If you've followed my journey for any length of time, you know I keep coming back to saying the church must learn to really sit with suffering, and to make room for pain without pretending it isn't difficult. I've challenged the tendency toward "the tyranny of the positive'. This is the pressure to keep smiling and to rush people toward victory speeches. What we often need is a friend who will simply stay present in the pain. Job's friends were at their best when they just sat quietly with their mourning friend. It all went downhill, as it so often does even today, when those well-meaning people opened their mouths and unhelpful platitudes came pouring out. People don't need us to fix them; they need us to sit with them. Presence is often the most Christlike thing we can offer. We're not rescuers -- we're companions on the journey.

In the body of Christ we're called to bear one another's burdens, not to explain them away. I've written before that hope isn't pretending; it's honest endurance inspired by the resurrection. That's the hope I cling to on hospital days and the hope I want our churches to embody for people whose minds feel like stormy seas.

I haven't been able to write or interview recently due to new health challenges on top of those I have been dealing with for eight years. Those new problems are happily settling, and so I recently sat down with Dr Mark Mayfield to talk about his new book, The Mental Health Handbook for Ministry. It's a resource aimed at clergy and church leaders who want to care well for people walking through mental and emotional distress, without pretending to be what they're not. It's a resource designed not to turn pastors into psychiatrists, but to help churches become safer places for the anxious, the depressed, and the traumatised.

When I asked Mark to describe the book, he said, "the hope is it's a desk reference guide for clergy across the board to sit better with people that are suffering and struggling with mental health issues or diagnoses, and so the goal is to equip them with enough information to be good placeholders and good caregivers for people that are struggling." That word -- placeholders -- stuck with me. We're not trying to perform instant cures. We're showing up, staying present, and holding a wise space that honours both prayer and proper treatment.

We discussed how there's a spectrum of views of mental health in churches. Accross traditions pastors have sometimes reduced complex struggles to a single cause, sometimes spiritual, psychological, biological, or social and then tried to fix people at the level of our favourite explanation. But life is rarely that simple. For too long the church has said, 'If you just prayed harder, you wouldn't be depressed.' That's spiritual malpractice. We have to normalise talking about mental health, and getting professional help where necessary.

A major theme in our conversation was integration. As Mark put it, "All these things are interconnected, and so we can't separate them." I've argued similarly for years. The body matters. The mind matters. Community matters. Spirituality and meaning matter. When any one pillar collapses, the whole person feels it. Mental illness as neither a purely spiritual failure nor a problem to simply outsource. The truth is much more integrated.

"We've got to stop pretending the body, mind, and soul are separate. They're all interconnected, and if we try to treat one without the others, we end up doing harm. Faith, medicine, and community can work together -- they should never be in competition."

That integrated approach reframes a pastor's role. Mark stressed the importance of confidence with basic recognition(spotting warning signs), clear boundaries (what you can and can't offer), and clean handovers when specialist help is needed. He spoke about creating simple pathways so leaders aren't improvising in a panic: who to call, how to stay with someone in distress, and how to ensure follow-up. In his words, you need relationships in place to make "warm hand-offs" to appropriate care, not a cold "good luck with that," but a next step on their journey through which you will walk alongside them. Knowing our limits is part of love. When a pastor recognises they're out of their depth and brings in professional help, that's not a failure -- it's good shepherding.

Chronic illness taught me that platitudes are cheap; presence is costly. Genuine pastoral care refuses to shame people for taking medication or seeking therapy. It also refuses to paper over their pain with a few verses and a smile. We talked about stigma, and how this can even be present for Christians with physical health problems but gets worse in mental health. Scripture understood properly won't let us get away with that; it shows us lamenting saints and gives many examples in the psalms of honest prayers for the dark night of the soul.

We also touched on how those with chronic and disabling conditions can feel devalued. The church must resist the cultural drift that devalues vulnerable lives. Every human is valuable and made in God's image. A Christ-centred community says you belong, even when you can't perform.

What is the most important lesson we must learn from all this? At least in this life, healing doesn't always mean a cure. Sometimes it means finding peace in the middle of the storm -- and helping others do the same."

I urge you to think about how you personally can be more compassionate towards the suffering and to offer them true hope. I trust this interview and Mark's book will help you do just that.

Compassion fatigue, the Saviour complex, and Benevolent detachment

We grieve, but not in the same way as those who have no hope

Resurrection: Rediscover the Heart of the Gospel

Jesus has a home for us: Tim Keller's Take on Suffering

God's word to the depressed: Bible verses on Depression

Examples of mental anguish and depression in the Bible

Right, well hi there, it's Adrian Warnock here. It's been a while since I've done one of these, but I'm really delighted to be joined today by Dr Mark Mayfield who's just about to publish a book which I've been given a pre-copy of. Mark, could you just remind us of the title of your book and give us a bit of a hint about what it's about? Yeah, absolutely.

It's called The Mental Health Handbook for Ministry, and the hope is it's a desk reference guide for clergy across the board to sit better with people that are suffering and struggling with mental health issues, diagnoses, and so the goal is to equip them with enough information to be good placeholders and good caregivers for people that are struggling.

Yeah, I think that sounds like a really noble aim. I don't know if it's the same in the US, I suspect it probably is, but there's a real spectrum of views on mental health still in the church, and it's not always easy to operate in this space as a Christian.

Would you agree with that, Mark? It's not, because it's, yeah, you kind of have those two extremes. It's either Bible-only or psychology-only, and they don't intersect, and I'm like, I'm not sure if we're reading the same Bible then, because we're created, you know, the idea of psychology is mind-body-spirit interconnectedness, and so we can't separate them. You know, well, it's all sin.

Well, no, like, being in this world is difficult. There's a lot of brokenness in this world that affects us, and sin is a part of it, but it's not all of it, right? So we tend to alienate each other with these polarizational frameworks instead of having conversations. Yeah, I think you're absolutely right, and I mean, I think one of the things that we've probably both seen a lot is people latch on to one thing or the other, or they get sort of an idea and think that's the solution to everything.

