Mental Illness and Ministry
Scott Harrower
When I first met Marcel, he was slowly rubbing the side of his head, a small figure sitting alone at the back of our church. Tears streamed from his eyes as he told me the sermon had moved him. Over the next few weeks, I began to get to know Marcel, his dog Winkie, and his dislike of loud noises. Having been a nurse for a decade before I became a pastor, I slowly came to understand that Marcel was suffering from severe depression and anxiety.
One day, he asked if I could help him stop feeling so “worthless and nervous.” I was faced with how to best care for Marcel. Should I refer Marcel to healthcare professionals and basically leave his mental health issues to them to care for? Or would it be best to care for his mental illness within the church community alone? Or could we develop a hybrid approach: a therapeutic model whereby our pastoral team and the wider church played a vital role within a more extensive professional approach to his care?
What would it look like if we went with the hybrid approach, and what would its fundamental principles be?
These are common questions that most Christians face, whether employed as pastors or not: How can we care for our brothers and sisters when they are unwell, yet their care requires far more than Christian friendship, support, and prayer? Lynn Baab asks,
In our time, when pastoral care interactions increasingly involve being present with people who do not share our faith commitment, and when the term “pastoral care” is sometimes applied to the kinds of care provided in secular settings by school counsellors and employee assistance programs therapists, Christian carers must be transparent in their own minds about the unique aspects of Christian pastoral care.1
So, what is a Christian approach to pastoral care? In what ways can it offer something unique in the context of distress?2 In this work, I outline what a Christian approach to pastoral care is within our secular culture.3
In order to make it manageable in this piece, I provide an approach that takes its lead from Jesus’s summary of the Christian life as loving God and our neighbour with all our heart, soul, strength, and mind (Luke 10:25–37)
Before outlining the biblical foundations for this “whole-person” model of pastoral care, I orient the context of our care with helpful definitions of mental health illness and the bio-psycho-social medical approach to working through mental illness. I then outline a “whole-person,” spiritual-bio-psycho-social model of people and the care we all need and point out the uniqueness of what this model has to offer Christians experiencing mental illness.4
1. Mental health and mental distress
According to the World Health Organization, “mental health conditions” are broadly defined with a focus on brain dysfunction. These mental health conditions are a broad range of problems, with different symptoms including mental, neurological and substance use (MNS) disorders, encompassing a wide range of conditions of the brain from depression to epilepsy to alcohol use problems”5
The DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, 5th ed.—the standard medical/psychological manual on mental distress symptoms and diagnoses) also provides a biologically based definition of a mental health disorder.
It is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour. It reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.6
Both the World Health Organization and the DSM-5 recognize the experiential, psychological, and social impact of mental health disorders. For example, these “conditions are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others.”7
Mainstream Christian medical and pastoral professionals such as Grcevich offer similar definitions, such as stating that a “mental disorder” is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.8
In the case of these mainstream medical and Christian examples, we can see that they all work with similar definitions of mental health distress.
Mental health crises
Mental health distress and crises are common. Approximately “10% of the world’s population is estimated to have some type of mental health disorder.”9 The percentages are as follows: “4.4% of the world’s population suffers from depression at any time, and 3.6% from anxiety disorders … .
Depression and anxiety represent the leading and sixth cause of disability around the world.”10 The social consequences of mental health distress are far-reaching, including higher rates of conflict between people with mental health illness and police compared to the rest of the population.11
Governments in Europe, Australia, and the USA are intervening in mental health care to promote well-being and productivity, as well as to offer clinical and educational programs.12 However, care for people experiencing mental health distress is uneven and varies greatly across socioeconomic groups.13
Concern for mental health distress has been driven by concerns for people and communities as well as for economic impact. That is, “Until recently, little attention was paid to mental health problems. However, due to its magnitude and associated health costs, it has become clear that this public health problem needs special attention.”14
The costs of mental health care are staggering: “Mental illness is projected to have a global economic impact of $6 trillion by 2030. This includes costs of healthcare, lower productivity due to absenteeism and presenteeism (defined as attending work when ill), and the cost of millions being unable to participate in the workforce.”15
From this data, we can see that it is reasonable to expect that most Christians, especially Christians in leadership roles in church groups and schools, will be involved in the lives (and care of) people with mental health conditions. The good news is that a lot can be done to support faith, hope, and love in this context and consequently enable quality of life, meaning, and growth within the context of mental health distress.16
A wide range of interventions in mental health have been developed—and are continually being developed—and these may yield positive results for the well-being of individuals and families.17
A complementary model
So, given that diagnosis and intervention are helpful, what kind of Christian pastoral care can we appropriately offer to people in our congregations?
