'What's Wrong with Him?'

Look around you. At work, at church. Chances are very good you'll see someone who's battling mental illness. Maybe you only need to look as far as the other side of the bed. … or the mirror.

Many Christians don't figure that mental illness could affect their marriages. But it does—in about the same proportions as with the general population. Each year, more than one in five Americans suffers from a clearly diagnosable mental disorder. And, Christian therapists add, more couples need to confront the whole issue rather than assume it's solely a spiritual problem.

Psychiatrist Ken Phillips treats many Christians who at one time thought the combination of a solid faith and a solid marriage made them invulnerable to mental illness. Phillips is founder and medical director of Alliance Clinical Associates, a Christian mental health center in Wheaton, Illinois. He points to three red flags in determining whether a person needs psychological help: degree, or severity, of the problem; duration of the problem; and level of disability inflicted.

To examine the issue of mental illness in Christian marriage, MP looks at the true stories of three people: Dennis, Linda, and Maggie.

Dennis' story

Dennis and his wife, Pat, had worked for much of their adult lives as missionaries in the Caribbean, where they ran a Christian radio station. After years of service, the time came to close and sell the station.

At about that time, Dennis started feeling strange pains. He'd battled chronic back trouble for years, but this was different. Now the pain had spread. His stomach and abdomen hurt. His arms and hands tingled sometimes. His skin was flush on his face, neck, and chest. Sleep was hard to come by. Some days, the pain was so bad he couldn't sit up for more than ten minutes at a time.

Two neurologists came up with no definite answers but prescribed various pain medications. When those created more problems than they solved, Dennis was hospitalized to straighten out his medications. Soon he felt better and went home. A month later he was back in the hospital.

This time, a third neurologist, who doubled as a psychiatrist, saw him.

"He took one look at me and he said, 'You're depressed,'" Dennis says.

Pat had suspected something, especially since things got worse physically for Dennis as the radio station didn't sell.

"I saw some indications that it was partially psychological," she says, "but you don't tell your husband, 'I think it's all in your head.' He appeared to be handling it well, but internalized a lot of things."

"I didn't feel depressed," Dennis says. "I didn't consider my work stressful, but obviously it is."

Dennis was sent back to the United States for psychiatric treatment. Through counseling and a period of medication, his physical and emotional problems leveled out.

Today, life isn't pain-free for Dennis. The back problem remains, and there's no guarantee he won't become depressed again. But he and Pat see the warning signs much more clearly now. Physical pain might mean there's something going on emotionally.

Dennis' illness might be an extreme example, but it fits Phillips's admonition to recognize when an unexplained condition interferes with normal life routines. It might be a symptom as simple as having chronic trouble getting to work on time or taking too many sick days.

When symptoms like these interfere with a normal routine, that's when you start to think a more serious condition needs to be looked into and treated, Phillips says.

Linda's story

Linda had been a single parent for twelve years before remarrying. The adjustment from being the single head of a household to sharing those responsibilities jolted her, though she didn't realize it immediately. Attending a new church and making new friends brought more stress.

One weekend pushed Linda over the edge. Her husband was away on a business trip, her daughter was home from college for the first time, and an intense rainstorm had flooded part of her house. When her daughter awakened her at midnight to tell her about a car problem, the dam broke.

"I had a hot feeling. It started at the top of my head and went all the way to my toes, and it tingled," she remembers. "I didn't know if something was shutting down inside or what. I tried to stay calm and not scare my daughter, and I think that aggravated it."

Linda was experiencing a panic attack. Hyperventilating, she was rushed to the hospital. "I thought they were going to open up my chest and pull my heart out and pump it," she says.

Emergency room doctors told Linda there was nothing physically wrong. But the experience sounded an alarm for her and her husband: She needed psychological help.

"It put me into the shock of asking, 'What am I doing to myself internally from all the stress I wear on the outside?" she says. "I guess I'm one of those people who doesn't want to admit that it is depression. But I believe it was probably there a lot longer than when I first acknowledged it."

