Archive for May, 2014

Benefits from Identifying the Cause of Mental Illness (Part III of III)

First, what did you learn from this exercise? (Note: This post is an extension of the previous two posts)

Chances are you discovered that most of life’s struggles can be attributed to factors in all three arenas. That is to be expected – as people, our lives do not sub-divide neatly. People are a dynamic unity of body, soul, mind, will, spirit, social context, and environmental influences. This means “cause” will rarely be as easy to identify as we would like.

Second, what are we looking for when we assess causation or contributive causes?

We want to know the place or places where we can catch the most traction in the process of change. The purpose of discussing causation is not to debate theories, but to identify how we can be most effective in our efforts to change. There are always many good and healthy things we could do which would positively impact our struggle, but we want to know which is most likely to provide the most benefit for the longest tenure because it is addressing the core of the problem.

Third, if cause can be unclear or overlapping, does that hinder our ability to make progress?

Yes and no. Consider an example pertaining to the brain but outside the field of mental illness – migraine headaches. Scientists and doctors do not know the changes or damage that happens at the cellular level which cause migraine headaches.

No one doubts that migraines are a biological problem with strong environmental influences. It also means doctors are alleviating symptoms more than working towards a cure until greater scientific advances can be made. Progress (i.e., pain relief through medicine and strategic decisions like avoiding allergens) can be made even if enough information does not exist to eliminate the problem. Even when the cause is unclear for a mental illness, similar forms of progress can be made.

Fourth, does identifying the cause always lead to a solution?

While identifying cause is a wise first step, no, it does not guarantee a solution; at least not to the degree that we often would like.

Often identifying the cause will point us in the direction to see near total redemption (alleviation of the struggle and opportunity to be used of God to bless others with what we learned in the experience). We use the information we derive from understanding causation to identity the most relevant truths, medications, insights, and life practices. We then experience and are able to more fully appreciate the health we longed for in our time of struggle.

Other times, struggles may still persist or return, even when we implement the truths, medicines, insights, and life practices that lessen their impact. For instance, events related to one’s post-traumatic stress may still produce an elevated sense of unrest even after those events are processed in a healthy way.

Does this mean we should just give up because what we want is not guaranteed in full? No, but it does mean that we need to understand the nature of redemption and how it relates to our various struggles better. That is the subject of the next question.

Distinguishing Physical, Environmental, and Volitional Causes of Mental Illness (Part II of III)

Let’s begin by remembering that not everything that can be diagnosed or makes us stand out as unique is a problem.

  • An “ideal graduate student” has mild OCD qualities – great attention to detail and drive for certainty.
  • Many police officers say if they lost the hyper-vigilance of PTSD (persistent tendency to look for what is wrong), they would be less effective at their job.
  • Mild mania – expansive thinking and energy for big goals – can be a very adaptive quality and is found in many great leaders; those who struggle with bipolar frequently have highly successful siblings or close family members.

So, as we look for the cause of particular struggles, we do not need to be exclusively problem-oriented. This is always an important caution for problem-oriented professions like counseling.

Additionally, because our weaknesses are often just exaggerated strengths, we can often feel shame where it is not needed and want to eliminate qualities God would prefer to see us refine.

  • Without the ability to be anxious we would have a hard time anticipating the needs of others.
  • Without depression our capacity to empathize with the struggles of others would be non-existent.
  • Also, consider again the strengths in the examples of OCD, PTSD, and mild mania described above.

But whether we are looking for strengths or weaknesses, illness or health, it is still helpful to be able to distinguish between the biological, environmental, and volitional source of a trait. The first step in this process it to let go of our pre-set assumptions. Ed Welch’s critique of medical explanation is true for spiritual and environmental explanations as well. Whenever we “know” where the “real answer” is found, it will make other questions seems silly.

