Mental illness is still murky territory for those who experience it, their families, and their church.
Not long after Rich Salazar moved to DeKalb, Illinois from California, he found himself knocking at the door of St. Mary's Church. The then-college student had recently been diagnosed with bipolar disorder and was in crisis mode. Unable to reach his mother at work and not knowing where else to go, Salazar told himself, "I have to go to church."
Father William Schwartz answered his knocks and, although the parish was closed for the evening, invited him in. "He talked to me, calmed me down," Salazar says. The priest called his mother and told him he could stay at the church as long as he needed. "He was very kind. I told him the church has never let me down."
That's when Schwartz responded, "Someday it might."
For many Catholics experiencing mental illness and their families, the church can be both a place of welcome and alienation. Just as society has struggled with how to deal with those with mental illness, U.S. parishes and dioceses have found the area equally challenging.
Many in Catholic mental illness advocacy agree with Chicago Deacon Tom Lambert when he says, "As a church we're just beginning to address the issues on a church-wide and institutional level."
The National Institute of Mental Health estimates that one in four Americans has a mental disorder. Of those, one in 17 has a serious mental illness such as major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, or borderline personality disorder.
To Portland, Oregon psychiatrist Dr. Thomas Welch, those large numbers mean that every Catholic is affected by mental illness in some way. "The people next to you in the pews may have a mental illness or have family [members] who have mental illness," he says. "By virtue of Baptism, we're all equal members of the church, and we need to be mindful of that."
As research has shown that mental disorders aren't just moods to be shaken off or, in severe cases, uncorrectable issues requiring time in a mental institution, the stigma once attached to them has slowly been eroding.
"The church's response parallels society," says Dorothy Coughlin, the Archdiocese of Portland's director of the Office for People with Disabilities.
Nancy Kehoe, a Society of the Sacred Heart sister and psychologist in Cambridge, Massachusetts, remembers a time when there was a lot of secrecy around mental illness. "If a nun had to be taken to the psychiatric ward in a hospital, there was a lot of shame in having a psychiatric disability," she says. "It wasn't even known to people immediately around her where she went."
On the flip side, Kehoe recalls the public nature of a Cambridge-area pastor who took leave for a few months. Upon his return he announced to his parishioners that he was experiencing depression and would be stepping down to serve a smaller parish and continue dealing with it. But, Kehoe notes, a pastor openly addressing his struggles with depression "was unusual even in 2009."
New Jersey psychologist Kenneth Herman started practicing in 1955 and says that at the time the Catholic clients who came to see him dealt with a lot of guilt, anxiety, and fear over their faith in everything from eating meat on Fridays to sexual issues. "It was a sin if you thought anything that was considered negative," he says. "You got the wrath of the church, and that produced a lot of guilt, especially with people who were a little fragile emotionally."
While Herman doesn't believe the Catholic Church did it intentionally, he says, "The church had an opportunity to send a lot of positive messages, but they didn't." By the time he retired a few years ago, Herman says he saw a change in how Catholics viewed their faith.
Author Therese Borchard writes about how guilt has played a large role in her own struggles with bipolar disorder in her new book, Beyond Blue (Center Street). But she also says that Catholicism is the perfect tradition for those with a mental illness.
"I think the Catholic faith, especially with all its traditions and rituals, can give you a kind of safety," Borchard says. "I joke that there's a saint for every disorder, and if you run out of saints there's always St. Jude for hopeless causes."
Today the church takes more of a holistic approach to mental illness. Welch describes a "synergy between religion and psychology" where there is an awareness of the biological, social, psychological, and spiritual aspects of a person suffering mental illness.
In Kehoe's eyes, suicide is the biggest area of attitude change for the Catholic Church. The Catechism of the Catholic Church still describes it as "gravely contrary to the just love of self," but since the 1983 revision of the Code of Canon Law, suicide is no longer listed as a reason to prevent a Catholic burial.
"Suicide is not a sin anymore," says Kehoe, who in her recent book, Wrestling with Our Inner Angels (Jossey-Bass, 2009), talks about working with suicidal patients. "Other religious traditions have not taken that approach yet."
A real disability
Mental illness outreach within the Catholic Church has often emerged from other disabilities work.
Connie Rakitan, a member of the Archdiocese of Chicago's Commission on Mental Illness, is the founder of Faith and Fellowship, a support group for people with severe mental illness. She thinks there's been a vast improvement in the "sensitivity and sophistication" of understanding mental illness, but that church outreach in that area has taken more time compared to the outreach to those dealing with physical disabilities.
