Source: Choose Your Insanity, Part I
Untreated or Under-Treated Depression
Source: Choose Your Insanity, Part I
Untreated or Under-Treated Depression
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
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.
If you have wintered in a climate where the snow flies and the winds blow until there are large drifts and closed roads, you know what it means to be stuck. If you have driven in a field, yard, or on a dirt road during a rainy spring, you know what it means to be stuck. If you have tried without success to solve a problem that appears to have no resolution, you know what it means to be stuck. But, you can shovel your way out of a drift, and push or pull your way out of the mud. You know you can get unstuck, eventually, even if you have to wait for the snow to melt or the mud to dry. And, there are very few problems mathematically or socially that cannot be solved with some knowledge and cooperation. However, I am stuck emotionally.
For the past three years, I have gone to counseling regularly for help with my major depressive disorder and the emotional stress from some disturbing experiences in my past. It took a few months to get stable, but afterwards I made good progress. My depression is now in a mild to moderate state and life is much better. However, the things haunting me in my dreams and many waking hours continue. My counselor tells me, and I acknowledge the truth of her observation, that I bring up the same subjects each session. So, there you are, I am stuck.
Here is the kicker – there is a way out, but I do not know if I want to take that path. My therapist has told me there is a treatment called Eye Movement Desensitization and Reprocessing or EMDR that has shown great promise for people with single or multiple episodes of trauma. In fact, the clinical and field trials show great success – over ninety percent for single episodes and over seventy percent for multiple. Apparently, I am in the “festering wound” stage emotionally and I need to activate my brain so it will remove the block in order that my healing may continue. I am told that it will help me become an objective observer of my experiences rather than an active participant.
My question is, “Do I want that?” Do I want to look at some of these troubling issues from a distance like a spectator? You see, my concerns are near and dear to my heart and they are very active, ongoing issues. I pray about and over them. Cry and get angry. Feel hurt and emotional pain. Ask the question “why?”, experience frustration, and wonder how others cannot see the answer that is so clear to me.
My problems are three in number. The first is with my ex-wife. There are some unresolved issues that I have attempted to settle without success. My goal is not that we would become besties and have standing invitations to each other’s events. No, I want an amicable relationship in which we share what we have in common – our children and grandchildren. This has been my prayer for nearly four years now.
Sure, I would love to be rid of the nightmares with the accompanying screams, yells, physical thrashing in bed, and fighting to stay alive in life-threatening situations. I would love to make the conflict dreams that are filled with arguments, disrespect, and aggravation end. It would be nice to have the subtle needling stop. No more “alternative facts” spread. And, an end to using our children against me. But, at what cost – less concern? Satisfaction with the status quo? Indifference?
The second of my frequent topics with my counselor is the loss of my ministerial credentials. Actually, it is not so much the loss, but the refusal to give me a path to reclaiming them. When I asked to be put under discipline in order to be reinstated, I was refused. No one interviewed me. I was not asked to produce character witnesses nor were any contacted. There was no guidance given me about the process or what the ministerial committee required. My defense was not asked for or recorded. The decision appears arbitrary to me, and I was told an appeal would be pointless. Do I need to just let this go? I have held a ministerial license of one kind or another since 1975. It was one of the things that defined me to others. Is there a way to feel differently or look more objectively at what appears to me to be a decision based on less than all the facts?
My third concern is my greatest. Two of my three children refuse to talk to me. Diligently I have sought reconciliation with them. I have written letters of sorrow, accepting blame and guilt, and asking for forgiveness. The efforts I am making to stay in touch with them are ongoing. I send them letters on New Year’s, Valentine’s, Easter, Fourth of July, Thanksgiving, Christmas, birthdays, and anniversaries. They have chosen to not respond to my outreach. When I was diagnosed with cancer I thought surely they will contact me now, but it was not to be.
Both profess to be Christians, and one works at a Christian organization and travels in ministry almost weekly. One of the them says I am forgiven, but continues to shun me. Not only was I not invited to their wedding, but some of my relatives were not invited simply because they helped me in a dark and needy moment. They blocked me on Facebook from seeing their site and had their spouse do the same. That does not look like the forgiveness the Bible espouses and which I once preached and emulated.
