“Prayer Is Fine, but Don’t Then Quickly Move on, as If You’re Done and Dusted”: How Can the Evangelical Church Better Support Those with Mental Illness?

Abstract

There is a long history of holistic responses to mental illness and suffering in many Christian traditions. In recent years, however, there has been growing controversy surrounding the response of the Evangelical Church to mental health. Adopting often literalist interpretations of scripture, these church communities may conflate mental illness exclusively with sin, demons, or diminished faith, thereby inadvertently promoting shaming and voluntaristic notions of psychological suffering. Other church communities, meanwhile, have perhaps over-secularized psychological illness, with neglect to the healing power of faith and community. This empirical paper seeks to contribute toward an open discussion of how the Evangelical Church can both respond to, and support, Christians with mental illness by being both faithful to theological witness and asserting that theological anthropologies must be reexamined from the site of lived experiences of mental illness. Qualitative responses from 309 UK-based evangelical Christians who have experienced some form of mental illness are, in this study, analyzed regarding their views on how the church can best support Christians with mental illness. A thematic analysis suggests that a relational and spiritually sensitive approach is advocated; one that moves beyond dichotomized accounts of psychological suffering as exclusively spiritual or biomedical and toward relational care and valuing of the other.

Keywords:

• Christianity
• Church
• Evangelical
• healing
• psychological suffering
• qualitative
• relational theology

Introduction

In part 1 of this paper, I provide a brief literary and research review on the issue of mental illness in the Evangelical Church before providing detailed information on the methodology employed in this paper. In part 2, I provide a thematic analysis (Braun & Clarke, 2019) drawing upon qualitative responses from 309 UK-based evangelical Christians, in which their views on how the church can best respond to and support those with mental illness are explored. In so doing, this paper seeks to be a resource and a valuable corrective to theological anthropologies, which perpetuate a “dividualizing” of the person. For example, wherein individuals or groups may be reduced to isolated and fragmented components, devoid of life context, meaning, and epistemic justice.

From the outset, however, it is useful to consider and reflect on the term “evangelical”; what this term might capture and mean for this research. Indeed, as Hart (2004) argues, there is perhaps something paradoxical about a religious group (evangelicals) that, while extensively utilized by scholars and practitioners, has yet resisted definition and description. To date, a precise definition of what “evangelical” signifies has been difficult to establish, and it is well-known that evangelical communities comprise a wide spectrum of beliefs and practices (Lancaster et al., 2021). These intra-group differences are also magnified when examining evangelical groups across cultures (e.g., the United Kingdom versus the United States) and pose challenges for research purposes, such as when making claims about certain groups or populations. Significantly for this study, evangelicalism was defined at the trans-denominational level. All participants in this study endorsed Bebbington’s (2003) quadrilateral definition of evangelicalism, namely purporting belief in the Bible as the ultimate authority, in Christ’s atoning death on the cross, in the conversion (“born again”) experience, and in living out the implications of the gospel in one’s life in the world. While a fuller discussion of the complications and controversies surrounding evangelical nomenclature is beyond the remit of this paper, interested readers are recommended to consult, Bebbington (2003), Lancaster et al. (2021), and Naselli et al. (2011) for a fuller discussion.

In my personal experience of the evangelical Christian faith, as well as through my research and that of others,¹ making sense of and remedying psychological suffering may create ongoing conflicts for those of faith and their church community (Swinton, 2020). On the one hand, Christians may be quick to subscribe to spiritual etiologies (the belief that mental illness is caused by demons, sin, diminished faith, or other spiritual causes) and, resultingly, attempt to “pray away” mental illness or suffering. This often has the unfortunate consequence of neglecting relational, social, and wider systemic causes of mental illness (T. Scrutton, 2020b).

On the other hand, some may deem mental illness to be an entirely medical or psychological phenomenon (thus beyond the realms of the church), and quickly refer people to external secular psychiatric services without considering the value of faith and community for recovery and meaning (Lloyd, 2021a). Both spiritual and biomedical explanations, on their own, however, may unwittingly contribute to the bifurcation between evangelical and secular mental health care, frequently reifying the concept of mental illness as an internal entity or problem to be remedied.

This theme has also followed through in my own research, as well as that of others (e.g., Scrutton, 2015). A few years ago, I sat together with a committed evangelical Christian listening to their experiences of mental illness and faith. I asked how they had experienced their church community and their self in relation to that community. I wish I could say that I was in some way surprised by the response, as they remarked: “It’s just all too easy to dismiss it as simply a spiritual problem.”² Sadly, this has become an increasingly common theme in my research over the last few years, and one that I feel still needs to be heard.

