The first thing a church owes someone living with depression, anxiety or serious mental illness is friendship. That means being known by name, welcomed and kept inside the community, before anyone tries to solve the illness. Treatment belongs to trained professionals, and the church should work alongside them. Belonging is the church’s own work, and nobody else can supply it in quite the same way. That is the case Dr. John Swinton makes, and his background is why it deserves a hearing.
Swinton worked as a mental health nurse for 16 years and then as a chaplain among people with severe mental health challenges. He is now a professor of practical theology and pastoral care at the University of Aberdeen. His doctoral research was on Christian friendship and people living with schizophrenia. He knows what clinical care can do. He also knows what it was never built to do, and that is where his argument for friendship begins.
Why friendship comes before fixing
Swinton names the church’s usual reflex directly. In disability theology and in mental health alike, the first question people tend to ask is what happens if there’s a problem. The question sounds responsible. In practice it treats a person as a risk to be managed before they have been greeted as a neighbor.
His correction is that “the vast majority of people who live with depression or anxiety are not gonna be problematic.” Some people will be difficult, he admits, and anyone who has spent time in church knows a diagnosis is not required for that. But the difficult few draw most of the attention and energy, and the church ends up shaping its whole posture around them. By Swinton’s estimate, something like one in four people live with a mental health challenge, which means a good share of any congregation already does. Most of them are sitting quietly in the pews. He also rejects the cultural myth linking mental illness with violence.
If he is right that “most people just want acceptance and friendship,” then the starting point changes. The church’s first job is making sure people are known.
Friendship across difference
Most friendships follow the principle that like attracts like. Our friends share our interests and experiences and see the world roughly as we do. Swinton observes that people with mental health challenges often see the world a little differently, and stigma does the rest. They become more and more alienated, simply because they do not match.
Jesus’ friendships ran the other way. Swinton reads the incarnation itself as friendship across radical difference: God, wholly unlike us, enters humanity and calls people friends. He points to John’s Gospel, where Jesus says, “Henceforth I call you not servants; for the servant knoweth not what his lord doeth: but I have called you friends; for all things that I have heard of my Father I have made known unto you” (John 15:15). The Gospels also describe Jesus eating with publicans and sinners and being criticized for it (Matthew 9:10-11). These passages are narrative. They describe what Jesus did rather than issue a rule. Swinton’s application is that the pattern shows the church who its friendships are for.
From there he draws his central claim: “friendship is really one way of articulating discipleship.” Friendship with the marginalized belongs to obedience. In his book Resurrecting the Person, Swinton describes how social stigma depersonalizes people with mental illness in the eyes of others, and how friendship can help them regain their personhood. Depression or schizophrenia can become the only thing other people see. A friend keeps seeing the whole person. That is real help in its own right, alongside whatever treatment is happening elsewhere.
When love comes back in a different shape
Friendship across difference has a cost the like-attracts-like kind does not. You may give love in one form and receive it in another you have not learned to recognize. Parents of children with autism often describe this, and Swinton’s response applies well beyond autism.
He starts with Scripture. “He that loveth not knoweth not God; for God is love” (1 John 4:8). Yet Swinton thinks many Christians carry a romantic picture of love, soft and warm, drawn more from culture and media than from the Bible, where loving one another can be dangerous work. He described an article by a Mennonite theologian who once held that romantic picture and could not understand why her husband and children did not relate to her as she expected. Then she learned that all three had Asperger’s syndrome. She began to recognize love in other forms, such as keeping the household routine steady and making sure her husband’s sandwiches were in the right place in the fridge each day. Swinton’s summary is that the love she found was “of a different shape, but no less meaningful.”
He insists this lesson belongs to the whole community: “love is a thick and a rich thing. And there’s no single model.” That is the practical meaning of friendship across difference. The friend who wants the same short visit at the same time every week, or who struggles to say what you mean to them, may be giving and receiving love in the only shape that works. A church that only counts familiar forms of affection will keep drifting back toward friends who look like itself.
Engagement, and what the church is not
A common hesitation is fear of doing harm. If I say the wrong thing to someone with schizophrenia or severe depression, I might injure them or create chaos, so perhaps withdrawing is kindest. Swinton calls withdrawal a temptation because it is easy, and he does not treat it as available: “engagement is what disciples are called to do.” The only real choice is how to engage. The fear is about method, and method can be learned.
Part of the method is accepting that the church does not have to do everything. Swinton says the church brings community, friendship and the gospel, while psychiatry and psychology bring knowledge of why people suffer and skills that help bring healing. When hard situations arise, he urges congregations to talk with mental health professionals, and he notes that many congregations already have psychiatrists and psychologists among their members. Clinical care and church belonging work best together.
