Mental Illness and the Ministry of the Local Church

Reggie Abraham

# Springer Science+Business Media New York 2013

Abstract Due to the stigma associated with mental illness in America, religious leaders andtheir congregations might be fearful of caring for and worshipping alongside a person withmental illness. This article recounts some of the challenges encountered by the pastor of asmall congregation in attempting to provide care for a church member suffering with schizo-phrenia. It is proposed here that congregations need to grow in courage as they attempt to servepeople who struggle with mental illness, just as people with mental illness exhibit courage inventuring out to participate in church life.

Keywords Schizophrenia .Churchministry.Courage .HansUrs vonBalthasar. JohnSwinton .

Paul Tillich

In The Invisible Plague, E. Fuller Torrey and JudyMiller (2001) make the claim that mental illnesshas been steadily increasing over the last two centuries and has reached epidemic proportions:

Imagine an epidemic that does not quickly kill a large percentage of those affected, butinstead slowly kills 15 % by suicide. Imagine an epidemic that is so insidious andingratiating that, two centuries after it has begun, it is barely noticed, so blended into thefabric of people’s lives that a few otherwise intelligent people even deny that the diseaseexists. Imagine an epidemic that affects over 4 million Americans, most of them in theprime of their lives, and will continue to affect more than one in every one hundred peopleborn, but that is not recognized as a major public health problem and is largely ignored byofficials overseeing the nation’s health. This is the epidemic of insanity. (pp. 2–3)

If Torrey and Miller are right, the mentally ill are among us in ever-increasing numbers. Itwould not be unreasonable to assume that if there is an increase in the percentage of peoplewith mental illness in the general population, there will be a corresponding increase amongchurch membership as well. Pastors and congregational leaders have to be prepared for thepossibility that there are more troubled people in the pews than they might otherwise expect.

People with mental illness attend worship services, partake of Holy Communion, andparticipate in the church’s social events. Anton Boisen (1992) observed that “the minister ofreligion is concerned always with the problems relating to mental health. This followsinevitably from his task as a servant of the Church” (p. 101). Due to the stigma associated

Pastoral PsycholDOI 10.1007/s11089-013-0590-0

R. Abraham (*)Princeton Theological Seminary, SBN 592, P.O. Box 821, Princeton, NJ 08542-0803, USAe-mail: reggie.abraham@ptsem.edu

with mental illness in popular society, the church is often a place where people with mentalillness seek refuge, guidance, and healing. If this is so, as pastoral theologians we have to askwhether clergy are being trained to engage with people with mental illness in ways that arecaring and considerate. A lack of training and a lack of exposure may translate to carelessattitudes towards people with mental illness in congregational settings. I have seen pastorsignore parishioners with mental illness (as if they were either subhuman or insignificant) whilecarrying on conversations with the “sane” members of the family. Such actions not only lackgrace, they are grievous to the ill person and her family members.

Churches attract the people with mental illness because Christian community matters tothose who suffer. In Darkness Is My Only Companion, Kathryn Greene-McCreight (2006)shares the story of her struggle with depression and makes the following observation on theimportance of Christian community:

Sometimes you literally cannot make it on your own, and you need to borrow from thefaith of those around you. Sometimes I cannot even recite the creed unless I am doing itin the context of worship, along with the body of Christ. Now, you could say that this isa fault of memory, and maybe it is in part, but I think it goes further than that. Whenreciting the creed, I borrow from the recitation of others. Companionship in the LordJesus is powerful. (p. 88)

Christian community matters to people with mental illness. Worship, prayer, and a sense ofbeing united to “brothers” and “sisters” in the faith helps the troubled and ill bear up under theweight of their heavy burdens.

Sadly, pastors and churches are not always prepared to offer companionship to the mentallyill in their midst. I know that I was not prepared when I served as the pastor of a small churchwith an unusually large number of people with mental illness. I knew of two members in mycongregation who suffered with schizophrenia and one who suffered with bipolar disorder. Ialso knew of others who suffered from illnesses that were not as readily apparent, such asdepression and social phobia. One of the schizophrenics, Tammy, was an active churchmember who rarely missed any service or function of the church. She attended prayermeetings, Bible studies, mid-week services, and both Sunday worship services. She was alsopresent at barbecues, Sunday school picnics, street fairs, etc. Although a troubled person,Tammy found safety and stability in the community of faith.

