Doing
Small Things with Extraordinary Love: Congregational Care of People
Experiencing Mental Health Problems
John Swinton ABC Religion and Ethics 6 Oct 2014
Living with a mental health problem is not like living with other forms of physical distress. It challenges the meaning of our personal stories; even the best efforts can erode our sense of humanness.
The mental health industry is a big and complex beast. Amid the high-tech, neurological, genetic and pharmaceutical landscape it is easy for religious communities to feel nervous and disempowered. "What could we possibly have to offer that might bring healing in the midst of such prohibitively high-tech approaches to mental health care?"
Jean Vanier, founder of L'Arche, provides us with a rather unusual answer: "The church is not called to do extraordinary things; it is called to do ordinary things with extraordinary love." In response to the complexities of the experience of mental health problems, the church's vocation is not to become a community of psychiatrists. Rather, it is called to become a community of disciples who strive to embody and reveal God's extraordinary love.
Such a sentiment may sound foolish and perhaps even naive. But, on reflection, doing ordinary things with extraordinary love is precisely the heart of the gospel. Indeed, doing things that look foolish to the world is central to the reframing power of Jesus; such gestures are the heart of discipleship. As the apostle Paul puts it in 1 Corinthians 1:25: "For the foolishness of God is wiser than human wisdom, and the weakness of God is stronger than human strength."
There is power in small things. I here want simply to highlight what it might look like to do ordinary things with extraordinary love and to pay correct attention to small things. Faithful mental health care emerges naturally from such a beginning point.
Understanding mental health problems Throughout this article, I will avoid using the language of illness, not because I don't think that psychiatry has a place within the conversation around mental health, but rather because I think mental health problems belong to communities rather than professional groups. Both have a place, but culturally, at least in the West, the professional understanding, tends to have a louder voice in the conversation. Here I want to try to "turn up the volume" on the community's role in caring for mental health and distress and in so doing try to provide grounds for confidence relating to the role of church communities in mental health care.
Let us begin by asking a pretty basic question: What exactly do we mean when we talk about "mental health problems." Rather than beginning to answer that question by turning to the definitions provided by the mental health services, I want us to begin from a different place.
Think of it this way: Before mental health problems become diagnoses they are deep and meaningful human experiences. They continue to remain that way after they have been named by professionals as schizophrenia, bipolar, personality disorder or whatever. Mental health problems are first and foremost unwanted intrusions into people's personal narratives.
Indeed, from the perspective of the church, mental health problems may best be described as unusual, unique personal experiences which disrupt people's life stories. They are experiences which may well have a biological, neurological or genetic root, but which simply cannot be fully explained on such a basis alone. Recognizing that something has a biological cause tells us nothing about how it impacts upon the unique life stories of individual people striving to live lives that are marked by love and the desire to be loved.
Mental health problems are unique experiences that come to light in the lives of special individuals who are deeply loved by God and who have their own unique stories, histories, dreams and desires which may or may not require the eradication of symptoms. It is true that people's stories may be altered by their biology, but it is not true that they should be defined by it. People's stories can, however, be deeply altered and affected by the meanings that we ascribe to their experiences.
The problem of stigma We live in a society where, for a variety of reasons, mental health problems have come to be considered in particularly negative terms. In a society that prizes intellect, reason and clear thinking, and assumes these to be the essence of what it means to be fully human, being the bearer of a condition that seems to interfere with any or all of these faculties inevitably holds a particular negativity.
Mental health problems are highly stigmatized conditions. Stigma is a way of creating a story that hides, or perhaps better, overpowers the humanness of an individual. Stigma occurs when one aspect of a person is highlighted in such a way that people consider it to be the only and/or most important aspect of a person's life.
