Clinical Anxiety and Christian Faith

In the UK, approximately 1 in 4 people suffer from a mental illness1, and around 6.6% of people in England suffer from anxiety2.

Mental illness is something that affects virtually everyone either directly or through friendships and relationships. However, it is a topic hardly ever mentioned in the public sphere- whether secular media, church settings or social situations. Therefore, many people find mental illness confusing and difficult to talk about at best, and stigmatised and tabooed at worst.

In this article, I hope to explore the clinical, psychological and spiritual aspects of clinical anxiety, and also to talk candidly about my own experience as someone who suffers from mixed anxiety and depression. I certainly do not claim to be an expert in psychiatry, counselling or theology. However, as a patient and also as someone who has cared for and supported a number patients, friends and colleagues through anxiety, my hope is that my thoughts may be of some help to people suffering from or caring for those suffering from anxiety. My aims with this article are to:

  1. Briefly outline what anxiety is
  2. Look at how we should approach anxiety, medically and spiritually
  3. See what the bible has to offer by way of spiritual counsel to those with anxiety

1. What is Anxiety?

Everyone gets anxious from time to time. As I write this blog, I am at medical school in the middle of the summer exam period, where it’s viewed as strange when a student is not suffering from intense anxiety and stress!  However, anxiety is more than the uncomfortable temporary inner unrest we normally feel when life stressors appear or intensify.

“Clinical anxiety” is a group of disorders characterised by excessive worry or apprehension out of proportion to the external trigger, or without any external trigger at all. These internal feelings are very often coupled with physical symptoms such as (but not exclusively) hyperventilation, heart palpitations, sweating, tremulousness, difficulty breathing, chest pain, dizziness or light-headedness.

Anxiety symptoms can be triggered by specific stimuli (called “phobias”), can come on suddenly in particular situations (called “panic disorder”), or can be continuously, chronically present (called “generalised anxiety disorder”). There are also lots of other associated conditions such as PTSD, OCD and anxious personality disorders, and as with most of psychiatry, there is much overlap between the groups.

2. Is Anxiety Medical, Psychological, or Spiritual?

One man whom I have learned a huge amount from about medicine and theology is former consultant neonatologist (UCH) Prof. John Wyatt. In a talk to a group of Medical Students (2014) Prof. Wyatt described the human nature as being composed of four different dimensions, all of which require care: the physical, psychological, relational and spiritual. Wyatt went on to emphasise how integrally linked these four dimensions are; physical illnesses can have psychological, relational and spiritual consequences, relational problems can have physical, psychological and spiritual effects and so on. This makes a lot of sense. A physical injury such as breaking a leg can leading to psychological upset, relationship changes and/or spiritual questioning. Similarly a relational event such as bereavement can have profound psychological impacts, physical manifestations such as difficulty sleeping and/or spiritual upheaval.

This all makes how we should approach mental illness a complex topic.

The more I have studied the psychology and medicine of anxiety, and experienced it myself and through friends, the more I have come to the belief that anxiety, as with the majority of mental illnesses, is very idiosyncratic- meaning that the causes, mechanisms and effects vary greatly between individuals.

For many, psychological issues dominate the experience of anxiety. Panic attacks and anxious thoughts can be triggered and propagated by difficult memories, or worrisome thoughts that become difficult to suppress or be distracted from. However, these thoughts can clearly produce physical symptoms, as well as deeply impact someone’s relational and/or spiritual life.

On the other hand, for many, the experience of anxiety will be predominately physical, with the salient features of physical symptoms such as difficulty breathing, palpitations and chest pain, or simply paralysing terror at a situation. But of course, these symptoms can be coupled with psychological, relational and/or spiritual components of anxiety.

For others, relationships and social interactions, past, present and hypothetical, are the key driving force behind anxiety. Anxiety can be triggered by social situations ranging from fear of particular people or groups, to anxiousness over unfamiliar social circumstances. But of course these anxieties are usually combined with distressing psychological thoughts and feelings, as well as potentially physical and spiritual manifestations.

And finally, for some, the spiritual aspects of anxiety play the salient role in their experiences. These can take the form of anxieties surrounding moral guilt, religious obligation, fear of the spiritual entities, personal identity, and perhaps most commonly of all, anxiety about our own mortality. And of course, these spiritual anxieties can affect our psychology, physicality and relationships.

I am clearly labouring the point that anxiety is highly idiosyncratic. However, I do think it is very important.

It is dangerous to view anxiety (and indeed all mental illness) through the reductional physicalist lens that claims that the physical is all there is. If this were true, just taking drugs like SSRIs would be far more effective for far more people. Similarly, some people go to the other extreme and view anxiety as a soley spiritual problem that just requires “getting right with God”. Proponents of such a view are equally misguided, and often make church a more anxiety-inducing place.

