When did you last hear a pastor talk about mental health issues?

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In my recent survey about application and what pastors talked about, I asked respondents to indicate whether or not they’d heard pastors address particular issues within the last 5 years. One issue concerned mental health.

This is such an important subject to address within our churches because as we preach and pastor we are so often ministering to people who are bruised and broken in different ways. As we come out of the pandemic, I believe that we are going to be made acutely aware of two things. First of all, there will be those who have suffered heavily because of the pandemic.  Isolation and loneliness will have played a part in triggering severe depressive episodes, worries about returning to work, school, college, even the church building may be causing anxiety.  This may well be complicated where experiences now trigger PTSD responses to past trauma.  Sadly, the pandemic will have taken away support and escape routes from some who will then have found themselves in abusive situations with no way out and that abuse will have been emotional as well as physical.

We are also going to be caring for and speaking to people who have suppressed serious issues over the past 18 months.  For some, this was a time to hide away and to try and ignore the pain and its causes. Now, they are being forced to face things they have managed to avoid.

I think that we face twin risks when talking about mental health. One the one hand we can be tempted to completely medicalise it. When we do that we assume that this subject belongs in the domain of doctors and therapists. We end up subcontracting a lot of pastoral care to them and leave those who are suffering to be treated with medication and secular counselling.  Partly, this arises out of fear. We are afraid of straying into territory where we are ignorant and of saying something that comes across as condemnatory leading to further harm. Worse still, sometimes I think the fear is that engaging on tricky pastoral issues will come back to bite us that our words and actions will be judged and condemned.

The second risk is to completely deny the medical aspects of mental health care.  I think this was the problem in the very early days of the Biblical Counselling movement and especially with Jay Adams.  If there wasn’t an obvious organic cause, then the root cause was assumed to be spiritual and specifically sin on the part of the sufferer. Even when the sufferer had been sinned against, their mental issue was seen as a sinful response. 

This approach ignored two things. First that when someone is sinned against then it is the sinful action of the abuser that inflicts pain. It is not sin on my part to experience and express pain if someone cuts me with a knife, so why would it be sinful to express pain when someone cuts me with their words? 

It also ignores the complexity of the human body including the brain and the nervous system.  Just because scientists and surgeons were not able to observe specific things back in the 1950s does not mean that there wasn’t something physically happening. Indeed, there have been significant developments in this area since Jay Adams was writing on Biblical Counselling.

In his classic book, Spiritual Depression, Doctor and pastor Martyn Lloyd Jones insisted that depression can have both spiritual and medical causes. It is crucial therefore to understand what types of causes we are dealing with. At the same time I would argue that things can be more complex still as spiritual and medical issues become mixed up together.  Therefore a pastor’s responsibility is both to encourage people to seek medical help (a legitimate application of Scripture’s wisdom teaching) and to find solace in God’s Word.

If we are going to talk about this subject, it’s important that we seek to be well informed.  Helpful reading might include

  • The Pastor with a thorn in his side (editor Steve Kneale)
  • Spiritual Depression (Martyn Lloyd Jones)
  • When darkness seems my closest friend (Mark Meynall)
  • Wrestling with my thoughts (Sharon Hastings)
  • The body keeps the score (Bessel Van Der Kolk).

The Pastor with a Thorn in his side and When Darkness seems my closest friend remind us that church leaders are not immune from mental illness and this is so important as there still remain some stigmas especially for men about admitting to such struggles.  One thing we can do as pastors is model what it means to live in this now and not yet world, not escaping suffering but learning how to be holy, faithful and fruitful through suffering.

Many people have found the Psalms helpful when facing the darkness of depression and at times some of them seem to accurately describe such struggles. There is a risk that we can end up second guessing and an providing amateur diagnosis several thousand years later for King David – or indeed Elijah in 2 Kings 19.

Personally, I would not rely on topical sermons about loneliness, depression and anxiety. Rather, we should be seeing how the weekly diet of expository teaching brings out application concerning God’s sovereignty over our lives, our security in Christ and the love, peace and joy that he offers offer timely hope for sufferers in their present circumstances. 

Additionally, I also think that there is something to be considered in terms of the puritan idea of preaching to the affections. Does our preaching reach people’s emotions. What affect do my words and my tone have on those who are anxious, depressed, nervous? Does my preaching challenge the comfortable and comfort the hurting?

Why not have a look back over a few of your recent sermons and consider what the text had to say to those struggling with depression. Do you think that this came through in your application?

If you are feeling particularly brave you might also want to ask people who have faced depression what impact your preaching has had on them.