Not everyone with a mental illness receives an indicator as unmistakable as a panic attack, but Phillips mentions other signs. Simple discouragement isn't necessarily clinical depression, but watch closely if it's paired with physical symptoms, such as insomnia, appetite change, weight loss or gain, drop in energy level, or change in sex drive, for more than a couple of weeks.

Maggie's story

Maggie and John enjoyed a happy marriage. Through several moves to various parts of the country with John's sales job, they had adjusted easily. But after the last move, from the sunny South to the frozen upper Midwest, Maggie got the blues.

Deep feelings of sadness, sometimes mixed with anger, began dominating her days. She wasn't sure why. "Coming up here was the first time I realized I was depressed," she says. "It seemed like any time I came in the front door that grief was just waiting for me."

Being a Christian kept Maggie from seeking clinical help right away. "I would tell myself that there were people who had it so much worse off than I did, and that I have a good marriage and the children are doing well," she says. "My husband is a kind and giving man, a good provider, and a good father, so I was thinking that I didn't have a right to be depressed. So I kind of ignored it."

Long winters with short days were the worst times. John traveled more in this new location, too, leaving Maggie feeling abandoned. Their new church offered a counseling program, and she eventually made an appointment. The counselor suspected serious depression and referred her to a psychologist, who confirmed that suspicion. Contributing to her depression were low self-esteem and seasonal affective disorder.

Maggie's case is common: When the blues don't go away, but spiral deeper, it indicates that a person needs help. "If someone gets distressed," Phillips says, "and that distress lasts for two weeks or more, we start thinking about a condition that is taking on a life of its own." And it may need treatment.

"That's not to say they won't recover without it," Phillips says, "or that it's not understandable. But it is to say they might be able to cope better if they had treatment."

Confronting a spouse

Phillips believes too many Christian couples ignore warning signs and wait for a crisis before seeking counseling. That's no different, he says, than neglecting regular car maintenance and then wondering why it suddenly breaks down on the expressway.

Measuring a spouse's problem in terms of degree, duration, and disability will help determine how serious it is. And of course, angry outbursts or abuse—emotional or physical—need immediate, outside attention.

Often when there is something wrong, only the "well" spouse initially sees it. Phillips advises that person to take action.

"A lot of times," he says, "someone will call me and say, 'I think my husband's got a problem, but he doesn't want to come in.' I'll say, 'Why don't you ask him to come in with you, so the two of you can have a checkup together?' That way, you're saying to your spouse, 'I think you're sick, but would you please help me out. Maybe this is my problem.' That way, it's 'we' instead of 'you.' "

If your spouse is in denial about his or her problem—especially an addiction—Phillips advocates the biblical model for discipline.

"Sometimes it involves getting a few trusted people together—whether that's a couple of family members, a couple's small group, or a few trusted friends—and with one voice, saying to the person, 'We're concerned about you. You don't seem yourself.' Or, 'We're worried about what we're seeing in you. Will you please have an evaluation? We want to support you.' "

This requires trust and tact—and doing things in the biblical order.

"People get into trouble when they talk to others before they talk to their spouse," Phillips says. For instance, talking to parents, in-laws, or friends about a spouse's problem can erode trust in a marriage.

"I'm not saying that you never share things with parents or others," Phillips says. "But to make a habit of bad-mouthing your spouse can be pretty destructive."

Knowing if there's been mental illness in your or your spouse's family may provide early warnings of danger. There's strong evidence that mental illness does run in families.

Your spouse's personal history factors in even more heavily. If your new husband was clinically depressed four times before you married him, the fact that you're in his life now and he's happy is no guarantee it won't happen again, Phillips says. Neither does mental illness's occurrence before someone became a Christian make the person invulnerable after.

Sometimes, especially if a spouse is unwilling to seek help, drastic measures may be required. In cases of addiction and/or abuse, that may mean separation. Keep in mind there's a big difference between separation and divorce.

Phillips says, "Sometimes we have supervised separations, under the eye of a pastor or a counselor, while they're working to improve their marriage. Sometimes if it's a severe situation, separation can be the only thing that gets the attention of the abusing spouse."

Is all of this biblical?

Wait a minute. Doesn't the Bible tell Christians to trust God with their problems? Doesn't getting psychological help, let alone mood-altering drugs, mean we're not praying like we should or trusting God enough?

