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Christian faith communities are often on the front lines of mental health care

Churches have a huge responsibility to people living with mental health issues. Are they living up to it?

For some people dealing with mental illness, religion can be a lifeline. For others, it can intensify their challenges.

Growing up in Birmingham, Alabama, Steve Austin had no idea how to explain what was going on inside his brain. In his evangelical church, he said, everything was “black and white.” If he couldn’t shake off the feelings of depression he had, it meant he wasn’t praying hard enough. “Anytime I’d ever seen someone confess a personal struggle with mental illness, a team of people prepared to cast out a demon.”

He longed for a “magic Jesus pill” to cure him. “I’d soaked my tears with prayers for Jesus to snap his cosmic fingers and fix me, but nothing was happening. The shame was nearly as unbearable as the panic attacks.”

First as a parishioner, then as a pastor, Austin tried plenty of spiritual remedies for the depression that plagued him.

“I had vegetable oil crosses smeared on my forehead [a common form of “anointing” in some Pentecostal communities] more times than I’d like to admit,” he said. “I’d been shoved backward by fiery preachers, praying for healing. I’d feigned ‘falling out’ in the Spirit” — a term popular in Pentecostal circles for allowing the Holy Spirit to take over the healing process — “so my friends wouldn’t know what a fake I was. I had done it all, but it seemed that either [faith healer] Benny Hinn was as much of a fake as me, or Jesus was a liar.”

Austin recalls that when he was finally prescribed medication for his depression, he worried his parishioners would find out. He’d hide his pills in his lunchbox and take them in a bathroom stall.

“Where I come from,” Austin said, “you can be Christian or ‘crazy.’ You can’t be both.”

Ultimately, after a suicide attempt and subsequent hospitalization at age 28, Austin found a new calling as a life coach and author focusing on mental health advocacy for Christians.

Austin’s struggle was extreme. But his story reflects a broader question among Christian communities: how to reconcile both secular and faith-based approaches to treating mental illness, particularly depression or anxiety.

On the one hand, the bonds of community fostered by a church can be invaluable for a struggling parishioner. On the other hand, pastors and church community members may not be equipped with the vocabulary or skills to handle issues of mental illness or, as in Austin’s case, might see mental illness as evidence of a lack of faith in God’s healing power.

According to 2014 research by evangelical polling organization Lifeway, only 27 percent of churches have established plans to help families affected by mental illness. Nearly two-thirds of religiously observant Protestant Christians with depression reported wanting their churches to speak openly about mental illness, but 66 percent of pastors said they spoke to their church on the topic once a year or less.

More recently, Lifeway found that while eight out of 10 Protestant senior pastors believed their churches were well-equipped to handle those threatening suicide, just 4 percent of respondents who had lost a loved one to suicide said church leaders were aware of that person’s struggles beforehand. “Despite their best intentions, churches don’t always know how to help those facing mental health struggles,” said Scott McConnell, LifeWay’s executive director, in a statement.

When I asked Warren Kinghorn, associate research professor of psychiatry and pastoral and moral theology at Duke Divinity School, about how well Christian communities were handling questions of mental illness overall, he said that the question was secondary to the fact that, often, those communities had no choice but to handle them. Clergy, he said, are “on the front lines” of mental illness response because of the importance of faith communities in religious people’s lives — whether or not they were equipped to do so. For this reason, he said, it was all the more vital that faith communities respond effectively to parishioners dealing with mental illness, getting them the help they need.

For many churches, getting rid of stigma around mental illness is the first step

But what might that help look like? Robert Vore, a suicide prevention instructor who focuses on Christian communities and the host of a podcast on Christianity and mental health, contrasts the kind of communal help a parishioner would get with a physical illness versus the response to a mental one.

“You see this when someone has a physical ailment or a disease or has lost a loved one,” he said. “Faith communities can really rally around them, visiting in the hospital, but we don’t yet see that really with people that are struggling with mental health, because we’re uncomfortable with it.

For Vore and many of the other experts I spoke to, the biggest barriers to a helpful church response to mental illness were not based in theology but in awareness; a stigma against mental illness that was more societal than theological. Removing that stigma by talking about mental illness openly in church communities is vital.

"We have to take the first step. The people who lead the church have to say, 'We’re talking about these things.’” Once the pastor leads the way, Vore said, “people come up and say, 'Hey, that’s my story, that’s my mom’s story, thanks for giving us permission to talk about that here.’"

Often, Kinghorn pointed out, change within church communities tends to come initially not through the efforts of pastors, but rather from parishioners or their family members who have mental illnesses themselves. That’s why, Kinghorn and others say, approaches to addressing mental illnesses vary widely from church to church, rather than between the denominations themselves.

Having gone through struggles with depression, anxiety, or self-harm, these families become better-placed to lobby their communities to handle mental illness more openly. Pastors are encouraged to normalize the condition from the pulpit. Parishioners with a mental illness or their family members may feel more comfortable asking for assistance from other parishioners, be it emotional or physical support. And the church may be able to use its position on the “front lines” to offer information about or referrals to secular mental health professionals.