This also frees ordinary members from a burden. Asked whether the church should respond differently to lifelong depression than to depression brought on by grief or broken relationships, Swinton says the cause matters for a psychiatrist choosing treatment but much less for the church, because “the church is not a psychiatric community.” He is blunt that “the church community can’t diagnose in that sense.” What the church responds to is the lived experience of the person in front of it. You need no diagnostic training to be a reliable friend.
He adds one small discipline. Stop using the word depression casually, the way people say they feel depressed on a Monday morning. When the word gets spent on ordinary low moods, it loses its power, and someone who is truly depressed is heard through a weaker word than the one they are using.
Is sitting with someone enough?
Christians often say that all we can do is sit with someone. Swinton respects the instinct and then complicates it with a woman he interviewed in his research on depression. She told him, “when I’m depressed, it’s like I’m at the bottom of a deep, deep pit, and the walls of the pit are laying with some kinda slippery substance. I don’t know what it is, but I can’t climb out.”
Swinton notices what she wanted. “She didn’t simply want somebody to jump down and sit with her.” She wanted out. Medication got her out, and Swinton says it reconnected her with life, with herself, with others and with God, a kind of spiritual process for her. She needed friends, and she needed mental health professionals. Presence that resists treatment is not faithful presence.
The second thing she described changed how Swinton understood the illness. When she was well, she said, she walked around the edge of the pit, aware she could fall back in at any moment. In her words as he recounts them, “the shadow of the pit is always with me.” It struck Swinton “how difficult it must be to live with depression even when you’re not depressed.” For the church, that means friendship cannot be only crisis response. The good weeks need friends too, and the patience Paul describes, “Charity suffereth long, and is kind” (1 Corinthians 13:4), is the kind that lasts through them.
She also told Swinton that she sometimes considered suicide, and that her love for Jesus held her back, which at times made her angry with God. If you or someone you care about is thinking about suicide, that needs real help today. In the US, you can call or text 988 to reach the Suicide and Crisis Lifeline. Part of being a friend is helping someone reach that care.
Words for when there are none
Her honesty sounded to Swinton like the Psalms of lament. Most of them follow a recognizable shape: things are terrible, God seems unfaithful, enemies are winning. Then partway through, the psalmist remembers God’s unchanging love. The situation stays horrible, but worship returns.
Not every psalm turns. Psalm 88 ends in the dark: “Lover and friend hast thou put far from me, and mine acquaintance into darkness” (Psalm 88:18). Many modern translations render the last line so that darkness becomes the speaker’s closest companion. Scripture includes that ending, and some people live there for a while. A church that only sings the psalms that resolve has less to offer them.
Swinton’s counsel is to “get into the habit of learning how to lament faithfully,” because “lament’s always prayer.” In the pit there are no words, and the Psalms supply language for devastation that is still addressed to God. A friend who can pray Psalm 88 alongside someone can stay in honest conversation without pressing for a resolution the person cannot feel. Swinton also separates happiness, a passing emotion, from joy, which he calls “the thing in the midst of your darkest hour” that makes hope possible. People with severe depression have told him that calling it unhappiness gets it wrong. Telling a depressed friend to cheer up misreads the illness. Joy can remain even when happiness seems ridiculous.
Staying without being worn down
Loving someone who pushes you away hurts, even when it isn’t personal. It is harder still when they have asked you to keep their depression private and you have nowhere to put the hurt. Swinton does not claim a tidy answer to that confidentiality problem. He offers a way of thinking about it.
He reads Jesus’ summary of the law as one movement of love toward God, neighbor and self. Matthew names the second commandment as “Thou shalt love thy neighbour as thyself” (Matthew 22:39), and Swinton draws healthy care for oneself out of that “as thyself.” Self-care, short of selfishness, is part of obeying the command. Christians are not required to put themselves in harm’s way to prove they love their neighbor, so stepping back from a harmful situation can be right. His boundary is firm, though: “abandonment is never acceptable.” If someone has to withdraw, the whole community’s task is to see that the person is still cared for, perhaps by someone else. No one is meant to be the entire church to one struggling friend.
For the hurt of rejection, his counsel is “making sure that somebody’s supporting you while you’re supporting somebody else,” someone you trust to tell you hard truths. He leaves open how this fits with a friend’s request for secrecy. As a practical suggestion rather than Swinton’s own, it can help to ask your friend early who you are allowed to lean on. And if their life may be in danger, that is not a burden to carry alone.
Moving the margins
Swinton questions a phrase Christians often use, that Jesus sat with the marginalized. The people religious society pushed to the edges were the people God chose to sit with, and so, in Swinton’s words, “he shifted the margins.” The center moved to wherever Jesus was eating with the people others avoided.
His worry is that a church can be full of worship and good administration and still miss where Jesus would be. That is why he asks congregations to treat this “not as an option, but as a fundamental aspect of discipleship.” Loving someone with a mental illness begins with deciding that the person at the edge of the room is where the church’s center actually is, and then moving your chair.