Mental Illness and Belonging

A Pastor's Inquiry

by Michael Tanner

What, from the perspective of my “consultants,” has helped them to feel that they have, or have not, belonged in and to a particular community of faith or to feel that they have been welcome, or not welcome, to belong in a new community?

This was the subject of conversations I conducted with 12 people (whom I call “consultants”), each of whom lives with a chronic mental illness. Holy Comforter Church is a mission of the Episcopal Diocese of Atlanta, and the 12 consultants are associated with the congregation. This question guided my research and analysis for my doctor of ministry program. This article, specifically edited for Church Health Reader, does not address the breadth of the question but rather provides an introduction to the larger research project and focuses specifically on the stigma of mental illness, how mental illness is perceived in the church, and what individuals and churches can do to foster a sense of welcome and belonging for people with mental illnesses.

Over 25 years ago, Holy Comforter, a small, urban parish in Atlanta, embarked on a journey toward becoming a safe and welcoming community for people with mental illness. More than half of its regular worshippers are people with mental illness. Since 1997, it has operated a day program for people with mental illness, called the Friendship Center. This program serves 75–100 people with a variety of activities that support wellness and recovery, including gardening, studio arts, meals, clothes closet, health monitoring, music, yoga, games, and field trips. It is managed by a small professional staff that coordinates the work of about 75 volunteers. I was vicar of the parish and executive director of the Friendship Center from 2006–2014.

The long-term composition of its membership suggests that Holy Comforter has become a relatively welcoming and safe place for people with mental illness. Thus, its members and associates, especially those with personal experiences of mental illness and of various churches, represent an important store of data concerning what makes churches feel safe and welcoming to people with mental illness and how churches make people with mental illness feel unsafe or unwelcome. If we would have our churches become places that are safe and welcoming to people with mental illness, places where they feel a secure sense of belonging, we must listen to such experts.

All 12 conversation partners have experienced mental illness as a chronic condition that has significantly affected the conduct of their lives. Most are officially classified as disabled and receive disability benefits (generally Supplemental Security Income). Most are regular worshippers at Holy Comforter or regular participants in the Friendship Center. All have experiences in churches other than Holy Comforter. Their education, gender, age and employment history vary. Eleven manifest awareness of having a mental illness and report a variety of conditions: anxiety, panic attacks, depression, bipolar disorder, borderline personality disorder, psychosis, paranoia, and trauma-induced disorder. One expresses no awareness of being mentally ill and generally manifests no obvious symptoms, but at the end of the conversation after the recorder had been turned off, she expressed patently delusional beliefs and declined to give permission to record conversation concerning those beliefs.

The Stigma of Mental Illness

Though they rarely use the term stigma, my consultants have directly experienced stigma both in how others have treated them and in their self-image and their attitude toward their illness. One example is David (names have been changed). Hearing about his growing up years, it is difficult to distinguish between the operation of stigma in his church and its operation in his family, given their high level of engagement with their parish. Because no one attributed his alienation and unhappiness to mental illness, its stigma was not an explicit issue for him in his early years. His first visit to a physician for a psychological issue occurred during his sophomore year of college, after he had attempted suicide by cutting his wrists. His attempted suicide carried its own stigma and unnamed fears, quite independent of any suspicion of mental illness. He recalls, “My parents tried to keep it the biggest secret in the world.” His parents made sure that his shirts covered the bandages on his wrists. “I was,” he says, “supposed to go on as if nothing had happened.” That same Christmas, a friend’s father committed suicide. His mother did not want him to go to the funeral.

David started seeing a psychiatrist when he returned to school, but he says, “I would fight anyone who said I had depression.” For the next two or three decades, he persisted in denial. During his forties, a psychiatrist told him, “You’ve been depressed all your life.” Even then, he fought the idea and wanted nothing more to do with that psychiatrist. “I was,” he says, “in a conspiracy to hide it.” Throughout those years, with their many episodes of deep depression and two more suicide attempts, he suffered silently, simply disappearing from his church. He feels that he inherited his penchant toward keeping his illness hidden from his parents, especially after their reaction to his first suicide attempt.

When David’s illness necessitated retirement, he pushed past that personal disaster and decided to replace his career by working as a volunteer mental health advocate. Though his connections with the church had become tenuous by this time, he began to look for a community that had a mental illness mission. He found a church that included mental illness among its primary ministries and started attending there and participating in that ministry. For the first time in his life, he found an intersection of his illness and church. There he felt free to speak of his illness and to engage in educational projects.

Mental health issues were not addressed in the churches he had attended prior. No one had ever suggested that his church or his minister might provide guidance or comfort as he struggled with depression. He does not blame his previous churches for a failure, as if they did not care about his illness. Rather, he confesses that he was afraid to let anyone know what he was suffering. Still, he says, the churches did not invite openness about mental illness. They made no effort to communicate that “It’s okay to be mentally ill in this place.” He remembers no bad talk about people with mental illness during those years, just “silence as if it didn’t exist in the world.” Now, as he reflects on that silence, he wonders what difference it might have made if “there had been an openness to having a mental illness, if there had been a ministering,” such as a support group.

