I wish there was a word or phrase to cover the mental and emotional disorders (e.g. depression, anxiety, schizophrenia) that result from both personal sin (for which we are responsible), and personal suffering (for which we are not – or not wholly –  responsible).

For example, when I sometimes write about “mental illness,” some Christians hear such “disease” terminology as denying sin, minimizing personal responsibility, undermining the sufficiency of Scripture, and ignoring the divine provisions of repentance toward God, faith in Jesus Christ, and the indwelling of the Holy Spirit. That’s not my intention.

On the other hand, I and others react against the way some Christians reject all (or most) “mental illness” categories. We see this as a serious denial of biblical anthropology, a denial of the extensive damaging effects of the fall upon humanity. Our reasoning for believing in such damage is rooted in Scripture and goes something like this:

Step 1: As a result of the fall, my body’s chemistry, physics, and electricity are damaged.

Step 2: My brain uses physical structure, chemistry, and electricity to process my thoughts and emotions

Step 3: My brain’s ability to process my thoughts and emotions will be damaged to the extent that my brain is affected by the fall.

Step 1 is a biblical fact. Step 2 is a scientific fact. Step 3 is the logical result of Steps 1 and 2.

There are three additional complications to contend with here. The first is that the brain acts as a bridge between our spiritual and physical worlds (our soul and our body) in a way that no other body part does, making it difficult to achieve clear distinctions between what is spiritual and what is physical. Second, the brain is the most complex organ in our body, with so much still to be explored, discovered, and understood that some scientists call it “the last frontier.” Third, just as with all areas of my body, the “natural” damage to my brain in Step 1 can be increased by three aggravating factors:

Factor A: Damage outside my control (e.g. genes, brain injury, aging, abuse**, shock, Parkinson’s, Alzheimer’s, etc.)

Factor B: Personal sin which is my responsibility (e.g. substance abuse, the deliberate choice to think sinful thoughts/feel sinful emotions, the refusal to trust/obey God, rejection of the means of grace, etc.).

Factor C: Direct divine intervention (i.e. God, in His sovereignty, may impact my brain processes: as a chastisement to correct my faith, or as a test to display my faith – as physical suffering did in the case of Job).

As the damage under Step 1 is increased by these three factors, so the disabling suffering in Step 3 will also be increased. But what should we call the mental and emotional disorders/effects in Step 3?

Misleading and harmful
Given that sometimes the disorders in Step 3 are the result of personal choices (Factor B), to use only “mental illness” terminology can be misleading and harmful.

But given that sometimes the disorders in Step 3 are the result of a fallen brain, or damage outside of my control (Factor A), or the direct intervention of God (Factor C), to use only “personal sin” terminology can be equally misleading and harmful.

So what do we call the disorders? “Sin” is too narrow in many cases. “Illness” is too narrow in other cases. Use of either category exclusively is inaccurate, provoking suspicion and often hostile reaction.

In the ongoing absence of mutually acceptable terminology that would allow us to speak more accurately and comprehensively, I have a number of suggestions that I hope might help to bring Christians a bit closer together as we discuss these vital matters that impact millions of suffering people. Tune in tomorrow for more details.

UPDATE: Here’s a link to that follow up post Maximizing and Minimizing Mental Illness

** See Eric Johnson’s book, Foundations for Soul Care for a review of the scientific evidence of the physical changes that take place in the brain due to sexual and verbal abuse in childhood.

  • http://www.karadedert.com Kara

    Thank you for breaking this down and articulating the differences! I felt SO frustrated years ago with PPD after our first baby. I knew it was a bizarre change that I had no contorl over but kept having people comment silly things like, “You’re so carefree and easy going, you need to just get back on track. Everything is going to be fine! Start thinking more positive.” I felt like saying something equally ridiculous back like “oh, you have kidney problems? Well, just start thinking more positively, that’ll help.”

    • Christine

      Amen, Kara! I had the same experience. Can’t really explain it or understand it unless you’ve lived there!

    • Steph

      YES!!! This.

  • http://fpinisrael.com Albert Hembd

    This all sounds very reasonable to me. I have decidedly known people in the church with organic problems that caused mental illness. Stop and think: have you known of persons suffering from bipolar disorder in the church? (manic-depression). Have you known of persons who were autistic? Have you known persons with long-term depression that improved with medication? These all argue that there can be illnesses that impact mental thinking which are a result of the Fall.

