In Search of an Answer

Image result for whyWhy?

Why me?

I have been asking that question for several weeks now. It’s a search to which I may never have a satisfactory answer. No records exist. No old journal or diary to consult. What information I have comes from my memory and that is not always reliable.

Why do I have depression?

The year was 1968. It was during the school year and I was in third grade. Although my oldest brother had taught me how to swim, Mom insisted that I take a course at the YMCA. Everyone was confined to the shallow end until you could swim under water from one side of the pool to the next. I accepted the challenge and gained my freedom to explore the deep. But, I couldn’t take advantage of it.

I got sick. It would take two weeks before I was well enough to go back to the YMCA. However, the course had ended and my opportunity had passed. The sickness came on suddenly. A high fever, spinning rooms, hallucinations, and paranoia gripped me. There were several days I couldn’t get out of bed.

My mother took me to three different doctors. We left their offices with three different diagnoses. As an adult I thought it may have been the Hong Kong flu epidemic, but with more study I found out that it didn’t reach the United States until 1969. No further clues and therefore answers are to be found.

It has been observed that people with the flu often become depressed, but it appears not to last much beyond the illness. I have focused on the high fever and that it caused some brain damage. However, fever with the flu (if that is what I had) rarely is high enough to cause brain damage.

The reason I focus on the fever is because of a long term after effect that troubled me for the next eight years. For lack of a better term, I will call them “seizures,” but they don’t strictly fit the definition. On occasion, I would wake up suddenly drenched in sweat, shaking, disoriented, the room spinning, and crying profusely without a reason. Always, I managed to awaken my mother and she gave me sweet hot tea and stayed with me until I was calm enough to go back to bed. A doctor suggested to her that I was just trying to get attention.  When the next one came on, I didn’t wake her and went through it alone.

At first, they were not frequent enough to rouse any concern, but the older I got the more frequent they became. My mother thought it might be related to my older brothers leaving home and beginning new lives with spouses and children of their own. But, when I had about three in a two week period of time, my mother took me to the doctor mentioned above. This time he referred me to a neurologist.

That doctor ordered a brain wave test. After the test results came back, he informed us that I had a blockage in my brain and put me on medication. I took those pills for two years – they were simply awful. Finally, I told my mother I had had enough and I was not taking them anymore. Mother didn’t object, but she prayed earnestly for me. I have not had another “seizure” from that time to this. The only residual effect I have is the room begins to spin if I have a slightly high temperature.

As I look back on those events, I can see a mood change. I was a happy kid, afterwards I was far too serious. Fear replaced courage. I became melancholy. Thirty years later melancholia turned into recurrent, severe depression.

That is all I know. Was that childhood illness the cause? If so, what was it? I can eliminate heredity as a cause – no one on either side of the family ever had long-term depression. No, I still think that prolonged fever caused a biological or chemical change in my brain. But, if that is true, is it reversible? I don’t have an answer.

The neurologist told Mom that I would never be able to handle much stress. I chose to be a pastor and a counselor – among the highest stress jobs you can take. The doctor was right. I have paid a heavy toll  both physically and mentally because of stress.

Although, I know all of the above information, there are questions still. What illness did I have in 1968? Was the water of the YMCA pool a contributing factor? What do I call those “seizures?” Is this the actual source of my depression, or should I look elsewhere?

I don’t know! So, I am still searching for an answer to the “Why?” question. I can only hope that the search is worth it.

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Harvey is Depressed

About three weeks back, I was brainstorming with my wife regarding writing prompts.Image result for hurricane Harvey at sea There was one that particularly caught my attention: “What would it look like if nature was depressed?” I began jotting down several ideas and planned to post it today. Then Harvey happened, and the thought about nature and the natural event merged into a single idea.

We live about 170 miles north-northwest of where Harvey came ashore. It was forecast that our community could be hit with 70 plus mph wind gusts and up to 12 inches of rain. We made preparations to evacuate, if necessary. The coastal region was hit fiercely, resulting in destruction and damage to infrastructure and property. Flooding has devastated Houston. People have lost their lives, families are separated, and many are missing. And, Harvey is not finished yet.

We were spared the worst. Winds reached the mid-50 mph range and we received about six inches of rain. As I was walking Monday during the waning hours of Harvey in our area, I noticed the north side of all the vehicles was covered with leaves while the south side was clean. Evidently, we were on the downward side of the counter-clockwise storm rotation. Limbs are everywhere, some trees are down, and shingles from roofs are scattered about. But, nothing more serious happened here. Please continue praying and helping the people along the coast.

The reason all this happened started with nature being depressed. The evolution of a hurricane is something like this: a tropical disturbance occurs followed by a tropical depression, tropical storm, tropical cyclone, and finally a hurricane. It all started with disturbed and depressed pressure.

Those are the facts, but allow me, with respect and sensitivity to those who have paid and are paying a high price because of Harvey, to explore the idea of nature being clinically depressed.Image result for dark and rainy clouds blocking out the sun

Depressed nature’s day begins in darkness. Tears drip from its cloudy pillow upon the sheets of grass covering the earth. The night lingers, resisting the presence of light. When at last the sun prevails, it emerges clothed in pajamas of black and gray. The light mopes through the day unable to stop its forward motion and uninterested in trying. There is no struggle against the dimness of dusk. Rather, it is strangely welcomed. The skies moan as another day ends with little hope that tomorrow will be different.

It appears nature is trapped in a state of perpetual fall and winter. Things are either dying or dead already. Plants are in various stages of drooping and wilting, the grass is turning brown. Trees that once stood as towers of strength and grandeur are now denuded, slumping toward the earth. Creatures of the earth roam aimlessly in search of what they know not. Some are thin for want of appetite, while others are fat but never satisfied.

The caretakers of the earth worry about its prolonged sadness, decreased production, and low birth rates. The perpetuation of species is so disturbed that many are endangered. Park rangers and visitors are finding neglected and abandoned offspring. At other times, they observe the little ones being over-protected to near suffocation. Fear is thick in the forests and glades.

