Ethics of Inclusion – Statements on Mental Illness and Disability

[1] The ELCA’s church council has approved an ELCA social message on mental illness entitled “The Body of Christ and Mental Illness.” The message seeks to raise awareness of the challenges of mental illness, offer reflection and direction, and inspire action. The message offers a definition of mental illness from the National Institutes of Health, one several other denominations use, and then describes some of the challenges posed by mental illness. Among other things, mental illness challenges basic human dignity, makes gaining access to treatment difficult, and it highlights social inequalities and lapses in the health care system. It makes the most basic aspects of everyday life daunting. What people with mental illness most need is time to pursue and engage in treatment, and relationships where they can exercise their abilities.

[2] The message puts to rest any notions that mental illness is a sign of sin particular to the person suffering from it. The theological move it makes is to call the church into companionship, heeding Galatians 6:2, and seeking healing via the restoration of relationships. As Christ was not afraid to be vulnerable, the body of Christ in the church is not afraid to be vulnerable: “When people with mental illness are present as full members, as their true selves, the church as the body of Christ is both wounded and authentic.”[1] Through companionship, its own health care, its public voice, and proper clergy preparation, the church seeks to counter the dis-grace heaped upon people with mental illness and offer hope of treatment and companionship.

Denominational Statements

[3] The ELCA is joined by a number of other Christian denominations which have made public pronouncements regarding mental illness. Among them there is a great deal of similarity. Themes of human dignity and reducing stigma predominate. Concerns for social justice, addressing wrongs, and achieving parity in health care drive all of the public statements. There is in the Christian history a rich resource for addressing this particular social issue. The confluence of themes would seem to indicate that the best of Christian theology has been brought to bear.

[4] The area of greatest difference lies in the kinds of imagery used to illustrate the isolation experienced by those living with mental illness. Describing the relationship of people who are living with mental illness, whether suffering from it themselves or living with its effects on others, to their religious communities is where most of the differences between denominational statements arise.

[5] What’s challenging about illustrating the isolation of mental illness is that mental illness is often hiding in plain sight. On the one hand, the statistical incidence is prevalent (one half of Americans will have a serious mental health condition in their lifetimes[2]), but on the other hand, public revelation of the presence of mental illness is not. The secretive aura surrounding mental illness is compounded by a shameful past of exclusion of people with mental illness from the mainstream, of blaming people with mental illness for their disease, and of imputing mental illness to socially vulnerable people (witness the condition of “hysteria”). The Church has played its own, robust part in this history—shaming the families of suicide victims, for example, and not allowing their bodies to be buried in consecrated ground. Historically speaking, the Church has been no more forgiving or welcoming of people with mental illness than society at large. Much as with any group that has been excluded in the past, the Church needs to change its relationship, and become more sensitive and inclusive.

[6] The difficult part of changing that relationship is that mental illness for the most part remains hidden. While social stigma remains, revealing a diagnosis imposes a risk to social and professional stature. It is quite possible to hide mental illness from a religious community. So the challenge to the Church becomes two-fold—reversing the course of exclusion and blame, and also creating at atmosphere where a diagnosis of mental illness is no more remarkable or shameful than a diagnosis of an illness whose origin is below the neck. At the same time, many people experiencing mental illness or its effects are already part of the community. Describing how the Church changes to ensure people are part of the community despite the Church’s history, while also acknowledging that people with mental illness are already part of the community represents two significant challenges.

Presbyterian Church USA

[7] The statement of the Presbyterian Church in the USA (PCUSA) uses the language of exile to describe the status of people living with mental illness, declaring: “We recognize God’s call to proclaim comfort to people in exile by welcoming them home into the covenantal community of the church.” (LINK: http://www.pcusa.org/resource/pcusa-policy-statement-serious-mental-illness-stud/ ) There are many advantages to using such imagery, rich as it is in biblical and emotional connections. Exile as a term conjures loneliness and isolation and longing to be part of the whole. What it does not convey fully is the wounded presence of people who are already part of the community, but whose suffering goes unnamed and unacknowledged because they fear exposing their vulnerability by revealing their own mental illness or the mental illness of loved ones. Being or becoming part of the community does not mean that suffering is over, or that it is even made public.

Reformed Church in America

[8] Another option might have been “hospitality,” which was used by the Reformed Church in America’s (RCA) Task Force on Disabilities (https://www.rca.org/sslpage.aspx?pid=4994) to describe welcoming those with disabilities. This usefully places the onus of accommodation onto the host, who must adapt to make the guest comfortable. In welcoming the stranger, the host welcomes and serves Jesus himself (Matthew 25:35). The dynamic of host and guest implies that the host must surrender power, but having power reside (albeit implicitly) in one part or another is not the most felicitous of situations in a congregation. Will (and can!) one group truly surrender its power to make others comfortable? And when does the guest become the host? Or is the guest always to be the stranger?

Episcopal Church in the USA

[9] A 1991 Episcopal Church in the USA (ECUSA) resolution from a task force on accessibility encourages the church and all its units: “to reach out, welcome, include and support persons with a mental illness, particularly those who have a prolonged, serious mental illness, and the families of those persons, and recognize the abilities and celebrate the gifts of those who have a mental illness.”[3] As brief at it is, this statement encapsulates the most desirable end result of the process of assembling community, which is that people with mental illness are fully a part of the fabric of their community, accepted for who they are and celebrated for what they can bring. The idea of people with disabilities bringing gifts to the community is echoed in a document from the Australian Catholic Bishops Conference. “People are liberated if and when they use their gifts. People are imprisoned when they are prohibited or not enabled to use their gifts.”[4]

[10] All of the aforementioned illustrations of isolation, while perhaps compelling, have a fundamental weakness. It is that mental illness is not revealed to be already in the community which, statistically speaking, it most likely is.

