(Having confirmed that a mental health crisis exists in America in part 1 of this series, we move to the next step in untangling the knotted shoelaces.)

               Second, now that we believe that a real problem exists and that it deserves an adequate response from us as a nation, we must pause to examine the nature of the problem before reflexively reacting.  Untying the wrong part of the knot or not seeing the superglue that your child used to hold things together will ultimately only lead to frustrations and failures.  In the case of our society’s mental health crisis, we need a better understanding of who is suffering and how they are suffering.  Once this picture begins to form in our minds, we should continue investigating until we have uncovered an adequate extent of the problem.  The length of this essay precludes such a full extent but those in positions of influence should go beyond this essay’s brevity.  From there we can work on root cause understanding in the next step towards a solution. 

               Once we decide to study a problem like the mental health crisis in greater depth than just whether or not it exists, we must determine how to study such a tangled knot.  The sources of information must cover a number of different angles to address an adequate scope.  These angles include examinations of psychiatric, physical, relational, functional, and spiritual effects of mental health dysfunction at individual and societal levels.  Each of these angles provide an essential view of the problem’s impact and combine to provide a 4-dimensional multi-faceted understanding as these angles interact over time. 

               The psychiatric angle stands out as the most superficial descriptive level and presents as the diagnostic statistics on one hand and a personal life experience on the other.  Medical codes provide labels such as major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder, schizophrenia, panic disorder, bipolar disorder and more.  Each label categorizes a set of symptoms and disease expressions which allow not only tracking of prevalence but also the planning of therapy.  This therapy planning begins at the experimental level of determining what therapy works best for different diagnoses and at the individual level where a provider recommends an individual’s approach to recovery.  Regardless of labels chosen, at the core, each diagnosis describes an emotional pattern in which a change in one’s thinking or emotions diverges from the accepted normal range sufficiently  enough to produce dysfunction in the person’s life.  The dysfunction always impacts on the individual with the diagnosis and usually impacts on others around them, leading to a limitation of what the individual can accomplish in life.  The dysfunction resulting from large numbers of such individuals plays a major role in labeling this situation as a societal crisis. 

               As these diagnostic statistics increase, direct experience with those suffering becomes more common and more personal.  We either face our own diagnoses or experience them second hand in family members or friends.  This may come in the form of lifelong struggles or just a period of life, from months to years, where such a mental health condition impacts us or those we care about.  When this occurs over longer periods of time in families, a parent’s or siblings’ diagnosis can beget similar or different diagnoses in the succeeding generations.  The stress created from mental illness in one family member can push another into their own mental health diagnosis while leaving less resources to support another family member through their own stressful time.  The repetition of mental health illness in families arises from not only their shared genetics, but also from these shared psychosocial factors as well.

               The physical angle flows out of considering the contributors to psychiatric diagnoses and moves beyond simple medical statistics or psychosocial factors.  This angle considers the two-way street between physical illness and mental illness.  On one hand, the onset of mental illness has been shown to be triggered by such physical processes as inflammation, chronic pain, different toxins, some infections, nutritional deficiencies, and clearly genetics as previously mentioned.  While each of these potential triggers would each require a book-length explanation, for now we can just appreciate that they individually or cumulatively push their subjects towards mental illness yet less commonly serve as the sole factor in one’s mental illness.  Far more frequently, they serve as one more contributing tangle in the person’s mental health knot that needs untangling. 

               On the other hand, mental illness also drives more physical symptoms and diseases.  Several examples demonstrate this secondarily exacerbating contribution of mental illness to physical conditions.  Studies indicate the experience of pain, either acute or chronic, frequently increases with states of depression and anxiety.  The stress hormones triggered by mental illness can further raise blood pressure contributing to hypertension or raise blood sugar contributing to diabetes.  Through a more generalized means of influencing physical conditions, many mental health conditions simply create non-compliance with another condition’s treatment needs either out of despair or direct dysfunction.  In these situations, the person with mental illness cannot or does not appropriately care for an otherwise treatable medical condition. 

               Besides worsening medical diagnoses, mental health has been reported as a primary contributor to several medical diagnoses.  These include conditions like irritable bowel disease, insomnia, and headaches.  The psychiatric world long ago created the diagnosis of conversion disorder when it believed someone’s psychiatric state was the sole cause of subjective physical symptoms.  This condition when applied to any given individual should be used sparingly to avoid unnecessary labeling that prevents identification of a previously unknown physical cause but is still a legitimate diagnosis in a limited number of those with mental illness. 

