Living Well with Jesus
I have come that they may have life, and have it to the full.
A FEW YEARS AGO, I ATTENDED A LECTURE ON THE POSITIVE RELATIONSHIPS between religion and mental health given by an eminent professor of psychiatry. He opened his lecture with an intriguing, if somewhat disconcerting, statement: “I only have fifteen minutes to see a patient, and I spend the whole of that time looking at the computer screen trying to work out the patient’s blood levels and checking the efficiency of the patient’s meds.” The rest of the lecture was excellent, but I couldn’t get past that opening statement. As a former mental health nurse, I understand the pressures of a busy, understaffed, and often underfunded health-care system. Nevertheless, that the psychiatrist decided to spend all of the paltry fifteen minutes of each patient’s visit looking at a computer screen is telling.
A person’s biological functioning is certainly important. If one assumes that mental health experiences can be primarily or even fully understood and explained in biological terms, then scrutinizing a person’s blood levels for chemical imbalances and checking the impact of medication on blood cell count make sense. However, human beings are not simply a conglomerate of chemical interactions. Humans are persons, living beings who have histories, feelings, experiences, and hopes, and who desire to live well. Living well is not determined by the functioning of our biological processes apart from our individual social, interpersonal, and spiritual experiences. Similarly, understanding the biological dimensions of mental health experiences may turn out to be helpful, but it is unlikely to solve problems that emerge from poverty, loneliness, war trauma, and abuse. It is also unlikely to tell us much about what it means to live with and to experience these things scientists describe as “symptoms.” If you don’t know what these symptoms actually mean for an individual, it is difficult to know what you are trying to control and what a “good outcome” might look like. If you have only fifteen minutes with a patient, you don’t need rich, thick experiential descriptions. Thin ones will do just fine. Time is an issue, but the problem of time reflects deeper issues.
The purpose of this book is to provide readers with rich, deep, and thick descriptions of the spiritual experiences of Christians living with mental health challenges. It assumes that in order to understand people’s mental health experiences, we need to find time to listen carefully and cannot be bound by assumptions, even those of powerful explanatory frameworks like the Diagnostic and Statistical Manual (DSM). This book is about how Christians living with severe mental health challenges—depression, schizophrenia, and bipolar disorder—experience their faith lives and strive to live life in all its fullness in the presence of sometimes deeply troubling experiences. The book is not about “severe mental illness” understood as a clinical category. Rather, it is about the experiences of unique and valuable disciples of Jesus who seek to live well with unconventional mental health experiences—experiences that some choose to describe as “severe mental illness” but that can also be described in other important ways.
In John 10:10, Jesus makes an intensely powerful statement: “I have come that they may have life, and have it to the full.” Life in all its fullness is certainly not life without suffering, pain, or disappointment. That much is clear as we reflect on Jesus’s own life. Nor is it a life without joy, hope, and resurrection life in the Spirit. The quest for life in all its fullness is not the basis for a theology of glory—one that minimizes pain and looks past suffering.2 Rather, it is the foundation for a practical theology of the cross that takes seriously the freedom and release that we have gained through the death and resurrection of Jesus at the same time that it recognizes that cadences of the cross still guide the rhythm and the tempo of the day-to-day life of the world. Life in all its fullness is life with God—a God who accompanies us on a complex journey within which we live in the startling light of the resurrection but remain intensely aware that Jesus’s cry from the cross, “My God, my God, why have you forsaken me?” still resonates throughout creation. Life in all its fullness is not life without tears but life with the one who dries our tears and moves us onward to fresh pastures.3 Such fullness of life is what I mean when I suggest that this book is about the ways in which Christians with severe mental health challenges can live well and live faithfully even in the most disconcerting storms. Mental health challenges are difficult experiences, but they needn’t prevent us from living well, living faithfully, and loving Jesus.
This book does not attempt to explain mental health challenges. It does not address causes directly, although I do clarify the problem of naming causation from both a scientific and a theological point of view. Instead, it intends to help all of us understand the experience of severe mental health challenges in general, and the role of Christian spirituality in particular, in ways that can bring about insight, compassion, empathy, and enduring faithful relationships. Its focus is on listening carefully to the ways people describe their spiritual experiences and trying to make theological and practical sense of lives that have been touched by difficult, troubling, but sometimes also profoundly revelatory challenges. The book is therefore not about curing mental health challenges. It is about healing, understood as the facilitation of understandings and circumstances in which people can live well with Jesus even when the prospect of cure is beyond our current horizons.
