Aside from my first article (in 1984) on medical mistakes, I have had more response from "When Mental Illness Blocks the Spirit" than any other article. I've suffered from clinical depression all of my adult life, and I've found it very difficult to experience the "joy in the Spirit" that is supposedly a hallmark of the Christian life. I've known others with similar problems. We have no difficulty recognizing that a person's physical ailments are not a sign of alienation from God, yet we still tend to think of mental illness that way. The article first appeared in The Other Side in the spring of 2002.

WHEN Mental Illness Blocks the Spirit

I first met Päivi the summer after my freshman year in college.  I’d flown to London, took a ferry across the English Channel, and hitchhiked to Finland to spend the summer visiting the foreign exchange student who’d caught my eye in high school.  Every Sunday night during the college year I’d written a long letter to Marja, and every Thursday there was a long letter from her in my postbox.  We were anxious to see each other again.  Marja’s parents welcomed me and were unfailingly gracious that entire summer.  Only later did I learn that they had not been particularly happy to see me.  They didn’t like the idea of losing their oldest daughter to a foreigner.  But they gave me a bedroom, I started work at a local construction company for 65¢ an hour, and Marja and I became reacquainted, taking walks and long bike rides through the forests and farmlands of a Finnish countryside that was bathed in light almost twenty-four hours a day.

Marja’s sister Päivi was sixteen, a year-and-a-half younger than I.  She spoke little English and I no Finnish, so Marja had to mediate our few conversations.  Her violin, however, revealed the depths of her spirit.  On occasion I glimpsed her running.  She was thin and lithe, a young deer loping along wooded paths.  It’s still a holy image for me. 

I would never again see her mentally whole.  The next time I visited Finland as Marja’s husband, Päivi was already victim to a destructive schizophrenia that held her captive the rest of her life.  It had begun gradually while she was at the university but by her early twenties—when she and her parents visited us at our home in Minneapolis—she was already firmly in its grip, paralyzed by voices, despondency, anger, confusion and all the other ravages of that terrible disease.  Before she could return home, we had to hospitalize her, and for weeks Marja tried to interpret Päivi’s confusion to the psychiatrists who sought to help her but could neither speak her language nor reach her soul.

Although neither of their parents was religious, Marja and Päivi had as children been “saved” through a small, Pentecostal church, and Päivi remained deeply religious.  Her delusions, paranoia, and obsessions, of course, were expressed through the language of her fundamentalist faith that was so important to her.  It would have been easy to blame her religious devotion for her trouble, but that wasn’t the case.  Though her faith was obvious, she was too often captive to her mental illness.  God was constantly speaking to her, telling her, for example, to give away or destroy not only all of her own possessions but those belonging to her parents and siblings as well.  The wallpaper of her bedroom was covered with Bible verses, written meticulously in small, tight handwriting.  When God told her to live more simply, she’d give away everything she could get her hands on and sleep for weeks on the plain wooden benches in the sauna, praying many hours each day. 

Finland has comprehensive medical and psychiatric care, and a mental hospital is in walking distance of her parents’ home.  Päivi’s illness could be partially controlled with medications, so she was often committed to the hospital for several weeks, followed at home by weekly Prolixin injections from a visiting nurse.  But Päivi believed the side effects of the medication damaged her communication with God, so she usually found a way to avoid the shots and pills.  In 1985, shortly after her thirty-seventh birthday, she brought her suffering to an end by throwing herself from a train on the way home from Helsinki.  In retrospect, I can’t argue with her decision.

Päivi had an intimate relationship with God.  Although her religious observation was often impossible to separate from her mental illness, her religious devotion and disciplined spiritual practice were profound.  Päivi was also one of the most deeply tormented human beings I’ve known.  Not only did her deep faith fail to protect her from the desolation of her mental illness, but it also gave her little help in coping with it.  Despite her faith, she received little consolation from God.