Am I wrong to believe that forgiveness and redemption cannot abide with shunning? Is it too much to ask conservative, evangelical Christians to live up to the Bible they profess to believe in? Sure, I hurt and offended them. I was not a good father after my depression went clinical. Anger, isolation, and emotional distance were what they experienced from me for many years. They have a right to feel wronged – I do not deny that; however, “all have sinned” and yet God seeks to save and redeem the sinner.
Maybe the image of what I was is so seared into their minds that they seem unable to see the new man I have become. Perhaps they fail to see me as redeemable, and therefore are blind to the redemptive work that continues to make me a better man. It appears there is so much insulation about them that they cannot or will not allow themselves to trust me and be vulnerable enough to give me a chance.
Is it too much of me to expect a Christian to forgive and act like it? Will EMDR rewrite my brain in such a way that I can see their side of things and conclude that they are justified in their continuing behavior? Will I suddenly have an epiphany that forgiveness and redemption can be interpreted to exclude rather than include? Do I want to not feel so troubled, disappointed, and hurt?
The answers are not readily evident to me, thus I remain stuck. I am open to solutions, but if they involve escape, indifference, and/or distance, I am not sure I want to be a buyer. What do you think will help me get unstuck? Response are welcome.
There were more days left than there was medicine. Between my last med check with my psychiatrist and my next appointment to come, I was going to be left with too many days and not enough medication to last. Of course, I did not notice this until the time to do anything about it was already past. To top it off, it was a holiday weekend – Saturday, Sunday, and Monday would pass before my regularly scheduled doctor’s visit. It was not a good three days.
I have missed taking my pills for a day before without any noticeable side effects. And, I knew from experience that any prolonged time without my medications would land me in the hospital. My last hospitalization was testimony to that. Before I left that mental health facility one of the group session leaders asked us what we had learned during our stay there. I had a ready answer, “Take your meds.” But, how would three days affect me? Here are my observations.
First, my sleep patterns were interrupted. For the past several years I have had PTSD-type symptoms during sleeping hours in the form of nightmares that often involve verbal and physical confrontations, some of which are life threatening. I can physically thrash about as if I were fighting someone, experience a whole range of emotions from crying and laughing to yelling and screaming, and talk in incomprehensible jabberings to quite intelligible conversations. It can all be very entertaining for my wife. Although my medication does not eliminate all of the above, it greatly suppresses it.
The first night without my medication I had trouble falling asleep and was awake until about 1:30 am and back awake by 3:30 am. I stayed up the rest of the day. The next night I slept longer, but the dreams came fast, furious, and vividly. According to my wife, I did a lot of talking and even cussed in my sleep – something I never do when I am awake, and especially the word I used. By the third night I was flailing about fighting perceived threats and defending against oncoming foes. To say it was a rough three nights would be fairly more than an understatement.
The next thing I noticed was headaches, flaring of my long dormant IBS, and a strange electrical shock-like feeling behind my left ear. I can explain the headaches – they were the first symptoms of withdrawal from some of the powerful medications I take. The IBS triggering gave me pause, but it sent me a warning that I may not be handling my stressors as well as I think. That popping in my head still has me puzzled, but I have a hypothesis.
You may think me not only off my rocker, but someone has also stolen my rocker off my porch when I propose that it was my neurons misfiring for lack of synaptic activity. Admittedly, what I know about the brain could be fit into a thimble with room to spare, but here goes anyhow. Our bodies send billions of messages to our brains along neuron pathways each day. In the brain, these pathways are interrupted by large fissures or canyons that have to be crossed. The neurons need help to get across these ravines in order to connect with the neuron pathway on the other side. That is where the synapses take over. They ferry the messages over the gorge to enable the neuron pathway to continue undisturbed. I think my brain’s electrical system (neurons) were misfiring for lack of current carriers (synapses). Whatever it was going on in my head felt physically uncomfortable and made a static electric shock sound in my ear.
The last thing I noticed was my mood began to change. Normally, I am a calm, quiet, somewhat reserved, unflappable guy. I do not react unless severely provoked. My voice rarely goes above a conversational tone, and then only for emphasis or to communicate firmness. I never yell or holler. But, during those three days I was harder to get along with. I still did not raise my voice, but I was more easily provoked, quicker to discipline our grandchildren whom my wife and I are rearing, and generally testy. My emotions were rawer as well. Several times I felt near tears and I thought I could lose control any minute now.
