God and Mental Illness

Part 3, Disease, Dualism and Blame

One of the first things we have to wrestle with when it comes to mental illness is how the category "disease" and "illness" functions within social norms and expectations.

When we claim to be "sick," or are diagnosed with an "illness," certain things happen in our social worlds. If you're sick, it is socially acceptable to step away from certain duties and obligations. The world is expected to accommodate sick people. We all know this. If our child says they are sick they don't have to go to school. If you are sick you don't have to go to work. If my students are sick they can miss a test.

Because there are incentives here, we do have some concerns about malingering. Teachers might ask for a doctor's note to verify that the student is legitimately sick. We also grow suspicious if an employee who called in sick is seen out on the golf course. If you're sick, you can skip work, but there's also the social expectation that you will limit your activity. So the social norms around sickness go both ways.

Sickness also bears upon issues of social responsibility and blame. For many illnesses and diseases you are not blame. If you are diagnosed with cancer, you are not to blame for that. If you come down with the flu, that's not your fault. 

True, empathy might wane if you are perceived to be somewhat responsible for your illness. Like getting lung cancer if you've been a lifelong smoker, or getting COVID after you refused to get vaccinated. But generally speaking, while the cause of the disease might have been partly within your control, once the disease has arrived you bear no responsibility for the continued presence and persistence of the disease. Once the disease arrives you are entitled to empathy and care. 

Which brings us to the issue of "mental" illness. 

While we don't blame people for the persistence for medical, biological conditions, we frequently do hold people partly responsible, and therefore blameworthy, for the persistence of mental, emotional, and behavioral symptoms. Why is that? 

Well, our culture tends to assume a dualistic view of human persons, that we are comprised of a body and a mind and that body and mind are different things, perhaps even different substances if we assume the mind is synonymous with our soul. Because of the presumed differences between body and mind we assume the mind is, to some degree, independent of the body. This independence gives us freedom, helps us transcend our biological conditions, which makes us moral agents and able to be held responsible for our actions. 

This dualistic view of human persons affects the stigma associated with mental illness. A medical illness sits inside your body. Consequently, there is nothing your mind can do about that. There is no blame, so you are entitled to the empathy and care illness demands. But for mental illness, the illness is located in the mind, which we believe to be the locus of choice and moral responsibility. Given this location "in the mind," we assume we have some control over our thoughts, feelings, and behaviors. This perceived control makes us responsible, and therefore blameworthy, for how we think, feel, and behave. If you're depressed or anxious, for example, you should be able to do something about that. Because depression and anxiety are feelings, and we expect people to have (some) control over their feelings. If you're addicted, you also should be able to do something about that. Because addiction is a behavior, and we expect people to have (some) control over their behavior.

Of course, this is complex and murky. We're not naive dualists. We know there is a brain. Consequently, there are some mental illnesses that strike us as more fully biological, as proper "brain diseases." We don't think patients with Alzheimer's can control their memory loss. Nor schizophrenics their hallucinations and delusions. 

Still, a dualistic, Cartesian vision of the mind/body relation drives much of the stigma associated with mental illness. We assume that the "mental" is under our power, at least partially, and thus hold people responsible for their thoughts, feelings, and behaviors. There is an oft-unstated but ever-present judgment that you have some control over your symptoms. This blame corrodes the empathy and accommodations we would otherwise extend to disease and illness.

This tendency toward blame is exacerbated among Christians for two related reasons. First, due to a worldview that was heavily influenced by Plato, Christians tend to be very dualistic, positing a supernatural, spiritual "soul" as the seat of the mind and location of the will. Secondly, Christians believe God gives them supernatural assistance, much of which is mediated by the soul/mind. These beliefs create even starker contrasts between the body and mind. The "mental" as soul and empowered by God is more radically independent from the influences of the body, more separate and free, and therefore potentially more blameworthy.

All that to say, one of the biggest issues we need to face when we talk about mental illness in Christian contexts is the pervasive dualism that governs much of our thinking. That dualism sits behind the stigma of mental illness.