Starting the Conversation

madness and grace

Pastoral Care and Serious Mental Illness

Excerpted From

Madness & Grace

By Matthew Stanford

While a majority of those living with serious mental illness and their family members believe that churches should talk more openly about mental illness, more than 60 percent of Protestant pastors report rarely or never speaking about the topic in sermons or large group meetings. Sadly, only 12 percent of church leaders feel that mental illness is openly discussed in a healthy way within their congregations.

As a pastoral counselor, you have the opportunity to help your church’s clergy and ministry staff develop a safe and accepting environment for those living with serious mental illness. Below are suggestions for simple changes you can promote that will help start a conversation about mental illness within your faith community.

• Pray collectively during the service each week for those who are struggling with a mental disorder. Use the actual names of the disorders during the prayer (e.g., depression, schizophrenia, bipolar disorder).

• Prepare sermons that acknowledge the struggles experienced by those living with mental illness and their families.

• Invite a member of the church who has struggled with mental illness to share his testimony with the congregation.

• Place brochures and other sources of information regarding mental illness and available mental health resources in the back of the church, in the bulletin, or in the pews.

• Invite mental health professionals to speak or offer seminars on topics like suicide or addiction at the church.

While a senior pastor or elder board may initially be resistant to some of these suggestions, they are unlikely to refuse all of them. Do what you can. It’s all about starting a conversation. Experience shows us that once a conversation starts, most pastors and churches become receptive to changes.

USING LIFE-GIVING WORDS

One way to eliminate the stigma related to mental illness is to carefully choose our words when describing mental health conditions and the people who live with them. We can choose to speak words that give life or words that shame.

Stigmatizing language brings shame. Its purpose is to minimize, disgrace, or dehumanize someone in order to justify inaction and lack of compassion. Derogatory terms such as “crazy,” “nuts,” “psycho,” and “loony” constitute stigmatizing language and have unfortunately become part of everyday lingo. These terms express contempt and disrespect toward individuals living with mental illness, even if the words are not being spoken directly to them; they simply should not be used. Using mental health terms to explain everyday individual quirks or behaviors that are common to many—for example, using “OCD” to describe someone who is organized or “anorexic” to depict a woman who is thin—is also stigmatizing. Such mental health clichés minimize the severity of mental disorders and further confuse people’s limited understanding of these complex conditions.

When speaking of those who have been legitimately diagnosed with mental health conditions, always put the person first, not the illness. For instance, do not use language that defines people according to their diagnoses, such as, “He’s schizophrenic” or “She is a bipolar.” A person is far more than a diagnosis. Instead say, “He has been diagnosed with schizophrenia” or “She is living with bipolar disorder.” Likewise, when talking about a suicide, do not say that a person “committed suicide.” The word “committed” suggests that the individual performed a reasoned and rational act, much like if someone has “committed a crime” or “committed a sin.” Rather, say that the individual “died by suicide.” In situations in which it was commonly known that the person was struggling with a diagnosed mental disorder, it may also be appropriate to say that the death resulted from the disorder. For example, “he died as a result of depression” or “her death was the result of bipolar disorder.”

As a pastoral counselor, you can help educate your congregation and ministry staff in the best language to use when talking about mental illness.

ACTIVE LISTENING

Listening is perhaps the most important communication skill you can develop to enhance the effectiveness of your pastoral counseling ministry. While it is not uncommon to be more focused on what you are going to say next than on what the speaker is currently saying, this listening approach is simply not useful within the counseling environment. The goal of listening, for the pastoral counselor, should be to fully understand the distressed individual’s situation while offering support and empathy. This approach is referred to as active listening. Active listening makes the speaker feel heard and valued. The following are tips to help you improve your active listening skills.

Pay Attention. Silence all technology and move away from any external distractions. Quiet your internal dialogue. It is impossible to actively listen to someone else and your own inner voice at the same time. Focus on what is being said rather than on what you want to say. Do not be preparing your reply while the other person is speaking. If you are truly paying attention, you should be able to accurately repeat the speaker’s last sentence.

Be Aware of Nonverbal Behavior. “Listen” to the speaker’s tone of voice and body language to pick up on unspoken emotions and hidden meanings. Nonverbal behaviors, such as facial expressions, can often tell you more than words.

Demonstrate That You Are Listening. Make eye contact while the other person is speaking. Use body language and gestures to show that you are engaged. Lean in toward the other person, keeping your posture open and inviting. Avoid folding your arms, as this signals that you are not listening. Nod occasionally and encourage the speaker to continue by making small verbal comments such as “yes” and “uh-huh.”

Paraphrase. Rather than offering advice or opinions, reflect back what has been said. You might start this off by saying, “What I’m hearing is . . .” or “In other words, what you are saying is . . .” Restating key points you have heard and asking whether they are accurate is an easy way to avoid misunderstanding and clarify any confusion.

Be Okay with Silence. Allow moments of silence to resolve naturally. You don’t always have to reply or make a comment to keep the dialogue going. A break in the conversation can give everyone an opportunity to collect their thoughts.

Show Interest by Asking Questions. Open-ended questions (e.g., “What do you think about . . . ?” or “Tell me about . . .”) are an important part of active listening. They encourage self-reflection and problem-solving. Closed (yes-or-no) questions, on the other hand, tend to shut down the conversation, so avoid these. Always allow the speaker to finish a point before asking a question.

VALIDATE—AFFIRM—RECONCILE

When an individual is struggling with severe psychological distress, his ability to effectively process information is altered. This disruption of thought can result in confusion, poor self-awareness, and the misinterpretation of words and actions. In this state, the person is more likely to react from emotion than respond out of reason, making communication difficult and extremely frustrating. Trying to correct or logically convince the person of your point will likely increase his agitation and escalate the situation. A better approach for communicating with those in distress is to connect with them emotionally using the Validate-Affirm-Reconcile method described below.

Validate. Instead of focusing on the accuracy of the words they are saying, determine the specific emotions they are feeling (e.g., fear, sadness). Appeal to their hearts with love rather than to their minds with reason. Reflect their feelings back to them and validate the emotions they are experiencing (e.g., “I can see that you are frightened, and I appreciate why you are feeling that way”). It is not important that you agree with their words or feelings, but only that you validate their emotional experience.

Affirm. To counter the feelings of isolation and rejection that the person may be experiencing, affirm the individual as a person of faith in Christ and as a valued friend, family member, or congregant (e.g., “God cares about what you are going through. You are important to me, and I want to help you get through this”). Reassuring people that they are cared for and loved despite their present circumstances will promote a sense of acceptance and emotional safety.

Reconcile. Offer the person an opportunity for reconciliation by providing the grace necessary to find a point of common ground (e.g., “I know we don’t have all the answers right now, but I will walk through this with you and we can find the answers together along the way”). Suggest practical solutions that might give the individual opportunities to improve her present situation. The goal is to build hope and restore harmony to the relationship.

Matthew S. Stanford is CEO of the Hope and Healing Center & Institute in Houston and adjunct professor of psychiatry at Baylor College of Medicine. 

Excerpted from Madness & Grace: A Practical Guide to Pastoral Care and Serious Mental Illness by Matthew Stanford. Copyright 2021. Published by Templeton Press. Used by permission.

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