Psychiatrist and Theologian from Leading Research University My Christmas message for those struggling with mental health challenge is that you are not alone, you matter, and there is hope for you

Dr. Warren Kinghorn is a psychiatrist and theologian at Duke University, which is ranked 9th in the world for clinical medicine. He is an Associate Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center, the Esther Colliflower Associate Professor of the Practice of Pastoral and Moral Theology at Duke Divinity School, and a staff psychiatrist at the Durham VA Medical Center, where he treats war veterans with a focus on PTSD and moral injury. He is also a Faculty Associate at the Duke Trent Center for Bioethics, Medical Humanities, and the History of Medicine. 

Dr. Kinghorn is also the author of the recent book Wayfaring: A Christian Approach to Mental Health Care (Eerdmans, 2024). In this interview, he discusses the significance of Advent and Christmas for those struggling with mental health disorders, how Christianity has pioneered mental health care, and how we can support individuals facing mental health challenges from a Christian perspective.

You are both an associate professor of psychiatry and pastoral and moral theology. How can these two fields complement and serve each other?

Both psychiatry and theology are complex traditions of wisdom about what it means to be human and how to live wisely in the world.

Psychiatry encompasses not just a body of scientific knowledge but also the wisdom of sitting with people who are thinking, feeling, and acting in ways that are distressing. It involves accompanying them and helping them find a better future.

Theology, on the other hand, is a much older tradition that explores what it means to live faithfully before God, in community with others, and what it means to be human.

In terms of how they complement each other, I see psychiatry as being focused on the "how." For example, if someone is depressed, psychiatry excels at understanding how to help them feel better. Theology, however, is more concerned with the "what" and "why." What does it mean to be human? What does it mean to suffer, and is there any value in it? What is health? What is mental health?

Can Christian faith play a role in helping psychiatry address mental pain?

I believe that psychiatry and psychology can be very helpful. However, modern mental health care often reduces people to symptoms, which are then grouped into diagnoses that are to be treated with various treatment protocols.

Christianity, on the other hand, offers a much broader perspective: we are not broken machines to be fixed but people who are known and loved by God. We are creatures who grow in relationship with one another, are on a journey, and are called to wonder.

I believe this is what Christianity can contribute to psychiatry—it deepens the understanding of what it means to be human.

For many, Christmas is a time of joy, family gatherings, gifts, and carols. However, for those with mental illness, it can be a challenging season, highlighting their struggles. Can individuals with mental illness experience the joy that comes from Christ’s birth?

Christmas has become a highly commercialized cultural holiday that is supposed to be about celebration and spending. This is very different from the way Christians are taught to observe this season of the liturgical year, which is not actually Christmas, but Advent. Advent is not a time of celebration but of waiting and longing. 

We do Christmas a disservice when we jump right to it without observing Advent first. It would be interesting to consider what it might mean for us in the modern West to make space for Advent before jumping to Christmas.

But Christmas is the fulfilment of Advent. There is should be some place for joy. How can mentally ill benefit from both Advent and Christmas?

Joy is a complicated thing; it’s different from happiness, which is more of an emotion coming from the satisfaction of our needs. Joy, on the other hand, can be felt even in the midst of suffering. It comes from the capacity to connect with a source of beauty, hope, and goodness that transcends our circumstances, meaning it isn't dependent on our mental well-being. 

Christ gave us the capacity to connect with Him, assuring us that we are not alone, that we matter, and that there is hope. One of the beautiful aspects of Christmas is that, through the incarnation of Jesus, we witness the truth that the Creator of the universe united Himself with human nature. God understands what it means to experience loneliness, dependency, and stigma. This is how those in mental distress can find joy during this season.

Now, let’s bring this to a practical level: how can people with mental health problems specifically benefit from Christmas? Let’s start with depression.

One Catholic moral theologian describes depression as a wilderness experience. In scripture, the wilderness is portrayed as a place of dryness, aridity, and danger—a place where one feels lost, vulnerable, and exposed. Yet, the wilderness in scripture is also a place where God meets people, often in unexpected ways. For those who are depressed, Advent can symbolize this wilderness, while Christmas represents the moment when God comes to them when they least expect it.

What are the unexpected ways in which God can meet people with depression?

Christmas signifies that God is stronger than their depression and is not limited by it. Then there is the reassurance that they are not alone, that they matter, and that there is hope. This perspective can help them shift their focus and become more aware of the everyday graces God provides, such as family, friendships, or opportunities for treatment. It also reminds them of their ability to bring goodness into the world, through acts like volunteering or showing kindness to others. However, this is a gradual process.

