A Christian Ethic for Treating Mental Illness

Research by the U. S. Burden of Disease Collaborators indicates neuropsychiatric disorders are the leading cause of disability in the United States.[1]  Consequently, the “raging epidemic of mental illness,”[2] results in “psychotropic medications [being] among the most commonly prescribed of all pharmacological agents.”[3]  Pointing to the Church’s intersection with this issue, Christian psychiatrists Paul Meier and Frank Minirth say estimates indicate “pastors do more than half of all the counseling in the United States.”[4]  While proponents of psychiatry suggest “psychotropics have improved the lives of millions of individuals living with mental illness,”[5] many Christians still find themselves hesitant to throw their full support behind psychotropic medication.  In an article from Christianity Today, Ed Stetzer calls out Christians as having “a tendency to tiptoe around [mental illness] as if . . . on eggshells,”[6] and says Christians likely struggle more than their mainstream-society-peers in reaching positions on the topic.[7]  Further, complicating matters are psychiatric professionals who themselves acknowledge “significant controversy exists surrounding ethical best practices in the prescription of psychotropics.”[8]  Granted, mental illness remains a broad sweeping, debilitating, and sometimes dangerous affliction that can’t be ignored.

Christian best practices must be established for the safety and well-being of our communities.  This article will first consider reasons why some Christians are resistant to psychopharmacology. Then, the ontological nature of human beings will be considered before expressing reasons why Christians should support the field of psychopharmacology.  Finally, the paper will consider some further concerns Christians might have in fully embracing psychopharmacology, and will offer a response to those concerns.  Following this outline, this paper will argue a proper view of health recognizes human beings as whole persons and incorporates all God-given means, both spiritual and physical.  In understanding the treatment of mental illness, Christians must choose the narrow position between over-spiritualizing mental and emotional struggles, and conversely over-materializing the mind.  This paper will further contend this narrow position is the ethical high ground and falling into the ditch to either the left or right is done to the detriment of both the mentally ill and the community around them.

Reasons Christians Reject Psychopharmacology

In mental health, a tension exists that Christians must admit they are sometimes unsure how to navigate.  While some Christians are open to discussing mental illness as a physiological reality to be benefitted by psychiatry and pharmaceutical science, others believe granting too much weight to secular practices undermines the authority of Scripture.[9]  Within Christianity is a spectrum of viewpoints resistant to psychopharmacology.  A fringe element of Christians rejects medication out of hand in a convicted adherence to faith healing.  This group believes all healing should be sought through the supernatural activity of God alone.

More common are Christians who accept medical science as helpful to physical healing but view matters of the mind as spiritual and emotional rather than physical.  This group’s actions suggest the belief that symptoms of mental illness come as the result of sin, lack of faith, or other spiritual deficiencies.  Issues like depression and bipolar disorder are combatted with more sincere faith, repentance, prayer, and spiritual disciplines.  Referencing these Christians, Ed Stetzer recounts, “When I became a Christian, the initial reaction I heard regarding [mental health] issues was that if people would trust the Lord enough they would be healed.”[10]  Christians of this mindset say things like, “It is impossible for a Christian to be depressed or to need psychiatric counseling for an emotional problem,”[11] and ask, “Shouldn’t faith alone be enough to solve a Christian’s [emotional] problems.”[12]  It is also not uncommon for these Christians to conflate instances of bipolar disorder and schizophrenia with demon possession or the occult.[13]

The more prevalent view among Evangelicals, however, acknowledges the physical nature of some mental health issues but finds difficulty discerning which issues are primarily spiritual, behavioral, or physical.  Knowing the field of psychiatry often diverges from the Christian worldview, many Christians are hesitant to celebrate the practice of psychiatrists.  Additionally, many in the Church expect that Christians should possess an inner strength uncommon to the world.  Emotional struggles that challenge this expectation and cause Christians to fall short of behavioral expectations often lead to a feeling of personal failure.  These factors, in combination with the historical stigmatization of mental illness, leads many afflicted Christians hide mental illness out of guilt and shame.