While there is now a large body of research on the positive effects of a church community and faith in general on certain mental illnesses (Koenig, 2012; Lloyd et al., 2021), the church community can also be a place of stigma, othering and relational rejection (Stanford, 2007; Swinton, 2020). For people with mental illness in Christian communities, a significant factor in shaping whether faith supports their well-being is the individual and community-wide specific religious beliefs (or what I term “seedling psychologies”³) held about the nature of their suffering; incorporating etiological factors and beliefs regarding recovery, trajectory, or intervention (Leavey, 2010; Leavey et al., 2016; Lloyd & Reid, 2022; Stull et al., 2020). The meaning⁴ of these beliefs and how they are experienced on an idiographic level are also significant, and this is something that my own research (Lloyd, 2021a; Lloyd & Hutchinson, 2022) and that of others (Allan, 2019; Scrutton, 2020b; Swinton, 2020; Waite, 2021; Weaver, 2014; Webb, 2017) has explored and continues to explore.

Theologian John Swinton (2001, p. 82) writes compellingly of such instances: “much of the disablement experienced by people with mental health problems has to do with the social context within which they experience their difficulties, and the destructive web of attitudes, false assumptions, and negative interpretation that people bring to their situation.”

In some of my previous research, I have termed this negative side of church interaction “spiritual reductionism” (Lloyd, 2021a, p. 2,719). This is a phenomenon that may be more likely to occur in Christian communities subscribing to literalist readings of scripture and in which individuals with mental illness have their suffering exclusively associated with spiritual terms or phenomena (such as the demonic), with neglect to immediate relational, psychological, physical, or economic aspects. All too often, such thinking is connected to that which is broadly defined as evangelicalism.

Although an exact definition is contested, evangelicalism is often associated with such readings of mental illness. Evangelicalism refers to a Protestant trans-denominational tradition characterized by four main doctrines with over 600 million global adherents (Pew Research Center, 2015). The main tenets of evangelicalism include belief in the inerrancy of the Bible, a literal interpretation of scripture, an exclusive soteriology through faith in Jesus Christ, and the importance of converting nonbelievers to this theological perspective through a personalized process of regeneration and renewal (i.e., being “born again”) (Bebbington, 2003). Considering their theology, evangelicals may sometimes conceptualize mental health as vertically representative of their spiritual life or, in other words, that the individual’s spiritual condition correlates with their physical and mental health (Lloyd & Panagopoulos, 2022). Growing empirical research continues to shed light on these processes and their effects on Christians with mental illness. Chiefly, the research at present suggests that understandings of mental distress as solely demonic in origin, or as the result of sin and divine punishment (Scrutton, 2015), may pathologize and stigmatize a vulnerable population (Weaver, 2014) and render individuals culpable for their mental suffering (Webb, 2015, 2017).

Within such a milieu, individuals with psychological distress may have their lived experiences invalidated or ignored (Lloyd, 2021a). In our recent qualitative study with over 200 hundred Christians (Lloyd & Hutchinson, 2022), we found that evangelicals with lived experience of psychological ill-health frequently reported being socially ostracized and relationally disconnected from their fellow believers due to their mental illness. As such, the evangelical worldview in which mental illness is seen as the result of sinful living may be particularly detrimental as it encourages believers to seek a spiritual solution in isolation and to be dismissive of alternative secular interventions. However, in the results of the study, a degree of nuance emerged whereby spiritual explanations and interventions were also experienced as sometimes helpful in alleviating suffering. This conceivably highlights the limitations of anti-spiritualization narratives, which in many ways can be seen to contribute further to a dichotomized view of mental illness (secular versus spiritual).

Within this context, this study seeks to explore how the Evangelical Church can potentially change and contribute to a positive and nurturing context for those suffering from mental illness. This study asserts that theological anthropologies can be helpfully enriched by examining the phenomenology of experience first-hand, and hence by seeking the experiences of evangelical Christians with mental illness, in their own words and terms. Accordingly, this paper seeks to necessarily move beyond dualistic terms, instead aiming to open up dialogue and begin to offer some practical and pragmatic pointers for community change, from the perspective of those with mental illness.

Method

Research design overview

A qualitative online survey design was used to capture the views, experiences, and recommendations of evangelical Christians concerning the ways the church community could best support those with mental illness. In view of the paucity of qualitative studies⁵ exploring the first-hand lived experiences of Christians with mental illness, an inductive thematic approach, rather than the delineation of cause and effect variables, was considered most appropriate (Swinton & Mowat, 2016; Willig & Rogers, 2017). Qualitative studies are particularly valuable in understudied topics as they permit a deeper understanding of experiences, phenomena, and context that may not otherwise be available through quantitative examination.

According to Braun et al. (2021, p. 3): “qualitative surveys offer one thing that is fairly unique within qualitative data collection methods—a “wide-angle lens” on the topic of interest that provides the potential to capture a diversity of perspectives, experiences, or sense-making.” Accordingly, this study draws on research data collected through an online survey, including a singular open-ended question, to capture participant experiences (Willig & Rogers, 2017).

Ontology and epistemology

Morrow (2005) suggests that qualitative researchers make explicit the philosophical assumptions or paradigms that ground their research. The present study is embedded within a contextualist epistemological framework, which appreciates the notion and importance of identifying “truths,” perspectives, or experiences—but also recognizes the deeply socially mediated nature of knowledge. Hence, understanding can never be dislocated from the individual, social, and spiritual milieu in which they are held.

