Plough’s Joy Clarkson speaks with John Swinton about discipleship and mental health.

Joy Clarkson: Both in your theological research and your prior work as a mental health nurse, you have been thinking and writing about mental health and the Christian faith for a long time. How have your thoughts on this topic developed? What does this new book focus on?

John Swinton: Finding Jesus in the Storm is my fourth book on mental health. My background is in mental health nursing, where I worked for many years before retraining as a nurse for people with intellectual disabilities. So mental health has always been an important aspect of my life. I did my PhD thesis on the relationship between schizophrenia and Christian friendship; I argued that schizophrenia is a grossly misunderstood condition that is highly stigmatized and significantly socially constructed. This is not to suggest that schizophrenia doesn’t exist; it is simply to point out that it may not exist in the negative ways people assume it does. I tried to get rid of some of the stigma by helping people see through unhelpful caricatures – “split personality,” “dangerous,” “violent” – and begin to see people living with schizophrenia as they truly are: people.

The key theme in that work was Christian friendship, or more accurately the friendships of Jesus. The principle of the incarnation is that God, who is radically unlike human beings, becomes a human and offers humans friendship. But that friendship is not based on cultural norms that assume friendships are like-attracted-to-like. It is based on the principle of Grace: we become friends just because that is what Christians do. Friendship helps rehumanize people whom society dehumanizes. My first couple of books focused on how we might actually achieve such a goal.

My later work in this area, Spirituality and Mental Health Care: Rediscovering a “Forgotten” Dimension (2001), tries to show how and why mental health professionals should incorporate spirituality into their caring practices. It develops the idea that spirituality is necessary for genuinely person-centered caring. Although the subtitle calls spirituality a forgotten dimension, it is clear from the contemporary literature that while that may have been true then, it is certainly not true now, as spirituality, at least in principle, is considered an important aspect of mental health care. So, my latest book is really a development of my earlier work, focusing on the lives of Christians who experience mental health crises.

Joy Clarkson: One of its most striking arguments is that the goal in addressing mental health challenges should not be to defeat mental illness, so to speak, but to seek “life in all its fullness” (John 10:10). You propose the metaphor of journey rather than that of battle in seeking to contextualize experiences of mental health crisis. In discipleship, then, Jesus is not the one who comes to conquer our “unconventional mental health experiences” but “the man of sorrows, acquainted with grief” (Isa. 53:3) who comes to accompany us through life’s valleys. How does this shift in metaphor shape how we might approach spiritual formation and mental health?

John Swinton: One of the challenges of living within a highly medicalized society is that it is almost impossible to think of illness without first thinking of medicine, despite the fact that most healing goes on in community via friendships, family, colleagues and so forth. We implicitly or explicitly have a bias towards a model of health that is gauged by the absence of illness and/or the control of symptoms: we are considered well when we have no symptoms and no distress. But for those living with enduring mental health challenges, this means they are always ill! If you and others consider yourself always to be ill, that inevitably limits your expectations.

Jesus says that he comes to bring life in all of its fullness (John 10:10). The life of Jesus and indeed of many of his followers down through the centuries would indicate that fullness of life does not mean life without suffering, or life without illness. Life in all its fullness comes to us when we learn what it means to be with Jesus in good times and in bad. It is as we journey through the complexities of life with Jesus that we discover fullness of life.

The metaphor of a journey helps us see this. A journey always has a direction and an intention. It is moving somewhere rather than nowhere. We journey through beautiful fields and lush pastures as well as steep mountain valleys and across barren ground. But even in the difficult times there is forward movement; there is hope. To be considered always ill, to be told “if you take your medicine your symptoms will be controlled but that is the best that we can offer,” is to turn the journey into a waiting room. So, I think the metaphor is helpful because it resonates with the possibility of hope.

Joy Clarkson: In your book, you suggest that the hermeneutic tools currently available (not least the Diagnostic and Statistical Manual of Mental Disorders) are inadequate to account for the complexities and beauties of human experience. You write, “Human beings are not simply a conglomerate of chemical interactions. Humans are persons, living beings who have histories, feelings, experiences, and hopes, and who desire to live well.” How can we begin to approach mental health more holistically and humanely?

