Author: Dave Burke

Are doctors over-diagnosing mental health problems?

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In 2018 back pain ceased to be the main reason people were taking days off work. The number one spot is now occupied by the stress-anxiety-depression family of mental health problems. Some used to say that people with back pain were malingering, now we reserve that accusation for people with mental health issues.

Wes Streeting, the health secretary, added fuel to this fire recently by suggesting that doctors were ‘over-diagnosing’ mental health problems. The cynics are having a field day.

As a Christian, what do I make of this? It is an important question because the answer has a bearing on pastoral care for those who suffer from mental health challenges. I think that three things are important to consider.

Here’s the first, scripture recognises mental health struggles, sometimes in surprising places. Just think of three ‘difficult’ Psalms. Psalm 6 where David’s feelings look very much like what we might call depression. Psalm 88 where the song writer feels immersed in inescapable darkness. In Psalm 137 where, traumatised by the destruction of his people, the writer asks God to bless those who kill little Babylonian children.

These Psalms show us that depression exists, that anxiety is real, that trauma makes godly people ask for ungodly things. Even Paul, in the months before he wrote his second letter to the Corinthians, experienced stresses so great that he says that he ‘despaired of life’ (2 Corinthians 1:9). Sometimes the bible is more real than we would like it to be!

The great Victorian preacher, C.H. Spurgeon, knew about this. Expounding Psalm 88 he says, “It is all very well for those who are in robust health and full of spirits to blame those whose lives are sicklied o’er with the pale cast of melancholy, but the evil is as real as a gaping wound… Reader, never ridicule the nervous and hypocondriacal, their pain is real; though much of the evil lies in the imagination, it is not imaginary.

Christians who brush aside the reality of mental ill health really need to think again.

Second, we should not be too sceptical about diagnosis itself. Even though mental illness is all about feelings such as low mood, anxiety, or feeling disconnected from reality, psychiatrists are trained to assess people’s feelings objectively. If a doctor has made a reasonably objective assessment, I need compelling reasons, and some expertise, to question it. A diagnosis can be helpful in itself for someone who is confused about their feelings, convinced that they are alone and that there is no hope.

Third, medical professionals are our partners when we support people who are experiencing mental health challenges. I encourage Christians I support to see a doctor because it opens the door to a variety of therapies within the NHS. Alongside the church’s ministry, these interventions can be effective in the journey to wellness.

The hair-raising experience Paul records in 2 Corinthians 1:9 had a purpose; Paul tells us that it both sensitised him to the struggles others face (equipping him to be pastorally effective) and it helped him to trust God more than he did before (read the whole chapter). The gospel changes the meaning of suffering. While others see it as random hardship a Christian sees it as a means to growing resilience, character and hope (Romans 5:1-5). Preaching the gospel should offer this to those who suffer but it should not exclude God’s goodness to us through medicine and other helpful therapies. Cynicism is not a Christian virtue.

The skill of being still

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We sing about it: ‘Be still for the presence of the Lord…’ We read about it: ‘Be still and know that I am God…’ But we are never still! The bible often speaks of ‘stillness’, and the things related to it, such as meditating and waiting on God. But Christians, especially evangelical Christians, cannot abide stillness, we like noise and activity, with a side-order of mild chaos. We don’t do stillness.

Here’s why the skill of being still is important. First, stillness is a helpful start to a time of prayer, it puts us in the right frame of mind. Second, the practice of stillness and Christian meditation develops a ‘still’ heart, so that we cope better when things get frantic. Third, at times of crisis we can retreat into that still place and re-connect with God. We all need to learn to be still, it is a vital component of a healthy spiritual life.

Achieving stillness

I use Psalm 131 to help me with this. When I start to pray, or study, or meditate, my head feels like a busy train station at rush hour, full of noise and clatter. Here is King David’s solution:

My heart is not proud, O LORD,

My eyes are not haughty.

I do not concern myself with great matters.

But I have stilled and quieted my soul, like a weaned child with it’s mother. Like a weaned child is my soul within me.

O Israel, hope in the Lord, both now and evermore.

David begins Psalm 131 by dealing with some of the distracting noises in his head. He names three.

Pride – that feeling that we are better than others, that God should be chuffed that we want to talk with him. ‘My heart is not proud’ he says, laying pride aside.

Second is haughtiness – that tendency to look down on others. ‘My eyes are not haughty’, he says and lays that judgemental spirit aside.

