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This article was first published in , December 2017 issue.

Question: We are struggling in our ministry with many people in our congregation who have mental health concerns. We have responded to this pastorally, but not really in worship. Are there resources for engaging this in worship?

Response by John Witvliet: I am grateful for this question, and I hope that it will help lead to many more resources and insights over time. I was reminded again recently that mental health concerns affect as many as one in five people overall at any given time, with one of every twenty-five people living with serious mental health challenges. Further, at some point in our lives, forty-five percent of us will develop some form of mental illness or disorder.

What we say or fail to say about these challenges in worship settings can be profoundly formative for how Christian communities respond to these challenges. Further, decisions we make about how to shape and lead worship can do a lot either to welcome or to inhibit the participation of those among us who struggle with these concerns.

There is so much wisdom to be gleaned from chaplains and other mental health professionals. Among the basic insights I have learned:

• Pray explicitly for these concerns in worship, always with an ear for how they will be heard by those directly affected. Pray in ways that show an awareness of different kinds of mental health concerns—the differences between anxiety and depression, addictions and schizophrenia, post-traumatic stress disorder and dementia. Be mindful of caregivers, family members, and others close to them.
• Cherish and use psalms that show us how even extreme lament is welcome before God’s face.
• Find places in worship to sing hymns such as Mary Louise Bringle’s poignant text “When Memory Fades” (). It is not designed to be a crowd-pleasing favorite. But what a blessing it can be to enfold an experience like dementia into grace-filled hymns! Similarly, Psalm 88 is a text of grace-shaped honesty for many who struggle with depression.
• Preach the good news of the gospel for all people, grateful for the ways the Holy Spirit can bring healing and hope, including through medical care and through Christian community support.
• Avoid anything that stigmatizes mental health. Delete the following words from your vocabulary: “insane,” “wacko,” “lunatic,” “psycho,” and even “crazy.”
• Use person-first language. Do not label people as “schizophrenic,” “bipolar,” or “anorexic”; instead speak of “people who have schizophrenia” or bipolar disorder or anorexia.
• Become more aware of people who choose not to come to worship because of their anxiety or fear, and listen to their suggestions for making worship more hospitable.

I hope we keep adding to this list of fundamentals that every congregation can embrace and practice.

I also hope we can probe deep questions related to the fundamental nature of worship itself: What are unique challenges that people with various mental disorders face as they participate in worship? What is it like for those struggling with depression, including youth, when worship services are unrelentingly upbeat? What is it like for those struggling with eating disorders to come to the Lord’s Supper?

Warren Kinghorn, a theologian and psychiatrist at Duke Divinity School, has pushed even deeper in his writing on dementia, noting that “persons with dementia suffer not only from neuropathology but also from cultural norms that exalt agency, privilege rationality, equate worth with capacity, and discourage disability and dependence” (“‘.”Journal of Religion, Spirituality, and Aging 28, issue 1–2 (2016), abstract). Kinghorn celebrates how the Christian tradition, in contrast, affirms a counternarrative that “humans are integrated, whole-person, embodied souls on a journey to God, dependent on others and on God, endowed by God with intrinsic worth that is unrelated to capacities.” Kinghorn challenges prevalent thinking, even among Christians, which asserts that it is good not to be a burden or to need others.

This makes me wonder: Does this counternarrative come through clearly in our worship? Are we ready to give an account of how essential this counternarrative is to flourishing together in communities of mutual dependence, including all of us, regardless of mental or physical capacity?

And what about the “worship industry” in North America (a phrase I do not like, but one I occasionally use in order to name the economic dimensions that profoundly shape our musical diets)? What are the ways that our typical habits of coming to love a given song might subtly reinforce cultural norms that exalt agency, accomplishments, and independence? What about the messages of songs themselves?

Tellingly, Kinghorn’s works also include moving descriptions of Lord’s Supper celebrations, hymns sung by people who are not able to remember almost anything else, and sitting next to his patients in an Ash Wednesday service in a psychiatric ward. What a gift these robust, psalm-shaped common practices of worship can be, not only in our present experience, but also for the future challenges many of us may well experience. And what a gift Romans 8 is for all of us: “The Spirit helps us in our weakness; for we do not know how to pray as we ought, but that very Spirit intercedes with sighs too deep for words” (Rom. 8:26, NRSV).

Mental health concerns have not yet been prominent in many North American worship conferences. At the 2018 January 91���� Symposium, we look forward to learning from Dr. Kinghorn and other voices with expertise to share. This column and that conference session are really just a beginning. This is not a topic that we will “solve.” It’s more a like a lifelong journey, a way of life that we can begin now and grow into throughout our lives.

What if in every worship planning meeting or worship course or workshop we paused to ensure that our own working picture of our congregation includes people across the spectrum of mental health and illness—people experiencing the full range of human needs, hopes, and fears? What if the grace-filled words of Romans 8:26—“the Spirit helps us in our weakness”—were at the center of our theological vision for worship?

The potential for profound, Spirit-shaped transformation is significant indeed.