When I was first installed as the pastor of the church, the “church mothers” took me asideand told me about the “poor dears” who were having such a “tough time” in life. One of these“poor dears” was Tammy, who was once a brilliant young lady with a bright future ahead ofher. She became sick, though, during her freshman year at Brooklyn College. As she rode thebus home from college on an otherwise uneventful day, Tammy heard strange voices talking toeach other. She tried to shake the voices off but could not. Eventually, Tammy dropped out ofcollege and preferred to stay locked in her room.

By the time I met her, Tammy was in her early thirties and had lived on her own for close toa decade. At times she was extremely paranoid, and at other times she was pleasant andcongenial. Her conversation was simple in syntax but difficult to understand because hersentences often failed to follow a logical order. Her gait was awkward and her body languagecould be intimidating at times; she often curled up her fingers and put her hand in the faces ofher conversation partners.

While psychiatric treatment was ongoing in Tammy’s case, she never managed to break freefrom her hallucinations. Demons often cornered Tammy in her apartment and told her the mostvile and despicable things. Exactly what those things were, I do not know. However, judgingfrom her prayer requests, I suspect that they told her “very bad things” about God’s character

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and made her question her own salvation and morality. Although the demonic voices were notactive every moment of every day, they spoke often enough to keep Tammy in a state ofperpetual fear and anxiety.

Once the demons started talking, only prayer could help Tammy function. She regularlycalled the church office and asked if I could pray for her. As the new pastor of the church, Isuddenly found myself traversing a landscape that I was unfamiliar with and totally unpreparedfor. How does one provide meaningful, responsible pastoral care for a person who is hearingvoices, is unable to take responsibility for basic personal hygiene, finds socializing at even themost elementary levels difficult, and lives in constant fear of the demonic?

In this paper, I suggest that living in community with those who suffer with mental illnessrequires courage. Specifically, it requires of the congregation and church leaders the courage tostand in solidarity and the courage to befriend people with mental illness. On the part of thetroubled person, it requires the courage to live with mental illness. For each of these differenttypes of courage, I draw on a Christian theologian who I believe speaks to the issue. First, inMysterium Paschale, Hans Urs von Balthasar describes the death and resurrection of Christ. Init, he considers the idea of Christ’s descent into hell as emblematic of Christ’s solidarity withthe dead (i.e., with those who are seemingly beyond all hope). In this I find a wonderfulanalogy to the church’s ability to stand in solidarity with people who are mentally ill. Second,in Resurrecting the Person, John Swinton points out that people with mental health problemsare often stigmatized and treated as nonpersons. This should not be the case in the church.When people with mental illness are in our midst, we should seize the opportunity to sharefriendship with them and, in that process, honor their humanity. Third, in The Courage to Be,Paul Tillich speaks of the anxieties and fears of human beings who cannot trust the establish-ments of society. In every individual there exists a struggle to be as oneself (as opposed tobeing as “part of”). I would say that when people with mental illness choose to live on despitethe challenges they face, they reject non-being. As such, the power of being is working inthem, and they provide others in the congregation with a model for finding hope and couragein life.

The courage to stand in solidarity

What does a person feel when she realizes for the first time that she is slipping into mentalillness? What does a schizophrenic experience, for example, when she first hears voices?Once, when Tammy was admitted at the psychiatric unit of a local hospital, she felt the need totell me that she was not always “like this.” Although I had heard the story from others who hadknown her as a teenager, I asked if Tammy might share with me her memories of the first timeshe heard voices. She remembered very little except the overwhelming sense of fear sheexperienced when the voices emerged on the bus ride home from college. The voices told hervile things and made her suspicious of people on the bus. On returning to her mother’sapartment, she locked herself in her bedroom and never wanted to come out again. Whenasked how she would describe that day, Tammy said that it was like “falling into darkness” andwaking up in “hell.”

