Our world today is concerned with mental health. There are almost daily reminders of this. For example, last Tuesday was World Mental Health Day, a day devoted to mental health education, raising awareness about the threats to mental health, and removing the stigma from mental illness.
For the first time in our history, our federal government is entertaining a national program to screen all adults under the age of 65 for anxiety disorders. Experts recommend that this be a part of every annual health checkup. This program, if enacted, would require a massive increase in the numbers of psychologists, social workers, and related professionals (Lewis M. Andrews). But the experts argue that this is necessary. We must expand the “undersized mental health care workforce” to meet the need, which has reached epidemic proportions.
Indeed, what people today have been calling the “mental health crisis” is evident everywhere we turn. But is universal screening and contemporary modes of treating anxiety and depression, the most common mental health conditions, the solution?
To be sure, a trained and experienced counselor can help people navigate the most challenging periods in their lives, when they are most vulnerable to toxic stress that can lead to breakdown and worse. Good counselors are worth their weight in gold. And a psychiatrist can intervene to treat clinical depression, which we recognize today as a serious illness that often needs urgent medical attention. Their intervention has literally saved lives.
But the record of the various psychotherapeutic strategies in reducing anxiety and depression, even among people who sought out counseling without the prodding of a required test, is far from perfect. Even the experts who advised the federal government concluded that screening and referrals for adults would produce only a moderate net benefit (Lewis M. Andrews)
But what about psychopharmacologic drugs—antidepressants, mood stabilizers, and tranquilizers? Again, the record suggests that they do help some, but by no means all. And universal screening puts many more millions at risk of a lifetime dependence on pharmaceuticals (Lewis M. Andrews).
Now please don’t misunderstand me. Pointing out the limitations of these conventional approaches to treating mental illness by no means implies their rejection. Far from it. But is there another angle from which we can approach the mental health crisis prevalent among us today, one that is relatively neglected today?
In our first lesson this morning the Apostle Paul urges the faithful in Philippi to be anxious for nothing.
Note that Paul does not recommend therapy, nor does he prescribe pharmaceuticals. What he does prescribe never makes an appearance in any medical textbook or in the latest edition of the diagnostic and statistical manual of mental disorders. He refers them to the God who cares for them, who is near to them, who is not only aware of their burdens but wants to bear them. “Praise be to the Lord, to God our Savior, who daily bears our burdens” (Ps. 68:19).
It’s for that reason that Paul can command them to “rejoice in the Lord always” (Phil. 4:4). Let us recall here that Paul is writing from his own desperate situation. He is in prison and faces the imminent threat of execution. He has more reason than anyone to be anxious and afraid. Perhaps that is why he repeats the command, almost as if he is trying to convince himself.
He goes on. “Let your gentleness be known to everyone.” What is it that characterizes an anxious person but agitation? An agitated person never appears to us as gentle. That is the last thing that comes to mind to describe him.
But here it seems that out of a prior discipline of rejoicing in the Lord comes a certain calm, a certain dispassion—a frame of mind that allows people to discern that the Lord is near. “The Lord inhabits the praises of his peoples” (Ps. 22:3).
And if the Lord is closer to me than my anxieties, then I can stay calm, because he is greater than my anxieties.
In this connection, we may recall the words of Jesus from John’s Gospel. “I have told you these things, so that you may have peace. In this world you will have trouble,” Jesus tells his disciples, but “take heart, for I have overcome the world” (John 16:33).
Today all this language is conspicuous by its absence from our national conversations about mental health. And yet it was not always so.
Up until World War 1, when many colleges and universities were more closely tied to their Christian roots, presidents led seminars for graduating seniors on the various problems they were likely to encounter in the world after graduation. A central emphasis was the need to respond to every fear and every setback by remembering that, in the words of Yale president Noah Porter (1871-1886): “He who has brought you [this far] will guide you to the end.”
Implied in these wide words is an affirmation of God’s providence. This is an important word that every Presbyterians should know. The doctrine of providence maintains that God lovingly orders, guides and directs all things to their appointed ends. Nothing escapes his notice.
“Are not two sparrows sold for a penny? Yet not one of them will fall to the ground outside your Father’s care. And even the very hairs of your head are all numbered. 31 So don’t be afraid; you are worth more than many sparrows, Jesus tells his disciples (Matt. 10:29-31). He is teaching them about God’s providence.
As John Calvin writes in his commentary on this passage in Philippians, anxiety reflects a failure to believe in God’s providence. What we need to do to combat anxiety, Calvin advises, is to “[rest] unreservedly in God’s providential care.”
The lesson was no different in women’s colleges. President Mary Lyon (1837-1849) told her Mount Holyoke students that “it is our blessed privilege to commit all these [things] to the [Lord], who will certainly take care of us, if he sees that we are not afraid to trust him.”
What are all these things?
No doubt she had our lesson in mind when she made her statement to her students. “In everything,” Paul says, “by prayer and supplication with thanksgiving let your requests be made known to God.”