Roman Catholic Church

[11] Taking a slightly different tack, the Roman Catholic use of human dignity endowed by the image of God as the basis for understanding how difference fits into community leads into a comprehensive ethic for inclusion and an understanding of how those with disabilities are essential to communities. Stanley Hauerwas arrives at an understanding of community wherein those who are vulnerable serve the community by their very presence,[5] not dissimilar to what we see from the Roman Catholic statements. I would argue that beginning with the dignity of humanity as endowed by God makes inclusion a less loaded and difficult term. Since our humanity is a matter of being rather than acting, community simply is, rather than must become. When the community is already formed from people who are present without being able to reveal their full selves, this reassurance of a community of being rather than a community of becoming might be the most inviting description to someone hiding the presence of mental illness.

United Church of Christ

[12] The theme of human dignity is a common thread in discussion of mental illness and/or disability, but its priority in the framework can make the difference. The United Church of Christ (UCC) resolution is different by nature of its being a resolution rather than an extensive study. Yet it is in keeping with UCC social concerns in that social justice is the first move. The resolution begins with the injustice of stigma, and addresses it via the imago dei and love commandment. The resolution advocates education for congregations, and resolves inclusion and welcome to be the approach. The ELCA’s message on disabilities (LINK: http://www.elca.org/What-We-Believe/SocialIssues/Messages/Human-Disabilities.aspx) begins its theological argumentation with human dignity, and relatively swiftly moves onto concerns about sin and social justice. The ELCA disabilities message also uses inclusion imagery to describe the relationship between individual and community. It places an emphasis on injustice that leads urgently to a conclusion of outward-looking action.

[13] This is appropriate in most cases, but whether it’s best for a situation such as mental illness is hard to say. It’s hard not to wonder whether, when more emphasis is placed on dignity, the individual/communal relationship flows together more easily than when emphasis is placed on social justice. Discussing mental illness requires being attentive to both the inside of the community and the outside of the community.

Evangelical Lutheran Church in America

[14] Ultimately, the ELCA message on mental illness uses the image of the vulnerability of the body of Christ to impart the sense of being simultaneously included in and excluded from a community. The message purposely avoids the use of the word “stigma” as already freighted with social connotations, and seeks to describe the experience of the person living with mental illness as one of alienation and isolation. Building on the relational aspect that underlies human dignity in the disabilities statement, the message maintains that such alienation transgresses our innate human dignity. The statement ultimately calls the reader into companionship in suffering. I believe (and I may be a tad biased as the author), this imagery is most compelling and proper in the case of mental illness rather than using terms such as inclusion and stigma. Companionship means a greater responsibility to become familiar with one’s companion than does inclusion. Stigma can be addressed to some extent by proper information (The ECUSA resolution leads with the emphasis on reducing stigma through accurate information), but to appreciate the depth of its harm, and to truly commit to dispelling it, one must be willing to risk true companionship.

[15] The ELCA message also addresses suffering to a greater degree than its Protestant counterparts. Mental illness confronts the person of faith with very real and palpable suffering. How suffering fits into the created order is another marker that differentiates one tradition from another. Stanley Hauerwas, in his work on suffering, describes the theological process behind a tendency to direct blame toward the victim[6] as a way of ensuring that those not afflicted feel they live in a beneficent order. The work of the ELCA on creation in the statement on genetics ( LINK: http://www.elca.org/Faith/Faith-and-Society/Social-Statements/Genetics) proves to be useful a useful basis for explaining the presence of variation in creation, some of which causes suffering. The ELCA message is careful to warn against associating mental illness with sin in an individual, while being open to asking how mental illness occurs. The message does not give meaning to suffering beyond a call to accompany others in it. A Roman Catholic statement, however, takes a different view of suffering, regarding the suffering brought on by mental illness as redemptive.[7] Mainline Protestants tend to steer far away from proclamations. Their attitudes toward creation reveals an unwillingness to allow imperfections in creation to become a matter of sinfulness, and a deliberate openness to the human scientific endeavor.

Conclusion

[16] There are, of course, many other areas where the different documents bear similarities. The PCUSA document makes the distinction between healing and cure that the ELCA’s statement on health care makes, one that underlies the mental illness message. Understanding that mental illness is (for the most part) not cured but treated, allows for a realistic perspective that means we are not hopeless in the face of relapse, but apply ourselves with renewed vigor to seeking treatment. Every statement advocates for seeking treatment from modern medicine. The UCC resolution emphasizes the possibility of treatment, though at a cost to a more realistic portrayal of the difficulty of seeking treatment for mental illness. The UCC statement also holds parity with other bodily illnesses as a principal platform, a perspective well-served by the emphasis on the possibility of treatment. Overall, this is significant of a fundamental difference between the UCC and ELCA documents. The ELCA document focuses more intensely on congregational life and practice.

[17] The aforementioned documents on mental illness and disability offer solace to the afflicted, draw attention to the suffering, and strengthen the resolve of the faithful. What the ELCA message brings in particular is an understanding of the depth and intensity of a religious community, and the many ways in which individually and collectively its members can answer their Christian call to their neighbors.