1 in 4 Pastors Have Struggled with Mental Illness, Finds LifeWay and Focus on the Family

[Updated with Ed Stetzer quotes]

Your pastor is just as likely to experience mental illness as any other American, according to a LifeWay Research survey commissioned by Focus on the Family.

Nearly 1 in 4 pastors (23 percent) acknowledge they have “personally struggled with mental illness,” and 12 percent of those pastors said the illness had been diagnosed, according to the poll (infographics below). One in four U.S. adults experience mental illness in a given year, according to the National Alliance on Mental Illness.

Recent deaths by suicide of high-profile pastors’ children, including Rick Warren’s son Matthew and Joel Hunter's son Isaac, have prompted increased attention to mental illness from pastors’ pulpits and pens. Warren launched “The Gathering on Mental Health and the Church” this past spring. High-profile pastors, including NewSpring Church pastor Perry Noble, have publicly documented their struggles with mental illness.

“Here’s what we know from observation: If you reveal your struggle with mental illness as a pastor, it’s going to limit your opportunities,” Ed Stetzer, executive director of LifeWay Research, told CT. “What happens is pastors who are struggling with mental illness tend not to say it until they are already successful. So Perry Noble, running a church of 30,000 plus, just last year says ‘I have severe depression.’”

“We have to break the stigma that causes people to say that people with mental illness are just of no value,” he added. “These high-profile suicides made it okay to talk about, but I think Christians have been slower than the population at large to recognize what mental illness is, let alone what they should do."

The majority of pastors (66 percent) still rarely or never talk about mental illness in sermons or before large groups, the survey found. About one-fourth of pastors bring up mental illness several times a year, and 7 percent say they tackle it once a month or more.

Image: LifeWay Research

Struggling laypeople wish their churches dealt with the issue more; 59 percent of respondents with a mental illness want their church to talk more openly about it, as do 65 percent of their family members.

“Our research found people who suffer from mental illness often turn to pastors for help,” Stetzer noted in a news release. “But pastors need more guidance and preparation for dealing with mental health crises. They often don’t have a plan to help individuals or families affected by mental illness, and miss opportunities to be the church.”

Other “key disconnects” uncovered by the study:

• Two-thirds of pastors (68 percent) say their church maintains a list of local mental health resources for church members. But few families (28 percent) are aware those resources exist.
• Only a quarter of churches (27 percent) have a plan to assist families affected by mental illness, according to pastors. And only 21 percent of family members are aware of a plan in their church.
• Few churches (14 percent) have a counselor skilled in mental illness on staff, or train leaders how to recognize mental illness (13 percent), according to pastors.

The disconnect isn’t because of a lack of compassion. Most pastors (74 percent) say they aren’t reluctant to get involved with those with acute mental illnesses, and nearly 60 percent have provided counseling to people who were later diagnosed.

Image: LifeWay Research

Instead, pastors can feel overwhelmed at times with how to properly respond to the mental health needs of members of their congregation; 22 percent said they were reluctant to do more because it took “too much time.”

“Pastors are trained for spiritual struggle. They’re not trained for mental illness,” Stetzer told CT. “And so, what they will often do is pass someone off. I don’t think what that 20 percent says is ‘Forget you,’ but ‘I can’t handle this.’”

The silence at church can lead to a reluctance to share, Atlanta-based psychiatrist Michael Lyles told LifeWay. “The vast majority of [my evangelical Christian patients] have not told anybody in their church what they were going through, including their pastors, including small group leaders, everybody,” he said in the release.

In fact, 10 percent of the 200 respondents with mental illness said they have switched churches after a church’s poor response to them, and another 13 percent stopped going altogether or couldn’t find a church.

But more than half of regular churchgoers with mental illness said they stayed where they were, and half also said that their church has been supportive. One way churches can be supportive, Stetzer suggested to CT, is regular meetings between pastoral staff and the person suffering from mental illness, even as the individual continues to receive consistent medical treatment.