  • Reg Schofield

    You have always been a very balanced and biblical voice when it has come to this difficult subject . Living in a post Genesis 3 world , sin is here but so is the reality of our bodies are fallen as well , genetically messed up leading to chemical imbalances , hormone issues etc.. that can lead to depression . Sometimes it can be a product of numerous factors , something you have as well highlighted . So thanks for speaking so well on this issue that does and will continue to face Christian until the Lord comes.

  • http://thenface2face.wordpress.com Karen Butler

    I feel myself in comfortable agreement with you here on all you have presented, and at some points I am vigorously nodding my head! If we can just call it ‘mental disorder’, and drop the happy pills, I’d be even happier. Or at least agree to taper off them, after a bit, right?

    I hate to break this happy peace with my next observation. Because I am puzzled by a conspicuous absence in your otherwise excellent etiology, of a certain evil influence towards madness. Challies mentioned Satan today,in quoting D.L. Moody. Haven’t you “done business” with him, especially in the area of mental disorder? I know I have.

    I think the demonic is probably the most important factor in the causes of mental disorder, next to trauma. Because Satan seizes upon our cataclysms . But we are so embarrassed to admit him into these discussions. To talk about Satan sounds so medieval.

    • http://thenface2face.wordpress.com Karen Butler

      But interestingly, one medical doctor wasn’t embarrassed by the real cause of the pain in the case of the patient with scoliosis in Luke 13:11-16:

      “…and a woman was there who had been crippled by a spirit for eighteen years. She was bent over and could not straighten up at all…ought not this woman, a daughter of Abraham whom Satan bound for eighteen years, be loosed from this bond on the Sabbath day?”

      So interesting to me that it was an organic disorder with a medical etiology, but the underlying cause was spiritual oppression. Jesus calls her a ‘daughter of Abraham’, too — an indication she was a believer!

      And in Matthew 17:15,the scripture calls the epileptic boy a ‘lunatic’– a medical belief that epileptic seizures were affected by the phases of the moon– and similarly frees him from a demonic spirit.

      Matthew Henry comments on this passage, “There was also something in the malady which rendered the cure difficult. The extraordinary power of Satan must not discourage our faith, but quicken us to more earnestness in praying to God for the increase of it. Do we wonder to see Satan’s bodily possession of this young man from a child, when we see his spiritual possession of every son of Adam from the fall!”

      No, I am not suggesting that every parent of a epileptic kid is showing a lack of earnestness in faith when giving their child Depakote. I do respite care for these parents! I know their hardships. But I do think these remedies make it much easier for us to ignore the spiritual components that Jesus makes very clear here. That is the real “lack of faith” — our unbelief in the scriptural etiology of some diseases.

      The fact that scripture makes these spiritual connections clear makes us very uncomfortable, and some of wish these passages were not in the Bible. I worked in special ed with autistic children, some of whom presented exactly like this young man. That is when I began to ask questions, and no one has ever satisfied my queries — except the Vineyard pastors in the churches we attended. If the Reformed community want to seriously reach out to confused Charismatics, your theologians need to seriously grapple with these scriptures, and stop ignoring them.

      • http://thenface2face.wordpress.com Karen Butler

        should read, ‘spiritual etiology’ not “scriptural”.

  • Patricia

    I see no relationship between a genetic mental disorder and “spiritual responsibility”. I am no more responsible for this this than I am for the sun and moon. I need help applying grace to my affliction. I need the stigma of mental illness to not exist in the church. I need a book about God’s love for me not a book about spiritual responsibility for my suffering………….

    • http://headhearthand.org/blog/ David Murray

      Patricia, I agree 100% with you, and I hope the article was clear on that. One of my motivations for writing on this subject is to remove the unnecessary stigma and to communicate God’s compassion for the depressed.

