photo by Andrew Mason CC
“Its all in your mind.”
“Its just a chemical imbalance.”
“You just need to turn it over to God.”
All of these are statements that have been made about mental illness. They tend to be made particularly often to individuals whose disorders have not impaired their reason, who still appear “normal”. Those struggling with anxiety and depression may be especially likely to hear views on their mental illness like the ones above. What might the impact of each statement be for an individual who struggles with mental illness? Lets break it down.
“Its all in your mind.”
This view posits a purely psychological root to mental illness. It attempts compassion by saying that the problem is solvable, since your mind can be changed. However, this statement is rarely received well because those who hear it may instead hear implications like the following:
- Since it’s only in your mind, you must be weak/broken/stupid because you haven’t been able to change it yet.
- If you are not weak/broken/stupid, then maybe some part of you wants to live this way.
- Either way, it is your fault.
- Your reality is not correct. The real world is fine, you just have it distorted, so we just need to re-adjust your mind to match reality.
At the extreme, this view invalidates the experience of the person with mental illness and robs them of the confidence and power they need to change.
“Its just a chemical imbalance.”
This view presents mental illness as a purely physical problem. It seems compassionate because those chemicals in your brain do not seem to be under your control. The message is intended to be “It’s not your fault”, which IS an important message. But the chemical imbalance frame also has unfortunate implications:
- The mental illness just happened. Or you inherited it. Either way, the origin is mysterious, and not related to your life.
- Change is not needed. Indeed, if mental illness is only imbalanced chemicals, then your only task is administering pills. Life need not change.
- Chemical imbalance causes mental illness. It would be more accurate to say that the imbalance is a symptom of mental illness, or the manifestation of the illness in the brain.
Taken literally, the chemical view of mental illness ignores the experience of the person and robs them of the ownership and motivation they need to change.
**A special note on this, because I think it is widely misunderstood. The truth of the matter is that nearly everything we do changes the levels of these chemicals (more specifically termed neurotransmitters) in the brain. Stressful situations, physical sickness, abusive relationships, soothing touch, religious belief and practice, eating healthy foods, practicing mindfulness, the amount of sleep we get – all these aspects of our experience influence the balance of neurotransmitters in the brain that are linked to mental illness. Even in cases where there is a strong genetic vulnerability or link to the mental illness (e.g. Schizophrenia, Bipolar Disorders), experience and environment influence when and how the disorders begin, and how impairing they are to the individual. Medication can be essential for individuals with a disorder that has a heavy biological influence. Nevertheless, attempting to alter brain chemistry without attending to the rest of life is counterproductive.
“You just need to turn this over to God.”
This view sees mental illness as a purely spiritual or religious issue. It seems compassionate because God is powerful and loving, so help is near and change is easy. Nevertheless, this kind of statement also has unhelpful implications:
- You are not a good Catholic. You haven’t yet done the correct (and obvious) religious thing.
- Having the illness is your fault. You haven’t given it to God yet. Or you weren’t close enough to God, which is how this got started in the first place.
- For the person who feels that they have tried to “turn it over”, this statement can imply that God is withholding healing, leaving them feeling abandoned or spurned.
- God only works personally through prayer and healing sacraments. Professional help from physicians, therapists and others is not needed.
As has been eloquently stated elsewhere, this frame ignores and invalidates the experiences of the person, can increase feelings of guilt, and robs them of helpful assistance toward change.
Just to be clear, all these bullet points are implications that could be heard. This does not mean they are intended.
Danger of Dualism
Mental illness is a “whole life” condition. It touches every aspect of the life of those who struggle with it. Each of these three common statements is in some way divorced from our actual experiences; life for us is mind, body and soul together. You cannot alter one without influencing the others.
Common misconceptions or distorted portrayals of mental illness usually emphasize one aspect of our humanity while neglecting the others. This separation, or dualism, treats the person like a machine that can be disassembled into its component parts. We like to be able to identify which part is at fault, and quickly fix it. But machine we are not, and in this case much is lost when a person is treated mechanistically. Specifically, some aspect of the person’s being and/or experience is being ignored or denied. This is not helpful to them, and often feels painful as well.
