Choose Your Insanity, Part I

Untreated or Under-Treated Depression

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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When Dreams Die

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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)

The Costs and Blessings of Depression: Career

It is widely cited that depression costs the U.S.A. economy $210 billion per year. That dollar amount represents the economic cost of treating the illness, physical side-effects, and lost productivity. But, the price of depression is so much more. In addition to the mental, physical, and economic consequences, depression also takes a toll on relationships, spirituality, career, and sometimes freedom. However, I have found in my own experience that inside the dark, stormy clouds of depression are proverbial silver linings.

Depression cost me my career. After I graduated seminary in 1994, my days of being on staff under a senior pastor were over. I became a senior pastor. Those days before I became clinically depressed were wonderful days watching God work. All the things that make up the office of the senior pastor – preaching, teaching, pastoral ministry, vision casting, worship, counseling, etc. – was rewarded by being a part in helping people to find their path toward healing and wholeness. Then my doldrums turned to clinical depression in the fall of my 38th year. Everything became a struggle. Sometimes the only energy I had was spent trying to stay alive.

As I mentioned in a previous blog, after eight years of being severely depressed without much relief and four hospitalizations in five years I was finished. I went from being the pastor to being in need of a pastor, from helping others to being desperately in need of help from others, from counseling others to being the counselee.

My experience is not unusual among those who have a mental illness. According to Mental Health America (MHA), “Depression ranks among the top three workplace problems for employee assistance professionals.” According to a Harvard Business Review (December 11, 2015) article, 584,000 people will call in sick from or under produce at work daily because of depression. “Depression accounts for an estimated 200 million lost workdays each year at a cost to employers of $17 billion to $44 billion. (Monster.com, “Depression at Work”)  According to the World Health Organization (WHO) major depressive disorders are the leading cause of disability in the U.S.A. I have a friend who was demoted twice because of his depressive episodes. He worked his way up to being a supervisor over 30 employees and three vital programs. But, after each hospital stay he lost more and more responsibility until toward the end he was hid from public view doing menial tasks. Eventually, he was fired for poor job performance. He and I are the face of the statistics above. For us it is more than a number on a computer program somewhere in the Bureau of Labor Statistics – it is real!

Men often find their identity in their work. That was true for me. I once told my wife I wanted my epitaph to simply say, “Pastor.” After leaving professional ministry I struggled with who I was and where I belonged. After much prayer I came to the conclusion that my real identity rested in Jesus Christ and who He thought I was. Now if someone asks me who I am, I tell them, “I am a person made in the image and likeness of God, redeemed by the blood of the Lamb.” There I find my intrinsic value and worth.

God has also blessed me with many opportunities to help others. During hospital stays and at my twice-weekly depression group, I have and have had opportunities to help others by sharing my own story and using my counseling skills. A door of ministry is open for me to share the good news of Jesus with people who feel hopeless and ostracized from society.  For over a year now I have been involved in trying to help a person overcome her substance abuse addiction. It has been rocky and filled with drama. A couple of weeks ago she consented to check herself into a long term treatment facility. I drove her there and stayed with her through the admitting process. Today, at this writing, she reported that she was where she was supposed to be. I am hopeful. Additionally, I get to spend more time with my children and soon coming grandchild and I fill the role of handyman from time to time. Life is good most days.