      • Wairimu

        David, maybe I’m blonde but the way your article came across was unclear on where the demarcations are. I was diagnosed with bipolar in 2010, have prayed for healing repeatedly/ consistently but I still suffer the symptoms. You sound like a lady who once said to me, right before she prayed for me that the doctors who diagnosed me don’t know what is wrong with me, that all I need is a renewed mind from Christ and that I shouldn’t believe the diagnosis. My question would be what if the diagnosis was kidney disease, or even cancer or even basic malaria?

        • http://headhearthand.org/blog/ David Murray

          See next post for more detail and clarity, I hope.

  • http://raisinghischild.com Romelle

    Depression is often circumstantial and should be worked through as grieving. My mother was offered depression meds after the death of my brother. One friend was offered meds for depression after a cancer diagnosis. We should be left alone to feel sad at sad times.
    Many other symptoms come from not successfully completing developmental markers like bonding and creating boundaries as laid out in Henry Cloud’s book Changes that Heal. I recommend it highly to anyone before signing on to a life of medication. Make sure you are using meds to treat biological problems, not circumstantial ones.

    • Steph

      I agree that meds shouldn’t be so quickly used. But sometimes something makes us so sad for such a long time that we rewire our brains to be sad, and what began as circumstantial has become biological or chemical. A revelation in my marriage devastated me for several months, and although I had ‘gotten over’ the grief of that, I couldn’t seem to get my brain back to normal. Meds helped me to just clear the fog away so that I could focus on right thinking. Does that make sense?

      • Dee

        Very balanced approach Steph. Medication is a crutch and there are times we require one. Nobody ever expects someone with a broken foot to walk without giving it time to heal. Thus, a crutch allows one to continue to get on with life. By contrast, we expect people to function well with a broken heart and depend on nothing to provide relief for healing except prayer?
        So YES what you said does make sense, Steph! Personal Example: For lots of understandable reasons, I previously suffered anxiety! I really couldn’t mess around with “natural healing,” while my baby girl was growing up! Now she is much older and I am considering alternatives to meds because I finally have the “mental space,” and time to delve more deeply within. We are all so different! One size does not fit all which is why God arranged for us to have a brain in the first place, right? ;)

  • Julie Love

    A problem I see today is that society has a label for almost every reason for bad behavior. Usually dwelling on the “my mom didn’t bake me chocolate chip cookies” or some other perceived childhood neglect. He was abused as a child so he is an abuser today. Etc, etc. The problem with this thinking is for everyone who uses this claim we can find 5 who have the same history who do not abuse. Using your past as an excuse for your present bad behavior is not acceptable and doesn’t change the fact that you are choosing to sin. I do believe satan knows where we are weak and enjoys sending his demons to haunt us if we allow it. With Christ in your heart you can fight anything. Staying in prayer, staying in the Word, fighting the good fight is all part of being “in Christ.” So many “mental illnesses” today are just excuses for bad behavior and are “self” centered in that we try to get others not to judge us too harshly for our behavior. Escaping to medication just compounds the problem.

    • http://headhearthand.org/blog/ David Murray

      How about a balancing comment, Julie, so that people who have genuine mental illnesses don’t feel utterly condemned by what you wrote?

      Nobody I know denies that a mental illness diagnosis is sometimes used to excuse sin. That does not make all mental illness a fantasy.

      “With Christ in your heart you can fight anything.” I presume you would say the same thing to people who have been paralyzed by brain disease/spinal injury? Have a look at some of the medical evidence, especially as interpreted by Christians such as Eric Johnson. I think that might temper your response a bit and give you a bit more balance.

      As a mental illness minimizer, maybe you could read the first part of my post today because you seem to have fallen into a number of the usual traps when talking about this issue: http://headhearthand.org/blog/2013/04/16/maximizing-and-minimizing-mental-illness/

      • Dee

        Amen, David.

    • Kristin

      It is a very complicated topic, Julie. It is true that multiple people can have very different reactions to the same trauma, but that simply does not mean that some of them are using the trauma as an “excuse.” I’m a sexual abuse survivor. I have issues that are undoubtedly directly attributable to my past, such as anxiety, hyper-vigilence, and being slow to trust. This is not an “excuse,” but rather it is simply the way that it is. I know that there are other women (or men) who have experienced similar things to what I went through, who do not have the same issues. Some of them seem to have almost no lasting major issues. That does not invalidate my feelings and experiences. Neither you or I nor anyone reading this understands how trauma can affect different people differently.