Robert H. Albers writes, “Ignorance concerning mental illness has historically often resulted in brutal treatment of suffering persons, of their being fettered both literally and figuratively by the chains of helplessness.”[14]  For these reasons, many Christians who are potentially afflicted choose to suffer quietly in emotional isolation.  Likening this shame and isolation to that of biblical lepers, Albers points out that “the stigmatization associated with both leprosy and mental illness elicits feelings of ‘disgrace shame’ within the afflicted as well as the affected persons,” and the net result of general insensitivity toward mental illness is “a progression of evaluative judgments by others, resulting in depersonalization, dehumanization, and finally ‘demonization’ of the one afflicted.”[15]  In these cases, it is not a misunderstanding of mental illness, but the fear of judgment that leads Christians to reject medication despite the clear acknowledgment of an issue.  Stetzer laments, “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.”  Thus, whether Christians acknowledge mental issues may be physical, shame may still render them reluctant to embrace medication.

Ontology and the ‘Whole’ Person

The first step in determining a view toward treatment of mental illness demands clarification be given to the nature of mental illness.  This requires definition be given to the ontological status of the person.  The pertinent ontological question asks, “What is the relationship between the body and the mind?”  Two erroneous answers permeate this discussion.

There exists an errant view of human ontology that understands all matters of the mind to be purely spiritual.  This view divides human ‘parts’ into a dichotomy or trichotomy – two or three distinct substances respectively.  This view draws a hard distinction between the mind/soul and physical body.  In this mind-body dualism, souls are perceived to be distinct from, but presently existing within physical bodies.  Crudely, this view reduces humans to “entrapped souls,” or “souls on sticks,” and separates mental and spiritual aspects of the person from the physical.

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A second errant view is naturalism, which views humans as purely physical beings.  This view rejects the existence of the soul and reduces all experiences of cognition to physical processes within the brain.  This view reduces humans to “meat computers,” and believes all mental and physical problems are corrected through physical means.

The Bible, however, does not depict humans as minds on sticks or meat computers.  In an elaborate word study, Anthony Hoekema summarizes the Bible’s ontological view of man with the phrase “psychosomatic unity.”  Man has “a physical side and a mental or spiritual side, but we must not separate these two.  The human person must be understood as an embodied soul,” and Scripture insists the human “must be seen in his or her totality, not as a composite of different parts.”[16]  Esteemed Christian ethicist Russell Moore agrees, “God created us as whole persons, with body and psyche together. . . . We don’t ‘have’ bodies or ‘have’ psyches.  We are psychosomatic whole persons, made in the image of God.”[17]

Minirth and Meier explain this understanding of the person implies the “separate dimensions of human nature interact so closely that ‘health’ on one level always impinges on ‘health’ on the other,” and “the state of our mental/emotional health affects our physical well-being, and vice/versa.”[18]  This points to a need for a holistic approach to healthcare.  Holistic healthcare “emphasize[s] the necessity for looking at the whole person, including physical condition, nutrition, emotional makeup, spiritual state, lifestyle values, and environment.”[19]  The holistic view suggests “mental problems should not be thought of as totally distinct from physical problems because neither type of problem is ever separate from the other. . . . The counselor ought not to think of spiritual and mental health as somehow totally separable.”[20] Thus, the Biblical view agrees with the psychiatric contention that physical factors are involved in functions of the mind while refusing the notion that human cognition is reduced to physical processes alone.

