Mental Health Problem or Sin Problem? Wait—Can’t It Be Both?
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Problems in our behavior can be both mental health problems and “sin problems.” Part of the confusion on the topic of mental health among conservative evangelicals and fundamentalists is the assumption that a life problem has to be one or the other.
Consider a physical health analogy: Suppose I lose a leg in an accident. Because it’s a lot harder to walk now, I lay on the couch excessively, experience a lot of unhealthy weight gain, and neglect important duties.
I started with a health problem and developed a sin problem. The two are interconnected yet have distinct features.
Suppose I start to have financial and relationship problems due to my excessive idleness. I decide to get help. I go to a pastor who says, “You have a sin problem. Repent and change your habits.” That doesn’t sound fun, so I also go to a medical doctor who says, “We can get you a better prosthesis. After some physical therapy, walking will be less painful and this will help you be more active.”
That doesn’t really sound fun either, but hopefully I still take both sets of advice.
It would be tragic if, instead …
- The pastor said, “The prosthesis industry is a sham. They’re all just trying to get people addicted to gadgets to make money for Big Gadget. You just need to deal with your sin.” Then I took that advice.
Or… - The doctor (prosthetist) said “No, your problems are 100% due to your pain. Leave religion and sin out of it.” Then I took that advice.
In light of eternity, one of these bad choices is worse than the other, but they’re both bad choices—because with physical health problems we don’t have to have either a medical problem or a sin problem. We can easily have both.
These are also not the choices with mental health. We can be mentally or emotionally messed up and also have sin problems that are related—related as results, or as causes.
Body, Mind & Sin in All Directions
This is where the dynamic gets more interesting. Let’s alter the analogy. Suppose, rather than losing my leg in an accident and then becoming overly indolent, I’m a lazy couch potato for years, lose my leg partly as a result, then become even more sedentary.
Mental illness might usually be more like that. Setting aside for the moment how my laziness would lose me a leg, let’s just say it did. (It’s a thought experiment, so we can do that!) How does that help us understand how sin and “therapy” work together?
We know from Scripture that sin has negative impacts on physical health, as well as on attitudes and feelings. I think few would dispute this, but here’s a few examples.
Many are the sorrows of the wicked, but steadfast love surrounds the one who trusts in the Lord. (Ps 32:10)
The wicked flee when no one pursues, but the righteous are bold as a lion. (Pr 28:1)
For the love of money is a root of all kinds of evils. It is through this craving that some have wandered away from the faith and pierced themselves with many pangs. (1 Ti 6:10)
A tranquil heart gives life to the flesh, but envy makes the bones rot. (Pr 14:30)
We could also note interesting narrative examples of sin leading to emotional and physical health problems. But the Bible also describes times where things worked in the other direction, emotional or physical states contributing to sin.
- Moses, in anger, strikes the rock (Num 20:10-11).
- Saul, in fear, offers the sacrifice (1 Sam 13:11-13).
- Esau, hungry, swaps the birthright (Gen 25:32-34).
- Hezekiah, sick and sorrowful, neglects (probably) his duties (2 Kings 20:1-3).
Scripture reveals that, as embodied spiritual creatures, our thinking, emotions, spiritual state, and behavior are all intertwined. Probably nobody reading this would take the position that all physical maladies are the result of personal sin. But sometimes they are. For the most part, we can easily see this.
So, with physical ailments in relation to sin, we allow adverbs:
- Partially
- Indirectly
- Sometimes
When we start talking about mental illness, though, many seem to become suddenly adverbless. To them, a problem has to be all one thing or all another thing—and this leads to extreme statements like those uttered by John MacArthur recently, and many before him.
Let’s return to the analogy/thought experiment. Because I have a laziness problem, I lose my leg. My behavior then worsens. I develop even lazier habits, with increasing harms—and also increasing pressure to continue down that path. As I gain weight and my muscles atrophy, physical activity becomes harder and harder. Maybe I develop depression as well.
I decide to get help. A pastor correctly helps me see that I got myself into this mess through my sinful choices. He, again correctly, advises me to repent and start being a better steward of my health.
I do that … but I’ve still only got one good leg and a lot of pain.
Enter the question of the sufficiency of Scripture!