When a person's unique story and personal experiences become stigmatized, their lives are given a new plot line. Now their stories are marked by cultural assumptions about the nature of depression, schizophrenia, bipolar disorder or whatever. They now find themselves forced to live in and to live out a story that is no longer owned by them their own; a story that often informs them that they are of little worth; that their illness is the reason for everything they are and do and that, other than perhaps their families, the only people who should care for them are people who are paid to care for them.
It is certainly the case that discovering a neurological or genetic cause for mental health problems helps to de-stigmatize unpleasant experiences and to draw them within the acceptable boundaries of the medical model. But such a way of naming psychological suffering has side-effects. As John Modrow puts it in his book How to Become a Schizophrenic:
"I cannot think of anything more destructive of one's sense of worth as a human being than to believe that the inner core of one's being is sick - that one's thoughts, values, feelings, and beliefs are merely the meaningless symptoms of a sick mind ..."
Stigma is a way of stealing someone's story and forcing them to accept a false, negative identity. Biologising mental health problems is a way of providing a helpful and non-stigmatizing explanation of disturbing experiences, which can have the effect of stripping away the deep and vital meaning of symptoms and experiences. To live with a mental health problem in our culture is not the same as living with other forms of mental or physical distress. It challenges the meaning of our personal stories and ultimately even our best efforts to help can end up eroding our sense of humanness.
A ministry of small things: What would Jesus do? It is remarkable how easy it is to take someone's story away from them and to give them a false name. If the reader of this article catches herself referring to people with mental health problems as "schizophrenics" or "depressives" or "neurotics" or "bipolars," then she/he will know that they have been well schooled in the ways of telling the wrong stories and that she/he has forgotten what it means to name people properly. That is a small thing for us to realize, but a huge revelation in its consequences. If that is the case, then the task of the church should be relatively straight forward: to love people experiencing mental health issues, to respect their stories and to learn to call people by name. In other words, to give people back their stories.
A good place for us to learn to talk properly about mental health problems is by reflecting on the life of Jesus and his ministry with "marginalized people." Many of the people that Jesus spent time with were highly stigmatized: tax collectors, sinners, prostitutes, lepers - people whom society considered to be unclean. Such people shared many similar with the experiences of people with mental health problems today.
It is often suggested that Jesus sat with the marginalized. Because Jesus sat with the marginalized, it is assumed, the task of the church is to do the same. The task of the church is to reach out to those on the margins and bring them into to its loving heart. Well, that is certainly not a bad idea. However, it is also a misunderstanding of what Jesus did and ended up doing.
It is certainly the case that Jesus sat with the marginalized and it is also true that he offered them friendship, acceptance and a valued place within his coming Kingdom. However, it is not quite the case that Jesus sat with the marginalized. He certainly sat with those whom religious society had excluded and rejected as unclean and unworthy of attention. However, in sitting with such people, Jesus, who was and is God, actually shifted the margins.
Now, it was the religious authorities that were marginalized. Those who thought they were pleasing God with their rituals and laws, completely missed the point of what God was up to. They didn't realize that Jesus had moved the margins to a totally different place. Now it was established religion that found itself alienated and marginalized. Those who thought they knew God continued to assume this to be the case. But God was with a totally different group of people doing something quite different: offering friendship and acceptance and revealing the Kingdom in and through that friendship. Jesus offered no "technique" or "expertise." He simply gifted time, presence, space, patience and friendship. He befriended the tax collectors and sinners; he befriended the prostitute, the stranger and the stigmatized. He offered relational space and time to people for whom the world (and religion) had no time. In and through his friendships, he gave people back their names. Indeed, he gave them new names: "I no longer call you servants; now I call you friends."
I sometimes fear that something similar might be happening in our own churches. Could it be that the reason some of our churches find little interest in ministering with people experiencing mental health problems or who put such ministry down to something apart from the centralities of the gospel - something for those "interested in such things" - is that by neglecting the marginalized they have become marginalized?
