Working with People with Mental Illness

Themes

• Alienation
• Punishment or Judgement
• Spiritual Isolation
• Physical Isolation
• Loss
• Delusions
• Worthlessness
• Elation

People with an ongoing mental illness are often isolated. Very often their loss of self-esteem or the symptoms of the illness exacerbate the tendency to withdraw. A consumer describes her experience:

When you say moving within ourselves, withdrawing, I don't think it's withdrawing. But sometimes what we are experiencing is terrifying. I think this is a key issue. Others are not experiencing what the ill person is. It is this experience, this reality to which we are reacting. And, understanding that, may lead to a pastor being able to reach someone. Or just sit, and just be, and just be present with that person.

When a pastor provides a referral to mental health resources, it does not imply that the individual's spiritual needs are not real. Neither does it imply that a mental health professional, agency or support group will necessarily deal with the person's spiritual concerns. What a referral CAN do is provide treatment for the person's mental illness. At the same time a pastor can provide care and support that focus on the religious and spiritual dimensions of the individual's situation. In many cases having the support and ongoing involvement of his/her pastor will enhance the prospects of a person having a positive experience with a psychotherapist and/or rehabilitation and support programs.

Themes

Punishment or Judgement: Individuals suffering from depression and feelings of hopelessness and helplessness because of their illness, may focus on religious themes of judgement. Some people believe that God must be punishing them or why would God have them in this situation. There is a strong feeling that the person is the guilty one, who has failed others and him/herself. The person believes that punishment from God is deserved. They may feel excessive guilt or shame, or believe themselves unworthy or incapable of accepting comfort and forgiveness for past failures. People who suffer from paranoid symptoms may focus on religious themes of persecution and the fear of being punished or abandoned by God and others (Weisinger, 1991, 32-33).

Spiritual Isolation: In this situation, the person is cut off from or is very distant in his/her relationship to God. A consumer describes his feelings:

When something like mental illness comes along, which is so incomprehensible to somebody who has otherwise had a reasonably solid life in terms of family background, schooling opportunities, professional opportunities, it's absolutely so devastating that it tends to severely shake faith. Why, if there's a providential God, which I believe there is, why does he allow things like this to happen to otherwise good people?

Physical Isolation: It may be that the illness makes it impossible for some people to tolerate the stimulation of being in a worshiping community. They may be unable to socialize and visit as often as is expected in church. Sometimes it is impossible to think clearly. Bible reading may be more confusing than helpful. Prayer may seem impossible. They may even feel they are losing faith.

Loss: A consumer describes his sense of loss:

My hope is often shaken by my periodic episodes of depression. It cost me my Air Force career. It cost me my marriage. It cost me, basically, my family. I only see my daughter once a year. This cost me every major romantic relationship I've had since it becomes too difficult for a loved one, a woman in my life, to put up with it for more than a year or two. I feel a social disparity between myself and my family members, because of my sense of deprivation and seeing them thriving. The same is true with friends, who are very achieving persons as I am when I'm well.

Worthlessness: Willard Wagner (1985, 82) describes a case where a pastor's wife characterized her life prior to coming to the hospital as a life of giving to others. For years she had taken an active part in church programs. She taught, led bible study, called on shut-ins and was involved in the activities of the parish. What caused her the most distress and contributed to her sense of worthlessness was that although for many years she had taught others that they should trust in God, she now found that she had great difficulty in trusting in Him because she felt that she was totally cut off from Him. Along with the loneliness of being disconnected from God she also experienced the loneliness of being out of touch with other people and with herself. She believed that all she had attempted to contribute in the past was meaningless and worthless. She came to a point where she gave up going to church, one of the things she had previously enjoyed.

Elation: People experiencing mania or a delusion may feel euphoric and elated because of their condition. They may have an elevated sense of self-importance or an exaggerated opinion about their relationship to God. They may lack an appropriate sense of shame, guilt or self control. They may feel that they can behave inappropriately without suffering the consequences of their actions (Weisinger, 1991, 32-33).