Mental Illnesses and Worship: Prayer, Lament, Language, and Discipleship

A Conversation from the Calvin Symposium on Worship, Part Two of Two

The following discussion is from the second part of a session led by Dr. Charlotte vanOyen Witvliet, Rev. Cindy Holtrop, Dr. Warren Kinghorn, and Dr. John Swinton at the Calvin Symposium on Worship in January 2018. The first section appeared in Reformed Worship 129 and dealt with the promises and pitfalls around public worship and mental health. The rest of the session focuses on prayer.

We are grateful for the panelists’ willingness to share this conversation with RW readers, the assistance of the Calvin Institute of Christian Worship in providing a transcription of the session, and to Charlotte vanOyen Witvliet, who edited it for publication. An audio version of this session is available at —JB


Witvliet: Could we talk about prayer—the postures, words, and silence that we use? And could we talk about promising prayers and also prayers full of pitfalls? What are some really problematic things that we should avoid?

Kinghorn: In preparation for this session, Charlotte was kind to provide us with some questions to prompt us, and I wanted the opinion of some friends that live with mental illness, people I really respect and trust. One friend, who has given me permission to quote her, is a doctor and also lives with a history of trauma and mental illness. I’ll just offer a couple of things that she said to me because I thought it was very helpful with regard to prayer. The first is more of a promise, and the second is more of a pitfall. First, she said, “Public prayers, especially pre-sermon prayers and non-liturgical services, include requests that those who are downcast be lifted up, that the vulnerable feel safe, that the fearful be encouraged, the brokenhearted be restored, the imprisoned and addicted be set free—you know, the way the Scripture is worded when talking about the coming world.” I thought that was helpful.

And she also said in the context of prayer, “Avoid references to the Holy Spirit’s presence that use patriarchal and sometimes even sexual language such as ‘have your way with us.’” Or, she said, “I’ve heard this numerous times: ‘Come have intercourse with us.’ No. Just no.”

Every one of our words in a service needs to be thought about in terms of how it will be received by somebody with a history of sexual trauma and sexual violence.

That’s not to say not to use any gendered language for God, but it is [a reminder] to think about how our language of gender operates in our prayers and in our proclamation and also to think about how we think about power—God’s power—God as father, God as parent. These are all things that we need to be thinking about—I mean, really thinking about how people who have survived—including recently survived—sexual trauma will experience that in the service.

Witvliet: A very helpful frame for me is to think about the difference between intent and impact. Often what we intend can be quite different from its impact. So, solicit feedback. Be welcoming of feedback. And do a pre-feedback check-in. Reflect often: How could this be received, experienced, felt? Let’s be very mindful of those dynamics that Warren mentioned.

Holtrop: Especially in the pastoral prayer . . . the pastor or the worship leader needs to be honest with themselves about their own pain and their struggles and their questions. If they are not in touch with their own struggles, they won’t be able to name the struggles of other people that sit in the pew. One of the ways in which that can happen is by carefully listening to the stories of the people.

I want to emphasize: Listen, listen, listen. I think that alongside of the prayer is good pastoral care. People sometimes know what the hope is, but they can’t always get in touch with it, and sometimes they don’t want to hear it, or they’re not ready to hear it. It’s very lonely experiencing any kind of pain—physical, emotional, or mental. But to have someone hold that pain, help carry it for you and just be present with it is very important. Somewhere I read just recently that the pastor needs to “incarnate” the presence of God in worship, and in pastoral care to make the presence of God known through just our very presence. I think that the way in which a prayer is delivered matters as well. People will sense the genuineness and the thoughtfulness of it.

Swinton: Prayer is participation in the work of the Holy Spirit, right? So it’s never about us. It’s always about God, and it’s always through the Holy Spirit. So Charlotte’s friend’s three-word prayer is valued by God [“Dear God, Amen.” See RW 129, p. 35]. . . . If you have the confusion of psychosis or the darkness of depression, it is very difficult to find words. If on top of that, if burdens are placed on people that they have to participate in the way that everybody else expects them to participate, then you are oppressive toward people.

