Challenges in Definitions
“Disability” is a word tossed about easily in our world. Yet the sheer spectrum of disabilities makes the term ambiguous and even artificial. It is helpful to conceive of disability as a term that points to a limitation due to an involuntary bodily impairment, social role expectation, or external physical/social obstruction impacting participation in communal life. Beyond this definition, the church is faced with a deeper challenge to define disability while wrestling with various theological implications of over-simplifying the term.
This article will briefly examine challenges faced by the modern medical world and the church in understanding and caring for those with intellectual disabilities. We will explore a refined concept of biblical discipleship to sharpen our understanding and care for those with intellectual disabilities and see how they have much to teach us on the nature of true discipleship.
Challenges in Systems: The Medical Field
For those with intellectual disabilities, the risk of depression and anxiety are particularly acute. In 2017, there were 7.4 million people with an intellectual or developmental disability in the United States. One study found “the rate of psychiatric comorbidities with affective and anxiety disorders was approximately 11 times higher for people with an intellectual disability compared to the general reference group.” Furthermore, “older people with intellectual disabilities suffer from advanced and complex somatic and psychiatric comorbidities, and accurate diagnosis and management can be difficult due to the person’s decreased ability to understand and express his or her illness, leading to inappropriate service and care.” Research reveals that communication deficiencies among those with intellectual disabilities limit their ability to describe their symptoms to health professionals, resulting “in unsatisfactory clinical consultations and poor treatment choices.”
It is not only the individual’s restricted ability to describe his or her own symptoms that is troubling. Healthcare providers themselves are severely underprepared to understand people with intellectual disabilities and their link to psychiatric comorbidities. Many psychiatrists have little experience in dual diagnosis, and as a result, “the presence of affective and anxiety disorders with other comorbidities might be hidden and thus underestimated by health care providers.” With such inadequate understanding and care, anxiety and depression quickly become silent enemies of those with intellectual disabilities. Consequently, the intellectually disabled, their families, and their caregivers often suffer in silence.
Historically, healthcare professionals have emphasized medications and controlled environments as primary treatment plans for the intellectually disabled. Yet some 20 years ago, the scientific community began to explore what spirituality could offer to the psychological process in those with intellectual disabilities. Researchers have seen that the integration of spirituality as part of treatment provides avenues of protection against depression and anxiety, and it offers tools for clinicians, enabling them to better differentiate between spiritual experiences and mental disorders. Researchers also see a correlation between spirituality and the acceptance of limitations, better impulse control, increased life expectancy, improved quality of life and subjective well-being, heightened self-esteem, motivation, and relatedness.
Challenges in Systems: The Church
Despite a shift in the medical field towards openness to the integration of spirituality in care, there remain those in the church who dismiss spirituality as a viable asset to the intellectually disabled. Some argue that the impairments of individuals with intellectual disabilities leave them unable to engage in the necessary conceptual thought about the inner life with God. These prejudices are based on a narrow and unbiblical understanding of the spirit, the inner life of the human person, and discipleship.
If we take the above studies seriously, revealing the importance of spirituality in the care of those with intellectual disabilities, then the church must explore ways to better understand those with disabilities within their own spiritual framework.
We must explore how our own understanding of discipleship might be too shallow and even unbiblically non-inclusive for our brothers and sisters with intellectual disabilities. God can and does meet those with disabilities during their struggle despite their inability to articulate their struggle, and we can too. We will explore the nature of Christian discipleship in relation to disability and how it offers a unique pathway for those with intellectual disabilities to cope with and overcome mental health challenges and be more fully acknowledged as part of the body of Christ.
“Discipleship,” just like “disability,” is a term used again and again. But most simply, a disciple can be understood as someone who follows a master and someone who is identified with that master. So how can this vision of discipleship include those with intellectual disabilities?
First, we must see that it is not just the medical system that has placed those with intellectual disabilities on the margins of proper care and inclusion. As the church, we must see how our methods and traditions of spirituality may place those with intellectual disabilities on the outside. One structural example is that many of our churches and ideas on discipleship have become hyper-cognitive, emphasizing creed, belief, and a mental assent understanding of faith. Our commitments to intellectual positions and propositional truths easily disqualifies many individuals with intellectual disabilities. This becomes yet another space in society contributing to anxiety, depression, isolation, and alienation. This is not to push away the church’s commitment to sound teaching and doctrine. Yet, let us search deeper into scripture to see how people who do not have the same faculties as “able-bodied” or “able-minded” people might meet with God.