It really bothers me to be so dependent on my medication. It scares me to think how rapidly and far I can fall without it. For this man, at least, it gnaws at me to realize I have so little control over my own body, mind, and emotions. But, it is my reality and if I am to remain healthy I must reconcile myself to the fact that I need my medication to stabilize me in order that I can successfully address the other issues in my life.
In 2003 I was given the task of starting a brand new program from scratch. The purpose of the program was to help individuals with long term psychiatric hospitalizations to achieve the least restrictive community environment possible and provide them with the supports needed for them to be successful. I was given a $200,000.00 budget and sent out to set up the rest of the program on my own.
From the few directions I received it was my understanding that patients housed longest in the hospital were my target cases. The state hospital sent me a patient list from longest to shortest stay. I chose the top twenty as my client base. Every one of them had been in the hospital from just over a year to over eight years. This is how Brenda[i] became my client.
On my way to meet Brenda I reflected on her case. She apparently had a normal childhood until she was eight years old. On a cold December night her family – two brothers, father, mother, and herself – were in a terrible accident. A drunk driver coming at a high rate of speed crossed the yellow line and plowed head-on into their car. Brenda was the sole survivor. For her the pleasant and secure life she had known was now over.
With no surviving relatives Brenda was placed into the foster care system. Troubled by post-traumatic stress disorder (PTSD) and recurring depression she became a difficult child to care for. In the system she was moved from house to house and family to family. By the time she aged out she had gone through twenty-seven placements. The longest stay was nineteen months and the shortest less than a week. Some of the homes were great, but they were eventually overwhelmed by her myriad of issues. In other homes she was physically, emotionally, and sexually abused. She bore a scar from her left ear across her cheek to her nose where she had been slashed with a kitchen knife from an angry foster mother. On another occasion she was raped repeatedly by her drunken foster father and his equally drunken buddies. As a result she became pregnant. She was strongly urged by her social worker to have an abortion, which she did.
Besides the PTSD and depression she was later diagnosed with a border-line personality disorder. She started self-harming when she was twelve and at the time I met her fifteen years later she was still cutting herself and swallowing foreign objects. Brenda was considered to be the most difficult case in the state and she was now my client. I was just beginning my third year working in the mental health field.
When I met with her it was hard not to notice the amount of scarring on her arms. (I was told that her inner thighs were nearly as bad.) There was not a place on either arm where she had not cut herself from her biceps to her wrists. This alone was unusual since most cutters use their dominant hand to cut their non-dominant arm. Because there were so few places left to safely cut she had begun to swallow. Hair brush handles, knives, and spoons were the most common things she forced into her esophagus. Her stomach was grossly distended from the multiple surgeries undergone to remove what she had swallowed. Soon after becoming my client a surgeon told her that if she required another surgical procedure he could not guarantee that she would survive. Thereafter, she quickly told someone when she had swallowed in order that she may be scoped instead of subjected to the scalpel.
Few people understand the pain that the Brendas of this world experience. An event like witnessing the unnecessary death of your parents and siblings and being left to wonder why you survived is extremely traumatic. Ripped from all you know you live the rest of your childhood without a real home and a forever family. Raped, abused, and discharged from what security net you have when you reach the age of majority you are left to your own devices. You barely know how to function in the world and you live from one disaster to another. Every relationship you have starts intensely and ends chaotically. You are a frequent visitor to your local psychiatric hospital. Finally, the court takes away your rights and once again the state becomes your guardian. No one wants you. You such a danger to the safety of yourself and others that not even local and regional mental health agencies will serve you. So you live in a locked facility for over three years. Is it any wonder you hurt so deeply?
On one occasion I was with Brenda immediately after she had cut herself. I got some antiseptic spray, a sanitary wipe, a topical antibiotic ointment, and some gauze to treat her wound. While tending the wound I began to speak to her in a low, calm, and sympathetic tone. I said to her that she must hurt an unbearable amount to harm herself in this manner. That she was trading her internal pain that she could not see and was helpless to do anything about for an external pain that she could both see and treat. I went on to say how helpless she must feel about her personal trauma that it was actually a relief to have an injury she could put a Band-Aid on. When I finished she looked up from under her hair that hid most of her face and said, “How do you know?” We had quite a long talk after that.
