HEALTH COMMUNICATION

http://dx.doi.org/10.1080/10410236.2015.1089458

How Dark a World It Is Where Mental Health Is Poorly Treated: Mental Illness
Frames in Sermons Given After the Sandy Hook Shootings
James O. Olufowotea and Jonathan Matusitzb
a

Department of Communication, University of Oklahoma; bNicholson School of Communication, University of Central Florida

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ABSTRACT

In the aftermath of the Newtown, CT, massacre, the United States is engaging in public deliberations
that will reshape future mental healthcare policies, practices, and systems. We know little about the
clergys contributions to these deliberations. Clergy, as with psychiatrists and mental health specialists,
are members of the helping professions and are regarded as front-line mental health workers and
gatekeepers to mental health services. To consider clergy contributions, we drew on Entmans framing
perspective to study sermons given in the state of Connecticut after the Sandy Hook shootings. We
examined 73 posted full-text sermons and performed the constant comparative method on 20 that
made references to mental illness. We discovered clergy used social support and social system
frames. Upon developing these frames, we discuss the studys contributions by considering clergy
silence, their use of frames to delineate between the secular and the spiritual, their mitigation and
promotion of mental illness stigma, and their incomplete social system frame.

On December 14, 2012, 20-year-old Adam Lanza shot and killed

twenty 6- and 7-year-old students and six adults at Sandy Hook
Elementary School in Newtown, Connecticut. The gunman, who
later took his own life, had previously shot and killed his mother
in their Newtown residence. In the wake of this tragedy, residents
of the United States continue to deliberate on issues such as gun
control, mental health/illness, and school security (e.g., Hall &
Friedman, 2013).
This study addresses a renewed public attention to and deliberations on mental health. Adam Lanza, as with other recent
perpetrators of mass killings, is suspected of suffering from mental
illness (Walkup & Rubin, 2013). According to the fifth edition of
the Diagnostic and Statistical Manual of Mental Disorders, A
mental disorder is a syndrome characterized by clinically significant disturbance in an individuals cognition, emotion regulation,
or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning
(American Psychiatric Association, 2013).
Estimates suggest that one in five American adults suffers from
a mental illness (Klin & Lemish, 2008; Safran et al., 2009). Mental
illnesses include bipolar disorder, depression, and schizophrenia.
Based on a national U.S. survey of 11,466 adolescents (age 1317
years) and adults (age 1864 years), Kessler, Petukhova, Sampson,
Zaslavsky, and Wittchen (2012) found a 32% lifetime prevalence
rate for adolescent anxiety disorders (e.g., posttraumatic stress
disorder, phobias) and a 34% lifetime prevalence rate for adults.
In the same study, Kessler et al. (2012) found a 14% lifetime
prevalence rate for adolescent mood disorders (e.g., major depressive episode, bipolar disorder) and a 21% lifetime prevalence rate
for adult mood disorders.
CONTACT James O. Olufowote, PhD, Assistant Professor
Norman, OK 73019.
2016 Taylor & Francis

olu@ou.edu

America, provoked by the Newtown massacre, is engaged

in public deliberations that will reshape U.S. mental health
care. When we acknowledge that clergy, as with health professionals such as nurses and physicians, are members of the
helping professions (see Miller & Considine, 2009) and are
front-line mental health workers and gatekeepers to mental
health services (Wang, Berglund, & Kessler, 2003), their contributions to academic and public discourse on mental health
become valuable yet noticeably marginal (Ellison, Vaaler,
Flanelly, & Weaver, 2006).
To consider clergy contributions to the discourse on mental
health, we drew on Entmans (1993) framing perspective, which
highlights the reality created by communication of a particular
causal interpretation (p. 52) and treatment recommendation
(p. 52). Clergy mental illness frames can influence understandings
of mental illness, coping strategies, decisions to seek professional
help, and stigmas of persons with mental illness. To discover clergy
frames, we sought out posted sermons, as these are public forms of
discourse. We collected and read 73 posted full-text sermons given
by Connecticut clergy after the Sandy Hook shootings and conducted constant comparisons on 20 sermons containing references to mental health. In what follows, we present the literature,
research question, methods, findings, and discussion.

