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Warren Kinghorn on Mental Illness and Our Deepest Identity

We hear a lot about using person-first language. Yet it is still common to label people with their mental health diagnosis. Christians and churches can offer another way to describe our common human identity.

Warren Kinghorn teaches pastoral and moral theology at Duke University Medical Center and Duke Divinity School in Durham, North Carolina. He codirects the Theology, Medicine, and Culture Initiative at Duke Divinity School and is a staff psychiatrist at the Durham VA Medical Center. In this edited conversation, Kinghorn talks about how to walk alongside a person living with mental illness.

What’s a helpful way for Christians and churches to talk about mental illness?

I find the wayfarer image helpful for understanding how Christians relate to healthcare. We are all fellow humans and wayfarers on a journey home to God. We come from God, our Creator, and return to God, our goal, to know and enjoy God forever.

This contrasts with the modern medical model, which only sees individuals as broken minds or broken bodies that need fixing. The medical model gives hopes and expectations that healthcare can’t always live up to. This focus makes us not see the context of a person’s life and community.

Don’t our minds and bodies sometimes need fixing?

Absolutely. But we need to ask what a person with mental illness needs right now. It might be medicine, therapy, a job, getting out of an abusive relationship, a safe place to live, a hug, or a casserole. We can’t explore this without seeing not just a diagnosis but a wayfarer with a history, goals, and aspirations, a person embedded in a community.

When we use words like depression, bipolar, obsessive compulsive, schizophrenia—how do we do so helpfully, in ways that lead to helpful healing responses and a way forward? Sometimes naming a diagnosis can lead someone away from a place they deeply don’t want to be. But, sometimes—even if someone seems to meet the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)—naming a diagnosis can ignore the person’s context.

What’s an example?

The diagnosis of major depressive order covers very broad territory. Some depression results from a biological change that comes out of nowhere. Poverty, threats, homelessness, or other enormous stresses can make people depressed. Other people who meet the DSM criteria for major depression may deal with chronic loss or illness or be survivors of trauma. If the clinician sees the diagnosis as only addressable by medication, then the diagnosis can close off options that may have led to healing.

There is a spectrum from unipolar major depression to mixed states to bipolar disorders. Sometimes medication can be very helpful to stabilize moods. From there, treatment can offer a way forward. But if the clinician simply makes a diagnosis and writes a prescription, without addressing core context issues, that’s not helpful. There’s not just one response that works for everyone with the same diagnostic label.

But are there general principles that can help a person or church walk alongside someone with a mental illness?

Our response to mental illness ought always to support a person’s agency—that is, the ability to make choices and take actions. We need to ask how we can encourage a person’s ability to act as a person in the world and to live with wholeness. Sometimes, when we are struggling, we need encouragement and support. At other times we need allies to fight the stigma of mental illness. And sometimes it means we need boundaries, limits, and consequences for non-helpful behaviors. Also, we can try to avoid us/them language. The categories—such as “we” who are not mentally ill helping “them” who are—always blur and change over time. "We" who help are also "we" who need help.

Christian theology and stories offer more than modern medicine does for thinking deeply about what it means to be human and flourish in the world. People with mental illness deserve and need our care, because Christ is in and with people who are sick, mentally ill, or dying.

How does your advice apply to people with dementia?

As dementia progresses, we can focus less on restoring the sense of being an active self and more on holding that person’s identity in trust. When dementia obscures someone’s sense of self, we—as families, churches, communities, and, ultimately, God—collectively hold their selfhood. The person we used to engage with doesn’t seem to be there. It’s appropriate to name and mourn that loss. But it’s not helpful to say that the person has disappeared or is just a shell or a vegetable. That person still has dignity and identity in community and in God.

The modern belief is that we are basically minds that inhabit bodies. Christians can offer an alternative narrative. Even when any of us no longer can express ourselves or act as individual selves in the world, God still knows us by name, claims us, and loves us.