The Sufficiency of Scripture
I deeply appreciate the concern for biblical sufficiency that drives many to take a hostile stance toward mental health. To the degree that concern drives them, they are acting for the best of reasons. And the potential for conflict between the biblical view of the human person vs. the perspective and instructions of a mental health therapist is real. Sometimes they really do come into conflict.
We need to ground the question of sufficiency better, though. Let’s give it more context.
(1) The same Bible that claims to be sufficient for life and godliness (2 Pet 1:3) also teaches us that body, mind, and behavior all interact, and contribute help or harm to our pursuits of right or wrong behavior. We are not upholding the sufficiency of Scripture if we take some of what it says and distort it to cancel out something else it says.
(2) Nobody thinks that physical healthcare and repentance are mutually exclusive. Returning to my thought experiment, nobody thinks I have to …
- either repent of my laziness
- or get a better leg prosthesis.
I can do both.
This might be a better example: If I wreck my liver because of drunkenness, I can do both of these things:
- Stop getting drunk.
- Get a liver transplant.
One does not prevent the other.
So, why do so many assume a person can’t receive mental health therapy (maybe even joining the less than 20% who take medication) and also repent of sins that led to the problem or result from the problem? If I’m struggling with clinical depression, I may or may not have sinned my way into that condition. I may or may not sin because of that condition.
But let’s say both are true. I can certainly repent, start obeying God, and also get help from a therapist. I might do the sin-correcting and also acquire the mental health equivalent of a prosthesis.
Arguments applying the sufficiency of Scripture to exclude any kind of help outside the Bible are errors of scope. If the problems we’re talking about are not exclusively spiritual, we should not expect their solutions to be exclusively spiritual.
Two things ought to be clear by now in the mental health vs. sin debate.
- Rejecting all mental health studies and therapies does not flow directly and simply from a high view of the sufficiency of Scripture.
- We cannot assume that repentance and treatment are mutually exclusive responses to problems.
Aaron Blumer 2016 Bio
Aaron Blumer is a Michigan native and graduate of Bob Jones University and Central Baptist Theological Seminary (Plymouth, MN). He and his family live in small-town western Wisconsin, not far from where he pastored for thirteen years. In his full time job, he is content manager for a law-enforcement digital library service. (Views expressed are the author's own and not his employer's, church's, etc.)
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I had and incorrect reference initially at “The same Bible that claims to be sufficient for life and godliness,” so thanks to a reader who pointed that out.
Sufficiency is a topic that always quickens my pulse because it intersects with so many other areas that continue to be tensions for me. A huge one is how we view the legitimacy of fields of study/academic disciplines and careers—especially in science and medicine. It was bad before Covid. It got worse during/after, seems to me.
One more example that didn’t make it into the article: If you’re called to preach, Scripture is all you ‘need,’ to fulfill your calling, but you’ll sure do it a lot better if you make use of the teaching of godly students over the centuries (books, commentaries, conversations). You also might do it a lot better if you have a glass of water on hand. You can’t preach a glass of water and you can’t drink the Bible. You need both.
We keep forgetting we are physical-spiritual beings and that very few activities are ever purely one or the other.
As for mental health, much of it falls into the area where physical and spiritual overlap/intersect. We could say “humans are really messy.” It’s true. But we could also say “humans are complex and interesting!” We shouldn’t dumb down how “being human” works. It’s a disservice to our Creator.
Views expressed are always my own and not my employer's, my church's, my family's, my neighbors', or my pets'. The house plants have authorized me to speak for them, however, and they always agree with me.
Good article. This probably should be about 10 Parts long. We also should recognize that mental health conditions may be natural and may not be the result of sin. You touch on this briefly above. The prime example of a mental disorder laid out in Scripture is Christ's anxiety and panic attack in the Garden of Eden. Did Christ sin? We would argue, no. So where does that leave us. The biblical counseling route would say that we are not trusting God enough and we need to pray harder about it, and address this from a spiritual perspective. We would easily argue that it was in prayer that Christ suffered this. So we need to provide room that some mental disorders and challenges are natural. A panic attack is at the root a natural process that is not operating in a proper space and time. It is out of balance Fight/or Flight response. One that everyone has gone through under normal circumstances. PTSD is very similar. Where we have the problem is two things:
First, a proper biblical framework is critical, not in fixing the issue or addressing the issue, but in having an obedient Scriptural response laid out by our Creator. Plenty of people overcome these without prayer or without a proper relationship or any relationship with Christ. Prayer and Scripture reading doesn't solve the issue, nor is it required to solve the issue, but it orients us to a position in which we do not sin, which is having a feeling of despair and emptiness. We can have despair but that despair needs to pointed to a hope in Christ.