I remember hearing about somebody, I mean, idolatry. All Christians would agree that idolatry is a sort of, you know, part of our battle in life, not to idolize things, you know, but one particular pastor, who shall remain nameless to protect the guilty, that I'm aware of, told one of his parishioners or members, whatever you want to call them, that they, as a young woman who had a young baby and was really struggling with looking after that baby, and I think was perhaps even maybe a bit of post-natal depression, I'm not quite sure, because I don't know the case that well, but basically they said to this young woman, you're idolizing sleep. Wow.

Yeah, I know. It's like, well, guess what? You're a young lady and you've got a young baby, chances are sleep's going to be bad, and I don't think it's really idolizing, but there might be a better way of addressing that, huh? Well, and how much does sleep play into our mental, emotional, and spiritual health, too, in how God designed us to regenerate and recuperate during sleep? If we don't get it, yeah, it's a big deal. No, that's right.

I think you're absolutely right about this as well about this spectrum that you've talked about. One of the things I like talking about is this sort of spectrum, and there's definitely a spectrum of attitudes to mental health, and you describe it quite nicely with, at one extreme,, there's the people who are anxious to stress just how much the Bible has to tell us about our mental health, and there is lots in it about our mental health, but that's all they want to say, and it's this sort of, it's the Bible is sufficient for everything kind of brigade, which, you know, it's funny because we don't, we don't, well, put it this way, the Bible doesn't tell us how to make the technological devices you and I are having this interview over, and yet we don't say Bible only for that, you know, Bible only for science, Bible only for, you know, medicine in other fields, like, I mean, most of these people would probably go to their doctors and take a blood pressure pill, or, you know, take heart attack medicine, or various other things like that, or anti-cancer medicine, like I've had, chemo, you know.

Yet when it comes to mental health, there are some people who go, oh no, no, no, Bible only, it's all about sin, it's all about your relationship with God, it's all about getting the truth into you, and maybe forgiving other people, all of these things are really important, of course, and we can even learn from some of these people, but there's a massive hole at that end, but then on the other hand, there are people who, as soon as there's any sort of hint of, in a mental health or an emotional problem, want to abdicate, and just say, okay, my job as a pastor, or as a concerned church member, or even as a friend, is just to identify that this person has a problem, and, you know, make sure they get to the psychiatrist, or the psychologist, or the counsellor as quickly as possible, and then rush your hands off them, and want nothing to do with them.

Right, right, yeah, and that creates a lot of deepening wounds in people that are truly seeking support and help, you know, I can't tell you how many times in my practice, my own practice, I've dealt with what we would call spiritual abuse, in that very sense of dismissal of some severe needs, or giving advice that wasn't in their wheelhouse, but they thought it was their prerogative to step in and create that, and it's created more damage, right, instead of kind of having a holistic understanding of what this looks like.

Yeah, that's right, so I mean, I think, I think there's two things, there's two important points here that we ought to stress quite early on in this interview, isn't there really? One is that it's vital that we understand our limits, and I think what you're describing, and certainly what I've seen a little bit over the years, in some of the sort of situations I've heard about, or been involved in in some way, is that, you know, we need to know our limits, and I mean, this is something that, it's funny that pastors don't get taught as much, I don't think, whereas obviously as a medical doctor, then a psychiatrist, in my own practice, and then for yourself as a counsellor, you know, you're told, aren't you, make sure you know what you can and can't do, and what you can and can't deal with, and where your experience lies, and you know, get supervision, but also get help, and refer people on if you, if you can't deal with them.

Right, yeah, and that's, I mean, that's basically the understanding of this book, is it's what, what are these, you know, we, I can't remember how many chapters there are, but there's, you know, any disorder or struggle that you can possibly think of, and we talk about what is it, what does the Bible say about it, and then what you're saying is, when are you above your pay grade, and when do you need to refer out to a qualified professional that's going, you know, don't just drop people, you know, they still get the spiritual support and that care, but when you're above your pay grade, you're going to be doing more damage than good if you don't help refer them to a qualified professional. No, that's right, and I know, for example, in the US, especially, and I don't know how it compares to over here, but suicide rates can be a massive problem amongst Christians, and particularly, I guess, you guys, I know we'll get into political issues on this, but access to guns is a big problem, isn't it, for Christians, well, for anyone in the US, if they're in mental health challenges.

It is, I mean, it's such a convoluted issue, and such a, there's so many layers to it, you know, and we tend to come at it from a singular lens, instead of the complexity that there, that is this conversation, right, and so it's, and I think the Church as a whole should be primed and ready to be at the centre of these conversations, right, almost as mediators in these conversations, because we have that foundational truth, but we tend to stray away from it. No, that's right, and I think there's a fundamental lack of understanding as well. I'm sure it's the same in your background, but I was taught, even in a secular world, that, you know, that mental health problems were biological, psychological, and social in their origins, and people sometimes talked about that as sort of almost like a kind of a three-legged stool, and I mean, I think, obviously, as a Christian, I would want to add a fourth to that, which would be the spiritual, and in fact, actually, one of the things I've discovered recently is there's been some interest in psychological and sociological literature, even outside of the Church, so now to start thinking about that, particularly in palliative care, but in certain other areas as well, and there's a recognition that, you know, even if you're not talking about someone's religion as such, because not everyone has one, that we are all spiritual beings, and there's elements of meaning, elements of, you know, understanding what suffering is, understanding our place in the universe, what's going to happen to us when we die, all of these kind of things, which, you know, are absolutely vital for people, and so, but all of those four areas can be disordered.

