A Christian's Guide to Mental Illness: Answers to 30 Common Questions

Thank you for downloading this Crossway book.

Sign up for the Crossway Newsletter for updates on special offers, new resources, and exciting global ministry initiatives:

Crossway Newsletter

Or, if you prefer, we would love to connect with you online:

This project answers the important questions, and the personal stories of the authors and their commitment to making this material accessible has brought it all close enough to enhance our wisdom, patience, gentleness, and perseverance. The light on the hill will be a bit brighter because of it.

Edward T. Welch, Counselor and Faculty Member, Christian Counseling & Educational Foundation; author, I Have a Psychiatric Diagnosis: What Does the Bible Say?

I believe that this well-written book will help mental health professionals, family members, and those struggling with mental illness. It takes a complex issue and breaks it down into an organized and practical guide of help and healing.

Bruce Langerak, DO, Internal Medicine, Grand Rapids, Michigan

In an engaging, practical, and insightful commentary, David Murray and Tom Karel Jr. challenge the Christian community to understand and embrace the struggle of mental illness. As a clinician with more than twenty-five years of experience, I am delighted to have this resource at my fingertips. The authors offer a welcome bridge between faith and clinical applications.

Emilie DeYoung, mental health clinician; Clinical Director, Winning at Home, Inc.

When people and their problems get more complex and acute, two equal and opposite reactions are either to withdraw or to rush in without humility, curiosity, or wisdom. Thankfully, David Murray and Tom Karel Jr. have written a primer for pastors, small-group leaders, family, and everyone in between. I am so thankful for this book and how it has the potential to make the church a safe place for all who struggle and seek to find God’s grace in the midst of their suffering. I highly recommend this book!

Tim S. Lane, President, Institute for Pastoral Care; President, Tim Lane & Associates; author, How People Change and Unstuck

There are few topics that have garnered as much interest and discussion in our day as mental health and illness. That is why I’m so grateful for this incredibly helpful resource from David Murray and Tom Karel Jr. They have managed to write a succinct book that is both informative and well-researched but brims with humanity, compassion, and understanding. Whatever role you might play, you will find biblical and practical help from two seasoned individuals who are honest about not only the troubles we face but also the hope we have in Christ. This is a book I know I will return to in my care and counsel of others. I trust the same will be true for you, too.

Jonathan Holmes, Executive Director, Fieldstone Counseling

"A Christian’s Guide to Mental Illness is the perfect book for those who have questions about how or whether mental illness has any place in their life as a Christian. David Murray and Tom Karel Jr. walk us through questions and concerns some Christians have wrestled with regarding the field of mental health. They provide answers that are clear, practical, personal, and grounded in their deep faith."

Mark Eastburg, CEO, Pine Rest Christian Mental Health Services, Grand Rapids, Michigan

How does Jesus view mental illness? I suspect this book comes about as close to capturing his understanding and compassion as anything I’ve read. Bringing together a God-centered approach to life with a deep sensitivity to the needs of Christians with mental illness, it is chock-full of practical wisdom and guidance to help the church become a place where such people feel safe, welcome, and supported—a place where the poor in spirit are being blessed.

Eric L. Johnson, Professor of Christian Psychology, Houston Christian University; author, God and Soul Care: The Therapeutic Resources of the Christian Faith

A Christian’s Guide to Mental Illness

A Christian’s Guide to Mental Illness

Answers to 30 Common Questions

David Murray and Tom Karel Jr.

A Christian’s Guide to Mental Illness: Answers to 30 Common Questions

Copyright © 2023 by David Murray and Thomas A. Karel Jr.

Published by Crossway

1300 Crescent Street

Wheaton, Illinois 60187

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopy, recording, or otherwise, without the prior permission of the publisher, except as provided for by USA copyright law. Crossway® is a registered trademark in the United States of America.

Published in association with the literary agency of Legacy, LLC, 501 N. Orlando Avenue, Suite #313-348, Winter Park, FL 32789

Cover design: Faceout Studio, Spencer Fuller

Cover image: Shutterstock

First printing 2023

Printed in the United States of America

Scripture quotations are from the ESV® Bible (The Holy Bible, English Standard Version®), copyright © 2001 by Crossway, a publishing ministry of Good News Publishers. Used by permission. All rights reserved. The ESV text may not be quoted in any publication made available to the public by a Creative Commons license. The ESV may not be translated into any other language.

The Scripture quotation marked KJV is from the King James Version of the Bible. Public domain.

