June 24, 2013

Interesting article from the New Scientist:

In a global study published last year, we showed that 79 per cent of people with depression had experienced discrimination in the previous year (The Lancet, DOI: 10.1016/s0140-6736(12)61379-8). More than 1000 people were interviewed across 35 countries, and a remarkably consistent picture emerged: such experiences are common and may severely limit how far people with mental illness can lead normal lives. Almost a quarter, for example, said they had been unfairly rejected when applying for jobs. Intriguingly, these figures are very similar to the findings of a previous international study that we had conducted, focusing on people with schizophrenia. . . more than a third of participants had not started a new relationship because they expected it to fail as a result of discrimination. For the same reason, 71 per cent said that they wished to conceal their diagnosis of depression from others . . . Those with mental illness are constantly confronted with this dilemma of keeping quiet or opening up.

READ MORE: The mental illness taboo is a problem for all of us – opinion – 20 June 2013 – New Scientist.

June 18, 2013

I am in the middle of one of my long blog series.  Today there is a significant change in what I am addressing, however.  So far, I have essentially been saying “mental illnesses are real, you should not be afraid to seek medical help,” from today I will be arguing for the other side of the same coin, “the Bible has a lot to say that is relevant for those with mental illnesses, and can help all of us live a more mentally healthy life.

There are some who advocate strongly for a purely biological view of mental illnesses and essentially wash their hands of church members after referring them for expert help.  Others feel that the only valid form of counseling is done by secular professionals outside the church and put their trust in that.  A third group are probably quite annoyed with me so far: they would say that the Bible is entirely sufficient on its own to treat all conditions that are called mental illnesses.

I say that all three groups are wrong.

One thing I should be clear about, however, is that I am not really advocating what some would call an “integrationalist” approach.  I am not convinced that what is always needed is a form of counseling that combines secular and biblical approaches, although I am sure that is helpful at times.

Rather, I am saying, Church, be the Church and offer help that comes from the Bible and at the same time encourage people to get the complementary help they can only get from mental health professionals.

If you have access to trained professionals who are also Christians, wonderful.  If you feel called to develop and offer an “integrated approach,” fantastic.  But the needs are too great for us to wait till there are enough double-trained people. And the problems are too acute for us to assume that a church member can easily be trained in a Christian context to the level that secular counselors and psychiatrists are.

Why can’t we work together with secular services, each playing to our strengths?  I do hope over time some genuinely integrated approaches will emerge.  Lets not be so proud as to assume that we can convert our people, or even our pastors into psychiatrists overnight, nor should we even try.  Often people with very limited knowledge of mental illness can do a lot of harm if they stray from the one area where we have a good authority base.  What is that area? Well it is the Bible, and everything it has to say.

Long-time readers of this blog will know that I don’t follow the usual advice which is to make your blog very focused on a specific subject and grow a “niche” brand.  I haven’t tended to do that, but I have often focused on a subject for an extended period before moving on to another one.  (If you want to read about another subject than perhaps search my site in the sidebar for what I’ve said before or look at the menu above.)

If I was to develop a “tight brand” in my case, I suppose I would be a British Christian,  doctor, psychiatrist, medical researcher, church leader, author, long-time blogger, twitter enthusiast, evangelical, debator, champion of conservative theology, believer in hell, and penal substitution, moderate calvinist, charismatic, soft complementarian, enjoyer of modern worship, advocate of churches that are multicultural and unafraid to grow (in some cases very large), cheerleader for both multi-site churches, and traditional church plants, multi-faith dialoguer, sci-fi and action moviegoer, and Formula One fan. 

If all those things apply to you, welcome, if I put everyone who isn’t then you will probably be my only reader moving forward!  My approach, is not to just focus on one of these things, or my unique so-called “brand” but rather to blog about whatever interests me.  So the focus on psychiatry will remain for a while yet, but eventually I will no doubt shift my gaze onto something else, but even then, I will no doubt now and then come back to my passion for what has after all paid my bills for my entire adult life.

As I was saying, today marks a bit of a change of course, but don’t miss the fact that everything else I have written so far on mental health has been an important foundation on which we are now going to build.