Literature Review
Faith-Based Organizations and Public Health
Faith-based organizations (FBOs) are nonprofits (Lewis, 2005).
Although FBOs have historically addressed social and political

Department of Communication, University of Oklahoma, 610 Elm Ave. Rm. 227,

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J. O. OLUFOWOTE AND J. MATUSITZ

issues such as abortion, gay marriage, and poverty, research has

begun to consider their contributions to community and public
health (e.g., Lachlan & Spence, 2011; Olufowote, 2014).
Communication research on FBOs has focused on three health
domains. One is that of HIV/AIDS (e.g., Derose & Kanouse,
2011). A second is mental illness (e.g., Abu-Ras, Gheith, &
Cournos, 2008; Mattox, McSweeny, Ivory, & Sullivan, 2011),
and a third is FBOs as channels for eliminating health disparities (e.g., Holt et al., 2009).
There are two major types of FBOs. One represents organizations whose central purpose is to provide explicitly religious products such as pastoral care and deity worship. These
include houses of worship such as churches and mosques
(Jeavons, 1998). They are organized faith communities, of a
particular religious ideology, composed of staff and volunteers
drawn from that ideology (Scott, 2003). Also relevant are the
programs launched from FBOs such as parish nurse programs
(Anderson, 2004). Another represents organizations such as
hospitals and universities that have a particular faith as central
to their identity and heritage (Feldner, 2006)
It is appropriate to focus on the first type because in most
instances the second type emerged from the first. Moreover,
these FBOs play important roles in public health. Nearly 25%
of persons suffering from mental illness turn first to clergy.
(Wang et al., 2003). FBOs influence the health frames of their
members. These frames suggest the causes of illness and the
appropriate responses (Payne, 2008). FBOs are also sites for
providing and receiving social support, particularly for older
adults (Robinson & Nussbaum, 2004), and they tend to have
strong ties to communities and access to underserved populations (Lachlan & Spence, 2011).
Religious Leaders as Front-Line Mental Health Workers
and Gatekeepers
Research suggests religious leaders are front-line mental
health workers (Ellison et al., 2006). The front-line designation refers to clergy as the first source of help for persons
experiencing mental illness. Analysis of the National
Comorbidity Survey (NCS) of 8,098 nationally representative
female and male respondents between the ages of 15 and 54
years found that 24% of those who initially sought treatment
for mental disorders (including major depressive episode,
panic disorder, generalized anxiety disorder, psychotic disorders) did so from a member of the clergy, such as a minister,
priest, or rabbi (Wang et al., 2003). This percentage of initial
contact (24%) was higher than that for human service providers, psychiatrists, and alternative treatment providers (spiritualists and herbalists), but lower than that for
nonpsychiatrist doctors of medicine (MDs) and mental health
specialists (Wang et al., 2003). In another study of 1,388 post9/11 U.S. military veterans with a probable mental disorder
(alcohol misuse, major depressive disorder, posttraumatic
stress disorder), 20% reported talking to a pastoral counselor
in the preceding year (Nieuwsma et al., 2014). A study of 317
older adults (65 years and older) found that 34 participants
(13%) sought help from a religious leader (clergy, pastor,
rabbi), 28 (9%) sought help from formal sources (e.g., mental
health specialists, psychiatrists), and 255 (80%) did not seek

help from any source (Pickard & Tang, 2009). Taken together,
these research results suggest that clergy, along with other
helping professionals, are front-line mental health workers.
Research also points to religious leaders as gatekeepers to
traditional mental health services (Abu-Ras et al., 2008;
Kramer et al., 2007; Mattox et al., 2011). As gatekeepers,
they can facilitate (or inhibit) help-seekers engagement with
traditional health services. Research results are mixed, suggesting that leaders open the gates to traditional care, close
the gates, and neither open nor close them. Abu-Ras et al.
(2008) studied 22 imams and 102 worshippers in New York
City to determine the role of imams in Muslim mental health
and worshippers attitudes toward mental health resources.
They found imams were the first and only contact for worshippers, were unaware of community resources for mental
health, and made no referrals to professionals. Mattox et al.
(2011) analyzed 47 televised sermons (83% of which were
delivered by European-Americans) to study messages about
emotion, mood, and anxiety disorders. They found that clergy
neither encouraged nor discouraged seeking professional help.
A Framing Perspective on Religious Leader
Communication
A framing perspective provides justification for studying the
posted sermons of religious leaders for their discourse on
mental health. This perspective is important because religious
leaders spend time communicating with constituents and the
public (Mattox et al., 2011). It is through such platforms that
religious leaders partly execute their roles as front-line mental
health workers and gatekeepers. Additionally, how religious
leaders frame mental illness can influence listeners understandings of mental illness (in terms of causes and solutions).
Framing is a communication phenomenon whereby a
communicator constructs or presents a version of reality
that is capable of influencing the interpretations, behaviors,
and worldviews of those party to the transaction (Fairhurst,
2011). Although there are various perspectives on framing,
Entman (1993) pioneered a perspective that is relevant to this
study. Entman (1993) defined framing as a way to select
some aspects of a perceived reality and make them more
salient in a communicating text, in such a way as to promote
a particular problem definition, causal interpretation, moral
evaluation, and/or treatment recommendation for the item
described (p. 52). Drawing on Entmans perspective, we
focused on clergy communication about the causal problems
of mental illness and solutions to the problems of mental
illness.
Religious Leaders Mental Illness Frames
In the following paragraphs, Entmans (1993) perspective
provides a way to organize research results on religious leaders communication about mental illness. Research has
found religious leaders framing mental illness as caused by a
variety of external and internal factors, as well as secular and
spiritual reasons. For example, Mattox et al. (2011) found
emotion, mood, and anxiety disorders being attributed to
external and internal factors such as external suggestions