They can, and I mean, as a medical doctor and psychiatrist, you know, too, that when somebody comes in with a presenting issue that looks physical, you're going to assess the other areas. Well, same with us, when we see something that comes in that looks psychological or spiritual, we want, I personally want to go, okay, how is your gut? How is your eating? How is your health? How is your sleep? All these things are intertwined, and I think when we silo those, you know, I love the four-legged stool idea, that when we silo those things, it becomes a one-legged stool, and we always will tip over and fall over, you know, and make a mess of it, and so we need to evaluate, you know, all four of those areas in a way that honors the holistic understanding of the person. Yeah, that's right, and it may well be that in trying to tackle someone's sort of mental health challenges or emotional health challenges, that there might be areas in each of those four areas that need addressing.

Right, well, and going back to what you're saying, that kind of the church's kind of tendency to be Bible only, you know, I have a mentor of mine that always told me that we all have a gravitational field of sin, brokenness, and spiritual warfare, that just that's what life has done to us, right, and part of it is our choice, and the sin, you know, the sin piece, you know, we're free to choose, but not free from the consequences of our choices, so that could be part of what's causing our disorder, but then there's just brokenness. This world sucks. I mean, turn on the news, see what's happening around the world.

It's a tough place to be, and that affects us as well, and then, you know, if we believe in the spiritual realm, then there's that spiritual warfare piece, too, that can convolute or complicate things, and so when we talk about the idea that it's a spiritual issue, the answer is yes, but how is it one, and then how is that colliding with the present here and now and the physical side of things, but I think we tend to, you know, the old adage, you know, if you're a carpenter, everything's a nail. Well, I mean, we have to look at different tools, different reasonings, different frameworks, so, you know, I've had a lot of debates with clergy that say, well, you're not addressing the sin. I'm like, well, how do you know that? I'm not coming at them with a pitchfork and a torch or beating them over the head with the Bible, but we're having conversations about, like, how have your choices, how have the life that you've lived led you to this place, and what do you want to do about it? What do you want to look different, and I think that could really positively affect clergy in coming at it from a different perspective at times, too.

That's right, so I mean, I think if we start, if we just have a little bit of, let's look at this in each one individually, I suppose, so biologically, what would you recommend? I mean, in terms of medicine, for example, do you think that medicines can be sometimes appropriate, and are there other things that people can do biologically that might help them if perhaps they didn't need to?

Yeah, well, 100%, I think I would be a hypocrite if I didn't think medicine had some place in this whole conversation. I mean, I'm a suicide survivor myself and have dealt with being on Prozac and trying to figure out levels for my anxiety, and I think the issue becomes when we think it's a one-size-fits-all or it's a silver bullet, this is the only thing that can work, fix me, or the easy piece, but I think medication is a beautiful tool to help get people either treading water or getting their head above water, that they're able to utilize, but it's not a one, it's not a I don't look at it as an only thing, I look at it as a yes and, but I'm not sure what you've experienced, but I love genome testing to find out what a body's, a person's metabolism looks like, because we know certain medications metabolize differently, and if you've got a higher metabolism, it's going to, half-life is going to be shorter, it's going to run through your bloodstream and body a lot quicker, so it may be the wrong medication type, and I'd love to do those extra testings instead of taking a dart at the dartboard and going, let's try this and see whether it works, like there's, science has created a lot of beautiful opportunities for more pinpoint studying to make sure that we're not just guessing with people, so that, I mean, neurotransmitter screenings I love, I love doing a comprehensive metabolic panel blood test to see where they are with magnesium and iron and, you know, their hormone levels and all that kind of stuff play in. Yeah, it's so important, isn't it, because, I mean, even just something as basic as an underactive thyroid, you know, that can mimic depression, and in fact, you can treat someone with that, and they don't need an antidepressant, they might not even need counseling, I mean, they might, but they might just need literally some thyroxine, which is, you know, important.

Well, right, and even thinking about like a, like a, like celiac disease or autoimmune disease, and that plays on anxiety, it plays on depression, and if we could help adjust those things, like you said, you might not even need counseling. Yeah, so I think that's right, so other biological things I suppose that I can think of would be things like exercise and getting enough sleep, but can you think of anything else for, for the people watching? I think just thinking through what we're feeding our body when it comes to food, I try to really encourage people to stay away from highly processed foods, eat whole foods, good proteins, you know, with the occasional snack or the occasional, you know, cheat day type of thing, but like I always do nutritional screenings with my patients, too, just to go, okay, I want to understand what you're eating breakfast, lunch, and dinner, what are you stacking on, high sugar, high processed or not, let's try to rethink those things as well, and that plays into our sleep as well, but technological advances, you know, being on our phone too much, being on social media too much plays into our sleep-wake cycle, and disrupt that.

Yeah, just a simple thing like putting your phone onto that night setting might help with sleep as well, so that a few hours before, if you can't, I mean, the ideal thing would be to be off the phone altogether for a few hours before you went to sleep, if you can't manage that, at least put it onto that redshift thing that some of us can do, and things like that, but yeah, so I suppose that's biological, we've then got psychological and social, and a lot of people put those two together, but I do think it's quite helpful sometimes to separate them, and perhaps we could look at those separately, and could you just talk a little bit about those, let's say with the psychological side first, so I guess for me that's very much the inner thinking processes, and looking at those, and you know, things like CBT, I mean, is that something that a Christian pastor can adapt to, and use a bit, maybe?

