Mental health matters: Hope for the Afflicted

The World Health Organization (WHO) estimates that 260 million people around the world suffer from some form of depression — and that’s just one of the many men. And even though, in many cases, it is a treatable condition, only about one-third of those suffering actually seek help. We tried to explore how we can better handle mental health illnesses moving forward, especially in the context of a local church.

Four panellists — Dr Ashok Chacko, Dr Raja Paulraj, Sarah Rufus Prabhakar, and Dr Scott Shiffer — joined us earlier this week for a discussion. Excerpts below:

SECTION A: The status quo

Garrett: Mental health discussions have become mainstream. Is the church being swept away by another trend in the world?

Dr Shiffer: I don’t think that it’s just a trend, as legitimate health issues are nothing new. But what does seem trendy is that if people look hard enough, they can find some kind of mental health disorder for virtually anything they want to correspond it with. In other words, it could be used as a crutch for some to, perhaps, avoid growing as a person or having to become responsible in a certain area of life. 

I think it’s important to note that we now live in a world where people have the opportunity to get the mental and emotional health support that they need. They have to be willing to seek that help out. So, one of the things we really need to do as a church is to be willing to encourage people to get the help they need.

Garrett: What’s an accurate definition of mental health? At what point can something be properly classified as a mental health issue that needs to be taken seriously?

Dr Raj: The World Health Organization defines mental health as the state of wellbeing in which the individual realises his or her own abilities, can cope up with the normal stress of life, and can work productively or fruitfully, and is able to make contribution to his or her community. 

Right now, I may be feeling sad — especially with Covid — but that doesn’t mean that I have a mental disorder. But let’s say I stopped eating or suddenly lost interest in talking to my wife or my kids, not just for one or two days, but for more than a week or two — even a month — then, at this point, I am looking at a functional disability — or, we say a mental disorder has occurred. It’s like saying, “I have a pain in my bone”, as compared to, “I have a broken bone”.

According to Harvard psychopathologist Richard McNally, mental illness occurs on a continuum with no clear natural boundary between non disorder and disorder. So, sometimes, we won’t be able to say, “Here is the day it all started.” 

When we talk about mental health, we are focused on the mind  — our brain. But Scripture gives us a richer view of mental health and mental illness under the broader category of suffering. It engages with the person — our life; it doesn’t look at me as a diagnosis. The primary focus is as a person living in an interpersonal universe, as a God-related being living in God’s environment.

Scripture gives us a richer view of mental health and mental illness under the broader category of suffering

Sarah: If we’re looking at mental health as a form of suffering, Scripture tells us that all suffering is important to God and, therefore, is important to one another. He cares about our suffering, and so we want to care about one another’s suffering. 

And if we can remember the continuum that Dr Raj was talking about, it means that we can identify and understand — be part of one another’s experience — even if we haven’t had the exact same experience.

Garrett: What is the need for churches to have more open discussions on mental health today?

Dr Ashok: Mental health issues are going to affect a majority of the world in the 21st century — and, therefore, the church is also going to be affected. Now, in India, we don’t have enough mental health professionals to deal with those who are ill. There is one psychiatrist for more than 100,000 people. 

This is where there is a role for the church: to be open to talk about it. When pastors and leaders share openly about these issues, that will help create a safe environment for people to share their struggles too. 

There’s much more of a possibility to handle these issues well within the church because we are a group of people committed to one another and to the Lord. We can help those who are struggling.

SECTION B: Relation to the Word

Garret: Does the Bible discuss mental health with clarity and at length? If so, what does it say?

Dr Raj: Yes and no. The Bible does not talk about mental health by using any of the clinical terminologies or under diagnostic labels. It doesn’t say, “Here’s a case of depression”, or “Here are the five symptoms of anxiety or bipolar disorder or schizophrenia.” The Bible is not a diagnostic manual, or a psychiatric textbook, so we cannot expect that to happen. It doesn’t tell us which medicine to take, or which kind of counseling to use. 

But the Bible does talk about mental health, addressing us as a person. It gives a very robust view of connecting our heart to the body, to our families, and to society. I’m just surprised by the Psalms. I use Psalms in my counselling every day. The third largest book in the Bible, by word count, has given so much space for human emotions. Let me give you a few examples:

“Therefore my spirit faints within me; my heart within me is appalled… I stretch out my hands to you; my soul thirsts for you like a parched land.” Psalm 143:4-6 

“In the day of my trouble I seek the Lord; in the night my hand is stretched out without wearying; my soul refuses to be comforted.” Psalm 77:2

To me, that seems like a person who is struggling with anxiety and depression. It doesn’t say here that David is anxious or depressed; rather, he talks about groaning and a faint spirit. He is saying that he’s tired, that he’s unable to sleep. In another place, David says his bones are dry. These are physiological symptoms. 

