My Diagnosis is Legion

What if mental illness is sometimes spiritual illness?

Photo by Tony Rojas on Unsplash

She was a young woman, manic, delusional and rhyming nonsense words. In psychiatric term that’s called ‘clang.’ ‘Look I’m jumping, bumping, thumping and mama says I can play, stay, way day….I’ll be good, wood, hood.’ You get the picture.

She wasn’t dangerous, but would sprint from her room to the nurse’s station where we sat, and would look under cabinets until she was redirected to her room. Then she would scream and cry out in sorrow as she sat down.

Others are different. Malevolent. One tells us of the many voices in his head and shouts at the police not to touch him, profane and angry, difficult to redirect. He makes no sense (well, not to us). His behavior made one nurse shake in terror when she was alone with him.

Some require physical restraints and multiple medications to keep them from harming themselves or anyone else. They come to us in handcuffs, with several police officers.

Sometimes they are children, filled with rage. ‘I want to kill Rick because he hurt me.’ Loud and running, fighting because they want a snack or a television remote in the wee hours of the night and are told no.

When I ask patients like this, ‘do you hear voices,’ they’ll say ‘yes.’ They pause. ‘What do they say,’ I ask. Looking away, tentative. ‘They say I’m no good and that I should just die.’ This is the voice they hear. This is the condemnation they endure. Little wonder they scream and run.

I have spent a career seeing these patients and trying to care for them. Not because I’m a psychiatrist. I’m an emergency physician. And even as resources for mental health have diminished, the numbers of the mentally ill have exploded. In the small, rural hospital where I work, we recently had four people on commitment papers brought to us within about three hours on one busy shift. They will be processed, held, have a telepsychiatry evaluation and may or may not actually go to a facility. They will often go home, and come back again until we know them by first name. Wash, rinse, repeat.

There are times when the looks on their faces, the sounds of grief and misery they emit, the howls of anger and range they scream out all fill me with a deep sense of unease, and a deeper sense of mystery. A feeling that there is something here that is both new and extremely ancient. It is unsettling. It is not the nice, tidy mental health care of people with money who speak to therapists weekly. It is the chaos of the man in the tombs that we hear about in the Gospels.

It’s a story that has always haunted me. I will quote from St. Luke’s Gospel. I relate to Luke. He was a physician with a careful way of observing.

‘Then they sailed to the region of the Gerasenes, which is opposite Galilee. When he got out on land, a demon possessed man from the town met him. For a long time he had worn no clothes and did not stay in a house but in the tombs. When he saw Jesus he cried out, fell down before him, and said in a loud voice, “what do you have to do with me, Jesus, Son of the Most High God? I beg you, don’t torment me.” For he had commanded the unclean spirit to come out of the man. Many times it had seized him and though he was guarded, bound by chains and shackles, he would snap the restraints and be driven by the demon into deserted places. “What is your name,” Jesus asked him. “Legion,” he said, because many demons had entered him. And they begged him not to banish them to the abyss.’

Later, after sending the demon into a herd of swine which rush into the lake and drown, we see this scene.

‘Then the people went out to see what had happened. They came to Jesus and found the man the demons had departed from, sitting at Jesus’s feet, dressed and in his right mind. And they were afraid.’

I can’t help but see our psychiatric patients in this story. I see our terrified, shattered, drug-addicted, psychotic and delusional patients, screaming in their homes, their jail cells, on the street, unable to be restrained, tormented day and night as friends, neighbors and officials try to do something but can’t do much.

What is behind our mental health crisis? It’s complicated. I believe a lot of it has to do with family dissolution, abuse and of course, drugs. Probably not all.

Am I suggesting that our most distressed patients are demon possessed? Maybe some are. I’m not opposed to that possibility. And is it so crazy?

We know that microorganisms influence mental health. It appears that our gut microbiome, that is the bacteria that naturally live in our intestines, have effects on our mental health. https://evidencebasedliving.human.cornell.edu/2021/02/25/how-gut-bacteria-are-linked-to-mental-health/ That is, a living thing inside of us affects our thinking.