Trade paperback ISBN: 978-1-4335-8727-6

ePub ISBN: 978-1-4335-8730-6

PDF ISBN: 978-1-4335-8728-3

Library of Congress Cataloging-in-Publication Data

Names: Murray, David, 1969- author. | Karel, Thom, Jr., 1969- author. 

Title: A Christian's guide to mental illness : answers to 30 common questions / David Murray, Thom Karel Jr. 

Description: Wheaton, Illinois : Crossway, [2023]. | Includes bibliographical references and index. 

Identifiers: LCCN 2022054289 (print) | LCCN 2022054290 (ebook) | ISBN 9781433587276 (trade paperback) | ISBN 9781433587283 (pdf) | ISBN 9781433587306 (epub)

Subjects: LCSH: Mental illness—Religious aspects—Christianity—Miscellanea. | Christianity—Psychology—Miscellanea. | Psychiatry and religion—Miscellanea. 

Classification: LCC BT732.4 .M87 2023 (print) | LCC BT732.4 (ebook) | DDC 261.8/322—dc23/eng/20230417

LC record available at https://lccn.loc.gov/2022054289

LC ebook record available at https://lccn.loc.gov/2022054290

Crossway is a publishing ministry of Good News Publishers.

David

To Ed Stetzer, whose Christlike compassion for sufferers has shaped me, and whose research expertise has shaped this book.

Tom

To my dear wife Ruthanne and our precious daughters Hannah, Gabby, and Lydia: your encouragement and prayers have helped me every step of the way.

Contents

Introduction

1  What Is Mental Illness?

2  Is Mental Illness a Helpful Label?

3  What Are the Different Kinds of Mental Illness?

4  How Is Mental Illness Different from Ordinary Sadness, Anxiety, and Confusion?

5  How Does Mental Illness Affect the Sufferer?

6  How Does Mental Illness Affect Spiritual Life?

7  How Does Mental Illness Affect Those around the Sufferer?

8  How Do People React to Having Mental Illness?

9  What Are Some Common Hurdles to Recovery?

10  What Causes Mental Illness?

11  Can a Christian Have Mental Illness?

12  What Role Do Pastors Have in Helping the Mentally Ill?

13  What Role Does the Church Community Have?

14  What Role Do Family and Friends Have?

15  What Role Do Mental Health Professionals Have?

16  What Role Does Medication Have?

17  What Role Do Biblical Counselors Have?

18  What Role Does the Sufferer Have?

19  How Can We Discern Faith and Spiritual Fruit in a Sufferer?

20  How Can We Help a Sufferer Grow Spiritually?

21  How Can We Help Sufferers Serve in the Church?

22  What Are the Biggest Challenges in Discipling a Sufferer?

23  What Are the Roles of Scripture, Prayer, and the Sacraments in a Sufferer’s Life?

24  What Are Some Things to Avoid in Ministering to Sufferers?

25  What Should We Do When a Sufferer Falls into Temptation?

26  How Can We Help Someone Who Is Suicidal?

27  How Can We Care for Caregivers?

28  How Can We Reduce the Stigma of Mental Illness?

29  How Can We Prepare for Mental Illness?

30  What Good Comes Out of Mental Illness?

The Story behind This Book

General Index

Scripture Index

Introduction

What do you think when you hear one of these words: depression, anxiety, bipolar disorder, schizophrenia, eating disorder, obsessive compulsive disorder (OCD), and so on? You probably try not to think about them, and hope you never have to. But, with one in five American adults suffering mental illness at some point in their lives, sooner or later someone we love in our family, among our friends, or at church will bring one of these scary labels to life in our lives.¹

As anyone who has gone through this knows, when one person suffers with a mental illness, it sends tumultuous waves into multiple lives. Spouses, parents, siblings, friends, pastors, elders, neighbors are called into demanding roles and responsibilities that they are not prepared for, frequently leading to a sense of helplessness and hopelessness. How can I help? Where can I get help? Who else can help? Is there any help that will help?

We know how people react in these situations because not only have we been involved in counseling for decades, we’ve both been surprised by depression and anxiety in our own lives. Yes, the counselors needed counseling!

Through all this, we’ve identified the most common questions asked by sufferers, their families, friends, and churches (the thirty questions we ask in this handbook). But we’ve also learned and lived answers to these questions through practicing a holistic Christian approach to mental illness. The answers are designed to be as simple and practical as possible so that family, friends, and churches can work together to help those who suffer with mental illness, giving them and us hope. Before we find that hope and help, let’s first identify the causes of the hopelessness and helplessness we experience when mental illness strikes someone we love.

