by Kenneth Phelps
Parents of a 4-year-old with autism and intellectual impairment find themselves preoccupied with how their gregarious boy is behaving when left in the church’s childcare on Sunday morning. “Will he stay in the room? What if he tries to run out? What if he gets upset and starts hitting his head?”
A 16-year-old with depression and self-harm behavior tugs at her sweater during youth group, hoping to hide the cut marks on her arm. “I am so ugly. I wish Morgan and Sarah would at least talk to me. I hate being around these people.”
A 25-year-old man with severe social anxiety slides into the back of a packed sanctuary at the recommendation of his therapist to broaden his interpersonal network. “I should have worn a jacket. What if others notice I don’t have any money for the offering? They will probably know I don’t go to church often.”
A 48-year-old woman with religious-focused intrusive thoughts from her obsessive compulsive disorder sits trembling during the morning sermon. “What if I go to hell because I didn’t ask for forgiveness in the right way? Maybe I could get the pastor to pray with me to get these vulgar thoughts of God out of my head.”
A middle-aged military veteran who is haunted by the echoes of war shudders during the opening organ instrumental. “What was that? Was that the music? I just wish this song would be over. I should move to the back so I could keep an eye on everything.”
An elderly woman grips the hand of her husband in the pew trying to provide some reassuring touch in the early stages of his dementia. “I can’t believe this is happening. Why is God putting us through this challenge? I wonder if he recognizes this hymn?”
Mental illness is not rare. The 12-month prevalence among United States adults is 7 percent for major depressive disorder, 8.5-16.2 percent for alcohol use disorder (i.e. problematic alcohol use), 3.6 percent for generalized anxiety disorder, 3.5 percent for post-traumatic stress disorder and 3 percent for panic disorder. Countless others are affected by attention deficit hyperactivity disorder, sexual dysfunctions, bipolar disorders and neurodevelopmental disorders. Regardless of the diagnostic category, mental illness does not discriminate. The emotional pain and suffering that accompanies these disorders can touch anyone.
Whether it is the loneliness of depression or the paralysis of anxiety, refuge is often sought in religious institutions. When attempting to build a sense of communion, it can be difficult for individuals to remain emotionally present. Bothersome judgmental or catastrophizing thoughts often lead to a brain fog. In therapy, we call these “cognitive distortions” or errors in thinking. These thoughts are not unique to individuals with mental illness, but are more frequent and severe than the thoughts of those without a diagnosable disorder. An example of this might be the 25-year-old man with social anxiety who anticipates scrutiny and humiliation during the Sunday service. While all of us can recall middle school angst — “Oh no, I have a pimple. What if they are judging me? Do they think I am weird? If I ask a question, will everyone think I’m an idiot?” — these cognitions and other significant fears persist for those with social anxiety disorder, often restricting them to few social outings and painful isolation. This man, like many of us, believe our thoughts automatically, rarely questioning the validity and utility of our thinking (e.g. “Are people always rejecting? Could there be another explanation for the behavior of others? It seems that the view of myself may differ from how others see me.”).
How can church members and leaders create a safe space for individuals to share their struggles and find resources in the community where they can learn valuable skills to change this stinkin’ thinkin’? How can we lessen the mental fog through love, care and spiritual support?
As a first step, it is important to recognize that those dealing with a mental illness are not that dissimilar from those who are not currently dealing with a mental illness. To help normalize and empathize with the struggles of someone overwhelmed by an internal struggle, it can be helpful to think of most mental illnesses on a continuum. For instance, on one end of the continuum might be mild difficulty (occasional sadness that gets in the way, shortness of breath and facial flushing prior to a performance, having an extra glass of wine to cope), where at the other end of the continuum might be severe difficulty (inability to get out of bed and suicidal thoughts, frequent and escalating panic attacks restricting a person to her home, binge drinking in the morning to dull traumatic memories). Factors that differentiate people on the continuum are severity of symptoms, degree of their cognitive distortions and overall life impairment. The continuum helps us remember that fleeting tearfulness can quickly shift to daily depression and a child’s separation fears can morph into hourly tantrums.
The church can provide resources to help those climbing the continuum. For instance, it is important to recognize that certain things help to decrease distress. An example of this is that social connection and attachment to faith have been linked to a lowered risk of suicide. Here are some other ideas:
- Ensure that the childcare center has sensory toys that are appealing to children with an autism spectrum disorder.
- Include staff in childcare centers that are familiar with children with attention deficit hyperactivity disorder, anxiety, autism, behavioral problems or other concerns.
- Consult with a child-centered mental health provider to tour the childcare center and offer recommendations.
- Create a list of providers in the community that treat commonly occurring concerns and display this in a public area.
- Invite mental health providers to engage in presentations on topics relevant to congregational concerns (such as grief, mood changes, trauma, marital tension).
- Make references to mental and emotional health during worship.
- Identify helpful bibliotherapy (self-help books such as “Mind Over Mood,” “The Feeling Good Handbook” or “Calmer Easier Happier Parenting”) to post alongside referral sources.
- Use “people first” language to empower those with emotional pain (such as “child with Tourette Syndrome” instead of “Tourette kid” or “man with schizophrenia” instead of “psychotic man”).
- Encourage use of mindful, diaphragmatic breathing that can assist with self-soothing and centering of one’s mind.
- Engage church members in National Alliance on Mental Illness walks.
- Partner with Alcoholics Anonymous, Narcotics Anonymous or another group to welcome those with mental illness or addiction into the church.
- Direct anyone with a plan or intention to harm himself or herself or someone else to the emergency room for a psychiatric evaluation, as this is an emergency.
- Be conscious of how we can create an environment of love and acceptance, avoiding judgment.
Psalm 34:17-20 reads, “The righteous cry out, and the Lord hears them; he delivers them from all their troubles. The Lord is close to the brokenhearted and saves those who are crushed in spirit. The righteous person may have many troubles, but the Lord delivers him from them all; he protects all his bones, not one of them will be broken.”
We are people first and our problems second. They are part of us, not us. One way we discover this fact is when others identify strengths and skills that can be utilized in our church family. People want to be seen, heard and valued. We don’t want to be seen as depressed, heard as a worrier or valued as a substance abuser. We want to be seen as a child of God, a person that deserves love in spite of our mood, anxieties or addictions.
Let us pray this prayer together as we seek to support those in our community dealing with mental illness:
Dear God, when our brothers and sisters in Christ cry out, help us hear; help us see; help us value; help us find resilience in pain; help us put mental illness where it belongs — in the hands of you to heal the suffering. Lead them toward qualified professionals where freedom from oppressive thoughts can occur. Lead them to communities of love where the burdens feel lighter. I pray to let me be part of this community. I pray to let your sacrificial love be a model for me of how to treat others in their darkest hours. Let our love for one another create moments of peace in the difficulties of life. Amen.
KENNETH PHELPS is an assistant clinical professor of neuropsychiatry and behavioral science at the University of South Carolina School of Medicine. He is a licensed marriage and family therapist and a member of Shandon Presbyterian Church.