(We continue to consider potential root causes contributors to the mental health crisis as begun in the prior installment.)

               Simultaneously with these economic forces, many today are entering the work force with a strong desire and expectation to achieve work-life balance.  Maybe their parents’ example of overworking for years leaves them with a longing for time and experiences of life outside the office.  Maybe they have been told that they can have their cake and eat it too in terms of work success and extracurricular fulfilment.  They often expect the benefits and wages of having invested years in a position at the very beginning of a career and may become disillusioned or resentful when those rewards are not forthcoming soon enough. The basic requirements for productive employment collide with the desires for a fulfilled life to create another source of stress.  Their responses of angst or wanderlust for something better creates stress for both them and the businesses they work for.

               Again, many hope that achieving such a balance will bring mental wellness and fulfillment.  The realities of our fallen world places great obstacles in achieving this balance.  The striving after such balance creates more stress and magnifies other challenges to mental health.  Sacrifices must be made to achieve such balance, often leaving these life balance seekers looking for more.  They too must go further upstream to find mental wellness.  That upstream insight, which can only come from a spiritual view of reality, can then guide them in overcoming the obstacles they wish to overcome. 

               With more information to process, more work to do, and more challenges to pursuing life fulfillment, some of us can find ourselves giving less attention to our physical well-being.  For some work leaves less time or less energy to exert our bodies in activities that not only make us feel better physically, but could improve our mental health (many studies support this).  Given the reality of aging and the reality of bodily dysfunction in a fallen world, lack of attention to our physical health will eventually reduce our capacity to handle the demands of life. 

               Even for those who press past the challenges, devoting the time to their physical health which leads to what society considers physical fitness, this only touches on the surface of the mental health crisis.  Healthy bodies contribute to healthy emotions but are not enough to guarantee it.  Going upstream from physical fitness into whole person fitness is still required.  A proper view of physical fitness will lead to a proper response to caring for the whole person, body and spirit.

               The pressures of life can also leave us with less time to gather with family or friends, thus resulting in less emotional support that could protect against threats to mental health.  Having others who provide perspective on life’s challenges, even if they just offer sympathy, empathy, and compassion makes the stress less burdensome.  Having relationships which provide tangible support when jobs fail or when financial hardship hits means that the stressed individual is protected from falling into mental illness.  In contrast, not having such relationships creates a sense of isolation which amplifies the stress rather than limiting its effects.

               Between the closing down of churches during the pandemic and the fracturing of many churches over politics and social issues, the fabric of life which held society and individuals together is wearing thin and giving way for many of us.  Social isolation has become all too common, preventing many from meeting their inborn need to socialize.  The societal safety nets of church, community, and government programs which try to catch the individuals who fall into mental illness cannot presently bear the weight of so many who are finding themselves on such life downward spirals.   

               Simply bringing these isolated people physically together would seem a promising approach, but so many attest to the feeling of greatest loneliness in the midst of a crowd.  Many are already surrounded by other people yet feel quite lonely and isolated.  Being located physically together does not guarantee a sense of belonging together.  The connection must go further upstream, although the increasing isolation does need a response.  Again, incorporating a spiritual view of reality is required.

               In the background of technology changes, work demands, life fulfillment expectations, and social isolation, society has devalued family as a foundation of society’s functioning.  The attempt of a revolutionary mindset to be discussed in the next section has attempted to undermine a traditional view of family and either restructure it or destabilize it into non-existence.  Families physically spread out at greater and greater distances thanks to the higher educational system and the world of labor.  Families spread out socially as teens are socialized to become their own person without regard to their parent’s legacy and beliefs.  Families spread out in what they stand for as the old-fashioned husband and wife with children are replaced by whatever combination of men, women, children, animals, or even inanimate objects.  The stabilizing force of family cohesion dissipates as each spreading out weakens the family structure and its supporting function.  Divorces multiply.  Depression and anxiety grow.  Children grow up without models or support to overcome their life struggles.  They grow into adults unable to withstand the pressures of life, succumbing to more and mental illness unless some other force intervenes.

               Many groups strongly emphasize a restoration of the family as an answer to the mental health crisis.  While this gets closer to the root as will be discussed in the final section of this series, an upstream answer to what is family and how to bring the family back together is required.  Restoring family as a foundational aspect of society requires a response, but is not the whole work of untangling the knot.  A restoration of family must include a spiritual understanding of what family is.