“The problem with immediately opting for a medical explanation is that, once the decision is made, every other perspective seems superficial or irrelevant (p. 30).” Ed Welch in Depression, A Stubborn Darkness

After you’re open to the possibility of each causal explanation, begin with these questions (the order is intentional). Use these questions to guide conversations with your trusted friends, counselor, pastor, or doctor.

  • When did this struggle begin?
  • What events or changes occurred just before and after the struggle began (for children and teens include changes in their physical-emotional-social developmental stages)?
  • Have I experienced this struggle before? If so, when and what did I learn?
  • What are the most common / obvious / simplest explanations of this struggle?
  • What potential causes can I most easily eliminate by simple life changes (i.e., getting more sleep) or tests (i.e., going to the doctor for a broad spectrum blood exam)?
  • Who should I pursue to come alongside me in this assessment process?

To provide guidance as you answer these questions, consider the following characteristics indicative of struggles rooted in each of the three causative areas. Remember that often a particular struggle may have its cause rooted in more than one area.

Indicators of Volitional Causes

  • Natural consequence of a sinful (immoral) or foolish (unwise) choice.
  • Result of over commitment in order to please people or achieve goals on an unrealistic time table.
  • Lack of clear life systems (e.g., budget, schedule, etc…) to allow you to make informed, cohesive decisions.
  • Conflict between life goals (e.g., healthy marriage) and temporal choices (e.g., continuing unhealthy dating relationship).
  • Destructive choices (e.g., inadequate sleep, substance abuse, etc…) which have a cumulative negative effect.
  • Struggles over which greater self-control or concerns for others would legitimately reduce its impact.
  • Expecting a level of satisfaction or meaning from activities or relationships which on God can provide.

What are other possible indicators of volitional causes for mental-emotional-relational struggles?

Indicators of Environmental Causes

  • Onset of the struggle near a traumatic event or major life transition.
  • A family history that models unhealthy ways of handling relevant emotions or relationships.
  • The presence of an unhealthy or unsafe dynamic in your environment or relationships.
  • Bullying and rejection, especially when based upon characteristics over which an individual has no control.
  • Physical or emotional stress can be an environmental trigger for struggles to which someone is genetically predisposed.

What are other possible indicators of environmental causes for mental-emotional-relational struggles? 

Indicators of Biological Causes

  • A family history can reveal where an individual is predisposed to particular struggles.
  • A side effect of many diseases, medications, or major surgeries can be changes in one’s emotions.
  • Aptitudes and attractiveness impacts mental health via the pportunities and acceptance these qualities provide.
  • Onset of a struggle after the age of 40 with little to no history of the particular struggle.
  • A significant change in an individual’s personality with no circumstantial explanations.
  • Chemical imbalances and neural pathways in the brain both cause and respond to emotions and choices.
  • General health factors (i.e., stamina, weight, strength, diet, etc…) impact mental health and neural functioning.

What are other possible indicators of biological causes for mental-emotional-relational struggles?

Tweets of the Week 5.27.14

There is great value in saying something in a memorable, concise manner. Twitter has caused us to make this a near spiritual discipline. For my own growth (as a generally verbose individual… that’s a long way of saying “wordy”) and for the benefit of others, I highlight tweets each week that deliver a big message in a few words.

An Exercise in Identifying the Cause of Mental Illness (Part I of III)

To help you assess how you currently think about mental illness, let me invite you to participate in an exercise. Take the list of struggles commonly known as mental illnesses and place them in the appropriate place on the Venn diagram below. Use the overlapping segments of the circles to indicate where you believe there are multiple causal factors involved.

If any of these terms are new or confusing to you, ignore them and practice with the one’s you already know. This is not the time to expand your therapeutic vocabulary. (I apologize for poor image quality of the Venn diagram, but it should still be able to serve its purposes.)