Second, we should encourage where we have conditions that affect the natural body, to seek help in those conditions that are rooted in helping the natural body. The church has held mental health at arms length, and as a result the church is wholly unprepared to deal with these issues, often provide very damaging advance, and has created a derth of Christian professionals in this field. We have Christian doctors, but somehow when it comes to mental health a Christian really shouldn't be involved in that.
The church should be the most prepared in dealing with mental health issues, yet I find myself more times than not telling people to avoid the church. It focuses on tools that are inadequate and misinformed at the exclusion of a good framework, and it avoides dealing with a multi-faceted problem.
I don't know if I'm at all an outlier, but my family's experience includes a fair number of relatives with depression, bipolar disorder, alcoholism, and more. As I look at what I've learned,one of the things that strikes me the most is how much self-care matters. Went to my cousin's wedding a few weeks back, and learned that two of my relatives had "gotten the monkey of their backs" and stopped drinking, largely through the care of various relatives. On the down side, it is a constant sadness that other relatives are on a constant roller coaster of "on the wagon" followed by "off the wagon".
A bit part of it, again, is whether or not the sufferer has consistent interaction with someone who is willing to help them with things like self-care. In my view, there are some things that drugs and "once a week" counselors simply cannot do.
Aspiring to be a stick in the mud.
Self-care is the biggest driver for mental health conditions. I doubt you will find any therapist (Christian or secular) who would argue against that. And most would say that is first and foremost before you get on drugs. But to be honest Bert, this is the same issue in the health field. It is easier to give blood pressure medication, than to change to eating and exercise habits. In fact, every doctor will tell you that a proper diet and proper exercise as well as general self care is the biggest contributor to having a healthy life. With that said, blood pressure medication does save lives. And people can have health problems despite a healthy lifestyle, just like people can have PTSD regardless of self care. And people need help with that, and there are good solutions that are not part of a biblical counseling approach that can help the physical body deal with lets say PTSD. Or a brain injury that creates a mood disorder?
The prime example of a mental disorder laid out in Scripture is Christ's anxiety and panic attack in the Garden of Eden. Did Christ sin? We would argue, no. So where does that leave us.
Um, how did you conclude Jesus experienced a "mental disorder"? Are mental disorders described in Scripture? I think they are (e.g. they are translated as "seizures" in Matt. 4:24), but they aren't attributed to Jesus. The Bible says Jesus heals these mental disorders, not that he suffered from them.
Mental disorders are due to improper functioning of the brain. Jesus' body was perfect and uncorrupted by sin. The fact that we describe Jesus as having a mental disorder tells me our definition of mental disorders is, well, disordered.
And, that is one reason why I am skeptical of the proliferation of mental disorder diagnoses.
“Mental health disorder” is a modern concept/category. That doesn’t make it wrong or useless, but it means we’re not going to find anyone in the Bible that the Bible identifies as having a disorder.
So any diagnosis of someone in Scripture is going to be … the technical term is “super iffy,” I think.
As for present day diagnoses, I find it useful to—once again—compare and contrast with physical medicine.
In my experience, diagnoses for physical ailments is often “super iffy.” Sometimes it’s very objective because there’s a specific identifiable pathogen. But if we’re talking about pain, for example, my own docs usually use words like “probably” or “maybe” a lot. Then remedies are aimed sort of widely to hit more than one of the top possibilities.
In short, you don’t have to know for sure why your knee hurts to get started on some therapies.