               As if we needed one more factor, we have the pressure which the government has forced upon us in its constant attempt to help us and protect us from ourselves.  While laws to limit sinful behaviors are needed to an extent, the extent to which government attempts to control can become a burden rather than a protection.  State and federal governments have a role in maintaining civil order, but their demand for the “rights” of real and imagined minorities again creates undue burdens on individuals and businesses.  Requiring handicapped access is one thing, but forcing compliance with immoral beliefs so that someone does not feel triggered by differing views goes too far.  The “Nanny State” has long moved from the mirage of a doting lady watching over little ones into the specter of a controlling and aggressive tyrant bent on micromanaging what it thinks is best for everyone else. Rather than offering relief from the burdens of modern life, this “nanny state” mentality intensifies these pressures of life and destabilizes the natural supports of family, church, and community.

               Still many others bemoan the growing influence of the government in contributing to life stress and thus to mental illness.  They focus on getting government out of the way which is another basic issue, but this still leaves factors unaddressed.  Mankind without any restraint leads to anarchy.  Finding the proper role of government requires us to again go upstream in exploring the purpose of government and its role in our lives.  We must respond to government’s contributions to the mental health crisis, but we must do so with a clearer and more robust worldview than just wanting the government to leave us alone.  Examining government and its role through a spiritual lens is required.

               Each of these materialistically oriented factors contribute to the dysfunctions of society leading to mental illness but biological factors impacting our mental health deserve their moments in the spotlight as well before going upstream.  We must momentarily consider the toxicity of our fallen world in terms of the living environment which we are creating for ourselves.    

               While the technological, social, and other factors are contributing to stresses and overburdening human limitations, the physical environment we are fashioning around ourselves as individuals and as a society is eroding our bodies’ abilities to withstand such stressors.  In the quest for the next technological breakthrough, chemicals are often produced which disrupt the normal functioning of our bodies.  The resulting inflammation, changes in metabolism, changes in brain function, changes in hormones, and more all alter our homeostasis, or balance of biochemical functions.  Our resilience to withstand the other previously mentioned stressors is diminished as conscious and unconscious resources are diverted to the effects of these toxins.  Besides the technologically produced toxins, our desire for aesthetics and youth drives the market demand for personal care products and cosmetics industries which introduce even more potential biochemical disruptors into our bodies.  Besides these chemicals we breathe and put on our skin, we have created a whole world of food additives to preserve shelf life, enhance flavor, and make food more colorful.  We then eat and drink to our own detriment from the formulations of the processed food industry.  Our physical bodies are presently challenged as never before, and we wonder why we are struggling so much with overall worsening health, including negative impacts on mental health.

               Removing toxins and sources of inflammation from our diet and our environment would definitely help but only so far.  Removing these triggers for mental and physical illness would make us feel better, but still does not guarantee mental wellness when so many other factors are present.  We must go upstream in not only finding the toxins, but understanding how we view our environment and how we view the stewardship of our bodies.  We can respond correctly only with these improved understandings. 

               When we look up on this materialistically focused description of the potential root causes of the mental health crisis, we could feel a little hopeless. Technological advances and their impact on how we live appear inevitable.  Inflation and the economic pressures of work life versus life goals seem unavoidable.  The breakdown of family seems to continue unabated.  The prospects of government’s increasing control of our daily life seems unstoppable. Environmental toxins appear to be encircling every area of life.  These physical factors are at their core, just sources of more and more stress.  Living in a fallen world will necessarily impress some elements of these or other stressors upon us.  Remove one source and others will fill in the gaps.   Pushing back on these societal changes mostly just creates more stress when one person or one family tries to live counterculture to everyone else around them.  Addressing any one of these only untangles one little loop of the knot and their interconnectedness makes a potential starting point impossible to find.  Rather than trying to simultaneously untangle all of these contributors plus others not mentioned, we must look upstream.  If we can move upstream in the factors to something that underlies multiple of the previously listed ones, we can find a common source which when addressed would solve these factors as whole rather than in parts. 

(In the next installment, we move upstream to look for spiritual root causes of the mental health crisis.)