Reflexive statement

In qualitative research, the researcher is understood not as a value-free medium through which to collect data or truth but, rather, as a socially embedded individual who brings their own experiences, values, and assumptions to the research endeavor (Swinton, 2001).

Consequently, it is necessary that researchers acknowledge their own assumptions and values, and how these might lead to a co-construction of knowledge. This process, termed “reflexivity,” refers to the ability to direct one’s awareness onto one’s own self by encouraging transparency and self-reflection and, in so doing, allowing the reader of a given text the ability to readily discern the assumptions and direction the writer may have taken. As a reflective qualitative researcher and psychologist, I am aware of the need to reflect on my own motivation for conducting this research, as well as my experiences of engagement with the data. I was raised in a Pentecostal Evangelical Christian home and grew up with direct and intimate knowledge and experience of this faith community. My childhood experiences of faith emphasized the mystical and spiritual realm in a way I now feel represents an extreme and unhelpful response⁶; especially regarding the subject of human suffering. As an academic and psychologist, I now conduct research that aims to bridge the gap between the two historically antithetical fields (Bergin, 1991). My aim is to support a holistic understanding of mental health for both the secular and Christian communities and, in so doing, contribute to the dissolution of false dichotomies (e.g., moving away from viewing psychological suffering only in binary terms). I bring this background and motivation to the current project.

Study participants

Participants were drawn from a larger convenience sample of 446 self-identified evangelical Christians who had previously taken part in an anonymous online mixed methods survey concerning their views of mental illness and experiences within the church (Lloyd & Hutchinson, 2022; Lloyd & Waller, 2020). In this original survey, participants were asked a singular, open-ended question: “Is there anything your church could do differently to support people with their mental illness?” Of the 446 total participants, 49 (11%) responded “no,” and 397 (89%) responded “yes.” Of those who responded “yes,” 309 (78%) elected to provide a free-text qualitative response. Of this final sample, the majority (73%) were female, with (27%) identifying as male.⁷ Participants were from a wide age range (18–84 years). All participants were residing within the UK, with the majority attending church/religious services regularly (45% once per week; 43% more than once per week; 5% once or twice a month; 4% a few times a year; 3% seldom/never). These questions were assessed using multiple-choice answers.

For study inclusion, all respondents were required to self-identify within the evangelical tradition (e.g., Bebbington, 2003), with a further free text option given to sub-identify by denomination. Results showed that 32% identified as “other,” 29% identified as Anglican, 16% identified as Baptist, 14% identified as Charismatic, and 3% as non-denominational. 6% opted not to disclose this information.

For this study, evangelical identification was operationalized at the trans-denominational level of belief system and practice, with denominational affiliation such as “Pentecostal” (evangelical identification, with added emphasis on the power and role of the Holy Spirit) subsumed under this. All participants were provided with the following four statements to determine evangelical identification before beginning the study. These statements were derived from Bebbington’s (2003) operationalization of evangelical.

Please read the following five statements, which provide an accepted definition of evangelical(ism). Do you broadly agree with these four statements?

• The Bible is the highest authority for what I believe.

• It is very important for me personally to encourage non-Christians to trust Jesus Christ as their Savior.

• Jesus Christ’s death on the cross is the only sacrifice that could remove the penalty of my sin.

• Only those who trust in Jesus Christ alone as their Savior receive God’s free gift of eternal salvation.

Participant recruitment

A survey weblink was disseminated via faith-based social media platforms, namely The Mind & Soul Foundation Facebook page and other open-access faith-based groups, with the following text:

I am currently running an online study to learn more about the diverse ways in which churches respond to mental health issues. Full study information is provided on the link below. Please take part if:

• You are 18 years +

• You self-identify as an Evangelical Christian (definition provided in study materials)

• You have experienced mental distress/illness (i.e., anxiety, depression or more enduring and severe types).

The full text of the survey included items pertaining to demographics, denomination, and church attendance, in addition to experiences of mental illness and experiences within church communities. The survey received full university ethical approval from the University of Oxford (SAME_C1A_18_024). All participants were fully briefed on the nature of the study, including their rights to withdraw from the study up to two weeks after having completed the survey. No participants were provided with compensation for taking part. To be eligible for participation, participants were required to be 18 years or older, to self-identify as evangelical (e.g., Bebbington, 2003), and to identify as having previously experienced or to be currently experiencing mental illness (broadly defined as anxiety, depression, or more enduring categories of mental illness). Experience of mental illness was assessed using an open-ended qualitative text question: “Have you ever experienced a mental health condition? This does not necessarily have to be diagnosed (although it can be) and can include undiagnosed conditions, such as anxiety or depression or more severe and enduring types.”