If one pauses to listen, silence meets them. Birds are not chirping against real or imagined danger.  The creatures of the earth fail to communicate with each other where food can be found or a pleasant resting place. There are no sounds of snorting deer or howling coyotes. Buzz is absent from the ear. The would-be-listener longs for the annoying gnat to appear, but alas it too is silent.

Frisbees lay undisturbed and balls gather dust as our companions lose interest in playing. The purr of pleasure is silent against our gentle strokes.

Batteries die as solar panels and wind mills are unable to collect energy from the unmoved wind and shadowed light. Coal and oil refuse to burn, atoms will not split. Thermal energy weakens as the core of the earth grows cold. The earth is too weak to quake.

Geysers are less faithful. Springs become temperamental and artesian wells sputter. The dysthymic morning mist that gives the Smoky Mountains its name lapses into depressive fog. The tide whimpers ashore. Nature appears to have lost its will to live.

The caretakers of the earth paint and decorate artificial masks of splendor in an attempt to both hide nature’s sadness and in a pretense of normalcy.

None of this, of course, describes Harvey. He is angry and violent. Anger is widely accepted as a symptom of depression in men. Dr. Michael J. Formica wrote, “Show me a mad guy and I’ll show you a sad guy.” Harvey came ashore in southeast and south-central Texas full of rage. Where he has been is evidenced by the destruction and misery he’s left behind. Although Harvey is weakening, he is still very capable of violence as he heads toward east Texas and western Louisiana.

This is a solemn piece, I know, but clinical depression is a grave condition. In the days before I became clinically depressed, my family and I laughed at the way I shuffled on days I had a depressed mood. I couldn’t replicate that shuffle when I was feeling good. Then came the day when it ceased to be funny and became frightfully chilling.

Texas will recover from Harvey. Nature will rebound. In a few years, scars left behind will exist in memories alone.

Most people who become depressed will eventually go into full remission and never have another episode. For a small minority, partial remission is the best outcome we can expect.

The greatest technological advances of humankind have yet to find a way to control the Harvey-like eruptions or dark and teary moods of nature. This is not so for most people who have a major depressive disorder. For all, but a limited few – 1/1000 of a percent of the population – depression is treatable.

Harvey is dying. By the end of the week it will likely be no more. The wind and rain, and all the other weather events a hurricane can spawn will be gone. The sun will shine again.

Unlike Harvey, you and I who fight depression do not have to die – either physically or emotionally. There is hope for a better tomorrow. You and I have a reason to live.

One Day’s Struggle Against the Dragon of Depression

July 15, 2017

Today is starting well. It is 5:30 and I’m ready to get up and start my day. But for the sakeImage result for dim light in darkness of Charity (my wife), I will read the news and check out the posts on Facebook until 8:00. Although my night was short, it was five hours of sound slumber without any PTSD dreams to disturb my sleep.

9:30 finds me in the shower getting reading for the day and anticipating brunch.

10:00. On the weekend, Charity almost always fixes a nice brunch on Saturdays. Today it’s pancakes and bacon. While I’m eating my breakfast a cloud of darkness descends and engulfs me in its blackness. I finish the meal with my head in my hands. My plans of putting baseboard down will have to wait.

Why am I suddenly sad? Every reserve of energy has evaporated like the morning mist does when introduced to the sun. My strength is failing as an abyss of sorrow overpowers me. Any will I had mustered for the task ahead, any determination and resolution, and any excitement and joy is being replaced with paralyzing fear and disabling weakness. Why is this happening? Is my tendency toward perfectionism causing me to question my ability? I have been undaunted about taking on projects that I previously had no experience doing. Why has my confidence left me now?

10:30 The night of restful sleep is consumed by my dragon of gloom until I am left chained to the desire for isolation and helpless against my eyelids forcing out the light.

2:00 Nearly four hours have passed. As I slump in my chair in various stages of sleep and wakefulness, my sleep is not deep enough to escape from Saturday’s normal house noises – our grandchildren playing, and Charity coming in to check on me and ask a question or two. Yet, my wakefulness is not enough to move beyond my four-legged dungeon. Only the call of nature makes the foreboding door open, but freedom is not within reach. A tether of sadness does not let me stray far.

2:30 Trying to chase away my dragon with numbing noise, I turn on the T.V. For a few moments as a story unfolds I climb upward, but with each commercial or the end of a story I fall off my ladder of escape. This repeats itself for the next eight hours.

4:00 Charity comes in again as she has done throughout the day. She comforts me with an engulfing hug, a tender and empathetic kiss, and a reassuring, “I love you.” Her kindness and supportive gestures are appreciated far beyond my ability to reciprocate. The bars of the dungeon are too strong and I remain trapped in the dragon’s lair.

Could it be a crisis of confidence? I wonder, looking for answers where there seems to be none. Has my fear of failure reduced me to inaction? Are my perfectionistic tendencies crippling my mind with a fog of mistakes? Bedtime releases me from the dungeon to walk two steps to my bed where the sense of gloom and sadness has me ensconced still.

10:00 As I prepare for the unknown night, the 25th day of my battle with the dragon comes to an end. It has won the day and gained ground. What will tomorrow bring – more defeat, a draw, or a little victory?

As I settle into the bed and pillow my head, I see a ray of light. It is the same Light that has always been there through nearly two decades of battle with the dragon.  It is sometimes so dull and faint the darkness threatens to shut Him out; sometimes bright, shining rays of hope into my despair.

Hebrews 6:18 reads, “This hope we have as an anchor of the soul, both sure and steadfast . . .” Hope is the best medicine for despair. If all of the things I treasure are suddenly gone and I still have a dose of hope, I can survive. I can thrive. Someone said, “There is nothing left but to bury a man when all hope is gone.” But, for the Light, however dim, I would be that man. Hope has kept me alive. It is when hope is fed that the shadow of death must give way.

A second thought entered my mind before I went to sleep. What can I learn from this depression episode? Here I confess my independence and the efforts to conquer my dragon by my own power. I need help – the help of God, my family, and my support network. When I humble myself and admit my weakness, that is when I grow in strength. May the lessons I learn be put to good use to help family, others, and myself.