"It is way easier to build a ramp than it is to deal with a person who comes to church talking to herself, which might be a manifestation of some of the more severe symptoms of mental illness," she says. "I don't think that the church is ready for that yet."
Recent Baylor University studies reflect this attitude. A 2008 study showed that almost one-third of a group of 293 Christians who approached their various churches about mental illness were told that they or their family member didn't really have a mental disorder. A 2009 Baylor survey of Texas Baptists found depression and anxiety were the maladies most often dismissed by clergy. Repeated studies have also shown that it is clergy to whom people most frequently turn when they are first in mental distress, not mental health professionals.
Like many working in Catholic mental illness advocacy, Lambert, the deacon from Chicago, has a personal connection to mental illness. His daughter was diagnosed with a serious mental illness 20 years ago, and he and his wife first sought resources through the National Alliance on Mental Illness (NAMI), a leading nonprofit organization that was founded in 1972.
"NAMI recognized that churches are a natural ally," he says. "Churches understand compassion. Churches understand justice."
NAMI has since extended its faith-based support to include working with interfaith groups and incorporating a website, nami.org/namifaithnet, to help users connect with religious groups. While groups like NAMI grew in the 1980s and '90s, the Catholic Church still lagged behind in terms of a mental illness network.
To help, the National Catholic Partnership on Disability (NCPD) created the Council on Mental Illness in May 2006. Lambert, Rakitan, Welch, and Coughlin are all members. In July 2009 the council began a mental illness initiative that has included creating a DVD, webinars, downloadable resources, and workshops.
The church "had always advocated for all people with disabilities, but we hadn't done enough for people with mental illness," says Janice Benton, the executive director of NCPD, which began in 1982. "We also want to have an informal network of people around the country who are doing outreach to people with mental illness."
Share the load
Rich Salazar, now 42, was later re-diagnosed with schizoaffective disorder, bipolar type, and had a second major breakdown. Today he is in recovery and is both a local NAMI affiliate board member and a facilitator of NAMI Connections support groups. He's getting married in the Catholic Church this June.
If he hadn't found the church welcoming, Salazar says he probably would have turned to another denomination for support or become lost without spiritual guidance.
"Most people with mental illness have a deep faith because of the nature of mental illness," he says. "It's such a catastrophe in one's life that it literally drives you to your knees in reaching out to a higher power, to Christ."
While Salazar says Jesus has acted as a "divine healer" in his life, the priest who helped him in college was right. He has had some negative experiences with the church.
Because he can be overly scrupulous and experiences manic episodes with his disorder, he has had priests snap at him because he called the parish too many times looking for support. Salazar came closest to leaving the church when one priest told him to go away after Salazar was taking an overly long time in Confession.
"I definitely struggle with that balance between wanting to stay close to God but having to stay away from God, because I don't want to become overly religious" in a way that could be dangerous to his mental health, he says.
"I realized that I needed to forgive the church because the church has always forgiven me," he says. "I believe that the church will eventually hurt every Catholic because it's human."
For Marty and Peggy Juricek of Chicago, their Catholic faith helped them reach stability in their struggle with mental illness.
"If it weren't for my faith I don't think I'd be here today," Peggy says. She developed schizoaffective disorder, bipolar type, in her mid-20s. While recovering in a hospital from a suicide attempt, a fellow patient with a master's degree in theology got her reading the Bible. Although she was raised Catholic, Peggy says this was where she first really connected to her faith.
"It took a long time, but the more I prayed the better I felt," she says. "God has worked miracles in my life."
Marty's attitude is practical: "I feel that God heals us, too, but that doesn't mean that you don't need to take your medication." He suffers from bipolar disorder and credits his recovery after his first breakdown at age 19 to his father, who sent him to volunteer with a Catholic priest in Appalachia. Today Marty is developing a business to connect faith groups with mental health agencies.
The two met at a singles event at their parish, St. Nicholas of Tolentine, where last April they coordinated a mental health awareness Mass.
Outreach to those experiencing mental illness does not need to be as extensive as starting your own social service agency. Many within the church say that while the mentally ill often need a range of services-including access to medicine and counseling-churches can begin by simply making those with mental illness feel welcome.
"If only our parishes knew how simple it is to be the support that people just hunger for," Dorothy Coughlin says. "For so many people with mental illness, what would be most therapeutic in their lives would be relationships and friendships."