      • Dee

        Very well said, Kristin. Thank you from the bottom of my heart and behalf of anyone else, who through no fault of their own, struggle with issues NOT of their own making.

  • Jeff

    David I appreciate your post and the work you are doing in this area. I am a physician and currently am working on a post-grad degree with Dr. Johnson. I am encouraged to see you reference his work and pray that both you and he will gain a wider reading and influence within Evangelicalism. (BTW, you know my brother-in-law Peter from Grand Haven.) One point I would like to make is regarding your comment about sinful emotions. One of the things Dr. Johnson talks a great deal about is this notion of sinful emotions. To be sure there can be sin here, like all areas of our life and world, but beyond that, at the core the emotions point to something that is true and needful for our lives and souls. There is too much to go into here but I am greatful for your voice in this arena.

    • http://headhearthand.org/blog/ David Murray

      Thanks Jeff. Yes, I know Peter. He’s a great guy. I continue to learn a ton from Dr Johnson. And yes, I love the astute and perceptive way in which he analyzes and reframes the whole “sinful emotions” idea. God bless your work with him.

  • Ash

    I think this is a helpful discussion and helpful distinctions, but it still reveals our immediate assumptions and judgements about mental illness. Can’t you say all these same things about physical illnesses and injury? Heredity, habits, foolish behavior, circumstances outside our control, and outright sin – can’t all of these also be involved whether we have depression, cancer, a broken leg, or some kind of infection? It just bothers me that with mental illness, sin or bad habits tends to be the first place people jump to rather than the fact that some one is sick and hurting and not at their full capacity, for whatever reason.

    I would rather keep the general term illness, because that’s what it is, and people need care and grace and time to heal, regardless of how they got knocked down. Yes, like any other kind of illness, the causes and factors do need to be considered and investigated and addressed to help recovery and hopefully prevent recurrence. I am not denying that.

    I know this isn’t a perfect analogy, but, you know, when we see someone with a broken leg our first thought is not ask them if they were doing something foolish or were drunk, and we don’t try to force them back to normal activity before they’re healed. Why do we do this to people with broken spirits and minds?

    • Kristin

      Perfect. You articulated what I wanted to say ever since I read this article, but couldn’t piece together.

    • Wairimu

      Thanks Ash.

  • anony-girl

    I completely agree with Ash. I am afraid by arguing vocabulary on “what to call it” we go down a slippery slope and pretty soon we are only increasing the stigma and judgment. If we have one word for mental “issues” caused by sin and a different word for “issues” caused by illness in the brain, we have just made it that much easier to stigmatize and shame people. Bottom line, it’s illness because it can be medically diagnosed. Doesn’t matter whether it was due to sin or illness.

  • Tim

    Well said! This post is a gift. As a professional in the field I have struggled to find the balance so well articulated here. For those who would be critical of David, please know that he does pastoral visits at our local psychiatric hospital when very few other ministers bother. I have seen him come unashamedly carrying his Bible to offer comfort to his parishioners. His example is exceptional.

    • http://thenface2face.wordpress.com Karen Butler

      I am not criticizing David personally, and I made it clear on the ’7 Questions’ thread how much I respect Dr. Murrays’ ministry and dread being some sort of annoying pest with quibbles about minor matters. These are of the utmost importance to me, they are questions I live with every day. I live Kay and Rick Warren’s life. I have twice had to put psychiatric holds on people I love and there have been days I dread opening certain doors for fear of what I would find. These are honest questions I have and to my endless disappointment no-one in the Reformed community wishes to answer them.

      So I will continue to rely on the most helpful source I have for the real spiritual conflicts I daily face, and trust Mark Bubek and his book “The Adversary.” There are some areas where my eyebrows are raised — generational curses,instances where he seemed to interview evil spirits and relied on their information. But he is far more doctrinally sound than Neil Anderson, and the Spiritual Warfare prayers he outlines in the appendix were also a lifesaver for me.

      I hope some day Dr. Murray you could find the time to answer my heartfelt questions. I will be praying the best for you, your wife, and family.