The church must make space for friendships. Friendships cannot, of course, be manufactured, but we can create spaces in our lives and in our communities where friendship becomes at least a possibility. Jesus didn't impose his friendship, but he clearly made sure he was available in the places where friendship with "marginalized people" was at least an option. Likewise, he sat with tax collectors, prostitutes and sinners; not reformed tax collectors, prostitutes and sinners. He just took people exactly as they were. The call of the church is to engage in the ordinary act of friendship with extraordinary love.
Re-thinking hospitality: Moving from host to guest Thinking about friendship with people experiencing mental health issues takes us to the practice of hospitality. The world can be a pretty inhospitable place for those who are considered to be different. One of the extraordinary things about Jesus' ministry is the way in which he worked out his practice of hospitality. Sometimes Jesus was a guest in people's houses; sometimes he was a host. The constant movement from guesting to hosting is a primary mark of the hospitable work of the incarnation.
This observation is crucial for understanding the nature of the church's life with people who have mental health problems. To be truly hospitable we need to learn how to be a guest in the house of the "stranger." Rather than assuming that the church's task is to host people with mental health problems - somehow to seek to find ways of "looking after them because they can't look after themselves" - what might it look like if our congregations were to become truly hospitable and began to think of themselves both in terms of guest and host in the presence of people experiencing mental health difficulties? What might it look like if churches were to consider themselves guests in the stories of the lives of those who have different experiences?
Rather than simply assuming that people's experiences are "nothing but" the product of misfiring neurones, chemical imbalances or genetic differences, what might it look like if we were prepared to slow down and take the time to listen to and take seriously the meanings of such experiences - not as simply the products of illness, but as important aspects of a person's life story? What kind of impact could it have if, instead of fretting about how we can help to control or cure a person's experiences (important as that may be in certain situations), we invited people with mental health problems to speak to our congregations about what it actually feels like to go through such experiences. I suspect that is the approach that Jesus would take - love first, then listen and always try to understand. When we take time and allow ourselves to move from host to guest, we gain the opportunity to learn some beautiful and important things.
I spoke to a woman not so long ago who was diagnosed as having bipolar disorder. She told me about a lovely experience she had on a mountaintop in Warwickshire where she thought, just for a while, that she was in heaven. It was a quite beautiful experience, even though technically it "didn't really happen." It is easy to dismiss such an experience as nothing but "mental illness." But, for her it was a deeply meaningful experience the memory of which even now, two years later, brings her comfort, joy and hope.
Another friend who bears the diagnosis of schizophrenia tells me how important some of her voices can be. It is true that some of her voices are deeply unpleasant (she welcomes medication at this level); but others are a source of comfort. She wants to be rid of the bad voices, but the good voices can be peaceful, comforting and helpful. This, of course, sounds ridiculous to those of us whose vision can only cope with a single medical narrative of mental health and ill-health. How can something "unreal" really matter? But these things do matter and it is only as we adopt the role of guest in the house of those with different psychological experiences that we can discover that, even if a condition has a biological origin, that is not the end of the story of what it is and what it means.
None of this should be read as in any way anti-psychiatry. Quite the opposite. Medication and therapy can be helpful. You can take medication without necessarily being defined by your condition. So what I am here writing should in no way be used as a rationale for not taking medication. That is not my point.
I would also emphasize that churches should have constructive relationships with mental health professionals and that standard services have an important role to play. Mental health problems can be deeply destructive and can ruin and profoundly disrupt people's lives. People do need relief and relief can come from psychiatry - although rarely on its own.
What I would stress, however, is that the stories told by the mental health professions are not the only stories in town. It is in the small stories of friendship, hospitality, love, listening and acceptance - all of which are modeled clearly in the life of Jesus - that we find the context and the seedbed for extraordinary love. Here we encounter healing, even if cure is not an option.
The task of the church is not world transformation, but signaling the Kingdom through small gestures. Look after the small things, and the big things will fall into place.
John Swinton holds the Chair in Divinity and Religious Studies at the University of Aberdeen, Scotland. His most recent book is Dementia: Living in the Memories of God. An earlier version of this article appeared in The Christian Citizen.
