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People with mental illnesses often feel as if the disorder is something almost apart from themselves. Certainly these illnesses sometimes behave as if they “have their own best interests at heart,” not those of their human host.

One good example is when a mental illness betrays its host’s mind into thinking that treatment is a bad idea. This is how so many people with bipolar disorder and schizophrenia end up in dangerous situations. Their illnesses convince them that it is better to live without medication. But without medication or other appropriate treatments, it is their illnesses — not the persons — that tend to flourish.

  • A person with schizophrenia may end up isolated in a paranoid panic, fearing to eat anything, go anywhere, or close his eyes to sleep.
  • A person with bipolar disorder may swing into increasingly grandiose fantasies until she attempts a near-fatally dangerous feat.

The truly astonishing thing, from the point of view of the “host” mind, is that if treatment is initiated and the illness brought under control, the extraordinary behaviors of the out-of-control mind may not even be remembered.

Who Is Responsible?

So who did those bad things? That is to say, who is responsible for them?

In courts of law, mental illness is recognized as a factor in crime in all but four states (Kansas, Montana, Idaho and Utah).

  • In most states, the M’Naghten Rule holds. Derived from 19th century English law, this rule finds a person not responsible for a crime if at the time of the crime he or she was not capable of recognizing that the act was wrong.
  • The Irresistible Impulse test was added to the M’Naughten Rule starting with the Alabama court in 1887. It allows for the possibility that a person might be under “the duress of such mental disease [that] he had … lost the power to choose between right and wrong” such that “his free agency was at the time destroyed.”
  • Eighteen states use the Model Penal Code standard, which combines the M’Naughten Rule with a variation of the Irresistible Impulse Test.

Even in the 46 states where mental illness is considered in jurisprudence, the law varies in the verdicts allowed:

  • Not guilty by reason of insanity is becoming uncommon
  • Guilty but insane is also becoming less common, but carries sentencing to treatment instead of prison
  • Guilty but mentally ill also involves sentencing to treatment

This question is particularly challenging when the acts are among those our faith would categorize as sins, even if the law doesn’t penalize them.

Forgive Me or My Illness?

When a teen with schizophrenia acts out at school because of paranoia, should she apologize to teachers and friends? Can she say, “My illness did it”? Does that get her a pass? Do we forgive illnesses or people?

When a man with bipolar disorder has an affair, should his wife’s forgiveness rest in part on the knowledge that sexual acting-out is typical for people with the disorder? Does he get to say “My illness did it” or is he fully responsible before God and his spouse? What about the congregation? What discipline is appropriate?

When a young adult with bipolar calls the choir master several truly foul names before rushing out of practice, should forgiveness be available without an apology? On what grounds?

Hate the Sin, Love the Person with Mental Illness?

The questions become more complicated for most churches when the person with mental illness is in leadership. So, for example …

  • Some denominations protect their leaders. A prominent pastor or worship leader who has multiple affairs as a result of a mental illness will remain in place, with or without public repentance, while the family is eased out of the picture.
  • Some denominations have strict rules about certain kinds of behavior. The pastor who embezzles funds under the influence of a mental illness is not even given the opportunity to make restitution but is stripped of position and all related benefits.

When churches don’t know anything about mental illnesses, they can make some unfortunate mistakes in ministry. They send away half of a couple instead of attempting to understand, counsel, and reconcile. They alienate young people who are themselves confused by the strange impulses taking over their minds.

We know to “hate the sin, love the sinner.” But when the sinner is “unrepentant” during a months-long bout of mental illness, it is hard to believe there is, somewhere in there, a person who will eventually come back to him or herself and honestly desire God.

What has been helpful at church when you have been out of control?