Self-harm is trading one pain for another, persistent for temporary, unseen for seen, and emotional for physical. It is not an attempted suicide or a scheme to get attention. It is a response to crushing internal conflict. It is repeated when one is under stress, in a difficult situation, or when certain dates and months come. Brenda self harmed during December, the month of the accident that stole her family from her, and the days surrounding July 4, the date she was raped. The memories were too excruciating to bear so she turned to the only coping mechanism she knew.
For three years I worked with Brenda until I was asked to assume a supervisory position. I passed her case onto another very capable mental health worker. The last I heard, she was living in a stable home and had ceased self-harming. She taught me a great deal about pain.
It is hard to pin down exact figures for those who self-harm. It is estimated that 20% of females and less than 15% of males engage in self injury. The age of inception is generally pre-adolescence to early teens. In more recent years cutting has become “popular” with endorsements by celebrities and instructional web sites. It makes it more difficult to separate those with a mental illness from those who do it for entertainment. Although self-harming is a symptom of borderline personality disorder, it can accompany eating disorders, depression, anxiety disorders, substance abuse, and conduct and oppositional disorders.[ii]
No one needs to be left in this kind of agony. If you or someone you know is self-harming, tell someone and seek help from a professional who is familiar with self injurious behavior. If appropriate, get medication to address the underlying mental illness. As one identifies the core issues s/he can become more aware of triggers and learn how to better cope with stress and emotions, boost self-image, improve relationships and social skills, and learn problem-solving skills.[iii] There is hope.
“I instantly realized that everything in my life that I’d thought was unfixable was totally fixable – except for having just jumped.” Ken Baldwin, Golden Gate Bridge jump survivor.
[i] This is a compilation of stories made into one in order to protect the confidentiality of the original clients. Names have been changed.
[ii] Source: Healthy Place.com
[iii] Source: Mayo Clinic.com
It was the year 2000, the first full year since I had become clinically depressed. I was so severely ill that my job had forced me to take a leave of absence. My brother invited me to come and stay with him for a few days. I accepted. My dad and a family friend took me the 200 miles south, southwest to his house where they planned to go fishing. I was supposed to go home after the fishing trip, but I stayed, and a few days turned into a few weeks.
During the day my brother and his wife were away at work and I had the house to myself. There were no responsibilities to be a husband and parent, no pressure from work to finish reports or perform daily tasks, no meetings to attend, speeches to give, or places to go. I was free to toddle around the house, watch TV, do some light housekeeping, play on the computer, or take a nap. Reformation of spirit and body was easy to claim in this environment. But, . . . Thanksgiving was coming.
I have always loved the Thanksgiving/Advent/Christmas season. Gatherings of family and friends. Feasts that included my mother’s special egg noodles. Music from long known church hymns to carolers on the streets and other holiday songs. Performances by school children, high school students, the local theatre troupe, and church plays. Did I mention food? Shopping for special and thoughtful gifts to give to my wife, children, parents, brothers, and the rest of our family. Putting up the Christmas tree and decorations. Being part of a caravan that went through town looking at the lights and seeking the best holiday display. Giving and receiving gifts. It was all great fun and I looked forward to it every year . . . except this year.
My wife and children, parents, niece and nephews gathered in to celebrate. The house suddenly became smaller and the opportunities for alone time fewer. Feasting, conversation, and playing games were expected. I could hear myself protesting silently, “I’ll take my meals in the bedroom, thank you.” And, the only contribution to the conversation was, “I would like to die now, please.” Games required concentration which was in quite limited supply at the moment. The worst was yet to come. When the festivities were over I was expected to return home and resume my role as a husband and parent, and prepare to go back to work.
Upon my return I tried to go shopping at the local mall with my family. It was unexpected how exhausted I became after walking through the first department store. One store . . . and all my strength for that trip was wasted and I had no reserves. My family deposited me in the courtyard for the remainder of the outing. I sat quietly alone, anxious for their return in order that I may go home and back to bed. It was the only attempt I made to go anywhere that season.
It was a miserable holiday season. I did not want to be around people because I fatigued too rapidly. It was nearly impossible to smile and laugh. There was no enjoyment to be found in the lines my children were learning for their school and church programs or the new songs my wife was using that year as she directed the annual Christmas cantata. I stayed home from church all but one Sunday during the season. If a genie had given me a wish, I would have wished to skip the holidays. It was too hard.
