Mental Health and Mental Illness 1 Discussion Questions How do you hear mental health and mental illness talked about (or not talked about) in: your family your congregation wider culture Identify at what ‘level’ of a systems perspective you most often hear mental health discussed (and give examples): Individual/Interpersonal Systems Family Systems Congregational Systems Macro-Systems -- Divide into groups of 3-4 where they are seated -- Not offering a definition of mental health or mental illness yet – want to get at popular perceptions first, and do some analysis of that, before offering any definition -- Reminder of multi-systems approach on next slide 2 Contextual (Multi-Systems) Approach 3 Individual and Interpersonal Often, mental illness is discussed and diagnosed (in both professional and popular language) as individual pathology Professionally, the Diagnostic and Statistical Manual of Mental Disorders is used to make diagnoses based on clusters of symptoms experienced by individuals Examples of popular language? “They must be crazy.” “He’s just a schizophrenic.” “The shooter must have had a mental illness” Whether professional or not, the discussion tends to be about individual pathology, not family or societal context 4 Mental Health in Systems Perspective John Swinton. Resurrecting the Person: Friendship and the Care of People with Mental Health Problems . Nashville: Abingdon, 2000. -- from 2000, so a bit out of date, but holds up well in large part because it takes a community and systems perspective seriously rather than focusing on the ever-shifting understanding of individual pathology -- title, “Resurrecting the Person,” refers to the way that stigma about mental health problems creates “non-persons”; the task of the church is to engage in the liberative practice of friendship by standing in critical soldiarity with those with mental health problems, thus participating in the resurrection or re-creation of the person 5 The Medical Model for Mental Illness Strengths: attempts to destigmatize mental health by putting it in the same conversation as physical health issues gives a name to an experience that was previously confusing and difficult to explain potentially opens doors for treatment and care recognizes limits of pastoral response Weaknesses: the “nothing but” of neurobiology care is entirely in the realm of the paid professional diagnosis can equal prognosis and/or become a label medical terminology of treatment and cure doesn’t always match lived experience of mental health problems Focuses on individual pathology while ignoring context and “person-in-relationship” Swinton, pg 77ff Strengths – note that many of the organizations advancing a medical model are advocacy groups that seek to support folks with mental illness, like NAMI. Whatever critiques can be made of the medical model, it’s intentions are good -- names have power; calling something “bipolar” gives me a power over some ...

1. Mental Health and Mental Illness
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Discussion Questions
How do you hear mental health and mental illness talked about
(or not talked about) in:
your family
your congregation
wider culture
Identify at what ‘level’ of a systems perspective you most often
hear mental health discussed (and give examples):
Individual/Interpersonal Systems
Family Systems
Congregational Systems
Macro-Systems
-- Divide into groups of 3-4 where they are seated
-- Not offering a definition of mental health or mental illness
yet – want to get at popular perceptions first, and do some
analysis of that, before offering any definition
-- Reminder of multi-systems approach on next slide
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2. Contextual (Multi-Systems) Approach
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Individual and Interpersonal
Often, mental illness is discussed and diagnosed (in both
professional and popular language) as individual pathology
Professionally, the Diagnostic and Statistical Manual of Mental
Disorders is used to make diagnoses based on clusters of
symptoms experienced by individuals
Examples of popular language?
“They must be crazy.”
“He’s just a schizophrenic.”
“The shooter must have had a mental illness”
Whether professional or not, the discussion tends to be about
individual pathology, not family or societal context
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Mental Health in Systems Perspective
John Swinton. Resurrecting the Person: Friendship and the Care
of People with Mental Health Problems . Nashville: Abingdon,
2000.

3. -- from 2000, so a bit out of date, but holds up well in large part
because it takes a community and systems perspective seriously
rather than focusing on the ever-shifting understanding of
individual pathology
-- title, “Resurrecting the Person,” refers to the way that stigma
about mental health problems creates “non-persons”; the task of
the church is to engage in the liberative practice of friendship
by standing in critical soldiarity with those with mental health
problems, thus participating in the resurrection or re-creation of
the person
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The Medical Model for Mental Illness
Strengths:
attempts to destigmatize mental health by putting it in the same
conversation as physical health issues
gives a name to an experience that was previously confusing
and difficult to explain
potentially opens doors for treatment and care
recognizes limits of pastoral response
Weaknesses:
the “nothing but” of neurobiology
care is entirely in the realm of the paid professional
diagnosis can equal prognosis and/or become a label
medical terminology of treatment and cure doesn’t always
match lived experience of mental health problems
Focuses on individual pathology while ignoring context and
“person-in-relationship”
Swinton, pg 77ff

