Perhaps you have heard the phrase “What doesn’t kill you makes you stronger.” Sounds nice, but it is not always true. If one survives something, one may come out stronger or may come out broken, battered, and barely hanging on. All we can truly say is, “What doesn’t kill you doesn’t kill you.” When bad things happen to us, we may be injured, hurt, or harmed, and we may suffer from it for a long time, sometimes even the rest of our lives. The broken world breaks us—some-times partially, sometimes completely.
While our understanding and acceptance of physical illness and suffering have become quite advanced, this is not as true when it comes to mental illness. Though very common, mental health issues still carry stigmas and misconceptions. Conservative estimates indicate that at least one in ten people worldwide suffer every year from a mental disorder that adversely and significantly affects their quality of life and, therefore, requires treatment. In a lifetime, at least one in four will suffer from a mental disorder and need treatment. The Global Burden of Disease Study 2016 showed that mental disorders, predominantly depression and anxiety, are leading causes of disability worldwide.1
Pastors live on the frontlines of the mental health battle. A study of 8,098 individuals from a nationally representative population survey found that, among individuals who sought treatment for mental health disorders, 16 percent contacted psychiatrists, 16.7 percent contacted general medical doctors, and 25 percent contacted clergy. Furthermore, nearly one-quarter of those seeking help from clergy have the most seriously impairing mental discorders, and the research shows that the majority of these patients are seen by the clergy only.2
Further research was conducted among the pastors of nearly all African-American churches in a metropolitan area regarding their pastoral counseling work and related aspects of their ministry. The clergy averaged 6.2 hours of counseling work weekly and often addressed serious problems similar to those seen by secular mental health professionals, with whom they reported readily exchanging referrals. Forty percent reported seeing people with severe mental illness and two-thirds saw substance abuse in their congregations. Over 60 percent had counseled people they considered dangerous; and two-thirds had counseled suicidal persons.3
As psychiatrists, we rightly ask ourselves, How can we help our patients? In light of these statistics, surely another relevant question must be: How can we help our pastors? We rejoice at what God is doing in the faith community and our ability to partner with them. Let us not underestimate or belittle the suffering that people go through—but instead recognize:
1. Mental disorders are more common than we might think. Although we may not be aware of who, what, and why, every one of us knows someone who suffers mentally. Meanwhile many of us will, at some point in our lives, experience the pain that comes when our mental defense systems are insufficient to meet the challenges that overwhelm us.
Unfortunately, people who suffer mental health challenges are often twice burdened when they are not met with understanding, compassion, and supportiveness. Never tell someone with a mental illness, “Pull yourself together” or anything like that. (You would never say that to someone with cancer or multiple sclerosis, right?)
Could you be suffering from anxiety?
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Over the last two months, how often have you been bothered by the following problems? (circle the one that fits best.) |
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Several days |
More than half the days |
Nearly every day |
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1. Feeling nervous, anxious, or on edge |
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2. Not being able to stop or control worrying |
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3. Worrying too much about different things |
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4. Trouble relaxing |
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5. Being so restless that it is hard to sit still |
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6. Becoming easily annoyed or irritable |
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7. Feeling afraid as if something awful might happen |
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Total Score |
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If your total score is 10 or higher, you may have an anxiety disorder that should be treated, and you should seek evaluation by a doctor or psychologist. If your score is lower, you may still be in need of support and help.
Source: Robert L. Spitzer et al., “GAD-7” (Generalized Anxiety Disorder) anxiety screener, https: //phqscreeners.com.
2. A mental illness is not some-thing you simply snap out of. Try to understand and respect that there are always significant reasons why someone develops a mental illness.
Many people around you have painful stories and are fighting battles that you know nothing about. We often take health for granted; but that is a mistake. We live in a fallen, broken, and sinful world; sickness and dysfunction, consequently, are to be expected. Sooner or later, something will happen to all of us.
3. Mental illnesess should not be equated with spiritual problems. Mental health and spiritual health are not one and the same. As the body may become sick, even despite the person being spiritually sincere and devout, so can the mind. The mind is, after all, a bodily function and, thus, is subject to human infirmities and hardships as well.