Alzheimer’s Disease; Anorexia and Bulimia; Anti-Social Personality Disorder; Anxiety; Asperger’s Disorder; Attention Deficit Disorder; Bipolar Disorder; Compulsive Gambling; Depression; Dyslexia; Hallucinations; Narcissism; Obsessive-Compulsive Disorder; Paranoia; Post-Traumatic Stress Disorder; Post-Partum Depression; Pyromania; Schizophrenia; Seasonal Affective Disorder; Social Anxiety Disorder; Sleep Disorders; Substance Abuse / Addiction

venn

“Christians don’t understand how physical, psychological, and spiritual realms interrelate because Satan muddies the boundaries. Many of our troubles are caused because we think a problem is spiritual when it is physical or we think a problem is physical when it is emotional or spiritual (p. 207-208).” D. Martyn Lloyd-Jones in The Christian Warfare

As you seek to identify the primary or initial cause of each struggle, many of them naturally find their place.

  • Post-traumatic stress is clearly caused by the environmental influences.
  • Substance abuse and addiction begin with choices by the individual that become life-dominating.
  • Post-partum depression is obviously rooted in physical changes and stresses related to pregnancy and child birth.

However, others seem to almost always overlap in their origin.

  • Anti-Social Personality Disorder involves many personal choices but also correlates strongly with a harsh upbringing.
  • Attention Deficit Disorder has strong influences from both biology (brain) and environment (parenting and stimulation related to technological entertainment).
  • Obsessive Compulsive Disorder appears to be rooted in both brain physiology and personal choices-beliefs-values.

We begin to see that other struggles may be caused by any one or all three of these areas.

  • Depression-related struggles can have their origin in any or all of these circles.
  • Anxiety-related struggles can have their origin in any or all of these circles.
  • Sleep disorders can have their origin in any of these circles.

To complicate things further, the same individual can have multiple struggles (i.e., post-traumatic stress, a learning disability, and substance abuse), each of which have different origins but which feed into one another. How to prioritize multiple diagnoses goes beyond the scope of this presentation. But it reminds us that people are never as neat as whatever categories we devise to understand them.

If it is this complicated, should the church (or any group of non-professional people) take an always-refer position that limits meaningful conversation about this subject? No, that would be unhelpful, unloving, and impossible. Why?

  1. We all have a theory of mental illness whether it is a good-accurate one or not.
  2. We struggle. This is not an us-them subject. We will all face these types of struggles at some point.
  3. Our everyday conversations pass along some culture and “common sense” about mental illness.
  4. For better or worse, people take what they learn in the church and apply it to their mental illness.
  5. Simplistic hope (hope that is simpler than reality permits) is actually a false hope and the church, of all institutions, wants to be leery of offering false hope (Jeremiah 8:11).

If the church ignores this conversation, several negative consequences will be strengthened.

  1. The stigma related to mental illness will be reinforced.
  2. An excellent we all should have in the church – authentic and healthy relationships – will be negated.
  3. The discussion of mental illness will continue to grow more professional and secular.
  4. People will live as if God has little concern about their emotions, at least the unpleasant ones.
  5. We will miss an important opportunity to disciple people on how to engage with sin and suffering in this world.

Seasonal Affective Disorder, Eskimos, and Cultural Intelligence

I was recently listening to a series of lectures on cultural intelligence. The presenter, Dr. David Livermore (President of the Cultural Intelligence Center in East Lansing, Michigan), was examining 10 aspects of a people group that helps to establish their culture: their approach to identity, authority, time, risk, achievement, communication, lifestyle, rules, expressiveness, and social norms.

In the discussion of time orientation (e.g., “being” cultures vs. “doing” cultures) he raised the example of Eskimos who live in an environment where instead of having relatively equal parts of light and dark each day, they have months of each. It was in this section that he made an observation that caught my attention.

According to Dr. Livermore, the Eskimos work hard during the light months to provide for the dark months and do as little as possible during the dark months to preserve the stores they have been able to accumulate. In this sense, there is a stark shift from a “doing” to a “being” culture bases upon the season.

