Liturgy and Mental Illness

English: Communion setting at an Evangelical L...

English: Communion setting at an Evangelical Lutheran Church in America worship service: an open Bible, both unleavened bread and gluten-free wafers, a chalice of wine, and another containing grape juice (Photo credit: Wikipedia)

Not all that long ago I moved from one end of the country to another and with it, moved church. I moved from a church which generally held an informal worship service to an Anglican church with a more formal style. Nevertheless my old church did, from time to time, hold a more liturgical type of service, which I found helpful.

What is liturgy? The word means “people’s work” and referred originally to any public work, not necessarily a religious one and, in the early translation of the Old Testament used by Jesus and his contemporaries, the services of the Temple were described as liturgical. It has come to mean a more formal service with fixed elements such as the recitation of creeds, prayers, responses (e.g. “The Lord be with you” to which the reply is “And also with you”) I am not all that knowledgeable about liturgy but I do know that there are different types ranging from the Orthodox to the Catholic to the Anglican, and also that other Protestant churches may use liturgies.

To understand what liturgy is better, and the positives of it, I have a quote from a book I own:

Liturgical forms give worshipers a sense of continuity. Confessing the ancient creeds reminds us that the church is a lot bigger than we are and has been around a lot longer. Forms help establish community by creating church family traditions, so valuable for people whose present situations change by the minute.

Liturgy gives people identity. It links them with saints around the world and down through the ages who share a common confession. It helps guard against an individual piety and a proud contemporaneity. People who tend to be dazzled (and tyrannized) by the latest model Oldsmobile and computer appreciate coming to a Sunday service and finding some things don’t change as fast.

Liturgy gives structure to worship, reminding the participants of the breadth of concerns in the hearts of the saints. You will have an agenda, whether it is planned years in advance or on the spot. Ritual provides a workable plan, which is often the springboard for spontaneity.

Liturgy is drama, and the better it is performed, the more beautiful worship can be. The psalmist who combined holiness and beauty (“Worship the Lord in the beauty of holiness”) saw that ethics and aesthetics are friends.”[1]

The downsides, of course, to these formal services are that they can become merely rote – that we can end up saying the words without reflecting on them or really meaning them, that the service can be a long series of saying this and that and a race to the end and off you go. There are reasons why some Protestant churches do not use these sort of services and prefer a more free-form type of worship.

I like the formal services – and I like them the most when I am ill. The fact that I can say the words, sing the hymns, participate in the drama that is the Eucharist using written materials provided to me, that I am not required to say anything new, to do anything new, is a great comfort if I am unwell. When I am depressed I struggle to worship, I struggle to participate in free worship, to say things spontaneously, to concentrate properly on the service. I end up leaving a free service thinking that I have not worshipped at all, and feeling like I shouldn’t have bothered. Worse yet I can feel that I have let the other worshippers down, that I have failed to join in and brought them down with me in my depression. I don’t feel that when I am in a formal service. There – I may not be able to concentrate properly, but I can say the words, and I can come away knowing that I have worshipped God even if I was not as fully there as a normal member of a congregation.

Paul talks, in 1 Corinthians 14:14 about his spirit praying while the mind is unfruitful. He is there condemning the use of tongues where they do not edify the church, and saying that we should pray with mind and spirit – but this particular verse has a resonance with me. If I am deeply depressed my mind is barely able to function in worship, although my spirit yearns for God. I am not the most fruitful mentally when I am ill, because mental illness disrupts the mind and distracts it. Yet I believe that when I worship insofar as I can – by reciting the words, singing the hymns, participating in Communion, my spirit is worshipping for me far more than I am able to worship with my mind at that time. That is not said, Biblically, but it is something that I believe.

If you are ill, I would urge you to check out a liturgical service – because you have things to do during that service which help you keep on course, so it is harder to get distracted by your mind. I find that in those services I am able to worship, even though my mind is roiling with illness, and the structured nature of the service helps me keep to the plan of worship, whereas otherwise I may wander off mentally, miss the sermon, not join with others, and walk away thinking that I have not worshipped. To me it is a way to be close to God even when I am ill.

My old church, which was Baptist, did occasionally hold a more formal service – particularly when I first attended, straight out of mental hospital, I went to a service with a simple liturgy where most of the other people had been in hospital or just come out. I believe the minister I had at the time understood the value of liturgy in a service for people who were ill, and it was when I reflected back on those services that I came to value a formal service. I would also urge people who are leading services for people with mental health problems to consider using a more formal, structured service with “things” for the congregation to do – it need not be complicated, but I believe it is something that can greatly help.


[1] Changing lives through preaching and worship: 30 strategies for powerful communication. 1995 (M. Shelley, Ed.) (1st ed.). Library of Christian leadership (189–190). Nashville, TN: Moorings.



  1. […] health friendly church and I wrote also about psychiatric chaplains and also about the use of liturgy. Supporting mentally ill people in the community by linking them up with advisers on welfare, […]

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