Pages Navigation Menu

St. Augustine, Catholics, and Mental Illness

Over at the Evangelical Channel on Patheos, Adrian Warnock is hosting a conversation about faith and mental illness in honor of the fact that May is Mental Health Awareness month.  Throughout the month, I hope to post blogs to contribute to that conversation, as I believe that it is a crucial conversation for Christians and all people of good will to be having.  This week, Warnock is asking bloggers to address how their religious communities have historically viewed mental illness and how their faith, today, shapes their view of mental illness.

When I think of the long history of the Catholic Church, of all the things that could be said about how we have viewed those with mental illness, I’m going to focus on three ideas, because I think they are the most constant and the most right (well, mostly) of the tradition.  The first comes from St. Augustine.  In his City of God, in which he covers and theologizes upon the whole of history as he knows it, he considers, briefly, the gift that is the human intellect.  What a wondrous thing it is that we have been given the ability to know our world, our selves, and even, with the help of grace, our God!  In the midst of this beautiful, celebratory passage, however, he interrupts himself to say this:

Crazy people say and do many incongruous things, things for the most part alien to their intentions and their characters, certainly contrary to their good intentions and characters; and when we think about their words and actions, or see them with our eyes, we can scarcely — or possibly we cannot at all — restrain our tears, if we consider their situation as it deserves to be considered.

One can almost see the tears of the saint on the page.  Or perhaps, those are the tears of his readers through the ages, who have known exactly what he meant.  When one’s intellect is shattered by an illness like schizophrenia, complete with its hallucinations and delusions (not to mention countless less dramatic but no less debilitating symptoms), one cannot know the world, one’s self, or one’s God in the way one was meant to.  And insofar as one cannot know well, one cannot act well.  As Augustine puts it, one acts against one’s own good intentions.  There is such a deep tragedy in this lack of understanding and the lack of full freedom that follows upon it.  But that is one thing that it seems the Catholic tradition has held onto well: the sense of mental illness as a tragic brokenness of a natural faculty.

The second idea that I want to mention is that Catholics have long considered the mentally ill to be among “the least of these” whom Christ calls us to care for as though they are Christ himself (Matthew 25:31-46).  From its earliest days, Christianity was reaching out to the poor and marginalized, and the mentally ill have been among them.  Whether in explicit service to those with mental health issues, or whether serving those who were poor, hungry, or homeless (all groups that ALWAYS include people with mental illness), the Catholic Church has a long tradition of service.

The third idea that I want to mention is one that I feel is more mixed.  Many Catholics are shaped by a sentiment expressed most succinctly by St. Ignatius of Loyola: “Work like everything depends on you, and pray like everything depends on God.”  I think that, in many ways, this can be freeing for Catholics who are concerned with mental illness.  For instance, I don’t think I’ve ever met a Catholic who thinks that mental illness should be solved by prayer rather than by psychiatry.  We are a people of the both/and!  (Note that there are plenty of Catholics, like plenty of others, who don’t seek help for other reasons; but generally not waiting for God to heal them.)

However, “work like everything depends on you and pray like everything depends on God” can have other painful implications.  It seems to promise that if you stick to whatever medication, work your program, and pray, you ought to get better.  So, if you are not getting better: are you lazy, or unfaithful? Of course, anyone who has paid much attention knows that mental illness is rarely cured but is a chronic illness that is more aptly described as “managed.”  And some people do incredibly well; others do not.  This usually has much more to do with the severity of their illness than their work ethic or their faith in miracles.   But it is very easy, especially for those who do not know that mental illness has real physiological bases, to assume that people with mental illnesses have those illnesses because they or their parents failed to work hard enough to develop the “good character” in accord with which they are tragically unable to act, as  Augustine knew over 1500 years ago.

At our very best, we know that mental illness is a tragedy, one that afflicts those who did not choose it, and we serve and care for those so afflicted as we would care for Christ.  But the range of mental illnesses and the variety of behavioral symptoms often make it hard for many of us not to judge those with mental illness as moral and/or spiritual failures.  The stigma of that judgment, for many, ends up being as big an additional burden as the illness itself.  Educating ourselves about mental illness is a great place to start.  Being courageous enough to talk about it is another.  NAMI (National Alliance on Mental Illness) is a great place to get some resources.  NAMI FaithNet may be of particular interest to churches.  Call your local NAMI affiliate and they will likely come (for free!) and offer an educational evening for your parish.  Let’s get this conversation going.



  1. Thanks for this post, Dana! I think your third point is most significant, rarely said, and dead on. And it connects to what it means to “consider their situation as it deserves to be considered.” I never would have thought to turn to Augustine for help in responding to the response you summarized like this: “So, if you are not getting better: are you lazy, or unfaithful?” So very often this is how we Christians respond to mental illness and it is so destructive. The stigma that results is very powerful.

    I also struggle with the ways in which the “heroes of Christian spirituality” are sometimes invoked for help in interpreting mental illnesses. These kinds of responses take the experience seriously in many ways that other responses do not, which is good. But they often seem to overlook or minimize the suffering involved. (What kinds of responses? I’m thinking here of reminders that many great artists of vision also suffered, and of those references to St John of the Cross, et al, which seem to highlight God’s purposes at work in such sufferings.) In short, there seems to be a theological implication that mental illness is a gift from God. There seem to be traditions which glorify the suffering of mental illness.

