Three choices for the critical thinker: God is not all-powerful, God is a managed care executive, or there is no God. Let's reason it out.

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Imagine no mental illness

It isn’t hard to do

No suicide, no grieving

And no hospitals, too

Apologies to John Lennon for those lyrics, but if you can imagine these things, you’re smarter than God. If an all-loving, all-powerful deity existed, why couldn’t He visualize a world free of mental illness, then proceed to create it? Clearly, the Beatles were not only bigger than Jesus, but brighter, too.

As Rush, another wiser-than-the-Trinity rock band, sings in “The Larger Bowl”:

            The golden one or scarred from both

            Some things can never be changed

            Such a lot of pain on this earth

            It’s all so badly arranged

I wrote in a previous column that losing my son Josh to suicide placed the arguments against God in a new light. There, I reasoned that the biblical God’s long record of child murder rendered him unworthy of worship, deserving of scorn.

But wait, there’s more. Growing up Lutheran, I was taught that God is perfectly loving and all-powerful. As a young adult, the realities of life on earth—poverty, natural disasters, wars religious and worldly—sowed doubt.

For a time, my questions were assuaged by the fable of original sin: God made a flawless world, but Eve and Adam blew it for the rest of humanity. We must wait for the afterlife, the new heaven and new earth, for perfection to return.

But, hold on a second! God is also all-knowing. He foresaw that Eve would succumb to the serpent’s temptation. He could’ve tweaked free will, or perhaps never created that damned snake, so we could still live in Edenic bliss.

Schizophrenia and the illnesses that killed my son are Ichneumonidae making their home in the brains of young humans.

Theologians will offer nuance upon nuance, narcotizing the doubts of the true believer. Or they play the “it’s a mystery beyond human comprehension” trump card. But this is where I deploy my just-invented Argument from Managed Care.

Health maintenance organizations (HMOs) are malign. This is mountain lake clear to me, as a physician whose morale is routinely ground into a nub from battling insurance bureaucrats for necessary treatment for my patients.

Christian apologists are defending a divine HMO executive. Sure, you can’t have your life-saving insulin or the mood stabilizer keeping you off the ledge, but managed care is a societal good! We answer firstly to our shareholders and must keep costs to a minimum. And don’t get us started on the evils of socialized medicine. Communism has no place on American soil!

Whether defending a broken health system or a broken deity, if the outcome is still sick and dead people—if you’re privileging the bastard Executive in the heavens over humans—I’m not buying what you’re selling.

Charles Darwin famously wrote, “I cannot persuade myself that a beneficent & omnipotent God would have designedly created the Ichneumonidae [parasitic wasp] with the express intention of their feeding within the living bodies of caterpillars.” As a psychiatrist, I argue from mental illness.

Take schizophrenia. The prevalence is the same worldwide (0.5-1.0%), so this is not a disease of industrialization. It’s not those kids and their durn cellphones. It doesn’t discriminate on the basis of nationality or social status. It’s an equal opportunity affliction.

Schizophrenia typically has its onset in the late teens or early 20s. I’ve treated college kids and high schoolers, even a former medical student, who were full of aspirations when they started getting paranoid. When derogatory voices assaulted their senses, when the television began sending them messages.

Even with the best medications and psychosocial rehabilitation, the disease lingers. The hallucinations and paranoia usually persist to a lesser degree. Social skills and motivation normally don’t return to their previous baseline. An estimated 10% of sufferers ultimately take their life.

I could speak similarly of devastating effects of depression, autism, addiction, bipolar disorder, panic attacks, and PTSD. With advances in neuroimaging, we know these conditions are based in brain structure and function. They don’t happen because of poor choices or moral failure. (Although many religious believers the world over assert otherwise, shaming the ill and erecting barriers to care.)

If more treatable than schizophrenia, these other conditions still induce great suffering and increase a person’s suicide risk. So, where is that “beneficent & omnipotent God” in all of this? Schizophrenia and the illnesses that killed my son are Ichneumonidae making their home in the brains of young humans.

Russian author Fyodor Dostoevsky began a revolutionary but ended a Christian nationalist. (And look how well that’s playing on the world stage!) But he got it right in this dialogue between two of the Brothers Karamazov:

Tell me straight out…answer me: imagine that you yourself are building the edifice of human destiny with the object of making people happy in the finale, of giving them peace and rest at last, but for that you must inevitably and unavoidably torture just one tiny creature, that same child who was beating her chest with her little fist, and raise your edifice on the foundation of her unrequited tears—would you agree to be the architect on such conditions?

Even the devout Alyosha had to answer his brother Ivan with a “no.”

Christians are left with two choices. Either their God is not all-powerful, or He is an omnipotent managed care executive. The conclusion I reached years ago, now reinforced by my son’s death, is that we live in a world without gods. It is left to us to imagine a healthier world and create it ourselves.

This column is Part 22 of the Secular Suicide Survivor series. Here’s how it began.

If you are having suicidal thoughts, please reach out to someone you trust, establish care with a therapist, call the National Suicide Prevention Lifeline (800-273-8255), or go to your nearest emergency room. Please stick around. We need you.

Disbelieve as you grieve: Rejecting the Almighty God of Mental Illness | Josh, gazing at the camera disinterestedly
Josh on our final family vacation together in 2019. Unbeknownst to me, he had stopped taking his meds, and was starting to get disheveled and disengaged. I prefer to remember Josh smiling and affectionate, but this is part of who he was, too.
Lincoln Andrews

Lincoln Andrews

Life seemed as good as it gets in early 2021, with a happy family, a job I loved, and a long-desired move out of the Bible Belt to the Pacific Northwest. My world split open on September 12th, when...