Through a Glass, Darkly

Ministry to the mentally ill.
Through a Glass, Darkly

When I was 15 years old, my mother picked me up at school to take me to a dental appointment. In the car, I could tell immediately that she wasn't functioning normally—she was headed for another "episode." She drove nervously, struggling to recognize her surroundings. She was silent except when I forced conversation, and when she did speak, her speech was slow and seemed to require deliberation.

It was as if half of her had already shrunk into some unknown place, and the other half was not sure whether to follow or to maintain her grip on the reality of her daughter and a trip to the dentist.

I asked Mom if she had taken her medication that day. Her answer was not straightforward, but it was clear that she was not fully medicated and stable. So with one part of my brain, I prayed for a safe trip to the dentist. With another part, I employed a technique used by many people who feel powerless in the face of an unnamed enemy: I acted as if nothing was wrong.

At the dentist's office, when my name was called, I left my mother in the waiting room and went back for my appointment. After half an hour or so with the dentist, I returned to my mom, who didn't look at me.

"Mom, it's time to go," I said. "I'm finished." I received no response of any kind. Suddenly I realized my instincts had been right: something indeed was wrong with Mom … again. And it was up to me to help her.

I touched her arm and gently tried to shake her back to awareness, with no results. She was rigidly catatonic, immovable, staring into space and clutching her purse in her lap with clenched hands—in a waiting room full of strangers.

After a couple of quiet attempts to rouse her, I began to attract attention. People stared at me as I tried to get her to respond. When she wouldn't move, I realized I needed to call my dad at work for help.

As everyone in the room continued to stare, I walked to the reception desk and asked the woman behind the counter—who was also staring—if I could use the phone.

"No, there's a pay phone around the corner," she said. When I explained that I needed to call my dad for help, I didn't have change for the phone, and it would be a local call, she still refused. So I went back to my mom and wrestled with her rigid arms, pulling them aside enough to get into her purse to find a quarter for the phone. I went back to the receptionist to ask if she could keep an eye on my mom while I went to use the pay phone. She shrunk back in horror: "Is she dangerous?"

After assuring the receptionist that my motionless mother was not about to attack her, I called my dad and then returned to sit next to my mom till he got there. The receptionist and the people in the waiting room took turns staring at my mom, glancing at me, and studying the floor. No one asked if I needed help.

In the years since, that incident has become for me a symbol. The way people in that waiting room responded to my family's public crisis is the way I've seen people—including those in the church—respond to serious mental illness. They didn't know what to do for my mom or anyone associated with her. So they did nothing.

Though I didn't know it at the time, my mother has schizophrenia. As often happens with schizophrenics, she had not been faithfully taking her anti-psychotic drugs and had lost touch with reality. Dad and I took her to the hospital for another of her psychiatric stays and restabilization on medication.

And so continued our family's journey with an illness that in many ways has defined us—and shocked us again and again.

Family crisis

When I was growing up, my mother functioned well enough that her illness was formally unacknowledged and undiagnosed. Then my dad left his position as pastor of a small church, and our family moved from a rural area to a city. Dad was out of a job for months, working temp jobs while he looked for another pastoral position.

The whole family struggled with the adjustments, and for my mother, the stress of this time brought on the full-blown psychosis of schizophrenia, with symptoms that were impossible to ignore. She was hospitalized repeatedly, medicated heavily, and inconsistent in taking her medication.

For families, mental illness presents a crisis, although the degree of crisis varies widely. In cases of serious and chronic illness like schizophrenia, family members develop long-term coping mechanisms that help them but aren't always healthy—"emergency measures" that aren't meant for long-term use. Two of these, for example, are denial and escapist behavior. These can be useful coping mechanisms as people protect themselves from a new and difficult reality. But long-term they are harmful, and they diminish a person's capacity to function.

In addition, families experience confusion when navigating the mental health system, which focuses on stabilization and medication of patients, is reluctant to "label" people with diagnoses, and often refuses to share any information with family members who are then left to guess at how to support their loved ones' treatment and ongoing health.

