Traditionally one of the tensions and taboos around mental health has been the perception that this is primarily a spiritual issue with people believing that mental illness from depression through to schizophrenia is caused by sin or even by demonic oppression and possession.
When I’ve written about mental health before, I’ve urged care in this area. There are two reasons for this. First of all when we think about mental health and spiritual health generally, I believe that balance is needed. What we believe affects how we live and so, I’ve argued that believing things that aren’t true can affect our emotions. Similarly, yes it is true that sinful lifestyles and thought patterns will affect our emotions. The reverse can be true as well, we can respond to our emotions sinfully and so wrong thoughts and behaviours may exacerbate depression and other forms of mental illness. Yet, this has sometimes been overstated. There are multiple causes of mental illness including what others have done to you (bullying, abuse etc), other health conditions causing suffering and sometimes a complete lack of known explanation.
Secondly, when it comes to demons, in the same way, I think that some people can overstate their activity, seeing demons in anything and everything. Sometimes where there has been restricted medical knowledge and a hefty amount of superstition, I think this has caused people to confuse mental illness with demonic activity. Yet Scripture doesn’t make that mistake. First of all, we see that it allows for demonic activity causing particular aberrant human behaviour as well as its cause being health issues and finally simply sin. Secondly, it allows for the different ways in which unclean spirits may work including causing aberrant behaviour directly and by afflicting a person’s health. Furthermore, I don’t think that Scripture leads us to expect demons around every corner. There seem to be specific pockets of demonic possession, particularly around the life of Jesus. This doesn’t mean that we won’t see demons at work today but it does mean that this kind of oppression is likely to be rarer than some assume and I would also dare to suggest that it is more likely to occur in strategic gospel and missional contexts.
Thirdly as my friend, Steve Sturman a neurologist with an interest in medical aspects of pastoral care observes:
There is, as you say, great potential harm in confusing mental illness and demonic possession. One, sometimes unforeseen, result of this is that because we conflate the two issues people may feel that because they have none of the supposed markers of ‘possession’ they could not possibly be ensnared in doing Satan’s work. So a perfectly ‘healthy’ Christian indulges in ungodly appetites that wage war against their soul over a period of time and nobody realises the extent of the Satanic/demonic damage that is going on. A lot of normalised behaviours that go on in Christian circles might well fall into this category, I am beginning to think, as the years go by.”Steve Sturman via personal correspondence (email 20-05-2022)
With all that in mind, what should we do when we are dealing with a pastoral context and there are questions about a spiritual component particular around the question of demonic possession or oppression?
Here are some questions I’d encourage you consider. Some of which may be appropriate to talk through with the person and/or with those close to them.
- Has there been a specific diagnosis of a mental illness? Do we know what the diagnosis was? What treatment has been prescribed and are there any signs that the treatment may be having an effect?
- Linked to this, are we aware of any potential disruption or change to medication and treatment that correlates with a change to moods and behaviours. For example, the person may have taken themselves off of medication or other health factors may be affecting their response to medication.
- If medical diagnosis is unknown or uncertain, I’d advise that the person needs urgently to see their GP and that simultaneously you may find it helpful to consult with a Christian leader who is medically qualified in a relevant field.
- Are there any obvious issues causing you to consider the possibility that there may be another dynamic at play here? For example, are there any examples of engagement with the occult?
- If the person themselves or others believe it is demonic, then on what basis do they think that? Are they able to describe specific experiences?
- It is worth noting at this point the need to handle descriptions of experiences carefully, not to discount the veracity of the account but to be aware that interpretation may be required. A person may be describing to you something even dressed up as occultic that was in fact abusive and so the cause of their mental distress now is a response to that abuse rather than that the abuser had specific supernatural power over them.
Those questions get us to the end of stage one. At this stage, I want to ask a further question. The question is this:
“What tangible difference does it make to the situation, your response and your expectations if the problem is through direct demonic interference or mental health?”
My reason for asking the question is because I believe the answer is in many cases going to be not a lot. The exception is where there is definite evidence of demon possession requiring exorcism. However, especially in pastoral situations with believers, you are more likely to talk in terms of oppression rather than possession.
Therefore, it is helpful to think about two further questions. The first is “What is the devil’s desire and intent?” The answer is that he seeks to destroy life. His aim is to test and tempt a believer to lead them into doubt, sin, guilt, shame, despair. The devil can do this by direct demonic torment but he more often than not does this through using the effects of the fall in order to encourage us to respond in those negative ways to suffering. So, whatever his tactics, his strategy is the same.
Secondly, I want to ask where God is in all of this? The answer is that whilst the devil will use those circumstances and tactics to tempt, God works in exactly the same situation for good. He tests us too but this testing is part of his discipline and refining work. We learn in those tough times to see God’s goodness at work, to trust him more, to be holy in the heat of the fire and to cling to Christ.
So, my concern in the situation should always be the same as a pastor/pastoral counsellor. My desire to help the counselee learn to be holy in their circumstances. Medical treatment is for the doctor and the psychiatrist, my priority is to help the person see their situation through the lens of the Gospel.
This means that whether Satan directly or through illness and suffering is tempting the person to believe lies, to act destructively in their relationships, to inflict harm on others that the Gospel helps them to say no to sin and yes to godliness. It means that if they are tempted to despair them my job is to point them back to Christ.
“When Satan tempts me to despair
And tells me of the guilt within
Upward I look and see him there
Who made an end of all my sin”