Phillips doesn't see an either/or conflict here.

"I try to see these as two sides of the same coin," he says. "Satan can use a significant medical condition to bring spiritual discouragement. And certainly we pray for God's help in that, and for the medicine and the doctor, and for our attitude. I see things like medication as instruments of God's grace."

People like Linda have heard many "spiritual" reasons from well-meaning Christians about why not to seek medical help for mental or emotional struggles. She counters that God also gave us discernment and medicine. After all, Christians see a doctor when they're physically sick. Why should an emotional illness be any different?

"I'm upset at people who think you shouldn't get help," she says. "Too often, people don't admit their weaknesses or accept that they've hit a speed bump they need to get over—whether it's their own or in their marriage. I think it's very critical to admit a weakness that Satan's attacking and allow it to be cared for by a professional."

Not that counseling or medication means giving up on prayer.

"I would say maybe your answer to prayer is right here," Phillips says of initial encounters with patients. "I want you to keep praying. We're going to work on this together."

Christians also tend to forget that God works through trials. Dennis hesitates to blame the forces of evil for his ordeal, mostly because he can point to so many good things that have come from it. He's been able to encourage many other Christians battling depression and be an effective witness to non-Christians in his therapy groups who were impressed by his honesty.

Taking a balanced view

No Christian couple enters marriage with the hope of entering psychological counseling together. And in some quarters, any remedy beside prayer is frowned upon as not trusting God enough. But in the past quarter-century, at least some of the stigma has been removed from mental illness and more Christians are getting help.

"For conservative Christians, it used to be that psychology was of the devil," Phillips says. "Then the pendulum swung, in the 1980s, to the idea that psychology is a savior, and maybe the pastor of the church didn't have much to offer. So you'd go to church and hear sermons on pop psychology.

"But in the last five to eight years, I think the pendulum is swinging back in a nice way: saying some things that are part of our spiritual life and spiritual heritage—prayer, sacraments, the power of the Holy Spirit—are unique. And there's power there that psychologists can't offer, no matter how effective they are."

"A lot of pastors are less intimidated by psychologists now, and a lot more psychologists are referring people to their churches," he says. "It's really a much healthier balance."

Jim Killam teaches journalism at Northern Illinois University. He lives with his family in Poplar Grove, Illinois.

Getting Help

"If someone thinks they have a problem, they probably do," Dr. Ken Phillips says. He says your pastor is often a good person to speak with. Pastors who suspect a clinical problem may refer the person to a mental-health professional. You could also ask your regular physician for a referral.

—J.K.

Common Disorders

In any given year, more than 51 million Americans have a mental disorder. Only about one in six seek treatment, with women being more likely than men to do so. Depression, the most commonly diagnosed emotional problem, affects 19 million people a year. At any given time, about 4 percent of the population has symptoms of depression.

Major depression. Affects 9.1 million Americans a year. Symptoms may include persistent sadness or loneliness, too much or too little sleep, major change in appetite, loss of interest in activities once enjoyed (including sex), difficulty concentrating, low energy levels, and thoughts of suicide.

Generalized anxiety disorder. Affects 4 million a year. Symptoms may include chronic, exaggerated, and unfounded worry; inability to relax; headaches; muscle tension; and fatigue.

Obsessive compulsive disorder. Affects 3.9 million a year. Marked by repetitive, ritualistic behaviors like hand-washing or checking locks.

Panic disorder. Affects 2.4 million a year. Symptoms may include chronic panic attacks. Panic disorder may accompany particular phobias or occur on its own.

Schizophrenia. Affects 2 million a year. Symptoms may include distorted thought patterns, paranoia, loss of self-esteem, and hearing or seeing nonexistent things.

Bipolar (manic depressive) disorder. Affects 2 million a year. Symptoms may include impulsive, reckless, or overly aggressive behavior; unrealistic beliefs in one's abilities; decreased need for sleep; extreme "high" feelings; irritability; and abuse of alcohol and other drugs.

—J.K.

Sources: National Mental Health Association; American Psychiatric Association; Dr. Ken Phillips

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