HEALTH COMMUNICATION

planted by the devil, internal inadequate faith, immature love,

powerlessness and ignorance, and sin and disobedience.
Payne (2008) found leaders attributed depression to internal
factors such as having a weakness and attitude.
Research also found leaders framed the appropriate solution to mental illness as a combination of secular (e.g., medication) and spiritual interventions (e.g., prayer) or as strictly
spiritual interventions. For example, Kramer et al. (2007), in
an interview study of 12 pastors of African-American and
European-American churches, found care pathways for
depression to include both secular (e.g., medication, psychotherapy) and spiritual interventions. Likewise, Mattox
et al. (2011) found clergy suggested members could attain
victory over anxiety- and fear-producing thoughts planted
by the devil through the spiritual interventions of prayer
and proclamation.

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Stigmatization of the Mentally Ill by Religious Leaders

Unfortunately, research suggests religious leaders discourse
may stigmatize persons with mental illness. Stigma refers to
deviant attributions of persons with illnesses, which confer
control and responsibility of the illness on persons, thereby
indicting their moral probity, and potentially resulting in
prejudice and discrimination toward such persons (Goffman,
1963; Meisenbach, 2010). Deacon (2006) defined stigma as a
social process of othering (delineating between in- and outgroup), blaming (controllable illness caused by immoral behaviors), and shaming (loss in social status).
Research studies in health communication have focused on
mental illness stigma (e.g., Caputo & Rouner, 2011).
Parcesepe and Cabassa (2013) conducted a literature review
of 36 studies on mental illness stigma. They found 23 studies
examined stigmatizing attitudes toward mental health helpseeking from professionals and use of psychiatric treatment;
15 studies examined stigma as beliefs about persons criminality, dangerousness to self and other, and incompetence; and
10 studies defined mental illness stigma as the action of social
distancing.
Research results on the stigmatization of persons with
mental illness by religious leaders are mixed. Some have
found evidence suggesting religious leaders stigmatize persons
with mental illness. For example, in her study of sermons by
Apostolic Pentecostal preachers, Payne (2008) found preachers at times referred to persons with mental illness as crazy.
Analysis of a General Social Survey of 1231 adults found that
clergy were perceived as having more stigmatizing attitudes
toward persons with serious mental health problems than
professionals such as psychiatrists (Ellison et al., 2006). In
her study of televised sermons by protestant ministers,
Mattox et al. (2011) found ministers describing emotion,
mood, and anxiety disorders as signs of sin and disobedience.
In contrast, research also suggests leaders mitigate stigma
surrounding mental illness. For example, in a study of 141
geriatric psychiatric patients, Milstein et al. (2005) found
patients rating clergy as most helpful in educational efforts
on stigma reduction.
The Newtown massacre ushered in a period of contemplation and public deliberations on the future of mental health

care. Although research suggests clergy play important roles

in mental health care, we know little about their contributions
to the current deliberations. To consider their contributions,
we drew on Entmans framing perspective to study posted
sermons as public forms of discourse, and we posed the
following research question:
Research question: How did Connecticut-based clergy frame mental health/illness in posted sermons given in the immediate aftermath of the Sandy Hook school shootings?

Method
Data Collection
To identify full-text sermons given on and after
the December 14, 2012, Sandy Hook school shootings, we
conducted an Internet search for websites belonging to
churches in three counties of the state of Connecticut:
Fairfield, Litchfield, and New Haven. We started the search
with Fairfield County (home to the city of Newtown). To
increase the number of full-text sermons that would be relevant to the study, we later broadened the search to include
neighboring Litchfield and New Haven counties. Fairfield
County is home to 24 cities and towns. Litchfield County is
north of New Haven County and is home to 26 cities and
towns. New Haven County is directly east of Fairfield County
and is home to 27 cities and towns.
For each city and town in the three Connecticut counties,
we conducted a Google search for churches with websites. By
simultaneously entering the name of each city or town and
variants of the term church, we found a list of potential
church websites. We then searched each website for postings
of full-text sermons. Although several churches posted audio
and video recordings of recent sermons, it was rare to find
postings of full-text sermons. For the relatively few church
websites with full-text sermon postings, we downloaded and
saved only those full-text sermons that met two criteria: (a)
The sermon was given between December 13, 2012,
and February 1, 2013, and (b) the sermon contained one or
more of the following keywords: Adam Lanza, Newtown,
tragedy, Sandy Hook, shooting. Most websites with postings
of full-text sermons also contained listings of the dates when
sermons were given. Furthermore, one can easily use
Microsoft Word to search the full text for specific keywords.
On identifying full-text sermons that met the studys criteria, we recorded the following for each downloaded sermon:
the URL where the full-text sermon was posted, the date the
sermon was given, the title of the sermon, the religious leaders title (e.g., Pastor), the leaders biography (where available), the leaders gender, the churchs name and
denomination, and the city/town and Connecticut county
where the church was located. An extensive search resulted
in a total of 73 full-text sermons. Taken together, these sermons totaled 278 single-spaced pages.
Data Reduction
We read through all 73 sermons to identify those with either
explicit or implicit references to mental health/illness. Explicit
references included specific terms such as mental health/illness.

