Ep. 085: A Christian Perspective on Mental Health

Read It

*Below is an edited transcription of the audio conversation.

With me today is Christian counselor and author Brad Hambrick. Brad serves as the pastor of counseling at the Summit Church in North Carolina. He’s an instructor of biblical counseling at Southeastern Baptist Theological Seminary, and he’s also a council member of the Biblical Counseling Coalition, so lots of counseling. Thanks for being here today, Brad.

It’s great to be with you. Thank you for the invitation.

You know, as we do with every single one of our guests, it just really helps kinda paint a picture of the voice. If you want to, it would be great to hear how you met Jesus, and also, what your day-to-day life looks like right now.

I came to faith at a small country church in the rural Midwest, Kentucky. I grew up on a corn and soybean row cropping farm, and came to faith under the faithful preaching and teaching in about a 150-200 member church, was nurtured in my faith by the same Sunday school teacher from the age of third grade through eleventh grade, as there were five or six of us. That was the totality of the youth group at our church, who were invited into the home, and played with, and taught the Scriptures there, in that area.

At this juncture in my life, I have two boys of my own, who are ten and thirteen. My wife Sally and I are having a blast, and this is that season of life when school, and different sports leagues, and hobbies, and the kids still want to play and have you be a part of most things that they’re a part of. And so that fills most of our days, and it really is a joy.

That’s awesome. Do you have any enjoyable hobbies that you do?

Well, right now, I’m coaching my boys’ sports teams, which happens to be baseball for each of them. A couple years ago, my youngest informed me that it was his goal that we run a marathon together before he graduates high school. And so, while I don’t enjoy running, I do love my son. And I love my son more than I dislike running, and so we are currently at the half marathon stage of training.

Oh my goodness. That is … Much respect to you. Anyways, thanks for just saying that. That’s good to let us know you a little bit.

Anyways, I guess the first and the basic question is simply this. What is mental illness? I feel like we talk about it, mental health, mental illness, but no one really knows what they’re saying sometimes, at least for me. We use the word, but it’s like what am I actually saying when I talk about mental illness? So yeah. What is mental illness?

I think one of the difficulties is the term is used to describe so many different things. And even when we narrow it down to a particular life struggle, say depression or anxiety, even there the word can have such a breadth of meaning, that these are the kinds of words that I often say, they’re words like “dog.” And the word “dog” can mean everything from poodle, which is a cat that barks, to great dane, which is a horse that people invite to live in their house.

And they’re all “dog,” but they’re very, very different, the temperament, the personality, degree of aggressiveness. All of those things are gonna be there. So when we start to ask the question, what is mental illness, I think it might be more accurate to say, what kinds of struggles fall under the category of mental illness. And so some guiding ideas that I would put out there.

Mental illness is a life struggle that is, to some degree, common to all people.

And so, we all experience depression, and every time I forget to set my alarm clock, I am OCD the next two weeks about making sure that I’ve done it, and my mind just can’t rest.

And so the kinds of things that fall under this are the things that we all struggle with. Now, they do tend to hit a degree of significance or persistence. The degree to which it’s impacting my life, or the duration of time, where we say, okay, this is moving from a garden variety, common to all people, where the passing of time is just gonna make it go away, or it’s not really worth our intention, to where now this merits more of our attention.

Now, mental illness, the kinds of things that fit in that basket, they can be caused by our physical body; whether that’s brain chemistry, habituated neural pathways, genetics, glandular system. It can be environmental causes; trauma, poor socialization, abusive or neglectful home life. Or personal choices; the consequences of sinful or foolish decisions, on a spectrum from an isolated bad choice with major implications, to addiction. And so oftentimes, in these kinds of debates, I hear people wanting to narrow it to one sphere. Is it brain chemistry? Is it environment? Is it choice? Well, with the breadth of things that can fall under the category of mental illness, I think the best answer to that is yes. And over time, usually all of those things begin to get involved.

And so the question is both one of causation, where did this have its origin?, and intervention, which sphere would be most helpful, given this individual, that we can begin to engage in the most fruitful ministry? And that’s something that is going to be much more a case by case, person by person assessment, than it is a universal, “This is what you need to do,” in all cases of something that might be called mental illness.

