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Apr 23, 2013

Mental Illness & Medication vs. Spiritual Struggles & Biblical Counseling

These past few weeks have been very trying. From deaths of people who inspired us to yet another reminder that we are not completely immune from the horrible acts of others, grief seems to be everywhere we turn.

Earlier this month, we spent a lot of time talking about mental illness here at the blog, in light of the sad news from Rick Warren and Saddleback. I spoke about the church's response to this problem that is bigger than we want to admit, and looked at what others have to say as well. I did want to discuss more fully one issue that we can have a tendency to tiptoe around as if we are on eggshells--mental illness and medication.

Michelle Boorstein from the Washington Post called me that week, and she asked some penetrating questions about why Christians might struggle with this issue more than, perhaps, mainstream society. In that article she quoted me as saying:

Part of our belief system is that God ­changes everything, and that because Christ lives in us, everything in our hearts and minds should be fixed. But that doesn't mean we don't sometimes need medical help and community help to do those things.

That's the heart of my issue, but let me address it more fully here.

Mental illness is a tough thing to consider because it can open a debate that many would rather not have. But given the overwhelming response these past few weeks on my blog and in other spheres of social media, it bears discussing more fully before we close the conversation for now.

Among evangelicals, you will find some who are very open to dealing with mental illness as a physiological reality, but you will also find others who think that there is no other value to be gained from listening to the world.

One might wonder why we can't just read enough Scripture or pray enough. Why can't that cure us? Because the reality is that in some cases, there are physical, chemical, or physiological issues. Yes, prayer can help, and yes, God does still heal in miraculous ways. But more often than not, more prayer and more faith are not the only remedy for mental illness. Medicine is still needed.

Most people would agree that in many ways we are an overmedicated society. I don't deny that. But that is a separate discussion for another day. Just because we need to be careful in how we prescribe and administer medication does not mean we should be afraid of medical intervention entirely.

And yes, mental health is a spiritual issue in some instances, but it can also be a medical issue. We have to recognize-- and admit-- that the faith community sometimes is unsure of how to deal with this tension. All truth is God's truth, and there are both spiritual truths and medical truths that are part of dealing with this issue.

Earlier in life, I became aware of some mental health issues in my own family. When I became a Christian, the initial reaction I heard regarding these issues was that if people would trust the Lord enough, then they would be healed. But let's use that same line of reasoning with a physical medical issue that we all can acknowledge. You don't trust the Lord through a broken leg alone. One of the ways you trust the Lord is that you go to a doctor and you get a cast.

When I became a pastor, I was a bit naive. In my recent CNN article, I gave the story of Jim. I began to realize that Jim and I were praying together, and we were reading the Scriptures together. And yet, when he was on his medication, he really was healthy and whole. This was a turning point for me to understand that perhaps the key word in real mental illness is illness. I had to see that he was sick-- not just struggling spiritually, but actually physically sick, which was a major distinction.

David Murray explains another helpful distinction:

If there's one thing we can all do, it's to avoid making our own experience the rule for others. That's the most common mistake I've seen people falling into here (and I've done it myself as well). Just because medication worked for you, does not mean it will work for everyone else. Just because biblical counseling alone worked for you, doesn't mean it's the answer for everyone else. Just because you've never been depressed, doesn't mean depression does not exist. Cases are so different, and causes are so complex, that we need to exercise charity, sympathy, and patience in all our dealings with one another.

David's article (and others I recently linked to) are probably MORE helpful than mine because I've only see mental illness and the benefits of medication through others in my family and church. The writers I linked have lived it themselves. The reason I listed prominent Christian leaders in that particular post was to help break the stigma.

At the end of the day, part of the reason it's difficult to acknowledge these real issues is that there can be a perception that Christians are not supposed to have these issues. Part of our belief system is that God changes everything. Sometimes we find ourselves asking "why hasn't God fixed this?"

But that stigma can be a hindrance instead of a help.

Some will respond to our questioning by saying it is all because of sin. Or a lack of faith. Or a lack of repentance. Yes, there are consequences for sin. But just because someone is struggling with anxiety or depression or another form of mental illness does not mean it is a result of something they've done or not done.

Tim Keller has written a helpful article on the four models of counseling in pastoral ministry. In it, he writes:

We must beware of giving people the impression that through individual repentance for sin they should be able to undo their personal problems. Obviously, we should not go to the other unbiblical extreme of refusing to acknowledge personal responsibility for sinful behavior as well...While we can't fall into the reductionism of believing all problems are chemically based and require medication, we also cannot fall into the reductionism of believing all problems are simply a matter of lacking spiritual disciplines. Schizophrenia, bipolar depression, and a host of other psychological problems are rooted in physiological problems that call for medical treatment, not simple talk therapy.

Keller is spot-on. Both ends of the spectrum are dangerous places to counsel from. It's not always a result of sin. Yet the answer is not always medication.

We sometimes think that because Christ lives in us, that everything in us-- in our hearts and our minds-- should be fixed and made perfect in this lifetime. As a Christian, I know that Christ does change all of those things. But to use the illustration from before, if a leg is broken, we still need a cast. The whole pulling-yourself-up-by-your-bootstraps-because-you-broke-your-leg thing just doesn't work. You're still going to fall down, and your leg will not heal correctly. And if a chemical imbalance is present, external help may still be needed. We need to extend that belief that physical illness and mental illness really can and should be seen as the same when it's genuine mental illness.

There are spiritual struggles. People do go through spiritual darkness, and all people of faith recognize that. It's not perfectly delineated, but there is a difference between a spiritual struggle and a physical mental sickness. They do relate-- yet they are also not the same.

When it comes to spiritual struggles or personal struggles (what some would call "a down time"), faith-based counseling (what we call biblical counseling) is a wonderful tool. But, at the same time, faith-based personal and spiritual struggles are not the same thing as mental illness. And it's exceedingly important for us to identify the difference between them.

If I'm struggling with grief, with sin, or with any host of issues, having people who can encourage me or even counselors in the Christian tradition are wonderful. But there is a difference between that and mental illness, which is a physiological reality.

We wouldn't shame someone for getting a virus. Why do we shame someone for having a chemical imbalance that leads him or her to a lifelong struggle with depression? Often there is an expectation-- because we really do believe, as the Apostle Paul writes to the Philippians that "I can do all things through Christ who strengthens me." But that doesn't mean that we don't need the support of the community to do those things. It doesn't mean we don't need medical help to do those things.

I may sound like a broken record, but it bears saying again and again. People are crying out for help, and we cannot afford to be ignorant or afraid. Christians have to break the stigma and the shame of mental illness.

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Posted:April 23, 2013 at 12:00 am

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