J. O. OLUFOWOTE AND J. MATUSITZ

We used the search function in Microsoft Word to identify

explicit references to mental health/illness. Implicit references
included terms such as emotional damage. Of the 73 sermons,
we found 20 (27%) containing either explicit or implicit references
to mental health/illness. We highlighted the sentences surrounding these references to contextualize these references to mental
health/illness during data analysis. These sentences and their
encapsulated references essentially formed the basic building
blocks of data analysis for the study.

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Clergy and Sermon Characteristics

Eight of the sermons containing references to mental health/
illness were given by female religious leaders (40%) and the
remaining 12 were given by male leaders (60%). This gender
distribution (fewer females than males) is similar to that of the
larger sample, which contained 47% female religious leaders and
53% male religious leaders. The majority of the sermons with
references to mental health/illness (39%) were given in New
Haven County. According to the denominations listed on the
websites, eight sermons were given by leaders of the Episcopal
Church (40%), four of the United Church of Christ (20%), two
of the Evangelical Lutheran Church in America (10%), two
nondenominational (10%), and one each of the Catholic
Church and the United Methodist Church. Eleven of the sermons were listed as given on Sunday December 16, 2012 (55%),
six were listed as given on Sunday December 23 (30%), and one
each was given on Monday December 24, 2012, Tuesday
December 25, 2012, and Sunday January 27, 2013. The 20
sermons totaled 60 single-spaced pages of text.
Data Analysis
To address the studys research questions, we drew on the
constant comparative method (CCM; Glaser, 1978; Glaser &
Strauss, 1967). The CCM is an inductive process by which
researchers proceed from a systematic and comparative analysis of data toward a set of themes. CCM includes unitizing,
open coding, and axial coding (Corbin & Strauss, 2008). We
largely performed CCM by hand (involving such things as the
highlighting of text and terms deemed important and the
copying and pasting of units into different Word documents).
In the unitizing phase, we began by reading and rereading
the sermons in their entirety, paying particular attention to
sentences that surrounded explicit and implicit references to
mental health/illness. These sentences contained the studys
units of analysis. In qualitative data analysis, possible units of
analysis include the transcript line, the semantic relationship
or unit of meaning, and themes. In light of the studys focus
on clergy mental illness frames, we focused on semantic
relationships or units of meaning as units of analysis
(Spradley, 1979). A unit of meaning captures each instance
of phenomena that are of interest to the analyst. Drawing
from both the data at hand and Entmans (1993) framing
perspective, we focused on the semantic relationships of X
as a causal problem of mental health/illness and Y as a
solution to the problems of mental health/illness. Although
we looked for these units, we also remained open to whatever
else the sermons contributed about mental health/illness.

During the open coding phase, we coded units in the

sermons and constantly compared units in arriving at
themes. This comparative process involved making
similaritydifference judgments. Units receiving similar
codes were clustered together. The open coding process
yielded five major themes. In the final steps of open coding,
analysts transition to axial coding.
Axial coding involves the integrating of connected themes
and the organizing and reorganizing of themes into broader
categories (Corbin & Strauss, 2008). In light of the studys
focus on frames (Entman, 1993), we organized the five major
themes into frame packages (Stefanik-Sidener, 2013). A frame
package includes an espoused causal problem of mental
health/illness and a logically related solution. We arrived at
two frames. One we labeled as a social support frame
because it had an episodic orientation. Episodic frames tend
to emphasize individual- and group-level causes and solutions
(Kim, Tanner, Foster, & Kim, 2014). The social support
frame encompassed two of the five themes that emerged
from data analysis. We labeled the other frame as social
system because it had a thematic orientation. Thematic
frames are built on broader societal-level causes and solutions
such as the law, the economy, and the government (see
Holton, Lee, & Coleman, 2014). This frame included three
of the five themes that emerged from data analysis. We
develop these major findings in the following.

