Guest Post: Severe Mental Illness (Part 1)

I’m hugely grateful to Sharon Hastings for this brilliant 2-part guest post on severe mental illness.

Sharon graduated as a medical doctor before becoming ill with schizoaffective disorder but has found therapy in writing and is working on a book about her experience of finding God’s peace in psychosis. She lives in Northern Ireland with her husband Rob and two golden retrievers.  

In today’s post Sharon looks at severe mental illness…and in part 2, she considers how as churches, we should respond.

Thank you Sharon! And we’re looking forward to your book :-)))

“But in fact God has placed the parts in the body, every one of them, just as he wanted them to be.” 1 Corinthians 12:18

Sarah is sitting alone in a back corner of the sanctuary. The service is over but she hasn’t gone for coffee. She’s wearing her sweater with the hood up over her head and she is covering her ears with her hands. Sarah is hearing voices. A scratchy whisper is repeating over and over again; “We’re going to get you. We’re going to get you…” She is also afraid to go home. She’s convinced that her living room has been bugged by secret police who know that she is going to commit a crime.

What is wrong with Sarah, and how would you help her?

The chances are that you’ve no idea. Maybe you haven’t encountered someone with this kind of problem before – Sarah has schizophrenia – and the idea of getting involved is actually a bit scary. Didn’t a paranoid schizophrenic commit that murder that was in the news last week?

Sadly, severe mental illness is rarely spoken of in our churches. We are quite comfortable talking about depression and anxiety, and – increasingly – about eating disorders and self-harm, and this is great. But I know that I have never heard a sermon which mentioned bipolar disorder, schizophrenia or schizoaffective disorder. These are sometimes known as the ‘severe and enduring’ mental illnesses: they have a life-changing and lifelong effect on people who suffer from them, and they are more common than you might think – a congregation of 200 members will, on average, have four to five people in it who have one of these diagnoses…people like Sarah, people like me.

So what are these illnesses – how do we recognise them, and can we really help?

Let’s look at them in turn.


The key symptom of schizophrenia is ‘psychosis’, a separation from the reality which others experience. This can involve hallucinations – like the voices Sarah was hearing – and delusions, which are false beliefs like Sarah’s, who was convinced that her house was bugged when it clearly wasn’t. Hallucinations can also be visual, when the person sees things that are not there.

Hallucinations and delusions are called ‘positive symptoms’: they are ‘added on’ to normal perceptions. People with schizophrenia also have ‘negative symptoms’, that is, some experiences are taken away from them. For example, they may have a narrower spectrum of emotions; reduced facial expression; and impaired, ‘slowed-down’ thinking.

People with schizophrenia need antipsychotic medication to control their symptoms and some will live in ‘supported accommodation’, but many continue to have meaningful and productive lives with the right help in place for those times when their symptoms are overwhelming. This may mean a stay in hospital or daily visits from a home treatment team to monitor medication and offer support.

Bipolar Disorder

Bipolar disorder, also known by its older name, manic-depression, is a disorder of mood. Those with bipolar disorder experience episodes of unusually high mood – mania, or, if it’s less severe,

‘hypomania’ – and episodes of depression, with periods in between when they feel reasonably okay. If you’ve ever seen the TV drama, Homeland, Carrie’s character provides a reasonably accurate representation of someone going through the ups and downs of bipolar disorder.

If someone has mania, they will appear euphoric. Everything in life is exciting to them and they may become unusually productive and creative, often sleeping very little. Their thoughts race and their speech can become hard to follow, jumping from one subject to another. They may develop delusions which are consistent with their high mood, for example, that they have been appointed to complete a special mission, or even that they are the Queen or the Messiah. Someone in this state will often spend more money than they can afford and may engage in inappropriate, out-of-character behaviour that they regret later.

In contrast, when the person with bipolar disorder becomes depressed (often after an episode of mania), their mood is very low. They lose motivation and concentration, take no pleasure in things that they usually enjoy, and withdraw from social interaction. Their sleep is disturbed, they lose their appetite, and they may start to think that life is not worth living. If the depression is severe, they may again develop delusions, believing that they are guilty of something they have not done, for example, or hallucinations, hearing voices telling them that they are worthless and should die.

Both mania and depression are dangerous states, so it is important that people with bipolar disorder are helped to keep their mood as even as possible. This is often achieved with the help of drugs called mood stabilisers, as well as antipsychotics; talking therapies; and education about how to manage the condition. With this support, they often live fulfilling lives, though there may be times when extra professional help or hospitalisation is needed.

Schizoaffective disorder

Schizoaffective disorder is my diagnosis. It is essentially an illness which combines elements of schizophrenia (the schizo- part), with symptoms of bipolar disorder (in psychiatry, ‘affect’ means mood); however, the ‘negative symptoms’ of schizophrenia are less prominent.

In the past twenty years I have had episodes of mania when my mood has soared and I have had all kinds of over-the-top ideas, often embarrassing myself; episodes of depression when I have felt so low that I have prayed day in and day out for God to take me to be with him; and episodes of psychosis when I have felt evil presences over my left shoulder and been visited upon by ‘tormentors’ who have mocked me and seemed to insert messages into my brain.
medication, as well as talking therapy, I am doing better today, but I do have to think about how I am going to manage each day in such a way as to minimise the risk of becoming ill again.


Image source: Toby Allen, 2013

6 thoughts on “Guest Post: Severe Mental Illness (Part 1)

  1. Thank you, Sharon (and Emma).

    The clarity and outhority of this article is exceptional – really helpful.

    I teach a two day Mental Health First Aid course, particulary to clergy and pastorally active people in north east churches. Do you mind if I use this as a handout?


  2. Hi Dave,
    Thanks for your encouraging feedback – I’m glad you’re finding the blog helpful and trust that you will enjoy Part Two as well.
    I’m interested in what you do with the churches and think that it’s a very important work. I’d be very glad for you to use the posts as a handout. If you have any questions about them let me know.
    Thanks again!

  3. Thank you Sharon. This is indeed important. It has set me thinking about how I might open this up in our church communities.

  4. I love the content of these guest posts but I struggle with the definition of ‘severe’ mental illness, which seems to exclude those of us with depression, anxiety, manageable OCD etc. It makes me feel like my condition – recurrent depressive disorder – is less valid because it’s not a psychotic illness. In reality, I’ve been saved by modern medicine on several occasions after suicide attempts, and have been a psychiatric inpatient three times. I find it difficult to accept that my illness is not considered severe because I haven’t experienced psychosis. I’m sure there are many people who are experiencing a so-called milder form of mental illness who may be reading this and feeling their experiences are less valid because they don;t have a psychotic illness. I’d be grateful to know your thoughts, but maybe I’m just an attention-seeking fraud.

  5. You’re not an attention seeking fraud my friend! Yes, I take your point about other mental illnesses being severe in a different sense. It might be that a better descriptor is something like ‘psychotic illnesses’. But of course, all labels have drawbacks

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