Yeah, absolutely, I mean, I think the psychological is, I really believe that's kind of the seat of the mind, and the soul intersection, right, it's hard to tease those things out a little bit, but we can, you know, but I don't think we understand just how powerful our brain is, you know, by itself it's a dumb organ, but we give it urgency and agency by how we utilize it, right, and the neural pathways we create, and a lot of that is recognizing our thinking patterns, and I was sitting with a patient the other day, and I said, what comes first, thinking or feeling, and they're like, I don't know, I'm like, well, give it a, you know, just give it a go, you know, give it a guess, and they said, well, thinking, and I said, yeah, technically, our thoughts are one one-hundredth of a second to one three-hundredth of a second before the emotion comes up, and then we give into the emotion that then affects our thoughts, and we get into this kind of thought-emotion spiral, and I said, the best way to adjust things is to recognize our thought patterns and slow down, and so what I encourage my patients to do, and pastors can do this too, is creating a thought autopsy, and so when something happens, and you have a big blow-up or life, you know, and you react, I'm like, I don't know how I got there, I don't know what happened, I will always tell them, go back, slow down, and do an autopsy on the event, and really hone into what was the thought that came first, and was that a negative thought, and if so, what can we begin to do to replace that, and because a lot of times our negative thoughts are reflexes, right, we've just, we have been conditioned in such a way that we don't even, we don't even put any cognitive effort into it, it just happens, and that thought leads to the emotion, so I said, if you want to change our behavior, we have to really slow down and create, so I have them create thought journals, we slow down and do, you know, moratorium autopsies on our events that are explosive, and eventually, as we do that, we begin to shift the neuropathway development to some new neuropathway frameworks that create new reflexes and new patterns that are very helpful, but most of us don't take the time to slow down and give much time to that.

I like that a lot. I think, for me, one of the things that you're sort of talking about, which I really like about what you're saying, is that I think it's really important sometimes for us to challenge our thoughts, and we haven't really mentioned the Bible too much yet, but the Bible does say, doesn't it, that we should take our thoughts captive, and there's a lot in the Bible about that, about, you know, replacing sort of negative thoughts with positive thoughts, which, interestingly enough, is very much what CBT is about today, and that's one of the leading psychological theories, but what I think is very important, and a subtle distinction that some people don't catch, and I wonder what your thoughts are on this, but I suspect you're on the same page from what you said, is that a lot of people get this wrong a little bit, and we can focus on our emotions, and we go, oh, I'm so depressed, I must stop myself feeling depressed, I feel so sad, I must try and feel happy. Actually, I've always said we shouldn't even try and challenge our emotions, because they just are, you know, and it's okay to go, oh, I'm feeling sad, and why am I feeling sad? Maybe, as you say, analyse it a little bit, and go, well, maybe I'm feeling sad because of this thought, or that thought, or this thing that's happened, or that thing that's happened, and then challenge the thought rather than challenging the emotion, and actually, hopefully, over time, the emotions will catch up, but actually, it's much easier, and much more appropriate, and much better to challenge the thought.

Would you agree with that? Well, I would, and I think you bring something up that I challenge quite a bit, is that emotions and feelings are two separate things, and I challenge people to say that an emotion is our physiological response to an activating event, internally or externally, so, you know, your stomach turning when you feel anxious, that's an emotion. When your chest gets tight, you know, because of something, or your hair stands in the back of your head, those are emotional responses that typically then we associate to a feeling, and a feeling is the meaning we make from those things based off of our observations and experiences of childhood, or in life, in general, so we associate, we make meaning of something based on how we, our emotional response, and we often get it wrong. Emotions are, like you said, emotions are almost null, they're just, they just are.

Yeah, it's like a, it's almost like a warning light on a, on a car dashboard, and that's important to pay attention to them, and they could be quite useful, like, you know, if you're, I don't know, if you're walking home at night, and you suddenly feel frightened, that might be a very good reason, something you might have, you know, your subconscious, you know, not subconscious, but you know, you might have, with the peripheral vision, detected something that you didn't realise was there, or, or there could be a valid reason for that emotion, that, that response, but you're absolutely right about the interpretation, I mean, this, the story I like to give people sometimes, it's a bit like, it's like, what, two people standing next to each other in line, or not in line, but right next to a roller coaster, a ride, they've both got pal, pumping hearts, maybe even a bit of sweat, and, you know, wobbly knees, whatever, one of them goes, oh, I've got such an adrenaline high, I'm really looking forward to jumping, this is amazing, this roller coaster's gonna be amazing, the other one goes, I'm terrified, I'm frightened, if I get on that roller coaster, I'm gonna die, there's no way I'm doing this, roller coasters are stupid, who would, why would anyone do it? Now, actually, physiologically, if you looked at those two individuals, they might have exactly the same, you know, sort of sensations, and the same bodily reactions, the heart rate going up, all of that, and yet, they would interpret it in such a completely different way, and I guess the challenge for people like you, is how do, how do we change that interpretation?

I think a lot of times, we don't, enough people don't understand that emotions and feelings are separate, that we don't make meaning of those experiences in a way that sheds light on the nuanced, either positive or negative responses, and so, it's really challenging to slow down that process, I talk about this in one of my previous books, The Path to Wholeness, that oftentimes, the best thing we can do is to become old friends with our emotion, so that it doesn't scare us, frighten us, or put us off, we actually embrace it, embrace the intention, get to know it well, and then know its patterns to a place where it doesn't create us to turn to addiction, turn to numbing, or avoiding, we just go, this is what it is, it's going to run its course, it's okay, I've made meaning, I've re-even conditioned the meaning around it, so it's not scary, and it'll be around for 15, 20 minutes, and it'll go away, and I'll be okay. Yeah, I think that's absolutely right, and it doesn't necessarily have to stop me doing the thing that I want to do. Right, exactly.

I can maybe live with that, and actually, you know, sit with it, if you like, and still go ahead, you know, like, and it's interesting, isn't it, because a lot of performers, or I mean, actually, I guess a lot of people watching this might be pastors themselves, it's, you know, it's an interesting thing, not every pastor will feel nerves when they get up to preach, but a lot of them do, and that doesn't stop them preaching, whereas, obviously, I guess for some people, you know, the very same emotional state, the same sort of reaction might be enough to stop them from wanting to talk, not just in a public context, but even one-to-one, you know, so where someone might be too scared to preach to a crowd of a thousand, but might be okay preaching to a hundred, there are people who can't even cope with meeting a group of, say, five or ten people, and actually what that would look like, and it's the same, in a sense, it's the same reaction, you know, a social anxiety, and I guess we're now starting to move on to sort of the social side, and I don't know about you, but I think that's quite broad, it's not just about our relationships and our work, it's also about what we do on our own, you know, what hobbies we might have, how much time we might need on our own to sort of look after ourselves, versus being, you know, enriched sometimes by being with other people, and just that sense of meaning and fulfillment in life.