The “wholistic” truth
There is also some truth in all these three views. You can engage your mind to help change your life; individuals with mental illness do have neurological imbalances and liabilities; and God is a powerful healer. Rather than choose sides, the helpful path is to acknowledge the ways in which mental illness impairs each aspect of our humanity. This “wholistic” view honors the full experience of the individual, and respects their dignity as a mind-body-soul person. Likewise, all aspects of a person play a role in growing through and healing from mental illness. As Msgr. Pope eloquently exemplified in a previous post, psychotherapy, support groups, medication, spiritual direction and religious practices can all be powerful in healing.
So what do you say to someone with a mental illness? There are no scripted answers. But keeping the following in mind should increase your odds of being helpful.
- Mental illness is real, and difficult. I consider these absolutely necessary assumptions. Denial of either is likely to feel like a slap in the face.
- Avoid simplistic characterizations of mental illness. This usually discounts the experience of the individual who lives with mental illness.
- Be curious. Attempt to understand the situation from the others point of view. How does it feel? What makes it so difficult?
- Be sympathetic. Listen attentively, accept their experience, validate their feelings. This is different than endorsing their thoughts or views.
- Offer support, not solutions. The drive to help fix the situation is often a factor when someone makes a statement like the three that opened this article. Your quick solution is likely to only make them feel worse for not being able to fix things themselves. Instead, offer presence, assistance, support. This fosters their ownership and honors their struggle, while offering help.
Those living with mental illness have enough to struggle with. Let’s work to make our views on mental illness one less thing that they must fight! Please feel free to use the comments box to share your experiences or examples of other responses that could be helpful!
A few caveats:
In this post, I am using mental illness to refer to the whole broad spectrum of mental disorders, in the same way that we would say both someone who has a cold and someone who has tuberculosis have a physical illness.
There are a few disorders which are genetically determined, and others in which normal development has been significantly disrupted (e.g. Autism, Intellectual Difficulties, Traumatic Brain Injury). It is my experience that the statements which began this post are rarely made to these individuals because they seem clearly different than others, and people intuitively know that their condition is complex and real.
Thank you forthis article. Mental illness is so often misunderssood. This is an article that offers both good advice for those with these illnesses as well as a solid beginner’s guide for those who love and care about them. I’ve been grateful to read and review some amazing Catholic books on the subject by authors such as Kathryn Hermes, Henri Nouwen, and Joyce Rupp on my blog that have helped me understand and have greater compassion for others.
This is great.
One note- the conditions listed in your caveat do not fall under the category of mental illness. Autism and intellectual disabilities fall under developmental disability.
I work in the intellectual and developmental disability field. It’s a common mistake for people to refer to an intellectual disability as a mental illness, but it’s incorrect. You’re right though, that generally people with intellectual and other developmental disabilities are not judged in the same way because they are clearly different. Another reason people with mental illnesses are misunderstood is that people do not understand the use of psychotropic medication, especially for anxiety and depression. It weirds them out. They want to believe that there are alternatives that work just as well, and that the illness is merely a bad mood. This saves them from considering the possibility that they or someone they love will suffer from a mental illness. But the fact is that no one judges someone with high blood pressure for taking beta-blockers. And mental illnesses have physical causes and solutions – there is a chemical imbalance in the brain, and the medication treats that imbalance.
Thanks for your article! Spot on.
Sarah! Yep, defining terms is important. I am used to referring to anything in the DSM diagnostic manual as a mental disorder, but you are right, developmental disability would be more specific.
Medication is a tricky subject, I have found. Some people do not understand it and think no one really needs it. Others think that medication is all that is needed for depression or anxiety. I tend to believe the truth lies in the middle. Some people can benefit from it, for others it is necessary, and for everyone with mental disorder there are factors aside from medication that need to be part of healing. Matt wrote another post on the site specifically about medications that would be worth reading. You should be able to find it on the home page right now.
Thanks for chiming in and adding to the discussion!
Even from childhood I suffered from clinical depression. When I would try to talk about my feelings, I would hear nothing but, “Oh, that’s horrible! You shouldn’t feel that way.”
Later, I’d hear, “Snap out of it.”