Findings
The Social Support Frame of Mental Health/Illness
The social support frame included causal problems of mental
health/illness (i.e., lack of care and social support for persons
with mental illness) and espoused solutions (i.e., advocacy for
the care and social support of persons with mental illness and
their family caretakers).
Lack of Care and Social Support for Persons with Mental
Illness
Clergy attributed the causal problems of mental health/illness
(Entman, 1993) to a lack of care and social support for
persons with mental illness. Care, in this instance, refers to
affectionate dispositions and expressions toward persons with
mental illness. Social support, on the other hand, refers to
inclusion and acceptance of persons with mental illness, as
well as various forms of helping persons with mental illness.
The following excerpts from the sermon of a female pastor of
the Evangelical Lutheran Church in America, given
on December 16, 2012, can be taken as emphasizing this
lack of care and social support for persons with mental illness.
How dark a world it is. Where children die daily from
violence, hunger, and more. Where mental health is poorly
treated and people with those diseases are not cared for. This
pastors contribution distinguishes between poor treatment of
mental health and not caring for those with mental illness.
This distinction is one between ineffective therapy and compassionate concern. Clergy spoke about this lack of care
(compassionate concern) as encompassing unfortunate

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HEALTH COMMUNICATION

behaviors such as ignoring persons with mental illness and

remaining uneducated about mental illness.
In a sermon given on December 23, 2012, a female minister (Rev.) of the United Church of Christ said, We can
diminish the Lord by our actions, our attitudes, our way of
life. In the same sermon, she later went on to say, We
diminish when the needs of the mentally ill are ignored.
The minister attempted to make the point that human actions
and attitudes involved in ignoring the needs of persons with
mental illness dishonor creation and the creator. Implicit in
this remark is the possibility of alternative (more compassionate and humane) attitudes and actions toward persons with
mental illness. In another sermon, on December 16, 2012, a
male minister (Rev.) of the United Church of Christ implied a
lack of education as part of the problem of not caring for
persons with mental illness: We can educate ourselves about
mental illness and depression. That would be a very important
step for everyone who cares for other people. In
a December 24, 2012, sermon, a male minister (Rev.) of the
Evangelical Lutheran Church of America implied that Adam
Lanza lacked an inclusive and caring worship community, I
wonder if Adam Lanza had a community to which he could
relatebe greeted at worshipbe cared for and prayed over?
The ministers question implies that an inclusive community
and spiritual support (prayer) are missing elements of the care
and social support of persons with mental illness.
Clergy decried the lack of compassionate care for persons
with mental illnesses. Their sermons suggested this lack of
care involved unfortunate actions such as ignoring persons
with mental illness, ignorance (lack of education about mental
illness), lack of inclusiveness, and lack of spiritual support.
Advocacy for the Care and Social Support of Persons With
Mental Illness and Their Family Caretakers
The social support frame found in clergy sermons included
not only a theme on the lack of care and social support for
persons with mental illness but also a theme that advocated
for the care and social support of youth with mental illness
and their family caretakers. On December 16, 2012, a male
minister (Rev.) of the United Church of Christ said the
following while speaking on the topic of mental illness:
And we can take the risk to reach out to others, even if it
means sometimes making mistakes and perhaps crossing
boundaries, in the name of love and compassion. The minister is encouraging his audience to reach out and pursue
relational connections with persons with mental illness. He
justifies the risks of crossing generational boundaries and
unfamiliar territory when pursuing such relational connections by calling on the emotions of love and compassion.
Although this sermon did not distinguish between persons
with mental illness and their family members as targets of
connections, other clergy advocated for the care and support
of persons with mental illness, particularly youth.
For example, on December 24, 2012, a male minister (Rev.)
of the Evangelical Lutheran Church in America contributed
the following in the parts of his sermon on mental illness:
We know we are blessed and have the responsibility of the
joy and care of children, looking out for the next generation,

which seems in this time and place to have many burdens. In

other words, this minister believes it is a blessing for adults to
have the interest of the next generation in mind and to
assume responsibility for the care and joy of youth facing
burdens such as disease and illness. On December 23, 2012,
a female minister (Rev.) of the United Methodist Church,
while speaking on the Christmas tradition of giving, offered
herself as an example of charity and care toward youth with
mental illness: Each Christmas after, I followed the same
tradition1 year sending a group of mentally handicapped
youngsters to a hockey game. By creating the opportunity for
persons with mental illnesses to attend a hockey gameand
possibly fulfilling their dreamsthis minister provides one
example of caring for youth with mental illness.
Besides advocating for the care and support of youth with
mental illness, clergy also advocated for the care and social
support of their family caretakers. Clergy first recognized the
difficulties and challenges these caretakers face. On
December 24, 2012, a male minister (Rev.) of the
Evangelical Lutheran Church in America sensitized his listeners to some of these difficulties.
Perhaps you have read online with the Huffington Post the article,
I am Adam Lanzas mother, the raw account of the love and
terror of bringing up a disturbed youngsterand the questions of
how a family relate to the larger social system which may or may
not help. (Evangelical Lutheran Church in America)