Reasons to Embrace Psychopharmacology

Crucial to embracing the necessity of psychopharmacology is understanding mental illness involves a “broken brain.”[21]  More technically, “schizophrenia is correlated with a chemical imbalance in the brain and causes varying degrees of abnormal behavior,” including “a basic loss of touch with reality.”[22]  Similarly, victims of clinical depression have brains with extremely low levels of neurotransmitters.[23] These physical issues are said to be virtually impossible to treat without medication.[24]  Prompt medical intervention, however, often alleviates faulty mental function, restores ordinary behavior, and makes full recovery possible for many people.[25]

Tragically, when “a psychotic person goes six months without medication to correct the dopamine imbalance in the brain, the psychosis nearly always becomes permanent and uncurable [sic].”[26]  People suffering from psychosis are also prone to extremely poor judgment, financial impulsivity, and action that brings peril to themselves and others.  Not every person suffering from mental illness suffers such severe symptoms, but Christians too frequently allow calamity to grow out of circumstances that could have been avoided with professional evaluation and treatment.

In cases of mental illness, “More often than not, more prayer and more faith are not the only remedy. [sic]”[27]  In cases of other physical ailments, like broken bones and malfunctioning organs, Christians rarely refuse medical care.  Likewise, Christians are not judged for suffering these ailments, and likewise do not feel guilt or shame because of them.  The Apostle Paul’s statement, “I can do all things through Christ who strengthens me,” is not a calling to Christians take a “grin-and-bear-it” approach to physical affliction when medical treatment is available – especially in the case that an affliction, left untreated, may increase in intensity until irreparable damage is done.  Additionally, it is flat out unethical to reject help for an affliction that could potentially threaten the emotional and physical well-being of others.  Christ himself said those who are sick are in need of a doctor (Matt 9:12).  Christians must acknowledge there is a serious difference between spiritual struggle and physical mental sickness.  While they can relate, they cannot be flattened into one or be considered the same.[28]  Mental illness must instead be viewed similarly to physical illness in cases of genuine mental illness.

Doctors Minirth and Meier caution, the Bible is fundamental to human wellness, but applying it as a “Band-aid” for every physical or mental disorder is more than a simplistic solution – it’s dangerous.”[29]  Additionally, it is not Christian to shame someone for having a birth defect or contracting a virus.  Therefore, it is unacceptable to blame a person for having a chemical imbalance.  Limiting treatment for physical mental afflictions to prayer and spiritual counsel is like telling a destitute brother to be well while offering him no blanket for warmth or bread to fill his stomach (James 2:16).  The Christian has an ethical responsibility to be concerned for fellow Christians’ physical well-being.

Regarding psychopharmacology, the ethical question becomes, “Will this course of action bring the afflicted person closer to physical and emotional wellness and better enable him to fulfill his purpose?”  This question is closely followed by a second question which asks, “Is this course of action the best and most appropriate means of reaching that end?”  If the answer to these questions is yes, then the onus is on the Christian to help his brother or sister in this way.  “People are crying out for help, and we cannot afford to be ignorant or afraid.”[30]  Christians must fight ignorance on these issues, conquer fear in addressing them, and eliminate the stigma and shame surrounding mental illness and psychopharmacology.

Remaining Concerns About Psychopharmacology

Despite acknowledging psychotropic medication as a helpful tool in whole-person health, there remain concerns for a wholesale embrace of psychopharmacology.  Many Christians fear that a locking of arms between the Church and psychiatry is a slippery slope which gives way to an increasingly materialistic view of humanity.  Increased materialism results in the elevation of medicine as the solution to all problems, and diminishes the value of faith.  Additionally, both Christians and non-Christians worry that the normalization of anti-depressants is redefining “normal” human emotional experience.  The normalization of psychopharmacology has also led to an increasing comfort with the unethical practice of abusing psychotropic drugs to exceed the limits of natural human ability.  Each of these issues feeds the exponential rise in the consumption of these substances and creates valid concern considering pharmaceuticals (especially those affecting the mind) are known to come with significant side-effects and inherent risks.