A controversial phrase in the Apostles’ Creed states that Christ “descended into hell.” InMysterium Paschale, von Balthasar (2005) picks up on this phrase and describes Christ’s“going to the dead” on Holy Saturday as an act of divine solidarity with them. “In the sameway that, upon earth, he was in solidarity with the living, so, in the tomb, he is in solidaritywith the dead” (pp. 148–149). In this sense, Christ’s descent “into hell” is simply his act ofparticipation with the experience of the dead, actualized by his own death on the cross. What

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this solidarity actually entails is difficult to understand. “One must allow to this ‘solidarity’ anamplitude and an ambiguity, even, which seem precisely to exclude a communication on hispart as subject. Each human being lies in his own tomb. And with this condition, seen herefrom the viewpoint of the separated body, Jesus is first truly solidary” (p. 149).

In considering von Balthasar’s image of Christ’s descent, I see in Christ’s solidarity with thedead an analogy for his solidarity with the mentally ill. Von Balthasar believes that death is

a happening which affects the whole person, though not necessarily to the point ofobliterating the human subject altogether. It is a situation which signifies in the first placethe abandonment of all spontaneous activity and so a passivity, a state in which, perhaps,the vital activity now brought to its end is mysteriously summed up. (p. 148)

For Tammy, the day she “descended” into mental illness was not a day of death, per se, but itcertainly was a day when all “spontaneous activity” ceased. It was the day when she had to lockherself in her bedroom in a vain attempt to hide from the powerful voices that repeated “bad”things to her. It was the day that the demons came out of the darkness and overpowered her.

In an information bulletin entitled Schizophrenia, the National Institute of Mental Health(2009) categorizes the symptoms of schizophrenia as “positive symptoms, negative symptoms,and cognitive symptoms” (p. 4). Positive symptoms include “hallucinations, delusions,thought disorders (e.g., disorganized thinking), movement disorders (e.g., repetitive motionsor catatonia)” (pp. 4–5). Negative symptoms include “flat affect, lack of pleasure in everydaylife, lack of ability to begin and sustain planned activities, speaking little—even when forced tointeract” (p. 5). Cognitive symptoms include “poor executive functioning, trouble focusing orpaying attention, problems with working memory” (p. 6).

In a case of Very Early Onset Schizophrenia (VEOS), Turkish researchers Coşkun &Zoroğlu (2008) recorded the rather dramatic behavior of a 5-year-old girl (which to somedegree echoes Tammy’s behavior—although she developed symptoms only at age 18):

The first features to be recognized were talking to herself, alternating crying andlaughing without any reason, having trouble in relations with her brother and anincreased level of hyperactivity. This period lasted for one month. Then shestarted to say “there is a grave,” “my friend died, somebody killed him/her witha knife.” Following this stage, she started to lick her palms and swear frequentlyin an unusual way without any reason. The father hit the girl sometimes due toher excessive talking, hyperactivity and odd behavior during this time. Towardsthe end of the second month, she started to say things like calling to a cat“come pisi pisi and eat grandmother,” “there are bugs coming from your mouth”and “somebody ate my pudding in the kitchen.” She waved her hand in the airas if she was picking or throwing something. She was not sleeping and kepttalking to herself until late hours. She was aggressive towards her toys andbrother. (p. 143)

Whether a 5-year-old girl or a 30-year-old woman, the behavior described above expresses thesense of suffering and dislocation that a schizophrenic experiences on an ongoing basis. Whatmight a pastor or church offer a person whose sufferings are so vivid and overwhelming?