               Again, as this number of those with mental illness increases and the severity of their condition begins to impact on these physical conditions, our personal experience hits closer to home.  For anyone who has watched a family member suffer more from a medical condition that was exacerbated by their mental illness, the frustration is real.  This second person view experience hits home as you watch your loved one struggle more and more but feel unable to truly help them.  Watching someone in the throes of despair due to mental illness as they mishandle necessary medical therapy multiples the sense of helplessness for this second person.  However, when you are the one in the midst of the mental health dysfunction, you may not be able to hear and apply what your loved ones are telling you.  You may even believe them when they say there is hope with proper therapy, but still not be able to follow through.  Diagnoses and statistics have their role in studying mental illness, but at the root, it still comes down to the reality of individuals and those around them suffering from these diagnoses in real life.

               The relational angle of approaching mental illness also travels a two-way street, producing adverse effects for the original sufferer through reactions from others that extend adverse effects for all involved.  As expected, and so often experienced, the one with mental illness can find themselves being misunderstood which can lead to others distancing themselves a little more.  The emotional or actual physical distancing will usually lead to a weakening of that relationship and add to isolation for the one with the mental illness.  This pattern can lead to the original sufferer either giving up hope for any relationship or even pushing others away to avoid the pain of losing relationships later.  When relationships are sustained, sometimes a co-dependency develops in which both parties support dysfunction in the other person. 

               At a more personal level within families, many of you can probably think of these situations in your family or with friends’ families.  The prevalence of mental illness means that many of you know what it feels like to be in these situations and feel the stress of such challenges.  You may be watching as someone you care about lives out these diagnoses and may be trying to determine the best approach to helping them.  For you and others in similar challenges, you may feel a variety of emotions from sadness to guilt to frustration and more, sometimes contributing to your own mental health conditions.  As several family members each with their own mental health illnesses come together, the potential for mutual exacerbation rather than cooperative recovery increases. 

               As the stress of these sufferers has grown in intensity and frequency, the capacity and wisdom of churches to respond effectively seems to have declined.  While many churches tout their addiction recovery ministries or divorce support groups, the actual day to day ministering to the average church member by church staff or other church members does not seem to be as effective.  As with the world’s approach, many feel more pressure to have their act together in order “serve” rather than be served such that they are less likely to share their own struggles.  When they do admit their mental illness, they are often shuffled off to the psychological experts rather than nurtured and ministered to by pastoral staff at the church.  This is something I hear frequently from patients in my practice.

               This is not to say that many churches do not have caring relationships established in which the hurting cannot find comfort and support in times of need.  Supporting others during grieving of lost loved ones or through cancer episodes and injury recoveries occurs for defined periods of time.  The challenge increases and the support often wanes when the problem involves mental illness lasting longer than a few months.  This is even more true if the condition includes minimal progress on the part of the sufferer.  Once the initial crisis wanes, the initial rally of support frequently trickles off, sometimes even blaming the one with mental illness for not getting over it.  Ask parents whose children have autism and you will find many who struggle to fit in at church with children who do not fit in with Sunday school and children’s church.  In a survey by Whitehead in Religion and Disability, the chances of never attending church services increased with several pediatric mental health diagnoses including: autism, depression, traumatic brain injury, conduct disorder, anxiety, speech problems, and others.  A blog by Key Ministry discusses the implications of this study on how the broader church is not caring for this demographic. This overall response of the body of Christ is disappointing outside the few the exceptions which do offer a sanctuary for the mentally ill rather than another source of stress for them.

(The functional angle is examined in the next continuing installment of this series)

Bibliography:

Whitehead, A.L. (2018), Religion and Disability: Variation in Religious Service Attendance Rates for Children with Chronic Health Conditions. Journal for the Scientific Study of Religion, 57: 377-395. https://doi.org/10.1111/jssr.12521

“It’s The Hidden Disabilities That Keep Kids Out Of Church” by Stephen Grcevich MD. Key Ministry Blog.  Published July 22, 2018.  Accessed November 7, 2023.  https://www.keyministry.org/church4everychild/2018/7/22/its-the-hidden-disabilities-that-keep-kids-out-of-church?rq=Whitehead

               Jill glances at the reflection before her but recoils not from the actual portrayal of her face by the light, but from the meaning overlaid by life upon her countenance.  The reflection reminds her that others have left her along the road of her long sorrow.  The reflection reminds her that the brokenness of family members’ own struggles strands her on a lonely island in the ongoing buzz of life which then cannot hear her cry in the night nor the day.  The reflection reminds her that nothing has relieved the suffering lying behind that reflection.  No therapy, no medication, no well-intended but misdirected words of friends have lifted that reflection out of darkness.  She knows that she will see that reflection tomorrow and the day after and so on until her eyes open no more.  She does not expect the spirit behind that reflection to remind her of anything different in those future encounters. 