"To support a friend with cancer I don't have to be an oncologist. To support a friend with mental illness, I don't have to be a psychiatrist," she adds.
Another refrain among Catholics involved in mental health outreach is that training, beginning at the seminary level, would go a long way toward helping awareness spread throughout the Catholic Church in this country.
"I'd say the majority of priests don't understand what mental illness is about, and they can't identify it when it comes to their door," Salazar says.
Welch says he's heard homilies in which priests referred to someone as crazy or as having a "Prozac moment" and other phrases that can be alienating to a person with mental illness.
Seminaries do pastoral training for areas like marriage and bereavement counseling but don't get into "the big guns" of mental illness, Rakitan says. She'd like to see churches host support and outreach groups not only through NAMI and other outside organizations but on their own.
An example of that is in the Archdiocese of Portland, where Welch started a faith-sharing group with Dorothy Coughlin last year at St. Philip Neri Church. The group gathers to have dinner, go over readings, do reflections, and pray for those who were unable to come that week.
Coughlin remembers one man who came to the group last year before committing suicide. He always used to ask for a window to be opened at the meetings. "We still open the window, remembering him," she says.
Yolanda Ortega has been involved in NAMI since her daughter was diagnosed with schizoaffective disorder 25 years ago. The lifelong Catholic believes that God took care of her daughter during her most unstable periods when she was homeless and wandering around the country.
So in April 2006 Ortega started the Faithbased Mental Health Initiative in San Antonio that now includes close to 20 support groups at different area churches, almost half of which are Catholic.
"I do believe that if churches do mental health ministries, they can help to keep people from falling through the cracks," Ortega says with passion. "People with mental illness are much sicker than they need to be, and we as Christians need to care."
She is looking for ways to expand mental health outreach within the Catholic Church and would like to see the Archdiocese of San Antonio follow the lead of the Episcopal Diocese of West Texas by appointing a staff person to work on mental health ministry.
Another Faithbased Mental Health Initiative team member, Carmen Ortiz, has helped organize several of the Catholic support groups and leads one at her parish, St. Brigid. She says they chose to have support groups in churches because it's a familiar, comfortable environment.
For the large Hispanic community in San Antonio, Ortiz says, it's also a way to get past the cultural stigma attached to mental illness. "We had to deal with a lot of Hispanics where it's hard for them to open up and talk about it."
Ortiz points to her 40-year-old son, who was a successful graphic designer before developing bipolar disorder, to show how "the disease has no respect for any race or career or anything." While her son is recovering, he still struggles with faith.
"All the [support group] families, when we get together, that's one of the struggles that we share, that because of their illness, our loved ones just give up on God."
Mad at God?
When she was 21 and a newly professed Daughter of St. Paul, Sister Kathryn James Hermes had a stroke that left her paralyzed. She recovered her speech and mobility but developed what was later diagnosed as temporal lobe epilepsy, an organic bipolar disorder.
Her mood disorder left her furious at God. Because she was a nun, she kept going to daily Mass and regular prayers, but, she says, "I would sit in the back of the church and glare at the cross. I couldn't believe for a year that God existed."
The only way Hermes could pray was to read the second half of the Book of Isaiah, the Book of Consolation. "I read those promises of God," she says. "I didn't believe it, and I couldn't find any joy in it."
Her turning point came when she was speaking to her spiritual adviser one day and asked him, "Why me?" His response: "Why not you?"
Hermes says that people tend to believe that God is punishing them and struggle with why they were singled out for this illness. She has since written six books, including Surviving Depression: A Catholic Approach (Pauline Books & Media), which tries to show people how to overcome the "Why me?" struggle.
Even a lack of faith is a type of prayer, according to Hermes, though it can be hard to see someone's spiritual life disintegrate, as she has seen in those with whom she's spiritually walked.
"I've told them, and I've seen that it is really true, that this experience can be a grace experience," she says. "Our childhood relationship with God crumbles, but we can find him anew, as an adult on a much deeper level, in a much more profound way."
Unlike many people, those with mental illness can see "the depths and heights of humanity, the soaring glory of the possible and the deep melancholy of life. And that is a gift," Hermes says. She and others in Catholic mental health advocacy hope the church continues to get even better at finding, as Hermes says, the "beautiful in the brokenness."
This article appeared in the February 2010 issue of U.S. Catholic (Vol. 75, No. 2, pages 12-17).
Image: Tom Wright