Discussion Questions

During this session there was time given for small group discussion. Consider forming a group from your church to gather after reading this and previous articles on worship and mental health (see RW 127 and 128) and discuss the following:

  1. In what ways can our congregational worship incorporate references to mental illnesses along with physical illnesses so that both are part of our general awareness and inclusion?
  2. What wise practices can guide the way we offer prayers of intercession for specific people who are living with mental illnesses (e.g., specific guidance on language used, consent ahead of time to name people and diagnoses, and asking for feedback afterward because intent and impact do not always match).
  3. What postures can be invited—in body or spirit—so that we can embody prayer?
  4. In what ways can we link intercessory prayer with other elements of worship and discipleship of whole persons?


Swinton: Prayer is also something that we do with the whole of our bodies, it’s not simply something we do with our minds. It’s something we do with the whole of our bodies, as is worship.

I have an anthropologist colleague in Amsterdam who is studying the Hillsong communities. (Hillsong is an Australia-based organization with a number of megachurches around the world, one of which opened up in Amsterdam a couple of years ago.) As she’s been exploring that community, she’s been looking at it through the lens of anthropology and neurology. The basic thesis she ended up with was that sometimes worship like Hillsong’s can be the end of the road for people because what you have is high-level, high-sound, high-impact worship that stimulates your limbic system, and you get to a stage where your limbic system is so [stimulated] . . . that you’re fed up because there’s nowhere else you can go. You can’t go back to the ordinary churches because your limbic says that’s really, really boring. Your brain’s shaped for a certain type of worship, and if you don’t get that level of excitement then you can have all sorts of spiritual difficulties. My point is that actually the kind of worship that we engage in shapes and forms us physically as well as spiritually. You’d expect that to some extent if you had holistic anthropology, but we don’t really think about it that much. It strikes me as something very, very important.

When I worked in health and social care, at a worship service with somebody with dementia, you come to that stage where you make prayer and sacrament; you have to bow down—maybe even kneel down—and reach out in order to give the sacrament. In other words, your body has to take the shape of the sacrament and the shape of the prayer before you can facilitate worship/prayer/sacrament for this other individual. And when you’re down there in your shape and form and you’re watching somebody respond to the sacrament or putting their hands together slowly in prayer, the power of embodied spirituality—spirituality that just lives within you—comes to the fore. That’s obvious in everybody, but it’s profoundly obvious there. When you recognize that, then you reevaluate your relationship with that person because you see, okay they’ve forgotten certain things about Jesus, but actually their body is telling me something quite, quite different. So remember the physicality of prayer, of worship, and remember that we’re called to become embodied people who don’t just think about worship or just do it; we actually live it in our bodies.

Holtrop: It is helpful, I think, in worship to sometimes embody the Scripture by having different readers and movement because we experience the Word in a different way. Sometimes it touches us on a deeper level, and I think that can be helpful in moving people and ministering to them.

Kinghorn: Two things. First, . . . it’s important to remember that the act of praying to God involves much more than petition, and even in petition, more happens than simply asking for something. A state of affairs comes about where we’re now linked in love to whomever and whatever we’re praying for, including ourselves, and we’re linked more to God and God’s cause in prayer. So, thinking broadly about what it means to pray beyond simply “I pray that this condition will come to an end” and then the only thing that matters is whether that immediately happens—there’s much more to prayer than that.

The other image I found really helpful over the years is in an anecdote in a book by Andrew Solomon called The Noonday Demon. He quotes a friend of his who experienced major depression, Maggie Robbins. She told Solomon that she was Episcopalian, and she made the comment that “the church is an exoskeleton for those whose endoskeleton has been eaten away by mental illness. You pour yourself into it and adapt to its shape. You grow a spine within it” (Andrew Solomon, The Noonday Demon: An Atlas of Depression, Scribner, 2015, p. 132). And I have always thought that that was such a helpful image of liturgy and worship—as a kind of exoskeleton when our endoskeletons are melted away.


Witvliet: I’ve been thinking about the psalms—our prayer book—and the vital role that lament can play. Could you speak about lament and the psalms of lament?

Holtrop: I think that in our prayers we often make statements, we often make proclamations, and we sometimes preach a mini-message. But I think we often don’t give a space for silence, and we don’t ask questions of God, which is part of lament—asking God some of the hard questions.