The biggest lie I was told was, “Real Christians don’t get depressed. They have Jesus!”
So, I simply shut up and bore with it.
Things finally reached the point I could bear it no longer and had myself committed.
THAT i where I learned that clinical depression is not a mental defect, character flaw, or spiritual failing. It is in my case a chemical imbalance, just like my gout and diabetes.
As long as I take my pill, I’m fine. Once I began to think I didn’t need it any more, and a screw-up at the pharmacy made me run out for 4 days. I had a major melt down.
Yes, I need it, and I thank God for the provision He’s made for me.
Jack – I am glad that you didn’t have to just listen to the unhelpful comments forever. I am glad that you found what you needed to help. I hope you experienced this post as an affirmation of your experience, and I hope you can use your experience to help others who have not yet found what works for them!
I have a chemical imbalance it doesn’t hurt me to hear someone call my imbalance a imbalance. I understand what y are saing but a imbalance is still a imbalance.
I think peace of mind is not guaranteed but peace of soul would be.Just befriend a solid Catholic priest for confession and direction and receive Holy Communion often.Ask oneself ” Right now am I alright? ” Usually the answer is yes and if so then all is well as Christ and Heaven is within us.Fears do not beset us at this very moment as we can eat walk and talk etc and the past and future can be ignored for the moment.Keep engrossed in the immediate task and since we can think of only one thing at a time,nothing else will disturb us.God bless.
Excellent analysis of the pitfalls at a surface (but helpful) level.
Perhaps more helpful is a look at the use of the term “mental illness” to avoid confusion.
As you more or less note people can have medical (physical) illness that must be treated with a medical approach.
People can also have a spiritual illness that requires pastoral counseling and spiritual formation in general.
If one suffers a medical condition, it can no doubt affect the way on thinks. Likewise, a spiritual condition affects how one thinks and perceives.
Where we run into serious problems is the effort by the mental health profession to “own” all mental disorders, claiming an equivalency between mind and brain. In other words, mind = brain.
This falsehood negates the existence of the soul / spirit and thus promotes a practical atheism when it comes to mental illness. This is the greatest danger for men and women of faith, as their spiritual essence is invalidated and dismissed, which exacerbates spiritual disorder.
Greg – I agree with you that mind is not just the brain, and that psychologists are not the only experts when it comes to individuals with mental disorders. I was actually in a discussion today about the way that spirituality is handled in psychotherapy, and how we can give this aspect of each person the respect it deserves.
One comment. In my opinion, saying medical disorders deserve medical treatment and spiritual disorders deserve spiritual treatment in some ways splits a person up in ways that can be unhelpful. I think that however we name the disorder, it affects the whole person, and there will be mental, physical and spiritual aspects that can be changed or healed. Body and spirit are united in one PERSON. I guess I am advocating for fewer silos and more collaboration, cooperation and understanding across professions. That way we respond to the full person, rather than only validating one piece of them.
on another note, I really like your site and your mission. St. Francis has been a huge influence in my life – I spent several years working with Franciscan and Capuchin priests. Thanks for your input in this discussion!
A very late response. I happened upon this old thread while responding to another blog.
You bring up a point that I am taking up in detail in a new book – the error of dismissing dualism as the proper understanding of flesh body and soul.
The collapse of body and spirit into one is an error that has arisen primarily out of neoscholasticism. (And some of the errors built into the work of Aquinas when he adopted Aristotle as his philosopher partner.)
Pope Benedict XVI has done an amazing job of correcting these old errors and restoring a correct understanding of dualism to Catholic theology. Flesh body and soul are not one. They are not the same. That belief has been an error that has opened the door to the materialism and atheism of psychology.
Benedict’s writings, especially Eschatology (including the most recent addenda) and An Introduction to Christianity (especially the final chapter) are very helpful in sorting out the errors.
“Nevertheless, attempting to alter brain chemistry without attending to the rest of life is counterproductive.”
What about schizophrenia? NIMH more or less attributes the cause of this illness to biological factors. And there are clear differences between the brains of patients with schizophrenia and people without it.
NIMH basically lists drugs as the treatment for disease. “Attending to the rest of life” for those with schizophrenia is all about handling things like drug addiction which might (or might not) be happening at the same time or learning to handle the symptoms not controlled by meds.