When leaders share openly about these issues, it will help create a safe environment for people to share their struggles as well

So, we understand that the Bible talks about mental health under the broader category of suffering. It talks about the personal God, who sees into our personal brokenness, and gives a personal word through a personal communication, and invites us to talk to others.

Garrett: Is Bible reading and prayer sufficient to tackle mental health issues? (A study indicates 35% of Americans think so.)

Sarah: That statistic surprises me in some ways. But I can see how we just often want someone to tell us what to do — or, give us a formula: tell me what to read, tell me what to pray, and then everything will be okay. 

I think one thing that’s really important to remember is that we were not alone in this. God calls us to be in community with others. We could be reading the Bible and praying on our own, but we were called to do that in community, as well, and to help one another along the way. 

The other aspect is to apply what we’re reading, praying as we live it out. We could stay inside on our own, reading and praying, but unless we are in situations where we are being tested where we can apply what we see in Scripture, we’re not going to see that growth taking place.

Garrett: If a Christian has serious mental health issues, should he/she seek Biblical counselling or professional help first?

Dr Raj: First, can a Christian get depressed? Yes. Just like cough and cold, I can develop mental health issues. Second, anyone with mental health needs — from common mental health issues like depression, anxiety, and substance abuse to severe mental health issues like bipolar or psychotic disorder, or schizophrenia — we all need help. 

Now, in my mind, I don’t see biblical counselling and professional help as different entities but, for the clarity of our audience, I will answer that. When we talk about biblical counselling, we are talking about people trained in the discipline of understanding various categories of mental health issues, categories of interpretation, and know how to help from Scripture — not merely offering a verse and a prayer. 

When we talk about professional help, we refer to trained counsellors, psychologists, psychotherapists, psychiatric nurses, or social workers. Now, at the time you need help, if you don’t have a trained biblical counsellor to reach out to, it’s important that you get any available help — even if it is your primary doctor. Because, as earlier noted, India has a shortage of 30,000 psychiatrists according to WHO (and that’s prior to Covid). 

The WHO calls it the mental health gap, but I call it the gospel gap. We need more helpers. And in many cases, biblical counselling and professional help go hand-in-hand. 

So my advice is this: please seek help, wherever the help is available. And if you are interested, get trained, so you can help others.

The WHO calls it the mental health gap, but I call it the gospel gap. We need more helpers

SECTION C: Navigating notions

Garrett: There are ‘degrees’ of mental health issues, with some more ‘socially unacceptable’ than others (for example, there is less social stigma around depression than schizophrenia). All are the fallout of a broken world. But there is a belief that they can also be brought upon ourselves as God’s punishment for sins. What is the relation of mental health illness to sin?

Dr Shiffer: I think that some mental health issues are more prevalent, and so we feel like we understand them more. As a result, they become more acceptable to us. On the other hand, mental health issues that affect fewer people become more alarming to us because we don’t understand them. People always tend to fear what they don’t understand. And because of that, certain health issues do carry a stigma. 

That being said, we sometimes get this idea in our mind that God is punishing us for sins — afflicting us with these mental health issues because of things that we’ve done. And perhaps we look at the story of King Nebuchadnezzar, who was clearly mentally ill for a year. That’s very likely the case in his specific situation. But I think, more often than not, that’s not the case at all. In John 9, we see Jesus explaining that the blind man was a means to prove the power of God.

What we really need to do is to grapple with the idea that, more often than not, mental health problems are a result of trauma. The trauma we experience is something that typically happens to us. We may have facilitated the trauma, but things in trauma are out of our control. And when we experience things that are out of our control, sometimes, the damage that’s done inhibits our ability to function normally. 

What we need to know is that even if God doesn’t take that away, in prayer and the reading of Scripture, He’s still walking with us throughout that process. And I think if we were more open in our churches, we would even recognise that more people struggle than we’re aware of. 

We need to know that even if God doesn’t take away our issues, He’s still walking with us throughout that process

Dr Raj: When I get this question, I often ask them, “What about common cold and sin?” Or, cancer and sin? We don’t understand that when it comes to mental health, we are dealing with a complex issue. And so, we try to give a simple answer — a reductionist approach of sorts — correlating sin to suffering, or mental health. This is a poor view of God and, by extension, a poor view of the theology of suffering. 

