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The HINGE International Theological Dialog for the Moravian Church

Opening Hearts and Hands to Those in Need: Mental Illness, Stigma, and the Church Notes from the Editors..........................................1

Heather H. Vacek..............................................3 Responses Eileen Edwards.........................................................14 Virginia Perry............................................................15 Ron Rice.....................................................................18 Robert Rominger .....................................................19 Julia Simmons ..........................................................21 Lucetta Zaytoun ......................................................24

The Author Responds..........................................26 Guest Sermon.........................................................28

Vol. 19, No. 1: Winter 2012-13

The HINGE Volume 19, Number 1: Winter 2012-13 The Hinge is a forum for theological discussion in the Moravian Church. Views and opinions expressed in articles published in The Hinge are those of the individual authors and do not necessarily reflect the views of the editorial board or the official positions of the Moravian Church and its agencies. You are welcome to submit letters and articles for consideration for publication. One of the early offices of the Moravian Church in Bethlehem, Pa., was that of the Hinge: The office of the Hinge requires that the brother who holds it look after everything and bring troublesome factors within the congregation into mutual accord without their first having to be taken up publicly in the congregation council. — September 1742, The Bethlehem Diary, vol. 1, tr. by Kenneth Hamilton, p. 80. The Hinge journal is intended also to be a mainspring in the life of the contemporary Moravian Church, causing us to move, think, and grow. Above all, it is to open doors in our church. The Hinge is published with the assistance of the Center for Moravian Studies of Moravian Theological Seminary, 1200 Main St. Bethlehem, PA 18018, and all rights are reserved. Recent issues of The Hinge may be found at www. moravianseminary.edu/center/hinge.htm. Articles in The Hinge may not be republished or posted on the Internet without the express permission of the author and the editor of The Hinge. Articles may be duplicated according to “Fair Use” rules, which allow for discussion in church classes and similar forums. The hinge illustration was provided by Todd Tyson of Kernersville, NC. Cover design was provided by Colleen Marsh of Bethlehem, PA.

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Notes from the Editors In the Bible we find reflected all of our human experience, including the experience of aloneness. In the Psalms, for example, we hear the full-throated anguish of those who suffer isolation: “My tears have been my food day and night, while people say to me continually, ‘Where is your God?’” (Ps 42:3). The lack of a comforter increases suffering: “I looked for pity, but there was none; and for comforters, but I found none” (Ps. 69:20b). And, heartbreakingly, in times of torment, even the most trusted companions may turn away: It is not enemies who taunt me—I could bear that; it is not adversaries who deal insolently with me— I could hide from them. But it is you, my equal, my companion, my familiar friend, with whom I kept pleasant company; we walked in the house of God with the throng [Ps. 55:12–13]. This issue of The Hinge explores a particular kind of aloneness in our church community. It is the isolation associated with mental illness—the type of illness sufferers are often afraid to confess, and should-be companions are often afraid to draw near to. In this issue the Rev. Dr. Heather Vacek considers how mental illness challenges the church in fulfilling Christ’s call to “attend to suffering, to narrate and enact Christian hope, especially amidst seemingly impenetrable darkness and despair.” How do congregations overcome the stigma, misunderstanding, and fear with which they distance themselves from the mentally ill and their families? Mental illness is frightening, for sufferers and for their neighbors. Again the Bible reflects this truth, in the story of a demon-possessed man (Mark 5:1–20): “Night and day among the tombs and on the mountains he was always howling and bruising himself with stones” (Mk 5:5). No wonder his neighbors left him alone; how frightening a figure he must have been! But also, how frightened—out alone in an isolated and unclean place, with no companion in his struggle. No wonder that after his healing he begged to be allowed to accompany Jesus. Jesus responds: “Go home to your friends.” In a class discussing this story, one seminary student cried out, “What friends?” The point is well taken: What companions remained to this man? What did he have to go home to? Jesus seems to have intended that his healing include a return to community. But how did the community respond? “Everyone was amazed” (5:20b), but was everyone welcoming? We cannot know; but we can look at our own congregations and ask whether we are welcoming; whether we are present with the suffering; whether we are willing to walk as companions with the mentally ill and their families. If our answer is a sorrowful “no,” how can we get to “yes”? If we can truthfully answer “yes,” how can we

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share those successes with other congregations so that all churches may learn to be companions in suffering and bearers of hope to the hopeless? It is hard to know what to do; but the worst thing to do is nothing. The effect of doing nothing is not neutral, because isolation itself produces illness. Studies of prisoners in solitary confinement show that “without sustained social interaction, the human brain may become as impaired as one that has incurred a traumatic injury.”1 Do we need stronger evidence that God created us to live in community? Do we need to wait for further instructions? Or can we simply reach out, and trust that the Holy Spirit will reveal the steps that follow? 1. Atul Gawande, “Hellhole,” The New Yorker, March 30, 2009.

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Opening Hearts and Hands to Those in Need: Mental Illness, Stigma, and the Church Heather H. Vacek Severe and persistent mental illnesses affect the lives of many Americans. Often, the impact proves disorienting. Mental illness can strain relationships – with friends, families, fellow churchgoers, strangers, and even God. Those who suffer, and people who love them, sometimes find themselves devoid of hope and detached from a sense of meaningfulness in life. What role are the people of God called to play amidst such suffering? Imagine the following scenario. A husband and wife sit in a church pew one Sunday morning surrounded by longtime friends and other worshipers. As their minister shares prayer concerns from the pulpit, the husband squeezes his wife’s hand. They both know who tops their prayer list, but that name will not be one they hear read aloud today. Four days ago their twenty-two-year-old son, Jacob, was admitted involuntarily to the local mental hospital. After weeks of severe depression, Jacob began to exhibit strange behavior and started having suicidal thoughts. No longer confident that they could ensure his safety—or their own—his parents drove him to the hospital and watched as staff members walked their only child down the hall and behind locked doors. His parents called their pastor after Jacob’s admission, but asked that he not be included in the week’s prayer concerns. They hoped to protect his privacy, and their own. While glad Jacob is safe, his parents are exhausted from the care they have provided in the past weeks. Each afternoon since their son’s admission, they have been to visit the hospital. The doctors seem competent, and sure that their son will recover, but Jacob remains depressed and withdrawn. He’s angry at his parents for having him admitted, and he refuses to acknowledge their presence. Jacob had battled depression since high school, but it had never gotten this bad. A member of Raleigh Moravian While still zeroing in on a diagnosis, doctors Church, the Rev. Dr. Heather H. at the hospital hinted that Jacob’s odd behavior Vacek currently teaches Church might be the result of schizoaffective disorder, History at Pittsburgh Theological a prospect that frightens his parents. They Seminary. She specializes in the study of American Protestantism, want to remain hopeful, but they fear for their with a particular interest in the son’s future. They wonder how illness and ways Christian beliefs have shaped hospitalization will affect his relationships, experiences of illness and suffering. educational plans, employment, and happiness. Her current work explores clerical Will Jacob be able to lead a normal life? Will and congregational reactions to mental illness from the colonial era they? “Normal” seems a category to which they through the late twentieth century. can no longer relate.

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Weary from worry, Jacob’s parents know they need physical, emotional, and spiritual support beyond the private prayers of their minister, but they are not sure how and where to find the care they need. When Jacob was a toddler, he spent several days in the hospital following a minor surgical procedure. Then, their church family provided meals for a week. They welcomed the help. Because they will keep Jacob’s current hospitalization quiet, they doubt they will receive similar assistance now.