Just as anxiety should be for nothing, so prayer should be for everything. Even the smallest matters, the little things, the very little things, what could even be called the trifling things—bring them before God.
Sometimes one hears this objection to prayer: “God has a whole universe to run. He has far greater business to attend to than to concern himself with the petty problems of my life.” But to Paul this objection is invalid. For Paul says “in everything.”
And so when we wake up in the middle of the night, and can’t get back to sleep, because of all that is on our mind, by a kind of spiritual instinct, we should turn to him, and bring our various little concerns before him in the sleepless night, the difficulties in connection with our families, our work, our responsibilities, whatever they may be.
Whatever disquiets our hearts in any way, let us speak to God about it. “By prayer and supplication, let your requests be made known to God.”
“With thanksgiving.” By laying out all our concerns and anxieties before God, all day, every day, by that very act we place ourselves under his providential care. We surrender control to him. And from there thankfulness naturally emerges. I can entrust myself to no one or nothing better than to the great God who cares for me, even more, who loves me so much that he gave his only Son for me, so that, because of him, and together with him, I may be received by him as his beloved child.
“By this elementary instruction Paul prepares us to pray properly,” Calvin writes, without which indeed we cannot even understand what it means to come to God as a child does to his father.
We must learn not only to be still enough to let prayer and supplication happen, we must also discipline ourselves, as Paul goes on to say, by having the right frame of mind for our prayers and supplications. Instead of “churning” over the problems that constantly weigh on us, that keep us up at night, we should make it a priority to focus on “whatever is “true,” “honorable,” “just,” “pure,” “pleasing,” “commendable.” If there is any “excellence” or anything “worthy of praise,” says Paul, we should “think about these things” (Phil 4. 8).
This is not a whistling in the dark. Or I should say this is only a whistling in the dark if this world of evil and chaos is not held together by God’s providential care. But since it is, we can think about the things Paul recommends with self-abandon.
In other words, if we train our eyes to look for the good in all, in spite of all the bad, we will not so easily be disturbed by anxiety, but will be held safely within God’s joy and providence for us all, even for our enemies (Sarah M. Coakley).
Paul insists that this whole process of prayer, of asking and thanking God, culminates in peace. When we relax into God’s care for us, anxiety is exchanged for the peace of God.
We can imagine that when Paul discovered in his lonely cell that the Lord was near, that therefore there was no longer any cause for worry, he experienced this same peace.
This is a deep and lasting peace that protects us from attacks of anxiety, or at least prevents us from being totally consumed by it.
God’s peace protects our hearts and minds. The verb that Paul uses here is a military term that pictures God’s peace as a detachment of soldiers that stands guard over a city to protect it from attack. God’s peace keeps guard over our thoughts and feelings so they will be as safe against the attacks of fear and worry as any fortress.
Note also that Paul’s language here of the peace of God tips over into the unique phrase used only here in the New Testament: the God of peace. Noticing this, Calvin writes: “Here Paul speaks of the peace of God; but now more pointedly confirms what he has said by promising that God himself, the author of peace, will be with them. For the very presence of God brings us every kind of blessing.”
What can we say in closing about what we may call Paul’s approach to mental health care?
This message of the transformation of anxiety through prayer, its mysterious enfolding in the joy and peace of God, through Christ and in the Spirit (Sarah M. Coakley)—this message is needed now more than ever.
This indeed is our heritage as Christians, and we must urgently reclaim it if we are going to be effective ambassadors of Christ to a post-Christian world that is desperately looking for effective treatments to anxiety and depression.
“Joy, prayer, thanksgiving, peace—these characterize Paul’s spirituality,” commentator Gordon fee writes. “In a post-Christian world, which has generally lost its bearings, because it has generally abandoned its God, such spirituality is the key to effective evangelism.”
Does this not seem to you to be true? There is so much to be done to restore the proper witness of the Presbyterian churches, and so much at stake in our lamentably shrunken congregations.
But it was not for nothing that Paul wrote these words at a moment of crisis in his own ministry, and not for nothing that he asked the Philippians to be imitators of his own example as a personal bearer of this spirit of joy, thanksgiving and peace.
We need vivid examples of these personal qualities in order to follow them. And in an era when absurd ideas and patent falsehoods are newly fashionable, and despair and depression and anxiety are all around us, especially among the young, it is worth considering imitating those who have found their way, amid extreme anxiety, into the mystery of peace and gratitude and joy of which the Apostle Paul speaks in our lesson so unforgettably (Sarah M. Coakley).
A government screening program would probably not acknowledge that many people have found help in their mental health struggles through praying to the God of Paul and Calvin and Fee. Even if it could be shown to be legal to fund the expansion of this program with a pastoral care component and require physicians to make their patients aware of “spiritual” treatment options, in today’s world such proposals would certainly ignite political controversy, and the experts probably would be unwilling to cope with that kind of anxiety (Lewis M. Andrews).
Fortunately, there is nothing to stop any believer who has turned his or her anxieties over to God from joyfully reporting the results of that treatment protocol. Amen.