Data collection was hosted by a secure online server between the period December 2018 to May 2019. Participants were able to provide as much detail as they wished in their responses, with length of responses varying from shorter (10–90 words, n = 282), medium (91–200 words, n = 24), and longer (201–500 words, n = 3). All results were extracted, anonymized, and securely stored after the survey had closed.

Data analysis

All data were downloaded into NVivo 12, a software developed for the coding and analysis of large volumes of qualitative data, and were analyzed using Braun and Clarke’s reflexive thematic analysis (2019) (RTA), which involves six stages of coding and theme elaboration. As RTA is theoretically flexible, it can be applied to inform either data- or theory-driven analysis. Braun and Clarke (2019) highlight the need for researchers to explicitly state their theoretical assumptions and approach to RTA. Thus, the analytic approach taken in this study was inductive or, in other words, led by what emerged following the analysis of the narrative accounts. This can be seen to contrast with a deductive, or theory-driven, approach whereby knowledge of literature and research dictates the direction of analysis. CL began by reading and re-reading the data, making note of any initial analytic observations (RTA phase 1). A process of systematic data coding then followed involving identifying significant features of the data (phase 2), which were pooled together into tentative codes under higher-level themes (phase 3). Example codes at this stage included: “accepting people without pushing for change,” “normalizing psychological illness,” and “offering more than prayer.” These codes were grouped in relation to narrative overlap, with some subsumed under new higher-level themes. This stage was not linear and involved several layers of revisiting and refinement (phases 4 & 5), as well as reflective discussions with a member of the clergy who was not involved in the study and who has considerable experience in pastoral care. These reflective discussions functioned as a form of independent validation or, as Swinton (2001, p. 109) acknowledges: “…enable[d] the researcher to reflect on and monitor his or her own prejudices.” Following a process of review and refinement (phases 4 and 5), four main themes were generated. Writing this paper constituted the final phase (6) of analysis and involved selecting illustrative data extracts, as well as the weaving together of theme definitions (5) and other analytic notes into a coherent analytic narrative. Spelling errors in the data have been corrected to aid readability and comprehension.

Results

Four main themes emerged from analysis of the participants’ extracts, which directly tapped into participants’ suggestions for improving the response of the Evangelical Church to mental illness. These themes are summarized in Table 1.

Table 1. Theme table.

Is there anything your church could do differently to support people with their mental illness?
1) Addressing Mental Health Stigma Through Education
A) Increasing Church Teaching on Mental Health
B) Normalizing Psychological Distress
C) More Training for Church Leaders
2) Implementing Relational Care that Supports Spiritual and Secular Integration
A) Formal Support Group and Safe Spaces
B) Accepting People with Mental Health Difficulties into Church Life
C) Provision of Christian Counseling with Referral Points
3) Encouraging Authentic Theological Witness Amidst Suffering
A) Moving Away from Spiritual Reductionism
B) Revisiting Biblical Teaching in Light of Suffering

Addressing mental health stigma through education

141 participants explicitly described the need for the Evangelical Church to begin addressing mental health stigma. Suggested strategies for this were varied but frequently centered around the need for education and explicit church teaching as a means to begin to dismantle stigmatized attitudes and responses to those with mental health needs within the life of the church.

Increasing church teaching on mental health

A core theme present across a significant proportion of participant responses was the suggestion that the Evangelical Church seems to lack explicit church teaching on the more complex issues in life, such as mental illness. For many, this void was felt to contribute directly to stigma because the church was considered to lack any explicit teaching or framework in this regard, as some participants shared:

There is a lack of knowledge about mental health in many of the churches that I’ve attended. I think that education and workshops about the interface between mental health and faith would be beneficial.

Be open about mental illness, focusing on biblical teachings applicable to the range of human emotional responses.

A core theme within this suggestion for improved education was the proposal that teaching on mental illness be integrated into routine sermons to have the most impact:

I think providing information for EVERYONE, not just those who are willing to give up time to join courses, but it should be more integrated into sermon series and series on caring for the church.

Other participants also reported a desire for their church communities to provide explicit teaching on mental health directly through preaching and sermons:

They could also say the right things from the platform to de-stigmatise mental illness.

I believe more direct teaching about it would help with any stigma attached to mental illness and help address the sense of failure, especially in those who it [mental illness] is not expected.

As seen in the above excerpts, participants reported that a core and significant improvement in the church’s response to mental illness would come about through increased teaching and discussion.

Normalizing psychological illness

Interwoven with the need for more explicit discussion and teaching, many participants felt that the symbiotic effect resulting from discussing mental health and illness more openly in church teaching, would have the consequence of increased acceptance of the prevalence, and often deeply human experience, of mental illness:

Put into real practice the view that mental illness is part of being human.

It was also suggested that a stronger integration of biblical teaching would go some way to normalizing illness and reducing stigma:

Teach about sadness and depression from the Bible. The psalms are full of the range of emotions not just joyful and triumphant but often depressed and doubting too.

More emphasis should be made on the fact that Christians are by no means immune from these conditions, and that if anything it can be harder to live with them because of your faith.

