Source: Choose Your Insanity, Part II
Medication side-effects can be its own brand of insanity.
Source: Choose Your Insanity, Part II
Medication side-effects can be its own brand of insanity.
Come 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.
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.
Source: Choose Your Insanity, Part I
Untreated or Under-Treated Depression
Over 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.
Within 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
Last 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
For 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.
Peace be with you!
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.
For my writer’s group, I read my blog contribution, “I Am Stuck.” It included this line, “The image of what I was is so seared into their minds that they seem unable to see the new man I have become.” One man in the group suggested I explore that line more in-depth. The following is my attempt.
For over four years now we have been estranged. It causes me pain every day and many nights I close my eyes to sleep with tears coursing down my cheeks. I pray for you almost daily. During that time I ask God to bless your marriage, ministry, education, and work; but I also pray that you will overcome the trials and temptations at which I so miserably failed.
Your mother and brother have told me that you feel you must protect the family from me. That is understandable, especially because you do not remember me when I was at my best. Your older sister and brother can recall the times when we laughed and played, went on camping trips together, fished, boated, swam, and piled in at Grandma and Grandpa’s house for holidays and vacations. Yes, I struggled with depression and anger even then, but I was never sidelined for long by my depression and my anger was infrequent and mostly controlled. Your older siblings braved the moves we made from Indiana to Mississippi and then to Kentucky. Those were adventuresome and blissful days.
That happiness and the love between your mother and me blossomed in the mountains of Eastern Kentucky. You were conceived in that love and welcomed into a joyful family. Oh the fun I had caring for you and watching you grow. You were the baby of our college community, too. All the girls wanted to hold you and all the boys wanted to play with you. You were never alone for long. It was Dr. John who cut your hair the first time. We gave you a sucker to distract you from what he was doing. What a sight you were holding a hairy sucker while 18 months of locks were cut away.
Those were the best years of our family and your mother’s and my marriage. We moved back to Indiana and things went well for 28 months more before it all dramatically changed. You were only six years old when I became clinically depressed. It wounds me deeply to think that the times after that are 90% or more of the memories you have of me. It must have been very frightening and uncertain for you.
You remember me as an emotionally distant father. I isolated from the family because my clinical depression was so severe that I could not function as a husband, father, or pastor. There were times, son, when my suicidal ideations were so strong that it took every ounce of energy I possessed to fight them off and prevent myself from carrying them out. When we returned to Eastern Kentucky and I found another job, all of my energy was consumed by the time I got home. You remember my routine as being off to work, come home, and go to bed. It was a seemingly endless cycle. On Saturday I slept all day and after I quit going to church, Sunday became another sleep day. I missed your ball games, lead performance in plays, cantatas in which you were the leading male voice, and a whole lot more. What can I say, son, I did not have the will or the strength to stay engaged. I was just trying to stay alive. Can you ever forgive me for missing so much of your life?
You remember me as an absent father. Your mother asked me to leave our home on three different occasions. The first was in 2001, the second in 2008, and the last in 2009. I will confess to you, my son, that she was fully justified in asking me to leave the second time. I was very sick, severely depressed, angry, and unpredictable. She, and the rest of you for that matter, needed a break from me. However, the separation robbed me of your teenage years from 15 on. While I was away I called nearly every day, wrote letters, and sent monetary support trying desperately to be involved as much as 300 miles separation would allow me. You have expressed hurt when I quit calling you nightly for evening devotions. Son, I will not disclose the reason, but I hope you will accept that there was a roadblock put in my way that I could not overcome. In what was to be my last fatherly talk with you, your mother told me you did not welcome it. I must accept that my four year physical, longer emotionally, absence from you had such an effect as to render my words as that of an intrusive stranger. Although I had little control over my absence, I am sorry I was away, and for the reasons I had to leave. Will you forgive me for being absent during some very important years in your life?
