This wouldn't be happening to you unless you had some unrepentant sin.—Job's friends
Evangelical, fundamentalist, or born–again Christians (48 percent) agree prayer and Scripture study alone can overcome mental illness. Only 27 percent of other Americans agree.—LifeWay Research[^1]
In spite of America's best doctors, meds, counselors, and prayers for healing, the torture of mental illness never subsided. Today, after a fun evening together with Kay and me, in a momentary wave of despair at his home, he took his life.—Rick Warren, letter to Saddleback Church after the death of his son to suicide, April 2013
Mental Illness and the Church
In April 2013, the son of pastor and author Rick Warren took his own life. Matthew had been suffering a life-long battle with depression. As you can imagine, the internet response to Matthew's suicide, and the suffering of Rick and Kay Warren, stretched the spectrum from love and care to outright horrendeous and horrible, harmful language.
It also helped to launch a longer conversation on the topic of depression, suicide, and mental illness.
The relationship between the Church and mental illness has been trubulent. Many of the great leaders and historical figures of Christianity exhibited the symptoms of depression—many of them heavily and greatly. From the Protestant tradition, two such figures are Martin Luther and Charles Spurgeon, well–known for their battles with depression. From the Catholic tradition, many conversations occurred after the death of Mother Theresa regarding her long bout with the
dark night of the soul. The Psalms explore the wide range of human emotion including many that exhibit symptoms of depression and anxiety. Even Jesus himself was said to be a man
acquainted with grief and sorrow.[^2]
And that's just a look at depression in the Church, to say nothing about other issues of mental health. The remainder of this essay will look at the various views on Mental Illness within the church, and then turn to a theology of mental illness and the use of psychotropic medicines.[^3]
Views on Mental Illness in the Church
Theologies of mental illness and how Christians should interact with the disciplines of psychology and psychiatry are many, and they lay across a spectrum without easy, tight categorization. There are many points of correspondence between views, however, that will allow us to discuss them in broad categories. The following introductions use the most commonly accepted categories of Christian counseling.
The first such category is
nouthetic counseling. Those who find themselves in this camp reject the concept of mental illness or view it with an extreme skepticism and prejudice. Nouthetic counselors believe that mental illnesses find their roots in an individual's sin rather than a biological cause. The only exception to this would be changes in mood and behavior that are the results of brain trauma, brain tumors, and other outside influencers. These views occur because of a dispute over the definition of the word
illness which is defined as the effects on the body by an outside agent, such as a virus or trauma. Furthermore, nouthetic counselors cast doubt as to the legitimacy of the scientific evidence for mental illness, raising the issue of a lack of evidence or the abundance of mystery within their findings and conclusions.
Thirdly, this view argues that the concept of (particularly modern) psychology and psychiatry is to be rejected due to its roots in naturalism, typically portraying behavioral and mood changes in terms of biology and physiology and a rejection of theological and spiritual foundations and realities.
Within nouthetic counseling, then, the role of the counselor is to come alongside those who are suffering and help them see what sin lies behind their uffering so that they can repent and move forward. of course, the suspicion and rejection of mental illness results in a suspicion and rejection of the medicine used to treat the disease.
The second category of counseling within Christianity is called
biblical counseling, which has the most nuance and spectrum of views of any of the categories. Broadly speaking, however, those in the biblical counseling category do not out– reject a clinical understand of mental illness, though some still view the concept of mental illness with skepticism. Others, however, are much closer to the third category of counseling in their affirmation of it.
Biblical counseling has somewhat of a different scope of counseling than either of the other two categories. Because counselors in this category do not reject mental illness, they tend are more comfortable in referring someone to see a professional psychiatrist or psychologist when they determine to the best of their ability that the care someone needs is outside of their skill and expertise. Where the scope differs, however, is that with such a referral the biblical counselor does not hand that person over and no longer provide care themselves, but continue to walk alongside them and offer pastoral care in tandem with the professional care they receive.