The brain infection called encephalitis can cause behavioral changes as well. https://www.hopkinsmedicine.org/health/conditions-and-diseases/encephalitis

In addition, the parasite called Toxoplasma, associated with cats and very widespread around the world, also has mental health consequences when humans are infected with it. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040223/

Maybe there are living things out there beyond our comprehension. Less than two hundred years ago, people would not have understood the idea of a virus. Even the assertion that bacteria caused infection was very contentious in the late 19th century. And yet, now the idea is well accepted. It is so well accepted that patients with no real knowledge of biology or medicine far too often inappropriately expect antibiotics because they believe that they have bacterial infections.

For years those with bacterial infections were treated with poultices and bleeding, or assorted herbal remedies that seldom had any benefit. The discovery of bacteria and viruses and the introduction of therapies for them changed the face of healthcare and saved untold lives.

It has been decades now that we have prescribed assorted psychiatric medications that have not stemmed the rising tide of profound mental illness. With due respect to psychiatrists and researchers, patients aren’t always compliant and their concomitant social situations, former and ongoing abuse and illicit drug use (and of course poverty) make any therapy very difficult.

But what we seldom see is a cure for anything in the mental health world. Caveat: at least in the ones I see in my little corner of it. We treat infections and patients can make full recovery. We treat cancer and patients consider themselves survivors.

We treat mental illness and patients seem only to have new diagnoses and new medications. Perhaps this is also because there is an identity associated with mental illness. I did not come up with this myself, but the idea comes thanks to Freddie DeBouer in this post on Substack. (I recommend reading his work. It’s very insightful.)

A Broken Model of Brokenness

In an age of loneliness and separation, the diagnosis itself, it seems, can become a kind of tribe. I see this as patients rattle off their list of diagnoses, well known and well rehearsed, as if it were an address, or a genealogy. ‘Oh, I have depression, panic disorder, bipolar disorder, OCD, PTSD, ADD, ADHD and explosive defiant disorder.’ They offer similar lists for their small children, who like their parents consume vast amounts of psychiatric medications.

It has a kind of dark similarity to the story above. ‘Legion.’ When Mark tells the story in Mark 5: 9, the demon says ‘we are called legion, for we are many.’

Perhaps some of our patients are inhabited with spiritual ‘infections.’ Not all mind you. And I’m in no way suggesting that patients throw off professional mental health care and abruptly stop their medications. I’m just saying that maybe, just maybe, our ancestors in culture and our ancestors in faith knew things we reject. We’re good post-enlightenment folks who like a tidy, scientific explanation. There may be times it’s more complex.

But then, is it unscientific? To assert that a living thing, even if it is intangible, has inhabited one’s mind or body and has caused illness and misery? Maybe it’s the very definition of science; to explore possible answers when existing answers fail. Even if those possible answers make us a little uncomfortable.

St. Paul said so powerfully in Ephesians 6:12, ‘For we do not wrestle against flesh and blood, but against the rulers, against the authorities, against the cosmic powers over this present darkness, against the spiritual forces of evil in the heavenly places.’ There’s a lot there.

What do I know? I’m no expert in mental illness and my hat’s off to all of those working in the field, from counselors to psychiatrists and all the rest.

But I do know that many days in my work, I walk past the tombs where dwell men, women and children in torment, who regularly break their chains and shriek. Who have no solace day or night. Who are broken by lack of love, by abuse, by cruelty, by addiction and loneliness; and by the accusatory voices that whisper or scream at them no matter what they do, no matter what they take.

How can I fail to ask if there’s something more going on there? How can I fail to wonder if the answer lies ultimately in the one at whose feet the possessed man finally sat, ‘dressed and in his right mind.’

I don’t know. But it’s worth asking.

Have a great week.

Edwin

PS You may think I’m a religious nut after reading this. Fair enough. But whatever you think about my assertion I think that we can agree on something.

There are far too many people suffering terribly from untreated or under-treated mental illness.

And as a culture, as a nation, we simply have to do better.