11:00 Sleep joins my hope and willingness to learn, which together provides a peaceful slumber.  My last thought of the night is that tomorrow will be a better day.

May the LORD be with you.

WITHOUT DEPRESSION, I WOULD . . .

A person sent me a note last week that read in part, “I am so sorry you have to suffer from the illness of depression.” Immediately I responded with a “Don’t be sorry for me.”

The 19th century pastor, Charles Haddon Spurgeon, had a mega-church before that phrase was coined. By age 22 he hadImage result for charles haddon spurgeon crowds that surpassed the 10,000-seat capacity of the largest auditorium in London. Yet, he was plagued with disabling depression. However, he credited his depression with making him a better minister.  “The way to stronger faith usually lies along the rough pathway of sorrow,” he said.

“I am afraid that all the grace that I have got out of my comfortable and easy times and happy hours, might almost lie on a penny. But the good that I have received from my sorrows, and pains, and griefs, is altogether incalculable.… Affliction is the best bit of furniture in my house. It is the best book in a minister’s library.”

At another time he wrote, “I would go into the deeps a hundred times to cheer a downcast spirit. It is good for me to have been afflicted, that I might know how to speak a word in season to one that is weary.”

Since I received that note, I have thought about what I would have lost without depression.

Without depression, I would not have the understanding or insight I possess today. The food of despair, the drink of hopelessness, the bitter cup of feeling forsaken by God, the acrimonious prayers to die, and the dish of suicidal ideations have plagued my soul. I can sit with people who lounge in the cellar of darkness and understand the depth of their agony. I have more authority than most to speak to them in their misery, because I sat where they sit.

Without depression, I would not have discovered my capacity for empathy and compassion. Because of the losses I have experienced I can sit at the table of sorrow with others and weep with those who weep. It brings a modicum of comfort and mollifies the feeling of aloneness when someone who has hazarded the treacherous waters before you enfolds you with arms of mercy.

Without depression, I would not be able to effectively advocate for those hidden and forgotten by society. I was homeless four times, penniless – without a cent to my name – for seven months, without transportation, unable to get housing or employment because of my criminal record, prevented from being near my fiance’s grandchildren, slandered, shunned, and denied a path to ministerial restoration without a hearing. Many doors were bolted against me because governments erected hundreds of barriers for the criminally convicted that prevent housing, employment, and stability. The floor attachment of a vacuum is being used to clean the fine furniture. As a result the beautiful upholstery is being sucked in along with the intended dust. The resulting damage far outweighs the harm the dust could ever have done. Federal, state, and local governments demand science based outcomes, but they are guilty of ignoring that same science when it comes to making laws and regulations. I have experienced the injustice and can now give voice to righteous causes.

Without depression, I would not know the need to fight against the stigma of mental illness. I become angry when I hear others define the life and character of an individual with a mental illness diagnosis, “He is schizophrenic” or “She is autistic.” In every other health discipline stigmatic vocabulary has been eliminated. “He is a dwarf,” thankfully has passed from formal usage. To say, “She is retarded,” is considered cruel. There would be a rousing chorus of fervent criticism against any hospital staff that referred to its patients as “the heart attack at the end of the hall,” or “the cancer in room 303.” The purveyors of kindness in our society have overlooked the labeling, prejudice, discrimination, and separation experienced by the mental health community. This needs to change.

Without depression, I would not have experienced the freedom that came inside a jail cell. Imprisonment was the only thing that stopped me cold on the path of personal destruction. A year of confinement gave my mind and body the rest it desperately needed after nearly forty years of abuse. Most importantly, it gave me an opportunity to renew my relationship with God.

Without depression, I would not be on the path to becoming the man I always thought God wanted me to be. Gone is the uncontrolled anger and yelling. In its place has come a capacity and ability to love others unconditionally, forgive, humble myself, and grow as a husband, father, and grandfather. What I had aspired to be all my life is becoming a reality and the boundaries of who I can become are being moved higher.

Without depression, I would not know the joy of being in right relationship with Jesus Christ. Beyond elevated emotions, beyond a rule book and a uniform, beyond correct dogma and doctrine, and beyond creeds and rituals; I have come to know that abiding place in Jesus where I as a branch receive nourishment from Him as the Vine, submission of myself and the desires and plans I may have to the Lordship of Christ, and a desire to know God in His revealed character and attributes, the splendor of His creation, and the grace of His redemptive work.

Spurgeon professed, “This depression comes over me whenever the Lord is preparing

a larger blessing for my ministry; the cloud is black before it breaks, and overshadows before it yields its deluge of mercy. Depression has now become to me as a prophet in rough clothing, a John the Baptist, heralding the nearer coming of my Lord’s richer benison (blessing).”

Do not be sorry for me. Without depression, I would not have the experience, knowledge, and wisdom I have today. Several years ago I quit praying for healing. My prayer now is to learn the lessons God is trying to teach me through each depressive episode.

May the LORD be with you.

 

Choose Your Insanity, Part II

Common Side-Effects of Antidepressants

Image result for medication side effectsCome imagine with me a resilient fellow, named Sebastian, with recurrent, severe depression. In his mid-40’s, he is active when he can be. With a wife and six children in the home, he tries to be the best husband and father he can. He has experienced what it means to be untreated and under-treated for severe depression and has suffered the consequences. Now that he has found the right cocktail of medications to keep him from suddenly plunging into darkness, he has discovered a new form of insanity.

Antidepressants can bring with them their own set of issues. The side-effects can range anywhere between slightly annoying to extremely agitating. What happens to you depends on the type of medication you take. Sebastian takes a SNRI (selective norepinephrine reuptake inhibitor), two atypical antidepressants, and an alpha blocker for nightmares.

Common Physical Side-Effects

One of the first side-effects our fellow had was blurred vision. He was driving his children to school one day when it happened. He could no longer see things in real proportion. Sebastian’s poor daughter had to take a quick lesson in driving a long wheel-base van. Fortunately for our fellow, it lasted less than two weeks, but it can drive one crazy during the experience.