Interestingly, this 4-dimensional approach to mental health is not far off the mainstream model used by psychiatrists and GPs to administer psychiatric care. In psychiatry, we primarily use the “bio-psycho-social” model to treat all mental illness and related symptomology, which takes into account a patient’s physical, psychological and social aspects and situations. There is an obvious absence of the spiritual component of the patient in this model. However, the General Medical Council (the legal governing body for doctors) states unambiguously that spiritual care is essential for holistic medical treatment4 and because of this, I am optimistic that spiritual care may one day become part of routine medical treatment for mental illness.

3. Spiritual Counsel in Anxiety

The NHS is reasonably well equipped to care for patient’s physical, psychological and social aspects of anxiety, in the forms of medications, therapies, counselling etc. Therefore if you suffer from anxiety or think you may be suffering from anxiety, I would really encourage you to seek professional medical help; I did (after much persuasion) and am very glad I did.

However, in this final part of the blog, I am going to turn to the spiritual side of anxiety and explore what biblical Christian faith has to offer on the subject.

Approaching Biblical Wisdom in Anxiety

The bible says a lot about anxiety in various forms. The words “anxiety” and “worry” come up a lot in the New Testament, and interestingly, the most common command is the bible (by a considerable margin) is “do not be afraid”.

When the bible mentions anxiety, there are two components that are usually present in the teaching: firstly we are told to stop being anxious, and secondly we are told a reason why. We will look at some of these verses shortly. However, it is always very tempting to approach the bible in the hope of quick fixes and easy answers to our problems. But, the bible was never intended to be a self-help guide with lines and liturgies that will cause our anxieties dissipate if read correctly. Rather, as we approach anxiety in the bible, it is important that we hold the bible’s wisdom in the correct way.

On this matter, Dr Martin Lloyd-Jones, the doctor-turned renowned bible teacher of the early 20th century, had much insight. In his remarkable book “Spiritual Depression- Its Causes and Cure” Lloyd-Jones comments on Psalm 42:11 which reads (NIV):

“Why, my soul, are you downcast?
Why so disturbed within me?
Put your hope in God,
for I will yet praise him,
my Saviour and my God.”

Lloyd-Jones writes:

“The first thing we have to learn is what the Psalmist learned- we must learn to take ourselves in hand. This man was no content just to lie down and commiserate with himself. He does something about it, he takes himself in hand. But he does something which is more important still, that is he talks to himself. This man turns to himself and says “Why art thou cast down O my soul, why art thou disquieted within me?” He is talking to himself, he is addressing himself…Take those thoughts that come to you the moment you wake up in the morning. You have no originated them, but they start talking to you, they bring back the problems of yesterday etc. Somebody is talking. Who is talking to you? Your self is talking to you. Now this man’s treatment was this; instead of allowing this self to talk to him, he starts talking to himself. “Why art thou cast down, O my soul?” he asks. His soul had been depressing him, crushing hum. So he stands up and says: “Self, listen for a moment, I will speak to you”.

…The main art in the matter of spiritual living is to know how to handle yourself. You have to take yourself in hand, you have to address yourself, preach to yourself, question yourself. You must say to your soul: “Why art thou cast down”- what business have you to be disquieted? You must turn on yourself, upbraid yourself, condemn yourself, exhort yourself, and say to yourself: “Hope thou in God”- instead of muttering in this depressed, unhappy way. And then you must go on to remind yourself of God, Who God is and what God has done, and what God has pledged Himself to do.”5

Lloyd-Jones describes the importance of ministering to oneself. In this instant-information age, we always desire quick fixes and easy immediate results. However, the bible’s teachings that address anxiety are not immediate-relief magic potions. Rather, we are to take the words of God in the bible, remember them, minister them to ourselves, and meditate on them over time. Ministering to oneself is such a neglected part of Christian teaching that I believe is so essential to treating spiritual anxiety. In secular therapy, the mainstay of much Cognitive Behavioural Therapy is thinking about one’s own thoughts and then training and convincing oneself to think differently. If this sort of self-ministry can work with CBT, how much could we benefit from ministering the wisdom of the bible to our souls?

So what should we be ministering to ourselves when anxiety overwhelms?

Biblical Counsel for Anxiety

Obviously, the bible does not make a distinction between general life anxiety and the clinical anxiety disorders that we diagnoses in psychiatry, given that the diagnostic criteria are more recent developments. However, it is also clear that people’s experience in the bible of worry and anxiety is varied and sometimes very severe, and it is thus not difficult to attach clinical diagnoses to certain characters in certain situations. But regardless of whether we are reading of general life worries, or states akin to our modern day diagnosable anxiety syndromes, there is a huge amount that we can learn from the bible about dealing with anxiety in all its forms.