Drawing on a Huffington Post article, this minister pointed

out two related challenges family caretakers face: coping with
a family member with mental illness, and relating with surrounding social systems such as the community and the
mental health care system.
On December 16, 2012, a sermon given by a male minister
(Rev.) of the United Church of Christ spoke more directly to
the care and social support needs of family caretakers:
I could talk about how families are either too proud to ask for
help, or too proud to admit they need help with a mentally ill
family member. I could also talk about how the families of the
mentally ill are overwhelmed by the needs of their sons and
daughters, brothers and sisters, grandparents, cousins. How they
need support. (United Church of Christ)

Although this minister chose not to delve into the topic of

family caretakers refusal to admit their need for help, he
emphasized that they were overwhelmed and needed support.
Our analysis of Connecticut-based clergys post-Sandy
Hook sermons yielded a social support frame where clergy
attributed the problems of mental illness to a lack of care and
social support for persons with mental illness. As solution,
clergy advocated for the care and support of persons with
mental illness and their family caretakers. We now turn to the
social system frame.

The Social System Frame of Mental Health/Illness

According to Entman (1993), frames diagnose causes in that
they identify the forces creating the problem (p. 52).
Through their sermons, clergy identified three interrelated
causal problems of mental health/illness: lack of financial
resources for mental health care, lack of access to mental

J. O. OLUFOWOTE AND J. MATUSITZ

health care, and lack of effective mental health treatment. The

forces identified exist at broader levels than those clergy spoke
of through the social support frame. These forces are
embedded in aspects of the U.S. mental health care system
and are both governmental and institutional problems (i.e.,
transcend specific organizations). Moreover, they reflect societal disparities and inequalities. We address each of these
forces in the following sections.

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Lack of Financial Resources for Mental Health Care

Through their sermons, clergy lamented the lack of financial
resources devoted to mental health care from different sectors
of U.S. society. For example, on December 16, 2012, a male
minister (Rev.) of the Episcopal Church pointed to the disparity between funding for political campaigns and funding
for mental health care: Do we see the immorality in spending
100 million dollars on a political campaign when funding for
the care of those with mental health issues like Adam Lanza is
woefully lacking? This minister hoped his audience would
see the immorality of politicians excessive spending on their
own political election campaigns in contrast to the lack of
political will and government funding for mental health care.
On December 16, 2012, a male minister of the United Church
of Christ also spoke of the lack of government aid and
assistance for the mentally ill:
I could also talk this morning of the importance of governmentsupported aid for the mentally ill, as I remember vividly when the
government-supported institutions that housed the mentally ill
began to close and the mentally ill swelled the ranks of homeless
population of every city. (United Church of Christ)

The United Church of Christ minister pointed to a

moment in U.S. history when the lack of government funding
for mental health care institutions led to an increase in the
problem of homelessness in several cities. In addition to lack
of government funding, this United Church of Christ minister
also spoke of mental health care workers meager salaries.
And I can tell you that counselors and social workers who are willing
to work with the poor and mentally ill get paid dismally. Ive known
too many masters degree counselors who made less than loading
dock workers or garbage collectors. (United Church of Christ)

This minister pointed out that although mental health care

workers such as counselors and social workers may be well
educated (with masters degrees), they are paid less than
loading dock workers and garbage collectors. His statement
reinforced the point of insufficient financial resources in the
mental health sector. Through their post-Sandy Hook sermons, clergy attributed one causal problem of mental
health/illness to a lack of financial resources.
Lack of Access to Mental Health Care
In the second theme that emerged in their sermons, clergy
lamented the difficult access to mental health care. Some
reflected on the ironic social injustice of easy access to guns
in comparison to difficult access to needed mental health care.
On December 16, 2012, a female minister (Rev.) of the United
Church of Christ asked her listeners, So why is it so difficult

to get a national ban on assault rifles? Or health care for those

so desperately in need? Also on December 16, 2012, in a
different parish of the United Church of Christ, a female
pastor also broached this injustice when she said, A world
where its easier for a troubled young man to acquire a gun
and a fake ID than it is to find the mental health assistance he
needs. Similarly, on December 16, 2012, a female minister
(Rev.) of the United Church of Christ spoke on behalf of
modern-day prophets who call out the gap between the
way things are and the way God intends them to be when,
she said, they [modern-day prophets] are the ones who call
us to transform our grief into action; to prayerfully, persistently grapple with thorny issues like too much access to guns
and not enough access to mental health care. Clergy pointed
out the ironic injustice of easy access to guns and difficult
access to mental health care.
On December 24, 2012, a male minister of the Evangelical
Lutheran Church of America also spoke about lack of access
to mental health care when he argued that the Sandy Hook
shootings have seen renewed questioning about the antiinstitutional strategy we Americans have taken for the behaviorally disturbed since the 1960s. In other words, the Sandy
Hook massacre has led to renewed questioning of the lack of
institutions (resulting from poor governmental funding) to
house the mentally ill. On December 16, 2012, a male minister
of the United Church of Christ also addressed this lack of
access when he spoke of disparity between insurance coverage
for physical health care and mental health care: I could talk
of how insurance companies and Medicaid/Medicare need to
bring the level of mental health care coverage up to parity
with physical health care. In addition to a lack of financial
resources devoted to mental health care and a lack of access,
clergy also attributed the problems of mental health/illness to
lack of effective mental health treatment.
Lack of Effective Mental Health Treatment
Clergy pointed to the ineffectiveness of the U.S. mental health
care system and mental health treatment. On December 16,
2012, a male minister of the Evangelical Lutheran Church of
America implied the ineffectiveness of the mental health care
system when he said, I myself have failed to say a word, to
push our elected officials toward providing far more robust
health care for mentally ill or unstable persons in our society.
This minister pointed to a double failure: the failure of the
mental health care system to provide effective treatment, and
his personal failure to lobby elected officials for the provision
of more effective treatment for the mentally ill. On
December 23, 2012, a female rector of the Episcopal Church
expressed a collective anger over the lack of effective mental
health treatment: Some of us are angryangry at the culture
of violence in this country. Angry that this young man didnt
have effective mental health treatment to help him cope. This
rector gave voice to those who were angry that Adam Lanzas
mental illness had not been properly treated. On
December 16, 2012, a female faculty fellow of a nondenominational church also spoke about the lack of effective treatment when she attributed the Sandy Hook massacre to
mental health treatment failures: Massacre is the bitter fruit