Dry mouth is another ongoing problem. He often wakes up with no liquid in his mouth, parched lips, and an awful taste that he thinks surely his wife and children can smell. If he does not take a drink first, one of his medications will stick to the top of his mouth and stay lodged there until some flood of fluids carries it away. Sebastian has discovered the only remedy is to keep something in his mouth throughout his waking hours. Copious amounts of water, flavored drinks, or hard candy help. See what our fellow has to look forward to every morning.

Sebastian has tremors, too. They can be mildly irritating or outright disabling. He tries to be somewhat of a handyman about the house, but often finds he has to make several attempts to get a screwdriver in the slot, hammer a nail, or put something up that requires a steady hand. He is especially embarrassed at supper. He sometimes spills his drink and when he tries to eat, there may be nothing left on his fork by the time he gets it to his mouth. Our fellow feels like a little child that needs a large bib and someone to feed him.

Other physical side-effects can be headaches, dizziness, sweating, nausea, constipation, diarrhea, joint pain, muscle aches, and skin rashes. These are often mild and temporary and “many people build up a tolerance to these early side-effects, and they rarely require discontinuation of medications.” (Dr. Madhukar Trivedi, MD.)

Issues with Sleep and Weight Gain

Sleep is quite an adventure for dear Sebastian. Without medication, he has terrible insomnia. (Sometimes anti-depressants can cause insomnia. Go figure.) When he does sleep, he has to take a “no dream” pill to prevent nightmares and acting out. It does not work all the time. Sebastian will flail about with his arms and legs, hitting and kicking imaginary people or things. At other times he screams, cries, sounds like a baby, makes speeches, or carries on a normal conversation with an unseen person. His lovely wife has to be a brave woman to sleep next to him. His sleep disturbances can contribute to irritability and anxiety. Trouble sleeping can cause Sebastian to be fatigued and drowsy during the day. Our fellow would either be taken to jail or declared legally insane if the right people observed his behavior while sleeping.

The inability to sleep also contributes to suicidal ideations. Although suicide is a slight risk affecting about two to four percent of those who take anti-depressant medication, it is a grave concern. Those who already have a plan to harm themselves may be the most vulnerable. Anti-depressants may give them enough energy, which was in short supply before, to carry out their plan.

Weight gain can be a late arriving and long lasting side-effect. It is one of the major reasons people either stop taking their medication or insist on a change. Sebastian has lost a significant amount of weight. He looks good and feels better about himself. However, the last 20 pounds he wants to lose has been tortuous. He has cut his food intake so severely that he wonders how long he can maintain his restrictive lifestyle. But, it is necessary if he wants to reach his goal. Our fellow is fighting the good fight against increased appetite and weight gain, but he wonders how long he can maintain his restraint without a complete breakdown.

Sexual Side-Effects

Sebastian is young and healthy enough to act on his sexual desires, but the medication prevents performance. Sexual side-effects from anti-depressants are long-term. Like weight gain, sexual dysfunction is a major reason people stop their medication.  Sebastian has experienced it all – difficulty getting an erection and maintaining it, trouble with decreased orgasm or none at all, and a decline in sexual desire. After all, why would you be interested in sex if you cannot perform? Sebastian has tried several things, but has not found anything that works consistently. He and his patient wife try to schedule a night for intimacy. On that day, he does not take his medication. Sometimes it works and sometimes it does not. The lack of medication during the day can leave him feeling sad and blue, and without any sexual desire. At other times, he is still unable to achieve or maintain an erection, or have an orgasm. Our fellow has a God given natural desire, but the inability to carry that desire to fruition is maddening.

I have often told my children that the most difficult decisions in life are not between good and bad, but between good, better, and best or bad, worse, and worst. Sebastian has found this to be true in regards to untreated, under-treated, or treated depression. The choice comes down to which form of insanity do you want to experience. Our long-suffering fellow has chosen to be treated for his recurrent severe depressive disorder and learn to live with or manage his side-effects. To be untreated or under-treated has caused too many adverse consequences that he does not care to repeat. Furthermore, the risk of suicide without proper treatment is too great for Sebastian.

Sebastian is right. Although the medication side-effects can be nearly intolerable, death is too great a risk to take with the other choices.

May God be with you.

 

Choose Your Insanity, Part I

Untreated or Under-Treated Depression

Image may contain: house, sky, tree, outdoor and natureOver the past 19 years I have learned the consequences of untreated and under-treated depression. And, I have picked up a thing or two about the side-effects of antidepressants. Either can drive you mad.

The first sign that my 30 years of occasional melancholia was turning into clinical depression was in the summer of 1999. It started with what the doctor called, “cluster-headaches.” It was painful and came in cycles of repeated headaches followed by periods without them. The doctor prescribed sunglasses. (He probably gave me a medication, but the sunglasses are all I remember). It may be a cool look to wear shades, but imagine me in church on a Sunday morning leading worship and preaching with sunglasses on. Believe me, it makes eye-contact pointless when the congregation cannot see your eyes.

The second sign began in the fall of the same year. After multiple trips to the hospital and the doctor, it was determined I had Irritable Bowel Syndrome (IBS). The pain was severe and disabling. Nothing I was prescribed helped. I was asked to join a trial study for a medication that reportedly “was the best thing since toilet paper.” Because of some bleeding, I had to have a colonoscopy. Every medical person who was part of the trial study was interested. My procedure became the main attraction of the day with a regular stream of doctors and nurses coming in and out for a look. Hey, bottoms up! After no noticeable change, I was referred to yet another specialist who prescribed a medication that finally worked. But, with the pain gone, the true culprit appeared with a vengeance – depression.

A moderate to severe depressive disorder can have serious effects on your physical and mental health. Besides headaches and digestive issues, depression is often accompanied by back pain, stomachaches, chest pain, achy legs and arms, sleep problems (insomnia or hyposomnia), and weight gain or loss. It can make it harder to get over the flu or other seasonal illnesses, too. Studies have shown that people recovering from a stroke or heart attack and have comorbid depression are at double the risk of death than a person without depression. One study concluded that an “episode of clinical depression is as dangerous as smoking in causing heart disease and heart attacks.”

