Mental Illnesses and Worship: Promises and Pitfalls in Preparing for and Practicing Public Worship

Witvliet: We are so grateful for this opportunity to reflect on mental illnesses and public worship. It is our hope that as we reflect on pastoral prayer, preaching, and participation in worship that you will catch a new vision for how we can be the church as one body, including God’s people who live with mental illnesses, those who work devoted to their care, and those who are learning about these deep challenges.

I have asked our presenters to introduce themselves and say why they care so much about mental health and worship.

Holtrop: Currently, I am an interim minister of pastoral care at a church in Grand Rapids. In my journey to ministry, I have always felt called to walk alongside people and to work with them in their difficulties and in their troubles.

I have always had an interest in worship. I helped start the Worship Institute many years ago. The mental health part of it comes from my lived experience of a mental illness—namely, depression. Through that experience of about thirteen years off and on with deep periods of depression, God carved an even deeper path in my heart of empathy and care for people. I regularly do the congregational prayers, or prayers of the people, in our congregation, so I’m very mindful of not only physical illnesses but also illnesses that affect our mind and struggles that people have in general that encompass their emotions and their well-being.

Kinghorn: When I was about twenty-two years old, I left my hometown in South Carolina for the first time—for medical school. I was in Boston at Harvard Medical School. I left behind family, and a girlfriend who’s now my wife, and pretty much everything that was familiar for a place that was exciting and new and challenging and very big. I carried with me an awful lot of expectations and fears of what might happen, and a constant fear that maybe I didn’t really belong here. Maybe if people knew who I really was, I wouldn’t be welcome in this place, and I found that to be incredibly burdensome.

I remember sitting one morning in a sun-splashed sanctuary right off of the Boston Common in a worship service about a couple months after I’d been there, increasingly feeling anxious and down and having a hard time focusing. I remember a hymn we sang that morning that I had never in my life heard before. [singing:]

Children of the heav’nly Father

safely in his bosom gather;

nestling bird nor star in heaven

such a refuge e’er was given.

Neither life nor death shall ever

from the Lord his children sever;

for to them his grace revealing,

he turns sorrow into healing.

—“Children of the Heavenly Father” Berg, LUYH 23, v. 1–2

That for me was a transformative moment. I heard the words of that hymn for the first time and they sunk in, and then I sat in that sanctuary—kind of on the side, not to be noticed—and just cried for the rest of the sermon that reinforced those words, that reinforced that God’s providence and God’s love were not to be separated from each other. I had a deep sense as I stepped out into the sunny day standing on the Boston Common around all these other people that I was known and loved by God—maybe not by many other people in that place, but by God. And that was enough.

Since then, I’ve finished medical school and trained as a psychiatrist and then as a theologian, and I teach in a medical school and divinity school context, trying to be a resource in terms of thinking with the church about healthcare. But for me this question of worship is not just an abstract one; it’s a personal one, because I’ve experienced in worship what it means to be deeply known and loved.

Swinton: I’m a professor in practical theology in the University of Aberdeen. . . . My background is in nursing. I worked for many years as a mental health nurse, and then I worked as a mental health chaplain for a number of years with people moving from institution into community. And then, in the ’90s, I stumbled into theology, and I’m still there, so I quite like it.

But all of my life, I’ve been shaped and formed by being with people with various forms of mental health challenges. If you are with people who see the world differently, eventually you come to see the world differently yourself. My job as a community mental health chaplain was to help people to find a worshiping place—a spiritual place where they could find acceptance and love and begin to enhance their spiritual journey in a different place. Sadly, I found it very difficult to find places for people to be accepted, to be loved, and to come to a space where they would be able to worship freely for the rest of their lives.

It struck me as something really strange, because worship for me is stepping into the presence of God and beginning intentionally to understand who you are, who God is, and who your neighbor is. So the gestures and the rituals we engage in in worship are simply recognitions of something beyond ourselves. . . . It’s whom we use it for and whom it points us to that’s highly significant. Now that moment of intentionality isn’t simply a Sunday morning; it’s something that expands into the whole of our life, and it’s the liturgy of day-to-day life that we should really take very seriously—stepping into the presence of God and intentionally reflecting. If it comes to the case—or if it is the case—where certain of God’s children are excluded from that because of the ways in which we create our worship—the way in which we perform our worship—then there’s something significantly wrong with the body of Christ.

So for me this kind of conversation today is not just about worship; it’s about what it means to be a disciple in the body of Christ. [It’s about] whether or not the body of Christ is broken—if that brokenness actually is reflected in our worship rather than simply healed by our worship.

