Medical Treatment of Mental Illness

A Christian View

scrupulosity

By Grantley Morris


In the following I wish to address the general question of whether it is honoring to God for Christians to take medication or any other kind of medical or psychological treatment for mental problems but I will do so using Religious Obsessive Compulsive Disorder as an example. For this I have extracted medical information from my series of webpages commencing at Scrupulosity: Obsessive Compulsive Disorder (O.C.D.), which discuss treatment options for this distressing mental condition. If you suffer from O.C.D., you are advised to read the full series, as it contains much additional help.

Religious O.C.D. is a perplexing mental disorder that one would expect to be spiritual rather than psychological or medical. It can manifest itself in one of two ways:

    1. Being plagued by blasphemous thoughts

    2. Or, despite repeated assurances, continually fearing you are unforgivable.

If you fall into either category, your friends, loved ones, counselors and spiritual advisors will end up not only distressingly perplexed and frustrated but unable to give you appropriate support. The condition affecting you is so rarely understood that the dear people who care about you need these webpages almost as much as you do.

If you suffer from this, I understand your agony. God’s solution, however, is very different to what you expect, and you and I will be at cross purposes until you can see beyond the superficial to understand what is really happening to you. Our priorities will differ as much as if you had acute appendicitis and want nothing but painkillers whereas my understanding of the medical necessities obligates me to focus not on pain relief (as much as I want that for you) but on the cause of the pain and to convince you of the critical importance of getting proper treatment. Just as pain killers would not be the real answer to appendicitis but would actually lessen your motivation to get the help you desperately need, so assurance that you are divinely forgiven or ending your unwanted thoughts is not the help you really need, despite it seeming that way to the sufferer.

It can take them years of agony before they finally realize it but it turns out that for many devout Christians nothing – with the possible exception of medical help – is capable of ending their doubts, fears and overwhelmingly strong guilt feelings. Like a thirsty man chasing a mirage, these genuine Christians sincerely believe there must be some assurance that would finally satisfy them. They will temporarily feel better after receiving a full explanation of why their fears are spiritually, biblically and rationally groundless but the horrible worry that they are doomed will soon return. Despite the mirage seeming so real, the truth is that this side of heaven there is literally no experience or proof, no matter how stupendous or spectacular that could permanently quell their fears.

Many people are tormented incessantly from what feels precisely like a guilty conscience and inability to feel God’s love, and yet it turns out that the cause is not spiritual at all. It seems initially unbelievable but for these people what drives intense feelings that are so easily mistaken for divine judgment – and it can even generate horrifically blasphemous thoughts as well – is a mild medical disorder that causes excess anxiety. None of my vast array of carefully written information will lower the deep concerns plaguing the millions of people whose anxiety has a medical basis. Just as proof that you are forgiven will not end the pain of a physical illness, neither will proof that you are forgiven end the inner pain of all the doubt, fears and worries caused by a physical illness – a disorder in one’s brain chemistry.

I completely understand you thinking I am mad, or at least unspiritual, to suggest such a thing. If you have not yet read many of my other webpages, you have not had the opportunity to discover how strongly conservative and into prayer and Scripture I am. If you need convincing, quickly scan You’re Forgivable: A Sample of the Bible Proof and Life’s Too Short to Skimp on Prayer for just a couple of sample webpages, and then immediately return to this page.

For years I have devoted enormous amounts of time and agony trying to help people who felt unforgivable. (For example, despite me being an exceptionally slow writer you will find on this website enough words to fill a 500 page book, written specifically for people who find it hard to believe God forgives them.) For very many of those years, if anyone had suggested that there could be a medical component to this spiritual matter I would have thought they were crazy or ungodly. Large numbers of people kept e-mailing me seeking help, however, and as I kept pouring my life into trying to help them, I began noticing something peculiar. It was astoundingly common for those who could not be helped even by large numbers of faith-building Scriptures to have an anxiety disorder. Usually they regarded their anxiety disorder as irrelevant to their spiritual concerns, but as I kept conversing with more and more people, the link kept occurring far too often to be mere coincidence. Eventually, I discovered that a huge body of scientific research had already confirmed the link.