A complementary model is best because it considers the full breadth of who we are: people with biological, psychological, social, and spiritual realities. Jesus teaches us that we are called to love God, others, and ourselves with our whole heart, soul, mind, and strength (Luke 10:47Open in Logos Bible Software (if available)); therefore, if any aspect of our self is unwell, we need to take this seriously and help it heal so that we may be able to receive and give love as God, other people, and our own selves deserve.
This “whole-person” approach to pastoral care will complement and support contemporary medical bio-psycho-social approaches, offering direct social and spiritual care on the one hand and supporting biological and psychological care by professionals on the other.
Within this complementary model between a scientific and Christian approach, Christians may be “team members” in a holistic model of care. To situate our spiritual and social care and support the biological and psychological aspects of medical care, an overview of the scientific bio-psycho-social model of health is provided below to point out the spiritual dimensions the model must consider.
2. A secular bio-psycho-social approach to mental health and distress
In secular societies, we draw upon a range of biological, psychological, and social research and tools to understand and resolve mental distress. This therapeutic approach understands the human person as a bio-psycho-social complex and tries to reckon with the various dimensions of who we are when we are unwell.
The bio-psycho-social model of health and therapy is known as the BPS for short. The benefit of this orientation is that it tries to treat the whole person. Furthermore, the BPS model is considered to be scientifically based, and thus a reliable framework that can be applied to all people because we share the same fundamental biology even of our individual and cultural psychologies and societies vary.18 The fact that this approach is so common facilitates communication, treatment, and education with mental health and mental health disorders.19
Naturally, there is diversity across mental health practitioners in terms of how this approach is used and applied. Some medical and mental health providers focus on the biological basis of mental health distress, in which “genuine mental disorders are classified as diseases, to be characterized primarily in biological terms.”20
Others, such as most psychiatrists, tend to lean more heavily towards the psychological and social dimensions of illness, preferring to focus on “psychotherapeutic approaches, which focus on the psychosocial factors involved in mental disorder.”
Therefore, “concepts of abnormal or impaired belief, experience and social structure take priority over concepts of neural dysfunction.”21 Therefore, though there is a common concern for the whole person, in practice, there is a range of mental healthcare strategies and treatments that we may receive within biopsychosocial approaches.
3. A spiritual BPS approach to pastoral care
Within this range of approaches within the bio-psycho-social approach, there is disagreement on which factors are most foundational to being well or unwell. In fact, a deeper conversation is being had that acknowledges that human beings are more than merely BPS processes. Yet, there is a hesitation to refer to the human soul as the unifying feature of the human self.22
Indeed, the language of mystery is invoked to fill in the gaps in our current understanding of mental health, mental distress, and ideal therapies.23
Christians, however, can identify the fundamental aspect of the self at the spiritual dimension—which Jesus calls our soul and is as essential to us as our heart, strength, and mind. The core of Jesus’s teaching was to “Love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind” and “Love your neighbour as yourself” (Luke 10:27)
Moreover, Jesus said that we will flourish when we love and give love to our souls as well as our elements: Jesus emphasized, “Do this and you will live” (Luke 10:28). Jesus’s teaching is the basis for the following features of the SBPS approach to pastoral care.
Referring to the soul as our spiritual aspect, my pastoral approach to mental illness is the spiritual-bio-psycho-social model (SBPS, for short). The spiritual dimension of the person is, at our core, united to Christ by the Holy Spirit and persists in a spirit-to-spirit union with God through psychosis, dissociation, and even biological death.