    • Ash

      I also want to make clear that I did not mean my previous post to be critical of Dr. Murray – like I said, it’s a helpful discussion, and I agree with most what he said. Pastoral ministry to individuals and families affected by mental illness is so difficult, and so desperately needed, and I admire his thoughtfulness and compassion and courage in tackling this difficult subject, a subject most people would ignore if they could.

      It’s the broader paradigm that behind this discussion that I’m trying to challenge. Mental illness is messy, we all know that. But physical illness is just as messy. And those steps and factors Dr. Murray lists above all apply to physical illness and injuries as well.

      A person might have cancer because their immune system was chronically depressed from all the stress in their life because of dealing with the fallout from some sinful behavior. And dealing with that sin before God could give a really positive boost to their treatment and recovery. You could have this same discussion about cancer (or arthritis, or fibromyalgia, etc., etc.), but we don’t.

      We are all a bit taken aback when the disciples see the blind man and ask Jesus, “Who sinned, this man and or his parents, that he would be born blind?” But are we really any different? Isn’t there a lot of the same attitude people had in biblical times towards things like leprosy and birth defects in how our current church culture looks at mental illness?

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  • Ash

    Just a few more thoughts, if I may.

    I meant what I said before, I think the discussion and distinctions Dr. Murray has brought up here are important and helpful to think about, especially for those in ongoing pastoral care and counseling.

    Having all the right answers won’t be helpful if they are given in the wrong spirit, most especially to someone who is already emotionally distraught.

    You can never go wrong with a hug, an “I’m sorry you’re going through this,” and a “How can I pray for you?”

    Modern medical science has failed many people with chronic mental and physical pain, and the modern church often fails them, too. God will never crush the bruised reed, but God’s people will, sometimes over and over. If some of us seem a bit sensitive or defensive about this subject, consider that we might have good cause.

    Whether or not we can perfectly discern the physical versus spiritual causes, the uncontrollable circumstances versus sin and personal responsibility, ultimately what suffering people need is healing from the Great Physician, comfort and, yes, conviction that only the Spirit of God can give us. You can always pray. You don’t have to know all the right answers and causes to pray. Most especially pray that God will give them the wisdom and insight as to what practical steps they need to take and give them the grace and strength to do it.

    So, will you pray? Will you fast and pray for the especially hard cases? Will you stand in the gap for God’s people? Will those of you who are strong lift up the burdens of those who are weak before the throne of grace?

    Seriously, will you periodically fast and pray for God’s healing and comfort and grace and mercy and hope and wisdom and strength and courage for everyone in your church and in your life who is suffering from grief, depression, mental illness, and/or chronic pain? You’d probably be surprised at how many people that would cover.

    • Ash

      Look, all of my posts could be better written, but this last one is particularly poorly worded. I would be fine if it were deleted, but please let me clarify a few things.

      When I say modern medicine has failed many people I mean people who have tried multiple medications and treatments over the course of years and are no better or are worse. I do not mean people should not take prescription meds or see psychiatrists. Many people are really helped by medications and I thank God for modern medicine and the wisdom and knowledge doctors and scientists. I see it as a gift from God, part of His common grace and mercy for us all. But modern medicine does not have all the answers for everyone, that’s what I meant. And people should also not be judged if they chose not to take prescription medications.

      And the rest of it really is more about the general tendencies of Christians to take on the role of Job’s friends when dealing with someone who is really suffering, to be too quick to throw out thoughtless, unhelpful advice, to add guilt and shame to someone already overburdened with pain and grief.

      My thoughts on prayer were not about ‘just pray and it will go away.’ Like I said, the most important thing to pray for is wisdom for what practical things need to be done, like medications or therapy or other things like lifestyle and exercise, diet and supplements. I was specifically referencing James 1:5 with this, and James 5:13-15 also came to mind.

      I’ll leave it at that. I crossed over into “where there are many words transgression is unavoidable” a while ago, and I do apologize for that.

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  • Deborah (Debbie)

    So much good said here…and so much more to be said…I look forward to your next post.

  • Dee

    This post and the resulting thread have been insightful and quite helpful!

    I love that what is reflected by one person here clearly illustrates what we are up against in the church regarding the false idea that if we just pray “it will all go away.”