Right. So you mentioned anxiety. You mentioned depression. What other manifestations of mental illness are there then?

Right. And it can really cover the spectrum. Attention deficit, the child who isn’t just misbehaved or poorly disciplined, but really struggles to pay attention in the classroom. Then you have things such as Asperger’s and the autistic spectrum, where some of us, we get relationships more than others. But there can be a significant deficit in somebody’s aptitude to pick up on emotional cues and relational cues. There can be things in the reality testing domain, where it is difficult to tell that passing thought that runs through my head, that’s just a crazy thought, and then know I have a hard time distinguishing that from reality.

You can get in the domain of OCD and addiction. That’s a bit of a cross section of the kinds of things that culturally, we say the best rubric we have right now for understanding this is mental illness.

That’s helpful. So Brad, in your experience though, why is mental illness such a taboo topic? Why are so many people afraid of engaging it, especially Christians, it seems like?What are your thoughts on that?

Yeah. And I’ll try to address that from two angles. One is the cultural angle, and one is the Christian angle.

Culturally, I think one of the things is when we hear mental illness, we often have the kind of fear that happens when somebody gets told that they’re experiencing Alzheimer’s, and we think, “Oh no. I can no longer trust that little voice in my head that runs all my life, because it’s glitching.” And the thought that if I struggle, this means I’m crazy.

That, and that kind of stigma, and that kind of fear … That’s why, where I started in defining it, anything that meets the criteria of mental illness is the kind of thing that we all struggle with. And so it’s just a matter of the depth of the struggle, the duration of the struggle, and so with most things that fit in this category, whether it is behavioral, relational, medical, there are interventions that can significantly diminish the impact that that is having.

Now, on the Christian side of the spectrum. I think that’s just kind of a general population of which Christians would be a part.

When we move to the subset of the population that is Christian, then I think oftentimes because the line between mental illness and morality is not clear, and we’re a culture that highly values character.

On the one hand, we don’t want to abdicate responsibility for anything that we’re responsible for, because if it’s a moral infraction, we have a remedy for that, and that is Christ and His death, burial, resurrection, the forgiveness that He authored. And anything that we can apply that remedy to, we want to do that.

We want to have a high view of God’s power, and presence, and willingness to intervene, and so somehow we think if we say, “Oh, I’ve got a struggle in an area that would be considered mental illness,” then this is somehow I’m saying God doesn’t apply to that.

And that can be a very false dichotomy. It has to be all of one, or none of the other.

And it can’t be the thinking patterns that I get into when I am highly anxious. Those are some things where a good, skill-based training on mental hygiene would serve me well, and I want to utilize those, in faith that God is going to use that as part of how He sanctifies me in my day-to-day life, and learning to manage my emotional world better.

Yeah. That’s good. Do we see, Brad, mental illness in the bible? Does the Lord address it in His word in some sense?

Well, again, if we say mental illness is as broad as every human experience, and that we are fallen, broken people, and none of us are operating normally (normal is between pre Genesis 3 and Heaven), everything in between there is broken. So in that sense, yes, we see it.

I’ll give an example, that I think has merit, but makes a lot of people uncomfortable.

I’ll take your question, and I’ll up the ante just a touch. Let’s ask the question,

did Jesus experience mental illness? Did Jesus ever get to a point when His emotions were so overwhelming that they began to change the way His body functioned? I would say yes.

Gethsemane, when the weight of what He was getting ready to experience was so overwhelming, and the change of what was going to be there, and His relationship with the Father, His level of anxiety became so great that He sweat drops of blood.

At that point, His emotions, they did not impair His ability to make moral choices – He still honoured God in every way.

But if He went to His psychiatrist and said, “I am so stressed out that my sweat looks red.” They could’ve given Him a diagnostic for that. And here’s the value of that. It’s not a shock value kind of thing. It’s that our Saviour, who was tempted in every way as we were, and was yet without sin, experienced that kind of overwhelming emotional moment. And it means even when we come to these things that are that overwhelming, it doesn’t make them less painful. It doesn’t mean that we shouldn’t look for ways to alleviate that suffering.