John Swinton: One of the main international manuals for diagnosing physical and mental disorder is the International Classification of Diseases (ICD), at the moment in its tenth version – ICD-11 is due to come out quite soon. As part of the preliminary work for that, research was carried out to explore how people living with mental health challenges – schizophrenia, depression, bipolar disorder, anxiety, and personality disorder – felt about the new classifications. Alongside a number of interesting comments, the thing that struck me most was that the reviewers with mental health challenges observed how negative the diagnostic criteria were, that they seemed to focus purely on the negative experiences of mental health issues and not on any possible positives. For example, people with bipolar disorder were concerned that its creative dimensions were not acknowledged. Many great painters and musicians have had bipolar disorder and their creativity has been enhanced by these experiences.

Psychiatry exists to deal with problems, so it’s not surprising that the basic criteria for describing mental health challenges tend to be problem-focused. This is not a criticism of psychiatry – problems need to be dealt with. It is, however, a significant limitation on the amount of information one can gain from a diagnostic manual. We will become more humane about describing mental health issues by listening carefully to the whole of people’s stories, not just of their illnesses, but their whole lives and how mental health challenges fit into and impact them. When we listen, and if we are willing to hear, surprising things can come to the foreground.

Joy Clarkson: I enjoyed your remarks on Elizabeth Anscombe’s notions of description and intentionality; that the way we describe something shapes our intentions toward it. What are some ways in which our descriptions of mental (un)wellness might be hampering our ability to act and live well?

John Swinton: Descriptions are profoundly important. The way we describe the world determines what we think we will see, and what we think we see determines how we respond to it. Imagine a scenario where you walk into a room with your partner. You introduce him or her like this: “Hello there. This is my partner. She has schizophrenia.” Now, there are a variety of ways in which you could describe your partner – husband, wife, lover, friend, parent – but you choose the description of their clinical condition. As soon as you do that you are positioning them in a quite particular way: diagnostic descriptor first, everything else second.

This of course is precisely how stigma functions: it reduces a person to only one part, as when a Greek slaver’s mark or stigma meant an enslaved person is no longer a person, no longer a human being, no longer anything other than the property of the slave owner. Something like schizophrenia is a highly stigmatized diagnosis which is culturally constructed by media characterization, false ideas and so forth. While the description “schizophrenia” may have some utility in a clinical context by enabling the mental health professional to practice their healing gifts, when it leaks out into society and morphs into a highly stigmatized label, all sorts of unpleasant things begin to occur. A basic premise of good mental health action, then, is simple: call people by their names and describe them in ways that enhance and encourage flourishing. When you do that you push back against descriptions that seek to destroy such flourishing.

Joy Clarkson: You advocate for the importance of giving “rich, thick, experiential descriptions” of mental health challenges, rather than as a merely biological reality. I found this really important but also complicated. My family has a history of bipolar disorder, depression, and OCD, and knowing that there was a biological/genetic dimension to my own mental health journey actually helped remove a sense of blame, the question of “why are you like this?” and the sense that somehow it was a result of being a bad Christian. On the other hand, if I were to describe my experiences solely as the result of the inevitable curse of genetics it could also contribute to a feeling of defeat and biological determinism, and ignore other important aspects – loneliness, poverty, trauma – of someone’s experience of mental health challenges. As Christians and caregivers, how can we grapple with embodied, genetic aspects of mental health in an integrated and holistic way? How do we faithfully tell these stories?

John Swinton:I don’t think it is an either/or. The way that this is framed within phenomenology, the underlying philosophy for my recent book, is that there are two ways in which you can look at the body. On the one hand you have the material body, on the other, the lived body. The material body you can feel touch, measure, and physically engage with. Here we find neurology, biology, pharmacology, and all the other sciences and interventions that focus on your physical body. The lived body relates to the way in which the material body encounters the world. So as the physical body moves through the world it has various experiences, relationships, emotions and so forth, all of which are vital for understanding the lived experience of being a human being. The two are of course connected, but one is not determinative of the other.

One problem I see in contemporary approaches to mental health issues is the tendency to try to reduce everything to the material body. I agree that there can be much comfort, solace, and utility in discovering the neurobiological roots of certain experiences. However, finding explanations for people’s mental health experiences does not mean that you have actually understood them. My focus on experience and personal narratives is an attempt to draw to the fore the importance of the lived experience of mental health challenges in a context where such experiences are too easily discounted as “mere symptoms.” I don’t push against medical explanations of psychological phenomena; I push against the reduction of people’s lives to the materiality of their bodies. I think there is more to being human than an understanding of the technical workings of your material body. We need to find and hold a creative tension between the material and the lived body.