Like me, you will probably need a lot of convincing. That’s okay. I am so passionate about helping people who are suffering this horrific spiritual torment that I have gone to immense lengths assembling and carefully explaining the evidence in a logical, easily intelligible manner. All I ask is that you keep prayerfully reading it.

People afflicted by blasphemous thoughts or by continual doubts are among the surprisingly large number of people who are perfectly sane – and some are highly intelligent – except that their mind plays tricks in whatever narrow area of their life is of greatest importance to them. It is not because they have less faith, Bible knowledge, will-power or devotion than other Christians. In fact, they are usually above average on such measures. It is just that in this area of life, anxiety is almost literally driving them crazy. Contrary to what seems intuitively obvious, their fears are not spiritually or rationally driven but stem from a chemical imbalance that causes them to suffer from abnormal levels of anxiety. Because it has a medical basis, you cannot switch off this anxiety (and corresponding guilt feelings, worries about salvation, inability to control your thoughts, etc.) by more Bible reading, trying to worry less, working harder on building up your faith, or whatever. To suffer from medically caused anxiety is no more an indication that one is spiritually lacking than suffering a broken leg means one is spiritually lacking.

It boils down to the fact that the unfortunate people suffering this physical problem feel needlessly guilty, ill at ease or worry about at least one thing (it usually zeroes in on whatever is most important to them) far more than average people. And regardless of what they do – how much fellowship with God they have, how much faith they muster, how much theological knowledge they gain – that awful, unsettling feeling keeps gnawing away at them because the cause is not spiritual or rational but physical. No matter what they believe or think and how much God approves of them and delights in them, that horrible feeling keeps returning. Our brain is designed to treat that feeling – usually called anxiety – as an alarm warning us that something is seriously wrong. The problem is that when a chemical imbalance sets off a false alarm, the very alarm we rely on to alert us to physical or spiritual danger has been triggered. The part of our brain designed to respond to the alarm cannot distinguish a chemically induced false alarm from the real thing. As the alarm keeps on and on, the brain keeps frantically hunting for some danger that set off the alarm. No matter what reassurances come from God, Scripture, spiritual authorities, past experiences or whatever, the alarm keeps blaring and so the fear keeps persisting that there must be some genuine spiritual danger.

What confuses these people is that what some call their gut feeling – some call it one’s conscience and some even confuse it with the voice of God – has been seriously distorted by a condition well known to the medical profession. Unfortunately, in contrast to the experts, the implications are rarely understood by the general population.

With this deeply disturbing false alarm indistinguishable from the real thing blaring within a person day after day it is enough to seriously distort anyone’s spiritual perception. This devastating feeling keeps incessantly nagging; drowning out what for anyone not subjected to it would be more than enough proof of God’s acceptance. Although this highly unpleasant and confusing affliction troubles a relatively small proportion of people, the numbers add up to literally millions of people worldwide.

Multitudes of people suffer from an undiagnosed anxiety disorder. There is no space for a full explanation here but once the process is carefully explained, it is readily understood by average people. Those suffering from this affliction, however, will have a much harder time accepting the truth because they find it so contrary to what feels intuitively right, and that dreadful feeling that something is terribly wrong keeps droning on as incessantly as ever. Everything within someone suffering from excess anxiety will scream against the truth. So despite trying to the point of utter exhaustion, those suffering this way will keep getting worse instead of better unless they totally change their understanding.

I hyperventilated once. I felt certain I was not getting enough air and so I breathed harder, totally oblivious to the fact that I was actually suffering from too much air and I needed to breathe less. So it is with those who are hounded by unwanted thoughts or yearning for assurance of salvation. They will only get worse until they learn to do almost the exact opposite of what they feel sure will help. They are so convinced that they need to be doing the opposite of what will actually help that they usually cannot even grasp what the following webpages are saying, but keep misinterpreting them to line up with their mistaken views.

cure for guilt

Although most people have heard of Obsessive Compulsive Disorder, few recognize it when it turns spiritual. Obsessive Compulsive Disorder is an anxiety disorder. Some experts go deeper into the cause of the anxiety and call it a biochemical or neurological (nerve) disorder. This highlights that the anxiety is not the person’s fault or ignorance or lack of faith. It is still correct, however, to call it an anxiety disorder because it manifests itself as anxiety that, in turn, causes repeated, unwanted thoughts or doubts (obsessions). For many, but not all OCD sufferers, these obsessions lead to feeling driven to certain repetitive behaviors (compulsions) such as excessive cleaning, checking, counting or seeking assurances. A not uncommon form of OCD that is less publicized is for a normal heterosexual to be plagued with fear that he or she is homosexual. Another is for a normal, mild mannered person to be stricken with an abnormal fear that he or she will violently harm loved ones.