Psychotropics are among the most commonly prescribed of all pharmacological agents, and alter the emotional receptivity of the brain.  This creates a growing concern that Americans are losing a healthy understanding of what “normal” is, and are becoming increasingly confused between what qualifies as depression and mere circumstantial sadness.  There is growing concern that twenty-first century America has lost any appreciation for the importance of healthy and natural emotions like sadness and shame, and no longer values the formative and healing functions of suffering and mourning.  Increasingly, people are attempting to medicate away unwanted feelings due to a misguided expectation that they should be happy all the time and should not be bothered with feelings of sadness and guilt.  Russell Moore suggests that whether a person’s issue is ultimately chemical or circumstantial, it is important that they start with a realistic picture of what “normal” is.  The “normal” human life is not the one marketed by pop culture or the pharmaceutical industry, but the one the Bible clarifies as a “groaning” along with the persecuted creation.  If the expectation of normal life is a kind of all-the-time tranquility, people might be attempting to bypass a purposeful part of the human condition itself.[31]  An endorsement of psychopharmacology cannot allow that every feeling of sadness, guilt, anxiety, or confusion is abnormal, unhelpful, or needing medical attention.

Concern for the redefinition of what is normal to human cognition is not limited to the emotional realm.  The field known as cosmetic neuroenhancement has already begun responding to patient requests for medications to enhance cognitive-affective function for the purpose of intellectual and vocational achievement.[32]  Widespread swaths of otherwise healthy American teens have already made a common practice of abusing ADD (attention deficit disorder) drugs like Ritalin and Adderall for the purpose of enhancing cognitive function in academic pursuits.[33]  Acceptance of psychotropic medication could open the door for the cosmetic neuroenhancement industry to become a growing market within psychopharmacology in the twenty-first century.  These medications threaten the underlying assumption that the ethical goal of medicine is to restore afflicted individuals to normal function.

Ultimately more pressing, however, are concerns regarding the anxiousness of pharmaceutical companies to push medications without first having comprehensive knowledge of side effects.  Neuroscience expert Sarah J. Meller confesses, “In truth, we know very little of the working of the human mind.  Although we do know what some individual medications do to a specific receptor in the brain, the huge jump from molecular interaction to improvement in mood, cognition, and reality testing remains a mystery.”[34]  Further concerning is the reality that the present applications of many psychotropics were discovered by accident. Valium, chlorpromazine, tricyclic antidepressants, the MAOI family, and lithium were all originally intended to treat illnesses unrelated to the brain. Meller continues, “None of these medications were [sic] initially produced to treat the illness they are now treating. . . . No one had a clue as to why medications work as they do.”[35]  This demonstrates that the discovery of popular psychotropic drugs did not come from an advanced awareness of the chemical compositions needed to correct problems in the brain, but instead by testing these substances on patients and observing the results.  The history of psychopharmacology is a trail littered with drugs once thought promising but ultimately found to be dangerous.  The drugs include barbiturates, opium, and hundreds of potions and herbs now known to be more dangerous than helpful.  Even Sigmund Freud had an early optimistic obsession with cocaine. [36] “This illustrates a common experience with psychotropic medications, in which the beneficial effects are often embraced before the unintended side of effects are known.”[37]  Therefore, embracing psychopharmacology as a helpful tool in the holistic approach to whole-person health assumes certain ethical, pastoral, and personal risks.

Responding to Concerns About Psychopharmacology

When making a nuanced consideration of psychopharmacology one must be concerned to perform actions that best help individuals achieve their God-given purpose.  Consideration of psychopharmacology must first suspect the individual in question is inhibited from “normal” function, and second, that medical treatment offers potential for assisting in restoring “normal” function.  Christians believe that each person’s purpose is to glorify God by imitating Christ in becoming more perfectly human.  Noting concerns surrounding psychopharmacology, the questions that persist are, “Will psychopharmacological intervention help restore the afflicted individual to a state of mental fitness in which he can better fulfill his purpose of imitating Christ without moving him beyond the God-given abilities natural to man?” And secondarily, “Does this individual’s need outweigh the potential risks involved with employing medication?”  In some cases, symptoms of the afflicted make the answers clear.  Other cases are less obvious, and the complicated nature of these situations requires openness.  A general ethical position, however, should not be formulated based on ethical dilemmas.