There are two equal and opposite errors we fall into.  One is to assume that psychiatrists and therapists have nothing to offer the believer.  The second assumes that the Bible has nothing to offer the mentally ill.  Both these assumptions are really untrue and can paralyze us and prevent us from caring pastorally for the many that suffer with mental illnesses.  Frankly you don’t even have to actually have a diagnosed mental illness to struggle with sorrow, anxiety, and lack of hope.  It is the Bible that holds out the ultimate answer to all these ubiquitous problems facing mankind, even though our experience of them is often intensified by genuinely biological factors.

And so, I have previously clearly argued that Christians can and do get depressed, that we should seek medical help, medication, and even secular counseling at times. In summary we must adopt a “Four Pillar” approach to mental health.  I am now going to focus the rest of the series on what the Bible has to say to help all of us be more mentally healthy.  I look forward to sharing more of all this in the coming weeks.

May 24, 2013

Today I post the last question in our conversation on mental health.  You will be able to read the answers to the first two questions in the following posts (I have not yet had a chance to collate the replies to the second one). You can also watch the recording of our video conversation with author Amy Simpson.

You can still submit an answer to any of the questions by linking your post to the relevant article and writing a comment there.

Question 1: How has faith shaped our view of mental illness?

Question 2: Suicide and Religious Faith

This week’s question:


How do you think that faith communities and society as a whole can better respond to mental illness?

May 15, 2013

As part of our ongoing conversation about Mental Illness, I hosted a video discussion right here on the blog. You can watch it above or on the YouTube page.

Participating in the conversation was myself, Amy Simpson who is the author of Troubled Minds, and Patheos editors Timothy Dalrymple & Deborah Arca.

One subject that we address in the conversation is more fully discussed in my post: Can a Christian get depressed?

You can also join a written conversation on faith and mental illness, by posting a reply to one of the questions below:

May 11, 2013

The folks here at Patheos asked me to host a broad conversation about mental illness which is inspired by the release of Amy Simpson’s book Troubled Minds. You can also read and reply to the second question which addresses suicide.

In this post I will share some quotes and excerpts from the first week’s question which was really two questions:

How has your religious community historically seen mental illness? – And how does your faith, today, shape the way you see mental illness?

First, let me share some of my own perspective on this. I believe that Christianity has historically a mixed report card on this subject. Fundamentally our faith has always valued people as inherently of worth because all of them were made in the image of God. Thus, when practiced correctly our faith should lead to compassionate care for the weak. Jesus said “Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me” (Matthew 25:31-41). Therefore throughout church history there have been good examples of Christians who have been inspired to care for the vulnerable, including the mentally ill. Some of the impulse behind the good aspects of the Asylum movement was definitely the Christian faith. We can follow in the footsteps of the best of that sentiment today by being willing as a starter to be on the look-out for mental illness, and not be afraid to ask people about suicidal thoughts.

But there has also been another side. Like all people Christians have struggled to understand mental illness. It is striking that the most popular post to date on my site was entitled “Can a Christian get depressed?” Many Christians are aware how their own faith has helped them feel peace, as well as joy, and hope. When we see a person with mental illness we can be tempted to say something like “pull yourself out of it!” Of course in some milder cases there are things that we can do to counter our emotions. But the more depression gets a grip, the less able people are to lift their mood in any way. Encouragement and regular pastoral counseling does have a role, but the more severe a mental illness is the more it may need to be supplemented by medical help. Psychological and spiritual exercises are not sufficient on their own to treat much mental illness.

Because Christians recognize that peace, joy, and hope are fruits of the Holy Spirit’s activity in them, another response to mental illness has been to want to pray for the person. This can of course be helpful. But, it is important that Christians grasp that we should no more rely on prayer alone for treating mental illness than for say cancer treatment. Asking doctors for help does not indicate a lack of faith.

Finally, there has been a tendency to blame demon possession for all mental illness in some circles. This is unfortunate, and does not in any case reflect the Scriptures where demonization can cause a raft of different physical symptoms, including deafness and muteness. Nobody today believes that all deafness and muteness is caused by a demon. So we should not make the same mistake about mental illness. There is so much more I could say about this subject, but it is time to turn to the posts of others.

