In my work as a therapist, one question I hear a lot is, “I’m struggling with anxiety (or depression)—does that mean I’m a bad Christian?” Many of my clients believe that if they were “holier,” they wouldn’t be experiencing crippling anxiety or paralyzing depression. They believe that their struggle with a psychological issue is a reflection of their lack of a strong spiritual life. Therapy is a last ditch effort for them.

This belief is very common. Many of my clients tell me that they feel guilty for coming to therapy. They feel it’s an admission they aren’t holy enough to be healed from their anxiety or depression on their own. They believe that if only they had a stronger prayer life, attended more Masses, and went to confession more often, they would be “cured” of their worry and sadness. They tell me that their worry is a sign that they don’t love God enough and approach therapy with a great deal of skepticism.

Or, they might tell me that they’re not sure whether they are dealing with a spiritual issue or a mental health issue. How do you know the difference?

Psychological or Spiritual (or Both)?

Before we answer that question, it is important to acknowledge the reality of psychological issues, the most common being anxiety and depression. There is a stigma surrounding anxiety and depression which serves as a barrier to people seeking the help they need. Many people mistakenly believe that disorders such as anxiety and depression are either signs of weakness (if you were a stronger person, you wouldn’t experience these things) or are made up (people just worry too much or just focus on the sad things too much). However, anxiety is more than just worry. It’s a collection of physical and psychological symptoms that impair a person’s daily functioning. And depression is more than just feeling sad. It’s an overwhelming feeling of darkness and hopelessness that manifests itself in physical and psychological ways. There are environmental, biological, and genetic factors that contribute to the development of a psychological issue. Anxiety and depression are very real and require professional treatment.

One analogy I frequently use with my patients is that of a broken bone. If you broke your arm, what would you do? Would you fashion your own sling or just hope it heals on its own without treatment? Probably not! Your response would likely be to schedule an appointment with your doctor or go to the nearest urgent care. My point is that seeking treatment for a physical injury is not even a question. We know that the best way to heal from a physical injury is to seek treatment from a doctor. Similarly, we know that the best way to heal from the wounds of sin is to seek forgiveness through the sacrament of confession.

Do we feel the same way about psychological issues? Because of the stigma and misunderstanding surrounding psychological issues, we often don’t feel the same way. If I said to you that your broken arm is a sign that you aren’t holy enough, would you believe me? Probably not. It’s easy to see the distinction between your spiritual health and your physical health when it comes to a physical injury. And it’s a given that you would seek professional treatment for your physical injury. However, the distinction is much less clear when it comes to our mental health and our spiritual health.

Discerning the Difference

So, back to our original question: How do you know if you are dealing with a spiritual health issue or a mental health issue?

Dr. Aaron Kheriaty offers some guidelines for knowing when what you are experiencing is a spiritual struggle versus a mental health struggle in his book, The Catholic Guide to Depression, an excellent resource for anyone who is looking to learn more about Depression. Kheriaty emphasizes that depression is not a sign of a lack of moral character and recommends examining your physical, emotional, and cognitive state. Depression and other mental illnesses affect all three of these areas while a spiritual issue may not. When working with someone with anxiety and depression, counselors look for signs that the person’s social and occupational functioning is being impaired. This is generally a sign that something related to mental health is going on rather than a spiritual issue.

Sometimes it isn’t easy to discern the difference. Our mental health can negatively affect our spiritual life. Scrupulosity is an example of this. Someone who struggles with scrupulosity experiences obsessions and compulsions of a religious nature. She is consumed with anxiety over committing the smallest sin and fears that she has committed a grave sin without knowing. Because scrupulosity is a form of Obsessive Compulsive Disorder (OCD) that has religious features, the treatment for scrupulosity is a combination of spiritual and psychological treatment. Working with both a spiritual director and a therapist who understands scrupulosity is important. The spiritual director can provide guidance for gently correcting spiritual misunderstandings while the therapist can use research-supported treatment methods.

Not a Sign of Spiritual Weakness

A good spiritual director can help you discern the source of what you are struggling with. If it is a spiritual issue, he can help you explore the source of that issue. If it is a psychological issue, he can help connect you with a therapist who can treat the psychological component.

And remember, experiencing a psychological issue is not a sign of spiritual weakness. In fact, did you know that St. Therese of Lisieux experienced scrupulosity for a time? Did you know that her mother, St. Zelie, experienced anxiety? It’s worth remembering that many saints experienced mental health issues and still became saints. They were able to strive for holiness while struggling with anxiety, depression, etc. Their struggles did not prevent them from having a strong spiritual life and achieving holiness. The same applies to you. Having a mental health issue doesn’t have to prevent you from living a rich, spiritual life.