The soul is the enduring part of who we are regardless of our changing mental, physical, and social states; therefore, a Christian approach to pastoral care uniquely cares for our most essential and enduring selves.
Because the spiritual dimension of health is taught by Jesus as being related to the heart, strength, and mind, we cannot ignore these other aspects of who we are. This does not mean that the BPS aspects of our lives and communities do not matter. Rather, it means that these aspects of one’s life cannot be understood aside from their relationship to the soul and the effect that these elements may have on one another. For example, taking medications that affect the brain and mood affects the soul, too: “It is Robert’s medication that helps him find a spiritual place, which he could simply not inhabit without its assistance. For Robert, the taking of medication is much more than an engagement with pharmacological products. Taking medication functions as a deeply spiritual act.”24
Therefore, Christian pastoral care endorses and supports care for each aspect of the person, ensuring the spiritual element is taken seriously. The goal of pastoral care is that each person and community may experience well-being to the degree that they may love God, their neighbour, and themselves with their whole self.
In sum, the foundation for the SBPS is Jesus’s call to love God and one another as a person whose self has many facets, including a spiritual one. Now we might ask what precisely Christian spiritual care provides for people.
4. The unique support offered by Christian pastoral care in the context of spiritual–religious distress
An integrated SBPS approach to pastoral care can meet spiritual needs that the BPS approach to mental health cannot meet. Key amongst these needs is profound stress known as “religious–spiritual struggles.” These “struggles arise when some facet of religious belief, practice, or experience becomes a focus or a source of tension or internal conflict.”25
When beliefs become sites of pain rather than support in the context of mental illness, these struggles are referred to as the “dark side” of religion because they occur when religious beliefs make a person’s situation worse than what it would have been otherwise.26
If religious–spiritual distress is unaddressed, people may experience a decline in BPS well-being.27 This research points out that when religious people, including Christians, experience mental health illness, they may experience religious dimensions to their illness as well as its BPS impact. We should not be surprised at this fact, given that we are integrated and complex people. Religious and spiritual struggles include battling and wrestling with tormenting questions/experiences/fears to do with God, doubts, ultimate meaning, right and wrong, and diabolic forces.28
For example, a Christian (or a member of another faith) may ask whether their depression is a form of punishment by God.29 A friend of mine once believed that their depression was a way for God to moderate their pride and had nothing to do with her biology, and for that reason, she refused medical treatment for three difficult years.
In this case, my friend’s distress was not only with the symptoms described as depression but with God and their own perceived sinfulness (pride). They believed that God wanted to keep them depressed for good reasons; therefore, there was no reason to treat their depression until they were humble. To their mind, they had received a demonic “thorn in the flesh sent by God” to restrain their enthusiasm—as it was for St. Paul. Paul wrote that “to keep me from becoming conceited, I was given a thorn in my flesh, a messenger of Satan, to torment me” (2 Cor 12:7O). My friend was merely following the passage's logic and applying it personally.
These complex matters profoundly affect a person’s understanding of what they are experiencing, what well-being looks like, and what support to seek out. Naturally, medical professionals without training cannot address these concerns. Christians offering pastoral care have a unique opportunity to help others work through these issues. Taking seriously how our spiritual lives relate to mental health distress is vital because:
The absence of [pastoral care and] preaching on mental health issues leads to a gap in the spiritual lives of a congregation in which the power of the gospel is not brought to bear on a fundamentally important issue in many people’s lives.30
Suppose there is a gap between what we experience on the one hand and how we view God’s interests on the other. In that case, people may see our faith and churches as irrelevant to their most fundamental needs—or they may feel pressured to “fake” a spiritual life that is disconnected from their lives: “Feeling that one has to mimic one’s spiritual life to fit in with what other human beings think is the norm can only be destructive.”31
Christians can uniquely offer spiritual care within a spiritual-bio-psycho-social approach to mental health care. This does not mean dismissing the spiritual concerns that people may have; indeed, at times like these, the full forgiveness that we have resulting from Jesus’s atoning death for us may be the most liberating truth we need as part of our mental health stabilization. Michael Emlet writes,
Even if we view medication as a potential piece in a comprehensive ministry approach, we always seek to bring the riches of Christ’s redemption to bear upon people’s lives. Sinners will always need mercy, grace, forgiveness, and supernatural power to love God and their neighbour. Sufferers will always need comfort, hope, and the will to persevere. Ultimately, these blessings are found not in a pill bottle … but in the person of Jesus Christ.32
Navigating these complexities can seem daunting. However, we must recall that Jesus summons us to love God with all our minds, souls, strength, and minds when offering pastoral care. This means that we are putting our whole selves at God’s disposal in the company of other people who have the potential to care holistically, too; therefore, we are not in this alone.