I remember, I remember one of my old patients who I managed to, who had all sorts of medicines, this is when I was a psychiatrist, and had all sorts of medicines to help their depression, and nothing much had sort of, well, it was better than it was, let's put it that way, but he was, he was stuck, you know, and I sort of encouraged him to just get, to just do a little bit of volunteering, I think it was only one morning a week, and the amount of change, it was much bigger than I thought it was going to be in his mental state, but I wonder if this is something that your book addresses as well, the social side of things.

It does, to some degree, my first book was The Path Out of Loneliness, which we talked a great deal about that, this idea that we are created for connection, like our physiology, if we go back to the physical, this is why we can't separate them, right? I don't know about the UK, but here in the United States, we are talking about that we're in a mental health crisis, and I actually, I debunked that going, I don't think we're in a mental health crisis, I think we're in a loneliness crisis, and the loneliness is begetting, or is a disease pathway to mental health and mental illness, and so if we're created for connection, the health of our physiology, the cardiovascular system, our variable heart rate, our breathing, even the way that our brain functions, does better when we're in safe and trusting relationships with people in communities, right? There was a study done recently here in the United States that checked the variable heart rate of people worshipping in a worship service, and after about 20 minutes or so, 15-20 minutes, their variable heart rates synced up to each other.

Wonderful. Isn't that crazy? We can't have this conversation without this point, that we have to be in relationships, and here's the thing, and you know this better than probably I do in some ways, is that, you know, trauma happens in relationships, but trauma can only be healed in relationships. No, I think you're absolutely right.

Reminds me of what, you know, God said when he saw Adam in the garden, it's not good for a man to be alone, and yet today, you know, there are more people living alone than at any time in recent history, probably any time in human history. It's considered, like, very common to live alone, and it's acceptable, and I'm not sure that's that good. I mean, I remember when I was at med school, I didn't live alone.

I lived with a group of four medical students, and we were all men, and the place was a dump, I have to say, but, you know, there was a sense of camaraderie, and you weren't on your own, and there's, you know, I haven't really lived on my own very much at all. I'm in very brief periods in my whole life, and I'm quite glad for that, but you see a lot of people today, that's exactly what they're doing, and actually not just that, but the relationships of friendship. I have my own little theory, which is that, you know, the reason why things like Big Bang Theory and Friends are so enduringly popular, is that actually people look at that kind of friendship that goes on over the years of those seasons, and they wish they had a group of friends like that, and many people don't.

Well, you're right. A dear friend of mine, Dr. Chap Clark, is an author and a sociologist here in the States, and he did some research recognizing that for kids to actually launch into society well, they need five safe, trusting adults to speak into their lives, and we extrapolated that research, and going, it could be the same for us as adults, that for us to be situated well in life, we need five safe people in our life that we can turn to, that we can give us, you know, exhortation, feedback, encouragement, and if we don't have that, it creates this isolation kind of construct that plays a huge role into our psyche and our spiritual health. But, you know, think about it.

I mean, one of the things, and I'm sure this has changed quite a bit in the UK and Europe, but one of the things I just loved so much early on in the 80s and 90s was that generational living. You know, you had grandparents living with the grandkids, and, you know, it created, you know, albeit maybe there are some difficulties, but it created that connectedness piece, you know. We don't have that.

Like you said, we try to leave the home as quick as we possibly can. We go away from our safe place or our home, and we try to be on our own, and it just creates, you know, the isolation. I say that loneliness leads to isolation, and isolation can lead to death mentally, emotionally, spiritually, and physically.

Yeah, and I think as well, you know, we ought to perhaps say a little bit about work, isn't it, and how you need a job that's challenging you and giving you a sense of purpose but isn't too stressful, and getting that challenge is right. I remember the Yerkes, I always used to talk about the Yerkes-Dawson curve with this, you know, that when you look at someone's life, are they on that side where actually giving them a bit more responsibility and a bit more pressure would actually help, or are they right up here or down the other side where actually the more pressure and the more, you know, responsibility put on them, the more close they are to actually breaking down and crashing, and the performance goes down also. So I think that's another interesting thing, isn't it, trying to make sure that, and that of course can change, people's capacity can change, either with mental health or indeed with physical health.

I mean, it's been a huge adaption for me actually, because before I got physically sick, I was one of these guys that, you know, used to do like five people's jobs, you know, I had a very responsible job as a medic in the pharmaceutical industry, I used to do a lot of church stuff, I was also blogging, I would do some preaching sometimes at church, I had, you know, all this other stuff going on, wrote a couple of books and all the rest of it, and then all of a sudden one day I got sick, and since then, that was 2017, you know, almost everything's had to stop, you know, or at least drastically reduce, because my capacity is much, much lower than it used to be, and it varies, of course, at different points. So, you know, earlier this year I was diagnosed with a new condition, diabetes actually, probably caused by something else I was taking, one of the other pills I was on. But at the time, until that was treated, my energy levels got even worse, which is why I didn't blog or anything.

So it's kind of like that kind of thing is difficult, isn't it? The interplay of how physical and mental health can affect our sort of social value, because we do take a lot in that, don't we? If we're not able to work or able to contribute, then we can feel a bit worthless or go through a massive adaption. And that can be really hard, I think, when there's a very obvious physical reason why you can't do it, but probably even more so when the reason is a mental health one. Well, it's the idea of purpose and meaning, right? I mean, Cigna, a big insurance company here in the United States, did a study in 2022 with about 20,000 participants asking about loneliness.

And of the study, 54% said that they didn't feel like they had anybody to, that nobody knew them well. So 54%, no one knew them well. And then 36% felt like they didn't have anybody to turn to if life got difficult.