Remember that David was a head of state, and the work never stopped. It was his job to think about ‘great matters’. But in this special place he lays this third distraction aside, All that work-related head-clutter must wait, it has no place here.

This is how to achieve stillness; you cannot eliminate random thoughts and feelings. Just recognise them and let them go. It takes a little while to learn how to do this but after a while it becomes easier.

Mindfulness and meditation

So far, this is rather like mindfulness, a method of being quiet, letting go of distracting thoughts, and being in the moment. I have found mindfulness to be a helpful way to learn the skill of being still. But Christian meditation is more than that. When my mindfulness teacher asked me how it was going, I used to say, ‘Wonderful, when I take time to be still, I get a lovely sense of the presence of God’. He would say, ‘That is not supposed to happen!’

This illustrates the big difference, mindfulness teaches you to ‘be still’, biblical stillness says, ‘Be still… and know that I am God’. That’s a world of difference, isn’t it? This is why I always focus on a verse or two of scripture when I meditate. I often use this little Psalm.

The picture we are left with is of a small child with a full belly dozing happy and safe in its mother’s arms. Stillness, for the Christian, is clearing the decks to be with the Lord. This is where you belong, this is where you are safe, here you are accepted.

Roy Searle, a Baptist pastor in northern England describes a moment when his young son came into his study while he was working. ‘What do you want?’ Roy asked, ‘Nothing’, the little boy said, ‘I just wanted to be with you’.

That, my friends, is stillness.

The both… and… mentality

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There are eighty-five billion nerve cells in your brain, only slightly fewer than the number of stars in the galaxy! But the real work is done by the connections between them. There are around one hundred such connections for every brain cell. Every time a tiny packet of a chemical messenger crosses one of these connections something important happens in your head.

These one hundred and eighty-five billion connections firing constantly can monitor your temperature, move your thumb, or make you seethe with resentment. Whatever your ‘soul’ or ‘spirit’ is it is intimately connected with this activity in your brain – we are whole beings, not independent spirits hitching a ride in some passing flesh. Christians believe that the psyche (your self) is more than just your brain, but our minds are intimately connected with our brains. Those brain cells are important to your health.

When people are unwell mentally it comes down to something happening, or not happening, in their brain. But that is a controversial statement among Christians. Is anxiety an illness or is it really a failure to trust in God? Is depression a genuine affliction or is it really a sinful refusal to rejoice in the Lord? Is a psychotic episode the result of those brain connections not working properly or are those voices really those of an evil spirit?

Sadly, these discussions often take place in an ‘either… or’, atmosphere that results in tetchy debate and very polarised answers to the problems we face. Instead, we need a ‘both… and’ mentality. Yes, poor mental health may have a spiritual cause, but it is more often about that complicated organ between our ears.

Christopher Ash, in his wonderful little book, ‘Zeal Without Burnout’ is helpful on this. He takes us back to Genesis 2:7 where man is made of dust from the ground and given life by God breathing into it. We are spirit, and we are dust, he says. Christians are attuned to nurturing the life of the spirit, but often neglectful of our dust. Christopher points out that this can lead to serious problems sooner or later. Often, they are mental health problems, burnout, anxiety or breakdown.

What causes this? The list is endless, stress, lifestyle, abuse, neglect, family history, trauma, etcetera, etcetera. Mental health issues have complex origins and far-from-simple solutions. That is why we need a ‘both (spiritual)… and (psychological)’ approach.

You find this is scripture. When Elijah ran for his life after the battle of the prophets on Mount Carmel, he was so upset he just wanted to die. What did he need most, a fresh encounter with God or a nice meal and a good night’s sleep? God gave him both, and a lot of exercise, a forty day walk to Mount Horeb. Then came the spiritual bit, speaking in a quiet voice, God reassured and re-commissioned Elijah.

Here’s what that looks like. A godly friend of mine has been diagnosed with depression, I pray for him, and we mull over scripture in our conversations, but I also meet him to walk in the hills and encourage him to go to the gym. I encouraged him to see his GP before he was diagnosed and to try Cognitive Behavioural Therapy when it was offered. An ‘either… or’ approach could reject therapy in favour of purely ‘spiritual’ ministry. Instead, I am commending a ‘both…and’ mentality, harnessing God’s common grace in recent research, and his special grace in the gospel towards his people.

Everyone needs the gospel; special grace that re-connects believers with God. But there are times when we need to access the gifts God gives through his common grace to everyone, doctors, nurses, therapists, medicine. The list, like the need, is endless.