My impression of mental health is that you can sort of lump it all under a couple of headings—with very indistinct boundaries: 1) Having a hard time and you get specialized coping help, 2) Having symptoms clearly outside the ‘normal’ range. I’m oversimplifying, but my point is that a ton of modern mental health ‘therapy’ doesn’t diagnose anything at all. It’s pretty much coping and insight coaching. Then you have the kind where you are, for example, randomly going into a panic and passing out—with no identifiable physical cause. You’re likely to get a disorder diagnosis and have some conversations about possible medications.
I’m not sure it matters much. You have things going on in your life and you have to deal with the sin involved and, if necessary, get some medical and/or mental health help to make good choices a bit easier and remove some barriers to correcting the things you have control of. If it’s extreme, there might be a diagnosis with a large or small “iffy” factor. There might never be any diagnosis.
So, in short, there is counseling for dealing with problems and then there is therapy for dealing with “disorders.” But the difference between the two is often not huge and it might not matter much.
Unfortunately, health insurers used to really pressure providers to diagnose. This seems to be loosening up, but I’m sure some still experience that kind of pressure a lot if they go to get help. The provider might get a little creative to satisfy the paperwork requirements.
But is that weird? Not especially. How many times have you seen an MD and gotten a fancy Latin term in your chart that basically means “pain” or “inflammation.” That’s not really a diagnosis. It’s a summary of symptoms.
Joel S. could tell us from his wife’s perspective, but I think it’s probably very common for mental health professionals to ‘diagnose’ along the lines of some technical term that basically means “pain.”
Edit: I’m remembering now some pretty broad “diagnoses” in DSM-IV… I’m not going correctly recall the names, but maybe “anxiety disorder” was one that could cover a broad range. Again, I’m not sure that the shape the help takes is affected much by whether there is a vague diagnosis or not.
Views expressed are always my own and not my employer's, my church's, my family's, my neighbors', or my pets'. The house plants have authorized me to speak for them, however, and they always agree with me.
“Mental health disorder” is a modern concept/category. That doesn’t make it wrong or useless, but it means we’re not going to find anyone in the Bible that the Bible identifies as having a disorder.
This is not accurate. The Bible does recognize and describe certain mental illnesses as mental illness. For example, the Bible describes the divinely caused mental illness of King Nebuchadnezzer (Dan. 4:28-37). David faked mental illness in the presence of Achish, and he was described as "insane" and a "madman" (1 Sam. 21:12-15). As I mentioned before, Matt 4:24 is translated "seizures," but this word is literally "to be moonstruck" or insane. Paul, in his argument, likens himself to a "madman" (2 Cor. 11:23). The word Paul uses here is used in Greek literature to refer to someone who is insane.
Certainly, not every behavior we consider mental illness today was considered a mental illness back then. PTSD or being shell shocked was certainly experienced back then, but it was often described as a form of cowardice (at least by the ancient Greeks).
My point is that Jesus is never described as having a mental disorder. Experiencing tremendous stress, having a "troubled" soul (John 12:27), or having a "very sorrowful" soul (Mark 14:34) does not equal having a mental disorder or a "panic attack."
Consequently, you could say that mental disorders are a subset of "troubled" or "very sorrowful" souls, but you could not say that every "troubled" or "very sorrowful" soul is a mental disorder. Part of the problem today is that many see these two as synonymous.
Luke, the physician laid out a classic presentation of a panic attack in Luke 22. A panic attack in general terms is defined as an intense level of agony or distress that culminates in uncontrollable physical symptoms. A consistent physical symptom of most panic attacks is intense sweating. Luke says that Christ was in extreme agony, so much so that an angel had to be present to strengthen him. Christ was unable, without divine assistance, able to escape from the condition he was in. The agony was so great that he profusely sweated. Very intense panic attacks will create sweat unlike anything most people have seen. It profusely pours off of you. I did not say that Christ suffered a mental illness. I also didn't say that he had a mental disorder, just that he displayed an example of a mental disorder. Christ was in a physical body and he suffered as we do. If prayer was fully sufficient for Christ, why did an angel appear to Him? Why was it sent to strengthen Him?
Elijah suffered, the most classic symptoms of suicidal ideation and a moment of suicidal crisis.
Psalms lays out example of example of classic anxiety.
