Mental illness in Christians is so difficult to understand and treat because there seems to be (at least) three sources of causation that overlap and intertwine: illness, dysfunction, and sin. They may manifest themselves in strikingly similar ways in terms of feelings and behaviors, but they are very different issues. Consequentially, each area has to be dealt with in a different way. Trouble is, it is difficult, if not impossible, to differentiate where one ends and another begins.
First, there is illness. Depression and other mental illnesses are often just that-- illnesses with a physiological basis to them. There may be no other explanation other than chemical or biological, but stressful events in life will most certainly aggravate it. Medicine is a usually a good option for treating the illness, although it takes time and sometimes lots of trial and error to find the medications that will help. Of course, no medicine is a cure-all. Its job is to help the person feel well enough to function and to think clearly. Sometimes a person is on meds and feels better, but then they feel surprised when they continue to struggle.
That leads to the next area-- dysfunction. An abnormality or impairment in function. A deviation of a norm. Dysfunction, as I understand it, means all the negative and unhealthy behaviors, habits, coping mechanisms, and so forth which one has learned throughout their life. We are all dysfunctional in some sense; we all choose to cope with things in unhealthy ways. It begins in our childhood-- we learn it from our parents and family, our teachers, our peers. We see, and we model. As we get older, we learn our own modes of coping, and we develop our own habits. Our way of dealing with life becomes our own "normal," even if it is unhealthy. The reason I differentiate dysfunction from sin is because it is not necessarily a violation of God's commands. It's generally just a poor way of doing something, but it can be changed and unlearned through therapy, counseling, and/or a conscious decision to alter behavior. For instance, take communication. A family who doesn't know how to communicate with each other in a crisis but rather sweeps the issues under the rug has a dysfunction in their communication. It's not necessarily a sin (although it can be), but it's not necessarily healthy either. Dysfunctions are sometimes hard to identify, because to the dysfunctional person, it IS normal. It is safe. It is all they know. But when a person realizes they have some dysfunctions that are impairing their daily life and relationships, they can begin to make progress to a more healthy way of dealing with the stress of life. Depression, then, can stem from dysfunctional habits and behavior; conversely, dysfunction can exacerbate an illness and prevent a person from getting the help they need.
Finally, there's plain old sin. Willfully choosing to do the wrong thing, or willfully choosing not to do the right thing. Lots of people want to call depression a sin-- a person should just be able to "choose" to feel better and "choose" to be joyful. On the other side of the token, a lot of people with depression want to blame all their bad behavior on the illness and not take responsibility for the sin in their lives. And, to complicate matters further, part of the reason they can't take responsibility is because of their dysfunctional way of living and coping. We are all sinners, so we know that on some level, sin and its consequences are coming into play in a person with a mental illness. It may not be the cause, but sin has to be (continually) identified and addressed along with the illness and the dysfunction. That's true even of a person who doesn't have a mental illness. That's just part of being a Christian-- identify, confess, and repent, in sins both big and small. Daily. Hourly, even.
So how does one sort through this mess? The Holy Spirit has got to step up to the plate on this one. But a person also has a responsibility to be self-aware. If someone knows they have an illness but refuses to get help, or if they are confronted with their dysfunction and refuse to make positive changes, then one could argue that their illness and dysfunction have led them to sin. But since part of mental illness involves a skewed view of reality, a person not only needs self-awareness, they also need wise counsel around them who can help them make good decisions for themselves. If they are not able to get help when they desperately need it, then family, friends, pastors, counselors, doctors, or somebody has to step in. If a person has gotten help but continues to wallow in their old patterns because it feels safe, or if they begin to place blame or make excuses, then it is not fair to lay the blame solely on illness. The best thing solution then is to own up and take responsibility for themselves in all three areas.
Again, none of this is cut-and-dry. It's like a big soup pot of issues floating around together, but they all get served up in the same bowl. But we all have a responsibility to repent of the things we can change (sin), address the issues we can improve (dysfunction), and get help for the things that are out of our control (illness).