Practically speaking, this means that we draw equally upon our intellect (our mind) as well as our heart’s empathy (our heart); we act with the strength of discipline (our strength) and spiritual words of wisdom (soul) as we care for others.
When we offer our whole self to God, we can best fulfil our God-given duties to those he brings into our path, as the Good Samaritan did when he used all he had to care for the person he found on the road. When we offer all our gifts and histories to God, we are more likely to be successful in pastoral care for people who suffer from mental health distress because we make more of our personal resources available to them. When we do so, we are likely to have a pastoral care “win” for the kingdom:
Your ministry “win” occurs whenever any person with a mental health condition or any family member of someone with a mental health condition experiences Jesus through the people and ministry of a local church.33
Conclusion
This article has outlined a “whole-person” approach to pastoral care in the context of mental illness: the spiritual-bio-psycho-social (SBPS) model of care. Its core idea is to take fully and seriously the fact that Jesus understood people as spiritual and bio-psycho-social beings. Furthermore, he called us to love one another with our whole selves with the help of God.
The spiritual-bio-psycho-social model of care permits us to attend to the religious–spiritual distress that often accompanies its biological–psychological features, which can impede healing and well-being. By intervening in mental health at the spiritual level, we may help people achieve the goal that Jesus knew was the key to life: to heal and grow to the extent that we may all be able to love God, others, and ourselves with our whole heart, soul, strength, and mind.
Related articles
Lynne M. Baab, Nurturing Hope Christian Pastoral Care in the Twenty-First Century (Minneapolis MI: Fortress Press, 2018), 53.
Please note that throughout this paper, I will use the language of mental health conditions, distress, illness, and diagnosis as equivalent language.
For the sake of this article, pastoral care includes both conversational elements and acts of service that we associate with traditional diaconal ministries. These diaconal ministries usually provide for the body and practical help, including transport and prayer. Mikkel Gabriel Christoffersen et al., “Pastoral Care as Diaconia—Diaconia as Pastoral Care,” Diaconia 14.1 (2023): 3. See the related articles in the volume on the question of what pastoral care is and how it relates to acts of service.
Though not covered in this short piece, it is essential to note that this model offers a pathway for dealing with religious/spiritual struggles, which is key to the unique pastoral support that Christians can validly offer to other Christians during mental distress.
World Health Organization (WHO), “Mental Health ATLAS 2020,” ed. Dévora Kestel (Geneva: World Health Organization, 2021), 124.
Cited in Stein Dan J. et al., “What Is a Mental Disorder? An Exemplar-Focused Approach,” Psychological Medicine 51 (2021): 895.
WHO, “Mental Health ATLAS 2020,” 124.
Stephen Grcevich, Mental Health and the Church: A Ministry Handbook for Including Children and Adults with ADHD, Anxiety, Mood Disorders, and Other Common Mental Health Conditions (Grand Rapids, MI: Zondervan, 2018), 22.
Adilson Marques et al., “Preface,” in Mental Health: Preventive Strategies, eds. Adilson Marques et al. (London: IntechOpen, 2023), xiii.
Bridget Hogg et al., “Supporting Employees with Mental Illness and Reducing Mental Illness-Related Stigma in the Workplace: An Expert Survey,” European Archives of Psychiatry and Clinical Neuroscience 273.3 (2023): 739.
Matthew M. Morgana and Angela Higginson, “Police and Procedural Justice: Perceptions of Young People with Mental Illness,” Policing and Society 33.7 (2023).
Hogg et al., “Supporting Employees with Mental Illness,” 739.