A Pervasive Concern

While Jacob’s story is fictional, millions of parents, spouses, children, and friends find themselves in similar situations. Each year one in four adults in the United States suffers from a diagnosable mental illness, and severe mental illnesses (e.g., major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, and borderline personality disorder) afflict six percent of the population. Children suffer too—one in ten lives with a serious mental or emotional disorder.1 While treatments are available, not all who ail seek help, and cures remain elusive. In 2007, nearly 35,000 Americans took their own lives, making suicide the tenth leading cause of death. More than ninety percent of those who died by suicide experienced depression, other mental disorders, substance abuse, or some combination thereof. Eleven attempted suicides occurred for every suicide death.2 Causes of mental illness remain as mysterious as cures, and they strike persons of all ages, races, religions, incomes, educational levels, and upbringings. Studies indicate that religious belief and participation may contribute to mental health. Wave III of the Baylor Religion Survey showed, for example, that those who “strongly believe that they have a warm relationship with God report 31% fewer mental issues” and that those who “strongly believe that God knows when they need support report 19% fewer mental health issues” that those without these beliefs.3 While worth consideration, such research rarely helps those afflicted with severe mental illnesses to cope. As Kathryn Greene-McCreight—a clergywoman, theologian, and sufferer—notes, such data often make those who ail feel worse. Faced with the perception that Christians should be happy and full of joy, the afflicted often “feel guilty on top of being depressed, because they understand their depression, their lack of thankfulness, their desperation, to be a betrayal of God.”4 With or without studies suggesting that belief in God or religious involvement aids mental health, congregations are called by Christ to respond when others suffer. Christians are called to attend to suffering, to narrate and enact Christian hope, especially amidst seemingly impenetrable darkness and despair. Responding, however, is rarely easy. Despite their prevalence, mental maladies often spark misunderstanding and fear. Sufferers face stigmatization. As a result, individuals and families, like Jacob’s parents, often keep illness quiet and suffer in isolation, compounding pain. Christians prove no exception to these dynamics. Mental maladies within American congregations often remain out of sight, whether purposefully hidden or quietly

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ignored.5 Protestants rarely seem to question the causes and origins of physical ailments; more often they simply provide support in the form of congregational prayers, hospital visits, spiritual support, and casseroles. Yet, when church and community members suffering from mental maladies do make their suffering known, they often face a strained and awkward reception. Even the homeless—who, ever since the mid-twentieth century deinstitutionalization of the mentally ill, constitute the nation’s largest population of mentally ill individuals—receive mostly physical care from America’s Protestants. Believers may happily feed and clothe the homeless, but they do so largely without attention to their mental health. I reflect on mental illness and the church from the perspective of one who—as a friend, a family member, and a chaplain at a state mental hospital—has journeyed with those experiencing the pain and disorientation of severe mental illness. I have tended to those whose deep depression left them unable to perform simple daily tasks. I have sat alongside who thought suicide was a better option than continuing to live. I have prayed for and with those whose illnesses cost them friendships and marriages. I have found grounding in Scripture with those whose grasp of reality had otherwise slipped away. I write as one who prays that, through the faithful discipleship of Christians and congregations, the love of Christ and the comfort and healing that only God can provide will be ever present with those who suffer.

Christian Profession

As Christians, we profess to care for the well-being of the whole person—body, mind, and soul; yet those living with mental maladies often receive limited care in our churches. With the world around us, we may wonder whether depression, anxiety, bipolar disorder, and schizophrenia stem from individual sin, insufficient faith, a poor upbringing, or a lack of morals. More so than with physical ailments, “sufferers, their families, and the community are more likely to interpret [mental illnesses] in moral and religious terms.”6 We may question the use of secular, instead of spiritual, treatments for mental distress. We may not know how to offer help. In The Ground of the Unity, Moravians profess that “our Lord Jesus entered into this world’s misery to bear it and to overcome it. We seek to follow Him in serving His people. Like the love of Jesus, this service knows no bounds. Therefore we pray the Lord ever anew to point out to us the way to reach our neighbors, opening our hearts and hands to them in their need.” Following Christ, we are called to help. What would it mean for us to enter more fully into the misery of mental illness with those who suffer, to help them bear that distress, and to accompany them as they navigate life and faith? The Ground of the Unity also asserts that Christ Jesus “redeems us from our isolation and unites us into a living Church of Jesus Christ.” In the case of mental illness, stigma often stymies this redemption from isolation as individuals like Jacob and his parents suffer silently and alone. What would it look like for us to be a community that stands in solidarity with those who suffer instead of remaining immobilized by stigma and uncertainty? What influences our reluctance to respond?

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Given that we profess a call—by and with Christ—to open our hearts and hands to those in need, a problem exists when individuals and congregations fail to acknowledge and attend to the suffering stemming from mental illness. Hope of the coming of the Kingdom of God shapes Christian communities. Gospel hope, however, rings true only when it can exist alongside an honest naming of human finiteness and suffering. When members of our communities feel they must hide their brokenness and cover up their needs for physical, emotional, and spiritual care, gospel hope seems difficult, if not impossible, to grasp. Given this reality, understanding the shape, force, and presence of stigma can help awaken Christians to hidden suffering and enable us to dismantle barriers to the provision of care.

Stigma Theory

I explore sociological theory about stigma, and its development over time, in order to deepen theological reflection and, hopefully, to help foster faithful practices of care and hospitality. I ask what it means when Christians accept cultural definitions of created-ness and humanity—ones open to social stigma —instead of biblical understandings that place all of creation in relationship with God and name it as good (Gen 1:31), albeit finite.7 I seek a practical theology, one that offers what theologian John Swinton names as “critical reflection on the practice of the church in the world.” As Swinton observes, “in the minds of the media and the general public, people with mental health problems frequently ‘cease being persons.’ Instead they become identified by their pathologies— ‘schitzophrenics,’ or ‘manic depressives,’ … terms that substitute their primary identity as human beings made in God’s image and passionately loved by God, for a socially constructed way of being” that then shapes their self understanding and relationships.8 Stigma proves powerful, even within the walls of congregations that profess God’s love and the promise of the redemption of all creation. Given this power, I ask whether social stigma’s infusion into the church might be labeled sinful—a sin of either omission or commission. How and why does stigma overpower the experience of God’s love and our call to care? How does stigma operate? In his 1963 Stigma: Notes on the Management of Spoiled Identity, the seminal work on social stigma, Erving Goffman explores how stigma infuses human social interactions. Humans living in societies develop ways to understand themselves and others, and the construction of social identities enables this process. When meeting someone new, “normative expectations” of identity help decipher and categorize who and what a person is. For example, a woman wearing a suit? She must be a professional. A young white man with dreadlocks? He must be a free spirit. A disheveled older man sleeping on a city park bench? He must be a bum. Stigma surfaces in human relationships and appears when the attributes of an individual vary from what social norms tell us one “should” be. Goffman argues that “while the stranger is present before us, evidence can arise of his possessing an attribute that makes him different from others in the category of persons available

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for him to be, and of a less desirable kind…. He is thus reduced in our minds from a whole and usual person to a tainted, discounted one.”9 A human attribute triggers stigma when it is, in some way, “deeply discrediting” as the result of a preexisting stereotype held by others. Some might presume, for example, that a woman previously incarcerated would not make a trustworthy employee, regardless of her crime or of changes she may have made to her life since release. Goffman names three origins of stigma. The first, rooted in “abominations of the body,” includes attributes like missing limbs, facial deformities and other very visible characteristics. Second are “blemishes of the individual character” including a “weak will” or “dishonesty” that might be inferred from “a known record of, for example, mental disorder, imprisonment, [or] addiction.” The final source includes “race, nation and religion.”10 Regardless of its origin and visibility, Goffman sees stigma defined in contrast to “normal”; thus stigma marks both normalcy and its alternative, “deviancy.” For the stigmatized, including those living with mental health problems, this division between normal and deviant creates distance in social relationships when we define those who suffer as “other” and “not like us.” Goffman argues that stigma can be either discrediting (i.e., readily apparent to all, such as race or physical deformity) or discreditable (i.e., hidden, but risking possible exposure such as sexual orientation or mental illness). An individual with a speech impediment (discrediting), for example, finds that strangers make assumptions about his intelligence and avoid conversation with him. A person taking medication for clinical depression (discreditable) fears making this known, even to her closest friends. She feels the need to withhold part of her identity from those around her, enabling her to “pass” as normal. As a result of stigma, individuals like these live in the world as less than fully themselves. Shame, self-derogation, and self-hate can compound already painful experiences and conditions.

The Emergence of Stigma

In the United States, stigma associated with mental illness emerged from a legacy of theological notions linking mental maladies with sin, and from the rise of cultural ideals of positive thinking and self-help that associated mental maladies with weakness. Care for the mentally ill—those named over time as distracted, mad, and insane—changed dramatically from colonial times through the mid-twentieth century. From the perspective of those who suffered, those changes were never entirely for the better. In the colonial era, illness was an expected part of life, and families and communities provided treatment and care. Church leaders, like the Puritan clergyman Cotton Mather, understood sin—whether personal or original—as the root of illness, but no more so for mental than for physical ailments. All sickness, Mather argued, should prompt the believer to search his or her soul and turn to God for healing. Mather assumed that attending to one’s own health and the welfare of others was part of the Christian life. Rather than a stigmatized ailment, madness, like all illness, was part of the reality of creation and garnered responses from families and communities.