In Romans 5, it talks about suffering. And there is a pathway from suffering that leads to hope. So when we talk about mental health, let’s focus where Scripture is focusing; where Jesus is focusing. 

We also need to consider the psychopathology of an illness. Low levels of thyroid, for instance, can make me feel weird, and lead to depression. So, we cannot just correlate sin and mental illness, and offer an easy solution to a complex issue. It’s very important for us, as believers, to be ready to invite people with open arms.

Garrett: We know we’re loved. We know Jesus saves. We know He is enough. Yet, too many experience darkness that convinces us otherwise. Can someone with strong faith who’s walking with the Lord still struggle with mental health?

Sarah: There is an idea that, as a Christian, we should feel happy all the time. But Scripture doesn’t tell us anything of the sort. It talks about rejoicing in all circumstances, but we understand rejoicing as a much deeper emotion. 

Coming back to the question, ‘Is weak faith the reason for our struggles?’ No. As counsellors, we love the Psalms. It gives a realness and a rawness of life. There is the full range of emotions — the sadness, the loneliness, the downcast soul, as well as the exuberance, joy, and celebration of life. It’s all there. 

And in Psalm 23, written by a man after God’s own heart, we see that he talks about walking through the valley of the shadow of death. We also see the example of Paul praying for the thorn in his flesh to be removed. If King David and Paul were having these struggles, I think we can be confident that it is not a weakness of faith, but simply a situation that we are experiencing. 

Correlating mental health issues with punishment for sin is a poor view of God and a poor view of the theology of suffering

Garrett: Many hold that if you can’t overcome mental health issues, this too is due to a shortcoming in faith. Should we view mental health as a spiritual issue?

Dr Shiffer: I think that mental health is a spiritual issue, just as anything else we deal with in life is spiritual as well. We’re holistic beings. And though it is easier to compartmentalise the areas of our life, in order for us to function as God intends for us to function, we have to look at ourselves in a holistic manner. 

When we do that, we will be willing to accept that there is more than just spiritual things at work in our mental health concerns. Sometimes, someone may need to be put on a certain kind of medication to help with depression or anxiety or other things of that nature. And while it is true that none of our struggles are completely devoid of spirituality, they’re not solely based on spiritual issues either. And as a result, we don’t need to shun modern medical technology, or medicine, or modern psychological theories or practices.

Garrett: There’s a massive taboo around therapy and medication for mental health issues. What do we need to know?

Dr Raj: As psychiatrists, we look at the pathway of care: how to get someone from suffering to a place of health. Now, in therapy or counselling, Cognitive Behavioral Therapy (CBT) is the first line for treating anxiety, depression, etc. 

As I was talking about this to a pastor once, he said this, “You call this as counselling, but I see this as a conversational ministry. You see 20 patients in your consultation room in a day. I see 200 people in my church every week. They’re all struggling with various kinds of mental health issues.” 

That term, conversational ministry, is very simple. We see an example of this in Jesus’ conversation with the Samaritan woman.  Now, of course, we need counselling, CBT, and all those specific things. But let’s start from loving one another through conversation. 

And then, there’s the issue of medication. I think Dr Mike Emlet’s words are helpful in this context. He says, “God’s design is to relieve suffering, and medications are a gift of common grace.” 

It’s important to note that there are two Kingdom agendas here: relief from suffering and transformation — and they need to happen simultaneously. Medicines are important, and necessary at times, but we have to look at the larger picture of their faith in God and their interaction in community. Even a simple exercise routine or a 10-minute walk is as spiritually reviving as talking to someone. 

God’s design is to relieve suffering, and medications are a gift of common grace

As churches, we need to remember these three things: knowledge, attitude, and practice. Know what mental illness is, what causes them, and how we can respond. Change our attitude to a balanced view of what Scripture talks about such illness. And be a welcoming place for people to come and receive help.

SECTION D: Church in focus

Garrett: What does a church equipped to deal with mental health issues look like?

Dr Shiffer: First, a church equipped to deal with mental health issues has to have a place where people can come to receive counselling. And that can be done in one of two ways. Either the church can have a pastor or someone there who works full-time to receive people for counselling, or they can have people who are volunteering, where they can utilise the church to meet with people. 

In order for that to happen, the church has to have people who are trained to talk to others about their mental health problems. Just because someone’s a pastor and has the gift of shepherding people doesn’t mean that pastor is a good counsellor. 

Another thing that the church could do to be equipped is to perhaps have some funds set aside to help those who need mental health support but can’t afford it on their own. 

