A theology of mental health

Humans are complex. Society is complex. Theology and science are complex. Mental illness is complex. What causes mental illness? What are paths to healing? Can it be prevented? Here I explore how Christian theology is a rich resource to help address these questions. I write as a non-expert in theology, cognitive science, and mental health. But I also write as someone who for four decades has struggled with my mental health, read widely, and walked with many others on their journey.

As with many issues, I find it helpful to begin my exploration, with the key theological concepts that are encapsulated in the Biblical narrative: creation, sin, redemption, and re-creation.

The doctrine of creation highlights that humans are made in the image of God. We are relational, rational, and wonderful. Human relationality is reflected in the Trinity. We are creatures; we have finite capacities. We are designed by God to enjoy and live in harmony with one another and with the rest of God's creation. We are like animals but distinct. Rest (Sabbath) is central to life and its rhythms. Creation, from our being to food and nature, is a gracious gift. Mental illness is not God's plan or design.

Sin. (The Fall) We do not experience God's ideal: life in the Garden of Eden. Like Adam and Eve, we want autonomy, to rule ourselves. Like them, we are alienated from God, ourselves (shame), each other, and nature. Work is toil and male-female relationships are a power struggle. We live in a world that is marred by sin: individual, collective and structural. Sin has corrupted our thinking and desires. The whole creation is broken and groaning. Violence, disease and death, are part of life, but not God's wish, plan or design.  Given the multiple-dimensional character of sin's influence and presence in the world we should not expect to be able to simply identify the cause of a specific incidence of mental illness in one individual.

The tower of Babel captures human hubris and ambition, the vanity of our futile attempts to know and understand everything. Even when we don't understand we will claim that we do and ridicule and silence those who don't have our "correct" understanding. 

In her book, Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness, Anne Harrington, a historian of science at Harvard, comments.

Today one is hard-pressed to find anyone knowledgeable who believes that the so-called biological revolution of the 1980’s made good on most or even any of its therapeutic and scientific promises. It is now increasingly clear to the general public that it overreached, overpromised, overdiagnosed, overmedicated and compromised its principles.

Fortunately, we are not cursed and condemned to forever live in a sinful world marred by disease, despair, shame, guilt, and violence. God acted according to his promises, sending his Son, Jesus Christ, to usher in the Kingdom of God.

Redemption. God identified with humanity by humbling himself and becoming fully human as Jesus Christ. He proclaimed the Kingdom of God, preaching repentance and the forgiveness of sins, healing the sick, and driving out demons. Mental illness is not God's design or plan. People are not sick simply because they sinned or their parents sinned. Jesus death and resurrection bring reconciliation: between us and God, with one another, and the whole of creation. The curse of sin is reversed. Jesus is the suffering servant. He suffers for our sake. He has entered into our suffering. As he lives in us and we in him, we can participate in his sufferings. If we struggle with mental illness, we can find hope and comfort as Jesus knows and shares our struggle. Our liberation from our sin and the world of sin and disease is "now, but not yet." In this life, an individual may experience no, some, or almost complete healing from mental illness. Nevertheless, we can be certain of a future day when we will all be completely healed from every affliction.

Re-creation. There will be a new heaven and earth, where there will be no more tears, sin, suffering, or death. In this Kingdom of God, justice, truth, and righteousness will reign. We will have new minds and bodies. We will be living in the City of God which contains the River of Life and the Tree of Knowledge. There will be no mental illness. Redemption will be complete. This hope can give hope to those who suffer and those who care for them.

Living with virtue. How then shall we live as we wait for our redemption, even while afflicted with mental illness or walking with those who are? The fruits of the Holy Spirit include love, joy, peace, patience, kindness, gentleness, and self-control. God has designed us to live a particular way. Hence, we should not be surprised to learn that research shows how forgiveness and thankfulness are beneficial to mental health.

What is a person? Our view will shape what we consider to be the causes and cures of mental illness. A Biblical anthropology acknowledges the complexity of the human person.  Different facets of the whole human person include heart, mind, body, and soul. These facets are highlighted in the following passage from Matthew 22:36-40.