Acknowledge it. Say it is out there and that it is a real condition which Christians face. Too often it is all love, positivity and nice sermons.

Many participants felt that, while increased church discussion brought tangible improvement, there also needed to be an explanatory framework in place that made it possible to understand that it is possible to live with mental illness as a Christian and, hence, that it is conceivable to be both a faithful Christian and to experience mental suffering. For all participants, it was reported that this would lead to a helpful normalization of mental illness.

More training for church leaders

Set within the broader suggestion of increased education around mental health was also an acknowledgment that church leaders or clergy should undergo mental health-specific training so as to support and equip the church community with this knowledge and understanding:

From my experience, the church generally backs away from mental illness and needs to provide appropriate support and training for those in leadership.

Pastors/Vicars should receive more training and be more open about it in sermons and the general life of the church.

Tantamount to this, it was generally reported by participants that increased training for church leaders on mental health issues would directly contribute to church teaching on mental health, thus improving understanding and openness, and reducing stigma.

Clergy should have mandatory trainings on mental illness…

Training of clergy on mental health and a systematic teaching about mental health to the church.

I would love to see church leaders training to be better able to recognize and minister to those suffering from mental illness.

Implementing relational care that supports spiritual and secular integration

One hundred seventy-five participants voiced the need for ground-level changes in pastoral care toward those with mental health needs. Many felt that these changes would also helpfully coincide with greater integration between church and faith-based support services—including Christian counseling—but also, where necessary, referral to specialist mental health services.

Formal support group and safe spaces

One recurring theme for many participants was the suggestion that church communities establish and embed dedicated mental health support groups. It was felt that these groups would afford church members empathy, dialogue, and an open space in which to share their difficulties:

Some sort of support group for those in the church with mental illness. I think discipleship with others who can empathise through shared experience is a very powerful thing in helping people to come to terms with and live with a mental health condition.

While these support groups could enable relational support between members, participants felt they could also be adapted to Christian groups by including biblical material or teaching on mental wellness from a Christian perspective:

To my knowledge, there is no Christian CBT groups or support groups in my area. Paul told us to take every thought captive and I think self-help programs ran by the church would be good.

I think that maybe groups to get together with other people at church who also identify themselves as struggling with mental health issues would help defeat some of the feeling that “I” am the only one. At times it can be easy to look at the outside, and feel that everyone else “has it together.” I know this is not true, simply from talking to people- and this is why I have remained in one church for so long, simply because I have come to know people’s stories. I think that facilitating this process helps, as it would be a safe place to do so.

Accepting people with mental health difficulties into church life

Developing and nurturing spaces for Christians with lived experience of mental illness, such as support groups, was only one form of relational support that participants felt could be improved. Beyond this, participants sensed a wider culture shift was needed toward a deeper level of inclusion in church life for those who suffer from mental illness. For many, this involved explicitly inviting those with mental illness into church decision-making:

Get feedback from those in the congregation who have mental health issues and let them be the lead in their recovery, doing it at their pace, not the pace that the church wants them to go.

The desire for Christians with mental illness to be included in church life also extended to formal positions of responsibility, whereby church members with mental illness could be actively witnessed to be taking part in, and to contributing to, church life:

Genuinely include people in responsibilities within the church accommodating for them in their different levels of ability so that they feel included.

People with mental health issues should not necessarily be excluded from serving in the church.

For many, a relationally sensitive approach was advocated, which included core conditions such as acceptance of the person beyond their suffering:

Just stand alongside us. Even when it’s hard for you don’t know what to do. Knowing that there are people on your side who want to help no matter what and want to see you mentally and spiritually healthy changes everything. Support, prayer, fighting alongside a person, empathy, and non-judgmental attitudes go a very long way. We want to feel included and understood just like your average person, not isolated and unwanted because of the struggles we face. The church can help tremendously if it’s the right source of true community with a focus on meeting people where they are in all of their brokenness but loving them enough not to leave them there. Show the gospel in the church. Don’t just preach it.

Provision of Christian counseling with referral points

A final suggestion for improved relational care and support within the church was one that rooted Christian counseling services into routine church life:

I think churches should provide someone who has counselling training who could listen, in a non-judgmental manner, to anyone who needs to talk, and if necessary, refer a person to more formal treatment if needed.

Embrace the counselling service instead of seeing us as a bunch of untrained advisors. Use qualified therapists, not people who just “have a go”—insist that people have certified or accredited evidence-based practice.

Participants also voiced a need for church communities to recognize when help was needed beyond the church. Participants critiqued pastors and faith leaders who they felt were offering counseling to church members on a lay basis and without formal training. Instead, participants voiced a need for churches to refer to external professional counseling services when necessary:

Stop trying to give counselling if you’re a pastor and leave it to the professionals. At least put really clear boundaries in place from the start which state what sort of pastoral care you are giving and insist that if they don’t seek professional counselling there will be an end date to the pastoral help so as not to cause further damage.

Encourage referral to the NHS, not just Christian therapy.