Joy Clarkson: Something you emphasize in your work is the discipleship of all people. “It is about the experiences of unique and valuable disciples of Jesus who seek to live well with unconventional mental health experiences.” What have the journeys of Christians with mental health challenges taught you about being a disciple of Jesus?

John Swinton: In his book on discipleship, Dietrich Bonhoeffer has a section on Matthew’s call. He points out that when Matthew first encountered Jesus, he didn’t know who he was: Jesus called and Matthew followed. Bonhoeffer points out that his calling was not based on what Matthew knew about Jesus. It is true that one can presume that he knew who Jesus was, that he had heard the stories and that he had made an informed choice to follow Jesus; the Bible does not say that. In order to think that you need to move beyond the text. This is important for thinking about the lives of, for example, people with profound intellectual disabilities for whom intellectual knowledge is not their primary way of communicating and coming to know things in the world.

What this teaches us about discipleship is that it is not knowing things about God that matters; it is following Jesus that is its essence. Following Jesus is not an escape from the world or a matter of accumulating knowledge about God. It is a way of being in the world, where even in the wildest of storms, you learn to trust that Jesus is with us and for us in all things and at all times. True, sometimes it doesn’t feel that way. When someone is in the depth of depression it is sometimes difficult to feel the presence of God. But Jesus had the same experience on the cross: “My God, my God why have you forsaken me?” (Matt. 27:46). Following Jesus does not mean escaping from problems, difficulties, pain, and suffering. It means finding the possibility of hope in all of these experiences and learning to live lives which are marked by the desire for God’s presence even when sometimes that presence is elusive. I think that is one of the many things that I have learned from listening to Christians living with mental health challenges.

And this changes our approach to mental health in the church. Sometimes when we think about mental health issues, we focus on pastoral care or/and ethics. Nothing wrong with that! All of us need to be cared for, and ethical issues are basic to the Christian life. However, I think mental health is best located within Christian life in a different way. I think the key question is: How can we (the Body of Jesus), enable this person who is a disciple of Jesus, who is going through difficult times, to find and hold on to their vocation even in the midst of the storms?

Joy Clarkson: The anxiety, isolation, and disruption of ordinary life over the past two years has led to what many have called a crisis in mental health. What steps should we take in the coming years to address that crisis? How should we move forward?

John Swinton: One thing the pandemic has taught us is that we are all, across the globe, interconnected and dependent on one another. Previously we may have thought that we were discrete individuals only responsible for ourselves and those close to us. We have learned that we are persons-in-relation at a personal and community level. We have also learned that many people within our societies are lonely and disconnected. All of us need love and connection.

Toward the beginning of Michael Verde’s recent powerful film Love Is Listening: Dementia Without Loneliness, an African-American woman with advanced dementia reflects on her life experience. “I don’t know where I am. I don’t know where I’m going. I don’t know where I’ve just come from. But I’m not fearful.” She pauses and looks deeply into the eyes of the person she is talking to. “Because I see all around me – I don’t see a lot – but I see patience.” She looks upwards and away; her eyes glaze over a little. “I see gratitude. I see tolerance.” She slowly looks back towards her friend and smiles. “I think I see love.” She smiles. “And your face is a picture of love.”

It’s a very beautiful and moving scene. Even when we feel lost, helpless, uncertain about the future and unable to work out where life is going, we can still feel, see, and experience love. More than that, the presence of such love can drive out fear. The experience of dementia and indeed of mental health challenges at times can be quite frightening. We need people who will love us out of our fear and help us to find love amidst the challenges. If we know we are loved, we need not be fearful. In times of mental health challenge, as in all times, we need people who will act gently, patiently, kindly, humbly, respectfully, peacefully. We need people whose lives are filled with forgiveness, honesty, and integrity (1 Cor. 13). We need to be reminded of the presence of the God who is love. We need people whose faces are a picture of love.

Learning to become such people is the way forward.

Further Reading:

John Swinton, From Bedlam to Shalom: Towards a Practical Theology of Human Nature, Interpersonal Relationships and Mental Health Care (Frankfurt: Peter Lang Publishing, 2000).

———, Resurrecting the Person: Friendship and the Care of People with Mental Health Problems (Nashville: Abingdon Press, 2000).

———, Spirituality and Mental Health: Rediscovering a “Forgotten” Dimension (London: Jessica Kingsley Publishers, 2001).

———, Finding Jesus in the Storm: The Spiritual Lives of Christians with Mental Health Challenges (Grand Rapids, MI: Wm. B. Eerdmans, 2020).