Mental Illness and Responsibility – Part 2
Updated: May 30
In our first article on mental illness and responsibility, we said the brain itself is unable to prevent a person from following Christ. Scripture teaches that any behaviour not conforming to God’s commands, any thought transgressing his prohibitions, is something that proceeds from the sinful heart. God created us as responsible, but through our own fault we have been deeply affected by sin.
The limits of the brain
Yet there is more that must be said. An over-simplified answer will not help us. In his book Blame it on the Brain? Ed Welch speaks about three categories:
1) When the brain can be blamed: There can be mental illness that affects brain functioning in a way that leads to sin. For example, people suffering from dementia might say and do very hurtful things. He might make sexually suggestive comments to women, or she might be sinfully demanding toward family. We are right to be immensely patient in these cases because of the obvious impairment of the brain.
Having said that, brain problems can expose heart problems. The damaged brain is not generating sin. It’s simply taking the cover off things that were previously hidden in the heart, like a poor attitude toward women, or a demanding spirit.
2) When the brain might be blamed: A physical change in the chemical levels of our brain can lead to certain conditions, such as depression or ADHD. This is why medications that address the imbalance can have a marked and positive effect on behaviour. Even so, while psychiatric problems can have this physical cause, there can be a spiritual element too. Many mental illnesses are hybrids, a combination of physical and spiritual problems. For instance, an anxiety disorder can arise from factors external to a person, such as living in a world that is under the curse, or dealing with a difficult work situation and many demands at home. Combined with a biological predisposition to anxiety, you’d say such a person is almost destined to suffer with it.
Conversely, a depressive disorder can also be a consequence of sinful choices that the person has made. He might be living in the misery of unconfessed sin, living far from God. In a sense, we shouldn’t be surprised that they have no rest (see Psalm 32). This is a heart problem that is manifesting itself in the brain.
3) When the brain cannot be blamed: There are behaviours that are physical, and they have a mental component, but they cannot be blamed on the brain. Take homosexuality as an example, which some will say is biologically determined. This is unclear, but even if there was evidence for the gay gene, we must respond in a biblical way. And that is to say that homosexual activity is forbidden by the Lord. We can be influenced by our genes, but that’s different than being determined by them.
Alcoholism is another example. It’s called a disease, and in the secular setting it’s often spoken of in those terms. There could even be a genetic predisposition towards alcoholism, yet the Bible states that drunkenness is a sin, and in the end we also have to treat it as such.
What about addictions?
“Addictions” is a much-used term today. The difficulty is that it is a very elastic and ambiguous category, and it covers everything from frivolous activities (being addicted to certain shows on Netflix) to far more serious (being addicted to drugs). While the term is misused, it is true that an addict can feel that he is trapped and out of control.
While the Bible doesn’t directly mention addictions, it does talk about our motivations and desires. It recognizes that there are forces so powerful they can overtake our lives. Yet our addictions are more than self-destructive behaviours; they are violations of God’s law. An addiction is about our relationship with God much more than about our biology. When we see the spiritual realities that are behind our addictive behaviours, we find that all people serve what they love: either our idols, or God.
As for the question of responsibility, we must be clear that an addiction begins with a choice. Idols exist in our lives because we invite them in and love them. Once they find a home in us, they resist leaving. They change from being servants of our desires, to being masters. Like James writes, “Each one is tempted when he is drawn away by his own desires and enticed. Then, when desire has conceived, it gives birth to sin; and sin, when it is full-grown, brings forth death” (1:14-15).
When we repeatedly choose to do evil, these decisions can also be accompanied by changes in brain activity. It doesn’t mean that the brain has caused the decision, but the brain renders the desires of the heart in a physical medium. Welch says that “it’s as if the heart leaves its footprints on the brain.”
That helps us to understand the research which suggests that the brain of an addict is different from the brain of a “normal” person. What has been going on in the heart, month after month, year by year, is being represented physically, with changes in the way the brain operates. This doesn’t prove that the brain caused the thoughts and actions; rather, brain changes can be caused by these behaviours. Once again, it started with sin.