There have been other holiday seasons in which I was experiencing depression, but that first one was the worst. I did not know how to cope or compensate. Where was a Rip Van Winkle when you needed him?
The subsequent holidays have not been as difficult for the following reasons:
I pick and choose the public things I can do and inform my family about my decisions. When I am in the midst of a depressive episode I find it especially difficult to be around crowds. Therefore, it can be very intimidating to go to a play or program in a small venue. Last year our grandson was in a play at his school. The performance was planned for the school gym, if you can call it that. I have played on backyard courts that were bigger. Well, not exactly, but you get the picture. All six grades, faculty, staff, parents, older and younger siblings, grandparents, godparents, and the rest were all jockeying for position, sitting shoulder to shoulder, and standing about, leaving only a single-person-wide aisle to the exits. The press of people was suffocating and there was no place to go to make it any better. I was stuck for the duration without a means of escape. If I had been in a moderately or severely depressed state at the time I most likely would have ended the musical in the fetal position.
One shopping trip in a crowded mall may be all you can abide. One program. One church event. One community affair. And, that is alright. You know your limits and it is to your own personal hurt that you press beyond them. Explain yourself to those who need to know, offer your regrets, and do not allow yourself to be guilted by anyone, including yourself. You are your own most competent advocate and you know best your boundaries.
I pick and choose the people I want to be around. Large family, church, work, or club gatherings can be nerve-racking, unpredictable, and ruinous to one’s already fragile health. Expectations to be festive, joyful, and participatory can feel overwhelming. A game face can only last so long. And, after that there are the ones who love and care about us, but always seem to say the wrong thing. “Snap out of it.” “Have you tried . . .?” “I have a friend who is just like you. . .” We have heard all the “help lines” before. We smile because we know they mean well, but on the inside we want to scream.
Then there is that person who belongs to your group, but is toxic to you. You know the one that makes your teeth grind and your stomach churn. The one you love and would do anything for so long as you did not have to be around them. That one! It may be that a more intimate setting and an invitation only gathering is necessary this year. The key is control. The more you can manage and arrange the less likely you are to find yourself in a detrimental environment.
I do what I can and leave the rest. My mother made a table top ceramic Christmas tree back in the 1970’s that I inherited. For about three years it was the extent of my decorating. Although it is becoming common to shop online, I have done it for about ten years as a means to escape the daunting crowds. As you become more aware and in tune with your personal needs and constraints, you will better be able to rightly judge what is best for you during the holidays.
This year I am in a pretty healthy state. I can enjoy the events and happenings with more spirit than in previous years. Thanksgiving, Christmas, and New Year’s will bring added happiness for me. I await joyous times with family and friends. The festivities of the season are anticipated with excitement. It has not always been so and may not be in some future holiday, but for now I will revel in the moment.
God bless you! Merry Christmas and a happy New Year!
I was helping my step-son load some things into his truck when I noticed this fence and structure. Out of the frame and to the right was a large wooden structure with a metal roof that appeared to be some kind of shop. In the middle of the photo you can see the remains of another smaller structure, now collapsed and in ruins. Surrounding it is this five foot heavy gauge fence with its galvanized coating long gone. Weeds, trees, and cacti have taken over and with time will blot out any recognition of what this may have been.
This was someone’s dream. It appears they poured a lot of money and sweat equity into making it a reality. The shop and fence were well built and appeared professionally constructed. I wonder how it died. Did the owner with the dream become injured or pass away? Perhaps the cost of running the business left him/her with too little cash to meet expenses. Maybe the community in which it existed went through a prolonged depression and s/he could no longer keep the business running. Possibly federal, state, local, and/or insurance requirements became too overwhelming. Conceivably the owner had the right dream for the wrong place or at a disadvantageous time? Albert Einstein is attributed with saying, “If you’ve never failed, you’ve never tried anything new.”
Some dreams live and die without much notice. I wanted to play the electric guitar and piano. I took lessons, but I did not have the aptitude or discipline required to be a musician. For me it was not traumatic to fail at playing an instrument. It was more a hobby than a hope, besides I can still find a C chord on a guitar and play scales on the piano.