If the ill person is expected to manage his or her own care and is noncompliant with medications, the family learns to expect the chaotic unexpected with each new day.

Hearing other teenage girls complain about fights with their moms, I wished I could fight with my mom because it seemed so normal.

For children of those with serious mental illness, life is built on a shifting foundation, which may leave them confused about who they are, emotionally starved, alienated from the "normal" world around them, fearful of the risks of their own problems with mental illness and substance abuse.

In the book Growing Up with a Schizophrenic Mother, Margaret J. Brown and Doris Parker Roberts cite a survey in which more than 25 percent of people with schizophrenic mothers reported that they had had problems with alcohol, drugs, or both at some point. Research indicates that anyone with a mentally ill parent has an increased risk of developing mental illness.

This increased risk is due in part to genetic factors and in part to the environment and parent-child relationship that develops under the influence of the parent's illness. Children of schizophrenics have a 13-percent chance of developing schizophrenia themselves, while the risk for the general population is less than one percent.

In my family, we each developed our own ways of coping with my mother's illness. I mentally and emotionally compartmentalized, so that I could be one person at home and another everywhere else. When I wasn't at home, I didn't give much thought to my mother's illness or our family's troubles. And I didn't talk about my family life with anyone—not even my best friend knew about my mother's struggle.

I remember hearing other teenage girls complain about fights with their moms and wishing I could fight with my mom because it seemed so normal and my mom would have to be strong to fight with me. So occasionally I made up a story about a fight with my mom, which never could have happened.

When I was home, I tried desperately to "fix" my mother and to suppress my negative emotions, which I didn't know how to handle. Unfortunately, this had the long-term effect of distancing me from all of my emotions—positive ones as well—which I have since had to painstakingly learn to embrace and which I continue to struggle to express.

Church life

As a pastor, my dad ministered to two congregations. He left the second church before Mom's illness became fully psychotic; however, she did struggle with some symptoms throughout his pastoral ministry. Her ongoing struggle meant that Dad sometimes had to spend more time at home, either to care for her or to care for the rest of the family.

As Dad explains it, "When I took responsibilities of pastoring a church, I wanted them to be aware that my first responsibility was to God, my second responsibility was to my family, and then my third responsibility was to the church." At times his responsibility to his family created "tensions between the church and the family," and members of the congregation were not always understanding about the impact on his ministry to the church.

After leaving the second church, Dad did not serve as a full-time pastor again. He did pulpit supply and served as an interim pastor, but "there was a time when I felt like I could not do it anymore. My time, my energies were needed here at home. I felt the Lord had something more important for me to do." So my family settled into membership in our local church as laypeople.

In general, my parents have felt supported as laypeople in the church because they connected with a few people who have been tremendously encouraging and who have prayed for them and walked with them through ugly times. But most people, including pastors, have kept their distance from both Mom and Dad.

In Dad's experience, most people in the church have been "a little fearful to talk to me or didn't know what to say, or just fearful of mental illness in general. And it was basically just a few people who were comfortable talking with me."

As for my siblings and me, no one ever asked what we might need. It just never came up. My sisters and I were active in the youth group and other church activities; no one ever asked how we were doing or how things were at home.

And since then, in the decades that have followed, I have heard a total of one sermon on depression—nothing else that even mentioned the reality of mental illness.

Several years ago, as I was sorting through some of my own baggage and some theological questions related to my mom's illness, I asked a pastor for help with these theological questions, and he was shocked when I brought them up. He was curious about my story, but deeply troubled by my questions, and completely unable to help.

Mental illness is mainstream

While we felt alone at the time my family's crisis first developed, I now know that we were not. In fact, mental disorders are the number-one cause of disability in North America.

According to the National Institute of Mental Health, "26.2 percent of Americans ages 18 and older—about one in four adults—suffer from a diagnosable mental disorder in a given year." That means more than 50 million people.

Serious mental illness is less common, but it is present among 6 percent of the population, or 1 in 17 adults. And antipsychotics are now the top-selling class of drugs in the U.S. If your church is typical of the U.S. population, on any given Sunday 25 percent of the adults in your congregation are suffering from some form of mental illness and many are under the influence of antipsychotic drugs.