When navigating most ethical issues the right path is the narrow path and ditches lie to the left and right.  Virtue always butts up against vice on both sides.  C. S. Lewis aptly instructed, “[The Devil] always sends errors into the world in pairs – pairs of opposites. . . He relies on your extra dislike of the one error to draw you gradually into the opposite one.  But do not let us be fooled.  We have to keep our eyes on the goal and go straight through between both errors.”[38]  In the case of psychopharmacology, one deception leads to the over-spiritualization of mental illness and fear of physical means for assisting healing.  The other deception leads to an over-materialization of health and is overly anxious to rely on medication.  Both are misguided and fail to care for the whole person.

In The Loss of Sadness, Horwitz and Wakefield contend that the “false epidemic” of psychiatric disorders has been driven by a dramatic rise in “false positive” diagnoses.[39]  While the merit of such contentions is a subject of necessary debate, this concern cannot be the primary factor in determining the value of psychopharmacology.  Improperly practicing doctors do no more to invalidate medication’s proven ability to help mental illness than misbehaving Christians do to invalidate the transformational power of God’s grace.  The value of psychopharmacological medications themselves is not determined by the behaviors of the psychiatrists who administer them.  “Most people would agree that in many ways we are an overmedicated society,” but “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.”[40]

Granting the value of psychopharmacology, medication is not a cure.  Many of these medications don’t fix the problem as much as they alleviate symptoms.[41]  People who believe medication will cure mental illness, or eliminate the need to work through difficult emotions, are mistaken. Treating symptoms alone is like going to the dentist and receiving nothing more than anesthesia.  Alleviating symptoms is not the same as fixing the problem.  Russell Moore advises, “God doesn’t want [the mentally ill] to be . . . ‘comfortably numb.’  He wants [them] to be whole.”[42]  Medication is a necessary and helpful tool but is not the long-term solution to underlying causes.[43]

The Scriptures, faith community, medicine, and therapy all have a place in healing the whole person.[44]  Recovering from mental illness is a long process, and there are aspects of healing that need to be addressed alongside medication.  These include a commitment to glorifying God, understanding one’s identity in Christ, spending regular time in prayer and Scripture, looking to God for primary support, avoiding sin and temptation, drawing near to loved ones, fellowshipping with Christian community, letting go of bitterness by practicing forgiveness, serving others, exercising the gifts of the Spirit, developing a life of routine and moderation, recognizing and accepting human limitations, and practicing humility in seeking help from others.

When a person belongs to a religious community, this is often their first means of support and counsel in a time of crisis.  “Schizophrenia, bipolar disorder, and a host of other psychological problems are rooted in physiological problems that call for medical treatment, not simple talk therapy.”[45]  At the same time, the embrace of medication does not diminish the responsibility of the spiritual community in healing.  Returning to the parallel between the mentally ill and the leper, restoration to the faith community is as notable as the healing of the illness itself (see Matt 8:4).[46]

While the ethical position sees psychopharmacology as necessary and right in treating genuine mental illness, concerns stemming from its embrace still need to be considered.  Constant changes in the pharmaceutical industry demand Christians should continuously reevaluate and revise their views.  What is consistent, however, is the Christian calling to love one another as “whole persons” and to take ethical positions that bring healing and restoration, opposed to positions that subject God’s image bearers to suffering and to potentially injury to themselves and others.

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Chad W. Hussey is an average Jesus loving iconoclastic non-conformist neighborhood hope dealer from Houston Texas – a husband, father, preacher, and Master of Divinity student at The Southern Baptist Theological Seminary.

 

 

 

[1]US Burden of Disease Collaborators, “The state of US health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors” in Journal of the American Medical Association 310/6 (2013), 591-608.