At heart, the book urges us to change our language about and modify our descriptions of mental health challenges in ways that can help all of us live peaceably and faithfully without misrepresentation and stigma. For the ways in which we describe the world determine what we think we see. What we think we see determines how we respond to what we think we see. How we respond to what we think we see is a measure of our faithfulness. Language and description matter.
Richard Arrandale, in his paper “Madness, Language and Theology,” urges us to reconsider the ways in which we talk about the experiences some describe as “mental illness.” He urges us to move beyond the language of illness, the limits of suffering, and the kinds of military metaphors that turn mental health experiences into battles that need to be fought and won. If “mental illness” is a war, then “those who professionally care for us are the allied forces deployed to win this war, and who often seem to do so with no consideration for the casualties. It is often the case that much of the treatment which is given has worse (and sometimes very long lasting) side-effects than the original problem itself.”4 Military metaphors—battling with schizophrenia, wrestling with bipolar disorder, fighting depression—narrow the person’s choice of description and “treatment” and easily preclude the development of “nonviolent” understandings and approaches. Instead, Arrandale urges the adoption of a kinder, gentler, and more generous hermeneutic that allows for forms of language that open up new worlds and new possibilities:
If we dwell in the language of the negative and the military there is a serious danger that this will set the agenda for the people the language is used for/against. If we can learn to dwell in a language which is positive and liberating this may help in shaping that movement beyond enslavement and existential death. Language used in this way can be part of an exorcism of the linguistic demons which “possess” those with mental health problems—language (and thus a world-view) which, in its negative usage, is content to leave people to live in “the tombs” (Mark 5.2) of labelled madness. A more positive and theological language might enable people to break free from the chains and fetters with which they have been bound. Such a language exorcized of negativity and value judgements may allow people with mental health problems to be brought back into the kingdom from which they can feel alienated.5
If the church is possessed by linguistic demons that prevent it from talking faithfully about mental health issues, then exorcism is vital in order to ensure its present and future faithfulness. A primary intention of this book is to facilitate faithful speech that moves us to faithful action. By developing a phenomenological approach that takes seriously the lived experience of unconventional mental health experiences, the book offers different ways of articulating the issues; different ways of understanding those who bear the weight of diagnoses; and different forms of description that I have seen bring about liberation and healing.
Arrandale asks us to consider framing mental health in terms of a journey. A journey is something we embark upon, willingly or otherwise, as we travel from one place to another. Sometimes we choose our journeys; at other times we are forced to go to places we do not want to. Along the way, we meet people and encounter situations—some helpful, some not—each of which changes the direction of our journey. Some change the meaning of the entire journey. Some journeys are easy and the burden light, like a summer hike; others feel like the winter journey of a refugee. Along the way, we may encounter enemies and become lost and confused. Some of these enemies are in our own heads, while others emerge as our perceived strangeness unsettles people and causes them to react with physical or psychological violence. Above all, the journey is surprising for us and for others. We will need maps, guides, friends, communities, equipment, and, for Christians, ultimately the guidance of God’s Spirit if we are to negotiate our mental health journeys faithfully. But properly equipped, guided, supported, and faithfully accompanied, we can survive even the most powerful and disturbing storms.
The key thing about a journey is that we are always heading toward somewhere and something, not nowhere and nothing. Destination matters. The destination, like the winter road before us, can be cold and unclear. If it is uncertain or disappears from sight, we find ourselves in a very difficult, lonely, and deeply hopeless situation. But if we know our destination even in the midst of our sense of lostness, then we have hope. And if we can find hope (or if others can hold it for us), then the journey might actually be going somewhere rather than nowhere. Thinking of mental health challenges as a journey reminds us to hold on to the kind of destination we might want to reach. What that journey looks like in the context of severe mental health challenges is what this book is about.
The core of the book emerges from a series of qualitative research interviews that I carried out over a two-year period with Christians living with major depression, schizophrenia, and bipolar disorder. I chose to focus on these diagnoses not because they are representative of all mental health challenges but because they are generally acknowledged as particularly problematic and also because they raise important theological and practical issues for individuals, church, and society.
Through these interviews, I intended the following:
1 to capture some of the complexities of how people actually experience their mental health instead of how they or others interpret it, given their assumptions of what their diagnosis represents. This is the phenomenological dimension.