Leadership Journal recently conducted a survey of 500 churches, using the National Alliance on Mental Illness definition of mental illnesses: "medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others, and daily functioning" and "often result in a diminished capacity for coping with the ordinary demands of life."

In this survey, 98 percent of respondents indicated they'd seen mental illnesses or disorders in their congregations.

The mentally ill might feel as if they are on the margins of society, but they're actually in the mainstream. And with the drugs available today—and future improvements to come—mental illnesses can be treated and managed effectively for most people. And yet our Leadership Journal survey also found that only 12.5 percent of respondents said that mental illness is discussed openly and in a healthy way in their church. Fifty percent said mental illness is mentioned in their church's sermons only 1 to 3 times per year; 20 percent said it is never mentioned.

Persistent stigma

It should be no surprise that people in the church aren't sure how to respond to the mentally ill. We live in a society that is still deeply confused about mental illness. Have you ever paid attention to the way the mentally ill are portrayed in popular media?

While some, especially more recent, works treat mental illness with honesty and sensitivity, most popular media treat the mentally ill as either frightening or funny or both. For people with loved ones who suffer from ongoing serious mental illness, such portrayals are hard to ignore. Most people don't give it a second thought, but try watching movies like Psycho, Strange Brew, Crazy People, The Shining, Misery, or Fatal Attraction through the eyes of someone who struggles with mental illness.

Or turn on the TV this week. On any given evening, you should be able to find at least one show that either reinforces terror of the mentally ill, or makes light of their illness for a cheap laugh. Even amusement parks use mental illness to entertain and terrify, with rides like "Psycho Mouse," "Psycho House," "Psycho Drome," "Dr. D. Mented's Asylum for the Criminally Insane," "The Edge of Madness: Still Crazy," and "Psycho Path."

And in everyday conversation, it's common to stigmatize the mentally ill by casually calling people "crazy" and "psycho." The mentally ill are widely believed to be more violent than the general population, even though studies have shown that this is not true. No wonder people in the church—and outside the church—have no idea how to relate to a real person who acknowledges or displays a mental illness.

In addition, other factors contribute to the stigmatization of mental illness in the church.

• Social discomfort—the church is a community drawn together in love by a common Spirit. But made up of imperfect and sinful people, that community often feels fragile and sustains itself by polite behavior and exaggerated piety.

In such an environment, mentally ill people can upset the balance and intimidate the rest of the community because their behavior can be unpredictable and socially unacceptable. And while people might show patience with a short-term difficulty, the prospect of ongoing interaction with someone suffering from a chronic mental illness may be more than most people are willing to endure.

You can make your church a relevant, accepting place for those who struggle with mental health, or who have a loved one who is mentally ill, by talking about it.

Pastors too can be put off by the ongoing nature of a chronic illness: "Sometimes clergy distance themselves from people with mental illness because they realize the problem can be long term. To become involved with this person may mean a lengthy commitment. Perhaps this person will never be cured. Such a problem is contrary to contemporary Western ideas of being in control of one's life and destiny. People in modern day America expect to find a rational solution to any problem. And yet, in this case, there may be no solution. It is tempting, if an answer is not apparent, to avoid the person for whom one has no answers" (www.pathways2promise.org/family/pastorandperson.htm).

• Referral for treatment and care—the increased professionalization of psychiatry and counseling reinforces pastors' feelings of inadequacy to help the mentally ill and their families. Pastors and others often refer those struggling with mental health to professionals inside or outside the church, and then assume that the person's needs are met. But the need for care remains, even if ill people are being treated by professionals.

We're tempted to see mental illness as something we're not qualified to deal with, so we ignore it. But when someone is struggling with a different type of physical illness, the church doesn't ignore the people who are suffering, even though they may be under a doctor's care. The mentally ill and their families still need pastoral care and the love of a Christian community.