Von Balthasar describes the redemptive mission of Christ as necessarily including theexperience of going down into death:

In order to assume the entire penalty imposed upon sinners, Christ willed notonly to die, but to go down, in his soul, ad infernum. As early as the Fathers ofthe second century, this act of sharing constituted the term and aim of the

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Incarnation. The “terrors of death” into which Jesus himself falls are onlydispelled when the Father raises him again. (p. 164)

Leaving aside the imagery of death and substituting in its place the imagery of mental illness, Iwould propose that Christ intentionally plunges himself into the abyss of mental illness as anact of identification with those who suffer. The “terrors of mental illness” are a type of the“terrors of death” for the person who suffers because all spontaneous activity ceases. Theperson with mental illness is trapped in her own hell, a prisoner of her disease. Christrecognizes the disease apart from the person, affirms the person and identifies with herexistential suffering.

Extending Christ’s ministry to (and through) the church, I would suggest that Christianclergy and congregations do God’s work when they attempt to stand in solidarity with thementally ill people in their midst. To suffer with, bear with, and work with a mentally illparishioner will never be easy. It will be extremely challenging and, at times, frustrating.However, it may be an integral aspect of Christ’s mission in calling the church to his service.

The courage to be a friend

I was recruited by the church as a “change agent.” My tasks were to lead racial integration ofthe church and to reach out to the community. At the time, the church had dwindled down toabout 40 people and was about to close its doors permanently. In a last-ditch effort to save thechurch, the retiring pastor encouraged the elders to recruit a young man who could appeal tothe diverse constituencies in the changing neighborhood. This was the only way, he felt, thatthe church could survive and grow.

When a church is trying to survive, and then push past survival to growth, people likeTammy are inconvenient reminders that the mission of God is not centered on “church-growthstrategies.”As a pastor, my focus was on congregational care before church growth. After all, achurch that could not develop the ability to care was probably a church that people would notwant to belong to in the long run. If we, as a community of faith, could care for Tammy andothers like her, our act of caring would define the type of community that we were in theprocess of becoming. If we discarded people like Tammy for the sake of convenience orchurch growth, we would have to seriously consider whether we were truly participants in themissio Dei.

Tammy was an extremely difficult person to deal with. She repeated the same “prayerrequests” every few minutes, telephoned incessantly, followed people in the church hallwaysto ask for prayer, etc. She was demanding, petulant, and unkempt. It should be noted here thatTammy’s personal hygiene was abysmal. Dry skin hung in big flakes on her face, brow, andhairline. Her unwashed hair was matted down to her scalp, where flakes of dead skin protrudedthrough the greasy morass. Often, her clothes smelled as bad as her breath. Tammy’s presencewas an assault on the senses, compounded by the fact that when she engaged in a conversation,she had the habit of moving her face uncomfortably close to her conversation partner. At timesshe looked emaciated, and I wondered whether she was eating properly. Once when I askedher if she needed help getting food, she assured me she was fine. “Did you have breakfasttoday?” I asked. “Yes,” she replied, “I had tuna fish with ice cream before I came to church.”

It was an age-old practice in this church to have a few moments to “greet one another”during the service. This was done with such enthusiasm that, to this day, I suspect that greetingone another was the real reason that many of the parishioners came to church in the first place.From my vantage point behind the pulpit, I would cringe internally as Tammy would make her

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way to all the visitors, bring her face close to theirs (no doubt with the scent of tuna fish and icecream fresh on her breath), and welcome them to church. The victims of Tammy’s heartyfelicitations were often unsure about what to do next. Often, they would thank her as theywiped their hands on their clothes after the greeting. Rarely would those visitors return for anencore performance.

In Resurrecting the Person, Swinton (2000) reminds us that people with mental illness arejust like other human beings in their existential needs. Although they may be difficult to dealwith, we have to keep in mind that their experiences with mental illness have beendehumanizing. As soon as a person is diagnosed with mental disease, they are no longerhuman. They are the disease. The labels that are attached to them become all-encompassingand overtake their identity as humans. Referring to a statement by John Strauss, professor ofpsychiatry at Yale University, Swinton notes that “when one conceives of an individual whosuffers from a mental health problem, one must think in terms of the individual as a personwho also has a disorder, rather than a person who is a disorder” (p. 137).

