Toward a Theology of Psychological Disorder

Toward a Theology of Psychological Disorder

Marcia Webb

foreword by John Swinton

TOWARD A THEOLOGY OF PSYCHOLOGICAL DISORDER

Copyright © 2017 Marcia Webb. All rights reserved. Except for brief quotations in critical publications or reviews, no part of this book may be reproduced in any manner without prior written permission from the publisher. Write: Permissions, Wipf and Stock Publishers, 199 W. 8th Ave., Suite 3, Eugene, OR 97401.

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paperback isbn: 978-1-4982-0211-4

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Cataloguing-in-Publication data:

Names: Webb, Marcia. | Swinton, John (foreword)

Title: Toward a theology of psychological disorder / by Marcia Webb, foreword by John Swinton.

Description: Eugene, OR: Cascade Books, 2017 | Includes bibliographical references and index.

Identifiers: isbn 978-1-4982-0211-4 (paperback) | isbn 978-1-4982-8856-9 (hardcover) | isbn 978-1-4982-0212-1 (ebook)

Subjects: LCSH: Psychology and religion. | Psychology. | Theological anthropology.

Classification: lcc bf51 w3 2017 (print) | lcc bf51 (ebook)

Manufactured in the U.S.A. 07/31/17

Unless otherwise noted, quotations from Scripture appearing in this text are from the New Revised Standard Version Bible, copyright © 1989, Division of Christian Education of the National Council of the Churches of Christ in the United States of America. Used by permission. All rights reserved.

Scripture quotations marked (NIV) are from the Holy Bible, New International Version®, NIV®. Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission of Zondervan. All rights reserved worldwide. www.zondervan.com The NIV and New International Version are trademarks registered in the United States Patent and Trademark Office by Biblica, Inc.™

Scripture quotations marked (NLT) are taken from the Holy Bible, New Living Translation, copyright © 1996, 2004, 2007 by Tyndale House Foundation. Used by permission of Tyndale House Publishers, Inc., Carol Stream, Illinois 60188. All rights reserved.

Scripture quotations marked (NCV) are taken from the New Century Version®. Copyright © 2005 by Thomas Nelson. Used by permission. All rights reserved.

Scripture quotations marked (NKJV) are taken from the New King James Version®. Copyright © 1982 by Thomas Nelson. Used by permission. All rights reserved.

Scripture quotations marked (KJV) are taken from the King James Version, published in 1611. The King James Version of the Bible is in the public domain.

Grateful acknowledgment for permission to reprint portions of A Confession of Acedia. Copyright © 2007 from Before Depression: The Medieval Vice of Acedia by Robert Daly. Reproduced by permission of The Washington School of Psychiatry (http://www.wspdc.org).

Table of Contents

Title Page

Foreword

Acknowledgments

Preface

Part I: The Current Dilemma Regarding Psychological Disorder in Christian Culture

Chapter 1: Introduction to the Dilemma

Chapter 2: Negative Lay Theologies of Psychological Disorder

Chapter 3: Evaluation of Negative Lay Theologies: Introductory Comments

Chapter 4: Is Psychological Distress (or Disorder) a Demonstration of Lack of Faith?

Chapter 5: Is Psychological Distress (or Disorder) Evidence of Selfishness?

Chapter 6: Does Personal Sin Cause Psychological Distress (or Disorder)?

Chapter 7: Is Psychological Distress (or Disorder) Due to Demonic Influence?

Chapter 8: The Historical and Cultural Context: Theological Traditions in the West

Chapter 9: The Historical and Cultural Context: The United States

Part II: Toward a Theology of Psychological Disorder

Chapter 10: Introduction to Theological Themes Regarding Psychological Disorder

Chapter 11: Power in Weakness

Chapter 12: Freedom in Finitude: The Contribution of Time

Chapter 13: Complexity in Disorder: Fearfully and Wonderfully Made

Chapter 14: The Stranger in Our Midst: Christ as Immanuel

Chapter 15: A Theology of Psychological Disorder and the Passible God

Bibliography

to my mother

the world is a smaller place without you

. . . or perhaps, without realizing it,

I have become larger, just from knowing you

thank you for everything

see you soon

in that City of infinite expanse

Foreword

Exploring the ways in which theology relates to mental health is one of the most important and challenging tasks for the church as it seeks to reflect on and faithfully practice its ministry of healing. Mental health challenges touch the very heart of our spirituality and are painfully prevalent within our communities. As one encounters the strangeness and confusion that accompanies the experience of living with a mental health problem, the big spiritual questions: Who am I? Where do I come from? Where am I going to? Why?—inevitably come to the fore. Finding answers to such questions is the essence of the spiritual task of mental health care.