• Theological challenges—seeing people suffer with mental illness brings up troubling theological questions many people would rather avoid …

  • Suffering—how can a good God allow people to endure the kind of suffering mental illness can produce? How can his followers suffer psychological terror, anguish, and despair?
  • Accountability—can mentally ill people be held accountable for their choices? Are they responsible for their sin if they are delusional or under compulsion? How lucid is lucid enough to be responsible? And how can God hold mentally ill people accountable for their spiritual choices?
  • Demon possession—is mental illness caused by demon-possession? If so, how should it be handled in the church? If not, what role does the person's spiritual condition play in his or her mental health?
  • Punishment—is mental illness God's punishment for sin? Is it a sign that God's judgment has fallen on the suffering person? And if so, how should the church respond?

Such questions are troubling, especially in the face of illnesses, like schizophrenia, which are at least largely caused by biological conditions/tendencies present at birth. Such realities are not inconsistent with Christian theology—all creation is groaning under the weight of sin—but can present a great test of faith.

Leaders who feel uncomfortable with raising questions they can't easily answer are unlikely to bring them up. And yet people in every congregation must face these questions—with or without the church's guidance. Perhaps if our theology is too small to allow us to wrestle with them, we need to repent for our lack of faith.

• Overspiritualization—for some Christians, every problem and every solution is spiritual. In this environment, mental illness is evidence of a lack of faith. Medical and psychiatric interventions are suspect. When "just have faith and pray more" doesn't work, they turn away, and the mentally ill are shamed and alienated even further.

What we can do

So as a church leader, if you want to help your church be more faithful and effective in ministering to those with mental illness, what can you do? How can churches help, besides referring people to the professionals? Several ways:

• De-stigmatize. Make a determined effort to rid your church of the stigma and shame associated with mental illness. Talk about it. Acknowledge the struggles of people you've known, and your own struggle if applicable. Contact some local organizations to see how churches can better support the mentally ill. And if necessary, repent privately or even publicly for the way your church has handled mental illness.

• Talk publicly about mental illness. When was the last time you mentioned mental illness in a sermon or class? Have you discussed the tough theological questions that mental illness can raise? Is your church a community of imperfect people growing in relationship with a God who is not confused or threatened by our imperfection? Or does your church inadvertently send the message that it's a place only for the mentally healthy? You can make your church a relevant, accepting place for those who struggle with their mental health by talking openly about it. One note of caution: no "crazy" or "psycho" jokes. Making light of mental illness alienates those who suffer and reinforces the stigma and shame associated with mental illness.

• Encourage relationships and ask questions. I asked my parents what the church has done right in ministering to them. They both focused on the open and genuine relationships they have had. Small groups have been lifelines for them, especially when they have been able to talk openly about their struggles, mention their therapeutic work, and relate their experiences to the Bible.

They also mentioned how helpful it is when curious people ask questions, learning about their experiences and seeking common ground. Questions like "what it's like to be on medication?" or "what's it like to attend group therapy?" might seem intrusive, but for my mom, they open the door to genuine conversation and provide relief from feelings of isolation. Because these are her everyday experiences, they are easy for her to talk about if someone shows interest.

Genuine and mutual relationships are irreplaceable. Encourage the ministry of honest relationships in your church so that when mental health struggles and crises arise, those who are suffering have friends to walk through the suffering with them.

• Ask what you can do to help. Pretty simple stuff, even cliché, but this takes courage with someone suffering with mental illness. You must be willing to actually help if the individual or family expresses a specific need. People in crisis don't always know what they need, but sometimes they do and they feel as if no one is available or willing. You may not be a mental health professional, but you can help—organize meal delivery, visit someone in a psychiatric hospital, provide a ride or child care. Be especially attentive to the people who are caring for or living with a mentally ill person. They may be better able to communicate what's really going on and what they need, and like anyone who loves and cares for the suffering, they are suffering themselves.

• Be present. This sounds simple, but it's powerful. When an individual is struggling with mental illness, and when the person's family is in crisis, the earth can feel as if it has come loose from its proper orbit. They need something stable in order to help them keep their faith. A pastor who refuses to abandon a family in crisis powerfully demonstrates that God has not abandoned them either. Make yourself consistently available, even if it's not clear what else you can do to help.

