“God is dead.”
While a highly cliched and overused statement, this statement has been proclaimed countless times by some of my psychiatric colleagues. Many Christian believers think that this is simply how all academics, and especially psychiatrists, understand the dialectic between religion and psychiatry – namely, that psychiatrists eschew religion. However, in my experience, many psychiatrists are actually deeply religious and understand that the science of psychiatry, and medicine as a whole, is wholly consistent with a Judeo-Christian worldview.
The inverse is, in my experience, unfortunately, more true. That is, more Christian believers eschew mental illness and the science of psychiatry. These individuals often believe that mental illness is simply related to immorality, drug use, bad parenting, or volition. Much of this may be related to what people read online and watch on television and in movie theaters. Ultimately, this way of thinking prevents people from seeking professional mental health treatment or medications when they most need it, the way they would for other conditions such as high cholesterol, arthritis, or the flu.
As a psychiatrist, I am routinely asked by family, friends, and patients of mine who are Christian believers about whether mental illness is consistent with a Christian worldview and how to distinguish between true mental illness and other experiences that Christian believes may have that may be unusual but are spiritual in nature, such as hearing God’s voice. While there are many ways to answer these types of questions, I generally, focus on three things that Christians need to know about mental illness.
1. Mental Illness Was Present in Biblical Times
My first approach to questions about mental illness with Christian believers is biblical. As I write in my new book, “On Satan, Demons, and Psychiatry: Exploring Mental Illness in the Bible,” Christian believers often do not realize that many individuals in the Bible had symptoms consistent with depression and psychosis. For example, King Saul had a severe depression complicated by persecutory delusions (aka, paranoia or psychosis). After Jonah saw that God spared the Ninevites, he descended into a severe depression and asked God to take his life. The Bible also describes Naomi as having suffered severe depression. Elijah, Job, Jeremiah, and Moses were all also suicidal at some point in their lives. Nebuchadnezzar, the great king of Babylon, was fully psychotic for approximately seven years before recovering his sanity. These examples suggest that even severe mental illness is not a modern condition but timeless and can affect anyone, even the most powerful or revered figures from antiquity.
Jesus could not have told people that He would cure a person’s schizophrenia or depression, as we did not understand those disorders until recently. Interestingly, the Bible is replete with stories in which obvious medical conditions, such as epilepsy, were described as spiritual or demonic in nature. Additionally, the Bible is actually very clear about how it describes Satan and his demons and what are more likely to be physical or mental conditions. Namely, the demons that are likely related to untreated mental illness are often described in the context of Jesus or the disciples healing physical ailments, while the demons of Satan are clearly described in terms of sin, distance from God, and condemnation.
The message of the Bible is clear – Jesus Christ is the Almighty and He can cure mental illness as easily as He can exorcise demons.
2. There Is a Big Difference between Spiritual Experiences and Mental Illness
I am also often asked about the difference between spiritual experiences that people sometimes have while praying or in deep meditation, such as hearing God’s voice, or thinking that one has a special mission assigned from God. These sorts of experiences are common among Christian believers and do not indicate that someone has a mental illness. However, there are also people who think God is speaking with them or think that they are “the Messiah,” literally speaking. These experiences fall into very separate categories. The former experiences may enhance our relationship with God, the latter is mental illness. So how is one to make a distinction? There are many ways to do so, which I go into in my book, but I think that the main ways in which these experiences are different are that people with mental illness are more likely to have other symptoms of mental illness, such as functional impairment. People with mental illness are also more likely to have these sorts of experiences at all times, not just when they are praying or meditating, especially in the cases when people are hearing voices. Finally, experiences of these sorts will only respond to medications if they are of the psychotic or mental illness variety. This last consideration is almost pathognomonic of mental illness.
3. Having Mental Illness Does Not Prohibit Salvation
Sin and mental illness are not synonymous. They are not even in the same category. Mental illness is no closer to sin than diabetes or hypertension are close to sin. Mental illness can at times contribute to “sinful” behavior, such as violence when one is severely agitated and delusional as a result of mania or even dementia. For example, it is, unfortunately, the case that some people, when severely psychotic and untreated, truly believe that people will kill them. Therefore, what would they be expected to do when confronted by someone whom they think wants to kill them? They will likely become violent, in order to protect themselves. While this may seem “sinful,” this sort of tragic behavior is simply the reality of mental illness.
Similarly, suicidal thinking is a natural part of severe depression. It is a symptom of depression the same way that coughing and a runny nose are a symptom of a cold. God understands the difference between mental illness, sin, and the effects of mental illness on the brain.
How to Help Those with Mental Illness during the COVID-19 Crisis
Whether or not we believe that with mental illness, it is our Christian duty to help people in need. Now, during the period of coronavirus, I would be remiss to not share what each of us can do to help those with serious mental illness during this pandemic:
Make Sure that the Patient has at Least a Six-Month Supply of Medications
There are many potential treatments for people with serious mental illness, and medications remain the most important for the majority of them. Without medications, many patients who are otherwise stable could rapidly decompensate. While I typically do not recommend hoarding supplies, I have always recommended to my patients with serious mental illness that they always have at least a six-month supply of medications on hand at all times. That amount will generally allow them to ride out nearly every potential crisis. This is particularly important given the recent reports out of China that they may limit the medication supply to the U.S. If the Individual is not living with you or in an institutional setting, ensure that they have developed strategies for obtaining food and basic household essentials.
Sadly, the people who have the least to begin with, such as the destitute, poor, and mentally ill, may not have the ability or resources to stock up on essentials. If you know someone who has a serious mental illness and is living alone, please reach out to them and make sure they know from where to obtain the basics, such as food, toilet paper, and other household essentials. It is very possible that the place from which someone normally obtains these items will have run out. Many of the seriously mentally ill can live alone but may have a more difficult time adjusting to a rapidly changing and stressful society. Helping such a person to identify a new source of these sorts of items can contribute a great deal to their well-being in ways that those of us without mental illness could not even imagine.
Ask Them How They Feel about the Coronavirus Situation
This one is obvious but critical. A few of the seriously mentally ill may incorporate the coronavirus situation into their psychotic experiences, and even fewer may be completely unaware of it, but most will respond to it in a very normal way. The seriously mentally ill are people too - which may sound like another obvious statement but is something I have to constantly remind my medical students, residents, and trainees all of the time. They experience all the same worries and struggles as the rest of us - anxiety, frustration, and a fear of the unknown are common emotions. Most people that I know are dealing with these feelings by striking up conversations with their family and colleagues. Many are discussing these concerns with their psychiatrists and therapists. All are trying to find relief through mastery, catharsis, or distraction. Few things are as cathartic as sharing one’s experience with another person who is genuinely empathic, caring, and interested.
The seriously mentally ill are particularly vulnerable during crises like the current coronavirus pandemic. However, these simple interventions can go a long way towards ensuring that those who are typically forgotten by society have the best chance of remaining happy and healthy.
Photo credit: ©GettyImages/Natali_Mis
Ragy Girgis, MD, MS, is an Associate Professor of Clinical Psychiatry at the Columbia University Department of Psychiatry and New York State Psychiatric Institute. His new book is On Satan, Demons, and Psychiatry: Exploring Mental Illness in the Bible