But what exactly are mental health challenges? How are we to understand them? Are they biological malfunctions that require medication? Psychological wounds that require therapy? Theological and spiritual problems that require prayer and spiritual intervention? The answer is probably yes to all of these questions. However, a good deal of contemporary thinking around the etiology of and response to mental health challenges has tended to prioritize the biological. Here the assumption is that mental health challenges are best understood as brain diseases, on par with diabetes, multiple sclerosis or cancer. By drawing mental health problems into the medical framework, certain troublesome experiences are destigmatized and solutions are offered that seek to address the perceived biological roots of people’s experiences.

However, there is a problem with this way of looking at mental health issues. Whilst biological approaches may help with certain aspects of de-stigmatization, they have certain easily overlooked side effects. As John Modrow, a psychiatrist who lives with schizophrenia, has put it:

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 . . . What the concept of mental illness offered me was scientific proof that I was utterly worthless, and would always be worthless. It was just the nature of my genes, chemistry and brain processes—something I could do nothing about.¹

The problem here is that this way of explaining mental distress means that one no longer has a mental health challenge, one is a mental health challenge; it is built into the very fabric of who you are. It’s in our genes, our neurology, our biology. We may well experience strange things, but they are nothing more than symptoms of an underlying biological flaw. Our meaningful experiences are reduced to mere symptoms. My point is not of course that biology is irrelevant to our understanding of mental health issues. My point is simply that it is insufficient as a way of explaining the fullness of the experiences that people go through as they encounter mental health challenges. The experiences that accompany schizophrenia, bipolar disorder, depression, anxiety or any other mental health issue are deeply meaningful occurrences that occur within the lives of human beings who are profoundly meaning-seeking creatures. To reduce such experiences to mere pathology is to misunderstand what it means to live with a mental health challenge as opposed simply to dealing with it.

Having a mental health challenge is quite different from having a physical illness even if it has physical roots. As one of the participants in a study I am currently working on put it:

People want to say that having a mental illness is just like having a physical illness. I guess in one sense that is true. But there is a sense of a disruption of the self—my-self that comes with my mental illness that makes it quite different. Depression is not like malaria.

Mental health challenges disrupt our stories and as such disrupt our sense of self; who we perceive ourselves to be in the world. The biological story helps us to understand some things but it does not explain all things. We are not simply defined by our brains. There are other stories that need to be told.

Marcia Webb is well aware that there are many stories that can be told about mental health challenges (both good and bad). Her intention is not in any sense to debunk the medical story. Rather her intention is to re-narrate mental health challenges by bringing together biology, psychology, biblical studies and theology in such a way as to show the necessity of each for the well-being of people whose stories have been disrupted by mental health issues. In developing a pastoral theology of mental health challenges (a way of looking at mental health issues in the light of what we know about God and what it means to be a human being made in God’s image), she masterfully holds the delicate tensions between the biological, and the spiritual. In so doing she offers vital insights and revised practices which enable these different ways of looking at the world to be brought together in order to create modes of understanding that are truly theological and genuinely healing. This book is a gift to the church and deserves to be taken seriously.

Rev. Professor John Swinton

Professor in Practical Theology and Pastoral Care

School of Divinity, History and Philosophy

King’s College, University of Aberdeen

1. Modrow, How to Become a Schizophrenic,

200

.

Acknowledgments

I would like to express my appreciation for the many colleagues, friends, students, and family members who encouraged me to write about faith and psychological disorder, who read drafts of earlier manuscripts, who offered constructive feedback, and who prayed for me as I wrote this book. I also want to thank Seattle Pacific University’s library staff, including Vance Lindahl, for their indefatigable assistance with what must have seemed at times an endless stream of research requests from me.

In addition, I am grateful to those individuals over the years who attended my therapy practice, who entrusted me with their concerns, who taught me so much about human frailty and courage, and whose lives informed my thinking in ways they may never know.

In 2009, I received SPU’s Winifred E. Weter Lecture Award, which provided me with my first opportunity to communicate many of the ideas included in this text. I am thankful for the members of the SPU Faculty Status Committee who believed my proposed lecture, entitled Toward a Theology of Mental Illness, was a worthy candidate for the award. In particular, I want to express my gratitude to Dr. Kathy Stetz who was a steadfast champion of my writing efforts as I conducted research with her and then composed the lecture.