• Radiate acceptance. Refuse to reject the person or family in crisis. Be the person who represents Christ's tenacious and bold love, refusing to be driven away by what you don't understand. Don't ignore them because you've given them a referral to a mental health professional. Like others in crisis, people affected by mental illness need to know that you care.

Try to treat them as you would a person who suffers from arthritis or diabetes. Ask questions: Are you managing your illness? Caring for yourself? Is the family healthy? A diagnosis or hospitalization doesn't change who a person is; it just changes your understanding of what someone needs.

• Draw boundaries and stick to them. Just because someone is mentally ill, you do not need to suspend standards of morality, biblical theology, or respectful behavior in your church community. Overlooking inappropriate behavior or beliefs is destructive to your congregation, and it does no favors for the mentally ill.

Regardless of how they respond to social expectations, mentally ill people do need structure and boundaries to grow in independence, understanding, and management of their illness. They need healthy people around them to give them objective feedback and an example of mental health. Help them pursue and maintain health by insisting on a healthy community around them. Communicate agreed-upon expectations openly and lovingly, and hold to them consistently.

• Know when you are in over your head. Sometimes you need to call in a professional to either handle an immediate crisis or provide long-term care. If you suspect a person in your congregation is struggling with mental illness, refer him or her to a professional counselor or psychiatrist.

Compile and keep a list of trusted professionals and their specialties: from depression to eating disorders to bipolar and schizophrenia. You'll have a relevant referral at your fingertips when someone in your church needs it.

And obviously if someone in your church is in danger or is endangering another person, call 911. This is not a situation for you or your congregation to handle; it's a situation for the police. Once everyone is safe, you can move to referrals and pastoral care as appropriate.

• Get help if you're struggling. If you or a member of your family is struggling with your mental health, seek professional help. You cannot effectively minister to a congregation without addressing your own needs. And your first ministry is to the family God has entrusted to your care.

Your suffering or your family member's suffering is not cause for shame. Seek answers to your theological questions. Facing a mental illness doesn't have to destroy your faith. On the contrary, it's more evidence of biblical truth: our world is fallen, and the creation groans under the weight of our sin.

Redemption

I don't know exactly where we get our ideas about the mentally ill or why we tend to simultaneously laugh at them and believe they're all dangerous criminals. I don't know why we believe mental illness is so much rarer than it is, or why we have such a hard time accepting the presence of psychosis in a world pervasively poisoned by sin.

I do know, though, that the mentally ill get a bad rap. And the people who love and care for those with mental illness often feel a shame they can't explain and a terrible burden to keep secret what they most need to share. This doesn't stop at the doors of the church.

I'll be among the first to acknowledge that what an illness like schizophrenia does to a person is not pretty. It's an ugly and heartbreaking reality, and my mother's illness has presented the single greatest test to my personal faith.

So I'm not trying to minimize the confusion and revulsion we can feel when dealing with someone whose brain is giving them a skewed picture of reality. But like any suffering person, the mentally ill should find solace and acceptance, love and redemption, in the church.

By God's grace (and I'm not using that term flippantly) and for his glory, my siblings and I are all healthy, productive, and living in relationship with Christ. Mom is currently managing her illness and benefitting from the advances made in the latest generation of antipsychotic drugs.

I'm proud of her determination to enjoy life and pursue health despite her struggles. I'm also proud of her enduring commitment to Christ. And Dad continues to live as a paragon of faithfulness, both to his God and to the woman he committed himself to nearly 50 years ago.

I've been inspired by his passionate pursuit of ministry in Jesus' name, whether in or out of the pulpit. God's redemptive work has used our family's pain to keep my dad's heart soft and ready to serve, and God uses him in a loving ministry toward people who cross his path.

May God's same redemptive work cause the struggles of people in your church to blossom into loving ministry toward the suffering.

Amy Simpson is editor of Christianity Today's Gifted for Leadership and the author of Troubled Minds: Mental Illness and the Church's Mission (InterVarsity Press, 2013).

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