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With the emergence of formalized medicine in the Revolutionary era, sickness became primarily a problem to be solved rather than a fact of creation prompting spiritual reflection. Many Christians shared the scientific assessment of disease and looked to medical advances to bring relief. Some, like the physician Benjamin Rush, pursued medical careers as part of a Christian call to attend to suffering. With medical discoveries and innovations, diagnoses eased the sense that sin caused disease. Mental distress remained just one form of illness, albeit a particularly tough one, worth remedying. Treatment and care still took place at home and in the local community, but now more often under the care of a formally trained or self-taught physician. In an era of scientific discovery, people were optimistic about the possibility of cure and amenable to professional care. As general hospitals and institutions for the insane sprang up around the country in the early and mid nineteenth century, a period of great hopefulness about treatment and cure for all disease ensued. Christians like the social crusader Dorothea Dix advocated on behalf of the afflicted to ensure the public provision of care for mental illness for all Americans. Cures for physical ailments, however, emerged more readily than remedies for mental maladies. And, by the late nineteenth century, squalid, crowded institutional conditions and a growing number of chronic patients clouded public perceptions and fueled suspicions that those who suffered with mental maladies might bear responsibility for their own illnesses. It was during this period, a time marked by rapid industrialization and economic growth, that stigma most firmly affixed to the nation’s mentally ill. Those confined to the nation’s asylums seemed detached from dreams of American progress and prosperity. Unlike prison inmates, who attracted much attention from Christian reformers, the mentally ill, sequestered and stigmatized, received little notice or care from the nation’s churches. During the country’s progression from a colonial outpost to an emerging world power of the early twentieth century, a period otherwise marked by tremendous ecclesial growth and institution building, the church—and particularly the clergy, the church’s representatives in the public sphere—struggled to compete with outside authorities in the provision of care for mental maladies. As advances in science, the professionalization of medicine, urbanization, population growth, the creation of institutions for the insane, and Enlightenment optimism about the possibility of a cure for mental illness converged, Protestant clergy lost their central position as sole providers of care and lone experts in the definition of mental illness. With such ailments defined as primarily medical issues, the advice of physicians was trusted over the counsel of clergy to bring relief. During the mid-twentieth century, mental illness formed a subject of debate among Christians. Was it a medical or spiritual problem? Who should provide care? Some endorsed treatment from psychologists and psychiatrists; others remained skeptical about care from secular providers. Alongside growing stigma, shifting professionalization further sequestered clergy—and congregational—authority in the private, spiritual sphere, leaving healing for mental maladies as primarily

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the responsibility of secular medical professionals. Together, these forces hinder Protestant responses to mental illness.

The Church as a Civil Place

Stigma shaped not only public perceptions, but also congregational life. Erving Goffman outlines three kinds of places where those with concealed (and stigmatizing) differences may find themselves. First are out-of-bounds places where stigmatized people are forbidden, and thus where “exposure means expulsion.” An African American, for example, who “passed” for white might be able to eat a meal at a southern restaurant in the early twentieth century, but only by concealing her ancestry. Second are civil places where stigmatized individuals are “carefully, and sometimes painfully, treated as if they were not disqualified for routine acceptance, when in fact they somewhat are.” A homeless man recently released from a state mental institution who shows up for worship at a prosperous suburban church might find a civil reception, but not a warm one. Finally, Goffman identifies back places, locations where individuals need not conceal their stigmatizing attributes. These back places can be experienced involuntarily (institutionalized mental patients gathering for group therapy) or created voluntarily (recovering addicts gathering for a Narcotics Anonymous meeting.)11 In the face of mental illnesses, what type of place does the church strive to be, and what type of place is it really? It seems likely that the majority of congregations today operate as civil places, places where those who suffer are not completely excluded, but where stigma causes individuals to navigate carefully, and often conceal, the visibility of their illness, the pain they suffer, and their needs for spiritual, emotional, and physical care.

Envisioning a Different Reality

Deeply seated social forces influence Protestants, and we often fail to acknowledge and respond to suffering. Individuals like Jacob’s parents sit in pews, physically present but otherwise isolated. Yet the power of stigma need not overpower the church. Christians can envision and enact a different reality, one rooted in adaptations of—and disruptions to—stigma. As we know from the witness of Scripture, the church is not called to adopt the world’s normative expectations, but to challenge them when they betray how we are called to worship, witness, and love. Goffman’s third category identified religious beliefs and practices as potential sources of stigma. Can we reinterpret his proposition to remind us that we have the resources and the power to alter our view of those around us (and ourselves)? What if we view religious “stigmatization” as a positive and productive force, rather than a limiting and discriminatory one? In many ways (following the example of Christ), Christians are called to be a stigmatized people, a people who enter into the suffering of one another. We are called to eat with outcasts and tax collectors, with sinners, and with those who ail. We are called to remember that those who suffer are not always the “other”; in fact, they are often us. Finally, while the world may tell us differently, we

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are called to remember—on our own or with the help of others—that when we suffer, especially when we suffer, Christ remains in relationship with us. Social stigma operates because humans have a sense of what others “should be.” Christian communities do not seek to cure illness, but rather to bring themselves and those who suffer into closer relationship with God and one another. Ultimately, our identity is based not on our occupation, health, or social status, but on our relationship with God and each other—though we often fail to act in ways that demonstrate this truth. In congregations, too often, we assume that each of us should be “happy” or “well adjusted” or “content.” Those who are not “fine” seem misplaced in our midst. We ourselves fear misplacement when we consider voicing our own (stigmatized) suffering. What if, instead of presuming or hoping for contentedness, we approached one another with love and acknowledged, first, that each of us is a child of God and a brother or sister in Christ? What if we encouraged one another to be open and honest in joy and pain, in suffering and hope? What if all felt welcome, in sickness as well as in health? What can and should love in Christian community look like in the face of mental maladies? What can Christians do? First, congregations can form themselves as places of deep Christian hospitality. More than the provision of coffee and pastries following worship, Christian hospitality creates what theologian Mary McClintock Fulkerson names as “a shared space of appearance.”12 Such an intentionally created space allows one whom disease and society have rendered less than whole to be acknowledged a human being in God’s image, one of equal worth with every member of the community. (It also encourages “healthy” members to appear in their own fullness and finiteness.) Offering genuine Christian hospitality—either as a whole congregation or in small group settings within churches—makes Christian communities places where those who suffer are welcome, and where suffering can be named safely and truthfully instead of remaining hidden or expressed only outside of the sanctuary walls. Second, congregations and individual Christians can accompany those who suffer. The gospels of Luke and Mark present the account of a paralyzed man whose four friends, instead of abandoning him to suffer alone, carry him to see Jesus. Not only do they bring him near to Jesus, “but finding no way to bring him in because of the crowd,” they go to great lengths to bring their friend to the source of healing. “They went up on the roof and let him down with his bed through the tiles into the middle of the crowd in front of Jesus” (Lk 5:19). Accompanying those who suffer, and their loved ones, might require that we take action (and attend to physical needs). Alongside any provision of physical care, though, listening in an effort to understand depths of suffering, especially when the naming of the reality of suffering is painful, provides welcome care. Those who suffer need companionship as they venture into the unknown, questioning why they suffer and what the future will hold. Attentive listening allows us to understand more fully the needs of those in pain. Our preconceived notions of illness and healing may be altered through this holy listening.13 Greene-McCreight, for example, makes clear that

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depression “is not just sadness or sorrow. Depression is not just negative thinking…. It is being cast to the very end of your tether and, quite frankly, being dropped.”14 Reading scripture together with those who suffer offers one way to help give voice to the depths of despair: Save me, O God,    for the waters have come up to my neck.  I sink in deep mire,    where there is no foothold; I have come into deep waters,    and the flood sweeps over me.  I am weary with my crying;    my throat is parched. My eyes grow dim    with waiting for my God [Psalm 69:1–3]. By gaining deeper understanding of suffering, we can resist the impulse to offer detached and unspecific advice like “Pray harder,” “Let Jesus in,” and even “Cast your anxiety on him, because he cares for you” (1 Peter 5:7). We will think twice before advising that “God never gives you more than you can handle,” or that one should simply “think happy thoughts”—words that sufferers like Greene-McCreight name as unhelpful platitudes that may compound pain.15 Like Job, those who suffer often benefit most from the presence of others brave enough to sit with them through their pain without hurrying to suggest solutions. As Christians, however, we are not called to remain in despair. We are a people of hope. After acknowledging the depth of suffering, we can accompany those who suffer by holding on to and professing the hope of healing and redemption, especially when they cannot. Greene-McCreight notes that in a state of severe mental illness, hope seems far away. “This is why we need the scriptures and the community of faith,” she insists. “They contribute faith and hope to us as from a well” that cannot be reached from the depths of mental illness.16 We profess the promise of God’s “making all things new”(Rev 21:5) through communal worship, through prayer, and by reading of scriptures of hope. As we do so we remind ourselves and others that God remains in relationship with creation, even when God seems far away. Finally, congregations can acknowledge the presence and impact of stigma and work to combat it. We begin by confessing our conscious and unconscious complicity—via fear and avoidance—in the sin of stigma. We continue by seeking to understand the effects of stigma on those whom the world labels. Greene-McCreight reflects that “the stigma of mental illness, including the jokes made by the healthy about the ill, is worse than the visions and voices. At least the visions and voices teach me something about myself and about God. But the stigma teaches me nothing except about the proclivity of humanity to harm humanity.”17 By educating ourselves and our congregation about the nature of mental illness and available treatment options,