We shouldn't run from these things. A disorder is not an illness. A mental disorder does not need to be chronic. Unfortunately, many in the church as well as many in the world fail to grasp much of this and view it as pseudo science, or fake, and that mental illness must look like a crazy person running around screaming. Unfortunately too many in church push a narrative that creates shame amongst those who are suffering.
The prime example of a mental disorder laid out in Scripture is Christ's anxiety and panic attack in the Garden of Eden.... We would easily argue that it was in prayer that Christ suffered this. So we need to provide room that some mental disorders and challenges are natural.
I did not say that Christ suffered a mental illness. I also didn't say that he had a mental disorder, just that he displayed an example of a mental disorder.
Nice try. You clearly implied, if not directly stated, that Jesus suffered from a mental disorder.
A panic attack is at the root a natural process that is not operating in a proper space and time.
A panic attack in general terms is defined as an intense level of agony or distress that culminates in uncontrollable physical symptoms. A consistent physical symptom of most panic attacks is intense sweating.
If Jesus experienced an intense level of agony or distress over the prospect of going to the cross, I would say that is the body and mind properly functioning, not an example of a mental disorder (or, the brain functioning improperly).
If Jesus experienced an intense level of agony or distress when going about his day-to-day activities, then that would be a mental disorder. Jesus did not have or experience a mental disorder because his body was perfect and uncorrupted by sin.
Therefore, it is not helpful to your argument to insist Jesus experienced or is an example of someone who suffered a panic attack when he was in the Garden of Gethsemane (not Eden, btw). The agony and distress he suffered in the garden was appropriate and normal for someone who was about to face the untold suffering (physical, emotional, and spiritual) that Jesus experienced on the cross.
That said, I agree with you that the church needs to do a better job in dealing with people who have true mental disorders and illnesses.
....is that mental health generally works on observations, not objective measurements. If you come in to a mental health practicioner with the "baby blues", stress from a personal situation, or organic depression, your first diagnosis is likely to be about the same, "adjustment disorder". It's more or less "something's wrong, but we're not ready to diagnose depression, generalized anxiety, or more. That's what will be put on the billing statements so they get paid. However, it really doesn't tell you much about the ultimate cause, or what the implications might be.
So I don't get worked up about the fact that modern mental health practicioners would diagnose Jesus with something. Everything in mental health is pretty well mixed between things attributable to circumstances, organic issues (e.g. postpartum depression/"baby blues"), and more. DSM does not claim to diagnose sin.
(BTW, David Szweda, agreed that there is clear evidence for use of psychotropics and the like....my point was merely that it was wonderful to see that my untrained relatives had managed to coax two of their number out of acute alcohol abuse, and I've got to wonder if there are a lot of cases in our churches where our brothers and sisters ought to be doing some imitation....)
Aspiring to be a stick in the mud.
My point was not to diagnose Christ with something. It was to point out that the only gospel author who was a physician, placed details in the narrative that were not only elements that this individual was uniquely qualified to state and comment on, but that the details that Luke put in, are classic signs of a panic attack. The second point is that mental health issues do not always need to be a mental illness, defect or something that requires medication. Third that mental health issues are a normal part of being a person that has been impacted by the effects of sin. Whether it is from behavior or from external causes. PTSD is not the result of sinful behaviors. Fourth, that Christ our mediator has suffered and understands our issues in a unique way. Luke made the very specific point that Christ was not able to overcome this intense level of agony, solely through prayer. Luke made the point that Christ's intensity of prayer increased, and yet an angel was sent to comfort Him to help overcome this level of agony. It paints a picture that prayer is critical, but that also help is needed. People are afraid to reach out for help in our churches, because of the messaging they receive, or the lack of relationships, or the inability to voice and frame their problems. We have churches filled with people who are not just struggling spiritually and physically, but mentally as well.
And yes, mental health is based on observation. One of the biggest elements that medical physicians use to base their practice on, is also solely based on observation. Pain. Pain cannot be measured. In fact, it is one of the most studyied elements of health sciences, because it is used to diagnose much, and yet cannot be measured. It may sound simple, but a big break through in measuring pain was the smiling face to sad face chart that you see in doctor's offices.