“The Bible is filled with people who struggled with suicide, or were majorly depressed or bi-polar,” said Focus on the Family pyschologist Jared Pingleton in the LifeWay release. “David was totally bi-polar. Elijah probably was as well. They are not remembered for those things. They are remembered for their faith.”

Researchers focused on three groups:

They surveyed 1,000 senior Protestant pastors about how their churches approaches mental illness. Researchers then surveyed 355 Protestant Americans diagnosed with an acute mental illness—either moderate or severe depression, bipolar, or schizophrenia. Among them were 200 church-goers.

A third survey polled 207 Protestant family members of people with acute mental illness.

Researchers also conducted in-depth interview with 15 experts on spirituality and mental illness.

LifeWay's full release is copied below.

CT frequently addresses mental health, including how pastors can guard against mental illness, the spiritual side of mental illness, how Facebook can affect your mental health, and how nothing, not even suicide, can separate people from the love of God. CT also covered Saddleback Church senior pastor Rick Warren’s mental health ministry launch after his son Matthew took his own life in 2013.

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Mental Illness Remains Taboo Topic for Many Pastors

By Bob Smietana

NASHVILLE, Tenn. – One in four Americans suffers from some kind of mental illness in any given year, according to the National Alliance on Mental Illness. Many look to their church for spiritual guidance in times of distress.But they're unlikely to find much help on Sunday mornings.

Most Protestant senior pastors (66 percent) seldom speak to their congregation about mental illness.

That includes almost half (49 percent) who rarely (39 percent) or never (10 percent), speak about mental illness. About 1in 6 pastors (16 percent) speak about mental illness once a year. And about quarter of pastors (22 percent) are reluctant to help those who suffer from acute mental illness because it takes too much time.

Those are among the findings of a recent study of faith and mental illness by Nashville-based LifeWay Research. The study, co-sponsored by Focus on the Family, was designed to help churches better assist those affected by mental illness.

Researchers looked at three groups for the study.

They surveyed 1,000 senior Protestant pastors about how their churches approaches mental illness. Researchers then surveyed 355 Protestant Americans diagnosed with an acute mental illness—either moderate or severe depression, bipolar, or schizophrenia. Among them were 200 church-goers.

A third survey polled 207 Protestant family members of people with acute mental illness.

Researchers also conducted in-depth interview with 15 experts on spirituality and mental illness.

The study found pastors and churches want to help those who experience mental illness. But those good intentions don’t always lead to action.

"Our research found people who suffer from mental illness often turn to pastors for help," said Ed Stetzer, executive director of LifeWay Research.

"But pastors need more guidance and preparation for dealing with mental health crises. They often don’t have a plan to help individuals or families affected by mental illness, and miss opportunities to be the church."

A summary of findings includes a number of what researchers call ‘key disconnects’ including:

Only a quarter of churches (27 percent) have a plan to assist families affected by mental illness according to pastors.And only 21 percent of family members are aware of a plan in their church. Few churches (14 percent) have a counselor skilled in mental illness on staff, or train leaders how to recognize mental illness (13 percent) according to pastors. Two-thirds of pastors (68 percent) say their church maintains a list of local mental health resources for church members. But few families (28 percent) are aware those resources exist. Family members (65 percent) and those with mental illness (59 percent) want their church to talk openly about mental illness, so the topic will not be a taboo. But 66 percent of pastors speak to their church once a year or less on the subject.

That silence can leave people feeling ashamed about mental illness, said Jared Pingleton, director of counseling services at Focus on the Family. Those with mental illness can feel left out, as if the church doesn’t care. Or worse, they can feel mental illness is a sign of spiritual failure.

"We can talk about diabetes and Aunt Mable’s lumbago in church—those are seen as medical conditions,” he said. “But mental illness--that’s somehow seen as a lack of faith."