Sure, good spiritual health may make you mentally stronger, as being physically and socially healthy can do too. But be careful not to add to the sufferer’s burden by accusing the sufferer of spiritual failure. Rather, as Jesus would do—of whom Isaiah said that “a bruised reed He will not break and a dimly burning wick He will not
extinguish” (Isa. 42:3, NASB)—carry the sufferer’s burden (Gal. 6:2). Treat others with the same kindness that you would like to be treated with. Likewise, treat yourself with the kindness that you would treat others with.
Just trying to keep it together
From the day we are conceived until the day we die, we are constantly exposed to threats: germs, toxins, dysfunctional genes, malnutrition, violence, accidents—the list goes on.
Our health and well-being depend on our ability and capacity to resist and withstand these threats. Without well-developed and sophisticated defense systems, our physical and mental health will soon succumb to the reality of our fallen world. We are at risk whenever these defense systems prove to be deficient or overwhelmed.
Could you be suffering from depression?
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Over the last two months, how often have you been bothered by the following problems? (circle the one that fits best.) |
Not at all |
Several days |
More than half the days |
Nearly every day |
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1. Little interest or pleasure in doing things |
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2. Feeling down, depressed, or hopeless |
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3. Trouble falling or staying asleep—or sleeping too much |
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4. Feeling tired or having little energy |
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5. Poor appetite or overeating |
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6. Feeling bad about yourself or that you are a failure or have let yourself of your family down. |
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7. Trouble concentrating on things, such as reading the newspaper or watching television |
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8. Moving or speaking so slowly that other people could have noticed or the opposite: being so fidgety or restless that you have been moving around a lot more than usual. |
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9. Thoughts that you would be better off dead or of hurting yourself in some way. |
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Summarize scores |
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Total score |
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If your total score is 10 or higher, you may have a depressive disorder that should be treated, and you should seek evaluation by a doctor or psychologist. If your score is lower, you may still be in need of support and help.
Source: Robert L. Spitzer et al., “Patient Health Questionaire-9” depression screener, https://www.phqscreeners.com/.
Pastors are acutely aware that for many, it is a challenge not to lose one’s mind in such a crazy world. Our world is so far below what we were created for. In order to stay sane, in order to safeguard our mental health, we need to cultivate mental resilience. Mental resilience is the ability and capacity to withstand and adapt appropriately in times of stress and adversity. Whether we already are suffering from mental illness or trying to protect ourselves from it by living healthily and wholistically, we may increase our resilience and benefit mentally.
While pastors join with mental health professionals to valiantly combat mental illness, ultimately we must accept that it is part of the human condition. It will be with us as long as we live in this broken world. Only in the world to come will it be a thing of the past.
Sidebar: How to cultivate mental resilience
- Sleep 7 to 8 hours every night.
- Exercise a minimum of 30 minutes five days a week.
- Eat nutritious and healthy food.
- Rest daily and weekly—set aside time for recreation, quietness, and reflection.
- Set appropriate boundaries and be temperate.
- Know yourself—write your life story and talk with someone you trust about it.
- Deal properly with your thoughts and feelings—do not run away from them or deny them.
- Take charge of your life— live according to your values.
- Connect with others—cul-tivate close, loving, and supportive relationships within and beyond the family.
- Practice compassion, forgive-ness, kindness, and gratitude toward others, as well as yourself.
- Live for something and someone.
Notes:
1 Theo Vos et al., “Global, Regional, and National Incidence, Prevalence, and Years Lived With Disability for 328 Diseases and Injuries for 195 Countries, 1990–2016: A Systematic Analysis for the Global Burden of Disease Study 2016,” The Lancet 390, no. 10100 (Sept. 16, 2017): 1211–1259, doi.org/10.1016/S0140-6736(17)32154-2.
2 Wang, Philip S., Patricia A. Berglund, and Ronald C. Kessler. “Patterns and Correlates of Contacting Clergy for Mental Disorders in the United States,” Health Services Research 38 no. 2 (2003): 647–673, https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.00138.
3 John L. Young, Ezra E. Griffith, and David R. Williams, “The integral role of pastoral counseling by African-American clergy in community mental health,” no. 3, Psychiatric Services 54 (2003): 688–692., https://ps.psychiatryonline.org/doi/ abs/10.1176/appi.ps.54.5.688