Sometimes, this means that high-profile tragedies have doubled as wake-up calls. In the evangelical community, for example, the 2013 suicide of Matthew Warren, son of the well-known megachurch pastor Rick Warren and his wife Kay, shocked members of Warren’s Saddleback Church.

Since then, however, Kay Warren has become an outspoken advocate for mental health care, encouraging pastors to educate themselves to recognize the warning signs of parishioners in need. She’s since made advocating for better mental health care in faith communities a foundation of her ministry. In a 2014 interview with Christianity Today, she criticized the tendency of her own evangelical community to focus on the positive at the expense of dealing honestly with spiritual crises and doubt: “It was all just happy, happy, joy, joy … [we need to] tell people that we are just like everybody else. We are sinners. We are broken. There are some days I'm not sure God exists.”

In another interview with the Christian Post, Warren rejected the view — prevalent in some Christian circles — that suicide is a sin that condemns those who take their own lives to hell. She condemned the “terrible, terrible” shaming and ostracism that families of suicides faced from their community and called on the contemporary church to do better.

When it comes to mental illness, adding a theological perspective can hurt, but it can also help

Vore also condemned an increasingly common evangelical church culture that expects God to instantly heal all ills, while remaining suspicious of secular approaches to mental health. "Someone has surgery or recovers from a disease … we’ll say that God really used doctors or surgeons [i.e., as a vessel for divine help], but we're not there with counselors or psychiatrists.”

A church culture that focuses exclusively on the “positive” side of Christianity or the perceived benefits of following Jesus is more likely to ascribe mental illness to sin, demonic influence, or a lack of faith than it is to be open to discussing unanswerable questions. But that, Vore said, is a fundamental misreading of what Christianity is supposed to be about. “The God of Christianity … isn’t one that necessarily instantly heals everything, so expecting that is harmful because what it insinuates is that it’s your fault … [we believe in a] God that’s with us through dark times, through our pain, through our struggle. That doesn’t mean that you’ve done something wrong to encounter that struggle."

While that particular “mind over matter” attitude is often associated with the evangelical church (for instance, a 49 percent of evangelicals polled by Lifeway, compared to 35 percent of Americans say they believe prayer alone can cure depression) many religious institutions across denominations have been criticized for similar approaches. Catholic Chicago Deacon Tom Lambert similarly told US Catholic, “As a church we're just beginning to address the issues on a church-wide and institutional level."

That said, a religious community’s demographics make it difficult to separate out formal religious attitudes about mental health from cultural ones. Ethnicity, class, and income level can all determine how a community defines, acknowledges, and responds to those issues. For example, a 1994 study by Harold Koenig and colleagues for Duke University found that depression, anxiety, and other mental health conditions were far higher among Pentecostals than among mainline Protestants, but, as Koenig pointed out elsewhere, those conditions also tend to vary across income levels. (Mainline Protestants, as a whole, tend to be wealthier than Pentecostals.)

At its best, however, Christianity, like other religious traditions, can ask the very hard questions — about the unknowable nature of evil or suffering, say — that offer solidarity, if not answers, to those struggling with mental health issues. Laura Turner, a journalist who has written extensively on both faith and anxiety, pointed out that, for her, the Bible was often a source of comfort in difficult times.

She told Vox that, from time to time, some people within her church community implied, “if I just prayed more or had the right kind of faith, things would be okay.” Overall, she found her faith community helpful when it came to coping with anxiety.

“Job was the first book of the Bible that I decided to read [start to finish],” she said, referring to a story in the Old Testament about a man who retains his faith in God despite experiencing unimaginable horrors, including the loss of his children. “And while it remains very mysterious to me … that’s the whole point, that human beings can’t know [what God is thinking]. I found a lot of comfort specifically in reading that.”

Encouraging Christian churches to focus on and acknowledge the more theologically thorny parts of their faith tradition, Turner said, is vital.

“A lot of churches need to be really focused on parts of the Bible that don’t make for great, easy morals,” she said. “They teach a lot of things about right behavior and morality and that’s all well and good, but if you’re not looking at the Songs of Lament with your students you’re [overlooking] that sorrow has been part of the human condition from the beginning, and God has something to say about that. Talking about someone who wishes he’d never been born — it’s not, like, a fun youth group challenge where you all drink yogurt until you vomit.”

But, Turner said, that makes these difficult discussions all the more important.

That kind of engagement, however, may be tricky in Christian cultures where celebrating the material benefits of belief and God’s “rewards” for the faithful have become more pronounced.

Earlier this year, former The 700 Club producer Terry Heaton spoke to Vox about a trend he worried had become endemic to modern evangelicalism, in part because of TV shows like The 700 Club: an obsession with Christianity as self-help. Heaton recalled being discouraged by Pat Robertson, the show’s founder, from doing segments that explored difficult questions like death, and instead being pressured to produce shows that celebrated, say, people who were healed by prayer, or Christians who were doing well in life.

“We always showed people getting healed, overcoming the odds,” Heaton said. “The strong impression that the viewer would get from the program was that if you just followed the formula, you would be blessed!”

Attitudes towards secular therapy differ among Christian communities

Another difficulty for Christians with mental illness can be finding a therapist or psychiatrist who will respect their perspective and are willing to challenge unhealthy thought patterns.