Most pastors say they know people who have been diagnosed with mental illness. Nearly 6 in 10 (59 percent) have counseled people who were later diagnosed.

And pastors themselves aren’t immune from mental illness. About a quarter of pastors (23 percent), say they’ve experienced some kind of mental illness, while 12 percent say they received a diagnosis for a mental health condition.

But those pastors are often reluctant to share their struggles, said Chuck Hannaford, a clinical psychologist and president of HeartLife Professional Soul-Care in Germantown, Tennessee. He was one of the experts interviewed for the project.

Hannaford counsels pastors in his practice and said many – if they have a mental illness like depression or anxiety—won’t share that information with the congregation.

He doesn't think pastors should share all the details of their diagnosis. But they could acknowledge they struggle with mental illness.

"You know it’s a shame that we can’t be more open about it,” he told researchers. “But what I’m talking about is just an openness from the pulpit that people struggle with these issues and it’s not an easy answer."

Those with mental illness can also be hesitant to share their diagnosis at church. Michael Lyles, an Atlanta-based psychiatrist, says more than half his patients come from an evangelical Christian background.

"The vast majority of them have not told anybody in their church what they were going through, including their pastors, including small group leaders, everybody," Lyle said.

Stetzer said what appears to be missing in most church responses is "an open forum for discussion and intervention that could help remove the stigma associated with mental illness."

"Churches talk openly about cancer, diabetes, heart attacks and other health conditions – they should do the same for mental illness, in order to reduce the sense of stigma," Stetzer said.

Researchers asked those with mental illness about their experience in church.

A few – (10 percent)—say they’ve changed churches because of how a particular church responded to their mental illness. Another 13 percent ether stopped attending church (8 percent) or could not find a church (5 percent). More than a third, 37 percent, answered, “don’t know,” when asked how their church’s reaction to their illness affected them. Among regular churchgoers with mental illness, about half (52 percent) say they have stayed at the same church. Fifteen percent changed churches, while 8 percent stopped going to church, and 26 percent said, “Don’t know.” Over half, 53 percent, say their church has been supportive. About thirteen percent say their church was not supportive. A third (33 percent) answered, “don’t know” when asked if their church was supportive.

LifeWay Research also asked open-ended questions about how mental illness has affected people’s faith. Those without support from the church said they struggled.

“My faith has gone to pot and I have so little trust in others,” one respondent told researchers.

“I have no help from anyone,” said another respondent.

But others found support when they told their church about their mental illness.

“Several people at my church (including my pastor) have confided that they too suffer from mental illness,” said one respondent. “Reminding me that God will get me through and to take my meds,” said another.

Mental illness, like other chronic conditions, can feel overwhelming at times, said Pingleton. Patients can feel as if their diagnosis defines their life. But that’s not how the Bible sees those with mental illness, he said.

He pointed out that many biblical characters suffered from emotional struggles. And some, were they alive today, would likely be diagnosed with mental illness.

“The Bible is filled with people who struggled with suicide, or were majorly depressed or bi-polar, he said. “David was totally bi-polar. Elijah probably was as well. They are not remembered for those things. They are remembered for their faith.”

LifeWay Research’s study was featured in a two-day radio broadcast from Focus on the Family on September 18 and 19. The study, along with a guide for pastors on how to assist those with mental illness and other downloadable resources, are posted at ThrivingPastor.com/MentalHealth.

LifeWay Research also looked at how churches view the use of medication to treat mental illness, about mental and spiritual formation, among other topics. Those findings will be released later this fall.

Methodology:
LifeWay Research conducted 1,000 telephone surveys of Protestant pastors May 7-31, 2014. Responses were weighted to reflect the size and geographic distribution of Protestant churches. The sample provides 95% confidence that the sampling error does not exceed +3.1%. Margins of error are higher in sub-groups.