You remember me as an angry father, which was perhaps the most damaging of all your memories of me. When my depression went clinical in November of 1999 it began to steal from me the abilities to do the things I loved. From the time I sensed a call into ministry when I was 14, I began to prepare. A sizable percentage of the money I earned from working with your Uncle John was spent on books to help me prepare for ministry. By the time I entered Bible college four years later, I had already read multiple books on theology, homiletics, evangelism, and the biographies or autobiographies of many heroes of the faith and of our Wesleyan heritage. Your mother and I took a position in ministry three months before we were married and continued in pastoral or educational ministry for the next 23 years without a break. During that time I worked on a graduate research degree and earned a Master’s of Divinity. Depression robbed me of my ability to pastor, teach, and preach. I was angry.
When I started looking for work in the secular world, I soon discovered that employers did not respect my MDiv. or the myriad of applicable experiences I gained from working as a pastor and teacher. There I sat, often with more education and experience than my interviewer, being required to answer such asinine questions like, “Do you think you can do this job?” Sure I could do the job and I could do their job, too, and be better at it. I became angry at the absurdity of it all and feelings of worthlessness and helplessness overwhelmed me.
As your mother began to emotionally withdraw from me, we struggled in vain to communicate with each other and save our marriage. (Please do not take this as a condemnation of your mother. As I fell deeper into depression, she had to become father, mother, and provider.) No matter what or how hard we tried, our marriage could not survive my depression. As my grip on my marriage and our family slipped away, I grew angrier.
I lost it all, son, – my full-time ministry as a pastor/teacher, three other jobs, two demotions, your siblings, our grandchildren, you, and your mother. There is no excuse for my abysmal behavior and I offer none. The more I lost the more livid I became. That is when your mother asked me to leave the second time. There is no reason for you to forgive me except unearned grace, and I pray you can find a way to extend your grace to me.
The good news is I am not that man now. I have prayed for and received forgiveness from God. My relationship with our LORD is more vital than it has ever been in my lifetime. I have attempted to make amends with all I hurt and reconcile with them where possible. In the past I thought I could handle my depressive disorder on my own; you know where that got me. I have given up on that destructive approach and acknowledged my need of help. I am on a medication regimen that works, regularly see a psychiatrist and counselor, participate in two Christian depression groups on Facebook, attend two mental health groups each week, write a blog about depression, and have gathered around me a strong support team. My depression has been stable for over two years now, although, admittedly, I am rarely symptom free.
My anger is under control. For just about the past four years, I have not yelled at anyone. (Save one time when I was severely provoked and it lasted for two words before I recovered my decorum.) Gone are the days when I screamed, intimidated, threw things, and hit things. That has not happened in the past four years, either. There was one time during these years that my anger reached the intensity that it did before on a virtually daily basis, but the outcome was much different. I did not behave in the old way; rather, I walked away and hid myself in a private place until the anger dissipated.
You see, son, I am living II Corinthians 5:17, “Therefore, if anyone is in Christ, he is a new creation; old things have passed away; behold, all things have become new,” (NKJV) and I am not the man I used to be.
Thanks to Calvary, I’m not the dad I used to be. Thanks to Calvary, things are different than before. As the tears run down my face, I’m trying to tell you, Thanks to Calvary, I don’t live there anymore. Written by Bill Gaither, adapted
As I sat listening to our pastor describe the plight of people with leprosy during Bible times, I began to listen more intently. Not that I did not know already from my own studies, but in that moment there was an epiphany. What I heard about the person with leprosy in the first century had an uncanny similarity with what I have experienced as a person with a mental illness in the 21st century.
A person with leprosy – which included far more skin diseases than what the modern “Hansen’s Disease” diagnoses, together with mold on clothing and in houses – was immediately cast out of the community. There was no quarantine period or time given to put personal or business affairs in order. Instantly the person was told to leave his home, family, job, and city. He was condemned to live alone or in the company of people who had the same illness as he. Not permitted to live in any walled city – the equivalent to our metropolitan cities – and outside any town or village, he was left to live in a separate dwelling, in caves, or in the open air. The religious orders of the day banished him from the temple or synagogue and it was often thought of as punishment from God. In his Middle Eastern culture, a greeting involved an embrace and a kiss, but no one was allowed to touch him nor could he touch anyone because he was “unclean.” This is why it is sometimes referred to as the disease that shuns. The day that he was told that he had leprosy EVERYTHING changed.