(Having examined the mental health crisis from various angles in the prior two essays…”

               Third, once the big picture view has solidified as much as possible in our mind, we must think logically in terms of causality and find what led us to this current state so we can start at the right place to untangle the mental health knot.  Working past the superficial statistical and diagnostic layer, we need to understand the factors leading the collective society to these diagnoses and descriptions.  To solve problems and lower statistics, we must aim at deeper changes than just these numbers.  In medicine, we regularly consider whether genetics or the environment are contributing to a disease we are treating or diagnosing.  In functional medicine, we search deeper for root causes, the deepest factor underlying a disease process which when addressed allows the body to move towards healing and restoration.  Here in the broader world of mental health across communities, states, and our nation, we need the same effort towards root cause analysis.  By understanding how our child’s shoelaces came to the present state and by asking the right questions we can simplify and accelerate the actual un-entanglement.  Although the present complexity of mental health in our society immeasurably surpasses that of tangled shoelaces, identifying the contributing factors logically and chronologically for either challenge is required to formulate hopeful solutions.

               Hints of contributing factors and candidates for root causes have already been seen in the prior examination of the big picture.  We have societal changes which are impacting upon human capacities and expectations.  Individuals and their various groups cannot sustain the weight of this burden being expected of them.  Human beings have limits in time, energy, knowledge, emotional capacity, mental capacity, physical capacity, and resources among other limits.  As our society seems to be pressing higher and higher levels of stress upon us, eventually the stress and burdens of life will overcome these limits.  Life for many has become one big multitasking juggling act in which technological advancements, work demands, life fulfillment expectations, lack of self-care and relationship attention, isolation, family breakdown, and governmental pressures have combined with many other factors to push people over their edges into mental illness. This is layered on top of physiologic burdens of tons of toxic chemicals pouring into our world daily.  However, despite their individual and collective contributions to the mental health tangled knot, none of these contributing factors actually get to the root of the problem.   

               Instead of serving as a root cause directly, each of these can be traced back to our spiritual view of physical reality which is where the untangling of the knot must begin.  If you agree, then you can proceed to the spiritual explanation.  If you are unsure or disagree, take the time to read the remainder of this section and better understand why the materially directed approach to untangling the knot only addresses portions of the tangle at a superficial level without going deep enough to address the knot as a whole.

               Each of these  materialistically focused contributors deserve some elaboration here. First, the hastening speed of technology drives our lives both at work and at home to accomplish more and more, while it promises to make our lives easier.  Although technology has enabled us to do things unheard in generations past, technology also creates situations where are forced  to move faster in more directions.  Multiple lines of communication such as texting, multiple emails, and other instant messaging, on top of phone and face to face means we sometimes have multiple conversations going simultaneously.  As technology moves faster, we no longer have the luxury of thinking for a time as we wait for computers to process or for others to respond.  Now the multiple lines of communication can be rapid fire back and forth.  This is difficult enough at work to keep up with.  Even in our personal life with text or other messaging services, we feel awkward if a message is left unanswered for a few minutes.  We can feel ghosted – and stressed — if someone misses an email for 3 days and doesn’t respond. 

               The amount of information we can access through the internet and smartphones can also overwhelm us.  Knowing more about what is happening in another country where we can do nothing about the depressing news can lead to anxiety and hopelessness.  This can later lead to guilt and regret.   Simultaneously, excessive access and attention to the broader world’s events may draw us away from time with family and face to face friends leading to isolation and more shallow relationships.  This can increase your sense of isolation.

               These communication expectations are compounded by expectations that we should be accomplishing so much more given this technology.  We expect greater returns from our time which is stressful on already stressed human capacities, and this makes us more heavily dependent on these technologies. We may keep up for a time until this technology falters.  The complexity of technological advances then means that we need more experts to fix overly complex electronics or programs.  The days of fixing something yourself are becoming rarer and rarer.  Instead of being empowered by the technologies, we can become trapped by them.  Emotionally the stress from needing the technology to meet our own and other’s expectations can outweigh the increased capacities they offer.  Life with the technology can become more stressed than life prior to the technology.