Encouraging authentic theological witness amid suffering

Beyond practical suggestions for improving the church’s response to mental illness were suggestions for deeper changes in attitudes or theology in the Evangelical Church, which were felt necessary to allow people with mental illness to live authentically in their Christian faith amid suffering or struggle. 180 participants made suggestions aimed at countering what they perceived to be more negative aspects of evangelical theology.

Moving away from spiritual reductionism

A dominant theme reoccurring in participants’ narratives was the suggestion that Evangelical churches move away from solely spiritual explanations for mental illness. For many, these explanations risked overstating possible spiritual factors, while minimizing context and lived experience, and were sometimes felt to be pathogenic in and of themselves, as participants shared:

Don’t assume everything is primarily a result of spiritual warfare. It can be further traumatizing.

Numerous participants reported experiencing a “spiritual warfare” interpretation of their mental illness from their church community. This seemed to be especially unhelpful if used to explain away or “move on” from the person’s suffering:

Prayer is fine, but don’t then quickly move on, as if you’re done and dusted—it’s highly unlikely the depressed/anxious feelings will have just evaporated, if the person is unwell…

For others, these explanations often served to perpetuate negative self-belief, as one participant shared:

Not make you feel like there is something wrong with your faith if you suffer from one [mental illness].

Altogether, it was often the exclusive focus on spiritual aspects, and the expectation of healing through “deliverance” as the only solution, that rendered other forms of healing invisible:

Not put so much emphasis on deliverance as being the only answer. A holistic approach is necessary. More emphasis needs to be put on the emotional and neurological side.

Stop triumphalist teaching which suggests that if our faith is strong enough, we’ll be at peace. It’s not that simple.

It can be helped with prayer but also people need to know how to support people who are suffering by befriending them and not pushing them to change. Often these conditions are long-term and not easily fixable but they are not as the result of sin or failure. It is the church’s duty to love and encourage but not to judge or try to fix.

Revisiting biblical teaching in light of suffering

In light of these negative aspects of evangelical theology, such as the view that mental illness was tantamount to the demonic, participants called for an urgent revisit of the underlying beliefs and practices connected with mental illness in the church. One participant, in particular, felt that mental illness should not be framed within the church as always solvable through a quick prayer and without the need for further support:

Don’t ignore mental illness as if it doesn’t exist nor suggest that a prayer at the back of a service will fix everything immediately.

For other participants, greater attention to biblical models of human suffering was felt to offer a potential remedy to solely spiritual accounts of mental illness:

A greater Biblical understanding of suffering and sin and God’s grace to inform our interactions with people. All this would provide a more welcoming and realistic basis for relationships within church.

Likewise, richer accounts of mental illness interwoven with theology were desired:

Teach about sadness and depression from the Bible.

Churches can become more trauma-informed and really look hard at why they believe Scripture says what they think it says-does it really?

The Bible is very clear about mental health in principle, however, the lines begin to blur when we start to combat emotional pain/intrusive thoughts with direct things like quoting scriptures at it or praying harder etc which “could” make things worse, rather than working through the root causes of things with a counsellor. Furthermore, people start to think what “should” I be thinking about this situation/person, what would be the Christian response to this, rather than allowing themselves to actually feel what the situation/person presents.

Bible study on Saints suffering illness such as Jonah/Moses/Paul/Jesus in Gethsemane etc.

Discussion

By utilizing a qualitative methodology, this paper has taken an “expert by experience” approach, placing Christians with lived experience of mental illness at the center of the dialogue regarding how the church can best support change for Christians wishing to live authentically with mental illness. Three recommendations for change emerged, which centered on the following three interrelated areas: countering mental health stigma through education, offering relational support and referral, and moving away from solely spiritual accounts. Below, some of the particular recommendations that emerged from the qualitative analysis are summarized, in relation to existing theory or literature.

Using education to combat reductive theologies

Emerging strongly from the participants’ accounts was the need for more focused, deliberate, and regular teaching and education regarding mental illness in the life of the church. Many participants voiced either a total absence of teaching in the area of mental health or teaching that conflated mental illness with negative spiritual influences.