The second dimension is: I’m a musician. For most of my life I’ve wanted to be a rock-and-roll star. I spent years playing in bands, and I always thought that maybe God had made me for fame and fortune. Turns out he wanted me to be a worship leader. And so all of that formation that I thought was for me turned out to be for God—isn’t that always the case? So I approach worship as someone who is responsible for facilitating and enabling the worship of the people of God, so that dimension—particularly in relation to music—is very important to me.

Witvliet: My training is as a clinical psychologist. I grew up in the church—my father was my pastor growing up—and when you sang “Children of the Heavenly Father,” Warren, that was a very poignant moment for me. That piece has been part of formative worship and my parents’ funerals as well. I’m not a stranger to trauma or to sorrow or to profound loss-shaping experience. I find myself deeply attentive to tell more of the truth, not less. We need to tell the truth about personhood—we are talking about people who live with psychological disorders, people we pray with and worship with. We must robustly understand the nature of what is going on, [the lived experiences of diagnoses,] . . . because it helps us tell more of the truth. But diagnoses must never become a way of totalizing who persons are. Personhood is primary, and we need to realize that in any room where we find ourselves, these issues are with us, right there.

As Warren has said with regard to mental illness and worship, it’s not as though we need to focus on “that person out there somewhere who might wander in [and] who might be dealing with mental illness.” Mental illness is already in the room, right? And yes, we have to be ready to welcome people who do wander in, but we also have to engage those among us here and now and be equipped for that.

So, I think it’s vital for us to reflect on the ways that worship can be welcoming and formative and to give space for the profound range of expressions of human experience and human emotion. I’m so grateful to be part of a congregation that engages with lament every week. The expressions of lament are so important, and they give way to hope. Even if we cannot experience that hope in the moment ourselves, others can carry that hope for us, and worship carries us in the anticipation of the new creation . . . and I think that’s very powerful.

Today we have an opportunity to reflect on public worship, and I’d like to ask each of you to reflect on some of the pastorally constructive ways that we can use language about mental health in worship, in pastoral prayers, in preaching. We could start, perhaps, by thinking about pitfalls, or we could start by thinking about promises. Where would you like to begin?

Pitfalls and Promises

Kinghorn: Let’s start with promises. . . . I think of my own experience about an hour ago, of walking very late across the highway and through a very quiet Calvin College campus on a morning that Charlotte would describe as balmy and I would describe as cold and gray, and [of] turning a corner and seeing this slightly odd-looking building of the chapel, and no one was there, and thinking “I’m not sure I’m in the right place,” and opening the door and being greeted with an incredibly amazing, warm group of people singing this amazing rendition of the creed—walking from this place of what seemed to me a kind of isolation and disorientation into a place where I was being welcomed into something new and different and greater. It left me longing for more.

To me that’s the promise of worship. Worship is not, as Harry Emerson Fosdick once described it, just “personal counseling on a group scale,” . . . and it’s not just a retreat from the world as it is into someplace that’s simply kind of a safe place or a sanctuary. It’s not just a retreat. The temple was not a particularly safe place to be for the Jews, and the upper room was not a particularly safe place to be for the early disciples. Worship is not just about retreat, but it’s about being invited to see the world, to kind of restate something John just said, as it really is, and to allow God to remind us of the world as it really is and to continue to induct us and shape us into God’s image and to God’s glory. To me that’s where we start with worship. It’s not just that we need to name the reality of the brokenness of the world, but also that in worship we are invited to see and to feel and to perform in the world in a different way. That, for me, is really profoundly exciting.

I think along with that, the possibility is that in doing that, we also have to be open to name in absolutely clear and truthful ways the reality of struggle that we go through as human beings and that some of us at any given time are going through in ways that others may not be.

To kind of put another exclamation point on what Charlotte just said, if you think about the prevalence of mental illness in the American population, about forty-five percent of us will experience some form of mental disorder at some point in our lifetimes. If you take just major depression, for example, about twenty percent of us over the course of our lifetimes will experience a major depressive episode. About five percent of us at any given time are depressed. About two to four percent of us live with bipolar disorder, about one percent with schizophrenia, and a lot with substance use disorders and other forms of addiction. So if you’re a worship leader, pastor, or lay leader in a congregation, and you have a congregation of, say, a hundred people that show up on a Sunday, then if your congregation is representative of the population, about five people will be actively depressed. And there will be people, if it’s representative, with psychotic disorders, other diagnoses, and with intellectual disabilities. These people are there, so you can’t get away from it. Either we know that people who are actively experiencing mental illness—which also includes clergy and pastors—are in our worship every single time that we gather, including here at this symposium, or they’re not. Either way we have some reckoning to do.