The role of the biblical counselor, then, is similar to the nouthetic counselor in that when counseling the focus is on the application of the gospel to the counselee's life and situation—where sin exists, it is met with a gospel&based;counsel and repentance is sought. The difference, however, is that the biblical counselor does not assume that sin is at the root of whatever issue has led that person to seek counseling. It may be that the person needs gospel–based wisdom to work through life's situation, much like the wisdom espoused in the book of Proverbs and other such wisdom literature. The nuance between biblical counselors is to what degree of cautian do they exercise in referring others out for professional care.
Christian Psychology / Integration
The third and final category are those who affirm Christian Psychology and Christian Pychiatry. Just as with the nuances and overlapping of biblical counselors to integration methods of counseling, so to are their nuances to integration and a spectrum of views. This spectrum is a continuum between biblical counseling and secular counseling done by Christians.
Those clinical practitioners who fall within this camp are called "integrationists." This is because they integrate psychological and psychiatric disciplines and models within the care. This does not mean that they subscribe uncritically to secular methodologies and theories, though some do. Rather, those within more conservative theological circles look to glean what they can from those methodologies and theories, recognizing that common grace allows for truth to be found in them.
Towards a Theology of Mental Illness
The argument against mental illnesses are systemic, often building on one another and interrelated. However, we can summarize these argumnts under one banner in particular: the sufficiency of Scripture. 1 Peter 1:3 says,
His divine power has given us everything we need for a godly life through our knowledge of him who called us by his own glory and goodness. Thus, the argument goes, we should not go outside of the Scriptures in dealing with these matters, as scripture testifies that within it is everything we need for a godly life.
The Sufficiency of Scripture
Wayne Grudem defines the sufficiency of scripture as meaning that:
Scripture contained all the words of God he intended his people to have at each stage of redemptive history, and that it now contains all the words of God we need for salvation, for trusting him perfectly, and for obeying him perfectly.[^4]
Further, the Westminster Confession of Faith says,
The whole counsel of God concerning all things necessary for his own glory, man's salvation, faith and life, is either expressly set down in Scripture, or by good and necessary consequence may be deduced from Scripture.[^5]
Abbreviated, the sufficiency of scripture means that God has revealed all that we need for salvation and holiness either explicitly or implicitly within the whole of Scripture.
Given this understanding, in order to apply the sufficiency of Scripture to mental illness, we must determine whether mental illness is foundationally an issue of individiual holiness. Is mental illness foremost an issue of individual sin? For nouthetic counselors, the answer is clearly
yes as they are not biological in origin, but sin and disorders of the heart and soul.
For others, however, the issue is more complex. Because of the biological reality, other camps say, mental illnesses are not prima facie a holiness issue, but can and often do lead to holiness issues. Depression by itself is not a sin, and neither is thereputic and medicinal support. However, people may act sinfully out of their depression. A parallel may be drawn from Ephesians 4:26—
be angry, and do not sin. Not all anger is sinful, but you can be sinfully angry. This is why biblical counselors and integrationists do not believe that medicine for mental illness, especially depression and anxiety, is not an end for soul care. It must be paired with biblical counseling for a holistic view of the complexity of human beings.
Towards a Theology of Sin and Mental Illness
When arguing from Scripture's silence on mental illness and the sufficiency of Scripture, we can only satisfy the issue of explicit teaching. And, this we can only do if mental illness is rooted in personal sin rather than a medical reality.
There is, however, a creational reality to sin that affects us holistically as human beings. Theologians categorize this reality as
Total Depravity, which is the teaching that human beings have wholly and totally been affected by sin. Total depravity means that every part of human beings have been corrupted by sin, including our mind, will, ability to reason, emotions, and physical bodies. It does not teach, as commonly misunderstood, that human beings are as sinful as they can possibly be.
The biblical formulation of total depravity cannot begin at our feet and end at our necks. There is to the holistic ruination of our depravity that must account for our psychology. While those who reject the theories of mental illness would not disagree with this formulation of depravity, they beliefs do not display the confession of this complexity. In categorically denying the possibility of mental illness, they are left with a deficient theology of sin and anthropology.