It is not too late for you to add your contribution, please link to it in the comment section here, and link back to this post in your article to help us track your replies. The second question will be posted on Monday.

Patheos Contributions

  • Joanne Portland of the Catholic channel wrote of her own experience, “That morning in April, I’d casually mentioned in a Facebook message to my best Episcopal friend that I didn’t want to be alive. Friend that she is, she saw right through the casual and recognized that this was more than just my usual blue mood. She called our Episcopal rector, who, after asking me where God was in all of this and hearing me respond “Nowhere,” bundled me off to the emergency room of the local hospital where he was a board member. He and my friend were upbeat and supportive, until they heard me tell the intake nurse that I did indeed have a plan for hurting myself. That shocked them, almost as much as it shocked me to hear it coming out of my mouth; I was so deep in the abyss of depressive apathy that I couldn’t manage to reassure them with a reminder of how terrible I am at following through on plans, even on the best day.”
  • What She Read writes, “So what can we do this week? If you’re like me, you usually steer clear because you’re afraid of becoming entangled. Mental illness is messy. Who needs a meal? Who needs to go out for coffee? Whose child needs a ride to soccer, or baseball, or ballet? Who looks lonely? Could there be more to their story? Should we ditch that “I just don’t connect with her” excuse?”
  • French Revolution quotes another author’s personal experience, “As we experience our rapid descents, how many of us reach out for anything we can grab to break our fall? To escape the pain. To find a way to numb out. We don’t believe God will actually rescue. So we sidestep. We look for a shortcut. Any way out. Because it hurts too much, and it has gone on for far too long. We are weary. Frankly, we are angry that it has gotten this hard. We’ve complained so long, even we are sick of hearing ourselves, never mind the effect it’s having on those around us.”
  • Muslimah next door wrote “Recently, at the first meeting of a support group for Muslim families with special needs organized by SMILE for Charity in New Jersey, parents of children with autism, Down Syndrome and other special needs broke down in tears as they shared stories: Stories where Muslims asked them what sin they must’ve have committed to be punished by Allah with a special needs child.”
  • Alt Muslim described the same meeting, “As I looked around the room I felt a wide range of raw emotions emanating from the group. Emotions usually kept hidden, but on this occasion, that was not necessary.I saw hope. Despair. Worry. Agitation. Empathy. Concern. Happiness. But most importantly, I saw love.”
  • God and the Machine wrote, “When your child has cancer, the course of action is self-evident. Tests, doctors, treatment, nurturing, healing, fighting. When your child has a sick mind, it’s much harder for a family to come to grips with how–and in many cases if–to proceed. And, as with cancer, the treatment might not succeed. Mental illness is both biological and psychological. Both aspects need to be treated, and you need to deal with the brain chemistry before you can hope to work on the psychological elements. Finding the right combination of meds isn’t an exact science. It’s just trial and error, usually over a grueling period of time that can grind down the patient.”
  • Frank Viola said, “In answer to the question, as a person who believes the Bible, humans are tripartite. We are spirit, soul, and body. The soul makes up mind, will, and emotion. All of these parts are connected.In addition, the brain is an organ just like the thyroid, the heart, and any other organ that can become imbalanced. I also believe in the invisible realm, where God, angels, and demons exist and operate on earth.” Frank also pointed to his post 3 Christian Responses to Mental Illness

More contributions from around the web:

  • Joe Padilla of the Grace Alliance notes that when dealing with mentally ill individuals sometimes “pastoral staff members grow frustrated when they don’t understand why their ministry methods are not working. In response, they unknowingly go into “religious default” mode, which places the blame on the individual.”
  • Stephen Grcevich, MD of Key Ministry writes “the church has made MUCH more progress in recognizing the signs of mental illness in adults and providing appropriate support than it has for children or teens. Mental illness in kids often manifests with anger, moodiness, irritability, aggression, defiance, and difficulties with self-regulation of emotion and behavior. It’s much more common in my experience for the signs of mental illness to be dismissed as a parenting problem as opposed to a spiritual problem.
  • David Murray takes a look at how the Puritans were much more enlightened on mental illness than some of us today, and quoted Richard Baxter describing people with depression: “Their misery is so much that they cannot but think of it. You may almost as well persuade a man not to shake in an fever, or not to feel when he is pained, as persuade them to cast away their self-troubling thoughts, or not to think all the enormous, confounding thoughts as they do, they cannot get them out of their heads night or day.”
  • Murray also posted on Baxter’s view of treatment “those with depression of a spiritual nature, require spiritual counsel. Those whose depression is a result of somatic illness need medical care to correct that cause. People who suffer from endogenous depression may require both spiritual and medical treatment, depending on their case.”
  • John O Dozier Jr linked to a sermon by Tim Keller on the complexity of the human spirit.
  • Deborah Bauers explained, “When the brain is sick, a counselor who has been trained to see the whole person will seek appropriate medical intervention. If the heart is sick he/she will recognize the need for emotional and spiritual healing. If the client’s psychological constructs suggest faulty thinking, unhealthy coping mechanism or an addiction, a wise Christian counselor will address the issues by implementing techniques and strategies that can stand up to Biblical scrutiny. If there is a spiritual problem, he will draw upon God’s wisdom and discernment to help him uncover its root and then apply God’s grace to transform it.”
  • Amy Simpson wrote, “In most cases, people in the evangelical church have stayed fairly quiet about mental illness. We have reflected the silence of the culture around us, which historically hasn’t had many beneficial things to say on a topic that seemed so unpleasant and so hopeless. At times we have reflected another aspect of our culture’s relationship to mental illness: speaking about it in ways that ridicule, romanticize, or reinforce frightening stereotypes about people with mental illness.”
  • Sarah Perry spoke about Winston Churchill’s Black dog of depression, that may have been Bipolar Disorder.
  • Dana Dillon of Catholic Moral Theology quoted Augustine who wrote, “Crazy people say and do many incongruous things, things for the most part alien to their intentions and their characters, certainly contrary to their good intentions and characters; and when we think about their words and actions, or see them with our eyes, we can scarcely — or possibly we cannot at all — restrain our tears, if we consider their situation as it deserves to be considered.”
May 6, 2013

Several things seem to have come together to make the subject of mental illness and people of faith very topical.

One month ago tragedy struck the family of Rick Warren, one of America’s best known pastors. Since then many have been writing about mental health with a new conviction. Also, Amy Simpson has released her moving book Troubled Minds – Mental Illness and the Church’s Mission which is now featured on the Patheos Book Club.

May has been declared Mental Health Awareness Month, and you can read more about that on the National Institute of Mental Health webpage, here is what Barack Obama said in launching the month:

“Today, tens of millions of Americans are living with the burden of a mental health problem. They shoulder conditions like depression and anxiety, post-traumatic stress and bipolar disorder — debilitating illnesses that can strain every part of a person’s life. And even though help is out there, less than half of children and adults with diagnosable mental health problems receive treatment. During National Mental Health Awareness Month, we shine a light on these issues, stand with men and women in need, and redouble our efforts to address mental health problems in America.

For many, getting help starts with a conversation. People who believe they may be suffering from a mental health condition should talk about it with someone they trust and consult a health care provider. As a Nation, it is up to all of us to know the signs of mental health issues and lend a hand to those who are struggling. Shame and stigma too often leave people feeling like there is no place to turn. We need to make sure they know that asking for help is not a sign of weakness — it is a sign of strength. To find treatment services nearby, call 1-800-662-HELP. The National Suicide Prevention Lifeline offers immediate assistance for all Americans, including service members and veterans, at 1-800-273-TALK. . .” READ THE REST

The people who run Patheos have asked me to host a broad conversation about Mental Health including bloggers from across Patheos and beyond. You are invited to contribute by answering the question below any time this week. There are also two more questions which will follow.

If you write your own blog, please consider joining in. If you know a blogger who might like to take part let them know. If you don’t have a blog, feel free to write your contribution in the comments section on each of the “reply” pages. At the end of the week I will be collecting quotes and links from a sample of the contributions and posting them on those pages, and they will also appear on the Patheos book club page.