Depression also affects your brain. Sluggish thinking, difficulty concentrating, trouble remembering, problems making both minor and major decisions, and difficulty focusing are common. Recent studies have determined that untreated or under-treated depression can cause the brain to shrink. In most cases the brain will recover, but it can become permanent if the depression is left untreated over a long period of time. Magnetic resonance imaging (MRI) scanning has shown that depression is related to abnormalities in the memory center, conflict-resolution area, and the planning and executing parts of the brain.

My under-treated depression was partly my fault. I was inconsistent about going to a psychiatrist or a mental health counselor. After a while, I thought I could forego the travel and hassle of seeing a psychiatrist and let my family doctor prescribe my medications. One general practitioner gave me prescriptions covering a whole year. One annual appointment was really convenient for me, but not healthy.

Finding a counselor with whom I could stay engaged was difficult. On the second visit to the first therapist I tried, she told me that maybe God was finished with me. After my next visit, I was finished with her. Other times I used the miles I had to travel or the money I had to spend as an excuse. You see, I had yet to lose confidence in my ability to handle my own depression. It was not until after four hospitalizations and losing nearly everything in my life that I held dear, that I decided it was time to see a psychiatrist and go to counseling consistently. During that time, I had frequent, long and persistent episodes of suicidal ideations. The first lasted four and one-half years, the second and third one year each, and the fourth two years.

Untreated or under-treated depression carries a high risk of suicide. Thoughts can grow worse with time. My last round of suicidal ideations was so severe that it took every ounce of will I had to not jump in the swift river I walked beside or run and step in front of the train whose whistle I heard. Feelings of hopelessness, worthlessness, and visions of an aimless future gripped my soul. At one point, only the thought of spending an eternity in hell prevented me from completing suicide to escape the pain. Suicidal ideations can also express themselves in reckless behavior, risky situations, and dangerous circumstances.

Relationships can be damaged beyond repair. Family and friends can feel ostracized by your changed mood and behavior. Irritability, isolation, anger, lashing out at loved ones, and a disinterest in most things including sex do not make for healthy relationships. During my under-treated depression, my marriage ended and I became estranged from my children and grandchildren. God seemed far away.

Careers can become a casualty of moderate to severe depression. Accumulating sick days, unproductive efforts, lack of energy, and diminished concentration is not a recipe for a good employee. Both of my careers – pastoral ministry and counseling – were lost and are now unrecoverable. Students can lose interest in or find it difficult to study. Class attendance can be sporadic and assignments are late if they get turned in at all. Aimlessly sitting around thinking about your symptoms, sadness, and misery can interfere with decision-making and make matters worse.

Substance and/or alcohol abuse, addiction, and self-injurious behaviors are possible.

Yes, untreated or under-treated depression can put you into a sad and worsening state of affairs. Psychotic breaks from reality, catatonic features, catalepsy, posturing, echolalia or echopraxia, anorexia, obesity, and leaden paralysis are possible.

Is there any hope? There is always hope. Proper treatment can go a long way toward restoring a new normal. However, that “new normal” can come with its own challenges and its own brand of insanity.

Come back next week for a look at the common side-effects of anti-depressant medications and the issues they cause.

NOT A CHANCE!

Image result for no chanceWithin the past couple of weeks someone asked if one could function normally and have severe depression. I responded with an emphatic “No!” There is no way one can go about his/her day without “a change from previous functioning” if they have a major depressive disorder. Even a person with dysthymia or a mild-to-moderate depressive disorder will have some impairment. However, severe depression is in a different league all together. In no way am I trying to minimize depression in whatever form it may take, but by definition severe depression severely interrupts one’s routine. According to the Diagnostic Criteria from the DSM, severe depression is marked by “several symptoms in excess of those required to make the diagnosis, and symptoms markedly interfere with occupational functioning or with usual social activities or relationships with others.” In order to meet the criteria of a major depression diagnosis, one must have at least five of the nine symptoms for a minimum of two weeks and have a change from previous functioning. Severe depression requires eight or all nine symptoms to be present. A depressive disorder is not to be equated with sadness, grief, or a “terrible, horrible, no good, very bad day.”

Four years ago this month I wrote the following attempt at a poem.

Ode to Despair

What can you say when there are no words to express                                    The pain, the sadness, and the foreboding hopelessness.                  Statements, remarks, and speeches reverberate like a round                       That goes on and on without end in meaningless sound.

“Due despair and agony on me, deep dark depression,                          Excessive misery,” is an all too common sad expression                                  For the weary and worn who go through life damaged,                           Hidden, misunderstood, in anguish, wounds un-bandaged.

“Who can deliver me from this body of death?” I shout,                                   But only an echo returns with scorns and mocks all about.                        “There is no help for him in God,” I hear as trouble multiplies,              Gloomy and cheerless, I want not to live and am afraid to die.

“It is enough! Now LORD, take my life,” I earnestly pray.                             “What are you doing here?” the LORD whispers in the fray.               “Forsaken, torn down, killed all the day through,” I reply.                              GOD listens with compassion HIS grace ready to supply.

Strong winds tear at mountains and break rocks into slivers.         Earthquakes alter the contour of the land and courses of rivers.                   Fire purges the grass from the field and fells the trees.                                    But, the LORD passes by gently and speaks to my needs.

As you can infer, I was severely depressed. As a Christian I could not end the poem in absolute despair, so I included a stanza of hope. To be truthful, it was not how I felt at the time. Death, I thought, would be a relief.

I had all the symptoms – depressed mood, diminished interest in activities, weight gain, hypersomnia, psychomotor agitation, fatigue, diminished ability to concentrate, and recurrent thoughts of death with suicidal ideations – of a major depressive disorder. To put it succinctly, I was a mess. Depression had been hounding me for a year as I spiraled downward into a bottomless free-fall. And, for the next eighteen months I trudged through a morass of thick, endless darkness with no hope of escape. Normal functioning? That was an unknown cloud in cuckoo-land. Severe depression destroyed everything I spent my life building and it very nearly destroyed me, too.