4. Strengths – note that many of the organizations advancing a
medical model are advocacy groups that seek to support folks
with mental illness, like NAMI. Whatever critiques can be made
of the medical model, it’s intentions are good
-- names have power; calling something “bipolar” gives me a
power over something that was previously fragmented,
incoherent, terrifying
-- “potentially” – but note how macrosystems can impact this
potential
Weaknesses – “nothing but” is a big issue for us as theologians!
Nothing is “nothing but”
-- diagnosis is prognosis means a loss of hope; someone can
become “the schizophrenic” or “the guy with bipolar”
-- not necessarily looking for a cure, looking for a meaningful
life
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Medication and Meaning
Sociologist David Karp -- taking medication for mental health
purposes is “a complex and emotionally charged interpretive
process in which nothing less than one’s view of self is at
stake.”
Barham and Hayward study: “What participants looked for from
psychiatrists was an approach in which the prescription of
antipsychotic drugs was an adjunct to a psycho-social
understanding of their predicaments rather than a substitute for
such understanding.”
To “emotionally charged” and “psycho-social,” we might add
“spiritually charged” and “theological/religio-social”
How do we both de-stigmatize medication and also make room
for questions of meaning?
Swinton, pg 72ff

5. Need a holistic view of care – cura personalis?
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What contexts impact mental health?
Family:
most people with mental health challenges are cared for by
families
Congregation :
churches tend to reflect and even amplify societal stigma, even
theologizing mental health problems as a lack of faith
Macro-Systems
deinstitutionalization, with all its pros and cons, is one aspect
of the broader policy trends of the neo-liberal age
race, gender, and class all play into our understanding of mental
health
stigma plays out in sociocultural systems in the form of
isolation and alienation
Reminder – these are just examples. Are there more that the
class can think of?
Family – note research on family resilience, which is different
than *blaming* families for mental health problems
Congregation – connect this back to the initial discussion; also,
on the other hand, some congregations might see visions and
voices where others see mental health issues
Macro-Systems – talk about Neuger, who says that we
pathologize women for the negative effects of oppressive
systems
-- “Hysteria” and female depression
-- more women attempt suicide, more men complete suicide
-- trauma/PTSD can be societal, communal, and generational,
not just individual

6. -- Dr. Johnson’s book talks about pathologies assigned to
slaves who resisted their slaveholders
-- note what Swinton says about our meaning in capitalist
societies coming from work (dad as an example)
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Mental Illness and Mental Health
Swinton and others propose a “two narrative” or “two
continuum” model, with mental illness and mental health
understood as two related but distinct concepts
The mental illness continuum “represents the primary focus of
the traditional psychiatric biomedical narrative” with a
“tendency to understand and define mental health according to
the absence or presence of pathology”
The mental health continuum, on the other hand, “focuses on
meaningful personal relationships, spiritual direction, the quest
for meaning, a valued place within society, and so forth”
Swinton argues that people who struggle with mental health
problems tend to evaluate their own experience based on the
latter continuum, rather than the former
Swinton, pg. 135
Two separate continuums – one of mental health, one of mental
illness/disorder (Swinton credits this to Keith Tudor)
Draw this on the board. Give people some time to react.
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The Mental Health Continuum
“Within this continuum, mental health can now be understood
in terms of growth and personhood, rather than by the person’s
illness experience, which affects, but does not define, the
person. It is then possible to define mental health in terms of
the whole person, rather than simply one aspect of the person,

7. or his or her experience. Mental health can thus be understood a
complex process of psychosocial and spiritual development, that
may or may not involve the eradication of specific mental
health problems….Understood in this way, mental health is
viewed in terms of a person being provided with adequate
resources to enable [them] to grow as an unique individual and
to live humanly as persons-in-relationship.”
– Swinton, pg. 135
Two separate continuums – one of mental health, one of mental
illness/disorder (Swinton credits this to Keith Tudor)
Draw this on the board. Give people some time to react.
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The “Friendship Model” of Care-in-Community
“If we reflect for a moment on the friendships of Jesus, one of
their primary aims was to enable hope and relational wholeness
to those who had been broken, isolated, and
marginalized….This type of friendship is catalytic. Unlike other
more instrumental relationships such as those found in
counseling and psychotherapy, which set out specifically to do
something, it is a form of relationship that acts as a catalyst that
enables health and rehumanization simply by being there.
Unlike many agents with whom people with mental health
problems may come into contact, the task of the Christlike
friend is not to do anything for them, but rather to be someone
for them—someone who understands and accepts them as
persons; someone who is with and for them in the way that God
is also with and for them; someone who reveals the nature of
God and the transforming power of the Spirit of Christ in a form
that is tangible, accessible, and deeply powerful.”
– Swinton, pg. 143