HEALTH COMMUNICATION

of our national sins of omission. The fruit borne of the mental

illnesses we fail to treat. Clergy lamented the state of the
society and expressed both individual and collective responsibility for failure to properly treat persons with mental
illnesses.
In the social system frame of the post-Sandy Hook sermons, clergy attributed the causal problems of mental illness
to aspects of the mental health care system, specifically, the
lack of financial resources dedicated to mental health, the lack
of access to needed mental health care, and the lack of effective mental health treatment.

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Conclusion
We drew on Entmans (1993) perspective on framing to pursue
the research question of how Connecticut-based clergy frame
mental health/illness in posted full-text sermons given after the
Sandy Hook shootings. From an original corpus of 73 sermons,
we performed the constant comparative method on 20 containing references to mental health/illness (Corbin & Strauss, 2008).
We arrived at a social support and a social system frame. In
the social support frame, clergy attributed the causal problems
of mental health/illness to a lack of care and social support for
persons with mental illness. Through this frame, clergy advocated for the care and social support of persons with mental
illness and their family caretakers. In the social system frame,
clergy attributed the causal problems of mental health/illness to
insufficient financial resources for the mental health care system, lack of access to mental health care, and ineffective
treatment.
The findings make several contributions to research on
religious leader discourse on mental health/illness (e.g.,
Kramer et al., 2007; Mattox et al., 2011; Payne, 2008). First,
we draw on Entmans (1993) theory of framing to organize
clergy communication into causes of and solutions to the
problem of mental health/illness. Although previous research
findings suggest framing theory and the cause/solution structure are appropriate for examining religious leader discourse
on mental health/illness, this theory has not been used in
previous research on this topic. Second, previous research
found clergy espousing a combination of internal and external
factors as causes and solutions to mental illness. The findings
comment exclusively on external factors such as the social
circumstances and social problems of the mentally ill and the
state of the mental health care system. For example, among
their many findings, Mattox et al. (2011) found clergy using
their sermons to claim sin and disobedience as causes of
emotion, mood, and anxiety disorders that can be overcome
through prayer and proclamation. These internal factors contrast with this studys findings of external factors such as lack
of access to mental health care and clergy advocacy for the
care of persons with mental illnesses and their family
caretakers.
Previous research also found clergy combining both the
secular and the spiritual in their discourses on the causes and
solutions of mental health/illness (e.g., Abu-Ras et al., 2008;
Kramer et al., 2007). We also found clergy incorporating both
1