From Swinton’s perspective, Christians must never underestimate the importance of friend-ship for people with mental illness. People with mental health problems are often experiencing“hopelessness, worthlessness, and poor self-esteem” (p. 139). If we have the courage to riskfriendship with these suffering people in our midst, we have the opportunity to help them findhope and meaning. Swinton says,

The model of friendship presented in the life and work of Christ offers real possibilitiesfor therapeutic change. Committed friendship that reaches beyond culturally constructedbarriers and false understandings and seeks to ‘resurrect the person’—who has becomeengulfed by their mental health problems—is a powerful form of relationship. It offershope and new possibilities to people with the types of mental health problems that arethe focus of this book. (pp. 138–139)

Friendship as modeled by Christ can enrich and even transform the life experience of atroubled person. Tammy found this type of friendship in our church for a season. She wasaffected and changed by it in significant ways. Her demeanor changed. She was happier,smiled more often, and engaged in small talk (as well as she could) with people who werefamiliar and kind to her. She was less abrasive and, for the most part, less suspicious. As thechurch leaders attempted to show more kindness to Tammy, the parishioners also became moreopen-hearted to her.

It was Tammy’s habit to call the church office every few minutes for prayer, making itimpossible for me to give sustained attention to any task I attempted. After a few weeks of this,I tried to impress on Tammy how her phone calls were preventing me from attending to otherimportant matters. Determined to speak to Tammy as an adult rather than a child (as was thehabit of many others), I attempted to negotiate a “phone call schedule” with her. Although sheinitially resisted my request, eventually she agreed to limit her calls to twice a day (I assuredher that in a crisis, she could call as needed). For the most part Tammy kept her side of thebargain, and I learned that she could be reasoned with. This was a growth opportunity for bothTammy and me. Sometimes Tammy fell back into her old habit of constantly calling at 5-minute intervals, but I soon discovered that these old habits emerged when she was off hermedication. I seized these opportunities to remind Tammy about the importance of taking hermeds, but my reminders annoyed her so much that she would stop calling me for a few days.

When boundaries regarding the frequency of telephone calls were somewhat successfullyestablished, I then negotiated with Tammy about her tendency to call out during the worshipservices. Normally, her comments, complaints, and prayer requests were blurted out before,during, or after worship services and tended to be quite disruptive. In order to make the

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worship experience a bit less jarring for visitors (as well as the more “sensitive” members ofthe congregation), Tammy agreed to do her best to refrain from calling out during congrega-tional gatherings. Also, instead of insisting on having my full attention before and afterservices, which often took the form of interrupting my conversations with other members ofthe church and following me around the building, Tammy agreed to give me a little morefreedom to interact with others. The elders of the church and I promised to pray with her15 minutes before and after each service and, in exchange, asked her to allow us a fewmoments to interact with other parishioners. These arrangements were initially difficult forTammy but eventually became second nature to her. In this way, the church attempted to honorits commitment to minister to Tammy while giving her the opportunity to be a responsiblemember of the faith community.

Unfortunately, in the long run our church failed Tammy. After my term as pastor was over,my successor ordered Tammy to stop attending the church. “You are never to come back hereagain. You are an obstacle to my church growth plans,” he told her. Of course, Tammy did notlisten. She kept coming back to church until she finally realized that she was, indeed, no longerwelcome. In the wake of a church split and the exodus of old friends and supporters, Tammystopped attending the church.

People with mental illness need friends. If we fail at being friends, we fail at being thechurch. Swinton notes:

Friendship is a learned skill. Friendship is the product of an ongoing process ofsocialization that continues throughout the life cycle, within which individuals learnthe rules of communicating and relating and work out the boundaries that encompasstheir encounters. One learns how to develop friendships in the process of encounteringothers in community. (p. 145)

People with mental health problems need friends because they are so often dehumanized bythe health care system and the social systems of the communities they inhabit. The church hasan opportunity to humanize the people with mental illness through genuine, intentionalfriendship. However, such friendship is not for the weak of heart. Friendship requires courage.