Thank the good LORD I have been in partial remission for over two years. Although I have accepted the fact that I will never be “normal” again, I find that life is well worth living. I have hope, fulfillment, happiness, and contentment. If you can function normally, thank God, address whatever is troubling you, and march on toward health and wholeness. On the other hand, if you are falling and cannot seem to right yourself, there is hope. Reach out to a professional who will help you begin to heal.

The peace, mercy, and grace of our LORD be with you. Amen!

*image from 123RF.com

RELAX ALREADY!

Image result for cabin and barn in the woods of southern indianaLast week I promised to write about relaxation techniques. The three I mentioned – systematic muscle relaxation, deep breathing exercises, and guided imagery – come from the field of behavioral sciences. These routines help me to achieve a modicum of serenity when the noise overwhelms me or claustrophobia threatens to box me in. Although the methods are borrowed from the behavioral sciences, my application of them is unique to me.

Systematic Muscle Relaxation                                                                                                              Many people use muscle relaxation unconsciously at bedtime to prepare for sleep and discharge the pent-up anxiety of the day. It is a means of releasing the tension that builds up in our muscles when stressed. One of the advantages of muscle relaxation is that it can be used discreetly in public without being noticed or thought strange. I like it, too, because muscle groups can be relaxed separately or in conjunction with the whole.

First, sit in a chair and put your feet on the floor and your hands on your legs. (You may also do this standing or lying down.) Begin with curling your toes tightly and keep them in that position for a few seconds, but not more than five, and gently and slowly release them. Next do the same to your foot muscles. Follow this procedure with each individual muscle set –calves, thighs, buttocks, waist, stomach and lower back, chest and upper back, fingers, hands, forearms, biceps, shoulders, neck, and face – always working systematically toward your face. If you cannot do the whole body, you can work up from your toes to your waist, up from your waist to your face, torso only, arms and hands alone, or simply the neck and face. Systematic muscle relaxation is very adaptable to nearly all situations.

When each set of muscles releases, you will feel the stress and tension recede from your body. The situation may not change, but the physical bonds that imprison your body can be loosened.

Deep Breathing                                                                                                                                        Deep breathing has the same advantages as muscle relaxation. It really helps me to regain control of my emotions, especially anger, when I am out-of-sorts. The preparation for this exercise is the same as for the above.

Take in a long deep breath through your nose. Deep breaths come from your diaphragm and fill the lower portion of your lungs. If your chest and shoulders move significantly, it is a shallow breath. With a deep breath your stomach expands and your chest and shoulders barely move, if at all. If it is hard for you to do sitting or standing, try it while lying on your back. Your body automatically reverts to deep breathing in that position.

So, take a long deep breath through your nose and hold it for the slow count of three. Then slowly blow it out through your mouth like you would gently release a balloon of its air. When done correctly the exhale will last for nearly ten seconds. Repeat and count to two. Finally, repeat and count to one. You can repeat this exercise in groups of three as many times as you need.

Guided imagery                                                                                                                                      With this method you need a quiet and comfortable place where disturbances can be kept minimal. It may help to do some muscle relaxation and/or deep breathing exercises in preparation. Come go with me as I journey to and from a special place.

I close my eyes and imagine all the goings-on of a large city. People are walking here and there with determined purpose taking little notice of others or their surroundings. Cars, buses, and trucks rapidly move through one light only to be stopped by another. The whine of mechanical machinery delivering heated or cooled air into attached buildings and the hum of electricity traveling from transformers to illuminate and power the equipment of endless offices and retail shops join other obnoxious noise makers in a city. I am driving in the midst of this organized chaos attempting to leave town. The interstate is backed up and moving slowly. Drivers dash from lane to lane trying to gain an advantage while others creep along in the fast lane impeding progress.  A couple of enraged drivers speed dangerously along access and exit lanes and use the breakdown lane in an effort to run from or catch the other for some unknown offense.  Eventually, traffic thins as weary travelers take exits away from the madness toward hoped for tranquility. The city shrinks from my rear-view mirror and the road sheds some of its lanes as I follow my escape route away from the hectic pace of crazy metropolitan life.

Finally, I exit, too, away from the rushing interstate onto one of the four lane federal highways that still exist apart from the characterless freeways. The pace slows as I travel past open fields, lone standing businesses, and single family dwellings imprisoned behind shrubs and trees. A small town closes shops and rolls up sidewalks as I creep through the unwelcoming community. Parks are mostly empty; windows are shuttered against the coming night. The only signs of life is the seemingly ubiquitous convenience store and gas station assaulting the skyline with its brilliantly illuminated and invasive lights.

Just beyond the sleepy town I turn off the federal highway onto a tree-lined, two lane, narrow, state road. Straight stretches are rare along this want-to-be highway; curves and winding ways are plentiful. Deeper into sparsely populated areas and forested hills I travel. Another world from the distant past begins to reveal itself. On a curve is an old store, narrow and long, with an inviting porch and benches to support the rest of friends and the occasional visitor. Unpainted and plain, it seems to exist not for profits, but for community. On an empty spot along the road, the remnants of a small town exist with a lone bank and feed store staring at each other across the road. The town has stayed alive for the single purpose of hosting a multi-acre flea market and nationally sponsored muzzle-loading contests twice a year.

A few miles past the village I turn off the state highway onto a county road. It is a “no-fault” road. The usual white lines along the side and yellow lines in the middle designating lanes are absent. Fields of pasture and crops lay on either side surrounded by fences and posts that mark my progress. Pavement gives way to gravel as I draw near another turn. Slowing down considerably I am careful not to miss the dirt road covered in a canopy of trees. I have entered an area where ghosts of pioneers past inhabit the hills and valleys and where time stopped about two hundred years ago. The path meanders along the bank of a creek. I always smile at the cardboard cutout of a man staring out the window of a cabin that hovers near the road intimidating all who pass. A little farther down I have to judge the depth and swiftness of the ten yards wide creek before crossing through to the other side. Safely navigated I climb the opposite bank and leave the heavily forested hills and swiftly moving creek behind to enter a wide and welcoming opening in the trees.