Then he notes that, generally speaking, the Eskimos enjoy the long dark winter months as a time to rest and be with family. As a counselor, I was expecting to hear that the depression rate went up significantly during these months. The lack of sunlight and reduced physical activity would seemingly lead to that conclusion.

I don’t want to make too much of an off-handed observation from a sociologist (the elevated suicide and addiction rate of Eskimos give some sense of a depression problem), but it did cause me to ask a fresh question about Seasonal Affective Disorder (SAD). By the way, that is why I enjoy listening to Great Courses lectures from various fields – beyond the benefit of learning about new things (e.g., culture), I gain new questions from people who approach / examine life for different reasons than I do as a pastor / counselor.

In this case, I began to ask, “How much of SAD in American society is the result of our culture being one of the most ‘doing’ oriented cultures in the world?”

Would this be the case for every case of SAD in America? No, and I don’t even think it’s responsible for me to guestimate what the percentage might be.

But it pushes me to consider a larger question, “How much does culture influence the emotional and relational struggles of individuals in those cultures?”

In addition to being highly “doing” oriented, America is also a highly “individualist” culture. One result of this orientation is that we seek the explanation for a struggle within the individual who struggles. Often, this is right and good. No one is more influential in my life than I am, so when I struggle it makes sense to begin by looking in the mirror.

In the case of SAD, personal changes should be made. That could mean going to the tanning bed, taking a vitamin D supplement, or getting additional exercise, especially if it can be outside.

Examining personal beliefs and values would also be in order. Do you give into grumbling-oriented thinking when you are cold? Do you struggle to be content when you are unable to be as productive as you like or in the ways you prefer?

If you answer “yes” to these latter questions, it may be harder for you to correct these beliefs and values because you are not just battling your flesh (e.g., unhealthy personal beliefs, values, and habits) but you are battling your flesh against the current of your culture.[1]

This doesn’t change the possible need for change in beliefs (e.g., productivity expectations or idols of achievement), behaviors (e.g., exercise routines and outside activities), and biology (e.g., vitamins or tanning bed). But it may help you understand why the battle is harder than other changes you have sought to enact.

This possible cultural-influence should not be considered unique to SAD, but would be true for any struggle we try to change which require us to think or live in ways that are at odds with our culture. I hope this reflection helps you consider the role of culture (i.e., our “corporate flesh” – a term I’m borrowing from Cornelius Platingia in his book Not the Way Its Supposed to Be) in shaping some of the aspects of the challenges you face.

[1] Here culture is not being used in the sense of “culture war” about moral issues, but the predominant preferences a group of people have about things like time and communication styles.

If this post was beneficial for you, then considering reading other blogs from my “Favorite Posts on Mental Illness and Medication” post which address other facets of this subject.

“What Is Mental Illness?” (Part II of II): A Proposed Definition

This is one blog in a series where I will be reflecting on the subject of mental illness. My purpose is not to lead the reader to the same conclusions I have, but to facilitate better conversations and reflections on this subject within the church.

In the previous post I examined several definitions of mental illness and tried to summarize their key points of similarity and difference. In this post, I will offer my definition of mental illness and highlights the points I am trying to emphasize with this definition.

Mental illness is a life struggle, which is common to all people to some degree, that significantly (degree of impact) and persistently (duration of influence) impairs an individual’s mental-social-emotional ability to function. With the exception of responses to trauma, this impairment is beyond a normal response to their life circumstances. The strengths and weaknesses associated with particular personality qualities and aptitudes are not mental illness.

Mental illness may have its cause in the physical body (i.e., brain chemistry, habituated neural pathways, genetics, glandular system, viral or bacterial infection, etc…), environmental causes (i.e., trauma, poor socialization, abusive-neglectful home life, etc…), personal choices (i.e., the consequences of sinful or foolish decisions on a spectrum from isolated bad choices with significant emotional-relational implication to addiction), or a combination of these causes.