The courage to live

While it took a certain amount of courage on our parts to live in community with Tammy, itprobably took more courage on Tammy’s part to live in community with us. I believe thatTammy was a person of great courage who modeled courage for us in three important ways.First, Tammy had the courage to live as a Christian, even though her mind could notovercome the voices that spoke against her faith, her morality, and her salvation.Second, Tammy had the courage to live in community with us. This is important tonote because churches can be dysfunctional at times. Even the “sane” are puzzled bysome of the irrational behavior that takes place in the church. It must have taken agreat deal of courage on Tammy’s part to sit in a church where there were so manyvoices and opinions. Yet she rarely missed a service or function. Third, Tammy hadthe courage to live with mental illness. She had the courage to face the stigma ofbeing labeled as a mental patient. She had the courage to go for treatment, to live onher own, to take her medication, to step outside her house (despite being bullied andpicked on by the neighborhood kids). She had the courage to occupy sacred space, allthe while conveying the sense that she belonged to the church regardless of theclothes she wore, the way she looked, or the way she carried herself.

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To some degree, the identity of people with mental illness are held by those who rememberwho they were (or how they were) before they manifested signs of their illness. In our church,there were some elderly women who remembered Tammy as a child, knew her family, and hadattended her parents’ funerals. They remembered Tammy’s high school graduation party andthe day she first went to college. They remembered Tammy as a bright, fresh-faced teenagerwith a promising future ahead. Their memories of Tammy identified her as more than theunkempt woman with tuna fish and ice cream breath. She was “somebody more” to them. In awider sense, the identity of the mental patient is safeguarded by the entire church community,if the community is willing to accept the individual as she is. In our church, we came to thepoint where we were determined to accept the person who was in our midst. She wasannoying, persistent, had poor hygiene, heard the voices of demons, spoke out loud atinappropriate times during the worship service, and scared visitors. But we received Tammyas a sister in Christ. As the body of Christ, the members of the church related to her as aChristian woman, as a creation of God, as a person of intrinsic worth. Together, we shared thelife of Christ in the bread and wine of the Holy Communion.

In The Courage to Be, Tillich (1952) expresses a complicated dialectic involved in beingand non-being. Although there is a marked difference between being as a “part of” and beingas “oneself,” both carry certain dangers:

We are threatened not only with losing our individual selves but also with losingparticipation in our world. Therefore self-affirmation as a part requires courage as muchas does self-affirmation as oneself. It is one courage which takes a double threat ofnonbeing into itself. The courage to be is essentially always the courage to be as a partand the courage to be as oneself, in interdependence. (pp. 89–90)

For the schizophrenic, to participate in the community—to be “part of”—requires tremendouscourage. Simultaneously, it also requires great courage to be “oneself” within that community.In our community, those who remembered what Tammy was like before she became sick had abifurcated view of her: the bright girl of the past and the troubled woman of the present.Despite the loss of her previous identity as a bright college student, Tammy chose to stay in thecommunity and participate because it strengthened her sense of self.

It is possible to participate in community and lose one’s sense of being and identity. Thishappens all too often when people join a club or try to fit into a clique. However, within ourcommunity of faith Tammy was accepted as the person she was at that particular period of herlife. Although some among us had an image of Tammy derived from the past, she was notasked to be that person anymore. The community did not want to modify her personality to itsdesires or memories.

Tammy had the courage to be “as a part” and also the courage to be as “herself”. As a part,she participated in the life of the community. As herself, she played by her own rules. It isimportant to note that, despite her limitations, Tammy was interested in forming and main-taining social relationships with others. She was also interested in belonging to a faithcommunity. In The Complete Family Guide to Schizophrenia, the authors offer the followingadvice on “The Power of Love” to the relatives of schizophrenics:

Your relationship with your relative is the single most valuable asset for helping yourloved one get closer to others. Having people in one’s life and enjoying closeness withothers, including intimate relationships, is an important part of what makes life worthliving. Because of your special relationship, you are in a unique position to help yourrelative articulate and pursue his interpersonal goals. By loving and supporting yourrelative, you convey that he has worth and something to contribute to others. Feeling

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close and loved by another sets the stage for being able to connect with and love others.Through your love and help, your relative can learn how to get closer to other people aswell. (Mueser & Gingerich 2006, pp. 390–391)

The authors point out that social relationships are necessary for those who suffer withschizophrenia but they need help in developing those relationships. Particularly, they needhelp developing the social skills that will enable them to initiate and sustain relationships.

