Approaching Conceptual Barriers to Christians’ Acceptance of Mental Health Treatment
John Peteet, MD, Harvard Medical School, Boston, MA
Despite growing research in recent decades on the positive role of spirituality in mental health, stigma regarding psychiatry persists within certain Christian communities. Stanford (2007) found that 30% of mentally ill Christian participants experienced negative church interactions, such as being told their mental illness was not real, or was purely spiritual in nature. This stigma, particularly common in conservative faith communities, can lead individuals to avoid seeking care from secular mental health professionals, or to rely solely on spiritual interventions rather than evidence-based treatments.
Here we explore four assumptive frameworks prevalent among Christians about the nature of mental disorder and its relationship to spirituality and treatment that limit access to care. In a model common in interfaith settings, spirituality is understood to function as a response to existential challenges. By contrast, many believers focused on personal responsibility see mental struggles as either blameworthy and in need of spiritual help or reflective of brain disease. Those focused on correct belief may reject psychological treatments based on secular schools of thought. Still others view mental and spiritual health as inseparable, and constitutive of human flourishing.
Clarification of the strengths and limitations of each of these assumptive frameworks can help to reduce religiously enforced mental health stigma. A functional conception of spirituality can present a barrier to acceptance of treatment for those who suspect their treaters have a relativistic view of the truth of the Christian faith that is important to them. Clinicians may need to clarify that their attention to how faith functions in their patients’ does not call into question the validity of its content – for example, by referring to spiritual searching as “finding”, rather than “making” meaning. A dualistic (moral vs. medical) conception of mental illness can present a barrier to acceptance of psychotherapy that is not focused on sin and repentance. Clinicians can acknowledge both the moral dimension of life and treatment, and that mental life has neurobiological correlates, while pointing out that psychological processes and vulnerabilities are often not under an individual’s control, or clearly traceable to brain pathology. They, along with spiritual leaders can consider examples from scripture of faithful individuals such as Elijah and the authors of Psalms who felt suicidal under stress, and needed support to recover (1 Kings 19, Psalms 69). From a more practical perspective, collaboration between Biblical Counselors and conventionally trained psychiatrists can help to allay the mistrust of secular psychotherapy which undergirds this conceptual framework. Acceptance of psychotherapy accompanied by rejection of non-Christian approaches can limit Christians who may need treatment with a range of modalities. To address their concerns, clinicians and spiritual leaders can point to insights shared by secular and Christian schools of thought – for example, the potential for self-centered, or id-driven motivation recognized by Freud, the importance of thinking clearly emphasized by Cognitive Behavior Therapy (CBT), and the focus on responsibility in Acceptance and Commitment Therapy (ACT). Pastors can remind believers that “all truth is God’s truth” whatever its source, and describe ways they or others have benefitted from various psychotherapeutic approaches. Finally, those who identify mental health with human flourishing may mistrust secular treatment that lacks an integrative theological perspective. Better understanding the distinctions among therapeutic approaches of spiritually integrated psychotherapy, pastoral counseling, spiritual direction and targeted skills-based interventions can help individuals to decide on an approach that enhances their well-being in specific ways. For example, a pastor who has benefited from grief counseling, or CBT for depression can serve as a model for his congregation. For their part, clinicians can articulate for patients an integrated, clear vision of their role in their patient’s life, that could include psychological, biological and spiritual interventions. An example is the psychiatrist and theologian Warren Kinghorn’s model of helping “wayfarers” along their journey toward flourishing in God.
Since metaphysical assumptions shape our society’s understanding of mental illness and health, it is important for mental health clinicians to appreciate and address the conceptual obstacles that Christians encounter in obtaining needed help.
Here we explore four assumptive frameworks prevalent among Christians about the nature of mental disorder and its relationship to spirituality and treatment that limit access to care. In a model common in interfaith settings, spirituality is understood to function as a response to existential challenges. By contrast, many believers focused on personal responsibility see mental struggles as either blameworthy and in need of spiritual help or reflective of brain disease. Those focused on correct belief may reject psychological treatments based on secular schools of thought. Still others view mental and spiritual health as inseparable, and constitutive of human flourishing.
Clarification of the strengths and limitations of each of these assumptive frameworks can help to reduce religiously enforced mental health stigma. A functional conception of spirituality can present a barrier to acceptance of treatment for those who suspect their treaters have a relativistic view of the truth of the Christian faith that is important to them. Clinicians may need to clarify that their attention to how faith functions in their patients’ does not call into question the validity of its content – for example, by referring to spiritual searching as “finding”, rather than “making” meaning. A dualistic (moral vs. medical) conception of mental illness can present a barrier to acceptance of psychotherapy that is not focused on sin and repentance. Clinicians can acknowledge both the moral dimension of life and treatment, and that mental life has neurobiological correlates, while pointing out that psychological processes and vulnerabilities are often not under an individual’s control, or clearly traceable to brain pathology. They, along with spiritual leaders can consider examples from scripture of faithful individuals such as Elijah and the authors of Psalms who felt suicidal under stress, and needed support to recover (1 Kings 19, Psalms 69). From a more practical perspective, collaboration between Biblical Counselors and conventionally trained psychiatrists can help to allay the mistrust of secular psychotherapy which undergirds this conceptual framework. Acceptance of psychotherapy accompanied by rejection of non-Christian approaches can limit Christians who may need treatment with a range of modalities. To address their concerns, clinicians and spiritual leaders can point to insights shared by secular and Christian schools of thought – for example, the potential for self-centered, or id-driven motivation recognized by Freud, the importance of thinking clearly emphasized by Cognitive Behavior Therapy (CBT), and the focus on responsibility in Acceptance and Commitment Therapy (ACT). Pastors can remind believers that “all truth is God’s truth” whatever its source, and describe ways they or others have benefitted from various psychotherapeutic approaches. Finally, those who identify mental health with human flourishing may mistrust secular treatment that lacks an integrative theological perspective. Better understanding the distinctions among therapeutic approaches of spiritually integrated psychotherapy, pastoral counseling, spiritual direction and targeted skills-based interventions can help individuals to decide on an approach that enhances their well-being in specific ways. For example, a pastor who has benefited from grief counseling, or CBT for depression can serve as a model for his congregation. For their part, clinicians can articulate for patients an integrated, clear vision of their role in their patient’s life, that could include psychological, biological and spiritual interventions. An example is the psychiatrist and theologian Warren Kinghorn’s model of helping “wayfarers” along their journey toward flourishing in God.
Since metaphysical assumptions shape our society’s understanding of mental illness and health, it is important for mental health clinicians to appreciate and address the conceptual obstacles that Christians encounter in obtaining needed help.