8. I would identify this as the central claim of Swinton’s book.
Note that Swinton is talking about a particular form of Christ-
like friendship carried out in Christian community. He proposes
a holistic model for this, including education in church,
community care models, and relationships with professional
care providers.
Pause here and give people some time to respond to this. Does
this stick? Do you have criticisms?
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Pastoral Care Image: Parakletos
“If you love me, you will keep my commandments. And I will
ask the Father, and he will give you another parakletos
[Advocate, Companion, Comforter], to be with you forever.
This is the Spirit of truth, whom the world cannot receive,
because it neither sees him nor knows him. You know him,
because he abides with you, and he will be in you….This is my
commandment, that you love one another as I have loved you.
No one has greater love than this, to lay down one’s life for
one’s friends. You are my friends if you do what I command
you. I do not call you servants any longer, because the servant
does not know what the master is doing; but I have called you
friends, because I have made known to you everything that I
have heard from my Father.”
-- John 14:15-27, 15:12-15
This excerpt from Jesus’ farewell speech to the disciples in
John’s gospel introduces the Spirit as “parakletos,” that is, “one
who is called alongside.” This concept, tied in with Jesus’

9. proclamation that he calls the disciples “friends,” gives us a
powerful image for pastoral care – the pastor as the parakletos
for a community that is called to be friends, formed by the
Spirit.
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Pastor as Reflection of Parakletos
Advocates
speak up on behalf of or beside those who have been silenced
challenge individual stigmas as well as oppressive systems
Companions
accompany people in their journeys
practice friendship as a spiritual discipline
Comforters
care for the afflicted
recognize our own need for care and comfort
Pastor reflects and facilitates the work that the parakletos is
doing in creating a Spirit-shaped community – a community that
advocates, accompanies, and comforts
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Basic Principles for Care-in-Community
Push back against stigma in your teaching, preaching, and
congregational care
“Hand the mic” to those with mental health problems,
empowering us to share our own stories
Recognize importance both of referrals and of non-professional
care-in-community

10. Use language with care (“crazy,” “out of my mind,” “OCD”)
Make sure you are receiving care, not just giving it, not only for
your own health but because it further destigmatizes mental
health problems
Create safe spaces for honesty, lament, questions of meaning
Educate yourself
Others?
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More Resources
National Suicide Prevention Helpline: 1-800-273-8255,
http://www.afsp.org
Albers, Robert H., et. al., editors. Ministry with Persons with
Mental Illness and Their Families. Fortress: 2012.
American Psychiatric Association’s Mental Health and Faith
Community Partnership: http://www.psychiatry.org/faith
Lund, Sarah. Blessed Are The Crazy. Chalice: 2014.
Mental Health First Aid training:
http://www.mentalhealthfirstaid.org/cs
National Alliance on Mental Illness (NAMI), Peer-to-Peer
support: http://www.nami.org/
UCC’s Mental Health Network: http://mhn-ucc.blogspot.com
UMC’s Caring Communities Program: http://umc-
gbcs.org/issues/mental-health
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11. Blatant Self-Promotion:
Some of my reflections:
Blog: “The church, the psych ward, and me,”
http://foolishhosey.blogspot.com/2014/10/the-church-psych-
ward-and-me.html
Blog with resource list: “A few scattered Wild Goose
reflections,” http://www.foolishhosey.blogspot.com/2015/07/a-
few-scattered-wild-goose-reflections.html
Blog: “Lithium and a Prayer: a few thoughts on mental illness,
medication, and spirituality, ”
http://www.patheos.com/blogs/emergentvillage/2015/07/lithium
-and-a-prayer-a-few-thoughts-on-mental-illness-medication-
and-spirituality
Podcast: “Mental Health and Christianity,”
http://mediascorch.podbean.com/e/where-are-we-going-6-
mental-health-christianity/
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