Again, that mental illness may be caused by the fallenness of human nature does not remove individual responsibility for sin. It does, however, resituate how we care for those suffering from issues such as clinical depression, schizophrenia, and the like. We do not remove the daily need for the Gospel and counsel, but we do add the possibility for medicinal help so that others suffering may be in a place to better properly understand the gospel and its affects in their daily lives.
A robust theology of sin does not necessarily deny the use of psychology and psychiatry, but in fact opens up the possibility for their need. Just as with any illness or medical affliction, the case for mental illness can be built upon empirical observation and repeated testing. It's at this point that those who reject mental illness claim that such scientific evidence is unclear and inconclusive. This accusation misses two important points, however: 1) evidence is actually growing in favor of a biological reality to mental illness,[^6] and 2) The same accusations could be argued against all illnesses and treatments, which typically begin without a consensus on origin, nor an understanding of why a particular treament works. In other words, mental illnesses are just like any other illness and treatment—even those that are accepted by those who reject mental illness.
Towards a Theology of Medicine and Mental Illness
As has been said, a theology that denies the existence of mental ilness further denies that medicines should be used to treat that mental illness. This is because medicating a non-biological problem covers up our sin rather than dealing with it through repentance as Scripture commands.
Those whose theological convictions maintain the possibility of mental illness, however, typically affirm the use of psychotropic medicine for treatment. But even for the majority of those Christians who affirm the use of such medicines, there is caution. While they may affirm that mental illness have a foundation in the physical, creational effects of sin, this does not deny the complexity of human beings and the ability for mental illness to be a trigger for personal sin. Nor, it should be added, does it remove the reality of a culture of over–medication which wrongly medicates depression as a result of non-chemical factors.
Yet, if we find a foundation for mental illness in Scripture, so too can we find a foundation for medicine. For this, we turn to another aspect of theological anthropology—from sin to creativity. Genesis 1 and 2 gives us our start.
The structure of Genesis 1 finds its culmination in the creation of Adam and Eve, forming a type of corronation celebration. Through the major movements of creation, God gives a liturgical assessment:
it is good. Then, in Genesis 1:26-28, God creates humanity:
Then, God said,Let us make mankind in our image, in our likeness, so that they may rule over the fish in the sea and the birds in the sky, over the livestock and all the wild animals, and over all the creatures that move along the ground.
So God created mankind in his own image,
in the image of God he created them;
male and female he created them.
God blessed them and said to them,Be fruitful and increase in number; fill the earth and subdue it. Rule over the fish in the sea and the birds in the sky and over every living tcreature that moves on the ground.
In these few verses, we find both the place and the purpose of humanity with regards to creation.
Our Place in Creation: Kings and Queens
First—what is our place in creation? Look at the following declarations God makes over Adam and Eve:
- Made in his image and likeness
- Rule over the earth and its creatures
- Fill and
- Subdue the Earth
What it means to be made in the image and likeness of God is a topic far too big for this essay. However, given its place amongst the other declarations listed above, we can draw out one particular aspect: human beings serve as
vice-regents, little kings and queens, within creation. That is our place. We are royalty, but our authority is one that is derived from the creator Himself.
Notice how God breaks his liturical rhythm in Genesis 1:31: creation is no longer good, but with the creation of Adam and Eve—with the crown jewel set in place so–to–speak, creation is now very good. His sub–rulers are in place and he has given them their commission.
Our Purpose in Creation: Subdue, Work, and Keep the Earth
Some have said that the Bible begins in a garden and ends in a city. This is true, but not quite true. The book of Revelation portrays the New Heavens and New Earth not just as a city, but as a garden–city. There is continuity and discontinuity between Eden and the New Earth—one may even call it a progress. We are not simply going back to Eden, but we are going to the new and better Eden.
Creation was never meant to be a small garden surrounded by uncultivated chaos, as we find it in Genesis 2. Rather, Adam and Eve were tasked with what theologians call
The Cultural Mandate—they were to subdue, work, and keep the earth. The New Creation is the fulfillment of this charge.