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we can keep stigma at bay and refrain from presuming a relationship between mental illness and sin. Easing stigma enables congregations to engage in conversation and discern, together with those who suffer, how to respond faithfully. More so than physical ailments, mental illnesses present a challenge to congregations. Sadly, too often, the response to this challenge exposes the reality that some suffering slips through the gaps of Christian care, even in congregations that pride themselves on attending to the love of God and care of the neighbor. Pervasive stigma often overpowers, or at least inhibits, the Christian witness to those who suffer. To be sure, amidst mental illness, many find solace and comfort in relationship with Christ and others, but too often, this is not the case. A short article cannot do justice to the complexity of mental illness or the experiences of those who live with it. I hope, however, that reflecting theologically on mental illness, stigma and the church will foster conversation about the realities of suffering and the possibilities of healing. I pray that by recognizing the pain of illness and the compounding pain of stigma and responding, we can more faithfully follow Christ’s call to open our hearts and hands to those in need. I pray that together we will foster places of true welcome for those like Jacob and his parents; that together we will create congregations where their hurt and suffering can be named and attended to more fully—not in a way that exposes them to embarrassment and shame, but in a way that reminds them of God’s steadfast love and the support of those around them. Together, we profess that “Our Lord Jesus entered into this world’s misery to bear it and to overcome it” and together we await the coming of the Kingdom of God, when They will hunger no more, and thirst no more;    the sun will not strike them,    nor any scorching heat;  for the Lamb at the center of the throne will be their shepherd,    and he will guide them to springs of the water of life, and God will wipe away every tear from their eyes [Rev 7:16–17].18

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Endnotes

1. National Alliance on Mental Illness, “Mental Illness: Facts and Numbers,” http:// www.nami.org/Template.cfm?Section=About_ Mental_Illness&Template=/ContentManagement/ ContentDisplay.cfm&ContentID=53155 (7 November 2011). 2. National Institute of Mental Health, “Suicide in the U.S.: Statistics and Prevention,” http://www.nimh. nih.gov/health/publications/suicide-in-the-us-statisticsand-prevention/index.shtml (7 November 2011). 3. Mencken, F. Carson, Paul Froese, and Lindsay Morrow. “Mental Health and Spirituality” in The Values and Beliefs of The American Public: Wave III Baylor Religion Survey (Waco, TX: Baylor University, 2011), 12. 4. Kathryn Greene-McCreight, Darkness Is My Only Companion: A Christian Response to Mental Illness (Grand Rapids, MI: Brazos Press, 2006), 13. 5. My conclusions arise from observations about Protestant churches in the United States. To be sure, Christians outside of North America suffer from mental illness, and stigma shapes experiences of illness, treatment, and welcome-ness in Christian communities. 6. Donald Capps, Fragile Connections: Memoirs of Mental Illness for Pastoral Care Professionals (St. Louis: Chalice Press, 2005), 6. 7. Cultural definitions of created-ness, for example, might place the potential for economic productivity as the primary designation of human value to society. 8. John Swinton, Resurrecting the Person: Friendship and the Care of People with Mental Health Problems (Nashville, TN: Abingdon Press, 2000), 11, 10. 9. Erving Goffman, Stigma: Notes on the Management of Spoiled Identity (Englewood Cliffs, NJ: Prentice-Hall, 1963), 2–3. 10. Goffman, 4. 11. Goffman, 81. 12. Mary McClintock Fulkerson, Places of Redemption: Theology for a Worldly Church (New York: Oxford University Press, 2007), 21. 13. Creating deliberate, safe spaces for such holy listening—perhaps in small group or one-on-one settings—offers both hospitality and accompaniment for those who suffer. 14. Greene-McCreight, 21. 15. Greene-McCreight, 21. 16. Greene-McCreight, 124.

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17. Greene-McCreight, 56. 18. Greene-McCreight names this as one of the scriptural texts she found important during her illness. All citations taken from the New Revised Standard Version.

Sources Cited

Capps, Donald. Fragile Connections: Memoirs of Mental Illness for Pastoral Care Professionals. St. Louis: Chalice Press, 2005. Fulkerson, Mary McClintock. Places of Redemption: Theology for a Worldly Church. New York: Oxford University Press, 2007. Goffman, Erving. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall, 1963. Greene-McCreight, Kathryn. Darkness Is My Only Companion: A Christian Response to Mental Illness. Grand Rapids, MI: Brazos Press, 2006. “The Ground of the Unity.” Edited by the Unity Synod of the Unitas Fratrum or Moravian Church. Dar es Salaam, Tanzania, 1995. Mencken, F. Carson, Paul Froese, and Lindsay Morrow. “Mental Health and Spirituality.” In The Values and Beliefs of the American Public: Wave III Baylor Religion Survey. Waco, TX: Baylor University, 2011. Swinton, John. Resurrecting the Person: Friendship and the Care of People with Mental Health Problems. Nashville, TN: Abingdon Press, 2000.

Additional Resources

Goving, Stewart D. Surviving Mental Illness in the Family: Louisville, KY: Westminster John Knox Press, 1994. Kehoe, Nancy. Wrestling with Our Inner Angels: Faith, Mental Illness, and the Journey to Wholeness. San Francisco: Jossey-Bass, 2009. Koenig, Harold G. Faith and Mental Health: Religious Resources for Healing. Philadelphia: Templeton Foundation Press, 2005.

Faith Based Resources

“Comfort My People: A Policy Statement on Serious Mental Illness with Study Guide.” In Advisory Committee on Social Witness Policy, edited by Presbyterian Church (USA), 2008, http://www.pcusa.org/resource/ comfort-my-people-policy-statement-serious-mental-/. “Pathways to Promise: Ministry and Mental Illness.” http://www.pathways2promise.org.

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Responses Eileen Edwards Prior to entering ordained ministry, I had the honor and privilege of walking with many people suffering from mental illness as I worked as a psychologist in schools and in private practice. As part of that work I heard stories of help and support from faith communities, but unfortunately, more often, I heard of experiences that deepened feelings of hurt, alienation, and separation. I appreciate Sister Vacek’s article and her calling our attention to this issue. Sister Vacek posed the important question, “What would it look like for us to be a community that stands in solidarity with those who suffer instead of remaining immobilized by stigma and uncertainty?” As I ponder the answer to that question I realize that it would be amazing, awesome, wonderful, messy, unpredictable and uncomfortable. I think that would also describe the life of the early disciples who followed Jesus as he listened and talked, ate with and touched, healed and forgave those who were outsiders, different, perceived in some way as “less than.” Mental illness is often messy, and those who suffer do not necessarily fit within our congregational ideas of appropriate behavior in church. What does this look like? In one church an older gentleman wanders in, stands with the worship team and starts playing the harmonica, then during coffee hour tells how he has fixed the roof, mowed the lawn and done assorted other tasks at the church where no one has met him before. In another a young woman wears a short sleeved shirt and the marks where she has repeatedly cut herself are clearly visible. A woman times her entrance to worship so that she misses the right hand of fellowship and the resultant anxiety that touching the germs on all those hands would bring— and tries to deflect comments about her consistent late arrival. Sister Vacek writes, “Social stigma operates because humans have a sense of what others ‘should be,’” and it has been my experience that congregations also have fairly well developed ideas of what church “should be.” People who are suffering from mental illness often act outside of our judgments of what “should be.” For us to truly be communities that stand in solidarity with those who suffer means to question and loosen our judgments of what should be and deal with what is. We need to realize also that mental illnesses, like other illnesses, may be episodic or chronic and that unfortunately, suffering may persist for quite some time. I have struggled with what this looks like in practice. We are not communities in isolation but are in the midst of a culture which treats mental illness differently from other illnesses. How do we break out of our cultural context to demonstrate the radical hospitality we find in Jesus Christ? How do we communicate that level of acceptance to those in our midst? My husband has a severe vision loss, and I know firsthand the pain and frustration of being told that if my faith or his faith were strong enough he would be cured. Though it is less common in our denomination than in some others, the belief persists for many Christians that if he or I had enough faith he would be able to see.