“In Australia and across the Western world, there are also major gaps in inpatient facilities for adolescents with severe mental illnesses where parents, guardians, and young people with mental illness struggle to navigate access to a piecemeal system of underfunded state and expensive private psychiatric beds.” Morgana and Higginson, “Police and Procedural Justice,” 642.
Marques et al., “Preface,” xiii.
Hogg et al., “Supporting Employees with Mental Illness,” 739.
“Despite the potentially lifelong challenge of severe mental illnesses like schizophrenia, schizoaffective disorder, bipolar disorder, and recurrent major depressive disorder, studies confirm that individuals with these disorders can achieve various degrees of symptom reduction and management, successful community integration, and vocational stability.” Marcia Webb et al., “Struggling and Enduring with God, Religious Support, and Recovery from Severe Mental Illness,” Journal of Clinical Psychology 4.4 (2011): 1161.
Melinda J. Goodyear et al., “Promoting Self-Determination in Parents With Mental Illness in Adult Mental Health Settings,” Journal of Family Nursing 28.2 (2022): 129.
The BPS model is predicated on a scientific methodology in which “the mechanisms discussed are arguably consistent, observable, (often) predictable, quantifiable and testable— that is, they are scientific.” William Lugg, “The Biopsychosocial Model: History, Controversy and Engel,” Australasian Psychiatry 30.1 (2022): 57. Robert C. Smith, “Making the Biopsychosocial Model More Scientific—Its General and Specific Models,” Social Science & Medicine 272 (2021).
Will Davies and Rebecca Roache, “Reassessing Biopsychosocial Psychiatry,” British Journal of Psychiatry 201.1 (2017): 3.
Davies and Roache, “Reassessing Biopsychosocial Psychiatry,” 3.
Davies and Roache, “Reassessing Biopsychosocial Psychiatry,” 3.
Currently, secular psychiatrists are philosophically (and thus theologically) “neither reductionist nor dualist, but rather non-reductive and monist. Glossing over many important details, this position maintains that descriptions and explanations expressed in the language of psychology are irreducible to descriptions and explanations expressed in biology, while insisting that mental states are nonetheless entirely physical in nature.” Davies and Roache, “Reassessing Biopsychosocial Psychiatry,” 4.
“Psychiatry is concerned with both mind and brain, and the relationship between the two is still something of a mystery. Clinical care sometimes involves attention more to one than the other, but usually involves giving attention to both.” Christopher C. H. Cook, “Mental Health in the Kingdom of God,” Theology 123.3 (2020): 165.
John Swinton, Finding Jesus in the Storm: The Spiritual Lives of Christians with Mental Health Challenges (Grand Rapids, MI: Eerdmans, 2020), 104.
Hisham Abu-Raiya et al., “Relationships between Religious Struggles and Well-Being among a Multinational Muslim Sample: A Comparative Analysis,” Social Work 63.4 (2018): 347.
Christopher G. Ellison et al., “Spiritual Struggles and Mental Health: Exploring the Moderating Effects of Religious Identity,” International Journal for the Psychology of Religion 23 (2013): 224.
Ellison et al., “Spiritual Struggles and Mental Health.”
Three religious struggles are outlined throughout Kenneth I. Pargament and Julie J. Exline, Working with Spiritual Struggles in Psychotherapy: From Research to Practice (New York: Guildford Press, 2022).
Abu-Raiya et al., “Relationships between Religious Struggles and Well-Being.”
The word of God needs to be preached in all areas of human experience … Similarly, Bible study and preaching that do not take lamentation seriously deprive people of a robust biblical resource—the Psalms of lament—that has the potential to bring about the holy articulation of pain and sadness, which leads to a sense of shared experience belonging in brokenness.” Swinton, Finding Jesus in the Storm, 210.
Swinton, Finding Jesus in the Storm, 86.
Michael R. Emlet, Descriptions and Prescriptions: A Biblical Perspective on Psychiatric Diagnoses and Medications, Helping the Helper Series (Greensboro, NC: New Growth Press, 2017), 16.
Grcevich, Mental Health and the Church, 191.