Discipleship: Communication and Cognition
What is it like for those with intellectual disabilities to be disciples of Jesus? We who are gifted with words and imagination attempt to share with one another ideas, concepts, and doctrines. Yet there are different ways of “knowing” things about God and there are many ways of being a “disciple.”
The Gospel writers describe encounters with Jesus in an assortment of ways, many of which are not purely cognitive or based on verbal communication: sitting, seeing, seeking, coming, approaching, begging, declaring, hearing, going, crying, asking, wanting, bringing, kneeling, gathering, running, pleading earnestly, shouting, listening with delight, being delighted, being overwhelmed, replying, touching, following, praising, being amazed, filled with awe, overwhelmed with wonder, worshiping, falling, abiding, marveling, recognizing, and exclaiming. On the road to Emmaus, we see experiences of talking, walking, asking, the opening of eyes, hearts burning, telling, and recognizing (Luke 24:13–35). Jesus’ commands to his disciples are not mere commands of speaking or doing. He commands his followers to listen to his voice (John 10), to abide in him (John 15), to find rest in him, (Matt. 11:28–30), etc.
Similarly, Pentecost presents a rich variety of somatic—embodied, physical—pathways in which the human and divine meet. Information is received through a multiplicity of diverse phenomena, actions, and senses: sound and wind (Acts 2:1); sitting and fire resting (Acts 2:2); the Spirit filling and enabling (Acts 2:4); speaking in other tongues (Acts 2:4); bewilderment in hearing (Acts 2:6); being amazed and perplexed (Acts 2:7). Pentecost is not just about speech or hearing: many tongues and senses serve as conduits for communication. Furthermore, the people were not taking an active posture of participation. The text clearly states that the people were simply gathered together in one place (Acts 2:1), and the Holy Spirit took it from there.
Perhaps there are dimensions of discipleship that have been overshadowed by our culture’s preference for such things as power, strength, and intellectual prowess. From Pentecost’s world altering event, we see that spoken words may not be the only or highest form of the Spirit’s communication. It is not people’s cognitive or verbal abilities that enable or disable God from filling them and speaking through them.
Beyond communication and cognition, one way we may reevaluate our understanding of discipleship and disability is in the context of identity. For disciples of Christ, our most core identity is found being in Christ.
Scripture is clear that all those in Christ are held together as one body (1 Cor 12:12), holding fast to Christ as the head, growing together in God (Col 2:19). We each contribute to the body with various functions. We are one body in Christ, and individually members of one another (Rom 12:4–), linked together in body, spirit (Eph 2:13, 16, 18; 4:4), and mind (1 Cor 2:16).
Somehow, Christ’s redemptive work becomes the inseparable link between himself and the redeemed. Paul does not elucidate or explain the “‘how”’ or the “‘mechanism”’ of this union. He asks: “Do you not know that you are God’s temple and that God’s Spirit dwells in you?” (1 Cor 3:16, NIV). This reality goes much beyond learning facts about Jesus. The identity of those disciples with intellectual disabilities, and all other disciples of Jesus, is then “hidden with Christ in God” (Col 3:3). We are all now “one in Christ Jesus” (Galatians 3:28).
Even with the clearest understanding of the body of Christ, it is still easy to push aside those with intellectual disabilities in our faith communities. Many suffer marginalization, misunderstanding, and loneliness within the church. As seen in the studies presented earlier, their suffering is acute and chronic, many times accompanied by anxiety and depression. It is the cross they carry. But God meets them, even there. He uses suffering as one of the very vehicles to meet with us and those with intellectual disabilities.
God’s validation and use of suffering is demonstrated most obviously in his own incarnation, suffering, and resurrection. Jesus’ resurrected body still carried his crucifixion scars, and it was precisely those signs of his suffering on his resurrected body that identified him first to his disciples. Swinton provocatively identifies these signs as an ongoing divine disability, saying, “rather than being associated with limitations of personhood, beauty, perfection, or desirability, human impairment as it is now, is found to be fully equitable with our present and eschatological hopes. More than that, such impairment is incorporated within the life (and the body) of the Divine.” Paul certainly saw suffering as a way to unite himself to Jesus, and to have fellowship with Jesus (Phil 3:10). What profound implications this has then for those who suffer through mental health challenges in the context of intellectual disabilities. Perhaps the “able-bodied” in the body of Christ might do well to look upon the “disabled” for clear examples of God’s imminent help, and how God meets all of us—disabled and able-bodied—in the midst of our human suffering.