LifeWay Research conducted 355 online surveys July 4-24, 2014among Protestant adults who suffer from moderate depression, severe depression, bipolar, or schizophrenia. The completed sample includes 200 who have attended worship services at a Christian church once a month or more as an adult.

LifeWay Research conducted 207 online surveys July 4-20, 2014 among Protestant adults who attend religious services at a Christian church on religious holidays or more often and have immediate family members in their household suffering from moderate depression, severe depression, bipolar, or schizophrenia.

For an article about ministry and neuroscience, it seems only right to begin with Scripture. So we start with one of the great neurological texts of the Bible: "David put his hand in his bag, and took thence a stone, and slang it, and smote the Philistine in his forehead, that the stone sunk into his forehead; and he fell upon his face to the earth" (1 Sam. 17:49, KJV).

Neuroscience has gained so much attention recently that it can seem like we're the first humans to discover a connection between the physical brain and spiritual development. But way back in Bible times, before EEGs and HMOs, people had noticed that putting a rock through someone's skull tends to inhibit their thinking.

For those of us in church leadership, information about "the neuroscience of everything" is everywhere. How much do we need to know about it? What new light does it shed on human change processes that those of us in the "transformation business" need to know? Does it cast doubt on the Christian view of persons as spiritual beings who are not merely physical?

Why is Neuroscience Exploding?

Neuroscience studies the nervous system in general and the brain in particular. Neurobiology looks at the chemistry of cells and their interactions; cognitive neuroscience looks at how the brain supports or interacts with psychological processes; something called computational neuroscience builds computer models to test theories.

Because the mind can be directed to any topic, there can be a "neuroscience" of almost any topic. Neurotheology looks at the brain as we believe, think, and pray about God. Researcher Andrew Newberg has shown the brain-altering power of such practices as prayer by looking at changes in the brain-state of nuns engaged in the practice for over 15 years as well as Pentecostals praying in tongues. It turns out that intense practice of prayer means their brains are much more impacted by their prayer than inexperienced or casual pray-ers. To find out who the true prayer-warriors in your church are, you could hook everybody up to electrodes, but it might be a little embarrassing. Paul Bloom pointed out that we shouldn't be surprised by this; the surprising thing would be if people experience a profound state without their brains being affected.

Brain studies made steady progress through the twentieth century; my own original doctoral advisor at Fuller Seminary was Lee Travis, who pioneered the use of the electroencephalogram at the University of Iowa in the 1930s. But for a long time, no one could actually look inside a working brain to watch it in operation.

That changed in the 1990s with functional Magnetic Resonance Imaging (fMRI), which allows researchers to track the flow of oxygen-rich blood (a proxy for neuron activity) in real time. Now it became possible to find out what part of the brain is involved in any given sequence of conscious activity, and how brain functions of liberals versus conservatives or religious versus non-religious people may differ from each other. It also became possible to find out if that guy in the second row whose eyes are closed when you're preaching really does have something going on in his brain during the sermon.

Why I'm Thankful for Neuroscience

"All truth is God's truth," Augustine said, and a deep part of what it means to "exercise dominion" is to learn all we can about what God has created. And there is very little God created that is more fascinating or more relevant to our well-being than our brains.

Neuroscience has immense potential to relieve human suffering. Already neuroscientists have found ways to alleviate symptoms of Parkinsons and create cochlear implants. Our church had a baptism service recently and several of those being baptized were young adults who suffer from cognitive challenges. In each case their parents were in tears. For those of us doing ministry to be aware of advances in brain science is part of caring for those in our congregation.

Research into the teenage brain made clear that the human brain isn't really fully developed until people are well into their twenties. Previously it was thought that the teenage brain was just "an adult brain with fewer miles on it." It turns out that the frontal lobes, which are associated with choosing and decision-making as well as with impulse-control and emotional management, are not fully connected—they lack the myelin coating that allows efficient communication between one part of the brain and another.