A successful set of meds for schizophrenia would be a completely productive treatment.
Zerk – I think you bring up a really important issue. My belief is that even the most biologically based disorders affect the person, and there are mental, physical and spiritual aspects of each person that are affected.
This discussion could take up a whole other blog post! In short:
The quote you excerpted was intended to highlight that medication and daily experience affect the same neurotransmitter systems in the brain. It seems silly to alter them with medication, while ignoring how daily life, diet, and relationships also impact them. You could have the two things working against each other!
Medication is a first line treatment for schizophrenia. Even so, only around a third of individuals treated with medication return to something like their previous levels of functioning. Every medication also has side effects that must be dealt with. Neither of which takes away from the importance of medication, just acknowledges that it is not usually simply the answer.
Medication ameliorates the psychotic symptoms, but does not “cure” schizophrenia. It also cannot help the individual cope with the mental and spiritual impacts of having the disorder, and the way that changes life. When people with schizophrenia are asked, many say that their ability to live their faith is impacted, but also that their faith is one of the things that helps them cope best with the disorder.
So this is not a call to abandon medication, but rather to acknowledge that disorders occur in individuals, each of whom is one PERSON who cannot be meaningfully separated into different spheres for the purposes of treatment. Medication treatment affects mind, brain and soul because the three are inseparable in one person. All aspects of the person deserve attention.
Thanks again for sparking discussion! Let me know what you think of this too!
Most of these anomalies are mysterious, and the current diagnoses and treatments are landmarks along the way to a real understanding. One of the first questions is are they illnesses or characteristics along a continuum? More questionable is the theory that all of them are something to be ‘cured’ because we don’t want to deal with a person who is different or troublesome. My experience is that we have to practice our Christianity to the ultimate degree to stop calling other people names because they are difficult. We have to practice patience and love, and above all stop labeling – another word for judging. Maybe pills work on some people, but by no means all, and there are still troubles even when the pills are working. Being different-that is what is intolerable to people-even Catholics. Dare not wear a hoody and sweatpants and long hair!
Mary – Thanks for chiming in! I definitely agree that compassion is a desperately needed attitude and response.
I also believe that what we call mental illness is not always a “sick/not sick” dichotomy. I have many tendencies in my life that could be exacerbated to the point of fitting a diagnosis if I did not have the upbringing, support, faith, and genes that I do. In many cases (not all) I think it is a continuum. This personally moves me toward compassion – “There, but for the grace of God, go I.”
I have bipolar disorder. I believe it was inherited from my father as he also had the illness, and I act as he did in so many ways. My problem is that my bipolar disorder is medication resistant. In fact, medication, which has not helped me, actually makes me worse. So I have to live as normal life as I can with really no support from medication or anyone. I tried to find a spiritual director but failed. What bothers me the most about my mental illness is that it affects what is most important to me — my spiritual life, my relationship with God. I don’t know when I am sinning or whether my behavior and thoughts are a result of my illness. For instance, in my manic phase, I cannot control my anger. I pray to God to help me not to become angry at such times, but I still become angry, usually unreasonably so. When I was younger, I suffered from hypersexuality which I later learned is a symptom of this illness. I confessed my sins, but I had no one to explain to me whether these sins were real or due to my illness and not under my control. I have prayed and have had countless people pray for me to be healed. I am 68 years old and still suffer from this. Since I am near the end of my life, I am terrified that I will no go to Heaven since I don’t know what is my fault and what is not. When I go to confession, all the priest tells me is to do the best I can. But I feel that is not enough since it is my eternal destination that is what is most important. Also, I am home bound and have no one who will take me to church. I tried having someone bring me Communion at my home, but because of my anxiety, I had to stop it because I was so afraid I could not receive Communion in a proper manner. I would smoke all day and immediately after the people left because my anxiety level was so high. I would rather have any other illness rather than this. I had cancer, and it did not bother me much at all, mainly because it did not affect my spiritual life. I guess there is no answer for me. As I said, I have no support. I only have one sister left alive in my family, and she cannot deal with my illness so much so that I have to live alone and not ever discuss with her how much I am suffering. The Church doesn’t seem to have much to help me. My pastor doesn’t have time for spiritual counseling, and I have no transportation or money to see someone else who might help me deal with this. I do watch daily Mass on TV but feel guilty every time since I cannot physically receive Communion. As discussed above in the article, I feel I am not a real person but am “my disease” since it affects every aspect of my life.
