Kansiewicz, Kristen, On Edge: Mental Illness in the Christian Context. 2014
[Note: This is the longest book review I have written, but the topics are critical and the discussion is important for the church.]
If someone is looking for the definitive guide and be-all-end-all book on this important topic, this book is not it (I don’t think such a book exists). But if you are exploring this topic, then this book serves as an excellent starting point in the discussion.
I have a personal interest in the topic. I have battled depression for a long time, and I have an immediate family member who has been diagnosed bipolar since 1987; little to no help for us, on the spiritual side of things. When I experienced the worst years of depression, the church had really nothing to address it for pastors or congregations. In the past 15 years that situation is beginning to change for the better. And I have a professional interest as a pastor of a congregation and as seminary professor teaching future pastors. Thus, I am looking for ways to equip them to be aware of developments in mental health issues.
My approach is to go through the book, chapter-by-chapter, and offer thoughts.
Part 1: Foundational Concepts: Understanding Mental Illness in the Church
Chapter 1: The Church and the Mental Health Revolution
Having grown up in the 1950s through mid 1960s, “mental health” was never discussed. In our family, to admit a problem such as that was an admission of weakness and failure. I remember how some WWI and WWII veterans struggled because they suffered PTSD (before it was recognized as such). They were ostracized, told to “get over it,” etc. As for mental illness in the broadest terms, the colloquial phrase was “they are nuts” and they needed to be confined. Yeah, there wasn’t any recognition of the problems, and if they were recognized, it was to be swept under the carpet to avoid facing it (in someone else).
When I served in the Navy (intelligence office) I came under the influence of a chaplain who was wholeheartedly supportive of Jay Adams and his approach to such issues (p. 10 ff.), namely that anything that could not be detected by medical tests was only the result of sin. I went through Seminary 1982-86, and that seemed to be somewhat the accepted stance (I’m sure that I missed some nuances in seminary training on this). During that decade my battle with depression began to surface. But I had no framework to deal with it.
As I began to serve in a congregation, it became apparent that such a simplistic division of problems was not matching what I saw. I ministered to people whose loved ones had committed suicide. They were looking for answers, and while I ministered and cared for them, I also realized I was not prepared for the more complex reality.
Kansiewicz describes the history (and my own journey) when she writes:
Average church attendees, who are likely unaware of this historical debate with the church about how to respond to mental illness and emotional problems, may find themselves caught in the crosshairs. In his book Grace for the Afflicted, Matthew Stanford shares his surprise and dismay in encountering Christians who did not believe mental illness—in this case depression—could happen to “true” Christians… In the American church culture, many have been taught that emotional problems are only a spiritual issue. (pp. 11-12)
The typical pastor seems to have followed my own path, giving some help, but not really understanding some of the inter connectedness of mental health and Christian care.
Kansiewicz offers the Church Therapy model, “a professionally trained, licensed Christian counselor works on a church staff alongside and in conjunction with the pastors” (p. 13). While I see the advantages of such an approach, it is not realistic in most parts of the US (let alone other cultures). I serve a congregation in an area in which the nearest hospital is 50 miles away. We have one doctor at a clinic, so only basic medical care is available, let alone a Christian counselor. So while I agree with the concept, I think a broader approach needs to be taken if the majority of congregations and pastors can be helped.
Chapter 2: Is Mental Illness Real?
The author notes that great strides have been made in science, and it is beginning to influence how to treat some mental illness. A simple blood test or brain scan cannot be used to accurately deal with mental illness, leaving only observation as a starting point medically. “However, because we have not yet developed objective measures, doctors and counselors are currently forced to rely on their observations of mood and behavior.” (p. 18)
Kansiewicz offers an accurate assessment of where we are as Christians: “Because of that in-between place of embracing the kingdom of God while we wait for it to be fully realized with Christ’s return, we fall victim to disease like the rest of humanity.” (p. 18) Accordingly, she notes “The church must be a place where hope resides, where love endures, and where emotional safety flourishes, for it is Christ alone who offers a way out of our present suffering. Christ alone will walk alongside us as One who has also suffered.” (p. 19)
Although this chapter is short, it is perhaps the most important for the current state of Christians and mental illnesses.