This helps explains the ancient mantra of parents and student ministry leaders everywhere: "What were you thinking?" Churches can help parents of teenagers understand why a practice as simple as insisting their teenage children get a good night's sleep is so necessary. They can also help parents set expectations for their teenagers' emotional lives at an appropriate level. They can also remind church leaders who are doing talks for teenagers to keep them short!

Neuroscience can also teach us compassion. For too long people who suffered from emotional or mental illness have been stigmatized. Churches—which should have been the safest places to offer healing and care—were sometimes among the most judgmental communities because it was assumed that if people simply got their spiritual lives together, their emotions should be fine.

Rick and Kay Warren noted after the death of their son: "Any other organ in my body can get broken and there's no shame, no stigma to it. My liver stops working, my heart stops working, my lungs stop working. Well, I'll just say, 'Hey, I've got diabetes, or a defective pancreas or whatever,' but if my brain is broken, I'm supposed to feel shame. And so a lot of people who should get help don't."

Pastors can offer great help to their congregation when we simply acknowledge the reality that followers of Jesus do not get a free pass from mental health problems. Christians have brains and neurons that are as fallible as atheist neurons and New Age neurons.

Beyond that, I'm thankful for neuroscience because it is helping us understand better how our bodies work, and that enables us better to "offer our bodies a living sacrifice to God." Knees that spend long hours in prayer change their shape. So do brains.

The Limits of Neuroscience

One of the reasons it's important for pastors to be conversant with the topic is that neuroscience is being accorded enormous authority in our day—not always for good reasons. I joke with a neuroresearcher friend of mine (who helped a lot with this article but wants to remain anonymous) that the easiest way to get an article published today is to pick any human behavior and …

1. Show which parts of the brain are most active when thinking about that topic;
2. Explain why evolutionary psychology has shown that behavior is important to our survival;
3. Give four common-sense tips for handling that behavior better—none of which has anything to do with #1 or #2.

Precisely because neuroscience has so much prestige, those of us who teach at churches need to be aware of its limitations as well as its findings. It's one thing to say that our brain chemistry or genetic predisposition may affect our attitudes or beliefs or behaviors. It's another thing to say we are nothing but our brain chemistry.

Sometimes writers make claims in popular literature that would never make it into a peer-reviewed academic journal. One example is a recent book, We Are Our Brains, which makes the claim that there is no such thing as free will, that our brains predetermine everything including our moral character and our religious leanings, so there is no good reason to believe God exists either.

People may be under the impression that "science" has proven this. This is sometimes called "nothing buttery"; the idea that we are "nothing but" our physical selves.

Yet let's be clear: we are not just our brains.

No one has ever seen a thought, or an idea, or a choice. A neuron firing is not the same thing as a thought, even though they may coincide. A brain is a thing, a human being is a person.

God doesn't have a brain, Dallas Willard used to say, and he's never missed it at all. (Dallas actually used to say that's why for God every decision is a "no-brainer," but I will not repeat that because it's too much of a groaner, even for Dallas.)

Neuroscience can help us understand moral and spiritual development. It shows the importance of genetic predispositions in areas of character and attitudes—from political orientation to sexuality. But it has not shown that personal responsibility or dependence on God are irrelevant. It does not replace the pastor or trump the Bible.

The Neuroscience of Sin And Habits

Neuroscience has shown us in concrete ways a reality of human existence that is crucial for disciples to understand in our struggle with sin. That reality is this: mostly our behavior does not consist of a series of conscious choices. Mostly, our behavior is governed by habit. Most of the time, a change of behavior requires the acquisition of new habits. Willpower and conscious decision have very little power over what we do.

A habit is a relatively permanent pattern of behavior that allows you to navigate life. The capacity for habitual behavior is indispensible. When you first learn how to type or tie a shoe or drive a car, it's hard work. So many little steps to remember. But after you learn, it becomes habitual. That means it is quite literally "in your body" (or "muscle memory"). At the level of your neural pathways. Neurologists call this process where the brain converts a sequence of actions into routine activity "chunking."