In particular, participants expressed the need for both increased teaching on mental illness through the perspective of faith; faith from the pulpit but also through more formal workshops and training. It was felt that both of these initiatives would provide an increased normalization of mental illness and combat mental health stigma derived from beliefs that mental illness is the exclusive manifestation of sin, demons, or other negative spiritual influences. These findings are not necessarily surprising, considering existing research in this area suggesting that evangelical communities may readily conflate common experiences of mental distress or illness as tantamount to a sign of demonic infiltration, sin, or lack of faith (Lloyd, 2021a; Lloyd & Panagopoulos, 2022; A. P. Scrutton, 2020a; Swinton, 2020). As one participant remarked: “Don’t assume everything is primarily a result of spiritual warfare. It can be further traumatizing.” Swinton (2020, p. 78) refers to such accounts of mental illness as “spiritual thinning” or “lazy theodicy,” in that the complexities and nuances of mental illness may be reduced to “ill-thought-through” explanations that readily shift the focus of responsibility onto the person with mental illness (e.g., if you only prayed more, you would feel better.) Likewise, they also echo remarks from Arrandale (1999, p. 200), who cautioned some Christian communities to “move away from the military metaphor to … developing a new approach to the language we use about mental illness, … we may at least begin to overcome the prevailing negative world-view which surrounds people who experience mental health problems.” Suggestions from theologians regarding the need for change in how churches discuss and convey experiences of mental illness are also supported by wider interdisciplinary research from the social sciences. Increasing research has shown the negative impact such theology can hold for Christians with mental illness, often leading to further relational disconnection and stigma (Lloyd & Hutchinson, 2022), as well as reduced help-seeking (Lloyd et al., 2021; Wesselmann et al., 2015), when individuals with mental illness are blamed, demonized, or othered for their suffering.

As an antidote to reductive theologies of mental illness, participants wished for church teaching and preaching that normalized experiences of mental illness or distress by drawing upon biblical examples of despair, suffering, and emotional pain. As one participant vividly remarked: “Teach about sadness and depression from the Bible. The psalms are full of the range of emotions not just joyful and triumphant but often depressed and doubting too.” The experiences of participants in this study seem to resonate with the work of Brueggemann (2002), who in his “The Spirituality of the Psalms,” highlights how the psalms were intended to structure, narrate, and scaffold meaning in the world—especially during times of suffering. He discusses that some Psalms, in particular Psalms of Lament, were anticipated to function therapeutically by enabling people to make sense of, or re-narrate, their suffering in light of their faith. Similarly, in the present study, many participants wished for a shift in dialogue, from a place of mental illness being rendered as incompatible with faithful Christian living and necessitating healing (often through spiritual means), toward a place of living an authentic Christian life in spite of pain or illness.

Intersecting closely with the call for a reimagination of the language of mental illness within the church life was a call for more church leaders to receive training in mental health issues. Many reported that having church leaders who received formal training on mental health issues would create immediate change in how mental health was approached.

While the provision of deeper education on mental health literacy may be limited by resource limits within some church settings. At the time of writing, there are growing numbers of organizations offering training exclusively focused on mental health and faith (e.g., Mind & Soul Foundation, Think Twice, Sanctuary Ministries). Such resources are likely also to be supported by Christian counseling, which integrates spiritual and secular insights to create psychological interventions rooted in faith, e.g., religiously focused cognitive behavioral therapy (Pearce et al., 2015). Such treatments are significant in that they may offer an important bridge between the often bifurcated evangelical and secular clinical settings, thus avoiding the potential pitfalls of discarding either the beneficial role of faith for well-being or psychotherapeutic intervention. As research suggests that evangelical Christians who report more literal beliefs—such as belief in demons or sin as causative agents in mental illness—are less likely to seek psychological support (Lloyd et al., 2021), knowledge of the existence of these interventions is vital for shaping communities’ attitudes and responses toward mental illness and facilitating attitudes toward change.

Being with rather than doing to

As one participant poignantly remarked: “Prayer is fine, but don’t then quickly move on, as if you’re done and dusted—it’s highly unlikely the depressed or anxious feelings will have just evaporated if the person is unwell…” For many participants in this study, there was a general unease with the church’s response, which they felt negated practical nurture and care of the other. Arrandale (1999) speaks of the need for Christian communities to journey alongside those who experience mental illness, rather than to demonize or diminish their experiences as needing to be resolved. Likewise, Swinton (2020) promotes the need for epistemic and epistemological justice and generosity, whereby Christians with lived experience of mental illness are truly listened to on their own terms and without having explanatory models thrust upon them.

Within this study, while excessively spiritualized theologies of mental illness promoting shaming or voluntaristic notions of mental illness were felt to be unhelpful by participants, increased relational care and nurture were felt to have a regenerating impact and offered an antidote. Many participants spoke of the basic need for support groups, in which Christians could share their experiences in a safe space without judgment, or the need to necessarily take spiritual action to remedy negative experiences. Swinton (2020, p. 213) has framed the importance of such groups, as sites through which Christians may experience testimonial healing: “testimonial healing occurs when a person is freed to give his or her testimony in all its fullness without fear of judgment and retribution.” Likewise, he writes testimonial healing (p. 210): “… has the potential to bring about the holy articulation of pain and sadness, which leads to a sense of shared belonging in the midst of brokenness.” For many participants in this study, education through formal workshops—alongside the provision of religiously syntonic counseling services within church settings that also referred to outside services when necessary (e.g., the NHS)—was felt to be vital. Existing research in this area suggests that there has historically been a divide between evangelical communities and secular mental health care (Cook et al., 2011), which has been characterized by mutual antipathy (Lloyd & Waller, 2020). This, however, has shifted in recent years. Some research suggests that Evangelical churches and, in particular, Evangelical church leaders, have significant potential to act as frontline mental health workers by supporting the way mental illness is discursively positioned, and by practically encouraging church members to engage in external care when needed (Heseltine-Carp & Hoskins, 2020).