Several months after my lecture presentation, theologians William Gaventa and John Swinton invited me to submit an abridged version of my lecture as an article for the Journal of Religion, Disability, & Health. I have greatly appreciated this support. At the time, I had not published in theological journals, and this opportunity offered to me by such prominent scholars with expertise in the theology of disability was very affirming.

In the years since I received the Weter lecture award and completed the article, I also heard from various individuals who located and read these manuscripts. I want to thank them for their encouraging words. Scholars often find themselves seated alone before their computer screens, writing for long hours in solitude; it is meaningful and inspiring when we learn that these efforts may somehow be touching others.

Finally, I am particularly indebted to Lew, Jackie, and Luke Dickinson, and to Keith and Jenny Hand. Their advocacy for persons with mental illnesses, their willingness to share their family story, their commitment to faith integration with mental health concerns, and their generous financial gifts to SPU over the years resulted in the establishment and development of the Living Well Initiative. The Initiative is a multidisciplinary program focused on severe mental illness which engages in educational programs, community outreach, advocacy, and research. My involvement with the Living Well Initiative for more than a decade has helped me to focus upon and develop ideas about psychological disorder and theology. It was, in fact, during my work with the Initiative that I first heard the phrase, a theology of mental illness. Professor Mícheál Roe, who was at that time my Dean, had met with SPU’s theology faculty and discussed with them contemporary issues in the theology of disability. He mentioned this conversation during a later meeting with the Initiative, and then suggested that one or more of us might conduct a Weter lecture focused on a corollary theology of mental illness. When he uttered this phrase, something resonated within me; I realized in that moment that so many of my disconnected ruminations and mental wanderings over the years as a Christian and a psychologist had been devoted to this very task— the development of a theological framework to understand psychological disorder. But suddenly I had a name to describe what had been until that time only a loosely organized and much-muddled collection of ideas. I am thus grateful to him; to all those who have worked with the Living Well Initiative during the past 15 years, including Lucille Kelley, former Dean of the School of Health Sciences, who brought grace and wisdom to every meeting; and to the Dickinson and Hand families, who provided the original impetus and funding for this unique program. The Initiative gave me time and a place, as well as the academic support I needed, to focus more deliberately on areas of scholarship close to my heart.

Preface

As a Christian, I am aware of the existence of stigma in the church regarding mental illness. I am also aware of individuals with psychological disorders who have felt so misunderstood and judged by believers they have chosen to leave the church altogether. As I have heard these stories over the decades, I have found them disturbing and tragic.

Even so, I know there is hope. Doctrinal statements from many denominations reflect increasing awareness of the challenge of mental illness among congregants. In many churches, there are individuals currently involved in ministries to support those with psychological disorders and their families. In recent years, new publications have specifically addressed methods to develop these ministries. And, most recently, there has been the dawning of discussions around a theology of psychological disorder. I am especially grateful for those, like John Swinton, who have begun to consider elements of this theology in books like Resurrecting the Person: Friendship and the Care of People with Mental Health Problems and From Bedlam to Shalom: Toward a Practical Theology of Human Nature, Interpersonal Relationships, and Mental Health Care.

My hope is that this book may further that discussion, and contribute to an understanding of psychological disorder that is faithful to the biblical witness at the same time that it welcomes the body of scientific knowledge that we now possess about diagnosis and intervention. Yet the task ahead is not without its difficulties. So let me first offer a few clarifying comments which may aid the reader in the interpretation of this text.

Diagnoses and Terminology

At the outset, we face challenges in our attempts to develop a theology of psychological disorder because psychological disorders are extremely varied. The Diagnostic and Statistical Manual of Mental Disorders, a standard guide for mental health diagnosis, catalogues literally hundreds of disorders. It seems unlikely any theological commentary could comprehensively address all of these mental illnesses. For this reason, I have chosen to focus this book on a select group of disorders. In particular, I focus upon affective disorders, such as depression or bipolar disorder; anxiety disorders; trauma- or stressor-related disorders, such as post-traumatic stress disorder; and schizophrenia spectrum disorders. These disorders may be more persistent in nature, and they may include both biological and psychosocial factors in their etiology. Although it is possible that comments in this book will apply to other diagnoses, the specific focus of my arguments is upon these mental health impairments.

