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Compassionate counselling

Mental illness is an affliction that must be faced directly rather than denied, and responded to compassionately rather than with punishment

2011 Available in English, French, Portuguese and Spanish

Stigma causes much shame and loneliness. Photo: Richard Hanson/Tearfund

From: Stigma – Footsteps 86

Tackling stigma through dialogue and building relationships

Mental illness is an affliction that must be faced directly rather than denied, and responded to compassionately rather than with punishment. People with mental illnesses have often been dismissed as ‘crazy’. Condemnation would view people with mental illness as hopeless. Compassion is the opposite of condemnation. A compassionate person communicates sympathy, empathy, concern, kindness, consideration and care.

This article has two parts. In the first part we share an example of how to care for someone who believes they may be troubled by evil spirits. In the second part we consider how to counsel those who are depressed. Like physical illness, mental illness can last a short while or a lifetime. The examples here show the possibility of recovery. (The book Where There Is No Psychiatrist advises on long-term mental health problems – see Resources page) Although Oasis Africa mainly has experience of working in African cultures and societies, much of the advice here is relevant to all cultures.

PART ONE - Jamba’s story

Jamba encountered the occult and was traumatised by the experience. His doctor referred him to Oasis Africa for counselling.

Jamba had suffered from anxiety attacks and nightmares for almost a month. Though only 25, Jamba looked older than his years. His parents died when he was 15, and for the past 10 years, he had acted as the head of his family, caring for his seven brothers and sisters. Jamba attended a local church from time to time.

Jamba was married, and the stress of caring for his new family increased his exhaustion. Before long, Jamba began to experience sleeplessness and headaches that would not respond to medication.

Finally, someone advised him to seek the help of a traditional healer. Jamba told of his visit to this man’s dwelling, an experience that totally changed his life. The ‘healer’s’ front room served as a reception area, where Jamba was asked to empty his pockets and leave all of his belongings as well as most of his clothes. Then he was ushered in to see the ‘doctor.’ He found himself in a dark room where he had to squint to see anything. When his eyes became accustomed to the darkness, he saw a wrinkled, clean-shaven man, naked to the waist, sitting on the floor.

The ‘healer’ beckoned Jamba to sit facing him. Jamba remembered the incantations the man said over him as he danced around Jamba and chanted in a strange tongue. At some point, the rhythm moved Jamba into a hypnotic state. A raw egg was broken over his head and the dancing ended. The man now looked at Jamba in the darkness, with eyes that shone through the hazy light. He told him, “I have cast a spell on you. I know you have a business with a regular income. At the end of every week, I want you to bring me an amount of money. If you don’t bring me your money, you will die.” Jamba ran, sprinting all the way to the police station to report his frightening ordeal. He even forgot his wallet and clothes.

This incident was the beginning of horrible nightmares and panic attacks for Jamba. He was afraid of falling asleep, because the medicine man always appeared in his dreams. He had headaches, he did not feel like eating or sleeping, and he feared that in his condition, he might leave his family and younger siblings with no help. He also feared that eventually, someone would come to him from the ‘healer’ demanding money. His friends and colleagues told him that he must have been bewitched by the medicine man, and Jamba believed them. His mind was often filled with thoughts of death. He thought this was because he had disobeyed the medicine man. However, Jamba was determined not to give in to his fear or to the threats he had received, although coping with this stress was proving very difficult. 

How to respond

Was Jamba oppressed by an evil spirit? In the situations of people like Jamba, there is much difference of opinion as to the cause of their suffering, as well as about appropriate treatment. Christian counsellors cannot avoid this debate. Our approach at Oasis Africa considers four aspects: psychological, physical, theological and demonic.

Psychological - In Jamba’s case, the counsellor examined the impact of losing his parents at such an early age, and the burden of caring for a whole family of younger siblings instead of enjoying adolescence. In subsequent sessions, Jamba was able to mourn his parents as well as the loss of his youth. He and the counsellor also worked together on his anxiety and panic attacks, using relaxation exercises, and changing his work schedule to include periods of rest and leisure. He became better at looking after himself, and learned how to give more responsibility to his younger brothers instead of continuing to act endlessly as their ‘father.’

