I served for 15 years as a pastor in several church settings, then spent five years in the counseling world, and now I’m back in the church / pastoring world again. One thing I’ve taken back into the church world from my counseling experience is an understanding that undiagnosed mental illness plays a big role in all-too-many “problem situations” and “problem people” in churches today.
I’ve seen people get by with outrageously manipulative behavior in churches, because pastors and fellow church members are trying to be “nice.” At the same time, I’ve also seen an amazing lack of compassion for people who struggle with things like depression or ADHD, because people expect them to “snap out of it.”
I believe that many pastors struggle to know how to deal with certain difficult situations, and more training and understanding of mental illness could help them. They are trying to be godly and compassionate, but they may actually be making problems worse by the way they give attention to — and therefore reinforce — dysfunctional patterns. Or else they might ignore people altogether because they don’t know how to deal with them.
In learning about mental disorders and how to help people move past them, we can learn excellent ways of communicating, interpreting, and relating with others. This is not just about helping people who have a mental illness; this is about helping people with emotional struggles as a whole, something which we can all benefit from. The steps needed to help someone who has been clinically diagnosed with Narcisstic Personality Disorder, for instance, are steps that would greatly assist anyone with strong insecurities in general.
Real “church” happens when people come together, without barriers amongst one another, to grow with God. When there are “problem people” who cause strife and anxiety, this interrupts the cohesion needed for a healthy church to function. Asking these people to leave the church, before making a serious effort to help them, is not what God calls us to do. Ignoring these people and their needs means the problem persists and the church is not able to do what it is supposed to. Learning the characteristics of these mental disorders and using this knowledge to help others is what we must do to create and preserve a good church.
Here is a quick primer with an overview of some of the mental disorders that show up in churches. The descriptions of these disorders have been created by mixing and blending the language from a variety of sources (identified at the end of this article).
Relatively Common Mental Disorders in Churches
ADHD or attention-deficit hyperactivity disorder - is a condition characterized by serious difficulties with attention and hyperactivity. The challenges brought on by ADHD vary from difficulty focusing on simple conversations to excessively losing track of details at work. Symptoms according to the U.S. National Institute of Mental Health include:
- Being easily distracted, missing details, forgetting things, and frequently switching from one activity to another
- Having difficulty maintaining focus on one task
- Becoming bored with a task after only a few minutes, unless doing something enjoyable
- Having difficulty focusing attention on organizing and completing a task, learning something new, or trouble completing and turning in homework assignments
The vast majority of people exhibit these behaviors to some extent. Some medical professionals are concerned this disorder is being overdiagnosed because of how common the symptoms are. The key distinction is that people with ADHD experience these issues to such a degree that it seriously and consistently hinders their ability to engage in day-to-day life.
Bipolar disorder or bipolar affective disorder - Also known as manic–depressive disorder or manic depression – bipolar disorder is a condition in which common emotions are magnified to an unhealthy and destructive level. Those with bipolar disorder go in and out of a state known as “mania”- periods of frenzied high energy- and will typically experience depression as well.
At the lowest degree, people with bipolar disorder can be energetic and excitable, and may sometimes be highly productive. In more severe cases, individuals are erratic and impulsive, often making bad decisions because of unrealistic ideas about themselves and the world around them. At the highest level, individuals can experience psychosis, in which they hold very distorted beliefs about the world.
A common symptom of bipolar disorder is to wildly swing between periods of mania and depression, with these phases lasting anywhere from days to months. In some cases, both of these states are experienced at the same time, hence the term “manic depression”.
Borderline personality disorder (BPD) - a condition characterized by instability, recklessness and impulsiveness in relationships, behavior, self-image, and moods. People with BPD typically can’t stand being alone, but their relationships with others are very dramatic and stressful. They behave recklessly and can tend to: abuse drugs, have unsafe sex, go on manic shopping sprees, etc. Sometimes people with BPD will hurt themselves, or attempt suicide.
People with BPD have extreme mood swings, feeling very confident or positive one day and then very negative the next. Despite these mood swings, people with this disorder usually feel consistently empty and angry.