    Albert Einstein said, “To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science.” I would add it also advances the truth of the bible and the whole book of James. We pray for wisdom to handle trials intelligently. We don’t whine about how others should handle their trials in a BETTER way.

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  • Kent

    What are your thoughts about the lack of tests for mental illness? Thank you.

    http://news.bbc.co.uk/2/hi/health/8138893.stm

    • http://headhearthand.org/blog/ David Murray

      I notice that the link is four years old. Much has happened since then. PET scans are increasingly revealing physical brain changes in some cases of mental illness. However, these are usually hugely expensive and not widely available. Fairly good accuracy can be achieved by diagnosis through symptoms at minimal cost. This is a developing area of medical science, made more difficult and slow by the fact that we can’t yet find bi-polar or schizophrenic mice to experiment on.

      • Kent

        I was just wondering, since a friend was diagnosed with depression. He said he was diagnosed because his mom has depression, no other reason.
        He took himself off the drugs because they made him feel more withdrawn.
        I guess it depends on the person.

        Thanks.

        • http://headhearthand.org/blog/ David Murray

          Yes, there are way too many grim stories like this, Kent.

      • Kathleen A. Peck (@purisomniapura)

        What do you think of this Dr. Murray ..psychiatrists saying not only is there no tests to diagnose but also that no one can be cured?
        http://www.youtube.com/watch?v=bguQkX1M1Pg&list=WL3A6802A0DA57CC93

        • http://headhearthand.org/blog/ David Murray

          The first thing I’d note is that it’s dated. A lot has happened on that front since 2006. Also, note that the question is frequently framed as “What conclusive/incontrovertible proof…?” No credible doctor will say that there’s no evidence of a biological or physical component. Lastly, remember that there were many areas of medicine without conclusive proofs for years (e.g. diabetes, MS). However, doctors have to work from symptoms and what works with experimental meds until conclusive tests are developed.

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  • Mark O’Neil

    The correct word you are looking for is “Evil”. Evil includes both natural evils (i.e. the effects of the Fall, pain, suffering, disabilities, illnesses, etc.) and also the moral component too (i.e. the intentional violation of moral laws, lying, stealing, murder, sexual immorality, etc.). It is because society has a misconception and misunderstanding about an accurate definition of “evil” that people do not use that term. Plus the fact that many people I know also embrace moral relativism instead of the fact that evils both natural and moral are objectively real. Feel free to contact me if you wish to discuss this more.

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  • Helen Boileau

    I have suffered anxiety and depression all of my life. It was not until three weeks ago at age 44 that I actually have bi poler medicine. With the new medicine I have absolutely no depression. I am free. Through all of it I have always loved the Lord. The Lord knew me before I was in my mothers womb. He created me this way and I now give Him all the glory. I d not believe it has anything to do with sin. Thank you Jesus.

    • http://headhearthand.org/blog/ David Murray

      Thanks Helen. Great testimony to the Lord’s special AND common grace.

  • Cate R.

    I just wanted to say thank you for this. I found this blog post and started reading the series. I go back and forth all the time about whether or not it’s acceptable for me, as a Christian, to at least partially submit to the idea that there are forces beyond my control involved in why I have pretty much always been depressed, as well as anxious and panicky. This is a very biblically balanced look at it. I take medication but have at times been in near torment about whether or not it’s ok. But anyway, it’s not like everything is peachy when I’m on it, the medication just takes me from incessant despair to occasional despair that I can bounce back from and lead what is closer to a normal life. I don’t think I’ll ever know, this side of earth, why I am the way I am. I went through abuse and neglect as a child, along with serious drug addiction before becoming a Christian, but it’s very possible there’s pre-existing factors too. No medication or understanding of mental illness could ever take away my state of neediness for God, so it helps to hear the way it’s articulated here.

  • Heath Lambert

    David,

    I just stumbled on this little article, and found it to be very helpful and clarifying. I am grateful for your careful work here. I think this lays out most of the reasons why Christians find it so challenging to speak about these issues. I also think it explains why well-intended Believers find it easy to speak past one another (even you, and I on occasion!). Thanks very much for writing this.

    I’m grateful for you,

    Heath.

    • David Murray

      Thanks for these kind words Heath. I’m glad we are getting closer to understanding one another.