Yes, I understand that most people with a severe mental illness do not experience extreme measures, but notice the similarities. As a person with a severe, recurrent major depressive disorder, I isolated myself at first. I did not want to be around people. That demands energy and I had none to give. But, as my illness progressed people did not want to be around me. After all, who wants to be around a person with depression? What fun is in that?
People with mental illness – for more reasons other than that they are not always the life of the party – are often shunned because people do not understand mental illness and are poorly prepared by our society to communicate with people who are so afflicted. Still others think it is “all in your head” – which is ironic since that is exactly where the problem lies. And, there are still ill informed or misinformed religious leaders that proclaim and congregants who believe that it is all a punishment from God for sins we have committed. We are “plagued” and therefore, isolated. It can be a lonely existence at times.
I experienced the loss of my home, going homeless a few times. After 34 years of marriage, my wife abandoned me because she could no longer deal with the effects or extent of my illness. Two of my children turned their backs on me for the same reason. One job discharged me for my inability to carry out my assignments. Another demoted me twice until I gave up and quit. Yet another broke my heart when I resigned because I recognized that I could never again carry out the responsibilities of that position. I reinvented myself twice and am now trying to do it again as a writer. My story is an all too common scenario among we who have a severe mental illness. Sometimes we are stripped of our rights and given a guardian or assigned a conservator to look out for our affairs. Others of us are sent to a mental facility to live out our lives, out of the sight of the community at large, or allocated a spot in the world where we will not be a bother. We, too, lose home, family, job, and city.
A man with leprosy in the first century had to proclaim to all his disease. Whenever people approached him or he approached people, he had to cry out in a loud voice, “Unclean, unclean!” He had to show the world his disease by rending his outer garment, keeping his hair unkempt or be bald with his head uncovered. His beard and upper lip was to be covered by his mantle when in the presence of people without leprosy. Around others he appeared to be in a constant state of mourning as if wailing about his impending death.
Many of us with mental illness understand the posture of such a man. Although not required, we sometimes appear unkempt and sloppily dressed. It is because the task that calls us into public requires a focused effort and we cannot be distracted with peripheral things. But, often we are put into that box of “publicly proclaimed separation” by society.
When I was a boy, a diagnosis of cancer was almost always a death sentence. You did not want to be around that dying person; there was an associated fear that hovered over them. If you were, you did not know what to say or what to talk about. One rule was clear though; never say the word “cancer” to or near them. They were going to die; the stench of death reeked from every pore of their body and we were told to be silent about it. Thank God, times have changed for the cancer patient. My doctor told me I had cancer in 2015; I hardly blinked an eye, took my treatments, and have been cancer-free for 18 months. Many others tell the same story.
Today, mental illness is the cancer of yesteryear. We do not talk about it in polite society. None of us volunteer our diagnosis to others and they do not ask. And, it would be totally uncouth to actually have a conversation with someone about their illness. We have a forever disease whose symptoms can be treated, but whose cause is incurable. People fear us because they do not understand us or the nature of our illness.
Jesus did not follow the first century rules concerning leprosy. He touched them, which as I mentioned above included an embrace and kiss. These banished people flocked to Jesus in large numbers because He welcomed them and was not embarrassed or afraid to be with them. He was not put off by the missing fingers, toes, noses, and ears that were often a result of their disease or the brilliant white spots that threatened to destroy their ethnic identity. In multiple instances throughout the Synoptic Gospels, Jesus had compassion on these ostracized people, healed them, and restored them to a life free from shunning.
Although I am no Jesus (far from it), I have great compassion for we that struggle with mental illness. One of the reasons I am so open about my depressive disorder and the effects it has had on my life is to help someone else feel not so lonely and misunderstood. Another reason is to educate others about our disease. You and I have intrinsic value, dignity, and worth. We are not our disease. There is hope. We who suffer and society at large are redeemable. Let us carry that message to the masses.