What about individuals with anxiety disorders? Their fears can be paralyzing. How can the message of Christmas help them break free from the cycle of anxiety?

Anxiety often corresponds to three core beliefs. The first is that I am not safe, a belief that many feel for good reasons. The second is that I am not enough, which is often accompanied by the shame that comes from our weakness. The third belief is that I or my loved ones won’t have what we need. It is in this space that we find Advent. Mary and Joseph, too, faced anxiety, yet they took the risk of answering God's call. I believe this can be the message of Christmas for those with anxiety: take the risks, face the obstacles, and know that God has not forgotten you and has a plan for you.

Sometimes anxiety can develop into panic attacks. Reassurance is the first-line treatment for these attacks. How can the birth of Christ provide reassurance during panic attacks?

Panic attacks are deeply distressing. People can feel as though they are dying or losing control. But panic attacks always pass. Many biblical figures also faced panic. Take the stories of Zechariah or the shepherds. They were visited by angels but were horrified, and in Zechariah's case, even unable to speak for months. Yet, their encounter with the Divine ultimately transformed them. Those experiencing panic attacks may also struggle with horror, but Christmas can be a transformative experience for them, as it reminds them that God incarnate has control over their lives, even when they themselves do not.

Those with obsessive-compulsive disorder (OCD) face intrusive thoughts and compulsive actions. Cognitive behavioral therapy, as one of the first-line treatments for OCD, helps patients manage these thoughts to reduce compulsions. How can the message of Christmas help in controlling these thought patterns?

In the Christmas story there are a whole lot of triggers for OCD. For someone with fears of contamination from dirt or germs, for example, think about what it would be like to give a birth to a baby in stable with animals around. So, the story is inherently messy and lacks structures of control that we might want to have. This means that God does not only provide a structure in an unpredictable world but is willing to enter our own messiness and to meet us there. This can provide comfort to those with OCD.

What about religious scrupulosity, which is a subtype of OCD?

I think that religious scrupulosity is often an intense need to follow religious rules and maintain a state of purity, driven by a deep fear of contamination by sin. However, Jesus was constantly reaching out to people like tax collectors, prostitutes, and others on the margins. This shows those who feel unclean that they, too, have access to Jesus and are loved by Him.

People with severe mental disorders, like schizophrenia or bipolar disorder, face symptoms such as hallucinations or mania, which often hinder their ability to work, pursue education, and maintain relationships. What hope does Christ’s birth offer them this Christmas?

The message of Christmas for someone living with psychosis or bipolar disorder is that they are not alone, they do matter, and there is hope for them. Jesus knows what it is to be stigmatized, to be considered a troublemaker or someone who is unreliable. So, if Jesus understood what that feels like, no one hospitalized or evaluated for these disorders should feel that God is absent in that situation.

But what is the hope that God offers them?

The hope for those living with psychosis or bipolar disorder is in that God is with them. These conditions cannot take away hope; people blessed with community, family, or meaningful relationships can live full lives, even when symptoms are present. However, when psychosis or bipolar disorder lead to social isolation or chronic stigma, hopelessness can settle in. Yet God can break through this isolation, often surprising us with unexpected graces, such as new friendships or communities. And no amount of stigma can erase the divine image we bear.

Christmas is a time when people reflect on their lives. What does Christ´s coming mean for those contemplating suicide?

Suicide is always a loss and a tragedy, not just for those who take their own lives and their loved ones, but for the world as well. Each person matters and has a unique purpose given by God. When someone dies by suicide, the world loses the goodness that they bring just by existing. Life is a gift from God, and Christmas is a perfect time to reflect on this and seek help.

If you're experiencing suicidal thoughts, talk to family, friends, or a professional. If you have a plan, go to the hospital immediately—don’t wait. If you have no family or friends, speak to a priest or someone at your church to get the help you need. Priests and faith communities play a vital role, as they are often an important source of hope for those contemplating suicide.

PTSD often affects those exposed to severe trauma, such as war veterans, first responders, or healthcare professionals. Some argue that PTSD arises from a worldview ill-equipped to address death and evil. How can Christmas help in this?  

I think people can adopt a worldview that helps to protect them from PTSD, but I wouldn’t say PTSD arises solely from a worldview ill-equipped to address death and evil. A mentor of mine called PTSD an overdose of reality. Trauma survivors have witnessed the amount and intensity of suffering that others have not, which can alter their worldview, making them see the world as untrustworthy and dangerous.