In his great little book “Living Without Worry- How to Replace Anxiety with Peace”, counsellor and bible teacher Dr Timothy Lane divides the bible’s teaching on anxiety into anxieties about the past, present and future. These categories are somewhat over-simplistic given that most people’s experience of anxiety does not fit neatly into one box. That being said, it is still a helpful way to navigate to bible’s teaching on anxiety.

(a)Anxiety About the Past

Anxieties about the past are common. Our experiences and memories can haunts us, fill us with fear, or paralyse us with anxiety even when everything around us seems normal and unthreatening. King David spoke of his experience of anxiety about the past in Psalm 13:

For the director of music. A psalm of David.

How long, Lord? Will you forget me forever?
How long will you hide your face from me?
How long must I wrestle with my thoughts
and day after day have sorrow in my heart?
How long will my enemy triumph over me?

Look on me and answer, Lord my God.
Give light to my eyes, or I will sleep in death,
and my enemy will say, “I have overcome him,”
and my foes will rejoice when I fall.

But I trust in your unfailing love;
my heart rejoices in your salvation.
I will sing the Lord’s praise,
for he has been good to me.
6

The Psalm can be split into two parts: verses 1-4 speak of David’s anxiety, and verses 5-6 speak of his way out.

From verses 1-2a, we see David’s struggle with anguishing anxiety that has now become a daily occurrence and the rhetorical questions give the impression that he is at a loss over where to turn and what to do. Then in verses 2a-4, we see that the source of David’s anxiety is his past defeats at the hands of his enemies, leading him to worry that God has left him alone to die. If we put ourselves in David’s shoes, I think most of us would see his anxiety as justifiable!

But then comes David’s realisation of a way out from anxiety in verses 5-6. In verse 5, David remembers God’s love and salvation as he writes “But I trust in your unfailing love; my heart rejoices in your salvation”. One can assume that the “salvation” event that David remembers is Israel’s great redemption story of the Exodus, where God rescued His people from slavery and oppression in Egypt. It is the remembrance of the past redeeming event of the Exodus that begins to bring David peace in his anxiety. Then in verse 6, David’s memory comes closer to the present has he declares “I will sing the Lord’s praise, for he has been good to me”. David not only remembers Israel’s great redemption story, but also of God’s past blessing and goodness towards him. These memories of past personal blessings from God lead David out of anxiety and into joyful song!

So how does David find peace in anxiety over the past? Put simply, he overrides memories of darkness with memories of peace. When memories of past military defeats causes anxiety to swell within him, David trains himself to dwell on other memories of deliverance and blessing, and thus reminding himself that God is present and good. This is something I think we can learn from. We all have past blessings from God in various shapes and sizes, from our very existence, family, successes, friendships, education, wellbeing, etc etc But far greater than any of those, we have the ultimate redemption story of history that the Exodus was a mere fore-shadowing of. We can look back c.2000 years to the cross, where Jesus, God incarnate, bore the punishment for all the evil and sin of human history, and offered us salvation from this broken, painful, earthly sin-filled life.

Replacing memories with other memories in the moments of anxiety is not an easy task, and takes time and training of oneself (as we learned from Martin Lloyd-Jones). However, we know it does work. “Reimagining” is a very big part of cognitive therapy for Post-Traumatic Stress Disorder (PTSD), where patients remember the traumatic event but then train themselves to synthesis a new ending or resolution to the memory. The results can be astonishing. But rather than imagining new memories, we can look back on God’s blessings and our own salvation at the cross c.2000 ago.

(b) Anxiety About the Present

Let us now turn to anxiety about the present. Often anxiety is triggered by present situations and circumstances, and of which the possibilities are endless. The apostle Paul had plenty to be anxious about as he wrote the epistle to the Philippians. As he wrote, he was chained up in prison, being deserted by his friends and longed to visit his planted churches to find out if they were still Christians. And in this midst of his present worries, Paul writes in Philippians 4:4-7:

Rejoice in the Lord always. I will say it again: Rejoice! Let your gentleness be evident to all. The Lord is near. Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.7

This little set of verses opens with Paul’s exaltation to the Philippians to be joyful and not to be anxious about anything (v4-6a). It is certainly an audacious command! And the reason Paul gives for not being anxious is four short words in verse 5: “The Lord is near”. As Dr Timothy Lane puts it:

“I do not think there is any other world religion that speaks as boldly about the presence of the divine with the Christian faith. At the heart of Christianity is a relationship. The ethical demands of Christianity are not the foundation of the Christian religion; a relationship with God is. God has promised to be with us… While you may feel that you are all alone, you are not. God, in Christ is with you through the ongoing work of the Spirit.”8

Paul’s antidote to anxiety at present circumstances is to minister to ourselves and remind ourselves that God is present with us. And once we remember that God is with us in the middle of anxiety, we can enjoy the communicative relationship with God as we pray (verse 6b) and have God’s peace fill our hearts and minds (verse 7) like a child’s comfort from a parent’s embrace. The God of the universe, who is far bigger than anything this world can scare us with, and who is far more loving and caring than we can possibly imagine, promises to always be alongside us as we face anxieties. And so as we face anxieties, we ought to train ourselves to cling onto the truths that God is with, for us, and desires our peace.

(c)Anxiety About the Future

Finally, let us now turn to anxiety about the future. Everyone thinks about what the future holds. But uncertainty about the unknowns or dread about the anticipatable can turn into debilitating anxiety.  Anxiety about the future is the topic of a large segment of Jesus’ Sermon on the Mount, as we read in Matthew 6:25-34:

25 “Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? 26 Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? 27 Can any one of you by worrying add a single hour to your life

28 “And why do you worry about clothes? See how the flowers of the field grow. They do not labor or spin. 29 Yet I tell you that not even Solomon in all his splendor was dressed like one of these. 30 If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you—you of little faith? 31 So do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ 32 For the pagans run after all these things, and your heavenly Father knows that you need them. 33 But seek first his kingdom and his righteousness, and all these things will be given to you as well. 34 Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.9

There is a huge amount of theological content in these verses, and much ink has been spilt over them. So I will only be able to briefly pull out what I think are the main points.

Jesus’ concluding statement is unequivocal: “Therefore do not worry about tomorrow” (verse 34). And the overarching reasons he gives for us not having to worry are firstly, that God cares for us and secondly, that God will provide for our needs.

Firstly, verses 25-30 paints the image of God as the loving carer and faithful guardian of the birds (v26) and the flowers (v28), who depend on God for their every need. Jesus then juxtaposes them with us humans, who are described as infinitely more valuable and treasured by God than the plants and animals (v26b), for we are His beloved children. Jesus’ point is unmissable- God cares for us so very much. We are not simply another species of created creatures; we are his precious children.

And secondly, it follows that God’s love and care leads Him to provide for our needs. Verse 30 reads: “If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you”, and verse 33: “But seek first his kingdom and his righteousness, and all these things will be given to you as well.”  Jesus promises that just like the animals and plants, God will provide for our needs. It is important to make the distinction between our desires and our needs. God will not necessarily give us everything we want or ask for. However, we have the assurance that God cares deeply about our needs and promises to provide for us what we require. What this means in terms of practical provision is explored in lots of other places around the bible, and is certainly not limited to food and clothing. We are promised that temptation will be limited to the surmountable10, that divine comfort will come in suffering11, that we will be fully equipped to work for God12, and much more besides. But the main point which I think we should take from this passage and minister to our souls is simply this: God cares for us so very deeply and will act upon that when the future troubles come. Whether anxiety stems from fear of the unknown or dread of the anticipatable, God knows what future will ask of you, and He is ready to help you through it in provision and presence.

Concluding Thoughts

So as I wrap up this article I am well aware that I have only scratched the surface when it comes to anxiety and faith. However, I hope that in looking at how the bible counsels anxiety and how we should use these truths to minister to our souls, some readers may be helped. It is also important for me to say that if you do suffer from anxiety, you are not alone. I write these blogs partly to try help people who are suffering, but also to simply show that there are others like me who suffer from anxiety, and we shouldn’t be afraid to talk about it.

 

God Bless.

 

  1. The Office for National Statistics Psychiatric Morbidity Report, 2001
  2. McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. Available
  3. Summary of ICD 10 and DSM 5 criteria for anxiety disorders
  4. General Medical Council, Good Medical Practice, paragraph 15a
  5. Martin Lloyd-Jones, Spiritual Depression- It’s Causes and Cure (Marshall Pickering, 1965), pg. 20-21
  6. Psalm 13 (NIV)
  7. Philippians 4:4-6 (NIV)
  8. Timothy Lane, Living Without Anxiety- How to Replace Anxiety with Peace, (The Good Book Company, 2015) pg. 79-80
  9. Matthew 6:25-43 (NIV)
  10. 1 Corinthians 10:13
  11. 2 Corinthians 1:3-4
  12. 2 Peter 1:3
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