How Pastors Can Be Mental Health Advocates
Clergy are often the real front door for many people of faith seeking help for mental health disorders like OCD. How can they best care for those in their care?
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In this article, Justin Hughes, a Licensed Professional Counselor who specializes in OCD and Anxiety Disorders, unpacks one of the most stigmatizing mental health disorders: OCD, and uses it as an example to help pastors—and those who care for the spiritual health of sufferers—better understand the complexity, needs, and opportunities that mental health disorders present. For more BioLogos faith-based mental health resources, consider checking out our Mental Health resources landing page here.
Faith leaders are the real front door to mental health. Even though doctors and hospitals are attributed this designation, more people feel most comfortable talking about mental health issues with their spiritual leaders, even exclusively. Research has shown that people seek them out 50% more than doctors or psychiatrists to help alleviate mental and emotional problems.
Leaders may find this challenging to navigate, especially when they are expected to be a “one-stop-shop” for all problems. Crisis and emergent situations come up often for clergy. Without training as a clinician, they may feel lacking. Confidentiality is also a common source of concern. Further, there isn’t a real pipeline for communication between clinicians and clergy; it is weak at best.
Health clinicians tend to overlook the faith concerns of their patients. As a result, providers may miss out on giving holistic care that honors the significance of spirituality in a patient’s life—even if unintentional. Amid these challenges, there is a great need and opportunity for pastors to collaborate with mental health providers like myself. Our professions serve well when we work together to alleviate suffering and help people grow. The number of people struggling with mental health issues has increased. It is time for change. Working together is an opportunity to care for body, mind, and spirit.
Health clinicians tend to overlook faith concerns of their patients. Providers may miss out on providing holistic care that honors the significance of spirituality in a patient’s life—even if unintentional.
As a Christian and mental health professional who specializes in OCD and anxiety disorders, I care not just for those who suffer, but for their community around them. Families, friends, and spiritual leaders commonly feel lost when it comes to this confusing disorder. They may want to help but not know where to start. Sadly, some with good intentions may over-spiritualize things and discourage those who need help from seeking proper treatment.
In this piece, I want to unpack one of the most stigmatizing mental health disorders: OCD. More importantly, I want to use this as an example to help pastors—and those who care for the spiritual health of sufferers—better understand the complexity, needs, and opportunities that mental health disorders present.
What is OCD?
Obsessive Compulsive Disorder (OCD) is a mental health disorder characterized by three parts. First, Obsessions are intrusive and unwanted thoughts, urges, or impulses that cause marked distress or anxiety. They are recurrent & persistent. Obsessions take many forms, ranging from contamination to the fear of disobeying God. Scrupulosity is the subtype of OCD that centers on themes of faith, spirituality, and morality.
Secondly, compulsions, or rituals, are attempts to avoid, suppress, ignore, or neutralize distress or anxiety caused by obsessions. Overt behaviors and thoughts (“mental acts”) can be involved. The final part is the disruption to a person’s life, thus “disorder.”
OCD is most likely to begin by puberty or young adulthood. The cause is unknown—though there are some associations (genetics, trauma, bacterial infection like strep, and other correlations). About 2.3% of people in the world today could be diagnosed with OCD at some point in their lifetime (186 million out of 8 billion population). Untreated, it causes some of the most severe disability in the world, beating out most medical diseases.
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Despite fascinating science and powerful already-established methods, if you go to a therapist, it is hit or miss trying to find someone trained in OCD…Additionally, when people with OCD seek out faith leaders, responses are also mixed. We need more integrative care and collaboration between clinicians and their spiritual leaders, which can lead to better health outcomes.
Clinical History of OCD
Various biological causes for OCD were suggested by 1860. Wild claims were made, but the best guesses were the autonomic nervous system or cortical blood supply. Interestingly, some old considerations are being renewed through neuroscience. For instance, we now know that cortical blood flow differs in OCD versus healthy controls, and dedicated brain regions are involved.
Psychiatry “took a stab” at treating OCD before the mid-twentieth century. Freud had good observations of “obsessional neurosis” (in 1909) but offered no effective treatment. Fast forward to the 1970s when one of the most effective mental health therapies ever was developed: Exposure and Response Prevention. By the 1980s, ERP was fully formed, and helpful medications were also first being used—decades later than many other first treatments. OCD’s “dark ages” were over.