The last thing I would say is that it’s a great idea for churches to also have communities inside the church — for people to connect with others who are having similar struggles, build one another up, and help one another along.

Dr Ashok: I’d like to add one or two things. First, we need to create a safe atmosphere. At the moment, there is still stigma surrounding mental health, so people will not talk about it. And to create that safe atmosphere, it has to start from the top — the pastor and the leaders opening up themselves and making it so that people are free to speak, knowing that they’re not going to be judged, that they will be received with grace, and that there will be someone to help them. 

Garrett: So many times, churches don’t know that believers are grappling with suicidal tendencies, crippling anxiety and more. What are the signs of mental illness? How can we identify them?

Dr Raj: There is a lot to talk about here, but I will just share the basic things we can look for. These can be physical symptoms, feeling symptoms, thinking symptoms, behaviour symptoms, and imagining symptoms. 

At a basic level, watch for these five things: dramatic change in eating and sleeping patterns, social withdrawal, extreme change in moods, long-lasting sadness, and paranoia, worry, or anxiety.

But in the church context, I would add this perspective. I recently heard a pastor giving a speech on mental illness, where he said that psychiatry diagnosis means ministry opportunities i.e., we are not waiting for them to come to us, we are going to move towards them. 

Ed Welch put it like this: “People with difficult psychiatric problems are in every church, and we hope their numbers will increase. We hope this happens because it would mean that our churches are both inviting and helpful. The challenge is that neither inviting nor helpful happens naturally when those needing help have problems that are especially hard to understand.” 

So, the first step is to move towards, understand, and even as ordinary or lay people, and serve the person who’s suffering.

Garrett: Church leaders are expected to ‘have all the answers’. What should those leaders who struggle with mental health themselves do? 

Dr Shiffer: It’s very clear that people in ministry do have mental health problems too. In fact, I’ve seen lots of pastors who don’t have people to talk to or who don’t get counselling end up getting burned out in ministry — and, at some point, even leaving the ministry altogether. 

Leaders need to humble themselves enough to know when they need help and be willing to get it

If you are in leadership, you’re, in essence, opening yourself up to hearing about other people’s problems, and walking through those with them. And, sometimes, you may begin to feel like no one’s there to walk through your situations. 

And so, I encourage pastors to get counselling. The thing is that nobody has it all figured out. Nobody has all the answers. Just because your gift is in pastoral leadership or in teaching, it doesn’t mean you’re no longer susceptible to certain issues that everyone else is susceptible to. We’re all human. 

We just need to get over our position and realise that we all are in need of help, at least on occasion. I think that leaders need to humble themselves enough to know when they need help and be willing to get it.

Dr Ashok: I often talk about Jesus’ example. If you go through the Gospels, you’ll find instances where He was in distress, or that He was deeply troubled, or that He was angry. How did the Gospel writers know the emotions of Jesus? Because He was expressing it to them. And He had a support group of His own. He used to take Peter, James, and John together to share. At Gethsemane, He invited them to pray with Him. 

Now, if Jesus needed support, how much more for us, humans, in ministry. Your support group could be other pastors or other leaders. We have to break this barrier which prevents us from talking to one another, and be open to humbly receiving counsel from one another. Scripture encourages us to love, bear with, forgive, and encourage one another — ‘one another’ is all over Scripture.

Garrett: How can parents, friends, churches walk with those who suffer from mental health issues?

Sarah: When I first started working as a counsellor, mainly with children and families, the biggest issue I noticed was the social isolation that these families were in. There were some people with diagnoses that made life difficult, but there was no community or family support. So, don’t think that just because you’re not trained professionally, that you have nothing to offer. 

Earlier, we talked about the body of Christ. And if someone is withdrawing, there’s a responsibility on the rest to pull him/her back into the body, as well as moving toward the person who’s pulling away. 

One of the first things I want to say is that we need to help one another remember that Jesus loves us. In our struggles, we functionally forget this. We functionally forget that His grace is sufficient. 

I also want to point out that the majority of people I meet with for counselling have relational struggles. It’s usually work stress, not high anxiety. And so there is a real importance of being with one another.

The other thing to remember, particularly with the more complex mental health struggles, is that it’s marathon work. It is not something that you can do just for a week, or a month, and leave it be. 

And so, realising that, we just need to keep looking out for where there is need, and trusting that God will keep giving us the strength to love. In our strength, love is not going to last. But we’re not filled by ourselves. We’re filled by God’s love that overflows. 

And that’s a good note to end on: it’s not us. It’s God through us. And we really want people to see that this is God’s work, that it’s His love, and not us.