Swinton: I’d quite like to read something. I am in the process right now of a research project that’s looking at the lived experience of Christian people with bipolar disorder, major depression, and psychotic disorder. [It’s] trying to work out how people experience their faith lives and the significance of faith for the way in which they not only live out their lives, but how they interpret things and the way in which they engage with God.

This is a quote from one woman that relates very much to what you’re saying about lament, and this is what she says talking about church: “And so there’s a lot of happy-clappiness, which when you’re depressed and crying is just awful. But thankfully our worship leader [is] a guy who really believes in ‘Let’s have worship that talks about how rotten life can be,’ which I really like. And so out of this happy-clappiness, he’ll often have a Sunday of lament where we’ll all just wail and go, ‘Life is awful,’ which really freed me up. It was incredibly helpful, but then saying that, it was also really helpful to be in a congregation of people who are still worshiping God, still being happy-clappy, still being hopeful, but I was just like, I can’t do this. . . . [The others let me know that] well, you can’t do it, but we can do it for you, which I just appreciated. People would be standing alongside me in prayer during worship time. They’d have a hand on my shoulder while they were just singing, worshiping, and rejoicing, and I was a wreck, I was crying. Well, I found that incredibly profound because it’s that sense of . . . someone’s willing to be alongside me and yet they were not forgetting the truth that I couldn’t grab hold of at that point.” And I said, “So they held it for you?” And she said, “Very much. Very much. Very much. They kind of held space for me.” And that struck me . . . speaking into that lament, both the sadness and the hope tied together.

Witvliet: I think it would be fruitful to reflect on both general themes and the specific naming of mental illnesses. General themes are very open so multiple people

can attach to prayers and comments and see themselves in it. What about times of explicitly naming the particularities of different disorders and illnesses? Are there times where our answers to some of the questions we’ve been engaging might be edited in light of specific disorders as opposed to general mental illnesses?

Holtrop: I like keeping things general because many people might not have a clinical diagnosis, but they might have aspects of some illness. Many people with depression go undiagnosed. You don’t even have to say the word “depression,” but say some of the words that reflect someone who has depression. I think there are other places for naming specific illnesses, perhaps outside of worship . . . in adult education or so.

Kinghorn: I’m of two minds about this—and this reminds me to encourage all of us that when we are talking about being ambivalent, don’t use the word “schizophrenic.” It’s not the same thing, obviously, yet I hear that over and over again in sermons and worship settings.

On one hand, when we think about naming specific diagnoses in a worship setting, that is profoundly powerful for those whose lives are heavily inflected with the language of these diagnoses. So in a worship setting—from the pulpit or in another context in the worship service—to name bipolar disorder, to name major depression, to name PTSD, to name alcohol use disorder, this is really important because if we don’t name it then it seems like . . . a mode of avoidance that we would prefer to not quite say those words. And words that can’t be said in a worship setting are words that are somehow too dangerous and therefore are to be imbued with shame and stigma. So the best way we can get rid of shame and stigma is simply to not be afraid to name the reality of experience as it comes to us, and I think that naming is really deeply important.

Another friend I consulted with before this session made a comment that to talk about mental illnesses without naming mental illness is kind of like having an Easter service that doesn’t actually name the resurrection. It’s right in front of you; you just have to speak its name and not be afraid of that. So that’s one end. I would say that’s really deeply important and it’s harder than it seems to do so because I think preachers and pastors and worship leaders are worried that they’ll somehow open a can of worms somehow—and I just think that’s not true. Every time in a worship setting that I’ve heard mental illness named specifically it’s been helpful, and people will talk about how it’s been helpful.

My deepest identity at any given time in my life is not that I live with depression or PTSD or bipolar disorder or schizophrenia, but it’s that I am loved and known as a child of God.

—Warren Kinghorn

The thing I’m of two minds about, as John pointed out before, is that the diagnostic terms that we use in psychiatry are really important. They’re helpful for guiding practice, they speak truths about the way that we experience our lives and our world, and they are designed by psychiatrists to help facilitate psychiatric care. They’re one way of describing human experience, but they’re not the only way of describing human experience, and they’re not the ultimate way in which any of our identities are constituted. My deepest identity at any given time in my life is not that I live with depression or PTSD or bipolar disorder or schizophrenia, but it’s that I am loved and known as a child of God.