The message of Advent and Christmas is that Jesus was born into a trauma-saturated world. If we view Christmas in a way that excludes violence, sexual trauma, and abuse, we are not truly experiencing Advent and Christmas. Jesus was born into a world where violence was ever-present, and even the holy family became refugees.  This season can teach us that joy can be born even amidst trauma, helping to restore lost trust and a sense of safety.

How can the message of Christmas bring hope and renewal to the lives of people who struggle with addiction?

The root of most addictions lies in unmet needs—these could be intimacy, touch, nourishment, safety. When we try to satisfy these needs in ways that create cycles of gratification and longing, the situation can quickly spiral out of control. We then become enslaved to the very things we believed would set us free, whether it’s alcohol, drugs, sex, gambling, exercise, or something else.

The reason addiction feels so inescapable is often a hidden hopelessness—a belief that things will never be better. People struggling with addiction may feel their lives lack meaning, future, or hope, leading them to destructive behaviors.

I believe the promise of Christmas is that the world—where hope can only be obtained through our own efforts—has been transformed by the coming of God. There is no longer a need to worry constantly about not having enough. Jesus brings a new creation that offers purpose and meaning.

Do you have any practical tips for people who struggle with addiction during Christmas?

Bethlehem was a town on the margins. Yet Jesus came into this world in the most unlikely place to the most unlikely people. People struggling with addiction should know that they are right at the center of the Christmas story. My encouragement to them is to reflect on what they truly need. Is it a healthy relationship? A better self-image? A sense of community? Christmas and Advent invite us to seek help for the deeper issues underlying our addictions. If they feel disconnected from others, I would encourage them to take the risk to reach out to church communities or Twelve Step programs. No person’s life is ever beyond hope. Each person has God-given dignity and purpose, which cannot be erased by failure.

Moral injury—a deep sense of guilt or shame arising from moral transgressions—can affect anyone who feels they’ve failed morally, including people who are in prison, those with troubled pasts, people struggling with addiction, or the homeless. What message does Christ’s birth bring to those burdened by guilt and shame?

Moral injury was initially associated with soldiers suffering from PTSD who blamed themselves for moral transgressions committed during combat missions, or who had been betrayed by others. However, moral injury can apply to anyone who has lost trust in themselves or others based on some kind of violation or breakdown of moral values.

The key message is that there is hope. If you feel your life is not going the way you want and you are burdened by guilt and shame from your past, the coming of Jesus marks a new beginning, even if you have been trapped for years. If you look at the life of Jesus, it is a life marked by gentleness. I believe that with God’s help it is always possible to change your life, and society should treat those who seek to repent with the same gentleness.

Personality disorders often hinder individuals from forming meaningful relationships and carry stigmas, such as when people are labeled as "psychopaths." Yet, they too bear the image of God. What does Christmas mean for them?

Especially with personality disorders, it is easy to get trapped in diagnostic labels such as borderline personality disorder, antisocial personality disorder, or histrionic personality disorder. These terms describe experiences but should not become names for people. Illness should never define identity. In the Christian story, identity is found in being beloved children of God. The central message of Christmas is that the coming of Jesus into the world reminds us of our deepest identity: the love of God, who delights in our existence. As humans, we matter in the eyes of God in ways that go beyond any diagnosis we may have been given.

For those grieving the loss of a loved one, Christmas can highlight an empty chair at the table or an empty bed in children´s bedroom. How can Jesus help them find joy in this season?

It is true that Christmas can be especially hard for those who have lost a loved one. It is important, in our grief, to give space for Advent, not just Christmas. Advent is a time of longing and dryness. In the U.S., many congregations hold a service called "Worship for the Longest Night," which is celebrated during the winter solstice, not because we observe the solstice as a religious event, but because it is the longest night of the year. This time symbolizes the darkest moments in our lives. 

During this service, people grieve, lament, and name their losses. I also believe that Mary can be a powerful role model for those who grieve, as she was the mother who lost her son. Although Jesus had resurrected and ascended to heaven, Mary had to wait until her Assumption to be reunited with him in eternity.

Foto: www.liberty.edu/lucom 

Another, perhaps even more profound, loss is the loss of faith, often resulting from spiritual or existential crises. How can Christmas help those who feel disconnected from God rediscover their faith and find new meaning?

Jesus was born during a time when the tendency to lose faith would have been common. The people of Israel were under Roman oppression, there was violence, and there was no immediate hope of deliverance. If we feel we are struggling with faith, we should feel solidarity with those who lived around the birth of Christ. Jesus came to this world unexpectedly, and for those wrestling with their faith, I encourage them to be more attentive to the new ways in which Christ is entering their lives. Christmas is a good time to do that.