The First question is:

How has your religious community historically seen mental illness? – And how does your faith, today, shape the way you see mental illness?   REPLIES

The Second question is:

Research suggests that religious faith protects against suicide. Why do you think that is in light of how your community responds to suicide? How can we tread the fine line of discouraging suicide while not making the grief of family members worse?  REPLIES


When you write an article in response to this question, it will help us include your posts if you link to it in the comments section of the posts listing replies.

You can join us for a live Google Hangout on Wednesday.

I have also written a number of times already about mental illness in recent weeks:

Please also feel free to respond specifically to those posts, or to take the discussion in a different direction entirely. Keep checking back here, or at the Patheos Book Club page to follow the whole conversation.

April 23, 2013

As psychiatrists we are taught the biopsychosocial model for the cause of mental illnesses. Note that this is written as one word, which is intended to indicate the unity of each of these aspects. As Christians we would include  spiritual as a forth aspect of the model.

When approaching mental illnesses, one major reason for the stigma often associated with them is that we often have a Greek, dualistic approach to thinking about ourselves, and about illness. Thus, in a gross oversimplification that is not biblical at all, we think of our bodies as a mere container for our true selves, our spirits.  Frank Viola quite rightly rejected this separatist view in a recent post. But all too often, we think of our minds as totally separate from our bodies.  Thus a mental illness can erroneously be constructed as not a “true” illness at all, but rather a disorder of the psyche which we may see either as our mind, soul, or spirit.

The Bible has a much more holistic view of our makeup.  It understands that God made us as a being that relates to him, that relates to others, and that is very much integrated with our bodies.

It is true that mental illnesses so far do not have a blood test or brain scan that can help us identify them. Having said that, there are a number of avenues of research ongoing that may lead to such tests in the future. Patterns of activation in our brains in response to faces that display different emotions is one such avenue.There is a lot of evidence for physical abnormalities seen in some mental illnesses.

Reduced activity of the thyroid gland can lead to depression, and increased thyroxine can mimic mania. People who have experienced the remarkable way giving thyroxine “wakes” them up will never again think that the brain is disconnected from the rest of the body.

Some will simplistically say mental illness is about “chemical imbalance” in the brain.  In fact, most psychiatric medications target the level of activation of various brain circuits of neurons. Thus, psychosis is associated with increased activity in certain neurons in the brain that use dopamine as a neurotransmitter. These neurons fire too often.  So far every antipsychotic medication that has been licensed works by blocking dopamine receptors, and reducing the firing of those neurons.

Similar changes are seen in different neuronal circuits in depression, where the goal of  medication is to increase the level of serotonin and/or noradrenaline.

However, to say that the illnesses are caused by these abnormalities is probably a stretch too far. There are other neural circuits involved in these conditions, and medications are being tested that target different receptors in the brain. It may be that raised dopamine activity and lowered serotonin activity are signs of an underlying problem rather than the actual cause.

We also see remarkable support for the fact that brain abnormalities can affect our emotional state, and behavior by what we observe when different parts of the brain are damaged by strokes or cancer.

Further evidence for the physical nature of mental illnesses is that they run in families, and are more common in twins who are identical than twins who are not.  Even when twins are raised in different families these differences persist.  It is not the case, however, that we simply inherit a mental illness. Environmental factors do play a part.

The evidence supports the idea that we can inherit a predisposition to mental illness, rather than the illness itself. What determines whether you actually get the illness is not always known. There may be some physical reasons that trigger the illness actually coming on, one that is controversial but appears to be correct is cannabis use. So, millions of teens use cannabis with no apparent ill effects, but some of them seem to be triggered into a psychiatric illness. Once that trigger has occurred, the illness might still appear and disappear without the need for that trigger, however.

There is a lot of evidence, however, that the triggers need not be physical. Psychological causes seem to play a part. It really is important what we fill our minds with. If we constantly harbor negative thinking patterns, we should not be surprised if eventually a tipping point is reached, and we are no longer able to pull ourselves out of the negative thinking.  Thus, someone who is told they are “useless” constantly may eventually internalize that belief, and eventually a full-blown depression might result.