So if people are present, then we have to live and work with that in mind. If people aren’t present, we have major questions to ask about why not, like, why do people not feel welcome coming into our worship spaces? Either way our worship practices have to acknowledge that at any given time, in any given context in worship, there are people experiencing all of these different forms of mental disorder and also people living with very significant histories of trauma and loss—histories of sexual trauma, of sexual violence, of racialized trauma, and other kinds of things—and we have to be fully aware of that in our worship practices. For me, the promise of worship is the capacity to truthfully name the struggles of this world and to do so in unvarnished ways, in truthful ways that I think psalms can help us with. . . . And truthfully naming this brokenness [in our worship practices] can also gesture toward the remaking of the world that God is actively engaged in.

Holtrop: For me in public worship the ritual was very important—doing things that I knew were going to happen every week, such as confessing my sin, but doing it in a context of the community. Charlotte had mentioned something about carrying hope, and when I was so severely depressed, and I had no hope, someone said to me, “Cindy, we will carry the hope for you,” and when I couldn’t believe or trust or hope it was so important then to worship in community and to hear the people’s confession of faith and to voice my own. During the time that I was depressed, I worshiped at another church for a while because I needed to be in a place where people didn’t say to me each week “How are you, Cindy?” I know they meant it lovingly, but I needed not to have to put on a smiling face. I needed to just be, and if I needed to walk out, I could and no one would really wonder why. When I worshiped at this other church, they had communion each Sunday, and that was very nurturing and healing for me.

When you are struggling, so often your sense of identity is deeply connected to that, so we make sure that somewhere in our worship service we sing or we say the words “God loves you. You are created by God. You are held by God.”

Songs are very important to me—in fact, in my journal I kept a record of songs that comforted me, and I would sometimes include the words and the music in my journal. One of the songs is “You Are Mine,” Haas, LUYH 430 and here are just a few lines from it: “I am hope for all who are hopeless . . . I am strength for all the despairing . . . Do not be afraid; I am with you . . . I love you, and you are mine.” That spoke so deeply to my heart. I think music in public worship can often reach places in us that we didn’t know were hurting and can really touch our inner spirit and move us and heal us in deep and profound ways.

Swinton: I’d like to think about some of the pitfalls, some of the ways in which we can misunderstand the journey that we think we’re on. If we’re thinking about mental health issues, mental health ministry, and mental health in worship, then we need to be quite clear about what we’re talking about. So what is this thing called mental illness or mental health challenges or whatever way we want to express it? One of the things that concerns me in the way I hear religious—and non-religious—people talking about these issues, it’s like people with mental health challenges are some kind of people group like Texans or Scotsmen—as if they’re somehow alien to whoever it is that’s writing or whoever it is that’s talking. And of course that’s ridiculous and you made the point very well that the term “mental illness” doesn’t exist like a table or a chair. It’s a way of naming particular experiences that people are going through.

So if you have a diagnosis, a psychologist or a psychiatrist says we’ll give you a name for it, but that’s all it is. It’s one way of naming experiences. There are multiple different ways in which we can name the same experiences differently in different contexts, in different cultures, in different situations. We don’t have to choose a single name; we can actually have a multitude of different names. So I often wonder whether it is the best way for us to name these experiences within the church or within the academy or wherever you happen to be located, because I get really nervous when people talk about a ministry to the stranger as if you’re not the stranger [too]. We’re all strangers. Scripture is pretty clear on that, so I think the dynamic is warped.

But if you look at the history of naming, . . . the Genesis account of creation says very clearly that Adam is given responsibility to name things. So the animals come up, and he gives them names—a rabbit becomes a rabbit and so on and so forth—but as soon as you give something a name, that’s what it becomes, at least what it becomes in your perception. So the primal responsibility of humans is to name things in the proper way, in a faithful way. And then I was thinking about when Jesus says “I no longer call you servants; I call you friends.” He gives disciples a new name, and what’s that new name? Friends.

So friendship is discipleship. It seems to me that’s profoundly important in relation to mental health issues in general, and particularly in mental health issues in relation to worship because what we’re doing is looking at how our friends can be incorporated effectively into what everyone else is doing, but as friends coming together with friends, as strangers coming together with strangers. If we shift the language a little bit and think, “Well, how can we incorporate somebody with this diagnosis or that diagnosis and the next diagnosis”—as important as these things are, if we shift that conversation to how can we really bring our friends into community or allow our friends to bring us into community, then it’s a different conversation. And what’s important about that is that in terms of the overall conversation around mental health, it means the church brings something unique, it brings something different, it renames something that’s highly stigmatized within a society, and it kind of manifests and embodies a desire to be with people in a way that much of society simply doesn’t want to do. So I think that the language we use and the way we name and the kind of structures that we’re thinking with is then profoundly important for how we worship together.

Importance of Being a Friend

Witvliet: I’d like to ask each of you to think of a story or an instance in which you experienced the friendship, the connection [of] not looking at the “other,” but seeing the belonging—how a worship experience transcended the ways we’re often fragmented.