Stopping in front of a gate I pull out a key to open, drive through, and close the out-of-place barrier. I have arrived at my “happy place.” Car windows come down and welcome the scents of clover and alfalfa mingled with wild flowers and blooming trees. The pleasant aroma fills my car conquering the stale and odoriferous smells of the city. Mist from the nearby creek moistens and freshens the air. The lane passes through fenced in fields. On the one side is a finishing pasture and on the other a hay-field. Beyond lies open ground and in the distance newly planted corn waiting to break into the light. Trees cover the surrounding hills on all sides eager for an opportunity to claim the emptiness. An unnamed creek steadily babbles past the property flowing first west and then south to continue its journey to an unknown destination. A low fence, hand-made with rocks harvested from the creek, line its bank for over a hundred yards.

Nearby is a barn supported by adze hewn girts joined together by mortise-and-tenon joints and wooden pegs. An original one story log cabin, built with Block House Ends corners supported by large rocks stands alone in the middle of this pastoral setting. Blond chinking make for alternating dark and light stripes decorating the outside walls. A “good sittin’” porch faces north and bids all to come and rest awhile.  Inside the house you are greeted with an enormous rock fireplace, a single bedroom, and a loft for sleeping. A primitive outhouse stands a few steps out the back door. All the material to build this ideal place was harvested from the land it sits upon.

Resting on the porch as the darkness swallows the light I hear the sounds of nature. Crickets are rubbing their legs together and bullfrogs are croaking, both in hopes of attracting a mate. Other wild lovers join the trumpeters of the night. Clear skies open to a panorama of the stars. The moon reflects light in an attempt to penetrate the night. The peaceful setting rocks me into a sound and invigorating sleep.

Drinking morning coffee on the porch before the break of the dawn, I listen as the sounds of the forest come alive to greet me. Chirping squirrels and cawing crows break out with other animals in a melodious chorus. And the wind causes the trees to sway in unison and musses my hair with tender approval. Contentment and peace hug me tightly on this perfect morning.

Behind the barn is a deep spot in the creek sufficient enough to submerge and bathe. The cold water of early spring shocks my body awake and intensifies my senses. Oh, how glorious and refreshing is the feeling of being alive. Walking through the forest discovering anew my surroundings, I am willingly lulled into a fully relaxed state. Every tree, bush, vine, and flower I pass reach out to tenderly caress and welcome me. I feel safe. While running my hands along the hewn logs that make up the house and barn, I indulge my imagination to make myself a skilled craftsman participating in building this farm in all of its order and raw beauty.

The food I prepare in the open-hearth is glorious. Sweet and tender morsels dance on my tongue and succulent bites melt in my mouth. Pure water from the deep well cleanses my system. Occasionally I pluck a blade of grass or another early green plant to chew and add to my stew of satisfying tastes.

As the second day passes into evening I see a figure approaching. It is my dad stirring from his six years of rest to visit with me, listen to my story, and share his wisdom. Watching him drift back into the night and his silhouette carried away on a whiff of wind strangely leaves me comforted and reassured.

The morning finds me preparing for the trip home. Passing through the gate onto the single lane path I carry the effects of my “happy place” with me in my mind and spirit. In and out of the creek I begin to retrace the steps of my journey. The card-cut-out man faithfully watches from his window and waves a friendly “goodbye.” Onto the gravel road and past the grazing animals and recently planted fields, I feel rested and revived. The paved county road falls behind me as I turn onto the state highway.  On the other side of the two-door town, I stop to patronize the little store. I am blessed with a hearty welcome, friendly banter, and make a courtesy purchase of something that looks promising. Before I merge onto the federal highway I acknowledge the contentment I feel and give thanks to my Creator.

As I pass through the little town, it demonstrates its vitality as Sunday afternoon pleasures and activities abound. Moving past the nature guarded homes and not-so-lonely-after-all businesses; I make my way with confidence toward the busy interstate. It feels friendly today as I confidently glide with the traffic. The city welcomes my arrival and home embraces my entrance. All is at peace.  All is at rest.

*picture from tinyhousetalk.com

DON’T HEM ME IN

Image result for claustrophobiaFor as long as I can remember I have had an arm’s length bubble. If anyone, but the closest family or friends, crosses that invisible line, I get very uncomfortable. During my seminary days we had a visiting professor who had no such compunction. One day on break from class he engaged me in conversation. When he crossed into my bubble, I retreated a bit and then he advanced. This little dance went on for several minutes before he moved on to invade someone else’s space. One of my other professors, observing this whole situation play out, afterwards empathized with me and told me he believed I could have retreated all the way across campus and he would have continued to advance. I laugh at the absurd image now, but at the time I felt infringed upon.

With my depression, I find that my bubble only gets bigger and when it is breached I get claustrophobic. It is widely accepted that a mood disorder and an anxiety disorder, in which the phobias belong, often co-exist. It is believed that the anxiety disorder comes first and depression follows, exaggerating the effects of the anxiety, but depression can also trigger anxiety. In more than one study it was found that nearly fifty percent of people with an anxiety disorder will develop a major depressive disorder. Among the class of anxiety disorders panic attacks, social phobia, and the other specific phobias are mentioned the most and often are or become comorbid disorders. One researcher went so far as to say the two are “highly comorbid.” An explanation for the two associated disorders remains elusive.

Although the two disorders are distinct and each has its own symptoms, they do share some commonalities: nervousness and worry, irritability and anger, restlessness and insomnia, difficulty with concentration, and feeling tired and cranky. The feeling that our lives are out of our control also contributes to both our anxiety and depression.

Claustrophobia appears to be one of the phobias that often co-occurs with depression. It includes a fear of being enclosed with no means of escape, or a fear of restriction and/or suffocation. It is a sense of confinement that hems you in like the bars of a prison. Situations that might lend themselves to these feelings are avoided or endured with great stress. We might go to great lengths to steer clear of such entrapments or smothering feelings, and thus it interferes with our otherwise normal routine, drains away our time, exhausts our energy supply, and robs us of our emotional reserves. Oh, more than likely the person with claustrophobia knows that their thoughts are irrational, but still they persist and the electric sensations traveling through our bodies overrule our logical mind.