               Jill does not realize that millions of others daily recoil at their own reflections.  They gasp at the reflected darkness of various mental illness shadow. The rest of today’s world continues on unaware of these millions until the news reports that one of them has chosen to put an end to the daily ritual of glancing at their own soul in the mirror.  Should we care? Should we act?  How far must this go and how many must fall before we acknowledge how tangled and knotted are the strings of life woven by today’s misunderstanding of reality as manifested in the mental health crisis presently weighing upon us..

               The specter of Jill’s suffering along with the millions of others rumored by the media deserves an answer.  Addressing such a problem as the multilayered complexity of our current mental health crisis requires understanding where the tangled mess begins and then following through the whole tangle to find the solution.  This stands out rather like a multilayered knot in your child’s shoelace.   Attempting to untangle and solve the knot starting halfway through it will either leave you at best with half a knot or possibly even worse with one and a half knots, i.e. a bigger mess than you started with.  The mental health in which we and millions of our neighbors are presently suffering, likewise, cannot be solved without going to the root of the tangle and working out from there.  The solutions offered by the secular world do not aim at the root of the tangle.  Similarly, the solutions currently present in the broader church are falling short and need revision.  The problem requires a solution that can only come from God’s design for the family and the church as the foundations of society, but which the current broader church is not leading as it is called to do.

               The process for untangling something so complex and so multilayered as the mental health condition of our society obviously requires more time, energy, and steps than untying your child’s knotted shoelaces, but the basic steps are strikingly similar.  First, we must be sure that a problem really exists.  Second, once we realize that the problem is real, we must take a big picture look and understand the depth and breadth of the problem (its nature).  Third, with a big picture understanding, we must find the best starting point from which to begin the disentanglement, or in other words, we must identify the root cause or causes of the tangle. Fourth, our response must be sufficiently powered and correctly focused while minimizing hindrances to have a hope of success.

               Over the coming installments of this series, I will walk through this process as it applies to the state of our society’s mental health crisis.  By answering each of these first three questions we will lead into the most important answer to the fourth question: how the work of the family and the church lie at the root of untangling this tangle mess of a mental health crisis.

Step One of Disentanglement: Confirmation that a Problem Exists

               Before allocating extensive time and resources to this issue, we should confirm the truth of the contemporary claim that a mental health crisis exists.  This applies whether referring to either the setting  of our own community or more broadly to our nation.  Just because your 4-year-old says that they can’t untie their shoe does not mean that it is knotted.  Just because the news media and experts say that we have a mental health crisis does it mean that we need to respond to their alarm bells.  Just because a Jill, as described earlier, looks into her mirror with sadness and despair does not mean we have a societal crisis.  We also don’t want to extrapolate our own mental health struggles of anxiety or depression across everyone assuming that every one of us “feels” the same as we do.  Before we devote much time, effort, or money into untying knotted shoelaces, we should be confident that a knot really exists.

               With these cautions in mind, we consider how we might assess the situation and determine if a problem truly exists or not.  Most of you reading this will not be mental health experts or public health experts with knowledge and extensive access to data sources that you trust.  We will have to find sources upon whom we can trust to provide sufficient and accurate evidence for a problem’s existence.  We must admit that looking to our own family and friends’ current experiences of mental illness does not mean that we have an epidemic or a national crisis.  We or our loved ones may have a crisis, but that is a somewhat different problem and solution than having a societal crisis.  The sources must be realistically free of bias, avoiding unnecessary conflicts of interest.  We don’t need a deceitful mechanic telling us that we need to replace our carburetor and we don’t need government officials telling us that a crisis exists so they can offer their solutions at our tax expense.  On the other hand, our sources will have to be sufficiently involved and knowledgeable in the mental health world for them to know something worth considering as a trusted and reliable/accurate source.

               We then want more than one source so that we can be more confident that even the well-intentioned and unbiased did not make an honest mistake in their assessment.  We might initially look to a governmentally derived report or study, but would also appreciate a study from a private or academic source that we trust.  We might also try to find sources from outside the usual ones which agree with our worldview so that we avoid having our own echo biases from other’s who think like us.  Then we would also consider personal experience whether in our family, our church, or our community.   For those of us in the health care world, we can also look to the experiences of our patients as informal surveys of what is happening in the broader culture.  Then we must evaluate each of these sources for bias, accuracy, breadth, depth and other factors to be sure it is worthy of our including it in our analysis.  Finally, by comparing and combining these sources we can develop a better appreciation for whether a problem exists or not.  This process also prepares us for later steps in our attempts to untangle the mental health knot.