Wow. And I'm like, oh my gosh, what an opportunity for the church to step into the fray. And maybe not have all the answers, but to your point of the meaning and purpose piece, to be able to fill in the gap a little bit with that and create that meaning and that purpose, that community and those types of things.

I think you're absolutely right. And the other thing about that as well is that if we've really got that well, then we can do that with a sort of mixed group of Christians and non-Christians sometimes as well. And so that can be quite amazing too, that if we learn how to love each other well in the church, even when things are messy, even when things are difficult, then that can also spill out sometimes into other environments.

And I'm thinking like support groups or all of these things. I mean, a lot of churches do it well with mums and toddlers. It's like mums and toddlers groups.

So you'll have church mums with their kids and maybe local mums with their kids as well, mixing, making friends. And that can sometimes be an opportunity for someone to start to feel like they belong to a community without even necessarily at that stage initially believing. But sometimes it can draw someone into believing.

Well, and that's the thing is, I think we have to get, as the church, we've got to figure out what are we going to die on hill-wise? Do they have to have their life together before they come through our doors? Or can they come through our doors just as they are? And we create that community, we create that connection, we create that space for openness and honesty and vulnerability to happen. And then maybe we introduce them to Jesus versus the other way around. And I think you're spot on with that.

It isn't one of the problems, though, that we still have this mentality that people are somehow meant to have their lives together, whether that's church members, lay leaders, whatever we call them, different types of church, or indeed pastors. And I think there might be pastors watching this who are thinking, I can't help other people with their mental health because I'm struggling. But they don't feel they can share it with anyone because... I'm sorry, say that again? Well, I think some of them are worried that they might lose their job if they're honest about how they're feeling.

Oh, right, right. And that's the thing is, when I meet with pastors, they say, well, what do I need to do to get this into my church? And I said, you know what, to be honest, the first thing you need to do is to look at yourself and go, am I healthy? Am I congruent? Am I able to be the person that leads this? If not, maybe I need to look at getting some support myself. But like you said, there's a culture sometimes that we've created in our churches that if you don't have it all together, you shouldn't be our pastor.

That's a damaging, damaging place to be because we create an era of perfectionism that is only reserved for Jesus, that these men and women are trying to live up to and they can't. No, exactly, exactly. And no wonder so many pastors then crash and burn, I think, as well.

Yeah, it's so sad. Yeah, absolutely. Yeah, so I guess I'm just a little bit on the sort of spiritual side then a little bit as well.

I mean, I think it's interesting, isn't it, because a lot of this stuff, you know, someone who's a Christian could get some of this help from someone who's not a Christian quite easily. And that's absolutely fine, especially if you don't have access to a counselor who understands. Because I think that's the thing, isn't it? There's wisdom in the world that we can benefit from.

And actually, sometimes even that wisdom itself echoes the Bible a little bit in terms of some of the values. And especially if you look in Proverbs, you look at Proverbs and then you look at some of the modern psychological theories and you think, oh, there's a bit of an overlap there. But how do we make sure that we address the spiritual elements where mental health can be impacted by, you know? I love it.

I think one of the big things is I would tell people seeking out support if they can't find a Christian counselor or psychologist or psychiatrist, that's okay. We are trained at the highest level of ethic to meet people where they're at and to integrate and to understand their worldview and their moral ethic and help them integrate that into their life. So you can take comfort in the fact that that's how we're trained, right? So if anybody comes into my office, I'm going to sit with them according to their worldview, according to how they want to engage things.

And that's the highest level of ethic that any of us have to uphold. And then in some ways, you become the expert in that and you help guide the conversation and take the ownership and agency of your own stuff and able to help them. So, yeah, I don't think - don't withhold getting support if you can't find the perfect person.

I think you've got to understand that it's going to be a process of relational development. A good therapist is going to relationally connect with you, going to give you a place to be yourself, to honor your story, to step foot into these kinds of things. And if they're not a Christian, ethically, they have to do what they have to - they have to engage in becoming a student of that so they can best support you where they're at.

But I always tell my students at the university I teach at is that there is a thread of truth in every theory out there because we are human beings that have been marred by the fall and our desire is to make meaning and sense of this world. And whether we realize it or not, we are asking questions that lead us back to that bigger existential question of what is life, what is the meaning of life, what is the purpose of life, what is after a Kierkegaardian framework of kind of existentialism. And even a secular theorist is going to be asking some of those big questions.

And so, like you said, there is beautiful wisdom in all of this, and we just have to make sure that we are curious, we are open, but we also know what we believe and why, and are really able to set that up with our therapist or our counsellor or psychologist. And of course, guilt, sin, forgiveness, and dealing with justice and all of those kind of issues are issues that actually do come up in secular context also, but are obviously areas where perhaps as Christians we have a unique perspective. This will date the interview, but we've just seen, haven't we, the whole situation with Charlie Kirk's death, and his wife going on a huge sort of platform of people watching and all the rest of it saying, look, she chooses to forgive the person that shot him, and that love would always conquer over hate.

And fascinatingly, actually, Donald Trump then came up and said, this is one area where I disagree with Charlie Kirk. But it's interesting because these are areas that I think can have a direct impact on our mental health and well-being. It can be a real challenge, of course, just to forgive.

Is that something that you get involved with, and you would advocate counsellors getting involved with, forgiveness? Yeah, I mean, the book is, we talk a lot about that, but I'm big on the conversation around forgiveness because I often talk to people that forgiveness is not about the other person that's wronged you, it's about you releasing that wrongdoing back to God in a way that releases you from the bondage of it. I think a lot of times we look at forgiveness as, well, that person has to ask for it, they have to, and I'm like, that's justice. We might not get justice this side of heaven.

And so forgiveness is a way that we can, you know, I talk through grief, I talk about laments, it's this process of letting go of those wrongdoings in a way that releases us from the bondage of them. Yeah, no, I think that's right. And I think that's why it's important, isn't it, to distinguish between, I think, really three things here, isn't it? You've got the issue of forgiveness, which is really, as you say, about yourself and not carrying that sense of, you know, emotional hurt, emotional pain and desire for revenge, perhaps, as well, and actually laying that down and going, you know what, Christ has forgiven me, I will forgive others.