In worship settings . . . we want to name the reality of mental illness . . . speaking specifically about alcohol use disorder, and depression, and schizophrenia, and bipolar disorder, and PTSD, and personality disorders . . . [but] not to do so in a way that reifies those ways of naming as our deepest identities as we come before God.

I’m a little bit ambivalent about, say, mental health awareness days, when a whole worship service is structured around the concept of mental illness. . . . On one hand, they powerfully help to name names and cut through stigma. On the other hand, if you stop with awareness and a call for the church to fight stigma, then it risks kind of reifying that our deepest identities are somehow in these diagnoses, and that’s just not the case. So how do we balance those two things?

My general advice would be: . . . mental illness needs to be named. . . . But the key question in worship is . . . what does it mean—given that I’m living with depression—for me to be formed as a disciple and a worshiper of God and a member of this community? So an awareness day, if it stops with awareness, isn’t enough; it needs to also involve calls to further discipleship.

Witvliet: Before we talk further about discipleship, I would like to ask you, Warren, to reflect on the language we use. Part of why I also think that explicitly naming certain diagnostic terms is helpful is because people who live with diagnoses are in the room, or people who love people who deal with these diagnoses are in the room, or people whose careers are devoted to the care of people with these diagnoses are in the room. For the last quarter century I’ve been devoted to talking about people with bipolar disorder, people with dementia, people with depression, people with eating disorders, people with substance disorders—all sorts of different diagnoses—but always people with, personhood first.

Yet when we do use particular diagnostic terms, are there some pitfalls to be aware of, such as, “Why is that one coming up?” Are there risks around confidentiality that might bubble up in this process? What wise words could you offer?

Kinghorn: So first of all, the naming of a diagnostic term doesn’t really tell you anything about what somebody is experiencing except that they in some way have become associated with that term. I work a lot with combat veterans at a VA hospital. I know that if you meet one veteran with PTSD, you’ve met one veteran with PTSD. You really don’t know much about the context of the trauma that engendered that experience. You don’t even know what that experience is. You just know that somebody at some point has been associated with this way of naming, so then the key question is okay, well, what does that mean for you to live with PTSD, and what is your experience like? . . . There’s still the person that you have to try to understand, and I think that’s one important thing to keep in mind.

The question of confidentiality: . . . There are probably a hundred people in this room. All of these diagnoses we’ve talked about today are present in this room. It’s not like you have to have a mental health awareness day or have to mention mental health because there’s been some crisis in the congregation. If that’s when it happens, it happens too late. The opportunity to do it is now, and in a regular way, so people aren’t surprised when mental illness is named, or when depression is named, or when anxiety is named, or when disability is named. All of these are just regular parts of being human, and so the time to start is now—before there’s a crisis that everybody’s thinking about and feeling like it needs to be addressed in a worship service.

Witvliet: What about praying for people who are dealing with different issues? You know how sometimes a prayer can become a feeder for gossip? Any thoughts about that?

Holtrop: I have wondered, and I want to ask somebody someday . . . when I was so severely depressed and hospitalized a number of times, was that named and was that said about Cindy Holtrop in worship? It was very public. I didn’t hide it because that would only increase the stigma and the gossip.

What would I want? I think that it would have been okay for them to pray for me because it was known, and my story is public now—I talk about it. But I know that for many people, it’s not okay because they don’t want to be known as a diagnosis.

Witvliet: So it seems to me that it’s important to ask a person what they would prefer: How is it that you would like us to pray for you? Is this wording okay? Is there something else you would prefer?

Holtrop: Definitely. Empowering the person that you are praying for—I think that’s very important.

Witvliet: John, would you reflect more on discipleship?