Unfortunately, the translation of
subdue the earth has been greatly misunderstood; it was never meant to mean that human beings have a domineering quality over creation. It is not subduing in a negative, destructive sense as we typically use it. Rather, Adam and Eve were to subdue the earth as God's vice–regents, and so the quality of their rule was to be like that of God's benevolent care for his creation: seeking the shalom of all creatures and call creation.
God did not abuse creation into being, but lovingingly called order out of chaos. The imagery in the garden of Eden is one of a loving gardener caring for their land—the same imagery God uses when he gives the cultural mandate to Adam and Eve. After listing several of the raw, natural materials that God has put within creation[^7],
The Lord God took the man, and put him in the Garden of Eden to work it and take care of it.[^8]
The connection is easy to miss, but incredibly important. Part of the cultural mandate is to mirror God in creating. Humanity is to rule over creation, partially through the actions of working the earth and taking care of it. These words and phrases are not those of destructive subduction, but those of great care, cultivation, and preservation.
working relates to the cultivation of the earth—the taking of the raw materials of creation and fashioning them into something that is greater than its parts. The phrase tak[ing] care of [the earth] is a way of translating the word keep, used in these verses, which speaks to the preservation or watching over the land. In both of these commands, we see God's heart towards creation—one of care, one of love, and one of seeking the shalom of all creation.
The Cultural Mandate and Science
What does the cultural mandate have to with science and medicine? Quite a bit. Of course, prior to the Fall there does not seem to be any reason for medicine. After the fall, however, medicine plainly fits into how we as human beings cultivate and subdue creation for the shalom of its inhabitants. Science does so by learning more about how God created this world to work, so we can harness its power. Knowledge is one sphere of our dominion.
Medicine is a direct result of the scientific method. Medicine is the result of the observations and experiments scientists do combined with the raw materials of creation. In utilizing the common grace of medicine, we are often able to fight against the curse of the Fall as seen in illness and disease, such that we are able to reach a level of health and wholeness we wouldn't be able to without medicine. These are exactly the principles of the cultural mandate simply applied to medicinal sciences.
This is widely accepted by orthodox Christianity. The nouthetic disagreement is not with medicine, though some may formulate their acceptance in different categories (rather than the cultural mandate). Rather, the nouthetic disagreement hinges on the reality of mental illness. Whether medicine should be used to treat mental illness follows from this rejection.
At the same time, the use of medicine to treat psychological disorders categorically fits within the same frame work as any other medicine, unless you have drawn a conclusion that mental illness does not have a biological component, but only a personal, individual component.
The debate on mental illness goes deeper than this introductory essay allows. The issue is not simplistic, and this essay has at best only touched on subjects that require a deeper study and research. However, and while affirming the doctrine of the sufficiency of Scripture, it seems that those who categorically deny the reality of mental illnesses are applying a narrow view of Scripture's sufficiency that we do not apply to other medical fields, let alone any other theological formulation. It seems that a robust theology of Scripture, sin, and anthropology cannot start with a categorical denial of mental illness, but it's very possibility. With this foundation in place, we can then begin to work out its implications in theology and life.
- [1.] Half of Evangelicals Believe Prayer Can Heal Mental Illness (Lifeway Research)
- [2.] Isaiah 53:3
- [3.] Essay Disclaimers: I am not a licensed nor trained psychologist or psychiatrist. What follows is merely a theological consideration of the topics. Furthermore, the opinions expressed in this essay do not necessarily reflect the opinions of my home church.
- [4.] Grudem, Wayne. Systematic Theology. Pg. 127.
- [5.] WCF 1.6
- [6.] See, for example: http://www.health.harvard.edu/mind-and-mood/what-causes-depression. It's not necessarily that research draws multiple contradictory conclusions, and therefore there is no consensus. Rather, it's more likely that differing conclusions are themselves correct but not complete, with reality being much more complex than a single origin for mental illnesses.
The gold of that land is good; aromatic resin and onyx are also there.— Genesis 2:12
- [8.] Genesis 2:15