David contrasts those years of silence in churches where no one would admit to having a mental illness to his experience at Holy Comforter. Catching a slip of the tongue as he speaks of its being difficult to be open even at Holy Comforter, he says, “I almost said, ‘Holy Comfortable.’” Even in this setting, he sometimes wants to hide, but says, “I don’t do it as much.” He says, however, that he has felt comfortable at Holy Comforter from the first “because mental illness was out on the table. It was simply okay.”

God’s Antidote for Stigma

A particular manifestation of stigma in churches can be even more damaging than hiding mental illness. This is uncritical acceptance of the ancient notion that mental illness has a spiritual etiology, such as possession by demons or an evil spirit, or that it is divine punishment for some moral deficiency. We have sometimes encountered this notion at Holy Comforter. Once, a young woman told of her humiliation when her ex-husband took her before their church for an exorcism. More recently, a regular worshipper reported that she and others from her group home had been taken to another church where “the service lasted six hours” and “they said we have demons.” Smiling broadly, she added, “I like this church better.”

Readers who filter the Bible through a modern mindset easily forget those who hear the Bible as literal truth or regard every word as historically and scientificallyaccurate. The former, even when they take the Bible seriously, dismiss references to demon possession as a peculiarity of ancient, pre-scientific cultures, which readily attributed illnesses to spirits or deities. The latter, however, may still entertain the possibility that demons are real operators today. Faced with people whose behaviors resemble those that biblical texts attribute to evil spirits from God or to demons, many ask, “Could this be demon possession?”

This perspective is not as rare as we sometimes assume. A survey by the Presbyterian Church (USA) found that, overall, 12 percent of its lay members believe that “demon possession is an important cause of mental illness.” When certain subgroups were isolated, the percentages increased significantly: “29 % of those who self-identify as theologically conservative,” “34 % of those who believe the Bible is ‘to be taken literally word for word,’” and “32 % of those whose formal schooling ended with high school or earlier.1

Given this context, it is surprising how little the issue of demons or possession comes up in conversation with my consultants. Lisa briefly mentions the teaching in some churches that mental illness is “a spiritual kind of possession.” John reports that a pastor in one church that he attended told him that he had “a lot of bad spirits on him” and needed to get them off him. John asked if he meant demons, and the pastor said, “‘Yes, I’m thinking you’ve got demons inside of you.’” As the pastor was talking about demons, others walked in and looked at John “kind of funny.” “I didn’t like that church,” he concludes. Though John did not accept the pastor’s diagnosis of demons, he does, apparently on his own, feel significant shame because he thinks that his mental illness is his fault, punishment from God for the way he treated his mother before her death.

Except for their experience at Holy Comforter, my consultants have usually found little or no support in churches for people with mental illness. Occasionally what they have found is positively harmful, for example, John’s experience with a pastor who said he had demons. Mostly, however, what they have found is a vacuum, silence about mental illness that leaves them unsure of how others will react if they disclose their illness. Stigma has been at work in our churches just as surely as it has been working in the rest of society. Underlying the silence is not merely ignorance of the ubiquity of mental illness and the desperate condition of many people with mental illness, but misunderstanding of mental illness and fear. As John says, “Some people are afraid of the dark.”

Stigma is based on misunderstanding of mental illness and of people with mental illness. There are a few notable educational efforts in churches to fight stigma and to foster churches as safe and inviting communities in which people with mental illness can flourish, but substantially more are needed. What churches can do to address stigma begins with promoting understanding. This can be pursued in a variety of ways and probably should not be left to a single approach. A variety of educational programs are available. There are National Alliance on Mental Illness (NAMI) presentations that fit in a Sunday school hour or more comprehensive programs that take days or weeks, such as NAMI’s Family-to-Family and Peer-to-Peer programs, which are spread over ten weeks. There is also Mental Health First Aid, a two-day course that equips participants to recognize and respond to mental health issues. Churches also address stigma when they facilitate support groups for people with mental illness or their families and promote them in the same contexts in which they promote support groups related to other situations that parishioners experience, such as cancer, divorce, parenting, substance abuse, or grief.

The all too common notion that mental illness is a spiritual or moral ailment, even punishment from God, is the theological cousin of the notion that poverty is a mark of God’s displeasure. It is one of the means by which, sometimes out of ignorance but often out of political ambition or economic greed, our society stigmatizes both mental illness and poverty and compounds the oppression. Yet, we do need to think of poverty and mental illness together, as co-occurring conditions. There is considerable evidence of a correlation between poverty and mental illness, even that poverty can be a “gateway to mental illness.”2 The situation of most of the people of Holy Comforter with a mental illness demonstrates that mental illness is certainly also a gateway to poverty. We do not, however, need to lump them together in stigmatizing people.