Swinton: Yes. Only—before I do, if I may contribute to what you were saying around the issue of prayer or the specifics of mental health challenges. If I go back to the story I told you earlier, [the man I mentioned] had a real theological tension because he really liked a certain type of right-wing theology. He liked it because it was black or white—so you’re in or you’re out, it’s yes or no. It’s not, “Well, let’s just think about what Jesus may have been like.” . . . Yet he found himself in a very liberal church where people really had a much more open understanding of what theology and doctrine was, and that always made him really uncomfortable because the God he was worshiping was not necessarily the God the rest of these communities worship, and the God he was worshiping would probably be quite destructive to somebody who has depression. . . . The way in which you experience a mental health challenge shapes and forms your image of God, . . . your worship, . . .and [your] day-to-day experiences. So I think it’s quite theologically complicated to say, “Well, let’s talk about anxiety” when you’ve got somebody over here who maybe has some kind of psychotic disorder and sees things completely differently, and you’re ministering to this person here but actually upsetting and offending this person over here. I think it’s just theologically complicated to name things as specifics unless you really think it through.

Resources for Mental Health and Worship

Articles from Reformed Worship (

  • Cindy Holtrop, “Practical Insights for Leading Worship: How to Be Inclusive of Persons with Mental Illnesses,” RW 128, p. 27–29 (
  • Scott Hoezee, “The Sensitive Sermon,” RW 128, p. 24–25 (
  • Carol Penner, “Litany for People Living with Mental Illnesses,” RW 128, p. 26 (
  • Emily Vanden Heuvel, “‘Why, God?’: A Trauma-Informed Worship Service,” RW 128, p. 22–23 (
  • Charlotte vanOyen Witvliet, “Speaking Well in Worship about Mental Illnesses: A Beginner’s Guide to Language and Resources,” RW 128, p. 12–20 (
  • Charlotte vanOyen Witvliet, Cindy Holtrop, Warren Kinghorn and John Swinton, “Mental Illnesses and Worship: The Promises and Pitfalls in Preparing for and Practicing Public Worship,” RW 129, p. 27–35 (
  • John D. Witvliet, “Worship and Mental Health,” RW 126, p. 34–35 (

Resources from the Calvin Institute of Christian Worship (

  • Cindy Holtrop, Warren Kinghorn, John Swinton, and Charlotte van Oyen Witvliet, “Mental Health and the Practice of Christian Public Worship: An Exploratory Conversation” (
  • Cindy Holtrop, “Beyond Stigma to Hospitality: Creating a Gracious Space for People with Mental Illness” (
  • Howard Vanderwell, “Post-Traumatic Stress Disorder (PTSD) and Veterans—Psalms and Prayers” (
  • Joan Huyser-Honig, “Vertical Habits and Mental Illness in Worship” (

Other Resources


Swinton: In relation to discipleship, my problem will be fairly straightforward. There’s a temptation for religious communities to assume that mental health issues are [solely] issues of pastoral care. Of course they are issues of pastoral care because everybody wants to be cared for, but I think it’s much more constructive and much more challenging to see mental health challenges in terms of discipleship. You hinted at that just now—that the question is not “How can we care for this person,” although it clearly is that; it’s “How can this disciple who has gone through these particular experiences, who has a vocation and a calling from God—how can they be facilitated to fulfill that vocation and calling?” And I think worship and vocation and discipleship are deeply tied together, and that’s a much more difficult question to face when someone is going through deep depression or going through an odd experience of psychosis, but it’s a fundamental question because these people are disciples, friends.

Witvliet: I’d like to ask now about worship and those whose vocations include professions in mental health care provision. So if you could, reflect on worship—prayers, preaching, blessings, in-between words—and how these acts can also be powerful for people who devote their energies to mental health care.

Kinghorn: I remember one particularly vivid time when I was working a twelve-hour overnight shift at a state psychiatric hospital. In these twelve hours I admitted seventeen people to the hospital, which was pretty overwhelming, and it was a constant overflow of intense pain and suffering. I saw people that had been picked up by police on a bridge, gasoline doused on themselves and threatening to light a match. I saw people who had been survivors of recent violence. I saw people who were disorganized and psychotic and terrified. I remember finishing that shift after 8:00 a.m., and the sun was out, and it was a bright, sunny morning. I remember driving on this country road from where the hospital was back toward Durham, and passing all these little houses on the way and just having this deep sense that I have no idea what’s happening behind the doors of those houses and that sense of it’s such a beautiful morning and there’s such profound suffering in this world. It was a Sunday morning, and I went from there to church. I stepped a little late into the back of a sanctuary of people who were gathered to worship, who were singing, and who were gathered in community. It was such a testament—not to the unreality of that suffering, because it was absolutely real; it wasn’t a denial of that suffering. But it was a way of upholding me to say that what [I] have just seen and experienced and lived through and are feeling now is not all that there is, and that there’s hope. And it was really profound for me just to sit there. I couldn’t do anything else in that service except just sit there.

