Mental Disorder

Portraits

• Barbara was a vigorous, energetic woman who loved to help at the local shelter. But every so often she’d stop her volunteer work and would not leave her house for weeks. At other times, she’d hang out at the shelter for days, often not leaving to sleep, being very gregarious and giving away a lot of cash.
• John works in a plastic manufacturing company and recently went off. His coworkers described his bizarre behavio  to a manager. One person reported "He seems crazy; angry and talking wildly."
• No one at church knew exactly why Michael seemed so odd. He’d been a star basketball player in high school and college, and he’d graduated with honors from law school and joined a good firm. But now he was unemployed, supported by his wife and son. People at church thought he’d damaged his brain with drugs, because he acted so spaced out. But his fall from success was not of his own doing.
• Sandy did everything to extremes. She was dramatic, loving, and enthusiastic some of the time. Then she’d become angry, obnoxious, and belligerent. She was divorced and had held a lot of different jobs and attended a lot of different churches. She was known among the local pastors as a troublemaker.
• Matt was shy and reclusive. He worked with computers and rarely spoke in Sunday school class. When he did speak, he often voiced bizarre opinions about numerological schemes in the Quran and predictions of the exact time of the end of the world.

Definitions and Key Thoughts

• A mental disorder is characterized by thoughts and behaviors that cause individuals to experience extreme problems in functioning in significant areas of their lives—relationships, employment, education, financial well-being, even spirituality.
• Mental disorder is not short term, but it is also not necessarily permanent. By definition, mental problems must endure for a certain minimum period of time before a mental disorder can be diagnosed.
• Most mental disorders resolve after treatment with counseling, medication, or simply the passing of time.
  

• Other mental disorders are lifelong and cause ongoing problems for thoseafflicted with them and for their families.
• If someone is mentally ill, he is not simply “odd.” Labels of mental disorderought never to be applied without a professional assessment. Mental disorders are—by definition—serious disturbances. These are some common typesof mental disorders:
• Psychotic disorders are those that result in bizarre, paranoid, or delusional thinking. The most common one is schizophrenia. Individuals with psychotic illnesses manifest the symptoms most often thought of as “crazy”— seeing or hearing things that aren’t there, making bizarre connections between unrelated events, or showing grossly inappropriate responses to ordinary occurrences.
• Mood disorders are those that primarily affect a person’s emotional stability. The most common are depression and bipolar disorder (formerly called manic-depression). Individuals afflicted with depression feel discouraged and hopeless almost every day, have lost interest in activities in which they used to take pleasure, and sometimes consider or attempt suicide. Those with bipolar disorder exhibit cycles of wildly changing emotions and behaviors.
  
• Anxiety disorders are characterized by extreme nervousness, panic, or phobias. Persons suffering from anxiety disorders cannot calm down, feel panicky much of the time, and have physical symptoms of constant nervousness. Those with post-traumatic stress may experience flashbacks of
  trauma and may react to loud noises or other reminders of the precipitating event.
• Personality disorders are disturbances in thinking and behavior that are a part of a person’s basic character. They result in lifelong patterns of counter-productive behavior. Unlike the above mental disorders, personality
  disorders do not often respond to medications or short-term therapy. There are many other disorders, and disorders associated only with children, but there is not enough space here to deal with them all.

• There are huge differences between mental disorder, sin, and demonic influence.
  
• Treatment must take place after a thorough assessment and careful diagnosis.
• In a church, mental disorders most often become apparent in relationships.
• Mentally ill people who are active in church may have difficulty tolerating the opinions of others, getting along on committees, or accepting limits. Other mentally ill people may be on the periphery of the church—a churchgoer’s spouse or child who is often the subject of prayer requests.
• Misdiagnosis and improper treatments are common. Far too many suffer needlessly. The failure to understand the multiple reasons people suffer—including the distinction between sin, mental illness, and demonic influence—has significant consequences.