Given the complexity of psychological disorder, and the challenge of examining this subject from the perspective of theology, I need also to comment on the matter of terminology. Throughout the history of the health sciences, various names have been used to describe what I refer to here as psychological disorders. As the standard diagnostic tool for mental health professionals, the DSM refers to these diagnoses as mental disorders. However, in the profession, and in grassroots organizations advocating for this population, these diagnoses may also be referred to as psychological disorders, psychiatric disorders, psychiatric disabilities, or mental illnesses."

In my earlier writing on this topic, I used the term mental illness to describe the focus of this theology.² However, I have felt increasing ambivalence toward the use of the term mental illness. There are philosophical and historical reasons why some groups prefer or reject various clinical terms. For example, among psychologists, the term mental illness has at times been viewed as suggestive of a medical model of these diagnoses, and thus may be misleading when describing those areas of human dysfunction which may be due, in part, to environmental influences, such as post-traumatic stress disorder.

However, my current use of the term psychological disorder to describe the focus of this theology is due not so much to these philosophical issues, but instead to practical concerns. Working with persons who are afflicted with these problems has taught me that they often have a language of their own to describe the thoughts, emotions, or behaviors that trouble them. For example, I have heard people with a history of major depression or psychosis use the phrase nervous breakdown or simply the word breakdown to describe their experiences. Yet I cannot recall the last time I heard a mental health professional use these terms.

Given my awareness of the significance of terminology, including its potential role in stigma, I have struggled with the use of the term mental illness in the phrase a theology of mental illness. My sense is that, while no term will be entirely free from troubling associations, the phrase a theology of mental illness may provide a barrier for at least some people, creating unnecessary hesitancy about engaging with the content of this theology. In my practice as a psychotherapist, I have worked with clients who have experienced milder forms of disorder. When I have occasionally used the term mental illness to describe their experience, not intending any harm by this terminology, I have sometimes seen their discomfort and confusion in response to my language. Thus I use instead the phrase, a theology of psychological disorder. It is my (perhaps illusory) hope that this phrase may be less stigmatizing for readers who are not health professionals, but who still might have questions about Christian theology as it applies to depression or anxiety, for example, even if they do not themselves consider these diagnoses to be mental illnesses.

It is perhaps not surprising that people with milder forms of disorder may feel some confusion about this terminology. I have sometimes sensed in the public consciousness an implicit assumption that persons with mental illnesses are generally understood as those individuals with severe and persistent mental disorders, and as such, they are to be distinguished, it seems almost entirely, from those with milder or more moderate forms of disorder. And it is true that severe and persistent mental disorder differs considerably in the degree of impairment experienced by individuals with these diagnoses, and in the amount of support these persons may need. Yet I am concerned that emphases on this degree of impairment may too often be understood as another subtle means in the broader public consciousness to separate us from them when categorizing persons with mental health conditions. As humans, we are all us, regardless of the degree, the type, or the source, of the challenges we face in this life. Thus I see a continuum in the degree of impairment among the disorders I consider in this text, from persons who are able still to manage most, if not all, of the typical components of everyday life—including family and vocational responsibilities—to those who struggle more acutely with these tasks. It is my hope, then, that the use of the term, psychological disorder, while perhaps still imperfect, is broad enough to include persons with varying degrees of impairment, including both mild and moderate forms of disorder, and severe and persistent mental illness. I wonder, in fact, if it is possible that, with greater discussion about these issues among both professional and lay communities, we will arrive at better, less stigmatizing, terminology in the years to come.

For the sake of my present purposes, however, within the text itself, I use many terms interchangeably with psychological disorder, including mental disorder, mental health impairment, mental health conditions, psychiatric disorder, psychiatric disability, and even mental illness. Because I am a mental health professional, I have been marinating in this terminology for decades. Although I am aware of the various public and philosophical connotations of these terms, when I use them, I am generally thinking about clusters of symptoms and research related to those clusters of symptoms more than anything else. So, when using different terminology in this book, it is not my intention to make distinctions among groups of diagnoses. Given my interchangeable use of these terms throughout the text, it is my hope that the reader will sense this.

Integration

A second challenge emerges in the construction of a theology of psychological disorder because of the complexities of integrating scholarship from different disciplines.

As I have mulled over the notion of a theology of psychological disorder over the past several years, my interaction with diverse academic fields occasionally created new questions and offered new insights for me. Thus, in the writing of this book, I have drawn upon scholarship from a variety of disciplines, including theology, biblical studies, history, the psychology of religion and spirituality, and clinical psychology. Each area of academic inquiry is itself a complex field of study. Thus, any attempt to present and integrate the findings of various fields brings with it the strengths, the limitations, and also the peculiarities of the disciplines involved. While I do not have expertise in all