Living with a mental health problem is not like living with other forms of physical distress. It challenges the meaning of our personal stories; even the best efforts can erode our sense of humanness.
The mental health industry is a big and complex beast. Amid the high-tech, neurological, genetic and pharmaceutical landscape it is easy for religious communities to feel nervous and disempowered. "What could we possibly have to offer that might bring healing in the midst of such prohibitively high-tech approaches to mental health care?"
Jean Vanier, founder of L'Arche, provides us with a rather unusual answer: "The church is not called to do extraordinary things; it is called to do ordinary things with extraordinary love." In response to the complexities of the experience of mental health problems, the church's vocation is not to become a community of psychiatrists. Rather, it is called to become a community of disciples who strive to embody and reveal God's extraordinary love.
Such a sentiment may sound foolish and perhaps even naive. But, on reflection, doing ordinary things with extraordinary love is precisely the heart of the gospel. Indeed, doing things that look foolish to the world is central to the reframing power of Jesus; such gestures are the heart of discipleship. As the apostle Paul puts it in 1 Corinthians 1:25: "For the foolishness of God is wiser than human wisdom, and the weakness of God is stronger than human strength."
There is power in small things. I here want simply to highlight what it might look like to do ordinary things with extraordinary love and to pay correct attention to small things. Faithful mental health care emerges naturally from such a beginning point.
Understanding mental health problems Throughout this article, I will avoid using the language of illness, not because I don't think that psychiatry has a place within the conversation around mental health, but rather because I think mental health problems belong to communities rather than professional groups. Both have a place, but culturally, at least in the West, the professional understanding, tends to have a louder voice in the conversation. Here I want to try to "turn up the volume" on the community's role in caring for mental health and distress and in so doing try to provide grounds for confidence relating to the role of church communities in mental health care.
Let us begin by asking a pretty basic question: What exactly do we mean when we talk about "mental health problems." Rather than beginning to answer that question by turning to the definitions provided by the mental health services, I want us to begin from a different place.
Think of it this way: Before mental health problems become diagnoses they are deep and meaningful human experiences. They continue to remain that way after they have been named by professionals as schizophrenia, bipolar, personality disorder or whatever. Mental health problems are first and foremost unwanted intrusions into people's personal narratives.
Indeed, from the perspective of the church, mental health problems may best be described as unusual, unique personal experiences which disrupt people's life stories. They are experiences which may well have a biological, neurological or genetic root, but which simply cannot be fully explained on such a basis alone. Recognizing that something has a biological cause tells us nothing about how it impacts upon the unique life stories of individual people striving to live lives that are marked by love and the desire to be loved.
Mental health problems are unique experiences that come to light in the lives of special individuals who are deeply loved by God and who have their own unique stories, histories, dreams and desires which may or may not require the eradication of symptoms. It is true that people's stories may be altered by their biology, but it is not true that they should be defined by it. People's stories can, however, be deeply altered and affected by the meanings that we ascribe to their experiences.
The problem of stigma We live in a society where, for a variety of reasons, mental health problems have come to be considered in particularly negative terms. In a society that prizes intellect, reason and clear thinking, and assumes these to be the essence of what it means to be fully human, being the bearer of a condition that seems to interfere with any or all of these faculties inevitably holds a particular negativity.
Mental health problems are highly stigmatized conditions. Stigma is a way of creating a story that hides, or perhaps better, overpowers the humanness of an individual. Stigma occurs when one aspect of a person is highlighted in such a way that people consider it to be the only and/or most important aspect of a person's life.
When a person's unique story and personal experiences become stigmatized, their lives are given a new plot line. Now their stories are marked by cultural assumptions about the nature of depression, schizophrenia, bipolar disorder or whatever. They now find themselves forced to live in and to live out a story that is no longer owned by them their own; a story that often informs them that they are of little worth; that their illness is the reason for everything they are and do and that, other than perhaps their families, the only people who should care for them are people who are paid to care for them.