• Some people are only confessing sin when they should be taking medication; others are blaming an illness when they should be confessing their sin.
• Demons are being cast out of schizophrenics who need medical treatment; people who need the casting out of demons are put into mental hospitals and drugged to complacency.
• Christians must understand that even throughout the Scriptures, physicians, balms, salves, and other medicines were used. The church and mental health professionals must value the contribution each can make and work together to relieve human suffering.

Assessment Interview

Keep in mind that much that passes for “insanity” in the general population is simply a brief crisis due to extreme circumstances. Don’t jump to conclusions or place labels on people.

Some people with mental disorders struggle for just a short time. Others are able to live near normal lives with regular medication and supportive counseling.

Some will suffer from constant emotional and behavioral chaos, inability to maintain relationships or jobs, difficulties with the law and with substance abuse. People’s responses to medications vary widely, and some disorders (such as bipolar disorder) cause symptoms that make afflicted individuals unlikely to stay on
medication.

With some forms of mental disorder there is the risk of violence due to severe depression, feelings of hopelessness, or aggression. Ask the “Rule Out” questions below to assess for the potential for violence. All the questions are directed toward the family member or concerned friend of a mentally ill person, but they could also be asked directly.

Rule Outs

Q1 Has your family member ever been violent?
Q2 Does he or she have access to weapons?
Q3 Has he or she ever expressed feeling threatened? (If so, turn to Action Steps
1 and 2.)
Q4 Does your family member seem despondent or hopeless?
Q5 Has she or he ever attempted suicide? (See section on Suicide for more information
on how to handle this situation.)
Q6 (If a woman) Has she recently had a baby?
Q7 Who could be endangered if this person becomes violent?
General Questions
Q8 Has anyone in this person’s family ever been under the care of a psychiatrist
or admitted to a psychiatric hospital?
Q9 If so, what reason was given?
Q10 Are you aware of a diagnosis?
Q11 What makes you think that this person has a mental disorder?
Q12 Describe the history of this person’s most significant relationships. (Unstable relationships—or a lack of personal relationships—may be an indicator of underlying mental problems.)
Q13 Has this individual ever been convicted of a crime? If so, what crime and when?
Q14 Does this person ever speak in bizarre ways?
Q15 Does this person express fear that people are “after” him or her?
Q16 Does this person describe hearing or seeing things that are not there?
(Questions 14-16 ask about symptoms of psychosis.)
Q17 Does this person show cycles of emotions or behaviors?
Q18 Does he or she ever go for long periods with little sleep?
Q19 Does he or she ever spend a lot of money recklessly or act grandiose and
above the law? (Question 17-19 ask about symptoms of bipolar disorder.)

Wise Counsel

Though only a small percentage of persons with mental disorder become violent, you should still be vigilant for the risk of violence.

People who are paranoid—believe that others are working against them, perhaps in an elaborate plot—can feel threatened enough to strike out at others.

Mania—feeling grandiose and on top of the world—can also breed violence when
the manic individual is crossed.

Never risk yourself, your family, or your congregation members by naively thinking that violence will not occur. If a situation is escalating, it is better to call for help than to overlook the potential of violence.

Police and paramedics are trained to assess the situation and to bring to local emergency rooms people who are exhibiting signs of mental problems. At the emergency room, medical professionals should be available to assess the individual and decide on a course of action. You can help by reporting your concerns to the police or paramedics.

Action Steps

1. Lessen the Risks
If there is any risk of violence, get professionals involved immediately. Remove any weapons (guns, knives, anything else sharp, and ropes, scarves, sheets, or belts) and drugs from the home. Try to observe the person until help arrives.

2. Watch Yourself

Explain to family members that if they are present with the person who is expressing extreme anger or paranoia, get out of the way. They should not block the individual’s exit. Instead, they should let him leave and call 9-1-1.

3. Get Professional Help
Encourage family members to talk with a professional if their loved one is

• Threatening violence
• Causing financial hardship
• Abusing substances (see also the section on Addictions)
• Participating in dangerous or destructive behavior
• Disappearing without explanation

4. Get Medical Help
The answer to the problem may lie in a drug that will help with the person’s disordered brain chemistry.