Chunking turns out to be one of the most important dynamics in terms of sin and discipleship. Following Jesus is, to a large degree, allowing the Holy Spirit to "re-chunk" my life. This is a physical description of Paul's command to the Romans: " … but be transformed by the renewing of your mind."

Habits are enormously freeing. They are what allows my body to be driving my car while my mind is planning next week's sermon.

But sin gets into our habits. This is the tragedy of fallen human nature. Self-serving words just come out of my mouth; jealousy comes unbidden when I meet someone who leads a larger church or preaches better; chronic ingratitude bubbles up time and again; I cater to someone I perceive to be attractive or important.

Neuroscience research gives us a clearer picture (and deeper fear) of what might be called the "stickiness" of sin. It is helping us to understand more precisely, or at least more biologically, exactly what Paul meant when he talked about sin being "in our members." He was talking about human beings as embodied creatures—sin is in the habitual patterns that govern what our hands do and where our eyes look and words our mouths say. Habits are in our neural pathways. And sin gets in our habits. So sin gets in our neurons.

Like so much else, our neurons are fallen, and can't get up. They need redemption.

The Neuroscience of Discipleship

You can override a habit by willpower for a moment or two. Reach for the Bible. Worship. Pray. Sing. You feel at peace with God for a moment. But then the sinful habit reemerges.

Habits eat willpower for breakfast.

When Paul says there is nothing good in our "sinful nature," he is not talking about a good ghost inside you fighting it out with a bad ghost inside you. Paul is a brilliant student of human life who knows that evil, deceit, arrogance, greed, envy, and racism have become "second nature" to us all.

Sanctification is, among other things, the process by which God uses various means of grace to re-program our neural pathways. This is why Thomas Aquinas devoted over 70 pages of the Summa Theologica to the cultivation of holy habits.

It's why 12-step groups appeal, not to willpower, but to acquiring new habits through which we can receive power from God to do what willpower never could.

Neuroscience has helped to show the error of any "spirituality" that divorces our "spiritual life" from our bodies. For example, it has been shown that the brains of healthy people instructed to think about a sad event actually look a lot like the brains of depressed people.

"Spiritual growth" is not something that happens separate from our bodies and brains; it always includes changes within our bodies. Paul wrote, "I beat my body to make it my slave"—words that sound foreign to us, but in fact describe people who seek to master playing the cello or running a marathon. I seek to make the habits and appetites of my body serve my highest values, rather than me becoming a slave to my habits and appetites. What makes such growth spiritual is when it is done through the power and under the guidance of the Holy Spirit. Paul's language remains unimprovable: We offer our bodies as living sacrifices so that our minds can be renewed.

One of the great needs in churches is for pastors and congregations to experiment with discipleship pathways that address the particular context that we face. Pornography (and misguided sexuality in general) has always rewired the brain. But now porn is so incredibly accessible that men and women can be exposed to it any time they want for as long as they want as privately as they want. Each time that connection between explicit images and sexual gratification is established, the neural pathway between the two grows deeper—like tires making ever-deepening ruts in a road.

Simply hearing that sexual sin is bad, or hearing correct theological information, does not rewire those pathways. What is required is a new set of habits, which will surely include confession and repentance and fellowship and accountability and the reading of Scripture, through which God can create new and deeper pathways that become the new "second nature," the "new creation."

At our church not long ago, one of our members spoke openly about many years of shame around sexual addiction. His courageous openness stilled the congregation, and it led to the formation of a recovery ministry that is one of the most vibrant in our church.

The Neuroscience of Virtue

Kent Dunnington has written a wonderfully helpful book, Addiction and Virtue. He notes that many federal health institutes and professional organizations assume addiction is a "brain disease" purely "because the abuse of drugs leads to changes in the structure and function of the brain." However, playing the cello and studying for a London taxi license and memorizing the Old Testament also lead to changes in the structure and function of the brain. Shall we call them diseases, too?