Chapter 3: Should Christians Take Psychiatric Medicines?
This chapter hit close to home because the example offered deals with depression. When I hit bottom, a breakdown, medicine was really necessary for me. I would never have considered it, except I had no choice. My treatment also involved sessions with a psychologist (3x week for a while).
The encouragement Kansiewicz offers is that the integration of all: psychiatrist, psychologist, and medical doctor are critical. And of course, the church/pastor. “Medication is simply a tool. It is one piece of the treatment puzzle that actually works best when combined with counseling, as numerous studies have shown.” (p. 29) That balance is critical. It is good that the church is finally entering team approach to mental illness.
From now on each chapter includes a case study and then the Counselor’s Response. Very effective and helpful approach in presenting the concepts.
Chapter 4: Is Faith a Feeling?
This is an interesting chapter, examining Dave as a case study. Feelings/emotions are an important part of who we are as people. But “sometimes our feelings can not be trusted…We must cling to truth to provide stability through all of our emotional states.” (p. 37) Obviously mental illnesses can exaggerate the disparity between healthy feelings and those that do not respond to the reality of what is happening.
Perhaps the most powerful statements in the book:
Equally important to note si that feelings cannot define truth. God alone can define reality, and His word creates truth. All humans must humbly acknowledge their inability to feel and perceive truth accurately. (p. 38)
Emotions are a tool for us that can enable us to experience life and God. Beauty, interconnection, and a sense of need for a Savior are all understood through emotional senses. But this tool does not provide a definition of reality—God alone can set reality in motion. Feelings must always remain in proper alignment to the One who sets truth in order. When we find that any of our senses lead us astray, we must cling to the truth of the God who is greater than all things. (p. 39)
Part 2: Specific Mental Health Disorders
Chapter 5: The Bipolar Experience
Again, this chapter hits close to home because our son is Bipolar. Kansiewicz offers the insight that the highs and lows can be deluding, and so systems need to be in place to help with each.
The hardest part is forcing yourself to keep these systems in place at your highest high and or lowest low. When you are on a high, you will be convinced you do not need grounding. When you are in a low valley, you will wonder why you should even bother to try. (p. 47)
And that is exactly the problem our son faced, and still does 30 years later. The systems she offers are: feedback, focus on truth, and “routines of obedience to God.” In my experience with Christian members in the congregation, someone who is bipolar presents perhaps the most challenging aspect of ministry in the congregation. Certainly extra grace is needed in such ministry.
Chapter 6: Can Real Christians Be Depressed?
I have already mentioned much on this topic. One helpful observation from the author highlights this chapter:
When true clinical depression has taken over the brain, removal of one’s life stress does not remove the depression symptoms. Even those things that led to the onset of depression do not need to remain for the depression to continue. (p. 55)
For me, I discovered that there are triggers that instantly bring about memories (even unconscious) that feed depression. It took many years to recognize this problem. This chapter is well worth reading many times.
Chapter 7: How Can I Trust God When I Worry All the Time?
Until 15 years ago I had not really encountered anxiety as a problem (or at least was not aware of it). Anxiety was generally considered just another emotion, but nothing to do with mental illness. But I have ministered to people who deal with this daily. GAD (Generalized Anxiety Disorder) is defined as “when a person worries excessively about a variety of everyday problems for at least 6 months.” Reading through the case study was helpful for me.
Often the extreme form of fear and worry leads to avoidance of activities and encounters with others. Responding to GAD requires medicine as well as psychology, and spiritual care. As the author states: “Counseling, medication, books on anxiety, prayer, and mental repetition of important biblical truths all play important roles for those with anxiety each and every day.” (p. 67)
Chapter 8: Schizophrenia: Didn’t Jesus Just Call It Demon Possession?