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However, most members of our congregations no longer subscribe to a theology that cites lack of faith as the reason for blindness, so this is an infrequent occurrence— but the same is not true for mental illness. Perhaps a first step would be to recognize the pain that attributing mental illness to spiritual causes brings to those who suffer, to abandon this explanation and question it when we hear others express it. Suffering is part of the human condition; faith gives us hope that suffering is not the final word. When we listen to the pain of another, without trying to fix it, we provide that ministry of presence that helps someone know that they are actually not alone. When we have no words but offer our continued prayers, we are communicating that we will continue to think about the person when they are not in our immediate presence and that we have hope in God who has promised that we are never alone. When we are accepting of those who are suffering without judgment or solutions, we are communicating the unconditional love of God. Becoming a place where people can share what is really going on in their lives doesn’t necessarily mean a new set of programs, but a calling us back to the discipline of truly loving those in our midst. I once led worship in a Lutheran church where a young boy with autism wandered around the sanctuary, flapping throughout the service, even coming up to the table as I celebrated communion. It was disconcerting at first, and I thought it must be terribly distracting to the congregation; but as I looked out at them it was clear that they were concentrating on the sacrament and not the young boy. This was a congregation that practiced radical hospitality to this boy and his family. It was a sign to me that this kind of hospitality is possible for all of us. Eileen Edwards serves with her husband, Ian, as pastor of Good News Moravian Church and the Connection in Sherwood Park, Alberta, Canada.

Virginia Perry When it comes to mental illness, we live in the best and the worst of times: the best of times because of recent brain research and advances in treatment modalities; and the worst of times because cultural ignorance prevents our taking responsibility to fund these effective treatments for the masses of people unable to afford them. Not only do we need to educate our communities and churches about the specific characteristics of mental illnesses and treatments, but also we need to support the work of mental health agencies and professionals who are trying to provide care. We need to see the persons beyond the illnesses as beloved and beautiful children of God. For the church to take a leading role in helping those who suffer mental illness, it needs to start learning to manage its own anxieties. We individuals need to be aware of, admit to and care for our anxieties so that we are not drawn into destructive behaviors.

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What does it mean to understand suffering? Suffering is all around us—just read the morning paper. And as long as suffering is “out there” somewhere, we don’t really have to be confronted with it. How do we embrace, avoid or simply deal with suffering when it is up close and personal? We need more specific understanding of the physiological, emotional and cognitive characteristics of anxiety, depression and substance abuse. For example, anxiety is not just an uncomfortable fluttery feeling that can stir up Irritable Bowel Syndrome. It is also reflected in tendencies to be hypercritical, attempts to achieve a quick fix or to control others. It is present in herding behaviors, when groups of people side off against others. And it links us to the animal world much more than we would like to admit. Uncertainty makes us anxious, and to fill that void, we often make unfounded assumptions. In seminary, many ministers read about anxiety phenomena in Ed Friedman’s Generation to Generation. Friedman studied with Murray Bowen, one of the foremost thinkers and researchers on anxiety within family systems. Anxiety that is not cared for can lead to depression and substance abuse. (Some anxiety can also be a force for good—for example, by encouraging us to study for a test or practice for a recital, or by bringing much needed change into an institution stuck in stale status quo.) Anxiety can be reflected from individuals to families to communities and back again; like depression, anxiety is contagious (see Michael Yapko, Depression is Contagious). Unmanaged anxiety is the source of stigma and prejudice. Depression often derives from excessive anxiety and is often characterized by global, “all or none” thinking. When we start having thoughts like, “Why bother?” or “I’m worthless,” we are engaging in global thinking. Both anxiety and depression are often accompanied by substance abuse or dependence or other behaviors such as excessive Internet use, sexual addictions or eating disorders. All of these have diagnostic criteria, many with associated brain studies, and treatment plans about which churches and communities would be wise to learn. Brain imaging reveals impaired thinking in people who are depressed or who have abused alcohol or drugs. One might think of the brain as sick or diseased, similar to someone who has high blood pressure or diabetes. And similarly, people manage and recover from illness and disease (giving rise to AA’s language of “being in recovery”). However, from a faith perspective, it is important to keep in mind that we are much more than our brain chemistry or any current illness we may have. Psychologist Stephen Gilligan points to the need to sit with and even bless the anxious and depressed thoughts, feelings and behaviors, to meet people where they are with acceptance, to let go of the labels. How much easier it is to admit to struggles when we know they will be blessed instead of rejected or feared. Isn’t that what happens in AA groups? Perhaps we church members should be encouraged to attend some open AA meetings to see how the church might become one of those “back places.” Perhaps we could spend some time with a caregiver of a family member who has Alzheimer’s. Such activities may help us see the face of God in all people, regardless of their state of well being.

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I have been fortunate as a therapist to learn about elements of brain elasticity, young adult brain remodeling, and brain damage from substance abuse. This is basic knowledge, much of it now taught in high school biology; it does not take years of training to understand it. It would be beneficial, especially for our youth in churches, to learn more in the context of the faith community about the brain and its amazing capacity to heal and generate new pathways. In this learning, we love God, others and ourselves. We marvel at the wonders of creation and learn to be good stewards of the bodies we’ve been given. We can also celebrate the gifts of the scientific communities that have advanced successful treatments through honest research. Did you know that there are now safer medicines to help reduce cravings in those struggling with alcohol and heroine? That there are virtual reality treatment modalities which have proven successful in stopping cravings in people addicted to crack? Are these some ways that “God makes all things new”? However we ignite our God-given sense of curiosity and wonder, however we delight in the gifts we see, hear, taste, smell and touch, we then move from fear to reassurance and gratitude, from despair to hope. Today’s institutional church needs to be alert to the propensity for its own mental illness. Where judgment and criticism prevail, there is destructive, unmanaged anxiety. (Doubters, please read Dennis Maynard’s When Sheep Attack!) If the church could adopt some of the spiritual wisdom of 12-step programs where people’s mistakes and struggles are openly stated, accepted, amended, and forgiven, where anxiety is given to God in exchange for an attitude of gratitude and assurance, where God is Love, then we might be able to think more clearly and function with more love. When church families support one another with a “We’re in this together” attitude, use logic and negotiation to solve problems, reject irrational all-or-none thinking, challenge ruminating “what ifs,” actively serve each other and the community, and focus on knowing God within oneself and others, then they are working to manage anxiety. Programs such as Servant Leadership can help to foster healthy church membership. But churches need to be open and alert to the signs of dysfunction, to be honest about their fears, and to take steps to create a caring community without falling into criticism, herding, manipulative or controlling behaviors. Churches can step up to support efforts to stem mental illness by giving generously to local mental health agencies, most of which are struggling financially. Agencies are on the line caring for victims and families afflicted by trauma, abuse, crime, sexual assault, loss, conflict or struggling relationships. We often breathe a sigh of relief when we hear, “He’s seeing a counselor,” not realizing we can help support that counseling relationship with our financial and our volunteer efforts. We would serve our entire faith community better by getting to know our local mental health and family services agencies, inviting them to educate our churches about mental illness and treatments, and celebrating the reality of God in ourselves and others while being instruments to one another of God’s love. Virginia Perry is a licensed marriage and family therapist who works part-time at Family Services, Inc., in Winston-Salem, N.C. She attends Messiah Moravian Church.

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Ron Rice Suffering in silence is the plight of many people in our congregations, families, and communities. Many with mental difficulties suffer in silence. Sister Vacek properly identifies problems associated with ministering to those with mental illness and calls us to action as Christian ministers. Her article deals with defining the problem, identifying causes, and suggesting positive action. I applaud her work. I would like to lift up a few of her thoughts and add some observations I have had during my ministry. “We may not know how to offer help,” she writes. Not only do we not know how to offer help, we do not know how to help. We do not understand people with mental problems. Some people think that telling a person what they should do will help them. Some believe that their problems are a result of sin. Still others believe that mental illness will go away if the person just tries harder or just takes the right pill. We do not like being around people with mental difficulties because we do not understand them and we do not know what to say or what to do. Being around a depressed person is in itself depressing. Sister Vacek suggests that understanding mental illness through the stigma theory will help. She writes, “Stigma surfaces in human relationships when attributes of an individual vary from what social norms tell us one ‘should’ be.” This is a good beginning. Stigma or prejudice hinders relationships and separates us from others. If we look deeper we find that many people who allow stigma and prejudice to pattern their relationships often feel inadequate themselves and believe that they are bad people. Instead of dealing with their own issues, they condemn others in order to protect their own needs. In her article Sister Vacek also suggests three ways a Christian community can help. “First, congregations can form themselves as places of deep Christian hospitality.” Providing a safe environment where we can trust others enough to be open is a great direction. “Second, congregations and individual Christians can accompany those who suffer.” Part of this direction, we are told, is to listen to others. Often we approach others with the solution to their issues; however, it is much better to listen to them rather than to try to solve their problem. Listening is not easy. We are often thinking of what to say to others rather than listening to what they are saying. We should be teaching our people how to listen. That skill will not only help with ministering to those who are mentally ill, but it will help in all our relationships. And third, “congregations can acknowledge the presence of social stigma and work to combat it” by learning about mental illness—its causes and treatments. These are all great suggestions. There is no surprise as Sister Vacek reports that “Goffman’s third proposed source of stigma includes stigmatization caused by religion.” Many times I have encountered “church people” who were causing mental difficulties in others. The term ecclesiogenic—problems caused by the church—is very appropriate. Philip Yancey, in his book What Is So Amazing About Grace? recounts the story of a prostitute seeking help in her recovery. In the past, she had sold not only her own body but that of her two-year-old daughter to those interested in kinky sex. When she was asked if she ever

