(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