I am thankful the author included this chapter. Especially helpful was the six guidelines to help distinguish between schizophrenia and demon possession by Steven Waterhouse. One quote from Waterhouse: “Authors who have clinical experience both with demon possession and mental illness believe those who claim to be possessed are very likely not possessed.” (p. 78)
In 1989 I had the privilege of interviewing a world recognized authority on demon possession. He advised taking a slow approach in consultation with medical specialists before claiming a person was demon possessed. In other words the tendency among some Christian movements is to automatically assumed demon possession. Unfortunately other Christian movements deny any possibility of demon possession of a Christian. This chapter provides the pastor and congregation a good starting point for assessing someone’s condition.
Chapters 9-10 ADD and Addiction
I only note that each chapter is important, and need attention. I think addictions within the Christian church are bigger problems than we want to admit. The key in addictions is that there is often a change in the brain that makes stopping the addiction more difficult. Note that such a statement is not an excuse for sin, but that sin combined with other changes complicate the interaction of physical and spiritual connections.
Kansiewicz offers wise words:
Addictive behaviors are sinful, but they can be different than other types of sin in that they require different and more complex steps to stop. (p. 96)
Most of the time, Christians struggling with addictions were at one point in their lives facing a lot of emotional pain that they did not know how to process. (p. 97)
Professional treatment is required through either medication or therapy. Understanding the root of the addiction is also critical to treatment and relapse prevention. A professional Christian counselor can help you explore the reasons that you became addicted in the first place, and can help you create strategies for quitting. (p.99)
It is in this area that I have appreciated a Christian counselor who can provide much more than I as pastor can provide. I have referred several people to Christian counselors for addictions. But I have also continued to meet with them for spiritual elements related to addiction. That combination is essential.
Kansiewicz makes a critical observation about addictions (but also true for other mental illnesses):
Some believe, “Once an addict, always an addict.” While it may be true that relapse prevention and recovery strategies need to be a permanent part of your life, it is important not to define yourself as something you once were. God certainly did not create you to be an addict, and your sense of identity should reflect what His designs are for your life. (p. 100)
Part 3: Other Challenges: When the Christian Life Isn’t Rosy
Chapter 11: Why Do I Still Hate Myself When God Loves Me So Much?
I can readily identify with this problem as well. Kansiewicz identifies causes, which can be verbal, physical, emotional abuse, as well as many other things. However, this is the one chapter in which I think the “Counselor’s Reponse” is wrong-headed. When someone says, “I hate myself,” she offers these words:
I have never heard someone who grew up in an emotionally stable, nurturing environment with a healthy family make that bold statement.(p. 106)
Now why is it that people in that happy circumstance does (sic) not come to the conclusion one day that they just aren’t worth it? My answer: they truly know themselves. They have been told about the beauty and wonder of just being themselves. (p. 107)
You entered this world with beauty. You entered this world with potential. …Maybe if you had been encouraged rather than told to conform you could have discovered that truly unique and beautiful self. (pp. 107-8)
If you were to ask the first century Pharisees they would have had a well adjusted view of themselves, but were sinners. So, what is wrong with this approach? I think it fails on two points: 1) It contradicts several Scripture passages that state that we were born as sinners, not neutral people with potential, and 2) it takes away from the true freedom, comfort, love, joy of the Gospel of Jesus Christ.
Ephesians 2:1-3 And you were dead in your trespasses and sins, in which you formerly walked according to the course of this world, according to the prince of the power of the air, of the spirit that is now working in the sons of disobedience. Among them we too all formerly lived in the lusts of our flesh, indulging the desires of the flesh and of the mind, and were by nature children of wrath, even as the rest. (NAS)
Psalm 51:5 Indeed, I was guilty when I was born; I was sinful when my mother conceived me. (HSCB)
There are many other passages that support this idea. I think part of the problem might be that in the book, sin is presented as only sinful actions and thoughts. But sin is deeper. Committing sinful actions does not make a person a sinner, rather sin causes the person to commit sinful acts and thoughts.
Romans 5:12 Therefore, just as sin entered the world through one man, and death through sin, in this way death spread to all men, because all sinned. (HCSB)
This is critical when considering how the New Testament presents the change that God works in the Gospel, namely through what Christ has done for us.
