Why is there a stigma about mental health issues and suicide?

If I called in sick with a broken ankle, a severe bout of flu (genuine flu not man-flu)  or because I was due serious surgery, you would probably think nothing of it. Yet, despite all of the progress in our understanding of mental health, we still have a problem with its stigma. Why is that?  This was a question raised on twitter in response to my recent article on suicide.

Indeed, as the questioner asks, it seems to be that on the one level, individuals are compassionate but on the other there still seems to be public reservation about the issue.  It should not be this way should it? After all, reformed/protestant Christianity started off on the right track with Richard Baxter’s Directory which identified despondency as a condition with a level of insightfulness you might associate with modern psychiatry.

Here are a few thoughts on why we have ended up where we are:

First of all, the association between emotional health and suicidal thoughts/actions is something that the church has struggled with because, as I mentioned in my previous article, of how this is viewed through sacramental approaches to salvation.  In Catholic theology, you receive grace through a series of sacraments in life but then you leak it out through sin.  So, you receive grace through baptism, marriage, confession, holy orders and last rites.  Suicide is identified as a form of murder and so considered a mortal (or deeply serious sin). The person who commits suicide is therefore unable to receive sacraments to restore grace prior to death. The stigma associated with this meant that you would not be buried on consecrated ground.

Now, evangelicals will reject that theology but sometimes the effects of a faulty theology can stay on long after the faulty teaching has been replaced.  Furthermore, I think that we struggle to really grasp how deep God’s grace runs so that as I said previously, our assumption if someone takes their own life is that they needed to repent and so we hope that they managed to do this before they died. Now, supposing that the last thing that I do as I lie on my death bed is to turn and swear at the nurse, that would be a really sad and distressing way for things to end but how would you consider my sin at that point. I think we would say that if I had truly believed then I was justified and so this sin was covered by the blood of Christ. Shouldn’t this be our starting point when answering questions about suicide?

Secondly, I think we have another theological challenge which affects our culture. We rightly talk about divine impassibility. Technically, this means that God is without passions. In other words, because God is sovereign, he cannot be manipulated, swayed or overcome in any way.  Now we are different. I can be overcome by emotions of deep despondency or great exhilaration. Others can use our emotional state in order to manipulate and move us to action. In fact, they can create emotional responses (try reading this blog post out loud and slowly with some soothing music playing in the background).    We want to be absolutely clear that God is not like that. However, does that mean that God lacks emotions, lacks feelings? Well we cannot talk about God in exactly the same way we talk about human beings but it should, analogically be possible to talk about his love, compassion, joy and yes his anger at evil.

I think that at times we have acted as though those states themselves are fleshly and embarrassing. So, put that together with the “stiff upper lip” and we create a culture where people are terrified of emotions and don’t know how to respond to them. 

Thirdly, the roots of the Biblical counselling movement although doing great good also caused great problems too. Jay Adams who founded the movement was concerned at an over dependency on medication and humanist therapy. He argued that what people really needed was God’s word. He further argued that the root cause of emotional health issues was sin.

Now, there is something we don’t want to lose there. You see for some people their current state will be rooted in wrong things from their past -both guilt at what they did and also a tendency to respond to wrong done to them in a sinful way.  Others will have been sinned against. They have suffered emotional anguish due to abuse.  Still others will be experiencing the consequences of living in a fallen, sinful world. So we are right to talk about sin as a factor in our understanding of mental health. Yet, the way it was framed by Adams suggested the sufferer themselves was almost always culpable and directly responsible for their mental health.  The assumption was that they were in sin. If you combine that with two other factors, you have a toxic cultural mix. First of all, Martyn Lloyd Jones wrote a fantastic book called Spiritual Depression. It is such a helpful book but Lloyd Jones was also clear that spiritual depression was only one form of depression and there could be other causes. Yet his book may have contributed to the belief that depression is almost always a spiritual issue.  Then add a charismatic theology of demonic activity, oppression and possession into the mix and its toxicity is complete.

Finally, I think we just find mental health hard. It isn’t a visible illness.  We are not really sure what is the right thing to say and those of us, including myself who have suffered depression will I’m sure admit that we didn’t/don’t make the easiest patients.  Whilst you cannot catch my depression from me, I know that there is a contagious element to it in that it will affect how you feel as you sit alongside me and talk to me. Further, depression is often chronic and recurring. It is one of those illnesses where there isn’t a ready cure. The focus is on helping people to learn to live with it.  So, it does not provide the neat happy ending we seek. There isn’t a day when the plaster cast is taken off and you start walking again. I think we really struggle with that.

Yet, all of these issues which contribute to the stigma are challengeable and beatable. The Gospel should do that as we recognise that all are vulnerable and yet we have a loving and compassionate saviour.

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