Those with intellectual disabilities can indeed approach God without doctrine, creed, or the ability to verbalize thoughts and feelings. They can lean into an utter dependence on God and perhaps live out their discipleship in an even deeper way than those who are able-bodied. Beyond this, those with intellectual disabilities might be able to cope with depression and anxiety in a deeper way as they draw strength from the One who suffered.
Hauerwas presents our universal human need for God as a backdrop for understanding those with disabilities:
for Christians, there is only one story; the story of human createdness and our communal need for redemption as it is offered to us through the life, death and resurrection of Jesus. Within this story we discover that we are creatures wholly dependent on God and on one another; all that we have is a gift. That being so, any ideas of ability or disability are trumped by the fact that as creatures we have nothing to offer; it is all gift and promise.
Let us now seek unity as the body of Christ, just as Jesus, our head, prayed on our behalf, “Holy Father, keep them in your name, which you have given me, that they may be one, even as we are one” (John 17:11, ESV).
 Thomas E. Reynolds, Vulnerable Communion: A Theology of Disability and Hospitality (Grand Rapids, MI: Brazos Press, 2008), 27.
 Sheryl A. Larson et al., In-Home and Residential Long-Term Supports and Services for Persons with Intellectual or Developmental Disabilities: Status and Trends through 2017 (Minneapolis: University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration, 2020): 29, https://risp.umn.edu/publications.
 Nadia El Mrayyan, Jonas Eberhard, and Gerd Ahlström, “The Occurrence of Comorbidities with Affective and Anxiety Disorders among Older People with Intellectual Disability Compared with the General Population: A Register Study,” BMC Psychiatry 19, no. 1 (2019): 1, https://doi.org/10.1186/s12888-019-2151-2.
 Mrayyan, Eberhard, and Ahlström, “The Occurrence of Comorbidities with Affective and Anxiety Disorders,” 2.
 Mrayyan, Eberhard, and Ahlström, “The Occurrence of Comorbidities with Affective and Anxiety Disorders,” 1.
 Dual diagnosis is a term used to describe mental health issues in people who also have a developmental disability. Sometimes it is called “concurrent disorders,” i.e., a psychiatric illness and addiction. The incidence of psychiatric illnesses is greater in the intellectually disabled when compared to the normally developing population.
 Mrayyan, Eberhard, and Ahlström, “The Occurrence of Comorbidities with Affective and Anxiety Disorders,” 6.
 For further discussion on the results of an inability to verbally express oneself and its link to mental health see Jane A. McGillivray and Marita P. McCabe, “Detecting and Treating Depression in People with Mild Intellectual Disability: The Views of Key Stakeholders,” British Journal of Learning Disabilities 38, no. 1 (2010): 68–76, https://doi.org/10.1111/j.1468-3156.2009.00573.x.
 Factors such as protection, resilience, and healing are some of the areas that show potential for growth in the intellectually disabled community when spirituality is integrated into mental health practices. See Marco O. Bertelli et al., “The Relationship between Spiritual Life and Quality of Life in People with Intellectual Disability and/or Low-Functioning Autism Spectrum Disorders,” Journal of Religion and Health 59, no. 4 (2020): 1997, https://doi.org/10.1007/s10943-019-00891-x.
 Bertelli et al., “The Relationship between Spiritual Life and Quality of Life,” 1997.
 Bertelli et al., “The Relationship between Spiritual Life and Quality of Life,” 1997.
 Bertelli et al., “The Relationship between Spiritual Life and Quality of Life,” 2004.
 Bertelli et al., “The Relationship between Spiritual Life and Quality of Life,” 1998.
 Richard N. Longenecker, Patterns of Discipleship in the New Testament (Grand Rapids, MI: Eerdmans, 1996), 2.
