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Language and the stigma of mental illness: 10 suggestions for churches

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November 3, 2017

There is a stigma that attaches to all things counseling. I experience it as a counselor. The second question people ask when you meet someone new, after “What is your name?” is “What do you do?” Having to answer, “I’m a pastor of counseling,” is the double social kiss of death.

The conversation either immediately accelerates into a personal subject that carries more weight than this fledgling social relationship should bear, or there is the awkward silence as that person wonders, “Does he have telepathic powers that can read my thoughts and knows my secrets? I’d better be careful what I say.”

Whatever awkwardness exists for a counselor can be greater for a counselee. I don’t think this is what “should be,” of course. I’m merely describing what I frequently hear reported to me.

The role of language

One of the culprits is language. Counseling is about as awkward to talk about as sex is, and it produces a similar amount of inappropriate slang. How many slang words do you know for counselor, psychological diagnoses, the therapeutic process, psychotropic medications, or a person who struggles emotionally? The common vernacular about such matters can often be on par with a middle school locker room.

Then you take the common-versus-clinical struggle of counseling language, and matters get more complicated. Consider the breadth of meaning that can be contained within the simple sentence, “I’m depressed.” That’s what many say after a bad math test, the end of a romantic relationship, the death of a parent, prolonged isolation, and when hung over from alcohol (a depressant).

Then, there is clinical depression, which has some relation to these experiences, but may or may not be present in the down mood associated with the list of experiences above.

The problem is a vicious catch-22. If counseling is going to be effective, then it must use language that people can understand and readily use. However, if clinical depression (or some other clinical phrase) is going to mean something more than “I’m down,” then counseling needs a language it can define and protect from being confused by common usage. We can’t have both.

C.S. Lewis describes a similar struggle in the development of the word “gentleman.” In his example we see how the “communizing” of language often robs words of their useful meaning.

The word gentlemen originally meant something recognizable; one who had a coat of arms and some landed property. When you called someone ‘a gentleman’ you were not paying them a compliment, but merely stating a fact (p. xiii) . . . A gentleman, once it has been spiritualized and refined out of its old coarse, objective sense, means hardly more than a man whom the speaker likes. As a result gentleman is now a useless word . . .  Now if once we allow people to start spiritualizing and refining, as they might say ‘deepening’, the sense of the word Christian, it too will speedily become a useless word (Mere Christianity, C.S. Lewis, p. xiv).

However, in the case of depression and many other common counseling words, we are left wondering who “owned” the word first and who should “own” it now? It has to be “shared,” but when have people ever been good at sharing?

From language to stigma

The problem with shared language is that it both (a) gives people the impression they understand something they may not and (b) convinces people they are saying something helpful when they may or may not be. Consider this simple dialogue between two friends.

Person A: “I think I’m depressed. Have you ever been depressed?”

Person B: “Yes, I’ve been depressed several times.”

Person A: “What did you do to move past it?”

What are the odds that these two people are discussing the same experience? How likely is it that what was helpful for Person B will be equally helpful for Person A? How likely is it that these two people are considering the difference between the common experiences of being depressed? How many situational and personal variables will be weighed in this conversation as advice is given? What happens when the most common answers to these questions reveal an uninformed conversation?

People get hurt. People give and/or receive bad or ineffective advice. People become insecure about the discussion of depression (on both sides of the conversation). A stigma emerges as this subject becomes a source of more pain rather than relief. A stigma often produces humor to cover the awkwardness and clichés to move past the complexity. Silence seems like the best alternative, and it builds an insulation around the pain; ironically, this keeps it fresh.

Ultimately, the helper, helpee, and helping process begin to take on a distorted significance—either marginalized or glorified, depending on the level of hope or cynicism of a given individual.

From stigma to hope

It is highly unlikely that we are going to train an entire culture, or even an entire church, to know the difference between the counseling-versus-clinical usages of terms like depression. It’s even less likely that common conversation will be marked by intentionality and precision each time a word like depression is used.

Should pastors seek to nuance the common-versus-clinical distinction every time they speak of anxiety, depression, someone being compulsive, or hyperactive? No. That would probably add to the stigma as people feel compelled to be that precise in their day-to-day conversations. Should churches leave this issue to the professionals and avoid such subjects? No. Again, that only adds to the stigma as people would feel like these struggles made them “different” in a way that was socially “off limits” if they admitted it. Therefore, people would have to be “that bad” before they would talk to anyone (friend or professional).

Here are a few suggestions that I believe can help remove the stigma:

  1. Don’t make counseling jokes in preaching and teaching. I love a good counselor joke, and I hear a lot of them, but at this stage in the Christian discourse on mental illness, I believe humor reinforces stigma more than it edifies or alleviates tension.
  2. Offer discipleship classes on basic emotions like depression, anxiety, anger, and grief which include clinically accurate descriptions of these struggles and their more severe expressions of bipolar, OCD, control, and PTSD. More of these resources need to be created. We won’t agree with them all, and we’ll have to be okay with that.
  3. Downplay the disease model debate. For most people, it is not essential that they have a position on this issue before they seek help. Scripture presents sin as a condition and as a choice. Scripture presents suffering as the environment in which we live (bodies and social networks affected by sin) and gives us hope and a voice in the midst of suffering.
  4. Don’t assume that taking psychotropic medication means someone is buying into the disease model. Medication can both provide relief from symptoms and treat underlying causes; it’s not either/or. Medication does not prevent spiritual maturity.
  5. Post good Christian testimonies and resources of counseling-related struggles in our social media channels. This is where many people begin their exploration of how to understand their struggles and how conversation will be received.
  6. Encourage testimonies about counseling-related struggles in small groups and larger gatherings, but the more public the forum, the more informed the testimony needs to be about the common-versus-clinical language in their story.
  7. In public testimonies we need to be more nuanced about anecdotal (what worked for me) versus prescriptive (general recommendations) regarding emotional struggles. Testimonies are usually better for giving hope and an example of this being a safe conversation than drawing a correlation, “My experience of depression is like your experience of depression, so what worked for me will work for you.”
  8. Be authentic about our own seasons of emotional difficulty in our preaching and teaching.
  9. Quit using air quotes when we refer to diagnoses. This is demeaning and shuts down conversation.
  10. Most importantly, every pastor should build a friendship with several people who clearly struggle with clinical depression, childhood sexual abuse, chronic pain, unwanted same-sex attraction, and similar struggles (we already know them, if we have courage and authenticity to ask). There is nothing like friendship to help us find language that is accurate, honoring, and inviting.

This article originally appeared here.

Brad Hambrick

Brad serves as the Pastor of Counseling at The Summit Church in  Durham, North Carolina. He also serves as Instructor of Biblical Counseling at Southeastern Baptist Theological Seminary, a council member of the Biblical Counseling Coalition, and has authored several books including Do Ask, Do Tell, Let’s Talk: Why and How Christians Should Have Gay … Read More

Article 12: The Future of AI

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24