However, for people in existential or spiritual crisis, it is hard to dwell on Christ. Something more practical?

If you are experiencing an existential or spiritual crisis and questioning the existence of Christ, engage in activities and surround yourself with people and places where you have previously encountered the goodness of God. Continue to show up at church, continue to read Scripture, and continue to seek out conversations with people you trust. Expose yourself to situations where you can receive grace, and grace will come..  Reading books or listening to podcasts on matters of faith can also be helpful for some.

Are spiritual or religious problems recognized as mental health problems?

In the DSM, which is used in the U.S., there is a code for religious or spiritual problems. Although this code is not classified as a mental disorder, it is included in the DSM because these problems may require clinical attention. If not addressed, they can lead to significant mental health issues.

Some individuals require hospitalization during the Christmas season. How can they and their families celebrate Christ’s coming while in the hospital?

Especially during Christmas, it is important to wrap people in community as much as possible—by visiting them, staying in touch through written notes or phone calls, and ensuring they know they are valued, loved, and held by their community. If these individuals have no relationships or family, and you are a member of the hospital staff—whether a clinician, chaplain, or nurse—make an effort to let patients know you are thinking about them, that they matter, and are loved. During the Christmas season it is vital to communicate God’s love to people who are hospitalized.

Chaplains are members of the staff in the US hospitals?

A: Yes, most hospitals in the U.S. have chaplains who are often part of treatment teams. In some hospitals, there may be only one chaplain for the entire hospital, and they may not spend much time with psychiatric patients. However, large university hospitals often have chaplains dedicated to psychiatric units, who spend a good part of their time addressing the spiritual needs of these patients.

Some psychiatric patients often feel like broken machines. How would you address this issue in Christmas perspective?

Psychiatry can often make people feel like they are machines to be fixed, especially when they are told there is something wrong with their brain or nervous system. People may start to feel like they are just taking medication and reporting back on how it works, as if they are in some sort of repair shop. Christianity offers a very different view of what it means to be human: to be someone whom God knows and loves. Mental health care is not about fixing machines, but about accompanying those who are on a journey. The key question is always: what is needed right now for the journey? If we shift our focus from fixing machines to wayfaring, we can do much better for our patients as psychiatrists or psychologists.

What can relatives do to support their loved ones struggling with mental disorders during Christmas?

As I said, the key question for clinicians is: what does the patient need right in this moment? Is it therapy? Is it medication, and if so, which one? The same question applies to relatives, but in a different way. What is needed right now for this person who is on a journey? It might be getting someone to the hospital or to their first appointment with a psychiatrist. But this person might also need a supportive community, a place to live, a job, or help getting out of a toxic environment. So, always ask: what’s needed right now?

This brings me to the topic of psychiatric medication, which can be both stigmatizing and intimidating. How can Christmas offer a Christian perspective on the use of psychiatric medication?

Although I work in a government-run veterans hospital and don’t practice a distinctively Christian form of psychiatry, I am very influenced by St. Thomas Aquinas, who presents a vision that we are called by God into freedom and agency to appreciate the goodness of creation. At the same time, he acknowledged the limitations of our physical bodies. Mental health problems can negatively affect our brains, just as our brains can influence our behaviors and emotions.

Psychiatric medication, while it may not reverse the root causes of these challenges, can support the proper functioning of emotions and practical reasoning, particularly in conditions like psychosis or bipolar disorder. Some medications even help us live more virtuous lives; for example, naltrexone blocks the reward that people struggling with addiction get from alcohol.

But some patients might still be reluctant to take psychiatric medication.

A psychiatrist is not just someone who medicates bodies, but also someone who is accountable for walking alongside people facing challenges that don’t seem reducible to the body. The issue is not the medication, but the temptation to overlook the broader context of the mental health challenge. This can often happen when people hold too tightly to the biological model of mental illness, which reduces patients to broken machines. Research suggests that while understanding mental disorders as brain disorders can reduce shame and self-blame, it has hidden costs, as patients become less optimistic about their own recovery and others may desire more distance from them. Christmas reminds us of the Christian view that people with mental disorders are body-soul unities.

It is generally not adequate to consider medication as the sole response to mental health challenges, and I understand why people are reluctant to take medication if this is the message that they have heard. But medication can be very helpful as a part of someone’s overall care and treatment, as long as we always maintain a broader view of the person.

There is a widely used scholastic quote: 'Grace builds on nature.' It is often invoked to suggest that when our hearts are broken, even religious life may not provide the nourishment we need. Yet, for many who suffer from mental illness, God's grace is often their only hope. Can God´s grace help to sustain our nature, broken by mental disorder, while respecting the need for treatment?

