Soul Pain

This happened to a dear friend of mine. He’s been gone for many years, so I think it’s safe to tell the story.

He had, for almost as long as he could remember, suffered spells of intense depression. He wasn’t an educated man. I’m not sure he even knew what to call his bad feelings. In the community where he lived, among the people he knew, there were two states of mental functioning: normal or crazy. For the latter you went to the state mental hospital. He analyzed his feelings in the only way he knew: it was a spiritual problem. 

In desperation he called the pastor. The pastor understood the malady the same way my friend did. He prayed with him. He told him it was up to him to overcome these feelings by his own effort and prayer, and he backed it up with a passage from Ellen White: “For the disheartened there is a sure remedy—faith, prayer, work.” And, he added, it was important to do so, for Ellen White said that just having such feelings was a sin! “Despondency,” she wrote, “is sinful and unreasonable.” (Prophets and Kings, p.164). My friend took from the counseling session the sense that these horrible feelings, feelings that made him want to kill himself to end the pain, were his own fault, and would cost him eternal salvation.

I wish I could say that he overcame depression, that God answered his prayers and for the rest of his life he was happy. But that wouldn’t be true. He struggled with depression until he passed away from cancer at a relatively young age.

I’m not casting blame, and I hope you won’t, either. Remember, this happened years ago, among people who lived in a rather small world. Both my friend and his pastor understood depression according to the only model they knew. Except for the part about depression being a sin, other sufferers in that community might have been receiving similar counsel from their pastors and priests. And it might have been better than the medical alternatives at the time. Early treatments for severe depression, tranquilizers and convulsive therapies, didn’t work well and had ugly side-effects. Surviving by talking to your pastor and praying probably wasn’t a bad outcome.

Mine was among the first generations of Seventh-day Adventist pastors who grew up with the medicalization of emotional problems, though the phrase “mental health,” was still new to us, and the boundary between mental health and spiritual health was (and remains) turbid. This new understanding coincided, not surprisingly, with the development of medications that treated mental illnesses astonishingly well. Anti-depressants, safer tranquilizers, even medications for bipolar disorder and schizophrenia—they aren’t perfect, but they work better than prayer alone.

How do we distinguish between mental health and spiritual health? If a pill made one feel very close to God, if it let a person who’d always struggled with prayer and spiritual feelings suddenly experience God’s presence, would we think that a good thing? That’s exactly what happened to one of my church members when she was prescribed a SSRI. On the other side, I once met a man who quit hearing the voice of God speaking to him after he was placed on psychiatric medications, leaving him spiritually bereft.

Nowadays there are many who, when faced with normal stresses of life, get a prescription for Prozac, or take a Xanax. It’s pretty clear that medicating isn’t always a good solution to everyday problems. Prayer and counseling might be better. But anti-depressants and anxiolytics are miracles for some people with mood disorders. Where’s the line?

Mental health has that same shared territory with science that causes us so much trouble when we talk about origins. That is, how much is God, and how much is science? We Seventh-day Adventists who believe that God is the Creator don’t question the accuracy of science when we need antibiotics, a weather forecast, a computer, or passage in an airliner. But, we ask, when scripture relies on one explanation for something, and science has another, which does a Christian trust? We resent that the more gaps science fills in, the less the need for the Bible’s explanations.

Scripture doesn’t provide a scientific outline for the treatment of disease, mental or physical.^[1] It says to lay hands on sick people and pray, and for the mentally ill, to cast demons out of them. Despite that, for reasons that I’m not the historian to explain, Christians don’t show much hesitation about using medical science—pharmacology, lab tests, surgery, physical therapy, organ transplants—to address physical maladies.^[2] As for mental health, nowadays pastors like me would consider it malpractice to tell a suicidal person, “Don’t see a doctor. Just pray about it.” (Though there are still corners of the Seventh-day Adventist world where pseudo-clergy hold marathon demon-expulsion sessions.) Yet I still meet people with depression who won’t get treatment because it would be an admission of spiritual defeat. A pastor told me, “If my church members knew that I rely on an anti-depressant, many would lose confidence in me. I’m supposed to be setting the example of victory through prayer.”

Many years ago a Seventh-day Adventist college experienced a sweeping spiritual revival on campus. The leader was an intense pastor-in-training who challenged his fellow students that Jesus was coming soon and they must get ready. As I remember the story, it involved long prayer vigils and much shared emotionalism. At first, everyone was thrilled. Isn’t that what we’ve been waiting for, a contagious outpouring of the Holy Spirit that awakens drowsy Seventh-day Adventists to finish the work and bring Jesus back? But when the leader began to style himself as selected in a prophetic way, when his messages became particular and grandiose, some wondered if the revival was healthy. When it was revealed that he was going 24 hours a day without sleep, campus health investigated, and the young man was eventually diagnosed with bipolar disorder.

The story raises some hard questions. What was it that raised concern? The leader’s claim to exercise dormant Biblical gifts? Or his shaking things up in a crazy, possibly destructive way that they feared wouldn’t end well? But can’t the same be said of great Bible characters who we today consider saints? Was Ezekiel, who had hallucinogenic visions and baked bread with his own dung, sane? Might Jeremiah have been in clinical depression when he wrote, “My soul has been rejected from peace; I have forgotten happiness” (Lamentations 3:17)? I wonder how “normal” some of the great characters in spiritual history would have seemed to us, had we been there with them? It appears that God occasionally chose strange, unstable people to work through—people we probably wouldn’t select for leadership in the church. Would some of the progress in human intellectual, spiritual and moral understanding have happened had it not been for people whose behavior can be found described in the DSM-5? For that matter, how much great literature, art, and music would be missing if all of the craziness had been therapied out of Van Gogh, Hemingway, Mozart, Wagner, and scores of other crazy creative people?

Nowadays we don’t eschew mental health treatment. We even have Seventh-day Adventist mental health facilities and a school of psychiatry. I don’t hear many saying we ought to shun psychiatric treatment and rely on prayer alone. Yet there is still more shame attached to mental illness than to physical illness, still questions like, “What did I do to make me feel this way?”, or “Shouldn’t I be able to pray my way out of this?”

I suspect this will always be a muddy area for us. It seems to me we should talk about mental illness in such a way that people wouldn’t hesitate to seek help when they ought to. But there may always be some question about when they ought to.