               While we could push back directly against technology in various ways, this approach has minimal chance of significant impact.  The world around us continues to depend on technology’s present contributions to daily life and excitedly awaits the next innovation.  We can develop better patterns of interaction with technology, but the impact will only go so deep as an individual effort.  A clear strategy against the onslaught of technology requires a deeper understanding so that we know how to respond to inevitable changes to society brought on by technological advances.  Ignoring the problem or responding with a simplistic approach will only make it worse.  This deeper understand demands a spiritual view of reality. 

               Beyond the effects of technology on the demands of work life, several general economic factors and trends are combining to increase the pressure of contemporary life.  To some degree the rising cost of living due to rising inflation presses upon nearly everyone.  As a result of competing for these tightening budget’s expenditures, businesses are constantly working on efficiency and productivity leads to requiring more and more of employees.  In the world of big business, many employees become little more than a cog in the machinery of the 100’s, or even 1000’s of employees who can be replaced at the drop of a hat.  The pressures of having to work more and work harder to keep up the family economy while recognizing that your company’s leaders could replace you with a hundred others willing to do the same work can create a lot of stress, increasing the pressure for developing mental illness.

               While we could voice louder and louder protest against the rising costs of living brought on not just by our human desire for more, but also by the clear mismanagement of our economy by government, this will not change the momentum of society.  We can implement better budgets and set more realistic expectations for what we can afford, but at some point, we will cut all the excess and inefficiencies yet still face the need to work harder and longer for the basics of life. We must look at the economics of life that lead to inflation from an upstream viewpoint as well as understanding the purpose and function of labor in the flow of life.  Only by taking a spiritual view of these realities can we respond in a deeper and longer-lasting way that offers hope of providing for ourselves and others.

(The next installment of this series will continue to examine these stressors)

(Continuing the examination of the mental health crisis from part 2 of this series.)

             Looking next to the functional angle of mental illness’s impact, we see societal statistics describing how such illness alters one’s ability to function at home or in society as well from the personal angle.  Considering marriage and its success rate as a good indicator of a person’s functioning in the home setting, survey results by researchers suggest that mental illness both decreases the incidence of marriage as well as increases the rate of its failure in divorce rates.  In the report published in the Acta Psychiatrica Scandinavia (Breslau 2011), researchers described their findings from a 19-country survey.  All mental disorders studied demonstrated an increased odds ratio of 1.2 to 1.8, meaning a 20 to 80% increase in divorce. The negative impact of mental illness on life’s closest relationship of marriage can likely be extrapolated to other personal relationship struggles.

             The ability of those with mental illness to function in broader society can be extrapolated from their capacity to handle employment.  In an online publication by Psychiatric Services, Luciano and Meara report how the severity of mental illness impacted employment rates. Looking at data from a survey in 2009-2010, they found that while those without mental illness reported an employment rate of 75.9%, those serious mental illness reported only a 54.5% rate.  Beyond this statistic, the percent of survey respondents with serious mental illness that reported incomes under $10,000 per year was 38.5% while it was only 23.1% in those without mental illness.  From the positive angle, this shows that many individuals suffering with mental illness are pushing through and working under the burden of their illness, yet it does demonstrate that many appear hindered from life functioning by their condition.

             At the personal level experienced by many of us, our own or our families’ struggles in mental health have hindered our functioning at these same levels of life.  Other family members have had to step in to provide financially or to support others sufficiently so that employment is not lost.  Other family members have dealt with the aftermath consequences of marriage discord and divorce.  While mental illness is not required for divorce, when it is a part of the divorce, the challenges of life post-divorce family dynamics can be even more challenging for all involved.  In each situation you live through or are living through, the shared weight lies heavy on many shoulders.

             The spiritual angle completes the view that most people should consider in understanding the scope and magnitude of the mental health crisis.  Examples of clearly sinful behavior which are known to correlate with future mental illness include abortion, drugs and alcohol abuse, and homosexuality.  We must come to some conclusions of how to view mental illness in terms of sin as both a contributing factor for the person and in response to the person.  On one hand, the majority who see little or no spiritual component to mental illness promote a dangerous and simplistic approach.  They ignore this critical spiritual portion of the problem and thus undermine any hope of fully resolving it.  By denying any spiritual component, they make guilt and shame challenging to deal with while preventing the adequate handling of sinful behaviors which contribute to the mental illness.