In our society there’s a naïve point of view that considers a rooted spirituality to be protection from emotional and psychiatric illness.  We don’t articulate the thought to others, of course, or perhaps even admit it to ourselves, but how many of us who have suffered from emotional or mental illness have at least once blamed our symptoms on our spiritual failings.  If I could just be grateful for God’s love, I wouldn’t be so depressed.  If I could just give my troubles over to God, I wouldn’t be so anxious.  If I could just pray with more integrity, I would have some relief from this confusion and chaos.  And how many of us have unconsciously judged another’s emotional chaos as some indication that their spiritual life was in chaos, too?

Most of us have gotten beyond the belief that faith in God will necessarily bring material blessings, even beyond the belief that faith will necessarily bring us physical health.  We understand that one’s material wealth or physical health is not an accurate reflection of the depth of one’s spirituality.  But sometimes, I suspect, we still get hooked by the illusion that deep spirituality should bring emotional or mental health.

How often do we hear something like the following?  “One of the marks of true spirituality is the joy one feels in one’s life.”  “Bring your life under the Lordship of Christ, and He’ll bring peace and joy into your life.”  “Enter into the Reign of God, and you’ll know the tranquility and joy of true obedience.” 

I find myself offended by such simplistic ideas passing as spiritual wisdom.  It’s a personal bitterness, I suppose.  For years I listened to Christian friends describe “peace” or “joy” as fruits of their walk with God, knowing that I hadn’t ever experienced anything remotely like it.  Their happiness was just further proof of my distance from God.  If the path of faith brings serenity, I hadn’t come close.

I have suffered from a clinical depression all of my adult life.  My symptoms are atypical, however: no thoughts of suicide, only occasional losses of energy.  I was energetic and successful in my studies and later in my medical practice.  Since no one tumbled to the diagnosis for the first twenty years of my illness, I was left without a name for my experience, almost worse than the experience itself.  I didn’t understand what was happening to me.  

My depression expresses itself in a limited sense of joy.  Life is usually gray and, until I began to understand what was happening, filled with dread.  I feel an almost constant emotional distance from others: from Marja, from my children, from my friends, and from God.  My daughter, now twenty-seven, recalls a childhood Christmas when she presented me a handmade gift.  I said I liked it, and I said I was grateful, but even at age eight she knew I was faking it.  That would have been typical for me: hindered from the positive emotions of the moment, emotionally blocked from the love and togetherness offered me by others.  And, not knowing what was going on, I felt constantly guilty about it.

I have never been fully able enter into the relationship with God, either.  I don’t experience God’s presence as real; I don’t experience joy in my relationship with God.  At least in comparison to what I sense in others, my relationship with God has always seemed to lack something.  I have tried to enter into the life of the church, done my best to follow Jesus.  I have taken on our church’s disciplines of membership: an hour of quiet time daily, tithing, weekly worship, silent retreat, and participation in corporate mission.  I have been physician to the very poor and homeless, lived in our home for homeless men with AIDS.  I have been an active preacher and worship leader.

But still, no experience of God.  No real joy in my work.  No sense of relationship with God.  I sometimes even kept myself outside of the faith community because I didn’t feel the relationship with God and didn’t want to be a hypocrite.  Twice I dropped completely out of church membership.  I’d sometimes complain to Mary Cosby—a truly wise elder of our community—about my inability to experience God.  Mary would listen carefully and then say something like this: “David, you may not feel you have a relationship with God, but God clearly has a relationship with you.  Trust me: God has entered into your life, and you’ve responded to Him.  You belong in this church as a member.” 

I’ve learned to take Mary at her word.  I’ve come to believe I do have a relationship with God, that it’s a real relationship, and that I belong in the body of believers … even if I don’t feel it.  In the same way that my depression interferes with my emotional relationships with others, it interferes with my spirituality.  That sense of great distance from God is a delusion of my mental illness.  Through such people as Mary, my community is able to restore in me some faith in my own relationship with God.

Even after I recognized Mary’s wisdom, my depression has at times overwhelmed my spiritual life, making it unavailable to me as a resource.  I’ve sometimes been unable to sit through church.  Listening to sermons about Christian life or watching others relate to each other in the community has been too difficult.  I’ve been acutely aware of my distance, my lack of relationship.  Sometimes, just being there was intolerable, and I would have to leave in the middle of the service. 