But it does mean, even in the midst of that kind of mental anguish, we can honour God.

So for the person who looks at me and says, “I experience bipolar, and there’s times when I don’t sleep for days, and my thoughts are racing, and in the moment, I have a hard time telling that they’re grandiose, but when I look back at the choices that I made. Even in the midst of that, there may be some things I need to do medically, and life choices, and that kind of thing, that will help alleviate that. But in that moment, I don’t have to be non-manic to honour God, that it’s in that context that if I steward that moment well, then I don’t have to be at a normal energy range in order for my life to honour God.

“And that’s where … You can see I’m kinda breathing a sigh of relief now, like I’m not sure what this means, and what it looks like, but you’ve given me hope as a believer, that this thing that I have very minimal direct control over … How much can I impact when my body goes into this manic episode, yet I don’t have to not do that.”

That’s so good. So pretty much, in general, you’re saying you can struggle with mental illness, even in the worst cases of that, and still honor God, because we see that in Jesus, especially in the Garden of Gethsemane? That’s actually really helpful. It’s freeing in a sense, so I’m glad that you say that.

I know this next question, Brad, is way larger than our time allows. I think every single one of these questions are, but anyways, maybe just on a very basic, surface level, how should we, as Christians, consider medicine, when it comes to mental health?

The short simple answer is: one potential tool in our toolbox.

Overcoming a life struggle, with or without medicine, has no impact on our degree of faith or non-faith.

So I think all of life can be explained by Little League athletics. That is not biased as a sports coach. And I can tell you when I played, and I had an injury, I did not want to take an aspirin or a Tylenol, or anything like that, because I thought it was more noble to play with pain than not.

And that was just a false sense of bravado. And so, whatever decision that we make, it is about a goodness of fit. One of the things that I’ll send, that you can link with this podcast, is something that I wrote up. It’s just sort of a six step progression for understanding the wise use of psychotropic medications, because the short version of what I’m wanting to prevent with that is: If somebody’s in a crisis situation, you don’t need to go through six steps. You need to alleviate the crisis. But if you’re at a spot where you can tell, this is mounting, and I’m trying to decide if this is a good fit, too often people may initially experience shame when they think about medication, which means they keep it a secret. When they keep it a secret, they feel bad about it. They get just enough relief from the medication, if it’s effective, that life is better, but they feel bad about life feeling better, so then they get tired of feeling bad while they’re feeling better, so they go off their medication quickly. That’s a big no-no.

Well then, they go off their medication and the side effects of coming off of the medication quickly then impact them, and their life situation gets worse, and they take that to mean, “See I need medication for the rest of my life.” And then all of life gets interpreted by “How is my medication working?” So then after that, if they’re having a bad day, “Well, I need to go get a medication adjustment.” That may be the case, because our bodies do change over time. I just turned 40. I’m a living testimony to that. But, it may also be that our life context, a change in our schedule, stress. And it may be that we need to manage something in life. So with those six steps, I just want people to have a good baseline.

I want them to look at what other interventions are possible, so that when they begin to take medication, if that’s a choice that they make, they can weigh the benefits that they get from that against whatever side effects that they feel, and they can have an intelligent conversation with their general practitioner or psychiatrist about whether this was a short term intervention, to gain more traction in an area of life, and that once they get that better, or under control, then general life management can accomplish what we want. Or whether this is something that’s a good long-term intervention, and it’s one of those things that just helps me manage life well, and experience more of the life, and have the kind of impact through my life that God designed for me to have, when He made me.

That’s good. That’s really good. But what would you say to Christians who almost look down on other Christians who say that they take medication for, say, their depression or what have you? What would you counsel to Christians that look down, have a sense of superiority, to that?

I think often in that kind of situation we take our life experience, and we say, “I’ve had some rough emotions. I’ve struggled with things like what you’re telling me. I didn’t need medication for that. You shouldn’t need medication for that.”

And it assumes my experience as the baseline for your experience.

And so, the question, again in my opinion, is not whether we take medication or not.