Traditionally, Kinghorn pointed out, Christians have been suspicious of secular psychiatry and psychology. Often, he said, Christians associated those fields with the work of Sigmund Freud, a neurologist and a founder of modern psychology, who was largely hostile to organized religion.

After all, Freud saw the human being as, essentially, an animal, whose neuroses were the result of repressing natural sexual and libidinal desires. That attitude was directly at odds with a Christian worldview that sees human beings as partly spiritual creatures that should transcend the desires of the flesh.

In her book about Christianity and depression, Darkness is My Only Companion, Kathryn Greene-McCreight, associate chaplain at Yale University, reports having difficulty finding a therapist who didn’t try to cure her depression by also “curing” her of her faith. Writing about the feeling that she wanted to live for the glory of her Creator — a common feeling among Christians — Greene-McCreight found that some secular therapists would suggest that she is inventing a divine “projection” to give herself value because she does not see herself as worthy in her own right.

“Here is another place where the chasm between the religious patient and the nonreligious therapist simply cannot be bridged,” she said. “Is he right? Am I really not valuing myself for myself? Yes, he is right. But the value I place on his being right is the opposite of that which he claims it should be. I do not value myself for myself but this in itself does not necessarily indicate illness on my part, spiritually or mentally.”

But, Kinghorn said, attitudes have shifted on both sides of the secular-religious divide. Christians have, by and large, become more open to psychiatry and psychology, even as these fields have developed a broader range of approaches that may better fit the needs of a person of faith.

Still, among some Christians, there may still be a stigma against seeking out therapists who have not been properly “vetted,” particularly as it pertains to hot-button issues like sexuality or gender. For example, the evangelical organization Focus on the Family actively encourages Christians dealing with mental health conditions to seek outside help through its referral program, which offered 250,000 referrals last year.

Geremy F. Keeton, senior director of Focus on the Family’s counseling services, decried the belief that mental illness was purely the result of sin or improper or insufficient faith or prayer, telling Vox that “a broad-blanket, sin-based view of mental illness is still a limited understanding of how the body, mind and spirit all integrate and cooperate in delicate ways in a fallen world. ... Rather, a good cooperation among the church and trained Christian counselors who know both the Bible and the field of mental health is key.”

He actively promotes both chemical medication and procedures like EMDR (Eye Movement Desensitization and Reprocessing), a treatment common for PTSD, as potential options for Christians. “We didn’t check our brains in at the door of the church nor at the door of our university training. Integration in most instances is possible, is smart, and is key,” he said.

But there are caveats. Counselors and therapists in the referral program must not simply be sympathetic to Christians, or even be Christian themselves. They must also affirm their sympathy to Focus on the Family’s “core values,” which include, for example, the belief that sex is designated exclusively for married heterosexual couples. This means some mental health patients referred to Focus-approved counselors whose issues put them at odds with a conservative interpretation of their faith may be encouraged to, for example, pray to be relieved of same-sex desire. (Focus on the Family advocates for conversion therapy for LGBTQ individuals and previously owned Love Won Out, a network of gay conversion ministries, which is now owned by Exodus International).

At its best, however, a combination of faith-based and secular approaches treats those who want to preserve aspects of their faith worldview as they seek wider help. Artur Sebastian Rosman, a managing editor at the McGrath Center for Church Life at the University of Notre Dame, told Vox how, as a Catholic, he found his priest vital in helping him contextualize and cope with his depression. He attended confession regularly with Father William Watson, who later developed a 40-week program for spiritual and personal development modeled after the devotionals of St. Ignatius. Rosman describes himself as a “guinea pig,” as Watson used techniques during their confessional sessions that would later shape his books on the topic.

While Rosman saw Watson alongside a secular psychologist, he found Watson’s guidance more practically useful, in part because they spoke to his wider Catholic worldview and his sense of his place in the world.

“After one of these long confessions with Fr. Watson ... he'd listen through what I thought were my ailments and would suggest ways of interpreting them and recommended exercises such as breathing and prayer regimens to refocus the mind,” he recalled. Watson described Rosman’s depression to him “as a gift to be discerned over time rather than a curse to overcome at all costs right now … an opportunity to understand myself and my wider community, rather than some towering disappointment that can be never be erased.”

For Rosman, at least, that was enough. “I basically told my shrink, I don’t need you anymore.”

But, for Laura Turner, one of the most important elements of her faith community wasn’t theological, it was communal. “There are a lot of ways in which [my] church group felt like a really safe place for me to talk about anxiety. And I realize that is definitely not the case for everybody, but I had a lot of good conversations about fear and worry and anxiety.”

Just talking about how she felt with people she could count on to be there for her allowed her to feel less alone.

“Isolation,” she said, “just breeds anxiety.”

Whether people of faith find solace in community, theology, or a simple reference to a trusted counselor from a pastor, churches and other faith communities can make a powerful difference for those with mental health needs. What remains to be seen is whether they’ll consistently live up to the challenge.

Correction: This article has been updated to reflect the correct title of Kathryn Greene-McCreight’s book.