The United Nations’ World Health Organization ranks Obsessive Compulsive Disorder high among the most disabling of all illnesses, in terms of the monetary and personal cost. Millions of people have their lives dominated by some form of OCD. It is so common throughout the world that if there are just one hundred people in your church, two or three of them probably have OCD, although there is a good chance that one is so embarrassed by it that he is trying to keep it secret, and another does not even know she has it. (More about these figures)

Put at its very simplest, OCD seems to be the consequence of a brain mechanism intended to warn a person of danger, doing so excessively. Scientists think they have identified a small part of the brain that does not function as perfectly in people with OCD. A key role of this part of the brain is to filter out inappropriate thoughts and feelings. Unless this filter is functionally normally, another part of the brain becomes overactive. Scans have shown unusual patterns of activity in the brains of OCD sufferers. In a few cases, head injuries seem to have caused OCD.

Scrupulosity is a form of Obsessive Compulsive Disorder that plagues people who are anxious to please God. For them, the unwelcome, involuntary thoughts or images feature God or the devil, and compulsions feature the need to keep seeking assurance of salvation, or repeatedly engaging in some sort of religious exercise – such as prayer or witnessing or confessing sin – beyond what other Christians feel is needed.

scrupulosity

Medical Considerations

It is tragically common for doctors to misdiagnose people with OCD as having depression, bipolar disorder, ADHD, autism or schizophrenia. Studies show that in USA it takes an average of nine years from the onset of Obsessive Compulsive Disorder for people to receive even a correct diagnosis and, amazingly, a further eight years before they are suitably treated. But if having the courage and knowledge to find treatment is difficult with general OCD, it is usually significantly harder with scrupulosity. Few people suffering from religious OCD even realize they have a medical or psychological problem.

It is much easier, for example, to recognize that washing your hands fifty times a day is abnormal and undesirable than if OCD manifests itself as an overly sensitive conscience or feeling the need to pray or witness for hours each day. In fact, people with scrupulosity usually mistake their out-of-whack, condemning conscience for their loving Savior. They feel driven to excessive devotion that leads only to feelings of inadequacy and burnout, or to mistakenly supposing that the Bible condemns them as unforgivable and because anxiety feels like an unappeasable guilty conscience, they are likely to stubbornly cling to this delusion, no matter how many pastors, theologians or spiritual advisors tell them otherwise. Similarly, it is easier to realize you have a purely psychological affliction if you feel compelled to keep checking locks, than if you feel compelled to cuss the Holy Spirit. These serious hindrances to seeking treatment are further magnified by some Christians, who have no qualms about seeking human help if they have a plumbing problem, but somehow fear it might be unspiritual or a lack of faith to seek human help for a medical or mental problem.

As a man of science, and someone who has devoted his entire life to serving people without charge, I find it annoying that almost every possible natural cure for anything has been less rigorously researched and tested than substances that drug companies could make money out of. There is much scientifically based evidence that there are medications that can help OCD (although, because everyone reacts differently, finding the exact medication that best suits you is likely to take patience and trial and error). However, there is some scientific evidence that there are some simple things like vitamins that can be equally effective, often at lower cost and with fewer side effects. Since I am not medically trained, I urge you to consult a doctor before trying even vitamins but if you have not yet tried medication, I suggest you seek medical advice about first trying inositol, an essential, apparently harmless, naturally occurring substance found in every cell of your body. Although the current amount of scientific proof is less compelling for the effectiveness of inositol than for certain medication, it is also less likely to have any side effects. Information about inositol and other simple, natural cures is provided in a subsequent webpage (Natural Cures for Anxiety-Related Illnesses) but I suggest you keep reading and come to that webpage at the end of this one.

When I mention medication, don’t for a moment suppose this is to drug you or in any way make you less mentally alert. I want your thinking sharpened, not dulled, and the way to facilitate mental clarity is for you to be in peak health and especially to correct any bodily abnormalities and imbalances that have the potential to distort one’s thinking and perceptions.