Bert, I agree that much can be done without a pill. And it is awesome to see your family members overcome addiction in this way. The study of addiction in mental health can even help those who want to fight addiction without the need for meds or medical lockup. With that said, addiction never goes away. It takes a lifetime of battling this. It would be awesome for churches to help in this way and for positive influences from church continue to live into these people's lives to help them during their lifetime of challenges.
Luke made the point that Christ's intensity of prayer increased, and yet an angel was sent to comfort Him to help overcome this level of agony. It paints a picture that prayer is critical, but that also help is needed.
I would be careful to use a debated text as the main biblical support for your position. The originality of verses 22:43-44 is heavily debated.
Even if original, this passage does not downplay the importance and necessity of prayer in facing extreme difficulties in life. The angel's appearance was a direct response to Jesus' prayer and continues a pattern seen throughout Scripture of God strengthening and providing for those who call out to him in prayer. In fact, the Bible never tells us to be self-reliant when it comes to experiencing illness, pain, trauma, or suffering (see James 5:13-16). So, I still find your angel argument unpersuasive.
People are afraid to reach out for help in our churches, because of the messaging they receive, or the lack of relationships, or the inability to voice and frame their problems. We have churches filled with people who are not just struggling spiritually and physically, but mentally as well.
If this is truly the case, then it points to a lack of discipleship taking place within the church (which is an issue!). Even if we can't fully understand what's going on in our brother's or sister's life, we are called to empathize with them, pray for them, strengthen them, and seek to meet whatever needs we can (see Rom. 12:15; 2 Cor. 1:1-4; 1 Thes. 5:14). Certainly, we are not to shame them.
Tom's comment from 12:37 today about not shaming people with difficulties hits home, as all too often, I see people being judgmental regarding people having difficulties. Sometimes it almost seems like a trained response, really.
Aspiring to be a stick in the mud.
Has anyone climbed half dome?
At the top you can stand on the edge of a cliff. It’s 4800 feet down to the valley floor. It’s scary. I couldn’t bring myself to walk to edge. I did crawl up to it, but even that was terrifying. Heart racing and breathing irregular.
I wasn’t having a panic attack. I was panicking.
A panic attack in general terms is defined as an intense level of agony or distress that culminates in uncontrollable physical symptoms.
Yes, but that is only what the symptoms are. The rest of the definition of a panic attack is that the fear and physical reactions happen when there is no real danger or apparent cause for them.
Jesus was facing the wrath of God. So no. Not a panic attack.
Aaron, thank you for your thoughtful article. I also liked what Dgswazeda wrote
The second point is that mental health issues do not always need to be a mental illness, defect or something that requires medication.
I fear that too often we have attached too much of a stigma to the idea of mental health issues. Of course we all need to renew our minds now and then, but some mental responses are actually a sign of good and normal mental health. As Dan pointed out, there are certain fears that are quite rational and there are mental responses that we are created to have. If we get sick to our stomach because of a repulsive smell, that is a mental response, but we should not jump to the conclusion that is sin. If we witness the loss of life from a terrible accident and our hearts are broken because of the love we have for the victims and their loved ones, that is not sinful- I would argue it is righteous. If our minds are strained because we saw God's image bearers mutilated by an accident, that is normal and right. If we grieve when a loved one dies, I would remind us that at the tomb of Lazarus, Jesus wept.
The mind and emotions are complex and I would argue that the ability to feel within is part of the image of God within us. How we deal with all those feelings can be righteous or unrighteous, but we must be careful not to equate emotion with sin.
We also need to consider the physical link to mental health. I have known people who were "not the same" mentally after an accident. I have known people whose hormones were distorted by thyroid imbalance or by simply having had a baby. Having a blood sugar imbalance can effect ones mental health. Although sinful choices and sinfully processing emotions can also contribute to ungodly mental health, we must not conclude that it is the sole reason for someone struggling with mental health issues.
Whether someone is struggling from problems of physical or mental health, we can look at the contributing factors and better understand why a person may respond as they do. This should not excuse any sinful response, but it should help us to show grace. If I know someone is in severe pain and they are a bit impatient with me, I cut them a lot of slack. If I know someone is struggling from nightmares about a war experience or having witnessed death in a terrible accident, I will also cut them a lot of slack. That doesn't mean I excuse sin when it exists. It does however mean that I want to be extra graceful as I address their sin.
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