A very good example of how things that we think about can affect our mood, is the almost universal response to bereavement. We all get depressed, at least for a while, when we loose someone we love. Just as we may cry when we are saying goodbye to a loved one who is emigrating, our smile and jump for joy when they return. In fact, most of us can improve our mood by thinking of a pleasant memory or a good joke, or we can make ourselves feel sad by thinking of a tragedy.  In depression our ability to influence our mood can become much less, and it can feel like too much effort to “think happy thoughts,” and that itself is part of the illness.

If we loose a job, or we loose our sense of value, we are not just affecting how we think, we are affecting our social selves. There is no question that mental illness can also be triggered by social aspects, whether it be the quality of our relationships, or our sense of contributing to society.  How we are getting on at work, in particular our relationship with our boss can have a massive effect on our mental health.  Marriage is strongly protective of mental health, but a sick marriage makes us miserable. Patients with mental illness often struggle to forge relationships that can be protective. One of the cruel things about stigma, is that it can maintain the problem that gave rise to it.

Clearly, there is also a long history of Christians reporting how their relationship with God can make them feel guilty at times, and at other times can fill them with great joy in forgiveness.

It is my view that when faced with an individual with mental illness, we should not seek for a single cause, but rather recognise a combination of biological, psychological, social, and spiritual causes may have given rise to the condition. When it comes to treatment, we should also target each of these areas for the best effect.

April 17, 2013

I began to explain the distinction between mental illnesses and disorders (including developmental disorders) last week. Today I will return to this discussion, with an explanation of how we can be a part of screening for mental illnesses, even if we have had no formal training.

This post has as its aim to encourage you to seek medical help for yourself or others rather than suffer in silence. As I began to explain in “Can a Christian Get Depressed?” we must get seek to eradicate all stigma associated with mental illness. Many of these conditions have treatments that can often alleviate the symptoms dramatically. But we will not address treatment today, not least because treatment is really rather complex.

The key to understanding the psychiatrist’s way of thinking about a mental illness is that these illnesses are episodic. In other words as a minimum they vary in their intensity, but in many cases it can even seem as if the illnesses go away altogether between what some call “breakdowns.” So, a developmental disorder, such as Autism, is not considered a mental illness because it has been present since birth (though often only recognized in the third or forth year of life). Also, a personality disorder is not considered a mental illness because its effects are again lifelong, pervasive and continual. I will not discuss personality disorders in this series much, except to say that some doctors are a little too eager to reach for that diagnosis in explaining odd behavior and symptoms. Really, it should be a careful diagnosis that first excludes treatable mental illnesses, since often people would include “untreatability” as part of the definition of a personality disorder.

What all this means is that people with a mental illness may not show many or any signs of that for much of their life. Thus, it can be a terrible shock when what can be very dramatic symptoms occur “out of the blue.”

Because, my goal here is not to turn you into a psychiatrist, let me focus on symptoms you should be aware of, and that should lead to you encouraging the person suffering to seek medical help:

1. Mood symptoms

The presence of any of the following symptoms may indicate the need to get an assessment for a possible diagnosis of a depressive episode. Note that you do not have to have all of these symptoms to have depression (see DSMIV criteria on which this is based):

  • A clear and persistent change of a persons normal mood that is unexplainable and is not responsive to changes around the person. What I mean by that is that we all have transient feelings of low mood, whereas depression represents a persistant low mood that in its most extreme form cannot be lifted by positive events such as hearing a good joke being told, or getting good news. This may actually feel more like an emptiness of mood or an inability to feel. Some people may feel guilty because they feel they “ought” to be happy, and yet cannot.
  • A lack of interest in, or perceived ability to perform, normal daily activities such that doing things becomes an effort. In some more extreme cases people may take to their beds and be unable to do any tasks.
  • A change in appetite (increased or decreased) leading to a change in weight (up or down) that is not explained by dieting efforts.
  • A significant increase or decrease in the amount of sleep taken. In particular waking up too early in the morning, feeling very tired.
  • A restlessness and excessive energy, or a significant reduction in energy leading to “slugishness“, often associated with fatigue.
  • Feelings of guilt or worthlessness which have no basis in fact, and which do not resolve when forgiveness is sought.
  • An inability to think clearly, concentrate, or make decisions
  • Thoughts of death, wishing to be dead, or the urge to commit self-harm or suicide (more about this in the next post)