 These scriptures are but a fraction of examples in the New Testament:
- Sitting: Mark 3:32; Luke 10:39
- Seeing: Matt 28:17
- Seeking: Luke 4:42; John 6:24
- Coming: Matt 5:1; 8:2; 13:36; 14:15; 15:25; 16:1; 21:14; 26:7; Mark 2:13; Luke 5:15
- Approaching: Matt 17:14
- Begging: Matt 8:31; 8:34; 15:36; Mark 5:18; 6:56; 7:26; 8:22; Luke 5:13
- Declaring: Mark 10:20
- Hearing: Matt 13:9; 14:1; Mark 3:8
- Going: Mark 6:12
- Crying: Matt 15:21
- Asking: Matt 8:5; 9:11–14; 11:2; 13:10; Luke 7:3
- Wanting: Matt 12:46
- Bringing: Matt 4:24; 8:16; 9:2; 9:32; 14:35; 15:30; 19:13; Mark 1:32; 2:3; 7:32; 10:13; Luke 4:4
- Kneeling: Matt 8:2; 9:18; 15:25; 17:14; 20:20; Mark 10:17
- Gathering: Matt 13:2, Mark 2:2; 4:4; 5:21; 8:1; Luke 12:1
- Running: Mark 10:17
- Pleading Earnestly: Mark 5:23
- Shouting: Matt 8:29; 20:31; 21:9; Mark 10:48
- Listening with Delight: Mark 12:37
- Being Delighted: Luke 13:17
- Being Overwhelmed: Mark 7:37
- Replying: Matt 9:28
- Touching: Matt 9:22; 14:36; Mark 5:27; 6:56
- Following: Matt 4:22; 8:23; 9:9; 9:27; 12:15; 14:13; 19:2; Mark 1:17, 20; Luke 5:11; 5:28
- Praising: Matt 9:8; 15:31; Luke 7:16; 13:13
- Being Amazed Matt 7:28; 8:27; Luke 9:43
- Filled with Awe: Matt 9:8; 9:33; 12:23; 15:31; 19:25; 22:33, Mark 1:22, 27; 4:22; 10:32, Luke 4:32; 8:26
- Overwhelmed with Wonder: Mark 9:14
- Worshiping: Matt 14:34; 28:16
- Falling: Matt 17:6; Mark 5:33; Luke 5:8; 5:13; John 11:32
- Abiding: John 15
- Marveling: Luke 9:43; John 7:14
- Recognizing, 14:34; Mark 6:33
- Exclaiming: Mark 9:24
 This is not to say that Jesus’ commands are void of action or requiring cognition. Yet these are not the only commands to his disciples.
 John Swinton, “The Body of Christ Has Down Syndrome: Theological Reflections on Vulnerability, Disability, and Graceful Communities,” Journal of Pastoral Theology 13, no. 2 (2015): 71, https://doi.org/10.1179/jpt.2003.13.2.006.
 When we look at those with disabilities, it is easy to see their need for care as central to their place in our communities. However, not only is giving and receiving care a universally experienced reality, but any “abledness” one might possess in life is temporary. For the able-bodied, weakness might be hidden for a time, only to resurface later in life as the parts of our body wear down. Naturally, humans go from needing care as infants, to being independent of care and giving care, only to revert into needing care when elderly. Care is sacred for the provider but also for the receiver; being cared for is not meant to be undignified, but part of our mortal life. Those with disabilities may then not fully participate in this middle stage of so-called “able-bodiedness” but this does not exclude them from any sort of participation in the body of Christ or a relationship with Christ himself.
 In fact, John focuses on Thomas’ need to see these physical scars as the mechanism to truly identify Jesus. Though this is turned into an example of the value of faith without sight, the reality remains that John includes a vivid description of Jesus’ resurrected body still having physical scars of his suffering (John 20:24–29).
 Swinton, “The Body of Christ Has Down Syndrome,” 283.
 Helpfully, John Swinton argues that “the type of God we assume God to be will, to a greater or lesser extent, determine how we understand what it means to be human, which in turn will determine how we respond to disability. It is therefore a deeply theological and practical question. If God is disabled, deaf, interdependent, friendly, accessible, and so forth, then our responses to those who are made in the image of such a God will be shaped accordingly.” John Swinton, “Who Is the God We Worship? Theologies of Disability: Challenges and New Possibilities,” International Journal of Practical Theology 14, no. 2 (2010): 300, http://dx.doi.org/10.1515/ijpt.2011.020.
 Stanley Hauerwas, Working with Words: On Learning to Speak Christian (Eugene, OR: Cascade Books, 2011), 296.