It is certainly the case that discovering a neurological or genetic cause for mental health problems helps to de-stigmatize unpleasant experiences and to draw them within the acceptable boundaries of the medical model. But such a way of naming psychological suffering has side-effects. As John Modrow puts it in his book How to Become a Schizophrenic:
"I cannot think of anything more destructive of one's sense of worth as a human being than to believe that the inner core of one's being is sick - that one's thoughts, values, feelings, and beliefs are merely the meaningless symptoms of a sick mind ..."
Stigma is a way of stealing someone's story and forcing them to accept a false, negative identity. Biologising mental health problems is a way of providing a helpful and non-stigmatizing explanation of disturbing experiences, which can have the effect of stripping away the deep and vital meaning of symptoms and experiences. To live with a mental health problem in our culture is not the same as living with other forms of mental or physical distress. It challenges the meaning of our personal stories and ultimately even our best efforts to help can end up eroding our sense of humanness.
A ministry of small things: What would Jesus do? It is remarkable how easy it is to take someone's story away from them and to give them a false name. If the reader of this article catches herself referring to people with mental health problems as "schizophrenics" or "depressives" or "neurotics" or "bipolars," then she/he will know that they have been well schooled in the ways of telling the wrong stories and that she/he has forgotten what it means to name people properly. That is a small thing for us to realize, but a huge revelation in its consequences. If that is the case, then the task of the church should be relatively straight forward: to love people experiencing mental health issues, to respect their stories and to learn to call people by name. In other words, to give people back their stories.
A good place for us to learn to talk properly about mental health problems is by reflecting on the life of Jesus and his ministry with "marginalized people." Many of the people that Jesus spent time with were highly stigmatized: tax collectors, sinners, prostitutes, lepers - people whom society considered to be unclean. Such people shared many similar with the experiences of people with mental health problems today.
It is often suggested that Jesus sat with the marginalized. Because Jesus sat with the marginalized, it is assumed, the task of the church is to do the same. The task of the church is to reach out to those on the margins and bring them into to its loving heart. Well, that is certainly not a bad idea. However, it is also a misunderstanding of what Jesus did and ended up doing.
It is certainly the case that Jesus sat with the marginalized and it is also true that he offered them friendship, acceptance and a valued place within his coming Kingdom. However, it is not quite the case that Jesus sat with the marginalized. He certainly sat with those whom religious society had excluded and rejected as unclean and unworthy of attention. However, in sitting with such people, Jesus, who was and is God, actually shifted the margins.
Now, it was the religious authorities that were marginalized. Those who thought they were pleasing God with their rituals and laws, completely missed the point of what God was up to. They didn't realize that Jesus had moved the margins to a totally different place. Now it was established religion that found itself alienated and marginalized. Those who thought they knew God continued to assume this to be the case. But God was with a totally different group of people doing something quite different: offering friendship and acceptance and revealing the Kingdom in and through that friendship. Jesus offered no "technique" or "expertise." He simply gifted time, presence, space, patience and friendship. He befriended the tax collectors and sinners; he befriended the prostitute, the stranger and the stigmatized. He offered relational space and time to people for whom the world (and religion) had no time. In and through his friendships, he gave people back their names. Indeed, he gave them new names: "I no longer call you servants; now I call you friends."
I sometimes fear that something similar might be happening in our own churches. Could it be that the reason some of our churches find little interest in ministering with people experiencing mental health problems or who put such ministry down to something apart from the centralities of the gospel - something for those "interested in such things" - is that by neglecting the marginalized they have become marginalized?
The church must make space for friendships. Friendships cannot, of course, be manufactured, but we can create spaces in our lives and in our communities where friendship becomes at least a possibility. Jesus didn't impose his friendship, but he clearly made sure he was available in the places where friendship with "marginalized people" was at least an option. Likewise, he sat with tax collectors, prostitutes and sinners; not reformed tax collectors, prostitutes and sinners. He just took people exactly as they were. The call of the church is to engage in the ordinary act of friendship with extraordinary love.