Our bodies are highly complex and dependent upon a vast number of factors. If some imbalance prevents our bodies from functioning normally, it could affect not only our physical well-being but our feelings, emotions, perceptions and clarity of thinking.

Here are some well-known examples:

    * Sleep deprivation can cause learning, concentration and memory difficulties, mood changes, lowered ability to tolerate stress, and make you error/accident-prone. Severe sleep deprivation often results in hallucinations.

    * Low blood sugar can cause impaired mental functioning, irritability, confusion, difficulty speaking, anxiety, paranoia and/or aggression.

    * Insufficient oxygen (such as in altitude sickness) can cause confusion, clumsiness, and stumbling. The first signs may be uncharacteristic behavior such as laziness, excessive emotion or violence.

    * Hormonal imbalance can cause all sorts of mood changes, including postnatal (postpartum) depression.

    * Insufficient sunlight can cause depression (Seasonal Affective Disorder, for example).

If your body were lacking in iron and it were affecting your health, would you refuse to take an iron supplement? Providing a doctor confirms you will benefit from an iron supplement, I believe it would be sinful to refuse because:

    1. Our bodies are the temple of the Holy Spirit and so should be looked after.

    2. As in the parable of the talents, we have a responsibility before God to develop responsibly what God has entrusted to us.

If someone kindly gave you a new car it would be disrespectful to the giver to let the car deteriorate by not changing the oil and so on. Likewise, it is disrespectful to the One who gave us our bodies not to do what we can to keep ourselves in peak health. We will one day have to give account to God if we achieve less in life because we have let ourselves be physically run down.

The same would apply if we achieve less in life than we are capable of because we let ourselves be psychologically run down by not taking dietary supplements if we have a deficiency. Just as being intoxicated creates a chemical imbalance that lowers one’s ability to think clearly and resist temptation, so do a number of other chemical imbalances that can occur within the body.

Religious OCD sufferers either feel spiritually inferior to most Christians or realize that they have it harder than most Christians. Few realize that the primary reason is not spiritual but physical. Correcting a physical imbalance that affects one’s thinking gives people a head start (pun intended) relative to where they would be if they kept suffering the disorder but it is no head start relative to where healthy people are. Knowingly maintaining the handicap by refusing to correct an imbalance is as spiritually irresponsible as deliberately choosing to expose oneself to horrific temptation. Like being sober, correcting an imbalance in no way eliminates the need for spiritual weapons, spiritual graces and so on; it simply allows a person to have more of the basic resources that help other Christians cope with trials.

To refuse whatever it takes to have a properly functioning body is neither being spiritual nor macho. It is simply being irresponsible.

There is not a Christian on the planet who is not tempted and it seems logical to assume that demons play a role in most temptation. Certainly Satan does not have the divine power to be everywhere at once, so if he is involved, it could only be through his underlings. Demons are nothing to be freaked out about; we should simply seek to expose and resist their attempts to deceive us. With this in mind, sober thought and experience with literally hundreds of people suffering from religious OCD has forced me to conclude that the temptation to not do whatever one can to correct a bodily chemical imbalance is not just illogical, it is demonically inspired. It is undeniable that demons have much to gain and the kingdom of God much to lose by keeping Christians from anything that would allow them to think more clearly.


Serotonin is a bodily substance essential for health. As a neurotransmitter it plays a vital role in brain function. Medications usually prescribed for Obsessive Compulsive Disorder are intended to affect serotonin levels and are technically known as Selective Serotonin Reuptake Inhibitors (SSRIs). Confusingly they are often popularly referred to as antidepressants. (It is not uncommon for a single medication to be prescribed for a diverse range of illnesses. For example, quinine is the first effective treatment for malaria and yet is used to treat arthritis and also lupus.) Certain medications that help people with OCD might happen to also benefit some people who are depressed, but their primary function is to correct a serotonin imbalance in the brain. This chemical imbalance seems to be a key factor in OCD and associated deceptive guilt feelings and unwanted thoughts. Sometimes a higher dosage is needed to treat OCD than to treat depression.

Interestingly, in trials involving placebos, a high proportion of depressed people reported less depression after taking fake pills, but very few people with OCD responded to fake pills.