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thought about going to church for help she responded, “Why would I ever go there? I was already feeling terrible about myself. They’d just make me feel worse .”1 If our perception of ministry is to assume God’s role as judge, then we hurt others rather than help them. Many faithful church people are very judgmental. Jesus’ directions to love God, others and ourselves must be taken seriously. We need to learn how to be loving ministers and channel God’s help to God’s children. While I understand that not everything can be covered in one short article, I do find one major concern that should be addressed. Sexual abuse is a major factor contributing to mental or emotional illness. We cannot pretend this does not happen to a great number of people in our churches, families, and communities. Many of these survivors of sexual abuse suffer in silence, most believing they are bad and that the abuse was their fault. The church, I believe, has a responsibility in preventing sexual abuse, in identifying survivors of abuse, and in providing help to those survivors. These tasks are not easy, but they constitute an important ministry that we have neglected too long. Not knowing how to help, or knowing that helping is difficult, should not prevent us from working on this vital ministry. 1. Philip Yancey, What’s So Amazing About Grace? (Grand Rapids, Michigan: Zondervan, 1997), p. 11.

Ron Rice is a retired pastor serving the Reading Moravian congregation in Reading, PA.

Robert Rominger Radically accepting others is difficult. We sometimes find it hard enough to accept ourselves. We are hardwired to find comfort in what seems familiar and to avoid moving out of our comfort zone. Sociology, as discussed in Sister Vacek’s paper, is a recent science, yet stigma is an ancient concept, which the writer of James addressed when he advised against showing favoritism: “Has not God chosen those who are poor in the eyes of the world to be rich in faith and inherit the kingdom he promised to those who love him?” ( James 2:5, NIV). Whether they know it or not, the parents Sister Vacek describes are not alone in their sufferings. Yet there seems to exist a wall of separation between the Christian world and the world of mental health advocacy—not because mental health advocates do not acknowledge the role of faith (as most do), but rather because, as Sister Vacek points out, Christian churches have tended to be civil places where the existence of deviancy must be concealed. Genuinely seeing ourselves as stigmatized might help us create more open churches. Accompanying those who suffer, however, demands our willingness to put ourselves in uncomfortable positions. Most of the work I do as a psychologist is in an outpatient clinic in a medical school. Integrating behavioral health care into this setting is one means of overcoming the stigma that prevents many people from seeking therapy and is predicated on

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considerable evidence that treating the whole person contributes to better health outcomes while saving costs. As a mental health professional, I would love to be convinced that churches are allies in promoting mental health. At best, the typical patient’s church is a mixed bag, with practical and social support generously available, along with a message that instills critical hope, unconditional acceptance, and varying degrees of interpersonal drama. At worst, a patient’s church can be a burden, the source of oppressive theology, guilt, or conflict over the idea of seeking secular treatment for emotional maladies. A noteworthy project in Winston-Salem, N.C., represents something of an alliance between the professional and church communities. A Kate B. Reynolds– funded project undertaken by the Psychiatry Department at Wake Forest Baptist Medical Center has been providing psychiatric treatment to residents of Samaritan Ministries for homeless individuals.1 This collaboration represents an interesting elaboration on the convergence of mind, body, and soul: Long paired with the food and housing provided by shelters such as Samaritan ministries, the Christian message is now being juxtaposed with brain health. (Psyche is the Greek work for soul.) While I am unaware of deliberate cross-fertilization of ideas across the spiritual and psychological planes in conjunction with this enterprise, I trust that some incidental shared respect is developing. Locally and nationally, groups are working to raise awareness of mental illness and fight the stigma against both the sufferer and the treatment. Winston-Salem, for instance, has just held its seventh annual Out of the Darkness community walk for suicide prevention, with its organizers now laying the groundwork for a local chapter of the American Foundation for Suicide Prevention (AFSP). Forsyth County also has an active chapter of the National Alliance for the Mentally Ill (NAMI). Every region of North Carolina has a Consumer and Family Advisory Committee (CFAC) that works closely with the Local Management Entity (LME) or Managed Care Organization (MCO) for mental health services in that community. Christian churches—and not just church members who have family who suffer with mental illness—should be natural allies in these various efforts: walking in support of suicide awareness, educating ourselves about community needs and treatment options, and advocating for more programming where it is needed. I believe the writer of James would characterize these as acts of faith. 1 “Grant from Kate B. Reynolds Charitable Trust Extends Program Providing Care to Homeless People with Mental Illnesses” [online press release, retrieved 8/30/12 from http://www.wakehealth.edu/News-

Releases/2012/Grant_from_Kate_B__Reynolds_ Charitable_Trust_Extends_Program_Providing_Care_ to_Homeless_People_with_Mental_Illnesses.html

Robert Rominger is a counseling psychologist on the faculty at Wake Forest Baptist Medical Center. He is a member of Konnoak Hills Moravian Church in Winston-Salem.

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Julia Simmons Since the mid-1980s I have been studying religion and mental health, in an effort to understand the relationship between the two fields. I am grateful to Sister Vacek for her informative and heart filled article. Her thoughts can inform our quest to reach out to those who suffer from mental illness and to their families for generations to come. I feel blessed to live in a time when we, as people of faith, can research the science of mental illness. Understanding that mental illness is an illness of the body, like heart disease or diabetes, will guide us as we create places of Christian hospitality for those who might otherwise hide themselves or a family member away. Also, understanding that it is stigma (a perceived mark of shame in those who appear or act differently from our ideal) that causes us to hide will help us to bravely tell our own stories and to support others with mental illness. I am blessed to have lived in two North Carolina counties and worked in many other geographic regions in which citizens have taken it upon themselves to prevent as many suicide deaths as possible. As Sister Vacek notes, suicide and mental illness are closely related, particularly when we consider that 90 percent of people who take their own lives are suffering from a diagnosable mental illness, most often depression. For many people, however, the stigma is too great. Reaching out to their pastor or others at church might seem to bring more shame than comfort. For this reason some North Carolina communities have developed a program through which churches can help shed light on mental illness. “Sunshine Sunday” has been held in Ashe, Alleghany, Stokes, and Wilkes counties for the past several years and has proven to be a valuable means for creating places of Christian hospitality for those who suffer from mental illness. “Sunshine Sunday” is created and sponsored by local suicide prevention collectives. Packets including bulletin inserts and fliers with information on mental illness and its treatments, nationwide and local hotlines, and treatment providers are offered to community churches, synagogues, and other places of worship. Volunteers who have suffered from mental illness and who have grown spiritually and through medical treatment share their stories during sermon times or during discussion groups or panel discussions. “Sunshine Sunday” can be held on any Sunday that the place of worship chooses. In Alleghany County we encourage participation in June. As all of our worship communities in the county are Christian, we create materials accordingly. The bulletin insert used for “Sunshine Sunday” 2012 is shown on page 22-23. The focus of the message is always to shed light on mental illness as a health challenge like any other and to encourage those with mental illness and their family members to ask for help from mental health professionals, medical providers, church leaders, family and friends. It is up to us as people of faith to create places of Christian hospitality. Let us not add our fears and stigma to the confusion of mental illness, but “open hearts and hands to those in need.” Julia Simmons is a member of Mountain Laurel Moravian Fellowship in Laurel Springs, N.C.