Today, lives have been vastly improved with almost 50 years of scientific know-how. We also know more about the biological basis for OCD. A recently discovered protein, dubbed “Immuno-moodulin” (Imood), might hold the keys to treating OCD. This fascinating discovery points to the immune system rather than the nervous system as a possible culprit and focus of treatment. Anxious mice relax when this protein is blocked. People with OCD have 10 times the Imood compared with non-OCD patients.
Despite fascinating science and powerful already-established methods, if you go to a therapist, it is hit or miss trying to find someone trained in OCD. In clinical settings, people commonly receive supportive psychotherapy, which is excellent for grief and other challenges but usually terrible for OCD. Anything that spends too much time playing with obsessions leads to more entanglement in them.
Additionally, when people with OCD seek out faith leaders, responses are also mixed. We need more integrative care and collaboration between clinicians and their spiritual leaders, which can lead to better health outcomes. It may be surprising to learn that many church leaders have led the way when it comes to OCD.
It may be surprising to learn that many church leaders have led the way when it comes to OCD.
Church History of OCD
Clergy were some of the first to catalog obsessions and rituals. Extraordinarily, Christian clergy also appear to be the first documented “front-line workers” helping people with OCD, writing about their attempts. St. Ignatius of Loyola, the founder of the Jesuit order, described urges to confess, write, and re-check things like confession, only to feel more uncertain after doing so. He also developed intrusive urges to harm himself. Many Christians likely had OCD, including Martin Luther, St. Therese of Lisieux, John Bunyan, and Hannah Allen.
Many in history linked such forms of suffering to demons. Importantly, misconceptions about OCD not only existed in the Church but also medicine and psychology. Clergy first called intrusive obsessions scruples. Later, religious melancholy (or just melancholy) was applied to everything from spiritual discouragement to depression to OCD to phobias. By the time of the Enlightenment, observations paved the way for specific guidance, at times closely mirroring treatment today. For example, an Anglican clergyman and author, Jeremy Taylor, developed “5 Rules” that offered guidance on moving forward from an illogical scruple and even counseled medical care.
Giovanni Battista Scaramelli, a Jesuit spiritual writer, offered outstanding advice to act despite scruples, and he approximated steps in current treatment. Richard Baxter, the English Puritan leader, cautioned against drinking away problems and suggested specifics in what type of community to surround oneself with and gain care from a physician. The confessor, Alphonsus Liguori, guided sufferers of scruples to “act in doubt” following a “competent and holy director.”
If church leaders were instrumental in helping with OCD in the early days, why not so much today? There is too much of a tendency to respond with reductionism and judgment. Sadly, responses like “What’s wrong with your faith?” or “Do you have any unconfessed sin?” are more frequent than questions like “How can I help you?” or “What do you need?” The widespread practices in both medicine and the church are sadly still astray. I believe the time is ripe for pastors and spiritual leaders to step up.
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…consider helping someone get started in discovery and education about mental health disorders like OCD. You can also locate a referral to a mental health professional or encourage them to find one. Help to normalize this—talk about how common it is, and if applicable, how you’ve utilized the help of various support yourself.
How Pastors Can Help
But how exactly can pastors or spiritual leaders help people suffering from OCD or other mental health issues? One way you can start is by asking questions. Consider the simple, straightforward question to someone who is suffering: “Have you ever been diagnosed with any disorder or OCD? If not, do you suspect it?” You may already have some excellent observations you can offer as a question: “Your attention to doing the right thing (morality, prayer, responsibility) is commendable—I can tell you care. It seems that these can cross into hypervigilance, guilt, fear, or shame and don’t seem to result in joy or hope. Why do you think that is?”
Beyond these initial steps, consider helping someone get started in discovery and education about mental health disorders like OCD. You can also locate a referral to a mental health professional or encourage them to find one. Help to normalize this—talk about how common it is, and if applicable, how you’ve utilized the help of various support yourself. Lastly, take joy in helping, knowing you are already doing so much!
Of course, a holistic view of a person includes the biological, psychological, social, and spiritual. My field of medical and mental health providers has done a very poor job of collaborating with faith leaders. It’s high time we worked with faith leaders and acknowledged their key role.
Working together will better meet the needs of those with OCD, and other mental health disorders. I’m seeing increasing firsthand examples of people on every side who are instrumental in helping. What happens when someone with OCD seeks help? It’s thrilling to hear people say, “Even though they didn’t know everything to say, I have been shown grace and love at every step of the journey.”
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At BioLogos, “gracious dialogue” means demonstrating the grace of Christ as we dialogue together about the tough issues of science and faith.
About the author
Justin K Hughes
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