But, there are those dreams that define us. I had a roommate in college who wanted so desperately to be a Marine, but he was discharged out of basic training. For several years he struggled to find where he belonged. Many of you reading this can identify with shattered dreams. An almost college degree. That had-to-have-it job that turned out to be disappointing. A marriage that ended in divorce. Deserved recognition overlooked. Promotion denied. Ideas rejected. Career destroyed. A once-in-a-lifetime vacation spoiled. A special-sought-for car that turned out to be a lemon.
If you have read my blog you know I have had several dreams die. From the age of fourteen, I dreamed of being a pastor/teacher and then one day I got sick and I was finished at 41. My next career choice was to be a counselor. Depression ended it at 53. After more than 34 years of marriage a signature and a court record said I was single again. At one time I was recognized as being among the top 50 graduates of my alma mater, a college with a 116 year history, but today my reputation is in such ruins I am not sure I would make the bottom fifty.
How does one carry on when his/her dream dies?
Grieve Your Loss
The five stages of grief are well known – denial, anger, bargaining, depression, and acceptance. Your loss is real and it is painful. You conceived your dream, felt it grow, gave birth to it, and did everything possible to make it live; but, alas, . . . it died. When my depression went clinical and became severe, I was pastoring the best church. Our attendance had nearly doubled, the church was once again healthy financially, the education wing had been remodeled, the church had settled on a purpose statement that was to give it clear direction for years to come, and property had been purchased for a new church campus. Everything I had dreamed I could be as a pastor and a leader was coming true, but it ended. Four years later when I was asked to choose a place where I dreamed of being; I said I wanted to be the pastor of that church again. For nearly fifteen years I carried a dollar bill in my pocket that the church had given me as a gag gift at Christmas. I hurt. It took a long time for me to get to acceptance.
Grief is messy and does not work itself out in five sequential steps. You often find yourself in déjà vu all over again. And, yes, you have been there before and it is not likely the last time you will visit. But, grief is essential and in the end the journey to acceptance is worth the heartache.
Assess Your Strengths
Remember the good times you had while your dream was alive. Think of all the things you have learned. Assess how you have grown. Consider the secondary skills you have gained. All of these add to your current strengths.
If you have lost a career, ask yourself what is it you like to do and can do well? Look into your past for what you have done before and enjoyed doing? Do you have something you always wanted to try and are willing to learn the necessary skills and make the sacrifices required to master it? I would have never learned counseling had I remained a pastor. Without losing both of those careers, this blog and my writing may never have existed.
Did your dream relationship go sour? What do you want in a relationship? What do you have to give? After my divorce I spent many hours taking relationship assessments, determining what kind of husband I wanted to be, and what kind of wife I wanted. I married again, but not before my wife and I vetted each other for three years. We are very compatible and happy together.
Dare to Dream Again
When all your dreams die there is nothing left to do but be buried. It can be devastating when a dream dies, but dare to dream again. New dreams are costly and risky, dream anyway. Learn from your failures and keep dreaming. My college roommate eventually reinvented himself as an expert in theology and his latest incarnation is as an advocate for those on the autism spectrum. After my many failures I can truly say I am especially satisfied with the man I am and am becoming, and with what I am presently doing.
“For I know the plans I have for you,” declares the LORD, ” plans to prosper you and not to harm you, plans to give you hope and a future.” Jeremiah 29:11 (NIV)
When I was about ten there was a boy in my neighborhood who decided he wanted to fight me. He had no reason – no offensive words or gestures were exchanged, no challenges made, no insults traded. I can only surmise that it was my turn to be tested in his effort to advance on the neighborhood “toughest” scale. I had no interest in participating in any such primitive ritual; therefore, I avoided any contact with him. My life was miserable for a couple of weeks. I ran home daily from school, stopped playing outside, and suffered humiliation piled on by my scornful friends. Besides lacking any reason to fight or interest in the same, I was sorely afraid of being hurt. It was a fear that would torment me for years to come.