Given the oppression prevalent in both poverty and mental illness, our reflections turn to liberation theology’s insistence on “God’s preferential option for the poor” and ponder its relevance to people with mental illness. Because stigma is oppression common to both, we might well broaden this slogan to encompass both people who are poor and those who are mentally ill and speak of “God’s preferential option for the stigmatized.” When we hear Jesus’ enemies stigmatizing him with allegations of demon possession and see him suffer the scandal of Roman crucifixion, the aptness of this modification becomes immediately apparent. The stigmata consist not only of the marks of the nails in his hands and the hole in his side but also of the untruths with which his crucifiers maligned him.

Here, then, is God’s antidote for stigma, including stigma found in biblical attribution of madness or other disease to God or demons: that God joins us in our insane, impaired, and abandoned flesh. “Surely he has borne our infirmities and carried our diseases; yet we accounted him stricken, struck down by God, and afflicted” (Isaiah 53:4).

A Road Forward for Churches

One of the risks of this report is that it might appear to hold Holy Comforter up as a model for how churches can effectively foster belonging in people with mental illness. Though the people of Holy Comforter have done important and remarkable work among and with people with mental illness over the last 25 years and though the rest of the church can learn much from Holy Comforter’s experience, it should not be seen as a model for the rest of the church. Rather it is a fallback for when the rest of the church is not effectively incorporating people with mental illness into local congregations. As they crisscross south Atlanta to collect people for worship or the Friendship Center, our vans pass dozens of churches. To use Holy Comforter as a model would relegate ministry with and among people with mental illness to ecclesial islands in the great ocean of the church, rather than asking every congregation to become safe and welcoming to people with mental illness.

Though mental illness is widespread in our society, affecting every community, every family, and every church, most churches go about their business oblivious to mental illness and to the alienation and suffering from mental illness on their doorstep and in their pews. It may well be that, because of the relationship of poverty and racial discrimination to mental illness, parishes in affluent suburbs do not experience the concentration of mental illness seen in poorer urban neighborhoods, but it is there. It is everywhere. The solution is not to create more congregations in which the majority of worshippers have a mental illness. It is to cultivate in every congregation a welcoming and safe environment that fosters belonging in people with mental illness and their families.

What is the road forward that every congregation can follow?

  1. Pray for the “will to embrace” all, especially people marginalized and stigmatized for their mental illness.
  2. Educate clergy, staff, lay leaders and other members about mental illness by using the many helpful resources available. Congregations can learn the effects of mental illness on individuals and their families and the principles of recovery. Education is a first step to eliminate stigma and allay unfounded fears of people with mental illness. Be thoughtful and gentle in this process, remembering that many people live in fear that their illness (or that of a loved one) will be disclosed, resulting in loss of friends, loss of regard in the community, or loss of employment.
  3. Regard people for who they are and whose they are, not for the illness they have or for the disadvantages that illness has worked in their lives. Recognize, however, that mental illness can affect functioning and learn how to accommodate the special needs that mental illness might bring. Accommodation for people with mental illness is very much a person-by-person undertaking, because it can entail emotional, cognitive, spiritual, and social, as well as physical effects.
  4. Invite and encourage full participation of people with mental illness in the life and work of the parish. Any limitations imposed on participation should be based not on the fact of mental illness but on actual incapacity to perform that cannot be accommodated, ideally in forthright consultation with the person who is seeking to participate. Focus on the person’s gifts and abilities, not on her limitations.
  5. Prepare for church to become an experience that shatters and surpasses your expectations, and accept the church God gives you, not the one you thought you wanted.

Finally, enjoy friendship and fellowship in your church with people who, among the many other qualities of their lives, have a mental illness. Be transformed as your openness to them lays you open to the Spirit of Life. The space we open in our hearts for our sisters and brothers, especially for our marginalized and neglected sisters and brothers, becomes in our hearts a sanctuary for God. The place we sanctify in our churches for marginalized brothers and sisters becomes in our churches a temple for the Holy Spirit. Doors open to all God’s children are open to God’s only begotten Son, who for our sakes bore the stigma of madness and crucifixion.

1. John P. Marcum, Report: Mental Illness, the February 2006 Survey (Louisville, Ky.: Research Services, Presbyterian Church (U.S.A.), 2006), 5; http://www.pcusa.org/resource/ presbyterian-panel-survey-mental-illness-full-repo/ (accessed 24 February 2013).
2. See, e.g., Gerald C. Ogbuja, “Correlation between Poverty and Mental Health: Towards a Psychiatric Evaluation,” SSRN eLibrary (Rochester, N.Y.: Social Science Electronic Publishing, 2012); http://dx.doi.org/10.2139/ssrn.2152161 (accessed 24 February 2013).

Dr. Tanner received his doctor of ministry from the University of the South in 2013. This article is excerpted from his full dissertation submitted in partial fulfillment of the requirements for the degree of doctor of ministry. 

A PDF download of Dr. Tanner’s dissertation is available on our website. Readers who are interested in publishing it further, or who have questions, may contact Dr. Tanner at mtanner@bellsouth.net. 

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