               These quotes provide a starting point, offering different perspectives and statistics demonstrating why we should be concerned with our nation’s mental health:

               From Abilene Christian University: “The statistics are startling. Between 2007 and 2019, adolescents reporting a major depressive episode increased 60 percent. Tragically, during a similar time frame, the suicide death rate among 10–24 year olds increased 56 percent. This issue isn’t confined to young people. In 2020, anxiety and depression increased globally by 25 percent. Depression and anxiety rates exploded so rapidly that, at the end of 2021, the U.S. Surgeon General declared a “devastating” national mental health crisis.

               From CNN:  “Nine out of 10 adults said ​they believed that there’s a mental health crisis in the US today. Asked to rate the severity of six specific mental health concerns, Americans put the opioid epidemic near the top, with more than two-thirds of people identifying it as a crisis rather than merely a problem. More than half identified mental health issues among children and teenagers as a crisis, as well as severe mental illness in adults.”

From SAMHSA: 

               “Fact: Mental health issues can affect anyone. In 2020, about:

               One in 5 American adults experienced a mental health condition in a given year

               One in 6 young people have experienced a major depressive episode

               One in 20 Americans have lived with a serious mental illness, such as schizophrenia, bipolar                disorder, or major depression

               Additionally, suicide is a leading cause of death in the United States. In fact, it was the second                leading cause of death for people ages 10-24. Suicide has accounted for the loss of more than                45,979 American lives in 2020, nearly double the number of lives lost to homicide.”

From Pew Research Center:  “Mental health and the pandemic: What U.S. surveys have found:

               1. “At least four-in-ten U.S. adults (41%) have experienced high levels of psychological distress at                some point during the pandemic, …”

               2. “More than a third of high school students have reported mental health challenges during the                pandemic. …”

               3. “Mental health tops the list of worries that U.S. parents express about their kids’ well-being,                according to a fall 2022 Pew Research Center survey of parents with children younger than 18. In                that survey, four-in-ten U.S. parents said they’re extremely or very worried about their children                struggling with anxiety or depression….”

               4. “Among parents of teenagers, roughly three-in-ten (28%) are extremely or very worried that                their teen’s use of social media could lead to problems with anxiety or depression, according to                a Spring 2022 survey of parents with children ages 13 to 17.”

               5. “Looking back, many K-12 parents say the first year of the coronavirus pandemic had a                negative effect on their children’s emotional health.”

               As I find further helpful sources to support the existence of a crisis, I will try to return to this blog and post those sources at the end.  I am open to your sharing of ones you find, even ones that argue against a crisis if you find some.  For now, I have also mentioned a few sources of proof in other blogs and can say that between several studies I have read and my experience in our clinic where we are truly seeing more and more mental health issues in our patients, there is a mental health crisis which seems to be worsening.  Various studies indicate that people are more stressed and experiencing more mental health dysfunction with more diagnoses being made and more meds being prescribed.  Weekly, I receive the same comments from my staff in caring for our patients that we are seeing more and more suffering both physically and mentally in those seeking our help.  Many experts are expressing their concern in news interviews, articles, and books.  Government and media are beating the same drum over and over, proclaiming that we need more mental health workers (I will address this inadequate response soon, but for now, their repetition acknowledges that they see a problem).  The consensus of these sources indicate that we have a problem – that the mental health shoelaces are truly knotted.

               If you doubt this assessment, I applaud your diligence to be more confident before responding to a problem that you are not sure actually exists.  If this describes you, take time to solidify your opinion one way or the other before proceeding to the rest of this series.  On the other hand, if you are in agreement with the knot’s existence in our society as well as its importance, return to read part two describing the nature of the mental health crisis.  As you wait, do a little research on your own and begin formulating your own view of this issue.  This work will prepare you for understanding in the next essay.

Bibliography:

Gramlich, John. “Mental Health and the Pandemic: What U.S. Surveys Have Found.” Pew Research Center, 2 Mar. 2023, www.pewresearch.org/short-reads/2023/03/02/mental-health-and-the-pandemic-what-u-s-surveys-have-found/. Accessed 12 Nov. 2023.

Krause, Chelsi. “The Mental Health Crisis: What’s Going on and What Can We Do.” Abilene Christian University, 9 May 2022, acu.edu/2022/05/09/the-mental-health-crisis-whats-going-on-and-what-we-can-do/#:~:text=In%202020%2C%20anxiety%20and%20depression. Accessed 12 Nov. 2023.

McPhillips, Deidre. “90% of US Adults Say the United States Is Experiencing a Mental Health Crisis, CNN/KFF Poll Finds.” CNN, 5 Oct. 2022, www.cnn.com/2022/10/05/health/cnn-kff-mental-health-poll-wellness/index.html.

SAMHSA. “Mental Health Myths and Facts.” Www.samhsa.gov, SAMHSA, 8 Feb. 2023, www.samhsa.gov/mental-health/myths-and-facts. Accessed 12 Nov. 2023.