Choose Your Insanity, Part II

Common Side-Effects of Antidepressants

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

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

Common Physical Side-Effects

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

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

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

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

Issues with Sleep and Weight Gain

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

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

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

Sexual Side-Effects

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

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

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

May God be with you.

 

Choose Your Insanity, Part I

Source: Choose Your Insanity, Part I

Untreated or Under-Treated Depression

Choose Your Insanity, Part I

Untreated or Under-Treated Depression

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NOT A CHANCE!

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

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

Ode to Despair

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

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

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

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

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

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

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

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

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

*image from 123RF.com

RELAX ALREADY!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*picture from tinyhousetalk.com

DON’T HEM ME IN

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

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

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

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

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

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

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

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

Peace be with you!

Please, Stop the Noise!

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

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

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

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

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

The Disease That Shuns

Image result for Jesus heals leprosyAs 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.

Depression and the Holidays

anderson-at-christmasIt 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!

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)