People’s mood can also become too “high” or simply too “irritable.” It is vital to a correct diagnosis that the presence of the following symptoms at any point in a person’s life be taken into account. (see also the DSMIV criteria on which this is based)

Again, the following symptoms do not all need to be present for a diagnosis to be made, and non-experts should not attempt to make a diagnosis. It is appropriate, however, for someone to observe the possible presences of some of these symptoms and recommend the person seek medical help, perhaps accompanying them to the appointment:

  • A period of time where a patient appears unusually “high” This means they may be overly excited, with elevated or expansive mood. This kind of mood is hard to describe but like depressed mood has an effect on those witnessing it. At first you may feel the person is just very happy, and they may even appear to be “on top of the world.” But what psychiatrists call mania is every bit as damaging as depression (and in some cases more so). Sometimes the mood state will not seem particulalry happy but rather overly irritable and aggressive. Associated with this are the following, and again even just a couple of these being present may indicate the need for an expert assessment:
  • Inflated self-esteem or grandiosity. Here the person may believe that they are superior to others. They may believe they have a special ability to solve a problem. Self-belief is very important for getting things done, but when it gets excessive can cause all kinds of problems.
  • Decreased need for sleep. This is different from the lack of sleep experienced in depression as people will often still feels rested after for example only 3 hours of sleep. Sometimes there is a total absence of sleep, which can be very disruptive for people around them.
  • More talkative than usual for them, or a pressure to keep talking. This can feel exhausting to people trying to communicate with the person.
  • Speech is hard to follow as it jumps from one subject to another (usually with some connection in the mind of the person, but this may not be clear to the listener).
  • A feeling felt by the person that their own thoughts are racing
  • Distractibility, where things around the person will suddenly be the focus of their attention. Colors may seem more vibrant, sounds more interesting, making focusing on a task or conversation difficult
  • An increase in activity levels (either socially, at work or school, or sexually) or psychomotor agitation.
  • A reduction in inhibitions that lead to “excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)” (DSMIV). This can be especially hard to handle in a Christian context where someone who normally acts in a self-controlled manner may suddenly behave very out of character.

Of course all the above symptoms can vary a lot in their intensity and level of concern. What can start as relatively minor worries can escalate, so it is often a good idea to seek expert help at an early stage.

2. Psychotic symptoms

Psychotic symptoms are essentially alien to most of us. Unlike mood symptoms they do not really sit on a spectrum with normal experience. The only thing I can suggest to help you understand what they feel like, is imagine that moment when you have just woken from a very active, scary, energetic dream. For a few seconds you may believe the dream is real. Imagine feeling something as incredible as a dream was real all day.

Delusions are defined as fixed false or unusual beliefs, that are held with unshakable conviction and that are incompatible with a persons religious or cultural background. These will usually have a personal component to them. Thus, someone who is low in mood may believe that they have an incurable disease despite a clean bill of health from the doctor. They can be sometimes very bizarre. You can ask a person, “Have experienced any thoughts or ideas that have been troubling you, or that others might have considered unusual?” Examples of common delusions include a fixed belief that people are plotting against you, a belief that the TV or radio is communicating to you directly, or that others can put thoughts into your mind.

Hallucinations are defined as experiencing a stimulus that is not present as though it was. People often speak of “hearing voices” when they mean a voice inside their head, or a replay of a conversation they have already had. A hallucination is not recognized as coming from the person, but is “heard” by them as coming from outside. So, during a conversation a person may suddenly turn and answer someone who is not in the room. The auditory hallucinations commonly experienced by patients can speak to them, or can speak about them. They are often very derogatory and frankly offensive.

There can also be other associated symptoms, which can include social withdrawal and certain cognitive difficulties.