Tammy not only had the courage to live with mental illness, she also had the courage tobear the weight of its stigmatization. Furthermore, she had the courage to foster socialrelationships, despite her limited emotional and psychological resources. I believe that faithwas at the core of her courage to live. Without faith, Tammy could not be true to herself or be aperson who could belong to a community. Tillich states:

Certainly there is faith in the elevation of the soul above the finite to the infinite, leadingto its union with the ground of being. But more than this is included in the concept offaith. And there is faith in the personal encounter with the personal God. But more thanthis is included in the concept of faith. Faith is the state of being grasped by the power ofbeing itself. The courage to be is an expression of faith and what “faith” means must beunderstood through the courage to be. (p. 172)

It is difficult to imagine what Tammy’s concept of God might have been. I am fairly sure thatshe did not differentiate between the God that she knew through personal encounter andexperience versus the God beyond personal faith, the ground of being. However, at someprimal level, she connected with that divine being, and this connection enabled her to live inthe moment, despite the numerous challenges to her existence. All in all, Tammy had thecourage to live with mental illness. She had the courage to be.

Conclusion

Clergy and other church leaders are not psychiatrists, psychologists, or case workers. Theirhope is simply to participate in the “care of souls.” However, as I mentioned at the outset ofthis paper, Anton Boisen believed that clergy are always concerned with “problems relating tomental health.” If there is an epidemic of mental illness in the United States, we can be surethat people with mental illness are present in our congregations, and churches have theresponsibility to provide pastoral care for them. This is not a type of care that can be providedby the mental health or medical community. Pastoral care matters, and pastoral caregivers havesomething to offer the person experiencing “problems relating to mental health.”

Perhaps becausementally ill people experience the divine in a way that might be different fromothers, they are often attracted to religious environments. This was certainly true in Tammy’s case.In serving as a pastoral caregiver to Tammy and other mentally ill people in my congregation, Ilearned that the church has much to offer those who suffer in this particular way. I learned thatmentally ill people in the church are not necessarily a problem to be addressed or an embarrass-ment to be silenced or hidden away. They are present in our midst because they desire to seekGodand because God has led them to worship in our particular community of faith. When given thechoice between rejecting them or affirming them, we should seize the opportunity to stand insolidarity with them. Such a welcoming attitude may negatively affect our church growth plans,but it goes a longway towards developing the identity and character of the church as a communityof friends. A church that can stand in solidarity with and offer friendship to those who suffer is achurch worthy of the title “Christian.”

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I learned that people with mental illness have much to offer the church. Tammy taught methings about God, faith, and religion that have shaped my thinking in important ways. Ilearned, for example, that my concept of God was too narrow, that God’s ways are beyondhuman logic and rational thinking. I learned that, while sola fide has been an essential aspect ofProtestant religion, faith does not always follow carefully systematized creedal forms. Faith issomething primal in the human heart, and it erupts in ways that we cannot fully understand.The Cartesian God who stands behind logical thought systems is also a wild, messy God whoinspires the cacophony of other tongues, ecstatic dance, and sometimes the seemingly inanebanter of the schizophrenic. I learned that ministry is sometimes sensible, follows clearliturgical order, and fills the sanctuary with the fragrance of sacred flames and frankincense.But sometimes ministry is messy as disruptive people call out in the middle of worship serviceand the sanctuary is filled with smells that are offensive to the senses. While we may prefer aclean, orderly, and fragrant ministry, the ministry we are given is sometimes unclean, disor-derly, and pungent.

I learned that people with mental illness often have a great deal more courage than I do. Ittakes courage for a person who is struggling with depression, bipolar disorder, schizophrenia,or any other such disease to leave the house in the morning. It takes courage to makeappointments with the psychiatrist, to take medications that may cause drowsiness and renderone ineffective for much of the day. It takes courage to continue living when it seems that thereis no experience valuable enough to live for. In the context of the church, it takes courage to sitwith people who do not understand you and sometimes react badly to your presence in theirmidst. It takes courage to answer their questions and face their looks of derision, sympathy, orfear on any given Sunday.