[2]Marcia Angell, “The Epidemic of Mental Illness: Why?” (The New York Review of Books, June 23, 2011), Retrieved November 20, 2016. http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/.

[3]Laura Weiss Roberts and Shaili Jain, “Ethical Issues in Psychopharmacology” (Psychiatric Times, May 6, 2011), Retrieved November 20, 2016.  http://www.psychiatrictimes.com/articles/ethical-issues-psychopharmacology.

[4]Frank Minirth and Paul Meier with Kevin Kinback, Ask the Doctors:  Questions and Answers from the Minirth-Meier Clinic Broadcast (New York:  Guideposts, 1991), 188.

[5]Roberts and Jain, “Ethical Issues.”

[6]Ed Stetzer, “Mental Illness & Medication vs. Spiritual Struggles & Biblical Counseling” (Christianity Today, April 23, 2013), Retrieved November 20, 2016.  http://www.christianitytoday.com/edstetzer/2013/april/mental-illness-medication-vs-spiritual-struggles.html.

[7]Stetzer, “Mental Illness.”

[8]Roberts and Jain, “Ethical Issues.”

[9]Stetzer, “Mental Illness.”

[10]Ibid.

[11]Minirth and Meier, Ask the Doctors, 183.

[12]Ibid, 44.

[13]Minirth and Meier, Ask the Doctors, 201.

[14]Robert H. Albers, “Introduction” in Ministry with Persons with Mental Illness and Their Families (Minneapolis:  Fortress Press, 2012), 2.

[15]Albers, “Introduction,” 3.

[16]Anthony A. Hoekema, Created in God’s Image (Grand Rapids, MI: Eerdmans Publishing, 1986), 216.

[17]Russell Moore, “Is it Right for a Christian to Take Anti-Depressants” (Russellmoore.com, February 28, 2012), Retrieved November 20, 2016.  http://www.russellmoore.com/2012/02/28/is-it-right-for-a-christian-to-take-anti-depressants/.

[18]Minirth and Meier, Ask the Doctors, 10.

[19]“Holistic Medicine” in Encyclopedia Americana vol. 14 (Danbury, CT:  Grolier, 1983), p. 294.

[20] Hoekema, Created in God’s Image, 216.

[21]Albers, “Introduction,” 7.

[22]Minirth and Meier, Ask the Doctors, 120.

[23]Ibid, 184.

[24]Ibid, 121.

[25]Ibid, 122.

[26]Minirth and Meier, Ask the Doctors, 193.

[27]Stetzer, “Mental Illness.”

[28]Ibid.

[29]Minirth and Meier, Ask the Doctors, 182.

[30]Stetzer, “Mental Illness.”

[31]Moore, “Is it Right?”

[32]D. Larriviere, M. A. Williams, M. Rizzo and R. J. Bonnie, “Responding to Requests from Adult Patients for Neuroenhancements: Guidance of the Ethics, Law and Humanities Committee” in Neurology (2009), 73:1406-1412.

[33]M. Talbot, “Brain Gain: The Underground World of “Neuroenhancing” Drugs” in New Yorker (April 27, 2009). 32-43.

[34]Sarah J. Meller and William H. Meller, “Conclusion: Psychopharmacology” in Ministry with Persons with Mental Illness and Their Families (Minneapolis:  Fortress Press, 2012), 229.

[35]Meller and Meller, “Conclusion,” 233.

[36]Ibid, 230.

[37]Ibid.

[38]C. S. Lewis, Mere Christianity (New York:  HarperOne, 2001), 186.

[39]A. V. Horwitz, J. C. Wakefield, The Loss of Sadness (New York:  Oxford University Press, 2007).

[40]Stetzer, “Mental Illness.”

[41]Moore, “Is it Right?”

[42]Moore, “Is it Right?”

[43]Minirth and Meier, Ask the Doctors, 184.

[44]Ibid, 182-183.

[45]Stetzer, “Mental Illness.”

[46]Albers, “Introduction,” 3.

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