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Lucetta Zaytoun I appreciate Sister Vacek’s examination of the space between people who dare to come forward in the church with the complexities of mental illness, and the congregations who must respond when they do. We are designed by God to be in relationship, and where mental illness is concerned, it can be a delicate dance. I believe bridging the gap created by this invisible malady requires intimate emotional connection. For those living with mental illness themselves, and for family members caring for loved ones, it is imperative that we create a place, as Sister Vacek states, “where suffering can be named safely and truthfully instead of remaining hidden or expressed only outside of the sanctuary walls.” In any group setting where bonding takes place, one person opening up in a real and vulnerable way can immediately take the entire group to a new and deeper level of intimacy. But it takes a courageous person to be the first to come forward, for it often seems easier to suffer alone than to run the risk of further pain by exclusion, back-pew judgment, or being the subject of gossip cloaked in a prayer request. To create a safe space requires an intimate emotional connection in which both parties feel valuable and validated. For congregants, it is the fear of the unknown, the unpredictability of mental illness, and the mirroring of our own lives that keeps the stigma in place. If we’ve had no experience with mental illness, we have no idea how to help those who suffer, and in our anxiety we do nothing; or, worse, we default to judging for our own selfprotection. We often find it easier to stay at arm’s length rather than risk being exposed to an emotional rollercoaster and— with no quick fix available— to the possibility of a long-term commitment. Congregations must lay aside these fears and make personal connections, creating a buy-in of understanding and a perspective shift. We must realize that the sufferers and those who love them feel the same fears of unpredictability, the unknown, and the possible hopelessness as well. Highlighting mental illness awareness in our congregations could be one way to bring sufferers and others together. Bringing in someone from the mental health community to share their own experience, or (carefully and sensitively) inviting a suffering member to come forward, could begin the move to a deeper level of understanding. By creating a format that also touches on the mutual need for each other—underlining that sufferers need the congregation’s support, while supporters need the sufferers to educate them on how best to provide care—we create a giveand-take, a valid inclusion. Ideally, through the experience, both would be open to new, admittedly uncomfortable ways of embracing one another, knowing that to love unconditionally is not always easy, but is always worthwhile. To understand that those who would help cannot say, “God, I will take care of your people; bring them to me. Oh, but not those people.” And those who suffer cannot cry out, “God, please, I need help through this struggle. Oh, but not from them.”

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Years ago, I was the youth leader at Raleigh Moravian Church with 50 teenagers in my group from all walks of life. Each evening, as I gave the talk portion of the program, one teen, rather than sit, would pace the back of the room—back and forth, back and forth, the entire time. One Sunday afternoon a group of the ‘most popular’ kids showed up on my front porch. “We want you to make him leave the youth group,” one boldly stated. “Yeah, he should be sitting down and joining in like the rest of us,” another agreed. “His pacing and his dark talk are unnerving.” I took a breath and tenderly responded, “I appreciate you coming forward in an honest way. We are all created uniquely by God, and for him, pacing is how he thinks and learns. He must be in motion. He walks the trails behind his house for hours to think and sort things out.” “It’s scary,” one girl softly added. I asked, “Are you afraid?” She thought for a moment. “No, it’s just … it’s just weird!” “So you’re uncomfortable?” “Yes, that’s it.” “Hmm, I wonder how uncomfortable he must feel, and lonely.” The teenagers stared at the bricks below their feet. I continued, “If he can’t come to the church to learn, be loved, and work out the darkness, then where can he go?” I paused, then asked, “What would God have you do?” Without looking up, one said with a sigh, “Love him.” “Yes, I think so,” I said with a smile. I hugged them all, and as they shuffled off the steps, they waved back, calling, “See you tonight.” That night at youth group, in the middle of my talk, one of the young men who’d been on my porch suddenly stood up. Without saying a word, he moved to the back of the room, where he gracefully fell in step with the walker. This is how we bridge the gap created by mental illness: with intimacy. With empathy. When the emotional connection is made, it can spark compassion and understanding, diminishing the power of fear and stigma, thus creating a relationship where vulnerability is safely held. This is the heart and strength of, “…In all things, love.” Lucetta Zaytoun is a personal life coach and holds a B.A. in Biblical Counseling.

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The Author Responds The vocations and avocations of the six individuals whose responses are included here show their attentiveness to those who suffer with mental distress. They bring insight as lay people, ordained clergy, psychologists, therapists, and counselors and present a variety of perspectives about the church and illness. By sharing anecdotes and offering wisdom from their lives and ministry, they display not only the depth of pain that mental illness can cause, but also the hope and hospitality to be enacted through Christian worship, service, relationship, and fellowship. The responses show thankfulness for the ministration of modern medical treatments, and I agree. Even as we consider “what the church should do,” it is useful to understand God at work in many ways, inside and outside of congregations. God may work by calling Christians to partner with others in the provision of care. As a counseling professional, Robert Rominger invites churches to be allies with the medical field. Julia Simmons’s recounting of “Sunshine Sunday” and Brother Rominger’s description of the counseling project at Samaritan Ministries offer two acts of solidarity with, and care for, those who suffer. Such service witnesses to God’s love and enables a re-formation of the unhelpful responses many sufferers have experienced (or fear experiencing) from Christians and in congregations. Relationship with God and with one another, through the power of the Holy Spirit, is central to Moravian identity. Eileen Edwards and Lucetta Zaytoun acknowledge, however, that being in relationship with those who suffer will often prove messy, uncomfortable, and unpredictable. We should remember with joy that one of the gifts of being members of Christian communities is the opportunity to walk together through difficult times. While discerning “what to do” may prove challenging, Sisters Edwards and Zaytoun show that hospitality in the face of suffering proves possible even without formal programs of care. They, along with Virginia Perry, remind us that sometimes the most healing Christian responses come in the form, not of words, but of physical presence and accompaniment. Learning to listen, Ron Rice argues, is a tough-to-acquire but important skill. To be sure, a perspective missing from this issue is the direct account of one who suffers. I suspect each of us brought those we know into our reflections, even if indirectly. As Sister Zaytoun notes, “carefully and sensitively” inviting those who suffer to be part of the conversation will deepen understandings and inform responses. Sister Perry and Brother Rice helpfully note that substance and sexual abuse can precipitate or worsen mental maladies. Rather than permit this reality to further stigmatize and isolate those who suffer, our questions, concerns, and fears can guide our learning. Rooted in Sister Perry’s call to churches to educate themselves about mental illness and the medical and other resources available to ameliorate it, let us challenge congregations to be in conversation, to learn, and to prayerfully consider responses. I suspect that one of the authors in this issue of the Hinge, or others with

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similar experiences and convictions, will be willing to be invited to get the conversation started. Simply reading this edition of the Hinge as part of a Sunday School class would offer a good start. In addition, a call to a local NAMI chapter may help congregations be in contact with local advocates and experts. I appreciate the chance this issue of the Hinge offers to be in conversation with Moravian sisters and brothers about mental illness, and am grateful for the texture my sisters and brothers have added to my own reflections. It is this sort of dialogue that I imagine will help congregations and individual believers attend to mental distress with more attentiveness and compassion. “Suffering,” as Sister Edwards notes, “is part of the human condition; faith gives us hope that suffering is not the final word.” Together, as we open hearts and hands to those in need, we witness to the hope and reality of God’s healing.

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Guest Sermon “The Prodigal’s Hometown” by Ginny Hege Tobiassen Text: Luke 15:11–32 In the prodigal son’s hometown, everyone in church knew the family. Good folks, solid home; two kids, both boys. One son was sturdy and responsible, the quintessential elder child. His reliability meant a great deal to his parents, who frankly had their hands full with the younger boy. Whip-smart, imaginative, and funny, the younger son seemed to stir up mischief wherever he went. They were a good family, regular attenders, active, involved. Both boys were confirmed in the church and attended youth fellowship. After college and an MBA, the elder son returned home to help his father manage the family business. The younger son had more trouble settling down; he seemed to flit about, moving from one thing to another. The congregation saw the boys less and less often at church, but at Christmas and Easter the younger son usually came, and he was still the same: cheerful, funny, making everyone laugh. The elder son, meanwhile, stopped coming to church altogether; everyone knew how hard he had to work in the family business. Eventually, word got around that the younger son had moved to California, and no one seemed to hear much about him anymore. The parents kept coming to church every Sunday, and the mother was present at all the weekday activities, always helpful, always smiling. When asked how her boys were doing, she’d say, “Oh, they’re fine. How are you?” And one day, the mother sat down and wrote, anonymously, to the newspaper columnist known as Miss Manners: Dear Miss Manners: My beloved adult son is currently incarcerated. When a casual acquaintance asks me how my children are and what they’re up to these days, I have no problems being polite but vague. But when dearer friends with whom I haven’t recently spoken ask about them, it becomes a bit more difficult. This is a rather painful subject, one I am not inclined to discuss with many. I also have no wish to violate my son’s privacy. On the other hand, I don’t wish to give a friend the impression they were wrong to ask, as the problem is mine, not theirs. When I worked as a chaplain at Baptist Hospital, I sometimes interrupted family conversations when I walked into a room. My supervisor suggested I keep in