Dunnington says that addiction is neither simply a physical disease nor a weakness of the will; that to understand it correctly, we need to resurrect an old spiritual category: habit. We have habits because we are embodied creatures; most of our behaviors are not under our conscious control. That's a great gift from God—if we had to concentrate on brushing our teeth or tying our shoes every time we did that, life would be impossible.

But sin has gotten into our habits, into our bodies, including our neurons.

Partly, we may be pre-disposed to this.

For example, people with a version of the Monoamine oxidase A (MOA) gene that creates less of the enzyme tend to have more troubles with anger and impulse control. (If you have that version of MOA, you're feeling a little testy right now.) This means that when Paul says "In your anger, do not sin," some people are predisposed to struggle with this more than others.

That doesn't mean that such people are robots or victims or not responsible for their behavior. It does explain part of why Jesus tells us to "Judge not"; none of us knows the genetic material that any other person is blessed with or battling in any given moment.

This also shows that the people in our churches will not be transformed simply by having more exegetical or theological information poured into them—no matter how correct that information may be. The information has to be embodied, has to become habituated into attitudes, patterns of response, and reflexive action.

The reason that spiritual disciplines are an important part of change is that they honor the physical nature of human life. Information alone doesn't override bad habits. God uses relationships, experiences, and practices to shape and re-shape the character of our lives that gets embedded at the most physical level.

A few decades ago scientists did a series of experiments where monkeys were taught how to pinch food pellets in deep trays. As the monkeys got faster at this practice, the parts of the brain controlling the index finger and thumb actually grew bigger. This and other experiments showed that the brain is not static as had often been thought, but is dynamic, able to change from one shape to another. This is true for human beings as well. The part of violinists' brains that controls their left hand (used for precise fingering movements) will be bigger than the part that controls their right hand.

But wait—there's more. In another study, people were put into one of three groups; one group did nothing; one exercised their pinky finger, a third group spent 15 minutes a day merely thinking about exercising their pinky finger. As expected the exercisers got stronger pinkies. But amazingly—so did the people who merely thought about exercising. Changes in the brain can actually increase physical strength.

No wonder Paul wrote: "Whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is pleasing, whatever is commendable, if there is anything worthy of praise, think about these things." Every thought we entertain is, in a real sense, doing a tiny bit of brain surgery on us.

Here's a thought worth contemplating: what must Jesus' brain have been like? Imagine having neural circuits honed and trained to trust God, to respond to challenge with peace, or to irritation with love, or to need with confident prayer.

Here's another thought worth contemplating: We have the mind of Christ.

That's worth wrapping your brain around.

John Ortberg is pastor of Menlo Park Presbyterian Church in California.

Copyright © 2014 by the author or Christianity Today/Leadership Journal.
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'Love Addiction': Biology Gone Wrong?

Deborah Brauser

NEW YORK ― "Love addiction," a condition characterized by severe pervasive and excessive interest toward a romantic partner, may actually be a form of attachment disorder, new research suggests.

A new literature review of studies using the terms "love addiction," "pathological love," and "behavioral addiction" showed possible involvement of the brain reward dopaminergic system as well as attachment-related biological systems.

"We wondered where does love, a feeling of well-being, devolve into addiction? And what might be the criteria for love addiction and its destructive and dysfunctional behaviors?" asked Vineeth P. John, MD, associate professor of psychiatry and behavioral health at the University of Texas Health Science Center in Houston, during a press briefing here at the American Psychiatric Association 2014 Annual Meeting.

Still, he told Medscape Medical News that it is important not to medicalize normal, albeit deep, love. Instead, clinicians should be concerned if patients stay in a relationship despite danger or if have severe pining long after a breakup despite knowing the relationship is over.

"There is an urgent need for a better conceptualization of [love addiction] from a nosological and neurobiological perspective," the investigators note.