I would just offer that I think that’s what a lot of people in mental health care need to be reminded of: to be called into discipleship ourselves. I never make any assumption that people in mental health care vocations are not also at the same time those of us who live with mental illness and need the same kind of call to discipleship and care and support. So “just never assume” is generally a good way to get around in the world, and I think I would apply that here also.

Swinton: Just one thought . . . and that’s about how we deal with our emotions, because emotions are transferable and they’re cumulative. If you’re with people who are anxious and in pain all day long, you’ll become anxious and in pain because that’s just the way it functions. The question is whether or not you have anywhere that you can place that. . . . So the question would be whether there’s space within our worship to either bring that through articulation or creating spaces of silence where you can give that straight to God in the midst of your worship. Otherwise it becomes really destructive.

One of the things [that concerns my colleagues and me in Europe is that] euthanasia is just accepted. . . . As soon as you get the diagnosis of dementia, you can go to your family practitioner and apply for euthanasia, and you can be euthanized just because you have fear of the future. And of course that leaves families a little bit traumatized cause Auntie Betty’s here one day and she’s not the next day; she seems fine then, and she was fine, but because of the fear and the stigma surrounding this particular diagnosis, it seems like dying is better than living into the journey of dementia. But one of the things my colleague was pointing out was that in Holland there is evidence beginning to emerge of post-traumatic stress disorder in doctors who carry out euthanasia. Once you realize what you’re doing—and the implications of what you’re doing—you really find it very difficult to cope with. And there’s a real danger on a smaller scale, if you’d like, that the same thing could happen to people who are always absorbing other people’s pain, always absorbing other people’s suffering. So creating intentional spaces for silence and even for confession, depending on your context, I think is one way I’ve begun to think that through.

Note: At this point (an hour and twenty-two minutes into the two-hour session), we engaged in small group discussion at tables followed by Q&A with the whole group (see sidebar on p. 38).

Then Charlotte Witvliet asked John Swinton to conclude with a story in which Gladys, a woman living with dementia, was in a worship service in her care facility. Swinton pointed out that even with advanced dementia, Gladys had an embodied remembering of the liturgy that allowed her to receive the sacrament of communion: the body of Christ given for Gladys, the blood of Christ poured out for Gladys.

To see embodied remembering and participation, Swinton recommended this beautiful video clip of Naomi Feil interacting with Gladys Wilson in which Feil’s attuned responsiveness to Wilson’s subtle responses through her “church songs” evokes Wilson’s tapping to “Jesus loves me, this I know, for the Bible tells me so” and vocalization to “He’s got the whole world in his hands” (

Charlotte vanOyen Witvliet, PhD, is trained as a scientist-practitioner clinical psychologist and serves as professor of psychology at Hope College. For the past twenty years her work has focused on mental health, flourishing, religion, spirituality, and virtues.

Cindy K. Holtrop is author of several Christmas dramas and So You've Been Asked to Greet or Usher--all available from CRC Publications, 1-800-333-8300.


Warren Kinghorn is Esther Colliflower Associate Research Professor of Pastoral and Moral Theology and co-director of the Theology, Medicine, and Culture Initiative at Duke Divinity School, Associate Professor of Psychiatry at Duke University Medical Center, and a staff psychiatrist at the Durham VA Medical Center. He lives in Durham, North Carolina with his wife and two children, and is an elder in the Presbyterian Church (USA).

John Swinton is Professor in Practical Theology and Pastoral Care at the University of Aberdeen, Scotland, United Kingdom. For sixteen years he worked as a registered mental health nurse and as a community mental health chaplain. He has published widely within the area of mental health. His book Dementia: Living in the Memories of God won the Archbishop of Canterbury’s Ramsey Prize for excellence in theological writing in 2016.

Reformed Worship 130 © December 2018, Calvin Institute of Christian Worship. Used by permission.