    (Is this observation reflected in your experience? Maybe I’m way off in left field here.)

    I think my main question is something like this: How do we discuss mental illness in a way which asserts that medical care is needed to manage mental illness while also engaging religious faith and/or theological beliefs?

  2. Nancy, thanks for the comment, and the great question. I really cannot speak too much to the traditions that glorify the suffering of mental illness. I think I tend to avoid those. Let me respond, though, very experientially. My brother, who suffers from schizoaffective disorder, was once suffering from what he described as “extreme mental anguish” during a stay in a mental hospital. He was surrounded by so many voices and images (hallucinations) that he could get no peace and quiet whatsoever. He even knew that some or all of them might not be real, but the energy it took to sort through and figure out what was real or not was just more than he could handle. That is the suffering of mental illness, or part of it.

    But the other thing that I’ll note here is that I know many people (thinking mostly of folks with schizophrenia or bipolar disorder) who themselves report what others consider symptoms of their illness as gifts from God. Again, I think of my brother in the initial onset of his illness: he was convinced that God’s voice was one of the voices he was hearing, and that it was “ye of little faith” who wanted to medicate his gift of hearing God’s voice away. When someone is approaching mania, they often feel energetic and creative and productive. They are often at their best in sort of a hypomanic phase. In both cases, when you are dealing with someone who is genuinely ill, medication and other treatment is really essential, so that they don’t swing further out of control. Many, many people complain that they are not themselves on their meds. This is true both because of the side effects of psychophamaceuticals (horrid) and because of their *intended* effects. The fact of the matter is that these illnesses and their solutions both touch on personality in such a deep way that it is very difficult to parse.

    To your last question: I think sticking to the language of illness is a starting point. But I think one of the things that churches may be poised to do more about than other organizations: people with severe, persistent mental illnesses need their communities to realize that all medicine has any hope of ever doing for them is to stabalize them. They need communities that value and welcome them, and that work with them to create ways for them to make real contributions. I’m a big believer in clubhouses on the ICCD model for this as well. ( Would love to see churches helping to create similar options, or contributing to these.

  3. Thanks, Dana! You understood exactly what I was asking. I also have some experience with these situations. I appreciate your recommendation and will look into the ICCD model–interesting! Maybe my church would be interested in getting involved.

    I appreciate even more your willingness to seek the middle way(s) between polarized views of medications and treatment. Many areas of Christian culture still question the necessity and even the good of seeking treatment. I agree, though, with your point in this post that Catholicism has great traditions of service which have helped us to respond to this phenomenon without falling into some of the dangerous views and practices that have recurred in other Christian traditions. It is a good place to start. I hope the conversations at Patheos are inspiring.

    Anyway, thanks again for engaging this issue!

  4. Hi Dana and Nancy,
    I also wanted to thank you for exploring this very important topic. I was a chaplain student at a major public hospital and was moved and educated on a daily basis by the patients and their families who face mental illness. The Clinical Pastoral Education Model is to treat the patient as the “living human document” who is there to educate us and to sanctify us, rather than for us to arrive, theology in hand, ready to save them. This model isn’t perfect, but it is patient centered and, I felt, clicked very well with my background which was fed by the tradition of service you mentioned. And you are right. I did hear other chaplains deride or dismiss treatment altogether and was appalled! Though I did see the occasional flashes of brilliance and insight from the patients, which I felt were unduly romanticized by some of my peers, I was more often struck by the grinding loneliness that the patients and their families experienced. Also, as you said, patients who are manic or delusional often have religious aspects to their experience, but because it is linekd to illness, we have no way of really being able to morally justify confirming that they are experiencing something divine. For every person I saw break and recover enough to be released, I saw many more whose illnesses refused to bend to either therapy or medications. Thanks for addressing this topic. I look forward to seeing this explore more in the future.

  5. Thank God for this site. I am schizoaffetve (schizophrenic and bipolar) I have been in and out of mental institutions for my whole life. Currently my illness is well managed with medication. I have had people tell me it is all spiritual basically saying there is no such thing as mental illness. I have had such terrible guilt and shame. This page brings tears to my eyes. I know Christ sustains me with this cross. Yet to actually hear a catholic teach on this subject is confirming and freeing.


  1. How has Faith shaped the way we see mental illness? - [...] Dana Dillon of Catholic Moral Theology quoted Augustine who wrote, “Crazy people say and do many incongruous things, things for…
  2. Sanctity and Mental Health (or lackthereof) | Extra Ecclesiam Est Libertas - […] You […]
  3. A Janus Post: 2014 Highlights in Moral Theology and 2015 Expectations | Catholic Moral Theology - […] St. Augustine, Catholics, and Mental Illness – Dana Dillon wrote this May post in honor of Mental Health Awareness…
  4. DT Podcast Episode 6 – Dana Dillon | Daily Theology - […] Catholic Moral Theology blog (in this conversation, she specifically references her piece on “St. Augustine, Catholics, and Mental Illness“).…

Leave a Comment