Re-thinking hospitality: Moving from host to guest Thinking about friendship with people experiencing mental health issues takes us to the practice of hospitality. The world can be a pretty inhospitable place for those who are considered to be different. One of the extraordinary things about Jesus' ministry is the way in which he worked out his practice of hospitality. Sometimes Jesus was a guest in people's houses; sometimes he was a host. The constant movement from guesting to hosting is a primary mark of the hospitable work of the incarnation.
This observation is crucial for understanding the nature of the church's life with people who have mental health problems. To be truly hospitable we need to learn how to be a guest in the house of the "stranger." Rather than assuming that the church's task is to host people with mental health problems - somehow to seek to find ways of "looking after them because they can't look after themselves" - what might it look like if our congregations were to become truly hospitable and began to think of themselves both in terms of guest and host in the presence of people experiencing mental health difficulties? What might it look like if churches were to consider themselves guests in the stories of the lives of those who have different experiences?
Rather than simply assuming that people's experiences are "nothing but" the product of misfiring neurones, chemical imbalances or genetic differences, what might it look like if we were prepared to slow down and take the time to listen to and take seriously the meanings of such experiences - not as simply the products of illness, but as important aspects of a person's life story? What kind of impact could it have if, instead of fretting about how we can help to control or cure a person's experiences (important as that may be in certain situations), we invited people with mental health problems to speak to our congregations about what it actually feels like to go through such experiences. I suspect that is the approach that Jesus would take - love first, then listen and always try to understand. When we take time and allow ourselves to move from host to guest, we gain the opportunity to learn some beautiful and important things.
I spoke to a woman not so long ago who was diagnosed as having bipolar disorder. She told me about a lovely experience she had on a mountaintop in Warwickshire where she thought, just for a while, that she was in heaven. It was a quite beautiful experience, even though technically it "didn't really happen." It is easy to dismiss such an experience as nothing but "mental illness." But, for her it was a deeply meaningful experience the memory of which even now, two years later, brings her comfort, joy and hope.
Another friend who bears the diagnosis of schizophrenia tells me how important some of her voices can be. It is true that some of her voices are deeply unpleasant (she welcomes medication at this level); but others are a source of comfort. She wants to be rid of the bad voices, but the good voices can be peaceful, comforting and helpful. This, of course, sounds ridiculous to those of us whose vision can only cope with a single medical narrative of mental health and ill-health. How can something "unreal" really matter? But these things do matter and it is only as we adopt the role of guest in the house of those with different psychological experiences that we can discover that, even if a condition has a biological origin, that is not the end of the story of what it is and what it means.
None of this should be read as in any way anti-psychiatry. Quite the opposite. Medication and therapy can be helpful. You can take medication without necessarily being defined by your condition. So what I am here writing should in no way be used as a rationale for not taking medication. That is not my point.
I would also emphasize that churches should have constructive relationships with mental health professionals and that standard services have an important role to play. Mental health problems can be deeply destructive and can ruin and profoundly disrupt people's lives. People do need relief and relief can come from psychiatry - although rarely on its own.
What I would stress, however, is that the stories told by the mental health professions are not the only stories in town. It is in the small stories of friendship, hospitality, love, listening and acceptance - all of which are modeled clearly in the life of Jesus - that we find the context and the seedbed for extraordinary love. Here we encounter healing, even if cure is not an option.
The task of the church is not world transformation, but signaling the Kingdom through small gestures. Look after the small things, and the big things will fall into place.
John Swinton holds the Chair in Divinity and Religious Studies at the University of Aberdeen, Scotland. His most recent book is Dementia: Living in the Memories of God. An earlier version of this article appeared in The Christian Citizen.