The primary declaration made by the term mental illness is outside help is needed because the passing of time is unlikely to produce the desired decrease of symptoms. Based on this definition of mental illness any number of soul-body physician-counselors may be relevant and effective in assisting the process of change. A mental illness may be a true disease, a syndrome, or a consequence of life choices / circumstances.

This definition seeks to protect the distinction between “normal day-to-day emotional struggles” and “mental illness,” and, thereby, protect against over-diagnosis and prescription. At the same time, this definition seeks to acknowledge that the symptoms of mental illness are commonly experienced by every person; recognizing that the symptoms of mental illness are not the mental-emotional equivalent of a sixth sense or third arm. This protects against stigmatizing those who struggle with mental illness like emotional mutants in a therapeutic X-Men movie.

The bullet points below clarify key points in this definition.

  • Common to all people – emotional regulation, reality testing, and social awareness are struggles all people face
  • Degree of impact – in order to qualify as a mental illness a struggle must impair someone’s ability to function
  • Duration of influence – in order to qualify as mental illness a struggle must last longer than is normal for its trigger
  • Outside personality trait and aptitudes – the advantages or disadvantages of particular personality types or aptitudes should not be confused with mental illness
  • No one universal cause – our cognitive-emotional systems and struggles are too complex to reduce to a single cause
  • Multiple relevant helpers – the term mental illness should not result in an exclusive or restricted domain of helping relationships; effective care for complex problems will cover the spectrum of formal to informal care

Tweets of the Week 5.20.14

There is great value in saying something in a memorable, concise manner. Twitter has caused us to make this a near spiritual discipline. For my own growth (as a generally verbose individual… that’s a long way of saying “wordy”) and for the benefit of others, I highlight tweets each week that deliver a big message in a few words.

“What Is Mental Illness?” (Part I of II): Examining 6 Definitions

This is one blog in a series where I will be reflecting on the subject of mental illness. My purpose is not to lead the reader to the same conclusions I have, but to facilitate better conversations and reflections on this subject within the church.

What is mental illness? As close as we can get to an accepted definition would be the one given in the Diagnostic and Statistical Manual: 5th Edition (DSM-V) by the American Psychiatric Association (APA):

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”

But the accuracy and benefits of this definition are debated, even amongst various groups within secular psychology and psychiatry. That is why it is easy to find nuances of and alternatives to this definition. After the examples below, I will highlight the modifications each organization or author made to the DSM-V definition.

“A mental illness is a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning.” National Alliance on Mental Illness[1]

    • Notice the narrowed declaration that mental illness is a medical condition.

“Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior… Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.” The Mayo Clinic[2]

    • Notice the desire to differentiate normal emotional struggles from those that are clinically significant.

“A disorder of the brain resulting in the disruption of a person’s thoughts, feelings, moods, and ability to relate to others that is severe enough to require psychological or psychiatric intervention (p. 43-44).” Matthew Stanford in Grace for the Afflicted: A Clinical and Biblical Perspective on Mental Illness

    • Notice the desire to locate the problem only in the physical organ of the brain (also in next definition).

“A group of brain disorders that cause severe disturbances in thinking, feeling, and relating, often resulting in an inability to cope with the ordinary demands of life (p. 17).” Marcia Lund in When Your Family Is Living With Mental Illness

“A mental illness can be defined as a health condition that changes a person’s thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning. As with many diseases, mental illness is severe in some cases and mild in others. Not all brain diseases are categorized as mental illnesses. Disorders such as epilepsy, Parkinson’s disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses. Interestingly, the lines between mental illnesses and these other brain or neurological disorders is blurring somewhat. As scientists continue to investigate the brains of people who have mental illnesses, they are learning that mental illness is associated with changes in the brain’s structure, chemistry, and function and that mental illness does indeed have a biological basis. This ongoing research is, in some ways, causing scientists to minimize the distinctions between mental illnesses and these other brain disorders.” National Institute on Mental Health[3]

    • Notice the care taken to differentiate that there are brain problems that are not mental illness; the mind is not considered co-terminus with the brain, but an acknowledgement that the mind and brain are so interwoven that it is often difficult to distinguish where the cause for a given struggle may be.