Romans 5:6-10 For while we were still helpless, at the right time Christ died for the ungodly. For one will hardly die for a righteous man; though perhaps for the good man someone would dare even to die. But God demonstrates His own love toward us, in that while we were yet sinners, Christ died for us. Much more then, having now been justified by His blood, we shall be saved from the wrath of God through Him. For if while we were enemies we were reconciled to God through the death of His Son, much more, having been reconciled, we shall be savedby His life. (NAS)
Galatians 2:20 I have been crucified with Christ; and it is no longer I who live, but Christ lives in me; and the life which I now live in the flesh I live by faith in the Son of God, who loved me and gave Himself up for me. (NAS)
Notice in that Romans passage, it is not the “truly well adjusted person who has a healthy esteem” that Christ died for, but for those who fall short of God’s demands, hence everyone. That is the good news, that no matter where anyone started as a sinner, Christ died for him or her, in other words, he only died for sinners, and that includes every person. And that is the worth and value of a person.
Chapter 12: How Does Christian Deal with Grief?
Chapter 14: Life or Death? When Mental Illness is Fatal
As a pastor I work with people in all stages of grief. I have found that everyone expects to recover quicker than they actually are. A doctor once told me that for every day you are down with sickness or surgery, it takes seven days to recover. So if someone is in the hospital for 7 days, it takes at least 49 days to recover. Many people laugh at that. But after surgery they discover how true that is.
So with grief, it takes time. No matter how many steps people identify, the time is non-negotiable. And here again triggers can present setback (each event in life after the loss: 1st birthday, 1st anniversary, 1st Christmas, etc.
I like how Kansiewicz adjusted the Kübler-Ross stages, especially the last one: “Acceptance with Prolonged Depression.” This is a very good chapter and offers help to the person, but also the church and pastor in continuing ministry to those who grieve.
Chapter 13: Submission or Abuse? Facing Domestic Violence
This is a topic very near to my heart. The abuse is bad enough, but the church’s often silent acceptance, or worse, indifference to those who are abused. I preached about this topic (The Silent Epidemic) about three years ago. You could hear a pin drop during the sermon.
Why do pastors and leaders as well as churches ignore this topic? Kansiewicz offered this assessment from John Shore,
Shore suggests that part of the problem may be that if you are not living in an abusive situation, it is hard to truly understand the systemic ways in which abuse festers. He also points out that abusers are very good at manipulating others, and may easily convince pastors to minimize the reality or severity of the wife’s report. (p. 129)
Do we need any more indictment of us as pastors or churches? Thankfully Kansiewicz offers several steps to move ahead in dealing with abuse. Here are a couple essential guidelines for pastors:
Pastors must also connect both abusers and victims with separate Christian counselors, and pastors should remain involved in this treatment by maintaining frequent contact with the counselors.…Pastors may be too personally involved to judge when it is or is not appropriate for a couple to reunite after an abusive situations. Christians counselors can offer a trained, objective insight into the appropriateness of reconciliation in a given situation. (p. 131)
I would modify that last sentence to “can offer a trained, more objective insight” since no one can be truly objective. But the advice? Every pastor ought to heed her words here.
Chapter 15: How Do I Talk to My Pastor About My Mental Health?
Another good chapter for advice on the one seeking help regarding mental illness. Also, a reminder for pastors to not avoid such conversations. If you don’t know the resources, then find out. Ask other pastors, visit Christian counselors to see what they recommend. Find out about psychiatrists who accept Christian pastor’s involvement.
The goal is not for the pastor to be all, serve all, but to work within a larger framework than just the local congregation. Some of these issues are far beyond out abilities, training. It is okay for us to seek out additional help and resources, for you as pastors and you as members of the congregation.
Excellent book that raises the right issues. I would add that Word and Sacraments as part of the liturgy become an essential environment for continued ministry to people, especially “on edge.” I found it challenging and had to read the book twice to make sure I was understanding it correctly. I recommend pastors especially, other leaders, and members in the congregation read this book. Even with my objections to the foundation of Chapter 11, this is a worthwhile resource.