3. Anxiety

We all feel anxious at times, but excessive anxiety can be very disabling and can respond to treatment. Sometimes people will be anxious about specific things, other times they will not know why they are anxious. Sometimes “panic attacks” can be very disturbing, and may be hard initially to distinguish from symptoms with cardiac origins. People will sometimes be rushed to ER, only for extensive tests to suggest that anxiety is at the root of the problem. Don’t allow yourself or anyone affected to feel ashamed by this. For the sufferer, and those around them, the symptoms of panic attacks are very concerning, and as is always the case, it is better to seek urgent medical help and be told the all clear than to not go when you should have.

The next post will answer the vital question: What can we do to reduce the risk of suicide?

Mental Illness and the Christian More Posts:

April 13, 2013

They say a picture speaks a thousand words, so surely a movie speaks a million. I know that due to what happened to Matthew Warren, there are large numbers of people currently seeking to better understand Mental illnesses and disorders (see How can I recognize a possible mental illness?)

I will be continuing my series of posts on the subject, but before I get back into it, I thought I would share a list of three movies that I would recommend you watch. Why not pick one of them to watch this weekend? In the comments section feel free to share other films that you have found helpful as you aim to understand these conditions better. Please note that mental illnesses are of course distinct from developmental disorders.

Note that none of these movies aim to turn you into a psychiatrist. But all of them will give you an emotional connection with people who suffer from psychiatric conditions, and in some cases will help with destigmatisation.

Many with mental illness deserve not just our compassion, but our admiration for what they have achieved. None more so than Temple Grandin, whose life has been made into an excelent TV movie starting Claire Danes better known for her betrayal of a spy with Bipolar Disorder in the TV show Homeland. The IMDB page will tell you more, and it is available in the TV Shows section of iTunes. This film charts the remarkable success this lady with autism had in changing the way cattle are managed across America. This is probably my favourite of the lot.

In A Beautiful Mind actor Russell Crowe gives surely his most engaging performance yet as a man with Schizophrenia. The film seeks to give an insight into what it is like to live with delusions and hallucinations that characterise some mental illnesses. There is a delicious twist to this film’s plot that caught me out completely the first time I saw it so I will not spoil it for you. Again you can read more about this film at IMDB or on the iTunes store.

In Awakenings starring Robin Williams and Robert De Niro we see that patients who are “locked in” and apparently unable to interact with the world can sometimes be woken up by medication. If only it was always this simple for psychiatrists. But still, this film is rightly considered a classic and will tug at your heart strings. Again it is listed on IMDB and Apple’s iTunes.


Now it’s your turn. What movies would YOU add to this list?

April 9, 2013

Ed Stetzer is one of the most widely respected Christians in the West with a broad appeal that goes beyond most of our tribal boundaries. I have had the privilege of getting to know him personally a bit as well, so I was thrilled to read him speak about  his article at CNN Regarding Mental Illness on his own blog.  I have decided that I will highlight a couple of other articles on mental illness before returning to my own series, which so far includes two posts:

Stetzer explains four critical points that I couldn’t agree with more:

1. We need to stop hiding mental illness.
2. The congregation should be a safe place for those who struggle.
3. We should not be afraid of medicine.
4. We need to end the shame.

Here are some more quotes from his blog post, or you can read the CNN article at their site.

“Most churches (and Christians) seem unprepared to deal with mental illness.

As a young believer, I heard so many say that mental illness was just a lack of faith, demonic oppression, or something else. Those can be real issues, but so is mental illness– and they are just not the same thing.

I’ve seen the impact of mental illness both in the church and in my own family. I’ve seen the shame that families felt and the scared or confused responses from churches . . .

  • There are people in the pews every week – ministers, too – struggling with mental illness or depression.
  • People of faith know that God has freed them to love others, and that love extends to everyone, even (and sometimes especially) those we don’t understand.
  • Christians need to affirm the value of medical treatment for mental illness.
  • Compassion and care can go a long way in helping people know they don’t have to hide.
  • Mental illness has nothing to do with you or your family’s beliefs. It can impact anyone.”
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