2 to gain insight into the ways in which people’s unconventional mental health experiences affect their faith lives and relationships with God. This is the experience of lived theology.
3 to try to make sense of this in terms of the theology and practice of the church. This is theological reflection and revised practice.
Though these three foci formed the basis of our conversations, the richness of our conversations drew us to other interesting and surprising places. As people granted me entry into the intricacies of their mental health experiences, they helped me to recognize and accept profound insights into the ways in which God is present (or sometimes apparently absent) in their mental health experiences. This entry into their interior worlds quickly taught me that their assumed strangeness is not quite as strange as it first appears. People are just people, even in the midst of difficulties.
Much has been written on the relationship between spirituality and mental health.6 Much of it assumes that spirituality is a broad and universal concept comprising a personal search for meaning, purpose, hope, value, and, for some people, God.7 Yet my interviews for this book yielded a quite different understanding of spirituality—that it is not a general search for meaning but something quite specific. The interviewees perceived themselves as disciples of Jesus who were desperately trying to cling to him in the midst of complex and difficult circumstances. Their question was not simply: “Where can I find meaning in the midst of my brokenness?” but much more specifically, “Where and how can I find Jesus and hold on to God in the midst of this experience?” The question is simple; the answer is much more complex.
Some of the people who share their experiences in the following pages find the language of mental illness beneficial and therapeutic and helpful for understanding and future development. Others do not. I believe people should be allowed to name their experiences in the way that is most helpful and pertinent for them. Readers will note that I don’t use the term “mental illness” in this book. This is not because I am in any sense antipsychiatry or don’t believe that people’s suffering is real.8 I know people’s experiences are very real. Yet describing mental health experiences in terms of illness is only one way of naming and responding to such experience, and not necessarily the best way.
I use the term “mental health challenges” for two reasons. First, it focuses our attention on what enables us to remain healthy in the midst of psychological distress. While mental health challenges can cause great suffering and distress, it is possible to find hope and faith in the midst of the wildest storms. Second, the shift from illness to challenge offers a positive and forward-facing orientation. Whereas illness reminds us of what is wrong with us and narrows our range of options, challenge sees the situation as potentially constructive and leaves the door open for a variety of perspectives, interpretations, and descriptions. How to enable people to take up those challenges and learn to live life fully is a primary task of what is to come.
1. Unless otherwise indicated, all biblical quotations come from the New International Version (2011).
2. For a very helpful overview of Luther’s theology of the cross, see Gerhard Forde, On Being a Theologian of the Cross (Grand Rapids: Eerdmans, 1997).
3. Rev. 21:4: “‘He will wipe every tear from their eyes. There will be no more death’ or mourning or crying or pain, for the old order of things has passed away.” Ps. 23:2: “He makes me lie down in green pastures, / he leads me beside quiet waters.”
4. Richard Arrandale, “Madness, Language and Theology,” Theology 102 (May 1, 1999): 195–202.
5. Arrandale, “Madness, Language and Theology,” 197.
6. H. G. Koenig, M. E. McCullough, and D. B. Larson, eds., Handbook of Religion and Health (New York: Oxford University Press, 2001).
7. For a critique of this approach to spirituality, see John Swinton and Stephen Pattison, “Moving beyond Clarity: Towards a Thin, Vague, and Useful Understanding of Spirituality in Nursing Care,” Nursing Philosophy 11 (2010): 226–37.
8. The term “antipsychiatry” refers to a movement that adopts the view that psychiatry and psychiatric treatments are more damaging than they are helpful. This movement considers psychiatry to be a coercive instrument of oppression based on unequal power relationships that lead to patients being treated for things the antipsychiatrists assume are problems of living rather than illnesses or diseases. Although I will critique psychiatry and also be quite critical of the idea of mental illness, I value psychiatry and consider it to have a legitimate and significant role in caring for people living with mental health challenges. Readers wishing to read more about antipsychiatry should see T. Szasz, “The Myth of Mental Illness,” American Psychologist 15 (1960): 113–18; D. G. Cooper, Psychiatry and Antipsychiatry (London: Tavistock, 1967); P. Rabinow, ed., “Psychiatric Power,” in Ethics, Subjectivity, and Truth, by M. Foucault (New York: New Press, 1997); and Peter Breggin, Toxic Psychiatry (New York: St. Martin’s, 1991).