Fear and anxiety are closely related, but there is a distinction. Anxiety is an alerting signal – like palpitating heart or sweaty palms – to a threat that is not immediately present. When you have alarm bells going off relative to that trip you are taking in a couple of months – that is anxiety. Fear, on the other hand, is an alerting signal to threats that are more immediate. Several years ago my dad turned left in front of a heavy line of traffic. My mother screamed out, “Oh, God!” Dad rebuked her saying, “Jenny, you know we don’t use God’s name except in prayer.” “I was praying!” was her quick reply. Mom responded with fear.*
Everyone experiences fear and anxiety. It is part of our innate nature when danger, real or perceived, presents itself. It can be both hereditary and experiential, both nature and nurture. You may have a generalized anxiousness about the stresses in your world, a phobia that has been passed from your parent to you, or a traumatic event that alters your sense of safety. When these fears and anxieties begin to disrupt your daily functioning, it is called a disorder. According to Kaplan and Sadock’s Synopsis of Psychiatry, “Anxiety disorders are among the most prevalent psychiatric conditions in the United States.”*
My fears and anxieties were varied. In my early teens I had recurring dreams about someone breaking into our house through the back door. It was so real that I frequently got out of bed, checked the back yard for any sign of intruders, and made sure the door was secure. Often I put a table knife in between the door and the interior casing to prevent easy entrance and noise makers in front of the door to alert me to trouble. This dream and behavior persisted until I went to college and then it inexplicably went away.
When I was fourteen I started working with my brother roofing houses. The heights and the wooden ladders he used did not bother me. It was not until I was hired out to scrape and paint exterior window casings on an old Victorian house that I discovered I had a real issue with aluminum ladders. I could not finish those third story windows while that ladder was fully extended. No, I was too busy hanging on for dear life to free a hand to do the necessary work. Bouncy aluminum ladders and I do not get along.
My fear of ledges and falling can be dated to that job. For our twenty-fifth wedding anniversary my wife and I visited the Grand Canyon. Picture a forty-something fat man crawling on all fours and eventually dropping on down to a belly crawl in order to get close enough to the edge to take a look at the canyon below. If video camera capable phones would have been as ubiquitous then as they are today, I am sure my experience would have gone viral.
As a new father of a darling baby girl, I was very anxious about her well-being. During those first several months I was up multiple times a night every night to check on her. I would silently tiptoe into her room to steal a gaze upon her chubby cheeks, gently touch her little torso to check for breathing, and adjust her blanket for warmth and comfort. It was not until she was old enough to climb out of her crib and into bed with my wife and me that I brought that behavior to an end.
There was a time when I became concerned about my eternal destination and especially a secret rapture of all Christians and children. Did I love God? Was I truly saved? For a couple of years I roamed our house during the night checking on my wife and children to see if they had been raptured and I had been left behind. I had given my heart to Jesus when I was fourteen, graduated from a Bible college, and served in pastoral ministries, but still I was haunted by the ghosts of doubt. It was not until the truth of I John 4:10, “Herein is love, not that we loved God, but that he loved us . . .” (KJV) soundly penetrated my heart and soul that I was able to put these doubts to rest.
I was reminded very recently during Grandparent’s day at our grandson’s school that I am claustrophobic, too. As several dozen of adults and children squeezed into a space no bigger than a great room for the annual book fair, I realized hastily that there was no room for me. My personal bubble had not only been breached, it had also been burst. Needless to say, I left the room quite abruptly.
But, back to my fear of being hurt. There is a name for that, traumatophobia. It is the fear of war or of getting physically injured. It may be harsh to say, but it made a coward out of me. I walked away, ran, or hid from the possibility of physical confrontation for over forty years. My self-esteem took hit after hit and I questioned if I could fulfill my role as my family’s protector if and when the time came. It was not until I was immersed for a year into a place where physical confrontation was a constant probability that I put that fear behind me. I did not realize that I had conquered it until I put myself at grave risk of bodily injury for a family member. I did not think about it, I just did it, and only awakened to the fact of what I had done after it was all over.
There are no easy or quick cures for fear and anxiety. If anyone tells you they can relieve you of your fears in three easy steps, walk away and write in your journal that you met a charlatan today. Medication can help, but be wary of depending on it or allowing it to mask the heart of your issue. Behavioral therapy involving some kind of desensitization is effective, but prepare for a long journey. Cognitive behavioral therapy also helps. By God’s grace I have overcome some of my fears, yet some persist. Thankfully, it has been rare that my phobias have disturbed my functioning for more than a few hours, days, or months.
By the way, my father caught wind of the neighborhood boy that was making my life unbearable. He threatened to whip me if I ran away again. I was more afraid of my father’s belt than I was of the bully from across the alley so I confronted him. In the end he went home crying. It was the last time I ever willingly had a physical confrontation with another human being.
*Kaplan & Sadock’s Synopsis of Psychiatry, 9th edition p. 591