BPD usually develops during adolescence and early adulthood, often in response to early life trauma or deprivation. This can make it difficult to spot early on, because of how tumultuous that phase of life can be in the first place.
Depression / major depressive disorder (MDD) - People with clinical depression feel bad, in every way. They lose confidence, feel “trapped” or hopeless, lack direction in day to day activities and overall life decisions, and feel consistently drained and tired. They lose interest in activities they used to find very enjoyable, and stop acquiring new skills or hobbies.
The term “depression” is imprecise and sometimes used to describe a low mood, or general unhappiness. Diagnosable depression runs deeper, and therapists distinguish problematic depression in two categories:
Major Depressive Disorder is not simply “feeling bad”. It is a mental condition tied directly to a neurological dysfunction. When affected with clinical depression, the brain has significantly less neurotransmitter activity. This means the brain’s neurons aren’t communicating with each other as much as they typically should. This is why depression affects so many aspects of a person’s life; the entire brain is slowed down. Clinical depression can last anywhere from months to years.
Histrionic personality disorder (HPD) - This disorder is characterized by an excessive and inappropriate need for approval. People with HPD are highly emotional and constantly seek attention from others. This tends to result in overly dramatic, energetic, and/or flirtatious behavior that ends up hurting them and the people around them.
People with HPD often are initially perceived as happy and enthusiastic. But they are, in fact, deeply troubled, with an extreme need for attention and validation from others. In the majority of cases, this disorder is found in people with above-average appearance, and it affects four times more women than men. People with HPD have strong feelings of dependency, are apt to make inappropriate scenes, and exaggerate their feelings and actions.
(Of the disorders mentioned so far, HPD is probably the least common in churches. I mention it, however, because it seems to show up in pastors of large churches more often than you’d think.)
Narcissistic personality disorder (NPD) - This is a disorder in which a person is constantly grappling with insecurities related to vanity, personal self-worth, and power. Because of these insecurities, the person puts on a false – and excessive – display of arrogance, disrespect and/or superiority over others.
People with NPD often act in ways that are similar to those who are very confident and secure with themselves. The difference between the two is the underlying root of these behaviors. A healthy, confident person acts the way she does because she truly believes in herself; a narcissist will act overly confident because she does not believe in herself at all. Narcissists have a low self-esteem, and since they compensate for this by belittling or demonstrating superiority over others, they are unable to handle even the slightest criticism.
Less common Mental Disorders in Churches
Paranoid personality disorder (PPD) - Paranoia is characterized by a long-standing and all-encompassing distrust of other people. Those affected will habitually interpret the intentions of others as insulting, malicious, or otherwise threatening. This applies to serious life choices made by others, and to things as small as off-handed comments and remarks.
People with PPD have an unusual way of relating to the world. On the one hand they never acknowledge the irrationality of their unjustified suspicions, but at the same time they do not lose touch with reality completely. Instead, they have a warped view of the world, as they constantly go through life searching for any validation for their fears and distrust. They do not open up and confide with others for fear of rejection or betrayal, even if they have someone who has proven to be very trustworthy. They are simply unable to not be suspicious. If left untreated, these individuals will build up unwarranted resentments and anger for an excessive length of time.
Schizophrenia - This disorder is characterized by a breakdown of thought processes into incoherence and irrationality. Schizophrenics often have hallucinations. These typically manifest themselves as imaginary voices, but visual hallucinations have been observed as well. More common is delusional thinking and perceptions about the world. These delusions frequently concern the person’s safety and imagined threats.
Over a long enough time-span, schizophrenics will experience disorganized thinking and speech. This breakdown ranges from losing one’s train of thought, to the extreme cases of “word salad,” in which a person will simply blurt out random words with no connection of meaning or structure. It is common to see social withdrawl, decreased motivation and ambitions, degradation of hygiene, and impaired judgment in schizophrenics. Emotional capacity starts to waver as well. The individual might have unusual or inappropriate emotional responses to events and developments in life, or have difficulty processing and feeling emotions altogether.
American Psychiatric Association (psychiatry.org)
American Psychological Association (apa.org)
Mayo Clinic (mayoclinic.com)
Psychology Today (psychologytoday.org)