We Are Hopeless and Helpless

We suffer from despair and defeatism because mental illness is hard to understand. Apart from a few rare exceptions, there is no test to confirm the existence of mental illness, tell us what’s gone wrong, or show us how to put it right. While we will discuss a range of causes in these pages, it’s often impossible to know which one or which combination of causes were relevant in each case. There’s a mystery in it at times, which science has never fully understood or explained.

Despondency and discouragement also set in for us when sufferers refuse to even admit there is a problem, are pessimistic about their chances of recovery, or refuse to accept offered help. This denial or defeatism makes it especially difficult for family, friends, pastors, counselors, or doctors who want to help them.

But the most horrendous hopelessness and helplessness can sink us when we see the way that mental illness damages a Christian’s faith and witness. We look on with horror as we see someone we thought was a Christian in a state of deep despair, dark depression, or fearful anxiety. Sometimes it shatters a Christian’s faith, so that he has no sense of God, or worse, a sense that God has forsaken him or turned against him. In extreme cases, some may even think that they are God. How can someone be a Christian when he is characterized by hearing voices, bizarre behavior, chaotic unpredictability, detachment from reality, or shameful sin? There don’t appear to be any fruits of the Spirit, but only works of the flesh (Gal. 5:19–23), raising huge questions such as, Can someone who is a Christian feel like that? Think like that? Act like that?

The spiritual torture of those questions for the loved ones of the mentally ill is part of the motivation behind this book. Norman and Vicki Van Mersbergen approached us a few years ago with a small legacy from the estate of Norman’s brother Gary, who passed away following complications related to schizophrenia. Although Gary had professed faith early in life, that was soon followed by three decades of mental instability.²

This painful personal experience of mental illness prompted many questions for Norman and Vicki: What comfort can we give loved ones amid such struggles? Are there any ways we can discern the fruits of the Spirit in a mentally ill person? If so, how do we do so and how do we minister to sufferers? What can the church do better, both for the mentally ill and for those who care for them?

Together, we decided to use Gary’s legacy to fund research into these and similar questions, and we are most grateful for our research partners, Lifeway Research and Focus on the Family, and their published findings.³ Norman and Vicki’s desire to share the results of our research with a wider audience and to turn it into a practical Christian guide for friends and family of the mentally ill resulted in this book. So where do we get hope and help amid hopelessness and helplessness?

God Gives Hope and Help

As the authors of this book, we want to assure readers that God is our hope and help. For a combined total of about fifty years, we’ve both been involved in helping Christians with mental illness and their families. Tom has served as a psychologist in a Christian healthcare setting and David has served as a pastor, counselor, and professor of counseling, as well as authoring various books on the subject.⁴

Most importantly, we have both suffered with bouts of depression and anxiety in recent times. Although these painful times delayed this book for a few years, we believe it was God’s delay and has resulted in a better book as well as a better us. When caregivers become care-receivers, it makes them better caregivers.

We approach this problem as Christians who not only believe but who have experienced that God provides hope and help for Christians with mental illness and those who care for them. While mental illness often has spiritual consequences, it is rarely only a spiritual problem that can be fixed simply with repentance and faith. God provides hope and help through his word and a word-based view of his world. This word-directed, holistic approach is the most honoring to God and the most beneficial for sufferers and their families.

As noted, this handbook is organized around thirty questions and answers that we’ve found are those most commonly asked by perplexed parents, spouses, friends, and pastors. We’ve tried to be ruthlessly practical, discussing only enough theory to help readers understand and have confidence in the practical directions, and grounding it all in biblical truth. We suggest you do a quick read of the whole book to get a big-picture view of how to help sufferers, then return to a closer study of chapters especially relevant to you, and then keep the book handy for reference purposes and answers to future questions. We also encourage church leaders to use this book to develop a holistic approach to caring for those with mental illness in their church and community.

There is no quick fix for mental illness. However, with faith in the Helper of the helpless and the Hope of the hopeless, all Christians can offer Christlike care to the mentally ill, giving help and hope to the helpless and hopeless.

1  In 2019, about 1 in 10 American adults reported symptoms of anxiety or depressive disorder. In 2020, it rose to 4 in 10, a fourfold increase (Nirmita Panchal, et al., The Implications of COVID-19 for Mental Health and Substance Use, Kaiser Family Foundation, https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/). Lockdowns, social isolation, cancelation of sports and graduations, and educational disruptions have had a particularly devastating effect on teens and children. Forty-six percent of parents report new or worsening mental health in their teens during 2020, with 1 in