Where do these definitions agree? There is one main point of agreement.

In order to qualify as a mental illness the life-struggle must “impair life functioning.” This reveals that the struggles known as mental illness exist on a spectrum; almost everyone will struggle with these challenges to some degree. However, there comes a point on the spectrum where life is impaired to a degree that it seems wise to classify this struggle differently.

Mental illness means that a common struggle has crossed a threshold and become “clinically significant.” The term is an assessment that outside help is needed; that (a) the passing of time and (b) continuing in the same life pattern will not result in the desired relief from these struggles.

This means, whatever mental illness is, it usually has more in common with sun sensitivity (a common experience that can be severe enough for some people to require specialized intervention) than it does to Chrohn’s disease (an uncommon experience that is only known by a small percentage of the population).

In this sense, what is unique to the person who experiences mental illness is not the experience itself, but the intensity and/or duration of the experience. What is shared in common by these definitions helps us forego an “us-them mentality” that fuels much of the stigmatization of mental illness.

Where do these definitions differ? We will consider two key points of difference.

First, some definitions seem very concerned to identify the location of mental illness in the physical organ of the brain. Other definitions seem less concerned with defining one single location for the struggle. The latter seems wise:

  • Many instances of depression are rooted in the glandular system more than the brain.
  • Often, with a brain-only focus, attention is exclusively given to brain chemistry to the neglect of neural pathways; which are not treated with psychotropic medications and have more to do with habituation.
  • The role genetics plays in some forms of mental illness can be lost by an exclusive brain focus.
  • A brain-only focus can reduce our “humanity,” and inadvertently our value, to the strength of our frontal lobe – the aspect of human neural anatomy that is most distinct from other creatures.
  • A brain-only focus can distract us from the beneficial influence of exercise, sleep, and other healthy practices; which not only improve brain chemistry, but also improve our quality of mental-emotional-social life through other body systems.

Yes, we want to continue to grow in our understanding of the brain’s role in our emotions. But we must realize there is a modern temptation to reduce people to their brains, which parallels the historic temptation of the church to reduce people to their souls. Whenever we allow one facet of our humanity to trump all others, we become blind to other important factors. We become excellent in the things we do well, but dangerous because of the things we fail to consider or give their full weight.

Second, some definitions seem content with the broader term “syndrome” while others want to use the more narrow term “disease.” Consider the difference in these two definitions.

  1. Syndrome: “a group of signs and symptoms that occur together and characterize a particular abnormality or condition.”[4]
  2. Disease: “an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors.”[5]

Disease implies a known and verifiable cause. Syndrome is merely a group of recognizable symptoms. With the multitude of factors that can result in depression, anxiety, inattention, addiction, and other experiences commonly called mental illness, it is seems wiser to call mental illness a syndrome rather than a disease.

Is this an attempt to somehow caution people against the use of medication?

No. It is merely an attempt to adjust people’s initial expectations of medication; from curing a problem to relieving symptoms until the cause their struggle can be identified. The present reality is that our prescriptive science (those things we can modify with medication and other biological-influencing treatments) is ahead of our diagnostic science (our ability to verify and measure the things we are modifying).

This expectation-management is important for several reasons. First, understanding a syndrome as a disease can give a false hope for medication; for those who are in an emotionally-fragile state this can be a dangerous thing to do. Second, with a syndrome a medication can be utilized while recognizing that the cause has not yet been found; “symptom alleviation” is a good thing for a syndrome because it reduces suffering while leaving room for continued efforts to identify the cause.[6]

Asking Good Questions about Mental Illness (Part IV of IV)

This is one blog in a series where I will be reflecting on the subject of mental illness. My purpose in raising this series of questions is not to lead the reader to the same conclusions I have, but to facilitate better conversations and reflections on this subject within the church.