I interpret Aquinas on nature and grace to mean that our created nature is good but finite and wounded by sin. Because of our natural finitude and the wounding of sin, God has to come to us and impart the virtues of faith, hope, and love, so that we can attain union with Him. The central message of Christmas is that God has come to us in the person of Jesus Christ—it wasn’t our project to come to God. That’s the affirmation of grace: even when we are struggling with mental health challenges, it’s ultimately not by our own efforts that we come to God, but by God coming to us. This is how grace elevates our nature to union with Him.

So, the broken nature in terms of mental disorder is not an obstacle to having a joyful spiritual life?

Not at all. You can have a flourishing Christian life even while experiencing symptoms of mental disorder.

What role should the Church play in supporting those in mental health crises during Christmas?

Clinicians have training to address certain kinds of situations, such as thoughts of suicide or psychosis, and people with mental health issues need to see them. But clinicians are never going to be enough for the kind of support these people will need.

The Church has an absolutely vital role to play in being the community where people know they belong. I think the task of the Church is to ensure that people with mental disorders feel they belong. This means these individuals have someone who misses them, they are invited to meals, and they are regularly checked on during difficult times.

The Church is also the body of Christ, where each member has a role. When somebody has mental health struggles or feels isolated or lonely, the church community should ask what they can be called to do in service of the Church. It may be as simple as inviting someone to set up chairs or to bring meals to others. It might be some other form of leadership or service. The Church should let them know that they too have something to contribute to the community.  

Mental health professionals can experience therapeutic despair, losing hope for some patients and considering them "unfixable." How can the message of Christmas offer them hope and a new perspective on their patients?

Yes, we as mental health professionals can sometimes lose hope because patients seem unfixable. But the problem there is our own images of what it means to care, because the word unfixable means I myself am a mechanic tasked with fixing this machine. We are not called to fix people, but we are given grace to attend to people and walk with them toward a better future. And that takes the burden of fixing away from us.

Not just at Christmas, but the whole Christian story reminds us that no one is beyond hope of living a meaningful life. The biblical story is full of people who seemed to be beyond grace, and yet grace came to them. Christianity helps mental health professionals continue to hope for people who have lost hope for themselves, because our deepest identity is being children of God, not a broken machine.

Some Christians distrust psychiatry and psychology. Yet, in your lectures you´ve mentioned that medicine, including mental health care, has deep roots in Christianity. Can you elaborate?

Christians have been attending to people in mental health distress for thousands of years, and Christian care has a much deeper tradition than psychiatry and psychology. The Psalms, for example, teach us what it means to be human at the highest of heights and the lowest of lows. The New Testament shows us how to console and encourage people who are feeling hopeless and in distress.

Based on this legacy, Christians invented the institution of the hospital in the 4th century. Later, Christians pioneered various forms of mental healthcare—not only through the story of Catholic priest Fr. Jofré, who in 1410 founded the Hospital of Holy Innocents in Valencia, the first specialized psychiatric hospital, but also through the community of Geel in Belgium, inspired by St. Dymphna, where, from the Middle Ages, the chronically mentally ill were cared for by local families, making it the birthplace of community psychiatry. 

Later, we saw the Quakers in England, who established residential treatment centers for the mentally ill, providing access to gardens and fresh air and revolutionizing mental healthcare, especially in the U.S.

We can see that Christians have been able to change the course of mental healthcare for the better multiple times in history. Christians can embrace much about modern psychiatry and psychology, but should know that they themselves have an even longer tradition of mental health care.

You are a faculty member at one of the world's leading universities and acknowledge the importance of religion in patient care. Is the role of religion in medicine and mental health becoming more recognized in academia?

I think there is a tendency to think that large research universities neglect religion, but actually, there is a lot of openness to religious questions, such as at Harvard or Duke. It depends on the institution, but there is a growing and deep network of not only Christians but also Jews and Muslims who are engaging with religious questions in the context of academic healthcare.

Each year, Dr. Harold Koenig at Duke sponsors an Annual Research Workshop on religion and spirituality in medicine. Our Theology, Medicine, and Culture Initiative at Duke Divinity School sponsors an annual theological conference for health practitioners called Practice & Presence.  There is also an annual conference in the US on religion and medicine, the Conference on Medicine and Religion. 

What is your Christmas message for those who face mental health challenge during this season?

My Christmas message for those struggling with mental health challenge is that you are not alone, you matter, and there is hope for you.