And that is, as you say, completely separate from issues of justice. And, you know, in certain situations, you know, you might very well be like, well, actually, you know, I'm going to leave God to deal with this, but I'm also going to leave the secular authorities to deal with this. And this is where churches have gone wrong sometimes in the past, I think.

It's like, you know, just because someone, you know, is forgiving another person doesn't necessarily mean that the police shouldn't be involved in the situation or the law courts or whatever, depending on obviously the situation. But then equally, I think there's a misunderstanding that forgiveness always means a restored relationship, and it doesn't necessarily, does it? No, no. And in fact, oftentimes it doesn't even come up.

I mean, no. And I think that's where I think we get ourselves in trouble. We think, well, I've forgiven the person.

I need to look them back in my life. Like, if they've not changed, no, like it's just going to happen. It's going to happen again.

And so that's where discernment comes in. I think that's where a healthy understanding of boundaries and others versus self. I mean, there's a lot of nuance there, but yeah, you're completely correct.

Yeah, so it's a very sort of interesting kind of field in general, really. And yet I do think that, you know, the sad thing is that, you know, I don't think that the church has moved on enough on this area in the last 20, 30 years, really. And we're maybe 20, 30, 40 years behind the world in some ways.

You know, I remember when I was younger, you know, there was a whole great a lot of excitement within the church about Freudian psychology all of a sudden. And it was really weird because it was about, I don't know, 40, 50 years after Freudian psychology had really taken over in the world. And yet what I was learning when I was in my psychology lectures and my psychiatry lectures was that, you know, most people weren't that enamoured by Freudian psychology anymore, at least, well, maybe some were, and in certain contexts it still had its place.

But actually there were lots of other theories that had come since then, maybe building on it and establishing, you know, more, you know, like CBT type basing. And it was really interesting because the church at that point, I don't think had really latched on to that, whereas, you know, CBT when I was growing up was, in my professional career, was very much the sort of focus. And I think now there's obviously other, you know, there's a lot of other theories as well.

It's not like CBT is seen as the sort of, you know, cure-all. But do you not think that we would do well to sort of listen sometimes to some of these different theories and pick the best bits from them? And also to not see them as a threat to our biblical worldview? Well, 100%. And that's why, here's what I challenge my students to do, because I'm teaching a theories of personality class right now, is I said, study the theory and see if you can find the golden thread of truth in each theory.

Because there is one. Because that's just normal in our human nature, like I said earlier, that we're yearning for meaning and purpose. And a lot of these theorists are trying to make sense of the world that they're living in, and they're doing it apart from God.

But our human condition is that we're yearning for something beyond ourselves and bigger than ourselves. And you can find that in these theories if you just take the time to look at it from a holistic perspective instead of throwing it out, you know, with everything else. But it's going to take intentionality.

It's going to take some work. And it's going to take some humility and some good questioning that I think the church could benefit from. No, I think you're absolutely right.

I think one of the other things which I'd like us to talk about a little bit before we come to the end is quite important. It's when things get really bad. So, like, either we're talking, like, really severe mental illness that might require the intervention, you know, forcible intervention of taking somebody into hospital against their will.

And one part of that can obviously be, you know, when the mind really does break down. But also, you know, sort of ideas of self-harm or indeed harming to others. And I think some people are quite frightened about these areas and frightened about talking about them and don't really know what to do about them if they do come up.

So maybe you could just talk to that a little bit. Well, yeah, and I'm not quite - I'm sure it's probably similar in the UK as it is here in the US, is that our pastors and our clergy are mandatory reporters for those that are self-injuring, suicidal, homicidal, if there's abuse in play, at play. And I try to really walk with pastors and clergy saying, listen, it's not a matter of, like, I need to figure this out.

It's, like, if you're a mandatory reporter, what are the steps that your town, that your county, that your area requires? And you follow those steps, and then you bring other people in. And so what I do with clergy here in the United States, I walk with them through the process of step one, step two, step three, step four. And we talk about this in the book a little bit, about how do you know you're above your pay grade and what do you do? And I think sometimes the kindest thing you can do is to make a mandatory report to bring other experts in on it, whether it be EMS, EMT, police, or mental health professionals at the hospital level.

Not everything can be handled by ourselves or should be handled by ourselves. And so instead of not discussing kind of the monster in the closet, it's what is our plan collaboratively as an organization, as a ministry, as a church, to go when we have somebody that is harming self, suicidal, or homicidal, what do we do? If there's abuse, what do we do? But now we're talking, you know, you didn't say this, but you're even maybe talking about somebody that's schizoaffective or schizophrenic, has bipolar, you know. Yeah, exactly.

And so I always tell pastors it's not just handing them off and saying good luck. It should be handing them off and saying, hey, I can be that spiritual support for you, I can be that relational support for you, but we need to get you professional help with a psychiatrist, a psychologist, or a counselor to deal with these other things that I am not capable of. But it's not a, hey, good luck, see you later, because that creates more emotional trauma, relational trauma.

And this is where I help clergy and churches go, okay, mandatory reporting aside, what is our protocol when somebody is severe and persistently mentally ill? They come to the church first. What is the protocol that a volunteer, a staff member, the pastor, the deacon, what is our protocol to get them connected? And have we vetted people in our communities to say, I want to be a preferred referral source to you. If I have somebody come in, can I call you up and we do these warm hand-offs to care for them holistically? It's so important.

I think you're absolutely right. It's interesting, isn't it? Because, I mean, if someone was in a church meeting or pastoral context and they suddenly had chest pain and collapsed to the floor, what would we do? We'd ring 999 in the UK or 911 in the US and we'd call the ambulance and we'd get them sent to hospital. But we also wouldn't just drop them.