Treatment of Obsessive Compulsive Disorder has sometimes been found even more effective when two or more medications are combined. If, with a particular OCD sufferer, a prescribed medication has an unwanted side effect, there is often an alternative medication that is just as effective and for that person does not have the side effect. In fact, my mother’s doctor told her there are four different classes of Selective Serotonin Reuptake Inhibitors. She had to try all four until finally finding one that suited her. Abruptly ceasing medication can cause additional problems, such as withdrawal symptoms.

So if dissatisfied with the medication, there are good reasons for seeking further medical advice. A general doctor could get you started but for maximum effectiveness it might be best to see a doctor who specializes in this type of medication. These medical specialists are psychiatrists. They should not be confused with psychotherapists – the type popularly portrayed as getting you to lie on a couch and talk about your childhood. Neither should they be confused with psychologists. In contrast to psychiatrists, psychologists are not qualified as medical doctors and so cannot prescribe medication. Psychologists usually specialize in cognitive-behavior therapy, which we will discuss shortly.

A common mistake that even some doctors make is to underestimate how long it will take for the medication to begin to lessen the symptoms of OCD. Although medication often takes just a few weeks to begin to work, in some cases it could take up to three months. It is also important to realize that treatment is expected to reduce the severity of OCD rather than a complete removal of all symptoms.

If you cease the medication, symptoms could return to pretreatment levels. In fact, Professor of Psychology, Henry A. Virkler wrote the following in The Journal of Psychology and Christianity (Vol. 18, No.3, 1999, page 269), I quote it because it might also apply when these same medications are used to treat OCD.

    Persons with major depression who stop antidepressants too quickly may experience a recurrence of the depression, and it may not respond to a second round of antidepressants as rapidly or fully as it did to the first round. Similarly, for those with bipolar disorder, current treatment guidelines recommend permanent use of mood-stabilizing medication, for without it each manic or depressive episode tends to become more serious and difficult to treat.

A woman shared the following with me and has allowed me to quote her. Her experience of medication helping but not eliminating the problem is what I expect to be fairly typical.

    I have suffered from scrupulosity practically all my life. It started with blasphemous thoughts while I was in church when I was 12 years old, and I am now a bit beyond middle-aged. Ultimately I stopped going to church because of the guilt. I felt as if I were possessed. Shortly after the thoughts, I began washing my hands a lot as if to “cleanse” the guilt. I also started checking things a lot.

    I basically suffered in silence and was not diagnosed until many years later. Then I was put on Prozac and later Zoloft. The medication helped quite a bit with the thoughts and cleansing rituals. The thoughts are still there, but more like background noise and less guilt-inducing. The hand washing is pretty much gone, and the checking is under better control – only at times of stress does it resurface.

    The only thing that still plagues me is an overwhelming feeling of responsibility, as well as feeling guilt over things I enjoy.

It is clear that she still has challenges – medication is not the wimp’s way out – but like carving an occasional foothold into a cliff face, it helps.

Please don’t be reluctant to get help. You owe it to God to seek the best treatment. For information about non-prescription ways of improving your brain chemistry, see Natural Cures for Depression & Anxiety-Related Illnesses.

New treatments are currently being tested, such as deep brain stimulation. Trials are also underway with drugs that target the brain chemical, glutamate, that is thought to be a factor in OCD.

In cases that are both extreme and rare, brain surgery or Electro-Convulsive Shock Therapy have been suggested. However, cognitive-behavioral therapy is far more proven and safe. It is widely recommended for people with Obsessive Compulsive Disorder, often in conjunction with medication.

Cognitive-behavioral therapy is basically being skillfully guided to train yourself to lower the anxiety that causes the problem. You could think of it as overcoming a brain problem by retraining the brain. The effect is a little like what happens when, by retraining themselves, people overcome the debilitating effect of brain damage caused by a stroke.

Cognitive-behavioral therapy is usually done in a carefully controlled manner, but treatment typically involves deliberately doing the thing you fear, and refusing to engage in any compulsive “remedy.” For a compulsive hand washer, for instance, it would usually involve reaching the point of deliberately getting the hands dirty and refusing to wash for hours. At first, the anxiety over not washing would be high, but as time progresses without washing, anxiety would gradually lower. For the treatment to be effective and long lasting, anxiety merely has to be lowered, not necessarily completely eliminated.