Swinton: One of my jobs as a community mental health chaplain is working with people coming out of institutional care into the community and trying to find them a spiritual home or a place where they can work effectively or faithfully. I remember one young man who had schizophrenia since he was twelve. When I met him he was probably in his early twenties and . . . for years the warden had tried to get relationships started out for him. So they have various befriending schemes, and eventually he’d got together this couple whom he got along really well with and whom he referred to as friends. But the thing I remember most profoundly [is his saying] to me, “I’m twenty-whatever-it-is years old, and this is the first time I’ve ever had a friend that hasn’t been paid for.” There’s something very, very profound about that.

I worked with him for quite some time, and my job was to help him find a church, and we tried various churches—traditional churches, if you like—and it didn’t quite work for him. But we found a little community church [near] the city center in Aberdeen that was specifically designed to create community. It was quite a diverse community—old people, young people—there were all sorts of people there. So I took him along to that for weeks and weeks, and the first time he went, he’s getting to know everybody, and he said to people, “Hello, I’m a schizophrenic,” and you could just see people’s faces . . . but he was testing them out. (Partly he was testing them out, and partly it was part of his identity, how he thought about himself. But that community actually got past that. I mean, they were nervous because of all sorts of social and cultural connotations over that particular way of naming things.) Eventually, after maybe two or three months, he began to refer to the people in that congregation as his friends, and they began to refer to him as their friend.

What was interesting to me looking back is that his presence shifted that community from simply wanting to include him in the worship to belonging in that community. And he belonged in that community because maybe after a year, possibly, he just left and never went back and that community missed him. You know that you belong if somebody misses you. If there’s a space there that really does belong to you, people will be looking for you there. His presence—and I don’t mean this in a romantic or mystical way—shifted the intentions of that worshiping community so that they opened up a space for him in friendship; that space remained after he left, and there was sadness.

Kinghorn: About ten years ago I was in my residency training, working as a psychiatry resident at a state psychiatric hospital in North Carolina. There was an Ash Wednesday service that was going to happen between two and two thirty in the afternoon in one of the group rooms, and I decided to go. So I took off the white coat that I was wearing at the time, and I went and sat toward the back of a group of about fifty people—about five of us were working at the hospital, and about forty-five were patients at the hospital. The liturgy was led by one of the hospital chaplains. It was a brief service with a reading of Scripture. There was an offering of prayers that were generally things like, “God, be with my daughter while I’m in the hospital,” or “God, give me a place to live when I’m out of the hospital,” and we sang, and then there was the imposition of ashes. I walked forward in line with people for whom I was actively caring as a doctor, and they were my patients, and yet we were there together in line hearing “from dust you came and to dust you shall return” over and over, and I received the ashes.

Then ten minutes later, I was out of the group room and I was back on the unit, and I wondered what in the world had just happened because I feel completely disoriented. I’m no longer sure exactly how I fit into this space. And for me it was because I realized that the kind of professional boundaries and roles that had completely scripted my way of interacting with people were not the deepest truth of the world. That was something that I really, really needed to know.

Witvliet: One of the memories I have right now is of two gentlemen who, for over twenty-five years, have visited classes I teach to talk about their own experiences of living with schizophrenia. Craig Geiser and Stuart Emmons have a book called Living with Schizophrenia. Craig is now working on another book featuring his artwork, and when we talked recently, he brought up again a time he was trying to pray and all he could get out was “Dear God, Amen.” He was feeling bad about his inability to formulate a prayer, and his wise friend Stuart said, “Oh, Craig, that’s a wonderful prayer because the Holy Spirit works through you and perfects our prayer. That’s a wonderful prayer.” This happened decades ago, but Craig has told this story to my students many times and mentioned it last week. He said, “It’s okay when you can’t put together what you think is a good prayer.” [Geiser and Emmons have given me permission to include this story.]

God’s Presence

Holtrop: I have been interested since seminary in the glory of God. In the Old Testament the glory of God indicates his presence. In a sermon I heard around Easter, the pastor talked about the glory of God and his presence being seen in our suffering. Because the suffering can be so dark and so alone, to think about glory being present in my suffering was just deeply moving to me and shaped my thinking in a new way about God’s presence.

During my periods of mental anguish, one of the things that became very important to me is receiving the blessing. Very consciously, I have made it a practice to extend my hand to receive the blessing. When there’s a greeting at the beginning of the service, I extend my hand for that. I want to hold it, I want it to be tangible, and I want God’s blessing resting on me, holding me, and cradling me.

Click on the link for audio recording of the conversation: Mental Health and the Practice of Christian Public Worship: An Exploratory Conversation

We look forward to reading the second part of this conversation in RW 130.