When engaging a difficult and highly personal subject, it is better to start with good questions than a list of answers. The better our questions are, the more responsibly we will utilize the answers of which we are confidant, the more humbly we will approach areas of uncertainty, and the more we will honor one another in the process of learning.

As I’ve read, counseled, and thought about the subject of mental illness, here are some of the questions that have emerged.

  • Are we trying to medically create an idyllic sanguine personality? Is “normal” becoming too emotionally narrow? If not in the medical establishment, then are societal norms pushing people in this direction and the service-oriented medical profession trying to accommodate its well-intended, but misguided clientele?

“The consumer model to which medicine seems to be uncritically adopting pursuance is providing what the patient wants—that is, customer satisfaction in matters of health—is the measure of success (p. 26).” Joel Shuman and Brian Volck, M.D. in Reclaiming the Body: Christians and the Faithful Use of Modern Medicine

  • Does the alleviation of symptoms with medication always mean we are curing a disease? We medically treat the symptoms of many diseases and non-diseases to provide relief. This is good. Why have we allowed the debate over the disease model for mental illness to polarize the conversation about the roles of medication can play in mental health?
  • How should we understand the effects of the Fall on the mind and brain? We know our bodies age and die. We know all of our organs are susceptible to disease and deterioration. We have “norms” for the frequency, duration, onset, and prognosis of these effects of the Fall; what are the equivalent expectations for the mind and brain?

“As the brain is the most complex organ in our body, it is liable to be the most affected of all our organs by the Fall and the divine curse on our bodies (p. 64).” David Murray in Christians Get Depressed Too

  • How do we understand the tension between “already” and “not yet” with regards to the health, development, and preservation of the mind? How much should we expect to be able to remedy the effects of the Fall upon the mind prior to the ultimate redemption that will occur when Christ returns (Revelation 21:4)?
  • How much should we expect conversion and normal sanctification (spiritual maturity) to impact mental illness? Outside of medical interventions, most secular treatments for mental illness focus on healthy-thinking, healthy-choices, and healthy-relationships; so how much should Christians expect sound-doctrine, righteous-living, and biblical-community to impact their struggle with mental illness?

Asking Good Questions about Mental Illness (Part III of IV)

This is one blog in a series where I will be reflecting on the subject of mental illness. My purpose in raising this series of questions is not to lead the reader to the same conclusions I have, but to facilitate better conversations and reflections on this subject within the church.

When engaging a difficult and highly personal subject, it is better to start with good questions than a list of answers. The better our questions are, the more responsibly we will utilize the answers of which we are confidant, the more humbly we will approach areas of uncertainty, and the more we will honor one another in the process of learning.

As I’ve read, counseled, and thought about the subject of mental illness, here are some of the questions that have emerged.

  • Is mental illness a physical event with spiritual side effects or a spiritual event with physical side effects; do choices-emotions trigger biology or biology trigger choices-emotions?
  • How do we best assess when the relief of medication would decrease the motivation to change versus when that same relief would increase the possibility of change? Pain can both motivate and overwhelm; is this simply about personal thresholds or should mental anguish be evaluated by a different set of criteria?
  • Are our emotions more than the alarm system of the soul (moral) and the chemicals of our brain (biological)? Do these two categories tell us everything we need to know about emotions? Are these categories complimentary or competitive with one another?
  • Can we have a collective disease? Is mental illness always personal or can it be cultural? Cultural changes necessarily add to or detract from the kind of stresses that influence mental illness. How should we understand this influence and when might an “epidemic” require a collective solution as much as personal choices?
  • Why are we, culturally, more open about almost everything in our lives than we were a generation ago except mental illness? Why does this stigma / prejudice maintain its socially-accepted status when most others have been rejected?

“The mentally ill are one group of handicapped people against whom it still seems to be socially acceptable to hold prejudice (p. 36).” Kathryn Greene-McCreight in Darkness Is My Only Companion