the secular and the spiritual in their sermons. Moreover,

unlike previous research, the findings speak to how clergy
are combining the secular and the spiritual. We found clergy
using frames to delineate between the secular and the spiritual
aspects of their discourse. The social support frame is concerned with emotional and spiritual subjects such as care,
concern, and prayer, whereas the social system frame, on the
other hand, is largely concerned with secular and material
matters such as housing, money, and treatment. It is interesting to note that the only explicit and substantive solution to
emerge was an emotional and spiritual one, an aspect of the
social support frame. Not only does a social support solution
reside more in the domain and expertise of clergy, but they
may explicitly or implicitly consider emotional and spiritual
support as mainly applicable to the sufferings of known persons and family caretakers with identifiable names and faces.
Although clergy may construct emotional and spiritual
support as solutions to the problems of known persons and
family caretakers, they may not consider problems of the
social system, which focus on a mental health care system
that is more abstract and less identified with one specific
person, as immediately amenable to spiritual solutions. The
lack of a spiritual solution for problems of the social system
may reflect a particular type of Christian theology. Yet there
were a couple of occasions where clergy stated that the social
injustices of the social system could be addressed instead
through forms of social action (e.g., I myself have failed to
say a word, to push our elected officials toward providing far
more robust health care for mentally ill or unstable persons in
our society). Although such instances point to clergy advocacy for a secular solution to problems of the mental healthcare system, this solution did not emerge as a substantive
theme.1fn1 Clergy may not have proposed explicit and substantive solutions because the financial, medical (i.e., ineffective treatment), and secular nature of the problems of the
social system frame may go beyond clergy comfort zones,
expertise, and domains.
Previous research has also examined whether and how
religious leaders discourse stigmatizes persons suffering
from mental illness (e.g., Kramer et al., 2007; Mattox et al.,
2011; Payne, 2008). Mental illness stigma includes stigmatizing attitudes toward seeking professional help and using psychiatric treatments; stigmatizing beliefs in persons with
mental illnesses blame, dangerousness, shame, and violence;
and stigmatizing actions such as avoidance and social distancing (see Parcesepe & Cabassa, 2013). The findings support
the conclusion that clergy frames mitigate stigma. For example, clergy frame the causal problems of mental illness as
external to, rather than internal to, persons with mental illness
(e.g., lack of care, support, and effective treatment). Moreover,
in framing the solution as care and social support for persons
with mental illness and family caretakers, clergy are in essence
seeking to minimize the social distance between community
members and persons affected by mental illness. Furthermore,
although clergy lament the mental health care system through
the social system frame, this frame also implies their acceptance of traditional mental health care and medications as

A substantive theme contains several related units that recur multiple times across different sermons.

Downloaded by [107.207.17.250] at 11:39 19 April 2016

J. O. OLUFOWOTE AND J. MATUSITZ

modalities for treating mental illness. In particular, the themes

of lack of access and lack of financial resources imply
clergy acceptance of traditional care because rather than promoting stigma surrounding use of the mental health care
system, these themes raise awareness of societal arrangements
that impose limitations on the system. Their implied acceptance of traditional mental health care thus mitigates stigma
surrounding professional help. This acceptance may stem
from a theology that embraces secular solutions, clergys educational levels, and community members socioeconomic status and their ability to afford traditional care.
Despite the conclusion that clergy frames mitigate stigma,
there is evidence to suggest clergy language stigmatizes persons with mental illnesses. Specifically, clergy inadvertently
use labels for persons suffering from mental illnesses that may
be considered demeaning and dehumanizing (e.g., disturbed, emotionally damaged, madman, troubled) and
characterizing persons with mental illnesses identities solely
based on their health challenge (e.g., the mentally ill, the
mentally handicapped). Language such as persons with
mental illnesses and people living with HIV/AIDS is generally considered less stigmatizing.
Although the study focuses on what clergy said, it is also
important to acknowledge clergy silence. Of the 73 sermons
that addressed the Sandy Hook shootings, only 20 contained
references to mental health/illness. This is low when we consider
the important roles that clergy play in constituents mental
health (see Ellison et al., 2006; Wang et al., 2003). There are
several possible reasons for the infrequent mentions. It is possible that the clergy role as front-line mental health workers is less
pronounced in affluent European-American communities
where secular solutions are accepted and members can afford
professional help. It is also possible that sermons that were
written in advance were used to reflect on other topics (e.g.,
Advent). It is also possible that because of stigma surrounding
mental illness, clergy may consider mental health/illness a more
appropriate topic for private rather than public discourse.

Limitations and Future Research

To begin, in focusing exclusively on clergy sermons, the
study cannot provide empirical reasons why clergy were
largely silent on mental health/illness. Future research can
inquire into reasons for clergy silence with research methods such as interviews or surveys. Second, data were
restricted to the communication platform of sermon texts.
In light of the growing uses of social media by religious
leaders and organizations (see Cheong, 2011), future
research can seek to incorporate clergy discourse on mental
health through social media platforms. Because findings
from analyses of full-text sermons may differ from those
of sermons posted in audio and video formats, future
research can seek to also incorporate sermons posted in
audio and video formats. Third, analyses were restricted to
sermons containing references to mental health/illness.
Future research can instead examine clergys broader framing of the Sandy Hook massacre for divisive social and
political health problems/solutions such as violent video
games and gun control.

By studying posted sermons, we sought to consider clergy

contributions to the public deliberations on mental health in
the aftermath of Sandy Hook. We found clergy largely silent
on mental illness. Those addressing mental illness drew on
social support and social system frames. Although they advocated for the emotional and spiritual support of persons with
mental illnesses and their family caretakers, they failed to
provide explicit and substantive solutions to problems of the
social system frame. Moreover, although clergy frames mitigated mental illness stigma, their language and labels for
persons with mental illnesses can be considered stigmatizing.

Acknowledgment
The authors thank Elaine Hsieh, Michael W Kramer, and the anonymous
reviewers for their feedback on previous versions of the manuscript.

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