             On the other hand, there are some who might lump any or all mental illness into the category of sin or its effects.  This simplistic approach makes it easier in one sense to respond to all mental illness with a “repent and change your attitude”.  So much harm is done by those in this camp as they ignore the factors already discussed as well as more to be discussed in the next section. 

             Between these two extremes, from those acknowledging the contribution of spiritual factors come a variety of potentially sinful options for responding to other’s mental illness.  While lack of compassion for the weaker brother can lead to sinful responses, overindulgence of one’s sinful behavior can also hinder efforts to overcome such patterns of sin.  Sometimes between these extremes, the emotional impacts of mental illness on friends and family may lead them to respond out of frustration, despair, or anger further amplifying the impact of sinful behavior and deepening a cycle for everyone involved. These sinfully inappropriate responses can further exacerbate both the depth of the mental illness and the obstacles to overcoming it.

             Instead, we must consider a Biblical view of how we should respond individually and societally.  When approaching an individual’s mental illness, the contribution of spiritual factors to the illness must be considered for full resolution.  Then the societal response, whether at the level of a family, a community or a church as well as the national level, must not ignore these spiritual factors if a proper and successful response is to be implemented.  A better approach of addressing the sufferer’s condition in the context of family and as a church will be discussed later.

             As a physician caring for many of these individuals suffering with or without actual mental illness diagnoses, I can add a further angle combining both personal and professional.  I look at the reported statistics on the increase in mental illness and can believe it as more patients present for evaluation in my office of these conditions.  Simultaneously, we are seeing more of the secondary physical complaints mentioned earlier in terms of chronic pain syndromes, irritable bowel type complaints, insomnia, and more.  We see how patients’ relationships are affected by their mental health symptoms as well as how they are struggling to function at home or at work.  For those willing to discuss the spiritual aspect, we hear their guilt and shame for not living up to other’s expectations along with their occasional despair in feeling alone or losing hope of recovery.  While we should never base a societal level response on the report of one doctor’s experience, my professional experience echoes the statistics being reported and I hear similar stories from other providers directly and indirectly.  I agree that we have a growing problem that is not being adequately addressed. 

               Before we give up hope of such an exhaustive understanding and return to the simplistic solutions offered by the world, we should recognize that omniscience concerning the mental health crisis is not the goal, but sufficient understanding so that we can eventually move towards a solution to the crisis that has a chance of success.  While we will never be able to identify and to fully understand the totality of factors contributing to even one person’s diagnosis of mental illness, we can understand enough about the nature of the individual’s condition or the societal patterns that we can plan and enact a response.  Understanding the root causes in the next section will overcome the immensity of the big picture and allow an appropriate response. For now, if you want more statistics on the impact of mental illness on functioning, go to The National Alliance of Mental Illness website on its “Mental Health By the Numbers” page where many insightful statistics are offered.  Statistics and experience show a growing problem.  The situation affects mental, physical, relational (isolation), spiritual and societal health and function.  The mental health knot is tightening while civilization unravels.

               Having examined the state of mental health from these various angles already encourages us to look for upstream foundational causes of such a complex crisis. Each of these angles offers a different perspective which will lead us in the next section towards finding remediable root causes. The potential causative factors must somehow answer the challenges of these psychiatric, physical, relational, functional, and spiritual angles at the individual and the societal levels.  We wean to untangle the whole knotted shoestring of the mental health crisis rather than just a portion of it. 

Bibliography:

Breslau, J., et al. “A Multinational Study of Mental Disorders, Marriage, and Divorce.” Acta Psychiatrica Scandinavica, vol. 124, no. 6, 30 Apr. 2011, pp. 474–486, www.ncbi.nlm.nih.gov/pmc/articles/PMC4011132/, https://doi.org/10.1111/j.1600-0447.2011.01712.x. Accessed 13 Oct. 2023.

Luciano, Alison, and Ellen Meara. “Employment status of people with mental illness: national survey data from 2009 and 2010.” Psychiatric services (Washington, D.C.) vol. 65,10 (2014): 1201-9. doi:10.1176/appi.ps.201300335

National Alliance on Mental Illness. “Mental Health by the Numbers.” NAMI, National Alliance on Mental Illness, Apr. 2023, www.nami.org/mhstats. Accessed 13 Sept. 2023.