5. Support Groups
There are many support groups for those who love persons with mental disorders. The best-known is NAMI, the National Alliance for the Mentally Ill, which sponsors both support and advocacy across the country.
Other groups can be found by contacting your local mental health agencies.

6. Practical Help
Local mental health agencies should have information about financial help, health insurance, supportive counseling, and other interventions that can aid persons with mental disorders and their families.

Persons with chronic mental disorder who need ongoing help may benefit from programs such as day treatment or supportive living facilities.

7. Spiritual Help
God is for those with mental disorders. Be sure to be spiritually sensitive and unbiased in your love and heart to them.

Help the person with mental disorder understand his need for Christ. Is he a Christian? Does he know the plan of salvation? Does he understand what Jesus can do in his life? (See John 1:12; Romans 3:23; 6:23.)

Pray for wisdom regarding your approach to helping the person with mental disorder. Does he need advice, encouragement, education, correction, a support system, insight, confession, verbal reinforcement, modeling, or confrontation?

8. Live in Peace
Do not blame the person with a mental disorder or get sucked into arguments with him.

The person is, indeed, ill and blaming this person is like blaming a patient for his heart attack.

Biblical Insights

But the Spirit of the Lord departed from Saul, and a distressing spirit from the
Lord troubled him. —1 Samuel 16:14

King Saul, who reigned in Israel before David, displayed classic characteristic of mental disorder, including wide mood swings and fits of depression and anger.

A person can develop such debilitating emotional symptoms for many reasons.

In this case, Scripture indicates that “a distressing spirit from the Lord troubled” Saul.

Saul’s heart had turned from God, so God sovereignly permitted affliction by a spirit of distress—possibly a demonic influence—to occur. Not all mental disorders are a result of demonic influence, but like any sickness or disease, the battle for our minds is a result of the Fall and Satan’s presence in this world.

That very hour the word was fulfilled concerning Nebuchadnezzar; he was driven

from men and ate grass like oxen; his body was wet with the dew of heaven till his
hair had grown like eagles’ feathers and his nails like birds’ claws. —Daniel 4:33

We are spiritual beings, created by God and incomplete without Him. Also, we are physical beings, and a physical disease can lead to psychological or spiritual problems, and vice versa. And then too, we are psychological beings, meaning that each person has a mind, emotions, and a will. The interrelationships among these three realms in our humanity mean that specific problems may have many symptoms and causes behind them.

If believers face some form of an emotional problem, they should seek counsel from wise, qualified Christians who can treat them with a comprehensive approach. During such a time, other believers must surround the hurting brother or sister in prayer. God promises to help His people through even the most difficult times.

Then they sailed to the country of the Gadarenes, which is opposite Galilee. And when He stepped out on the land, there met Him a certain man from the city who had demons for a long time. And he wore no clothes, nor did he live in a house but in the tombs. —Luke 8:26-27

In this case, the man’s situation was caused by demon possession. Usually, however, mental disorder has other causes, such as genetics or hormonal imbalances.

Such people need assurance of their worthiness before God, as well as Christian professional help. Jesus has the power to heal many kinds of afflictions.

Prayer Starter

Dear Lord, we are concerned about ____. We have good reasons to be concerned. Please lead us to those people who will be able to help us, to offer resources, and to aid this person we love. Give us strength, patience, and rest. In Jesus’ name, Amen.

Recommended Resources

• Battling Bi-Polar Disorder, American Association of Christian Counselors Courageous Living Video Series, by Michael Lyles
• Facing ADHD: Assessment and Treatment of the ADHD Child, American Association of Christian Counselors Courageous Living Video Series, by Grant Martin
  Mastering Your Moods: Understanding Your Emotional Highs and Lows, by Paul Meier, Stephen Arterburn and Frank Minirth
• Psychiatric Medication and the Christian, American Association of Christian Counselors Courageous Living Video Series, by Michael Lyles