When I’m depressed, my spiritual resources often aren’t available.  My mental illness isn’t as severe as Päivi’s, but it nevertheless makes it difficult to access a sense of spirituality.  I have come to believe that the mental illness does not change the spirituality itself; but it does hide it in certain ways. 

The question becomes: Can my community continue to offer its spiritual support even when the mental illness blocks my receiving it?

Like many people with mental illness, I’m not particularly easy to be around when I’m in the depths.  I don’t give many clues about what I need nor do I give much positive feedback to those who help.  I just can’t.  Although I can hardly blame people when they can’t respond to me, the support of my community is crucial.  Mary’s frequent, sincere reflection of what she sees in me is enormously comforting.  During those times of blackness, I need to “lean upon” the faith of others in my community, their faith that I have faith.  I need them to understand that, though my depression may hide my relationship with God, it’s still there.

I need people not to require that my spirituality bring me any particular joy, for if joy is some measure of spirituality I’m a long way from home.  If a relationship with God brings one peace and a sense of harmony with the world, then I have little relationship with God.  My spirituality needs to be understood as different from others … at least when I’m in the throes of my depression.

My spiritual need is like my emotional need.  I need my community to enter into the darkness of my distance from God.  I need their willingness to bring their relationship with God into my darkness and hold it there without imposing it on me.  Can they be there even if I don’t respond very much?

One of the reasons that Marja and I have been able to maintain our marriage relationship over thirty years is that Marja has never taken on my emotional or spiritual health as her responsibility.  At a certain point—after she’s listened and tried to understand—she rolls over and goes to sleep.  She gets on with her life.  I need my community to come into my darkness with me, but I don’t want them to get consumed by it.

What if my depression or anxiety or psychosis pushes me to break off my relationship with my community?  What does it mean for them to hold me when my mental brokenness leads me to exclude myself from the community? 

Perhaps this is one place where our spiritual understanding can help when more traditional therapeutic understandings can’t.  When we are most deeply rooted in God’s love, we know that no one can move himself outside of God’s love.  When I’m sick, I may not be aware of my spiritual connection to the depths of life, I may not be able to utilize my spirituality as a resource, but those in my community know it’s there, anyway.  Their willingness to bring that certainty into our relationship is healing.  They don’t necessarily need to say anything.  (In fact, when I’m in the depths, being verbally reminded of God’s love can be really aggravating.)  But they know it, and they can hold me in their knowledge of it.

There is a spiritual paradox within my mental illness.  While it alienates me from others, it also brings me closer to my community and through it closer to God.  A solid bout with depression leaves me no illusions of being in charge of my own self.  Mental illness leaves no doubt that life, as Alcoholics Anonymous says, is unmanageable.  No one is ever in charge of his or her life, of course; life is always unmanageable; but mental illness makes that academic theological assertion absolutely and experientially clear.  Perhaps that is one of the reasons that mental illness has such a stigma in modern civilization: It so thoroughly smashes the cultural icon of the individual’s control over his or her life.

Nevertheless, such self knowledge is a solid anchor for life in community and for life with God.  Precisely because it shatters our notions of self, it not only leaves room for the community and for God but also invites them in.  When we learn at the depths of our being that we are not enough, we have been given a foundation for life together.

It is, of course, both easy and clean to write all this from a safe emotional distance.  The path that we are asked to walk, whether with the mentally ill or with out own mental illness, feel in the experience so much less clean and crisp than what I’ve written above.  It’s so much dirtier, so much messier, so much more vague and less clear.  With some profound exceptions, brokenness—yours or mine—is beautiful only in the highly abstract; in the day-to-day it is usually nothing to celebrate at all.  It is this that so often arouses our sense of incompleteness, our sense of guilt and anger.

And yet, if we can accompany one another through the messy reality, we do understand at certain moments of clarity that we’ve been offered a profound journey of healing and wisdom, that our journeys together with all their messiness bring us closer to our deepest selves and to our littleness, closer to God.

It’s a paradox of the highest order, understood only by the deepest spiritualities that it’s precisely through our brokenness that we touch God.