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mind what the conversation might have been, because what had been going on before I walked into the room would have an effect on the situation while I was in the room. Entering the story of the prodigal son is like walking in on a conversation. Here’s how it starts: “Then Jesus said, ‘There was a man who had two sons. The younger of them said to his father, ‘Father, give me the share of the property that will belong to me.’” Right away, we think we know this kid. That’s no accident. Luke’s original audience would have recognized the inappropriateness of the son’s request. To ask for his inheritance while his father was still alive was to speak as if the father were already dead. It was disrespectful of his father and severed family ties. These cultural cues prepared the audience to condemn this young man. And somehow, that has not changed to the present day. We read the son’s first line of dialogue, and we think we know him. Lazy! Wastrel! Sense of entitlement! Wants instant gratification! And he performs true to our expectations. But what was the conversation before we entered the room? What were the younger son’s dreams, and how had they played out to that point? What were his plans, when he asked his father for the money? What was he longing for? Why did he go away? And why did it turn out the way it did? And whom did he have to talk to? What was life like for the prodigal back in his hometown? As a child, was he full of dreams, filling the margins of his tests and assignments with doodles, illustrating the stories he was telling himself in his head? As a teenager, was he excited by his new freedoms but alarmed by a sense of growing responsibility for his choices? What interested him, pulled him, compelled him? Did he have an outlet for his talents? Did he just always feel different, and dream of a place where he could fit in? How did that work out, back in the prodigal’s hometown? What did he long for, and did he have anyone to talk to about it? Because clearly, the story—at least as I read it today—is full of longing. The young man wanted something, wanted it badly. When he asked his father for money, was he at that point already angry, disaffected, disconnected? Or did he just want something so badly that he was willing to risk breaking relationship with his family, hoping that his success in his planned venture would make them proud, make them take him back? But of course, as we know, that’s not what happened. Whatever his plans, they led not to success but to disaster. Today the painful family dynamics of the story would suggest that the young man’s longing had led to despair and from there, perhaps, to addiction: We see the spiraling downward, to the moment when the younger son hits bottom, coming to himself in the mud of a pigpen. We see the resentment of the elder son: Has he been unwillingly taking care of his brother on the sly? After all, the elder son complains that the younger has wasted all the money on prostitutes—that’s new information, not given in the beginning of the story. I imagine late-night phone calls to the elder son from the younger, too ashamed to call his father, relying on the sturdiness of his sibling to see him through just one more time. Resentful at being everyone’s caretaker, always the reliable one, the older son is not at all happy to see the

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younger come home. What about his own longings? What about what he dreamed of? And whom could he talk to? Longing is the condition of the human heart. Because we are beings who envision, who imagine, who see or hear or feel what is not physically present, we have the capacity to long for what we do not have, and even to long without knowing what we long for. We desire what will bring us to completion—even when we cannot get a fix on what that might be. Retired professor of Christian Ethics James Nelson writes that “the search for, naming of, and reflecting on this desire lie at the heart of all great literature and art, all philosophy and psychology, and, surely, all theology. It is a restlessness, a disquiet, a hunger” at the center of the human experience.1 We hunger for the meaning that is found in connection to something larger than ourselves. But to achieve that connection, we must make ourselves vulnerable to someone or something. We must let down our boundaries. When the boundaries come down and the connection is made, what we feel is belonging. To belong is to find our place in the universe. To achieve connection feels like waking from a dream to find ourselves at home. But letting down those boundaries, making those connections, can be very difficult. Being vulnerable is dangerous; when you place your trust and vulnerability in another’s hands, you can get hurt. For some, it’s just too dangerous to contemplate, and then the search for meaning and connection can lead to self-destructive, selfmedicating solutions. Is that what happened to the prodigal son? It’s what happened to psychologist and recovering alcoholic Christine Gorf, who in her book Thirst for Wholeness writes, “As far back into my own childhood as I can remember, I was searching for something I could not name. Whatever I was looking for would help me to feel all right, at home, as though I belonged.... I found it in the delicious oblivion of alcohol. My boundaries melted.... I felt comfortable within my own skin and felt connected ... accepted, and cherished.”2 Until, as she says, the alcohol turned against her. No child ever says, “When I grow up, I want to be an alcoholic.” Or a drug addict, or a compulsive gambler. And the younger son in today’s parable—I don’t think he said, “When I grow up, I want to be the prodigal son.” So I started imagining what he did say, what he did want. That’s how I wound up thinking of this family—the one I told you about in the beginning. The one in the church, with the two sons. And a father. And, I am quite sure, a mother, who would eventually write this letter to Miss Manners. I made up the family, but the letter is real. Like you, I have read the story of the prodigal son many, many times. It is such a rich story. It’s huge, actually. Within its 20 or so verses it contains practically the whole story of humanity and God: We yearn; we seek; we mess up; we return; God welcomes us back. Also, like the elder son, we resent, we complain, we point out our own virtues and our brother’s faults; and still, God welcomes us. When you get a story this big, the thing they teach you in homiletics class is, preach just a piece of it. You’ll get another shot at it down the road. For now, find the question that interests you today. Preach on that question.

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So here’s my question today. Whom did the prodigal son have to talk to, before he became the prodigal son? Where in his hometown could he have let down the boundaries, made himself vulnerable, and found connection? Did anyone in the church know that the prodigal son and his family were hurting? I spoke recently to a friend in a church congregation that seems to glow with good health. This congregation is vibrant, alive. Their worship services are joyful. They are involved in many aspects of community life, with much service work. One of their recent successes is the development of a Stephen Ministry, which trains people in the congregation to minister to each other closely, one-on-one. Each trained caregiver is linked to a “care receiver” in the congregation—someone who can benefit from more visitation time than the pastor can handle on his or her own. The care receiver might be grappling with grief over the loss of a spouse, or a loved one’s illness, or the loss of a job. Anyone with a special need for focused, one-on-one pastoral visitation can be a care receiver and be paired with a Stephen Minister. It’s a wonderful program. The only problem is, when I asked my friend how the ministry was going, he said that right now they just don’t seem to have anyone to minister to. “Really?” I said. “How can that be?” “Well,” he answered, “I guess nobody has any problems.” Now, I don’t have a lot of experience as a pastor, but I’ve been in churches most of my life, and I have never seen a church congregation in which nobody has any problems. But I guess it’s entirely possible to be in a church congregation in which nobody will own up to having problems. Owning up is hard to do. When you walk into church on Sunday, everybody looks so happy. Like nothing ever hurt them. How would it feel, to make oneself vulnerable in a congregation where everyone else appears to have no problems? Could anyone take that risk? Would anybody step forward to be the single care receiver in a congregation full of caregivers? It seems unlikely. In fact, a wayward, confused, and broken son in search of wholeness might feel there was no one to talk to, no one who would understand; and before long he would be asking for his inheritance and buying that bus ticket to California. Leaving his brother to stir in resentment, and his father to sit on the porch keeping watch, and his mother to write a letter to Miss Manners: “What do I say, when dear friends ask me about my son?” The parable of the prodigal son is one of a series of three parables Jesus offers in response to the Pharisees’ criticism that he eats with tax collectors and sinners. Each parable features something lost and found—a sheep, a coin, a son. In each case, the finder invites the community to celebrate. Surely we as a church community celebrate when our lost ones return to us. My question today is: Can we be the community that keeps them from leaving in the first place? To be that community, we need to be vulnerable to one another, so that each in his or her times of seeking will find comfort and connection knowing that others have sought as well. We need to be honest with one another about our struggles. We need to be willing to seek one another’s help. While it is almost certainly true that no child hopes to grow up to be the prodigal son, each of us has been at least one character

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in that story, and probably all of them at various times: the confused and longing younger son, the simmering sibling, the grieving father, the unwritten but surely existing mother. In every role there is pain, but there is also opportunity for connection through each character’s vulnerability to one another. And that connection to community is vital, because it is through community that each of us returns at last to the home that we sought all along. That longing that we feel—that nameless desire? This parable identifies it, and so did St. Augustine, who asserted in his Confessions that our hearts are restless till they rest in God. As Christians we believe that our path to God is found in Jesus Christ. Who is the body of Jesus Christ on earth? The church. The pathway to God runs right through our church community; we are the hometown through which the seeker passes on his journey to his ultimate home. In this hometown, may every would-be prodigal find neighbors to talk to, friends with their own stories of longing and brokenness, companions who share the path back to wholeness. What do people say about their hometowns? “Oh, everyone knows each other.” Let it be so. Amen. 1 James B. Nelson, Thirst: God and the Alcoholic Experience (Louisville: Westminster John Knox Press, 2004), p. 23.

2

Quoted in Nelson, p. 169.

Ginny Hege Tobiassen is associate pastor of Home Moravian Church in Winston-Salem, N.C.

Editorial Board Craig Atwood, Jane Burcaw, Christy Clore, Otto Dreydoppel, Sarah Groves, Margaret Leinbach, Russell May, Jeff Mortimore, Hans-Beat Motel, Joe Nicholas, Graham Rights, Volker Schultz, Neil Thomlinson Co-Editors: Ginny Hege Tobiassen, Janel Rice, Christian Rice

Send letters to the editor, articles, book reviews, and other contributions to co-editor Ginny Hege Tobiassen at: virginiaT1@bellsouth.net

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Hinge 19.1: Opening Hearts & Hands to Those in Need: Mental Illness, Stigma & the Church