An approach for helping
Let’s draw this together in an approach to the question of responsibility and response. Bear in mind that every situation is different, and there is not a one-size-fits-all approach. In that spirit, may some of these guides can be helpful.
1) Distinguish between symptoms: When there is mental illness, there can be a host of symptoms. And it’s important to distinguish between spiritual and physical symptoms and to consider whether the Bible commands or prohibits this behaviour.
For example, with depression the spiritual symptoms are feelings of worthlessness, guilt, anger, unbelief, and thanklessness. These are heart issues which need to be addressed with Scripture and prayer. But depression also has physical symptoms, such as feelings of pain, sleep problems, weight changes, fatigue, problems with concentration. This set of difficulties requires a different response, but they do need a response.
2) We are not our genes: There are genetic problems, even genetic predispositions toward things that are sinful. But we are not our genes. The Scriptures teach that we are born as sinners, and that sin arises naturally in our heart. We enter the world as slaves of sin, but we are still blameworthy for surrendering to sin. So even if it were discovered that we are predisposed to certain sinful behaviours like alcoholism or homosexuality, this would not eliminate our responsibility for such sinful actions. Our individual makeup and background provide context for sin, and may fuel the craving for sin, but these things don’t take away the accountability for our sin.
3) Medication isn’t the only answer: We mentioned earlier that psychiatric disorders sometimes respond to medication. There can be a real benefit, so this becomes our reflex response: we assume a prescription will fix the situation, and we advise a visit to the local psychiatrist. Yet we shouldn’t rush to medicate. It can be effective with some people, not all. There can be adverse effects to almost every tablet, and there can be a danger of over-medication. More to the point, we have to remember that medication cannot change the heart; it cannot remove our tendency toward sin, revive our faith, or make us more obedient. We still need the help and benefit of such things as the spiritual disciplines and Christian community.
4) Maintain a sense of responsibility: God created us as responsible beings, for we were made in his image. We diminish a person’s God-given dignity by looking at them and seeing only their infirmity, and not their responsibility.
Scripture directs us to this principle of responsibility too. Think of Jesus’ words in Luke 12:48, “For everyone to whom much is given, from him much will be required; and to whom much has been committed, of him they will ask the more.” We can almost always require of people that they give an account of their conduct. The same text teaches us that not everyone is the same. Some have received more blessing, others less. One person’s situation in life is far more difficult than another’s. It doesn’t mean they aren’t responsible, but it means we have to weigh their responsibility in the light of everything else we know about them.
5) Be patient: Trying to help people with mental illness can be frustrating. If we haven’t experienced anything like it ourselves or among those who are close to us, it is hard to relate. We might get exasperated with their constant struggles, their ups and downs, and behaviours that seem inexplicable. Sometimes we want to give up, but we need to be patient.
Think of what David says in Psalm 103:14. He says, “The LORD knows our frame; He remembers that we are dust.” That’s a mark of loving and attentive parents: they know their kids, what they’re made of. Parents can see pretty quickly when their kids are tired, or when they’ve had a rough day at school. And so parents will try hard to fight against their own impatience, and try to cut the kids a little slack.
God is a Father who sees the weaknesses of his children. He knows our frame: the Father knows exactly where we’re come from in life, and He knows the good and the bad that we’ve gone through. The LORD also understands what we’re made of, and that no matter how we seem on the outside, we’re weak: physically, emotionally, spiritually weak. We don’t have it together, so He is patient with us.
That teaches us about our own response toward those who suffer with mental illness. We should treat them as responsible, while we also remember their frame. We know that not everyone has a strong mind, or a stable outlook, or the mental and spiritual resources to get through the dark times of life. God has been immensely patient with us, so as we help our members, we ought to be patient with them.
Let’s keep central our goal as fellow members of the church: we want to care for each other in a Christ-like way. Our desire is to see our fellow members enjoy life in God’s grace and service.
Helping them effectively requires us to take into account the full picture of who they are, including when there is the presence of mental illness.
We don’t encourage them to blame their illness, and we don’t ignore it, but we try to help them be faithful to the Lord even in the midst of their hard struggles of spirit and body.