Kathy,
I am saddened to hear your story. I am sorry I cannot fix things for you. I do not have answers, but here are some thoughts/beliefs:
Our God is loving and merciful and he came specifically for the wounded and hurting.
You are not the only one with so much pain…others struggle like this too.
You deserve good help, and it sounds like you would like help across the aspects of your life.
Psychologists and counselors train to assist in situations like this.
A good priest could help you discuss your concerns about sin and salvation.
I am glad you posted this – it is hard to receive help without asking.
I encourage you to share your struggle and ask for help as honestly with those who could help you as you have here online. Make your voice heard!
I have really bad social anxiety. Others might not like this, but when I first truly pledged my life to God, and told others about why I don’t do this or that, I was able to be in more social situations. Now that I don’t say why I don’t do this or that anymore and such, I am in my worst rut yet. That said, maybe me and others with bad anxiety DO need to get over it by placing our anxieties on Him (1 Peter 5:7) for it is written: “But the cowardly… they will be consigned to the fiery lake of burning sulfur.” (Revelation 21:8) Maybe the #3 should be said in an encouraging way, if that’s possible. Something to think about.
I definitely think there is a role for giving our struggles over to God, inviting Him to walk the journey with us, or whatever respectful way we would phrase it. I think this is very important and shouldn’t be neglected. Lets just not imply that a little “offering it up” is all that is needed to solve the problem. Thanks for the input!
An encouraging post, thank you.
I am aware of your post above Kathy and truly sympathise with you. It is real trial. People can get it so wrong and the affects are crippling. May the good lord lead you down paths to health and wholeness.
In my job I have dealt with quite a number of teens with mental health issues and have worked with clinical and educational psychologists. I have also had the privilage and pain of having a wife with post natal psychosis and I will be studying educational psychology this year. Mental health is very complex and cannot be tackled simply. Yet some aspects for treatment are not often discussed. We all know the affect too much coffee has on you and yet we are quick to discount diet and mental health. So one can confess until one is blue in the face and no difference will be made. A change in medicatation can change a life and no spiritual advice will cut it. I have had numerous converstaions with psychologist who insist on a behaviourist approach to dealing with issues. The real causes are then left.
I have noticed that when my health is right, when my diet is right for me, I am academically stimulated and I am getting enough physical exercise I am less stressed and can cope with the rigours of daily life much better. My own personal prayer time is essential along with family prayer and most definately prayer with my wife. So there we have a real combination.
However, I will return to the issue of diet. Various mental health issues can be triggered by what we eat and drink and the corresponding physiological affects. I see it in my family, I see it in my students and I see it in myself. It does seem simple while it is not, but I do believe it is an important part of treatment. Surely God wishes us to eat wisely for ourselves.
Also, please please do not identify ADHD and Autism under mental health. I work with students on the Autism spectrum, those with ADHD and have been diagnosed with ADHD (innatentive). A developmental disorder does not necessarily result in mental health issues, but often can as the person struggles to deal with their difference and innability to communicate and function in our complex social world.
There is hope, there is life and it is truly in the Lord. “I lift my eyes up to the mountain where does my help come from. My help comes from the Lord who made heaven and earth.” Because our Lord became one of us he can empathise with us and knows our condition. In this world of metal earth he is truly emmanuel, God with us.
Thank you for this post. On a side note, does anyone know of an examination of conscience for an adolescent with Asperger’s?
Loyola Press has an Adaptive Reconciliation Kit which was designed to help individuals with special needs enter fully into their faith experience, prepare for the Sacrament of Penance and Reconciliation, and use the materials from this kit throughout their lives so they may experience God’s healing through the Sacrament of Reconciliation. Here is the link:
http://www.loyolapress.com/adaptive-reconciliation-kit.htm
You can also call up a parish with a SPRED program and they can direct you in the right direction.
God bless!