You have to look no farther than an internet chat room to discover a treasure trove of empirical evidence. One person wrote he just has to get outside sometimes no matter the weather. Another agreed saying that no one could imagine what kind of weather she endures to escape feeling enclosed. Several confessed issues with tight spaces. You have no doubt read or heard about people taking the stairs even in high rises to avoid riding in an elevator. Many wrote of the fear of being engulfed by a crowd or trapped in a line.

Although there have been times when I have had to, I do not like the “in a coffin” feeling I get when I enter the crawlspace under a house. This past summer I dropped a tool into our crawlspace. I recruited my nine-year-old grandson and our 10-year-old neighbor to retrieve my screwdriver. There I was on the outside directing the boys to the right spot, but I could not get under there with them. As I wrote in last week’s blog, I also have an issue with crowds and lines. It is not the organized crowd, like in a church sanctuary, that bothers me as much as the unorganized crowd you find in a store the weekend before Christmas. I feel trapped and without control over who gets near or touches me. My bubble does not extend all the way around my body unless I am being tussled by a crowd. I can have a person shoulder to shoulder with me on one side (both sides might be a bit much), close behind, or in front of me, but put someone closer than arms length face to face with me and I start feeling like I cannot breathe.

There are at least three things that can help us cope with our claustrophobic sensations.

  • We have to CHALLENGE OUR THOUGHTS: We need to admit the irrationality of our fears – no, the ceiling will not fall on us, the walls will not move to squeeze us in, and we will not be trapped in a box. Then REPLACE our unreasonable thoughts with reasonable ones. Currently, the reaction of our bodies in certain situations is controlling our minds. We must TAKE CHARGE and make progress toward our rational mind controlling our bodies.
  • We have to FACE OUR FEARS: Through slow and methodical practice we can overcome our fears. Several years ago there was a TV program that showed people overcoming their phobias. I remember one episode where a woman was trying to rid herself of her fear of heights. The “therapist” put her on a rock that was near ground level and asks her to jump into a pond. Next he increases the challenge by asking her to go 10 feet higher. This was repeated three more times. Although the principle depicted on the show is correct, the application of it was preposterous. She may have been able to go four inches higher, but, I guess, that would not have made for entertaining TV. No, facing our fears comes in baby steps and takes months or even years to overcome. It is a PROCESS, NOT AN EVENT.
  • We have to PRACTICE RELAXATION techniques. That includes deep breathing exercises, systematic muscle relaxation, and guided imagery. Next week, I plan to invite you into my personal relaxation methods. For me it really works. So, please check with me next Wednesday.

Peace be with you!

Please, Stop the Noise!

Image result for noise and depression Everywhere you go, there is noise.  Be it in New York City or Gnawbone, Indiana, on the plateau of Africa or the Grand Himalayas of Asia, in the heavily wooded areas of Washington State, or the Great Plains of the Midwest, on the British Isles or in the turbulent North Sea, by the Great Lakes of North America or in a pond behind your grandpa’s house, upon the vast Amazon River, or wading in Dry Comal Creek in South Central Texas, at the lowest point on earth, the Dead Sea, to the highest peak, Mount Everest.

Some noises are calming, while other noises are agitating.  I love to sit in the woods before dawn, far away from human produced sounds, and listen as the forest comes alive.  The scurry of ground squirrels rushing through the leaves, the chirping of red or grey squirrels calling one another as they jump from limb to limb in the treetops, the snort of a white-tailed deer warning others of an unfamiliar scent, and the call of the birds communicating their messages.  I listen with contentment at the gentle breeze rustling through the trees, the creaks and cracks of trees settling or dropping branches, and the babble of a brook making its way over the pebbles and around the rocks.  Oh, and let there be a pitter-patter of rain making glorious music as drops fall on the melodious note-makers that nature provides.  For me, that is peaceful and satisfying.

However, put me in a city with all the cacophonous racket and it does not take long for me to get tense.  Over 50 percent of the people living with severe depression are sensitive to noise.  I have learned in my nearly 18 years of living with a mood disorder that the indecipherable chatter of large crowds, people raising the volume of their voices near or at me, blaring music, TV, or the like, loud noise making toys or objects, and monotonous sounds make me want to run and hide in a quieter place.  Sudden, unexpected noises produce an exaggerated startle reflex in me, which is common among the sound-sensitive.  In a 2014 published study from Germany, nearly fifteen percent of the severely depressed participants found airplane noise to be the worst among the five choices offered.

It is unknown if the irritating sounds cause people to experience deeper depression, or if severe depression causes people to be more sensitive to noise.  What is known is the clear connection between the two in some sufferers. Noise can interfere with our activities of daily living such as resting or sleeping, mealtimes, social occasions, and concentrated thoughts.  You might want to say, “Well, duh! We all experience that,” but with the severely depressed population it creates exaggerated and anxious responses.  To put It more succinctly it causes a heightened response times 100, and very negative and irritated feelings.  We are distressed and exhausted by, sensitive to, and have a lower tolerance for the louder sounding noises.

So, what do we do with these annoying sounds?  I wish I knew.  The literature I consulted was long on problems and short on solutions.  It is not healthy for us to isolate from social functions or crowded spaces, and wearing earplugs or headphones everywhere may be a bit awkward, to understate it. For me, I have found that I may not be able to control the noise levels in the places I go, but I can mostly control where I stand, sit, or otherwise settle myself in public places.  Usually, that is away from the push of the crowd and a reasonable distance from the noise makers.  Intimate settings are preferred over crowded places.  Large, expansive rooms with high ceilings and lots of doors and windows are better than small, enclosed ones.  Almost subconsciously now, I look for escape routes, if other things fail.  Relaxation techniques are also quite helpful. Whatever you do, I am confident that with some forethought, we can win, or at least mitigate, our battle with noise.