Study limitations and further research

While this study has provided some qualitative data from the lived experiences of evangelical Christians with mental illness, there are some limitations.

Firstly, a foundational theological question at the heart of this study is the authority of human experience. Evangelical theologies maintain a clear hierarchy of authority in which not all human experience (for example, non-heterosexual identity) has legitimate theological standing (Bacote et al., 2004). This article does not tackle theological questions such as these but acknowledges that they naturally arise from the analysis of the survey results. This article may well, therefore, prompt further theological work from evangelical Christians wishing to respond to these experiences and themes.

In addition, as documented previously, evangelical communities comprise a wide spectrum of beliefs and practices (Lancaster et al., 2021) and this poses challenges as to operationalizing definitions of key terms such as “evangelicalism” or “evangelical” for research purposes. Furthermore, church structures vary notably, both intra-and interdenominationally, and this has implications in terms of doctrine and interpretation, and the coalescing thereof. Accordingly, this study does not claim to capture or represent the whole evangelical spectrum of belief but, rather, to offer a localized snapshot of some evangelical Christians in the UK.

Additionally, the data taken from this study was part of a larger online research survey. While it is well recognized that online surveys are helpful in gathering the perspective of participants, relatively little can be verified about the characteristics of those participants who completed the survey. Furthermore, given that the large majority of this study’s participants were female (73%), it would be fruitful for further research to begin to focus on male perspectives in this area.

Lastly, while the survey helpfully generated qualitative data concerning participants’ experiences of their mental distress in relation to their church communities, further qualitative studies may be useful to build upon the initial themes of interest generated through this qualitative survey: Specifically, what form good spiritual interventions for mental illness may take in evangelical communities. Both traditional qualitative methods—such as surveys, interviews, and focus groups—would be useful in this respect. Of further use would be more novel forms of qualitative data collection, including the story completion task, which can be beneficially used for accessing implicit social assumptions and discourses around stigmatized topics or populations (Lloyd, 2021b, 2023; Lloyd et al., 2022; Lloyd & Panagopoulos, 2022).

Ethical statement

This project received full university ethical clearance. The author abided fully by the Ethics Guidelines for Internet-mediated Research (BPS, 2017) and the British Psychological Society’s Code of Human Research Ethics (2014).

Acknowledgements

I am grateful to all the participants who openly and authentically shared their experiences for this study. I would also like to thank Dr. Jonathan Jong for supporting the earlier ethical approval process, as well as Reverend Peter Needham for providing both a listening ear to my analytic reflections and a place of balance, in which I could seek perspective.

Declaration of interest

The author declares no conflicts of interest.

Notes

1 See Brock and Swinton (2012); Cook and Hamley (2020); Greene-McCreight (2015); Scrutton (2020a); Swinton (2020); Weaver (2014); Webb (2017).

2 Interested readers can refer to my papers here, which document the process of these interviews and findings (Lloyd, 2021a; Lloyd & Hutchinson, 2022; Lloyd & Panagopoulos, 2022; Lloyd & Waller, 2020).

3 “Seedling psychologies” refer to ontological statements or beliefs surrounding the reality of mental illness. This may include beliefs surrounding what mental illness is, possible aetiological factors, and what might constitute viable treatment options (Hartog & Gow, 2005; Lloyd & Waller, 2020). These beliefs may be individually and/or community located and often stem from deeper theological teaching regarding what it means to be human and to experience suffering. For example, some Christian communities may believe that mental illness exists as a spiritual phenomenon while others may believe in biopsychosocial origins, or a combination of spiritual and biopsychosocial explanations. These beliefs may alter how mental illness is conceptualised, talked about, and remedied.

4 It is vital to consider the “meaning” a belief or experience holds for individuals rather than judging externally. For example, for some, medical or psychological explanations may make the most sense, whereas for others, spiritual narratives may be most helpful.

5 It should be noted that there is a small number of qualitative doctoral theses in this area, e.g., Allan (2019) and Waite (2021).

6 It is not my intention here to argue for, or against belief in demonic forces or agents. While I retain a belief in the demonic, and other spiritual forces, my concern here is more their function and consequence when applied unilaterally to all experiences of mental illness. Historically, I think evangelical Christian circles have at times labelled mental suffering, as exclusively caused by spiritual factors, while minimizing or disregarding the role of social, physical and economic drivers. For example, where mental illness is conceptualised as demonic in origin and other lifestyle factors, such as relationships, beliefs about self and others, trauma, economic status, to name just a few, are not explored.

7 That the majority of participants were female (73%) is not necessarily surprizing. Firstly, it is widely recognized that more woman attend church than men (Pew Research Center, 2016). Consequently, it can be inferred that more woman were eligible to take part in this survey. Another explanation may be that women are known to participate more in online surveys (Smith, 2009).