As complicated as community is at times, there is no way to discount its importance insustaining troubled people. In considering the importance of a supportive community, I thinkparticularly of the stories of the Clinical Pastoral Education pioneer Anton Boisen and themathematician John Nash. For Boisen, the friendship and encouragement he received fromFred Eastman were essential in sustaining him through troubled times. He also received thesupport and encouragement of many others—Richard Cabot, Macfie Campbell, WilliamMcDougal, and Elwood Worcester. “With their help he prepared himself for a ministry tothe mentally ill and, at the same time, for further research which would be foundational for themore effective training of future ministers” (Eastman 1992, p. 132). Similarly, John Nash wasthe beneficiary of an incredible amount of support from his wife Alicia and a circle of friendsin the academic community. In the American Experience episode entitled “A BrilliantMadness,” his biographer, Sylvia Nasar, pointed out that his acceptance by friends made animportant difference in Nash’s life. According to Nasar, “The fact that people did not abandonhim, that there were people who treated him like a human being, made it possible for him to re-emerge” (Samuels & MacLowry 2002).

The mathematician Harold Kuhn once asked Nash, “John, how the devil have yourecovered?” Nash responded, “I willed it. I decided I was going to think rationally”(Samuels & MacLowry 2002). Perhaps the church’s ministry to people with mental illnessis partially oriented around helping them to cultivate rational thoughts. From one perspective,it could be said that the church has its own share of “crazy talk.” Ministers regularly preachabout God sending the Son to die a bloody death on the cross, the resurrection of Jesus fromthe dead, or tongues of fire appearing over the apostles on the day of Pentecost. Every week wejoin together to “eat the body” and “drink the blood” of the Lord. As odd as it all is, perhaps inthese retellings and reenactments (which matter so much to our communities of faith) we areactually offering mentally ill people a spiritual haven, a place where illogical thought is notnecessarily crazy talk. Perhaps in retelling our faith stories we are actually participating in the

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ministry of cultivating rational thoughts. It is possible that, through our doctrines, solidarity,and friendship, we are enabling people—at some primal, mysterious, mystical level—tocultivate thoughts that strengthen the inner being and renew hope and vigor. If so, we aretruly doing the work of God in ministering to people with mental illness.

References

Boisen, A. (1992). The minister as counselor. In G. Asquith (Ed.), Vision from a little known country: A Boisenreader (pp. 97–107). Decatur: Journal of Pastoral Care Publications.

Coşkun, M., & Zoroğlu, S. (2008). Very early onset schizophrenia: a case study. Archives of Neuropsychiatry, 45,142–145.

Eastman, F. (1992). Father of the clinical pastoral movement. In G. Asquith (Ed.), Vision from a little knowncountry: A Boisen reader (pp. 131–136). Decatur: Journal of Pastoral Care Publications.

Greene-McCreight, K. (2006). Darkness is my only companion. Grand Rapids: Brazos Press.Mueser, K. T., & Gingerich, S. (2006). The complete family guide to schizophrenia. New York: Guilford Press.National Institute of Mental Health. (2009). Schizophrenia. Washington, DC: National Institute of Mental Health.Samuels, M., & MacLowry, R. (Writers), & Samuels, M. (Director). (28 April 2002). A brilliant madness

[television series episode]. In R. MacLowry (Producer), American experience. Boston: PBS/WGBH Boston.Swinton, J. (2000). Resurrecting the person. Nashville: Abingdon Press.Tillich, P. (1952). The courage to be. New Haven: Yale University Press.Torrey, E. F., & Miller, J. (2001). The invisible plague: The rise of mental illness from 1750 to the present. New

Brunswick, NJ: Rutgers University Press.von Balthasar, H. U. (2005). Mysterium paschale. San Francisco: Ignatius Press.

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