
  • Outside personality trait and aptitudes – the advantages or disadvantages of particular personality types or aptitudes should not be confused with mental illness
  • No one universal cause – our cognitive-emotional systems and struggles are too complex to reduce to a single cause
  • Multiple relevant helpers – the term mental illness should not result in an exclusive or restricted domain of helping relationships; effective care for complex problems will cover the spectrum of formal to informal care

Webinar Invitation

This case study was written to set up the presentation for the free webinar “Thinking Well about Mental Health.” The webinar will be Thursday December 2^nd at 1pm EST. My goal in this twice-monthly series of free webinars is to teach one primary counseling concept or skill each month and then provide a case study that allows participants to become more proficient at utilizing that skill or concept.

These are great events for:

• Pastors, chaplains, and ministry leaders looking to enhance their pastoral care skills
• Counselors wanting CEU credits to help them learn more about the intersection of their faith and practice
• Leaders in church-based counseling ministries looking to grow in their case wisdom
• Undergraduate students looking to discern a calling to vocational ministry or a career as a professional counselor
• Friends and small group leaders committed to walking faithfully alongside their peers in tough times