Religious Fundamentalism and Later-Life Anxiety

Dinah Miller, MD


July 13, 2022

I was a resident, young and naive, when I bumped into my neighbor in the hospital hallway as he walked out of a psychiatrist's office.

"Why are you here?" I asked, thinking that my neighbor, a theology professor, had some professional reason to be meeting with a psychiatrist, perhaps some type of community project. As the question escaped from my lips, however, I had an instant sense of regret and made a "note to self" in bold, all capital letters with a few exclamation points: Don't ever ask friends or neighbors why they are visiting a psychiatrist. 

Fast-forward a number of decades, and I received an email from that neighbor. Charles Marsh is now a professor of religious studies at the University of Virginia, director of the Lived Theology Project, and author of several books. He sent me a link to an article he'd written about his treatment for an anxiety disorder and let me know he was working on a book on the topic. I later received the galleys for his manuscript, Evangelical Anxiety: A Memoir, which was released last month by HarperOne.

Marsh opens his story as he's sitting with his family in church, listening to his pastor's sermon. It is a quiet April day, and as they are throughout this memoir, his descriptions are so vivid that the reader is sitting next to him in his familiar pew, there in that church on that Sunday, seeing what he sees, smelling what he smells, and feeling what he feels. The pastor confers a wish on his congregants: He'd like them all to have a nervous breakdown in their youth. He goes on to say that if Martin Luther had lived in the days of Prozac, his inner torment would have been quelled and there would have been no Protestant reformation. Professor Marsh then treats us to the first of many humorous moments — he rushes home and swallows a tablet of Ativan.

Marsh focuses on a single dividing point for his life, a day in the fall of 1981. He was resting on his bed in his dorm room at Harvard Divinity School at the ripe age of 23 years, 6 months, and 3 days (but who's counting), when all of who he was changed. He described what he went through that night:

It was then that a high pandemonium ripped away everything protecting me from the world outside. I was no longer a person alone in his room. In an instant, I could hear all things inside my body in their deepest repercussions. My heart and its soft aortic murmur, my breath's every exhalation and inhalation, the downward silences, the laborious intake—would this one be the last? How much noise the body makes when amped up on fear! I could hear the hiss of molecules colliding. And outside in the yellow night, the compressors harrumphing atop the nearby physics building, the sound of car engines and slamming doors. All these things I heard as tormenting assault, a soundscape I could not mute. I'd become a thought thinking about thinking itself and nothing else, metaphysics' ancient curse. A cogitation cycling through every autonomous body function, placing on each a question mark like flowers for the dead.

This moment in time — this "breakdown," as Marsh repeatedly refers to it — bifurcated his life. He went from being a person who lived "…disguised to myself as unaghast and free" to someone who could no longer find escape in his reading, who struggled in his own skin and his own mind, and who, for lack of a better description, was tortured. The "breakdown" passed, and Marsh diagnosed himself with generalized anxiety disorder.

That night, he did not go to an emergency department nor did he seek help from services that were available to Harvard students. There was no psychiatrist, no therapy, no medication. It was, for him, with his fundamentalist Christian background, a religious event of sorts.

I counted it all joy if I should suffer. My sorrow, my soul's sin-sickness, was not unintelligible—it was a kind of blessing, something that might draw me, like a medieval saint, to the suffering of my Lord, something that would testify wordlessly to my heroic exertion to attain purity. And, at least during those late days of autumn 1981, the heavens above and the earth below, spirit and flesh, felt miraculously aligned. Though suffering, this was the life I had craved.

Charles Marsh grew up as a Baptist pastor's son in the Deep South during a time when the civil rights movement came to a head, and life was marked by fear and change. The memoir is not simply about one man's struggle with an anxiety disorder, but a beautifully written account of life as an evangelical Christian during a tumultuous time of racial tensions and horrible violence. He details his life as a lonely only child in a God-fearing world cast in dark shadows, one where he struggled to belong and called out to his mother in the nights. Inside this world, Marsh searched for his own religious identity, with the pride of being a high school "Jesus freak," running alongside his repressed and frustrated sexual longings.

It was a world of good and bad, of heaven and hell, only the two became so confused as he talked about his existence full of fears: The windows were barred; violence and fear were central in his Alabama hometown, "the epicenter of white terrorism," and then later when his family moved to Mississippi. He feared the barking dogs that guarded the houses, the bullies who tormented him, and the bullying in which, he too, joined in. He feared the switch-wielding adults — his mother, his principals, his coaches, and his youth pastor, all set on "breaking the will of the child," a term he explains to be a Christian concept in which the child's own will is broken so that he will be submissive to his parents and to God. 

Marsh wanted so much to be good. And we're not sure he even knew what that was as he battled his desire to conform and belong, and his ever-present sexual impulses. Even as an adult, he was certain his mother would know if he had premarital sex and he would have to kill himself. Sex outside of marriage was the one unpardonable sin.

He suffered in silence and shame. It was not until a few years later that he entered psychotherapy as a doctoral student. When he moved to Baltimore, he again looked for a therapist and eventually found himself with a psychiatrist who was training to be a psychoanalyst in the hospital where I was a resident. This psychoanalysis proved to be transformative and healing, but first, Marsh needed to reconcile his treatment with his religious beliefs, as therapy and fundamental religion travel different roads.

Analysis and faith traverse similar terrain—they understand how language and narrative heal. They may see each other as strangers or competitors, but they need not. Like prayer, the analytic dialogue slows down to ponder, to meander, to piece together, to redeem; both inspire the mind toward hope under the influence of an empathetic listener. Neither needs the other to effectuate its truths, but they follow parallel tracks into the mysteries of being human, where all truth is God's truth. It's more than fine that they neither merge nor collide.

He goes on to describe how powerful the process was for him and his healing. 

Analysis is the space where one feels—where I felt in an embodied way, in the unhurried hours over months and years—a trust in the beautiful interplay between the center and the extremes. My body and mind would not be raised in resurrected splendor in the course of the treatment. I wish to emphasize the point. It was tempting to think that it would, that I would undergo a miraculous transformation. If not resurrected splendor, then surely I would take on the "new man." Instead, I received the gift of mortal life: the freedom to be imperfect, to have fears and face them, to accept brokenness, to let go of the will to control all outcomes.

Evangelical Anxiety is a beautifully written book, and a look into two worlds that can feel so secretive to the outsider. Marsh's use of language is extraordinary; he has a gift for metaphors and descriptions, and he carries the reader alongside him on a splendid journey. It has to be said, however, that he assumes a lot: Marsh is a sophisticated scholar who mentions religious leaders, philosophers, historical characters, and the occasional rock song, with no patience for those who don't follow his quick transitions and impressive vocabulary; I could have read this book with a dictionary beside me (but I didn't).

It's an illuminating journey, often sad and disturbing, sometimes funny and endearing, and ultimately uplifting. In our skeptical world where psychiatrists are so are often undone, it is refreshing to read a memoir where the psychiatrist is the good guy and the patient emerges healed and whole.

Evangelical Anxiety: A Memoir (HarperOne) was released on June 14, 2022.

Dinah Miller, MD, is a coauthor of Committed: The Battle Over Involuntary Psychiatric Care (Johns Hopkins University Press, 2016). She has a private practice and is assistant professor of psychiatry and behavioral sciences at Johns Hopkins in Baltimore.


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