“Teacher, which is the greatest commandment in the Law?” Jesus replied: “‘Love the Lord your God with all your heart and with all your soul and with all your mind.’ This is the first and greatest commandment. And the second is like it: ‘Love your neighbor as yourself.’ All the Law and the Prophets hang on these two commandments.”

[For the first commandment, Jesus quotes Deuteronomy 6:5 but replaces "strength" with "mind"].

Mind, body, heart, and soul are not well-defined separate entities but inter-twined facets. For example, "heart" refers to our will, desires and inclinations. It is hard to separate this from the "mind".

We are a complex whole and cannot be reduced to just one dimension: genetics, physiology, personality, experience, social conditioning,...

If we accept this complexity of a human person and the presence of these different but inter-related facets then it is natural that understanding the causes of mental illness and proposing action to prevent or cure it will also be complex and multi-faceted. We will never be sure we really do understand.

For two thousand years philosophers have debated the mind-body problem, which is now being addressed in cognitive science. In spite of many advances there is no clear philosophical or scientific consensus on the relationship between the body, brain, mind, and consciousness.

Another dimension to Biblical anthropology is the social. A human person is not an isolated individual who can be defined independently of their social context. Rather, a human is part of a family, community, and nation. The person is also defined by a network of relationships. The emphasis of Western modernity on individualism and postmodernity on the "authentic self" conflicts with the anthropology of the Bible and almost all times and places outside the past four hundred years of the Western world. Mental health needs to be addressed within relational and social contexts.

I now introduce one model for a person. It is discussed in the book, Mental Health and Your Church: a Handbook for Biblical Care, by Helen Thorne and Steve Midgley. I recently encountered the model at a one-day seminar given by Midgley in Brisbane.

I introduce the model with the caveat as a scientist I consider that all models are wrong, some are useful. I think this also applies to models in theology.

A human person is created by and lives in the presence of the Triune God. The Word of God and the Spirit of God can speak to the heart of the person, changing its sinful, wicked, rebellious, and hard state to one that is oriented towards the desires of God. But the heart is not some abstract free floating essence. My heart is embodied. My heart and mind are intimately connected to my physical brain which is also part of my physical body. My mind and brain have been conditioned and moulded, for better or worse, by my experience living in my body. Stress, trauma, and addictions have an effect. Relaxation, sleep, diet, and habits can heal and train my body. Furthermore, my body is also embedded in a social context. These are my circumstances: family, housing, school, church, workplace, neighbourhood, and nation.

There are several competing models of mental illness, and I have reviewed them in this post. The current dominant model in the secular world is the biomedical model. However, I would consider that these models are complementary and we need a multi-faceted model, nicely captured in the figure below.

[Figure from Sanctuary Mental Health ministries]

Three of these models [biomedical, psychological, and social] are promoted by people who may not be Christian and do not operate from a Christian theological framework. However, the models can be valuable for understanding and treating mental illness, due to the doctrine of common grace. Thus, there is a role for drugs and counselling.

Human diversity. Paul uses the metaphor of the human body to describe the church. It is the body of Christ, his living presence in the world. Like a human body, there are many members. They are not all the same. They have different purposes, gifts, and functions. The weaker members are indispensable. This means that those who struggle with mental illness are indispensable members of a church. They are not a burden that has to be carried. They are not a problem that has to be solved. They are not a distraction from the "more important" work of preaching and evangelism. They are indispensable. The whole body grieves with them, walks with them, and celebrates them. Christ's power is made perfect in weakness.

Acknowledging human diversity is also important to understand and to treat mental illness. On the one hand, we are all made in the image of God. We are all sinners. We all have the same biology. On the other hand, Paul acknowledges a diversity of backgrounds, life histories (calling), and gifts. This diversity means there are no "one size fits all" answers to mental illness.

Finally, the concept of the "powers of this age" is helpful to understand the causes of mental illness, and particularly its proliferation in the modern world. There are massive power struggles going. Some are clearly visible. Others are not. Forces such as globalisation, capitalism, and autocracy, unleash ideologies and technologies that undermine good mental health. Mobile phones, social media, junk food, consumerism, secularism, movies, television, internet, alcohol and drugs, are not just neutral. They are tools for some people to gain inordinate amounts of power and money, with no regard for human flourishing. These powers need to be resisted, from the individual to the global level.