Someone might even go with them, perhaps. And certainly, well, hopefully at least someone from the congregation will go and visit them while they're in hospital. And then once they were out of hospital, we'd see how we can support them and how we could help.

And, you know, and if social services were involved, we might even talk to the social worker and say, well, this is what we as a church can do, you know, so that the social worker could then figure out, you know, what were the gaps that they needed to fill in as well. So it's kind of like that kind of holistic approach. I think we would do it in physical health.

I mean, maybe some churches are better than others at that. But my fear is that we don't really think in quite the same way about mental health. You're shaking your head, so I'm guessing you're agreeing with me that it's not like that, unfortunately.

No, unfortunately it's not, because it is the big hairy monster in our closet. And so once we sit with, you know, places and help them figure that stuff out, it becomes less scary. Like you said, with 999 or 911 and, you know, and the physical health side of things, we can do the exact same thing for the mental health places in our congregations as well.

And we should, we should. No, exactly. Because if not, then the risk is that, you know, you will have the tragedy of a suicide in your congregation and think, well, I could have done something here to prevent that or worse, you know.

Yep. 100%. Yeah.

I mean, that seems like, I mean, a pretty low, low place, but actually there's nothing more satisfying, really, than seeing somebody in a terrible state. Either, you know, sometimes when they are very, they can be very manic as well. That's the other side.

They might not want to harm themselves at all, but their brain might be in a complete mess. And actually it can be incredibly satisfying seeing those people get back on their feet and do well and then be able to support them to recover and get back into work, get back into life. And church should be about that, just as much as it is about supporting us in other areas.

Well, and this is what I challenge churches is to develop a theology of suffering so that they can have a theology of care. And if we don't have a theology of suffering, which we see throughout scripture, we're going to really stink at this whole caring for people. Yeah.

No, I think now you're talking my language. I mean, it's so important. I mean, one of the things, I love Tim Keller's book, Walking with God Through Pain and Suffering.

I don't know if you've read that one. But one of the things he says in there, which I absolutely love, was this idea that he had this bit at the beginning, all about philosophy and really sort of thinking about philosophy and also about religion almost as a subset of philosophy, really. And he talks in the beginning that the whole of philosophy in the ancient world and more recently has all been about trying to handle suffering.

And this modern culture that we live in is one of the worst at dealing with that. And the reality is, unfortunately, many of our churches have imbibed too much of that culture and or have created their own Christian culture, which is not particularly good at handling suffering. And it's an interesting thing because you go back and read the Puritans or Spurgeon's sermons or even sermons from people like Lloyd-Jones and all the rest of it.

I mean, Lloyd-Jones wrote a whole book about spiritual depression. There's not too many books like that around today. And so it's kind of like you say, if we don't actually work out what Jesus meant when he said, in this world, you will have trouble, but take heart of overcome the world.

I mean, you know, Jesus keeps his promises. You will have troubles. Yes.

Well, and I do a sermon when I travel on a God that whispers in the dark and it takes through 1 Kings 18 and 19 of Elijah's story after Mount Carmel. And I challenge any church not to read that, 1 Kings 18 through 1 Kings 19 and not see a theology of suffering develop and how God deals with Elijah during that time. Takes care of his physical needs first, gives him purpose, sends him on mission, shows up, asks questions that aren't damning or judgmental but are just curious, and then sends him off with purpose and meaning.

I'm like, being alive, we could take a lot of lessons from that. I mean, there's a lot of other stories, you know, Job and Paul, and, you know, there's a ton of stories in the scriptures that leads us to develop a good theology of suffering, but we don't talk about it. You're very right.

We don't talk about it in the way that we should. And I think we don't, actually, my experience, having had a sort of major physical health problem for the last few years, is that I think some Christians are really uncomfortable even about that. But when you then make it a mental health problem, it's even more of a challenge.

And I think we, you know, we need to understand that Jesus, well, you know, he's described as gentle and lowly, as someone who won't snuff out the bruised reed and all of those sorts of things. And, you know, I just get the feeling that, you know, if he was around today, you know, he would be looking in the mental health hospitals and, you know, probably at least one of his disciples would have come from there, you know. Just like in his day, he was looking at the lepers and, you know, the tax collectors and all of those sorts of things, the so-called sinners, you know.

And I just think, it can be challenging though, of course. And I think some churches will really struggle when someone walks in and they don't quite fit the mould of, you know, successful, you know, the demographic that perhaps they're going for in that church. And yet, you know, actually the most, you know, Jesus' heart is for the sick.

I agreed. I agreed. And I just would say this.

The church has such an opportunity to step into the fray in this. We've just got to stop over-complicating it. And really the power of our presence showing up begins the process of all the conversations we've had this afternoon.

That's beautiful. It's probably a lovely place to finish our interview there, Mark. And, you know, this book, I'd encourage people to have a look at it.

Actually, it's the sort of thing that anyone who's interested could read, but certainly pastors. And it might be of interest to people who work in the field. One of the things which is interesting is that there are lots of, in the UK, and I suspect it's probably the same in the US, there are a lot of Christians who do choose to work in some of these caring fields, but don't necessarily, you know, get tapped into the church context or don't often have the opportunity to think these things through from a Christian perspective as well.

And I think that's something else we can encourage people to do. And hopefully your book will help some of those folks as well. That if you're, you know, if you're a social worker or a psychiatrist or a mental health nurse or a counsellor or a psychologist, to actually read how another Christian has grappled through some of these issues and is trying to integrate the things you learn in your workplace with, you know, Christian ideas.

I think that's a great approach. And it's something that we need to encourage. And I guess it's more, we need to do a bit more to encourage each other, I think, across the different disciplines as well.

You know, so, you know, often psychiatrists and psychologists don't really talk or psychiatrists and counsellors don't really talk. So it's great that you and I have had this conversation today. And let's hope that many more such conversations, you know, can perhaps even be sparked by this book as people read it, this interview as people watch it and, you know, other contexts that will come up.

Well, I appreciate it, Adrian. Thank you for taking the time. That's great.