Physical - Physical illness and emotional well-being cannot be separated. One impacts the other. We should always ask the question: Is this problem caused by a lack of physical well-being? The counsellor began by asking Jamba about not only his history, but also his physical condition. Gradually, the counsellor was able to learn what was troubling Jamba. He was exhausted, afraid of becoming sick and failing to support his family.

Theological - Some people think that all emotional problems are a result of specific, individual, sinful behaviour. Although it is true that guilt can cause emotional problems, it is not the only cause. At an appropriate time, the counsellor explored Jamba’s faith, and urged him to imagine Jesus as victorious over the evil spirit(s) that he feared had oppressed him. The counsellor told Jamba that following Jesus meant that evil was overcome, that Jesus understood suffering, and that Jesus was a healer for the sick. Jamba eventually joined a study and fellowship group of young adults in his church, and their support increased his courage to face his fears. In time, the nightmares and panic attacks ceased.

Demonic - Some Christians believe that all emotional problems arise from demonic influence, and that treatment must be limited to exorcism and spiritual warfare. However, not all mental and emotional instabilities are demonic in nature, and much care should be taken in diagnosis as well as in treatment. Therefore, while prayer was appropriate and important – because Jamba’s fear of evil spirits was affecting him, and because there was a possibility that evil spirits had indeed been troubling him as a result of the medicine man’s words – Jamba also needed to strengthen himself emotionally, spiritually, physically, and psychologically. If Jamba had not done this important work in personal and spiritual growth, his fears might have left for a while only to come back later. A prayer for deliverance or exorcism without compassionate listening or discernment can leave the person with greater fears of demons and without the confidence to recover and remain free from troubling thoughts.


PART TWO - Depression

A friend can help by listening and caring without judging. Photo: Peter Caton/Tearfund

A friend can help by listening and caring without judging. Photo: Peter Caton/Tearfund

A counsellor helps a child who suffered trauma following a natural disaster. Photo: Marcus Perkins/Tearfund

A counsellor helps a child who suffered trauma following a natural disaster. Photo: Marcus Perkins/Tearfund

Christians sometimes say that depressed people are lacking in faith. Many Christians view depression as a sign of spiritual defeat. Often they ignore the fact that the peaks and valleys of emotional life are part of normal living. 

The causes of depression are varied. Any attempt to explain away causes or to claim to find a cure-all for depression simplifies a very complex situation. 

There is a distinction between occasional periods of sadness and clinical depression, which needs treatment. A counsellor will help people in both situations, but those with clinical depression will need more intensive treatment over a longer period of time. 

How do we recognise clinical depression? 

When depression starts affecting sleep, appetite, our capacity for work and social relationships and starts controlling our responses to life.

What is needed when counselling depressed people? 

First, if depression is a symptom of a physical illness, providing insight that this phase will pass can provide hope. What the client needs is help, encouragement, and support to recover from the illness. 

If the depression is a reaction to a life event such as bereavement, loss, or terminal illness, the Christian counsellor realises that counselling may be long and difficult. Sadness is normal, except when it extends beyond a normal grieving period. 


  • give an opportunity to retell the story of a loss
  • explore the role a person who died played in his or her life
  • prepare for the pain of anniversaries, birthdays, significant family times and festivals that will be difficult without the person who died
  • address immediate tasks at hand.


  • give quick solutions
  • suggest some miraculous spiritual technique to end the pain
  • give false hope by saying “All will be well soon”
  • over-spiritualise the pain, saying things like “God must surely be teaching you something”.

To help depressed people, you need:

  • compassion and warmth
  • a non-condemning attitude
  • the ability to listen carefully.

The role of the counsellor is to affirm hope through listening. The counsellor must watch for signs that the person wants to kill him or herself, and for any ideas the person has about hurting someone else. The counsellor should seek to protect the person being counselled and others who may be in danger.

Counsellors need to have a referral list available. As soon as the situation becomes too difficult for us, if possible we must refer the person to someone more experienced. This should be done in a positive way, so that we continue to communicate hope and care.

This article is based on extracts from Christian Counselling: An African Indigenous Perspective by Gladys K Mwiti and Al Dueck, with thanks to the authors for permission.

  • Think of a person you know who you think may be suffering from mental illness. 
    • How is she or he treated by people? 
    • Can you think of a good way to support him or her?
  • How do spiritual beliefs influence our understanding of mental illness? 
    • When are beliefs harmful? 
    • When are beliefs helpful? 
    • Think of examples.

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