"This would be the first step in devising controlled studies aiming at properly assessing the efficacy of different psychosocial and pharmacological interventions in the treatment of this intriguing condition."

Lack of Control

Dr. John reported that the researchers wanted to question whether being addicted to love was possible and if so, whether it could be a diagnosable disorder.

Dr. Vineeth John

They defined love addiction as a pattern of maladaptive behaviors and intense interest toward 1 or even more romantic partners at the detriment of other interests and resulting in a lack of control and significant impact on functionality.

Although it can occur simultaneously with substance dependence or sex or gambling disorders, it can also be considered an addiction behavior itself, a part of a mood or obsessive-compulsive disorder, or even a part of erotomania.

"It is thought that it affects as many as 3% of the population. And in certain subsets of young adults, it may even go up to 25%," said Dr. John.

He added that individuals who are most at risk for the condition include those with an immature concept of love, a maladaptive social environment, or high levels of impulsivity and anxiety; are anxious-ambivalent or "seductive narcissists"; or have structural affective dependence.

Results from the analysis showed that a picture of a participant's "beloved" elicited activation in the brainstem, the right ventral tegmental area (VTA), and the caudate nucleus regions. These areas have been shown to be central to the brain's reward, memory, and learning functions and have been implicated in substance abuse.

In addition, addiction and attachment disorders share overlapping neural circuits, through the VTA to the nucleus accumbens.

"So basically, what we might be looking at is an attachment problem," he said.

Love Molecules

He also reported that 4 possible "molecules of love" include dopamine (which incites desire and facilitates repetition of love behavior), oxytocin (which mediates social behavior), the opioid hormone (which activates pleasure sensations), and vasopressin (which affects protective behaviors).

Interestingly, men who carried the "allele 334 for the gene coding for vasopressin receptor (AVP R1A)" showed less stable relationships.

"But the most plausible and practical aspect of love addiction would be to look at how to treat it," said Dr. John.

Because they found few studies examining benefits of psychotherapy and no studies assessing the efficacy of medications for this condition, the investigators came up with hypothetical guidelines for target symptom interventions.

For psychosocial treatments, they suggested self-help groups, cognitive-behavioral therapy, psychodynamic psychotherapy, or enrolling in Sex and Love Addicts Anonymous.

In addition, they suggested using selective serotonin reuptake inhibitors and/or antidepressants to treat obsessive thoughts about a romantic partner; mood stabilizers to treat mood instability or seeking out multiple partners; mood stabilizers, antipsychotics, naltrexone, or buprenorphine for treating impulsive seeking of romantic partners; and oxytocin or vasopressin for treating impaired attachments.

"It might be possible to devise drug-based therapies for the treatment of difficult love, based on neurobiological substrates," said Dr. John.

"But this is clearly a futuristic concept. We cannot medicalize noble human emotions. This particular addiction has to be harmful, disruptive, and destructive and cause significant psychological distress. And the treatment has to be totally voluntary," he added.

"Overall, it's time to think about our patients, or at least a small subset of them who are clearly suffering with what is probably an attachment problem."

Worth Pursuing

"I think this is a very important area of study," said Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation in New York City.

Dr. Jeffrey Borenstein

"The issue of attachment is extremely important because it relates to other conditions that we treat, including some of the personality disorders," he added.

Dr. Borenstein, who was not involved with this research, was moderator of the press briefing.

He noted that the investigators' approach of looking specifically at the question of love addiction was interesting.

"Obviously Dr. John is not saying that we have pills for this or even that we should be treating this. But I think it's an area of study worth learning more about," concluded Dr. Borenstein.

The study authors report no relevant financial relationships.

American Psychiatric Association's 2014 Annual Meeting. Abstract NR8-35. Poster presented May 6, 2014.

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Cite this article: 'Love Addiction': Biology Gone Wrong? Medscape. May 07, 2014.