This exact approach is awkward with religious OCD, however. It is easy to believe that you will not die or go to hell if you do not check locks thirty times a day. You will then be free to use cognitive-behavioral therapy to address the irrational anxiety you feel over not engaging in that behavior. But for cognitive-behavioral therapy to work, someone with scrupulosity must first reach the point of believing that the behavior he is anxious about – such as uncontrollably swearing at God or witnessing less – does not threaten one’s walk with God. Arriving at that belief will not automatically lower one’s anxiety – that’s where cognitive-behavioral therapy comes in.

treating scrupulosity

There’s an alternative to a purely medical approach. Research has proved that, through continual practice, our brains’ physical and chemical structure can be altered.

As a faulty alarm system needs at least part of it to be rewired, so if you have OCD, a part of your brain needs rewiring – new neural pathways need to be developed. This can be done by retraining your brain, just as certain neural pathways might no longer work because of a stroke but continual practice will establish new ones.

Consider someone who panics whenever he sees a spider. If you were to monitor his pulse, how much he sweats, and so on, you would find they suddenly peak at the sight of a spider. Such a person is not unintelligent or a nutcase; it is simply that something has caused his brain to be wired in such a way that seeing a spider triggers the alarm system in his brain. Through practice, however, that connection between the sight of a spider and his brain’s alarm system can be rerouted. This can be done, for example, by the person being exposed to a spider that is so far away that he feels calm, and over a long period of time he gets closer so slowly that his brain establishes a connection between seeing a spider and remaining calm, rather than seeing a spider and triggering an internal alarm.

Similarly, much patient practice can train one’s brain not to set off false alarms that seem like spiritual worries. Psychologists are able to guide people in this retraining process.

Whether it be through medication or retraining the brain or a combination of both, using any such means is exercising faith in God. It is clinging by raw faith to the belief that God loves and forgives through Christ and that any feelings or thoughts to the contrary – no matter how intense – are simply false alarms that need correcting. Exercising this degree of faith will be exceedingly difficult because the false alarms will so be so deeply disturbing that few people who have not suffered them will be able to comprehend the magnitude of the challenge.

Further on in this series of webpages I provide information and techniques that consistently put these principles into practice. They have the potential to be life-transforming for scrupulosity sufferers. Nevertheless, I make one last plea to try combining it with appropriate medication. I remind you that opting for medication is not wimping out but is exercising faith in God. It shows you believe in God’s goodness, faithfulness and righteousness by not accepting a tormenting conscience as being your loving Lord.

When the Bible says there is no condemnation in Christ Jesus and our conscience says there is condemnation, which will we call the liar? Opting for medication declares to the entire spirit realm that you have correctly chosen to regard your conscience as malfunctioning when guilt feelings contradict the basic Christian revelation that Jesus saves from all sin.

Scrupulosity can be spiritually crippling. Honor God by doing everything you can to fight it, including taking medication. You might convince yourself that it is “faith” that is keeping you from seeing a doctor, but could it actually be pride or fear?

Suppose we were missionaries whose vehicle has broken down, thus render us unable to reach the remote peoples we are called to minister to. Would it be honoring to God to refuse to call a mechanic and instead spend years sidelined doing nothing but pray that God “heal” the vehicle? Everyone knows God would expect us to do everything we can to get the vehicle fixed, including seeking human help. What matters is that we leave behind pride and stubbornness and get on with serving God. So why should anyone throw all logic out the door by refusing help from someone who fixes human bodies?

Some anti-depressants can help not just depression but anxiety and OCD. That’s a bonus because some people suffer from all three.

For most illnesses, currently available medical options cannot be guaranteed to work for everyone. Except for a revelation from God himself, however, you will never know how much it could help you unless you try it. If medication works for you, it could help you successfully concrete into your life the truths expounded elsewhere in my webpages.

Not to be sold. © Copyright, 2007, 2012, 2013 Grantley Morris. Not to be copied in whole or in part without citing this entire paragraph. Many more compassionate, inspiring, sometimes hilarious writings by Grantley Morris available free at the following internet site www.net-burst.net Freely you have received, freely give.


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