It’s whether we are stewarding all of our life, for the glory of God, to make the impact that He designed us for, before the foundations of the world, when He had good words that we were going to do and walk in them.

And so, if somebody says, on a scale of one to ten, my anxiety sits at a six, which means a little bit of a bad day takes me to a seven or eight, and the medication gets me down to a three or four, so that I am managing life better. And we look at our friend, and we go, “Yeah. They’re engaging their family well, and their workplace, and they’re productive. They’re not making excuses for other things that they are or are not doing.” Then medication shouldn’t be the big deal.

Because this is somebody who is stewarding their life well. If, on the other hand, somebody’s making excuses, and they’re not engaging certain spots, then the issue is still not medication. The issue is life stewardship.

And we’re coming to that person and saying, “Hey, I feel like there’s some things that you need to own a little more, or you’ve got these gifts or this amount of time that is not being stewarded well. And as a brother or sister in Christ, I’d love to come alongside of you and at least engage that, because from where I’m sitting, I would love to see you have more of an impact for God’s kingdom.”

In neither case are we, as a layperson, and even myself as a pastoral counselor, I don’t advise on medication. I don’t have the credentials to do that.

If it’s helpful or not, I say, “Hey, you should talk to your general practitioner. You should talk to your psychiatrist.” But the conversations that I have are discipleship conversations, with a counseling bent.

And most of us in a church context, those are the conversations we’re gonna be having.

Yeah. That’s good. Our last question here, before we wrap up this first conversation. What’s the best way, I guess, for someone listening, and they want to learn more about mental illness, mental health, in more of a Christian, biblical way – what’s the best way they can start to learn this stuff better?

My initial thought there is

we never talk to a subject. We only talk to a person.

So I never talk to mental illness. I never talk to depression. I never talk to anxiety, or bipolar. I talk to a person. And so the context for most of us, in the local church, where we’re doing one another ministry, is going to be a friend. So I think the first step that we take is just to get to know our friend better. And when they say, “I struggle with X,” and X is something that fits in the basket of mental illness, then I want to balance getting to know my friend, and as much as I can about their area of struggle.

And one of the things that I’ve tried to do, at the site that I run, is to keep it topically indexed to where if X is an eating disorder, then somebody can come, and they can link, and here is a series of resources that the stuff that I’ve done is going to be coming from a Christian perspective. It’s going to allude to some of the secular best practice research. There’s going to be some book recommendations there. And to try to give somebody a resource where I’m not reducing you to a struggle.

Which is one of the real dangers on both sides of the cultural and Christian part of the conversation.

We tend to put whatever the X of mental illness is, and we place an “I am” in front of it. I am bipolar. I am anorexic, as opposed to my identity is who God made me to be, and I have a particular struggle.

“I’m a Christian who struggles with depression.” “I’m a Christian who struggles with anxiety.” And so one of the ways that, as a friend, when we’re coming alongside, getting to know this, we get to know them as a person, and we never allow their life struggle to become the forefront matter of our conversations.

Always our friend.

We’re more than happy to talk about their struggle. And we honor them in that kind of one another relationship, where it’s kind of a two way mutual care. We let them care for us in some ways, and oftentimes, when any emotional struggle, when we think about anger, depression, anxiety, when we struggle with those emotions, who is the person that we think about more than anybody else? It’s ourselves.

So when we get into that, our thinking kinda spirals in on itself. So when we are in a context where our friend is still enjoying life, with their interest and hobbies, and we allow them to pray for and support us in some things, those are ways that we’re helping them stay outside of that experience, and then we’re also learning about whatever that struggle is.

And we don’t assume we’re an expert on the struggle. We do want to be an increasing expert on our friend, and knowing about their experience of that struggle.

That’s so good. Brad, thank you so much for spending this time with me. If you’re listening right now, and you want to know more, Brad’s website is simply his name, BradHambrick.com. I’ll link that to the episode page as well. There, you can find much more material from him, including the topics, and all those different things, like he was just saying.

Thanks Brad, and I look forward to talking with you again next week.

Wonderful. Looking forward to it.